Tehran University Medical Journal

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The papillary cystadenoma lymphomatosum (PCL), also called warthin's tumor, is a benign salivary gland tumor which primarily involves the parotid gland. These lesions are composed of a double layer of cuboidal or culmnar eosinophilic cells lining a cystic cavity which lymphoid tissue is present in the supporting stroma. The lesions shows a predilection for males, with peak incidence during the sixth decade of life. Bilateral lesions have been found to occur in 5 to 7.5 percent of the cases. Rarely, these lesions have been reported in the minor salivary glands and oropharynx. Case report: A 47-year-old woman presented with a red lesion on the hard palate between the midline and right maxillary side. The patient had awared of the lesion for one year. The clinical dignosis was a mucocele. An excisional biopsy was performed. Gross examination of the formaline-fixed specimen revealed three pieces of soft tissue measuring 1.0 x 0.3 x 0.3. Histologic examination revealed a nodular mass surfaced by keratinizied stratified squamous epithelium. The connective tissue stroma contained a papillary cystic area lined by a double layer of cuboidal cells with centrally placed nuclei

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Background: Ovarian hyper stimulation syndrome (OHSS) and its consequences, especially thromboembolic events, are of the most dangerous complications of assisted reproductive technologies (ART). It is unclear whether a thrombophilic predisposition or changes in blood components during clinical presentation of OHSS increase thrombotic risks. Testing for certain thrombophilias in selected high risk patients may help risk assessment and decision-making about prophylactic measures.

Methods: In this study carried out in April 2010 to March 2011, 108 in vitro fertilization candidates with ≥20 follicles following ovarian stimulation were recruited. Protein S, protein C, antithrombin, lupus anticoagulant and anticardiolipin antibodies were measured. Blood tests were compared between severe and non-severe OHSS groups and their changes were traced after onset of clinical OHSS in 43 patients presenting with severe symptoms by repeating the tests at hospital admission.

Results: Mean protein S activity was lower in severe OHSS group (101.7±16.3 vs. 118.4±17.0 P<0.001). After clinical presentation of severe OHSS, this level decreased to 91.6±20.1 (P<0.001). Antithrombin levels decreased 2.09% after the onset of symptoms in the group with severe OHSS, but this difference was not statistically significant (P=0.051). Protein C, lupus anticoagulant and anticardiolipin antibodies were not correlated to severe OHSS development.

Conclusion: Patients with relatively lower protein S activity were at higher risk for the development of severe OHSS, and its dangerous consequences. During clinical OHSS presentation, protein S decreased even more, and patients were more vulnerable to hypercoagulability states. These points should be kept in mind in risk assessment and adoption of prophylactic strategies.