Ferenc Paulin

Changes of Cell Adhesion and Extracellular Matrix (ECM) Components in Cervical Intraepithelial Neoplasia

Cell-cell and cell-extracellular matrix interaction is crucial in tumor progression. Tight junction (TJ) proteins as occludin and claudins (CLDNs) play important role in this process together with several extracellular matrix components, as syndecan. Our previous work suggested significant changes in the expression of claudins even in the early stages of cervical carcinogenesis. The aim of our present work was to study the expression of occludin and syndecan-1, as compared to CLDNs, in early phases of cervical carcinogenesis. Paraffin sections of 50 samples were studied by immunohistochemistry, including cervical intraepithelial neoplasias (CIN-I-II-III), in situ carcinomas (CIS) and normal cervical samples. Occludin and CLDN-2 were found colocalized in the basal layer, while syndecan-1 and CLDN-1, -4 and -7 were coexpressed in the parabasal and intermedier layers in normal epithelia. Intensity of occludin staining decreased in CIN/CIS lesions, although it was more extended towards the upper epithelial layers with inverse relation with grades, as seen in the case of CLDN -2 expression. CLDN -1, -2, -4 and -7 were detected in the entire epithelium in CIN, showing decrease in CIS. The progression of CIN was associated with reduced syndecan-1 expression, in contrast to CLDN -1, -4 and -7 which increased toward CIS. The obtained data suggest that significant changes occur in the composition of cell adhesion complexes even in early stages of cervical carcinogenesis. The pattern of expression is characteristic for the alteration, the changes in the different components, however, are not parallel with each other.

Successful Management of Intrauterine Twin and Concomitant Cervical Pregnancy: A Case Report

Use of in vitro fertilization techniques increases the frequency of pathological implantation. However, simultaneous pregnancies are a rarity. Ectopic implantation of the embryo may occur in the cervical canal. This is the first case report, which describes successful management of an intrauterine twin pregnancy which occurred simultaneously with a cervical pregnancy. Diagnostic and therapeutic options are discussed along with the outcome of pregnancies. The cervical pregnancy was removed by aspiration, without dilation of cervical canal, which saved the lives of intrauterine fetuses and preserved fertility for following pregnancies. Finally we review the advanced methods in the literature.

Prenatal Diagnosis of a Giant Congenital Primary Cerebral Hemangiopericytoma

Congenital primary intracraniai hemangiopericytomas are exceptionally rare tumors. We present a case of a fetus, with the prenatal sonogram at 33 weeks of gestation revealing a large cerebral tumor. Because of the enlarged head, a cesarean section was performed. The tumor was confirmed by postnatal ultrasound, magnetic resonance imaging (MRI) and biopsy. Elevated intracraniai pressure and hemorrhage led to death on the 11th day. Autopsy revealed a 10×9 cm large inhomogeneous tumor located centrally, mainly in the posterior fossa. Histology showed a hypercellular and hypervascular tumor with extended necrosis and high mitotic rate. The tumor cells were positive for vimentin and CD34 antigens and negative for several neurological markers, desmin and CD31. The diagnosis of a congenital primary cerebral hemangiopericytoma was confirmed.

Pleomorphic rhabdomyosarcoma of the uterus in a postmenopausal patient

Pure rhabdomyosarcomas occurring in the adult uterus are very rare, with poor prognosis. We present a case of a 67-year-old woman with postmenopausal vaginal bleeding caused by pleomorphic rhabdomyosarcoma of the uterus, treated with hysterectomy, bilateral salpingooophorectomy, pelvic/paraaortic lymphadenectomy and partial sigmoidectomy. Postoperative chemotherapy (Doxorubicin) was given according to protocol. Followup examinations one year after surgery revealed no abnormalities or tumor recurrence. The rarity of this histological entity makes the presented case worthy of publication.(Pathology Oncology Research Vol 12, No 2, 102–104)

Successful Management of Pregnancy with Nephrotic Syndrome due to Preexisting Membranous Glomerulonephritis: A Case Report

The influence of membranous glomerulonephritis (MGN) on maternal and fetal outcome is controversial, as is the effect of pregnancy on the course of preexisting nephrotic syndrome. We report a case of successful management of a pregnancy with preexisting severe nephrotic syndrome due to biopsy-proven primary MGN. Our patient became pregnant in a non-compliance period, discontinued the nephrological follow-up program and her kidney disease decompensated. From the 22nd gestational week the patient was treated with intermittent pulses of methylprednisolone (250 mg i.v.) and a maintenance dose of 32–64 mg/day orally, along with azathioprine 100 mg/day. She also received antihypertensive, diuretic, and anticoagulant therapy, and supplementation with fresh frozen plasma and albumin. In the 33rd gestational week a cesarean section was performed due to deteriorating creatinine clearance, low serum total protein levels, increasing edema and progression of intrauterine growth retardation of the fetus. Three months after delivery, the patient’s renal disease went into complete remission. To our knowledge, this is the first report of using azathioprine during pregnancy with severe nephrotic syndrome due to primary MGN.

High early uterine vascular resistance values increase the risk of adverse pregnancy outcome independently from placental VEGF and VEGFR1 reactivities.

OBJECTIVE From data in the literature, we hypothesized that high vascular resistance values in the uterine arteries at the end of the first trimester would increase adverse pregnancy outcomes and therefore might be accompanied by changes in VEGF/VEGFR1 immunoreactivities. STUDY DESIGN In our university hospital 82 women (Study I n=62 and Study II n=20) were divided into two groups according to their uterine vascular resistance values. Uterine vascular resistance values were measured in the 10-13th weeks of gestation by color-Doppler ultrasonography. Women were divided into low and high vascular resistance groups. In the prospective follow-up study (Study I) the data of the pregnancy outcome were recorded. In cross-sectional study (Study II), VEGF and VEGFR1 immunoreactivities were measured on the tissue samples from women who underwent termination of pregnancy. RESULTS In the high vascular resistance group (PI>2.3), the probability of adverse pregnancy outcome was significantly higher (40.0% vs. 12.8%). No differences in VEGF and VEGFR1 immunoreactivities were observed between groups. In both groups, intense VEGF immunoreactivity was observed in the maternal glandular epithelium and in the decidual cells. Weak reactivity was observed in the villous trophoblast. VEGFR1 immunoreactivity was intense in all regions. CONCLUSIONS Our data suggest that high vascular resistance values in the first trimester are independent from VEGF/VEGFR1 immunoreactivities and markedly increase the probability of adverse pregnancy outcomes. This may be used for early screening of pregnant women in the first trimester.

Four pregnancies and two deliveries after unilateral orchidectomy and chemotherapy for testicular embryonal carcinoma

This case report describes a 33-year-old patient diagnosed with left-sided testicular embryonic carcinoma with vascular invasion. Unilateral orchiectomy was performed and the patient subsequently underwent chemotherapy. He retained fertility and later fathered healthy children.

Effect of Mg Therapy on the Outcome of Pregnancy in Certain Obstetric Diseases

Preeclampsia (PE) and intrauterine retardation (IUGR) are known to significantly alter perinatal morbidity, mortality and the outcome of pregnancy. The smooth muscle- relaxant effect of the intravenously applied MgS04 was first described in 1905 [1]. Rissman was the first to use Mg in order to prevent eclampsia in 1916 [2]. The method came into general use first of all in the USA [3,4], followed by the wide-spread use of it both in the prevention and treatment of eclampsia in Europe, too [5,6]. The chemical and biochemical basis of the therapeutic effect was summarized by Gunther et al. [7]. In our study the effect of Mg infusion treatment on pregnancy outcome in patients with PE, IUGR, imminent abortion and imminent premature labor was examined.

Retrospective analysis of clinical data of normotensive and hypertensive pregnant women and their newborns

The medical history of 256 hypertensive and 263 normotensive pregnant women was analysed retrospectively. There was a negative correlation (P less than 0.01) between the maximal pretreatment diastolic blood pressure and the birth weight of newborns in the hypertensive group. The prevalence of a hypertensive family history, pyelonephritis, proteinuria, delivery by Caesarean section, fetal asphyxia during delivery and death of the newborn during delivery was significantly higher in the hypertensive group than in the normotensive one. The gestational age at delivery was shorter and the birth weight of the newborn was lower in the hypertensive women than in the normotensive women.