Sarcoma Botryoides: Optimal Therapeutic Management and Prognosis of an Unfavorable Malignant Neoplasm of Female Children

Embryonal rhabdomyosarcoma (ERMS) is a rare malignancy and occurs primarily in the first two decades of life. Botryoid rhabdomyosarcoma is an aggressive subtype of ERMS that often manifests in the genital tract of female infants and children. Due to its rarity, the optimal treatment approach has been a matter of debate. We conducted a search in the PubMed database and supplemented it with a manual search to retrieve additional papers eligible for inclusion. We retrieved 13 case reports and case series, from which we summarized that the current trend is to approach each patient with a personalized treatment plan. This consists of a combination of local debulking surgery and adjuvant or neoadjuvant chemotherapy (NACT). Effort is made in every approach to avoid radiation for the sake of preserving fertility. Radical surgeries and radiation still have a role to play in extensive disease and in cases of relapse. Despite the rarity and aggressiveness of this tumor, disease-free survival and overall prognosis is excellent, especially when it is diagnosed early, compared with other subtypes of rhabdomyosarcoma (RMS). We conclude that the practice of a multidisciplinary approach is appropriate, with favorable outcomes; however, larger-scale studies need to be organized to have a definite consensus on optimal management

Impact of weight loss after treatment on survival outcomes of overweight and obese patients with early‑stage endometrial cancer

Despite the fact that obesity is the main risk factor for endometrial cancer, there is limited evidence regarding the effects of body weight change on overweight and obese women treated for early‑stage endometrial can its impact on cancer outcomes. A retrospective cohort study was performed including all overweight and obese patients with early‑stage type‑I endometrial cancer that were treated at the Insular University Hospital of Las Palmas (Las Palmas de Gran Canaria, Spain) between January 2007 and December 2019. Body weight change at 12 months of treatment was evaluated, as well as its impact on cancer outcomes. Weight loss ≥5% was independently evaluated regarding its impact on survival. A total of 526 women were studied, of which 152 (28.90%) were overweight (BMI ≥25 and <30) and 374 (71.10%) were obese (BMI ≥30). The median follow‑up was 76.17 months, during which time 77 (14.64%) women died. In the survivor group, body weight at initial diagnosis was 86.4±17.9 kg compared with 84.6±16.4 kg 1 year after treatment, which corresponded to a significant mean weight loss of 1.47 kg (P<0.001). However, in the group of non‑survivors, body weight at initial diagnosis was 84.7±15.7 kg compared with 84.7±14.6 kg 1 year after treatment, which demonstrated a non‑significant mean weight loss of 0.63 kg (P=0.180). When comparing between the patients who maintained or gained ≥5% weight and those who lost ≥5% weight, there were no significant differences taking into account the whole cohort and follow‑up time; however, when adjusting for the period between 32 and 98 months, survival was significantly higher in those patients that lost ≥5% of their initial body weight (P=0.025; log‑rank test). Based on the final univariate and cer and multivariate analyses, body weight change at 12 months was not indicated to be a factor significantly affecting overall survival; adjusted hazard ratio was 1.01 (95% CI 0.97‑1.05, P=0.723). In conclusion, even if greater weight loss is observed in patients with endometrial cancer that survive the disease, no significant impact on survival outcomes is observed based on multivariate analysis

Study of progesterone receptors’ and avb3 integrins’ expression patterns in the endometrium of infertile women according to the cause of infertility

Τhe aim of the present study was to study the expression of total progesterone receptors (A+B), type-B progesterone receptors and integrins avb3 in the endometrium of infertile women during the implantation window. A prospective observational study study was conducted during 03/2013-06/2016 in 3rd Department of Obstetrics and Gynaecology Laboratory of Biological Chemistry of Medical Faculty of Aristotle University of Thessaloniki. and Infertile women consisted the patients’ group (group 2) while fertile women the study’s control group (group 1). Infertile women were also categorized to those with tubal factor infertility (group 2a), ovarian factor (group 2b), endometriosis (group 2c) and unexplained infertility (group 2d). An endometrial biopsy was performed by Pipelle on 7th-8th menstrual day after ovulation in each woman and expression of total progesterone receptors (Α+Β), type-B receptors and integrins avb3 was studied by immunohistochemistry. Positive nuclei percentage, intensity of staining and h-score in epithelial and stromal cells were the primary outcomes of our study. Real-time PCR was also performed to compare mRNA levels of progesterone receptors and the score A=2-ΔΔCT was assessed, where ΔΔCT was the difference of expression cycles between fertile and infertile women. There were overall 20 fertile (group 1) and 60 infertile (group 2) included in the present study, of which 15 with tubal factor infertility, 20 with poor ovarian reserve, 10 with endometriosis and 15 with unexplained infertility. Mean age was 31.3 ± 4.3 years for group 1 vs. 37.4 ± 4.1 for group 2 (P<.001). Expression of total progesterone receptors (Α+Β) was significantly decreased in the epithelial cells of infertile women. H-score was 215,0 ± 17,1 for fertile vs. 142,0 ± 14,6 for infertile women (P=.002). Real-time PCR demonstrated a 3.55-fold decrease of produced mRNA in the epithelial cells. Relatively, expression of type-B receptors was also decreased in the epithelial cells of infertile women. H-score was 160.5 ± 22.7 for fertile vs. 101.3 ± 14.3 for group 2 (P=.04). No significant difference was detected in stromal expression of both types of receptors between fertile and infertile women (P=.56 και P=.64 respectively). No significant difference of αvβ3 integrins was also observed between fertile and infertile women both regarding epithelial and stromal cells (P=.23 and P=.72). Study of biomarkers in various sub-groups of infertile women demonstrated that expression of total (Α+Β) progesterone receptors was significantly decreased in the epithelial cells of women with ovarian factor infertility, endometriosis and unexplained infertility (P=.02, .05 και .001 respectively). Expression of type-B receptors was also significantly decreased in the epithelial cells of women with ovarian factor and unexplained infertility (P=.04 and .004 respectively) as well as in stromal cells of women with tubal factor infertility (P=.03). No significant difference was detected in the expression of αvβ3 integrins between any sub-groups of infertile women and control group. In conclusion, ovarian factor infertility and unexplained infertility are associated with impairment of progesterone receptors’ expression during implantation window. The role of αvβ3 integrins in the aitiopathogenetic drawback of cases with unexplained infertility seems to be untenuated.Σκοπός της παρούσας μελέτης ήταν η μελέτη της έκφρασης των υποδοχέων προγεστερόνης (Α+Β), των υποδοχέων προγεστερόνης τύπου Β καθώς και των αvβ3 ιντεγκρινών στο ενδομήτριο των υπογόνιμων γυναικών κατά το παράθυρο εμφύτευσης του εμμηνορρυσιακού κύκλου. Πραγματοποιήθηκε προοπτική μελέτη παρατήρησης κατά το διάστημα 03/2013-06/2016 στη Γ’ Μαιευτική-Γυναικολογική Κλινική του Α.Π.Θ σε συνεργασία με το Εργαστήριο Βιοχημείας της Ιατρικής Σχολής Α.Π.Θ. Ως πληθυσμός ασθενών ορίστηκαν υπογόνιμες γυναίκες (ομάδα 2), ενώ την ομάδα ελέγχου αποτέλεσαν οι γόνιμες γυναίκες (ομάδα 1). Οι υπογόνιμες γυναίκες της μελέτης ταξινομήθηκαν με βάση το αίτιο της υπογονιμότητας σε γυναίκες με σαλπιγγικό παράγοντα (ομάδα 2α), ωοθηκικό παράγοντα (ομάδα 2β), ενδομητρίωση (ομάδα 2γ) και ανεξήγητη υπογονιμότητα (ομάδα 2δ). Πραγματοποιήθηκε ιστοληψία ενδομητρίου με Pipelle κατά την 7η-8η ημέρα του εμμηνορρυσιακού κύκλου μετά την ωοθυλακιoορρηξία. Μελετήθηκε με ανοσοϊστοχημεία η έκφραση των συνολικών υποδοχέων προγεστερόνης (Α+Β), των υποδοχέων τύπου-Β καθώς και των αvβ3 ιντεγκρινών τόσο στα επιθηλιακά όσο και στα στρωματικά κύτταρα. Προσδιορίστηκε το ποσοστό ανεύρεσης θετικών πυρήνων ανά δείγμα, η ένταση της χρώσης και το Η-score. Πραγματοποιήθηκε συνοδά real-time PCR με σκοπό τη σύγκριση του mRNA των υποδοχέων προγεστερόνης και προσδιορίστηκε ο δείκτης Α=2-ΔΔCT, όπου ΔΔCT η διαφορά των μέσων κύκλων έκφρασης μεταξύ γόνιμων και υπογόνιμων γυναικών. Ως μάρτυρας χρησιμοποιήθηκε η β2-μικροσφαιρίνη. Συνολικά 20 γόνιμες και 60 υπογόνιμες γυναίκες συμπεριλήφθησαν στη μελέτη, εκ των οποίων 15 με σαλπιγγικό παράγοντα, 20 με ωοθηκικό παράγοντα, 10 με ενδομητρίωση και 15 με ανεξήγητη υπογονιμότητα. H μέση ηλικία των γυναικών ήταν 31.3 ± 4.3 έτη για τις γόνιμες έναντι 37.4 ± 4.1 για τις υπογόνιμες γυναίκες (P<.001). Παρατηρήθηκε σημαντικά μειωμένη έκφραση των υποδοχέων (Α+Β) στα επιθηλιακά κύτταρα των υπογόνιμων γυναικών. Το h-score ήταν 215,0 ± 17,1 για τις γόνιμες έναντι 142,0 ± 14,6 για τις υπογόνιμες (P=.002). Η real-time PCR επιβεβαίωσε την μειωμένη κατά 3,55 φορές έκφραση του παραγόμενου mRNA στα επιθηλιακά κύτταρα. Αντίστοιχα, παρατηρήθηκε σημαντικά μειωμένη έκφραση και των υποδοχέων τύπου-Β στα επιθηλιακά κύτταρα των υπογόνιμων γυναικών. Το αντίστοιχο h-score ήταν 160,5 ± 22,7 για την ομάδα 1 έναντι 101,3 ± 14,3 για την ομάδα 2 (P=.04). Δεν παρατηρήθηκε σημαντική διαφορά στην έκφραση των υποδοχέων στα στρωματικά κύτταρα μεταξύ γόνιμων και υπογόνιμων γυναικών (P=.56 και P=.64 αντίστοιχα). Ακόμη, δε διαπιστώθηκε σημαντική διαφορά στην έκφραση αvβ3 ιντεγκρινών τόσο στα επιθηλιακά όσο και στα στρωματικά κύτταρα των γόνιμων και υπογόνιμων γυναικών (P=.23 και P=.72). Η μελέτη των βιοδεικτών στις διάφορες κατηγορίες υπογόνιμων ασθενών κατέδειξε ότι η έκφραση των συνολικών υποδοχέων προγεστερόνης (Α+Β) ήταν σημαντικά μειωμένη στα επιθηλιακά κύτταρα των γυναικών με ωοθηκικό παράγοντα, ενδομητρίωση και ανεξήγητη υπογονιμότητα (P=.02, .05 και .001). Η έκφραση των υποδοχέων τύπου-Β ήταν επίσης σημαντικά μειωμένη στα επιθηλιακά κύτταρα των ασθενών με ωοθηκικό παράγοντα υπογονιμότητας και ανεξήγητη υπογονιμότητα (P=.04 και .004) καθώς και στα στρωματικά κύτταρα των γυναικών με σαλπιγγικό παράγοντα υπογονιμότητας (P=.03). Δεν παρατηρήθηκε σημαντική διαφορά στην έκφραση των ιντεγκρινών αvβ3 μεταξύ κάποιας εκ των κατηγοριών υπογόνιμων γυναικών και της ομάδας ελέγχου. Συμπερασματικά, η ωοθηκικού τύπου υπογονιμότητα και ειδικά η ανεξήγητη υπογονιμότητα σχετίζονται αιτιοπαθογενετικά με τη διαταραγμένη έκφραση των υποδοχέων προγεστερόνης. Ο ρόλος των ιντεγκρινών αvβ3 στην αιτιοπαθογένεια της υπογονιμότητας παραμένει αμφίβολος

Aneurysm of the Vein of Galen Diagnosed with MRI

We describe the case of a neonate with aneurysm of vein of Galen that was diagnosed prenatally in the 33rd gestational week by MRI. A 27-year-old woman, gravida 2, para 2, was admitted to our department at 33 weeks of gestation with suspected fetal hydrocephaly. Ultrasound examination after admission demonstrated an anechoic, supratentorial, and median mass with regular borders, raising the possible diagnosis of an aneurysm of the vein of Galen. MRI confirmed the presence of an aneurysm of the vein of Galen. An elective caesarean section was performed at 33 weeks of gestation. The newborn was admitted to the Neonatal Intensive Care Unit. Despite the full respiratory and medical support given, the sustainment of cardiac failure resulted in neonatal death just one day following its admission

Mature Ovarian Teratoma with Carcinoid Tumor in a 28-Year-Old Patient

Introduction. Coexistence of carcinoid tumor inside a mature cystic teratoma is an extremely rare phenomenon, especially in young women. We present the case of a 28-year-old woman diagnosed with a right ovarian carcinoid and treated uneventfully with conservative surgical approach. Case Report. A 28-year-old woman, gravid 0, parity 0, presented to our department for her annual gynecological examination and Pap smear test. During her examination, a mobile cystic mass was detected in the right lower abdomen. Ultrasound indicated a right ovarian mass 10.5 × 6.3 cm, confirmed by CT scan. Further investigation revealed AFP levels (1539 ng/mL). The ovarian mass was excised by laparoscopy, leaving intact the remaining right ovary. Frozen sections showed a mature cystic teratoma. However, paraffin sections revealed the presence of a small carcinoid within the teratoma’s gastric-type mucosa. The patient was set to a close followup. Nine months postoperatively, ultrasound pelvis imaging and CT scan of the abdomen as well as serum tumor markers have shown no evidence of recurrence disease. Conclusion. Despite the weak evidence, fertility spare surgical approach for women wanting to preserve their genital tract might be a reasonable option

Predictors of Pain Development after Laparoscopic Adnexectomy: A Still Open Challenge COMMENT

[No Abstract Available

Cytomegalovirus, toxoplasma gondii and rubella vertical transmission rates according to mid-trimester amniocentesis: A retrospective study

Objective: To examine vertical transmission rates of Cytomegalovirus, Toxoplasma Gondii and Rubella infections according to amniotic fluid PCR analysis. Methods: A retrospective analysis of mid-trimester amniocenteses performed in in pregnancies with diagnosed maternal infection by Cytomegavirus (CMV), Rubella or Toxoplasma gondii during 1994-2008 was performed. Vertical transmission rates were observed according to the presence of the infectious agent′s DNA in the amniotic fluid. A univariate regression model was also performed to investigate possible correlations between transmission and epidemiological parameters. Results: Overall, 7033 amniocenteses were performed during study′s period, of which 166 (2.4%) with the indication of maternal infection by CMV, Rubella or Toxoplasma. Mean maternal age was 27.4 ΁ 2.5 years and the mean gestational age at amniocentesis was 18.7 ΁ 2.5 weeks. Vertical transmission was observed in 21 cases (12.7%). Transmission rate was 17.3% in cases with infection from CMV, 9.5% from Toxoplasma gondii and 7.8% from Rubella (P = .05). Maternal age was the only parameter being significantly associated with increased risk for vertical transmission (P = .04). Conclusions: According to our results, overall vertical transmission rate marginally exceeds 10%. CMV infection is characterized by relatively higher transplacental transmission rate, while increased maternal age appears to be associated with a higher risk for vertical transmissio