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Objective: The aim of the study was to examine, by an immunohistochemical method, the distribution of Inhibin-A and -B, in placentas from normal and pathological gestations., Materials and Methods: Sixty-two specimens of placental tissue were examined: i) ten cases from early gestations, ii) 28 cases from mature placentas, iii) six cases associated with intrauterine growth restriction, iv) four cases associated with diabetes mellitus and v) 14 placentas from gestations with fetal chromosome abnormalities. The expression of Inhibin A and B was studied by automatic Ventana method., Results: i) Early gestation specimens: Inhibin A (+) immunoreaction was observed in the syncytiotrophoblast (8/10 cases) and in the intermediate trophoblast (6/10 cases). Inhibin B (+) immunoreaction was observed in the syncytiotrophoblast (10/10 cases) and in the intermediate trophoblast (4/10 cases), ii) Normal mature placentas: Inhibin A (+) immunostain was observed in 2/28 cases in the syncytiotrophoblast and in 7/28 cases in the intermediate trophoblast. Inhibin B (+) immunostain was observed in 28/28 cases in the syncytiotrophoblast and in 18/28 cases in the intermediate trophoblast. iii) Placentas associated with intrauterine growth restriction: Inhibin A (+) immunostain was observed in the intermediate trophoblast in 2/6 cases. Inhibin B (+) immunostain was observed in 5/6 cases in the syncytiotrophoblast and in 4/6 cases in the intermediate trophoblast. iv) Placentas associated with gestational diabetes mellitus: Inhibin A (+) immunostain was observed in 2/4 cases in the intermediate trophoblast. Inhibin B (+) immunostain was observed in 2/4 cases in the syncytiotrophoblast. v) Placentas from gestations with fetal chromosome abnormalities: no Inhibin A immunoreaction was observed. Inhibin B (+) immunostain was observed in 13/14 cases in the syncytiotrophoblast and in 9/14 cases in the intermediate trophoblast. The cytotrophoblast, the umbilical cord, and the membranes do not participate in the production of Inhibins., Discussion: Inhibin A and B are located in the syncytiotrophoblast and the intermediate trophoblast of the placenta, during early pregnancy (Inhibin A) and present throughout pregnancy (Inhibin B). No remarkable findings in placentas of pathological gestations support the evidence that Inhibins do not participate in processes that affect the development of the placenta or the fetus, but may participate in,the mechanism of labor.

Aim: The aim of this study was to investigate the clinicopathological and immunopathological features of Brenner ovarian tumors., Materials and Methods: Thirty cases of Brenner ovarian tumors were examined in our laboratory among 1,680 cases of ovarian tumors, representing 1.5% of all tumors examined. Blocks of paraffin-embedded tumor tissue for all cases were available for additional immunohistochemical stain by a Ventana autoimmunostainer. Moreover, antibodies for Uroplakine III (cellmarque AU-1 clone, 1:25) Chromogen (monosan clone 5H7,1:25) WT1 (novocastra, clone 3F-H2, 1:25) NSE (DAKO, clone BB5/NC/V1-H14, 1:50), CK20 (DAKO, clone Ks20.8, 1:50),CK7 (Zymed 1:25, clone V-TL12/30)were used., Results: The mean age of the patients was 51.4 years ranging from 16 to 82 years. The tumor was unilateral in 28 cases (16/28 in the right ovary and 12/28 in the left ovary) and bilateral in two cases. Twenty-eight cases (93%) were benign and two (7%) were proliferating (borderline) tumors. Seventeen cases (56%) were pure Brenner tumors, measuring from 0.5 to 2.5 cm and 13 cases (44%) were mixed tumors consisting of a Brenner tumor element and a mucinous ovarian tumor (10/13 cases, 53.8%) and a germ cell tumor in 3/13 cases. The largest diameter of the mixed tumors ranged from 7 to 22 cm. The largest area consisting of Brenner elements measured 7 cm. The immunoprofile of Brenner tumor cell was cytokeratine-7 positive (30/30 cases) cytokeratine-20 negative in the Brenner cell element but positive in the mucinous component in 5/7 cases of mixed Brenner tumors, focally WT-1 positive (5/30 cases), NSE negative (0/30 cases) and focally chromogranine positive (6/30 cases), Uroplakin-III positive in 23/30 cases, with faint cytoplasmatic or luminal distribution. In conclusion, Brenner ovarian tumors are unilateral, small and benign neoplasms in their majority and present specific histopathological and immunopathological characteristics and mixed forms with other epithelial and germ cell neoplasms. This could be explained as a form of metaplasia or a diverse histogenesis from surface epithelium and/or the germ cell ovarian component.

Purpose: The purpose of the current experimental research was to investigate whether hydroxyzine can reduce the necrotic area in ischemia-reperfusion injury in epigastric rat skin flaps and to compare its role with cimetidine and vitamin C., Methods: From a total of 77 ischemic rat skin flaps, 18 were treated with normal saline, 18 with vitamin C, 18 with cimetidine and 18 with hydroxyzine before reperfusion. Flap necrotic area, neutrophils and mast cells were measured on the 7th day. Analysis of variance for multiple comparisons and post hoc Dunnett's test were used for statistical analyses., Results: The sham group of animals (n=5) showed 0% flap necrosis. The saline-treated group demonstrated 75±15.3% of necrosis. The vitamin C, cimetidine and hydroxyzine groups had 56.2 ± 24.4%, 25.8 ± 19.3%, and 33.6 ± 27.8% of flap necrosis, respectively. In addition, the number of neutrophils and mast cells were decreased in the pharmacologically treated groups compared with flaps perfused with normal saline (p<0.05)., Conclusion: Our data suggest that administering hydroxyzine in rat epigastric skin flaps before reperfusion may attenuate necrosis, neutrophils and mast cell counts. The beneficial effect of cimetidine was the same as hydroxyzine's but the use of vitamin C was less effective.

Introduction: Substantial histopathology data provide evidence that endometriosis might be viewed as a precursor lesion of endometrioid and clear cell carcinoma of the ovary, via intermediary atypical borderline lesions. Also, genes involved in both endometriosis and epithelial ovarian cancer have been shown to play a role in the pathogenesis of endometriosis-associated ovarian carcinoma., Material and Methods: A retrospective study of 17 cases of ovarian carcinomas associated with endometriosis, diagnosed between 2000 and 2009, at Aretaieion Hospital of University of Athens, is presented. 10/17 cases in this study (58.8%) were clear cell carcinomas (CCC), 6/17 cases (35.3%) were endometrioid adenocarcinomas (EAC) and 1/17 cases (5.9%) was a serous carcinoma associated with ovarian endometriosis. Patients's age was 27-76 years (mean age 58 years). Typical ovarian endometriosis was documented in 8/17 (47%) of the tumors. In 9/17 cases, areas of fibrosis or cystic lesions infiltrated by iron-laden macrophages and endometrial-like stroma, consistent with endometriosis, were observed., Conclusion: In comparison with common epithelial ovarian cancers, CCC and EACs of the ovary were presented at earlier stages. Cytoreductive surgical treatment is critical in order to plan appropriate post-operative management.

Purpose: Retroperitoneal sarcomas (RPs) are characterized by slow indolent growth and metastasize at a late point in their natural course. The purpose of this study was to review our experience in the management of RSs and identify prognostic factors for local control and survival., Methods: Between January 1990 and December 2010, the hospital records of 75 patients with RSs were retrospectively studied. Sixty-four (85.3%) patients had undergone surgical resection in our hospital for primary RS, whereas 11 (14.7%) were referred to our department for recurrent disease., Results: The patient median age was 57 years. Median tumor size was 18.5 cm. The most common histologic type was liposarcoma (44%) followed by leiomyosarcoma (17%), paraganglioma (10%), malignant fibrous histiocytoma (6.5%) and rare tumors such as 2 chondrosarcomas and 1 pecoma. Complete initial resection with negative macroscopic margins (R0) was achieved in 39 (60.9%) patients. En bloc resection of adjacent organs was required in 8 (12.5%) patients with primary RS and in 8 (72.9%) with recurrent disease. Mortality rate was 4%. For the group of patients initially treated in our hospital, 1-year recurrence rate was 34.3%. The 3- and 5-year overall survival rates were 56.2% and 53.1%, respectively. Satellite tumors were recognised in 13 (20.3%) patients treated for primary RS, from whom 11 (84%) recurred within one year. Seven patients received adjuvant chemotherapy., Conclusion: Radical surgical resection is the treatment of choice for patients with primary and locally recurrent RSs.

Background: Atypical leiomyomas are relatively uncommon in the general practice of gynaecology. We present a case of a large uterine bizarre leiomyoma removed by operative hysteroscopy and review of the literature., Case: The patient, a 49-year-old, gravida 3, para 3, perimenopausal Greek woman presented to our Department because of dysmenorrhea and abnormal vaginal bleeding. She underwent hysteroscopy in which a large submucosal leiomyoma was detected and entirely removed in one session. The histopathology revealed bizarre uterine leiomyoma., Discussion: There is no evidence to indicate that hysterectomy is necessary, if the diagnosis of atypical leiomyoma has been firmly established.

Objective: The diagnosis of an incidental adnexal lesion during pregnancy has become more common after the widespread use of routine ultrasonography (US). The aim of this study was to examine the diagnostic approach, management strategy and the pathological findings in cases of adnexal lesions that were diagnosed and treated during pregnancy in our department., Materials and Methods: This was a 15-year retrospective study. Cases of adnexal lesions detected during routine prenatal care by US or while performing cesarean section, between January 1996 and December 2010 at Aretaieion Hospital of the National University of Athens, were analyzed., Results: In this study period 39 cases of adnexal lesions were diagnosed during pregnancy or cesarean section. The age of the women was between 21 and 40 years (mean age 32.4). Surgical excision of the lesions was decided in 32 cases and conservative treatment was followed in the remaining seven cases. Surgical removal of the lesions was performed during cesarean section in 13 cases of term gestations and in four cases of preterm gestations in which pregnancy termination was considered necessary. Laparotomy during the antepartum period led to excision of adnexal lesions in 15 cases. Histology revealed benign ovarian lesions in 25 cases (78.1%), borderline ovarian tumors in two cases (6.3%), malignant ovarian tumors in four cases (12.5%) and adenocarcinoma of the appendix in one case (3.1%) presenting as an ovarian mass., Discussion: The management of cases diagnosed with adnexal lesions during pregnancy remains controversial. According to the literature, the estimated risk of malignancy for adnexal masses during pregnancy is low (2-3%) and complications of these lesions are extremely rare. These data suggest that adnexal masses could be managed conservatively if possible with US follow-up. On the other hand, the results of this study showed a higher incidence of malignancy among adnexal lesions that were surgically treated (15.6%)., Conclusion: Surgical intervention and histological examination in cases suspicious for malignancy at US and clinical findings remain the treatment of choice even during pregnancy.

Objective: Gonadotrophin-releasing hormone agonist (GnRHa) has been commonly used for the medical treatment of prostate cancer, precocious puberty, endometriosis, adenomyosis and uterine leiomyomas. GnRHa therapy in cases of symptomatic uterine leiomyomas aims for the reduction of their size and remission of symptoms such as menometrorrhagia, causing a state of hypoestrogenemia. This is considered to be a helpful preoperative strategy in cases of large myomas, or anemia because of abnormal vaginal bleeding. The aim of this retrospective study was to examine the clinicopathological changes in uterine leiomyomas exposed to preoperative GnRHa therapy for two up to six months., Materials and Methods: The study group consisted of 10 premenopausal patients who were treated with GnRHa prior to surgery., Results: In all cases the size of leiomyomas was reduced after GnRHa therapy. A microscopic review of the surgical specimens showed increased cellularity and ischemic type of necrosis., Conclusion: Morphological changes of uterine leiomyomas are often associated with preoperative GnRH agonist therapy. The differential diagnosis from uterine leiomyosarcomas includes absence of mitotic activity.

Endometriosis is a multifactorial disease with unclear pathogenesis. Urinary tract endometriosis occurs in about 1% of all endometriotic lesions while isolated ureteral endometriosis is extremely rare. We present a case of intrinsic ureteral endometriosis causing ureteral stenosis in a 40-year's old woman, in combination with intestinal, extensive peritoneal and ovarian endometriosis. The clinicopathological features and investigation methods used, as well as the treatment approach are discussed. An individual therapy plan depending mainly on the patient's age, desire for children and the extent of the endometriotic foci should always be attempted. Collaboration between gynecologists and urologists was essential in our cases.

Purpose of Investigation: To report our experience of autopsied cases of fetal cystic hygroma (CH) and discuss the role of fetal autopsy in genetic counseling., Methods: A review of autopsy reports at our institution revealed 18 cases of fetal CH over a 10-year period (from 2000 to 2010). The clinical data, results of cytogenetic analysis and prenatal ultrasound findings were also retrieved and compared to the autopsy findings., Results: Fetal death was due to intrauterine death in eight cases, therapeutic abortion in eight cases and spontaneous abortion in two cases. Cytogenetic analysis was available in 12 cases, and the results showed an abnormal karyotype in seven cases (5 cases of Turner syndrome and 2 cases of trisomy 21). The mean size of CH was 5.4 cm. Other malformations or findings suggestive of the cause of fetal death were diagnosed in 10/18 cases (55.6%). The most common autopsy findings were hydrops and central nervous system anomalies. The autopsy findings were in agreement with the prenatal ultrasound findings in 13/18 cases (72.2%), while in five cases (27.8%) additional findings were detected during autopsy. The most common placental abnormalities were infarcts and calcifications., Conclusion: In addition to prenatal diagnostic studies, fetal autopsy and pathologic examination of fetal and placental tissues may help to establish the exact cause of death and disclose important information as to the presence of various fetal malformations or placental abnormalities.

Adiponectin has been associated with colorectal cancer (CRC) risk. This study aims to investigate the association of both adiponectin and tissue expression of its receptors with CRC risk as well as clinicopathological characteristics, notably stage and grade. Determination of serum adiponectin and immunohistochemical expression of adiponectin receptors in adenocarcinoma/normal colorectal tissue was performed in samples from 104 newly diagnosed CRC patients and 208 age- and sex-matched controls. Multiple logistic regression odds ratios and 95% confidence intervals for CRC risk were derived, controlling for a series of covariates. Serum adiponectin was negatively associated with CRC risk (odds ratio, 0.72; confidence interval, 0.53-0.99) and also with tumor grade (P = .05). Expression of both adiponectin receptors was stronger in adenocarcinoma vs normal tissue (P = .001). AdipoR1 expression was negatively associated with nodal stage (P = .03); AdipoR2 expression was positively associated with tumor, node, metastasis stage (P = .01). Established positive associations with red meat consumption and diabetes, and negative associations with physical exercise and plant food consumption were confirmed along with a more than 60% higher risk associated with central obesity. Adiponectin levels and tissue expression of hormonal receptors seem to be associated not only with CRC risk but also with components of clinicopathological characteristics; given power limitations, these results should be interpreted with caution. The exact nature of the association and the underlying pathophysiological mechanisms need to be further examined in large prospective studies assessing adiponectin and its receptors as novel targets for exploring CRC growth., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: To present the clinicopathological features of metastatic ovarian neoplasms with emphasis in the diagnostic challenge., Methods: This is a retrospective study including 97 patients with pathological diagnosis of metastatic ovarian neoplasms, examined during the decade 2000-2009. The gross, microscopical and immunohistochemical characteristics as well as the clinical data (age of the patients, origin of the neoplasm, symptoms, treatment options) and 5-year survival rates were examined., Results: The mean age of the patients is 55 years (range 26-78 years). 62.89% of the tumors were metastatic from extragenital organs (from stomach 21.65%, breast 15.46%, colon 15.46%, appendix 3.09%, pancreas 2.06%, lung 1.03% and kidney 1.03%, sarcoma 1.03% melanoma 1.03%) and 37.11% tumors originated from the genital tract. The 3-year survival rates ranged from 25.39% for metastatic ovarian neoplasms originating outside the genital tract up to 29.41% for those originating from the genital tract. Tumor immunohistochemistry is a helpful aid in the differential diagnosis mainly between primary mucinous ovarian tumors and metastatic colon cancers and in the recognition of metastatic breast cancers and other neoplasms of the GI tract., Conclusion: The management of metastatic ovarian neoplasms should include specific immunohistochemical methods in order to identify the primary neoplasm site. The differential diagnosis of a pelvic mass should always include metastatic neoplasms of the ovaries.

Aim: 24 cases of single umbilical artery (SUA) are presented and the related histopathological findings of the fetuses and placentas examined. SUA is the most common congenital anomaly of the umbilical cord, resulting in the absence of one of the two umbilical arteries. It has an incidence of approximately 2.1% in autopsy material and there is evidence that is associated with anomalies of the fetus and placenta., Material-Method: The files were reviewed of 24 cases with SUA, out of 1,570 autopsies of fetuses and placentas performed in the Pathology Laboratory of Aretaieion Hospital, due to spontaneous or induced abortions after written parental consent., Results: The incidence of SUA was 1.6%. Gestational age ranged between the 15th and 33rd week and mother's age ranged from 17-44 years. Three of 24 cases were twin pregnancies; 17/24 fetuses were male. In 21/24 cases complex congenital anomalies were observed and in five of 24 cases chromosomal anomalies were detected. In eight of 24 placentas extensive infarcts were observed; 7/24 dysmaturity, 5/24 severe chorioamnionitis, 3/24 extensive fibrin accumulation and 1/24 chorioangiosis., Conclusion: SUA is an umbilical congenital anomaly associated with severe fetal congenital anomalies and once detected with ultrasound techniques, further and more detailed control of the fetus is considered mandatory.

A case is reported of a 60-year old woman who had intermittent abdominal pain due to a mesenteric teratoma which was misdiagnosed by the standard methods of abdominal tumor diagnosis as an ovarian tumor. The neoplasm measured 9 x 8 x 8 cm, was filled by hair and sebum, and histologically presented the typical features of a mature cystic teratoma. The mesentery and overlying small intestine showed an extensive inflammatory granulomatous reaction. The uterus and adnexa were free of neoplasmatic disease. This case of extra ovarian mature cystic teratoma which developed in the mesentery is unique among > 2000 ovarian tumors examined during a 30-year period at Aretaieion Hospital Pathology Laboratory.

The case of a 20-year-old pregnant woman with a history of one previous cesarean section (CS) who developed a tumorous mass in the area of the CS scar is presented. The clinical diagnosis of endometriosis or fibromatosis was made but the histologic findings were confusing and the pathological diagnosis of an inflammatory type of liposarcoma was made. The case was referred to our Laboratory for re-evaluation and the diagnosis of gossypiboma was made based on histopathological features, the patient's age, her medical history and the exact location of the lesion. Gossypiboma is a foreign body-related inflammatory pseudotumor caused by retained non-resorbable or even resorbable substances, such as glue, surgical gause or sutures. It is an obscure lesion ignored by doctors of all specialties studying the differential diagnosis of a postoperative mass.

Context: Von Hippel-Lindau disease is an inherited syndrome of multiorgan neoplasia caused by a germline mutation in the von Hippel-Lindau gene and can include central nervous system tumors, renal cell carcinomas and benign pancreatic cystic tumors., Case Report: We report the case of a 56-year-old patient who had a past history of cerebellar hemangioblastoma and presented with abdominal pain. Imaging revealed renal tumors and multiple pancreatic tumors which caused duodenal and pancreatic duct compression. The patient was treated with a combination of radical right nephrectomy, total pancreaticoduodenectomy and splenectomy. Pathology identified a multifocal unilateral clear cell renal carcinoma which interestingly coexisted with multiple large pancreatic serous microcystic adenomas with infiltration of the fibrous capsule., Conclusion: In past cases of von Hippel-Lindau disease, pancreatic adenomas with malignant transformation have not been reported. In our case, the infiltration of the fibrous capsule by parenchymal cells may indicate malignant transformation.

A case of a male embryo aborted at the 20th week of gestation with extensive ascites, hydrothorax, pulmonary lymphangiectasia and pulmonary hypoplasia is presented together with the pathological findings, the etiology, differential diagnosis, course and therapy of this pathologic entity. Also a short review of the literature is discussed.

Purpose: The relationship between breast cancer and thyroid diseases is controversial. Conflicting results have been reported in the literature. The incidence of autoimmune and non-autoimmune thyroid diseases were investigated in patients with breast cancer who had received prior therapy as compared with age-matched control individuals without breast or thyroid disease., Patients and Methods: Clinical and ultrasound evaluation of the thyroid gland, and determination of serum thyroid hormones and autoantibody levels were performed in 143 breast cancer patients and 128 healthy control individuals. Patients were classified into subgroups according to estrogen receptor (ER) and progesterone receptor (PR) status and type of oncological treatment., Results: The mean values for serum antibodies against thyroid peroxidase (anti-TPO) were 9 IU/ml and 25 IU/ml for antithyroglobulin antibodies (anti-TGB) in breast cancer patients, and 9.5 IU/ml and 23.5 IU/ml, respectively, in the control group (p>0.05. The difference between breast cancer patients and the control group in the incidence of autoimmune and non-autoimmune thyroid diseases was not statistically significant. No significant differences between the groups according to both menopausal status and ER status were seen (p= 0.67). Also, no significant influence of hormonal therapy with tamoxifen and chemotherapy on serum levels of thyroid stimulating hormone (TSH), free thyroxin (fT4), TPO and TGB autoantibodies was proved., Conclusion: This study demonstrated a similar incidence of thyroid enlargement and the same frequency of thyroid disturbances in patients with breast cancer and controls. No relationship was found among ER and PR status, and the presence of serum thyroid autoantibodies. Although we have been unable to demonstrate any impact of breast cancer therapy on thyroid function tests, more prolonged studies with larger number of patients may be required to demonstrate significant trends.

Aim: To investigate the risk of pelvic lymph node metastasis in patients with a preoperative diagnosis of early endometrial cancer with favorable histological characteristics, assessed by complete pelvic lymphadenectomy., Patients and Methods: A total of 108 patients with clinical early endometrioid grade I or II endometrial carcinoma underwent complete pelvic lymphadenectomy between 2001-2007. Only cases with at least 15 nodes histologically examined were included. All operations were performed by the same team. The preoperative tumor histology was compared with the final pathological findings. The incidence of pelvic nodal involvement was estimated in relation to the final grade and depth of myometrial invasion in halves., Results: The median age of patients was 63 years. In the final histology, 10 tumors (9.3%) of non-endometrioid histology were found. The discordance between pre- and postoperative tumor grade was 32.4%, with 24.1% being upgraded. Nine patients (8.3%) had poorly differentiated tumors and 23 (21.3%) deep (>50%) myometrial invasion in the final pathology. A total of 11 patients (10.2%) had pelvic nodal metastasis. The rate of lymph node metastasis in relation to final grade I and II and myometrial invasion was as follows: grade I, 1.8% (inner half 0%, outer half 14.3%); grade II, 15.9% (inner half 12.1% outer half 27.3%). Overall 19.4% of patients were upstaged at surgery., Conclusion: A significant proportion of patients presenting with early endometrial cancer of optimal characteristics will have a more advanced disease at surgical staging. Complete pelvic lymphadenectomy may increase the possibility of detecting metastatic disease in the lymph nodes.

Background: The sentinel lymph node (SLN) technique aims at predicting the absence of regional nodal metastasis and seems promising in the management of cervical cancer patients., Patients and Methods: Forty patients undergoing surgery for early cervical cancer were submitted to the SLN procedure, using Blue Patente alone in 3, radiocolloid injection alone in 4 and both methods in 33 (82.5%). All patients underwent radical hysterectomy and pelvic lymphadenectomy., Results: The detection rate was as follows: overall 85%, blue dye alone 66%, radiocolloid alone 75%, dual method 87%. Detection was successful in 34 patients, with one false-negative result. No micrometastases were demonstrated during ultrastaging of the sentinels. The detection rate was higher in tumors <2 cm (94.1%) than in larger tumors (78.2%, p>0.09). Significant negative correlation between lymphatic vascular space invasion (LVSI) and detection rate was found (p<0.001)., Conclusion: SLN detection is feasible in early cervical cancer but presence of LVSI and a tumor size >2 cm negatively affect the detection rate and may increase the incidence of false negatives.

Large ovarian tumors weighing more than 5,000 g are rarely reported in the recent literature because of the improvement in health care systems. Such tumors present many challenges in diagnosis and in surgical approach due to severe circulatory and cardiopulmonary complications. The case of a 27-year-old unmarried patient, who complained of progressive increased abdominal girth of more than six months duration, metrorrhagia, constipation and dysuria is presented. A cystic ovarian tumor weighing 8,500 g (after preoperative fluid aspiration) proved to be a mucinous neoplasm of borderline malignancy with functional stroma. Problems in establishing a correct diagnosis are discussed together with a literature review.

The stroma often fibroepithelial and ten adenomatous cervical polyps, 12 fibro-epithelial vaginal polyps, 20 non neoplastic cervices, 15 cone specimens with CIN changes and five specimens with infiltrative squamous cell carcinoma was investigated. Vimentin, desmin, actin, collagen III, CD34, ER and PgR were studied using the Ventana Automatic Immunostaining System. A subepithelial stromal layer was detected in 17/20 normal specimens, 16/20 cervical polyps, 10/12 vaginal polyps and in 6/15 cone biopsies but not in neoplastic specimens. Vimentin staining was positive in all fibroepithelial polyps, normal specimens and in 6/10 adenomatous polyps. Actin was negative in the loose subepithelial zone but positive in the underlying stroma. Desmin, alpha-1-antitrypsin and CD34 were detected in isolated cells in normal specimens. ER and PgR were observed in isolated subepithelial cells, with greater density in the cells of the fibromuscular wall. In conclusion, loose mesenchymal stroma in the lower female genital tract of a fibrohistiocytic nature was observed with minimal smooth muscle participation--which is the matrix of vaginal and cervical polyps.

We present two cases of nulliparous women with ectopic pelvic spleens who were hospitalized in our department during the last decade. The clinical and laboratory characteristics and the management of such a rare entity are discussed.

The clinopathological features are presented of two cases of placental chorioangiomas and four cases of chorionagiosis diagnosed in a total of 2,400 placental specimens examined in our laboratory. The differential diagnosis, clinical effects and therapeutic approach are discussed.

Cogan's syndrome is a rare multisystem disorder of unknown etiology which is characterized by nonsyphilitic interstitial keratitis, vestibuloauditory dysfunction and systemic vasculitis. We present the clinical manifestations and the follow-up of a 39-year-old pregnant woman with Cogan's syndrome. The treatment and especially the histologic findings of the placenta are discussed.

Atypical polypoid adenomyomas are tumors of low malignant potential. We present a case of endometrial carcinoma arising in a 36-year-old woman with atypical polypoid adenomyoma. The diagnosis and treatment of such a tumor is discussed through an English literature review.

The aim of the study is to present two cases of premenopausal women with early stage cervical carcinoma who underwent ovarian transposition. The role and the advantages of this technique are discussed.

Purpose: The aim of this retrospective study was to analyze the pathologic and clinical characteristics of borderline ovarian tumors., Methods/results: During the period from January 1993 up to December 2002 we found 93 cases of borderline ovarian tumors. The mean age of patients was 44.3 years (range 28.9-59.7 years); 77.4%, 10.8% and 11.8% of patients had Stage I, II and III, respectively. The histological outcomes revealed 52.7% of serous and 41.9% of mucinous origin; 44.1% underwent radical surgery, whereas 55.9% had unilateral salpingo-oophorectomy or cystectomy. The mean follow-up was 84 +/- 22 months. The overall five-year survival was 97.4% and 98% for mucinous and serous tumors, respectively. The survival rate was 100%, 90% and 81.8% in Stages I, II and III, respectively., Conclusion: From our results it can be concluded that borderline ovarian tumors have a favorable prognosis even after conservative management.

The incidence of ectopic pregnancy has been high over the last decades. Many risk factors are potential causes, among them IUDs use which might have a significant role. According to the current thinking, the use of IUD does not increase the risk of ectopic pregnancy. However, IUDs are more effective in protecting from intrauterine rather than ectopic pregnancy. Our review focuses on current and past IUD use, duration of its use, type of IUD and the associated risk of ectopic pregnancy. Fertility after IUD removal regarding the incidence of ectopic pregnancy is also discussed. Conflicting results regarding the association of ectopic pregnancy risk with the use of intrauterine devices exist.

Congenital cystic adenomatoid malformations of the fetal lung (CCAM) are rare embryonic developmental abnormalities. They are considered as benign hamartomatous or dysplastic lung tumors characterized by overgrowth of the terminal respiratory bronchioles at the expense of the saccular spaces. A minority of cases may not be identified by prenatal imaging techniques and the pulmonary lesions are recognized postnatally. Two cases of congenital cystic adenomatoid malformation of the fetal lung diagnosed in our institution during the last four years are reported. The ultrasonographic and pathologic findings of these cases are discussed.

Purpose: To further study the clinicopathological features of synchronous ovarian and endometrial carcinomas., Methods: We retrospectively studied all cases of synchronous ovarian and endometrial carcinomas diagnosed in our laboratory over the last 15-year period. The pathological findings were correlated with the clinical records of the patients., Results: Seven cases of synchronous primary ovarian and endometrial carcinomas were retrieved. The most common presenting symptom was abnormal vaginal bleeding (5 cases, 71.4%). Five patients (71.4%) were postmenopausal and two (28.6%) were nulliparous. All seven patients had Stage I ovarian and endometrial carcinomas of endometrioid histology. Moreover, in all seven ovarian carcinomas endometriosis foci were observed, while atypical endometriosis was found in four of them. With the exception of one patient, who received adjuvant postoperative radiation, all remaining patients were treated with surgery alone. All patients were alive and free of disease at completion of the study., Conclusion: The correct classification of synchronous primary ovarian and endometrial carcinomas is often problematic because of the frequent confusion with their metastatic counterparts. Although the exact etiology remains unclear, endometriosis seems to be a major risk factor for their development.

Background: Paget's disease of the vulva is a rare neoplasmatic lesion which mainly affects postmenopausal women., Results: We conducted a retrospective study during the period January 1996 till December 2005 in which 11 cases of Paget's disease were detected. The clinical manifestations, management, specific pathological features, treatment and prognosis of each patient are presented., Conclusion: Surgical treatment is the current standard and long-term follow-up is required.

The objective of the present study is to present a case of a 48-year-old woman with leiomyomatosis and multiple pulmonary metastases. The classification, pathophysiology, clinical signs, treatment and prognosis of this rare case are discussed. Leiomyomatosis is potentially life-threatening while patients with pulmonary metastases are usually asymptomatic and the condition is incidentally discovered. The treatment of leiomyomatosis is not standardized and many possible variations are under investigation. Still the prognosis is usually excellent.

In the present study we report two cases of fetal ovarian cysts. In the first case the cyst was initially discovered during prenatal ultrasound examination, while in the second case the cyst was identified during autopsy examination of a stillborn fetus. Pathologic examination of both specimens revealed similar histology, which was mainly characterized by the presence of an ovarian cortex comprising several maturing and primordial follicles which were occasionally biovular, and a focal lining of luteinized theca cells. Another prominent feature was the presence of multiple deposits of dystrophic calcifications within the cyst wall. Both cysts were diagnosed as follicular in origin.

Involvement of the colon by extraovarian peritoneal serous papillary carcinoma (EPSPC) is considered as rare. During a 10-year period the records of five female patients with a mean age of 73.4 years who were admitted for colonic obstruction due to EPSPC were reviewed. Preoperative and postoperative data were studied. All patients presented with symptoms of colonic obstruction and high concentrations of CA-125. Involvement of the sigmoid colon was demonstrated preoperatively both in CT and colonoscopy. Operative findings of multiple peritoneal implantations involving the surface of the ovaries in two cases, the greater omentum in three cases and invasion of the sigmoid colon in all cases prompted us to perform sigmoidectomy and omentectomy in all cases with bilateral salpingo-oophorectomy in four of them. All patients received adjuvant paclitaxel plus platinum-based combination chemotherapy.

Aim: To investigate the incidence of KIT immunohistochemical staining in (GI) stromal tumors (GISTs), and to analyze the clinical manifestations of the tumors and prognostic indicators., Methods: We retrospectively analyzed 50 cases of previously diagnosed GISTs. Tissue samples were assessed with KIT (CD117 antigen), CD34, SMA, desmin, S-100, NSE, PCNA, Ki-67, and BCL-2 for immunohistochemical study and pathological characteristics were analyzed for prognostic factors., Results: Fifteen tumors (30%) were negative in KIT staining. A significant association was observed between gender (male patients: 14/15) and KIT-negative staining (P = 0.003).The patients's mean age was 56.6 years. Tumors developed in stomach (n = 8), small intestine (n = 5), large intestine (n = 1) and oesophagus (n = 1). The mean tumor size was 5.72 cm. The mitotic count ranged from 0-29/50 HPF (mean: 3.4) and 73% of tumors showed no necrosis. The majority of the tumors (67%) had dual or epithelioid differentiation. Tumors were classified as very low or low risk (n = 7), intermediate risk (n = 5), and high risk (n = 3) groups. Twelve (80%) patients were alive without evidence of residual tumor for an average period of 40.25 mo (12-82 mo); three patients developed metastatic disease to the liver and eventually died within 2-12 mo (median survival: 8.6 mo)., Conclusion: A small subgroup of GISTs fulfils the clinical and morphological criteria of these tumors, and lacks KIT expression. These tumors predominantly developed in the stomach, being dual or epithelioid in morphology, which are classified as low risk tumors and presented a better survival status than KIT-positive tumors. The ability to diagnose GISTs still depends on immunohistochemical staining but the research should extend in gene mutations.

Paraganglioma of the urinary bladder is a rare pathologic entity with no definitive histological, immunohistochemical or molecular features to determine its malignant potency. Malignancy is essentially determined by the presence of deep local invasion, invasion of adjacent structures, and lymph node or distant metastases. So far, up to 180 cases of paraganglioma have been reported, with less than 30 being malignant. We present a case of malignant paraganglioma of the urinary bladder in a 44-year-old woman. The patient's symptoms were painless hematuria and micturitional headache. The tumor presented the characteristic "zellballen" pattern of growth and immunohistochemically was positive for all neuroendocrine markers. The patient underwent partial cystectomy and the following two postoperative years were uneventful. The literature on paraganglioma of the urinary bladder, analyzing the histological, immunohistochemical and molecular characteristics, is reviewed.

Malignant eccrine poroma is a rare cutaneous neoplasm that originates from the intraepidermal portion of the eccrine gland. It affects mainly elderly people while its occurrence in younger adults is extremely rare. We present the first reported case of a malignant eccrine poroma in a pregnant woman, with emphasis on its pathologic and immunohistochemical features. Early diagnosis and treatment of eccrine neoplasms are of crucial importance when pregnancy coexists, because of their tendency to aggravate under the influence of gestation-related changes.

A case of a postmenopausal woman who was investigated for a large cystic peritoneal tumor which turned out to be hematometra is presented. From her clinical history, a wide excision of the uterine cervix was reported due to a high-grade intraepithelial squamous neoplasia. Laparotomy showed a greatly enlarged uterus and the histological exam revealed a hematometra with a superficial endometrioid adenocarcinoma of the uterine cavity. The remaining cervix had extensive fibrosis and complete obliteration of the cervical canal. A review of the literature revealed that hematometra in postmenopausal women should be investigated because it may harbor a cancer.

Cavernous hemangiomatosis of the colon and liver in a 38-year-old woman presenting with a history of cramp like abdominal pain and a mass in the right iliac fossa are presented. Abdominal ultrasonography and computed tomography demonstrated multiple liver hemangiomas as well as a noncystic lesion in the right iliac fossa. Operative findings were suggestive of diffuse hemangiomatosis of the right colon and an extensive right hemicolectomy was performed. A review of the literature is presented, considering current diagnostic and therapeutic methods.

The clinical manifestations, the radiologic appearance and the treatment of four women with extragenital endometriosis of the abdominal wall are presented. In two patients endometriosis was found adherent with the structures of the inguinal canal and in the other two the tumors infiltrated structures of the abdominal wall. Symptoms included cyclical pain and palpable subcutaneous masses fixed to the surrounding tissues. Computed tomography and magnetic resonance imaging failed to differentiate the lesions from other soft tissue tumors. Resection to healthy tissue margins is the treatment of choice, in order to avoid local recurrence.

Objective: To investigate the primary site and the pathological features of secondary intestinal tumors in females, with emphasis on their differential diagnosis from primary neoplasms of the intestines., Methods: Seven cases of secondary intestinal tumors in females were retrieved from the archival files of our laboratory. The relative clinical data were also reviewed. Inmmunohistochemistry was performed in cases with diagnostic difficulties., Results: The primary site of the tumor was defined as follows: the ovary (ovarian adenocarcinoma) in five cases (71.4%), the skin (cutaneous malignant melanoma) in one case (14.28%) and the uterine corpus (mixed mullerian tumor) in one case (14.28%). In two cases the primary site was not determined initially, but the investigation showed that the primary tumor was ovarian in origin. In five cases the existence of a primary tumor was already known. Immunohistochemistry was applied in three cases for confirmation of the suspected primary tumor by histological examination., Conclusion: Histological diagnosis of secondary intestinal tumors may be extremely difficult, especially when the primary site is not previously known, and because of the tendency of certain secondary tumors to mimic, both grossly and microscopically, the primary ones. Immunohistochemistry is extremely helpful in resolving these diagnostic difficulties.

Objective: To study the histopathological features of mesenchymal tumors of the uterine corpus with heterologous and hematopoietic components, and review their histogenesis and differential diagnosis from other neoplastic and non-neoplastic lesions., Methods: Ten cases of mesenchymal tumors of the uterine corpus, massively infiltrated by hematopoioetic cells, or composed of other benign heterologous elements (adipose tissue in the present cases) were retrieved from the archival files of our laboratory and studied histopathologically. Immunohistochemistry was applied in selected cases., Results: Six of our studied cases were diagnosed as leiomyomas, two as lipoleiomyomas, one as a symplastic lipoleiomyoma, and one as an endometrial stromal tumor. The leiomyomas were massively infiltrated by lymphocytes (5 cases) or eosinophils (one case). Immunohistochemical study of the leiomyomas with massive lymphocytic infiltration revealed the presence of a predominantly B-cell population within the infiltrate, which was polyclonal in nature. The endometrial stromal tumor was severely infiltrated by histiocytes, and was positive for vimentin, CD10, PgR and negative for actin, desmin, ER and caldesmon., Conclusion: The presence of hematopoietic or heterologous elements within an otherwise bland uterine leiomyoma or endometrial stromal tumor may give rise to diagnostic difficulties. Regularity of the tumor margins, low mitotic activity and absence of nuclear atypia or necrosis should be established for the exclusion of a malignancy. In the presence of massive lymphocytic infiltration of a leiomyoma the clonality of the infiltrate may aid in differentiating it from a malignant lymphoma. The pathogenesis and clinical significance of these rare neoplasms remain to be clarified.

Uterine leiomyomas are extremely rare neoplasms in the pediatric and adolescent population. We report a case of a giant uterine leiomyoma measuring 30 cm in the largest diameter in a 16-year-old girl. To our knowledge this is the largest leiomyoma reported thus far in women under the age of 20 years. The patient was admitted to our hospital for the investigation of menstrual disorders, vaginal bleeding and progressive abdominal enlargement. Preoperative diagnosis was ovarian malignancy. Myomectomy was performed. Histopathologic study of the tumor showed an otherwise typical leiomyoma, both grossly and microscopically, with extensive hydropic and myxomatous degeneration and areas of prominent vessels, suggesting an angiomatous neoplasm. Leiomyomas in teenagers often exhibit histological features favoring the diagnosis of malignancy, and should be evaluated with extreme caution. The management of leiomyomas in these young patients should be conservative for the preservation of fertility.

The majority of ovarian masses in childhood and adolescence are non-epithelial in origin, with a predominance of germ cell tumors, while epithelial neoplasms comprise a small proportion of the total (approximately 15-20%). Mucinous cystadenomas in particular are only sporadically reported in this age group. We present a case of an ovarian mucinous cystadenoma with extended calcification in a premenarchal 11-year-old girl. Pediatric mucinous cystadenomas of the ovary may on rare occasions display extended calcification. Careful evaluation of the remaining pathological features of the tumor is needed in order to avoid misinterpreting this relatively non-specific finding as a feature of malignancy.

Gonadoblastoma is a rare tumor occurring almost exclusively in phenotypic females with intersex disorders and dysgenetic gonads. We report a case of gonadoblastoma in an 18-year old female who was admitted to our hospital for the investigation of primary amenorrhea. The patient underwent bilateral gonadectomy. A histopathologic study revealed streak gonads with extended calcification and bilateral gonadoblastoma. We describe the histopathologic features of gonadoblastoma and the pattern of its potential malignant transformation. Difficulties in the histological diagnosis of this rare tumor are also discussed. The need for early prophylactic removal of dysgenetic gonads, especially in patients that carry the Y chromosome, is emphasized.

The clinicopathological characteristics are presented of 19 extragenital cystic lesions of female patients located at the retroperitoneum (9 cases), the mesentery (6 cases) and the peritoneum (4 cases). Median age was 42.3 years and the main symptom was abdominal pain. The cysts measured 4-27 cm in diameter and were classified as: epithelial (7/19), mesothelial (5/19), vascular (2/19), parasitic (1/19) and developmental in origin (4/19). Of the cases 18/19 were benign lesions and one case was a borderline mucinous cystic tumor. Immunohistochemistry by a streptavidin-biotin method was performed to investigate CEA transcripts (MoAb, Novosan), CA125 (MoAb, CIS Diagnostics), vimentin (MoAb Ve6, Novocastra), secretory component (a polyclonal antibody, DAKO), Factor VIII (MoAb, DAKO), CD34 (MoAb, Scytec), calretinin (a polyclonal antibody, Zymed, San Francisco, CA). Cytokeratins were of low and high molecular weight (Immunon, AE1-MoAb). The results are helpful in the correct classification of various tumors. The treatment of choice is complete surgical resection of the tumors.

The development of ectopic decidua is generally considered as a physiologic phenomenon of pregnancy, even though it has been occasionally noted in non-pregnant women. We present three cases of ectopic decidua located in the greater omentum and discuss the histopathologic characteristics, as well as the problems encountered in the differential diagnosis from metastatic lesions. Decidual transformation of the omentum could simulate, both grossly and microscopically, malignant neoplastic lesions such as malignant deciduoid mesothelioma, metastatic mucin-producing adenocarcinoma or even metastatic squamous carcinoma. The application of immunohistochemistry is essential for the establishment of the diagnosis, especially in the presence of deceptively atypical vacuolated cells resembling carcinoma cells. Ectopic decidua does not require any therapeutic intervention because it usually regresses postpartum without any complications.