Malignant changes in adenomyosis in patients with endometrioid adenocarcinoma.

OBJECTIVE: The aim of our retrospective study was to evaluate pathological changes in adenomyotic foci in hysterectomy specimens, and point out a possible mechanism of carcinogenesis in adenomyotic foci inside the myometrium. METHODS: Retrospective analysis of clinical data; 219 patients were operated at our departments from 2003-2008 with the diagnosis of early endometrial cancer. Standard staging operation was used in all cases and all hysterectomy specimens were afterwards routinely analyzed. RESULTS: Adenomyosis was found in 88 of a total of 219 hysterectomy specimens, while 205 of these 219 were affected by endometrioid adenocarcinoma, ten with clear cell carcinoma and four with papillary serous carcinoma. Within these subgroups adenomyosis was documented in 87 of 205 specimens with endometrioid adenocarcinoma (42.4%) and in one specimen of ten with clear cell carcinoma (2.2%), all found in the eutopic endometrium. All cases of malignant changes (n = 6) in adenomyosis were found exclusively with coexisting endometrioid adenocarcinoma: adenocarcinoma in adenomyosis was well or moderately differentiated in five cases, and poorly differentiated in just one case. Differentiation of the tumor in adenomyosis correlated with differentiation of the eutopic endometrial cancer in 50%. Hyperplastic changes like benign glandular hyperplasia, or atypical complex hyperplasia (ACH) were identified simultaneously in all cancer-positive adenomyotic foci. CONCLUSION: Malignant changes in adenomyosis were present in 6.8% of patients with endometrial cancer. All malignancy-positive cases of adenomyosis were associated with endometrioid adenocarcinoma of the eutopic endometrium. Interestingly, in all these cases, different stages of hyperplastic changes were also simultaneously identified. This observation suggests a similar pathway of carcinogenesis in adenomyosis as is known in estrogen-responsive endometrial cancer type I.

[Quiscent trophoblastic disease]. / Neinvazivní trofoblastická nemoc.

TYPE OF STUDY: Case report. SETTING: Center for trophoblastic disease in Czech Republic, Institute for care of mother and child, 3rd Faculty of Medicine of Charles University Prague. METHODS: The autors present a case of quiscent trophoblastic disease diagnosed at 27 years old primipara, secundigravida after previous molar pregnancy. The patient had low levels of serum hCG present for more than 18 months after the termination of pregnancy. After this period there was a malignant transformation associated with rapid elevation of hCG levels with need for chemotherapy which was succesfully completed. CONCLUSION: Quiscent (dormant, noninvasive) trophoblastic disease is a recently described unit defined by low levels of hCG present in patients serum and urine samples without any evidence of trophoblastic tumour or other source of hCG production. Quiscent trophoblastic disease is associated with high risk of malignant transformation.

[Rectal duplication cyst--case report]. / Cystická duplikatura rekta--kazuistika.

OBJECTIVE: The authors demonstrate a rare case of duplication anomaly of the rectum. DESIGN: Case report. SETTING: Institute for the Care of Mother and Child, Prague. SUBJECT AND METHOD: We present a rare case of cystic rectal duplication in adult, completely removed and histologically confirmed. A literature review was summarized. CONCLUSION: The case was complicated by delay in diagnosis, multiple operations, and by the association with endometriosis, as well. Mentioned anomaly is published in the Czech literature for the very first time.

[Histological differential diagnosis of hydatidiform moles and hydropic abortions]. / Histologická diferenciální diagnostika hydatidózních mol a hydropických abortu.

OBJECTIVE: To describe the diagnostic methods enabling histological differential diagnosis of complete hydatidiform mole, immature complete hydatidiform mole, partial hydatidiform mole, proliferative mole and hydropic abortion. METHODS: Our study consists of 1321 partial hydatidiform moles, 805 complete hydatidiform moles, 524 proliferative moles, and over 2500 hydropic abortuses diagnosed and treated at the Trophoblastic Disease Center in the Czech Republic (TDC-CZ), Institute for the Care of Mother and Child, plus 2896 of these lesions examined at the TDC-CZ by referral. The material was examined by routine histopathological methods, which in selected cases were supplemented by immunohistological examination and correlated with cytogenetic and molecular genetic results and clinical features. RESULTS: The study describes the diagnostic procedures enabling differential diagnosis between mature complete hydatidiform mole, immature complete hydatidiform mole, partial hydatidiform mole, proliferative mole and hydropic abortion. Fourteen histological parameters have been defined which are most common, individually or in combination, in various types of hydatidiform moles and hydropic abortions. Warning is given to errors in histological diagnosis, correlated with cytogenetic and molecular genetic results. We propose a reliable method of eliminating the influence of these errors on the possible development of trophoblastic disease. CONCLUSION: The study describes a histological differential diagnosis of complete hydatidiform mole, immature complete hydatidiform mole, partial hydatidiform mole, proliferative mole and hydropic abortion.

[Pregnancy complications after intrauterine hysteroscopic surgery]. / Tehotenské komplikace po intrauterinní hysteroskopické chirurgii.

OBJECTIVE: To evaluate our clinical experience of cases of pregnancy after transcervical septum resection and endometrial ablation. There are several case reports in the literature showing increase fetomaternal morbidity after intrauterine surgery. DESIGN: Analytic retrospective study. SETTING: Mother and Child Care Institute, Prague, Institute for Postgraduate Medical Education, Prague. RESULTS: There were three cases of severe complications during pregnancy after intrauterine surgery. We experienced one case of uterine rupture after transcervical septum resection in the second stage of labour. The other two cases were pregnancies after endometrial ablation and septum resection complicated with severe bleeding in the second trimester. CONCLUSION: Pregnancies after some types of intrauterine surgery (septum resection, endometrial ablation) are at high risk. They can lead to increased fetomaternal morbidity. We recommend intensive prenatal care with immediate surgical intervention when complications occur.

[Comparison of steroid metabolism markers in endometrium of women with endometriosis, endometrial hyperplasia and without pathological changes of endometrium]. / Porovnáni ukazatelu steroidního metabolismu v endometriu zen s endometriózou, s hyperplazií a bez techto patologických zmen.

OBJECTIVE: To find out any relationship between presence of P450 aromatase and estrogen (ER) and progesterone (PR) receptors in eutopic endometrium of women with and without endometriosis and in estrogen-dependent gynecologic lesions (endometrial hyperplasia and endometriosis). DESIGN: Retrospective study. SETTING: Sikl's Institute of Pathology, Department of Gynecology and Obstetrics, University Hospital and Medical Faculty in Pilsen, Charles University. METHODS: The examined samples were obtained from patients of Department of Gynecology and Obstetrics, University Hospital and Medical Faculty in Pilsen (2001-2002) and elaborated in Sikl's Institute of Pathology, University Hospital and Medical Faculty in Pilsen. There were four experimental groups: endometrial hyperplasia, endometriosis and eutopic endometrium of women with and without endometriosis. P450 arom, ER and PR were detected by using immunohistochemical methods with specific antibodies. RESULTS: P450 aromatase was detected in a higher amount in endometriosis, hyperplasia and some samples of metaplasia. Estrogen and progesterone receptors were detected in all examined tissues. Number and spreading of ER and PR depend on the phase of the cycle. Lower number of ER was found in atrophic and metaplastic endometrium and in atypic hyperplasia. There was not found any direct relationship between presence of P450 aromatase and both types of receptors. CONCLUSION: Steroid metabolism in examined pathologically changed tissues is due to molecular aberrations regulated on the local level. It is not possible to use detection of P450 aromatase as a diagnostic test for pelvic endometriosis.

Helicobacter heilmannii gastroduodenal disease and clinical aspects in children with dyspeptic symptoms.

AIM: To evaluate the occurrence and clinical characteristics of Helicobacter heilmannii infection among children presenting with dyspeptic symptoms. METHOD: Prospective cohort study of 580 patients. RESULTS: Of all examined dyspeptic children, 26.4% were infected with spiral-shaped organisms, and 0.9% of patients were found to be infected with spiral H. heilmannii-like organisms. CONCLUSION: In children with dyspeptic symptoms, the possible presence of gastroduodenal disease due to H. heilmannii should be considered. Further studies are needed to clarify H. heilmannii-related gastroduodenal pathology in the paediatric population.

[Angiotropic lymphoma (intravascular lymphomatosis)--2 case reports]. / Angiotropní lymfom (intravaskulární lymfomatóza)--popis dvou prípadu.

Described are two cases of angiotropic lymphoma where eventually autopsy elucidated nonspecific neurologic symptoms. One patient suffering ambiguous encephalitic syndrome died three months later, the second one passed away after an unusually long three-year period of progressive dementia and cumulative motoric dysfunction. The autopsy disclosed pure intravascular malignant lymphoid aggregates (LCA, CD 20, Bcl 2-positive) in the brain and kidney of both patients. In the patients with the longer disease period, a dissemination to lung was also found. Definitive diagnosis was issued as a B cell type of angiotropic lymphoma. Skin, lymph nodes, spleen, and bone marrow were not affected in any case. The clinical differential diagnosis algorithm did not involve this rare etiology in these particular uncommon neurologic cases and even brain biopsy performed in both women did not recognize the substantiality of the disease.

[Accurate noninvasive diagnosis of Helicobacter pylori infection using antigen determination in the feces in the pediatric population]. / Presná neinvazivní diagnostika infekce Helicobacter pylori pomocí stanovení antigenu ve stolici v detské populaci.

BACKGROUND: H. pylori can cause several gastroduodenal diseases. Because H. pylori infection is usually acquired in childhood, accurate diagnosis of the infection in the pediatric population is important. Tests for the diagnosis of H. pylori infection can be divided into invasive and noninvasive. The aim of our study was to compare invasive tests (endoscopy, gastric mucosal biopsy, histology) and the noninvasive, newly developed stool antigen test to diagnose H. pylori infection. METHODS AND RESULTS: 91 children (40 boys, 51 girls, mean age 12.6 +/- 3.5 years) with dyspeptic symptoms were tested for H. pylori infection using endoscopy and gastric biopsy and a new antigen test in stool samples (immunoassay). Thirty-one of the children (34.1%) with dyspepsia were found positive for H. pylori according to histologic examination and rapid urease test. In 28 of the 31 patients, H. pylori stool antigen could be detected (sensitivity 90.3%). Of the 60 patients with negative direct histologic examination and rapid urease test, 60 were H. pylori--negative in stool antigen test (specificity 100%). Positive predictive value of stool antigen test is 100% and negative predictive value is 95.2%. CONCLUSIONS: The stool antigen test is highly sensitive and specific. It will be potentially very helpful in the diagnosis of H. pylori infection and can replace endoscopy for detection of H. pylori infection in children with comparable accuracy and reliability.

[Hypergastrinemia associated with Helicobacter pylori infection and sideropenic anemia in a 15-year-old girl]. / Hypergastrinémie spojená s infekcí Helicobacter pylori a sideropenickou anémií u patnáctileté dívky.

H. pylori is a major cause of primary chronic gastritis and peptic ulcer disease in children. The authors give an account of H. pylori infection (cagA+, vacA+) in a 15-year-old girl where the initial clinical features included fatigue, collapses, and anorexia, elevated serum gastrin level (> 1000 mIU/l) raised the suspicion of gastrinoma. H. pylori gastric infection was also associated with iron-deficiency anemia. After treatment for H. pylori infection (omeprazole, clarithromycin, amoxycillin), clinical symptoms improved consistently, the serum gastrin level was repeteadly quite normal and hematologic and iron profiles were within the normal range. There is compelling evidence that H. pylori must be taken into account as a cause of hypergastrinemia other than gastrinoma in childhood.

[Cervical glassy-cell carcinoma--case report]. / Karcinom delozního hrdla ze sklovitých bunek--kazuistika.

OBJECTIVE: A rare case of a mixed cervical carcinoma is described. SUBJECT: Glassy-cell carcinoma of the uterine cervix in association with a bilateral benign superficial serous papilloma of the ovary in a 44-year-old woman. CONCLUSION: The possible occurrence of aggressive tumours of the uterine cervix with emphasis on their adequate treatment is pointed out. At the same time the importance of a peroperative biopsy of suspect macroscopic findings on the ovaries is stressed. The paper reports on a previously unpublished case of simultaneous occurrence of the above mentioned tumours.

[Extensive metastases in the thoracic wall as an unusual manifestation of malignant hepatoma]. / Rozsáhlá metastáza hrudní steny jako neobvyklý príznak maligního hepatomu.

In a 53-year-old man an extensive tumour of the thoracic wall was extirpated. It was examined histologically and identified as a secondary of a malignant hepatoma. In the second stage a primary hepatic tumour was removed by extended right-sided lobectomy. The case-history provides evidence of a remote secondary of a malignant hepatoma and a successful palliative approach.

[Diagnostic reliability of pre-biopsy methods (colposcopy and cytology) in predicting the histological basis of cervical lesions]. / Diagnostická spolehlivost prebioptických metod (kolposkopie a cytologie) pri predpovedi histologického podkladu cervikální léze.

The more frequent incidence of cancer of the uterine cervix and thus of precanceroses in younger age groups, the introduction of new therapeutic methods (cryotherapy, CO2 laser, modernized diathermocoagulation) call for an estimate of the histological basis of the cervical lesion and in precanceroses assessment of its grade. These data must be provided by prebioptic methods (cytology and colposcopy). This diagnosis is essential to provide optimum therapy under the given circumstances. During the two-year period of 1985-1986 at the Gynaecological Clinic in Plzen 308 women detected by cytological screening were examined who were subsequently operated on account of a cervical lesion. In the investigated group a prebioptic predicition of high reliability was made. A concordant finding was recorded in 286 women, i.e. 92.9%. False negative, i.e. so-called risk errors were made in 9 women, i.e. 2.9%. False positive errors without risk, where the only consequence was unnecessarily radical treatment, were made in 13, i.e. in 4.2% women.