Cellular angiofibroma in women: A review of the literature

Cellular Angiofibroma (CA) represents a quite recently described mesenchymal tumour that occurs in both genders, in particular in the vulvo-vaginal region in women and in the inguino-scrotal area in men. The first description of this tumour dates from Nucci et al. article in 1997; since then, the literature reports different reviews and case report of this tumour in both genders, but no article specifically addressing CA treatment and follow-up in women. In this review we collected all 79 published female CA cases, analyzing the clinical, pathological and immunohistochemical features of the tumour. CA affects women mostly during the fifth decade of life, it is generally a small and asymptomatic mass that mainly arises in the vulvo-vaginal region, although there are reported pelvic and extra-pelvic cases. The treatment requires a simple local excision due to an extremely low ability to recurrent locally and no chance to metastasize. Throughout the immunohistochemical and pathological findings it is also easily possible a differential diagnosis from the other soft tissue tumours which affect the vulvo-vaginal area, such as spindle cell lipoma, solitary fibrous tumour, angiomyofibroblastoma and aggressive angiomyxoma

Polymorphisms in cyclooxygenase-2 gene in endometrial cancer patients

The enzyme cyclooxygenase 2 is an inducible enzyme expressed at sites of inflammation and in a variety of malignant solid tumors such as endometrial cancer (EC). In EC patients, its over-expression is correlated with progressive disease and poor prognosis. The expression is encoded by a polymorphic gene, called PTGS2. The aim of the current study was to test the hypothesis that rs5275 polymorphism of PTGS2 influence the prognosis of EC patients. This paper is a retrospective cohort study. Clinical and pathological data were extrapolated and genotypes were assessed on formalin-fixed and paraffin-embedded non-tumor tissues. A total of 159 type I EC patients were included in the final analysis. Univariate analysis indicated that patients with rs5275 genotype CC have a lower risk to develop a grade (G) 2–3 endometrial cancer. rs5275 effect on EC grading was confirmed by multivariate analysis also after data adjusting for age, BMI, parity, hypertension, and diabetes. Adjusted odds ratio (OR) confirmed that patients with rs5275 genotype CC have a risk 80 % lower (OR = 0.20, P = 0.009) to develop a G2 and/or G3 EC in comparison with patients with TT or TC genotype. Differentiation of the type 1 EC is significantly and independently influenced by rs5275 polymorphism. rs5275 CC patients have a lower risk to present a G2–G3 EC

HNF1B polymorphism influences the prognosis of endometrial cancer patients: A cohort study

Background: HNF1B (formerly known as TCF2) gene encodes for a transcription factor that regulates gene expression involved in normal mesodermal and endodermal developments. A close association between rs4430796 polymorphism of HNF1B gene and decreased endometrial cancer (EC) risk has been demonstrated. The aim of the current study was to test the hypothesis that rs4430796 polymorphism can influence the prognosis of EC patients. Methods: Retrospective cohort study. Clinical and pathological data were extrapolated and genotypes were assessed on formalin-fixed and paraffin-embedded non-tumour tissues. The influence of patients' genotype on overall survival and progression free survival were our main outcome measures. Results: A total of 191 EC patients were included in the final analysis. Overall survival differed significantly (P = 0.003) among genotypes. At multivariate analysis, a significant (P < 0.05) effect on overall survival was detected for FIGO stage, and rs4430796 polymorphism of HNF1B gene. After grouping EC patients according to adjuvant treatment, rs4430796 polymorphism resulted significantly (P < 0.001) related to overall survival only in subjects who received radiotherapy plus chemotherapy. A significant (P = 0.014) interaction between rs4430796 polymorphism and chemo-radiotherapy was also detected. Finally, only a trend (P = 0.090) towards significance was observed for rs4430796 polymorphism effect on progression free survival. Conclusions: rs4430796 polymorphism of HNF1B gene influences independently the prognosis of EC patients with a potential effect on tumor chemo-sensitivity

Development of a Nomogram Predicting the Risk of Persistence/Recurrence of Cervical Dysplasia

Background: Cervical dysplasia persistence/recurrence has a great impact on women's health and quality of life. In this study, we investigated whether a prognostic nomogram may improve risk assessment after primary conization. Methods: This is a retrospective multi-institutional study based on charts of consecutive patients undergoing conization between 1 January 2010 and 31 December 2014. A nomogram assessing the importance of different variables was built. A cohort of patients treated between 1 January 2015 and 30 June 2016 was used to validate the nomogram. Results: A total of 2966 patients undergoing primary conization were analyzed. The median (range) patient age was 40 (18-89) years. At 5-year of follow-up, 6% of patients (175/2966) had developed a persistent/recurrent cervical dysplasia. Median (range) recurrence-free survival was 18 (5-52) months. Diagnosis of CIN3, presence of HR-HPV types, positive endocervical margins, HPV persistence, and the omission of HPV vaccination after conization increased significantly and independently of the risk of developing cervical dysplasia persistence/recurrence. A nomogram weighting the impact of all variables was built with a C-Index of 0.809. A dataset of 549 patients was used to validate the nomogram, with a C-index of 0.809. Conclusions: The present nomogram represents a useful tool for counseling women about their risk of persistence/recurrence after primary conization. HPV vaccination after conization is associated with a reduced risk of CIN2+

New Trends in Gynecologic Oncology

The specialty of gynecologic oncology was established in the late 1960s to early 1970s to improve the well being of women with cancer. The pioneers in this field set out to establish an evidence-based approach to the care of women with gynecologic cancer, combining the modalities of surgery,chemotherapy, and radiation. The aging of the population is a social phenomenon that will present a challenge to clinical practice in the 21st century. Women constitute a majority of the elderly population as they outlive males by 5 to 7 years. Ovarian, endometrial, and vulvar cancers are diseases seen more commonly in postmenopausal and elderly women. Cervical cancer continues to be a significant problem in the elderly and is usually detected at a later stage in that population than in younger patients. However, age-adjusted cancer death rates have started to decline in the United States and other developed nations - thanks in large part to widespread screening programs that detect cancers at early, treatable stages - cancer in developing countries is on the rise. Rising life expectancy in those nations along with the adoption of 'Western' lifestyles will leave many more people vulnerable to cancer. Unfortunately, the early detection tools and treatment technology that have helped control cancer in wealthier lands are often not readily available in many other countries.Actually, quality of life has become the cornerstone of care for these patients, in addition to advancing survival through surgical technology, collaborative research trials, and molecular approaches to early diagnosis and management. Here I report my research activities during the three years of PhD

Sindrome da encefalopatia posteriore reversibile in puerperio, diagnosi e management clinico

Le donne gravide con convulsioni sono considerate affette da eclampsia finchè non siano individuate altre cause. L’eclampsia è un quadro clinico caratterizzato dall’insorgenza di convulsioni e/o coma nel terzo trimestre di gravidanza, nel travaglio o entro sette giorni dal travaglio in assenza di altre cause diagnosticabili. Tuttavia altre entità cliniche quali l’epilessia, l’encefalite e i tumori dovrebbero essere prese in considerazione, soprattutto in assenza di segni di preeclampsia. Vi illustriamo il caso clinico di una paziente che ha presentato convulsioni a poche ore dal parto spontaneo in assenza di prodromi preeclamptici. Il quadro clinico e le immagini di RMN mostrano le tipiche caratteristiche della PRES. Anche se l’eclampsia può manifestarsi in modo molto più vario di quanto si pensi, la nostra paziente era affetta da convulsioni in assenza di gestosi, presentando, invece, un quadro clinico e neuroradiologico riconducibile alla PRES. È stato rilevante per noi confermare l’associazione tra gravidanza e PRES, essendo la PRES una condizione reversibile, se velocemente riconosciuta e opportunamente trattata, nonché sottolineare l’importanza dell’ esecuzione di una RMN in donne affette da episodi convulsivi

New surgical approaches to early-stage endometrial cancer

Endometrial cancer (EC) is the most common gynecologic malignancy in developed countries with an increasing incidence. It is usually diagnosed at early stage and surgical treatment generally yield excellent survival outcomes. Standard surgical treatment for early stage EC includes peritoneal washing, total abdominal hysterectomy and bilateral salpingo-oophorectomy with or without pelvic and paraaortic lymphadenectomy. However, the lack of univocal data on the value of peritoneal washing, pelvic/paraaortic nodes resection and type II radical hysterectomy in early stage EC had simplified the use of several surgical approaches. Actually, the minimally invasive techniques are widely accepted by many authors for treating early stage EC, and the classical laparoscopic one should be considered the gold standard. Further techniques include the vaginal surgery, the robotic, the single port and micro/minilaparoscopic approaches. Fertility sparing surgery is also a potential approach for younger patients in reproductive age

Hysteroscopic Resection in Fertility-Sparing Surgery for Atypical Hyperplasia and Endometrial Cancer: How Important Are Intrauterine Adhesions?

To the Editor: We read the article by De Marzi et al [1] with great interest. The authors were aiming to evaluate the rate of intrauterine adhesions after hysteroscopic resection of cancer and/or hyperplastic areas and the efficacy of combined surgical and medical treatment. The evaluation of the rate of intrauterine adhesions after hysteroscopic resection is an important issue considering that intrauterine iatrogenic sinechiae may severely impair fertility