Irreversible electroporation of the uterine cervix in a rabbit model.

The aim of this study was to evaluate the effects of irreversible electroporation (IRE) on the uterine cervix in a rabbit model. IRE ablation was performed in the cervices of 48 New Zealand rabbits, with one ablation lesion in each animal. Gross pathology, transmission electron microscopy, hematoxylin and eosin (H&E), Masson's trichrome (MT) stain, and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assays were performed at pre-set time points (0 h, 12 h, 1 d, 2 d, 4 d, 7 d, 14 d, and 28 d post-IRE). All the rabbits tolerated the IRE ablation without serious complications. IRE caused complete cell death of the ablated cervix via cell apoptosis. However, fast recovery of the cervix was observed from 7 d post-IRE, with the signs of collagen fibers hyperplasia, the disappearance of the necrotic cells and muscle fibers, and regeneration and extension of the cervical epithelium. At 28 d post-IRE, the ablated cervices recovered to almost normal. Our study suggested that IRE might be an efficient and safe technology to treat cervical tumors, without causing serious cervical damage.

Endocervicosis of the Uterine Cervix.

Endocervicosis is considered a form of Mülleriosis affecting mainly the bladder and is comprised of endocervical-type glands and cysts. It has been rarely described in the uterine cervix where the extensive involvement of cervical and paracervical tissue poses the suspicion of malignancy, mostly minimal-deviation adenocarcinoma. We describe a case of cervical endocervicosis causing long-term symptoms leading to hysterectomy. We provide evidence that this pathology is associated with cesarean section similar with isthmocele. Its differential diagnosis is discussed.

Histopathological analysis of hysterectomy specimens.

The objective of this study was to explore the histopathological findings and the rate of removal of ovaries in hysterectomy specimens. This study took into account 328 hysterectomy specimens examined in the Department of Pathology, Mymensingh Medical College and in one private Pathology Laboratory in Mymensingh town from March to August, 2005. Formalin fixed paraffin embedded tissue sections stained with haematoxylin and eosin were examined under light microscope. Patients' age, parts of uterus examined and their histopathological findings were retrieved from laboratory records. The common histopathological findings were: chronic cervicitis (87.80%), leiomyoma (17.07%), uterine prolapse (16.72%), adenomyosis (3.96), non-specific endometritis (3.35%), squamous cell carcinoma of cervix (2.44%), endometrial polyp (2.44%), serous cystadenoma of ovary (2.44%) and endometrial hyperplasia (1.83%). Some of the specimens show more than one lesions in the body of uterus, of which coexistence of adenomyosis and leiomyoma was the most common. Neoplastic lesions in cervix were 4.27%, in body 16.92% and in ovaries 5.06%. Malignant neoplasms were found in cervix 71.43%, in uterine corpus 3.03% and in ovaries 25%. Ovaries of both sides were removed in 48.17% of total cases. Their median age was 45 years, lowest age 23 years and maximum age was 82. The rate of removal of both ovaries was found to be increasing with the increase of age. Only one case was found to be subtotal hysterectomy and others were total hysterectomy. The present study revealed that the most common histopathological cause of hysterectomy is chronic cervicitis. Most common neoplastic cause of hysterectomy is leiomyoma. The rationalities and the possible after effect of hysterectomy in sexual functions and other physiological impairment should be followed up.

A comparison of efficacy of Tolpa Torf Preparation (TTP) in the treatment of cervicitis with or without surgery.

Tolpa Torf Preparation (TTP) is an immunomodulating drug produced by Torf Corporation, Wroclaw and registered for human use in Poland. TTP enhances the process of tissue regeneration. Authors evaluate TTP effectiveness in the treatment of inflammatory states of the cervix, especially cervical erosions and the influence of this preparation of the macroscopic, cytological and bacteriological state of the cervix. TTP was used in 31 patients with the diagnosis of cervical erosion. All patients treated as yet were classified into 3 groups, depending on the treatment of cervical erosion used previously. TTP was administered orally in the dose of 5 mg (in 10 ml of water) daily during 10 days and locally in the form of tampons soaked with 1% TTP solution in the volume of 5 ml also during 10 days. TTP administered this way has beneficial therapeutic effects on the healing of cervical erosion accelerating the process of epithelialization and bringing normalization of the cytological picture. Especially beneficial in the treatment of cervical erosion is combined use of TTP and electrocoagulation or curettage--the healing time can be shortened by half.

Cytomorphologic study on the atypical cells following cryosurgery for the treatment of chronic cervicitis.

One hundred and twenty-nine patients of chronic cervicitis were treated by cryosurgery and periodically followed up by Pap smears and biopsies. Cytomorphologic studies were carried out on atypical cells following cryosurgery. Atypical cells were detected within four weeks. These were divided into two categories. The first group consisted of cells with abundant cytoplasm and occurred in sheets, aggregates and/or as isolated forms. Irregular nuclear borders were observed in 5.1 per cent and fine granular chromation pattern was found in 99.4 per cent. Irregular nucleolar borders were observed in 7.5 per cent and macronucleoli, over 2.5 microns in diameter, were disclosed in 11.3 per cent. Nuclei within 10 microns in diameter were observed in 56.6 per cent, and the maximum length was 20 microns. It was suggested that these cells were exfoliated from either basal cell hyperactivity or atypical reserve cell hyperplasia. The second group consisted of cells with scanty cytoplasm of bare nuclei and occurred in aggregates. Irregular nuclear borders were observed in 1.7 per cent and fine granular chromatin patterns were found in 99.7 per cent. Irregular nucleolar borders could not be encountered. Macronucleoli were observed in only 0.4 per cent. Nuclel within 10 microns in diameter were observed in 95.3 per cent and the maximum measured length was 15 microns. It was suggested that these cells could be derived from reserve cell hyperplasia or from immature squamous metaplasia. In conclusion, atypical cells following cryosurgery exfoliate from the regenerating tissue in which atypia is frequently observed. The cells of the first group have identical features with those observed in the cases of tissue repair; on the other hand, the cells of the second group were derived from reserve cell hyperplasia or from immature squamous metaplasia.

Human papillomavirus detection in cervical smears and cervical tissue excised by the Loop Electrosurgical Excision Procedure (LEEP). Diagnostic value of cytology, colposcopy and histology.

A study was performed on 176 patients with benign cervical lesions. Human papillomavirus (HPV) structural antigens which were stained with the immunoperoxidase staining were sought for in cervical smears and in cervical tissues excised by the loop electrosurgical excision procedure (LEEP). HPV infection was found in 16.4% of the patients. Furthermore, cytologic screening on Papanicolaou (PAP) smears, colposcopy, and histologic examinations of whole transformation zones excised by the LEEP were performed. The diagnosis of HPV was based on the positive immunoperoxidase staining of either the exfoliated cells or the cervical tissue. HPV was detected on 5.6% of the PAP smears. The reliability of cytologic colposcopic, and histologic diagnosis of HPV was investigated.

CO2-laser vaporization of human papillomavirus (HPV)-induced abnormal cervical smears. A simple and effective solution to a recurrent clinical problem.

Fifty women with human papillomavirus (HPV)-induced abnormal cervical smears were randomly allocated to either CO2-laser vaporization or routine control. The success rate at the 6 months check was 100% after laser treatment compared to that of 72% in the control group (p less than 0.05). Although longer follow-up is needed to fully establish the efficacy of the treatment, the method seems appropriate to this large group of women at risk of developing cervical intraepithelial neoplasia.

Ovarian abscess as an unusual infectious complication of laser vaporization of the cervix: a case report.

Laser vaporization of the cervix has been reported to have an extremely low incidence of infectious morbidity compared to other treatment modalities. This case report describes the development of an ovarian abscess following laser surgery of the cervix in a patient with no known risk factors for disease.

Experience of the large loop excision of the transformation zone (LLETZ) for the treatment of women with abnormal pap's smear at Ang Thong Hospital.

From October 1990 to September 1991 2,471 women in Ang Thong Province had Pap's smear screening at both Gynecological and mobile clinics. Of these women 267 had abnormal smears. The Large Loop Excision of the Transformation Zone (LLETZ) was carried out in 30 selected women. The final microscopic findings were 5 cases of CIN I, 2 cases of CIN II, 1 case of CIN III and 22 cases of chronic cervicitis.

Vaginal intraepithelial neoplasia III detected after hysterectomy for benign conditions.

Because primary vaginal cancer is rare, many experts discourage routine cytologic sampling of the vaginal vault following hysterectomy for benign circumstances. The following report describes a case of vaginal intraepithelial neoplasia III (VAIN III) detected by a vaginal vault Papanicolaou smear obtained from an asymptomatic 57-year-old woman 23 years after she had a total abdominal hysterectomy for a benign condition. As VAIN III is a true vaginal cancer precursor, the innocent disregard of recommended screening practices averted significant morbidity and possibility mortality for this otherwise healthy woman.

Amoebic cervicitis mimicking posterior wall fibroid: a rare presentation.

Amoebiasis of the uterine cervix is an extremely rare entity, and presentation as fibroid uterus has not been reported, to the best of our knowledge in our extensive search of the English literature. It can clinically simulate cervical malignancy by virtue of surface papillomatous and overall ulcerated and necrotic appearance. We present a case of amoebic infection of the cervix in a 45-year-old female which was suspected to be a posterior wall fibroid with degeneration until a histopathological examination of the surgical specimen revealed the presence of Entamoeba histolytica trophozoites. The patient recovered after surgery and antiamoebic therapy.

Placental and uterine pathology in women undergoing peripartum hysterectomy.

OBJECTIVE: To estimate if peripartum hysterectomies performed for intractable uterine atony have pathologic findings consistent with infection more often than those hysterectomies performed for other indications. METHODS: This is a retrospective cohort study of all consecutive peripartum hysterectomies at our institution from 1988 to 2009. Scheduled cesarean hysterectomies were excluded. Maternal, fetal, and pathologic data were obtained by medical record review. Pathologic evaluation was performed for each specimen per a standardized protocol. Patients undergoing hysterectomy for uterine atony were compared with those requiring hysterectomy for another indication. Pearson's χ and Student's t test were used for analysis. RESULTS: Of 324,654 deliveries during the study period, 558 (1.7%) women underwent emergent peripartum hysterectomies; 190 (34%) were for intractable uterine atony. Those requiring hysterectomy for uterine atony were more likely to be at term (87% compared with 62%), have clinical chorioamnionitis (19% compared with 6%), and have longer labors (8 hours compared with 2.5 hours). Certain placental pathologic findings were significantly more common in the atony group, including chorioamnionitis, umbilical vasculitis, chorionic plate vasculitis, and funisitis. Acute endometritis and cervicitis were also more common in the atony group. Conversely, abnormal placental implantation (37% compared with 8%) and leiomyomas (21% compared with 8%) were significantly more common in the group requiring hysterectomy for other indications. CONCLUSION: Patients requiring emergent peripartum hysterectomies as a result of intractable uterine atony are more likely to have clinical and pathologic findings consistent with acute inflammation and infection. LEVEL OF EVIDENCE: II.

Müllerianosis of the urinary bladder.

Müllerianosis of the urinary bladder is a rare condition that encompasses 3 histological entities (endometriosis, endocervicosis, and endosalpingiosis). The authors report 2 patients with bladder müllerianosis, one of whom had endometriosis and the other a history of past pelvic surgery, describe the histological and cystoscopic features, and review the literature on this condition. Mucosal hyperemia and submucosal nodules or cysts with associated fibrosis and distortion of the bladder wall may mimic malignancy on cystoscopy, as may the infiltrative growth pattern sometimes evident histologically. Recognition of this complex diagnostic entity is important to avoid misdiagnosis and inappropriate investigation. There is a clinical association with endometriosis and past pelvic surgery.