Efficacy, safety, and patient acceptability of thecombined chlormadinone acetate-ethinylestradioloral contraceptive

Since their introduction in 1959, development of hormonal contraceptives has beenongoing, with the ultimate aim of creating not only an effective and safe contraceptive method,but also a drug able to meet the need for treatment of other conditions, such as acne, seborrhea,and hirsutism, with few or no side effects. With this objective, a new progestin, chlormadinoneacetate (CMA), has been developed as a derivative of progesterone for contraception.Thisnew molecule has been introduced in combination with ethinylestradiol (EE) 30 μg as a safecontraceptivewith antiandrogenic properties. Many clinical studies have investigated this neworal combination and found it to be safe, with a Pearl Index similar to that of other combinedhormonal contraceptives. CMA, because of its antiandrogenic properties, has been also consideredeffective for resolution of acne, seborrhea, and hirsutism. The data show it to be asafe molecule in terms of glucose and lipid metabolism. No major weight changes have beenlinked with its use, and it seems to be the only progestin able to reduce fat mass during use.The CMA-EE combination is well tolerated and acceptable to women. Adverse events relatedto its use are similar to those reported with other third-generation contraceptives.We canconclude that CMA-EE is an effective, safe, and well tolerated antiandrogenichormonalcontraceptive

Spitz Nevus with Features of Clark Nevus, So-Called SPARK Nevus: Case Series Presentation with Emphasis on Cytological and Histological Features

Background: SPARK nevus represents a little-known and characterized entity, with few case series available in the literature. Methods and results: we present a case series of 12 patients (6 F and 6 M) between January 2005 and December 2020 and conduct a review of the current literature. Ten articles were selected on the basis of the adopted inclusion criteria and the PRISMA guidelines. Conclusions: The definition of histopathological and dermoscopic criteria are important to allow for an agreement to be reached among dermopathologists, and for the development of a consensus on higher case studies. To our knowledge, there are not many case series in the literature, and ours is part of the attempt to increase the knowledge of an entity that remains little-known and characterized

Turbinate Surgery in Chronic Rhinosinusitis: Techniques and Ultrastructural Outcomes

Chronic nasal obstruction due to hypertrophic rhinitis is commonly associated with perennial allergic and nonallergic rhinitis. It is not a simple enlargement of mucosal and submucosal tissues, but it is characterized by deep histological modifications. This pathology, a very frequent condition encountered in rhinological practice, has a significant impact on quality of life. Patients usually complain about sneezing, rhinorrhea, frontal headache, postnasal drip, snoring, blocked nasal ducts, and sleep disorders. When medical therapy fails, surgical reduction of inferior turbinates is mandatory. A large variety of surgical techniques in literature exist, but there is a lack of consensus about which is the proper technique to perform. In this chapter, we describe the most important techniques of inferior turbinate reduction with advantages and disadvantages of each one

The Great Mime: Three Cases of Melanoma with Carcinoid-Like and Paraganglioma-Like Pattern with Emphasis on Differential Diagnosis

Melanoma is among the most aggressive tumors, with different histological patterns of presentation ranging from the usual and easily diagnosable pictures to complex patterns of difficult diagnostic interpretation. Here, we present three cases of a very rare melanoma variant described as "carcinoid-like" and "paraganglioma-like" in the literature, and a brief review of the current literature of the very few cases described to date

Efficacy, safety, and patient acceptability of thecombined chlormadinone acetate-ethinylestradioloral contraceptive

Since their introduction in 1959, development of hormonal contraceptives has beenongoing, with the ultimate aim of creating not only an effective and safe contraceptive method,but also a drug able to meet the need for treatment of other conditions, such as acne, seborrhea,and hirsutism, with few or no side effects. With this objective, a new progestin, chlormadinoneacetate (CMA), has been developed as a derivative of progesterone for contraception.Thisnew molecule has been introduced in combination with ethinylestradiol (EE) 30 \u3bcg as a safecontraceptivewith antiandrogenic properties. Many clinical studies have investigated this neworal combination and found it to be safe, with a Pearl Index similar to that of other combinedhormonal contraceptives. CMA, because of its antiandrogenic properties, has been also consideredeffective for resolution of acne, seborrhea, and hirsutism. The data show it to be asafe molecule in terms of glucose and lipid metabolism. No major weight changes have beenlinked with its use, and it seems to be the only progestin able to reduce fat mass during use.The CMA-EE combination is well tolerated and acceptable to women. Adverse events relatedto its use are similar to those reported with other third-generation contraceptives.We canconclude that CMA-EE is an effective, safe, and well tolerated antiandrogenichormonalcontraceptive

The Multiple Faces of Nodular Trichoblastoma: Review of the Literature with Case Presentation

Trichoblastoma (TB) is a rare biphasic benign adnexal neoplasm originating from follicular germ cells but clinically, it can simulate basal cell carcinoma (BCC), making the diagnosis more difficult. There are several variants of Trichoblastoma and a good knowledge of these is essential for correct diagnosis and management. We report two new cases observed in the last year at our Pathological Anatomy Operative Unit, and conduct a careful review of the literature, from the first description of this lesion by Headington in 1970 to the most recent classifications

Ultrastructural features of the nasal mucosa after massive removal of all soft tissues in the inferior turbinate hypertrophy

The nasal respiratory mucosa plays a key role in conditioning the inhaled air and in regulating the immune response against foreign particles. Many authors recom- mend mucosal sparing techniques for the surgical management of the inferior turbinate hypertrophy, such as laser surgery, radiofrequency electrocautery, cryosurgery, etc. In spite of their conservative purposes, ultrastructural studies demonstrate that these methods produce irreversible changes in the nasal mucosa. The aim of this study was to analyze ultrastructural features of the healing process after Microde- brider Assisted Turbinoplasty, alternative procedure that provides a radical interven- tion with removal of both mucosal and submucosal soft tissues of the inferior turbi- nate. Nasal mucosa biopsies from 7 patients (mean age 42+10) affected with inferior turbinate hypertrophy were taken before operation and 4 months after surgery and compared with 2 unaffected controls of the same age. Preoperative samples, routinely processed for Transmission Electron Microscopy (1), displayed a number of ultrastructural changes compared to normal controls such as disrupture of tight junctions, disappearance of pseudostratification, loss of cilia, fibrosis, and abundant inflamma- tory infiltrates. By contrast, in postoperative samples the nasal mucosa showed a normal appearance, with restoration of the pseudostratified ciliated pattern, intercellular connections and normal cellular morphology; collagen showed a normal organization in bundle and fibrosis and submucosal oedema were considerably reduced. In the light of these observations and previous Scanning Electron Microscopy findings (2), we can conclude that Microdebrider Assisted Turbinoplasty is a surgical procedure able to radically remove the inflamed tissue typical of hypertophic rynopathy and, consequently, to allow the resident stem cells to re-epithelize the nasal mucosa and restore its normal function

Skin Mycetoma in an 11-Year-Old African Boy: Case Presentation with Emphasis on Histopathological Features and Differential Diagnosis

Mycetoma is an uncommon, chronic infective disease of the skin and subcutaneous tissues, characterized by the triad of tumefaction, draining sinuses, and the presence in the exudate of colonial grains. In cases of long-term disease, the presence of colonial grains together with the host's derivative material can lead to the formation of real sinuses. Histological analysis is of fundamental importance to allow an accurate etiological diagnosis and to understand if the basic pathogen is an actinomycete (bacterium) or a real fungus (eumycetic mycetomas) and is also fundamental for therapy, which is quite different. Here, we present a case of Mycetoma in an 11-year-old patient who emigrated from Djibouti, Somalia, and showed the essential histopathological features of this rare and forgotten nosographic entity in the industrialized world and briefly discuss the major and most important differential diagnoses

Dedifferentiated Melanoma: A Diagnostic Histological Pitfall! Review of the Literature with Case Presentation

Dedifferentiated melanoma is a particular form of malignant melanoma with a progressive worsening of the patient's clinical outcome. It is well known that melanoma can assume different histo-morphological patterns, to which specific genetic signatures correspond, sometimes but not always. In this review we address the diagnostic difficulties in correctly recognizing this entity, discuss the major differential diagnoses of interest to the dermatopathologist, and conduct a review of the literature with particular attention and emphasis on the latest molecular discoveries regarding the dedifferentiation/undifferentiation mechanism and more advanced therapeutic approaches

Histological Hallmarks of Malignant Melanoma

The histopathological diagnosis of malignant melanoma remains the gold standard to allow the patient to access the entire process of the diagnostic-therapeutic-assistance path. Despite the continuous search for markers that can assist in the diagnostic process, there are cases that remain complex to diagnose, and the presence of different criteria among dermatopathologists further complicates the issue. This section will focus on the state of the art of dermatopathological diagnostics of melanoma, starting from the morphological bases up to the latest acquisitions of immunohistochemistry for diagnostic purposes, and molecular biology for therapeutic purposes. Furthermore, we will focus on particularly “challenging” MM histotypes and on what are the current guidelines for a correct diagnosis