Laparoscopic in-bag morcellation - a comparison of two tissue extraction systems.

OBJECTIVES: Morcellation is an integral part of laparoscopic procedures related to uterine fibroids, which consist of the mechanical fragmentation of the tumor and its extraction outside the abdominal cavity. To avoid the risk of tissue dissemination, special extraction systems have been developed, which allow morcellation of the specimen under visual control and its removal without contact with the abdominal organs. The aim of the paper is to compare the two systems for laparoscopic morcellation. MATERIAL AND METHODS: The study included 33 premenopausal women with symptomatic leiomyomas or adenomyosis, who were qualified for laparoscopic surgery with contained power morcellation. Patients were allocated alternately to a different tissue extraction system's group. According to the study protocol, selected operative parameters were prospectively recorded. Finally, an assessment of bag use was performed. The data was statistically analyzed. RESULTS: There were significant differences between the two tested systems in terms of introducing and positioning the bag, its removal from the peritoneal cavity, as well as optic trocar insertion and establishing the pseudo-peritoneum. CONCLUSIONS: Despite the minor design differences and some ergonomic aspects, both presented systems proved to be safe and feasible tools for laparoscopic contained morcellation. This technique both reduces the risk of tissue dissemination and preserves the advantages of minimal invasiveness.

Uterine myoma with massive lymphocytic infiltration - case report.

INTRODUCTION: Uterine leiomyomas are the most common neoplasm of the uterus in women. Massive lymphocytic infiltration in a myoma is an unusual finding. It is characterised by the varying intensity of lymphocyte infiltration, the presence of scattered plasma cells, eosinophilia, and rarely, other items. We would like to call attention to such a rare lesion. CASE DESCRIPTION: We present the case of a 31-year-old woman who had undergone surgical excision of a uterine tumour. Grossly, it had the typical uterine smooth muscle wall consistency. The microscopic examination revealed leiomyoma with heavy infiltration composed mainly of lymphocytes. On immunohistochemistry, in the lymphocytic infiltrate the T mature (CD3+/CD5+/TdT-) lymphocytes, small and of cytotoxic (CD8+/CD56-) type, prevailed, with moderate proliferative activity (expression of Ki67 found in ca. 30-40% of the cells), whereas B lymphocytes (CD20+/CD5-/TdT-) were innumerous and present in nodular aggregates. Despite a strong suspicion of neoplastic lymphoproliferation, the histopathological diagnosis was: leiomyoma with massive lymphoid infiltration. The cause of this feature is not known, although the gonadotropin-releasing hormone agonist and post-menopausal processes may promote such transformations. In differential diagnosis, malignant lymphoma, inflammatory pseudotumour, and pyomyoma should be included. CONCLUSIONS: Lymphocytic infiltration within the uterine myoma is rare. The recognition of its distinct histological features is important to avoid possible misdiagnosis.

[Endometriosis in adolescents]. / Endometrioza u mlodocianych.

The majority of adult women with endometriosis report that their symptoms started in adolescence. Early diagnosis and optimal treatment prevent disease progression and mitigate long-term morbidities, such as infertility and chronic pelvic pain.