Cellular Angiofibroma (CA) represents a quite recently described mesenchymal tumour that occurs in both genders, in particular in the vulvo-vaginal region in women and in the inguino-scrotal area in men. The first description of this tumour dates from Nucci et al. article in 1997; since then, the literature reports different reviews and case report of this tumour in both genders, but no article specifically addressing CA treatment and follow-up in women. In this review we collected all 79 published female CA cases, analyzing the clinical, pathological and immunohistochemical features of the tumour.CA affects women mostly during the fifth decade of life, it is generally a small and asymptomatic mass that mainly arises in the vulvo-vaginal region, although there are reported pelvic and extra-pelvic cases. The treatment requires a simple local excision due to an extremely low ability to recurrent locally and no chance to metastasize. Throughout the immunohistochemical and pathological findings it is also easily possible a differential diagnosis from the other soft tissue tumours which affect the vulvo-vaginal area, such as spindle cell lipoma, solitary fibrous tumour, angiomyofibroblastoma and aggressive angiomyxoma.

A growing number of studies provided the evidence that human decidua is a pregnancy-related tissue capable of hormone production and metabolism. The aim of the present study was to evaluate the possible presence of inhibin subunits in human decidua. Tissue samples were collected in pregnant women during the first (8 weeks) and second trimester (18 weeks) of gestation and at term (40 weeks). Immunohistochemical data were obtained using affinity purified polyclonal antisera raised in rabbit against porcine alpha, beta A, or beta B subunits. Levels of the respective inhibin subunits were evaluated by Northern blot analysis using cDNA probes encoding sequences corresponding to each subunit. The present results indicated that human decidua contains and synthesizes inhibin alpha, beta A, and beta B subunits. The immunohistochemical data showed that decidual cells were stained with both inhibin alpha and beta B antisera, showing a similar localization. On the other hand, cells stained with inhibin beta A antisera were sparse and followed a distribution pattern different from that of cells stained with alpha or beta B antisera. The first inhibin alpha and beta B subunit mRNAs were both expressed in first trimester of pregnancy, and those mRNA levels showed a gestational related increase. The beta A subunit mRNA was expressed at very low levels at term and could not be detected earlier during pregnancy. The present data showed that human decidua actively produces inhibin subunits with a gestational-related profile. The results suggest that decidua may be a further source of inhibin-related proteins during pregnancy and emphasize the endocrine competence of human decidua.

Objective: The objective of this study was to give a reality-based picture of the use of laparoscopic surgery for staging endometrial cancer patients out of the experimental setting. Methods: Consecutive data of patients with endometrial cancer who underwent laparoscopic or abdominal surgical staging in 6 Italian centers were recorded. Baseline patients and tumors characteristics, surgery performed, and safety data were collected and analyzed. Results: A total of 1012 subjects (403 and 609 treated by laparoscopy and laparotomy, respectively) who received surgical stadiation for endometrial cancer were included in the final analysis. The laparoscopic approach to endometrial cancer was more commonly performed in younger and nonobese patients who had received less previous surgeries, whereas the abdominal approach was preferred for the advanced stages and rare histotypes. Irrespectively to stage, the operative time was higher for the laparoscopy than laparotomy, whereas blood loss and postoperative complications were lower in the laparoscopy group than in the laparotomy group. No difference between surgical approaches was observed in complication rates in stage I endometrial cancers, whereas they were worst in higher stages. The site, but not the incidence, of recurrences differed only for advanced stage endometrial cancers. No differences in overall, disease-free, and cancer-related survival rates were also observed. Conclusions: In the clinical practice, heterogeneous criteria are adopted to recur to laparoscopy for staging endometrial cancer. The safety and the feasibility of the laparoscopy are confirmed for stage I endometrial cancers, whereas they appear suboptimal for the advanced stages.

BackgroundEpithelial ovarian cancer (EOC) is the most lethal gynecological cancer. Several hospitals throughout the region provide primary treatment for these patients and it is well know that treatment quality is correlated to the hospital that delivers. The aim of this study was to investigate the management and treatment of EOC in a Region of the North Italy (Emilia-Romagna, Italy).MethodsA multidisciplinary group made up of 11 physicians and 3 biostatisticians was formed in 2009 to perform clinical audits in order to identify quality indicators and to develop Region-wide workup in accordance with the principles of evidence-based medicine (EBM). The rationale was that, by setting up an oncogynecology network so as to achieve the best clinical practice, critical points would decrease or even be eliminated. Analysis of cases was based on the review of the medical records.Results614 EOC patients treated between 2007 and 2008 were identified. We found only 2 high-volume hospitals (≥ 21 patients/year), 3 medium-volume hospitals (11–20 operated patients/year), and 7 low-volume hospitals (≤ 10 operated patients /year). Only 222 patients (76.3%) had a histological diagnosis, FIGO surgical staging was reported only in 206 patients (70.9%) but not all standard surgical procedures were always performed, residual disease were not reported in all patients. No standard number of neoadjuvant chemotherapy cycles was observed.ConclusionsThe differences in terms of treatments provided led the multidisciplinary group to identify reference centers, to promote centralization, to ensure uniform and adequate treatment to patients treated in regional centers and to promote a new audit involving all regional hospitals to a complete review of the all the EOC patients.

This is a comparative proteomic study on biopsies from patients with ovarian cancer to identify potential diagnostic/prognostic biomarkers in both healthy and tumor tissue, interstitial fluid (normal interstitial fluid and tumoral interstitial fluid and peritoneal effusion. Protein expression/identification was evaluated by 2-DE and MS analysis: six proteins showed differential expression in tumoral interstitial fluid and tumor tissue compared to normal interstitial fluid and healthy tissue: five were found to be downregulated and identified as galectin 3, glutathione S-transferase A-2, retinol binding protein 1, phosphatidylethanolamine-binding protein and annexin 5, while the calgranulin, was significantly upregulated in all pathological samples, including the ascitic fluid. Validation of S100A8 overexpression in carcinoma tissue was obtained by immunohistochemistry. To our knowledge, this is the first study to report an over-expression of calgranulin by 2-DE associated with MS/MS analysis on surgical biopsy. The reduced expression of galectin 3 and retinol binding protein 1 in cystic fluid and serum of patients with early stage disease is confirmed in this study. The results highlight alterations in proteins that control cell-cycle progression and apoptosis, as well as factors that modulate the activity of signal transduction pathways. Moreover, this study suggests that calgranulin expression may be used as a diagnostic and/or prognostic biomarker.

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It is possible for a provincial oncology group to build an oncology network providing an improvement in the assistance of patients with endometrial cancer through the use of clinical audit. Clinical audit made it possible to obtain the full attendance of specialists of various disciplines involved in the treatment of endometrial cancer to optimize response time schematizing process.

The authors describe a case of multifocal perivascular epithelioid cell tumor (PEComa) arising in the pelvis of a 39-year-old woman affected by tuberous sclerosis. The tumor presented in the form of multiple fascicular, focally cystic nodules involving the uterine corpus, both ovaries, and the omentum. Microscopically, the nodules were composed of foci of adenomyosis and endometriosis (with focal atypical complex hyperplasia) associated with a stromal spindle cell population immunoreactive for HMB-45, smooth muscle actin, and estrogen and progesterone receptors. We interpret these foci as the result of a widespread proliferation of perivascular epithelioid cells (PEC). Because of the diffuse quality of the process, the designation of PEComatosis seems warranted.