Synchronous primary ovarian endometrioid carcinoma and poorly differentiated endometrial stromal sarcoma

Introduction: The presence of two concomitant genital malignant tumours is a rare phenomenon with an incidence of 0.7%. They are typically localised in the uterus and ovary, and approximately 50% are identical endometrioid - endometrioid histological type. In the presence of two different histological types of tumours, diagnosis is easier, but because of the small number of reported cases, there are no precise data on their clinical course. Generally, women with synchronous endometrial and ovarian tumours have a better prognosis and are more frequently younger, obese, multiparous and in menopause compared with women who have metastatic ovarian cancer or endometrial cancer. Case Report: In this work, we present a 53-year-old woman who contacted a gynaecologist because of irregular uterine haemorrhaging. The gynaecological exam revealed a tumour protruding through the cervical canal. The biopsy with initial histopathological diagnosis and additional ECHO and CT evaluations indicated the presence of a cervical tumour spreading over the uterus and both uterine adnexa. After surgical intervention, macroscopic and microscopic analyses of the postoperative material showed the simultaneous presence of two different malignancies, ovarian endometrioid carcinoma and poorly differentiated endometrial stromal sarcoma, which infiltrated all layers of the uterus, cervix and both fallopian tubes. Conclusion: The prognosis of synchronous tumours of the ovary and the uterus is primarily dependent on the stage and histological type of each tumour. Because of the rather small number of reported cases, a large part of this phenomenon remains unknown. Our report is the first description of the synchronous occurrence of endometrial ovarian carcinoma and uterine stromal sarcoma

Cervical precancerous lesions - Chromosomal instability in peripheral blood lymphocytes in relation to lesion stage, age and smoking habits

Objective. To evaluate chromosomal damage in peripheral blood lymphocytes (PBL) of patients newly diagnosed with cervical precancerous lesions with respect to age, smoking habits, miscarriages, abortions and lesion stage. Design. Clinical study. Setting. Clinic of Gynecology and Obstetrics in Kragujevac, Serbia, during 2009-2010. Population. The analyzed samples included 41 untreated patients aged 24-65years with a diagnosed low-grade squamous intraepithelial lesion (LSIL; 19 patients) or a high-grade squamous intraepithelial lesion (HSIL; 22 patients). Control samples were obtained from 40 healthy women aged 24-53 years. Methods. The frequency of micronuclei (MN) was estimated in circulating lymphocytes by using the cytokinesis-block micronucleus assay. Main Outcome Measure. The frequency of MN in PBL. Results. The mean MN frequencies of both LSIL and HSIL patients were significantly higher than the MN frequency of healthy control women. There was no significant difference in MN frequency between LSIL and HSIL patients, between smokers and nonsmokers in both patient and control samples, or between miscarriage groups and abortion groups of patients. Considering confounder factors, age and health status influenced MN frequency. Conclusions. The results suggest that MN frequency in PBL of patients with cervical precancerous lesions corresponds to an increase of chromosomal damage, irrespective of smoking habits, miscarriages, abortions and lesion stages. © 2011 Nordic Federation of Societies of Obstetrics and Gynecology

Cystic lesions of anterior mediastinum: Case report

© 2020, University of Kragujevac, Faculty of Science. All rights reserved. Cystic lesions of the mediastinum are uncommon, comprising 12% to 18% of all primary mediastinal tumors and unless they attain a large size and cause compressive symptoms, these tumors are generally asymptomatic and are discovered incidentally upon radiologic investigation of some other condition. We present in this paper a case of cystic lesions of the mediastinum in a 70-year-old male patient who underwent a surgery for mediastinal mass removal. Histopathology report had shown it was the case of mature cystic teratoma of anterior mediastinum. Based on a review of the literature, as well as our experience, we conclude that best treatment for cystic lesions of anterior mediastinum is complete surgical resection if possible

Polymorphisms of the GSTT1 and GSTM1 genes in women of central Serbia - Absence of association with uterine myoma

Since glutathione S-transferase (GST) enzymes are involved in cellular protection, we aimed to determine the distribution of GSTT1 and GSTM1 null genotypes in women in central Serbia in order to assess the risk of development of uterine myoma. The study consisted of 34 clinically diagnosed uterine myoma patients and 35 healthy control women. Analyses of GST polymorphism were carried out by multiplex PCR. Our results showed no significant differences in the GSTT1 and GSTM1 null genotypes between the patients and controls. Using the GSTT1 positive/GSTM1 positive combination as reference, there was no statistically significant risk of uterine myoma with the combination of GSTT1 null and GSTM1 null genotypes. We conclude that polymorphism of both GSTT1 and GSTM1 genes, alone or in combination, did not present the main risk for uterine myoma in women from central Serbia

Dystocia as a cause of untimely cesarean section

Background/Aim. One of the most frequent indications for cesarean section is dystocia. It is impossible to predict, difficult to identify and coincident with the rapid expiry of the expected time, so it is important to point out some mistakes in expecting vaginal delivery. The aim of this study was to examine the frequency and the length of dystociarelated cesarean delivery, as well as the vitality of the newborn immediately after birth. Methods. A prospective 3- year study was conducted including a total number of 6,470 deliveries regardless of whether they were completed using cesarean section after an unsuccessful attempt of spontaneous vaginal delivery or not. The Apgar score, a proved useful tool for the assessment of the vitality of newborn children in the first minute, was used. Results. On the basis of the established indications, 653 (10.10%) of deliveries were completed using cesarean section. Dystocia was the third most common indication for cesarean section (16.38%). Deliveries in which dystocia was established as a diagnosis lasted much longer (p = 0.030) which resulted in weaker vitality of newborn children (p = 0.000) compared to the deliveries ended by spontaneous vaginal delivery. Conclusion. This study shows that deliveries caused by dystocia last much longer and newborn children are of weaker vitality compared to other deliveries caused not by dystocia. Decisions concerning cesarean section must be made in a timely fashion

Factors associated with fetal growth restriction and small for gestational age newborns

Objectives: To identify risk factors that contribute to the occurrence of fetal growth restriction (FGR) and small for gestational age (SGA) and quantify the strength of their impact. Material and methods: This study was designed as a retrospective-prospective observational cohort study conducted on pregnant women at the Clinic for Gynecology and Obstetrics at the University Clinical Centre Kragujevac, Serbia. We measured the intrauterine degree of fetal development through the estimated fetal weight (EFW) on ultrasound examination, which was calculated using Hadlock’s formula 3. Fetuses whose EFW was below the 10th percentile on the World Health Organization (WHO) fetal growth charts adjusted for gender and gestational age were classified as FGR fetuses, while newborns weighing less than the 10th percentile were considered SGA. Results: The study included 320 pregnant women with an average age of 30.3 ± 5.5 years who gave birth to 332 newborns. The results of univariate and multivariate stepwise backward conditional binary logistic regression showed that the occurrence of FGR during the second trimester was more likely in pregnant women with lower body height and proteinuria. The risk factors for the occurrence of FGR during the third trimester were lower body height and proteinuria, while iron supplementation had a protective effect. SGA newborns were more common in pregnant women who were shorter, had proteinuria, used corticosteroids, or smoked during pregnancy. Conclusions: Clinicians should pay special attention to pregnant women with lower body height, proteinuria, who smoke and use corticosteroids in order to prevent FGR and SGA

Assessment of chromosomal damage in umbilical blood lymphocytes of newborns from kragujevac in central serbia born 18 years after environmental contamination

The measurement of micronuclei (MN) in umbilical blood lymphocytes of newborns are increasingly used in cytogenetic epidemiology as one of the preferred methods for assessing chromosomal damage resulted from maternal exposure to mutagen. In the present study, we evaluated the effect of strong environmental contamination (EC) (which occured in the City of Kragujevac, Central Serbia in 1999) on the MN frequency in group of 22 newborns born in Kragujevac 18 years after EC, using cytokinesis-block micronucleus (CBMN) assay. The mean MN frequency in umbilical lymphocytes of these newborns was 5.14 ± 2.17/1,000 binucleated (BN) cells, which is significantly lower than mean MN frequency of newborns born 12 months after contamination (9.36 ± 5.60/1,000 BN cells). Sex of newborns, age of mothers, cigarette smoking, and number of pregnancies did not affect the MN frequency of newborns. Our results showed that in utero exposure to environmental pollution affected genome instability of the fetuses, but that by improving the quality of environmental conditions there was a decrease in mean MN frequency of newborns born 18 years after contamination. In general, genome of umbilical lymphocytes shows a realistic picture of all changes in body and the environment

Continuous controllable balloon dilation: a novel approach for cervix dilation

BACKGROUND: Cervical dilation using mechanical dilators is associated with various complications, such as uterine perforation, cervical laceration, infections and intraperitoneal hemorrhage. To achieve safe and painless cervical dilation, we constructed a new medical device to achieve confident mechanical cervical dilation: a continuous controllable balloon dilator (CCBD). METHODS: Controlled pumping of incompressible fluid into the CCBD increases the pressure and outer diameter of the CCBD, continuously dilating the cervical canal. The reliability of the CCBD was confirmed in vitro (testing for consistency and endurance, with no detected risk for breakage) and in vivo. A multi-center clinical study was conducted,with 120 pregnant women randomly assigned to one of three groups: Group I,control group, no dilation;Group II,mechanical dilation, Hegar dilator (HeD); and Group III,CCBD. The tissue material for histological evaluation was obtained from the endocervical mucosa before and after dilation using the HeD or CCBD. RESULTS: The CCBD dilations were successful and had no complications in all 40 patients of Group III. The cervical tissue was markedly less damaged after CCBD dilation compared with HeD dilation (epithelium damage: 95% (HeD) vs. 45% (CCBD), P <0.001; basal membrane damage: 82.5% (HeD) vs. 27.5% (CCBD), P <0.001; stromal damage: 62.5% (HeD) vs. 37.5% (CCBD), P <0.01). Cervical hemorrhagia was observed in 90% of the patients after HeD dilation versus in 32.5% of the patients after CCBD dilation. CONCLUSIONS: The CCBD should be used as a replacement for mechanical dilators to prevent uterine and cervical injury during cervical dilation. TRIAL REGISTRATION: ISRCTN5400749