Automated and robust extraction of genomic DNA from various leftover blood samples.

With the development of genomic technologies, the isolation of genomic DNA (gDNA) from clinical samples is increasingly required for clinical diagnostics and research studies. In this study, we explored the potential of utilizing various leftover blood samples obtained from routine clinical tests as a viable source of gDNA. Using an automated method with optimized pre-treatments, we obtained gDNA from seven types of clinical leftover blood, with average yields of gDNA ranging from 3.11 ± 0.45 to 22.45 ± 4.83 µg. Additionally, we investigated the impact of storage conditions on gDNA recovery, resulting in yields of 8.62-68.08 µg when extracting gDNA from EDTA leftover blood samples stored at 4 °C for up to 13 weeks or -80 °C for up to 78 weeks. Furthermore, we successfully obtained sequenceable gDNA from both Serum Separator Tube and EDTA Tube using a 96-well format extraction, with yields ranging from 0.61 to 71.29 µg and 3.94-215.98 µg, respectively. Our findings demonstrate the feasibility of using automated high-throughput platforms for gDNA extraction from various clinical leftover blood samples with the proper pre-treatments.

Strategy for the formation of microalgae-bacteria aggregates in high-rate algal ponds.

This work studied the formation of aggregates used for wastewater treatment in high-rate algal ponds (HRAP). For this, the establishment of microalgae-bacteria aggregates in these systems was evaluated, considering strategies for the inoculation and start-up. Two HRAP were operated in parallel, at first in batch mode and then in continuous flow. The wastewater treatment was efficient, with removal rates around 80% for COD and N-ammoniacal. Volatile suspended solids and chlorophyll for the culture grew continuously reached a concentration of 548 ± 11 mg L-1 and 7.8 mg L-1, respectively. Larger photogranules were observed when the system was placed in a continuous regime. The protein fraction of extracellular polymeric substances was identified as a determinant in photogranules formation. During the continuous regime, more than 50% of the biomass was higher than 0.2 mm, flocculation efficiency of 78 ± 6%, and the volumetric sludge index of 32 ± 5 mL g-1. The genetic sequencing showed the growth of cyanobacteria in the aggregate and the presence of microalgae from the chlorophytes and diatoms groups in the final biomass.

Different types of functional training on the functionality and quality of life in postmenopausal women: a randomized and controlled trial.

BACKGROUND: Physical exercise is widely recommended for improving physical fitness. However, the most effective training method in improving the daily life of postmenopausal women is not clear. Therefore, this study compares different ways of functional training, focused on the task, and directed to the physical abilities on the functionality and quality of life of the postmenopausal women. METHODS: Forty-seven participants were randomly assigned into three groups: element-based functional training (EBFT); task-specific-based functional training (TSBFT); and the control group (CG). The intervention lasted fourteen weeks, with three weekly sessions stimulating several physical valences in the same session. The global functionality, functional reach, gait speed, handgrip strength, jumping ability, and quality of life before and after the intervention were evaluated. RESULTS: A similar increase was detected in both experimental groups for the variables-analyzed when compared to the initial moment (P<0.05), except in the dynamic postural control (P>0.05), which showed no difference. However, in the tests of rising from the floor and handgrip strength, only the task-specific-based functional training showed difference over time (P<0.05). CONCLUSIONS: Functional training protocols improve the performance in daily activities of postmenopausal women. However, task-specific-based functional training is more effective when compared to the control group in the analyzed variables.

Effects of different multicomponent training methods on functional parameters in physically-active older women.

BACKGROUND: Negative functionality changes are among the effects of aging. The multicomponent training performed on conventional machines or with new implements and features directed to daily activities is strongly recommended among attenuation strategies. However, the efficiency of both types of training is not yet clear in the recent literature. The aim was to compare the effects of different multicomponent training methods on functional parameters in older women. METHODS: Thirty-seven volunteers were randomly selected into the functional multicomponent training (MFT: N.=15), traditional multicomponent training (MTT: N.=14) and control group (CG: N.=8). They were assessed in the tests: Six-Minute Walk Test (6MWT), Ten-Minute Fast Walking Test (10FWT), Timed Up and Go test (TUG), Functional Reach Test (FRT), Ankle Test (AKT), Sit To Stand Modified test (STSM), and quality of life (QOL). ANOVA (3×2) followed by the Bonferroni post-hoc was used, adopting P≤0.05 for statistical significance. RESULTS: When compared pre-post values, MFT showed significant differences in all functional tests evaluated (AKT: P<0.01; STSM: P<0.01; FRT: P<0.01; QOF: P<0.01; 10FWT: P<0.01; 6MWT: P<0.01; TUG: P<0.05). In the same comparison, MTT showed a significant change in all tests (AKT: P<0.01; STSM: P<0.01; FRT: P<0.01; QOF: P<0.05; 6MWT: P≤0.05; TUG: P<0.05) except 10FWT. When compared to CG, MFT showed a significant difference in all walking tests and MTT showed a better performance in 10FWT and TUG. CONCLUSIONS: Both experimental protocols were effective to improve functional parameters in older women. However, the MFT was performed better in most tests that required efficiency in gait ability.

Functional Training Induces Greater Variety and Magnitude of Training Improvements than Traditional Resistance Training in Elderly Women.

The objective was to investigate the effects of functional (FT) and traditional (TT) training on trunk muscles maximal isometric strength, rate of force development and endurance with trained elderly women. Forty-five elderly women were directed into three groups: FT (n =1 6), TT (n = 14) and Control (n = 15). The FT (multi-planar, and multi-articular movements) and TT (primarily machine-based resistance exercises) performed mobility, muscle strength and power exercises. Both training groups also performed intermittent cardiometabolic activities. The maximum strength and endurance of the trunk muscles were verified, both at baseline and after 12 weeks of training (3xweek for 50 min each). Data were analyzed using a 2-way ANCOVA with contrast of adjusted mean values. FT significantly increased all variables: maximum trunk flexor strength (p = 0.002, 22%); rate of flexor force development (p = 0.001, 84%); trunk extensors maximal strength (p = 0.003, 17%); trunk extensor rate of force development (p = 0.05, 16%); trunk flexors (p = 0.001, 19%) and extensors (p = 0.017, 13%) endurance compared to baseline. TT showed an increase only in RFD of trunk extensors (p = 0.003, 53%), and flexors (p = 0.033, 42%), and trunk flexors endurance (p = 0.008, 11%). However, there was no statistically significant difference between groups. FT promoted improvement in all variables; strength, endurance and rate of force development of the trunk flexors and extensors of the elderly. On the other hand, TT improved only the rate of force development of trunk flexors and extensors and endurance of the trunk flexors. FT is recommended for elderly women as it improves a broader array of physiological parameters.

Comparison between functional and traditional training exercises on joint mobility, determinants of walking and muscle strength in older women.

BACKGROUND: Currently, several strength training protocols have been verified aiming improvements on functionality in older population. For this purpose, integrated exercises aimed at improving essential movements may be an interesting strategy in improving performance for daily activities. This randomized trial compared the effects of eight and twelve weeks of functional and traditional training (TT) on joint mobility, gait determinants and muscle strength, and verified the maintenance of the effects after eight weeks of detraining in the older women. METHODS: Fifty-two older women were randomized into three groups: Functional Training (FT: N.=19), TT (TT: N.=16) and Stretching Group (SG: N.=17). The data were analyzed by ANOVA with Bonferroni post-hoc test. RESULTS: The FT and TT groups obtained significant improvements in the tests of muscle strength and muscle power both after twelve weeks of intervention, as well as with SG. Only the FT presented statistically significant improvements in dynamic agility/balance (32%, P=0.000), and cardiorespiratory condition (8.71%, P=0.020) in relation to SG. CONCLUSIONS: The experimental protocols are equally effective in improving joint mobility and strength components in active older women. However, FT seems to be more effective than TT in the improvement of the determinants of gait ability.

Acute effect of different exercise intensities and differences related to age on muscle performance in young and older women.

BACKGROUND: The aim of this study was to compare the acute effect of different exercise intensities on the number of repetitions and total volume and differences related to age on the fatigue index. METHODS: Twelve young women (19.0±1.6 years) and ten older women (66.6±5.8 years) performed two experimental sessions for the elbow flexor muscles in a balanced cross-over design. In one experimental session, the participants performed three sets to concentric muscle failure at 100% of 10-12 maximum repetitions (RM). In the other experimental session, the participants performed two sets of 12 repetitions and one final set until concentric muscle failure at 90% of 10-12 RM. A 90-second rest interval was adopted between sets. RESULTS: The session performed at 90% of 10-12 RM showed a higher number of repetitions in the second and third sets and a greater total volume, compared to the session at 100% of 10-12 RM for both young and older women (all P<0.05). However, significant no differences were observed in the fatigue index between the young and older women for the sessions performed at 90% or 100% of 10-12 RM (P>0.05). CONCLUSIONS: These findings suggest that a 10% load reduction promotes a greater number of repetitions and higher total volume in young and older adults. Moreover, the results indicate that young and older women present the same Fatigue Index for the elbow flexor muscles.

The effects of functional and traditional strength training on different strength parameters of elderly women: a randomized and controlled trial.

BACKGROUND: Physical exercise is the main strategy for improving physical fitness in elderly population. However, it is not clear which training method lead to greater adaptations on maximal dynamic strength, muscle power, muscle endurance and isometric strength in this population. Thus, our aim was to compare the effects of functional and traditional training on these variables in the elderly. METHODS: This study lasted twelve weeks, where 44 elderly women were randomly divided into three groups: functional training (FT; N.=18), traditional training (TT; N.=15), and control group (CG; N.=11). Maximal dynamic strength and muscle power tests were performed in pushing (Chest Press), pulling (Seated Row), and squatting (Leg Press 45°) actions. In addition, isometric strength with hand grip test (HG) and isometric dead lift test (ID) and muscle endurance with 30-s chair stand (CS) and 30-s arm curl (AC) tests were used. RESULTS: Both experimental groups improved significantly in strength (FT: Chest Press 24.9%, Leg Press 45° 38.4%, Seated Row 21.6%; TT: Chest Press 27.6%, Leg Press 45° 40.9%, Seated Row 24.5%), power (FT: Chest Press 13.6%, Leg Press 45° 11.6%, Seated Row 13.6%; TT: Chest Press 18.2%, Leg Press 45° 9.8%, Seated Row 19.2%) isometric strength (FT: HG=14.7%, ID=13.6%; TT: HG=19.1%), and endurance (TF: CS=19.6%, AC=23.8%; TT: AC=15.5%) with P≤0.05, except TT in ID (4.4%) and SL (4.6%). There was no difference between experimental groups; however, both experimental groups were statistically superior to CG. CONCLUSIONS: Both training protocols were equally effective in improving different strength manifestations in the elderly.

Immediate effects of transcutaneous electrical nerve stimulation (TENS) administered during resistance exercise on pain intensity and physical performance of healthy subjects: a randomized clinical trial.

PURPOSE: Exercise-induced muscle pain is a self-limiting condition which impacts physical activity habits. Transcutaneous electrical nerve stimulation (TENS) promotes pain reduction and functional improvement in different pain conditions. We propose that applying TENS during exercise might reduce pain and improve physical performance. Thus, we aimed to investigate immediate effects of TENS applied during resistance exercise. METHODS: Healthy subjects of both sexes, irregularly active or sedentary were assigned into two groups: active (n = 24) or placebo (n = 22) TENS. The study was conducted over five moments: on day 0, subjects were recruited, on day 1 subjects performed the one-repetition maximum test (1RM); 72 h later, on day 2, 1RM was retested; 48 h later, on day 3, TENS was applied during a functional-resisted exercise protocol for upper limbs (bench press and rowing), with an intensity of 80% of 1RM; and 24 h after, on day 4, subjects were reevaluated. Assessment included pain intensity at rest and with movement, pressure pain thresholds, and muscle fatigue. RESULTS: TENS did not reduce pain intensity when compared to placebo (p > 0.05). TENS reduce PPT in the latissmus dorsi: p = 0.02 and anterior tibialis: p = 0.04 in immediate reassessment. Immediate effects of TENS were significant for fatigue perception at rest (p = 0.01) and number of maximum repetitions during exercise sets, starting from the 5th set of rowing exercise (p = 0.002). CONCLUSION: Our results show that TENS did not reduce pain perception in healthy individuals, but its use induced increased muscle action, contributing to a greater fatigue perception.

Integrated Analysis of Biopsies from Inflammatory Bowel Disease Patients Identifies SAA1 as a Link Between Mucosal Microbes with TH17 and TH22 Cells.

BACKGROUND: Inflammatory bowel diseases (IBD) are believed to be driven by dysregulated interactions between the host and the gut microbiota. Our goal is to characterize and infer relationships between mucosal T cells, the host tissue environment, and microbial communities in patients with IBD who will serve as basis for mechanistic studies on human IBD. METHODS: We characterized mucosal CD4 T cells using flow cytometry, along with matching mucosal global gene expression and microbial communities data from 35 pinch biopsy samples from patients with IBD. We analyzed these data sets using an integrated framework to identify predictors of inflammatory states and then reproduced some of the putative relationships formed among these predictors by analyzing data from the pediatric RISK cohort. RESULTS: We identified 26 predictors from our combined data set that were effective in distinguishing between regions of the intestine undergoing active inflammation and regions that were normal. Network analysis on these 26 predictors revealed SAA1 as the most connected node linking the abundance of the genus Bacteroides with the production of IL17 and IL22 by CD4 T cells. These SAA1-linked microbial and transcriptome interactions were further reproduced with data from the pediatric IBD RISK cohort. CONCLUSIONS: This study identifies expression of SAA1 as an important link between mucosal T cells, microbial communities, and their tissue environment in patients with IBD. A combination of T cell effector function data, gene expression and microbial profiling can distinguish between intestinal inflammatory states in IBD regardless of disease types.

Oxygen Consumption and Substrate Utilization During and After Resistance Exercises Performed with Different Muscle Mass.

This study investigated the energy expenditure (EE) and substrate utilization reflected by the respiratory-exchange ratio (RER) during and after resistance exercises performed with different muscle mass. Ten male volunteers (mean±SD; 26±4yr, 179±6cm, 77±8kg) performed multiple sets of the horizontal leg press (LP) and chest fly (CF) (5 sets of 10 repetitions with 15 repetition-maximum, 1-minute between-set intervals) in a counterbalanced design. Oxygen uptake and carbon dioxide production were measured during 40 minutes of resting; resistance exercise protocols (sets and intervals); 90 minutes of post-exercise recovery. Total fat and carbohydrate oxidation rates were calculated according to the non-protein respiratory quotient. Both exercise conditions elicited net excess post-exercise oxygen consumption (EPOC) of similar duration (approximately 40min). The EPOC magnitude at 40 minutes was greater after LP than after CF (7.36±1.10L vs. 4.73±0.99L; P<0.001). The RER was higher in LP (1.30±0.04) than CF (1.16±0.05, P=0.0003) during exercise. During recovery the RER was similar in LP and CF (P>0.05) and lower than pre-exercise (Pre-exercise=0.78±0.04 vs. CF40min=0.74±0.04; CF90min=0.68±0.02 and LP50min=0.73±0.06; LP90min=0.65±0.04, P<0.05). However, fat oxidation after LP was greater than CF between 30-90 minutes of recovery (mean total fat oxidation: LP=10.9 g vs. CF=8.4 g; P<0.01). The increases of EE and fat oxidation during post-exercise recovery were greater after multiple sets of resistance exercises performed with larger muscle mass than smaller muscle mass. This finding has practical implications for resistance training designed as part of weight management programs.

Myeloid sarcoma presenting as a colon polyp and harbinger of chronic myelogenous leukemia.

Myeloid sarcoma, also known as granulocytic sarcoma or chloroma is an unusual accumulation of malignant myeloid precursor cells in an extramedullary site, which disrupts the normal architecture of the involved tissue. It is known to occur more commonly in patients with acute myelogenous leukemia and less commonly in those with myelodysplastic syndrome and myeloproliferative neoplasm, such as chronic myelogenous leukemia. The most common sites of involvement include bone, skin and lymph nodes. However, rare cases have been reported in the gastrointestinal tract, genitourinary tract, or breast. Most commonly, a neoplastic extramedullary proliferation of myeloid precursors in a patient would have systemic involvement of a myeloid neoplasm, including in the bone marrow and peripheral blood. Infrequently, extramedullary disease may be the only site of involvement. It may also occur as a localized antecedent to more generalized disease or as a site of recurrence. Herein, we present the first case in the English literature of a patient presenting with an isolated site of myeloid sarcoma arising in the form of a colonic polyp which, after subsequent bone marrow biopsy, was found to be a harbinger of chronic myelogenous leukemia.

Colonic in situ mantle cell lymphoma.

This report describes the first case, to our knowledge, of in situ mantle cell lymphoma (MCL) in the gastrointestinal tract identified retrospectively by immunostains and fluorescence in situ hybridization (FISH) analysis after progression to disseminated disease with pleomorphic morphology several years later. A 45-year-old man with blood per rectum underwent colonoscopy and had random biopsies interpreted as benign colonic mucosa. Two years later, he presented with ileocolic intussusception related to enlarged lymph nodes. Biopsies on the second presentation demonstrated widespread MCL. Reevaluation of the original colonic biopsies showed cyclin D1-positive cells within small lymphoid aggregates, confirmed by FISH for t(11;14). Postchemotherapy, lymphoid aggregates in colonic biopsies showed scattered cyclin D1- and FISH t(11;14)-positive cells, similar to the original in situ lymphoma. We discuss this case in the context of the current understanding of the evolution of MCL and the difficulties associated with detecting primary GI lymphoma.

The effect of between-set rest intervals on the oxygen uptake during and after resistance exercise sessions performed with large- and small-muscle mass.

Between-set rest intervals (RIs) may influence accumulated fatigue, work volume, and therefore oxygen uptake (VO2) and energy expenditure (EE) during resistance training. The study investigated the effects of different RIs on VO2 and EE in resistance exercises performed with multiple sets and recruiting large and small-muscle mass. Ten healthy men performed 4 randomized protocols (5 sets of 10 repetitions with 15 repetition maximum workloads in either horizontal leg press [LP] or chest fly [CF] with an RI of 1 and 3 minutes). The VO2 was measured at rest, within sets, and during 90-minute postexercise recovery (excess postexercise oxygen consumption [EPOC]). The EE was estimated from VO2net (total VO2 - rest VO2). The VO2 increased in all protocols, being higher within the exercises and during EPOC in the LP than in the CF regardless of the RI. The 1-minute RI induced higher accumulated VO2 during LP (p < 0.05) but not during CF. The EPOC lasted approximately 40 minutes after LP1, LP3, and CF1, being longer than after CF3 (20 minutes, p < 0.05). Total EE was mainly influenced by muscle mass (p < 0.001) (LP3 = 91.1 ± 13.5 kcal ∼ LP1 = 88.7 ± 18.4 kcal > CF1 = 50.3 ± 14.4 kcal ∼ CF3 = 54.1 ± 12.0 kcal). In conclusion, total VO2 was always higher in LP than in CF. Shortening RI enhanced the accumulated fatigue throughout sets only in LP and increased VO2 in the initial few minutes of EPOC, whereas it did not influence total VO2 and EE in both exercises. Therefore, (a) the role of RI in preventing early fatigue seems to be more important when large-muscle groups are recruited; (b) resistance exercises recruiting large-muscle mass induce higher EE because of a greater EPOC magnitude.

Pigment epithelium-derived factor regulates early pancreatic fibrotic responses and suppresses the profibrotic cytokine thrombospondin-1.

Pigment epithelium-derived factor (PEDF) is important for maintaining the normal extracellular matrix. We hypothesized that the initiation of pancreatic fibrosis is dependent on the loss of PEDF. Pancreatic PEDF expression was assessed in wild-type mice fed either a control or ethanol diet using an intragastric feeding model. Pancreatitis responses were elicited with either a single episode or a repetitive cerulein-induced (50 µg/kg, 6 hourly i.p. injections) protocol in wild-type and PEDF-null mice. Quantitative real-time PCR and immunoblotting were performed to assess fibrogenic responses. In wild-type animals, PEDF expression increased with pancreatitis and was more pronounced in mice fed ethanol. Compared with wild-type mice, α-smooth muscle actin staining and expression levels of fibrogenic markers (eg, transforming growth factor-ß1, platelet-derived growth factor, collagen I, and thrombospondin-1) were higher in PEDF-null mice at baseline. Sirius red staining revealed more fibrosis in PEDF-null versus wild-type pancreas 1 week after pancreatitis. Differences in tissue fibrosis resolved with longer recovery periods. PEDF overexpression suppressed thrombospondin-1 levels in vitro. Ethanol feeding and experimental pancreatitis increased PEDF expression in wild-type mice. PEDF-null mice, however, demonstrated enhanced early fibrotic responses compared with wild-type mice with pancreatitis. These findings indicate that PEDF acts as a compensatory antifibrotic cytokine in pancreatitis.

Elevated expression of p21 (WAF1/Cip1) in hormonally active pituitary adenomas.

Although most pituitary adenomas arise sporadically, molecular studies show alterations of known oncogenes and/or tumor suppressor genes in a small percentage of adenomas, and the molecular pathology of most is unknown. The p21 gene is a universal inhibitor of cyclin-dependent kinases and serves as a cell-cycle blocker and cell-growth inhibitor. Pituitary adenomas (n = 54) were immunophenotyped for hormone production (prolactin, growth hormone, adrenocorticotropin, thyrotropin, follicle-stimulating hormone, and luteinizing hormone), and expression of p21 was determined by immunohistochemistry. The percentage of cells expressing p21 for each tumor was evaluated blindly with regard to hormone status, and expression of p21 was then correlated with the results of hormone immunotyping. Results show a striking difference in the expression of p21 between immunonegative adenomas and hormone-producing tumors. Whereas 71% (10/14) of nonfunctional adenomas exhibit p21 expression in fewer than 5% of cells, 77% (31/40) of hormone-producing adenomas show expression in more than 25% of cells, and of these, 68% (21/31) show expression in more than 75% of cells. Overexpression of p21 is particularly striking for growth hormone-producing tumors, of which 92% (11/12) show expression in more than 75% of cells. Hormone-producing pituitary adenomas express much more p21 than do immunonegative adenomas. These high levels of p21 expression represent the most widespread molecular genetic alteration demonstrated to date in pituitary adenomas.

Textiloma (gossypiboma) mimicking recurrent intracranial tumor.

CONTEXT: Resorbable substances used to achieve hemostasis during neurosurgical procedures comprise 3 principal classes based on chemical composition: (1) gelatin sponge, (2) oxidized cellulose, and (3) microfibrillar collagen. Nonresorbable hemostatic aides include various forms of cotton and rayon-based hemostats (cottonoids and kites). Resorbable and nonresorbable hemostatic agents have been reported to cause symptomatic mass lesions, most commonly following intra-abdominal surgery. Histologic examination typically shows a core of degenerating hemostatic agent surrounded by an inflammatory reaction. Each agent exhibits distinctive morphologic features that often permit specific identification. Hemostat-associated mass lesions have been variously referred to as textilomas, gossypibomas, gauzomas, or muslinomas. OBJECTIVES: The aims of this study were to (1) identify cases of histologically proven cases of textiloma in neurosurgical operations, (2) characterize the specific hemostatic agent associated with textiloma formation, and (3) characterize the preoperative magnetic resonance imaging appearance of textiloma. DESIGN: Cases in which a textiloma constituted the sole finding on repeat surgery for recurrent brain tumor, or was a clinically significant component of a radiologically identified mass lesion together with residual tumor, constituted the study set. RESULTS: Five textilomas were identified and evaluated. The primary neoplasm was different in each case and included pituitary adenoma, tanycytic ependymoma, anaplastic astrocytoma, gliosarcoma, and oligodendroglioma. In all cases, preoperative magnetic resonance imaging suggested recurrent tumor. Textilomas included all categories of resorbable hemostatic agent. Other foreign bodies were present in some cases; the origin of these foreign bodies was traced to fibers shed from nonresorbable hemostatic material placed temporarily during surgery and removed before closure (cottonoids and kites). Inflammatory reactions included giant cells, granulomas, and fibroblastic proliferation. Microfibrillar collagen (Avitene) textilomas were associated with a striking eosinophil infiltration that was not seen with any other hemostatic agent. CONCLUSIONS: Hemostatic agents may produce clinically symptomatic, radiologically apparent mass lesions. When considering a mass lesion arising after intracranial surgery, the differential diagnosis should include textiloma along with recurrent tumor and radiation necrosis.

Metastatic tumors of the vulva: a clinicopathologic study of 66 cases.

Metastatic tumors involving the vulva are rare, with only a few series and case reports published in the English literature to date. In this study, we present the clinicopathologic features of 66 cases of metastatic tumors of the vulva seen at the University of Texas M. D. Anderson Cancer Center from 1944 to 2001. The patients' age ranged from 18 to 84 years (mean 54.8 years). The most common presentations were vulvar nodules or a mass (39 cases), pain (7 cases), and ulceration (5 cases). In 46.9% of cases, the primary tumor was of gynecologic origin, whereas in 43.9% of cases the primary tumor was of nongynecologic origin. The remainder had unknown primaries. The site most frequently involved by metastasis was the labium majus (44 cases: 18 on the right, 13 on the left, 6 bilateral, and 7 unspecified side). Thirty percent of the patients received chemotherapy as treatment for the metastasis, 27% received radiotherapy, and the rest received some combination of chemotherapy, radiotherapy, and surgery. Of the 60 patients with available follow-up, 52 died of disease within 1-81 months (median 7.5 months) from diagnosis of the metastasis. Metastatic tumors of the vulva are rare; however, the diagnosis of these tumors is facilitated by the knowledge of a preexistent malignancy and the lack of a mucocutaneous intraepithelial lesion.

Metastatic melanoma to the vagina: clinicopathologic and immunohistochemical study of three cases and literature review.

We report the clinicopathologic features of three cases of malignant melanoma metastatic to the vagina; only one similar case has been previously reported. The age of the patients ranged from 33 to 70 years; two presented with vaginal bleeding. Two patients had a history of a previous primary malignant melanoma, one a preauricular melanoma treated 7 years earlier and the other a vulvar melanoma treated 2 years earlier. In the third case, a primary malignant melanoma was found on the sole of the right foot after the patient had presented with the vaginal metastases. On gross examination, the vaginal tumors were polypoid; two were on the posterior wall and one was on the anterior wall. All were of epithelioid cell type and were positive with S-100 and microphthalmia-transcription factor. Tyrosinase was positive in two cases, HMB-45 was positive in one case, and MART-1 was focally positive in one case. One patient underwent wide local excision of tumor followed by chemotherapy, one patient had intracavitary radiotherapy, and one had palliative radiotherapy to the brain only. The patients died after a follow-up of 3, 14, and 48 months.

Endometrial endometrioid adenocarcinoma in a premenopausal woman presenting with metastasis to bone: a case report and review of the literature.

We describe the clinicopathologic and immunohistochemical features and microsatellite instability analysis of a rare case of endometrial endometrioid adenocarcinoma presenting as a metastasis to the ischium in a 39-year-old premenopausal woman. The patient was treated with a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic and para-aortic lymphadenectomy. One month later, she underwent an ischial resection followed by radiotherapy. After a follow-up of 3 years, the patient shows no evidence of disease.