Ovarian adult-type granulosa cell tumors are often associated with endometrial hyperplasia or even uterine cancer. Herein, we present a case report of a 65-year-old female patient who had undergone curettage of the uterine cavity several times due to abnormal and irregular uterine bleeding. Owing to recurrent episodes of vaginal bleeding as well as ineffective pharmacological treatment of simple endometrial hyperplasia without atypia, the patient underwent a laparoscopically-assisted vaginal hysterectomy. Owing to an enlarged right ovary with bluish color, intra-operative pathological examination was immediately performed. Surprisingly, an ovarian adult-type granulosa cell tumor was diagnosed, and the surgery was extended to pelvic lymphadenectomy and omentectomy. Immunohistochemical staining with selected antibodies (Arginase 2, Nidogen 2, BAF250a/ARID1A, GPR30, SF-1/NR5A, and 1LRH-2E1/NR5A2) was also performed. In conclusion, in cases of recurrent vaginal bleeding concomitant with endometrial hyperplasia, the existence of rare ovarian tumors connected with extensive estrogenic stimulation must be taken into account. Immunostaining with selected antibodies (Arginase 2, Nidogen 2, ARID1A, or GPR30) may help elucidate the possible molecular mechanisms associated with the BAF250a/development of various ovarian/endometrial abnormalities.
It is of utmost importance to investigate the newly discovered immunohistochemical proteins that are helpful in differentiating various histological subtypes of endometrial carcinomas (ECs). In this study, we aimed to compare the localization and expression profile of selected proteins (ARID1A, nidogen 2 (NID2), LRH-1, and GPR30) in 60 early-staged (I and II) G2/G3 ECs with different histological subtypes. Methods: Endometrioid-type (n = 20), serous (n = 20), and clear-cell (n = 20) ECs were immunohistochemically stained applying the anti-ARID1A, -NID2, -LRH-1, and -GPR30 antibodies. Normal endometrial samples (n = 8) were selected as a control group. Results: In general, 95% (19 out of 20) and 100% (20 out of 20) of endometrioid and serous samples revealed moderately/intense cytoplasmic/nuclear ARID1A immune-positivity, while only four out of 20 (20%) clear-cell carcinomas showed moderate staining. A significant difference in ARID1A expression was noted between different histological subtypes of ECs (clear-cell cancer vs endometrioid cancer, p < 0.001, and clear-cell cancer vs serous cancer, p < 0.001). Cytoplasmic NID2 staining did not differ significantly between histological subtypes. Most of the endometrioid (19/20; 95%) and serous (19/20, 95%) neoplasms revealed intense cytoplasmic LRH1-immunopositivity. Weak/moderate GPR30 cytoplasmic reactivity was detected in 16 out of 20 (80%) endometrioid EC, however, this protein was neither noted in clear-cell and serous neoplasms nor normal endometria. Differences in GPR30 immunoreactivity between endometrioid cancer and serous/clear-cell cancer were of significant values (p < 0.005). Conclusion: Weak ARID1A expression may be associated with gene alterations in selected EC histological subtypes. GPR30 staining may help to differentiate various histological EC subtypes.
Introduction: Spontaneous orbital exophthalmos is an extremely rare incident during a vaginal delivery. In most cases, it is associated with venous malformations and presents spontaneous resolution. Case description: We report a case of orbital hematoma after vaginal delivery due to a superior ophthalmic vein rupture. The patient presented proptosis of the right eye and diplopia immediately after the delivery and was diagnosed with unilateral orbital hematoma. The patient was given conservative treatment with complete resolution of clinical symptoms 4 weeks after the delivery. Conclusion: Increased abdominal pressure during a vaginal delivery may lead to a spontaneous orbital hemorrhage.
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