Hysteroscopic diagnosis of uterine sarcomas at the Department of Gynaecology, Sant Joan de Déu University Hospital.

Uterine sarcomas are rare and the clinical diagnosis of sarcoma is difficult. Diagnostic and surgical hysteroscopy is a minimally invasive outpatient procedure that makes an accurate diagnosis of malignant intrauterine pathology and could play a role in the diagnosis of the uterine sarcomas. Uterine sarcomas diagnosed at the Department of Gynecology of Sant Joan University Hospital by hysteroscopy between January 2004 and August 2010 are described. In this period 2,441 hysteroscopies were performed; a total of 67 adenocarcinomas of the endometrium and five sarcomas were diagnosed by hysteroscopy. The data are presented with a review of the literature, focusing on the diagnostic value of hysteroscopy in these tumors.

Granulosa cell tumor and endometrial cancer: a case report and review of the literature.

Granulosa cell tumors (GCTs) of the ovary are an uncommon type of ovarian cancer, representing only 2-5%. Frequently, their tumoral cells present some features of normal granulosa cells, like hormonal production. As a consequence, this neoplasia can be diagnosed either by common ovarian cancer symptoms or endometrial pathologies due to an estrogenic effect. Symptoms caused by estrogen production can also give rise to different clinical manifestations depending on whether they appear in postmenopausal or young women. In the case we present below, a patient was referred for presenting postmenopausal bleeding of one year's duration. Once endometrial cancer was diagnosed and subsequently staged, an ovarian mass was detected. We report an atypical case of ovarian cancer with the aim of reviewing the clinical features of GCT, as well as its prognosis, treatment and follow-up recommendations, according to the available literature.

Hysteroscopic diagnosis of a high-grade endometrial sarcoma in a 41-year-old woman.

Endometrial stromal sarcomas originate in the endometrial cavity. These tumors represent between 15-27.9% of uterine sarcomas. We present the case of a 41-year-old woman who underwent surgical hysteroscopy for metrorrhagia over a period of one month who had an intrauterine polypoid mass detected by ultrasonography. Histologic analysis of the polypoid mass removed by hysteroscopy was a high-grade endometrial stromal sarcoma of the uterus. The description of this case provides an opportunity to review the literature on uterine sarcomas diagnosed by surgical hysteroscopy.

Predictive factors for the detection of CIN II-III in the follow-up of women with CIN I.

PURPOSE OF INVESTIGATION: To determine which factors may increase the risk that women diagnosed with CIN I may later develop CIN II-III. METHODS: A prospective study of 174 women with a grade 1 intraepithelial lesion (CIN I) confirmed by biopsy, with a follow-up time of at least one year. The following factors were studied: age, HPV infection, HPV infection by a high-risk genotype, the HPV genotypes involved, coinfection by several HPV genotypes and duration of follow-up. These factors were correlated with later detection of CIN II-III by biopsy during follow-up. Statistical analysis was performed using SPSS. RESULTS: CIN II-III was detected at the follow-up in 24 of 174 women included in the study (13.7%), in four cases by colposcopically directed biopsy and in 20 by LLETZ. Correlation of the factors studied with the incidence of CIN II-III in this group showed that the only statistically significant factors were overall HPV infection and HPV infection by genotypes 31 and 70 (Chi-square and Fisher's test, p < 0.05, respectively), while the duration of follow-up came close to statistical significance (Student's test, p = 0.052). CONCLUSION: HPV infection and duration of follow-up are predictive factors for the detection of CIN II-III in follow-up care for women with CIN I.

Factors modulating circulation of hematopoietic progenitor cells in cord blood and neonates.

BACKGROUND: Hematopoietic progenitor cells (HPC) circulate at high levels at birth and disappear rapidly afterwards, but the underlying mechanism it is not known. The aim of this study was to assess circulating HPC in cord blood at different gestational ages and shortly after birth and concomitantly study the biologic markers involved in this phenomenon. METHODS: All samples were analyzed for CD34(+) cells, colony-forming units (CFU) and cytokines. RESULTS: The results obtained confirmed a slight decrease in HPC concentration during the late stage of fetal life (R(2)=0.41). After birth, CD34(+) cells showed a rapid decline from circulation: 25+/-29% at 3 h, 51+/-42% at 12 h and 80+/-48% at 60 h. CFU cleared following a similar pattern. Cord plasma showed higher concentrations of stem cell factor (SCF), fetal liver tyrosine kinase 3-ligand (FLT3l), erythrpoietin (EPO), granulocyte colony-stimulating factor (G-CSF) and interleukin-11 (IL-11) compared with an adult control. Interestingly, the EPO concentration in newborn plasma correlated with the kinetics of HPC decline after birth. Moreover, we observed an up-regulation of l-selectin and a down-regulation of CXCR4 expression in CD34(+) cells 3 h after birth. DISCUSSION: These data combined suggest that an active homing process results in the clearance of HPC from the circulation immediately after birth.

Villoglandular papillary adenocarcinoma of the uterine cervix: a case report and literature review.

Villoglandular papillary adenocarcinoma is an infrequent form of well differentiated cervical papillary adenocarcinoma that has recently been described. It usually affects young women and is distinguished from other adenocarcinomas by its generally good prognosis, since it infrequently invades the lymphovascular space. We present a case of villoglandular papillary adenocarcinoma in a 28-year-old woman presenting risk factors for developing it: use of oral contraceptives, tobacco use, and infection with human papillomavirus types 16 and 33. The presentation of this case provides an opportunity to review the literature on the diagnosis and treatment of villoglandular papillary adenocarcinoma, and the factors that may influence the prognosis of women diagnosed with this histological type of cervical cancer.

Comparison of conization and limited excision of the transformation zone (LETZ) in the treatment of squamous intraepithelial lesions (SIL) of the uterine cervix.

OBJECTIVE: To compare the treatment of squamous intraepithelial lesions of the uterine cervix using conization with limited excision of the transformation zone (LETZ). MATERIAL AND METHODS: A retrospective study of 285 women who received surgical treatment for cervical SIL between 2003 and 2006 was carried out. Prior to treatment, all the women underwent cervicovaginal cytology, colposcopy, and HPV testing. The women whose histology showed the presence of high-grade SIL were then divided into two groups for purposes of comparison: those treated by conization, and those treated by LETZ. RESULTS: In group 1 (treatment by conization), 92 women met the selection criteria, and in group 2 (treatment by LETZ) 33 women met the selection criteria. Histology results showed high-grade SIL involvement of the-cone biopsy surgical margins for 22 cases (23.9%) in group 1, and high-grade SIL involvement of the LETZ surgical margins for six cases (18.1%) in group 2. In 13 of the women in group 2, the indication for LETZ was persistent low-grade SIL. DISCUSSION: The percentage of surgical margins involved was similar in the two groups in our study, and comparable to that reported in the literature (16.2 to 26.6%). Our study, like other published studies, thus supports the possibility in certain cases of treating high-grade cervical SIL conservatively with LETZ or minicones. In the 13 women with a diagnosis of persistent low-grade SIL, 11 of whom (84.6%) were infected with a high-risk HPV genotype, LETZ made a diagnosis of occult high-grade SIL. CONCLUSION: LETZ may be an alternative to conization in young women, and it is advisable in cases of persistent low-grade SIL with high-risk HPV infection.

Prognostic factors for the development of vaginal intraepithelial neoplasia.

OBJECTIVE: To identify risk factors for the appearance of vaginal intraepithelial neoplasia (VAIN). MATERIAL AND METHODS: A total of 485 women with abnormal cytologies were followed over three years (2003-2006). They underwent cytolology and colposcopy, and testing for human papillomavirus virus (HPV) infection. If the colposcopy was atypical, a biopsy was performed. RESULTS: A total of 256 women were treated: 161 by cone biopsy, 103 by LLETZ, 12 by repeat conization, and 44 by total hysterectomy. In eight cases VAIN was diagnosed following hysterectomy. The average age at which VAIN appeared was 49.8 years (age range 39-61). Hysterectomy was indicated in two cases of cervical cancer, four cases of persistent high-grade cervical SIL, and two cases of recurrent high-grade cervical SIL. The mean time for the appearance of VAIN following hysterectomy was 3.8 years (range 1-9 years). Of these eight women, seven had HPV infections at high risk for carcinogenesis. CONCLUSIONS: Long-term follow-up cytology is necessary for women treated for high-grade SIL, even after hysterectomy, because of the increased risk of a primary vaginal VAIN lesion, especially in women with high-risk HPV infection.

Stage 1B cervical cancer in a pregnant woman at 25 weeks of gestation.

Cervical cancer associated with pregnancy is rare (0.05%), although it is the most frequently diagnosed malignancy in pregnant women. We present the case of a 28-year-old woman at 25 weeks of gestation diagnosed with Stage 1B cervical cancer. Treatment was delayed until fetal maturity, and an elective cesarean section was performed at 33 weeks' gestation, followed by a total hysterectomy preserving the ovaries, and a pelvic lymphadenectomy. A review of the literature on the treatment of cervical cancer during pregnancy relevant to the case described is also presented.

Cancer of the vulva in a 25-year-old woman with VIN III and high-grade cervical SIL--case report.

Human papillomavirus (HPV) infection is associated with an increase in intraepithelial lesions of the genital tract which are often multicentric. Following is a presentation of a case of vulvar cancer in a young woman (25 years of age) with multiple vulvar intraepithelial neoplasia (VIN III) lesions, a high-grade squamous intraepithelial cervical lesion, and a HPV type 16 infection at high risk of oncogenic transformation. This case offers an opportunity to discuss the risk factors that may favor the appearance of these lesions in young women, and their clinical management, diagnosis, and treatment.

Cervical cancer and low-risk HPV; a case report.

A case of cervical cancer in a 32-year-old woman with a genotype 6 HPV genital infection that developed from a cervical low-grade SIL after a LLETZ procedure two years before is presented. This case obliges us to reconsider both the benign nature of low-grade lesions and the potentially good prognosis of low-risk HPV infection.

Prevalence of human papilloma virus infection of the uterine cervix in women with abnormal cervical cytology.

PURPOSE OF INVESTIGATION: To determine the prevalence of human papillomavirus (HPV) using polymerase chain reaction (PCR) in women with abnormal cytology results. METHODS: A prospective study of 215 women with abnormal cytology results referred consecutively to the cervical pathology clinic was carried out. A second cervical cytology using the Bethesda System was performed on all the patients to confirm the initial diagnosis, as well as to test for the presence of HPV by PCR and a colposcopy and punch biopsy in cases presenting with an abnormal pattern on colposcopy. The sensivitiy, specificity, and positive and negative predictive value (PPV and NPV) were calculated using 2 x 2 tables. RESULTS: The women aged 35 years or younger presented a higher percentage of HPV infection (85.6%) than the women over 35 years of age (54%). The highest percentage of women with a positive result for HPV was found in those with a cytological high-grade squamous intraepithelial lesion (HSIL) (85.5%), as compared with 47.4% of the women with a cytological low-grade squamous intraepithelial lesion (LSIL). HPV infection has a high negative predictive value (93.2% of cases) and a high sensitivity (93.5%) for the detection of HSIL by biopsy, although the specificity and positive predictive value were low, 51.5% and 52.1%, respectively. CONCLUSION: Patients with cytological HSIL have a high prevalence of HPV infection.

Uterine adenosarcoma diagnosed following hysteroscopic resection of an intrauterine tumour.

Uterine adenosarcoma is a mixed müllerian tumour consisting of a benign epithelial component and a malignant stromal component. It is a rare tumour that represents 8% of uterine sarcomas. We present a case of a 61-year-old woman who underwent a surgical hysteroscopy for postmenopausal metrorrhagia and thickened endometrium detected by ultrasonography. The pathologic diagnosis of the tumour removed by hysteroscopy was uterine adenosarcoma. The description of this case provides an opportunity to review the literature on uterine sarcomas diagnosed by surgical hysteroscopy.

Long-term ovarian function evaluation after autografting by implantation with fresh and frozen-thawed human ovarian tissue.

The transplantation of ovarian tissue has recently been the focus of intense investigation with the aim of avoiding premature ovarian failure mainly in patients receiving chemotherapy or radiotherapy for malignant disease. Here, we present an evaluation of the long-term function of both fresh (patients 1, 2, and 3) and cryopreserved (patient 4) ovarian autografts in four premenopausal patients aged 46-49 yr who underwent heterotopic ovarian transplantation and were followed over a 1-yr period without receiving gonadotropins to stimulate follicular growth. In patients 1 and 2, approximately 1 cm(3) ovarian cortical autograft was placed sc in the inner aspect of the arm, whereas and in patients 3 and 4 minced ovarian tissue was placed into a muscle pocket in the abdominal wall. In patients 1, 2, and 4 the ovarian hormone secretion (as suggested by sequential estradiol and FSH serum measurements) was reestablished 3-4 months after autotransplantation, and graft function was not improved by immediate rather than delayed heterotopic ovarian autografting. Despite a reestablished ovarian function, a 2- to 7-fold increase in peripheral FSH concentration was evidenced. The cases reported here suggest that hormonal protection can be restored after fresh or cryopreserved heterotopic ovarian transplantation in women, albeit for only a short reproductive span.

Heterotopic ovarian transplantation without vascular pedicle in syngeneic Lewis rats: six-month control of estradiol and follicle-stimulating hormone concentrations after intraperitoneal and subcutaneous implants.

OBJECTIVE: To assess the recovery, maintenance, and quality of ovarian function by comparing the success of autotransplantation in intraperitoneal (IP) and SC locations over a 6-month period in syngeneic Lewis rats. DESIGN: Experimental animal study. SETTING: Unit of Experimental Research at the Barcelona University School of Medicine. ANIMAL(S): Female syngeneic Lewis rats. INTERVENTION(S): The animals were randomized to one of three groups: group A, control group with ovariectomy (n = 15); group B, ovariectomy and IP autologous heterotopic transplant of ovarian tissue without vascular pedicle (n = 14); and group C, ovariectomy and SC autologous heterotopic transplant (n = 15). MAIN OUTCOME MEASURE(S): Serum levels of FSH and 17beta-E2 and vaginal cytology. RESULT(S): In groups B and C, E2 serum concentrations from day 7 and day 10 onward remained comparable to basal levels, and significantly higher than in group A, throughout the 6-month period. In group B from day 7 after surgery onward, and in group C from day 10 after surgery onward, FSH concentrations remained low (comparable to basal levels) throughout the follow-up period. Vaginal cytology of groups B and C showed trophic maturation between days 4 and 10 after ovariectomy and insertion of the ovarian tissue implant, whereas the control group remained atrophic. There were no statistically significant differences between IP and SC implants. CONCLUSION(S): A heterotopic autotransplant of ovarian tissue without vascular pedicle in syngeneic Lewis rats is successful for > or =6 months.

Total LDH and its isoenzymes in gynecological malignancies and other gynecological conditions.

Total LDH and its five Isoenzymes have been evaluated in 354 patients from a Gynecological Ward. These patients had uterine fibroids, benign ovarian tumors, tubo-ovarian abscesses (T.O.A.), endometrial cancers, cancers of the cervix and ovarian cancers. 90 patients had no gynecological disease and served as controls. A statistical analysis was performed comparing each group of patients with the control group. A significant elevation in total LDH and Iso-IV and a significant decrease in Iso-I was observed in patients with uterine fibroids. Patients with benign ovarian tumors had a significant elevation of total LDH. Patients with T.O.A., Endometrial cancer, cancer of the cervix and cancer of the ovary had a significant elevations of total LDH and Iso-V and a significant decrease in Iso-I. When the group of patients with endometrial cancer, cancer of the cervix and cancer of the ovary were compared with each other, no differences could be found in total LDH and Isoenzyme values. We conclude that total LDH and Isoenzyme serum levels are not useful clinical indicators for the diagnosis and management of gynecological malignancies and particularly of ovarian cancer.

Intraarterial infusion chemotherapy as a primary treatment in cancer of uterine cervix limited to the pelvis.

Percutaneous intraarterial infusion chemotherapy via the internal iliac arteries was performed as a primary treatment in 14 patients with invasive cancer of the uterine cervix. The drugs used were Mitomycin-C, Bleomycin and Cis-Platinum in cycles of 52 hours which were repeated, in some cases, 21 days apart. Complete responses were observed in two patients. Partial responses were seen in 10 patients and no response in two patients. 5 patients were treated surgically and 8 patients received radiotherapy after the infusion. The effect of chemotherapy was more evident in exophytic tumors with less effect on the parametria. Tumor masses can be reduced and patients can then be treated by surgery or radiotherapy. 6 patients died from sepsis.

Myometrial hypertrophy and uterine metropathy without apparent organic cause: rate or responsibility.

Between 1971 and 1980 more than 6,000,000 hysterectomies were performed in the USA. Dysfunctional uterine hemorrhage with non tumoral uterus and hypertrophic characteristic has been one of the principal indications, without possibility of definition as a pathological entity with its own characteristics. With all these premises the Authors have attempted to see, by means of morphometric studies, the myocyte characteristics and the proportion and composition of the uterine wall and at the same time eventual hormone-dependence of this phenomenon. For this they turn to to determination of oestrogen and progesterone receptors.