Gianluca Leanza

Uterine Myxoid Leiomyosarcoma Associated with Multiple Myomas in a Fertile Woman: A Case Report

A 37 year old woman was admitted to our university hospital for menometrorrhagia. The case history showed that the patient had menometrorrhagia for six months; moreover, during the abdominal examination we found a mass occupying the hipogastric and mesogastric area. The tumefaction was hard and it reached the level of the umbilicus. On combined vaginal-abdominal examination a mass on the anterior wall and multiple myomata were felt; the uterus was found to have been enlarged to the size equivalent to 18 weeks pregnancy; adnexa regular were felt. During the surgery multiple myomas were found. The largest, 10 cm diameter, was soft in consistence with a gelatinous structure. Total abdominal hysterectomy with preservation of adnexa was performed (Figure 1). Histopathological result gave evidence of myxoid leiomyosarcoma in the largest myoma, whereas the others fibroid nodes were without atypia.

Delivery Mode and Pelvic Floor Disfunction

Introduction: Pelvic floor disorders compromise quality of life for a lot of women of all ages. The prevalence of urinary incontinence (UI) is thought to range from 17 to 45% among adult women. The etiology is thought to be multifactorial. Traumatic damage to fascial and muscular support structures during childbirth may be, an important contributor to the development of UI and prolapse of pelvic organ (POP). The aim of this study is to consider the association between delivery mode and pelvic floor disorders (POP and UI) Materials and methods: A review of the literature was undertaken using the Medline and Popline CD Rom considering articles published from 1996 to 2011; additional sources were identified from references cited in relevant research articles. We studied articles concerning stress urinary incontinence, pregnancy, childbirth, pelvic prolapse were considered. Conclusion: Literature research confirms that anatomic and functional damages are linked with obstetric factors. Pregnancy may cause urinary incontinence and prolapse. However vaginal delivery is associated with a significant higher risk of urinary incontinence and pelvic defects. Caesarean section may protect from perineal risk of delivery but not from the damage due to the pregnancy itself. During pregnancy UI ranges from 31 to 39%, in post-partum ranges from 24,5 to 29% and from 5 to 8% after vaginal and caesarean respectively. Pelvic floor disorders ranges from 21 to 36% after instrumental operative delivery and from 9 to 21% in vaginal spontaneous delivery. Forceps is found out the most dangerous instrument for pelvic floor, followed by vacuum and vaginal delivery with tears. The consequences of a traumatic delivery affect quality of life and increasing late damages have to be considered.

Case Report: Atypical Cornelia de Lange Syndrome

Cornelia de Lange Syndrome (CdLS) (also called Bushy Syndrome or Amsterdam dwarfism), is a genetic disorder that can lead to several alterations. This disease affects both physical and neuropsychiatric development. The various abnormalities include facial dysmorphia (arched eyebrows, synophrys, depressed nasal bridge, long philtrum, down-turned angles of the mouth), upper-extremity malformations, hirsutism, cardiac defects, and gastrointestinal alterations. The prevalence of this syndrome is approximately one per 15,000. Ultrasound is not the perfect means to diagnose CdLS, however, many abnormalities can be detected prenatally by scrupulous image observation. We report an atypical CdLS case characterized by increased nuchal translucency in the first trimester, normal karyotype, saddle nose, micrognathia with receding jaw, low set ears, facies senilis, arthrogryposis of the hands, absence of the Aranzio ductus venous, dilatation of gallbladder and bowel, a unique umbilical artery, increased volume of amniotic fluid, and intrauterine growth retardation ending with the interruption of pregnancy.

Retroperitoneal Sarcoma Involving Unilateral Double Ureter: Management, Treatment and Psychological Implications

The case of a 45-year-old woman who was admitted to our university hospital for polymenorrhea, weight gain and pain in the left iliac region is reported. An abdominal ultrasound revealed a 9.5 × 5.2-cm, hypoechoic and inhomogeneous mass located on the left side of the pelvis and behind the ovary. The patient underwent surgery. The pelvic mass was firmly anchored to the small intestine, colon, sigma and uterine fundus. After removing the adhesions, double ureters, which had been incorporated in the mass, were observed on the left side. Resection of the unilateral double ureters was necessary in order to remove the entire mass, and thereafter, a left salpingoophorectomy was performed. A histological examination showed a malignant retroperitoneal mass. Termino-terminal ureteral anastomosis with two double-J stents was carried out. Total hysterectomy with preservation of the right adenexum and regional lymphadenectomy was performed. The purpose of this case report is to discuss the physical and psychological implications related to the combination of two rare entities: leiomyosarcoma and a double ureter located within the mass. A literature review on the clinical management and psychological aspects from a female cancer patients perspective undergoing surgery with the aforementioned disorders will be discussed.

Spontaneous Uterus Rupture in the Post-partum

Uterine rupture occurs when the integrity of the myometrial wall is compromised. It could interest the uterine body (prior to labour) or the lower segment (during labour). The main causes of uterine rupture are obstetric anamnestic factors and/or the administration of oxytocin. The authors report the case of a 37 years old patient with risk factors for uterine rupture of precedent endometritis post-abortion. After the expulsion of the placenta the mother had continuous blood loss, for this reason she was subjected to subtotal hysterectomy. Histological examination revealed the absence of decidua in the uterine fundus and thinning of the myometrium. Histological examination of the lesion at the site commented that there was infiltration of the chorionic villi into the endometrium, and this is undoubtedly the features of placenta accreta.

Small for Gestational Age

Lots of diagnostic procedures are assessed to evaluate intrauterine retardation (IUGR), among them ultrasounds are the most relevant ones. Foetal surveillance includes assessment of growth, detection of the Doppler blood flow and volume of amniotic fluid. There is an evidence of the association between IUGR and foetal blood perfusion. Pregnancies with early onset of IUGR remain a challenge not solved yet, even if the velocimetry of the foetal middle cerebral artery is considered mandatory for neurological risk when altered. In mid-late onset, IUGR cerebral and umbilical blood Doppler is useful to detect the potential damage of the foetus and avoid the hypoxic risk. Ductus venous flow is also an indicator of foetal jeopardy in case of abnormal umblical artery waves. Review of literature shows that middle cerebral, umbilical arteries, ductus venosus and uterine arteries are the most relevant vessels to be evaluated in order to establish the foetal well-being when IUGR arises. Obstetric management aims to lead what is the better choice: prematurity with associated Infant Respiratory Distress Syndrome (IRDS) or, on the contrary, waiting with correlated either stillbirth risks or catch-up growth advantage. Small for Gestational Age

Umbilical Cord Blood Collection: Ethical Aspects

Treatments with stem cells are used today with very promising results. Three sources of cells are used for hematopoietic reconstitution: bone marrow (BM), peripheral blood (PB) and umbilical cord blood (UCB) [1,2]. The first UCB transplantation was performed in 1988 in a patient affected by Fanconi anemia (FA), using his brother’s cord blood who had a compatible human leukocyte antigen (HLA) [3]. His umbilical cord blood was collected at birth, cryopreserved and used after thawing for transplantation [4]. After the first UCB transplant more than 20,000 have been performed, mainly in children and adolescents [5,6].

Management and Time of Delivery in Asymptomatic Complete Placenta Previa: A Case Report and Review of Literature

The Authors present a case of a 40-year-old primigravida with complete placenta previa, stable and asymptomatic all throughout pregnancy, which was referred, at 34 weeks of gestation, to the high-risk ob clinic of their hospital for follow-up and delivery-plan. Placenta previa is a condition derived from an abnormal implantation of the embryo in the lower uterine segment. Risk factors for the development of placenta previa include: prior cesarean delivery, pregnancy termination, intrauterine surgery, smoking, multi-fetal gestation, increasing parity and maternal age and the rising rates of cesarean section. Usually complete placenta previa becomes symptomatic in the third trimester of pregnancy and it is associated with adverse maternal and neonatal outcomes, such as: antenatal and intra-partum hemorrhage, maternal blood transfusion and emergency hysterectomy, intra-uterine growth restriction and preterm birth. There is no doubt that patients with either partial or complete placenta previa should be delivered by cesarean section; it is not clear, however, at what gestational age the cesarean section should be scheduled in a patient with a stable and asymptomatic total placenta previa. The Authors based the management of the reported case on the review of the last 20-year International Literature, according to which, in the presence of this type of previa, an Early Term Birth (ETB) at 37 weeks and 0 days is associated with a better maternal and neonatal prognosis if compared to both a Late Preterm Birth (LPTB) at 34-36 weeks or a Term Birth (TB) at 38-39 weeks.

CD34+ stem cells from umbilical cord blood

We describe the relation between umbilical cord clamping time and two different enrichment system of CD34+ stem cells from umbilical cord blood with the proliferative ability and bone marrow reconstitution of the stem cells obtained. After an obstetrician performed the cord blood collection, the purification of stem cells was performed either with a combination of monoclonal antibodies (negative selections) using the Stem Sep method, or with a positive cells selection based on their surface CD34 antigens using the Mini Macs system. An excellent recovery of haematopoietic progenitors [Burst Forming Unit Erythroids (BFUE); Colony Forming Unit Granulocytes and Macrophages (CFU-GM); and Colony Forming Unit Granulocytes, Erythroids, Monocytes and Macrophages (CFU-GME)], inversely related to the increase in clamping time, was performed with the Mini Macs system (54% of colonies, with 90% purity). With Stem Sep method, haematopoietic progenitors recovery was 35% (with 80% purity). By applying early clamping of umbilical cord blood we obtained a greater number of CD34+ cells and their clonogenic activity was increased with enrichment. This is a useful technique considering that the number of CD34+ stem cells usually contained from a unit of placental blood is enough for the transplant to a child, but not for an adult. Thus, using these methods, we can get a larger number of CD34+ stem cells which reduces the risk of Graft versus Host Disease also in adult patients, producing survival rates similar to those obtained with transplantation of bone marrow from unrelated donors.