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Tympa A, Grigoriadis C. 106 Pregnancy in women with multiple genitourinary anomalies: High incidence of adverse perinatal outcome? Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tympa A, Grigoriadis C, Terzakis E, Goudeli C, Melemeni A. Leiomyoma of the uterine round ligament: A case report. Exp Ther Med 2021; 22:1285. [PMID: 34630640 PMCID: PMC8461511 DOI: 10.3892/etm.2021.10720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/06/2021] [Indexed: 12/02/2022] Open
Abstract
Leiomyomas are common benign tumours that can arise in any anatomical structure containing smooth muscle. Their localization in the uterine round ligament is rare, although leiomyomas are the most frequent tumour of this structure. Leiomyomas present as inguinal, labial or intra-abdominal masses, and are often misdiagnosed as hernias or enlarged lymph nodes. The aim of the present study was to describe a rare case of a large intra-abdominal mesenchymal neoplasm arising from the right round ligament of the uterus. A 51-year-old asymptomatic female patient (gravida 3, para 3) presented herself for a routine gynaecological examination. A transvaginal ultrasound examination revealed a solid heterogeneous mass with a maximum diameter of 9 cm localized at the right parametrial space. Further preoperative evaluation using magnetic resonance imaging revealed that the mass contained solid and cystic components, which was suggestive of a mesenchymal neoplasm with possible involvement of the right ovary. Complete excision of the tumour and total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed via laparotomy under general anaesthesia. The intraoperative findings, frozen section biopsies and final histological examination of the tumour established the diagnosis of an intra-abdominal myoma of the right uterine round ligament. The majority of abdominal round ligament myomas are initially asymptomatic. The role of synchronous imaging examinations, such as ultrasonography and magnetic resonance imaging, in the diagnosis of these lesions is crucial.
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Affiliation(s)
- Aliki Tympa
- First Department of Anaesthesiology, Aretaieion Hospital, University of Athens, Medical School, Athens 11528, Greece
| | | | - Emmanouil Terzakis
- Department of Obstetrics and Gynaecology, Leto Maternity Hospital, Athens 11524, Greece
| | - Christina Goudeli
- Department of Obstetrics and Gynaecology, Leto Maternity Hospital, Athens 11524, Greece
| | - Aikaterini Melemeni
- First Department of Anaesthesiology, Aretaieion Hospital, University of Athens, Medical School, Athens 11528, Greece
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Tympa A, Grigoriadis C, Theodoraki K, Vassiliou I. Abdominal cystic lymphangioma mimicking ovarian mass: A case report and literature review. Mol Clin Oncol 2020; 14:43. [PMID: 33437481 PMCID: PMC7788561 DOI: 10.3892/mco.2020.2202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 12/17/2020] [Indexed: 11/11/2022] Open
Abstract
Cystic lymphangiomas are uncommon benign lesions extremely rare in the adult population. Most cases are found in the neck and axillary regions; while <1% of patients present with cystic lymphangiomas in the mesentery, greater omentum and retroperitoneum. The present report describes a rare case of large omental lymphangioma mimicking ovarian mass. A 40-year-old G2P2 female patient presented without symptoms for routine gynecological examination. Transvaginal ultrasound examination revealed a cystic mass with a maximum diameter of 10 cm localized at the right parametrium space, suggestive of large cystic lesion of the right ovary. Further preoperative evaluation by magnetic resonance imaging indicated that the mass was either cystic lymphangioma or mesenteric cyst. Complete excision of the cyst without need for gastrectomy was performed via laparotomy under general anaesthesia. Histology revealed omental lymphangioma. Most abdominal lymphangiomas are initially asymptomatic. The role of synchronous imaging examinations, such as ultrasonography and magnetic resonance imaging, in diagnosis of these lesions is crucial. Full preoperative differential diagnosis evaluation in cases of large intraabdominal lesions is required in order to decide the appropriate surgical approach and management.
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Affiliation(s)
- Aliki Tympa
- First Department of Anesthesiology, Aretaieion Hospital, Medical School, University of Athens, Athens 11528, Greece
| | | | - Kassiani Theodoraki
- First Department of Anesthesiology, Aretaieion Hospital, Medical School, University of Athens, Athens 11528, Greece
| | - Ioannis Vassiliou
- Second Department of Surgery, Aretaieion Hospital, Medical School, University of Athens, Athens 11528, Greece
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Grigoriadis C, Tympa A, Delivoria V. Transplacental therapy of fetal supraventricular tachycardia: Maternal and neonatal outcome. Eur J Obstet Gynecol Reprod Biol 2019. [DOI: 10.1016/j.ejogrb.2018.08.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Grigoriadis C, Tympa A, Delivoria V, Baka S, Theodoraki K. Long-term steroid treatment: a potential risk factor for uterine rupture during pregnancy? G Chir 2019; 40:112-114. [PMID: 31131809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIM Uterine rupture during pregnancy is a rare but life threatening event in Obstetrics, with potentially catastrophic consequences for both the fetus and the mother. There are few published case reports that investigate the possible association between long-term steroid treatment and uterine rupture during the antenatal period. CASE REPORT A 33-year-old G2P1 woman with obstetrical history of one previous transverse low-segment caesarean section presented at the 30th week of gestation with severe abdominal pain which started spontaneously one hour before. She had medical history of pemphigus under long-term treatment with prednisolone. Clinical examination showed acute abdomen while the fetus developed heart rate decelerations. Emergency caesarean section via Pfannenstiel incision under general anaesthesia was performed. Uterine rupture was recognised with localization not at the scar of the previous caesarean section but at the left posterolateral site of the uterine fundus. A healthy premature male infant with an excellent Apgar score and weight of 1510 gr. was delivered by a low-segment caesarean section. Surgical repair of the site of the rupture with isolated sutures followed. There was no need for hysterectomy as hemorrhage was controlled and hemodynamic stability of the woman was restored. DISCUSSION Uterine rupture should be included in the differential diagnosis by all obstetricians not only during labour but in acute abdominal pain during the antenatal period as well.
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Gerolymatos G, Karlovasiti P, Sianou A, Logothetis E, Kaparos G, Grigoriadis C, Baka S. Antenatal group B streptococcus detection in pregnant women: culture or PCR? J Infect Dev Ctries 2018; 12:631-635. [PMID: 31958325 DOI: 10.3855/jidc.10367] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/29/2018] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Group B streptococcus (GBS) is an important cause of neonatal infections. Maternal GBS colonization screening and intrapartum antimicrobial prophylaxis of colonized women can prevent neonatal diseases. The aim of this study was to assess the prevalence of GBS colonization in pregnant and non-pregnant women and to compare the performance of a polymerase chain reaction (PCR) assay with the established as gold standard technique, culture method, used for the detection of this microorganism. METHODOLOGY Vaginal and rectal samples collected from 857 pregnant and 370 non-pregnant women were examined through cultures, while the samples collected from 452 pregnant women between 35 and 37 weeks of gestation were assayed by culture and PCR method targeting the cfb gene. RESULTS GBS colonization was present in both pregnant and non-pregnant women. The colonization rate was similar in non-pregnant and first trimester pregnant women and then increased from first to the third trimester of pregnancy. GBS cultures for vaginal and rectal samples were positive in 13.2% and 14.3% in non-pregnant women, while in pregnant women 13.2% and 13.7% in the first trimester, and 15.0% and 16.5% in the second trimester, respectively. In third trimester pregnant women, compared to culture method, PCR identified a significantly increased number of GBS positive vaginal (18.4% vs 22.6%, p = 0.0006) and rectal (18.1% vs 21.2%, p = 0.01) samples. CONCLUSIONS GBS colonization rate was higher in the third trimester. PCR proved to be a rapid and useful GBS screening method allowing a shorter detection time, while identifying more colonized women than culture.
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Affiliation(s)
| | | | - Argiri Sianou
- National and Kapodistrian University of Athens, Athens, Greece.
| | | | - George Kaparos
- National and Kapodistrian University of Athens, Athens, Greece.
| | | | - Stavroula Baka
- National and Kapodistrian University of Athens, Athens, Greece.
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Grigoriadis C, Tympa A, Terzakis E, Theodoraki K, Hassiakos D. Surgical management of complex atypical endometrial hyperplasia in a woman with rare genitourinary anomalies: unicornuate uterus with rudimentary horn, ipsilateral ectopic ovary and pelvic kidney. G Chir 2018; 39:245-247. [PMID: 30039793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM According to the so far published literature, only one case of endometrial cancer in a patient with unicornuate uterus has been reported. This is a case report study, presenting a rare case of complex atypical endometrial hyperplasia in a woman with unicornuate uterus and multiple genitourinary anomalies. CASE REPORT A 43-year old G1P1 woman presented with episodes of menometrorrhagia and anemia. She had previous surgical history of laparoscopy due to infertility, in which she was diagnosed with unicornuate uterus with a rudimentary left uterine horn and ipsilateral ectopic ovary in the anatomic place of the left kidney. Dilatation and curettage was performed. Histology showed complex atypical endometrial hyperplasia. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, in an extremely interesting operation due to the multiple genitourinary anomalies. The uterus with a 6-centimeter uterine myoma and the adnexae were removed en block. Great effort was put into dissecting the left fallopian tube which arised from the cervix and via the rudimentary horn led to the left ectopic ovary that was located at the left kidneys' anatomic space. The patient recovered well and final histology was negative for malignancy. DISCUSSION All necessary imaging examinations have to be scheduled prior to surgical intervention in order to give valuable anatomic information in cases of women diagnosed with Mullerian abnormalities.
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Grigoriadis C, Tympa A, Chasiakou A, Baka S, Botsis D, Hassiakos D. Bilateral primary ovarian non-Hodgkin's lymphoma and fertility preservation: 5-year follow-up. G Chir 2017; 38:77-79. [PMID: 28691671 DOI: 10.11138/gchir/2017.38.2.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM Primary ovarian non-Hodgkin's lymphoma is a very rare disease. Median age at diagnosis is estimated at 42 years, something that leads to fertility preservation issues in many cases. This was a case report study, presenting a rare case of bilateral primary ovarian non-Hodgkin's lymphoma. CASE REPORT A 38-year old nulliparous woman, underwent exploratory laparotomy because of bilateral ovarian masses. Left salpingooophorectomy, partial omentectomy and excision of an ovarian mass of the right ovary was performed. Great effort in order to preserve healthy ovarian tissue of the right ovary as well as the right fallopian tube was given, due to fertility reasons. Final histology showed bilateral diffuse large B-cell primary ovarian non-Hodgkin's lymphoma. Postoperatively, the patient underwent chemotherapy with the CHOP regimen in combination with rituximab. Five years after initial diagnosis, the patient remains well with normal menstrual cycle, without evidence of recurrence. DISCUSSION Fertility preservation issues in some cases of rare gynecological malignancies could be managed via minimally invasive oncological approach.
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Grigoriadis C, Tympa A, Chasiakou A, Kondi-Pafiti A, Liapis I, Botsis D, Liapis A. Immunohistochemical analysis of collagen types I, III, matrix metalloproteinases-1, -9, and gonadal steroid receptors alterations on the pathophysiology of female pelvic organ prolapse and urinary incontinence. Maturitas 2017. [DOI: 10.1016/j.maturitas.2017.03.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Karachalios C, Bakas P, Kaparos G, Demeridou S, Liapis I, Grigoriadis C, Liapis A. Matrix metalloproteinase-3 gene promoter polymorphisms: A potential risk factor for pelvic organ prolapse. Biomed Rep 2016; 5:337-343. [PMID: 27588175 PMCID: PMC4997987 DOI: 10.3892/br.2016.736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 07/13/2016] [Indexed: 01/02/2023] Open
Abstract
Pelvic organ prolapse (POP) is a common multifactorial condition. Matrix metalloproteinases (MMPs) are enzymes capable of breaking down various connective tissue elements. Single-nucleotide polymorphisms (SNPs) in regulatory areas of MMP-encoding genes can alter their transcription rate, and therefore the possible effect on pelvic floor supporting structures. The insertion of an adenine (A) base in the promoter of the MMP-3 gene at position -1612/-1617 produces a sequence of six adenines (6A), whereas the other allele has five (5A). The aim of the present study was to investigate the possible association of MMP-3 gene promoter SNPs with the risk of POP. The patient group comprised 80 women with clinically significant POP [Stage II, III or IV; POP quantification (POP-Q) system]. The control group consisted of 80 females without any or important pelvic floor support defects (Stages 0 or I; POP-Q system). All the participants underwent the same preoperative evaluation. SNP detection was determined with whole blood sample DNA analysis by quantitative polymerase chain reaction (PCR) in LightCycler® PCR platforms, using the technique of sequence-specific hybridization probe-binding assays and melting temperature curve analysis. The results showed there was no statistically significant difference between 5A/5A, 5A/6A and 6A/6A MMP-3 gene promoter variants in the two study groups (P=0.4758). Therefore, MMP-3 gene promoter SNPs alone is insufficient to increase the genetic susceptibility to POP development.
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Affiliation(s)
- Charalampos Karachalios
- Second Department of Obstetrics and Gynecology, Aretaieio University Hospital, National and Kapodistrian University of Athens, Medical School, Athens 11528, Greece
| | - Panagiotis Bakas
- Second Department of Obstetrics and Gynecology, Aretaieio University Hospital, National and Kapodistrian University of Athens, Medical School, Athens 11528, Greece
| | - Georgios Kaparos
- Department of Biopathology, Aretaieio University Hospital, National and Kapodistrian University of Athens, Medical School, Athens 11528, Greece
| | - Styliani Demeridou
- Department of Biopathology, Aretaieio University Hospital, National and Kapodistrian University of Athens, Medical School, Athens 11528, Greece
| | - Ilias Liapis
- Second Department of Obstetrics and Gynecology, Aretaieio University Hospital, National and Kapodistrian University of Athens, Medical School, Athens 11528, Greece
| | - Charalampos Grigoriadis
- Second Department of Obstetrics and Gynecology, Aretaieio University Hospital, National and Kapodistrian University of Athens, Medical School, Athens 11528, Greece
| | - Aggelos Liapis
- Second Department of Obstetrics and Gynecology, Aretaieio University Hospital, National and Kapodistrian University of Athens, Medical School, Athens 11528, Greece
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Grigoriadis C, Tympa A, Theodoraki K. Cystic fibrosis and pregnancy: counseling, obstetrical management and perinatal outcome. Invest Clin 2015; 56:66-73. [PMID: 25920187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The progress in research of in vitro fertilization and fetal-maternal medicine allows more women and men, with fertility problems due to cystic fibrosis, to have a baby. In the majority of cases, pregnancy in women with cystic fibrosis results in favorable maternal and fetal outcomes. However, the incidence of preterm delivery, intrauterine growth restriction, caesarean section and deterioration of the maternal health are increased. Pre-pregnancy counseling is a crucial component of overall obstetric care, especially in women with poor pulmonary function. Additionally, closer monitoring during pregnancy with a multidisciplinary approach is required. The value of serial ultrasound scans and fetal Doppler assessment is important for the control of maternal and fetal wellbeing, as well as for the definition of the appropriate timing of delivery. In this article, clinical issues of pregnant women with cystic fibrosis are reviewed; counseling, obstetrical management and perinatal outcomes are being discussed.
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Vrachnis N, Grigoriadis C, Siristatidis C, Vlachadis N, Balakitsas N, Mastorakos G, Iliodromiti Z. The Janus face of maternal serum relaxin: a facilitator of birth, might it also induce preterm birth? J Matern Fetal Neonatal Med 2014; 28:2187-91. [PMID: 25363010 DOI: 10.3109/14767058.2014.981804] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Preterm birth is a major cause of neonatal morbidity and mortality in the developed world. In order to better understand the pathophysiological pathway of this condition, the role of genetic factors and/or inflammation-associated molecules, as well as of socioeconomic parameters, is therefore under intense investigation. The purpose of this review study was to examine the potential role of maternal serum relaxin levels in the etiology of preterm birth. METHODS Electronic databases (Pubmed, Embase, Cochrane Library) were searched for previously published research studies that investigated the biological role of relaxin and the mechanisms in which this hormone is involved during pregnancy and labor. RESULTS It is evident that while relaxin is an essential endometrial/decidual angiogentic factor playing a vital role in maternal accommodation of pregnancy, elevated levels of this hormone could well be associated with preterm birth. CONCLUSIONS There are strong indications that maternal serum hyperrelaxinemia correlates with an increased risk of preterm birth.
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Affiliation(s)
- Nikolaos Vrachnis
- a 2nd Department of Obstetrics and Gynecology , Medical School, Aretaieion Hospital and
| | | | - Charalampos Siristatidis
- b 3rd Department of Obstetrics and Gynecology , Medical School, Attiko Hospital, University of Athens , Athens , Greece
| | - Nikolaos Vlachadis
- a 2nd Department of Obstetrics and Gynecology , Medical School, Aretaieion Hospital and
| | - Nikolaos Balakitsas
- a 2nd Department of Obstetrics and Gynecology , Medical School, Aretaieion Hospital and
| | - George Mastorakos
- a 2nd Department of Obstetrics and Gynecology , Medical School, Aretaieion Hospital and
| | - Zoe Iliodromiti
- a 2nd Department of Obstetrics and Gynecology , Medical School, Aretaieion Hospital and
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Bakas P, Hassiakos D, Grigoriadis C, Vlahos NF, Liapis A, Creatsas G. Effect of a low dose combined oral contraceptive pill on the hormonal profile and cycle outcome following COS with a GnRH antagonist protocol in women over 35 years old. Gynecol Endocrinol 2014; 30:825-9. [PMID: 24954511 DOI: 10.3109/09513590.2014.932343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This prospective study examines if pre-treatment with two different doses of an oral contraceptive pill (OCP) modifies significantly the hormonal profile and/or the IVF/ICSI outcome following COS with a GnRH antagonist protocol. Infertile patients were allocated to receive either OCP containing 0.03 mg of ethinylestradiol and 3 mg of drospirenone, or OCP containing 0.02 mg of ethinylestradiol and 3 mg of drospirenone prior to initiation of controlled ovarian stimulation (COS) with recombinant gonadotropins on a variable multi-dose antagonist protocol (Ganirelix), while the control group underwent COS without OCP pretreatment. Lower dose OCP was associated with recovery of FSH on day 3 instead of day 5, but the synchronization of the follicular cohort, the number of retrieved oocytes and the clinical pregnancy rate were similar to higher dose OCP.
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Affiliation(s)
- Panagiotis Bakas
- 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, University of Athens , Greece
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Grigoriadis C, Androutsopoulos G, Zygouris D, Arnogiannaki N, Terzakis E. Uterine angioleiomyoma causing severe abnormal uterine bleeding. CLIN EXP OBSTET GYN 2014. [DOI: 10.12891/ceog16122014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Grigoriadis C, Androutsopoulos G, Zygouris D, Arnogiannaki N, Terzakis E. Uterine angioleiomyoma causing severe abnormal uterine bleeding. CLIN EXP OBSTET GYN 2014; 41:102-104. [PMID: 24707699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Angioleiomyoma or angiomyoma or vascular leiomyoma is an unusual benign mesenchymal neoplasm. The authors present a rare case of large uterine angioleiomyoma causing severe abnormal uterine bleeding. CASE The patient, a 53-year-old, gravida 2, para 2, premenopausal Greek woman presented with a complaint of severe abnormal uterine bleeding. On gynecologic examination there was a palpable pelvic mass. Preoperative computer tomography (CT) of the abdomen and pelvis revealed an intra-abdominal mass 25 x 15 cm with abnormally increased vascularization. She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, total omentectomy and elective pelvic lymph node dissection. Histopathology revealed uterine angioleiomyoma. Follow up 84 months after initial surgery showed no evidence of recurrence. CONCLUSION Despite the type of surgery, patients with uterine angioleiomyoma have very low risk of recurrence and excellent prognosis.
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Grigoriadis C, Tympa A, Creatsa M, Bakas P, Liapis A, Kondi-Pafiti A, Creatsas G. Hofbauer cells morphology and density in placentas from normal and pathological gestations. Rev Bras Ginecol Obstet 2013; 35:407-12. [DOI: 10.1590/s0100-72032013000900005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 09/25/2013] [Indexed: 11/21/2022] Open
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Grigoriadis C, Bakas P, Derpapas A, Creatsa M, Liapis A. Tension-free vaginal tape obturator versus Ajust adjustable single incision sling procedure in women with urodynamic stress urinary incontinence. Eur J Obstet Gynecol Reprod Biol 2013; 170:563-6. [PMID: 23972452 DOI: 10.1016/j.ejogrb.2013.07.041] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 06/17/2013] [Accepted: 07/29/2013] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess the efficacy and complications of inside-out transobturator tension-free vaginal tape (TVT-O) in comparison with a single incision sling procedure (Ajust) for the treatment of urodynamic stress urinary incontinence. STUDY DESIGN Prospective closely matched controlled study. In total, 171 patients were included in the study: 86 women underwent the TVT-O procedure, while in other 85 cases the Ajust procedure was performed. Subjective and objective cure, improvement and failure rates, mean operative time, hospital stay and incidence of complications were assessed. RESULTS There was no statistically significant difference between the two groups for age, body mass index, parity, menopausal status and severity of prolapse. No major intraoperative complications occurred. There was no significant difference in the mean operative time and the duration of hospital stay between the two groups. The mean follow-up time of the study was 22.3 months (range 12-36 months). For the TVT-O group the objective cure rate was 86%, the improvement rate was 5.9% and the failure rate was 8.1%, while the subjective cure rate was 82.6%. For the Ajust group the objective cure rate was 84.7%, the improvement rate was 4.7%, 10.6% of patients showed no change in their symptoms and the subjective cure rate was 81.2%. CONCLUSIONS The Ajust sling procedure presents success rates, at 22 months' mean follow up, comparable to the TVT-O method. Both techniques seem to be safe and effective for the treatment of urodynamic stress urinary incontinence.
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Affiliation(s)
- C Grigoriadis
- 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Greece.
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Vrachnis N, Salakos N, Iavazzo C, Grigoriadis C, Iliodromiti Z, Siristatidis C, Katsetos C, Creatsas G. Bakri balloon tamponade for the management of postpartum hemorrhage. Int J Gynaecol Obstet 2013; 122:265-6. [DOI: 10.1016/j.ijgo.2013.03.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Revised: 03/24/2013] [Accepted: 05/22/2013] [Indexed: 10/26/2022]
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Vrachnis N, Gkogkas L, Iliodromiti S, Grigoriadis C, Samoli E, Iliodromiti Z, Pangalos C, Pappa KI, Drakoulis N, Creatsas G, Botsis D. Resistin in mid-trimester amniotic fluid in trisomy 21. J Matern Fetal Neonatal Med 2013; 26:1576-80. [PMID: 23544842 DOI: 10.3109/14767058.2013.789848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to examine whether resistin is present in second trimester amniotic fluid from trisomy 21 (also known as Down's syndrome) pregnancies and whether its concentration differs compared with euploid pregnancies. METHODS The study cohort consisted of 58 women in the mid-trimester of pregnancy who underwent amniocentesis for prenatal diagnosis, 31 of whom carried a single fetus with diagnosed trisomy 21 (study group) and the rest with normal karyotype (control group, n = 27). Groups were matched for maternal and gestational age. Levels of resistin in amniotic fluid were measured by a commercially available enzyme-linked immunosorbent assay (ELISA) kit. RESULTS Resistin was detected in all amniotic fluid samples. Its median concentration in the second trimester amniotic fluid of trisomy 21 pregnancies (2.1 ng/ml) was statistically significantly lower (p value <0.001) in comparison with that in euploid pregnancies (3.3 ng/ml). CONCLUSIONS Resistin is a physiologic constituent of second trimester amniotic fluid. Lower levels of amniotic fluid resistin in pregnancies with trisomy 21 may reflect altered metabolic pathways in utero that could possibly be related with phenotypic features of the syndrome.
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Affiliation(s)
- N Vrachnis
- 2nd Department of Obstetrics and Gynecology, University of Athens Medical School, Aretaieion Hospital , 115 26 Athens , Greece
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Affiliation(s)
- Aliki Tympa
- 1st Department of Anesthesiology, Athens Medical School, Aretaieion University Hospital, 76 Vas. Sofias Avenue, 11528, Athens, Greece,
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Grigoriadis C, Vezakis A, Salakos N, Triantafyllidou O, Vlahos NF. Successful management of evisceration occurred after exploratory laparotomy for bilateral ovarian micropapillary serous borderline tumors. G Chir 2013; 34:128-131. [PMID: 23660166 PMCID: PMC3915579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Micropapillary serous borderline tumor of the ovary is characterized by a more frequent association with extraovarian, especially invasive, implants. The aim of this study was to report the clinicopathological findings of a rare case of micropapillary serous borderline tumor of the ovary since there are less than 100 similar cases in the published literature. Additionally, the successful management of evisceration that complicated the postoperative stay of the patient is analyzed. The incidence of this severe complication is estimated between 0.29-2.3%. There are four main causes: suture tearing through the fascia, knot failure, suture failure, and extrusion of abdominal contents between sutures placed too far apart. At least 50% of the cases are due to technical error with a potentially lethal result.
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Zygouris D, Androutsopoulos G, Grigoriadis C, Terzakis E. The role of mini laparotomy in patients with uterine myomas. CLIN EXP OBSTET GYN 2013; 40:137-140. [PMID: 23724528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM The aim of this study was to evaluate the therapeutic effectiveness of myomectomy by mini laparotomy in patients with subserosal and/or intramural uterine myomas. MATERIALS AND METHODS Between January 2002 and December 2008, 83 women with symptomatic uterine myomas were referred to the Second Department of Gynecology of St. Savvas Anticancer--Oncologic Hospital of Athens. The study included women with subserosal and/or intramural uterine myomas with a maximum diameter of ten cm. All patients underwent myomectomy by mini laparotomy. RESULTS The median age of the patients was 36.8 years (range 19-43). The median number of the removed uterine myomas was 3.1 (range 1-12) and the median operative time was 98 minutes (range 47-170). All patients were mobilized within the first 24 hours and the median time of postoperative ileus was 1.6 days (range 1-3). The median hospital stay was 44 hours (range 30-120). There were no serious intraoperative or early postoperative complications. Conversion to laparotomy was performed only in four cases (4.82%), but none of the patients underwent emergency hysterectomy. During a mean follow up of 38 months, no recurrences of uterine myomas in the study population were observed. CONCLUSION Mini laparotomic myomectomy is a safe and effective minimally invasive method alternative to laparoscopic myomectomy for patients with subserosal and/or intramural uterine myomas.
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Affiliation(s)
- D Zygouris
- 2nd Department of Gynecology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece
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Kondi-Pafiti A, Grigoriadis C, Samiotaki D, Filippidou-Giannopoulou A, Kleanthis C, Hassiakos D. Immunohistochemical study of inhibin A and B expression in placentas from normal and pathological gestations. CLIN EXP OBSTET GYN 2013; 40:109-112. [PMID: 23724521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
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.
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Affiliation(s)
- A Kondi-Pafiti
- Pathology Laboratory, Aretaieion Hospital, University of Athens, Medical School, Athens, Greece.
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Grigoriadis C, Androutsopoulos G, Zygouris D, Arnogiannaki N, Terzakis E. Uterine malignant mixed Müllerian tumor after adjuvant tamoxifen treatment for breast cancer. EUR J GYNAECOL ONCOL 2013; 34:94-98. [PMID: 23590011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Uterine malignant mixed Müllerian tumor (MMMT), also known as carcinosarcoma, is a biphasic tumor of the female genital tract and demonstrates both malignant epithelial (carcinoma) and mesenchymal (sarcoma) components. The authors present two cases of uterine MMMT after adjuvant tamoxifen (TAM) treatment for breast cancer and a review of the current literature. CASES The patients presented with a complaint of abnormal uterine bleeding. They both had a history of breast cancer Stage IIB previously treated with modified radical mastectomy, at 51 and 78 months, respectively. They also had history of tamoxifen treatment 20 mg daily for seven and 73 months respectively. They underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and total omentectomy. Histopathology revealed a uterine MMMT. Postoperatively, they received adjuvant chemotherapy and radiotherapy. One of the patients died 26 months after initial surgery due to uterine MMMT. CONCLUSION Uterine MMMT is a rare, highly-aggressive, and rapidly-progressing tumor associated with a poor prognosis. Postmenopausal patients, with prolonged adjuvant TAM treatment for breast cancer, are at increased risk for the development of uterine MMMT.
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Affiliation(s)
- C Grigoriadis
- 2nd Department of Gynecology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece
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Zygouris D, Androutsopoulos G, Grigoriadis C, Terzakis E. M281 LEEP EFFECTIVENESS IN GREEK PATIENTS WITH VAGINAL INTRAEPITHELIAL NEOPLASIA AND HISTORY OF CERVICAL CANCER. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)61472-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Gregoriou O, Bakas P, Grigoriadis C, Creatsa M, Sofoudis C, Creatsas G. Antibiotic prophylaxis in diagnostic hysteroscopy: is it necessary or not? Eur J Obstet Gynecol Reprod Biol 2012; 163:190-2. [DOI: 10.1016/j.ejogrb.2012.03.027] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 01/13/2012] [Accepted: 03/21/2012] [Indexed: 11/28/2022]
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Gregoriou O, Bakas P, Grigoriadis C, Creatsa M, Hassiakos D, Creatsas G. Changes in hormonal profile and seminal parameters with use of aromatase inhibitors in management of infertile men with low testosterone to estradiol ratios. Fertil Steril 2012; 98:48-51. [PMID: 22579129 DOI: 10.1016/j.fertnstert.2012.04.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 04/04/2012] [Accepted: 04/04/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To compare the effects of 2.5 mg letrozole with those of 1 mg anastrazole daily on the hormonal and semen profiles of a subset of infertile men with low T/E(2) ratios. DESIGN Prospective, nonrandomized study. SETTING Reproductive medicine clinic. PATIENT(S) The study group consisted of 29 infertile men with a low serum T/E(2) ratio (<10). INTERVENTION(S) Patients were divided into two groups. Group A included 15 patients treated with 2.5 mg letrozole orally once daily for 6 months, and Group B consisted of 14 patients treated with 1 mg anastrazole orally every day for 6 months. MAIN OUTCOME MEASURE(S) Hormonal evaluation included measurement of serum FSH, LH, PRL, T, and E(2). In all sperm analyses pretreatment and posttreatment total motile sperm counts (ejaculate volume × concentration × motile fraction) were evaluated. RESULT(S) The use of aromatase inhibitors (either letrozole or anastrazole) in cases of infertile men with low T/E(2) ratios improved both hormonal and semen parameters. CONCLUSION(S) This study suggests that some men with severe oligospermia, low T levels, and normal gonadotropin concentration may have a treatable endocrinopathy.
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Affiliation(s)
- Odysseas Gregoriou
- 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, University of Athens, Athens, Greece.
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Grigoriadis C, Kleanthis C, Papadakis E, Bakas P, Kondi-Pafiti A, Liapis A. 188 THE ROLE OF VAGINAL OESTRADIOL THERAPY FOLLOWING ANTI-INCONTINENCE SURGICAL PROCEDURES IN POSTMENOPAUSAL WOMEN. Maturitas 2012. [DOI: 10.1016/s0378-5122(12)70299-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zygouris D, Grigoriadis C, Androutsopoulos G, Arnogiannaki N, Terzakis E. 202 SURGICAL TREATMENT OF POST MENOPAUSAL WOMEN DIAGNOSED WITH PELVIC ORGAN PROLAPSE AND STRESS URINARY INCONTINENCE: A 5 YEAR REVIEW. Maturitas 2012. [DOI: 10.1016/s0378-5122(12)70313-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Grigoriadis C, Papaconstantinou E, Mellou A, Hassiakos D, Liapis A, Kondi-Pafiti A. Clinicopathological changes of uterine leiomyomas after GnRH agonist therapy. CLIN EXP OBSTET GYN 2012; 39:191-194. [PMID: 22905461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
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.
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Affiliation(s)
- C Grigoriadis
- 2nd Department of Obstetrics-Gynecology Aretaieion Hospital, University of Athens, Medical School, Athens, Greece.
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Zygouris D, Androutsopoulos G, Grigoriadis C, Arnogiannaki N, Terzakis E. Primary ovarian leiomyosarcoma. EUR J GYNAECOL ONCOL 2012; 33:331-333. [PMID: 22873115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Primary ovarian leiomyosarcoma is an extremely rare subtype of ovarian sarcomas. It most commonly occurs in postmenopausal women and has unfavorable prognosis. CASE The patient, a 58-year-old postmenopausal woman, presented with a complaint of abdominal pain. Preoperative examination revealed an intraabdominal mass 25 x 17 x 14 cm in the right adnexa. She underwent bilateral salpingo-oophorectomy, total omentectomy, appendectomy and bilateral pelvic lymphadenectomy. The histopathology revealed leiomyosarcoma of the right ovary Stage Ia. She did not receive any postoperative adjuvant therapy. Follow-up 21 months after initial surgery, showed no evidence of recurrence. CONCLUSION Additional studies are needed to understand more about the nature, clinical behavior and treatment of this very rare tumor.
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Affiliation(s)
- D Zygouris
- 2nd Department of Gynaecology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece
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Gregoriou O, Grigoriadis C, Hatzidakis VE, Mantzavinos S, Kondi-Pafiti A. Removal of a large bizarre uterine leiomyoma by operative hysteroscopy. Case report and review of the literature. CLIN EXP OBSTET GYN 2012; 39:124-126. [PMID: 22675972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
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.
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Affiliation(s)
- O Gregoriou
- 2nd Department of Obstetrics-Gynaecology, Aretaieion Hospital, University of Athens Medical School, Greece
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Kondi-Pafiti A, Grigoriadis C, Iavazzo C, Papakonstantinou E, Liapis A, Hassiakos D. Clinicopathological characteristics of adnexal lesions diagnosed during pregnancy or cesarean section. CLIN EXP OBSTET GYN 2012; 39:458-461. [PMID: 23444743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
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.
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Affiliation(s)
- A Kondi-Pafiti
- Pathology Laboratory, Aretaieion Hospital, University of Athens, Medical School, Athens, Greece.
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Grigoriadis C, Androutsopoulos G, Zygouris D, Arnogiannaki N, Terzakis E. Synchronous squamous cell carcinoma of the endometrium and endometrioid adenocarcinoma of the ovary. EUR J GYNAECOL ONCOL 2012; 33:666-668. [PMID: 23327069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Synchronous primary endometrial and ovarian cancers are relatively uncommon in general population. The etiology and pathogenesis of this phenomenon remains unclear. The authors' aim was to present a case of synchronous squamous cell carcinoma of the endometrium and endometrioid adenocarcinoma of the ovary and review current literature. CASE The patient, a 64-year-old, nulliparous postmenopausal Greek woman presented with a complaint of abdominal pain and abnormal uterine bleeding. Preoperative computer tomography (CT) of the abdomen and pelvis, and abdominal ultrasound (U/S) revealed an intra-abdominal three cm mass with solid components between the left ovary and small bowel. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH+BS), total omentectomy, pelvic and para-aortic lymph node dissection, and removal of the implant at the serosa of small bowel. Histopathology revealed Stage IA endometrial cancer squamous type and Stage IIIC ovarian cancer of endometrioid-type. Postoperatively the patient underwent adjuvant chemotherapy and radiotherapy. Follow-up of 22 months after initial surgery revealed no evidence of recurrence. CONCLUSION The reason for better median overall survival of patients with synchronous primary endometrial and ovarian cancers is not intuitively obvious. Perhaps favourable clinical outcome may be related with the detection of patients at early stage and low-grade disease with an indolent growth rate.
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Affiliation(s)
- C Grigoriadis
- Second Department of Gynaecology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece
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Sofoudis C, Kalampokas T, Grigoriadis C, Kalampokas E, Bakalianou K, Salakos N. Endometrial stromal sarcoma in a 29-year-old patient. Case report and review of the literature. EUR J GYNAECOL ONCOL 2012; 33:328-330. [PMID: 22873114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Endometrial stromal sarcomas are rare tumors accounting for about 0.2% of all genital tract malignancies. They are considered to occur more often in premenopausal women. Endometrial stromal sarcomas are hormone sensitive tumors. A state of hyper-estrogenemia could act as a growth stimulus. Given the rarity of these tumors there are limited reports in the literature referring to the clinical management and final outcome of these cases. CASE The patient, a 29-year-old woman, had a surgical history of myomectomy in another hospital three months before her referal to our department. The histological examination of the removed myoma showed an endometrial stromal sarcoma. Total abdominal hysterectomy, with bilateral salpingo-oophorectomy, omentectomy and elective pelvic lymphadenectomy were then performed as a second radical surgical approach. CONCLUSION Endometrial stromal sarcomas are uncommon and their differential diagnosis from typical submucosal uterine myomas or benign endometrial polyps could be difficult. The hysteroscopic features of uterine sarcomas are often similar to those of endometrial polyps or submucosal myomas. The histological examination of the specimen is necessary to exclude malignancy and establish the final diagnosis. Total abdominal hysterectomy, bilateral salpingo-oopherectomy with pelvic lymphadenectomy is the optimal treatment in cases of endometrial stromal sarcomas.
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Affiliation(s)
- C Sofoudis
- 2nd Department Obstetrics and Gynecology, University of Athens, Medical School, Aretaieion Hospital, Athens, Greece.
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Iavazzo C, Boutas I, Grigoriadis C, Vrachnis N, Salakos N. Management of ASCUS findings in Papanicolaou smears. A retrospective study. EUR J GYNAECOL ONCOL 2012; 33:605-609. [PMID: 23327054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM Atypical squamous cells of undetermined significance (ASCUS) are a cervical cytologic finding category suggestive but not definitive of squamous intraepithelial lesions. ASCUS remains an incompletely described entity and accounts for even 5%-10% of reported Papanicolaou (Pap) smears. The management of women with such cytologic findings remains controversial. The aim of this study was to evaluate the cytology laboratory findings with regards to ASCUS diagnosis, using cervical Pap smears, and colposcopic biopsies, as well as their management. MATERIALS AND METHODS This is a retrospective study of patients with ASCUS Pap smears taken during the period January 2010 - December 2010 in the Second Department of Obstetrics and Gynecology, Aretaieion Hospital. RESULTS During the study period, 657 Pap smears were examined at the Aretaieion Hospital; moreover, seven patients, whose Pap smears were cytologically diagnosed with ASCUS, were referred from other clinics, providing a total of 42 cases with a descriptive diagnosis of ASCUS for review. Of the 42 cases, eight were not studied because they were either lost in follow-up or they did not have available data. The remaining 34/42 patients were evaluated by colposcopic examination and directed biopsies where necessary. The ratio of ASCUS to low-grade squamous intraepithelial lesion (LGSIL), high-grade squamous cell intraepithelial lesion (HGSIL) or squamous cell carcinoma (SCC) was 5/34, 1/34, and 0/34, respectively. In the 34 ASCUS cases evaluated by colposcopy, the age distribution varied from 22 to 54 years. Eight of 34 cases did not have a child, 7/34 were primigravida, 18/34 were secondi-gravida, and 1/34 had four children. Four out of 34 cases were postmenopausal, 3/34 referred no history of abnormal bleeding, 21/34 were smokers, 6/34 used oral contraceptives, 2/34 used intrauterine devices, 1/34 took replacement of hormones, 4/34 had prior abnormal Pap smears human papillomavirus (HPV), or 1/34 had previous cancer (breast cancer). Colposcopy was inconclusive in 4/34 patients, while 8/34 cases were negative for Schiller and acetic acid tests and also had normal colposcopy. Infectious organisms were found in 8/34 patients with ASCUS, including actinomyces (1/8), trichomonas (5/8), and candida albicans (2/8). Histologic tests revealed 16/34 koilocytosis cases, 5/34 LGSIL, 1/34 HGSIL, and 0/34 SCC. CONCLUSION The dilemma in the management of patients with an ASCUS diagnosis still exists as a significant problem for clinicians.
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Affiliation(s)
- C Iavazzo
- Second Department of Obstetrics and Gynecology, University of Athens Aretaieion Hospital, Athens, Greece.
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Kondi-Pafiti A, Filippidou-Giannopoulou A, Papakonstantinou E, Iavazzo C, Grigoriadis C. Epidermoid or dermoid cysts of the ovary? Clinicopathological characteristics of 28 cases and a new pathologic classification of an old entity. EUR J GYNAECOL ONCOL 2012; 33:617-619. [PMID: 23327057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The aim of this study was to present the clinical and pathological findings that aid in the differential diagnosis between epidermoid and dermoid ovarian tumors. MATERIALS AND METHODS This was a 15-year retrospective clinico-pathological study. A total of 28 cases of epidermoid ovarian cysts histologically confirmed after pathological examination at the Pathology Laboratory of Aretaieion University Hospital between January 1996 and December 2010, were analyzed and a literature review was performed. RESULTS Patients with epidermoid cysts presented with a main complaint of either abdominal pain or a palpable abdominal mass. In the 28 cases studied, 18 patients underwent cystectomy and four cases underwent oophorectomy. In six cases of post-menopausal women, abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. No recurrent disease in the pelvis was reported during the available follow-up period which was from 12 to 30 months. DISCUSSION Epithelial epidermoid ovarian tumors represent less than one percent of ovarian surface epithelial tumors. The differential diagnosis of epidermoid cysts includes dermoid (mature cystic teratomas) tumors of the ovary. However, it should be mentioned that up to 17% of teratomas may include epidermoid tumors. In comparison to dermoid cysts which present at an earlier age but with a greater size, ovarian epidermoid tumors present as small- to medium-sized cystic lesions occurring at a significantly older age. The treatment of choice is conservative surgical therapy.
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Affiliation(s)
- A Kondi-Pafiti
- Pathology Laboratory, Aretaieion Hospital, University of Athens, Medical School, Athens, Greece.
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Derdelis G, Zygouris D, Grigoriadis C, Terzakis E. Conservative Management of Vulvar Cancer Stages I–II: Past and Future. J Gynecol Surg 2011. [DOI: 10.1089/gyn.2010.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Grigorios Derdelis
- Second Department of Gynecology, Anticancer Hospital of Athens “Agios Savvas”, Athens, Greece
| | - Dimitrios Zygouris
- Second Department of Gynecology, Anticancer Hospital of Athens “Agios Savvas”, Athens, Greece
| | - Charalampos Grigoriadis
- Second Department of Gynecology, Anticancer Hospital of Athens “Agios Savvas”, Athens, Greece
| | - Emmanouil Terzakis
- Second Department of Gynecology, Anticancer Hospital of Athens “Agios Savvas”, Athens, Greece
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Terzakis E, Androutsopoulos G, Zygouris D, Grigoriadis C, Arnogiannaki N. Loop electrosurgical excision procedure in Greek patients with vaginal intraepithelial neoplasia and history of cervical cancer. EUR J GYNAECOL ONCOL 2011; 32:530-533. [PMID: 22053668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The aim of our study was to evaluate the therapeutic effectiveness of loop electrosurgical excision procedure (LEEP) in Greek patients with vaginal intraepithelial neoplasia (VAIN) and history of cervical cancer. MATERIALS AND METHODS Between January 2002 and January 2009, eight women with histologically confirmed VAIN and history of cervical cancer were included in our study. For the LEEP procedure we used a high frequency Electrosurgery Unit with at least 80 W output. RESULTS Complete response rate, at 12 months of follow-up, was 75%. Recurrence rate, at 12 months of follow-up, was 25%. Complete response rate, at 24 months of follow up, was 62.5%. Recurrence rate, at 24 months of follow up, was 37.5%. CONCLUSION LEEP may constitute a valuable excisional method for the treatment of VAIN in cases with a history of cervical cancer. It provides an interpretable specimen of the whole lesion within a few minutes. It needs a short period of training and has low cost.
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Affiliation(s)
- E Terzakis
- 2nd Department of Gynaecology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece
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Arnogiannaki N, Grigoriadis C, Zygouris D, Terzakis E, Sebastiadou M, Tserkezoglou A. Proliferative Brenner tumor of the ovary. clinicopathological study of two cases and review of the literature. EUR J GYNAECOL ONCOL 2011; 32:576-578. [PMID: 22053680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Ovarian Brenner tumors are rare epithelial tumors that account for 1%-2% of all ovarian neoplasms. They can be subdivided into benign, borderline or proliferative, and malignant neoplasms. In the vast majority of cases, these lesions are benign. Tumors of borderline malignancy are less frequent and only about 1% of Brenner tumors are malignant. We present two cases of Brenner tumors with borderline malignancy which were treated in our Department together with a review of the literature. CASES A 50-year-old, gravida 1, para 1, patient was admitted for abnormal vaginal bleeding. Clinical examination, abdominal ultrasound (US), and computed tomography (CT) revealed a cystic multilobulated tumor of the right ovary with solid elements measuring 20 x 19 x 15 cm in diameter. In the other case a 70-year-old, gravida 2, para 2, patient presented with severe urinary difficulties. Palpation revealed a mobile abdominopelvic tumor 10 x 15 in diameter. US and CT exhibited a cystic tumor with multiple solid elements and calcifications of the left ovary. Both patients underwent exploratory laparotomy. Total abdominal hysterectomy with bilateral salpingo-oophorectomy and total omentectomy were performed in both cases, while pelvic lymphadenectomy was decided only in the second case. Histologically, in both cases the diagnosis confirmed borderline Brenner tumor. CONCLUSION Although Brenner tumors are rare and the majority of them are benign, the correct histological diagnosis at frozen section with identification of the small proportion of malignant tumors, allows the extent of the operation to be adapted if needed.
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Affiliation(s)
- N Arnogiannaki
- Department of Pathology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece
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Terzakis E, Androutsopoulos G, Adonakis G, Zygouris D, Grigoriadis C, Decavalas G. Fallopian tube primary cancer: report of five cases and review of the literature. EUR J GYNAECOL ONCOL 2011; 32:95-98. [PMID: 21446336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The aim of this retrospective study was to analyze the clinical characteristics, management and prognosis of five patients with fallopian tube primary cancer (FTPC) who were diagnosed and treated in our departments. A review of the current literature is also presented. MATERIALS AND METHODS Between January 2000 and August 2009, five cases with histologically confirmed FTPC were diagnosed in our departments and were then evaluated retrospectively. All patients underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and total omentectomy. RESULTS We had two patients in Stage IA (40%), two patients in Stage IC (40%) and one patient in Stage IIIA (20%). All patients received adjuvant chemotherapy with platinum-based combinations and two of them received additional radiotherapy. CONCLUSION FTPC, compared with ovarian primary cancer (OPC), is more likely to present at an early stage and have an overall more favourable outcome. More extensive clinical research must be performed to have definite aetiologic, diagnostic and management modalities.
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Affiliation(s)
- E Terzakis
- Department of Gynaecology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece
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Arnogiannaki N, Grigoriadis C, Zygouris D, Androutsopoulos G, Derdelis G, Terzakis E. Primary ovarian non-Hodgkin's lymphoma. EUR J GYNAECOL ONCOL 2011; 32:441-442. [PMID: 21941973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Primary ovarian non Hodgkin's lymphoma (PONHL) is a very rare disease. We present a case of PONHL and review the literature. CASE The patient, a 24-year-old nulliparous Greek woman, presented with the complaint of abdominal pain. She underwent left salpingo-oophorectomy, multiple biopsies from the right ovary, total omentectomy, pelvic and paraortic lymphadenectomy, appendectomy and curettage. The histopathology revealed diffuse large B-cell non-Hodgkin's lymphoma of the left ovary. She underwent postoperative chemotherapy. She remains well without evidence of disease, 15 months after initial surgery. CONCLUSION The use of chemotherapy is based on the principle that PONHL must be considered a localized manifestation of systemic disease. Patients with PONHL have a similar outcome compared to patients with other NHL.
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Affiliation(s)
- N Arnogiannaki
- Department of Pathology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece
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Terzakis E, Androutsopoulos G, Adonakis G, Zygouris D, Grigoriadis C, Decavalas G. Vaginal primary malignant melanoma: report of four cases and review of the literature. EUR J GYNAECOL ONCOL 2011; 32:122-124. [PMID: 21446344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The aim of this retrospective study was to analyse the clinical characteristics, management and prognosis of four patients with vaginal primary malignant melanoma (VPMM) who were diagnosed and treated in our departments together with a review of the current literature. MATERIALS AND METHODS Between January 1997 and September 2009, four cases with histologically confirmed VPMM were evaluated retrospectively. All patients underwent wide local excision. RESULTS One patient was in Stage I (25%), two patients in Stage II (50%) and one patient in Stage IV (25%). Among them, one patient received additional radiotherapy and three patients received additional immunotherapy with interferon. CONCLUSION The prognosis of VPMM is very poor, despite the treatment modality, because most cases are diagnosed at late stage.
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Affiliation(s)
- E Terzakis
- 2nd Department of Gynaecology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece
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Terzakis E, Androutsopoulos G, Zygouris D, Grigoriadis C, Derdelis G, Arnogiannaki N. Angiokeratoma of the vulva. EUR J GYNAECOL ONCOL 2011; 32:597-598. [PMID: 22053688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Angiokeratoma of the vulva is relatively uncommon in the general population. We present two cases of angiokeratoma of the vulva and review the literature. The two patients presented with the complaint of vulvar pruritus. They underwent wide local excision of the lesions. Histopathology revealed angiokeratoma of the vulva. The women remain well with no evidence of recurrence 48 and 32 months after initial surgery. Although it is a rare disease, angiokeratoma of the vulva should be included in the differential diagnosis of a vulvar tumor.
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Affiliation(s)
- E Terzakis
- 2nd Department of Gynaecology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece
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Grigoriadis C, Haase N, Butt HJ, Müllen K, Floudas G. Negative thermal expansion in discotic liquid crystals of nanographenes. Adv Mater 2010; 22:1403-1406. [PMID: 20437491 DOI: 10.1002/adma.200903264] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- C Grigoriadis
- Department of Physics, University of Ioannina, Ioannina, Greece
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Terzakis E, Androutsopoulos G, Derdelis G, Zygouris D, Grigoriadis C, Apostolikas N. Loop electrosurgical excision procedure in Greek patients with vulvar intraepithelial neoplasia. EUR J GYNAECOL ONCOL 2010; 31:191-193. [PMID: 20527238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The aim of our study was to evaluate the therapeutic effectiveness of loop electrosurgical excision procedure (LEEP) in Greek patients with vulvar intraepithelial neoplasia (VIN). MATERIALS AND METHODS Between January 2002 and January 2009, 55 women with histologically confirmed VIN usual type were included in our study. For the LEEP procedure we used a high frequency electrosurgical unit with at least 80 W output. The tissue was removed to the second surgical plane. Statistical analyses were performed using the SPSS-13 for Windows. RESULTS Complete response rate at 12-month follow-up was 100%. Complete response rate at 48 months of follow-up was 80%. Recurrence rate at 48 months of follow-up was 20%. CONCLUSION LEEP may constitute a valuable excisional method for the treatment of VIN. It provides an interpretable specimen of the whole lesion within a few minutes. It needs a short period of training and has low cost.
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Affiliation(s)
- E Terzakis
- 2nd Department of Gynaecology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece
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Terzakis E, Androutsopoulos G, Zygouris D, Grigoriadis C, Derdelis G, Arnogiannaki N. Loop electrosurgical excision procedure in Greek patients with vaginal intraepithelial neoplasia. EUR J GYNAECOL ONCOL 2010; 31:392-394. [PMID: 20882879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The aim of our study was to evaluate the therapeutic effectiveness of the loop electrosurgical excision procedure (LEEP) in Greek patients with vaginal intraepithelial neoplasia (VAIN). MATERIALS AND METHODS Between January 2002 and January 2009, 23 women with histologically confirmed VAIN were included in our study. For the LEEP procedure we used a high frequency electrosurgery unit with at least 80 W output. RESULTS Complete response rate at 12 months of follow-up was 86.96%. Recurrence rate at 12 months of follow-up was 13.04%. Complete response rate at 24 months of follow-up was 75%. Recurrence rate at 24 months of follow-up was 25%. CONCLUSION LEEP may constitute a valuable excisional method for the treatment of VAIN. It provides an interpretable specimen of the whole lesion within a few minutes. It needs a short period of training and has low cost.
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Affiliation(s)
- E Terzakis
- 2nd Department of Gynaecology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece
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Terzakis E, Androutsopoulos G, Grigoriadis C, Zygouris D, Derdelis G, Arnogiannaki N, Fragkakis G. Synchronous primary endometrial and fallopian tube cancers. EUR J GYNAECOL ONCOL 2010; 31:467-468. [PMID: 20882898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Synchronous primary cancers are relatively uncommon in the general population. We present a case of synchronous primary endometrial and fallopian tube cancers and review the literature. CASE The patient, a 54-year-old, gravida 2, para 2 postmenopausal Greek woman presented with a complaint of abnormal vaginal bleeding. She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and total omentectomy. The histopathology revealed synchronous primary cancers of the endometrium and right fallopian tube. The patient underwent postoperative chemotherapy and postoperative radiotherapy. She remains well without evidence of disease, 65 months after initial surgery. CONCLUSION The reason for the better median overall survival of patients with synchronous primary endometrial and fallopian tube cancers is not intuitively obvious. Perhaps it is due to the detection of patients at earlier clinical stage and lower grade disease state.
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Affiliation(s)
- E Terzakis
- 2nd Department of Gynecology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece
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