Objective: To investigate the differences of the amount of paracervical lymphatic structures removed when performing classical type III, modified type II and nerve-sparing radical hysterectomy (RH). Material and Methods: Open macroscopic or laparoscopic pelvic dissections in 18 fresh adult female cadavers after lymphatic channels and nodes staining by Lipiodol dye solution injection of the uterine cervix. Results: We distinguished three different lymphatic pathways: 1) the supraureteral paracervical pathway (vascular portion of paracervix-uterine artery and superficial uterine vein), identified in 96% of cases, and removed in all types of RH, 2) the infraureteral paracervical pathway (vascular portion of paracervix-deep uterine vein), identified in 22% of cases, and removed by type III and nerve-sparing RH, and 3) the neural paracervical pathway (nervous portion of paracervix), identified in 7% of cases, and removable only by type III RH. No evidence of stained lymphatic structures running into the vesicouterine and uterosacral ligaments was found. Conclusion: Nerve-sparing RH offers the most effective ratio between oncological safety and surgical-related complications, and would be particularly useful in patients with high risk of paracervical involvement while our results suggest caution in the use of modified type II RH in patients at low-moderate risk of paracervical involvement, unless the use of adjuvant radiotherapy, because of the large amount of potentially lymph-bearing paracervical tissue leaved in situ. Classical type III RH affords the complete resection of all paracervical lymphatic pathways potentially draining the cervix, however this procedure implies a high risk of lesions of the autonomous nerves of pelvic organs.

Madelung’s disease or multiple symmetric lipomatosis (MSL) is a rare disorder of unknown etiology which typically presents symmetrically subcutaneous accumulation of non-encapsulated adipose tissue which slowly grows around the neck, upper part of the arms, pelvis, back and thigh. This disease is also frequently associated with hepatopathy, glucose intolerance, hyperuricemia, and malignant tumors of the upper airways. Nevertheless, only one description of malignant transformation of Madelung’s disease has been presented in literature. Here, we report a case of liposarcomatous transformation of Madelung’s disease in a 59-year-old Italian woman with a coincidental diagnosis of breast cancer.Virtual slideThe virtual slide for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/3480884087499351

The role of obesity should not be overestimated when evaluating the chance of enrolment of LACC patients into preoperative chemoradiation protocols.

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Massive and severe epistaxis is an uncommon event in pregnancy. It could be life threatening and could affect the normal pregnancy course. The best management is still on debate; it could be medical, conservative or surgical. Pregnancy termination often is problem solving. Hormonal changes during pregnancy affects nasal physiology. Vaginal delivery, labour induction or cesarean section are all suitable, after hemodynamic stabilization of pregnant woman. We report a case and review the available literature.