Search

We compared transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) for detecting myometrial infiltration, cervical involvement, and for measuring tumor volume in endometrial cancer patients. We also correlated tumor volume to worse histological prognostic factors.We recruited women with a histological diagnosis of endometrial cancer between March 2019 and March 2021. Inclusion criteria were: age ≥ 18 years, written informed consent, biopsy-proven endometrial cancer, absence of previous neoadjuvant chemo- or radiotherapy treatment, patient suitable for primary surgery. Exclusion criteria were: advanced disease stage and other coexisting malignant tumors. TVUS and MRI were used, in the absence of any contraindication. We compared the preoperative imaging results with final histopathology.The accuracy of TVUS and MRI in evaluating myometrial infiltration, cervical invasion and tumor volume were comparable. A tumor volume ≥2 ml showed a positive correlation with worse histological prognostic factors, such as high tumor grade, diffuse lymphvascular space involvement (LVSI) and deep myometrial invasion (p 0.05).TVUS should be used as first-line imaging modality, being more available, cost-effective, and more acceptable by patients. A careful local staging of endometrial cancer patients before surgery is fundamental in order to improve tailored treatment and minimize costs.

The extrapulmonary tuberculosis (TB) is a serious medical problem in developing countries, affecting 16% of all new patients with pulmonary TB (World Health Organization 2018). In particular, genit...

Introduction/Background Endometrial cancer is the most common gynecological malignancy in developed countries. Transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) are widely accepted as imaging tools in preoperative local staging. In this prospective study, we evaluated the diagnostic accuracy of TVUS and MRI for detecting the depth of myometrial invasion and cervical involvement and for measuring tumor volume. We also correlated tumor volume to negative histological prognostic factors. Methodology We enrolled women with a histological diagnosis of endometrial carcinoma. The study was conducted from January 2018 to March 2019. All patients were evaluated by TVUS and pelvic MRI with gadolinium, in the absence of any contraindication. We compared the preoperative imaging results with final histopathology. Results The mean age was 63,65±9.79 years. Fifty-four out of the 60 patients resulted suitable for primary surgery. Six patients underwent neoadjuvant chemotherapy for carcinomatosis. Twenty-eight women underwent both TVUS and MRI. The additional 26 patients underwent only TVUS because they were not able to perform MRI. Both TVUS and MRI showed an accuracy of 85.7% for diagnosing presence or absence of myometrial invasion and an accuracy of 100% and 89.3% respectively, for the assessment of deep myometrial infiltration. The accuracy for the cervical involvement was 92.9% and 96.4% for TVUS and MRI respectively. The coefficient of determination (R2) of tumor volume measurement was 0.99, 0.95 and 0.98 using 3-Dimensional (D) TVUS, 2-D TVUS and MRI respectively. A value of tumor volume ≥2 ml showed a positive correlation with negative histological prognostic factors, such as high tumor grade, lymphovascular space involvement (LVSI) and deep myometrial invasion (p Conclusion The accuracy of TVUS and MRI in evaluating deep myometrial invasion, cervical involvement and tumor volume measurement were comparable. A preoperative evaluation of the tumor volume would allow the identification of the patients with a poor prognosis. Disclosure Nothing to disclose.

Introduction/Background Endometrial cancer is generally associated with a good prognosis, due to an early diagnosis in stage I and II, 75% and 13% respectively. For advanced-stage disease, the recurrence rate is high and the site of the relapse is heterogeneous with localized or spread peritoneal disease. The treatment strategy is based on site of relapse. For non-localized relapse the chances are limited with a poor prognosis. Methodology We reported our experience of three cases with peritoneal spread recurrences, in endometrial cancer patients with advanced stage diagnosis. Results The patients had been underwent to multiple lines of chemotherapy including rechallenging with platinum regimens, pegilated liposomal doxorubicin and taxane, with a progression of disease. These patients came at our Department for abdominal distension and breathing difficulty, CA 125 increased and radiology find (CT scan or US scan) of ascites. In these cases, after paracentesis and a single administration of intraperitoneal chemotherapy based on carboplatin (AUC5) were showed quality of life improvement, reduction of fatigue, improved breathing and reduction of anorexia. No complications occurred. Conclusion Although only few cases have been reported, the exceptional results and the absence of side effects observed in these cases, strongly warrant future trials to investigate the role that intraperitoneal chemotherapy can have both as palliative treatment of refractory ascites and as salvage therapy in advanced endometrial cancer. Disclosure All authors declare that they have no conflict of interest and nothing to disclose.

Background. Epistaxis is a common problem during pregnancy. Few cases of severe epistaxis, not associated with nasal lesions or clotting disorders, were described in the literature. We reported a case of severe epistaxis in a pregnant patient, exploring all the different possible management options.Case. A 33-year-old primigravida, who was 38 weeks pregnant, presented with spontaneous severe left-sided epistaxis. Her blood pressure was into normal ranges. Clotting disorders and nasal lesions were excluded. The patient clinical worsening, due to severe anemia, and the failure of conservative treatment have imposed an emergency caesarean section, with an immediate resolution of the nasal bleeding.Conclusion. Treatment of severe epistaxis must always consider conservative measures first-line with early recourse to otolaryngologist. In general, delivery of the fetus is considered curative.

Radiologists play an important role in the diagnostic assessment of patients in the emergency setting. An acute abdomen in pregnancy represents one of the most challenging diagnostic and therapeutic dilemmas. The difficulty is due to the anatomical and pathophysiological changes related to pregnancy, including the different locations of abdominal and pelvic structures, displaced by the uterus, altered laboratory tests, difficult abdominal/pelvic physical examination, and non-specific symptoms. Physicians have to choose the appropriate imaging techniques in order to avoid, as much as possible, the use of ionizing radiation due to the potential risk for the fetus. Ultrasound is widely considered to be the first imaging examination that should be performed. Magnetic resonance imaging and computed tomography are used when ultrasound diagnosis is uncertain. In general, they are more accurate than ultrasound in the second and third trimesters. Magnetic resonance imaging is preferable to avoid ionizing radiation.

Acute abdominal pain in pregnancy presents diagnostic and therapeutic challenges. Prompt diagnosis and treatment are crucial for the well-being of the mother and the fetus, and imaging is often required to clarify the clinical picture. Ultrasound (US) remains the primary imaging modality for the pregnant abdomen and pelvis because of its availability, portability, and absence of ionizing radiation. US can often be used to elucidate the cause of abdominal and pelvic pain, particularly if the pain is due to an obstetric or gynecologic abnormality. However, evaluation of the bowel, pancreas, ureters, and mesenteric vasculature may be limited on US because of patient body habitus, a small field of view, and the presence of overlying structures, especially in the later stages of pregnancy. Magnetic resonance imaging (MRI) has been shown to be highly useful in the diagnosis of acute gynecological and obstetric disorders, and particularly in the setting of an acute abdomen during pregnancy. MRI is often used when US is inconclusive. Computed tomography (CT) is the imaging examination of choice when there is a life-threatening situation, and in patients with trauma, when a rapid diagnosis is required, and US is not diagnostic.

To evaluate the accuracy of pelvic MRI in the diagnosis of unusual ectopic pregnancy (EP), when ultrasound (US) examination is inconclusive. We retrospectively reviewed the medical records of 150 patients with suspected EP. Clinical, US and MRI features of 15 unusual EPs were analysed. Two radiologists independently reviewed each case resolving by consensus any diagnostic discrepancy. Interobserver agreement was assessed using the Cohen κ test. MRI displayed a gestational sac-like structure surrounded by a thick wall in all cases. The thick wall displayed hyperintensity in 41 %, isointensity in 35 % and hypointensity in 24 % of cases on T1-weighted images. Diffusion- and fat saturation T1-weighted images were the most accurate sequences, as they enabled identification of 15/15 and 14/15 patients, respectively. Although US was false negative in detecting cervical and uterine infiltration underlying the caesarean scar, MRI was able to identify the invasion. Interobserver agreement was very good for all sequences (κ=0.892–1.0). MRI plays an important role in the early diagnosis of unusual EP. It should be considered after negative US findings, providing accurate evaluation of the site and the possible infiltration of these lesions, which help in the management of these patients. • MRI is being increasingly used as a problem-solving modality in ectopic pregnancy. • MRI plays an important role in early diagnosis of unusual ectopic pregnancy. • Knowledge of MRI features in EP is essential to determinate appropriate management.

Renal colic is the most frequent nonobstetric cause for abdominal pain and subsequent hospitalization during pregnancy. The physio-anatomical changes in the urinary tract and the presence of the fetus may complicate the clinical presentation and management of nephrolithiasis. Ultrasound (US) is the primary radiological investigation of choice. Magnetic resonance urography (MRU) and low-dose computed tomography (CT) have to be considered as a second- and third-line test, respectively. If a study that uses ionizing radiation has to be performed, the radiation dose to the fetus should be as low as possible. The initial management of symptomatic ureteric stones is conservative during pregnancy. Intervention will be necessary in patients who do not respond to conservative measures. Therefore, it is crucial to obtain a prompt and accurate diagnosis to optimize the management of these patients. Teaching Points • In pregnancy, renal colic is the most frequent nonobstetric cause for abdominal pain and hospitalization. • Magnetic resonance urography should be considered when ultrasound is nondiagnostic. • Low-dose CT should be considered as a last-line test during pregnancy.

Purpose In a retrospective observational study, we evaluated the feasibility and safety of medical therapy with transabdominal ultrasound-guided injection of methotrexate (MTX) into the gestational sac (GS) in patients with interstitial ectopic pregnancies. Methods Fourteen interstitial ectopic pregnancies were treated with transabdominal ultrasound-guided injection of MTX (25 mg). All patients were hemodynamically stable. In all patients, the 10-cm distance between the GS and vaginal fornices was ≥10 cm, making transvaginal injection difficult. To evaluate feasibility and safety of the procedure, we assessed complications clinically and with imaging during a 1-year follow-up. Results In all 14 patients, MTX injected locally into the GS successfully terminated the interstitial pregnancy, thereby avoiding surgery. There was no complications during follow-up. Conclusions The successful outcome in our patients suggests that the transabdominal route is feasible and safe as a nonsurgical option for terminating an ectopic interstitial pregnancy in patients in whom the transvaginal route is contraindicated or difficult, provided the patients are properly selected and operators have sufficient experience with the technique. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 42:522–526, 2014

Acute abdominal pain in pregnancy presents diagnostic and therapeutic challenges. Ultrasound remains the primary imaging investigation of the pregnant abdomen because of its availability, portability, and lack of ionizing radiation. MR imaging has been shown to be useful in the diagnosis of gynecologic and obstetric problems and in the setting of acute abdomen during pregnancy. MR imaging is often used when ultrasound is inconclusive. Computed tomography is the investigation of choice when there is a life-threatening situation and in case of traumatic injuries, when a rapid diagnosis is required.

Objective.To assess the quality of sexual life of women with primary Sjögren syndrome (pSS) and to identify its correlations with disease activity and damage, quality of life, and mood disorders.Methods.The quality of sexual life of 24 women with pSS was assessed with the Female Sexual Function Index (FSFI). Twenty-four healthy women, matched by age and hormonal status, were enrolled as controls. Mood disorders and quality of life were investigated using the Hospital Anxiety and Depression Scale (HADS) and the Medical Outcomes Study Short Form-36. Patients underwent a gynecological visit with vaginal pH measurement, cervicovaginal swabs, and Pap smears. Disease activity and damage were assessed by the European League Against Rheumatism Sjögren syndrome disease activity and damage indexes.Results.Patients with pSS showed a pathological mean FSFI score (19.1 ± 7.33) significantly different from controls (p = 0.004), both in menstruating women (p = 0.006) and in menopausal women (p = 0.03). Major differences between the 2 groups were detected in dyspareunia (p < 0.005), lubrication (p = 0.006), desire (p = 0.004), and arousal (p = 0.018). The FSFI score was inversely correlated with age (p = 0.008) and anxiety HADS (p = 0.031). No early anatomical changes, swabs, and Pap smear alterations were revealed in patients with pSS; however, vaginal pH was higher than normal in premenopausal patients (6.0 ± 0.77).Conclusion.Both premenopausal and postmenopausal women with pSS have a worse sexual quality of life. We reported a greater prevalence of dyspareunia that is statistically significant when compared with controls. The FSFI could be a useful tool to assess this topic, but has been neglected in the care of patients with pSS heretofore.

In a retrospective observational study, we evaluated the feasibility and safety of medical therapy with transabdominal ultrasound-guided injection of methotrexate (MTX) into the gestational sac (GS) in patients with interstitial ectopic pregnancies.Fourteen interstitial ectopic pregnancies were treated with transabdominal ultrasound-guided injection of MTX (25 mg). All patients were hemodynamically stable. In all patients, the 10-cm distance between the GS and vaginal fornices was ≥10 cm, making transvaginal injection difficult. To evaluate feasibility and safety of the procedure, we assessed complications clinically and with imaging during a 1-year follow-up.In all 14 patients, MTX injected locally into the GS successfully terminated the interstitial pregnancy, thereby avoiding surgery. There was no complications during follow-up.The successful outcome in our patients suggests that the transabdominal route is feasible and safe as a nonsurgical option for terminating an ectopic interstitial pregnancy in patients in whom the transvaginal route is contraindicated or difficult, provided the patients are properly selected and operators have sufficient experience with the technique.

Background Mammalian target of rapamycin inhibitors (mTORi) are a promising new family of immunosuppressive drugs. No teratogenic effects have been reported to date. Their lipid and glucidic effects should not be underestimated, however, especially during pregnancy. Moreover, mTORi may affect fetal growth by mTOR placental activity. Objective Our purpose was to highlight mTORi placental impact and metabolic implications to detect possible maternal or fetal effects and define management guidelines in pregnant women after solid organ transplantation. Methods A literature search was performed for articles from the Medline and Pubmed databases with the use of the following keywords: mTOR inhibitors, pregnancy, placental transport, lipid metabolism, glucose metabolism. Results mTOR works as a positive regulator of system A, system L, and taurine placental amino acid transporter activity, which are critical for the transport of amino acids to the fetus. Exposing trophoblast cells to rapamycin reduces system L activity; therefore, treatment with rapamycin in human pregnancies could alter fetal growth with intrauterine growth restriction (IUGR). Regarding the metabolic effects mTORi increase lipolysis, impair insulin's antilipolytic effect and reduce lipid storage, which may potentially contribute to dyslipidemia. Chronic rapamycin treatment reduces adipose tissue size and β-cell mass/function, causes hyperlipidemia, severe insulin resistance, and glucose intolerance, and promotes hepatic gluconeogenesis. Conclusions The studies on mTORi treatment in transplanted pregnant women have not focused to date on the potential metabolic and placental effects. Selection of women at high risk for metabolic disorders could be needed and consideration of switching to another immunosuppressive drug required if diabetes and abnormal blood lipids have been diagnosed in prepregnancy counseling. It seems to be mandatory to encourage prompt reporting of any additional cases of pregnancy during mTORi exposure to provide a better understanding of the placental effects and safety profile of these immunosuppressive drugs.

Renal colic is the most frequent non-obstetric cause for abdominal pain and subsequent hospitalization during pregnancy. Intervention is necessary in patients who do not respond to conservative treatment. Ultrasound (US) is widely used as the first-line diagnostic test in pregnant women with nephrolithiasis, despite it is highly nonspecific and may be unable to differentiate between ureteral obstruction secondary to calculi and physiologic hydronephrosis. Magnetic resonance imaging (MRI) should be considered as a second-line test, when US fails to establish a diagnosis and there are continued symptoms despite conservative management. Moreover, MRI is able to differentiate physiologic from pathologic dilatation. In fact in the cases of obstruction secondary to calculi, there is renal enlargement and perinephric edema, not seen with physiological dilatation. In the latter, there is smooth tapering of the middle third of the ureter because of the mass effect between the uterus and adjacent retroperitoneal musculature. When the stone is lodged in the lower ureter, a standing column of dilated ureter is seen below this physiological constriction. MRI is also helpful in demonstrating complications such as pyelonephritis. In the unresolved cases, Computed tomography remains a reliable technique for depicting obstructing urinary tract calculi in pregnant women, but it involves ionizing radiation. Nephrolithiasis during pregnancy requires a collaboration between urologists, obstetricians, and radiologists.

Successful transplantation should lead to improvements in sexual function and sex hormone disturbances in both men and women, but immunosuppressive drugs may interfere with hormone metabolism. In this regard, several studies have showed a potential negative effect of mTOR inhibitors (mTORi) on male gonadal function, while their role in the female patients is not well documented in the literature. Successful pregnancy is possible after solid organ transplantation. The fetal effects of mTORi are still poorly defined but they seem not to represent an absolute contraindication for pregnancy. The aim of our study would be to review the impact of mTORi on fertility and pregnancy in order to have a clearer picture about their possible use after organ transplantation.

Background: teenage pregnancy is a worldwide social problem. The aim of this study is to provide more data for a better understanding of the possible maternal and foetal risks associated with teenage pregnancies.Methods: the hospital records of all pregnant women, aged between 14 and 19, from the obstetric registers of the Policlinico Umberto I Hospital in Rome, between 2000 and 2010, have been completely reviewed (n=184). For each pregnant woman socio-demographic characteristics, obstetric history, pregnancy and birth outcomes were also determined. Our results were compared with a control group composed of 150 primigravida adult women aged 20-29 years who delivered at the Policlinico Umberto I Hospital in Rome in the same period.Results: the mean age ± SD of the study group was 17.9 ± 1.2, while that of the control group was 25.4 ± 2.4. The control group had a significantly lower risk of preterm delivery (p=0.000). The rate of low birth weight babies born to the young mothers was significantly higher than that of babies born to the adult mothers (p=0.036). The study group had a lower risk of instrumental delivery and a higher proportion of spontaneous delivery (p=0.000). Finally, we observed a statistically significant difference of the APGAR score at the fifth minute between the two groups (p=0.004).Conclusions: our results seemed to confirm the outcomes of previous studies for adolescent pregnant women, mainly regarding the increased risks of preterm deliveries and low birth weight babies, the higher incidence of spontaneous vaginal delivery and the lower incidence of instrumental delivery.

Background Current knowledge indicate that epirubicin administration in late pregnancy is almost devoid of any fetal cardiotoxicity. We report a twin pregnancy complicated by breast cancer in which epirubicin administration was causatively linked to the death of one twin who was small for gestational age (SGA) and in a condition of oligohydramnios and determined the onset of a transient cardiotoxicity of the surviving fetus/newborn. Case presentation A 38-year-old caucasic woman with a dichorionic twin pregnancy was referred to our center at 20 and 1/7 weeks for a suspected breast cancer, later confirmed by the histopathology report. At 31 and 3/7 weeks, after the second chemotherapy cycle, ultrasound examination evidenced the demise of one twin while cardiac examination revealed a monophasic diastolic ventricular filling, i.e. a diastolic dysfunction of the surviving fetus who was delivered the following day due to the occurrence of grade II placental abruption. The role of epirubicin cardiotoxicity in the death of the first twin was supported by post-mortem cardiac and placental examination and by the absence of structural or genomic abnormalities that may indicate an alternative etiology of fetal demise. The occurrence of epirubicin cardiotoxicity in the surviving newborn was confirmed by the report of high levels of troponin and transient left ventricular septal hypokinesia. Conclusion Based on our findings we suggest that epirubicin administration in pregnancy should be preceded by the screening of some fetal conditions like SGA and oligohydramnios that may increase its cardiotoxicity and that, during treatment, the diastolic function of the fetal right ventricle should be specifically monitored by a pediatric cardiologist; also, epirubicin and desamethasone for lung maturation should not be closely administered since placental effects of glucocorticoids may increase epirubicin toxicity.

Background Metastases to the breast from extramammary malignancies are very rare, and ruling out the diagnosis of primary breast tumor is important in order to decide on clinical management and predict prognosis. Case presentation Clinical examination revealed in a 49-year-old hairdresser a 3-cm hard lump adherent to the underlying layers in the right breast. Trucut biopsy was performed. Histology showed a solid proliferation of medium-sized neoplastic polygonal cells. Immunohistochemical analysis showed tumor cells diffusely positive for cytokeratin 8/18 and calretinin and focally positive for cytokeratin 5/6 and Wilms’ tumor 1, e-cadherin, and human bone marrow endothelial-1. Estrogen receptors and progesterone receptors were negative. The final diagnosis was metastatic epithelioid malignant pleural mesothelioma. Conclusions Immunohistochemistry is an important tool for a conclusive diagnosis of malignant pleural mesothelioma. Owing to the degree of histological and immunohistochemical overlap, a high level of clinical suspicion is essential in order to avoid unnecessary mutilating surgery.