Organoid (hypermature) ovarian teratomas: Report of four cases, one of which harbored a well-differentiated neuroendocrine tumor / Teratoma hipermaduro u organoide del ovario: descripción de cuatro casos, con un tumor neuroendocrino bien diferenciado en uno de ellos

Organoid (hypermature) teratomas are highly specialized teratomas showing organ formation, most frequently from the digestive tract or bronchial wall. We present four cases of ovarian organoid teratomas, one with a distinguishable mandible with teeth, one with small intestine, one with large intestine containing a well differentiated neuroendocrine tumor and another with both large intestine and bronchial wall. These tumors have a distribution similar to conventional teratomas and usually behave benignly, although cases of malignancy have been reported.(AU)

Los teratomas hipermaduros u organoides son teratomas altamente especializados en los que existe formación de órganos. Los más comunes son del tracto digestivo y de la pared bronquial. Presentamos cuatro casos de teratomas organoides del ovario: uno con formación de mandíbula con estructuras dentales, otro con intestino delgado, otro con intestino grueso con un tumor neuroendocrino bien diferenciado, y otro intestino grueso y pared bronquial. Estos tumores son de comportamiento benigno, aunque se han descrito casos con malignización. Pueden ocurrir en cualquier lugar donde se localicen los teratomas convencionales.(AU)

Organoid (hypermature) ovarian teratomas: Report of four cases, one of which harbored a well-differentiated neuroendocrine tumor.

Organoid (hypermature) teratomas are highly specialized teratomas showing organ formation, most frequently from the digestive tract or bronchial wall. We present four cases of ovarian organoid teratomas, one with a distinguishable mandible with teeth, one with small intestine, one with large intestine containing a well differentiated neuroendocrine tumor and another with both large intestine and bronchial wall. These tumors have a distribution similar to conventional teratomas and usually behave benignly, although cases of malignancy have been reported.

Método Essure: contracepción definitiva por vía histeroscópica / The Essure method: a hysteroscopic method for permanent contraception

Objetivo: Describir el procedimiento Essure de contracepción por vía histeroscópica y compararlo con los ya existentes en el armamentario actual de contracepción definitiva. Sujetos y método: Se han analizado tanto los estudios multicéntricos previos a su aprobación como la experiencia referida en trabajos posteriores de grupos expertos en histeroscopia. Resultados: Los resultados de dos estudios multicéntricos internacionales, prospectivos y aleatorizados publicados en 2003 demuestran que el método Essure presenta una elevada eficacia en la prevención del embarazo, superior al 99% con tasas de complicaciones menores inferiores al 3%. Conclusiones: La contracepción definitiva mediante el método Essure, apoyada en una curva de aprendizaje y en una adecuada experiencia en histeroscopia permiten convertirlo en una técnica factible en régimen de consulta y exitosa en el 95% de los casos

Aim: To describe hysteroscopic permanent contraception through the Essure procedure and to compare this procedure with other already available methods. Subjects and methods: We analyzed multicenter studies published before approval of the Essure method as well as the experience reported in subsequent studies by groups with expertise in hysteroscopy. Results: Data from two multicenter, international, prospective, randomized studies published in 2003 demonstrate that the Essure procedure provides high contraceptive efficacy (greater than 99%), with a minor complications rate of less than 3%. Conclusions: Permanent contraception with the Essure procedure, when performed after an adequate learning curve and by practitioners with extensive experience in diagnostic hysteroscopy, can be carried out as an outpatient technique with a 95% success rate

Diagnostic value of hysterosalpingography in the detection of intrauterine abnormalities: a comparison with hysteroscopy.

OBJECTIVE: The purpose of this study was to evaluate the diagnostic accuracy of hysterosalpingography (HSG) in comparison with hysteroscopy in the detection of intrauterine abnormality in infertile patients. MATERIALS AND METHODS: Seventy-eight patients being investigated for infertility and undergoing HSG and hysteroscopy were studied retrospectively. Radiologic findings on HSG, including single or multiple filling defects and uterine wall irregularities, were evaluated and compared with hysteroscopic findings, which were considered the reference standard. RESULTS: HSG showed a sensitivity of 81.2% compared with that of hysteroscopy and a specificity of 80.4%, with a positive predictive value of 63.4% and a negative predictive value of 83.7%. HSG also had a false-negative rate of 90% and a false-positive rate of 21.8%. Overall agreement between the two procedures was 73%. CONCLUSION: HSG is still a useful screening test for the evaluation of the uterine cavity in the study of primary or secondary infertility. In addition, HSG provides information concerning the assessment of tubal morphology and patency. We believe that these two procedures are complementary in the evaluation of the uterine cavity.

Essure: a new device for hysteroscopic tubal sterilization in an outpatient setting.

OBJECTIVE: To evaluate the results of hysteroscopic placement of an intratubal device for permanent birth control in 85 women in an outpatient setting. DESIGN: Prospective, observational study. SETTING: Private university hospital. PATIENT(S): Eighty-five premenopausal women who asked for tubal sterilization by hysteroscopy between July 2002 and July 2003. INTERVENTION(S): Hysteroscopic placement of titanium-dacron intratubal devices in an outpatient setting. MAIN OUTCOME MEASURE(S): Procedure feasibility without anesthesia, success rate of device implantation, patient satisfaction, and confirmation of correct placement. RESULT(S): Successful placement was achieved in 81 patients (95%). Mean time elapsed between the start of hysteroscopy, placement of devices, and removal of optics was 9 minutes (range, 1-35 minutes). No intraoperative or postoperative complications were detected. Of 81 patients, 75 (93%) had abdominal x-ray performed at the third month; bilateral correct placement was confirmed in all of them. CONCLUSION(S): Essure is a safe, effective, and minimally aggressive procedure with satisfactory patient acceptance that does not require anesthesia or hospitalization. It seems to be a good alternative to laparoscopic tubal sterilization.

Endometrial hyperplasia with secretory changes.

OBJECTIVE: Secretory changes in endometrial hyperplasia are uncommon. The aim of this study is to review the morphologic and clinical findings of 24 cases of endometrial hyperplasia with secretory changes. METHODS: In 24 patients diagnosed with endometrial hyperplasia with secretory changes during 6 years, clinical characteristics such as menopausal status and hormone treatment were correlated with morphological features. A matched age control group of 24 women with conventional endometrial hyperplasia was used to compare the hormonal effect. RESULTS: Nineteen patients were premenopausal. Nine women showed simple hyperplasia without atypia and 15 complex hyperplasia, 7 of them with atypia. Seventeen women were under hormonal treatment at the time of diagnosis, 10 of them with progestins. In 7 patients endometrial adenocarcinoma could be seen, 5 coexisting with endometrial hyperplasia with secretory changes and in 2 appearing after 1 and 4 months. In control group only 2 patients were undergoing progestin hormonal treatment. CONCLUSIONS: Secretory changes can be found in hyperplastic endometrium, particularly in premenopausal women under hormonal treatment with progestins, with the risk of misdiagnosis.