Coincidence of giant uterine myomatosis and detection of two advanced malignancies in 77-year-old female patient.

OBJECTIVE: Our aim is to emphasize the importance of patient participation in screening programs available in the Czech Republic and in preventive gynaecological examinations. As an example, we present a case report of a 77-year-old female patient with the accumulation of serious gynaecological diseases (extreme uterine myomatosis, breast cancer) and non-Hodgkin´s B-lymphoma. DESIGN: Case report. SETTING: Department of Obstetrics and Gynaecology, Faculty Hospital in Pilsen, Charles University Medical Faculty in Pilsen. CASE REPORT: Our case report of a 77-year-old patient is a rare case of the simultaneous detection of giant uterine myomatosis causing voluminous ventral hernia, invasive ductal breast cancer, and non-Hodgkin´s B-lymphoma. The patient was not gynecologically examined for last 20 years and did not undergo any screening examinations. In the postoperative period, the patient was diagnosed with invasive ductal breast cancer and follicular lymphoma. All the diseases were diagnosed in advanced stage. CONCLUSION: The occurrence of bulky fibroids is very rare in postmenopause. Long-term neglect of clinical symptoms and adverse health signals allows their gradual progression. Especially in older patients, other serious illnesses may complicate the situation.

Significance of bizarre cells in cervical screening liquid-based cytology: A prospective study of 15 cases.

OBJECTIVE: The aim of this study was to assess the significance of bizarre cells (cells of squamous origin with a superficial squamous cell-type cytoplasm and characterised by multinucleation that produces bizarre nuclear shapes) in liquid-based cytology (LBC) Papanicoaou (pap) smears with clinical and histological follow-up correlation. METHODS: Fifteen patients, all with LBC samples containing bizarre cells, were identified in routine ThinPrep® LBC workload. HPV testing was performed in each case using residual LBC material. Cytological-histological correlations were reviewed. RESULTS: All 15 LBC samples contained bizarre cells and tested positive for high-risk HPV types. Ten of the 15 cases were identified as atypical squamous cells - cannot exclude an HSIL (ASC-H) with secondary diagnosis of low-grade squamous intraepithelial lesion (LSIL), while five cases were identified as high-grade squamous intraepithelial lesion (HSIL), and a subsequent biopsy was recommended. Additionally, 13/15 cases underwent cone biopsy or hysterectomy within 1-11 months, of which 10 showed histologically confirmed HSIL end-points. LSIL was present in three cases. Bizarre cells were identified in the HSIL epithelium of five cone biopsies. CONCLUSIONS: Identification of bizarre cells in LBC is straightforward and may facilitate diagnosis. The cytology of bizarre cells is associated with HSIL in cone biopsies. We recommend assigning LBC samples containing bizarre cells as ASC-H with secondary diagnosis of LSIL.

[One-Step Nucleic Acid Amplification method - what is the future of sentinel lymph node management?] / Metoda One-Step Nucleic Acid Amplification - jaká je budoucnost zpracování sentinelových uzlin?

OBJECTIVE: The article summarizes current possibilities of usage of the One-Step Nucleic Acid Amplification method (OSNA) in the perioperative management of sentinel lymph nodes in oncologic surgery. The principle of this method is the detection of cytokeratin 19 (CK19) in the lymphatic tissue as a marker of the metastatic spread. DESIGN: Review article. SETTINGS: Department of Obstetrics and Gynaecology, University Hospital Pilsen, Faculty of Medicine in Pilsen, Charles University, Prague; Department of Biology, Faculty of Medicine in Pilsen, Charles University, Prague; Department of Immunochemistry, University Hospital Pilsen, Faculty of Medicine in Pilsen, Charles University, Prague; Sikl´s Department of Pathology, University Hospital Pilsen, Faculty of Medicine in Pilsen, Charles University, Prague. METHODS: The review of the literature published until the end of April 2017 available on the PubMed database was performed. The official abbreviation OSNA and the full name of the method One-Step Nucleic Acid Amplification was used for search in this database. CONCLUSION: The usage of the OSNA method with the detection of CK 19 in the sentinel lymph nodes as a marker of metastatic spread to the lymphatic tissue currently represents an acceptable form of perioperative sentinel lymph node management in patients with breast and colorectal cancer. Until now published data are pointing towards possible successful application of this method in sentinel lymph node management in patients with some other malignancies, such as thyroid carcinoma, gastric cancer, uterus cancer and head and neck cancer. More data is needed to establish this method also in those neoplasms.

[Carcinosarcoma of the endometrium with melanocytic differentiation, case report]. / Karcinosarkom endometria s melanomovou diferenciací, kazuistika.

OBJECTIVE: The case report presents a case of 60-year old woman with a rare malignant mixed Müllerian tumor with melanomatous differentiation diagnosed from a histology after cervical polyp ablation and curettage. DESIGN: Case report. SETTING: Department of gynecology and obstetrics, University Hospital in Pilsen. CONCLUSION: Carcinosarcoma, previously malignant mixed Müllerian tumor, is a very rare aggressive endometrial carcinoma with low incidence, which typically occurs among older women and commonly affects the uterine body and cervix. Clinically, the carcinosarcoma is impossible to be distinguished from endometrial carcinoma or uterine sarcoma and the definitive diagnosis can only be made based on histological examination.

Incidence of uterine sarcomas in West Bohemia, at the Department of Gynaecology and Obstetrics, University Hospital in Pilsen, Czech Republic.

OBJECTIVE AND SETTING: A retrospective review of women of the West Bohemian population was performed at the Department of Gynaecology and Obstetrics, University Hospital in Pilsen, Czech Republic from 1/2005 - 1/2017. METHODS: The following data was analysed: patients age, histological type, tumour size, FIGO stage, body mass index, previous irradiation, Tamoxifen usage, and other possible risk factors. A total number of 20 uterine sarcoma patients were detected in the period from 1/2005 to 1/2015, and these cases were followed until 1/2017. RESULTS: The histological types identified were: leiomyosarcoma in 12 cases, endometrial stromal sarcoma in 7 cases and one case of high-grade undifferentiated uterine sarcoma. This only patient diagnosed with high-grade undifferentiated uterine sarcoma showed distant metastases 12 months after the surgical treat-ment and died one month later. The whole group of uterine sarcoma patients regardless histological subtype reached two years in 50% of cases, with the median disease-free interval 18 months and the median follow up of 38 months. The diagnosis of sarcoma was already known in 25% of cases from dilatation and curettage histology. There were suspicious sonographic findings suggestive of sarcoma in 10% of cases. Multiparity was associated with 48.2% of endometrial stromal sarcoma cases. The leading clinical symptom was postmenopausal bleeding in 55% of patients. CONCLUSION: We confirmed uterine sarcomas to be rare malignancies, even in the Czech population with high uterine malignancy incidence. Uterine cold knife morcellation during the vaginal part of laparoscopically assisted vaginal hysterectomy didnt worsen the prognosis of our patients.

[Agressive small cell carcinoma of the ovary, hypercalcemic type, surgery and oncological treatment: case report]. / Agresivní malobunecný karcinom ovaria hyperkalcemického typu, chirurgická a onkologická lécba: kazuistika.

Small cell carcinoma of the ovary (SCCOHT) is a rare tumor typically affecting young women. It is a highly malignant tumor accompanied with poor prognosis, early relapse and low survival rates. The most significant prognostic factor is stage of the disease. Due to above mentioned factors there are no guidelines for therapy of this rare tumor. We present a case of 22-years-old patient initially treated with antibiotics under diagnosis of pelvic inflammatory disease. Due to persistent mass at left adnexa, she was indicated for diagnostic laparoscopy, converted to laparotomy and left adnexectomy with frozen section revealing unspecified malignant tumor of left ovary. A conservative operation was performed and, after diagnosis of SCCOHT was established, the patient was indicated for adjuvant chemotherapy.

[Non-neoplastic epithelial disorders of the vulva - lichen sclerosus]. / Nenádorové epiteliální zmeny vulvy - lichen sclerosus.

Lichen sclerosus (LS) belongs to frequent non-neoplastic epithelial disorders of the vulva. LS is a disease of unknown ethiology, affecting mainly postmenopausal women. LS has a typical macroscopic pattern, and it is characterized with an intensive pruritus and dyspareunia. Patients with LS have a risk of scarring of external genitalia and risk of developing squamous cell carcinoma of the vulva (4-5%). Treatment of LS is usually long-term, repeated, and it is based on local potent corticosteroids. Frequent reccurences require repeated therapy. A close follow-up in a 6-months intervals and biopsy of all atypical lesions is required. Surgical treatment is rarely indicated in the management of LS. Follow-up at the specialized center is recommended.

[Detection of cancer stem cells in ovarian cancer]. / Detekce nádorových kmenových bunek karcinomu ovaria.

OBJECTIVE: Detection of cancer stem cells (CSCs) in ovarian cancer, influence of CSCs on overall survival, disease free interval. Results in comparison with literature. DESIGN: Original study. SETTINGS: Department of Gynaecology and Obstetrics, Faculty Hospital Pilsen and Medical Faculty in Pilsen, Charles University, Sikls Institute of Pathology, Faculty Hospital Pilsen and Medical Faculty in Pilsen, Charles University. METHODS: 23 specimens of papillary-serous ovarian carcinoma and 4 specimens of endometroid ovarian carcinoma were included in the study. Specific antibodies to CD44 and CD133 antigens were used. Immunoreaction of both CD44 and CD133 was evaluated for the high power field. RESULTS: There was no significant correlation between CD44 expression and disease free interval and overall survival. CD133 expression was not evaluated due to an inadequate immunoreaction antibody - antigene. CONCLUSION: We did not find any statistically correlation between CD44 expression and overall survival and disease free interval in our series of patients with ovarian carcinoma. It seems to be better to use different antibody for CD133 detection.

[Evaluation of p16 protein in the managementof cervical dysplasia]. / Význam stanovení proteinu p16 v managementu prekanceróz delozního hrdla.

OBJECTIVE: Protein p16 as an important cell-cycle inhibitor is a promising diagnostic and prognostic factor of cervical dysplasia. In our study we evaluate the impact of p16 protein evaluation on management of cervical dysplasia. DESIGN: Retrospective study. SETTING: Department of Obstetrics and Gynecology, Medical Faculty Pilsen, Charles University Prague. METHODS: A retrospective study was performed on 122 consecutive patients with colposcopically-directed cervical biopsy (CDB) with following excisional procedure (LEEP or cold-knife conisation). P16 expression in the specimen from CDB was independently evaluated using immunohistochemistry in all patients. Relation among CDB histology, p16 expression, and final histology from excisional procedure was analysed. RESULTS: In our series, we identified 44 CIN 1 and 61 CIN 2/3 in CDB specimens. In the CIN 1 group, 15 cases (34.1%) were p16 negative and 29 (65.9%) cases were p16 positive. In CIN 1 p16 negative group, only 2 of 15 patients (13.3%) had CIN 2/3 in the final histology comparing to 19 of 29 patients (65.5%) in CIN 1 p16 positive group (statistically signifiant,p < 0,05; Wilcoxon test). In CIN 2/3 group, 60 (98.4%) specimen were p16 positive and 57 patients (93.4%) had also CIN 2/3 in the final histology. CONCLUSION: In our study of 122 patients with CDB we found that in group of CIN 1 patients, p16 evaluation had significant predictive value for final histology. In the group of patients with CIN 2/3, 98% specimens were p16 positive and therefore p16 evaluation had no prognostic impact on final histology. Prospective study is needed to confirm this data.

CD44v6 as a prognostic factor in cervical carcinoma FIGO stage IB.

The aim of our study was to clarify whether CD44v6 evaluation can serve as a universally applicable prognostic factor in patients with FIGO stage IB cervical carcinoma. A retrospective study was performed on 178 FIGO stage IB (142 IB N0, 36 IB N1) radically operated cervical carcinoma patients. The expression of CD44v6 was investigated by immunohistochemistry (IHC). The prognostic significance of established prognostic factors and CD44v6 expression was analyzed by univariate and multivariate analyses. To test the reproducibility and to account for interobserver variability, all specimens were evaluated independently at two institutions. Two different IHC scoring systems, several cut-off levels for CD44v6 positivity and several statistical methods for IHC results evaluation were used. In a univariate analysis, the most significant prognostic factor for overall survival (OS) was lymph node status (p<0.001) followed by tumor volume, LVSI, GOG score (p<0.01) and a deep stromal invasion (p = 0.06). We found a strong correlation between CD44v6 expression and squamous cell carcinoma (SCC) (SCC vs. adenocarcinoma - p<0.001) and between CD44v6 expression and deep stromal invasion, LVSI and GOG score (p<0.05). The CD44v6 expression was not a statistically significant prognostic factor for OS in a univariate analysis (p=0.39 Vienna; p=0.54 Freiburg). In a multivariate analysis, the most significant prognostic factor for OS was lymph node status (p =0.002), followed by tumor diameter and LVSI (p<0.05). CD44v6 expression was not a statistically significant prognostic factor for OS or disease-free interval (DFI) independent of the scoring method used. In conclusion, we demonstrated that CD44v6 expression is associated with LVSI, deep stromal invasion and SCC, but has no prognostic influence on OS and DFI in a population of 178 women with FIGO stage IB cervical carcinoma.

[Neurological complications during gynecological pelvic surgery]. / Neurologické komplikace gynekologických pánevních operací.

OBJECTIVE: To summarize literary data dealing with neurological complications during gynecological pelvic surgery and present a case report. DESIGN: Literary review and a case report. SETTING: Department of Obstetrics and Gynecology, Medical Faculty Hospital Plzen. METHODS: Literary review of lesions of cerebrospinal nerves during gynecological pelvic surgery, case report. CONCLUSION: Neurological complications of pelvic surgery are usually discreet and their diagnosis is often delayed. A close cooperation with neurologists and anestesiologists is necessary.

Blood acid-base and serum electrolyte values in red deer (Cervus elaphus).

Acid-base, serum electrolyte, plasma protein, and packed cell volume (PCV) values were determined in venous blood samples from 30 red deer (Cervus elaphus) of both sexes showing no clinical signs of disease. The animals were 5 months of age and kept on pasture in the Valley of Mexico, at an altitude of 2450 m. Blood samples were collected without sedation. Mean blood values were: pH 7.411 +/- 0.041, pCO2 37.7 +/- 4.4 mmHg, base excess 0.7 +/- 3.2 mmol/L, actual bicarbonate 24.3 +/- 3.1 mmol/L, total CO2 25.3 +/- 3.2 mmol/L and anion gap 23.5 +/- 5.5 mmol/L. Mean serum electrolyte levels were: Na+ 142.3 +/- 2.5 mmol/L, Cl- 100.5 +/- 2.3 mmol/L, and K+ 7.03 +/- 1.03 mmol/L. Plasma protein and PCV values were 60.0 +/- 6.6 g/L and 0.47 +/- 0.05 L/L, respectively. Blood values determined in this study can be considered reference data for health control and disease diagnosis.

An unusual case of malignant Brenner tumor in association with low-grade urothelial carcinoma of the urinary bladder. A case report.

We present a case of a 45-year-old Caucasian female with a malignant Brenner tumor arising at the site of the right ovary 21 years after right adnexectomy performed for ectopic pregnancy. Several months after the presentation of the malignant Brenner tumor the patient was diagnosed with low-grade urothelial carcinoma of the urinary bladder. All clinical, biochemical, and pathological findings with the emphasis on the differential diagnosis are summarized. A brief survey of histological theories and classification of Brenner tumors as well as therapeutic approaches with their results are given. We have found a few papers [1, 2] dealing with the coexistence of Brenner tumors with urothelial ones, but to our knowledge the coexistence of both malignant tumors has not been published previously.

[Metabolic reactions of calves to the feeding with Laktosan or unpasteurized whole milk]. / Metabolické reakce telat na krmení laktosanem nebo plnotucným nepasterizovaným mlékem.

The acid-base and other metabolic reactions to nutrition with Laktosan produced by two feed plants and with unpasteurized whole milk after transport to a dairy plant were studied in calves up to the ninth week of age. Laktosan feeding reduces the metabolic component of the acid-base balance; the use of a lower-quality Laktosan mixture, containing drum-dried milk, gives a picture of metabolic acidosis lasting about 11 days. The changes are cuased by an increased intensity of dissimilation, by the release of metabolic H+, and, in part, by the loss of bases during diarrhoea. With the use of low-quality Laktosan, the utilization of the nutrients of the feed ration is much lower than the utilization of the nutrients of unpasteurized milk or high-quality Laktosan. The use of high-quality Laktosan causes much lower acid-base changes, far from reaching pathological values. At the same time, the utilization of nutrients is higher than with the use of unpasteurized milk. This milk which cannot be considered microbially or chemically undamaged offers no advantages from the health-condition and economic point of view. The facts, revealed by the study, emphasize the high health and economic importance of the production of calf feed mixtures. At the same time the results show that enither milk nor Laktosan feeding provides enough magnesium for the calves to grow. Other metabolic aspects of different calf nutrition are discussed.

[Utilization of urea nitrogen in young calves]. / Vyuzitelnost dusíku mocoviny u mladých telat.

The influence of an increasing intake of urea in feed rations for calves on its levels in blood plasma and urine, development of health condition, weight gains and on other biochemical characteristics in the blood of calves was studied. The experimental group (n = 4) received urea in feed ration from the 17th day of age, at the beginning in the preparation Syrur, later on (from the 66th day) in the synthetic form only. The feed ration of the control group (n = 3) differed only in the zero content of urea. Over the period of ten weeks the blood was sampled for biochemical examination twice a week, since the 52nd day of age urine was also taken at the same intervals. Starting the 24th day of age, the levels of urea in the blood plasma of experimental animals were significantly higher (P less than 0.05). The concentrations of urea in the urine of the animals belonging to the experimental group were also higher, however, the differences in the average values were not significant. In both groups of animals under study no significant differences in the content of vitamin A, concentration of total protein, glucose, bilirubin, activities of aspartate aminotransferase (AST), gammaglutamyl transferase (GMT) and lactate dehydrogenase (LD) were observed. The average daily weight gains were higher in the calves of the control group, however, the differences were not significant. Over the whole experimental period the health condition of both groups of calves was good.

[The effect of colostral immunoglobulins on hematological and biochemical indicators in calves]. / Vliv kolostrálních imunoglobulinu na hematologické a biochemické ukazatele u telat.

Haematological values (haemoglobin concentration, haematocrit, erythrocyte and leucocyte number) and the levels of biochemical parameters (plasma concentrations of magnesium, zinc and copper) were studied in dependence on the level of immunoglobulins in calves in the early postnatal period. As a parameter of colostrum intake and quality the immunoglobulin level in blood serum was chosen, according to which the calves (n = 300), aged from two to six days, were divided into four groups. A relationship between the colostrum intake, or the immunoglobulin level in blood serum, and the magnesium concentration in blood plasma was observed. The magnesium level in plasma was in correlation with the Ig level in the blood serum of calves. As far as the other studied blood parameters are concerned, no statistically significant differences were proved in the calves aged two to six days.

[Ascorbic acid levels in the bronchopneumonia of calves]. / Hladiny kyseliny askorbové pri bronchopneumonii telat.

The level of ascorbic acid in the blood plasma of 59 calves was determined. The age of the calves ranged between two and three months and the samples of blood were collected in January. The first group of calves included 30 animals displaying no clinical symptoms of disease: the average ascorbic acid level was 0.50 +/- 0.18 mg per 100 ml. In the second group, consisting of 19 calves, the blood of the animals was collected three weeks after the termination of the acute stage of bronchopneumonia; the average value of ascorbic acid was 0.30 +/- 0.14 mg per 100 ml. The lowest average value of ascorbic acid was obtained in the calves at an acute stage of bronchopneumonia, reaching 0.18 +/- 0.11 mg per 100 ml. The differences of results between groups I and II and between groups I and III were found to be statistically significant. A conspicuous drop of ascorbic acid level was ascertained in calves suffering from bronchopneumonia-this problem needs deeper scrutiny, owing to the fact that bronchopneumonia is responsible for considerable economic losses in large-capacity calf houses.

[The effect of the use of milk-based feed mixtures and whole milk on the development of selected indicators in the blood plasma in calves]. / Vliv príjmu mlécné krmné smesi a plnotucného mléka na vývoj vybraných ukazatelu v krevní plazme telat.

Two milk feeding systems were investigated as influencing the health and development of calves. After the termination of colostrum feeding, the ten animals of the experimental group were given whole milk whereas the control group (also ten calves) was given the Laktosan milk replacer. By the age of three months, blood was collected from the calves for biochemical examination in weekly intervals, later once a month. The content of urea, determined in the blood plasma of the calves of the experimental group was significantly lower in the fourth to seventh week. The plasma levels of nitrogen, potassium, calcium and magnesium were about the same in the experimental and control groups, being within the limits of the reference values. At the age of six to nine weeks, the content of inorganic phosphorus in the blood plasma of the tested animals was statistically significantly higher. Vitamin A concentration in the blood plasma was about the same in both groups. The content of vitamin E in the blood plasma of the calves of the experimental group was statistically significantly higher in the fourth to eight week of age. No significant differences between the two groups were observed in the plasmatic activities of aspartate aminotransferase (AST) and gamma-glutamyl transferase (GMT). The activities of alkaline phosphatase (ALP) were significantly higher in the third to fifth week of life. From the fifth to eighteenth week of age, the average daily weight gains were significantly higher in the calves given whole milk.

[Labor induction in cows and its effect on the development of biochemical and hematologic indicators in the blood of calves]. / Indukce porodu u krav a její vliv na vývoj biochemických a hematologických ukazatelu v krvi telat.

The effect of induction of parturitions in the 1-2 weeks of pregnancy was tested as exerted on the health of calves and on some biochemical and hematological indicators. The observations concerned 26 cows, out of which 14 cows (experimental group) were applied intramuscularly 500 micrograms of synthetic analog of prostaglandin F2 of alpha- cloprostenol. The other 12 cows were a control group. These indicators were determined in the blood of calves before colostrum intake, in 24 h, 5 and 15 days from the intake of the first colostrum ration: acid-base balance, hematocrit and leucocyte counts, in the blood plasma it was concentrations of glucose, urea, Na, K, Ca, inorganic P, vitamin A and E levels and AST and GMT activities. The same range of examinations was performed in the blood and/or in the blood plasma of cows, in addition to urea screening. Blood and urea samples were taken a month before and a month after parturition. No deviations from the normal state were found by the examination of highly-pregnant cows. Afterbirth retention was found in 87% cows of the experimental group after parturition, while it was only 9.8% in the control group. All the calves in the experiment had good vitality, very good health in the course of 15-day observation. There were not any significant differences in the birth weight and weight gains of the calves of experimental and control groups.(ABSTRACT TRUNCATED AT 250 WORDS)