Endoscopy of the uterus and its congenital malformations

Laparoscopy and hysteroscopy are two endoscopic procedures with which the outer surface of the uterus, its cavity can be studied with a detailed analysis of the endometrium and ostia. The stages of the study are described and uterine congenital malformations are described in relation to the reproductive performance of women.     

A comparison of ultrasound-guided high intensity focused ultrasound for the treatment of uterine fibroids in patients with an anteverted uterus and a retroverted uterus

Objective: The aim of this study was to compare the treatment outcomes of ultrasound-guided high-intensity focused ultrasound (USgHIFU) for uterine fibroids in patients with an anteverted uterus versus a retroverted uterus.

Materials and methods: Based on the principles of statistics we enrolled 221patients with an anteverted uterus and 221 with a retroverted uterus. All patients had a solitary uterine fibroid and every fibroid was identified as hypointense on the T2 weighted images (T2WI) on magnetic resonance. The baseline characteristics of the patients, treatment results and adverse events were compared between the two groups.

Results: There were no significant differences in baseline characteristics between the two groups. The average non-perfused volume ratio of fibroids was 85.2?±?18.7% in the group of patients with a retroverted uterus, while it was 87.7?±?11.8% in patients with an anteverted uterus (P?Conclusion: The results of this study indicated that uterine fibroids with hypointensity on T2WI in a retroverted uterus can be safely and effectively treated with USgHIFU. However, the fibroids in an anteverted uterus are easier to treat with USgHIFU.     

Electron spin resonance studies on normal human uterus and cervix and on benign and malignant uterine tumors

Electron spin resonance (ESR) studies at -130 degrees have been made on frozen samples of normal human cervix and uterus and on frozen samples of various pathological conditions of the cervix and uterus including fibroleiomyoma and carcinoma. Fifty-five samples of normal cervix and endometrium, 40 samples of nonmalignant disturbances, 15 benign tumor samples, and 20 malignant samples were studied. Very strong ESR signals were seen in frozen powders and frozen intact samples of normal cervix and endometrium and in nonmalignant gynecological conditions. In many cases, the ESR signal was greatly decreased or even undetectable in cancer samples. The substance(s) responsible for the ESR signal in frozen intact tissue (g = 2.11 to 2.15) is decreased in concentration when the sample is ground to powder under liquid nitrogen, and an anisotropic signal (g = 2.002 to 2.035) then becomes much more evident. The ESR signals in intact and in powder samples are sensitive to temperature variations; the signals disappear around 0 degrees, and only the intact samples show significant recovery of signal on recooling. The anisotropic g values and temperature sensitivity in the powders may result from an organic peroxy radical that is more strongly associated with a metal ion in intact samples.     

不同手术方法对子宫肌瘤患者卵巢功能及性功能的影响

目的探讨子宫全切术和子宫肌瘤剔除术对子宫肌瘤患者卵巢功能及性功能影响。方法选取60例子宫肌瘤患者,采取随机数字表法分为子宫全切术组和子宫肌瘤剔除术组,每组30例。对比两组患者术前1周和术后3个月雌二醇水平、黄体生成素水平、卵泡刺激素水平、性欲方面、性心理方面、性行为中异常症状方面的变化。结果子宫全切术组术前1周和术后3个月的雌二醇、黄体生成素、卵泡刺激素水平与子宫剔除术组相比,差异均有统计学意义(P<0.05)。子宫全切术组术前1周和术后3个月的性欲方面、性心理方面、性行为中异常症状方面的国际女性性功能评估量表(BISF-W)值与子宫剔除术组相比,差异有统计学意义(P<0.05)。结论采用子宫肌瘤剔除术治疗子宫肌瘤对卵巢功能及性功能的影响较小,可以作为一种理想方法应用于临床工作中。     

Endometrial endometrioid adenocarcinoma associated with primitive neuroectodermal tumour of the uterus: a poor prognostic subtype of uterine tumours

Uterine primitive neuroectodermal tumours are extremely rare tumours. They can occur in pure form or combined with another component including endometrioid adenocarcinoma. We aimed to review the clinical impact of neuroectodermal phenotype in uterine tumours, after we recently diagnosed one such case. A 58-year-old female presented with irregular vaginal bleeding. Ultrasonography and CT showed the presence of a large uterine mass with irregular contours. At laparotomy it was found to extend to the right ureter, sigmoid colon and some small intestinal loops. Microscopic examination revealed that the tumour consisted of an endometrioid adenocarcinoma component merging with an extensive neuroectodermal component. No EWSR1 or FUS rearrangement was found in the two tumour components. The patient received two courses of chemotherapy but died 11 months after the initial diagnosis. We reviewed the morphological and molecular criteria for the diagnosis of uterine primitive neuroectodermal tumours published in the literature. We conclude that regardless of the detection of an EWSR1 rearrangement, the presence of a neuroectodermal differentiation component in these rare uterine tumours is a marker of aggressive behaviour, and its presence should be highlighted in the diagnosis.     

On the apparent failure of adjuvant pelvic radiotherapy to improve survival for women with uterine sarcomas confined to the uterus

Despite numerous studies documenting reduction of pelvic relapses after adjuvant pelvic radiotherapy stage I and II uterine sarcomas, improved survival remains unproven. This retrospective report analyzes patterns of failure, survival, and toxicity in 42 women with stage I and 7 patients with stage II uterine sarcomas treated from 1972 through 1998 to identify patients likely to benefit from pelvic or abdominal radiotherapy and chemotherapy. Four of these patients also received adjuvant chemotherapy. There were 20 leiomyosarcomas, 18 homologous mixed mullerian tumors, and 11 heterologous mixed mullerian tumors. Disease-free survivals for mixed mullerian tumors were 65% at 5 years and 61% at 15 years. Disease-free survivals for leiomyosarcomas were 40% at 5 years and 40% at 15 years. There were 14 distant only, 5 distant and abdominal, 1 abdominal, 1 distant and pelvic, and 2 unknown initial sites of failure. Acute toxicity was acceptable as measured by a median 1-kg weight loss from radiotherapy and a 2% rate of failure to complete therapy. Chronic toxicity consisted of 3 small bowel obstructions and 1 sigmoid colon obstruction. In conclusion, the efficacy of adjuvant pelvic radiation is demonstrated by the absence of any isolated pelvic failures. Although the frequent occurrence of peritoneal failures suggests a role for prophylactic abdominal radiation for mixed mullerian tumors, more effective systemic therapy is necessary to substantially increase the chance of cure for women with early-stage uterine sarcomas.     

C-kit expression in uterine leiomyosarcomas: an immunocytochemical study of 29 cases of malignant smooth muscle tumors of the uterus

Uterine malignant stromal tumors are rare neoplasms characterized by fatal prognosis. At the moment no effective systemic treatment is available for metastases or recurrent disease. The drugs employed in advanced neoplasms are iposfamide, doxorubicin or epidoxorubicin, but the clinical response to chemotherapy is poor. Recent studies have shown that cells in gastrointestinal stromal tumors express a growth factor receptor with tyrosine kinase activity termed c-kit. Lately reports of efficacy of a specific anticancer drug with imatinib (ST1571) based on specific molecular abnormalities of proto-oncogene c-kit present in gastrointestinal stromal tumors induced us to identify the c-kit phenotype also in uterine leiomyosarcomas. These data may be useful for treating metastatic uterine leiomyosarcomas with increased c-kit kinase activity.     

超选择子宫动脉栓塞治疗子宫肌瘤的临床研究

目的　研究超选择子宫动脉栓塞治疗子宫肌瘤的临床研究。方法　于 2 0 0 0年 1月～ 2 0 0 1年 6月对 5 6例子宫肌瘤患者进行双侧子宫肌瘤供血动脉的栓塞治疗。结果　插管栓塞成功率 10 0 % ,随访 1～ 6个月。B超随访 1个月肌瘤体积平均缩小 2 5 %。随访 6个月 ,16例肌瘤消失 ,40例肌瘤体积平均缩小 66% ,并均有月经量的明显减少。结论　子宫肌瘤的介入治疗疗效肯定 ,对黏膜下肌瘤尤为适宜。     

Congenital malformations and testicular germ cell tumors

Cryptorchidism is one of the few known risk factors for testicular germ cell tumors (TGCT). It has been postulated that other congenital malformations, in particular hypospadias, are also associated with increased risk; however, associations with birth defects have not been extensively studied. Using Swedish population‐based registries we evaluated the relationship between birth defects and risk of TGCT. TGCT cases (n = 6,593) diagnosed between 15 and 65 years of age were identified from the Swedish Cancer Registry between 1964 and 2008. Five controls per case were randomly selected from the population register and matched on birth year and birth county. Congenital malformations were identified via linkage with the Hospital Discharge Register. Odds ratios (ORs) and 95% confidence intervals (CIs) for the association between each group of malformations and TGCT were estimated using conditional logistic regression. In addition to the expected association between cryptorchidism and TGCT risk [OR (95% CI): 3.18 (2.50–4.04)], hypospadias [2.41 (1.27–4.57)], inguinal hernia [1.37 (1.11–1.68)] and other genital malformations [2.19 (1.17–4.10)] were associated with an increased risk of TGCT. Mutual adjustment for cryptorchidism, hypospadias, inguinal hernia and other genital malformations did not appreciably change the associations (ORs: 3.16, 2.25, 1.30 and 1.90, respectively). The other (nongenital) malformations evaluated were not associated with TGCT. These data suggest that developmental urogenital abnormalities, specifically cryptorchidism, hypospadias and inguinal hernia, are associated with an increased risk of TGCT, further supporting the hypothesis that prenatal exposure(s) related to proper genital development are related to this tumor.     

Long-term survival in uterine clear cell carcinoma and uterine papillary serous carcinoma

Uterine clear cell carcinoma (UCC) and uterine papillary serous carcinoma (UPSC) are rare entities that differ in clinical behavior from endometrial adenocarcinoma. Compared with endometrioid adenocarcinoma, they more often metastasize early and more commonly in the upper abdomen including the omentum. Treatment programs of UCC and UPSC at different stages vary and range from no adjuvant therapy in stage Ia to a wide variety of chemotherapies and radiotherapies in more advanced stages. This study presents the outcome of 109 patients with UCC or UPSC treated according to essentially the same treatment program from May 1993 to December 2004. Most patients were treated with a simple hysterectomy with no further adjuvant treatment. In stage Ia, 2/46 patients died of their disease and amongst all the stages, 30/109 patients died of their disease. These survival outcomes are comparable to or better than those presented previously.     

Melanotic paraganglioma of the uterus

Two cases of melanotic paraganglioma of the uterus are reported. Interpreted as a pigmented paraganglioma, both lesions were an incidental finding in uteri removed for unrelated benign conditions. Microscopically, both tumors were circumscribed, and composed of nests of large round or angulated polygonal cells with abundant clear or granular pale, eosinophilic cytoplasm. Large amounts of coarse intracytoplasmic melanin pigment were present in many cells, whereas other cells were completely devoid of pigment. Both lesions contained psammoma bodies. Electron microscopy showed abundant intracellular melanosomes, including many compound melanosomes and few premelanosomes. A lamellar whorled structure was the dominant infrastructure on which melanin pigment was deposited in many cells. The absence of microvilli or dendritic cell processes and basal lamina, as well as the lack of S-100 protein, pointed against a Schwannian or melanocytic differentiation. The presence of abundant pigment and only rare neuroendocrine-like secretory granules in the cytoplasm of a few cells indicated divergence from classic paraganglioma. Architecturally, this lesion is similar to a paraganglioma; but, functionally, instead of neuroendocrine granules, the tumor cells produce melanin pigment.     

HIV and uterine cervical cancer

There is an increased risk in patients infected with the human immunodeficiency virus (HIV) to he also infected with the human papillomavirus (HPV). Type of HPV is the same in patients infected -or not- by the HIV (in patients with the same criteria of HIV infection). However, there is a higher rate of persistent HPV infections in HIV+ patients, especially with oncogenic virus subtypes. Persistence of high-risk virus is necessary for the development of dysplasic lesions: therefore, there is a higher incidence of cervical intra-epithelial neoplasias (CIN) and cervical cancers in HIV+ patients. In 1993, the Centers of Disease Control (CDC) designated invasive cervical carcinoma as a defining condition of AIDS. After conservative treatment in CIN, the recurrence rate is higher, together with a high rate of positive margins. It may he of some interest to perform a medical treatment, in association with the dysplasia surgical procedure. Invasive cancers have a worse pronostic than in HIV- patients, due to the specific aggressiveness of cervical carcinomas in seropositive patients. Standard treatment consists in surgery and radiotherapy with or without cisplatin chemotherapy, depending on the stage. This treatment is modulated according to CD4 rate. Antiviral treatment and infectious prophylaxis have to be reinforced. A special care will be required for radiotherapy technical execution and clinical (digestive) and hematological follow-up through out the treatment.