Dario Bucella

Estrogen and progesterone receptors in smooth muscle component of deep infiltrating endometriosis

OBJECTIVE To analyze the expression of estrogen (ER) and progesterone (PR) receptors in the smooth muscle component (SMC) of deep infiltrating endometriosis (DIE). DESIGN A prospective clinical and pathologic study of 60 cases of DIE. SETTING University Hospital Department of Gynacology. PATIENT(S) Sixty patients with symptomatic DIE (uterosacral endometriosis n = 14; bladder endometriosis n = 10; colonic endometriosis n = 16; rectovaginal endometriosis n = 20). INTERVENTION(S) Laparoscopic surgery. MAIN OUTCOME MEASURE(S) The expression of ER and PR was studied by immunohistochemistry in the SMC directly around endometriotic foci and at distance (at least >1.5 cm) from them in correlation with proliferative and secretory phases of cycle. RESULTS The ER and PR were present in the SMC of DEI in each location excepting colonic endometriosis where ER were absent. Independently of cycles phases the PR were more abundant than ER. With the exception of rectovaginal endometriosis, where the ER and PR were more abundant in the proliferative than in the secretory phase, in other locations the ER and PR did not differ significantly with cycles phases. Last, if ER and PR were more abundant in SMC around endometriotic foci than at a distance from them. However, the difference was not significant. CONCLUSIONS Our data substantially confirm for the first time that in various forms of DIE, ER and PR are present not only in glands and stroma but also in the smooth muscle major histologic component of this disease.

Omental trophoblastic implants after surgical management of ectopic pregnancy

Peritoneal implants secondary to a tubal ectopic pregnancy or extratubal omental secondary trophoblastic implants (ESTI) are a rare entity often underestimated or unknown. It can be responsible of rising in the ß-hCG titer after salpingectomy for ectopic tubal pregnancy. Moreover, implants on the omentum are exceptional. This particular localization is exceptional and its physiopathology, diagnosis, surgical management and follow-up are discussed in this paper.

Recurrence of Mitotically Active Cellular Fibroma of the Ovary

Background. 10% of ovarian fibromatous tumours typically exhibit increased cellularity, mitotic activity, and less frequently nuclear atypia. Therefore, the classification within the group of fibromatous tumours may represent some difficulties, thus, one or several of these features should appear. Case. We introduce the clinical and pathologic features based on one case of recurrence of a mitotically active cellular ovarian fibroma (MACF) in the pararectal fossa. This recurrence took place six years after primary surgery. Macroscopically, the tumour was firm, fibrous, well delimited, yellow-white without gross necrosis. On microscopic examination, it was composed of a densely cellular proliferation of fibrolastic-like cells with bland nuclear features and arranged in a fascicular pattern. There was no sign of significant atypia or necrosis. Conclusion. Recently, this case is the first report of a recurrence of MACF, following primary surgery with no tumoral rupture or surgical difficulty. The clinical outcome of ovarian cellular fibromas (CFs) and MACFs is typically uneventful. This case, however, strongly suggests maintaining a long-term clinical follow-up even though the principal tumour was surgically treated without tumour rupture or in the absence of adherence or any surgical difficulty.

Androgen receptor expression in cervical intraepithelial neoplasia and invasive squamous cell carcinoma of the cervix.

If in vitro studies have demonstrated a potential interaction between human papillomavirus (HPV) and androgen receptor (AR), their expression in vivo during cervical carcinogenesis remains unknown. To clarify the issue, we have tested by immunohistochemistry the expression status of AR in low-grade cervical intraepithelial neoplasia (LSIL-CIN1) (n=30), high-grade cervical intraepithelial neoplasia (HSIL-CIN2/3) (n=30), and invasive squamous cell carcinoma (ISCC) (n=13). All the patients with these lesions have got a corresponding liquid-based cytology and were proved to be HPV positive by using hybrid capture II methodology with probes against high-risk oncogenic HPVs (HR-HPVs). Thirty cases of normal exocervix epithelium served as controls. The evaluation of AR expression was performed by using H-score system, and an H-score >50 was considered positive. Androgen receptor expression was observed in 100% of normal epithelium (30/30) and LSIL (30/30), but only in 63% of HSIL (19/30) and 23% of ISCC (3/13). A statistically significant difference (P<0.05) concerning this expression was found between normal epithelium and HSIL or ISCC, between LSIL and HSIL or ISCC, and between HSIL and ISCC. To the best of our knowledge, this is the first study describing that the loss of AR expression is a frequent and common event in HSIL and ISCC resulting probably from complex interactions between HR-HPVs and these receptors. These data provide new insights concerning a potential role of androgen and AR in cervical carcinogenesis, which should be confirmed in furthers studies.

Intérêt de la recherche des séquences virales HPV dans le dépistage du cancer du col utérin

Resume A l’heure actuelle, les Papillomavirus humains sont consideres comme la cause majeure des lesions malpighiennes intraepitheliales (SIL) et des cancers invasifs du col uterin. Dans cet article, nous avons revu d’une part les principales donnees concernant la taxonomie, l’epidemiologie et les methodes de detection de ces virus et d’autre part les applications cliniques pratiques du test HPV, a savoir son role dans le tri des lesions cytologiques dites « limites » (ASC-US, ASC-H, LSIL), dans le suivi apres traitement des neoplasies intraepitheliales (CIN) de haut grade et enfin pour le depistage primaire associe ou non a la cytologie.

Un galactocèle géant chez une femme allaitante

Une jeune femme, âgée de 20 ans, allaitante, consultait après l’apparition de douleurs localisées au niveau du sein droit et irradiant dans le creux axillaire. Cette patiente, d’origine maghrébine, sans antécédents particuliers et immunocompétente, n’avait pas de notion de contage tuberculeux. La patiente était subfébrile et à l’examen physique, on retrouvait au niveau du quadrant supéroexterne du sein droit une tuméfaction douloureuse et des signes de lymphangite. L’échographie et la mammographie démontraient une volumineuse masse kystique hétérogène mesurant 8 × 5 cm au contour bien circonscrit au niveau du quadrant supéroexterne, ainsi que deux adénopathies axillaires de 3 cm de plus grand axe. Les vidanges échoguidées ont ramené un liquide lactescent avec des résultats bactériologiques négatifs. La cytologie était peu contributive, ramenant uniquement quelques cellules macrophagiques. Face à ce tableau, le diagnostic de galactocèle a été posé et une antibiothérapie fut instaurée pendant 21 jours. Devant l’échec de cette antibiothérapie et la persistance de cette masse douloureuse, une exérèse de cette dernière et des deux ganglions axillaires est décidée. Macroscopiquement, la formation tumorale kystique mesurait 8 cm de grand axe et était entourée d’un tissu fibreux et les ganglions présentaient un aspect nécrotique et blanchâtre (Fig. 1). L’examen histologique retrouvait des granulomes nécrotiques gigantocellulaires, tant au niveau de la paroi de la formation tumorale kystique qu’au niveau des ganglions lymphatiques (Fig. 2).