DOI: 10.3897/folmed.67.e153005

Authors: Alyea Al-Harthy, Mohammad Arafa

Abstract: Introduction: An endometrial polyp (EP) is an abnormal growth of the endometrium inside the uterine cavity. Histologically, the polyp contains glandular, stromal, vascular (thick-walled vessels), and connective tissue elements (fibrous stroma). The most common symptoms of patients with endometrial polyps are abnormal bleeding and infertility. Aim: To assess cases of endometrial polyps received at the pathology department of a hospital by exploring the different presentations of the patients and the correlation with the clinico-pathological features. Materials and methods: This retrospective, cross-sectional study used patient data from January 2018 to December 2022. It was conducted in the pathology department of a tertiary care center. It included 180 women with endometrial polyps. Data were collected from the hospital information system’s medical records, and the Statistical Package for the Social Sciences (SPSS), version 26.0, was used to analyze the data. Results: The patients’ ages ranged from 29 to 88 years. About one-third of the patients were aged between 30 and 40 years. Patients with a single polyp were more than those with multiple polyps. Abnormal bleeding and infertility were the most prevalent symptoms. All the cases were histopathologically benign except for one who presented with malignancy. Age did not show significant association with recurrence. In more than 75% of patients, there was a consensus between the clinical assessments and pathology results. Conclusion: Most endometrial polyps are benign and single with a good concordance between the clinical suspicion and the histopathological confirmation.

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DOI: 10.3897/folmed.67.e139770

Authors: Evripidis Bekiaris, Konstantina Psalla, Gabriela Stanc, Vasilios Tselepidis, Evgenia Karavioti, Christos Iavazzo

Abstract: Low-grade appendiceal mucinous neoplasm (LAMN) is a rare malignancy originating from the epithelium of the appendix. The diagnosis is difficult to make, and it is often found during surgery. In the present case, we prepared our patient for a total abdominal hysterectomy with bilateral salpingo-oophorectomy, but during laparotomy, a cystic dilation of the appendix was found. We did an appendectomy and the pathological diagnosis was LAMN. Gynecologists may encounter this disease incidentally. Whenever there is a right abdominal mass, cystic or not, found in the preoperative imaging, gynecologists should always consider appendiceal origin.

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DOI: 10.3897/folmed.66.e125700

Authors: Eleni Papamattheou, Ioannis Katsaros, Eirini Chorianopoulou, Kyriaki Theodorolea, Gabriela Stanc, Christos Iavazzo, Elissaios Kontis

Abstract: The rectovaginal septum is a rare location for gastrointestinal stromal tumors (GIST) to occur. The aim of this study was to present a case of synchronous local recurrence of solitary liver metastasis originating from an extra gastrointestinal tumor (E-GIST) of the rectovaginal space. A 55-year-old woman, with a medical history of a resected meningioma, was referred to our department due to a 5 cm solitary liver metastasis located within the left lateral segment. The patient had undergone a transvaginal resection of a low-risk E-GIST 6 months prior without receiving adjuvant chemotherapy. The patient underwent a synchronous laparoscopic left lateral hepatectomy and a transvaginal resection with posterior vaginal wall reconstruction. Her postoperative course was uneventful and was discharged on the fifth postoperative day. The histological examination of the vaginal lesion revealed the development of neoplasm with pathological characteristics consistent with the initial histology expect for a mitotic index exceeding >20%. Liver histology report also included a high-risk GIST with CKIT (+), DOG1 (+), ki67 ≥30%, high mitotic activity and clear resection margins. The patient was referred for adjuvant chemotherapy. E-GISTs are rare neoplasms with low malignant potential. However, these tumors may exhibit metastatic potential and require aggressive treatment.

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DOI: 10.3897/folmed.66.e116865

Authors: Dimitrios Bairaktaris, Stefania Tsoplaktsoglou, Efthymia Souka, Konstantinos Kalmantis, Christos Iavazzo

Abstract: Paraovarian tumors of borderline malignancy (PTBM) are exceedingly rare, with only slightly over 60 cases reported worldwide. This report presents the case of a 22-year-old nulliparous patient who incidentally discovered a left paraovarian mass during a routine abdominal ultrasound. Subsequent MRI revealed a 2.5×2.1 cm cystic lesion located in close proximity to, but outside of, the left ovary, with no other pathological findings. A laparoscopic cystectomy was performed with meticulous care to prevent tumor spillage, and the patient experienced an uneventful recovery. Histopathological examination unveiled irregularly shaped tissue measuring 2.2×1.2×1 cm, characterized by fibrous tissue/wall with spindle cell stroma and an epithelium displaying features consistent with a serous borderline tumor. Our multidisciplinary team recommended diligent follow-up. This case contributes to the existing literature on PTBM and highlights the imperative for additional cases to enhance our comprehension of the optimal management of these exceedingly rare tumors.

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DOI: 10.3897/folmed.65.e100064

Authors: Georgi D. Prandzhev, Tihomir P. Totev, Svetlana A. Mateva, George Mathew, Grigor A. Gortchev

Abstract: Uterine tumor resembling ovarian sex-cord tumor is a rare group of uterine neoplasms with unknown histogenesis and differentiation towards ovarian sex-cord elements. They are benign in nature with low malignancy potential. Diagnosis is based on immunohistochemistry and morphological features, and the distinction from other more malignant differentials is paramount to correctly individualizing treatment. A 47-year-old patient was admitted to the hospital complaining of abdominal pain and abnormal uterine bleeding. Subsequent detection of multiple uterine fibroids by ultrasound study and CT scans lead to a robot-assisted total hysterectomy. Histological studies revealed that one of the fibroids in the myometrium had a morphology resembling an ovarian sex-cord tumor with low Ki-67 proliferative activity. After 12 months of follow-up, no additional treatment was required, and no signs of recurrence or progression were observed. Uterine tumor resembling ovarian sex-cord tumor is a rare gynecological entity with no established treatment protocol. Differentiation between benign and malignant behavior is based on structural features and immunohistochemical expression assessment. This highlights the importance of immunohistochemical staining and morphological analysis to determine the degree of surgical radicality. Minimally invasive approach is feasible and safe, but more experience is needed for further conclusions.

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DOI: 10.3897/folmed.64.e68688

Authors: Irina Sagaidac, Dorina Rotaru, Olga Cernetchi

Abstract: Neonatal hemorrhagic syndrome, which affects several principal organs during the early neonatal period, denotes a deficiency of vitamin K and coagulation factors. This article presents the case of a patient who gave birth at term, had congenital heart disease and required several prior surgical interventions including corrected transposition of the great vessels via ventricular septal defect (VSD) repair, atrial septal defect (in childhood) and tricuspid valve replacement (6 years ago), mitral regurgitation (MR), grade I pulmonary regurgitation (PR), grade II mitral and tricuspid valve regurgitation, and grade II heart failure based on the New York Health Association (NYHA) classification. Throughout the pregnancy, the patient received large doses of anticoagulant, specifically acenocumarolum, until the moment she gave birth. The vaginal delivery was spontaneous, contrary to the recommendations given to the pregnant woman in a secondary healthcare institution. At birth, the newborn was in satisfactory condition, with 8/9 on the Apgar score. However, the newborn’s condition worsened over time, suspected of having neonatal hemorrhagic syndrome caused by medications received by the mother. Forty-eight hours after birth, the newborn died. Anticoagulant therapy cannot be regarded as 100 percent risk-free during pregnancy due to the potential for hemodynamic disorders to develop in both the mother and the unborn child. Considering the high incidence of perinatal mortality in such cases (10-30%), it is advised that a multidisciplinary team work together to inform the mother about potential complications, collaboratively determine the length of treatment with vitamin K antagonists (VKAs), develop a plan for monitoring the pregnancy, and determine which institution the mother and newborn would benefit from receiving qualified medical assistance.

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DOI: 10.3897/folmed.63.e56489

Authors: Dolina G. Gencheva, Fedya P. Nikolov, Ekaterina H. Uchikova, Rosen D. Mihaylov, Blagovesta G. Pencheva, Katerina I. Ivanova

Abstract: Introduction: Gestational hypertension is a less investigated hypertensive disorder of pregnancy than preeclampsia, but evidence exists of an unfavourable cardiovascular profile for women after such a pregnancy.Aim: To determine serum high-sensitivity C-reactive protein (hs-CRP) levels in women with preeclampsia, gestational hypertension, and in normotensive pregnancy in order to assess the cardiovascular implications and to examine its correlations with some characteristics of women.Materials and methods: Thirty-six women with gestational hypertension, thirty-seven with preeclampsia, and fifty maternal and gestational age-matched controls were included in a single-center prospective clinical-epidemiological study. Serum hs-CRP levels were determined using ELISA method.Results: Significantly higher hs-CRP levels were found in the gestational hypertension group than in the controls (p=0.043), but not in the preeclampsia group (p=0.445). The levels between the two pathological groups did not differ significantly (p=0.247). Odds ratio for hs-CRP levels higher than the provided cut-off was 3.31 (95% CI 1.32–8.29) for the presence of gestational hypertension. In the normotensive pregnant women, the hs-CRP levels had a positive correlation with BSA, pre-pregnancy and current BMI, but such correlations were absent in the hypertensive groups. There were no correlations with the maternal or gestational age, current weight gain in any of the groups or with the highest detected blood pressure in the pathological groups. These levels did not differ according to gravidity, smoking status and smoking during pregnancy.Conclusions: Elevation of hs-CRP was more pronounced in women with gestational hypertension than in women with preeclampsia, which could indicate a different pathophysiological mechanism and a higher cardiovascular risk for those women.

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DOI: 10.3897/folmed.62.e48736

Authors: Anastasios Pandraklakis, Nikolaos Thomakos, Anastasia Prodromidou, Maria D. Oikonomou, Ioannis G. Papanikolaou, Dimitrios-Efthimios G. Vlachos, Dimitrios Haidopoulos, Georgios Daskalakis, Alexandros Rodolakis

Abstract: Advances in modern medicine have allowed patients with early stage cervical cancer (stages Ia - IIai) to preserve their fertility with oncologic efficacy comparable to previous radical treatments. A variety of conservative-fertility sparing procedures, also known as Fertility Sparing Surgeries (FSS) have been proposed. The present review aimed to provide the current evidence on obstetric outcomes and the prematurity rates as well as to discuss the management modalities of these high-risk pregnancies. Our review of the literature included 3042 women with early cervical cancer, of whom 2838 underwent FSS (204 excluded for oncologic reasons). Almost half of these patients attempted to become pregnant and about two thirds of them achieved at least one pregnancy either spontaneously or with the help of Assisted Reproduction Technologies. Data revealed that 63.9% of these pregnancies resulted in live births, whereas 37.6% of them were preterm. The main cause of preterm births in this subpopulation is the postoperative cervical length restriction that consequently leads to cervical incompetence and ascending infections that eventually lead to (clinical or subclinical) chorioamnionitis. Radical operations such as ART, VRT and MIRT presented with higher prematurity rates. The lack of standardized protocols for the management of pregnancies after FSS precluded reaching to firm results with regards to the efficacy of them in achieving favourable obstetrical outcomes. Further large volume studies are warranted with the intent to acquire standardized guidelines for pregnancies achieved after FSS for early stage cervical cancer.

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