Tamoxifen and giant endometrial polyp

We present the case of a woman with a giant endometrial polyp of uncommon dimension who was receiving adjuvant tamoxifen for breast cancer. In her gynecologic examination, she had a mass measuring 3 x 4 x 4 cm protruding from the cervical os. The mass was extirpated under general anesthesia. The mass originated from the endometrial cavity. The endometrial polyp measured 10 x 6 x 3 cm macroscopically and was found to be benign under microscopic examination. We conclude that physicians should be aware of the confounding effects of tamoxifen on the histological and ultrasonographic appearance of the endometrium.

Immunohistochemical expression of MMP-2, MMP-9 and COX-2 in Stage IA malignant polyps of the endometrium

OBJECTIVE

To study whether endometrioid type malignant endometrial polyps (MEP) are different from endometrium cancer not associated with polyps (ECNAP) in means of immunohistochemical expressions of MMP-2, MMP-9 and COX-2.

METHODS

Archived tissue samples of eight MEP, eight ECNAP and 16 benign endometrial polyps were selected and immunohistochemically analyzed for MMP-2, MMP-9 and COX-2 expression.

RESULTS

MMP-2 and MMP-9 were overexpressed in ECNAP compared to MEP and benign endometrial polyps (p < 0.05). MMP-2 and MMP-9 expressions were not different in the malignant part of MEP, benign part of MEP and benign endometrial polyps. COX-2 expression was found to be higher in benign lesions, although this was not statistically significant.

CONCLUSION

Similar immunohistochemical expression of MMP-2, MMP-9 and COX-2 within a polyp and with benign polyps may indicate an immunohistochemically indolent characteristic of MEP.

Intrauterine lidocaine plus buccal misoprostol in the endometrial biopsy

OBJECTIVE

To evaluate the efficacy of intrauterine lidocaine plus buccal misoprostol in reducing the discomfort caused by endometrial biopsy with a suction curette.

METHODS

In this double-blind, randomized, placebo-controlled trial 126 women undergoing endometrial biopsy were administered a 200-microg tablet of misoprostol buccally, followed by a 5-mL uterine instillation of either of 2% lidocaine or a saline solution. The main outcome measures were the intensity of pain during, immediately following, and 20 min following the biopsy, as assessed on a 10-cm visual analog scale. Statistical analysis was performed using the Friedman test with the Bonferroni correction, the t test, and the chi(2) test.

RESULTS

There were no statistically significant differences between the study and control groups in mean age, parity, or relevant medical history. A statistically significant difference in pain scores was noted in premenopausal women during the procedure (lidocaine, 4.93+/-1.67; placebo, 6.17+/-1.26; P<0.001) as well as immediately later (lidocaine, 4.12+/-1.14 vs. placebo, 5.42+/-1.08; P<0.001) and 20 min later (lidocaine, 3.60+/-1.10; placebo, 4.22+/-1.46; P<0.001). No significant differences in pain scores were observed in postmenopausal women for any of the 3 time points (6.72+/-2.01, 5.18+/-1.22, and 4.56+/-0.80, respectively; P>0.05). The number needed to treat was 2.6 (95% confidence interval, 1.9-4.8).

CONCLUSION

Intrauterine lidocaine plus buccal misoprostol appears to be effective in decreasing pain in premenopausal women undergoing endometrial biopsy with a suction curette.

Expression of gelatinase (MMP-2 and MMP-9) and cyclooxygenase-2 (COX-2) in endometrial carcinoma

OBJECTIVE

Matrix metalloproteinases (MMPs) are key players in the degradation of extracellular matrix and basement membranes, and are thus important in tumor invasion. Gelatinases (MMP-2 and MMP-9) in particular are prognostic factors in many solid tumors. In this study the immunohistochemical expression of both COX-2 and matrix metalloproteinases has been shown for the first time in endometrium carcinoma.

METHODS

Forty-two endometrial carcinoma tissues were immunostained for MMP2 antibody (1:100, Rabbit polyclonal), MMP9 antibody (1:100, Rabbit polyclonal) and CoX2 antibody (1:100, Epitope specific rabbit antibody).

RESULTS

90.5% of the cases were positive for MMP-2 and MMP-9, and 83.3% of the cases were positive for COX-2. A statistically significant association was found between COX-2 overexpression and FIGO stage (p = 0.001). A positive correlation was also found with histological grade (p = 0.006), myometrial invasion (p = 0.033), vascular invasion (p = 0.017), and lymphatic invasion (p = 0.007). A positive correlation was found between MMP-2 overexpression and vascular and lymphatic invasion (p = 0.030 and p = 0.003, respectively). MMP-9 overexpression was also found to be correlated with vascular and lymphatic invasion (p = 0.001 and p = 0.012, respectively). Furthermore, there was a statistically significant correlation between MMP-2 and MMP-9 overexpression (p = 0.0001).

CONCLUSION

The results showed that COX-2, MMP-2 and MMP-9 were expressed in a high percentage of primary endometrial carcinomas and their expressions may be associated closely with parameters of tumor aggressiveness.

CD24 expression is a poor prognostic marker in endometrial carcinoma

OBJECTIVE

CD24 is a cell adhesion molecule that has been implicated in metastatic tumor progression of various solid tumors. Its expression is known to be related to the prognosis of several kinds of tumors. This study was designed to examine the prognostic significance of CD24 in endometrial cancer patients.

METHODS

Forty-four endometrial carcinoma tissues were immunostained for CD24 antibody (Ab2, clone 24 C02). Cytoplasmic and membranous immunoreactivity were scored semiquantitatively by Fisher's exact test.

RESULTS

CD24 expression was detected in 34 (77.3%) out of 44 cases. Membranous and cytoplasmic staining of CD24 was significantly associated with the International Federation of Gynecology and Obstetrics (FIGO) grade (p = 0.011 and p = 0.002, respectively) and nodal status (p = 0.002 and p = 0.000, respectively).

CONCLUSION

Our data suggests that CD24 expression in endometrial carcinoma as detected by immunohistochemistry might be a new marker for a more aggressive endometrial cancer biology. CD24 is commonly up-regulated in endometrial cancer and this corroborates the importance of CD24 in tumor progression among these cases.

Mucinous adenocarcinoma arising from the gastrointestinal epithelium in benign cystic teratoma of the ovary--case report

Benign cystic teratoma of the ovary (BCTO) is the most common ovarian germ cell tumor occurring predominantly in early adulthood. Malignant transformation of a BCTO is rare, with an incidence of 2%. Most benign cystic teratomas with malignant transformations are squamous cell carcinomas with just 6.8% being adenocarcinomas. We present a rare case of adenocarcinoma arising from the gastrointestinal epithelial elements of BCTO based on the microscopic examination and immunohistochemical studies. Adenocarcinoma arising from gastrointestinal epithelium within BCTOs is extremely rare. This is the fifth reported case of adenocarcinoma arising in gastrointestinal epithelium of a BCTO.

Placenta accreta associated with a ruptured pregnant rudimentary uterine horn. Case report and review of the literature

Pregnancy in a rudimentary uterine horn is rare and is usually associated with fetal death and serious maternal morbidity and mortality. A case of pregnancy in a rudimentary uterine horn with rupture 14 weeks after last menstrual period and is complicated with placenta accreta is presented. The patient had signs and symptoms of massive hemoperitoneum. An emergency exploratory laparotomy revealed rupture of the gravid rudimentary horn of a bicornuate uterus. Histologic examination of the specimen showed that placenta was accreta. The relative literature is reviewed and the association of placenta accreta in such situations is pointed out.

Bilateral globus pallidus lesions in a patient with Tourette syndrome and related disorders

BACKGROUND

The neuroanatomic and pathologic basis of Tourette's syndrome or related disorders such as obsessive-compulsive disorder and attention deficit-hyperactivity disorder remains unknown. Although a substantial body of neuroimaging and other data implicate basal ganglia and some point out specifically the globus pallidus in the etiopathogenesis of these three related disorders, no clear or pathologically significant isolated lesions restricted to this region have yet been demonstrated, with the exception of obsessive-compulsive disorder.

METHODS

A seventeen-year-old male case of Tourette syndrome with comorbid obsessive-compulsive disorder, attention deficit-hyperactivity disorder, stuttering and gait disturbance, who had negative family history is presented.

RESULTS

The patient has failed to respond to drug treatment and his MRI scan revealed bilateral and symmetrical globus pallidus lesions with specific "tiger's eye" appearance of unknown etiology.

CONCLUSIONS

Well-localized lesions in the globus pallidus support growing data suggesting the involvement of this brain region in Tourette syndrome and related disorders.

Primary repairing in penetrating colon injuries

BACKGROUND/AIMS

The large bowel is injured in about 10% of penetrated abdominal injuries. Primary repair with colostomy has been discussed recently.

MATERIALS AND METHODS

Between 1987 and 1995, sixty-five patients were operated on with penetrated colon injuries were treated with primary repair without colostomy. Any patient with one or more of the following criteria was excluded: Age > 60 years, blood pressure < 80/60 mmHg, time from injury to treatment > 8 hours, Penetrating abdominal trauma index > 50.

RESULTS

The mean age of the patients was 31 and female/male ratio was 1/7. Fifty-one patients (78.5%) were exposed to colon injury by stabbing and 14 patients (21.5%) by gunshot. The most frequently injured segment was the transverse colon (36.9%). The liver was the most commonly injured organ associated with colon injury (32.3%). Colon wounds of 48 patients (73.8%) were treated with simple repair consisting of meticulous debridement. All gunshot wounds (14 patients) and 3 of the stab wounds were treated with segmentary resection and two layered anastomosis because of the massive colonic wall injury and/or impairment of the blood supply. The most common postoperative complication was wound infection (12.3%). Intraabdominal infection and leakage of the anastomosis were not observed.

CONCLUSION

Primary repair or, if necessary, segmentary resection and anastomosis will be more appropriate in civilian colon injuries.