Breast and Cervix Uteri: Rare Locations for Mycobacterium Tuberculosis Infections and Complications-Cases Report and Literature Review

Breast and cervix uteri are rare locations for Mycobacterium tuberculosis (MbT) infection and MbT association to cervical cancer is more rare in European countries. This chapter analyses two cases of rare locations of tuberculosis (TB) in young Romanian women. The first patient presented a chronic primary TB breast abscess, non-pregnancy related with periods of apparent healing and repeated areolar fistula formation. In the second case, the unexpected discovery of secondary TB endocervical granulomatous inflammation with caseous necrosis on a radical hysterectomy specimen, performed after chemoradiotherapy for squamous non-keratinizing cell carcinoma is presented. Worldwide incidence, risk factors, hypothetic mechanisms of primary/secondary breast and cervix uteri MbT infection, the association to high-risk HPV, microbiological diagnosis difficulties, the differentials to pyogenic abscesses, other chronic granulomas and breast cancer treatment issues are presented in the reviewed literature, focusing on the peculiarities of these rare locations and complications. It is recalled an old concept of “therapeutic antitubercular” test when all other assessments steps are usefulness

Abnormal Cervical Remodeling Early Depiction by Ultrasound Elastography: Potential Opportunities for Preterm Birth Prevention and Delay

Early depiction of abnormal cervical remodeling (CR) is a prime information source with days/even weeks to uterine contractions for preterm birth (PTB) risks. CR phases, softening-ripening-dilation, are distinctive by molecular, and timing in preterm/term: integrity loss in ripening and dilation. Changes in extracellular matrix, cellular content, water retention drive progressively to resistance reduction, rising elasticity, relaxing cervical smooth muscle cells (CSMCs) are organized like a sphincter at internal os. Shear Wave Elasticity Imaging-SWEI (dynamic elastography) based on objectively measurable cervical response to deformability is more accurate for early CR depiction from 8–12 weeks vs. conventional ultrasound cervical length (CL) measurements (16–23+6days weeks). SWEI quantifies tissue microstructure, constant fractional stiffness reduction (~ 4%/week), and spatial gradient in Shear Wave Speed (SWS) along cervix, and CL serial measurements in addition offers better strategies for prolongation, actual/future fetal safety, when cervical softness/shortness progresses. Vaginal progesterone (P4) from early pregnancy to complete 37 weeks is preventive: controls CR, indicated by SWS prior to CL 28, 34, 37 weeks) in asymptomatic cases, with characteristic history/actual abnormal CR/shortness, a small better efficacy for vaginal P4, and cerclage vs. pessary, when separately analyzed; few retrospective studies exist on triple association efficacy for PTB prevention/delay and neonatal outcomes