Primary uterine cervical cancer: correlation of preoperative magnetic resonance imaging and clinical staging (FIGO) with histopathology findings.

The most commonly used staging system for cervical cancer is based on the International Federation of Gynaecology and Obstetrics (FIGO) staging system. Magnetic resonance imaging (MRI) has been accepted as the optimal tool for evaluation of the main prognostic factors and selection of therapeutic strategy. The purpose of this study was to compare the preoperative clinical examination FIGO staging findings with MRI and postoperative pathology report in females with primary cancer of the cervix. The study prospectively included 46 females consecutively hospitalized at the Department of Gynaecology and Obstetrics at the "Sestre milosrdnice" University Hospital Center in Zagreb. Interviews, clinical examination, transvaginal ultrasound and MRI were performed in all patients. In selected patients the surgical procedure was done and the correlation of clinical findings according to FIGO classifications, MRI and histopathological findings was completed. According to FIGO classification, positive clinical findings for stage IIA were found in 26/46 (55.5%) and stage IIB in 20/46 (44.5%)patients. FIGO MR modified classification confirmed stage IIA in 30/46 (66.6%) and stage IIB in 16/46 (33.4%) patients. Surgery (Wertheim radical hysterectomy with bilateral pelvic and selective para-aortic lymphadenectomy) was performed in 33/46 (71%) patients with clinically, MR, cytologically and pathohistologically confirmed findings of cervical cancer: 26 patients with IIA clinically FIGO stage and 7 with IIB stage. MRI examination proved better than clinical examination in staging of cervical carcinoma with 90.9% versus 79.0% accuracy rate. We suggest the application of the following MR protocol in all clinically staged FIGO IIA and IIB patients: T1W, T2WI and postcontrast dynamic T1WI after 3 and 60 seconds and after 5 minutes, performed on 1.5T MR machine.

The possibility of respiratory distress syndrome prevention of premature born children.

Pregnant women and premature born children were classified into four groups. In each group there were thirty of them. The first group included the pregnant women with premature rupture of membranes and amniotic fluid effluxed for 72 hours before the delivery. The second group included the pregnant women with amniotic fluid effluxing less then 72 hours before the delivery. The third group included the pregnant women who were given corticosteroids. The forth group was a control group formed by those pregnant women (and their premature born children) whose amniotic fluid did not efflux long and those who weren't given corticosteroids during pregnancy. In all groups of pregnant women we observed: median age of pregnant women, the duration of pregnancy and mode of delivery (vaginal or cesarean section). In groups of premature born children we also observed: newborn birth weight, Apgar score in the first minute after delivery, Apgar score in the fifth minute after delivery, pH of the blood of umbilical cord, L/S ratio of amniotic fluid (lecithin-sphingomyelin ratio), RDS (neonatologist valuation in any degree of RDS developed et newborn child). Symptoms of RDS include tachypnoea, chest wall retraction and cyanosis and a zground glass' appearance of the chest on X-ray. Histopatological examinations of placentas compared the frequency of inflammatory or noninflammatory changes, also in all groups. No significant difference was found among groups of pregnant women for the following factors: the age of pregnant women, the duration of pregnancy and mode of delivery. No significant difference was found among the groups of children for the following factors: newborn birth weight, Apgar score in the fifth minute after delivery, blood pH of umbilical cord, L/S ratio of amniotic fluid. Significant difference was found among groups for the following factors: Apgar score in the first minute after delivery, the frequency of RDS and hystology of placentas. The prevention of premature delivery is the most important. All the pregnant women with symptoms of the premature delivery must be transported to the centers with the well developed unites of intensive neonatal care ("transport in utero").

Cytologic follow-up in patients with CIN treated by LLETZ, Cold knife Conization and Semm's cold coagulation.

Management of cervical premalignant lesions starts with abnormal Pap smear. Regular screening of asymptomatic women (the Pap smear) allows us to diagnose and treat preinvasive lesions before they progress to cervical cancer. There is a wide variety of ablative and destructive methods used in treatment of cervical premalignant lesions. In this study we have compared follow-up cytology results in patient groups treated by LLETZ (Large Loop Excision of the Transformation Zone), Cold Knife Conization (CKC) and Semm's cold coagulation (Electrocoagulation, ECG) according to CIN on target biopsy specimen, and definite therapeutic approach according to patient age, parity and lesion grading. The aim was to evaluate therapeutic success in all three patient groups on the basis of control cytology findings. Normal cytology findings after treatment were recorded in 43 women in LLETZ group (88%), 22 women in CKC group (73%) and in 22 women from the Semm's cold coagulation group (73%). The importance of the use of diagnostic and therapeutic guidelines and regular follow up is emphasized, bearing in mind primarily the young female population with severe preinvasive lesions of uterine cervix. Treating cervical preinvasive lesions offers an excellent opportunity to prevent the occurrence of cervical cancer in the large majority of women with abnormal cervical smears.

Diagnostic approach for precancerous and early invasive cancerous lesions of the uterine cervix.

Invasive cervical cancer is second most common female cancer worldwide with about 493,000 new cases per year. About 273,000 women die from cervical cancer each year, 85% of which take place in developing countries. Cervical cancer has a slow progress, from pre-invasive cervical intraepithelial neoplasia (CIN) to invasive phases, meaning that the disease can be diagnosed while in the phase of pre-invasive lesion, and treated successfully thanks to the regular screening of asymptomatic women (the Pap smear). The authors review new possibilities of early detection of cervical cancer with emphasis on colposcopy. The role of colposcopy is discussed among possibilities of early diagnosis. The authors discuss additional diagnostic procedures for preinvasive lesions of the uterine cervix like DNA cytometry, (flow cytometry). This method can point to dysplasia which can progress to severe stages, such as HSIL (High grade Squamous Intraepithelial Lesion). If the level of chromosomal disturbance is higher (aneuploidy), it is more probable that HSIL will develop. Laser screening of cells extracted with modern cytologic screening LBC (Liquid Base Cytology) enables us to automatically measure ploidy (chromosome regularity, or irregularity) and PCR provides analysis of HPV types. These methods are recommended for a routine check-up of borderline cervical lesions in order to anticipate ones likely to regress or progress.

Undetectable Serum Levels of Anti-Müllerian Hormone in Women with Ovarian Hyperstimulation Syndrome During In Vitro Fertilization and Successful Pregnancy Outcome: Case Report.

We report a unique case of undetectable serum levels of anti-müllerian hormone (AMH) in women with polycystic ovary syndrome (PCOS) who developed ovarian hyperstimulation syndrome (OHSS) during in vitro fertilization (IVF). A case is described of a 28-year-old woman with clinical symptoms of PCOS and AMH serum level below analytical sensitivity (<1.0 pmol/L). After undergoing controlled ovarian stimulation, the patient developed OHSS. After follicle aspiration, seven oocytes were recovered. Three of them were used for intracytoplasmic sperm injection (ICSI) and fertilized, but with unsuccessful pregnancy outcome. A successful pregnancy was achieved in the second IVF/ICSI cycle with six oocytes retrieved and three embryos transferred. At 39 weeks of gestation, the patient delivered a healthy baby weighing 3930 g and 50 cm long. In conclusion, although AMH is considered a useful tool in ovarian reserve assessment and in predicting response to controlled ovarian hyperstimulation, the case presented shows that AMH should not be used as an independent ovarian marker.

Coexistence of ruptured ectopic tubal pregnancy, dermoid and endometriotic cyst with tubo-ovarian abscess in the same adnexa: case report.

A 32-year-old pregnant woman presented to the hospital with abdominal pain and minimal vaginal bleeding. Transvaginal ultrasound revealed visible fluid in pelvic region with suspected tubal rupture, and subsequently laparoscopy was performed. During laparoscopy, additional gynecologic pathologies were noticed. Histopathologic finding showed dermoid and endometriotic cyst, as well as tubo-ovarian abscess in the same adnexa. This case report highlights the necessity of considering multiple diagnoses in the same organic system, which may be encountered by surgeon and histopathologist.

Abdominal wall endometriosis: case report.

Abdominal wall endometriosis, also known as scar endometrioma, is a rare condition, in most cases occurring after previous cesarean section or pelvic surgery. The incidence of scar endometrioma is estimated to 0.03%-1.5% of all women with previous cesarean delivery. The predominant clinical picture is cyclic pain. Due to a wide range of mimicking conditions and a relative rarity, a significant delay is often observed from the onset of symptoms to proper treatment. We report on a case of a 36-year-old patient with scar endometrioma after two previous cesarean deliveries. The possible diagnostic pitfalls and treatment options are discussed.