Gastric endometriosis is a very rare event. It enters in the differential diagnosis of cyclical or chronic epigastric pain, especially in the context of endometriotic patients. The diagnosis of a gastric submucosal mass requires further investigations to rule out the presence of malignancy or associated adenocarcinoma. Because of it can be associated with transverse colon endometriosis and/or diaphragmatic endometriosis, careful examination of the upper abdomen at laparoscopy should be emphasized. We report here a very rare case of gastric endometriosis associated with transverse colon endometriosis.

Purpose: To analyze laparoscopically treated cases of adenomyosis based on intraoperative and histopathology findings and to correlate different types with patients' presenting symptoms and characteristics, as well as with the surgical approach. Materials and Methods: Sixty-eight women who underwent laparoscopic treatment of adenomyosis at a referral center for gynecological laparoscopy. Results: Four distinct types of adenomyosis could be identified: diffuse, sclerotic, nodular, and cystic (54.5%, 13%, 28%, and 4.5% of cases, respectively). Menorrhagia as the main presenting symptom was significantly more frequent in patients with the diffuse type (84%) compared to those with sclerotic (44%) and nodular (37%) types (p = 0.025 and p = 0.001, respectively). All cases of cystic and nodular adenomyosis were treated by laparoscopic excision of the lesion. Eighty-nine percent of patients with sclerotic adenomyosis were treated with wide laparoscopic excision of the abnormal tissue. Eighty-one percent of patients with diffuse adenomyosis were treated with laparoscopic hysterectomy. Conclusions: Adenomyosis can be classified in four distinct types with differences in the presenting symptoms, as well as in the ideal surgical approach.

Background/Aims: Deep infiltrating endometriosis is a very painful condition and the mechanism of pain is still poorly understood. Pain and hyperalgesia can partly be explained by an increased number of nerve structures in the painful lesion. In order to clarify this issue, we assessed the nerve density in deep infiltrating endometriotic nodules of the posterior vagina and in the adjacent healthy vaginal tissue of the same patient. Methods: A prospective clinical and pathological study of 31 cases of deep infiltrating vaginal endometriotic nodules was conducted. Fifteen patients were in the proliferative phase and 16 in the secretory phase. The nerve density was studied by immunohistochemistry with the monoclonal antibody NF against neurofilaments in deep infiltrating endometriosis and in the adjacent unaffected vaginal tissue in the proliferative and in the secretory phases. Neurofilaments constitute the main structural elements of neuronal axons and dendrites. Results: The nerve density was significantly different in the endometriotic nodule than in the adjacent unaffected vaginal tissue (p = 0.0013). The same significant difference was found between endometriotic nodules and the unaffected vagina in the proliferative phase (p = 0.009) and in the secretory phase (p = 0.04). This difference was not significant between the proliferative and the secretory phases in the endometriotic lesions and in the controls. Conclusions: We hypothesize that the significantly increased number of nerve structures in the endometriotic nodules may contribute to the occurrence of severe and neuropathic pain that characterizes these lesions

Conclusion and discussion This is the first study reporting an over-expression of all neurotrophins in endometriosis, as only NGF was previously documented. It confirms the central role of this family in the genesis and modulation of pain in endometriosis. Anti-neurotrophin selective therapy might be a promising way of analgesia in the future.

OBJECTIVES Glucocorticoids (GCs) are used in cancer treatment to cause programmed cell death in transformed cells of the hematopoietic system and to lessen side-effects as nausea, vomiting, edema formation and allergies to specific chemotherapeutic agents. GCs act also as cofactor with human papillomaviruses in the etiology of cervical cancer. Moreover, recently GCs were described as inhibitors of some chemotherapy or radiation-induced apoptosis. The presence or not of a glucocorticoid receptor (GR) in normal and abnormal exocervices is thus interesting. METHODS To clarify the issue, we tested by immunohistochemistry the expression status of GR in normal cervix epithelium (n = 30), in low-grade cervical intraepithelial neoplasia (LSIL) (n = 30), in high-grade cervical intraepithelial neoplasia (HSIL) (n = 30) and in invasive squamous cell carcinoma (ISCC) (n = 30). All the patients with these lesions have a corresponding liquid-based cytology and were proved to be HPV-positive by using hybrid capture 2 methodology with probes against high-risk oncogenic HPVs. The evaluation of GR expression was performed by using the H-score system and an H-score > 50 was considered positive. RESULT GR expression was observed in normal epithelium, LSIL, HSIL and ISCC. No statistically significant difference concerning this expression was observed. CONCLUSION Because GCs could play a positive role in the progression of cancer, our demonstration of GR persistence in cervix cancer cells raises concern about the widespread combined use of GCs with antineoplastic drugs or agents in the clinical management of cervix cancer in women.

There are various possibilities for treating cornual ectopic pregnancies, including medical approaches using methotrexate and surgical approaches using laparoscopy. This report describes the laparoscopic management of a large cornual ectopic pregnancy associated with a high β-human chorionic gonadotropin level and reviews the techniques and outcomes of conservative treatment described in the literature.

Background. To analyze the expression of laminin-5 gamma 2 chain, a protein which plays a major role in keratinocyte migration, in cervical intraepithelial neoplasia (CIN), and invasive cervical carcinoma associated with high-risk oncogenic human papillomaviruses (HR-HPVs).Material and methods. The expression of laminin-5 gamma 2 chain protein has been analyzed by immunohistochemistry in 17 cases of low-grade squamous intraepithelial lesions (LSIL-CIN1), 35 high-grade squamous intraepithelial lesions (HSIL-CIN2/3), 18 microinvasive or invasive carcinomas, and three metastatic lymph nodes. All these lesions have been proved to contain HR-HPVs and were also positive for p16 protein which classically is overexpressed at all stages of cervical neoplasia and dysplasia linked with HR-HPVs. 20 cases of normal cervix served as controls.Results. The expression of laminin-5 gamma 2 chain protein was observed in 100% of invasive or microinvasive carcinoma and in their related lymph node metastasis with an immunoreactivity located preferentially at the invasive front of the lesions. All the HSILs (100%) associated with invasive carcinoma were also positive. In contrast, in HSILs without associated invasive component, the expression of the protein has been found in only 34% of cases. In positive HSILs, laminin-5 gamma 2 protein was expressed in basal layers. In LSILs and normal epithelium, no expression of the protein was noted.Conclusions. We conclude the following: (i) the expression of laminin-5 gamma 2 is a late event in cervical carcinogenesis increasing with the grade of dysplastic lesions; (ii) laminin-5 gamma 2 expression facilitates the identification of invasive and microinvasive lesions which could be difficult to diagnose on the basis of routine stains; (iii) laminin-5 gamma 2 expression in HSILs could potentially identify those lesions with a more increased risk of tumor progression.

BACKGROUND: Little is known about the mode and the extent of infiltration of endometriotic lesions in the large bowel. METHODS: In 31 patients undergoing large bowel resection for severe deep-infiltrating endometriosis of the sigmoid and rectum with severe digestive symptoms, we performed a prospective morphological, histological and immunohistological study (using the monoclonal antibodies S100 for the detection of the nerves and CD10 for the detection of the endometriotic stromal cells) on the large bowel resection specimen. The evaluation of invasion of the large bowel by endometriosis was performed by studying the presence, localization and mean number of lesions in the different layers of the colon, the relationship between endometriosis and the nerves of the colon, the nerve density in the respective layers of the large bowel and the presence of endometriosis on the resection margins. RESULTS: The most richly innervated layers of the large bowel are the most intensely involved by endometriosis. We found that 53 +/- 15% of endometriotic lesions were in direct contact the nerves of the colon by means of perineurial or endoneurial invasion. The mean largest diameter of the lesion does not seem to be correlated with the depth of infiltration. The margins were positive in 9.7% of cases. In cases of positive margins, the endometriotic lesions were in close histological relationship with the nerves. CONCLUSIONS: There is a close histological relationship between endometriotic lesions of the large bowel and the nerves of the large bowel wall. Endometriotic lesions seem to infiltrate the large bowel wall preferentially along the nerves, even at distance from the palpated lesion, while the mucosa is rarely and only focally involved.

BACKGROUND AND METHODS:Eight patients (seven clinically negative stage Ill ovarian cancer and one peritoneal mesothelioma) respectively underwent second-look laparoscopy for staging, adhesiolysis and insertion of an intraperitoneal catheter and fixation of a portal. All patients had received six courses of cisplatin-paclitaxel-based chemotherapy intravenously. At the end of the laparoscopic staging, a 5-mm catheter was inserted under direct vision through a 5-mm trocar in the abdomen. A preaponevrotic forceps was used to grasp the catheter and bring it to the portal, which is located on the intercostal aponevrosis 2 or 3 cm above the laparoscope entry. RESULTS:Although previously operated, laparoscopy was possible in all patients and the catheters were easily inserted. All patients received intraperitoneal chemotherapy on the second postoperative day. We did not observe any complication after a mean follow-up of 12 months. CONCLUSIONS:Laparoscopic insertion of intraperitoneal catheters is a feasible and safe procedure but requires experience in laparoscopic surgery. In many cases it might preclude from performing non-useful laparotomies. It might help to reduce the hospital stay and the morbidity in relation to second-look laparotomies. Compared with the blind surgical technique of insertion of intraperitoneal catheters, this technique also allows intraabdominal staging. Nevertheless, further studies are necessary to confirm our results.

Physiotherapy including pelvic floor muscle exercises, vaginal cones, biofeedback or electrical stimulation can be recommended as first step therapy for genuine stress incontinence. However physiotherapy has its limitations: 30% of women do not improve at all and only 10 to 20% of women are totally dry after treatment. In case of failure or insufficient response, surgery must be considered. Until recently, the gold standard for the treatment of urinary incontinence was the "Burch" procedure. However the surgical approach has been considerably modified since the introduction by Ulmsten in 1995 of the tension-free vaginal tape (TVT) and more recently of the "Uratape". Short and mid-term results of the TVT are very encouraging with about 85% "dry patients" at five years follow-up. This technique can also be used with good results in patients with a low urethral pressure (< 20 cm H2O). Of course the superiority of TVT over other "classical techniques" must be confirmed by randomized comparative studies.

Objective: To evaluate the tolerance to vaccination against human papillomavirus (HPV)16 E7 (in SB adjuvant ASO2B) and its histological and immunohistological effects on HPV16 associated high-grade cervical dysplasias associated with HPV16. Study design: Five patients with histologically demonstrated severe cervical dysplasia (CIN3) HPV16 positive were injected three times before conization was performed 2 months after the first injection. We studied cytological, histological, proliferative pattern and immune profile before and after vaccination. The slides were compared with those obtained from non-injected patients. Results: The injections were well tolerated and the specimens displayed a limited regression of the lesions. Nevertheless, massive CD4 and CD8 T cell lymphocytic infiltration was noticed after vaccination. Discussion: We conclude that the vaccination we used provides an obvious immune histological reaction in the HPV infected cervix and that the 2 months delay before the final step (conization) is done is probably too short.

prophylactic surgery, their prophylactic surgery decisions, risk perception, breast cancer worry and adherence to screening recommendations. The contribution of sociodemographic variables, family history and medical variables, psychological and behavioural variables und variables of counselling and the influence of the health care system are analysed in terms of their effectiveness to predict prophylactic surgery attitudes and decisions. Predictor of prophylactic surgery intentions will be described in detail.

BACKGROUND:The aim of this study was to investigate a possible role for nerve growth factor (NGF) in the mechanism of pain and hyperalgesia induced by deep adenomyotic nodules and other forms of endometriosis and to clarify the relationship between endometriotic lesions and the surrounding nerves.METHODS:Endometriotic lesions (deep adenomyotic nodules, peritoneal endometriosis, ovarian endometriosis) and eutopic endometrium were obtained from 51 patients presenting with pain. Patients were allocated to two groups (group 1: patients with a deep adenomyotic nodule (n = 23); group 2: patients with peritoneal and/or ovarian endometriosis but without deep adenomyotic nodule (n = 28). Immunohistochemistry with antibodies against NGF, NGF specific tyrosine-kinase receptor (Trk-A) and S-100 protein was performed. Results were expressed as mean H-scores +/- SD, and correlated with the presence of hyperalgesia.RESULTS:The percentage of patients presenting hyperalgesia at physical examination was significantly higher in group 1 (96%) than in group 2 (11%) (P < 0.001). NGF expression was significantly stronger in deep adenomyotic nodules (DAN) than in ovarian (OE) and peritoneal endometriosis (PE), both in the proliferative phase in the glands [DAN: 226 +/- 18; OE: 140 +/- 9 (P < 0.001); PE: 110 +/- 7 (P < 0.001)] and in the stroma [(DAN: 204 +/- 21; OE: 125 +/- 15 (P < 0.001); PE: 100 +/- 9 (P < 0.01)]. NGF expression in DAN is also significantly stronger than in OE and PE in the secretory phase in the glands [DAN:181 +/- 32; OE: 85 +/- 3.3 (P < 0.001); PE: 65 +/- 9 (P < 0.001)] and in the stroma [DAN: 173 +/- 28; OE: 85 +/- 3.7 (P < 0.001); PE: 35 +/- 13 (P < 0.001)]. Perineurial and intraneurial invasion by endometriotic lesions were found only in deep adenomyotic nodules and not in the other forms of endometriosis. The specific receptor for NGF (Trk-A) is expressed in all the nerves that were included in the biopsies.CONCLUSIONS:These results suggest a role of NGF in endometriotic pain and hyperalgesia in deep adenomyotic nodules. The strong expression of the NGF-TrkA pathway in deep adenomyotic nodules could explain why this type of lesion infiltrates in richly innervated anatomical sites.

Lymphoepithelioma-like carcinomas of the uterine cervix are uncommon variants of squamous cell carcinomas, histologically characterized by nests of poorly differentiated epithelial cells surrounded by a dense lymphocytic and, more rarely, a eosinophilic infiltrate. We report the case of a 72-year-old woman who presented a lymphoepithelioma-like carcinoma with a prominent eosinophilic infiltrate of the uterine cervix. By using polymerase chain reaction amplification with secondary DEIA (DNA enzyme immunoassay) typing, we demonstrated the presence of the human papillomavirus-18 DNA. To our knowledge, the association of the human papillomavirus-18 with lymphoepithelioma-like carcinomas with prominent eosinophilic infiltration has not been previously described in the literature. Our data suggest the highly probable role of the human papillomavirus in the pathogenesis of this particular variant of lymphoepithelioma-like carcinoma. Lymphoepithelioma-like carcinomas (LELC), also known as medullary carcinomas, are a very rare variant of the squamous cell carcinomas of the uterine cervix. This tumor is histologically characterized by the presence of tumoral epithelial strands surrounded by an inflammatory infiltrate composed principally of lymphocyte, plasmatocyte and rarely eosinophilic cells (1). However, in some cases, eosinophilic cells are prominent, appear to constitute a particular form of LELC, and have a favorable prognosis (2). The authors and others have previously suggested the possible role of the human papillomavirus (HPV) in the pathogenesis of a classic LELC (3). The aim of this case report is to demonstrate the presence of HPV DNA by using the polymerase chain reaction (PCR) technique with L1 consensus primers MY11 (positive strand) and MY09 (negative strand) followed by the DNA enzyme immunoassay (DEIA) technique, in a case of LELC with prominent eosinophilic infiltration. A 72-year-old Caucasian woman was admitted 3 months ago for a temperature of unknown origin. Different bacteriologic and radiologic investigations were normal. She had previously had an abdominal aorta aneurysm and a left atrophic kidney. Tumoral marker CA125 was elevated. No obvious etiology was found to explain her fever. A gynecologic examination performed for metrorrhagia revealed a suspect cervix, and a biopsy was performed. Pathology confirmed the presence of a cervical carcinoma. Human papillomavirus-18 was identified by the PCR technique. A pelvic examination while under anesthesia was concluded in clinical stage 1b. A total radical hysterectomy with pelvic lymphadenectomy according to Wertheim-Meigs was performed. Histology concluded a lymphoepithelial carcinoma of the cervix. The tumor was limited to the cervix; there was no infiltration of the uterus, adnexa, parametrium and lymph nodes. According to the stadification of the International Union Against Cancer (UICC) (1997), the staging of the tumor was pT1b2. No adjuvant therapy was administered. The tumor was homogenous, well circumscribed with a capsule, and measured 4 × 2.8 × 2.1 cm. Microscopically, the nest of undifferentiated epithelial cells were surrounded by an inflammatory infiltrate rich in lymphocytes, plasmatocytes, and numerous eosinophils. The epithelial cells demonstrated eosinophilic cytoplasm and vesicular nuclei with prominent nucleoli. Mitotic figures were particularly numerous. No lymphatic or venous tumoral embolisms were noted (Fig. 1). The microscopic aspect of a lymphoepithelioma-like carcinoma (H&E x200): a nest of undifferentiated epithelial cells surrounded by an inflammatory infiltrate rich in lymphocytes and eosinophils. DNA extraction. Paraffin-embedded tissue blocks were cut into four sections of 5 µm. To reduce the possibility of contamination between the samples, we used a new, disposable, clean blade for each specimen and positive displacement pipettes. Gloves were also systematically changed. The sections were deparaffinized twice by adding 1 ml of xylene, and then centrifuged for 5 min at 15 000 r.p.m. Xylene was again decanted to remove all of the paraffin, which might inhibit the amplification reaction. The tissue was resuspended in 100 µl Tris/EDTA (50 mmol/l Tris, 1 mmol/l EDTA, pH 8.5), which contained between 20 (0.5%) and 200 µg/ml proteinase K (Boehringer-Mannheim Biochemicals, Mannheim, Germany), and was incubated for 3 h at 55°. Heating at 95° for 10 min inhibited the proteinase K. The supernatant was used for PCR amplification. Human papillomavirus amplification and typing. The presence of HPV DNA was studied using the ‘hot start’ PCR DNA amplification method from paraffin-embedded tissue, as previously described with the L1 consensus primers MY11 (positive strand) and MY09 (negative stand). Positive controls consisted of cervical carcinomas, previously proved to contain HPV-18. An additional pair of β-globulin primers, which initiated a 268 base pair DNA fragment, was also used in parallel to provide an internal positive control (4). After amplification, we also used a DNA enzyme immunoassay (DEI, Dia Snin, Salugid, Italy) detector with specific biotinylated HPV DNA probes for HPV-18, as described by the authors and by Sangiuolo et al. (5,6). This method of detection has recently been used successfully for processing many PCR products, and particularly for HPV detection with a specificity and sensitivity equivalent to the gold standard southern blotting method. Our case of LELC with prominent eosinophils was positive for HPV-18 DNA sequences. The external and internal controls gave accurate results (Fig. 2). Human papillomavirus amplification and typing using the DNA enzyme immunoassay method. Column 1: a pBR 322 molecular weight-marker positive control; column 2: a cervical carcinoma previously proved to contain HPV-18 DNA; column 3: a negative control (water); and columns 4–6: a medullary carcinoma positive for HPV-18 DNA. Lymphoepithelioma-like carcinomas of the uterine cervix are uncommon, with only a few reported cases (1,7–14). This type of carcinoma represents less than 1% of all primary cervical malignancies in Western countries. In contrast, the incidence of this tumor in Asia is higher and represents 5.5% of all cervical carcinomas. Also, lymphoepitheliomas of the nasopharynx are more frequent in Asia than in the West: suggesting that ethnic or geographic factors might have an affect (7,15). The prognosis of this type of tumor, particularly when eosinophilic infiltrate is prominent as observed here, seems to be better than that for a squamous cell carcinoma (SCC). In fact, at the same stage of disease, there is less regional lymph node metastasis in LELC than in classic SCC (1). This was effectively the case with our patient; lymph nodes were negative. Histologically, visible lymphocytic infiltration may represent a host response to neoplasia, and may explain the improved outcome of this tumor. The pathogenesis of LELC of the uterine cervix is not well understood. The Epstein–Baar virus (EBV) has been incriminated as a potential causal agent for LELC of the uterine cervix in Asian women. In fact, the EBV has been detected in approximately 75% of cases in Asia (7). In contrast, the role of the EBV in the pathogenesis of LELC in women in Western countries is less evident. In fact, the EBV has not been detected in LELC of the uterine cervix in Caucasian women (3,8–10). Therefore, racial and/or geographic factors probably have an influence in the association of the EBV with LELC of the uterine cervix occurring in Asian women. The human papillomavirus has an important role in the pathogenesis of cervical intraepithelial lesions and SCC. In fact, the HPV has been detected in more than 90% of SCC of the uterine cervix. The role of the HPV in the pathogenesis of LELC of the uterine cervix is poorly understood. Only a few cases of LELC have been investigated for the HPV. The first case investigated for the HPV was negative (9). Unfortunately, the authors have used in-situ hybrydation for the detection of HPV DNA. However, we know that the sensitivity of in-situ hybrydation is lower than in the PCR technique. We have already reported two cases of LELC of the uterine cervix associated with HPV-16 and -18 in Caucasian women (3). To our knowledge, we have reported the first case of LELC with a prominent eosinophilic infiltrate associated with HPV-18. These data suggest that the HPV probably plays a role in the pathogenesis of LELC of the uterine cervix in Western countries. However, more investigations are necessary to confirm these findings.

The psoas abscess is a rare complication in obstetric and gynaecology. Two types of psoas abscess are recognized. The primary psoas abscess is generally following haematogenous dissemination of an infectious agent and the source is usually occult. The most frequently isolated pathogen is Staphylococcus aureus. On the other hand, the secondary abscess is the result of local extension of an infectious process near the psoas muscle. We report the case of a patient who develops a bacteremia from an infected cesarean section wound. The complications were thigh and psoas abscesses with left sacroiliitis. Medical management with prolonged antibiotherapy permit clinical, biological and radiological improvement. Although it required a long hospital stay, medical treatment alone was effective. More experience is required to determine which therapeutic option: medical treatment and/or surgery, is the best choice for this type of complication.

The scientific and clinical activities of the Department of Obstetrics and Gynaecology have involved the three main subdivisions: the gynecological surgery, the obstetrics and fetal medicine, the endocrinology and the reproductive medicine. Minimal invasive surgery including laser assisted laparoscopy or robotic assisted surgery has been particularly developed. Endometriosis, a frequent and sometimes particularly invasive disease, and oncologic surgeries have been developed in collaboration with the digestive surgery department. The department has also contributed to the comprehension and treatment of prenatal pathologies such as premature labor and deliveries or the gestational diabetes. The department has supported the development of techniques to study the fetal well-being in utero: the prenatal echography, the chorionic villous sampling, the amniotic puncture or the cordocentesis for prenatal genetic diagnosis or fetal infectious contaminations, the CMV transmission more specifically. In endocrinology and reproductive medicine, the department has mainly developed the in vitro fertilization techniques. The prolonged embryo culture, the study of preimplantation embryo metabolism, the preimplantation genetic diagnosis and the cryopreservation of ovarian fragments to preserve fertility in women undergoing oncologic treatments represent the more recent developed topics. Finally, the security of viral transmission in assisted procreation and the treatment of these patients with chronic viral diseases (Hepatitis C or HIV) are another domain with important scientific activity.

BACKGROUND:The monoclonal antibody Ki-67 allows to investigate the proliferative activity of tumor and is a clinically useful marker to characterize breast cancer. In this study, we have compared Ki-67 activity in 38 primary breast tumors and in their respective positive axillary lymph nodes (ALNs).METHODS:Immunohistochemistry with the monoclonal antibody against Ki-67 was performed in 38 nodes positive breast carcinomas and in their respective positive ALNs. Statistical analysis was performed with the Student's t-test (2-tailed) for equality of means.RESULTS:The proliferation index measured by Ki-67 expression was significatively higher (p < 0.02) in ALN than in the primary tumor (29.8% v.s. 21.8%).CONCLUSION:These results strongly suggest a higher proliferation and perhaps aggressivity of metastatic neoplastic cells when compared with their respective primary tumor. Perhaps, in the future, these differences in proliferation behavior might be taken into account when considering the choice of the adjuvant therapy.

Background : The most important clinical infections caused by Streptococcus Bovis are bacteremia and endocarditis. Usually, Streptococcus Bovis bacteremia has been described in association with bowel pathology.Case report : A 67-year-old woman with an history of endometrial cancer Ic was admitted with the suspicion of peritonitis at examination. At exploratory laparotomy, a total hysterectomy was performed and the abdomen was drained. Histology revealed an uterine adenocarcinoma staged IIIa with intramyometrial cocci accumulation. Streptococcus Bovis was isolated from the peritoneal fluid cultures and three haemocultures.Conclusion : Because we excluded bowel pathology and endocarditis, this is the first case of Streptococcus Bovis bacteremia from endometrial cancer origin.