Unusual histologic finding in tissue obtained from voluntary pregnancy termination: a case report

BACKGROUND: An unusual histologic finding in tissue obtained from voluntary pregnancy termination (VPT) is reported to demonstrate the utility of pathologic examination of this specimen. METHODS: A 30-year-old woman with a history of depression was referred to the gynecology clinic for VPT in the eighth week of gestation. Material obtained from uterine cavity curettage was macroscopically and histologically examined. Based on the histological findings, a molecular study by polymerase chain reaction amplification (PCR) was performed to evaluate the presence of human papilloma virus (HPV) DNA. For DNA extraction, 4-microm-thick histological sections were stained with hematoxylin and examined under a stereomicroscope. The PCR amplification was performed with the L1 consensus primers Gp5+/Gp6+, giving an expected PCR product size of 150 bp: these primers have been developed to allow the detection of a broad spectrum of mucosotropic HPV genotypes. RESULTS: Histological examination of tissue obtained from the VPT showed immature villi with post-abortive hydropic degeneration and the presence of a small fragment of cervical mucosa with a squamous intraepithelial lesion characterized by mild to moderate nuclear atypia (SIL). PCR revealed that this lesion was related to HPV. Subsequently, the pap smear and cervical biopsy revealed a high-risk squamous intraepithelial lesion due to high-risk HPV. CONCLUSIONS: This report demonstrates that tissue obtained from VPT cannot be considered normal "a priori" and that a histological study can be useful to provide new information regarding a woman's gynecological health

The Role of Mesothelin Expression in Serous Ovarian Carcinoma: Impacts on Diagnosis, Prognosis, and Therapeutic Targets

Mesothelin (MSLN) is a protein expressed in the mesothelial cell lining of the pleura,peritoneum, and pericardium; its biological functions in normal cells are still unknown. Experimental studies using knockout mice have suggested that this molecule does not play an important role in development and reproduction. In contrast, it has been observed that this molecule is produced in abnormal amounts in several malignant neoplasms, such as mesotheliomas and pancreatic adenocarcinomas. Many molecular studies have also demonstrated that mesothelin is overexpressed in HSOCs. Here, we discuss the current knowledge of mesothelin and focus on its role in clinical and pathological diagnoses, as well as its impact on the prognosis of HSOC. Moreover, regarding the binding of MSLN to the ovarian cancer antigen CA125, which has been demonstrated in many studies, we also report on signal transduction pathways that may play an important role in the spread and neoplasticprogression of this lethal neoplasm. Given that mesothelin is overexpressed in many solid tumours and has antigenic properties, this molecule could be considered an antigenic target for the treatment of many malignancies. Consequently, we also review the literature to report on mesothelin-targeting therapies for HSOC that have been recently investigated in many clinical studies

A case of ovarian psammocarcinoma with homolateral serous cystoadenofibroma and thecoma associated with Brenner tumour and cystoadenofibroma of the contralateral ovary

Psammocarcinoma of the ovary is a rare serous neoplasm, with only 32 cases reported in the international literature. Characteristically, this tumour shows extensive formation ofpsammoma bodies, low-grade cytological features, and invasion of the ovarian stroma, peritoneum or intraperitoneal viscera. The behaviour of this entity is unpredictable, with benign, low malignant and metastatic potential. Herein the authors report a case ofpsammocarcinoma of the ovary with homolateral serous cystoadenofibroma and thecoma, which were associated with Brenner tumour and adenofibroma of the contralateral ovary, in a 78-year-old woman. Thus, this example shows an unpredictable tumour associated with multiple benign epithelial neoplasms and a benign stromal tumour. Moreover, this example of psammocarcinoma is very interesting because it measures only 1.5 x 0.5 x 1.5 cm and, to the best of the author's knowledge, represents the smallest case ofpsammocarcinoma described so far in the literature

The impact of uterine neoplastic tissue in accurately examined Fallopian tubes in pathological diagnosis and clinical managment

ABSTRACT The presence of intraluminal uterine neoplastic tissue or neoplastic cells in accurately examined Fallopian tubes can pose serious diagnostic problems for pathologists. Indeed, this finding, with the simultaneous presence of neoplastic cells in the intraoperative cytology of peritoneal washing, might suggest the retrograde transtubal spread of a uterine malignancy and, consequently, can be responsible for its upstaging, with an impact on the therapeutic approach. In a comment on our previously paper, in which we demonstrated this unusual mechanism of metastasis in a case of uterine serous carcinoma, and by a mini-review of the retrograde transtubal spread of uterine carcinoma, we discuss the pathological criteria for this findings and its impact on the management of patients affected by all subtypes of minimally invasive uterine carcinomas

Primary pure spindle cell carcinoma (sarcomatoid carcinoma) of the ovary: A case report with immunohistochemical study

BACKGROUND: In the ovary, sarcomatoid carcinoma has been reported only as mural nodules in epithelial malignant or borderline serous or mucinous cystic neoplasms, and in teratomas. In this paper we report a rare case of a solid sarcomatoid carcinoma of the ovary, without accompanying component of giant cells, pleomorphic cells, or glandular and other epithelial structures. CASE PRESENTATION: This case report refers to a sarcomatoid carcinoma of the ovary in in a 57 year-old woman with abdominal pain. Macroscopically, the neoplasm was a 15x10x5 cm ovarian mass that featured gray white solid fleshy areas, interspersed with areas of necrosis, hemorrhage and cystic spaces filled with thick fluid. The epithelial differentiation of the tumor was demonstrated by strong and diffuse reactivity to CAM5.2 and focal immunoreactivity to EMA. A diagnosis of malignant mesenchymal tumor was excluded due to negativity for desmin, smooth muscle actin, caldesmon, CD34, CD10, and myoglobin. Neural, neuroendocrine neoplasm, melanoma and Perivascular Epithelioid Cell Tumor (PEComa) were excluded because of negativity for S100, chromogranin, synaptophysin and HMB45. CONCLUSION: Primary ovarian spindle cell carcinoma is a rare neoplasm, which must be considered in the differential diagnosis of solid ovarian mass with spindle cell appearance. This case adds to our knowledge of the biological behavior of these rare neoplasms. The distinction from true sarcomas and carcinosarcomas is important because of the more favorable prognosis of the spindle cell carcinomas. However their diagnosis necessitates a careful tissue sampling and immunohistochemical staining

A new case of primary signet-ring cell carcinoma of the cervix with prominent endometrial and myometrial involvement: Immunohistochemical and molecular studies and review of the literature

<p>Abstract</p> <p>Background</p> <p>As a rule, endocervical tumours with signet-ring cell are classed as metastatic extra-genital neoplasms. In a patient aged 45 years, we describe primary cervical signet-ring cell carcinoma (PCSRCC) characterized by prominent endometrial and myometrial involvement, simulating primary endometrial adenocarcinoma with cervical extension. In addition, a review was made of the literature to identify the clinical and pathological features of this rare malignancy.</p> <p>Case presentation</p> <p>A 45-year-old woman was referred to our Gynaecology Department due to persistent abnormal vaginal bleeding. Transvaginal ultrasonography showed slight endometrial irregularities in the whole uterine cavity suggestive of endometrial neoplasms. Pelvic magnetic resonance imaging revealed diffuse enlargement of the cervix, which had been replaced by a mass. Induration extended to the parametria and sigmoid colon fat.</p> <p>Histological examination of endometrial curettage and a cervical biopsy revealed a neoplasm characterized by neoplastic signet-ring cells and trabecular structures. Immunohistochemical analysis and molecular studies showed certain findings consistent with a cervical neoplasm, such as positivity to CEA, keratin 7, Ca-125 and p16 and the presence of HPV (Human Papilloma Virus) DNA 18.</p> <p>On examination of the hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy, the lesion replacing the cervix, endometrium and myometrium, revealed the same immunohistochemical findings observed on endometrial curettage and cervical biopsy specimens. Metastases were found in an ovarian cystic lesion and the lymph nodes.</p> <p>Conclusion</p> <p>With this report the authors have demonstrated that the spread of cervical adenocarcinoma to the uterine corpus, although rare, may be observed, and that in this instance immunohistochemical and molecular studies can provide sufficient information for accurate diagnosis even on small biopsy specimens.</p

An unusual mechanism of metastasis in serous carcinoma of the endometrium associated with BRCA1 mutation gene: A case report with clinical and immunohistochemical features

The current case report documented a uterine highgrade serous carcinoma in a 48yearold woman with previous clinical history of breast cancer, BRCA1 gene mutation, and melanoma of the back. Uterine Serous Carcinoma (USC) was minimally invasive with fallopian tubes, ovaries, omentum, peritoneal surface and lymph node biopsy demonstrating no evidence of neoplasm at the time of total abdominal hysterectomy with bilateral salpingooophorectomy. In the peritoneal washing cytology and in the lumen of both fallopian tubes there were neoplastic cells which, on immunohistochemical analysis, showed immunoreactivity for p53 and p16 and negativity for WT1, supporting the endometrial origin of these malignant serous neoplastic cells. One year after surgery, the patient presented with recurrent peritoneal neoplastic nodules and metastases into intestinal lymphnodes. To detect neoplastic USC cells in the fallopian tube lumen and to prove a retrograde transtubal spread into the peritoneal cavity, it is mandatory to examine the fallopian tubes in their entirety according to the SEEFIM (Sectioning and Extensively Examining the Fimbria) protocol. In addition, this case report highlights the importance of the peritoneal cytology and omentectomy during a total abdominal hysterectomy with bilateral salpingooophorectomy to establish adequate staging and future patient management, even in cases of minimally invasive serous endometrial carcinoma

Presentation and management of diabetic ketoacidosis in adults in Malta

Aim: The aim of this audit was to assess adherence to local guideline in the management of Diabetic Ketoacidosis (DKA). Method: Patients admitted with DKA between April 2013 and March 2015 were identified and data was retrospectively collected from patients’ confidential files and Isoft®. Data collected included initial parameters recorded and biochemical investigations taken (initial and subsequent assessment of pH, HCO3-, blood glucose, potassium levels and urinary ketones), insulin regime started and intravenous fluid administered. Results: During the established time period 40 cases of DKA were identified in 18 patients. Median age was 33 years with a female preponderance of 60%. Six patients had newly diagnosed diabetes mellitus while 8 patients had more than one admission of DKA. All cases had capillary blood glucose monitoring (BGM) and/or venous random blood (plasma) glucose (RBG) checked and pH and HCO3- recorded on admission. 0.9% sodium chloride was the intravenous fluid started in all cases (as recommended by the guideline) and a median of 6.75L was prescribed during the first 24 hours. The median time spent on intravenous insulin infusion was 42.7 hours while the median time to pH >7.30, HCO3- >15mmol/L and negligible urinary ketones were 6.88, 12.83 and 34.5 hours respectively. Subcutaneous insulin was started at a median time of 48.21 hours from initiation of DKA protocol. Conclusion: This audit showed good adherence to local guideline. The great discrepancy between the time to pH >7.3 and the time to negligible urinary ketones highlights the need to introduce tools to measure systemic ketone production in the management of DKA with an update in the current local clinical practice guideline.peer-reviewe

Cold-active molecules for a sustainable preservation and restoration of historic-artistic manufacts

In the last decades biotechnology research provides sustainable alternatives to traditional procedures for preventive preservation of cultural assets. Recently, bioactive molecules (BMs) isolated from marine invertebrate organisms have been isolated and tested for bioremoval of protein layers (BMP) or to controlling microbial colonization (BMA), acting at temperature lower than 30°C. The Protease or Antimicrobial activity was tested on ad hoc assembled specimens and on different historic-artistic manufacts. In bio-removing protocol BMP molecules were applied as gelled solutions, in order to guarantees a selective action, respectful of constitutive materials and manufact integrity. Peculiarity of Protease bioactive molecules is the temperature of action, lower than 30°C. Instead, BMAs molecules have been tested to control bacteria and fungi colonization in laboratory specimens. In our hypothesis these novel molecules provide an important contribution to the development of innovative protocols safe both for the environment and conservator health, representing a valid alternative to traditional methods according to the preventive conservation and "Minimal Intervention" concept in restoration procedures

UV-protective compounds in marine organisms from the Southern Ocean

Solar radiation represents a key abiotic factor in the evolution of life in the oceans. In general, marine, biota particularly in euphotic and dysphotic zones depends directly or indirectly on light, but ultraviolet radiation (UV-R) can damage vital molecular machineries. UV-R induces the formation of reactive oxygen species (ROS) and impairs intracellular structures and enzymatic reactions. It can also affect organismal physiologies and eventually alter trophic chains at the ecosystem level. In Antarctica, physical drivers, such as sunlight, sea-ice, seasonality and low temperature are particularly influencing as compared to other regions. The springtime ozone depletion over the Southern Ocean makes organisms be more vulnerable to UV-R. Nonetheless, Antarctic species seem to possess analogous UV photoprotection and repair mechanisms as those found in organisms from other latitudes. The lack of data on species-specific responses towards increased UV-B still limits the understanding about the ecological impact and the tolerance levels related to ozone depletion in this region. The photobiology of Antarctic biota is largely unknown, in spite of representing a highly promising reservoir in the discovery of novel cosmeceutical products. This review compiles the most relevant information on photoprotection and UV-repair processes described in organisms from the Southern Ocean, in the context of this unique marine polar environment