Biomedical subjects
Publications and source records attributed to C Crescini.
Rare cases of massive ascites associated with pelvic endometriosis have been reported. Our patient developed ascites several days after laparoscopy, probably as an infective complication.
We report 2 cases of ovarian metastases of malignant melanoma arisen 4 and 6 years after the removal of the primitive epithelial neoplasia. In both cases the ovarian neoplasia was unilateral. Both the macroscopic and the histological aspects of the malignant melanoma were examined. From both cases it was clear that it was a solid neoplasia with histological aspect of wide epithelioid cells with abundant cytoplasm and intracytoplasmatic melanotic pigment. The immunohistochemical results supported positivity for protein S100, vimentine and HMB45, negativity for cytokeratine.
One ovarian mucinous cystic tumor that contained a mural solid nodule of anaplastic carcinoma is described in a 35-year-old woman. The epithelial elements consisted of invasive well differentiated mucinous carcinoma. The anaplastic nodule showed some similarities with the cells described in sarcoma and sarcoma-like mural nodules. In favor of a diagnosis of anaplastic carcinoma there are poor circumscription of the nodules, vascular invasion and absence of a prominent inflammatory reaction.
The frequency and meaning of epithelial alterations adjacent to a vulvar invasive carcinoma are examined. In the period from 1986 to 1989, 37 cases of vulvar invasive carcinoma were observed in the Bergamo Hospital (Anatomopathology Institute of Bergamo) in women aged between 54-95 years operated for vulvectomy. The vulvar epithelium adjacent to the invasive carcinoma was studied in order to determine the frequency and the type of associated lesions. Two lesions seem to be meaningfully correlated to the vulvar carcinoma: the lichen sclerosus in 59% of cases and the VIN3 of differentiated type in 35%. The identification of these epithelial lesions can serve to select the cases with increased risk to develop invasive carcinoma.
Seven cases of blue nevus of the endocervix were examined macroscopically and histologically. The endocervical blue nevus is a rare lesion which can be incidentally found in surgical pieces after hysterectomy in middle-aged women. It looks like a blue-blackish little lesion, located superficially in the submucosa of the endocervix. The immunohistochemical results are positive for Protein S100 of the nevus cells. Due of its localization in the cervical duct the lesion can be hardly identified through colposcopy. Histogenetical hypotheses are finally discussed.
Three adenomatoid tumors of the uterus were examined. These tumors arising in the uterus are often regarded as incidental findings at operation, and are sometimes not well recognized at the time of diagnosis. They are small nodular lesions in the wall of the myometrium. Microscopically they presented with four distinctive histologic types, and immunohistochemically gave positive staining for keratin and for the mesothelial marker. The immunohistochemical results support the theories of histogenesis of the adenomatoid tumor as a type of benign mesothelioma.
One case of giant-cell arteritis involving the female genital tract of a post-menopausal woman is reported. The patient was a 75 year-old female, who presented anemia, fatigue, weight loss and a palpable abdominal mass. A hysterectomy and bilateral salpingo-oophorectomy proved multiple uterine leiomyomas. The uterus, ovaries and tubes unexpectedly revealed extensive giant-cell arteritis of small and medium sized vessels. Giant-cell arteritis of the female genital tract is a rare finding that may occur as an isolated form or as part of generalized giant cell arteritis.
This paper describes a case of acute pancreatitis occurring in a patient immediately after delivery and in primigravida. The patient had a family case history of dyslipidemia (Type IV). The pregnancy had been complicated by preeclampsia treated at home with nifedipine tablets (one tablet three times a day) with good results on pressure values; lipidic values were high despite dietary measures taken. The baby at birth weighed 3830 g after physiologic labour and a natural delivery. Acute pancreatitis was diagnosed after observation of epigastralgia with irradiation on the left shoulder, vomiting, symptoms of acute abdomen such as sweating, increased pulse rate, hypotension, abdominal pain on palpation, and absence of peristalsis. An analysis of the blood showed high levels of amylase and hyperglycemia, an increase in XDP, and leucocytosis. Instrumental tests such as pancreatic echography revealed an increase in pancreatic volume, uneven structure of the parenchyma and higher levels of liquid in the peritoneum. The patient was moved to intensive-care, a nasal gastric probe inserted, hydroelectrolytic treatment was begun, vital functions monitored, pain kept under control by medical therapy, and antibiotics administered. Subsequent tests showed an improvement in the parameters of pancreatic functions (amylase, lipase, calcium hematic) and their gradual return to normal values. The computerized tomography of abdomen additionally revealed the presence of pancreatic pseudo-cysts and effusion of peritoneal liquid near the right kidney. The patient was discharged after two weeks in the surgical ward. There are many caused of acute abdomen during and immediately after pregnancy, and one of these is acute pancreatitis, though rare (occurring between 1:3800 and 11.467 according to Rabkin).(ABSTRACT TRUNCATED AT 250 WORDS)
One case of large solitary luteinized follicle cyst of puerperium is reported. The patient presented with a palpable adnexal mass at four weeks post-partum. The ovarian cyst was solitary and unilocular and had a diameter of 14 cm. On microscopical examination the lining of the cyst consisted of luteinized cells that exhibited focal nuclear atypicality.
Thirty-four patients, with a history of persistent abnormal uterine bleeding and dilatation and curettage or suction curettage performed within the previous year, were evaluated by office hysteroscopy and biopsy. For 16 patients (47%) the hysteroscopic diagnosis was in agreement with the curettage. Hysteroscopy revealed more information in 18 patients (53%): 8 had polyps, 6 had submucous or pedunculated myoma, 2 had endometrial neoplasia, 1 had myoma and polyp, 2 had endometrial neoplasia and 1 had synechia. Moreover in 3 patients with diagnosis of suspected myoma by curettage, hysteroscopy revealed a normal cavity. The high incidence of missed diagnosis of pathologic conditions by "blind" curettage supports the opinion that diagnostic hysteroscopy is the method of choice in the evaluation of abnormal uterine bleeding.
The use of outpatient diagnostic hysteroscopy is discussed with reference to a series of 425 women. The test was performed in an outpatient setting with no form of analgesia, anesthesia or premedication in 385 patients (90.6%); the degree of acceptability was very low (intolerable) in 5.5%, supportable in 15.8% and excellent in 78.7% of patients. Fourty-two per cent of patients were aged between 45 and 54 years old, and the mean age was 47.5 years with a range between 18 and 83 years. The indication for the test was pre- or postmenopausal anomalous uterine bleeding in 74% of patients. Hysteroscopic diagnosis was normal in 56% of cases; endometrial polyps were diagnosed in 11.4% of patients; myomas in 11%; low-risk hyperplasia in 9.9% and malignant tumours in 3.6%. The correlation between hysteroscopic diagnosis and histological tests was above 95% in cases of malignant tumours, atrophy and functional endometrium, whereas it was 67% in cases of low-risk hyperplasia. No accidents or complications related to hysteroscopy were reported.
Colposcopy and biopsy were performed in 97 patients whose referral smears showed mild dysplasia (CIN 1). Of 97 women, 40 (41.2%) had a biopsy or a colposcopic examination alone considered normal, 36 (37.1%) had CIN 1 or HPV changes, 12 (12.4%) had CIN 2 and 9 (9.3%) had CIN 3. No invasive cancer was detected. This data suggest that, if colposcopy resources are available, repeat smear alone is inadequate to follow women who have a mild dysplasia smear.
We have taken into consideration the obstetric outcome in 173 women, with prior cesarean section, who were delivered in our hospital between june 1988 and january 1991. This group of patients represented 5.3% of our obstetric population. Overall 64 patients (37%) achieved vaginal delivery and 109 (63%) underwent an iterative cesarean section. Considering the 76 patients (44%) admitted to trial of labour, 64 (84.2%) achieved vaginal delivery and 12 (15.8%) were delivered with iterative cesarean section. No maternal or neonatal complications occurred, even though the silent dehiscence of the uterine scar, found during cesarean section, seems to occur four times (12%) more frequently than that reported in recent literature. It follows that vaginal delivery after prior cesarean section is, in our experience, lacking in risks, and we think that such management may be widely adopted. In 1986 iterative cesarean section represented 35% of cesarean section indications, in 1990 this rate was reduced to 23.7% by the introduction of a policy to allow women to undergo trial of labour.
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One case of large epidermoid cyst of the ovary is presented. This rare lesion was uniformly described previously in literature as incidental finding in the study of hysterectomy specimens.
Pruritic vulvar squamous papillomatosis (PVSP) is a recently described clinical entity whose aetiologic agent has been reported to be the human papilloma virus. We have seen 9 patients with PVSP. We believe that our clinical and histological data, along with the results of the in situ hybridizations stress out the evidence of a viral aetiology in the PVSP.
The clinicopathological and immunohistochemical features of three types of endometrial stromal neoplasms are analyzed. The tumors are divided into three groups on the basis of two observations: 1) the presence or absence of invasion; 2) the frequency of mitotic figures.
Authors report five cases of intravenous leiomyomatosis, one of which had colonized the inferior vena cava and the right atrium, and make a review of the literature. The morphology of the lesions is in keeping with that previously reported. Moreover the immunostainings confirm the nature and the intravascular location of the neoplastic tissue. Authors taking into consideration the two most likely differential diagnoses afford the problem of the so-called "metastasizing leiomyoma". Eventually they agree that intravenous leiomyomatosis is an underdiagnosed entity that possibly will be more easily recognized due to the modern non-invasive diagnostic procedures.