Hiperplasia endometrial cística e hidrossalpinge em coelha / Cystic endometrial hyperplasia and hydrosalpinx in a rabbit

Cystic endometrial hyperplasia is an endometrial modification the uterus of female dogs and catscorrelated to high levels of estrogen and prolonged exposure to progesterone. In this context, the present studyreports the occurrence of cystic endometrial hyperplasia and hydrosalpinx in rabbits. A rabbit was referred tothe HOVET/UFRA for elective ovarian-hysterectomy. Histological examination showed an increase in the size ofthe endometrial glands and cystic distension. The tube uterine constituted cystic distention with epithelial ofpseudostratified epithelium ciliated. This case report describes the first time the cystic endometrial hyperplasiaand hydrosalpinx in a rabbit.(AU)

Hiperplasia endometrial cística e hidrossalpinge em coelha / Cystic endometrial hyperplasia and hydrosalpinx in a rabbit

Cystic endometrial hyperplasia is an endometrial modification the uterus of female dogs and catscorrelated to high levels of estrogen and prolonged exposure to progesterone. In this context, the present studyreports the occurrence of cystic endometrial hyperplasia and hydrosalpinx in rabbits. A rabbit was referred tothe HOVET/UFRA for elective ovarian-hysterectomy. Histological examination showed an increase in the size ofthe endometrial glands and cystic distension. The tube uterine constituted cystic distention with epithelial ofpseudostratified epithelium ciliated. This case report describes the first time the cystic endometrial hyperplasiaand hydrosalpinx in a rabbit.

Management of "Atypical Endocervical Cells" Compared to "Atypical Glandular Cells".

OBJECTIVE: To assess adherence to management guidelines based on the terminology used to describe atypical glandular cells (AGC) on cytology reports. MATERIALS AND METHODS: We analyzed AGC pathology reports from Hartford Hospital, 2004-2007, and identified cases of AGC with the terminology atypical glandular cells or atypical endocervical cells (AEC). We calculated rates of clinical evaluations based on the terminology used to describe the AGC. Statistical analysis was performed using the χ test. RESULTS: Seventy-eight reports contained the terminology AEC and 97 reports contained the terminology AGC. The rate of histologic sampling in women with AEC was lower than in women with AGC (52.6% vs 83.5%; p < .01). Similarly, the rate of comprehensive evaluations was lower (33.3% vs 71.1%; p < .01). Fewer endocervical curettages (47.4% vs 77.3%; p < .01) and fewer endometrial biopsies in women 35 years or older were performed (26.9% vs 69.1%; p < .01) in women with AEC than in women with AGC. CONCLUSIONS: Women with AGC reports containing the term AEC were managed less optimally than those with AGC. These results suggest that the terminology used to describe the finding of atypical glandular cells may influence the clinical evaluation. Clinicians may not recognize AEC as AGCs. Ours results suggest that the terminology atypical endocervical cells should be avoided or accompanied by the terminology atypical glandular cells.

Caracterização das alterações hemodinâmicas do útero em cadelas com hiperplasia endometrial cística-piometra / Uterine blood flow in bitches with Cystic Endometrial Hyperplasia-Pyometra

O diagnóstico presuntivo da Hiperplasia Endometrial Cística (HEC)-Piometra é comumente realizado por meio da avaliação ultrasonográfica bidimensional. Entretanto, o diagnóstico diferencial das afecções que constituem o complexo HEC-Piometra (HEC-mucometra, endometrite e piometra) é confirmado por meio dos achados ultrasonográficos, avaliação clínica, avaliação macroscópica e histológica do útero. Com o objetivo de instituir um meio de diagnóstico precoce e não invasivo, o presente estudo caracterizou a dinâmica vascular uterina por ultrasonografia Doppler em cadelas com HEC-Piometra. O total de 28 cadelas foram alocadas em 4 grupos, de acordo com a sintomatologia clínica, avaliação ultrasonográfica e histologica uterina: Grupo Controle (n=6); Grupo HEC-mucometra (n=10); Grupo Endometrite-Piometra (n=12). O Doppler colorido foi utilizado para o mapeamento dos vasos e o Doppler espectral, para caracterização da forma da onda. Os parâmetros de velocidade do fluxo sanguíneo e os índices hemodinâmicos foram calculados automaticamente. A avaliação quantitativa da vascularização uterina apresentou variação entre os grupos, sendo: Grupo Controle mínimo 1 e máximo 1; Grupo HEC-mucometra mínimo 1 e máximo 2; Grupo Endometrite-Piometra - mínimo 2 e máximo 4. Observou-se que nos grupos Controle (PS 47,30 ± 2,63; ED 1,29 ± 0,54; TAMAX 8,47 ± 1,13) e HEC-mucometra (PS 60,80 ± 4,50; ED 9,76 ± 0,77; TAMAX 20,47 ± 0,12) as velocidades do fluxo sanguíneo foram menores que no Grupo Endometrite-Piometra (PS 86,72 ± 6,35; ED 33,34 ± 3,02; TAMAX 48,34 ± 4,14). Em relação aos índices hemodinâmicos, os grupos Controle (RI 0,97 ± 0,01; PI 6,45 ± 0,60; S/D 78,83 ± 9,82) e HEC-mucometra (RI 0,84 ± 0,008; PI 2,59 ± 0,12; S/D 6,73 ± 0,36) os índices foram superiores em relação ao Grupo Endometrite-Piometra (RI 0,62 ± 0,02; PI 1,22 ± 0,09; S/D 2,86 ± 0,17), sendo caracterizado um fluxo sanguíneo contínuo. Pode-se inferir que as alterações do diâmetro uterino e, principalmente, a presença de processo inflamatório culminam com fluxo de baixa resistência e pulsatilidade. A análise comparativa entre os Grupos HEC-Mucometra e Endometrite-Piometra permite sugerir que quanto maior a severidade da afecção uterina, maiores os índices de velocidade de fluxo sanguíneo, uma vez que tal característica pode contribuir para a eliminação do agente. Para os quadros clínicos nos quais a ausência de sintomatologia clínica e as alterações encontradas na avaliação ultra-sonográfica bidimensional não permitem o diagnóstico diferencial, os índices de RI, PI e S/D podem ser conclusivos.

The presumptive diagnosis of Cystic Endometrial Hyperplasia (CEH)-Pyometra Complex is ultimately determined through two-dimensional ultrasound examination. However, the differential diagnosis between CEH-mucometra, endometritis and pyometra is achieved by the combined analysis of ultrasonographic findings, clinical signs, uterine macroscopic and histological evaluation. In order to establish an accurate, precocious and noninvasive method of diagnosis, the aim of this study was to characterize the uterine blood flow in bitches with distinct uterine pathological conditions. For this purpose, we allocated 28 bitches into 3 groups, according to clinical signs, ultrasound analysis and uterine histological examination: Control Group (n = 6), CEH-mucometra Group (n = 10); Endometritis-Pyometra Group (n = 12). Scanning of the uterine horns by colour Doppler was performed for quantitative assessment of the overall uterine vascularization. With the use of colour Doppler, the uterine vessels were identified and the flow velocity waveforms generated with the pulsed-wave Doppler. Parameters of blood flow velocity, as well as hemodynamic parameters were calculated electronically. Groups showed quantitative variations of uterine vascularization: Control Group - minimum and maximum of score 1, CEH-Mucometra Group - minimum of score 1 and maximum of score 2; Endometritis-Pyometra Group - minimum of score 2 and maximum of score 4. No differences were observed between right and left uterine arteries for blood flow velocimetry. However, Control (SPV: 47.30 ± 2.63; EDV: 1.29 ± 0.54; TAMAX: 8.47 ± 1.13) and CEH-mucometra (SPV: 60.80 ± 4.50; EDV: 9.76 ± 0.77; TAMAX: 20.47 ± 0.12) groups showed lower blood flow velocities when compared to Endometritis-Pyometra Group (SPV: 86.72 ± 6.35; EDV: 33.34 ± 3.02; TAMAX: 48.34 ± 4.14). Conversely, Control (RI: 0.97 ± 0.01; PI: 6.45 ± 0.60; S/D: 78.83 ± 9.82) and CEH-mucometra (RI: 0.84 ± 0.008; PI: 2.59 ± 0.12; S/D: 6.73 ± 0.36) Groups presented higher hemodynamic indices in comparison to Endometritis- Pyometra Group (RI: 0.62 ± 0.02; PI: 1.22 ± 0.09; S/D: 2.86 ± 0.17). In the latest Group, uterine perfusion was characterized as continuous blood flow. This study demonstrated that the changes in uterine diameter and especially, the presence of inflammatory process culminate with the rise in uterine blood flow, marked by low resistance and pulsatility. In addition, the severity of the uterine disease is associated with low blood flow, thus contributing to further elimination of the infectious agent. Doppler velocimetric evaluation may be a promising adjuvant diagnostic tool for uterine disorders, mainly because of its noninvasive feature. It may allow for the differential diagnosis between CEH-mucometra and endometritis-pyometra, whenever clinical symptoms and ultrasonographic findings are inconclusive.

Hiperplasia endometrial: análisis de serie de casos diagnosticados en biopsia endometrial / Endometrial hyperplasia: analysis of cases diagnosed by endometrial biopsy

Antecedentes: La hiperplasia endometrial es una entidad en la que existe una proliferación de glándulas endometriales de tamaño y forma irregular, con mayor proporción de glándulas sobre el estroma, a consecuencia de una excesiva exposición a los estrógenos. Aproximadamente, en el 15 por ciento de legrados/biopsias endometriales de mujeres postmenopausicas con cuadro clínico de hemorragia uterina anormal, se diagnostica esta entidad. Objetivo: Describir la incidencia y hallazgos histopatológicos en legrado/biopsia endometrial en pacientes de un hospital público de tercer nivel. Métodos: Se revisaron 22.048 procedimientos realizados en el Hospital Universitario de Santander, procesados en el Departamento de Patología de la Universidad Industrial de Santander, en el periodo comprendido entre 1 de enero de 2005 y 31 de diciembre 2008, de los cuales 1.750 correspondieron a legrados/biopsias de endometrio y en 168 de estos se realizó el diagnóstico histopatológico de hiperplasia endometrial. Resultados: Se encontró que el promedio de edad de presentación de está entidad fue de 44,8 años y que el mayor porcentaje de pacientes (68,5 por ciento) estuvieron en el grupo de la hiperplasia simple sin atipia. En el 19,7 por ciento de los casos hubo evidencia de atipia. Conclusiones: El promedio de edad encontrado y los porcentajes por subgrupos de hiperplasia estuvieron en relación a otros estudios. Se destaca una menor proporción de casos con atipia.

Background: Endometrial hyperplasia is an entity in which there is a proliferation of endometrial glands of irregular size and shape, with the highest proportion of glands on the stroma, resulting from excessive exposure to estrogen. Approximately 15 percent of curettages/endometrial biopsies of postmenopausal women with clinical symptoms of abnormal uterine bleeding is diagnosed this entity. Objective: To describe the incidence and pathological findings in curettage/endometrial biopsy in patients of a tertiary public hospital. Methods: A retrospective review of 22,048 surgical procedures performed in the University Hospital of Santander, processed in the Pathology Department of Industrial University of Santander in the period from 1 January 2005 and 31 December 2008, of which 1,750 corresponded to curettage/biopsy of the endometrium and in 168 of these histopathological diagnosis was made of endometrial hyperplasia. Results: We found that the average age of presentation in this institution was 44.8 years and that the greater percentage of patients (68.5 percent) were in the group of simple hyperplasia without atypia. In 19.7 percent of the cases had evidence of atypia. Conclusions: The mean age and percentages found by hyperplasia subgroups were relatively within limits with regard to other studies, although broadly outlined in a lower proportion of cases with atypia.

Hiperplasia endometrial atípica en pacientes infértiles: manejo conservador / Atypical endometrial hyperplasia in infertile patients: conservative management

Se presentan 4 pacientes infértiles portadoras de hiperplasia endometrial con atipías que se manejaron en forma conservadora en nuestro hospital. Tres pacientes recibieron acetato de medroxiprogesterona oral por 6 meses (100 mg día) con demostración histológica de regresión de la lesión e inducción de ovulación subsecuente. Un caso no recibió tratamiento por presentar regresión espontánea de su patología endometrial. Tres pacientes se embarazaron (dos únicos y un gemelar) obsteniéndose un aborto espontáneo y tres recién nacidos de término. Se concluye que el manejo conservador de la hiperplasia endometrial con atipías, empleando acetato de medroxiprogesterona oral en altas dosis, es efectivo. Una vez corregidos los ciclos anovulatorios con inductores de ovulación es posible obtener gestaciones viables

Hiperplasia atípica del endometrio: caracteres de diagnóstico histopatológico en raspado / Atypical endometrial hyperplasia: histopathological diagnosis characters in curettage

Se analizó la frecuencia con que se encuentran elementos histológicos descritos en carcinomas endometrilaes por Hendrickson y Kurman, entre otros, en 25 raspados con diagnóstico de hiperplasia atípica, todos con histerectomía ulterior que descartó un carcinoma. El 88 por ciento presentó elementos citológicos de Hendrickson, y el 84 por ciento , elementos arquitecturales. En ningún caso se encontraron elementos arquitecturales de Kurman, y sólo un caso presentó desmoplasia de estroma. Sólo en 3 casos 12 por ciento , se encontraron cribas pequeñas, todas en pequeños focos y de menos de 0,5 mm. El 76 por ciento de los casos presentó glándulas pequeñas. Los criterios arquitecturales y citológicos de Hendrickson no son específicos para carcinoma; también se encuentran en hiperplasias atípicas. Los criterios de Kurman están ausentes en hiperplasias endometriales. La mayoría de las hiperplasias atípicas del endometrio presenta ausencia de cribas pequeñas. Cuando éstas están presente, se encuentran focalmente y miden menos de 0,5 mm

Hiperplasia endometrial

Se trata de una revisiòn bibliogràfica sobre hiperplasia endometrial, la misma que es muy frecuente en nuestro medio y, algunas otras regiones del mundo donde la indigestiòn de altas concentraciones de estrògenos y la exposiciòn prolongada al mismo causan dicha enfermedad; se debe contrarrestar sus efectos con el uso concomitante de progestàgenos, en el caso de presentar una celularidad no atìpica; al contrario en la clasificaciòn atìpica la histerectomìa es la soluciòn para evitar la progresiòn a càncer endometrial.