Fetal ovarian cysts. Our clinical experience over 16 cases and review of the literature.

OBJECTIVE: Fetal ovarian cysts are intra-abdominal structures frequently diagnosed prenatally, tending to present as isolated unilateral lesions in normal fetuses in the third trimester. These cysts may present with complications and their diameter and echogenicity are the main criteria for establishing their prognosis. Spontaneous regression of fetal ovarian cysts is very usual. In the present study, we present our clinical experience on fetal ovarian cyst surveillance and treatment, as well as a review of the literature in the same field. MATERIAL AND METHOD: In this study, we reviewed pre- and postnatal medical records and ultrasonography of 16 fetuses that were diagnosed with ovarian cysts, in Obstetrics Department of University Hospital of Alexandroupolis, between January 2000 and April 2010. We have also reviewed the available literature about fetal ovarian cysts. RESULTS: In a total of 16 cases, postnatal surgery was performed in one infant due to ovarian cyst torsion. In the remaining 15 cases, cysts regressed completely in two fetuses during pregnancy and all the rest of the cysts, including four complex ones, resolved spontaneously after birth. CONCLUSIONS: When fetal ovarian cysts are detected, they should be followed up by serial ultrasonographic examinations. The majority of them will regress spontaneously in a period of 12 months after birth, independent of their sonographic findings. Only symptomatic cysts or cysts with a diameter >5 cm, which do not regress or enlarge, should be treated.

The contribution of rapid intraoperative cytology in the evaluation of endometrial cancer spread.

INTRODUCTION: Peritoneal washing cytology and imprint cytology of pelvic lymph nodes samples were used to evaluate the rapid cytologic detection of peritoneal and retroperitoneal spread of endometrial cancer. MATERIALS AND METHODS: We undertook a study on 194 endometrial cancer patients who underwent primary treatment in the Gynecologic Clinic, Democritus University of Thrace. All patients were subjected to peritoneal washing (PW) cytology and imprint cytology performed on lymph node sampling. The cytologic specimens were stained by May-Grünwald Giemsa (MGG) and Haematoxylin eosin (HE) techniques. Cell-blocks prepared from peritoneal washings (PWs) and the lymph node samples were sent for histologic examination. The cytologic fi ndings were correlated to histologic results. RESULTS: Rapid intraoperative cytology provides a useful diagnostic technique for the assessment of endometrial cancer spread. HE and MGG stain presented different values of sensitivity and specifi city in the detection of peritoneal and retroperitoneal spread of endometrial cancer. CONCLUSION: Cytologic assessment of intraperitoneal and retroperitoneal spread of endometrial cancer is a rapid, intraoperative procedure, which provides the surgeon with useful information regarding the stage of the disease and the subsequent therapeutic approach.

Transvaginal aspiration of ovarian cysts: our experience over 121 cases.

We performed an evaluation of ultrasound-guided transvaginal aspiration of ovarian cysts as a viable alternative to surgery in 104 reproductive and 17 postmenopausal women. One-hundred and twenty-one patients with a simple >4 cm diameter ovarian cyst, with a benign appearance on ultrasound as well as on clinical and blood examination, underwent transvaginal fine needle aspiration of the cyst under ultrasonographic control. One-hundred and four patients were of reproductive age and 12 were postmenopausal. Sixty women who were of reproductive age and in which OCP treatment was not contraindicated followed a six-month therapy with oral contraceptives after the intervention. In the group of patients of reproductive age under OCP treatment the cyst persisted in nine of the 60 women (recurrence rate 15%). In the other group of patients of reproductive age,under no OCP treatment, the recurrence rate was 47% (21 of the 44 women). In the group of postmenopausal patients, the cyst persisted in ten out of 17 cases (recurrence rate 58,9%). Transvaginal aspiration of ovarian cysts is a reliable alternative to surgery with many advantages such as excellent tolerance, low risk and cost of complications and recurrence. The OCP treatment after aspiration seems to increase the success rate of expectant management.

Alpha2B-adrenergic receptor insertion/deletion polymorphism in women with spontaneous recurrent abortions.

AIM: The aim of our study was to investigate the relationship between the alpha2B-adrenoreceptor insertion/deletion (I/D) polymorphism and recurrent spontaneous abortions (RSA). METHODS: Genotyping was performed in 48 women with a history of at least three consecutive spontaneous abortions and 96 women with at least two live births and no history of pregnancy loss. Peripheral venous puncture, DNA extraction and PCR were used for the research of DD, ID and II genotype characters. RESULTS: The distribution of DD, ID and II genotypes of the alpha2B-adrenoreceptor gene was 2 (4.2%), 19 (39.6%) and 27 (56.2%) in the study group and 6 (6.5%), 28 (30.4%) and 58 (63%) in the control group, respectively. There was no significant difference between the groups. The presence of the D allele was not associated with RSA (P = 0.78, odds ratio = 0.88, 95% CI = 0.47-1.65). CONCLUSION: Our data fall short of showing any association between the presence of the alpha2B D allele and the occurrence of spontaneous abortions in the examined population.

Autophagy in endometrial carcinomas and prognostic relevance of 'stone-like' structures (SLS): what is destined for the atypical endometrial hyperplasia?

Autophagy, as an intracellular adaptation mechanism for oxygen and nutrient deprivation, is associated with tumor cell survival and aggressiveness. This was reaffirmed in a series of 360 endometrial carcinomas, using a standard immunohistochemical technique and the LC3A antibody, capable of recognizing both the soluble (LC3A-I) and the membrane-bound form (LC3A-II) of the protein. LC3A reactivity was recognized in three basic patterns-diffuse cytoplasmic, cytoplasmic/juxta-nuclear, and the so-called "stone-like" structures (SLS). The latter has emerged as the: hallmark of autophagic activity, being detected exclusively in endometrial carcinomas and their immediate precursor lesions, namely the atypical hyperplasias, albeit in small numbers. Other forms of hyperplasia without cytological atypia and normal endometrial tissues expressed only cytoplasmic staining patterns. High SLS counts, presumed to reflect excessive levels of autophagic activity, were associated with tumors of extremely poor prognosis. In contrast, a basal level of autophagic activity, as exemplified by the diffuse cytoplasmic and the cytoplasmic/juxta-nuclear patterns, had no impact on prognosis. Survival, according to tumor cell types, showed that serous papillary, clear cell and the high-grade endometrioid carcinomas had the worst prognosis compared to low-grade endometrioid carcinomas, but interestingly, within this tumor group, those having high-SLS counts had a much worse survival rate than those that did not. It is concluded that an assessment of autophagic activity, particularly in the form of SLS, is useful for evaluating tumor aggressiveness and, in the absence or an excess of SLS, it may also prove valid for differentiating grade 1 endometrioid adenocarcinomas from their precursor lesions.

Fetal distress evaluation using and analyzing the variables of antepartum computerized cardiotocography.

OBJECTIVE: In this study, we tried to establish cut-off values for more than one parameters of computerized cardiotocography (c CTG) in the prediction of fetal distress during labor, using a group of pregnant women with low-risk pregnancies. METHOD: A retrospective study was performed. Data were collected from 167 patients for measurements of fetal heart rate (FHR) variables and perinatal outcome. Computerized CTG was performed with an Oxford Sonicaid monitor with connection to a 8000 system for CTG spontaneous analysis. The following c CTG variables were considered: FHR, number of accelerations, the presence and the number of episodes of high and low variation, the number of decelerations, short-term variation (STV), peaks of contractions (per hour) and fetal movements assessed by maternal perception (per hour). Computerized CTG recordings started not earlier than the beginning of week 38 of gestation. Immediately after delivery, blood sample was collected from umbilical artery for umbilical artery blood gas analysis (UBGA). The main UBGA parameter in cord umbilical artery that was considered for analysis was pH. pH values<7.25 were considered as suspicious for acidemia and pH values>or=7.25 as normal. RESULTS: Women suspicious for fetal distress during labor presented significantly lower fetal movements (P=0.026), accelerations (P=0.018), variability (P<0.001), number of high episodes (P<0.001), higher values of FHR baseline (P<0.001) and low episodes (P<0.001). Only the number of decelerations did not differ significantly between the two groups (P=0.545). The cut-off points of 5.00 for STV and 3.00 for high episodes were determined to classify women with fetal distress, which yielded high sensitivities (34 and 52%) and specificities (96.6 and 94.9%), with positive predictive values of 81.0 and 81.3% and negative predictive values of 77.4 and 82.2%, respectively. CONCLUSIONS: In conclusion, we believe that not only STV but also other components of the cCTG, mainly the presence and the number of episodes of high variation, are related to pregnancy's outcome as measured by an umbilical artery pH.

Vascular endothelial growth factor gene polymorphisms and idiopathic recurrent pregnancy loss.

OBJECTIVE: To investigate whether four common polymorphisms (-2578C/A, -1154G/A, -634G/C, and 936C/T) of the gene encoding for vascular endothelial growth factor (VEGF) are associated with idiopathic recurrent miscarriage. DESIGN: Prospective case-control study. SETTING: University teaching hospital. PATIENT(S): Fifty-two patients with a history of three or more unexplained consecutive pregnancy losses and 82 healthy, postmenopausal controls with at least two live births and no history of pregnancy loss. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Polymerase chain reaction and restriction fragment length polymorphism analysis were performed to identify the different VEGF alleles. RESULT(S): There was a significant difference in the -1154G/A genotype and allele frequency between women with recurrent pregnancy loss and controls. The risk of recurrent pregnancy loss was lower in the carriers of the G allele than in women carrying the A allele (odds ratio = 1.91, 95% confidence interval, 0.12-3.28). No significant association between recurrent spontaneous abortions and -2578C/A, -634G/C, and 936C/T genotypes was found. Between women with primary and secondary idiopathic recurrent miscarriage, no statistically significant differences with respect to allele frequencies were observed. CONCLUSION(S): This is the first report on VEGF gene polymorphisms in women with recurrent miscarriage, demonstrating that the -1154G/A VEGF gene polymorphism is associated with idiopathic recurrent abortions.

Cytologic differential diagnostic problems in ulcerative cervicitis.

OBJECTIVE: To improve the detection rates in the determination of signs consistent with ulcerative cervicitis against signs of intraepithelial neoplasia, in PAP smears. STUDY DESIGN: We investigated the frequency of establishing a diagnosis of a simple ulcerative cervicitis by histology in a cohort of 58 females with cervical cytology suggestive of intraepithelial neoplasia. RESULTS: There was found a detection rate of 81.58% in the determination of ulcerative cervicitis by cytology and a rate of 100% in the determination of HPV-infection, CIN1, CIN2 and CIN3 respectively. There was no statistically significant difference between cytology and histology in the diagnosis of ultracerative cervicitis (p>0.5, chi-square). CONCLUSIONS: There is an overestimation of the cytological signs in the diagnosis of ulcerative cervicitis 18.42%). There is also an excellent agreement in the diagnosis of HPV-infection and CIN grades (100%) between cytology and histology, discordant with the literature (2.4%-71%).

Fetal magnetoencephalography in intrauterine growth retarded pregnancies.

OBJECTIVE: To investigate the fetal brain activity in pre-eclamptic and normal pregnancies. Biomagnetic measurements were performed by means of a superconducting quantum interference device (SQUID) in an electrically shielded room of low magnetic noise. METHODS: The study population included 28 pre-eclamptic (34-37 weeks' gestation) and 19 normal pregnancies (34-37 weeks' gestation). The pre-eclamptic group consisted of 11 cases with birth weight below the 10th percentile (1969 +/- 129 g) and 17 cases above the 10th percentile (2496 +/- 257 g). Biomagnetic signals (waveforms) recorded from fetal brains were expressed in terms of magnetic power spectral amplitudes. RESULTS: The total corresponding spectral amplitudes in the frequency range 2-7 Hz were high (719 +/- 69 Ft/ radical Hz in neonates <10th percentile and 537 +/- 105 Ft/ radical Hz in neonates >10th percentile) in most (82%) pre-eclamptic pregnancies and low (382 +/- 35 Ft/ radical Hz) in most normal pregnancies (95%). The difference between normal and all pre-eclamptic pregnancies was highly significant (Student's t-test: p < 0.0001). Comparing the two groups of pre-eclampsia we found also a highly significant difference (Student's t-test: p < 0.0001). CONCLUSION: Biomagnetic measurements of fetal brain activity could be useful in the assessment of fetal central nervous system development.

Interpregnancy interval and the risk of preterm birth in Thrace, Greece.

OBJECTIVE: To examine the influence of short interpregnancy interval on the prevalence of preterm birth in two, ethically different, Greek populations. STUDY DESIGN: We studied 652 urban Christian women and 578 rural, Romany, Muslim women who had had two consecutive, singleton pregnancies. We related the prevalence of preterm birth to the interpregnancy intervals (cut-off point, 6 months). Student's t-test, x(2)-test and relative risk estimation were used. RESULTS: Preterm birth and interpregnancy intervals less than 6 months occurred more often among Muslims than Christians. Among Muslims, an interval of <6 months was associated with greater prevalence of preterm birth (16% versus 7.3%, P=0.013, RR=2.4 and 95% C.I. 1.3-4.7). Christians did not demonstrate a similar relationship. CONCLUSIONS: A short interpregnancy interval seems to be a risk factor for preterm birth in the population of rural, Romany, Muslim women.

Incidence and Detection of Contralateral Breast Cancer.

In this study we estimated the efficacy of contralateral breast biopsy as a subsidiary method of early detection of bilateral breast cancer. We performed blind biopsies in the upper outer quadrant of the opposite breast in 195 patients undergoing surgical treatment for primary breast cancer. The histologic examination of the biopsy specimens showed 12 malignant lesions, which accounts for an incidence of 6.1%. In detail, we had two infiltrating ductal cancers, two infiltrating lobular cancers, three ductal in situ cancers, and five lobular in situ cancers. The overall incidence of invasive disease was 2.05%. We concluded that contralateral breast biopsy should be reconsidered as a method for enhancing early detection of contralateral breast cancer in high-risk groups, especially when it meets the emotional needs of patients. Permission given, it is included in the main surgical treatment of patients, avoiding the cost and complications of anesthesia, and it is cosmetically acceptable, without being an emotional burden for the woman.