Maternal complications in molecularly confirmed diandric and digynic triploid pregnancies: single institution experience and literature review.

OBJECTIVES: Assessment of the maternal complications in molecularly confirmed diandric and digynic triploid pregnancies. METHODS: Sonographic features, biochemical results, and clinical presentation were analyzed. Beta-hCG level was controlled after diandric triploidy. RESULTS: The study included nine diandric and twelve digynic triploid pregnancies at the mean gestational age at diagnosis of 14.9 and 18.0 weeks, respectively (p = 0.0391). Mean value of total-hCG was 979 703.6 U/ml in diandric cases and 5 455.4 U/ml in digynic ones (p < 0.000). Maternal complications occurred in 88.9% of diandric triploid pregnancies, including: thecalutein cysts (44.4%), hyperemesis gravidarum (44.4%), symptomatic hyperthyreosis (33.3%), early onset gestational hypertension (22.2%) and vaginal bleeding (11.1%). No case of proteinuria, preeclampsia or HELLP syndrome was observed. Only maternal complication observed in digynic triploidy was vaginal bleeding (50.0%). The mean time of beta-hCG normalization after diandric triploid pregnancies was 84 days (range 11-142 days). No case of gestational trophoblastic neoplasia (GTN) was observed. CONCLUSIONS: Maternal complications (except for vaginal bleeding) are associated with diandric triploidy. The relatively low incidence of hypertensive maternal complications and their less severe course in our cohort may be attributed to the earlier prenatal diagnosis. The frequency of GTN after diandric triploidy may be lower than previously reported.

Endometriotic lesions mimicking advanced ovarian cancer - A case report and a review of the literature.

BACKGROUND: Approximately 2-5% of women affected by endometriosis are postmenopausal. The disease may simulate various malignancies. A case of endometriosis in a postmenopausal woman, spreading similarly to ovarian cancer, is reported. A broad review of existing literature on postmenopausal endometriosis, endometriosis involving the urinary tract, and the links between endometriosis and cancer are also presented. CASE DESCRIPTION: A 51-year-old woman was diagnosed with a pelvic mass. She complained of pain in the lower abdomen that began three weeks prior, and had no history of dysmenorrhea, acyclic pelvic pain, or infertility. CT scan revealed a solid and cystic tumor in the region of the right adnexa, infiltrating the surrounding tissues, with possible infiltration of the urinary bladder, as well as soft-tissue lesions of the small intestinal mesentery. Bilateral hydronephrosis and distension of the ureters were also present. A malignant neoplasm of the ovary or the corpus uteri was suspected. Total abdominal hysterectomy and appendectomy were performed. A superficial infiltration of the urinary bladder was also excised. The pathology report revealed endometriotic foci in the tumor and in the bladder infiltration, as well as an endometriotic cyst in the right ovary. Two years postoperatively the patient is disease-free and in good condition. CONCLUSIONS: Clinicians should remain conscious of the possibility of endometriosis mimicking advanced ovarian cancer and infiltrating the peritoneum and internal organs of the abdominal cavity, including the urinary tract. Imaging techniques, including CT and MRI, are not always effective in establishing the correct diagnosis preoperatively.

Ovarian cancer diagnosed accidentally during treatment for ruptured ectopic pregnancy: is fertility-sparing surgery a viable alternative? Case report and review of the literature.

According to cancer incidence statistics, it is estimated that 226,000 women are diagnosed annually with epithelial ovarian cancer (EOC) and 140,000 die of the disease worldwide. Ovarian cancer represents the fourth leading cause of all cancer-related deaths in women, and the first cause of death among all gynecological malignancies. With the constant shift towards later parenthood, the growing incidence of EOC in women of reproductive age is noted. Most young EOC women are concerned with preserving their fertility despite oncological outcomes. Nowadays gynecologic oncologists are being asked to include into their decision-making processes the patients' desire for fertility preserving alternatives. The question remains whether it is possible to use fertility-sparing surgery (FSS) without compromising the survival. In the present report, the authors present a case of a 27-year-old patient with ovarian cancer accidentally diagnosed during surgical treatment of an ectopic pregnancy. In this paper, the proper selection of the patients for the conservative management, oncological safety, indications for subsequent chemotherapy, the risk of relapses, obstetrical outcomes, and further oncological control were analyzed based on the largest and most relevant series outcomes data and recommendations. Numerous recent studies have confirm that FSS in young women with early stage of epithelial ovarian cancer, who wish to preserve their childbearing potential, after appropriate selection, appears a viable and safe option. However, there is still a possibility of relapse and regular oncological control is strongly recommended.

Postradiation carcinosarcoma of the corpus uteri--a case report.

INTRODUCTION: Radiation therapy is a very effective treatment modality, commonly used for numerous gynecological malignancies, e.g. cervical cancer. Unfortunately, ionizing radiation is associated with numerous side effects, including secondary cancer formation. A case of carcinosarcoma of the corpus uteri in a woman with a history of pelvic irradiation for cervical carcinoma is reported. The literature has been reviewed to present the incidence, optimal management, and prognosis in cases of postradiation uterine carcinosarcoma. CASE: A 55-year-old woman with a history of pelvic radiotherapy for cervical cancer five years earlier was diagnosed with a pelvic mass. Endovaginal ultrasound examination revealed a solid and cystic tumor, 12.5 cm in diameter. The patient was scheduled for surgery. Gross examination revealed an enlarged, plain corpus uteri, 12 cm in diameter. Both adnexa were normal. Pelvic and abdominal peritoneum were macroscopically normal and normal on palpation. Iliac and obturatory lymph nodes were enlarged on both sides. Radical hysterectomy, omentectomy, and ilio-obturator lymph node dissection were performed. The pathology report revealed carcinosarcoma of the corpus uteri with lymph nodes metastases--FIGO IIIC1. No adjuvant treatment was given. The patient is still alive and disease-free one year after surgery. CONCLUSIONS: Clinicians should.remain conscious of the potential carcinogenic effect of radiation therapy. Uterine carcinosarcoma may occur years after radiotherapy applied for cervical cancer. Therefore, long-term control following pelvic irradiation is always necessary.

Studies on stimulation and properties of antiglobulin antibodies. II. Antiglobulin antibodies against homologous globulins and antigens of thermally denatured autologous sera in the sera of rabbits immunized with various antigens.

Sera of 48 rabbits after long-term immunization with suspensions of Diplococcus pneumoniae, Klebsiella friedländeri, Proteus OX19 and solution of bovine albumin were examined for antibodies reacting with homologous gamma-globulins and antigens of thermally denatured autologous sera. Appearance of antibodies of this type was related to duration of immunization, but not related to the type of antigen used. The experimental results were explained as a result of altered antigenic properties of antibodies following reaction with homologous antigen.

Studies on stimulation and properties of antiglobulin antibodies. I. Influence of heatig at 56 degrees C and 60 degrees C on antigenicity.

The autoimmunogenic properties of whole rabbit serum heated at 56 degrees C and 60 degrees C were studied in rabbits. Autologous rabbit serum heated 20 min at 60 degrees C was immunogenic. The state of induced immunity manifested itself by the appearance of antibodies to antigens of heterologous sera: human, goat and guinea pig. No antibodies for autologous sera were found, including autologous sera heated 20 min at 60 degrees C. The antibodies for heterologous sera directed against gamma-globulins were detected by the passive hemagglutination test and by precipitation in agar gel.

Studies on stimulation and properties of antiglobulin antibodies. III. Antiglobulin antibodies with different specificity in patients with bronchial asthma complicated by suppurative catarrh of the respiratory tract.

Sera from 14 of 50 patients suffering from bronchial asthma complicated by suppurative catarrh of the respiratory tract contained antibodies to homologous and heterologous gamma-globulins. The findings were attributed to hyperimmunization causing changed in antigenic properties of antibodies. Antigenically altered antibodies can act as autoimmunogenic stimuli inducing an immune response manifested by the appearance of antibodies to autologous gamma-globulins and cross reacting with homologous and heterologous gamma-globulins.

Serum retinol level in patients with pre and malignant lesions of female genital tract.

The blood retinol level in women with genital tract malignancies and in a control group has been determined. In all groups of patients the mean serum retinol level was significantly lower than in control group. Based on these results we can postulate, that the low retinol level could predispose to the development of malignancy in female genital tract.

[Adenocarcinoma of the cervix--stage IB: results of treatment and prognostic factors]. / Rak gruczolowy szyjki macicy w stopniu IB--wyniki leczenia i analiza czynników prognostycznych.

The study presents the results of treatment of 63 women with stage IB adenocarcinoma of the cervix. The treatment consist of radical Wertheim-Meigs hysterectomy with adjuvant brachytherapy or external beam irradiation. A statistical analysis with Kaplan-Meier and cox model was conducted to assess the influence of selected prognostic factors on survival. After 5-year long follow-up 73.4% of patients were alive without recurrence. The results of univariate analysis showed that metastatic pelvic nodes, cervical tumor size of more than 4 cm and the presence of microscopic parametrial infiltration had a statistically significant negative influence on survival. In a multivariate analysis tumor size of more than 4 cm and microscopic parametrial involvement had an independent negative impact on survival (relative risk of death--12.1 and 15.7).

[The influence of selected prognostic factors on the results of combined treatment of invasive carcinoma of the cervix on stage IB and stage IIA]. / Wplyw wybranych czynników rokowniczych na wyniki leczenia skojarzonego inwazyjnego raka szyjki macicy w stopniach IB i IIA.

This is a retrospective analysis of 180 patients treated by combination of radical surgery and radiotherapy for invasive carcinoma of the cervix in stage IB and IIA. The influence of the following prognostic factors on the survival has been evaluated: the presence of pelvic lymph node metastases, histopathology of the tumor, the size of the primary tumor, presence of vascular space invasion and surgical margines. Nodal status has proved to be the most important prognostic factor: 91% of patients without pelvic lymph node metastases survived 5 years, 57% with up to two metastases and 36% with three and more metastases to the pelvic nodes. A significantly worse prognosis has also been observed in patients with adenocarcinoma of the cervix, and with the size of the tumor of more than 2 cm.

[The use of plastic mesh for reconstruction of abdominal wall after surgery for recurrent carcinoma of the cervix]. / Doswiadczenia z zastosowaniem siatek syntetycznych do rekonstrukcji powloki brzusznej po wycieciu przerzutów raka szyjki macicy.

The experience with the use of plastic mesh for abdominal wall reconstruction after surgery for recurrent carcinoma of the cervix is presented. This method has proved to be effective with an excellent mechanical support for the viscera, with good early and distant morbidity. This technique allowed a subsequent radiotherapy with good tolerance. The presence of abdominal mesh proved not to be a serious obstacle when a secondary surgical intervention is required.

[Primary vaginal and uterine melanoma--a case of long term survival after local excision and vaginal brachytherapy]. / Pierwotny czerniak pochwy i macicy--przypadek wieloletniego przezycia po pierwotnym leczeniu operacyjnym i brachyterapii.

This report presents the case of long term survival of primary vaginal melanoma treated by local excision and vaginal brachytherapy. A unique histopathological pattern of preinvasive vaginal melanoma is also described. A review of the literature revealed 22 long term survivals after treatment of malignant melanoma of the vagina, and only 4 surviving more than 10 years. In general the prognosis in women with these malignancy is poor regardless of type of surgery. Depth of infiltration seems to be the only important prognostic factor influencing the survival.

[Carcinoma of the fallopian tube. Clinical analysis of 40 cases]. / Pierwotny rak jajowodu. Analiza kliniczna 40 przypadków.

The results of clinical analysis of 40 cases of primary carcinoma of the fallopian tube are presented. All patients were treated with surgery and post operative external beam irradiation. Overall 5 years survival was 37% and symptom free survival 21%. The influence of following prognostic factors on the results of treatment had been evaluated: clinical stage, histologic grading and depth of infiltration of fallopian tube wall. Only the depth of infiltration proved to be statistically significant negative prognostic factor. The main cause of treatment failure was the intraperitonal dissemination of the disease. The results of treatment of recurrences was only palliative. No long term survivors were noted.

[Granulosa cell tumor--the assessment of some clinical and therapeutic parameters as prognostic factors]. / Ziarniszczak jajnika--ocena wybranych czynników klinicznych i terapeutycznych w ich prognostycznym znaczeniu.

The results of the clinical and therapeutic factors in prognostic mean was presented. 48 cases of granulosa cell tumours treated from 1984 to 1994 in Oncology Centre in Warsaw were analysed. In investigated group 13 patients died, but only 8 because of relapse of the tumour. Among all analysed patients, 79% have reached 5 years free survival period. Tumour rupture, FIGO stage and incidence of irregular bleeding before recognition of the tumour had significant prognostic value. There were surprising that relative risk of relapse between patients stage I and II were similar (1.0 vs 1.01). The relative risk between I and III stage had strong prognostic difference. Additional operation after no radical surgery did not influence on better prognosis, but followed radiotherapy increase treatment results.