Hysteroscopic findings of endometrial carcinoma. Evaluation of 104 cases.

PURPOSE OF INVESTIGATION: Retrospective evaluation of hysteroscopic findings in the accurate diagnosis of endometrial carcinoma. METHODS: A retrospective monocentric study from January 1995 to December 2004. One hundred and four patients with hysteroscopic aspects evocative of endometrial carcinoma confirmed by endometrial biopsy during diagnostic hysteroscopy, by surgical hysteroscopic resection pieces or by hysterectomy specimen were included. RESULTS: Among the 104 patients, diagnostic hysteroscopy pointed out endometrial features suggestive of endometrial carcinoma in 102 cases. In two women diagnostic hysteroscopy failed to diagnose endometrial malignancy which was identified on pieces of polyps by surgical hysteroscopic resection. DISCUSSION: Polypoid proliferations cerebroid in appearance, with ulceration and necrosis, friable and with irregular vessels, represent endometrial findings highly indicative of malignancy. The diagnosis may be missed in cases of focal neoplasias, within endometrial polyps or in conditions of unsatisfactory endouterine visualization.

Voluminous ovarian cystoma in term pregnancy: case report.

Treatment of a large voluminous serous cystoadenofibroma during a cesarean section is described. The relative frequency of such pathology in pregnancy and the importance of early diagnosis are discussed.

[Delivery at the Institute for Gynecology and Obstetrics of the Messina University Polyclinic. Comparison of two periods]. / Il parto nell'Istituto di Ginecologia ed Ostetricia del Policlinico Universitario di Messina. Due epoche a confronto.

BACKGROUND: Delivery methods and current pregnancy monitoring, comparing the last twenty-years in the light of new medical and diagnostic findings are presented. METHODS AND RESULTS: Moreover, examining carefully vaginal and laparotomic delivery it is to be noticed that a more careful wait can increase spontaneous deliveries, with the due exceptions, so that the rate of cesarean section is established on current values. CONCLUSIONS: At last it is to be hoped that maternal mortality and morbility decrease and particularly fetal mortality so as to guarantee a future devoid of psychophysic handicaps to newborn infants.

Prolonged retention of fetal bones: intrauterine device and extrauterine disease.

A case of prolonged retention of fragments of fetal bones is reported in a 47-year-old woman. The pieces of bone, retained in utero for 8 years after an elective abortion, were unexpectedly discovered after total hysterectomy with adnexectomy performed for bilateral pyosalpinx, persistent vaginal discharge and severe pelvic pain. The role of this rare complication as a cause of infertility is also discussed.

PIP: Prolonged intrauterine retention of fetal bone parts is a rare complication of induced abortion, spontaneous intrauterine fetal death, and missed abortion. Here, a case of long-term retention of fetal bone fragments in a 47-year-old Italian women who underwent elective abortion 8 years earlier is reported. The patient was admitted for acute pelvic pain with purulent vaginal discharge. She reported recurrent episodes of abdominal and pelvic pain, meteorism, dysuria, nausea and vomiting, headaches, and irregular cycles with dysmenorrhea and inter menstrual bleeding since the 1979 abortion. Initially, pelvic inflammatory disease was diagnosed and antiphlogistic drugs were prescribed. When symptoms persisted after 10 days of drug treatment, the patient underwent a laparotomy that revealed pyosalpinx with extensive pelvic adhesions. Total hysterectomy with bilateral adnexectomy was performed. The uterine cavity was found to be closely packed with fragments that were determined at stereomicroscopic examination to be pieces of fetal bone. Of particular concern is the potential of this complication to lead to secondary infertility. The retained bone fragments can function similarly to an IUD by producing an increase in the local insertion of prostaglandins and preventing blastocyst implantation. Moreover, the retained fragments are an ideal substrate for bacterial colonization, which can spread to the tubes and destroy the functional integrity of the reproductive apparatus. Retention of fetal bones should thus be considered as a possible etiologic factor in cases of infertility of women with a history of abortion.