Concomitant ectopic Enterobius vermicularis infection in uterine cervical cancer

BACKGROUND

Enterobius vermicularis (E. vermicularis), also referred to as pinworm, is a widespread human intestinal parasite which predominantly occurs in young children, making their caretakers a population at risk for the transmission of this helminth. It can occasionally affect extraintestinal organs and tissues, including the female genital tract. Infestation can be asymptomatic or manifest as different kinds of gynaecological disorders, such as pelvic inflammation mimicking tumours, abnormal uterine bleeding, or vaginitis. Diagnosis is made by identifying ova in the sample collected from the perineal skin using a transparent adhesive tape or microscopic examination of resected tissue. Mebendazole is the first-line medication and should also be administered to all household members.

CASE PRESENTATION

We present a case of a patient who had undergone surgery for invasive cervical cancer with an accidental finding of E. vermicularis eggs in the cervix.

CONCLUSIONS

Although not very common, infestation with E. vermicularis should be considered in differential diagnoses of various gynaecological disorders accompanied by histological findings of granulomatous inflammation.

Modulation of sHLA-G, PD-1, and PD-L1 Expression in Cervical Lesions Following Imiquimod Treatment and Its Association with Treatment Success

(1) Background: Cervical intraepithelial neoplasia (CIN) is a precancerous condition linked to human papillomavirus (HPV) infection, often necessitating surgical interventions carrying the risk of subsequent preterm births. This study explores the potential of imiquimod (IMQ), as a non-invasive alternative treatment. The focus is on understanding IMQ impact on immune checkpoint molecules, particularly PD-1, PD-L1, and sHLA-G, which play pivotal roles in shaping immune responses and cancer progression. (2) Methods: Forty-three patients diagnosed with a high-risk squamous intraepithelial lesion (HSIL, p16-positive) self-applied 5% IMQ encapsulated in sachets containing 250 g of cream into the vaginal cavity three times a week for 16 weeks. The impact of IMQ therapy on cervical lesion regression was assessed through immunohistochemistry (IHC), examining changes in sHLA-G, PD-L1, and PD-1 levels. The antiviral activity of IMQ was evaluated through HPV-E7 immunofluorescence. Ethical considerations were adhered to, and the research methods were based on a previously approved clinical trial (clinicaltrials.gov Identifier: NCT04859361). (3) Results: IMQ treatment demonstrated efficacy, leading to lesion regression. sHLA-G levels in CIN before starting IMQ application were associated with unsuccessful treatment (p = 0.0036). IMQ did not significantly alter the expression of PD-1. We observed a decrease in PD-L1 levels in those who were successfully treated (p = 0.0509) and a reduction in HPV burden. (4) Conclusions: IMQ exhibits promise as a non-invasive treatment for CIN, emphasising its potential to modulate the immune microenvironment. Baseline sHLA-G levels emerge as potential predictors of treatment response. Understanding the nuanced dynamics of immune checkpoints sheds light on IMQ mechanism of action. Further exploration is warranted to decipher the intricate mechanisms underlying IMQ treatment in the context of cervical lesions.

Tumour budding and poorly differentiated clusters in colon cancer - different manifestations of partial epithelial-mesenchymal transition

Morphological features including infiltrative growth, tumour budding (TB), and poorly differentiated clusters (PDCs) have a firmly established negative predictive value in colorectal cancer (CRC). Despite extensive research, the mechanisms underlying different tumour growth patterns remain poorly understood. The aim of this study was to investigate the involvement of epithelial-mesenchymal transition (EMT) in TB and PDCs in CRC. Using laser-capture microdissection, we obtained distinct parts of the primary CRC including TB, PDCs, expansive tumour front, and the central part of the tumour, and analysed the expression of EMT-related markers, i.e. the miR-200 family, ZEB1/2, RND3, and CDH1. In TB, the miR-200 family and CDH1 were significantly downregulated, while ZEB2 was significantly upregulated. In PDCs, miR-141, miR-200c, and CDH1 were significantly downregulated. No significant differences were observed in the expression of any EMT-related markers between the expansive tumour front and the central part of the tumour. Our results suggest that both TB and PDCs are related to partial EMT. Discrete differences in morphology and expression of EMT-related markers between TB and PDCs indicate that they represent different manifestations of partial EMT. TB seems to be closer to complete EMT than PDCs. © 2022 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.

Initiation and elongation factor co-expression correlates with recurrence and survival in epithelial ovarian cancer

High grade epithelial ovarian cancer (EOC) represents a diagnostic and therapeutic challenge due to its aggressive features and short recurrence free survival (RFS) after primary treatment. Novel targets to inform our understanding of the EOC carcinogenesis in the translational machinery can provide us with independent prognostic markers and provide drugable targets. We have identified candidate eukaryotic initiation factors (eIF) and eukaryotic elongation factors (eEF) in the translational machinery for differential expression in EOC through in-silico analysis. We present the analysis of 150 ovarian tissue microarray (TMA) samples on the expression of the translational markers eIF2α, eIF2G, eIF5 (eIF5A and eIF5B), eIF6 and eEF1A1. All translational markers were differentially expressed among non-neoplastic ovarian samples and tumour samples (borderline tumours and EOC). In EOC, expression of eIF5A was found to be significantly correlated with recurrence free survival (RFS) and expression of eIF2G and eEF1A1 with overall survival (OS). Expression correlation among factor subunits showed that the correlation of eEF1A1, eIF2G, EIF2α and eIF5A were significantly interconnected. eIF5A was also correlated with eIF5B and eIF6. Our study demonstrates that EOCs have different translational profile compared to benign ovarian tissue and that eIF5A is a central dysregulated factor of the translation machinery.

MFUM-BrTNBC-1, a Newly Established Patient-Derived Triple-Negative Breast Cancer Cell Line: Molecular Characterisation, Genetic Stability, and Comprehensive Comparison with Commercial Breast Cancer Cell Lines

Triple-negative breast cancer (TNBC) is a breast cancer (BC) subtype that accounts for approximately 15–20% of all BC cases. Cancer cell lines (CLs) provide an efficient way to model the disease. We have recently isolated a patient-derived triple-negative BC CL MFUM-BrTNBC-1 and performed a detailed morphological and molecular characterisation and a comprehensive comparison with three commercial BC CLs (MCF-7, MDA-MB-231, MDA-MB-453). Light and fluorescence microscopy were used for morphological studies; immunocytochemical staining for hormone receptor, p53 and Ki67 status; RNA sequencing, qRT-PCR and STR analysis for molecular characterisation; and biomedical image analysis for comparative phenotypical analysis. The patient tissue-derived MFUM-BrTNBC-1 maintained the primary triple-negative receptor status. STR analysis showed a stable and unique STR profile up to the 6th passage. MFUM-BrTNBC-1 expressed EMT transition markers and displayed changes in several cancer-related pathways (MAPK, Wnt and PI3K signalling; nucleotide excision repair; and SWI/SNF chromatin remodelling). Morphologically, MFUM-BrTNBC-1 differed from the commercial TNBC CL MDA-MB-231. The advantages of MFUM-BrTNBC-1 are its isolation from a primary tumour, rather than a metastatic site; good growth characteristics; phenotype identical to primary tissue; complete records of origin; a unique identifier; complete, unique STR profile; quantifiable morphological properties; and genetic stability up to (at least) the 6th passage.

Comparison of Conservative Treatment of Cervical Intraepithelial Lesions with Imiquimod with Standard Excisional Technique Using LLETZ: A Randomized Controlled Trial

(1) Background: There are limited data on the success of conservative treatment of high-grade cervical squamous intraepithelial lesions (HSIL) with imiquimod directly compared to standard of treatment with LLETZ. (2) Methods: Patients aged 18-40 with histological HSIL (with high-grade cervical intraepithelial neoplasia, CIN2p16+ and CIN3), were randomly assigned to treatment with imiquimod or LLETZ. The primary outcome was defined as the absence of HSIL after either treatment modality. The secondary outcomes were the occurrence of side effects. (3) Results: 52 patients were allocated in each group and were similar regarding baseline characteristics. In the imiquimod group, 82.7% of patients completed treatment, which was successful in 51.9%. All patients in the LLETZ group completed treatment, which was successful in 92.3% (p < 0.001). In the subgroup of CIN2p16+ patients, treatment with imiquimod was not inferior to LLETZ (73.9% vs. 84.2%, p = 0.477). During and after treatment, no cases of progression to cancer were observed. Side effects and severe side effects (local and systemic) were more prevalent in the imiquimod than in the LLETZ group (88.5% vs. 44.2% (p-value < 0.001) and 51.9% vs. 13.5% (p-value < 0.001), respectively). (4) Conclusion: Generally, in patients with HSIL, LLETZ remains the gold standard of treatment. However, in a subgroup analysis of patients with CIN2p16+, the success rate was comparable between the two treatment modalities. Due to the prevalence of side effects, the treatment compliance with imiquimod use may, however, present a clinically important issue.

Rosette-forming glioneuronal tumor of the fourth ventricle; A case report and review of the literature

Despite mostly indolent course and favorable postoperative outcome long-term follow-up studies are needed to identify the most appropriate therapeutic strategies to minimize surgical morbidity and neurologic injury in patients with RGNT.

Gynaecological cancers and their cell lines

Cell lines are widely used for various research purposes including cancer and drug research. Recently, there have been studies that pointed to discrepancies in the literature and usage of cell lines. That is why we have prepared a comprehensive overview of the most common gynaecological cancer cell lines, their literature, a list of currently available cell lines, and new findings compared with the original studies. A literature review was conducted via MEDLINE, PubMed and ScienceDirect for reviews in the last 5 years to identify research and other studies related to gynaecological cancer cell lines. We present an overview of the current literature with reference to the original studies and pointed to certain inconsistencies in the literature. The adherence to culturing rulesets and the international guidelines helps in minimizing replication failure between institutions. Evidence from the latest research suggests that despite certain drawbacks, variations of cancer cell lines can also be useful in regard to a more diverse genomic landscape.

Latent brain infection with Moraxella osloensis as a possible cause of cerebral gliomatosis type 2: A case report

BACKGROUND

The gram-negative aerobic bacterium Moraxella osloensis is an opportunistic pathogen in brain tissues.

CASE SUMMARY

The gram-negative aerobic bacterium Moraxella osloensis was isolated from a patient’s brain tissue during a stereotactic biopsy.

CONCLUSION

This is the first report of a brain tissue infection with Moraxella osloensis possibly causing brain gliomatosis.

Digital squamous cell carcinoma associated with possibly carcinogenic human papillomavirus type 73 (HPV73): a case report

We present a case report of a 64-year-old female patient with a 5-year history of a digital papule that clinically mimicked a common wart but was histologically diagnosed as digital squamous cell carcinoma (DSCC), a rare malignant cutaneous entity etiologically associated with high-risk human papillomaviruses (HR HPVs). This DSCC was positive for HPV73, which is currently classified under possible human carcinogens and has already been identified in DSCCs. Treatment with electrocoagulation and subsequent total excision with safety margins was successful, and no recurrence was detected during 6 years of follow-up. Analogously to cervical and other anogenital carcinomas, we assume that the incidence of DSCC will significantly decrease in the near future due to the widespread use of effective prophylactic HPV vaccines, which cover the majority of HR HPV types also associated with DSCC. However, HPV73 and other possibly carcinogenic and HR HPV types (as classified per the International Agency for Research on Cancer), which are not included in current prophylactic measures, will cause some portion of HPV-associated neoplasms, but this portion will be very minor.

Determination of Causative Human Papillomavirus Type in Tissue Specimens of Common Warts Based on Estimated Viral Loads

Background: Assessment of human papillomavirus (HPV) type-specific viral load (VL) is a valid tool for determining the etiology of HPV-related skin tumors, especially when more than one HPV type is detected within one lesion.

Methods: The causative HPV type was determined in 185 fresh-frozen tissue specimens of histologically confirmed common warts (CWs) collected from 121 immunocompetent patients. All tissues were tested using the type-specific quantitative real-time polymerase chain reactions (PCR) for the most common wart-associated Alpha-PV (HPV2/27/57) and Mu-PV types (HPV1/63/204). The presence of 23 additional low-risk HPVs was evaluated using a conventional wide-spectrum PCR.

Results: HPV DNA was detected in 176/185 (95.1%) CWs and multiple HPV types in 71/185 (38.4%) lesions. Using the VL approach and a robust cutoff of one viral copy/cell established in this study, HPV2/27/57 were determined as causative agents in 41/53 (77.3%) and 53/71 (74.7%) CWs with single and multiple HPVs, respectively.

Conclusions: CWs are mostly etiologically associated with HPV2/27/57 and only rarely with HPV1. In the majority of CWs containing multiple HPVs, a single HPV type was present in high concentration, indicating etiological association. No significant differences in VLs of lesion-causing HPV types in CWs containing single or multiple HPVs were found.

Why do some titanium-alloy total hip arthroplasty modular necks fail?

BACKGROUND

Increased modularity in total hip arthroplasty (THA) through extra junction between the neck and the femoral stem is gaining popularity among orthopaedic community. However, the advantage of the additional junction is shadowed by an increased risk of mechanical failure. The aim of this study was to describe the exact mechanism of fracture of the modular femoral neck in an uncemented stem.

METHODS

Clinical, metallurgical, and mechanical analysis including finite-element modelling and elemental-sensitive tissue analysis with the micro-PIXE method was performed on two patients treated with fully modular primary THA made from Titanium alloy of the same oval taper-cone design. In patient A revision was performed 7.8 years after the unilateral primary procedure because of modular femoral neck fracture, while patient B was left-side revised 15 years after the bilateral primary procedure because of aseptic loosening of the femoral stem.

RESULTS

Body weight was 30% higher and the arm of implanted modular femoral neck was 51% longer in patient A compared to patient B. Therefore, the stress ratio on the modular femoral neck of patient A was calculated to be 2.45 times higher than in patient B, preventing cold welding and producing taper damage and degradation at the neck-stem junction. Large clusters of metallic debris containing Titanium and Vanadium from the alloy were present in the periprosthetic soft tissues of patient A.

CONCLUSIONS

Patients with higher body mass index treated with fully modular Ti-alloy THA may be at increased risk to experience catastrophic failure of the device. Orthopaedic surgeons should avoid using long necks whenever possible, as these are especially prone to develop a vicious circle starting with the fretting process and crevice corrosion at the taper-cone connection, leading to crack initiation and crack propagation, accelerated by the increased vulnerability of the Ti-alloy in biologic media, ultimately ending as fracture at the typical site. Serum Ti concentration may represent a rough estimation of taper degradation and patients with elevated levels should be warned and followed accordingly.

Single Nucleotide Polymorphisms in Genes MACC1, RAD18, MMP7 and SDF-1a As Prognostic Factors in Resectable Colorectal Cancer

BACKGROUND

Colorectal cancer (CRC) represents one of the most common malignancies worldwide. Research has indicated that functional gene changes such as single nucleotide polymorphism (SNP) influence carcinogenesis and metastasis and might have an influence on disease relapse. The aim of our study was to evaluate the role of SNPs in selected genes as prognostic markers in resectable CRC.

PATIENTS AND METHODS

In total, 163 consecutive patients treated surgically for CRC of stages I, II and III at the University Medical Centre in Maribor in 2007 and 2008 were investigated. DNA was isolated from formalin-fixed paraffin-embedded CRC tissue from the Department of Pathology and SNPs in genes SDF-1a, MMP7, RAD18 and MACC1 were genotyped using polymerase chain reaction followed by high resolution melting curve analysis or restriction fragment length polymorphism.

RESULTS

We found worse disease-free survival (DFS) for patients with TT genotype of SNP rs1990172 in gene MACC1 (p = 0.029). Next, we found worse DFS for patients with GG genotype for SNP rs373572 in gene RAD18 (p = 0.020). Higher frequency of genotype GG of MMP7 SNP rs11568818 was found in patients with T3/T4 stage (p = 0.014), N1/N2 stage (p = 0.041) and with lymphovascular invasion (p = 0.018). For MACC1 rs1990172 SNP we found higher frequency of genotype TT in patients with T3/T4 staging (p = 0.024). Higher frequency of genotype GG of RAD18 rs373572 was also found in patients with T1/T2 stage with disease relapse (p = 0.041).

CONCLUSIONS

Our results indicate the role of SNPs as prognostic factors in resectable CRC.

Total hip arthroplasty-related osteogenic osteosarcoma: case report and review of the literature

BACKGROUND

Orthopedic implant-related sarcoma is an exceedingly rare, but a known complication of total hip arthroplasty (THA).

CASE PRESENTATION

The authors describe clinical and radiologic features, histologic appearance, and treatment of osteogenic osteosarcoma located in the proximal femoral diaphysis associated with an unstable femoral prosthesis following THA in a 65-year-old male patient. The patient with HLA-B27 positive ankylosing spondylitis underwent arthroplasty 15 years ago.

CONCLUSIONS

The neoplastic process may be considered as an extraordinary complication of THA and might just be coincidental or the result of some derangement of the healing process in host tissue with no definitely proven hypothesis that the implants or their by-products are carcinogenic. The soluble chemical substances from the implanted prosthetic material are, at least in animals, suspected to play a vital role in the pathogenesis of the neoplastic transformation of the bone tissue. The presented case shall alert orthopedic surgeons to clinical, radiologic, and macroscopic similarities between a malignant tumor and benign lesions caused by wear debris at THA sites. At the examination of plane X-rays of patients with THA loosening, the differential diagnosis should always include osteogenic sarcoma, as well. To our knowledge, there have been only nine cases of THA-related osteogenic osteosarcomas described in the English-language literature.

Abstract 1503: HP1-gamma's expression correlates with glioma grade and survival and is a putative marker of glioma stem like cells

Genetic and signaling pathways involved in the development of glioblastoma have been relatively well characterized. Gene/protein expression profiles of glioblastoma have been described that reflect stem-like phenotype of the tumor. However, no reliable individual markers exist up-to-date that differentiate glioblastoma stem-like cells from the neural stem cells. Glioblastoma appears to be of heterogenous cellular population, but detailed cellular origin of these tumors is unknown. Using a label-free proteomic approach, we analyzed two different glioma models with proven de novo tumorigenic properties, and compared them with primary neurospheres. Of almost 2000 identified proteins, we found 482 to be significantly differentially expressed among the three groups. Among the identified substrates, the clusters of proteins with highest density of protein-protein interactions were functionally enriched in RNA processing related to development and metabolic processes. We then focused on two putative quantitative markers of glioma stem-like cells, HP1-gamma (Heterochromatin Protein 1- gamma) - CBX3 (chrome box 3), an epigenetic regulator involved in RNA processing, and LDHA (Lactate Dehydrogenase A), a key metabolic enzyme of anaerobic glycolysis. We quantitated their expression in glioma tissue of different grades in a large set of patient samples and were able to show that the expression of HP1-gamma, highly upregulated in glioblastoma stem-like cells, correlates to glioma grade. Independent analysis of publicly available glioma patient data showed that LDHA expression is linked to IDH1 mutation status both in high grade and low grade gliomas. The same analysis reinforced our findings towards an increased involvement of CBX3/HP1-gamma in high grade gliomas. Altogether, CBX3/HP1-gamma and LDHA are novel biomarkers for cancer stem cell phenotype with different clinical importance in gliomas.

Citation Format: Uros Rajcevic, Sabrina Fritah, Petr V. Nazarov, Mara Popovic, Rajko Kavalar, Tadej Strojnik, Neza Podergajs, Jaco C. Knol, Thang V. Pham, Sander R. Piersma, Connie R. Jimenez, Simone P. Niclou. HP1-gamma's expression correlates with glioma grade and survival and is a putative marker of glioma stem like cells. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1503. doi:10.1158/1538-7445.AM2015-1503

Can we improve the clinical risk score? The prognostic value of p53, Ki-67 and thymidylate synthase in patients undergoing radical resection of colorectal liver metastases

OBJECTIVES

The aim of this study was to assess whether biological markers can provide prognostic information additional to that supplied by the clinical risk score (CRS) in patients with colorectal liver metastases.

METHODS

A retrospective review of a prospectively maintained database was conducted. Patients selected for this study were treated between 1996 and 2011 with potentially curative liver surgery. Expressions of p53, Ki-67 and thymidylate synthase were assayed using immunohistochemical techniques on tissue microarrays.

RESULTS

A total of 98 (24%) of 406 patients met the inclusion criteria. The median follow-up was 103 months. Analysis revealed a correlation between p53 protein overexpression and high CRS (P = 0.058). Following multivariate analysis, only high CRS remained as an independent negative prognostic predictor of survival (P = 0.018), as well as an indicator of early recurrence of disease (P = 0.010). Of the biological markers investigated, only Ki-67 overexpression was identified as a positive predictor of survival on multivariate analysis (P = 0.038).

CONCLUSIONS

Ki-67 overexpression was a positive predictor of survival. Only high CRS remained an independent negative prognostic predictor.

Evaluation of a focused sentinel lymph node protocol in node-negative gastric cancer patients

BACKGROUND/AIMS

A specific preoperative work-up was used to access a limited number of high-risk lymph nodes with RT-qPCR for micrometastatic sentinel lymph node involvement. We validated our protocol with IHC screening for micrometastases and long-term survival analysis.

METHODOLOGY

From the 32 patients included 22 were node-negative patients. With a specific preoperative protocol sentinel lymph nodes (1-2 per patient) were extracted for further RT-qPCR analysis for CEA and CK20 expression. In 10 patients from the study group, the remaining lymph nodes around the extracted sentinel lymph node from the first compartment were additionally screened using IHC for missed micrometastases.

RESULTS

Micrometastases were detected in seven of 22 (31.8%) node-negative patients. RT-qPCR identified micrometastases in four of 10 haematoxylin-eosin-negative lymph nodes (40%), and in three of eight IHC negative lymph nodes (37.5%). The cumulative 3-year survival for the study group was 80.8%. The 3-year survival in the RT-qPCR-negative group was 90%, compared with 66.7% in the RT-qPCR-positive group (p=0.289).

CONCLUSIONS

Encouraged by these results, we will include more patients in our focused sentinel lymph node protocol. With a refinement of our method, we believe the focused sentinel lymph node protocol can be implemented for intraoperative tailoring of extent of lymphadenectomy.

Subinvolution of placental bed vessels: case report and review of the literature

Subinvolution of placental bed vessels, a well-recognized cause of postpartum and postabortal hemorrhage, is defined with prolonged or excessive uterine hemorrhage beginning after the delivery or abortion. Although physiological changes in uteroplacental parts of spiral arteries are well known, the sequence of events in involution of these vessels is not yet clearly understood. In this article we present two cases of subinvolution of placental bed vessels in which we were able to demonstrate the presence of extravillous trophoblast in and around the placental bed vessels. The disease is supposed to be the result of abnormal interaction between maternal uterine cells and fetal trophoblast.

Hepatosplenic gamma-delta T-cell lymphoma in a female patient after delivery

Hepatosplenic γδ T-cell lymphoma (HSTCL) is a very rare peripheral T-cell lymphoma characterized by extranodal infiltration of mature malignant post-thymic T-lymphocytes into sinusoids of the liver and spleen without lymphadenopathy and significant cytopenias. The aetiology of the disease is unknown. We describe the case of a female patient in whom HSTCL developed after delivery and who was previously without disease. Flow cytometry and liver puncture are essential for diagnosing HSTCL, especially in patients with unexplained pancytopenia and hepatosplenomegaly. Since phenotypic results can easily be misinterpreted as non-malignant, the examiner should have enough experience to recognize clonal changes of T-lymphocytes. Namely, in contrast to B-lymphocytes, T-lymphocytes do not have an efficient indicator of clonality and are recognized by flow cytometry based only on aberrant expression of commonly present antigens of T-cell and NK-cell subsets. At present, there is no known cure for HSTCL with a maximum survival up to 2 years.

Experimental model and immunohistochemical comparison of U87 human glioblastoma cell xenografts on the chicken chorioallantoic membrane and in rat brains

BACKGROUND

To study the neuropathology and selected tumour markers of malignant gliomas, an animal glioma model was developed using the implantation of U87 human glioblastoma cells into chick chorioallantoic membrane. The immunohistochemical characteristics were studied and compared with an orthotopic rodent model.

MATERIALS AND METHODS

The U87 cell suspension was inoculated onto the chick chorioallantoic membrane on embryonic day seven and into the brain of nude rats. Brain tumour sections were examined for various known tumour markers by routine haematoxylin and eosin staining and immunohistochemical analyses.

RESULTS

The immunohistochemical analyses showed that S100 protein, glial fibrillary acidic protein and synaptophysin expressions, initially present in tissue culture, were lost in both models. Persistent kallikrein, CD68 and vimentin expressions in U87 cells, as well as in both animal tumour models, were detected. The percentage of p53-positive nuclei, which was higher in the tumours grown on the chick chorioallantoic membrane than in rats, did not correlate with the Ki-67 labelling index. Strong cathepsin expression was maintained from the cell culture to both tumour models. CD3-positive cells and numerous leukocytes, but no CD20-positive cells were detected in any of the animal samples, indicating the immunological response of the host to be primarily cellular. Stronger immune reaction for vascular endothelial growth factor in rats correlated with an observed increase in vascular proliferation in these tumours.

CONCLUSION

A simple, fast-growing, cheap and well-defined chick chorioallantoic membrane model of glioma was established, providing a basis for further experimental studies of genetic and protein expression during human glioma tumourigenesis. This model may possibly replace some rodent models for selective studies.

p53, Bcl-2 and AgNOR tissue markers: model approach in predicting prostate cancer characteristics

The balance between proliferation and apoptosis is represented by changes in the expression of the tissue markers, Bcl-2 and p53, and the presence of silver-stained nucleolar organizing regions (AgNOR) on DNA in prostate adenocarcinomas. Identifying a mathematical model that would take into account the opposing nature of both processes and relate this to cancer stage and grade would be a useful adjunct for studying disease behaviour. This retrospective study investigated tissue marker expression in prostate adenocarcinoma biopsy samples from 17 patients. Staining for p53 was inversely correlated with patient age. Staining for Bcl-2 correlated with the presence of advanced metastatic cancer and American Joint Committee on Cancer (AJCC) disease stage. A mathematical model was developed which combined coded staining intensity data for Bcl-2 and AgNOR, as markers of proliferation, and for p53, as a marker of apoptotis. The mathematical model significantly correlated with Gleason score, AJCC stage and serum prostate specific antigen level, whereas each tissue marker alone did not correlate with all these measures.

A large hymenal polyp in a 21-year-old virgin

Pathological conditions of the hymen are rare in everyday medical practice. They are usually encountered in the pediatric patient population and are sometimes a matter of forensic interest. We report an interesting case of a large hymenal polyp in an adolescent virgin that presented only a cosmetic problem. The polyp was excised, the hymenal ring was preserved, and the sample was histologically verified.

Prognostic value of immunohistochemistry in the Ewing's sarcoma family of tumors

BACKGROUND

The expressions of different markers have been immunohistochemically studied in various types of the Ewing's sarcoma family of tumors, especially for diagnostic purposes. However, little is known about their prognostic value in combination with the clinicopathological data of such patients.

MATERIAL/METHODS

This retrospective study investigated the immunohistochemical expressions of NSE, TdT, EMA, S-100, CK MNF116, p53, bcl-2, CD99, and CD117 on formalin-fixed paraffin-embedded material of 72 patients (age range: 2-59 years) with various types of Ewing's sarcoma family of tumors using the tissue microarray method. The immunohistochemical results were compared with clinicopathological features using survival analysis (Cox regression).

RESULTS

CD99 expression was detected in 90%, CD117 in 75.8%, bcl-2 in 70.1%, NSE in 66.6%, p53 in 66.6%, EMA in 26%, S-100 in 25.4%, TdT in 22.1%, and CK MNF116 in 10.2% of the cases. No immunoreactivity was observed in the normal tissue around the tumors.

CONCLUSIONS

The expressions of EMA (p=0.107), NSE (p=0.126), CD99 (p=0.14), TdT (p=0.198), bcl-2 (p=0.382), p53 (p=0.54), CD117 (p=0.612), S-100 (p=0.867), and CK MNF116 (p=0.934) had no statistically significant impact on survival. Patient age at the time of diagnosis (p=0.008) and the presence of tumor necrosis (p=0.033) were the only significant prognostic factors in this study. Tumor location was an insignificant prognostic factor (p=0.38).

Prognostic impact of CD68 and kallikrein 6 in human glioma

AIMS

To evaluate the expression of CD68 and kallikrein 6 in human gliomas, and investigate their prognostic significance for survival of brain cancer patients in comparison to some known prognostic markers.

PATIENTS AND METHODS

Histological sections of 51 primary astrocytic tumours (11 benign, 40 malignant) were immunohistochemically stained for CD68, cathepsin B, kallikrein 6 and Ki-67. CD68 and kallikrein 6 expressions were also analyzed by real-time PCR in nine brain tumour biopsies.

RESULTS

Both microglia and tumour cells expressed CD68. High CD68 and cathepsin B staining scores were significantly, more frequent in the malignant than in the benign tumours (p=0.036 and p=0.014, respectively). In contrast, the benign group presented a stronger immunoreactivity for kallikrein 6 compared with the malignant tumours (p=0.013). A CD68 staining score of tumour cells higher than 3 was a significant predictor of shorter overall survival (p<0.01) in all patients and of borderline significance in the malignant group (p=0.057). Strong CD68 staining was of greater predictive value in the subgroup of anaplastic astrocytomas (p=0.021). Furthermore, as expected on the basis of our previous studies, prognostic significance was confirmed for cathepsin B, but not for any of the other markers under evaluation.

CONCLUSION

Kallikrein 6 was down-regulated in malignant glioma, but this differential expression did not have an impact on patient prognosis. In contrast, immunostaining of glioma tissue for CD68 and for cathepsin B may be used for prognosis of survival in these patients. This finding suggests that besides the known role of cathepsin B in invasion and angiogenesis, CD68 may be also associated with glioma progression.

Neural stem cell markers, nestin and musashi proteins, in the progression of human glioma: correlation of nestin with prognosis of patient survival

BACKGROUND

The IF protein nestin and the RNA-binding protein musashi are expressed by neural progenitor cells during CNS development. Their expression in glial tumors was evaluated by immunohistochemistry, and the histopathological scores correlated with levels of cysteine cathepsins that are known prognostic markers in several tumors.

METHODS

The levels of nestin, musashi, and cathepsins B and L were assessed by immunohistochemical analysis of biopsies from 87 patients with primary CNS tumors. To confirm the immunohistochemical data, nestin expression was analyzed by real-time PCR in 12 brain tumor biopsies. The exact location of nestin-positive cells was determined by mapping the distribution of nestin in a highly invasive human glioma xenograft model.

RESULTS

Immunostaining revealed nestin to be expressed in 95.8% and musashi in 80% of the patient biopsies. The total IHC score for nestin was significantly higher in high- than in low-grade tumors (P < .0001). No difference was observed for musashi (P = .11). Real-time PCR of nestin expression confirmed the immunohistochemical data. Nestin expression was shown to be a strong prognostic marker for decreased overall survival (P = .0001), whereas musashi expression has no prognostic significance. Moreover, nestin was shown by Cox regression analysis to be a stronger prognostic marker than cathepsins B and L. IHC staining of nestin in a xenograft model showed that its expression is localized mainly in the invasive tumor cells at the tumor periphery.

CONCLUSIONS

Nestin is shown to be a strong prognostic marker for glioma malignancy. The presented data links the invasive glioma cells to CNS precursor cells, indicating that the most malignant cells in the gliomas may well be closely related to the glioma stem cells.

Clinicopathological and immunohistochemical markers after radical gastrectomy for gastric cancer

BACKGROUND/AIMS

The aim of the study was to verify the classic clinicopathological prognostic factors of the expected survival, to determine the frequency of immunohistochemical factors (C-erB-2, p53) and to verify these immunohistochemical factors in their function as prognostic factors in gastric cancer patients after a potentially curative gastric resection.

METHODOLOGY

In 78 gastric cancer patients after a potentially curative resection the clinicopathological factors (age, general performance of the patient, tumor diameter, TNM stage, stage according to UICC, type of operation and the extent of lymphadenectomy) and immunohistochemical factors (p53 and C-erB-2) were analyzed.

RESULTS

In univariate analysis ASA stage of general performance, size of tumor, TNM stage and stage according to UICC exert significant influence on the median survival. Median survival is higher in patients with C-erB-2 negative reaction and in those with p53 positive reaction, although not significant. In patients with tumor located in proximal two thirds, patients with negative reaction to C-erB-2 have a significantly higher median survival than patients with positive reaction to C-erB-2. The Cox regression model reveals ASA stage and UICC classification to be significant factors whereas immunohistochemical parameters C-erB-2 and p53 do not reveal any significance in the multivariate survival analysis.

CONCLUSIONS

According to the results of our study the ASA stage and UICC classification influence the expected survival of potentially radically resected gastric cancer patients significantly, while immunohistochemical parameters C-erB-2 and p53 do not.

Prognostic value of additional pathological variables for long-term survival after curative resection of rectal cancer

AIM: To evaluate the prognostic value of some pathological variables in rectal cancer survival.

METHODS: 247 patients who underwent curative resection of rectal cancer were included in the study. The influence on survival of five pathological variables (histopathological tumor type, histopathological tumor grade differentiation, blood vessel invasion, perineural invasion and lymphatic invasion) was assessed using statistical analyses.

RESULTS: Overall 5-year survival was 71.2%. Univariate analysis of all tested variables showed an effect on survival but only the effect of lymphatic invasion was statistically significant. At stages three and four it had a negative effect on survival (P = 0.0212). Lymphatic invasion also significantly affected cancer related survival in multivariate analysis at stages three and four. At lower stages (stage 0, stage 1 and stage 2) multivariate analysis showed a negative effect of perineural invasion on cancer related survival.

CONCLUSION: Patients with lymphatic and perineural invasion have a higher risk for rectal cancer related death after curative resection. Examination of these variables should be an important step in detecting patients with a poorer prognosis.

Experimental model and immunohistochemical analyses of U87 human glioblastoma cell xenografts in immunosuppressed rat brains

BACKGROUND

To study the neuropathology and selected tumour markers of malignant gliomas, an animal glioma model was developed using the implantation of human glioblastoma clone U87 into rat brains.

MATERIALS AND METHODS

The U87 cell suspension, or precultured U87 tumour spheroids, were inoculated into the brain of 4-week-old cyclosporin A immunosuppressed Wistar rats. The resulting first generation tumours were then transferred, through serial transplantations to rats, to obtain second and third generation tumours. Brain tumour sections were examined for various known tumour markers by routine HE staining and immunohistochemical analyses.

RESULTS

The immunohistochemical analyses showed that p53, S100 protein, glial fibrillary acidic protein (GFAP) and synaptophysin expressions, initially present in the tissue culture, were gradually lost in later tumour generations, whereas nestin and musashi expressions increased, possibly indicating progressive tumour cell dedifferentation. Persistent kallikrein, CD68 and vimentin expressions in U87 cells, as well as in all the generations of tumours, may be related to the preservation of the mesenchymal cell phenotype in this tumorigenesis model. Decreased cathepsins expression indicated lower invasive potential, but increasing Ki-67 expression marked higher proliferation activity in the subsequent tumour generations. The strong immune reaction for FVIII in the second and third generation tumours correlated with the observed increase in vascular proliferation in these tumours.

CONCLUSION

A simple, and well-defined rat model of fast-growing glioma was established, providing a basis for further experimental studies of genetic and protein expression fingerprints during human glioma tumorigenesis.

Ewing sarcoma/PNET: 27 years of experience in Slovenia

The study includes 91 patients treated for Ewing sarcoma between 1972 and 2002. Forty were younger and 51 were older than 16. The overall 5-year survival was 36%: 53.5% in the younger and 22.5% in the older age group. Among patients with localized disease, 5-year survival was 58% in younger and 25.5% in the older. Survival was similar whether patients received three treatment modalities or chemotherapy combined with either surgery or radiotherapy. Recurrence was noted in 47 out of 75 patients with localized disease, most commonly as local recurrence or lung metastases. Among 18 evaluated patients, 14 had minor physical defects and 4 had severe late treatment effects (sterility in 3 and secondary osteogenic sarcoma in 1).

A colloid cyst of the third ventricle – the cause of episodic headache and sudden unexpected death in an adolescent girl

An 18-year-old girl was found dead in her bed. The autopsy revealed a colloid cyst of the third ventricle. The cyst obstructed the flow of cerebrospinal fluid, leading to prominent internal hydrocephalus with consecutive brain edema and compression of the caudal medulla at the foramen magnum. The girl's only previous complaints were episodic headaches for the previous 2-3 years. Computed tomography and magnetic resonance imaging were not performed prior to her death. This case report highlights the importance of early diagnosis of colloid cyst of the third ventricle and the need to perform computed tomography and magnetic resonance imaging in patients with episodic headaches even when they show no neurologic deficit. Although it is a very rare disorder, it should be included in the differential diagnosis of headaches in children and young adults, and also in the differential diagnosis of conditions causing increased intracranial pressure, in view of the life-saving management required to prevent a fatal outcome.

Phlegmonous gastritis: case report and review

Phlegmonous gastritis is an acute infection of the stomach wall by pyogenic bacteria. It represents an extremely rare disease with a fulminating course and a high mortality rate. A precise lifetime diagnosis is generally unsuccessful. The inflammation, most often caused by alpha-hemolytic streptococci, is most frequently expressed in patients who are more susceptible to infection. Among these are elderly patients, women, patients with chronic gastritis, chronic peptic ulcer, hepatic cirrhosis and decreased immune tolerance, T-cell leukemia, patients with a low socio-economic status and alcoholics. In our paper we are describing the case of a 66-year old female patient, who had received many years of treatment for rheumatoid arthritis. She died due to phlegmonous gastritis, which was only established post-mortem. The authors share the opinion that the occurrence of the phlegmonous form of gastritis was influenced significantly by the treatment with nonsteroidal antirheumatics and corticosteroids, which she had received for many years and also immediately prior to the complication.

Cathepsin L in glioma progression: Comparison with cathepsin B

OBJECTIVE

Lysosomal cysteine cathepsins have been implicated in tumor progression. This study is aimed to reveal differential expression and compare the prognostic significance of cathepsins B and L in glioma patients.

METHODS

The histological slides of 82 patients with primary astrocytic tumors were reviewed. We evaluated the immunostaining of the cathepsins in tumor and endothelial cells.

RESULTS

Cathepsins B and L stained positive in 98 and 88% of cases, respectively. The total score was significantly higher in malignant than in benign tumors, both for cathepsin B (p<0.001) and for cathepsin L (p<0.01). The IHC score in endothelial cells in the malignant group was significantly higher only for cathepsin B (p<0.0001). Survival analysis indicated that in contrast to the prognostic significance of total cathepsin B and endothelial cells associated cathepsin B for shorter patients' survival, the prognostic role of cathepsin L was not confirmed.

CONCLUSION

Cathepsin L is preferentially expressed in tumor cells, increasing with glioma progression, but is not significantly associated with new vasculature of glioblastoma. In contrast to cathepsin B, cathepsin L has no prognostic impact, suggesting different roles of the two cathepsins in glioma progression.

Urgent Whipple resection for solid pseudopapillary tumor of the pancreas

We report a 14-year-old boy who was urgently transferred to our institution after a blunt abdominal trauma. CT scan and repeated ultrasound examinations revealed a subhepatic mass, which slowly increased in size. Imaging features were not specific enough to permit a precise diagnosis. Because of the positive peritoneal signs and increased signs of circulatory instability, the decision was made to perform an urgent explorative laparotomy. The exploration revealed that the large haematoma-like bleeding mass was a tumor arising from the head of the pancreas, which ruptured on the surface. We performed a curative R0 Whipple resection. Histology of the resected specimen revealed a solid pseudopapillary tumor of the pancreas, an extremely rare tumor predominantly occurring in young and middle-aged women. It has a favorable prognosis if resected radically. The boy is well 30 months after the operation. To our knowledge, there are only two other descriptions of pancreatic solid pseudopapillary tumor in boys treated urgently by Whipple resection because of acute presentation after blunt abdominal trauma.

What have we learned from surgical treatment of gastric adenocarcinoma? A comparison of two periods

In January 1992, a standardized and more radical surgical approach in gastric cancer treatment and a standardized pathohistological workup of specimens was introduced at our institution. The aim of our retrospectively designed study was to compare the results of two consecutive groups of altogether 348 patients who underwent a total or subtotal gastrectomy for gastric cancer (period A: 162 patients operated between 1992 and 1996; period B: 186 patients operated between 1997 and 2000). The two groups of patients were comparable in age, sex, their general condition, and the proportion of potentially curable (R0) resections. There was a significant difference between the groups with regard to tumor site (fewer distal and more proximal stomach tumors in period B), type of operation (more total gastrectomies in period B), extent of lymphadenectomy (more D2 and D3 in period B), average number of affected lymph nodes (higher in period B), average number of examined nodes (higher in period B), and in UICC stage (less stage II in period B). UICC classification was impossible in 19 patients overall, but there were fewer non-classified patients in period B. The incidence of surgical complications (15.6% vs. 18.7%) and average hospital stay (14.72 days vs. 14.70 days) was not significantly different in the two groups. The drop in overall mortality rate (potentially curable and non-curable resections) in period B almost reached statistical significance (period A: 8%, period B: 6.5%; p = 0.57). The 5-year survival for all R0 resected patients (279) in 9 years was 31%. The median survival was significantly longer in period B (941 days) than in period A (570 days) for R0 and non-curable (R2) resections together (p=0.0132) as well as for R0 resections alone (period A: 844 days, period B: 1176 days; p = 0.0127). Comparison of the two consecutive groups of patients shows that after a defined period of systematic surgical work our results improved, reflected in the higher number of extracted lymph nodes, the higher number of total gastrectomies, and the longer median survival in the second period.

Acute presentation of a solid pseudopapillary tumor of the pancreas

We report a case of acute presentation of a solid pseudopapillary tumor of the pancreas in a young boy who had suffered a blunt abdominal trauma. Urgently performed CT examination and repeated ultrasound revealed a subhepatic mass, which gradually increased in size, but the imaging features were not specific enough to permit a precise diagnosis. Because signs of peritoneal irritation and increased circulatory instability gradually developed within the hours of observation, the decision was made to perform an urgent exploratory laparotomy. The exploration revealed a hematoperitoneum and a large hematoma-like subhepatic bleeding mass. Further exploration showed that this mass was a tumor arising from the head of the pancreas, which had ruptured on the surface. A curative pancreatoduodenectomy was performed. Pathohistological examination of the resected specimen revealed a solid pseudopapillary tumor of the pancreas, an extremely rare tumor predominantly occurring in adolescent girls and in young adult women. It has a favorable prognosis if resected radically. The boy in our report is feeling well 36 months after the operation.

Solitary fibrous tumor of the parapharyngeal space

Solitary fibrous tumors are rare tumors originating from the mesenchymal tissue. In most cases they arise from the subpleural tissue but have also been described in other locations in the body. Most such tumors in the head and neck region occur in the orbit. Although malignant tumors can occur, benign tumors are far more common. The therapy is surgical excision. For a conclusive diagnosis, a typical morphology and immunohistochemistry are required. The tumor is strongly positive for CD34 and vimentin. This report describes the clinical appearance and treatment of a solitary fibrous tumor of the parapharyngeal space in a female patient. The symptoms were similar to those in a peritonsillar abscess, one of the more common ear-nose-throat dysfunctions. Fewer than 10 cases of a solitary fibrous tumor of the parapharyngeal space have been described in the literature.

Flow and image cytometric DNA ploidy, including 5c exceeding cells, of serous borderline malignant ovarian tumors. Correlation with clinicopathologic characteristics

OBJECTIVE

To analyze DNA ploidy of serous borderline ovarian tumors by flow cytometry (FCM) and image cytometry (ICM), with 5c exceeding cells also analyzed, and to evaluate their correlation with clinicopathologic characteristics of patients and tumors.

STUDY DESIGN

Cell suspensions were prepared according to a modified Hedley method from formalin-fixed, paraffin-embedded tissue blocks of 43 tumors. One part of the suspension was used for flow cytometric measurement; from the other part, filter slides were prepared for ICM.

RESULTS

FCM and ICM found 2 aneuploid (peridiploid) serous borderline ovarian tumors, and FCM found 1. ICM found 3 tumors with 5c exceeding cells and 2 tumors with octaploid cells. There was no correlation between DNA aneuploidy and presence of 5c exceeding cells with tumor size, International Federation of Gynecology and Obstetrics stage or survival.

CONCLUSION

The results confirm a good correlation between FCM and ICM DNA ploidy and the ability of ICM to detect 5c exceeding cells. The prognostic value of DNA ploidy and 5c exceeding cells in serous borderline malignant ovarian tumors warrant further evaluation.

Spontaneous dissecting aneurysm of the coronary artery. A rare cause of myocardial infarction and sudden death

Spontaneous dissecting aneurysm of the coronary artery (SDACA) not associated with aortic aneurysm or trauma is a very rare cause of myocardial ischemia. It has a higher prevalence in otherwise healthy women, especially in the peri- and postpartum period. In 80-90% of cases the diagnosis of SDACA is confirmed at autopsy, as the majority of patients present with acute myocardial infarction or sudden death. We describe the case of a 47-year-old Caucasian woman who died suddenly without any previous sign of cardiac disease. She had no clinical signs of Marfan's syndrome or arterial hypertension, she used no oral contraceptives and she was not in the peri- or postpartum period. At autopsy we found a recent dissecting aneurysm of the right coronary artery. Histology showed a hematoma between the media and adventitia of the coronary artery, flattening and occluding the lumen. Acute myocardial infarction was present in the posterior wall of the left cardiac ventricle. SDACA is an unpredictable condition and prompt diagnosis and life-saving procedures--either surgical or conservative--are rarely successful. We report a very rare disease documented in only 108 cases according to the English-language literature accessible to us.

Expression of MAGE tumour-associated antigens is inversely correlated with tumour differentiation in invasive ductal breast cancers: an immunohistochemical study

MAGE (Melanoma antigen E) family gene products encompass tumour-associated antigens (TAAs) recognised by human leukocyte antigen (HLA)-restricted specific T-cells. Agents inducing DNA demethylation, an event typically detectable in cellular de-differentiation processes, were shown to induce the expression of MAGE genes. By using a monoclonal antibody specific for MAGE family gene products, we have studied the expression of these TAAs in a group of 144 patients with invasive ductal breast cancers. Immunohistochemical data were correlated with tumour differentiation, lymphatic vessel invasion, oestrogen receptor expression, intratumoural necrosis, lymphocytic infiltration, perineural invasion, tumour microcalcifications and axillary lymph node metastases. MAGE immunoreactivity was undetectable in non-neoplastic cells. In poorly differentiated cancers positive staining was observed in 30/63 cases (47.6%) as compared with 13/51 (25.4%) and 5/30 (16.6%) in moderately and well-differentiated tumours, respectively (P<0.05). In addition, MAGE immunoreactivity was significantly correlated with lymphatic vessel invasion and intratumoural necrosis. Moreover, a significant inverse relationship with oestrogen receptor expression was also observed. However, no significant correlation could be established between MAGE immunoreactivity and defined phenotypic characteristics of tumour infiltrating lymphocytes, including expression of CD3, CD4, CD8, CD20 or granzyme B. Thus, expression of MAGE family gene products in invasive ductal breast cancers appears to be associated with poorly differentiated histological phenotypes. These data support the concept of specific immunotherapy in highly aggressive forms of breast neoplasms. Furthermore, they suggest that MAGE immunoreactivity could represent a tumour marker of potential prognostic relevance.

Primary breast cancer of the vulva: a case report and review of the literature

Since 1872, 40 cases of ectopic mammary gland tissue in the vulva have been reported in the literature. Out of these, 12 had a primary cancer in the ectopic breast tissue. Seven metastases of an orthotopic breast cancer have been found in this location. We are presenting the 20th case of cancerous breast tissue in the vulva whom we classified as the 13th case of primary cancer based on clinical and histopathological criteria of primary and metastatic malignant disease. Because of the advanced age of the patient, wide local excision followed by adjuvant hormonal therapy was opted for. Nineteen months after surgery, there is no evidence of recurrent disease. Due to the rarity of this entity, its management presents therapeutic dilemmas, and variable treatment strategies are being found in the literature. In our opinion, the same basic principles used for treatment of cancers of the orthotopic breast should be applied in ectopic breast carcinoma.

Brown tumor in association with secondary hyperparathyroidism. A case report and review of the literature

Since 1993, our 34-year-old female patient was on replacement treatment with hemodialysis for terminal renal failure due to hypertensive nephropathy. She developed severe secondary hyperparathyroidism. In 1996, she presented with a brown tumor, localized in the region of the left maxillary sinus and at its front. The patient did not take phosphate binders and treatment with vitamin D was not possible due to the increased Ca x P product. She had no difficulties, so she did not desire a surgical parathyroidectomy. As she had trouble breathing through the nose, and because of the facial deformity due to the brown tumor, she decided to have the tumor removed surgically.

Pelvic actinomycosis

Pelvic actinomycosis is a rare chronic infection caused by bacteria of the family Actinomycetaceae. Prolonged use of an intrauterine contraceptive device (IUD) is a well known risk factor. We report six patients with pelvic actinomycosis, all of whom had an IUD inserted for over six years. Diagnostic problems necessitated a laparotomy in all patients. The pathohistological diagnosis was based on the characteristic microscopic image and specific staining. The patients were treated with penicillin and amoxycillin for several months.