Clinicopathological characteristics of ovarian carcinomas associated with endometriosis.

INTRODUCTION: Substantial histopathology data provide evidence that endometriosis might be viewed as a precursor lesion of endometrioid and clear cell carcinoma of the ovary, via intermediary atypical borderline lesions. Also, genes involved in both endometriosis and epithelial ovarian cancer have been shown to play a role in the pathogenesis of endometriosis-associated ovarian carcinoma. MATERIAL AND METHODS: A retrospective study of 17 cases of ovarian carcinomas associated with endometriosis, diagnosed between 2000 and 2009, at Aretaieion Hospital of University of Athens, is presented. 10/17 cases in this study (58.8%) were clear cell carcinomas (CCC), 6/17 cases (35.3%) were endometrioid adenocarcinomas (EAC) and 1/17 cases (5.9%) was a serous carcinoma associated with ovarian endometriosis. Patients's age was 27-76 years (mean age 58 years). Typical ovarian endometriosis was documented in 8/17 (47%) of the tumors. In 9/17 cases, areas of fibrosis or cystic lesions infiltrated by iron-laden macrophages and endometrial-like stroma, consistent with endometriosis, were observed. CONCLUSION: In comparison with common epithelial ovarian cancers, CCC and EACs of the ovary were presented at earlier stages. Cytoreductive surgical treatment is critical in order to plan appropriate post-operative management.

Comparing transvaginally defined endometrial thickness with hysteroscopic and histopathologic findings in asyptomatic postmenopausal women.

PURPOSE: To assess the diagnostic value of transvaginal sonography (TVS) measurement of the endometrium compared to hysteroscopic findings and histopathologic reports in order to facilitate clinical management in asymptomatic postmenopausal women with thickened endometrium. METHODS: During the period between January 2000 and December 2008, a retrospective analysis was performed including cases of women who were preoperatively diagnosed with a sonographically thickened endometrium, while asymptomatic, and therefore underwent hysteroscopic and fractionated dilatation and curettage (D & C) under general anesthesia at the Second Department of Obstetrics and Gynecology at Aretaieion Hospital in Athens, Greece. In the present study we compare US, hysteroscopic and pathologic findings. RESULTS: The mean age of the patients ranged between 54-74 years (mean age 65.2 +/- 6.8 years). In 108 cases, sonographically measured endometrial thickness ranged between 5 and 10 mm. In 59 cases, endometrial thickness ranged between 11 and 15 mm, whereas in 22 cases, between 16 and 20 mm and finally, in 13 cases endometrial thickness was more than 20 mm. Hysteroscopic examination revealed endometrial polyps in 161 cases, focal hyperplastic lesions in 28 cases, complete hyperplastic lesions in five cases while atrophy was found in five and cancer in three cases, respectively. Pathological results of the samples taken after hysteroscopy are as follows: in 169 cases (83.67%) in women with asymptomatic abnormal endometrial thickness, an endometrial polyp was present. Endometrial thickness in these cases patients was 10.9 +/- 7.5 mm. In patients with focal hyperplasia (22 cases), endometrial thickness was 7.2 +/- 0.5 mm but in patients with complete hyperplasia (5 cases) endometrial thickness was higher (12.3 +/- 5.1 mm). Finally, in three cases with endometrial carcinoma endometrial thickness was 15.5 +/- 7.8 mm. Six cases out of 28 described in our study were diagnosed as focal hyperplasia and two out of five cases as complete hyperplasia, whereas histological reports classified these cases as endometrial polyps. The other histological diagnoses confirmed hysteroscopic findings and thus provided the same results. CONCLUSIONS: We recommend hysteroscopy to follow gynecological TVS when a thickened endometrium is found in asyptomatic postmenopausal women for better diagnostic and, in a later stage, therapeutic efficacy.

Removal of a large bizarre uterine leiomyoma by operative hysteroscopy. Case report and review of the literature.

BACKGROUND: Atypical leiomyomas are relatively uncommon in the general practice of gynaecology. We present a case of a large uterine bizarre leiomyoma removed by operative hysteroscopy and review of the literature. CASE: The patient, a 49-year-old, gravida 3, para 3, perimenopausal Greek woman presented to our Department because of dysmenorrhea and abnormal vaginal bleeding. She underwent hysteroscopy in which a large submucosal leiomyoma was detected and entirely removed in one session. The histopathology revealed bizarre uterine leiomyoma. DISCUSSION: There is no evidence to indicate that hysterectomy is necessary, if the diagnosis of atypical leiomyoma has been firmly established.

Endometrial polyps and their relationship in the pregnancy rates of patients undergoing intrauterine insemination.

PURPOSE: To evaluate the effect of the presence of endometrial polyps (EP) on pregnancy rates and how polypectomy could affect pregnancy rates in women scheduled for intrauterine insemination (IUI). METHODS: The study included patients who had attended the Second Department of Obstetrics and Gynecology of the University of Athens from April 2003 to October 2008 for infertility treatment and were candidates for IUI. In these women the presence of an endometrial polyp had been already diagnosed during the infertility evaluation. The study group consisted of 86 women who, following the diagnosis of endometrial polyp, had agreed to have the polyps removed hysteroscopically prior to the IUI. The control group consisted of 85 women, who despite the fact that the presence of an endometrial polyp had been previously diagnosed and its removal suggested, elected not to have the polyp removed. We used statistical analysis to check what effect the removal of the polyp had on the total number of pregnancies. RESULTS: There was a statistically significant difference in cumulative pregnancy rates between the two groups. The group that underwent polyp removal had higher pregnancy rates as compared to the one that the polyps were left intact. CONCLUSIONS: We propose that hysteroscopic polypectomy of any size appears to improve fertility in women with otherwise unexplained infertility.

Surgical management of invasive carcinoma of the vulva. A retrospective analysis and review.

PURPOSE: A retrospective study aiming to assess the survival rate, recurrence rate and complications of patients with invasive squamous cell carcinoma of the vulva. METHODS: 91 patients with invasive carcinoma of the vulva were included in the study. The following clinical factors were assessed: clinical stage, diameter of lesion, and degree of tumor differentiation. The Kaplan-Meier estimate for statistical analysis of survival was used. RESULTS: Surgery was primary treatment for 76 patients. The 5-year survival for FIGO Stage I was 93.3%, Stage II 85%, Stage III 51% and for Stage IV it was zero as estimated by the Kaplan-Meier test. Of the 52 women who underwent inguinal lymphadenectomy, 11 or 21.1% had positive nodes and four patients underwent pelvic node resection. Patients with tumor size < or = 2 cm had 16.7% positive inguinal nodes, while patients with tumor size > 2.1 cm had 29.4% of positive nodes. CONCLUSIONS: The right choice of surgical treatment after appropriate staging of the disease offers very good survival rates, while a more accurate assessment of the status of inguinal lymph nodes could reduce the extent of surgical treatment.

The slow levonorgestrel-releasing intrauterine system (LNG-IUS) 20 mcg/day: a literature review.

The aim of the study is to present the mechanisms of action, indications, complications, contraindications and the necessary tests before the insertion of a levonorgestrel-releasing intrauterine system (Mirena). After a literature search in Pubmed, a narrative review in the field is presented.

Clinical parameters linked with malignancy in endometrial polyps.

AIM: To investigate the association of different clinical parameters with the histological diagnosis and the prevalence of premalignant and malignant endometrial polyps. METHOD: The study included 516 cases from January 2002 to December 2006. Possible risk factors such as age, menopause status, abnormal bleeding, obesity, hypertension, diabetes mellitus, hormone therapy, use of tamoxifen and size of polyp were investigated in relation to their association with the malignant potential of endometrial polyps. RESULTS: All cases of endometrial polyps underwent hysteroscopic resection; 96.9% of the cases were benign, 1.2% premalignant and 1.9% malignant. Premalignant and malignant endometrial polyps were significantly associated with advanced age (>60 years), menopause, obesity and diabetes. The malignant polyps were analyzed to eight endometrioid, one serous and one clear cell carcinoma. CONCLUSION: The prevalence of premalignant and malignant endometrial polyps is very low. Advanced age, menopause, obesity and diabetes increase the risk of endometrial polyp malignancy.

Paget's disease of the vulva. A ten-year experience.

BACKGROUND: Paget's disease of the vulva is a rare neoplasmatic lesion which mainly affects postmenopausal women. RESULTS: We conducted a retrospective study during the period January 1996 till December 2005 in which 11 cases of Paget's disease were detected. The clinical manifestations, management, specific pathological features, treatment and prognosis of each patient are presented. CONCLUSION: Surgical treatment is the current standard and long-term follow-up is required.

Abortion rates and the role of family planning: a presentation of the Greek reality.

OBJECTIVE: Due to lack of consistent evidence, it is widely believed that Greece holds one of the highest abortion rates in Europe. The aim of this study is to clarify these rates. STUDY DESIGN: The Greek Society of Obstetrics and Gynecology collected data demonstrating that abortion rates seem to be declining which coincides with the rise of the use of more effective methods of contraception. Data were collected both from public and private hospitals, and an attempt was made to correlate the data with the current trends of family planning and birth control. RESULTS: A decline in abortion rates in Greece was found, which may be due to the better organization of counseling programmes in the field. CONCLUSION: The programmes organized by the Greek Family Planning Association under the guidance of the University of Athens has led to a decline in abortion rates in Greece.

Misoprostol use as a method of medical abortion.

AIM: The aim of our study was to verify with the use of ultrasound (US) scanning the effectiveness of misoprostol in medical abortion. MATERIALS AND METHODS: The study population included women with a medical miscarriage attending the 2nd Department of Obstetrics and Gynecology, University of Athens in Aretaieion Hospital, Athens, Greece. All women < 49 days since their last menstruation received 800 microg vaginal misoprostol. The diagnosis of complete abortion was possible by the US measurements as endometrial thickness of 15 mm by transvaginal US was used as a cutoff level for successful abortion. RESULTS: The mean age of the study population was 27 years (ranging from 19 up to 37 years). Complete evacuation with misoprostol was performed in 149 women. The success rate was 85.2% (127/149). Twenty-two women experienced intrauterine echogenic structures with a diameter > 15 mm and all of them underwent surgical evacuation (14.8%). Vaginal bleeding was present in 17 patients after the procedure (11.4%). Less usual reported side-effects included nausea, vomiting, pain, or diarrhea. CONCLUSION: Misoprostol use is an effective, safe and acceptable method of medical abortion for women.

Prolactin levels during labor.

To test the hypothesis that prolactin (PRL) plays a role in the hormonal events of labor, serum PRL levels in 15 normal secundigravidas were measured on 2 occasions 10-15 days before delivery, at the onset of labor, at cervical dilatation of 5 and 10 cm, at the time of delivery, and on the first, second, and fifth days postpartum. The mean level of PRL was 163 ng/ml +/- 26 ng/ml at the onset of cervical dilatation; it typically decreased with the progress of labor, reaching a value of 140 ng/ml +/- 21 ng/ml at the time of delivery. The differences during the various stages of labor, however, were not found to be statistically significant. Postpartum values were significantly lower (P less than 0.01) on the fifth day after parturition. It is therefore unlikely that PRL is involved in or influenced by the hormonal interplay that occurs during labor.

Long term effects of Tibolone on postmenopausal women with uterine myomas.

OBJECTIVES: The aim of the present study is to evaluate the long term effects of Tibolone (Livial) on uterine myomas volume as well as on uterine arteries pulsatility index (PI) in postmenopausal women. METHODS: This study included 66 naturally menopausal women. Twenty of them (group A) had no uterine myomas; 23 of them (group B) had a single, asymptomatic, intramural or subserous myoma of a maximum diameter less or equal than 2 cm; 23 of them (group C) had a single, asymptomatic, intramural or subserous myoma of a maximum diameter between 2 and 5 cm. The volume of the myomas as well as the pulsatility index of the uterine arteries was assessed by transvaginal ultrasonography every 6 months after administration of Tibolone (2.5 mg daily). RESULTS: No statistically significant difference on myomas volume was found after a 3-year period of Tibolone administration. The uterine artery basal PI was significantly higher in group A compared to that of groups B and C. After 6 months of Tibolone administration the PI in group A was significantly lower compared to the basal one whereas in groups B and C was significantly higher compared to the basal value. CONCLUSIONS: Our results suggest that treating postmenopausal woman with Tibolone on a long-term basis: (a) does not increase the volume of uterine myomas and (b) has an early effect on uterine haemodynamics (decrease of PI in women without myomas and increase of PI in women with myomas).

Effect of tibolone on postmenopausal women with myomas.

OBJECTIVE: The aim of this study is to assess the effect of Tibolone (Livial) on uterine fibroids in postmenopausal women. METHODS: This study included 40 naturally postmenopausal women with at least one uterine fibroid measuring > 20 mm. All of theme were scanned by transvaginal ultrasonography. Patients were randomized into two groups. Group A (n = 20) were treated with Tibolone 2.5 mg daily for 1 year and group B (n = 20) did not received therapy. The size of the uterine fibroids was reevaluated on the end of the treatment. RESULTS: No statistically significant difference was found in the mean volume of fibroids before and after treatment with Tibolone. The administration of Tibolone resulted in an increase of fibroid volume in three patients, whereas it remained constant in the majority of the patients (70%) and decreased in three patients. CONCLUSIONS: Our results suggest that treating menopausal symptoms with Tibolone does not affect preexisting asymptomatic uterine fibroids.

Detection of sperm-bound antibodies in the male partners of infertile couples using the immunobead test.

The aim of this investigation was to determine the incidence of sperm-bound antibodies in the male partners of an unselected infertile population using an immunologically specific test (IBT). With this method 34 out of 450 infertile men (7.55%) were positive for one or more of the immunoglobulins IgA, IgG and IgM. For IgG and IgA, the majority of antibody binding was located on the entire sperm with a minor amount bound to the head or tail. For the IgM, the majority of the binding was detected to the tail tip, and tail binding was observed only in a minority of cases.

The role of chlamydial serology in fertile and subfertile men.

The incidence of serum antibodies to Chlamydia trachomatis and the possible association of a positive serology on semen parameters in 120 subfertile men were studied. The findings were compared with those of 120 fertile volunteers fathering two or more children. The two groups were divided into those without and those with a history of genito-urinary infection. There was no significant difference (p greater than 0.1) in the prevalence of antibody testing between the subgroups of fertile population. A statistically significant difference in the incidence of antibodies was found between the two subgroups of subfertile population. No significant difference was noted in the semen parameters between Chlamydia-positive and Chlamydia-negative fertile and subfertile patients.

Pregnancy rates in gonadotrophin stimulated cycles with timed intercourse or intrauterine insemination for the treatment of male subfertility.

OBJECTIVE: To compare the pregnancy rates achieved by intrauterine insemination or timed intercourse in gonadotrophin stimulated cycles in couples whose only detectable abnormality was poor sperm quality. DESIGN: Sixty-two couples with primary or secondary infertility due to male factor entered the study. The 62 couples were randomly equally divided into two groups. Each group began one of the two treatment modalities (controlled ovarian hyperstimulation in conjunction with timed intercourse or intrauterine insemination) for three consecutive cycles and then switched to the alternative treatment after one rest cycle, if pregnancy was not achieved. RESULTS: Five pregnancies (3.9%) were achieved after 128 cycles with timed intercourse and 15 pregnancies (11.5%) after 130 cycles with intrauterine insemination. The difference was found to be statistically significant (P < 0.05). CONCLUSION: We suggest that intrauterine insemination during hMG stimulated cycles improves the pregnancy rates of couples whose only detectable abnormality is poor sperm quality.

Sexually transmitted diseases in women with urethral syndrome.

Frequency of micturition and dysuria were prominent symptoms in 135 (57%) of 237 women with urethral syndrome. Ureaplasma urealyticum, Mycoplasma hominis and Chlamydia trachomatis were the principal organisms associated with the urethral syndrome (38.41%, 28.14% and 11.11%, respectively). Escherichia coli was cultured from four patients and Herepes genitalis and Neisseria gonorrhoea were isolated from five patients. Infections with more than one organism were frequent. Thirty-one of 135 patients were infected by two organisms, 27 by three and 4 patients by four microorganisms. Vaginitis due to Garnerella vaginalis, Candida spp. and Trichomonas vaginalis was discovered in 52 (39%) of 135 patients.

The value of computed tomography in staging cervical carcinoma.

The purpose of our study was to determine the value of computed tomography (CT) in relation to the local extension of cervical carcinoma and the possible spread in the peritoneal and the retroperitoneal space. Sixty-five patients treated for cervical carcinoma during the period 1980-1986 were included in the study. Histologic diagnosis of the disease was done by punch cervical biopsy and diagnostic curettage. The investigation of all patients included intravenous pyelography, barium enema, bone and liver scanning and CT. Our results demonstrate a correlation between CT and pathologic data in 75-78.5% depending on stage. CT may be considered as a dependable method for staging of cervical carcinoma.

A randomized comparison of intrauterine and intraperitoneal insemination in the treatment of infertility.

OBJECTIVE: To compare the pregnancy rates (PRs) between intrauterine insemination (IUI) and intraperitoneal insemination (IPI) in women receiving comparable ovarian stimulation in couples who were infertile for various infertility conditions. METHOD: Fifty-four couples were treated. Of these, 25 were diagnosed as having unexplained infertility, 21 as having male infertility and 8 as having cervical mucus hostility. RESULT: Nine pregnancies occurred with 89 cycles of IUI and 6 pregnancies with 85 cycles of IPI, giving an overall PR of 28%. Twelve of the 15 pregnancies occurred during the first treatment cycle and three during the second treatment cycle. There was no significant difference in the (PRs) between the IUI and IPI (P > 0.25). CONCLUSION: Both procedures combined with superovulation proved to be simple, inexpensive safe and worthwhile for infertile couples with unexplained infertility, male infertility and cervical mucus hostility.

Clinical efficacy of LH-color: a new home ovulation test.

In this study we evaluate the efficacy of a new home ovulation test to identify LH surge (LH-Color, Organon). Fifty-five spontaneously ovulating women were followed during their cycles with twice daily urinary LH testing as well as daily ultrasound and BBT charts. In 39 (70.91%) of the 55 patients, ovulation occurred within 24 h after the decoloration of the LH-Color. Follicular collapse as visualized by ultrasonography, took place in all patients within 36 h after the decoloration of the LH-Color. Thus a good correlation was found between urinary LH surge and ultrasound. We conclude that the rapid LH test was able to predict impending ovulation.