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Influenza is associated with an increased risk for serious illness, hospitalization and/or death in pregnant women and young infants. We prospectively studied the effectiveness of a quadrivalent inactivated influenza vaccine (QIV) in pregnant women and their infants during the 2018-2019 influenza season. A QIV was offered to pregnant women cared in a maternity hospital in Athens. Women were contacted weekly by telephone during the influenza season and PCR test was offered to women or infants who developed influenza-like illness (ILI). We studied 423 pregnant women and 446 infants. Unvaccinated pregnant women had a 7.5% probability to develop laboratory-confirmed influenza compared to 2.1% among vaccinated women (Odds ratio: 3.6; confidence intervals: 1.14-11.34, p-value = 0.029). Infants whose mothers were not vaccinated had a 7.9% probability to develop laboratory-confirmed influenza compared to 2.8% among infants of vaccinated mothers (Odds ratio = 2.849, confidence intervals: 0.892-9.102, p-value = 0.053). Cox regression analyses showed that QIV vaccination was significantly associated with a decreased probability for laboratory-confirmed influenza, ILI, healthcare seeking and hospitalization among pregnant women and a decreased probability for laboratory-confirmed influenza, healthcare seeking and prescription of antibiotics among infants. The effectiveness of QIV against laboratory-confirmed influenza was 72% among pregnant women and 64.5% among infants during the 2018-2019 influenza season. Vaccination of pregnant women with the QIV was associated with a lower risk for laboratory-confirmed influenza for them and their infants during the influenza season. Our findings strongly support the World Health Organization recommendations for vaccinating pregnant women against influenza.

Objective to evaluate the effect of the addition of low dose human chorionic gonadotropin (hCG) to human menopausal gonadotropin (HMG) throughout the early follicular phase in controlled ovarian stimulation (COS) conducted with two difference regimens. Gonadotropin-releasing hormone (GnRH) antagonist and short GnRH-agonist protocol were applied in two in vitro fertilization (IVF) clinics. Methods Clinical study conducted during the period 2014–2016 in two IVF clinics in a cohort of 240 women. In the first group 1 (124 women), a GnRH antagonist protocol with HMG and addition of low dose (100IU/day) h CG was applied. The other group 2 consisted of 116 women who underwent a short GnRH- agonist protocol with HMG and addition of low dose (100 IU/day) h CG. Results Multiple logistic regression analysis was performed. The group 2 found to be associated with greater number of follicles and oocytes. The pregnancy rates were 12.1% and 26.7% in group 1 and group 2, respectively (p = 0.004). For patients over 40 years, the number of follicles and oocytes retrieved were significant higher in group 2.The pregnancy rate in group 2 was higher than in group 1 (21, 6% vs 5%, p = 0.017). Conclusions Advanced age women are likely to achievepregnancy using the GnRH Short than GnRH antagonist, when HMG/hCG is used, while HMG–hCG gonadotropins have the same potentialas Recombinant follicle stimulating hormone (rFSH)–hCG used in GnRH short protocol.

Highlights • The association of LCIS with total metastatic LBC is very rare, presented in mammography as microcalcifications or focal asymmetric densities. • Normal or benign mammographic findings are more frequently reported with ILC than other invasive breast cancers. • LCIS is treated as a benign entity with an associated risk for a future developing carcinoma., Introduction Lobular breast carcinoma includes lobular carcinoma in situ (LCIS) and invasive lobular carcinoma (ILC). The association of LCIS with total metastatic lobular breast cancer is very rare. Presentation of case We present a case of a totally metastatic lobular breast cancer in an asymptomatic 64-year-old postmenopausal woman, with no suspicious microcalcifications in mammography. A total hysterectomy with bilateral salpingo-oophorectomy, pelvic lymphadenectomy, infracolic omentectomy and appendectomy was performed along with a quadrantectomy of the upper outer quadrant of left breast, and systematic isolateral lymphadenectomy of the left axilla. Discussion LCIS is usually undetectable because it isn’t associated with clinical abnormalities in clinical examination and is presented in mammography as microcalcifications or focal asymmetric densities. ILC histopathologic features are responsible for the high false-negative rates on mammography, leading to moderate detection sensitivity. Conclusion Our case is a very rare condition. No ‘similar’ case have been described in the literature so far.

Highlights • The median age between BRCA results receipt and RRSO should be reconsidered. • Occasionally, no correlation exists between tumor size, malignancy or metastasis. • Initial total excision of the mass, ensure the positive histological diagnosis., Introduction BRCA1 inherited mutation carriers face a lifetime risk of 72% to develop breast cancer and a percentage of 44% risk for ovarian cancer. Presentation of case We present a case of a 35-year old Caucasian woman who, after the excision of a possible malignant finding on the right breast, was diagnosed with ductal breast carcinoma. The patient treatment included first chemotherapy and radiotherapy and then prophylactic bilateral mastectomy with plastic reconstructive surgery. At the age of 37, she underwent prophylactic laparoscopic bilateral salpingoophorectomy. The histological diagnosis of the surgical specimens was suggestive of a unilateral invasive high grade salpingeal cancer and the patient underwent an abdominal hysterectomy by laparotomy, omentectomy and bilateral pelvic lymphadenectomy. Discussion Women with known BRCA mutations are strongly recommended to consider a risk reducing prophylactic salpingoophorectomy (RRSO) from their early 40 s to gain maximum benefit in cancer risk reduction from the procedure. The prevalence of occult carcinomas in BRCA1 carriers is almost 1, 5% if the prophylactic bilateral salpingoophorectomy is performed before the age of 40, while this percentage may be increased to 3, 8% for women who undergo the surgery between 40 and 49 years. Conclusion We present an interesting case, of an accidentally revealed salpingeal carcinoma via RRSO in an asymptomatic young premenopausal woman.

Highlights • Giant juvenile fibroadenomas are very rare and they have very low prevalence in prepubertal period. Although they should not be ruled out in differential diagnosis in premenarchal period. • Breast examination in premenarchal girls and adolescents plays a pivotal role in order to prevent these peculiar giant lesions. • Another remarkable point is the rapid growth of these breast lesions that should not be ruled out in the diagnostic process of the continuously growth of the adolescent breast., Introduction Giant juvenile fibroadenomas represent only the 0.5% of all fibroadenomas, constituting a rare condition in adolescence. In prepuberty, the presence of this condition is extremely rare. Presentation of case We describe a rare case of a 12- year-old Caucasian girl who presented to our Hospital complaining of a palpable mass with rapid enlargement in her right breast that she had first noticed 3 months ago. Her menarche hadn’t occurred yet. Discussion Physical examination showed a giant mass of 15 × 13 cm in the right breast. The patient was further evaluated via ultrasonography showing a sole large lesion of 13 × 12 cm in the right breast. A surgical procedure under general anesthesia was performed. Histopathological findings after the surgical excision were suggestive of giant juvenile fibroadenoma. The patient has a normal breast development over a period of 9 month follow up. Conclusion Giant juvenile fibroadenomas should be included in differential diagnosis of a breast mass in prepubertal girls despite the fact that they are very rare in prepuberty, tend to appear later during adolescence and their prevalence is lower in Caucasians. The remarkable size and the rapid growth of the lesion should not be ruled out in the diagnostic process of an adolescent breast.

Highlights • BML is a rare entity that usually affects women after hysterectomy for leiomyomas. • This is one of few reports in literature of tumors’ appearance in the same patient both in estrogen rich and poor environment. • Τransvaginal ultrasonography seems to be a pivotal tool for the diagnosis and follow up of these challenging lesions., Introduction Benign metastasizing leiomyomas represent benign lesions consisted by leiomatosous tissue and could be observed in positions away from their usual localization, the human uterus. They commonly affect women that have undergone total hysterectomy. Approximately 100 similar cases have been reported in the literature, so the case we present is rare and reviewing the literature and needs to be reported. Presentation of case We report a case of a 55 year old Greek woman, gravida five and para three, who attended our unit 3 years ago complaining of occasionally lower abdominal pain and irritation the last months. Fourteen years ago she underwent abdominal hysterectomy and left salpingo-oophorectomy due to a 13 cm uterine leiomyoma. In the meantime she underwent two surgical procedures for recurrent benign leiomyomas. Discussion When patient was admitted at this time, clinical examination revealed a palpable mass of 5 cm. The transvaginal ultrasonography revealed 3 masses in the lower pelvis of unknown origin. The patient underwent a new laparotomy revealing three masses of benign leiomyomas with low mitotic activity. Conclusion Our case supports the recurrent appearance of leiomyomas in pelvis after total abdominal hysterectomy and is one of few reports in literature where the tumors appear in the same patient both in estrogen rich and estrogen poor environment. Additionally, we show the importance of transvaginal ultrasonography and 3 dimensional power Doppler in the differential diagnosis of pelvic masses. Thus, transvaginal ultrasonography seems to be a pivotal tool for the diagnosis and follow up of these challenging lesions.

Background Mesenteric cyst is a rare clinical entity especially in pregnancy; therefore, few cases have been reported in the literature. The standard method of their treatment is surgical excision either with laparotomy or laparoscopy. In addition, mesenteric vein thrombosis is a rare and life-threatening condition in pregnancy and needs immediate treatment because it can lead to intestinal necrotic ischemia. This is the first report of the coexistence of mesenteric cysts and mesenteric vein thrombosis during gestation. Case presentation A 27-year-old Greek woman, gravida 2 para 1, presented at 10 weeks’ gestation to the Emergency Unit of our hospital complaining of diffuse abdominal pain which deteriorated the last 3 days, which was localized in her right iliac fossa, along with vomiting. She had undergone open laparotomy and right salpingo-oophorectomy at the age of 23 due to an ovarian cyst. Besides this, her personal and family medical history was unremarkable. She had never received oral contraceptives or any hormone therapy. On arrival, a clinical examination revealed tenderness on palpation of her right iliac fossa, without rebound tenderness or muscle guarding. Within 10 hours of hospitalization, her symptoms deteriorated further with rebound tenderness during the examination, tachycardia, and a drop of 12 units in her hematocrit value. An emergency laparotomy was performed. Two mesenteric cysts and a 60 cm necrotic part of her intestine were revealed intraoperatively. In the postoperative period, she complained of acute abdominal pain, tachycardia, and dyspnea. Computed tomography imaging revealed mesenteric vein thrombosis and pulmonary thromboembolism. She was treated with low molecular weight heparin and she was discharged on the 11th postoperative day. Conclusions To the best of our knowledge, this is the first report in the literature of a simultaneous mesenteric cyst and mesenteric vein thrombosis in pregnancy. It is known that pregnancy is a state of hypercoagulation and clinicians should bear in mind this rare clinical condition in their diagnostic algorithm for acute abdominal pain.

Background: Ovarian hyper stimulation syndrome is an iatrogenic serious complication that presents after human chorionic gonadotropin stimulation or after the spontaneous peak of luteizing hormone. Pelvic inflammatory disease following the in vitro fertilization and oocyte retrieval is a rare and infrequent complication. Tubo-ovarian abscess has been described as rare and significant complication .We present an uncommon case according the literature in which rare complications of IVF are described. Methods: We present a case of a 35 year old female patient, gravida 1, para 0 with history of in vitro fertilization short protocol and oocytes retrieval before a month ,attended our hospital complaining for deep abdominal pain since 8 days with significant gynecological past history. Clinical evaluation proved abdominal pain on palpation without fever. Serum levels of C-reactive protein were significantly elevated reaching the plateau of 320,943. Results: Transvaginal ultrasonography noticed the presence of a big left adnexal formation max diameter 18 cm that could be attributed to marked inflammation. Behind this, free fluid detected by the presence of adhesions that could be attributed to hydrosalpinx. The diagnosis of ovarian hyper stimulation syndrome followed by pelvic inflammatory disease was made and she hospitalized for 10 days. The patient came to our hospital 3 months later for her follow up and the transvaginal examination revealed left tubo-ovarian abscess. A new transvaginal ultrasonography after 3 months was clearly improved compared to the previous images. Conclusion: Ovarian hyper stimulation syndrome which is complicated with pelvic inflammatory disease and especially pelvic abscess after in vitro fertilization and oocyte retrieval guided by ultrasound is a rare and simultaneously significant complication. Transvaginal ultrasonographical examination seems to be a pivotal tool primarily for the diagnosis and secondarily for the follow up of these infertile women.

with specific tumor markers .So, tumor markers Ca 15-3, Ca19-9, Ca 125, and CEA were fluctuated in normal ranges. Serum levels of alphafetoprotein (a-FP) were significantly elevated reaching the plateau of 392 iu/ ml (normal ranges