Microbiology of the female genital tract

Patients who contract genital tract infections are predominantly young, are otherwise healthy, and generally respond well to treatment for bacterial infections. These infections are most commonly polymicrobial in etiology, with several noteworthy exceptions. Often there is an inciting event such as childbirth, surgical intervention, pregnancy termination or intrauterine contraceptive device insertion. With treatment, prognosis for cure is excellent; however, sequelae such as recurrent infections, infertility, or ectopic pregnancy can be serious. Bacteria encountered in the female genital tract can be divided into aerobic and anaerobic organisms. Among the aerobic gram-positive organisms, several varieties of streptococci such as Group B streptococci and enterococci occur frequently. Staphylococcus aureus is an infrequent but important pathogen. Among the aerobic gram-negative organisms, the most common is Escherichia coli. Klebsiella sp. and Proteus sp. occur in about 5% of genital tract infections. Species that are more resistant to antibiotics, such as Pseudomonas aeruginosa and Enterobacter sp., occur in approximately 1% or 2% of these cases and are more likely to appear in patients who have previously received antibiotic therapy or who have been hospitalized for some time. Among the anaerobic organisms, the most common gram-positive isolates are Peptostreptococci and Peptococci. Clostridia sp. occurs less frequently. Among the anaerobic gram-negative organisms, the Bacteroides sp. most frequently encountered are Bacteroides bivius and Bacteroides disiens. Bacteroides fragilis is still a common problem but appears to be less predominant. Other organisms encountered are Chlamydia trachomatis, the genital mycoplasmas, yeasts, protozoa, and viruses.     

Tamoxifen and the female genital tract

Ugwumadu AHN, Carmichael P, Neven P. Tamoxifen and the female genital tract. Int J Gynecol Cancer 1998; 8 : 6–15.
Tamoxifen was originally developed by Imperial Chemical Industries (England) (ICI) in 1966 as an anti-estrogenic contraceptive. Ironically, it found a role in the treatment of anovulatory infertility, but its most important application to date is in adjuvant hormonotherapy for breast cancer. Tamoxifen has a complex and poorly understood mix of estrogenic and anti-estrogenic properties with variable and contrasting effects on hormone-sensitive target tissues, such as the endometrium. This article reviews the gynecologic lesions associated with tamoxifen therapy and discusses the merits and acceptability of endometrial surveillance tests and the role of progestogens.     

女性生殖道畸形新分类

女性生殖道畸形是涉及子宫、宫颈、阴道、输卵管极其广泛的一大类先天性结构异常,且常合并生殖道以外的器官畸形。由于苗勒管（副中肾管）发育与午非管（中肾管）以及泌尿系发育在胚胎早期密切相关,其中以肾脏畸形最为常见。对不同生殖道畸形的分类目前主要取决于结构特征和临床表现,也力求与胚胎发育学相联系,最具代表性的分类法包括美国生育协会（AFS）分类法（1988）、阴道-宫颈-子宫-附件-相关畸形（VCUAM）分类法（2005）和欧洲人类生殖与胚胎学会和欧洲妇科内镜协会（ESHRE/ESGE）的女性生殖道先天异常分类法（2013）。文章将对各自的特点、优点以及局限性进行综述和评论。     

Adenomatoid tumor of the female genital tract

Objective: To remind gynecologists of the diagnosis of adenomatoid tumor of the female genital tract, a pathology which is often mistaken for leiomyoma, and in addition to warn of the malignant appearance of adenomatoid tumor. Materials and methods: During the study period from January 1988 to May 1994, the clinical features and pathologic findings of 25 cases of adenomatoid tumor of the female genital tract were reviewed at the National Taiwan University Hospital. Results: The age of the patients ranged from 26 to 55 years with a median of 41 years. Adenomatoid tumor was an incidental finding during the surgical treatment of myoma (16 cases), cervical intraepithelial neoplasm (two cases), invasive cervical cancer (one case), adnexal cyst (five cases), and pregnancy with myoma (one case). Twenty-three cases had tumors in the uterine corpus and two in the fallopian tubes. Twenty percent of the patients had multiple tumors. Their sizes ranged from 1.0 to 8.0 cm. The case with the largest tumor measuring 8 cm in diameter is presented in detail. Its histologic, immunohistochemical and ultrastructural characteristics strongly support the mesothelial origin of adenomatoid tumor. Conclusion: Some different results were obtained than those hitherto reported in the literature, such as younger age, frequency of multiple tumors, and fewer cases accompanied by leiomyomas.     

Verrucous carcinoma of the female genital tract

Verrucous carcinoma is a variant of epidermoid carcinoma with distinctive clinical and pathologic features. It is a warty, fungating or cauliflower-like tumor that gradually increases in size and usually invades into contiguous structures with a pushing margin rather than by infiltration. To date, 41 verrucous carcinomas involving the cervix, vagina, or vulva have been reported. Three recently observed cases of this rare and distinct entity are presented. The slow-growing insidious nature of verrucous carcinoma along with the great tendency of local recurrence, marked freedom from metastases and lymph node involvement, and poor response to radiation are the chief characteristics of the clinical course of this disease. Both gynecologists and pathologists should be alert to the fact that precise initial diagnosis may be difficult because of the close gross and microscopic similarity to benign squamous papillomas and condyloma acuminata.     

Verrucous carcinoma of the female genital tract

Verrucous carcinoma is a variant of epidermoid carcinoma with distinctive clinical and pathologic features. It is a warty, fungating tumor that gradually increases in size and pushes into rather than invades contiguous structures. The diagnosis is often difficult. Originally, verrucous lesions in the mouth and pharnyx were described. Subsequently, similar lesions in the female genital tract have been encountered. To date, 22 verrucous carcinomas involving the cervix, vagina, or vulva have been reported in the literature. A survey of the members of The Society of Gynecologic Oncologists has added another 10 to the total number of cases. The clinical features, histologic findings, and therapy are discussed.     

Sarcoma botryoides of the female genital tract

Results of treating 14 patients with sarcoma botryoides of the female genital tract are reviewed. Nine patients were younger than four years old and five were older than 14. Primary tumors were in the vagina (eight), cervix (three), vulva (one), and cervicovaginal region (two). All but one patient underwent surgery, including wide local excision (one), vaginectomy (one), hysterectomy (one), hysterectomy and vaginectomy (two), anterior exenteration (two), and total pelvic exenteration (six). A combination of vincristine, actinomycin-D, and cyclophosphamide was the chemotherapy regimen most frequently administered. Only one of the nine patients receiving chemotherapy died from recurrence. One patient with disease too extensive for surgery received intraarterial vincristine and radiation therapy; 16 years later she developed an adenosquamous carcinoma of the uterus. Sarcoma recurred in three patients. This review of patients treated between 1956 and 1983 reflects the evolution of therapy over 30 years. Conservative surgery alone was inadequate; therefore, radical (exenterative) surgery was adopted; recently less extensive surgery has been combined with chemotherapy, producing satisfactory results.     

认识女性生殖道癌肉瘤

女性生殖道癌肉瘤是一类很少见、侵袭性强、易于复发转移、预后差的肿瘤。该类肿瘤包含癌和肉瘤两种恶性组织成分,目前的研究对此类肿瘤的起源更倾向于转化学说,即认为该类癌瘤为单克隆起源,其中肉瘤成分由癌细胞化生为肉瘤样成分。在治疗上,对癌肉瘤首选手术治疗,术后通常需采用辅助化疗和放疗等综合治疗。     

外阴癌前病变的诊断及治疗

外阴上皮内瘤样病变 (vulvarintraepithelialneoplasia ,VIN)是一组外阴上皮内基底膜之上的病变 ,是外阴癌的前期病变。多见于绝经后妇女 ,近年来年轻患者的发病率逐年上升[1,2 ] 。我院 2 0 0 0年 1月至 2 0 0 3年 3月共收治VINⅠⅢ级患者 32例 ,其中年龄最小者 2 2岁 ,年龄最大者 6 8岁 ,平均 35 9岁。1　发病诱因VIN发病与病毒感染、外阴慢性皮肤病、性传播疾病、免疫功能低下及吸烟有关 ,其中以病毒感染和外阴慢性皮肤病关系最为密切[3 ] 。有文献表明 ,近年来年轻患者VIN发病率的逐年上升与人乳头瘤病毒 (HPV)感染有关[4,5] 。…