Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome, also known as Mullerian agenesis, is a largely sporadic disorder resulting in absence or hypoplasia of the vagina, uterus, and fallopian tubes. In order to foster adequate psychosocial development and sexual intercourse, a number of surgical procedures are available, one of which is the creation of a neovagina from a segment of sigmoid colon. In this report, we describe a patient who presented at age 17 amenorrhea and was found to have MRKH. She underwent vaginal reconstruction with a neovagina from a segment of her sigmoid colon at age 19. Subsequent to this procedure, the patient developed carcinoma of the breast and renal cell carcinoma, and in addition developed an invasive mucinous adenocarcinoma of her neovagina. This is only the third case of an adenocarcinoma arising in a neovagina in the setting of MRKH, and the first case described with an accompanying adenomatous component. All three cases to date demonstrated a mucinous phenotype. Overall, this case emphasizes that neovaginal mucosa may undergo neoplastic transformation, and that recognition of this possibility is important in long-term follow up care for patients affected MRKH treated by surgical reconstruction.

It was hypothesized that parents and child care providers are not prepared to accept children infected with human immunodeficiency virus (HIV), who are increasing in number, into the day care center setting. To determine their knowledge and attitudes toward HIV transmission, 219 parents in 4 day care centers and 176 care providers in 12 day care centers were given confidential questionnaires. More than 98% of respondents knew that sex and needle sharing can transmit HIV; 84% of parents and 77% of care providers knew that contact with blood can transmit HIV. There was, however, uncertainty about transmission via many common contacts in day care centers: human bites, urine, stool, tears, and vomit; kissing; sharing of food and eating utensils; and diaper changing areas. Only 43% of parents said they would allow their child to stay in the same room with a child who was infected with HIV. In a multiple logistic regression model, the unwillingness of parents to have their child stay in the same room with a child who was infected with HIV was significantly (P < .0001) associated with black ethnicity, beliefs that such a child is likely to infect others (40%) and is dangerous to others (58%), and fear of their child being exposed to HIV (86%). Care providers' unwillingness to care for a child infected with HIV in the classroom (48%) was significantly (P < .0001) associated with beliefs that such a child is likely to infect others (44%) and that common day care center contacts can transmit HIV (62%). Most parents and care providers wanted to be informed if a child infected with HIV was in the classroom. A serious effort will be needed to educate parents and care providers if children who have been infected with HIV are to be accepted into the day care center setting routinely.