Histologic architecture and vascularization of hysteroscopically excised intrauterine septa.

STUDY OBJECTIVE: To investigate histologic structures of intrauterine septa resected hysteroscopically. DESIGN: Prospective, consecutive study (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: Seventy-six women evaluated for uterine septa and infertility. INTERVENTIONS: All patients with diagnosis of uterine septum detected by transvaginal color Doppler (TVCD) underwent operative hysteroscopy in which the most prominent part of the septum was encircled with a hysteroscopic loop electrode and removed. Specimens were sent for histopathologic evaluation. The rest of the septum was divided by monopolar needle electrode until the uterine cavity assumed a globular shape. MEASUREMENTS AND MAIN RESULTS: In 63 women (82.8%) preoperative TVCD revealed septal vascularity typical for radial arteries with mean resistance flow of 0.64 +/- 0.06, and enlarged sunusoidal and capillary spaces. Histopathologic results revealed fibromuscular tissue with moderately more connective tissue in 55 cases (72.3%) and myometrial tissue in 21 (27.6%). There was no statistically significant difference (p >0.05) in frequency of septa between patients with primary and secondary infertility. CONCLUSION: Intrauterine septa consisted of the same type of tissue as normal myometrium, with many muscular fibers. We suspect that muscular tissue within the uterine septum is a potential cause of irregular contractility and consequently increased abortion rate in these patients. (J Am Assoc Gynecol Laparosc 8(1):111-116, 2001)

Preoperative diagnosis of primary fallopian tube carcinoma.

INTRODUCTION: Transvaginal color and pulsed Doppler can detect areas of neovascularization within the tubal carcinoma and can distinguish it from other benign adnexal pathology. SUBJECTS AND METHODS. During a 7-year period eight cases of Fallopian tube carcinoma were detected using transvaginal color and pulsed Doppler. RESULTS: Transvaginal sonography revealed complex, sausage-shaped, and/or cystic structures in the adnexal region. Additional color Doppler examination depicted low vascular impedance (RI ranged from 0.29 to 0.40). Histopathology reported different types of Fallopian tube carcinoma. CONCLUSION: Transvaginal color Doppler may aid in diagnosis of Fallopian tube malignancy more reliably than using other costly diagnostic procedures.

Detection and typing of human papillomaviruses by polymerase chain reaction in cervical scrapes of Croatian women with abnormal cytology.

The association between certain human papillomaviruses (HPV) and cervical intraepithelial neoplasia (CIN) is well documented, but still unknown among Croatian women. In 1995, women between the age of 17 and 64 with cytomorphologically abnormal smears (CIN I-IV) were tested for the presence of HPV. Consensus and specific primers were used in the polymerase chain reaction (PCR) to detect the most common types: 6, 11, 16, 18, 31 and 33, as well as the unknown-risk HPV types (HPV X). Out of 379 specimens, 163 (43%) contained one or more HPV types. Coinfection with different HPV types in the same sample was observed in 16 cases. Beside low-risk HPV 6/11 (25.8%) the most frequently observed types were high-risk HPV types 16 (20.2%) and 31 (17.8%). Globally, the HPV positivity rate declines with age. The presence of HPV DNA significantly increased from 35.5 to 61.1% along with the severity of the cervical intraepithelial neoplasia (CIN I-IV). HPV type 6/11 was strongly associated with CIN I (33.8%), HPV type 31 with CIN II (22.9%), and HPV type 16 with CIN III (50%).

Uterine sarcoma: a report of 10 cases studied by transvaginal color and pulsed Doppler sonography.

OBJECTIVE: To evaluate the role of transvaginal color Doppler in differentiating uterine sarcoma from myoma. STUDY DESIGN: A group of 2010 women were examined by transvaginal color Doppler ultrasonography 1 day before planned hysterectomy. Ten cases with uterine sarcoma were analyzed with respect to their color Doppler sonographic patterns and compared with 150 normal and 1850 myomatous uteri. Analysis of variance was used to test the significance among the subgroups. RESULTS: All cases of uterine sarcoma (100%) revealed abnormal tumoral blood vessels. The mean resistance index (RI) of these vessels was 0.37 +/- 0.03, ranging from 0.32 to 0.42, which is statistically significantly lower than that of the normal and myomatous (P < 0.001) uteri. There was no significant difference between RI in the right and left uterine arteries in each separate group; however, there was a decline in these values from normal, through myomatous, to sarcomatous uteri. Using a cutoff point of 0.40 for RI we were able to distinguish between benign and malignant myometrial tumors with a sensitivity of 90.91%, specificity of 99.82%, positive predictive value of 71.43%, and negative predictive value of 99.96%. CONCLUSION: Color Doppler sonography has the potential to distinguish uterine sarcoma from benign uterine lesions.

[Angiogenesis of gynecologic tumors studied with color Doppler]. / Angiogeneza ginekoloskih tumora ispitana obojenim doplerom.

Angiogenesis is obligatory event in solid tumors growth. Weak muscular layer in the newly formed tumoral vessels results in decreased resistance to blood flow and characteristic Doppler signal. The number and arrangement of the blood vessels differ between benign and malignant lesions as well. Parameters mentioned above enable a precise ultrasound differential diagnosis between benign and malignant tumors. Malignant uterine tumors are better perfused and have lower resistance to blood flow than benign ones. Benign lesions with secondary changes (necrosis) may have lowered resistance indices. The finding of pathological perfusion makes the diagnosis of endometrial carcinoma also very accurate. High sensitivity of the transvaginal color Doppler in detecting newly formed blood vessels in an early stages of ovarian cancer may establish this technique as a screening method for this still very high lethality disease.

The value of transvaginal color Doppler in the assessment of pelvic inflammatory disease.

This study compares transvaginal color and pulsed Doppler (TVCD), laparoscopic and clinical findings in 102 women with proven pelvic inflammatory disease (PID). Seventy-two (72) of them had acute symptoms, 11 presented with chronic pelvic pain and 19 patients were infertility cases suspected of tubal etiology. Uterine sonographic findings were demonstrated in 72 patients (70.6%). Free fluid in the cul-de-sac was demonstrated in 39 (38.2%) patients. Ovarian enlargement as the only finding was demonstrated in 6 (5.9%) patients, 22 (21.6%) presented with tubular adnexal structure, while in 74 (72.5%) patients it was of a complex nature. Color flow was obtained in all 6 patients presenting with ovarian enlargement, in 12 (54.5%) of those presenting with tubular adnexal structure, and in 56 (75.7%) of those with complex adnexal mass. Ovarian morphology was clearly delineated from adnexal mass in 59 patients (55.9%). The ipsilateral ovarian flow was altered in 50 of them (84.7%). The mean resistance index (RI) in patients with acute symptoms was 0.53 +/- 0.09 (+/-SD). It significantly differed from those obtained in patients with chronic pelvic pain (RI = 0.71 +/- 0.07) and infertility cases (RI = 0.73 +/- 0.09). We concluded that transvaginal color Doppler is useful additional tool in diagnosis and treatment monitoring in patients with PID.

An attempt to screen asymptomatic women for ovarian and endometrial cancer with transvaginal color and pulsed Doppler sonography.

Several screening procedures have been proposed to detect ovarian and endometrial cancer. However, none of them is sensitive and specific enough to be used in population-based screening programs. During our 5 year long study, 5013 asymptomatic women (44% premenopausal and 56% postmenopausal women) were scanned by transvaginal color and pulsed Doppler ultrasonography in an attempt to detect malignancy. These women had 404 adnexal cysts; 70 had resolved spontaneously on follow-up scans and 18 persisted. Another 316 sonographically benign cysts are still in the procedure of follow-up second scans. Of 5013 women, four women had stage I ovarian carcinoma and six had stage I endometrial carcinoma. There was one false-positive case encountered with an endometrioma. Only 14 women were subjected to major operative intervention; others underwent minor procedures based on the benign scan findings. No medical or surgical complications were reported. Transvaginal color Doppler ultrasonography, a noninvasive procedure, can detect ovarian and endometrial carcinoma in asymptomatic women and may be used as a screening procedure for these diseases.

Expression of nm23-h1 gene in squamous-cell carcinoma of the cervix correlates with 5-year survival.

We have examined nm23-H1 protein levels in human squamous cell carcinoma of the cervix by immunohistochemistry and correlated detectable nm23-H1 with patient survival. Normal cervical tissue samples were consistently strongly immunoreactive. In contrast, cervical carcinomas stained poorly, if at all. Well differentiated carcinomas stained more frequently for nm23-H1 protein than poorly or undifferentiated carcinomas. Our results clearly demonstrated a significant correlation between absence of nm23-H1 protein staining and shorter survival of patients with cervical cancer. Our results suggest that nm23 may serve as a potentially valuable prognostic marker for this type of tumor and to our knowledge is the first report of this kind for cervical carcinoma.

Proposal of a modified (FIGO 1985) classification of stages I and II cancer of the uterine cervix.

A modified FIGO (1985) classification of cancer of the uterine cervix has been suggested. The changes refer to stages I and II of the disease. The already accepted system of cervical cancer staging has been used. Stages Ib, IIa, and IIb have been subdivided, similar to stage Ia. The criterion used in staging is the size of the tumor up to, or more than 2 cm (Ib 1 and Ib 2) and, for stage II, the extent of penetration into adjacent tissue. The condition of lymph nodes should be noted by LN(+) or LN(-) along with the stage of the disease. Such staging should demonstrate an objective evaluation of treatment results obtained by different methods and their combinations.