Immunohistochemical analysis of p16 expression in uterine smooth muscle tumors.

The expression of p16 as a tumor suppressor protein was evaluated in a retrospective analysis of paraffin-embedded tissue specimens of leiomyosarcoma (LMS), leiomyoma (LM) and normal myometrium. In this study, we investigated by immunohistochemistry p16 expression in 15 LMSs, 15 LMs and ten normal myometrium. Strong expression of p16 was found in 12 of the 15 LMSs and in three cases weak expression; three LMs had focal and weak p16 staining but none of the normal myometrium. A statistically significant difference regarding the frequency of p16 protein expression was observed between LMS and LM (p: 0.0001). We concluded that the results of this study confirm the overexpression of p16 in LMS. Therefore, the present study suggests that p16 might be a useful immunohistochemical marker which could help in distinguishing uterine LMS from LM and its benign variants.

Multiple uterine angioleiomyomas mimicking an ovarian neoplasm: a case report.

Angioleiomyoma is a rare benign neoplasm that originates from smooth muscle cells and contains thick-walled blood vessels. A 69-year-old woman had been complaining of progressive abdominal distention for the last five years. At the exploration, a tumoral mass that could not be differentiated as to whether it had its origin from the uterus or ovary was specified. The patient underwent total hysterectomy and bilateral salpingo-oophorectomy (TAH+BSO). On pathologic examination of the specimen, the tumor was diagnosed as an angioleiomyoma. Here, we present a case of giant-multiple uterine angioleiomyomas mimicking an ovarian neoplasm.

Expression of E-cadherin in squamous cell carcinomas of the cervix with correlations to clinicopathological features.

OBJECTIVE: To evaluate the expression of E-cadherin, a calcium-dependent cell adhesion molecule, in a retrospective analysis of paraffin-embedded tissue specimens of cervical squamous carcinoma and the relationship with histopathological differentiation and lymph node status. METHODS: In this study, we investigated by immunohistochemistry E-cadherin expression in ten normal cervical epithelia and 24 cervical invasive squamous carcinomas. RESULTS: Normal cervical squamous epithelium showed strong expression of E-cadherin at the membrane of the cell and intercellular junctions. In 24 tumors immunnostained by E-cadherin antibody, 11 (46%) showed preserved expression and 13 (54%) reduced expression. There was no significant correlation between E-cadherin expression and histological differentiation (p = 0.650, p = 0.294). In the status of lymph node metastasis, reduced expression of E-cadherin was seen in 11/15 (73%) with lymph node metastasis versus 2/9 (22%) without lymph node metastasis. There was a significant inverse correlation between E-cadherin expression and lymph node metastasis (p = 0.032). CONCLUSION: Reduced E-cadherin expression may be an important factor among a variety of biologic events that occur during the process of metastasis. However, this should be explored by a large scale study.

Treatment of chronic cervicitis: the loop electrosurgical excision procedure.

The effectiveness and morbidity of excisional biopsy of cervical tissue using the electrosurgical excision procedure for the treatment of chronic cervicitis was investigated. In this study, loop diathermy was used in the treatment of one hundred patients with chronic cervicitis. Before the procedure, cervical smear and colposcopic examination were done. Then the loop diathermy was performed under local anesthesia. All the removed specimens were evaluated histopathologically. The mean operation time was 6.34 +/- 1.37 minutes. The complication of bleeding and secondary infection were 5% and 4%, respectively. All the patients had normal cervical smear (Papanicolaou class I or II). In the microscopic evaluation, thermal damage of the removed specimens were negligible. Six cases (6%) with CIN (CIN I = 4, CIN II = 2) were determined and the others (94%) were reported as chronic cervicitis in the histopathologic examinations of the removed specimens. After the operation, these cases with CIN were followed up for one year with cervical smears and colposcopic examinations. One of the six patients with CIN had recurrence and underwent cold-knife conization. This new technique is simple, quick and cheap. It can be used confidently to provide both diagnosis and treatment with minimal thermal tissue injury in cases with chronic cervicitis.

Prevalence, management and outcome in eclampsia.

OBJECTIVE: To review the management of eclampsia in our institution. METHOD: The prevalence, management and outcome of women with eclampsia over a period of 8 years were reviewed at our referral medical center. There were 444 patients with eclampsia among 5757 deliveries (1 in 12.96 deliveries or 7.71% of deliveries). Most of the cases were uneducated and had received no antenatal care. One hundred eighty-one cases were nulliparous (40.77%). High parities of more than five were observed in 27.93% of cases. A standard magnesium sulfate regimen, similar to Prichard's intramuscular regimen, was used. RESULTS: Magnesium sulfate effectively controlled the convulsions. The incidence of abdominal delivery among 397 cases with ante- and intrapartum eclampsia was 50.12%. Perinatal mortality was very high (591.47% 0) for all cases. Maternal complications were serious and led to maternal death in 42 women (9.46%). CONCLUSION: Eclampsia is still a serious obstetric complication particularly in uneducated women who do not receive antenatal care.

Sertoli-Leydig cell tumor of the ovary: a clinicopathologic study of 10 cases.

Ten patients with Sertoli-Leydig cell tumors of the ovary treated consecutively were analyzed retrospectively for clinicopathological characteristics, treatment modalities and survival. All patients were subjected to a surgical procedure including unilateral salpingoophorectomy (USO) in 5, total abdominal hysterectomy, bilateral salpingoophorectomy (TAH+BSO) in 2, TAH+BSO and omentectomy and pelvic and paraaortic lymphadenectomy and appendicectomy in 3 patients. Following surgery, 5 patients were subjected to adjuvant VAC (vincristine+actinomycine-D+cyclophosphamide) chemotherapy. Sertoli-Leydig cell tumors constitued 0.6% of all ovarian neoplasms in our institution (10/1621). The mean age at diagnosis was 28.2 years. Of the patients, 8 had stage IA, one had IB and one had stage III disease at surgery. Bilaterality was observed in two patients (20.0%). Four patients had poorly-differentiated tumors, of whom 1 had a retiform pattern and 1 had a heterologue element, with marked mitosis whereas the others had well--or moderately--differentiated tumors. Only one patient presented with recurrence during pregnancy and died 16 months after initial surgery. Since most of the patients present with stage IA disease, a favorable outcome can be achieved in most of them and conservative surgery seems to be the treatment of choice in younger patients. However, late recurrences even in early stages, especially in patients with poorly-differentiated tumors, can be detected, resulting in a fatal outcome despite any form of aggressive therapy.

Menstrual disorders and pelvic pain after sterilization.

Changes in menstrual cycle length, menstrual duration, number of pads, dysmenorrhea and non-cyclic pelvic pain were studied in 43 women following tubal sterilization with three different techniques. One group consisted of 17 women undergoing laparotomy by Pomeroy technique; the second group consisted of 11 women undergoing laparoscopy by Fallope rings; and the third group consisted of 15 women undergoing colpotomy by fimbriectomy. The differences before and after sterilization in cycle length were non-significant in all groups (p > 0.05). After sterilization, menstrual duration and number of pads were significantly increased in the laparotomy (p < 0.001) and laparoscopy (p < 0.01) groups but non-significantly in the colpotomy group (p > 0.05). Comparison of these parameters between the groups did not show any significant differences (p > 0.05). After sterilization, increases in the severity of dysmenorrhea and non-cyclic pelvic pain were non-significant in all groups (p > 0.05). We concluded that there were no significant differences in menstrual disorders after sterilization among these three different techniques.

Changes in ovarian function after tubal sterilization.

Changes in ovarian function were evaluated in 43 women, before and after tubal ligation. Midluteal endocrine profiles and endometrial biopsies were investigated before and at 3, 6 and 12 months after the operations. During postoperative follow-up there was significant increase in luteal phase deficiency and midluteal FSH, LH and E2 levels (p < 0.001). Progesterone levels significantly decreased (p < 0.001) and anovulation was observed in 13 (30.2%) of 43 cases. Our data suggest that tubal sterilization carried increased risk in ovarian function, particularly luteal phase deficiency and anovulation.