At least CIN2 was found in 81.5% in women referred with cervical cytology reporting ?glandular neoplasia. A thorough evaluation of the whole genital tract is needed if colposcopy is negative.
Case reportA 59 year old nulliparous woman presented with a two year history of irregular vaginal bleeding. She was not taking hormone replacement therapy. She was found to have an abdominopelvic mass and ultrasound con®rmed an enlarged uterus, measuring 16x13cm with the appearance of multiple ®broids. There was also gross endometrial thickening of 5cm and a loculated cystic adnexal mass measuring 13cm in diameter. Laboratory investigations revealed iron de®ciency anaemia (Hb 5.5 g/dL, MCV 54.0¯, MCH 15.8 pg) and elevated serum CA125 (115 U/L). There was also biochemical evidence of abnormal oestrogen secretion. Serum oestrogen levels (156 pmol/L) were in the premenopausal range and gonadotrophin secretion was suppressed (FSH 1.5 iu/L, LH 6.3 iu/L). Serum electrolytes and liver function tests were normal as was a chest X-ray.Four units of blood were transfused prior to undertaking a laparotomy. A midline incision was performed. A grossly enlarged uterus containing several large intramural nodules, right ovarian cyst measuring 20cm in diameter and a left ovarian cyst, 3 cm in diameter, were found ( Fig. 1). There was a small amount of clear ascites. On opening the retroperitoneum the appearance was of bilateral parametrial and pelvic side wall lymph node masses, the largest measuring 10cm and ®lling the left obturator fossa (Fig. 2). The omentum, peritoneal surfaces and upper abdomen appeared normal. Total hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic lymphadenectomy and infracolic omentectomy were performed. It was possible to develop a plane around the nodal masses in the parametrium and on the pelvic side wall such that there was no remaining macroscopic tumour at the conclusion of surgery. Operative blood loss was 3000ml and a further six units of blood were transfused.Post-operatively she developed a mild degree of disseminated intravascular coagulation which was corrected with fresh frozen plasma. She became hypoproteinaemic with a protracted ileus and required intravenous nutritional support. She was discharged on the 16 th day after her operation. Histological examinationThe ascitic¯uid contained reactive mesothelial cells only. There were three separate pathologies. The larger ovarian mass of 30cm diameter was a benign ovarian ®brothecoma (Fig. 3) containing multiple degenerative pseudocysts and one small nodule of smooth muscle proliferation (Fig. 4). There was severe atypical hyperplasia of the endometrium with polyp formation (Fig. 5). The myometrium was in®ltrated by well-de®ned smooth muscle nodules, con®rmed by immunohistochemical stains for desmin. They contained no more than four mitoses per high power ®eld, and there was no evidence of vascular invasion. Similar smaller lesions were identi-®ed in nodules from the left parametrium, left pelvic lymph node and right pelvic mass. The extrauterine pelvic masses contained normal lymphoid tissue as well as smooth muscle (Fig. 6). The greater omentum, which appeared normal to the naked eye, also contained microscopic smooth muscle nodul...
Case reportA 59 year old nulliparous woman presented with a two year history of irregular vaginal bleeding. She was not taking hormone replacement therapy. She was found to have an abdominopelvic mass and ultrasound con®rmed an enlarged uterus, measuring 16x13cm with the appearance of multiple ®broids. There was also gross endometrial thickening of 5cm and a loculated cystic adnexal mass measuring 13cm in diameter. Laboratory investigations revealed iron de®ciency anaemia (Hb 5.5 g/dL, MCV 54.0¯, MCH 15.8 pg) and elevated serum CA125 (115 U/L). There was also biochemical evidence of abnormal oestrogen secretion. Serum oestrogen levels (156 pmol/L) were in the premenopausal range and gonadotrophin secretion was suppressed (FSH 1.5 iu/L, LH 6.3 iu/L). Serum electrolytes and liver function tests were normal as was a chest X-ray.Four units of blood were transfused prior to undertaking a laparotomy. A midline incision was performed. A grossly enlarged uterus containing several large intramural nodules, right ovarian cyst measuring 20cm in diameter and a left ovarian cyst, 3 cm in diameter, were found ( Fig. 1). There was a small amount of clear ascites. On opening the retroperitoneum the appearance was of bilateral parametrial and pelvic side wall lymph node masses, the largest measuring 10cm and ®lling the left obturator fossa (Fig. 2). The omentum, peritoneal surfaces and upper abdomen appeared normal. Total hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic lymphadenectomy and infracolic omentectomy were performed. It was possible to develop a plane around the nodal masses in the parametrium and on the pelvic side wall such that there was no remaining macroscopic tumour at the conclusion of surgery. Operative blood loss was 3000ml and a further six units of blood were transfused. Post-operatively she developed a mild degree of disseminated intravascular coagulation which was corrected with fresh frozen plasma. She became hypoproteinaemic with a protracted ileus and required intravenous nutritional support. She was discharged on the 16 th day after her operation. Histological examinationThe ascitic¯uid contained reactive mesothelial cells only. There were three separate pathologies. The larger ovarian mass of 30cm diameter was a benign ovarian ®brothecoma (Fig. 3) containing multiple degenerative pseudocysts and one small nodule of smooth muscle proliferation (Fig. 4). There was severe atypical hyperplasia of the endometrium with polyp formation (Fig. 5). The myometrium was in®ltrated by well-de®ned smooth muscle nodules, con®rmed by immunohistochemical stains for desmin. They contained no more than four mitoses per high power ®eld, and there was no evidence of vascular invasion. Similar smaller lesions were identi®ed in nodules from the left parametrium, left pelvic lymph node and right pelvic mass. The extrauterine pelvic masses contained normal lymphoid tissue as well as smooth muscle (Fig. 6). The greater omentum, which appeared normal to the naked eye, also contained microscopic smooth muscle nodu...
We report a case of B-cell chronic lymphatic leukaemia (B-CLL) complicated by constrictive pericarditis. The pericardial involvement was confirmed histologically to be leukaemic in nature. We draw attention to this complication which is amenable to surgical correction. To our knowledge this has been described only once before as an autopsy finding and has not been encountered ante-mortem.
Granulomatous prostatitis may result from tuberculosis and fungal infection and has been described following prostatic surgery. In most cases, however, the aetiology is unknown, although it may be due to a reaction to extravasated or altered prostatic secretions. We have investigated cells (macrophages, lymphocytes), serum proteins (fibrinogen, alpha 1-antitrypsin) and prostatic epithelial products (prostatic-specific antigen and prostatic acid phosphatase) in diffuse granulomatous prostatitis (3 cases), focal periacinar prostatic granulomas (9) and focal prostatic infarcts (5), using an immunohistological technique. T-lymphocytes and macrophages are present in diffuse and focal granulomatous prostatitis, but few B-lymphocytes occur. Fibrinogen-related antigen is absent from granulomas, but a small amount is present within infarcts, whereas plentiful alpha 1-antitrypsin was detected both in granulomas and infarcts. Significant reduction in prostatic-specific antigen and acid phosphatase reactivity occurs in granulomatous prostatitis. This suggests that cytokines derived from activated macrophages and T-lymphocytes may be exerting a cell regulatory effect and altering cell secretions, as well as causing destruction of the prostatic epithelium.
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