[Sucessful pregnancy outcome following three severe placental abruptions and intrauterine fetal death in the patient--heterozygous carrier of R506Q mutation of factor V (Leiden)]. / Uspeshen izkhod na bremennostta sled tri predshestvuvashti tezhki abruptsii na plantsentata s murtuv plod pri patsientka--kheterozigoten nositel na mutatsiia R506Q na faktor V (Leiden).

A case of successful pregnancy outcome is reported in a patient with 3 preceding severe placental abruptions with intrauterine fetal death and caesarean deliveries. In the course of the current pregnancy heterozygosity for R506Q mutation of factor V (Leiden) was diagnosed in 26 weeks of gestation [w.g.] and low molecular weight heparin [LMWH] therapy initiated. Maternal condition was stable until delivery and all laboratory findings were within normal range. The fetus was followed up by ultrasound biometry and Doppler blood flow studies. From 28 w.g. on NST and biophysical profile were included. An emergency caesarean section was performed in 34 w.g. because of contractions not responding to tocolysis. The newborn was in good condition with weight and length corresponding to the 10th centile for gestational age [g.a]. Histologic study of the placenta showed anemic infarctions and recent haemorrhages in the basal and the chorionic plate. The initiation of LMWH therapy in the case reported was late (26 w.g.). By that moment there was already evidence of impaired fetal growth with fetal biometry corresponding to the 10th centile for g.a. After LMWH therapy was started no further slow down of fetal growth was registered. Successful pregnancy outcome may be related not only to LMWH therapy but also to other factors like active fetal monitoring after 28 w.g. and the emergency caesarian delivery immediately after the onset of uterine contractions. Patients with past obstetric history of severe preeclampsia, placental abruption or fetal growth restriction have to be screened for hereditary or acquired thrombophilia. If a thrombophillic state is present early LMWH therapy has to be considered. It is aimed to prevent anaemic placental infarctions and thrombotic complications.

[Histological analysis of endometrial polyps in breast cancer patients treated with tamoxifen (nolvadex)]. / Khistologichen analiz na endometrialni polipi pri patsientki, lekuvani s tamoxifen (nolvadex) po povod kartsinom na gurdata.

Endometrial polyps are the most common endometrial pathology described in association with Tamoxifen exposure. The aim of this study was to evaluate the malignant potential of endometrial polyps in breast cancer patients receiving Tamoxifen. We analyzed 140 endometrial polyps divided into two groups: 1) 73 endometrial polyps from 57 breast cancer patients receiving Tamoxifen (Nolvadex): T+ endometrial polyps; 2) 67 control endometrial polyps received for analysis in the period January-December 2000. The analysis was performed on archival H&E sections. We found that the rates of endometrial carcinoma and atypical hyperplasia were high in patients treated with Tamoxifen (7.02% vs 2.99% and 17.54% vs 11.94%), but the results did not reach statistical significance (p > 0.05).

[Umbilical metastasis - "Sister Joseph's nodule" of an endometrial adenocarcinoma: a case report and review of the literature]. / Umbilikalna metastaza - "Sister Joseph's nodule" pri endometrialen adenokartsinom: predstaviane na sluchai i predgled na literaturata.

The umbilical metastatic lesions have been termed the "Sister Joseph nodule" by Sir Hamilton Bailey in 1949. SJN is an important diagnostic finding, as it often is the first clue and sometimes the only physical indication of an advanced intra-abdominal malignancy. SJN is most often associated with malignancy of the stomach or ovary. It usually appears late in the course of neoplastic disease and suggests a poor prognosis. In our review of English language medical literature we could find only 27 reports of SJN in endometrial adenocarcinoma. We offer a case of SJN, presenting as umbilical hernia, in a female patient, who, 12 years previously, had undergone laparotomy with total hysterectomy and bilateral salpingo-oophorectomy for endometrial adenocarcinoma. Three years after the surgical excision of the umbilical lesion, the patient underwent surgery for a tumor located subcutaneously in the suprapubic area. Histologically, in the samples obtained with both surgical interventions, endometrioid adenocarcinoma with squamous differentiation was found. The clinical examination and imaging studies found no evidence of other metastases. On the basis of clinico-pathological analysis we offer a hypothesis about development of metastases and discuss their prognostic significance.

[Cytological and histological parallels in atypical colposcopic findings]. / Tsitologichni i khistologichni paraleli pri atipichni kolposkopski nakhodki.

The aim of the present study was to analyse the cytological and histological equivalents in 112 patients with atypical colposcopical findings. The results showed the follow distribution of the findings: for cytological examination in 66 of the patients-I gr. PAP, in 32-II gr. PAP, in 6 III-A gr. PAP, in 1-III-B gr. PAP, in 4-IV gr. PAP and in 3-V gr. PAP. The histological study of the obtained target biopsies established: 7 cases with normal epithelium, 82 with different findings of abnormal epithelium with or without nonspecific and specific inflammatory changes; 18 cases with dysplasia from I to III degrees, 2 cases with CIS and 3 with invasive cancer. The degree of correlation of the different findings, as well as the possible causes for hypo and hyperdiagnostic assessments are discussed.

[Pelvic actinomycosis]. / Tazova aktinomikoza.

Actinomycosis is an uncommon inflammatory disease of the female genital tract predominantly affecting the upper sections. Its appearance is in close connection with expended use of different IUDs. Its histological demonstration needs the detection of the specific sulphur granules. Because they often are rare it is recommended working of 8-12 paraffin blocks from suspected cases. The exact diagnosis is of high significance for preventing possible recivides after surgical intervention.

[The differential diagnostic criteria in metastatic ovarian tumors]. / Diferentsialno-diagnostichni kriterii pri metastatichni iaichnikovi tumori.

Ovaries often are a target organ for metastases from another primary locus, especially in young women in reproductive age. This review focuses on the diagnostic difficulties in distinguishing between primary and metastatic ovarian tumors.

[Primary multiple malignant tumors of the female genitalia]. / Purvichno mnozhestveni zlokachestveni tumori na zhenskite genitalii.

Occurrence of multiple malignant neoplasms in individuals is rather rare but not casuistic phenomenon that should not be neglected in oncologic practice. Our present work demonstrates 11 cases with primary multiple malignant tumors of female genital tract, that have been checked and followed for a two-year period (1993-1995) at the State Obstetric and Gynecology University Hospital. In discussion we argue on criteria that help the differentiation between primary, simultaneously originated multiple neoplasms and metastatic tumors.

[Malignant Müllerian mixed tumors of the female genitalia]. / Maligneni smeseni miulerovi tumori na zhenskite genitali.

Morphological features and clinical data of 27 malignant mixed Müllerian tumors of uterus and ovaries are represented. These neoplastic entities have been systematized and controversial problems of terminology, nature and origin, as well as macroscopic and histopathological features have been discussed. Based on our own experience and on references to literature on this subject, clinicopathological correlation have been analyzed in order to point out reliable criteria for differential diagnosis, prognosis for therapeutic response and biological behavior of these tumors.