[Acute complete uterine inversion--care report]. / Calkowite wynicowanie macicy w trzecim okresie porodu--opis przypadku klinicznego.

OBJECTIVES: Acute puerperal uterine inversion is a rare but very feared obstetrical complication. It determines an almost immediate shock and serious metrorrhagia. It is a introflexion of parietes uteri which takes place during the third stage of labor or during the first hours of puerperium. It can be distinguished in inversion of I, II or III degree according to the zone concerned by the introflexion: only the fundus of the uterus, all the corpus emerging in the vagina or the entirety of the uterus coming out from the vulvar orifice. RESULTS: This is report a case of inversion of the uterus during third stage of labor in multiparous aged 24 years admitted to Department of Gynecology & Obstetric in Hospital of Slupsk. The uterine III degree inversion was spontaneous during third stage of labor and was immediately diagnosed. Manual manipulation was attempted immediately to reverse the inversion but it was not successful. Because patient fell in cardiovascular shock she was resusciated and the inverted uterus repositioned using Huntington's method under general anaesthesia. After intra-abdominal repositioning of the uterus the placenta was removed manually and intramural injection of oxitocine was done to avoid immediate relapse. Whole obstetrical procedure was carried out within one-half hour after inversion. CONCLUSIONS: Although uncommon, in left unrecognized, uterine inversion will result in severe hemorrhage and shock, leading to maternal death. Manual manipulation should be attempted immediately to reverse the inversion. In the most resistant of inversions, surgical correction might be required. Following inversion of the uterus, further normal pregnancies can be expected.

[Giant fibroma of mesocolon transverse imitating tumor of ovary: a case report]. / Olbrzymi wlókniak krezki okreznicy poprzecznej imitujacy guz jajnika--opis przypadku klinicznego.

OBJECTIVES: The fibroma of mesocolon transverse is a rare lesion occurring primarily in age about 45-55 of years. The rarity of these lesions and the absence of characteristic clinical findings makes diagnosis difficult. STUDY DESIGN: The authors describe a case of fibroma mesocolon transverse in woman aged 75 years which became directed to Department of Gynecology & Obstetric in Hospital of Slupsk on account suspicions of ovarian tumor. RESULTS: Fibroma mesocolon transverse usually present as abdominal distention of long duration, pain, vomiting, less frequently as a palpable abdominal mass. Rarely they cause an acute abdominal surgical crisis clinically resembling appendicitis with peritonitis. Ultrasonography was the diagnostic method of choice. Other diagnostic modalities included intravenous pyelogram, barium enema examination, upper gastrointestinal tract series, CT scan and MRI in selected patients exclude gastrointestinal and genitourinary cysts and tumors. Histologically, several specific types could be distinguished of intra-abdominal lesions: lymphangioma, nonpancreatic pseudocyst, enteric duplication tumor, mesothelial tumor, enteric tumor, torsion of an omental segmental infarction cyst, hydatic omental cyst, omental fibromatosis tumor, ectopic ovarian cyst of the omentum, benign teratoma of the omentum or mesocolon. Treatment of choice of fibroma mesocolon transverse is always surgical (enucleation or resection of fibroma). Morbidity and mortality should be very low because of modern surgical techniques and follow-up procedures.

[The analysis of the coexistence of endometrial carcinoma and uterine myoma]. / Analiza wspólistnienia raka endometrium z miesniakami macicy.

OBJECTIVE: An epidemiologic study of coexistence uterus myoma with endometrial cancer patients is presented. Coexistence of endometrial carcinoma with uterus myoma was evaluated and controlled for age, residence, civil status, education, parity, menarche age, last menstruation age, length of reproductive period, blood group, hypertension, diabetes, body mass index, sterility, histological subtype, grading, staging. DESIGN: From 1984-1998 136 endometrial carcinomas have been evaluated in the Department of Gynecology & Obstetrics in Hospital of Slupsk retrospectively. MATERIAL AND METHODS: Uterus myoma was coexistence with endometrial cancer in 22 cases (16.2%). Of 136 endometrial carcinomas 16 (11.6%) were multiple malignant neoplasms. Of these neoplasms 9 (6.6%) occur together with breast cancer, 3 (2.2%) with ovarian carcinoma, 1 (0.7%) with stomach carcinoma, 1 (0.7%) with rectum carcinoma, 1 (0.7%) with carcinoma in focus of endometriosis and 1 (0.7%) coexists with double neoplasms (bowel and endometriosis carcinoma) During the 14-year period of study 15 patients (11.0%) out of 136 patients diagnosed as having endometrial cancer had double and 1 (0.6%) had triple primary malignant neoplasms. There was not significant difference in age rate (p = 0.16), residence rate (p = 0.72), civil status rate (p = 0.37), education rate (p = 0.53), parity rate (p = 0.49), menarche age rate (p = 0.33), last menstruation age rate (p = 0.12), length of reproductive period rate (p = 0.66), blood group rate (p = 0.19), hypertension rate (p = 0.38), diabetes rate (p = 0.96), overweight status rate (p = 0.76), sterility rate (p = 0.35), histological subtype rate (p = 0.25), grading rate (p = 0.29), staging rate (p = 0.54), second primary malignant neoplasma (p = 0.77) between both patients group (with and without uterus myoma). CONCLUSION: Patients with endometrial cancer should be carefully and regularly followed up by monitoring et every anatomic site, especially the breast, stomach, and colon, in order that the development of a second primary carcinoma can be detected as early as possible, and not be overlooked in examinations. There is not additional risk factors for endometrial carcinoma between patients with and without coexistence uterus myoma. In the observation of patients with myoma in postmenopause, cytological investigation of endometrial aspirates, ultrasound and mammographic screening should be carried out.

[Abrikosov's tumor of the vagina--clinical case report]. / Guz Abrikosova pochwy--opis przypadku klinicznego.

OBJECTIVES: Granular cell myoblastoma (Abricosov's tumor) is an uncommon benign tumor of mesodermal origin of which no more than sixty cases with genital involvement have been reported. Among the genital organs, the labium majus of the vulva are the predilect site. STUDY DESIGN: The authors describe a case of the Abricosov's tumor in woman aged 58 years which became directed to Department of Gynecology & Obstetric in Hospital of Slupsk on account suspicions of vagina tumor. RESULTS: The origin and nature of granular cell myoblastoma have been debated since the original description of a granular cell tumor by Abricosov in 1926. Many cell types have been implicated in its histogenesis, including muscle cells, histiocytes, fibroblasts, neural sheath cells and undifferentiated mesenchymal cells, but the origin of the lesion remains still controversial. It is rarely diagnosed clinically and frequently discovered only as an incidental finding on physical examination. It usually occurs in the tongue, skin, breast, or subcutaneous tissue and very rarely in genital organs. Treatment remains controversial, but most studies suggest surgical or endoscopic resection as the treatment of choice. The prognosis is good but is dependent upon complete removal.

[The coexistence of endometrial cancer with second primary malignant neoplasms]. / Wspólistnienie raka endometrium z drugim pierwotnym nowotworem zlosliwym.

OBJECTIVE: An epidemiologic study of multiple primary malignant neoplasms with endometrial cancer patients is presented. Coexistence of endometrial carcinoma with second primary malignant neoplasms was evaluated and controlled for age, residence, civil status, education, parity, menarche age, last menstruation age, length of reproductive period, blood group, hypertension, diabetes, body mass index, sterility, histological subtype, grading, staging. DESIGN: From 1984-1998 136 endometrial carcinomas have been evaluated in the Department of Gynecology & Obstetrics in Hospital of Slupsk retrospectively. All double and triple neoplasms have been histologically recorded, doubtful cases have been excluded. MATERIAL & METHODS: Of 136 endometrial carcinomas 16 (11.6%) were multiple malignant neoplasms. Of these neoplasms 9 (6.6%) occur together with breast cancer, 3 (2.2%) with ovarian carcinoma, 1 (0.7%) with stomach carcinoma, 1 (0.7%) with rectum carcinoma, 1 (0.7%) with carcinoma in focus of endometriosis and 1 (0.7%) coexists with double neoplasms (bowel and endometriosis carcinoma) During the 14-year period of study, 15 patients (11.0%) out of 136 patients diagnosed as having endometrial cancer had double and 1 (0.6%) had triple primary malignant neoplasms. There was not significant difference in age rate (p = 0.72), residence rate (p = 0.93), civil status rate (p = 0.76), education rate (p = 0.70), parity rate (p = 0.76), menarche age rate (p = 0.46), blood group rate (p = 0.45), hypertension rate (p = 0.94), diabetes rate (p = 1.0), not overweight status rate (BMI < 29) (p = 0.55), sterility rate (p = 0.45), histological subtype rate (p = 0.39), grading rate (p = 0.67), staging rate (p = 0.26) between both patients group (with and without second primary malignant neoplasma). We observed statistically significant difference in body mass index (BMI > 32) rate (p = 0.03), last menstruation age rate (p = 0.04), length of reproductive period rate (p = 0.04) between both patients group (with and without second primary malignant neoplasma). CONCLUSION: Patients with endometrial cancer should be carefully and regularly followed up by monitoring et every anatomic site, especially the breast, stomach, and colon, in order that the development of a second primary carcinoma can be detected as early as possible, and not be overlooked in examinations. Additional risk factors for endometrial carcinoma with multiple malignant neoplasma include: menopause occurring after age fifty-one; obese women with body mass index (BMI) higher than 32; reproductive period longer than 37 years.

[Successful pregnancy after conservative surgery and chemotherapy for dysgerminoma of the ovary: case report]. / Ciaza zakonczona urodzeniem zdrowego noworodka po leczeniu skojarzonym z powodu rozrodczaka jajnika--opis przypadku klinicznego.

OBJECTIVES: Considering the important improvement of surgical techniques and chemotherapy in the last few years, it is possible today, in selected cases of patients previously treated for ovarian cancer, to support their desire for motherhood, thus improving the quality of life for them. The major problem for the Gynecologic Oncologist in treating young women for ovarian tumor is the lack of statistically significant experience world-wide, because of the very few cases in which the reproductive function is preserved, and pregnancy is subsequently possible. STUDY DESIGN: The aim of this study was presentation the successful pregnancy after conservative surgery and chemotherapy for dysgerminoma of the ovary stage Ia. RESULTS: The patient age 23 was admitted to Department of Gynecology & Obstetric in Hospital of Slupsk in 1995 year with diagnosis right ovarian tumor. Right-side adnexectomy was performed initially. Histopathological examination of surgical specimen revelated dysgerminoma ovary stage Ia. Due to the clearly elevated tumor marker levels, indicating an involvement of other germ cell elements, and necrobiosis of tumor, we opted for postoperative chemotherapy instead of radiotherapy. Six cycles of BEP protocol chemotherapy was given. The follow-up included regular monitoring of the tumor markers. In the year 1998 the patient conceived and had a delivery of a normal infant at term. To date, there has been no indication towards tumor recurrence. CONCLUSION: After adequate staging and accurate information is given to the patient, conservative treatment may be safe in some women with early ovarian cancer. In early stage pure ovarian dysgerminoma conservative surgery combined with radiotherapy or chemotherapy showed high complete remission rates and excellent survival rates. For younger patients and those with gestation desires as well as patients with advanced diseases, adjuvant chemotherapy following surgery might be a better choice.

[Prolonged ovarian pregnancy: a case report]. / Przetrwala ciaza jajnikowa--opis przypadku.

OBJECTIVES: Case of advanced ovarian pregnancy are exceptional because ovarian pregnancy itself is very rare. STUDY DESIGN: The authors describe a case of prolonged ovarian pregnancy with retention of the dead fetus for more than a year. Usually ovarian pregnancy finishes in rupture which occurs before the end of the first trimester. It is then difficult to make out the integrity of the organs and in particular of the tube and indeed to recognize them. On the other hand when the mass persists intact with the development of pregnancy in a retort shape, it is easy to see how confusion is possible and arises between it and an intra-uterine pregnancy. In this case, however, the different anatomical forms are clear and an almost definite diagnosis can be made at the time of operation (the three first criteria of Spiegelberg). The diagnosis of ovarian pregnancy is never made before operation. At the very best one can say, when things happen early, that an extra-uterine pregnancy has ruptured, or in certain particular circumstances like in the case we are reporting lithopedian. The presence of ovarian tissue in the wall of the sac, which is the fourth criterion of Siegelberg, is easier to recognize in early accidents than in advanced cases of ovarian pregnancy in which the parenchyma of the ovary is compressed, distended and laminated by the increasing development of the fetus and the adnexae. The absence of the placenta being adherent to other organs than the ovary can then be kept as a worthwhile criterion of ovarian pregnancy.

[Initial estimation effect of body mass on survival of patients with endometrial carcinoma]. / Wstepna ocena wplywu masy ciala na przezycie chorych na raka blony sluzowej macicy.

OBJECTIVES: It has long been known that the risk of some cancers, including endometrial, are associated with obesity. A question that remains is whether over-weight is associated with significant difference in survival rate between patients with different body mass index (BMI). STUDY DESIGN: During the period 1984-1996 121 patients with endometrial carcinoma have been evaluated retrospectively in the Department of Gynecology & Obstetrics in Hospital of Slupsk. RESULTS: The middle age of women with endometrial carcinoma was 60.2 years, the youngest has been 38 years old and the oldest--86 years. In the city lived 74.4% women and in the village 25.6%. The percentage of nulliparas was 11.6%, in women group with 1-2 parity 42.1% and when they had more than 2 parity 46.3%. The middle age of nulliparas was lower than multiparas (59.4 vs 63.6 years). In our material endomeriosis was found in association with endometrial carcinoma in 12 (9.9%) of 121 cases. In two cases of endometriosis carcinoma developed. Of 121 patients with endometrial carcinoma 22.3% had over-weight; 9.9% hypertension; 0.8% diabetes mellitus, 28.1% over-weight and hypertension, 2.5% over-weight and diabetes mellitus, 0.8% hypertension and diabetes mellitus, 7.4% over-weight with hypertension and diabetes mellitus. 28.1% patients hadn't these diseases. There was statistically significant difference in survival rate between patients with BMI (p = 0.02). On the whole, five-year-survival was observed in 73.0% of women. Five-year-survival patients with BMI (25-29) was 86.8%; with BMI (30-34) was 74.1%; with BMI (> 34) was 67.4%. The patients with BMI (20-24) five-year-survival was lowest 67.4% and the same as in patients with highest obesity [BMI (> 34)]. CONCLUSIONS: Endometrial carcinoma patients with BMI (25-29), were found to have better survival rate than patients with other BMI. There wasn't effect of hypertension and diabetes mellitus on of survival rate of patients with endometrial carcinoma (p = 0.25 and p = 0.26). The study was limited by the confinent and bias of a retrospective analysis, but this finding was statistically significant (p = 0.02).

[Coexistence of ovarian epithelial tumor of borderline malignancy with pregnancy: a case report]. / Guz jajnika o granicznej zlosliwosci wspólistniejacy z ciaza--opis przypadku.

OBJECTIVES: Ovarian tumors during pregnancy are a rare event. In most cases the tumors are detected accidentally during routine examination, ultrasound or a caesarean section at term. Histologic subtypes and prognosis do not differ from tumors not associated with pregnancy, it seems however, that there are more lesions of borderline malignancy and of low grade. STUDY DESIGN: The patient age 26 during 16 week of pregnancy was operated in Department of Gynecology & Obstetrics in Hospital of Slupsk. RESULTS: During laparotomy ovarian epithelial tumor of borderline malignancy stage I A has been diagnosed and unilateral cystectomy after meticulous surgical exploration was done. A successful spontaneous delivery occurred subsequently when the patient was in 38 week of pregnancy. The patient is followed for disease status every three month and her health is good. CONCLUSIONS: Serous low malignant potential ovarian tumors during pregnancy have microscopic and clinical features suggesting aggressive behavior, however, these features appear to regress at the termination of pregnancy. Limited resection, after meticulous surgical exploration is adequate therapy for women of reproductive age.

[Omental cyst imitating tumor of ovary: case report]. / Torbiel sieci wiekszej imitujaca guz jajnika--opis przypadku klinicznego.

Omental cyst is a rare lesion occurring primarily during childhood and young adulthood. The rarity of these lesions, with an incidence of only about 1 in 105,000 to 1 in 140,000 hospital admissions, and the absence of characteristic clinical findings makes diagnosis difficult. The authors describe a case of an omental cyst in woman aged 49 years which became directed to Department of Gynecology & Obstetric in Hospital of Slupsk on account suspicions of ovarian tumor. The diagnosis of omental cyst and subserosum uterine myoma was done after ultrasonographic examination. The laparotomy was performed: the excision of omental cyst and uterine fibrome was done. The histological examination confirmed the macroscopic observations. The post-operative period was uneventful.

[The analysis of coexistence of endometrial cancer with other malignant and benign neoplasms with endometriosis]. / Analiza wspólistnienia raka blony sluzowej macicy z innymi nowotworami lagodnymi i zlosliwymi oraz endometrioza.

OBJECTIVE: An epidemiologic study of multiple primary malignant neoplasms i endometrial cancer patients is presented. DESIGN: From 1984-1996 121 endometrial carcinomas have been evaluated in the Department of Gynecology & Obstetrics in Hospital of Slupsk retrospectively. All double and triple neoplasms have been histologically recorded, doubtful cases have been excluded. MATERIAL & METHODS: Of 121 endometrial carcinomas 12 (9.9%) were multiple malignant neoplasms. Of these neoplasms 7 (5.8%) occur together with breast cancer and 5 (4.1%) with other primary malignomas, 11 are double, 1 is triple malignomas. During the 12-year period of study, 23 patients (19.0%) out of 121 patients diagnosed as having endometrial cancer had another primary benign neoplasms. Of these neoplasms 19 (15.7%) occur together with leiomyomas of uterus and 4 (3.3%) with ovarian cysts. The relation of endometriosis to endometrial carcinoma has been subject of only few studies. The investigations have resulted on the association between the conditions. Endomeriosis was found in association with endometrial carcinoma in 12 (9.9%) of 121 cases. In two cases of endometriosis carcinoma developed. CONCLUSION: There is not statistically significant difference in survival rate between group with synchronous primary malignant neoplasms and group with second primary benign neoplasms or group without multiple primary neoplasms (p = 0.07). Patients with endometrial cancer should be carefully and regularly followed up by monitoring at every anatomic site, especially the breast, stomach, and colon, in order that the development of a second primary carcinoma can be detected as early as possible, and not be overlooked in examinations.

[Coexistence of ovarian adenocarcinoma with tubal pregnancy and plano-epithelial cervical cancer of uterus]. / Wspólistnienie raka gruczolowego jajnika z ciaza jajowodowa oraz rakiem plaskonablonkowym szyjki macicy.

OBJECTIVES: Ovarian tumors during pregnancy are rare event. Histologic subtypes and prognosis do not differ from tumors not associated with pregnancy, it seems however, that are more lesions of borderline malignancy and of low grade. An extremely rare of ovary adenocarcinoma coexisting with tubal pregnancy and planoepithelial cervical cancer of uterus has been discussed. STUDY DESIGN: The patient S. D. age 39, was admitted to hospital with a diagnosis of peritonism, shock and general condition-hard. The patient was operated half an hour after admission to hospital. During laparotomy tubal pregnancy coexisting with ovarian carcinoma has been satisfied and total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, appendectomy and staging was done. RESULTS: Histopathological examination of surgical specimen revealed tubal pregnancy coexisting with bilateral focal ovarian adenocarcinoma (stage IC) and planoepithelial praeinvasive cervical cancer of uterus. Six cycles of PC chemotherapy are given. During second look laparotomy complete pathological response (pCR) was observed. The Ca-125 value was less then 35 IU/ml. Now the patient is followed for disease status every three month. Her health and is good. CONCLUSION: On the basis of the follow-up of the patient it seams that the coexistence of ovarian carcinoma with cervical cancer and tubal pregnancy neither accelerate the development of disease or make worse the prognosis.