Renal cell carcinoma in pregnancy: a case report

Renal cell carcinoma is seen most frequently after childbearing years, but occasionally is diagnosed in pregnancy. The pregnancy demands special considerations in terms of the diagnostic evaluation and management. A case of a patient with renal cell carcinoma diagnosed in the first trimester of pregnancy, which suddenly enlarged at the end of the second trimester, is presented. She underwent radical nephrectomy after delivery. Since the mother's welfare is the primary concern, surgical management should not be delayed.

Leiomyoma of the uterus and retroperitoneal angioleiomyoma: case report

Retroperitoneal angioleiomyoma is a benign mesenchymal neoplasm that is composed of smooth muscle cells and thick-walled vessels. In a 36-year-old patient a retrouterine and retroperitoneal tumor, 70 x 65 x 50 mm in size, was discovered during a surgical procedure due to uterine myoma. The tumor had a soft consistency and was completely removed. Histopathology showed features of angioleiomyoma. Angioleiomyoma is a rare benign entity; hence a benign course and good prognosis are expected.

Treatment for infertility and risk of invasive epithelial ovarian cancer--a case report

A 30-year-old women was admitted to the Institute of Gynecology and Obstetrics, Clinical Center of Serbia in April 2004 with the following diagnosis: adnexal mass soon after in vitro fertilization. Her history revealed salpingo-oophorectomy for mucinous cystadenofibroma of the left ovary eight years before and cystectomy of the right ovary three years before. At admission, the most remarkable findings were high temperature and elevated white blood cells with erythrocyte sedimentation rate. After the antibiotic treatment, laparatomy was performed and a multilocular right adnexal tumor was found. The right salpingo-oophorectomy was performed and pathological diagnosis was mucinous ovarian adenocarcinoma. Two weeks later, radical surgery was carried out and chemotherapy was applied. There is an urgent need for clear interpretation of the link between ovarian stimulation and ovarian cancer. An association between ovarian stimulation treatment and ovarian cancer has still not been completely proven.

Paget's disease of the vulva--a review of our experience

OBJECTIVE

The aim of our study was to review our experience with Paget's disease of the vulvar relative to initial examination, treatment and oncological outcome.

METHODS

Ten women with extramammary Paget's diseases of the vulva were treated during the 10-year period. The charts of these patients were reviewed and data were collected regarding patient demographics, symptoms, previous Paget's disease, surgical treatments and time to recurrence.

RESULTS

Eight women (80%) were treated with wide local excision or partial vulvectomy, and two patients (20%) required radical resection for invasive adenocarcinoma. The group of women who had invasive diseases also underwent inquinofemoral lymphadenectomy and no lymphatic metastases were noted. Three women (30%) experienced recurrence. The mean time to relapse was 30 months (range 3-88 months).

CONCLUSION

Recurrence is very common and long-term monitoring is recommended with careful examination of any abnormal vulvar lesion.

Effects of tibolone on the risk factors for cardiovascular diseases in postmenopausal women

Background/Aim. Tibolone is a preparation that belongs to the group of steroidal substances. The effects of the use of the use of tibolone are the consequence of the activities of its metabolities, considering that their hormonal activity depends on the type of tissue in which they develop. The aim of this study was to evaluate the influence of the use of tibolone on risk factors for the development of cardiovascular diseases in postmenopausal women. Methods. A prospective observational stady included 94 patients who had the concentration of l7? estradiol < 50 pg/ml, and who was in menopause more than a year. Out of the total number of patients, 63 accepted to receive tibolone 2.5 mg daily (tibolone group), while 31 of the patients refused to take tibolone (control group). We measured the concentration of lipids (cholesterol, LDL cholesterol, HDL cholesterol, triglicerides), antitrombin III, fibrinogen, and C-reactive protein, before and after the treatment within a 6-month period. Then, we compared the difference between the values of concentrations and tested the statistical significance of the difference. We also evaluated the changes of values in the concentrations of the examinated parameters inside a 6-month period in the control group. Results. In 31 patients of the control group, from the control group there were no significant changes in the values of the defined parameters as compared to their initial values after six months. But there were changes of statistical significance (p < 0.001) in values of the concentrations of the exeminated parameters before and after the treatment in the tibolone group. In fact, we recorded decreases in the total cholesterol by 17.8%, HDL cholesterol by 27%, LDL cholesterol by 4% (without statistical significance p > 0.05) and triglicerids by 35%. There were no statistical differences in the concentrations of antitrombin III, fibrionogen, and C-reactive proteine in the tibolone group before and after the treatment. Conclusion. The use of tibolone dose decrease the concentration of the total cholesterol, triglicerides, HDL cholesterol, without a significant decrease of LDL cholesterol. Also, the use of tibolone does not have any significant effect on the concentrations of antitrombin III, fibrinogen and C-reactive proteine. The number of serum parameters measured in this study was limited, thus that was the reason to discuss only about the metabolism of lipids in the patients from the tibolone group. The final conclusion about the risk for cardiovascular diseases in the patients on tibolone, howerer, reqnires were extensive further clinical exeminations.

[The polycystic ovary syndrome associated with ovarian tumor]

Case report of a girl with PCOD (polycystic ovarian disease) and Sertoli-Leydig ovarian tumour. A sixteen-year old girl was clinically, endocrinologically, echosonographically and laparoscopically examined, and polycystic ovarian disease was diagnosed. After a two-year period she was reexamined: normal adrenal function was confirmed and left ovarian tumour was discovered echosonographically. Therefore, she was operated on and adnexectomy of the left ovarian tumour and biopsy of the right ovary were done. The histopathologic analysis revealed the Sertoli-Leydig tumour of the left ovary and polycystic degeneration of the right ovary. In conclusion, because of the greater frequency of ovarian tumours in women with PCOD, the permanent follow-up of women with PCOD is necessary.

[Effect of opioids and gamma-aminobutyric acid on ovulation]

Neurons secreting gonadotropin-releasing hormone (GnRH) contain receptors of gamma-aminobutyric acid (GABA), glutamate, fibroblast-growth factor, prolactin, beta-adrenergic receptor and dopamine receptor. Oestrogens and opioid peptides have a very important influence on gonadotropin secretion, but have no their own receptors in GnRH neurons. The role and interaction between gamma-aminobutyric acid and opioids in the inhibition of ovulation were studied, using valproate (GABA agonist) and naloxone (opioid antagonist)

SUBJECT AND METHOD

Groups: postmenopausal women (50), postmenopausal women on oestrogen replacement therapy, consisting of 200 mcg/day transdermally oestrogen for one month (50), and women in luteal phase of their regular menstrual cycle (50). Thirty women from each group were studied after placebo (1st day) administration, and after 300, 600 or 1200 mg of valproate (2nd day). Gonadotropins and prolactin were measured in the same way, at intervals of 24 h, on the placebo day, and on the 2nd day. The interaction between naloxone and valproate was tested in 20 women from each group; day 1-placebo; day 2-naloxon (infusion-1.6 mg/h for 6 h); day 3-naloxon infusion, preceded by 1200 mg of valproate.

RESULTS

Valproate. The concentration of luteinizing hormone (LH) was significantly decreased after the administration of valproate in postmenopausal women (up to 20%) and to women in luteal phase of the cycle (up to 80%). In substituted postmenopausal women there was no change in LH concentration after valproate administration. Naloxon. Naloxon infusion had no effect on LH concentration in postmenopausal women, and was significantly increased in mean serum LH in substituted postmenopausal women (52%) and in women in luteal phase of the cycle (27%). Valproate and naloxon. In women with a high oestrogen concentrations (substituted postmenopausal women) opioid blockade with naloxon (situation analogous to preovulatory phase of the cycle) contributed to the appearance of inhibitory influence of valproate on LH secretion (29.2 IU/L-after naloxone infusion; 13.2 IU/L-after administration of valproate and naloxone). In this group of patients there was no effect of valproate on LH previous secretion.

CONCLUSION

GABA may have a significant role in the inhibition of ovulation because of its inhibitory role in LH secretion in the situations when oestrogen secretion is high, and opioid concentration is low.