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Ovarian cancer is the second most common gynecologic malignancy and is one of the leading causes of death among women. The disease course and the accurate diagnosis are correlated with the early detection of the lesion. About 5% of ovarian cancers are poorly differentiated and difficult to be classified, and are referred to as undifferentiated carcinomas. They are usually large, solid with haemorrhage and necrosis, bilateral, and very difficult to be histologically classified. Generally, cases with undifferentiated components are very rare. The authors present a case of a young female patient with a rapidly progressive undifferentiated ovarian carcinoma and a final unfortunate clinical result.

Choledochal cysts are rare congenital cystic dilatations of the biliary tree. Choledochal cysts in pregnancy are a rare entity and represent a diagnostic and therapeutic challenge. The authors present a case of two full-term pregnancies in a woman who underwent multiple hepatobiliary operations for a choledochal cyst. The patient had two major problems: a type IV(a) choledochal cyst with atrophy of the left side of the liver and a congenitally dilated pancreatic duct in the head of the gland. She underwent a drainage surgical procedure using a Roux loop of jejunum and a revision surgery in which complete excision of the cyst and hepaticojejunostomy was performed. The surgical management was completed by a left lateral hepatic segmentectomy. During her first pregnancy, she experienced an episode of cholangitis, most probably due to the remaining congenitally dilated pancreatic duct. In succeeding years, the patient presented with recurrent pancreatitis and finally she underwent a Whipple operation. After that, the patient had a second pregnancy without any complications from the biliary tract system. Although choledochal cysts rarely occur in pregnancy, clinicians should be aware of this condition, as delayed or inappropriate therapy may be catastrophic for both the mother and the fetus.

This retrospective study was undertaken to assess the epidemiological and clinical features, laboratory findings, preoperative work-up, surgical treatment and pathologic findings in adolescents with ovarian cysts. All adolescents who were referred to our institution and had been operated on because of a diagnosed ovarian mass, from January 1997 to June 2003, were included in this study. Forty-four cases of women with an ovarian mass were retrospectively analyzed. These patients, aged between 12 and 21 years, had 47 ovarian masses (three patients had bilateral lesions), of which 49% were non-neoplastic and 51% were neoplastic. Of the neoplastic lesions, 62.5% were germ cell tumors, 20.8% were epithelial and 16.7% were sex cord-stromal tumors. Of the neoplastic tumors, 95.8% were benign while 4.2% were malignant. Procedures included 30 operative laparoscopies (68.20%) and 14 exploratory laparotomies (31.8%). Simple excision of the ovarian cyst was performed in 39 cases (88.6%). According to our study, most of the adolescents with an ovarian cyst underwent an operation because of a neoplastic lesion. The majority of ovarian tumors occurring in adolescents are non-epithelial in origin, and germ cell tumors are the most common histological type. Ultrasound examination is one of the most important diagnostic tools. Preoperative diagnostic approach of these patients should always include careful history taking, physical examination, imaging and evaluation of serum assays. Gynecologists who care for young girls must be familiar with the differential diagnosis of ovarian masses whose surgical treatment should be conservative when appropriate, so that hormonal status and future fertility are not compromised in this group of patients.

Extragenital carcinomas secondarily involving the uterus are very rare and they usually occur as a manifestation of widespread disease. When the metastases involve the endometrium in a diffuse, permeative pattern, sparing the glands, they may cause problems in the diagnosis.A case of metastatic carcinoma to the endometrium with a decidua-like pattern is reported. The patient had a history of breast carcinoma and presented with vaginal bleeding. The pathologic findings in the uterine curettings raised the differential diagnosis between metastatic breast carcinoma and non-neoplastic stromal lesions. The presence of nuclear atypia and mitotic activity along with the appropriate immunohistochemical findings revealed the neoplastic nature of the endometrial lesion and confirmed its origin from the breast.Unusual uterine bleeding in a patient with breast cancer should alert the gynecologist to the possibility of metastatic breast disease. Furthermore, the metastasis to the uterus and to other organs of the genital tract can be considered as a preterminal event.

To compare maternal and neonatal oxygenation and acid-base status after elective cesarean section (CS) under different anesthetic techniques.Three hundred and eighty parturients undergoing elective cesarean section were randomly assigned to receive general (GA, n =140), epidural (EA, n = 117) or subarachnoid anesthesia (SA, n =123). Blood gases, oxygen content, and acid-base status parameters were measured in maternal artery and umbilical cord vessels. Neonatal Apgar scores were also recorded.Umbilical artery pH, HCO3-, and actual base excess (ABE) were significantly higher in the GA compared to SA group (p0.001, p0.05, andp0.05, respectively). Umbilical vein ABE was lower in the SA compared to GA and EA groups (p0.05). Oxygen content in maternal artery was higher in the GA and EA groups compared to the SA group (p0.05). Neonatal oxygen content in both cord vessels was higher in the GA group compared to EA and SA groups (p0.05). Umbilical venous-arterial difference of PO2, oxygen content, and Apgar scores did not differ significantly among groups.Neonatal oxygenation and acid-base status values were better preserved when GA was administered for elective CS compared to regional modalities. Apgar scores and neonatal outcomes were not affected by the anesthetic technique.

To report our experience of autopsied cases of fetal cystic hygroma (CH) and discuss the role of fetal autopsy in genetic counseling.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.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.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.

Peutz-Jeghers syndrome is a rare syndrome which is inherited in a dominant manner. It is characterized by hamartomatous polyps of the gastrointestinal tract, hyperpigmented macules of the oral mucosa and an increased risk of developing neoplasms in the gastrointestinal tract, pancreas, breast and genital system. Women with Peutz-Jeughers syndrome often develop an ovarian sex cord tumor and cervical adenocarcinoma of minimal deviation adenoma malignum type. A case of a 58-year-old patient with Peutz-Jeghers syndrome and history of multiple malignancies (thyroid, breast and colon cancer) who presented with metrorrhagia is reported. The dilatation and curettage revealed endometrial adenocarcinoma. The patient underwent total abdominal hysterectomy with bilateral oophorectomy. The histologic examination showed an endometrioid endometrial adenocarcinoma that developed in atypical endometrial hyperplasia. The histologic examination of the right ovary revealed a sex cord tumor with annular tubules, measuring 3 cm. Sex cord tumors with annular tubules in patients with Peutz-Jeghers syndrome are usually small, bilateral tumors of the ovaries which have common characteristics with granulosa cell tumor and Sertoli cell tumor. Hyperestrogenism is a rather common finding with development of estrogen-dependent lesions.

Angiomyofibroblastoma is a rare benign distinctive mesenchymal tumor that occurs in the genital pelviperineal region, commonly the vulva and vagina. We report a case of angiomyofibroblastoma in a 42-year-old woman, presenting as a "cystic mass" located subcutaneously in the right labial area of the vulva. Recognition of this entity is based on specific histological and immunopathological features, and the correct treatment is important because of the aggressive behavior of other related mesenchymal tumors of the vulva and vagina, such as angiomyxoma and cellular angiofibroma.

We present the clinicopathological findings of a rare case of a monodermal teratoma of the right ovary with functional ovarian stroma and extensive decidualization in a 74-year-old woman. The patient presented with vaginal bleeding. Ultrasound scan revealed a pelvic mass measuring 9.5 cm in the lower right abdomen. A right oophorectomy was performed. The tumor was cystic and multilocular filled with colloid material. Histological examination revealed follicles of thyroid type, and stromal clusters of fusiform or polygonal cells were found in the stroma. An extensive decidual reaction was observed. Morphological and immunohistochemical examination of the tumor revealed cystic struma ovarii with functional ovarian stroma and ectopic decidua. Total abdominal hysterectomy with oophorectomy was performed. A benign endometrial polyp, proliferative endometrium, two fibroids, and an ovarian cyst were observed.

Clear cell cervical adenocarcinoma (CCA) is a rather rare malignancy of the genital tract. We report six cases of CCA, diagnosed in our laboratory during a 15-year period: five patients with sporadic primary CCA and one young patient with CCA and a history of in utero exposure to DES. The possible DES exposure, clinicopathological findings as well as the differential diagnosis and the the prognosis of such patients are presented in a mini-review of the literature.

The clinical and pathological characteristics of a rare granular cell tumor that developed in the vulva (4 cases) and the breast (1 case) offive women aged 35-52 years are reported. The differential diagnosis from skin carcinomas, melanoma and various soft tissue tumors is emphasized.

Pelvic exenteration is the only potentially curative surgical procedure for patients with recurrent cervical, vaginal, vulvar or rectal cancers, especially following adjuvant chemotherapy or radiotherapy. Morbidity rates, however, remain high, which is significantly attributed to complications of the pelvic floor reconstruction techniques. We describe a novel reconstruction technique of the pelvic floor, involving a combination of an oblique rectus abdominis myocutaneous flap and a synthetic absorbable mesh as a pelvic sling for additional support, in a 63-year-old female patient with recurrent vulvar carcinoma. Combining the use of myocutaneous flaps and prosthetic mesh material can provide an effective alternative solution to the complications arising from pelvic floor reconstruction of large defects after exenteration procedures, especially in previously irradiated settings. Further studies are necessary to define the long-term outcomes and indications of these techniques, as well as the optimal combination between the available myocutaneous flaps and prosthetic materials.

To further study the clinicopathologic and immunohistochemical features of ovarian granulosa cell tumors (GCTs).We retrospectively studied all cases of GCTs diagnosed in our laboratory over the last 10-year period. Immunohistochemistry for inhibin, vimentin, cytokeratin, Ki-67 and p53 was performed on archival paraffin blocks. Pathologic and immunohistochemical findings were correlated with the clinical records of the patients.Twenty-one cases (15 of the adult and 6 of the juvenile type) were retrieved. All patients were FIGO Stage I at the time of diagnosis. Recurrent disease was detected in four patients (19%) during a median follow-up of 36 months (range 2-26 years). Pathology revealed a concomitant theca-cell component in three cases, a Sertoli-Leydig component in one case, and a thecoma in one case. Archival tissue material was available in 12 cases. Immunohistochemistry was positive for: beta-inhibin in 12/12 cases (100%), vimentin in 11/12 cases (91.7%), cytokeratin in 3/12 cases (25%), CD34 in 0 cases (0%), and p53 in 2/12 cases (16.7%). The Ki-67 index was5% in 12/12 cases (100%). No significant correlations were observed between the pathologic and immunohistochemical parameters examined and the clinical outcome.Despite the relatively indolent nature and favorable prognosis of most GCTs, late recurrences are not a rare event even in Stage I patients, necessitating a close and long-term follow-up. The identification of novel prognostic markers, in addition to our traditional staging parameters such as clinical staging, is needed in order to more accurately predict probabilities of recurrence in these patients.

To further study the clinicopathologic features of carcinosarcomas of the uterus and ovary.We retrospectively studied all cases of uterine and ovarian carcinosarcomas diagnosed in our laboratory over the last 5-year period. The pathologic and immunohistochemical findings were correlated with the clinical records of the patients.Eleven cases were retrieved . The commonest presenting symptom was vaginal bleeding (9 cases, 81.8%). Most patients (8 cases, 72.7%) were submitted to total abdominal hysterectomy with bilateral salpingo-oophorectomy and adjuvant chemotherapy was administered to all of them. In the majority of cases the tumor was located in the uterine corpus (7 cases, 63.6%), followed by the ovary (4 cases, 36.4%). The tumor was homologous in ten cases (90.9%) and heterologous in one case (9.1%). Most of our patients (6 cases, 54.6%) were diagnosed at an advanced stage (FIGO Stage III or IV). The sarcomatous element was strongly positive for vimentin in all cases and focally positive for cytokeratin 7 in four cases, while the epithelial component showed a strong positivity for cytokeratin 7 and focal staining for vimentin, cytokeratin 20, CA-125 and CEA.Carcinosarcomas of the uterus and ovary are highly aggressive biphasic neoplasms with a prominent epithelial component. Their most common location is the uterine corpus. Although distant metastases are rarely found at the time of diagnosis, the prognosis of these tumors is unfavorable. The optimal chemotherapy remains to be determined.

Adnexal torsion is a rare cause of acute abdominal pain during pregnancy. It is frequently associated with ovarian stimulation for in vitro fertilization (IVF) or with ovarian masses, mainly of functional origin. The clinical, laboratory and imaging findings are non-specific. The authors present four cases with adnexal torsion diagnosed during the first trimester of pregnancy. The clinical picture, the mode of diagnosis, and the therapeutic approach are discussed. In two cases, the adnexa was removed, because there was extensive hemorrhage and ischemia. In the other two cases, unwinding of the adnexa was carried out and the ovary was preserved. The diagnosis of adnexal torsion is difficult, especially during pregnancy, and occasionally remains a diagnostic dilemma. It necessitates a prompt surgical intervention, because any delay leads to irreversible ovarian necrosis, so that adnexectomy is ultimately required.

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.

Granulosa cell tumors (GCTs) are rare functional sex cord-stromal ovarian tumors constituting approximately 2-3% of all ovarian malignancies. They are characterized by low malignant potential, local spread, late recurrence and high survival rates. We report a case of recurrent ovarian GCT in a 60-year-old woman 25 years after the initial diagnosis. The patient underwent surgical resection of the pelvic masses and refused to receive any adjuvant treatment, considering the late recurrence and high survival rates of this tumor. This case illustrates an example of a very late recurrence and emphasizes the importance of the extended follow-up required for these patients.

Cervical sarcomas are rare entities comprising 0.5% of all primary cervical malignancies. Endometrial stromal sarcoma (ESS) is the least common (10%) type of uterine sarcoma. It has traditionally been divided into two categories: low-grade stromal sarcoma (LGSS), which constitutes 50-60% of all ESS, and high-grade stromal sarcoma (HGSS). Low-grade ESS may arise in extrauterine locations, classically described as arising in foci of endometriosis. In our case, a 44-year-old woman presented with a 4-week history of abnormal vaginal secretions and occasional bleeding. Physical examination revealed a soft, hemorrhagic mass on the posterior cervix, approximately 7 x 4 x 3 cm, looking like a degenerated myoma. The patient underwent a radical hysterectomy with bilateral salpingo-oophorectomy and bilateral pelvic lymphadenectomy. Histopathological findings, including immunohistochemical study, led to the diagnosis of a LGSS of the endocervix, which was in close relation with endometriotic foci. Our case represents an extrauterine low-grade ESS arising in the endocervix, where a problem in the differential diagnosis was encountered and which was finally treated only with surgery. Adjuvant treatment of ESS is controversial. Generally, low-grade ESS is associated with good prognosis and long overall and disease-free survival.

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.

To date, the effects of freezing on spermatogenesis have not yet been fully investigated at a molecular level. Antibody localization studies have identified the MutL homolog 1 (MLH1) protein, a mis-match repair protein, at the prophase I stage of meiosis, which allows the detection of recombination foci during pachytene. This study investigated the effect of long-term testicular tissue cryopreservation on meiotic prophase I, identified by recombination foci frequency and synaptonemal complex (SC) integrity. Frozen–thawed testicular tissues from 12 males who had each fathered a child were used. Because vasectomy or reverse vasectomy procedures are rare in the locale of the investigation, it was not possible to obtain fresh testicular tissue and use the males as their own controls. Immunocytogenetic analysis of 612 spermatocytes at the pachytene stage was performed. The results indicated a mean number of MLH1 foci of 49.2 (SD ± 5.9), and no correlation was found between the freezing period, the MLH1 frequency and the SC integrity. The results suggest that freezing of testicular tissue taken post-puberty does not appear to be detrimental to the crossover process as identified by occurrence of MLH1 loci.

Ovarian cysts are the most frequent type of abdominal tumor, in female newborns. The most of the cases resolve spontaneously with no clinical significance. However, ovarian cysts often present complications such as torsion.The authors reviewed the pre- and postnatal records and ultrasonograms of five fetuses, who were diagnosed with ovarian cysts. No complication was observed prenatally. However, one infant 2 months after birth required surgical intervention because of cyst torsion. The cysts of the other four infants showed complete resolution in a time interval of 3-9 months.An ovarian cyst is not a life-threatening condition, so they should be just closely monitored pre- and postnatally until spontaneous resolution. When torsion of the cyst is suspected, surgical intervention is necessary.

Gestational choriocarcinoma usually arises in the uterine cavity and is associated with coincident or antecedent pregnancy. Extrauterine choriocarcinomas are very rare entities, and most of these are located in the uterine cervix. In our case, a 43-year-old woman was admitted in our hospital because she had amenorrhea for 2 months and elevated serum beta-human chorionic gonadotropin levels. The patient was considered to have an ectopic pregnancy. Initially, she was treated with methotrexate, but since there was a continuous rise in human chorionic gonadotropin levels, the patient underwent a laparoscopy, along with dilatation and curettage (D&C) of the uterine cavity. Histopathologic findings, including immunohistochemical study, led to the diagnosis of choriocarcinoma of the cervix. Finally, the patient underwent a transabdominal hysterectomy and received single agent chemotherapy with methotrexate. Our case represents a primary choriocarcinoma of the cervix, which was initially misdiagnosed as an ectopic pregnancy. The difficulties in differential diagnosis are discussed. Immunohistochemical evaluation remains the mainstay of the diagnosis in most cases. Choriocarcinoma has a very good prognosis even in advanced stages, since it is a very chemosensitive tumor.

Angiokeratomas are rare benign dermal lesions of the external genital system and occur before the age of 50 years. Four cases of angiokeratoma of the vulva diagnosed at our institution in a ten-year-period are reported and issues of the differential diagnosis are discussed.

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.

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.

Vascular lesions comprise benign and malignant neoplasms as well as non-neoplastic conditions that may be located in various sites but only rarely in the pelvis or the retroperitoneum. In our study we describe five diverse and unusual cases of vascular lesions of the pelvis, retroperitoneum and colon in female patients: a case of retroperitoneal angiosarcoma, pelvic hemangioendothelioma, pelvic angiomyxoma, retroperitoneal lymphangioleiomyomatosis and a case of diffuse cavernous hemangiomatosis of the colon, with emphasis on their clinicopathological features and differential diagnosis. The recent literature on the subject is also briefly reviewed.

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.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.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.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.

Two cases of squamous cell carcinoma developing in mature cystic teratoma and two cases with a malignant change involving an ovarian epidermal cyst diagnosed in our institution over a 15-year-period are reported. This is a reminder that such changes may occur and issues regarding the problem of the differential diagnosis and management of these rare complications are discussed.

Background. Juvenile granulosa cell tumors account for about 5% of all granulosa cell tumors and are diagnosed in nearly 80% of cases during the first two decades of life. Only 10% of granulosa cell tumors present during pregnancy. The incidence of ovarian malignancies during pregnancy varies from 0.05 to 0.07 per 1000 pregnancies. Case. A 31-year-old pregnant woman was admitted to our university hospital due to an adnexal mass, 9.5 cm in diameter, which was detected at 34 weeks of gestation. At 37 + 5 weeks of gestation, a cesarean section with right salpingo-oophorectomy and removal of the tumor was performed. Histopathological findings, including immunohistochemical study, led to the diagnosis of juvenile granulosa cell tumor (JGCT). Conclusion. The histological features and the differential diagnosis of the JGCT are discussed. The optimal management of such adnexal masses during pregnancy is also discussed. A JGCT that is confined to the ovary appears to have an excellent prognosis and can be treated by unilateral salpingo-oophorectomy.

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.

Women with scleroderma who become pregnant have an increased incidence of perinatal loss, premature birth, and growth restriction [1]. Placental abnormalities, including acute atherosis, infarcts, and other manifestations of reduced placental blood flow, are found in many cases of collagen vascular disease [2]. A 27-year-old woman (gravida 1) with scleroderma was admitted to hospital at 31 weeks of gestation with uterine contractions and intrauterine growth restriction (IUGR). Scleroderma was diagnosed 2 years previously and she was treated with penicillamine (250 mg per day). Antitopoisomerase I (anti-Scl-70) and anti-nuclear antibodies were positive. Doppler examination revealed IUGR and increased resistance index in the umbilical artery (pulsatility index (PI), 1.24). At 37 weeks of gestation she underwent a cesarean delivery; the 1860 g female infant developed necrotic enterocolitis after 4 days. Three days postpartum the patient developed elevated blood pressure (170/100 mm Hg), mild proteinuria (280 mg/ 24 h), with normal serum creatinine level and liver function tests, but reduced creatinine clearance (70 mL/min). Renal crisis episode and pre-eclampsia were included in the differential diagnosis. In order to control hypertension, an angiotensin-converting enzyme (ACE) inhibitor was used. On discharge from hospital the patient had normal blood pressure and normal renal function. At histopathology examination the placenta weighed 395 g and measured 16×9×4 cm. The umbilical cord presented eccentric insertion and was 38 cm in length and 1.2 cm in diameter. It contained 3 vessels. More than 5 placental infarcts were identified (measuring 1–3 cm). Histological examination of multiple sections (15) showed old placental infarcts and changes consistent with placental mesenchymal dysplasia (PMD, Fig. 1a), decidual vasculopathy (Fig. 1b), foci of decreased vascularity, foci of chorioangiosis, stromal fibrosis of villi, and extensive fibrinoid deposition on the villi. Focal

174 Expression of Angiopoietin-2 and Endostatin in Intrauterine Growth Restriction During The Perinatal Period

Background: Vascular endothelial growth factor (VEGF) and placenta growth factor (PlGF) are expressed, among other organs, in the placenta and play cardinal roles in angiogenesis. Production of VEGF, in contrast to PlGF, is enhanced by hypoxia, which is present in intrauterine growth restriction (IUGR) pregnancies. This study aimed at investigating circulating VEGF and PlGF levels in maternal blood (MS) during the first stage of labor, in the doubly clamped umbilical cord (UC) at delivery, representing fetal state and in the neonate in the first (N1) and fourth (N4) day of life, reflecting transition and stabilization to extrauterine life, respectively. Methods: VEGF and PlGF were determined by enzyme immunoassay methods in serum, deriving from 15 fullterm appropriate for gestational age (AGA) and 15 fullterm IUGR infants, as well as from their mothers. Results: Statistical significant difference was noted in MS PlGF, being lower in IUGR as compared to AGA cases (p=0.014). Statistical significant correlations existed for VEGF between: UC and N1 (p=0.04), UC and N4 (p=0.011) and N1 and N4 (p=0.009) and for PlGF between N1 and N4 (p=0.018). In the IUGR group variables presenting a statistically significant association with: a) MS VEGF, were placental weight (p=0.031) and birth length (p=0.049), b) UC VEGF, was placental weight (p=0.016), c) N4 VEGF, were gestational age (p=0.028) and birth weight (p=0.026), d) UC PlGF, was head circumferance (p=0.036), e) N1 PlGF, was birth weight (p=0.023), f) N4 PlGF, was gestational age (p=0.011) and birth length (p=0.040). Conclusion: Low MS PlGF was associated with IUGR, while no differences were found between IUGR and AGA fetuses and neonates concerning PlGF and VEGF circulating levels. In IUGR fetuses VEGF is associated with placental weight, while in IUGR newborns with gestational age and birth weight. Similarly, PlGF in IUGR newborns is associated with gestational age and birth weight, in general reflecting the implication of angiogenic factors in angiogenesis and tissue growth.