Postpartum regression of human papillomavirus-related vulvar cancer: A case report.

We report a case of a 23-year-old pregnant woman (gravida 2 para 0, pregnancy 33 weeks and 3 days) with a history of laser ablation for cervical intraepithelial neoplasia-3 at 22 years. At initial visit, a 2 × 2 × 1-cm elevated mass was found on right labia majora. Biopsy results revealed squamous cell carcinoma of right labia; immunostaining revealed p16 positivity. Patient was diagnosed with human papillomavirus-related vulvar cancer. Selective cesarean section was performed at 36 weeks and 4 days of gestation. Postoperative histopathological diagnosis of squamous cell carcinoma, and 1.7-mm deep infiltrations led to vulvar cancer stage IB diagnosis. Reduction operation was performed, and postoperative follow-up of 1 year and 8 months revealed no recurrence. These results emphasize that small vulvar tumors during pregnancy should not be underestimated and histological examinations should be performed without hesitation. Careful observation and evaluation of tumors is necessary during pregnancy and after delivery because they may shrink postdelivery.

Laser vaporization of the cervix is associated with an increased risk of preterm birth and rapid labor progression in subsequent pregnancies.

PURPOSE: Laser vaporization of the cervix is an established method of treating cervical intra-epithelial neoplasia, but its effect on subsequent pregnancies remains controversial. The aim of this study was to investigate pregnancy outcomes after laser vaporization. METHODS: We conducted a retrospective study involving women who delivered live singletons between 2012 and 2019 in a tertiary hospital. The risks of adverse pregnancy outcomes after laser vaporization of the cervix were assessed using a multivariate regression model. The primary outcome was the adjusted odds ratio for preterm births. We also evaluated the course of labor progression, duration of labor, risk of emergency cesarean deliveries, and the risk of cervical laceration as secondary outcomes. RESULTS: In total, 3359 women were analyzed in this study. The risk of preterm birth was significantly higher in pregnancies after laser vaporization of the cervix (adjusted odds ratio [AOR] 1.84, 95% confidence interval [95% CI] 1.06-3.20; p = 0.030). The duration of the first stage of labor was significantly shorter in the post-treatment group (median 255 min vs. 355 min; p = 0.0049). We did not observe significant differences in the duration of the second stage of labor (median 21 min vs 20 min; p = 0.507) or the rates of other obstetric events, including emergency cesarean deliveries (AOR 0.736; 95% CI 0.36-1.50; p = 0.400) and cervical laceration (AOR 0.717; 95% CI 0.22-2.35; p = 0.582). CONCLUSION: Laser vaporization of the cervix is associated with an increased risk of preterm births and a shorter duration of the first stage of labor in subsequent pregnancies. Careful consideration is necessary when selecting a method of treatment for the uterine cervix of patients wishing future pregnancies.

Maternal characteristics and neonatal outcomes of emergency repeat caesarean deliveries due to early-term spontaneous labour onset.

BACKGROUND: The optimal timing of elective repeat caesarean delivery has yet to be determined. One of the reasons to schedule an elective repeat caesarean delivery before 39 weeks gestation is to avoid emergency caesarean delivery due to spontaneous onset of labour. AIMS: By ascertaining maternal characteristics and neonatal outcomes associated with early-term onset of spontaneous labour, we aim to determine the optimal timing for each individual repeat caesarean delivery. MATERIALS AND METHODS: We performed a retrospective analysis of women with repeat caesarean deliveries planned at 38 weeks gestation between 2005 and 2019 at a tertiary referral hospital in Japan. A multivariate logistic regression analysis was adopted to identify independent contributing factors for early-term spontaneous labour onset. We also compared the rate of neonatal adverse events between women who underwent emergency repeat caesarean deliveries due to the onset of early-term labour and the ones who underwent elective repeat caesarean deliveries at 38 weeks. RESULTS: We included 1152 women. History of vaginal deliveries (adjusted odds ratio (AOR), 2.12; 95% confidence interval (95% CI), 1.21-3.74), history of preterm deliveries (AOR, 2.28; 95% CI, 1.38-3.77), and inadequate maternal weight gain during pregnancy (AOR, 1.78; 95% CI, 1.15-2.75) significantly increased the risk of early-term spontaneous labour onset. In terms of occurrence rate of neonatal complications, we found no significant difference between the groups. CONCLUSION: These maternal factors are significant predictors for early-term labour onset of repeat caesarean deliveries. The onset of early-term labour did not increase the likelihood of neonatal complications.

Compilation of copy number variants identified in phenotypically normal and parous Japanese women.

With increasing public concern about infertility and the frequent involvement of chromosomal anomalies in miscarriage, analyses of copy number variations (CNVs) have been used to identify the genomic regions responsible for each process of childbearing. Although associations between CNVs and diseases have been reported, many CNVs have also been identified in healthy individuals. Like other types of mutations, phenotypically indefinite CNVs may have been retained and accumulated during anthropogenesis. Therefore to distinguish causative variants from other variants is a formidable task. Furthermore, because previous studies have predominantly focused on European and African populations, comprehensive detection of common Asian CNVs is eagerly awaited. Here, using a high-resolution genotyping array and samples from 411 Japanese women with normal parity without significant complications, we have compiled 1043 copy number variable regions. In total, the collected regions cover 164 Mb, or up to 0.5% of the genome. The copy number differences in these regions may be irrelevant not only to infertility but also to a wide range of diseases. The utility of this resource in reducing the candidate pathogenetic variants, especially in Japanese subjects, is also demonstrated.

An Extragastrointestinal Tumor Diagnosed as a Vaginal Mass during Pregnancy.

We report a case of an extragastrointestinal stromal tumor diagnosed as a vaginal mass during pregnancy. The mass was detected during routine examination at 24 weeks of gestation. At 26 weeks, the patient underwent transvaginal ultrasonography and magnetic resonance imaging, which revealed a blood flow-rich mass of approximately 50 × 30 mm in the rectovaginal septum. At 29 weeks of gestation, we resected the mass vaginally and the pathological diagnosis was a gastrointestinal stromal tumor. Chemotherapy was withheld until after full-term birth because the proliferation index of the tumor cells was low. The patient delivered a healthy infant. Imatinib was commenced at 1 month postpartum, with no recurrence or metastasis after 2.5 years. An extragastrointestinal stromal tumor as a vaginal mass in pregnancy has not been reported; however, our case suggests that the tumor should be considered a differential diagnosis of a vaginal mass in pregnancy.

Tracheal Mucoepidermoid Carcinoma Mimicking Deteriorated Bronchial Asthma during Pregnancy.

Primary bronchial tumors are extremely rare. However, symptoms, such as coughing and wheezing, are not specific to this disease, and primary bronchial tumors are often misdiagnosed as bronchial asthma. This report describes the case of a pregnant patient with a bronchial tumor that mimicked deteriorating bronchial asthma. A 37-year-old female patient suffered from repeated episodes of pneumonia since 26 weeks of gestation. Despite treatment, she suffered from another episode of pneumonia at 28 weeks of gestation. This was considered as deteriorating asthma. Bronchoscopy performed at 34 weeks of gestation showed a tumor in the left main lung bronchus, obstructing nearly 100% of the trachea. After cesarean delivery at 34 weeks, she underwent endoscopic bronchial tumor resection. Because of recurrent bronchial obstruction and the possibility of malignant disease, subsequent left main lung bronchial resection and bronchoplasty were performed. The pathological diagnosis was low-grade mucoepidermoid carcinoma. In conclusion, if pneumonia develops repeatedly during pregnancy, the possibility of bronchial tumor should be considered.

Intravascular large B-cell lymphoma involving mainly the uterus: report of a case using liquid-based cytology of the endometrium.

BACKGROUND: Intravascular lymphoma is a rare subtype of extranodal lymphoma. Most instances of the disease are of B-cell lineage. Diagnosis is difficult because of its nonspecific clinical signs, and many cases are diagnosed at autopsy. Uterine involvement is rare, and it is commonly manifested as genital bleeding. In this case, the chief complaint was fever, which is also very rare. CASE REPORT: A 62-year-old woman presented with fever of unknown origin. Computed tomography revealed no localized lesion except for swelling of the right internal iliac nodes. A cytologic smear of the endometrium by liquid-based cytology demonstrated malignant cells. Based on the curettage material, the lesion was diagnosed as an undifferentiated malignant tumor. Total abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic/paraaortic lymphadenectomy revealed widely scattered lymphoma cells of B-cell lineage mainly in the vascular lumina of the uterus, right ovary and lymph nodes. CONCLUSION: The final histologic type was established on the basis of the surgical material of hysterectomy. Diagnosis was difficult because of prominent cellular atypia and rare location of the tumor. Immunocytochemical examination of liquid-based samples can lead to a correct diagnosis of malignant lymphoma, even at the stage of endometrial cytologic examination.

Pelvic recurrence of an ovarian seromucinous borderline tumor detected by vaginal cytology: A case report and review of the literature.

Seromucinous borderline tumors are typically confined to the ovaries and rarely relapse after surgery. We report the case of a woman with a seromucinous borderline tumor with peritoneal implant at the Douglas pouch, who was affected by a recurrent tumor at the vaginal stump 2 years and 6 months after the primary surgery. The recurrent lesion was detected by vaginal cytology. Histology of the recurrent lesion showed perineural infiltration, and progression to low-grade adenocarcinoma was suggested. After the second surgery, vaginal cytology showed that the tumor cells remained positive. At postoperative follow-ups of ovarian borderline tumors, an examination of the specific region where recurrence is likely to occur can contribute to the early detection of tumor relapse. Diagn. Cytopathol. 2016;44:912-916. © 2016 Wiley Periodicals, Inc.

Large cell neuroendocrine carcinoma of the uterine cervix: a clinicopathological study of six cases.

Six cases of cervical large cell neuroendocrine carcinomas (LCNEC) were found among 972 patients (0.6%) with invasive cervical carcinoma. The patients, who were from 27 to 51 (mean 38) years of age, presented with vaginal bleeding or an abnormal Papanicolaou smear. Five tumors were stage Ib and one was IIa. All patients underwent radical hysterectomy and received adjuvant chemotherapy and pelvic radiotherapy. Four patients died of tumor 6 to 19 months (mean 14 months) postoperatively. On histologic examination, the tumor cells were arranged in an organoid growth pattern and were larger than those of typical small cell carcinoma. Glandular differentiation was present in one case. Mitotic figures ranged from 15 to 45 (mean 29) per 10 high-power fields. Prominent vascular invasion and necrosis was seen in all of the tumors. Each tumor was immunoreactive for chromogranin A and/or synaptophysin. The results of this study confirm the aggressive nature of cervical LCNECs. The recognition of LCNECs is necessary to establish the most effective treatment for these aggressive tumors.

Prognostic value of histologic grading of ovarian carcinomas.

Histologic grading of ovarian carcinomas has prognostic and therapeutic relevance, but although several grading systems have been proposed, no universal grading system has been established. Silverberg's group has recently proposed a simple histologic grading system of ovarian carcinomas. We studied its prognostic value in 70 patients with invasive ovarian carcinomas and compared it with that of histologic typing and clinical staging. Kaplan-Meier survival curves showed the following 5-year survival rate using the Silverberg grading system: grade I (n=21) 91%, grade II (n=20) 64%, grade III (n=29) 38% (p<0.001). Multivariate analysis indicated that the histologic grade, the clinical stage, and clear cell histologic type were significant prognostic factors. The Silverberg histologic grade correlated well with prognosis for all histologic types of ovarian carcinomas except for clear cell carcinoma. It is simple, reproducible, and provides useful prognostic information.