Risk factors to develop multicentric lesions of the lower genital tract.

Purpose ofinvestigation: To analyze which are the risk factors in developing multicentric lesions of lower genital tract. MATERIALS AND METHODS: A prospective study of 1,011 patients was conducted at the low genital tract pathology clinic of Sant Joan de Deu Hospital between 2003-2011. A complete assessment of cervix, vagina, and vulva was carried out including HPV-DNA testing, cytology study, colposcopy, and biopsy in case of atypical findings. The statistical analysis was done with SPSS v.19 software. Differences between groups were considered statistically significant atp < 0.05. RESULTS: Twenty-two patients presented multicentric lesions (2.2%). The average age was 43 years. Most of the lesions were bicentric affecting cervix and vagina and cervix and vulva. Only in two cases (9%) there were three sites of genital neoplasia. The authors found four cervical cancer, 17 high grade, and one low grade lesions of the cervix. Eighteen vaginal intraepithelial neoplasia (VAIN), six high grade, 14 low grade, and four vulvar intraepithelial neoplasia (VIN) were found. HPV infection, age > 35 years, multiparity, contraceptive method, immunodeficiency, and level of studies were significantly correlated with multicentric lesions. High percentage of affected margins were found. VIN cases were treated with surgical excision and in two cases microinvasion was found. VAIN III cases were treated with surgical excision or with laser and one case progressed to vaginal cancer. Recurrence after treatment was 27%. CONCLUSION: Age, multiparity, contraceptive method, immunodeficiency, and level of studies were significantly correlated with multicentric lesion. Multicentric lesions had an increased risk of recurrence and progression to cancer.

Ovarian mature teratoma: a ten year experience in our institution.

PURPOSE OF INVESTIGATION: To describe the surgical management and diagnoses of mature ovarian teratomas and ovarian strumas in the present centre. MATERIALS AND METHODS: Descriptive retrospective analysis of cases of mature ovarian teratoma at the present university-associated hospital over ten years. RESULTS: The mean age was 29 years and in 17 patients the diagnosis was made during other surgery. When surgery was planned, the approach was 80.2% laparoscopic and 16.1% laparotomic. In the laparoscopy group more cases had been diagnosed previously as dermoid cyst by ultrasound and fewer days of hospital admission. In the laparotomy group the authors found higher ultrasound size and the size in the gross pathology description. With regards to treatment, 45.3% of cases underwent ovariectomy and 49.3% a cystectomy. Comparing these two groups, the authors found larger pelvic mass size in the group of ovariectomies. Healthy ovarian tissue in the removed specimen was found more frequently in the ovariectomies group (29.1%) but also in some cystectomies (7.5%). CONCLUSIONS: The surgical treatment of the ovarian mature teratoma in the present center was directed on the basis of ultrasound diagnosis, ultrasound tumor size, and the existence of associated gynecologic pathology. The authors strongly recommend a laparoscopic approach and a cystectomy in order to preserve fertility especially in young women.

Relationship between smoking, HPV infection, and risk of Cervical cancer.

PURPOSE OF INVESTIGATION: To document the relationship between smoking and HPV infection, and the risk of developing preinvasive lesions and cervical carcinoma. MATERIALS AND METHODS: Prospective, cross-sectional descriptive study. A total of 1,007 patients were recruited among women seen at the cervical pathology clinic of Sant Joan de Déu University Hospital in Barcelona (Spain) between January 2003 and March 2011. Patients were asked specifically about their smoking habits. Statistical analyses were done with SPSS v.19 software. Differences between groups were considered statistically significant at p < 0.05. RESULTS: In patients studied, 48.7% were smokers. The average number of cigarettes per day among smoking patients was 7.07 (1-40). In the of patients with HPV infection, 53% were smokers versus 37% of patients without HPV infection (p < 0.05). The average number of cigarettes per day among patients with HPV infection was 7.64 cigarettes/day versus 5.55 cigarettes/day among patients without HPV infection (p < 0.05). In the patients with high-risk HPV genotypes infection, 54.5% were smokers versus 43.2% of patients without high-risk HPV infection (p < 0.05). Risk of HPV infection increases 1.905 times among smoking patients versus no smoking patients (OR = 1.905, CI 95% (1.426-2.545), p < 0.05). Among patients with changes associated to HPV and atypical cells, there were 29.2% and 14.4% of smokers, respectively, versus 45.5%, 55.6%, and 48.6% of smokers among patients with grade 1 cervical intraepithelial neoplasia (CIN 1), CIN 2-3, and carcinoma, respectively (p < 0.05). Risk of CIN 2-3 or cervical carcinoma cervical increases 1.642 times among smoking patients versus no smoking ones (OR = 1.642, CI 95% (1.325-1.884), p < 0.05). CONCLUSIONS: Smoking interferes in the increase of HPV infection prevalence and in an increased risk of CIN and cervical carcinoma. Risk also increases with more cigars smoked per day.

Utilidad de la resonancia magnética en la estadificación prequirúrgica del cáncer de endometrio / Utility of magnetic resonance imaging in the preoperative staging of endometrial cancer

Objetivo: Analizar la utilidad de la resonancia magnética nuclear (RMN) en la estadificación prequirúrgica del cáncer de endometrio. Material y métodos Estudio retrospectivo de 71 casos de neoplasia endometrial diagnosticados en el Hospital Sant Joan de Déu. Comparación de la RMN prequirúrgica y el estudio anatomopatológico definitivo (AP). Resultados Existe la misma estadificación en la RMN y la AP en un 69% de los casos. Al valorar de forma independiente en la estadificación final el grado de afectación miometrial, ganglionar, cervical, de parametrios y la presencia de metástasis, el porcentaje de casos coincidentes se eleva. Conclusión La RMN es el método diagnóstico de elección para la estadificación prequirúrgica del cáncer de endometrio

Objective: To evaluate the usefulness of magnetic resonance imaging (MRI) for preoperative staging of endometrial carcinoma. Materials and methods: We performed a retrospective study of 71 endometrial neoplasms diagnosed in Hospital Sant Joan de Déu. The results of preoperative MRI scans were compared with those of the definitive histological examination. Results: The preoperative stage obtained by MRI and the final stage were concordant in 69% ofcases. Conclusion: MRI is the most useful diagnostic method for preoperative staging of endometrial carcinoma

Relationship of human papilloma virus multiple genotype infection with patient's age and type of cervical lesion.

PURPOSE OF INVESTIGATION: To document the prevalence of infection by multiple genotypes of the human papilloma virus (HPV) in patients with cervical pathology in a study population, and to determine the relationship between multiple genotype infection, age of the patient, and the type of cervical pathology. MATERIALS AND METHODS: Prospective, cross-sectional descriptive study. A total of 1,007 patients were recruited among women seen at the cervical pathology clinic of Sant Joan de Déu University Hospital in Barcelona (Spain) between January 2003 and March 2011. Statistical analyses were done with SPSS v.19 software. Differences between groups were considered statistically significant atp < 0.05. RESULTS: There was 28.3% of the women (286 cases) that were infected by multiple HPV genotypes. The mean number of genotypes identified was 2.52 (range 2 to 8). Mean age of the patients with multiple genotype infection was 32.31 years, and mean age of the patients with single genotype infection was 37.27 years (p < 0.001). The prevalence of infection by multiple HPV genotypes was 28% in patients with cervical intraepithelial neoplasia grade 1 (CIN 1) and 33% in patients with grade CIN 2-3 lesions, and both prevalence rates were significantly higher than in patients with carcinoma (20%) (p = 0.03). CONCLUSIONS: In the present study population the authors found no evidence of higher prevalence of multiple HPV genotype infection in women with carcinoma. Age of women with multiple infection was lower than those with single infection.

Mesonephric carcinosarcoma of the uterine cervix: a case report.

Cervical carcinosarcomas are rare neoplasms that aggressively progress and belong to the histological group of mixed tumors with both epithelial and mesenchymal components (malignant mixed Müllerian tumors). At diagnosis, most patients present with vaginal bleeding and a palpable cervical mass. Given the rarity of this neoplasm, there is no consensus regarding the management of these patients and should be approached on a case-by-case basis, taking into consideration the clinical and pathological features of the tumor. The authors describe a woman with mesonephric cervical carcinosarcoma and review the literature regarding these rare tumors to better understand the natural history of these neoplasms.

Prevalence of infection by different genotypes of human papillomavirus in women with cervical pathology.

OBJECTIVE: To document the prevalence of different human papillomavirus (HPV) genotypes in our population, and the relationships between different genotypes with age and type of cervical pathology. MATERIAL AND METHODS: Prospective, cross-sectional descriptive study. A total of 1007 patients were recruited among those seen at the cervical pathology clinic of Sant Joan de Déu University Hospital in Barcelona (Spain) between January 2003 and March 2011. The statistical analysis was done with SPSS v.19 software. Differences between groups were considered statistically significant at p<0.05. RESULTS: Most patients (73.2%) had HPV infection, and among these women the genotype was considered high-risk in 86.4%. The most frequent genotype was HPV 16, found in 31% of the patients. Other genotypes identified, in decreasing order of frequency (all <10%), were HPV 51, HPV 53, HPV 31, HPV 66, HPV 58, HPV 33 and HPV 18. Mean age of the patients with HPV infection was 32.3 years, versus 39.8 years in women without HPV infection (p<0.05). The prevalence of HPV infection was significantly higher among women with grades 2 or 3 cervical intraepithelial neoplasia (CIN 2/3) (86%) or carcinoma (87%) than in women with grade 1 cervical intraepithelial neoplasia (CIN 1) (64%), HPV-associated changes (50%) or atypical cells (40%). CONCLUSIONS: In the population we studied, the proportion of women with infection by different genotypes of HPV 16 and HPV 18 was high. This finding confirms the need for further studies to compare the efficacy and protection of current vaccines against intraepithelial lesions and cervical cancer.

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.

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.

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.

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.

Rotura uterina asociada a desprendimiento prematuro de placenta normalmente inserta en gestante de 25 semanas / Uterine rupture associated with premature separation of a normally inserted placenta at 25 weeks’ gestation

Se presenta un caso de rotura uterina en paciente secundípara de 25 semanas que ingresó en nuestro centro por rotura prematura de membranas. Se practicó una cesárea de urgencia ante la sospecha de desprendimiento prematuro de placenta normalmente inserta y se objetivó rotura de la cicatriz de la cesárea anterior (AU)

We report a case of uterine rupture in a secundipara at 25 weeks’ gestation who was admitted to our center for premature rupture of membranes. Emergency cesarean section was performed due to suspicion of premature separation of a normally inserted placenta. Rupture of a previous cesarean section scar was observed (AU)

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.

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.

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.

Valor de la medición ecográfica de longitud cervical en gestantes con amenaza de parto prematuro para predecir un parto pretérmino / Value of ultrasonographic measurement of cervical length in predicting preterm birth after threatened preterm labor

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