Adenocarcinoma de cérvix diagnosticado por histeroscopia / Hysteroscopically-diagnosed cervical adenocarcinoma

Paciente menopáusica de 48 años que ingresa por sospecha de enfermedad inflamatoria pélvica. En la ecografía se observó endometrio engrosado. La citología fue negativa y la biopsia endometrial estableció el diagnóstico de endometritis sin signos de malignidad, con cultivo positivo para Streptococcus pneumoniae. Al mes se realizó una nueva citología que presentó células glandulares de probable origen endometrial, pero sin atipias, y una biopsia endometrial compatible con hiperplasia endometrial compleja. En la histeroscopia se observó una mucosa irregular con vascularización aumentada en el orificio cervical interno. La biopsia fue informada como adenocarcinoma de tipo endocervical, por lo que se realizó intervención de Schauta-Amreich y linfadenectomía pélvica. En la histeroscopia deben biopsiarse o extirparse todas las alteraciones que encontremos

We present the case of a 48-year-old woman who was admitted to hospital with suspected pelvic inflammatory disease. Ultrasound showed a thick endometrium. The results of Pap smear were negative and endometrial biopsy established a diagnosis of endometritis without malignant signs and positive Streptococcus pneumoniae culture. One month later, a further Pap smear revealed glandular cells of probable endometrial origin, but without any atypia, while endometrial biopsy showed findings compatible with complex endometrial hyperplasia. Hysteroscopy revealed an irregular surface with increased vascularization in the internal cervical orifice. Biopsy showed endocervical adenocarcinoma, and a Schauta-Amreich intervention with pelvic lymphadenectomy was performed. All alterations found on hysteroscopy should undergo biopsy or be removed

Pólipos endometriales: riesgo de malignización y correlación clínico-anatómica / Endometrial polyps: risk of malignant transformation and clinico-anatomic correlation

Objetivo: Conocer la incidencia de pólipos endometriales malignos en función del estado hormonal, la presencia o no de hemorragia uterina anormal (HUA), el uso de tamoxifeno (TMX) y de terapia hormonal sustitutiva (THS).Material y métodos: Se analizan 1.822 polipectomías histeroscópicas. Tomaban THS 85 pacientes y TMX, 150.Resultados: Los pólipos de pacientes premenopáusicas presentan más HUA que los de las posmenopáusicas. Se hallaron 16 pólipos histológicamente malignos (0,87 por ciento). De éstos, 14 se extirparon a pacientes posmenopáusicas, 11 de ellas presentaban HUA. Entre pacientes premenopáusicas se resecaron 2 pólipos malignos, uno de ellos era asintomático. No se detectaron pólipos malignos entre pacientes con THS. Se encontraron 4 pólipos malignos entre mujeres con tratamiento con TMX, 2 de ellos eran asintomáticos. Conclusiones: La resección sistemática de los pólipos endometriales permite detectar todos los pólipos malignos, incluso en los casos de pacientes asintomáticas y/o premenopáusicas (AU)

Amenorrea secundaria por adherencia cervicoístmica / Secondary amenorrhea due to cervical-isthmical adhesion

La adherencia cervicoístmica continúa siendo, en algunos casos, un problema de difícil solución. El diagnóstico de esta amenorrea sin hematometra sigue siendo histeroscópico, pero en el tratamiento terapéutico, la adhesiolisis no resulta siempre suficiente. Mediante el presente artículo pretendemos aportar un nuevo caso, intentando proporcionar nuevos datos que nos permita esclarecer los mecanismos fisiopatológicos de este complejo síndrome (AU)

Neoplasia vulvar intraepitelial (vin) / Vulvar intraepithelial neoplasia (ivn)

No disponible

Evaluation of the effect of GnRH on follicular ovarian cysts in dairy cows using trans-rectal ultrasonography.

The objectives of this study were to evaluate ovarian changes in cows with follicular ovarian cysts following treatment with either GnRH or saline. The parameters determined were the intervals from treatment to observation of a CL and from treatment to disappearance of the cyst, and the association between serum concentrations of LH, FSH and the LH/FSH ratio, before and after treatment, with the test intervals. Thirty-nine cows were identified as having follicular cysts. The GnRH treatment induced a significant increase in LH and the LH/FSH ratio. The gonadotropin response was not associated with the intervals from treatment to CL detection or to disappearance of the cyst. Survival curves for the intervals from treatment to CL detection and cyst disappearance indicate that treatment with GnRH or saline did not yield significantly different results for either parameter. The results question the efficacy of treating cystic ovarian disease with GnRH.

[Schistosomiasis imported by Spanish travelers: clinico-epidemiologic study of 80 cases]. / Esquistosomiasis importada por viajeros españoles: estudio clínico epidemiológico de 80 casos.

BACKGROUND: Swimming in rivers or lakes is a risk activity, in areas where the life cycle of schistosomiasis occurs. This report presents and analyzes the clinical presentation and epidemiological data of 80 Spanish travellers. PATIENTS AND METHODS: Descriptive longitudinal and retrospective study that includes clinicoepidemiological and the laboratory data and imaging diagnosis. Patients were seen at the Section of Tropical Medicine, Hospital Clínic i Provincial, Barcelona. RESULTS: Most patients acquired the infection in the Dogon country of Mall. 25% of them presented with symptoms related to the genital tract. In some groups, 45% of travellers that swam, contracted the infection. The most prevalent species diagnosed was S. haematobium and 10 travellers presented with mixed infections. CONCLUSIONS: The trip to the Dogon country should be considered as "a risk activity". Travellers Advice Clinics should include the subject of swimming in infected waters in their routine counselling. Genital tract localizations were registered for three species of schistosome. The classical clinical presentation of schistosomiasis in the endemic areas differs considerably from that seen in travellers.

[The detection of papillomavirus by in situ hybridization. Clinico-pathological and virological correlation in patients with squamous intraepithelial lesions of the uterine cervix]. / Determinación del papiloma virus mediante hibridación in situ. Correlación clinicopatológica y virológica en pacientes con lesiones escamosas intraepiteliales del cérvix uterino.

BACKGROUND: Clinical usefulness of human papillomavirus (HPV) detection by molecular techniques is not well established. The aim of the study is to determine, by in situ hybridization, HPV DNA in patients with cervical intraepithelial neoplasia (CIN), assessing the prevalence rate, the association with epidemiologic factors and the correlation with classic diagnostic procedures (cytology, colposcopy and histology). PATIENTS AND METHODS: Among 138 patients diagnosed with CIN, HPV was determined in 75 treated by excisional procedures. All cases underwent pap-smear, colposcopy, and colposcopically directed biopsy. RESULTS: Histologic diagnosis was as follows: 1 cervical condyloma (1.3%); 31 CIN-I (41.3%); 23 CIN II (30.7%), and 20 CIN-III (26.7%). HPV was detected in 31 cases (41.3%), being more frequent in higher histologic grades (35.5%) CIN-I, 43.5% CIN-II and 45% CIN-III). No association between cytologic, colposcopic and histologic diagnoses and HPV positivity was observed. HPV detection in patients with false negative cytologies was lower than in positive ones (p = 0.021). Smoking was the only epidemiologic factor significantly associated to HPV presence (chi 2 for trend = 4.022; p = 0.045). CONCLUSIONS: Clinical usefulness of in situ hybridization for HPV detection remains controversial because of its low sensitivity, and the scarce relationship between its results and those obtained by cytology, colposcopy and histology. Smoking is associated with a higher detection rate of HPV in patients with squamous intraepithelial lesions of the uterine cervix.

Treatment of cervical intraepithelial neoplasia in a prospective study comparing large-loop excision of the transformation zone, laser vaporization, and knife cone biopsy.

OBJECTIVE: Our aim was to compare cervical intraepithelial neoplasia (CIN) treatment results in the use of large-loop excision of the transformation zone (LLETZ), laser vaporization, and cold-knife cone biopsy. MATERIALS AND METHODS: We included in the study patients with CIN lesions diagnosed at the Hospital Universitario Materno-Infantil Vall d'Hebron and Hospital Clinic i Provincial de Barcelona, Barcelona, Spain, between March 1991 and March 1994. Patients with unsatisfactory colposcopy were excluded from the study. One hundred twenty-three patients were included in this study: 98 patients were compared for LLETZ treatment versus laser vaporization, and 69 CIN3 patients were compared for three treatments: LLETZ, laser vaporization, and knife cone biopsy. Patients were followed at 3-month intervals for at least 1 year. Follow-up included physical examination, cervical Papanicolaou (Pap) smear, cervical colposcopy, and a colposcopically guided biopsy when required. Treatment failure (persistence or recurrence) was defined by the presence of CIN confirmed histologically by a colposcopically guided biopsy. RESULTS: The mean age of patients was 34.1 years. The agreement between histology from the colposcopically guided biopsy and the surgical specimen was 60%, and the kappa coefficient was 40.7% (moderate agreement). Three cases of microinvasive carcinoma were diagnosed in patients whose initial diagnosis was CIN3 on colpobiopsy (4% of invasion in the initial CIN3 group of patients). In a comparison of LLETZ with laser treatment for all CIN grades, the unique independent prognostic factor for persistence-recurrence of the disease was the colposcopic size of the primary lesion (relative risk, 4.9; Cl, 1.33-18.45). CONCLUSIONS: We conclude that the LLETZ procedure for CIN treatment demonstrates an advantage over destructive methods for detection of occult microinvasive and invasive cancer. This process is a simple outpatient technique with the same failure as that of laser vaporization in all CIN grades. In the treatment of CIN3, cold-knife cone biopsy had better cure rates. Close follow-up is required in these patients, because of their risk of developing recurrent CIN or invasive carcinoma.

Endometrial ossification successfully treated by hysteroscopic resection.

BACKGROUND: Endometrial ossification is a rare condition. The common feature in most reported cases is a previous history of abortion and retention of fetal bones. Few cases of endometrial ossification can be explained by osseous metaplasia. Clinical presentation may include abnormal vaginal bleeding or discharge, dysmenorrhoea, pelvic pain, and secondary infertility. Hysterectomy or dilation and curettage have been the usual therapeutic methods used. Recently, some cases have been treated by means of hysteroscopic resection. CASE: We report a case of endometrial ossification in a woman who presented with dysmenorrhoea, dyspareunia and pelvic pain. The patient had a pregnancy voluntarily terminated at 16 weeks. Five subsequent routine annual gynaecological exams, including ultrasonographies, were normal. A new gestation was also voluntarily terminated at 6 weeks. One month later the patient started with clinical manifestations. Ultrasonograms performed 4 months after the second abortion revealed a strong uterine echogenic band. Bone tissue was successfully removed by hysteroscopic resection. CONCLUSION: This case adds further evidence favouring new bone formation in the uterus as a pathogenic mechanism for endometrial ossification and illustrates the feasibility of hysteroscopic treatment for this condition.

Endolymphatic chemotherapy in gynecologic cancer.

Bleomycin oil suspension was infused preoperatively into the bilateral pedal lymphatic vessels of 18 patients with cancer of the vulva, uterine cervix, and endometrium. The object of this technique was to reduce the number of local recurrences in pelvic and abdominal lymph nodes. Except in the case of two patients, it was possible to infuse both extremities. Side effects of the treatment were generally mild. In a postoperative study of the surgical specimens, metastases were found in 18 lymph nodes. All of these showed selective necrosis of existing metastases and conservation of the morphology of healthy nodes. Necrosis of the primary tumor was occasionally produced.

Treatment of CIN with the CO2 laser vaporization.

A group of two hundred and sixty women, most of them young, with histologic diagnosis of CIN located at the exocervix, has been treated by means of CO2 laser vaporization. The entire transformation zone and a minimum of 10 mm at the base of cervical canal was vaporized to a depth of 6-7 mm. Of the treated group, 239 patients (114 CIN I, 78 SIN II and 47 CIN III), were followed for a mean of 19 months. The failure rate of a single treatment was 8.8% for CIN I, 11.5% for CIN II and 12.7% for CIN III. These results are in agreement with world Literature The majority of failures, diagnosed within the first year of follow-up were small areas of CIN I-II located around the squamo-columnar junction, and only two CIN III were detected. No evidence of CIN was observed after a second treatment. No case of invasive cancer has been detected. Fertility was not affected by the treatment. It is concluded that CO2 laser vaporization is a safe and effective method for treatment of CIN. Patient selection, proper technique, close follow-up and adequate treatment of failures are essential to this end.

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.