Pregnancy in fanconi anaemia with bone marrow failure: A case report and review of the literature

BACKGROUND: Fanconi anaemia is a rare inherited disease characterized by congenital abnormalities, progressive bone marrow failure and predisposition to malignancy. Successful pregnancies in transplanted patients have been reported. In this paper we will describe the pregnancy of a patient with Fanconi anaemia without transplantation. CASE PRESENTATION: A 34-year-old nulliparous woman with Fanconi anaemia was referred to our institution. Pregnancy was complicated by progressive pancytopenia and two severe infections. C-section was performed at 36 weeks. Both infant and mother are well. CONCLUSION: Successful pregnancy in a Fanconi anaemia patient with bone marrow failure is possible. The mode of delivery in patients with bone marrow failure should be determined by obstetric indications. The case highlights the safe outcome of the pregnancy with strict clinical and laboratory control by a multidisciplinary team

Ovarian vein thrombosis presenting as acute abdomen in puerperium

Postpartum Ovarian Vein Thrombosis (POVT) is a rare, but serious condition that causes slow quadrant pain in the postpartum period. POVT must be considered in the differential diagnosis of postpartum acute abdomen. We hereby report a case on a 36-year-old Italian woman who developed an acute abdomen a week after spontaneous vaginal delivery. She had persistent fever and constipation. Diagnosis of POVT was made with an abdominal Computed Tomography (CT) and treatment with heparin and broad-spectrum antibiotics were started. After 72 hours, the patient was switched from low molecular weight heparin to oral anticoagulant treatment. After 5 months a complete recanalization was demonstrated by abdomen CT and the treatment was stopped 6 months after diagnosis. POVT is a diagnosis of exclusion in the puerperium. This case illustrated that POVT may also occur in low risk patient

Cervicoisthmic choriocarcinoma mimicking cesarean section scar ectopic pregnancy

Primary choriocarcinoma of the uterine cervix is an extremely rare disease. The clinical diagnosis of cervical choriocarcinoma is difficult, because of its rarity and being non-specific abnormal vaginal bleeding the most common symptom. In the present report, the authors present a case of cervical choriocarcinoma, which was initially misdiagnosed as a cesarean section scar ectopic pregnancy. Remission of cervical choriocarcinoma was accomplished with the combination of hysterectomy and chemotherapy

LH/hCG-Receptor Expression May Have a Negative Prognostic Value in Low-Risk Endometrial Cancer

Introduction: A 51 years-old woman was diagnosed with endometrial cancer and underwent surgical staging. Pathologic evaluation showed a 2x1 cm G2 endometrioid endometrial cancer with a 30% myometrial deep invasion (FIGO stage 1A). The patient was classified as low-risk of recurrence and no adjuvant treatment was offered. Six months after surgery, the patient developed an early vescico-vaginal recurrence and chemotherapy treatment was started. Few months later a subsequent involvement of vaginal wall, ileum and omentum was detected and the patient underwent second surgery. Background: LH/hCG-receptor (LH/hCG-R) expression has been previously reported to be associated with an invasive phenotype in endometrial cancer cells. Moreover, in a preclinical mouse model of EC behaves as a pro metastatic molecular device. Discussion: We analysed the expression level of LH/hCG-R in cancer specimens collected during surgeries. Molecular and immunohistochemical analysis showed a strong expression of both mRNA and protein for LH/hCG-R in all specimens. Conclusion: LH/hCG-R expression may be assessed together with other clinicopathological parameters in order to better predict the risk of recurrence in low-risk endometrial cancer patients. Further clinical trials are warranted in order to validate LH/hCG-R as biomarker in endometrial cancer

Benefit of Radiation Boost After Whole-Breast Radiotherapy

PURPOSE: To determine whether a boost to the tumor bed after breast-conserving surgery (BCS) and radiotherapy (RT) to the whole breast affects local control and disease-free survival. METHODS AND MATERIALS: A total of 1,138 patients with pT1 to pT2 breast cancer underwent adjuvant RT at the University of Florence. We analyzed only patients with a minimum follow-up of 1 year (range, 1-20 years), with negative surgical margins. The median age of the patient population was 52.0 years (+/-7.9 years). The breast cancer relapse incidence probability was estimated by the Kaplan-Meier method, and differences between patient subgroups were compared by the log rank test. Cox regression models were used to evaluate the risk of breast cancer relapse. RESULTS: On univariate survival analysis, boost to the tumor bed reduced breast cancer recurrence (p < 0.0001). Age and tamoxifen also significantly reduced breast cancer relapse (p = 0.01 and p = 0.014, respectively). On multivariate analysis, the boost and the medium age (45-60 years) were found to be inversely related to breast cancer relapse (hazard ratio [HR], 0.27; 95% confidence interval [95% CI], 0.14-0.52, and HR 0.61; 95% CI, 0.37-0.99, respectively). The effect of the boost was more evident in younger patients (HR, 0.15 and 95% CI, 0.03-0.66 for patients <45 years of age; and HR, 0.31 and 95% CI, 0.13-0.71 for patients 45-60 years) on multivariate analyses stratified by age, although it was not a significant predictor in women older than 60 years. CONCLUSION: Our results suggest that boost to the tumor bed reduces breast cancer relapse and is more effective in younger patients