Atypical Endometrial Hyperplasia Arising in a Cesarean Section Scar: A Mechanism of Malignant Transformation

The incidence of scar endometriosis in Cesarean sections varies between 0.03 and 0.4%. However, the recently increased rate of Cesarean sections worldwide may be causing an increase in occurrence of scar endometriosis. This report presents anatomopathological evidence of an early-stage malignant transformation in endometriotic tissue from a post-Cesarean scar and briefly reviews possible underlying mechanisms. A 40-year-old woman with a body mass index of 42.7 was referred to the gynecological department with recurrent pain and presence of a palpable mass in her Cesarean section scar. She had undergone this procedure 7 years earlier and began experiencing discomfort and pain at the incision site 6 months postoperatively. Surgical treatment was instituted with complete removal of the lesion. Anatomopathological examination revealed endometriotic tissue intertwined with atypical endometrial hyperplasia and fibrosis. At 2 years’ follow-up, she was asymptomatic, both clinically and based on ultrasound examination. Endometriotic foci inoculated within an abdominal scar may undergo malignant transformation. Long-lasting abdominal scar endometriosis, in morbidly obese women, requires special attention from the physician

„alicja” Romana Honeta – szkic analityczny

The article analyses the volume of poetry by Roman Honet, alicja, by means of the method of analysis and interpretation of a literary text proposed by Jerzy Faryno. The division into primary content (direct, resulting from a linguistic utterance) and secondary content (resulting from a linguistic utterance indirectly) enables one to attempt to interpret uninterpretable, as it is considered in the literature on the subject, alicja. The structure of the volume itself, specific punctuation and grammar provide certain conditions concerning the image of poetic reality existing in the world presented by the lyrical I. What is more, the same motives appearing again and again, specific meta-oneirism, permanent palette of colours became a starting point for developing our proposal. This approach to the problem was also supported by thematic triplicity of poetic content visible in the poetry. The further part of the article presents intertextual references to the extratextual reality and real historical figures (related to the Second World War)

Ovarian endometrioma – a possible finding in adolescent girls and young women: a mini-review

Abstract Young girls before menarche or menstruating adolescent women may experience long-term drug-resistant chronic pelvic pain, as well as other symptoms associated with pelvic mass. In such cases, it is of great importance to consider ovarian endometrioma in the differential diagnosis. In general, endometrioma is recognized as an ovarian cyst. However, in most cases, the pathology represents pseudocyst with a partial or complete endometrial-like lining with extraovarian adhesions and endometriotic implants which are likely to occur at the sites of ovarian adhesions and at the ceiling of the ovarian fossa. Ovarian endometriomas occur in 17–44% patients with endometriosis and account for 35% of all benign ovarian cysts. The time span from the onset of menarche to the time of endometrioma formation, which requires surgical intervention, has been evaluated to be a minimum of 4 years. The pathogenesis of early-life endometrioma may be different from other types of endometriosis. Diagnosis is often delayed, especially in adolescents, who tend to wait too long before seeking professional help. The three specific aims of treatment in adolescents with endometriosis and endometriomas are control of symptoms, prevention of further progression of the disease as well as preservation of fertility. Increasing evidence demonstrates association between ovarian endometriosis and ovarian cancer. In the present mini-review, we draw the particular attention of clinicians to such a possibility, even if relatively infrequently reported

Renal adenomatosis

Adenomatosis is a rare lesion of unknown etiology, defined as multiple (usually 5 or more) adenomas in one kidney. A case of renal adenomatosis in a 68-year-old woman treated previously for urolithiasis, who underwent nephrectomy because of the nonfunctional left kidney is reported. Apart from multiple adenomas, numerous hyperplastic lesions involving single tubules were present in the resected kidney. Both adenomas and hyperplastic lesions exhibited the expression of alpha-methylacyl-coenzyme A racemase (AMACR). Renal adenomatosis is worth special attention, since renal papillary adenomas are suggested as precursor lesions of papillary renal cell carcinoma that show similar AMACR expression

An Unusual Coexistence of Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma with Endometrioid-Type Endometrial Cancer in a 58-Year-Old Woman: A Case Study with Literature Review

Introduction: The coexistence of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) with different gynecologic neoplasms is a rare phenomenon. Here, we report a case of simultaneously developed CLL/SLL with endometrioid-type uterine cancer. Case Report: A 58-year-old woman was admitted to the 2nd Department of Gynecology, Lublin Medical University, Lublin, Poland, in June 2017, where the uterine cancer was diagnosed. After the surgery, pathological examination revealed a uterine moderately differentiated adenocarcinoma of endometrioid subtype (subtype I according to Bokhman) deeply infiltrating the myometrium as well as the uterine cervix. Surprisingly, CLL/SLL was subsequently diagnosed in all removed pelvic as well as para-aortic lymph nodes. Immunohistochemical analysis showed CD45 (++), CD20 (+), CD3 (–/+), CD19 (+), CD23 (+), CD5 (+), and CD34 (+). Proliferative activity, assessed by MIB-1 proliferative index immunostaining, reached 18%. The patient was admitted to radiotherapy and chemotherapy at the Oncology Hospital, Lublin, Poland, and is still on follow-up. Conclusions: The coexistence of CLL/SLL with various gynecological malignancies, especially primary human endometrial cancer, is a rare entity. The detection of both tumors simultaneously, in general, is accidental, and the management should not be different from the situation in which malignancy appears de novo

Expression of p53 and selected proliferative markers (Ki-67, MCM3, PCNA, and topoisomerase IIα) in borderline ovarian tumors: Correlation with clinicopathological features

Background. The expression of p53 has been studied not only in primary human ovarian carcinomas, but also in borderline ovarian tumors, however, the results were discordant. Expression patterns of proteins involved in cell proliferation and apoptosis have been investigated in various human neoplasms, including female genital tract neoplasms. Objective. The aim of this investigation was to assess the staining pattern and immunolocalization of p53 and selected proliferative markers (Ki-67, MCM3, PCNA, and topoisomerase IIα) in borderline ovarian tumors (BOTs). Design. The study group consisted of 42 women who underwent pelvic surgery between 2006-2015. The median patients’ age was 46 years. The immunoperoxidase technique was employed using antibodies against p53, Ki-67, MCM3, PCNA, and topoisomerase IIα. Results. For p53, nuclear expression was observed in BOTs, however, cytoplasmatic immunoreactivity was also detected. Altogether, 25 (60%) tumors demonstrated positive p53 immunostaining, including overexpression found in 6 (14%). There were no significant differences in p53 expression between subgroups of clinicopathological variables. Immunoexpression of Ki-67, MCM3, PCNA, and topoisomerase IIα was nuclear. Ki67 expression was positive in 12 (29%) cases and there was a trend towards a relationship between patients’ age and Ki-67 staining (P=0.08). Interestingly, a significantly higher Ki-67 expression was found in tumors of ≥10 cm in diameter compared to smaller tumors (P=0.008). MCM3 expression was detected in 38 (90%) tumors, and PCNA expression in 28 (67%), yet none of clinico-pathological factors was related to them. Topoisomerase IIα expression was present in 14 (33%) cases and, interestingly, its significantly higher expression was observed in BOTs of ≥10 cm in diameter compared to smaller tumors (P=0.008). Moreover, Spearman’s correlation revealed highly significant positive associations between Ki-67 and topoisomerase IIα (R=0.403, P=0.008) and Ki-67 and MCM3 (R=0.469, P=0.001). Conclusions. We report a high positive immunostaining rate for p53, suggesting a role of TP53 alterations in the development of BOTs in humans. The new finding of higher topoisomerase IIα immunostaining positivity in BOTs of ≥10 cm may be clinically relevant and requires further studies on larger patient groups