Occult uterine leiomyosarcoma in women undergoing abdominal and minimally invasive surgeries for myomas

Objectives: To estimate (i) the incidence of occult uterine leiomyosarcoma (LMS) in patients operated on for presumedmyomas, and (ii) the proportion of occult LMS to preoperatively diagnosed LMS in a tertiary center.Material and methods: An Institutional Review Board-approved retrospective cohort study was performed. The electronicdatabase of 30,476 patients was searched for women who had undergone surgery due to presumed myomas (N = 2675) as well as those with uterine LMS recognized via histology (N = 10) between January 2010 and December 2016.Results: Six of the 2675 treated women had occult LMS (incidence 1:446; 0.002; CI 0.0–0.013), and one underwent power morcellation (incidence 1:951; 0.001; CI 0.0–0.006). Parallel searching revealed that 6 of the 10 cases (60%) with uterine LMS recognized via histology were diagnosed postoperatively, whereas 4 of the 10 (40%) were diagnosed preoperatively. The incidence of LMS morcellation during laparoscopy was 1:951 and, when all MIS cases were included, 1:1178. The patient who underwent LMS morcellation was operated in the general surgery ward 5 years after laparoscopy (omental recurrence).Conclusions: These results are similar to the first and recent conservative FDA estimations, but two-times lower forprocedures with laparoscopic morcellation and all MIS procedures than for abdominal. Because above half of LMS may be recognized after surgery, the risk of occult LMS and the delay of targeted surgical treatment should be included in all informed consent forms for conservative management of presumed myomas without histology

Evaluation of the effectiveness of histopathological verification of the endometrium by means of an outpatient aspiration biopsy

Cele badań: 1) Sprawdzenie skuteczności ambulatoryjnej biopsji aspiracyjnej z jamy macicy w uzyskiwaniu satysfakcjonującego materiału do oceny. 2) Badanie czynników ryzyka uzyskania niediagnostycznego materiału. 3) Poszukiwanie wzorców obrazu ultrasonograficznego według systemu International Endometrial Tumor Analysis, które mogą przemawiać za potencjalną nieskutecznością biopsji. 4) Ocena skuteczności biopsji ambulatoryjnej w wykrywaniu raka endometrium. Materiał i metody: Obserwacyjne badanie prospektywne na niewyselekcjonowanej populacji kobiet zgłaszających się do poradni ginekologicznej podejrzanych o patologie endometrium. Wyniki: Przeanalizowano 116 biopsji aspiracyjnych endometrium. Diagnostyczny wynik histopatologiczny udało się uzyskać w 100 przypadkach (86,2%). Nie wykazano istotności statystycznej w uzyskiwaniu niediagnostycznego wyniku biopsji w aspekcie statusu menopauzalnego, obecności mięśniaków macicy, występowania nieprawidłowych krwawień macicznych, wieku, grubości endometrium oraz liczby przebytych porodów. Uzyskano dużą różnorodność obrazów ultrasonograficznych według parametrów International Endometrial Tumor Analysis. Nie stwierdzono jednoznacznie dominujących wzorców parametrów ultrasonograficznych endometrium u pacjentek z niediagnostycznym wynikiem biopsji. U wszystkich (100%) badanych w wieku pomenopauzalnym z nieprawidłowymi krwawieniami macicznymi w wywiadzie ujawniono raka endometrium. Średnia grubość endometrium w tej grupie była istotnie statystycznie największa: 16,2 mm (4-22,3 mm) (p = 0,025). Wnioski: Ambulatoryjna biopsja aspiracyjna endometrium jest skutecznym, mało obciążającym postępowaniem w przypadku stwierdzenia wskazań do weryfikacji histopatologicznej endometrium.Objectives: 1) Examining the effectiveness of an outpatient aspiration biopsy from the uterine cavity in the context of satisfactory sampling. 2) Assessing risk factors of obtaining a non-diagnostic sample. 3) Search for ultrasound image patterns according to the International Endometrial Tumor Analysis that may indicate potential ineffectiveness of the biopsy. 4) Assessment of effectiveness of an outpatient biopsy in detection of endometrial cancer. Methods: Observational prospective study on a non-selected population of women suspected of endometrial pathologies. Results: 116 endometrial aspiration biopsies have been analyzed. Diagnostic histopathological samples were obtained in 100 cases (86.2%). There was no statistical significance in obtaining a non-diagnostic result of a biopsy in terms of the menopausal status, presence of uterine fibroids, occurrence of abnormal uterine bleeding, age, endometrial thickness and the number of deliveries. A large variety of ultrasound images were obtained according to the International Endometrial Tumor Analysis parameters. There were no clearly dominant patterns of endometrial ultrasound parameters in patients with non-diagnostic biopsy results. 100% of endometrial cancer cases were reported in postmenopausal patients with the history of abnormal uterine bleeding. The mean thickness of the endometrium was statistically the largest in this group: 16.2 mm (4-22.3 mm) (p = 0.025). Conclusions: An outpatient endometrial aspiration biopsy is an effective, low-impact procedure in case of indications for histopathological assessment of the endometrium

Ovarian reserve assessment in women with different stages of pelvic endometriosis

Introduction: Endometriosis is defined as the appearance of ectopic endometrial cells outside the uterine cavity. Ectopic cells demonstrate functional similarity to eutopic cells, but structural and molecular differences are significant and manifest themselves in gene expression of the metalloproteinase genes, integrin or the Bcl-2 gene. Pelvic pain remains to be the main symptom of the disease. Endometriosis may cause dysfunction of the reproductive system and lead to infertility. Pathogenesis of infertility in endometriosis is based on its influence on the hormonal, biochemical and immunological changes in the eutopic endometrium, as well as structural damages of the ovaries and the fallopian tubes. Objectives: The aim of the study was to assess the ovarian reserve in patients with endometriosis. Material and methods: A total of 39 patients (aged 22-34 years) with different stages of endometrial changes were recruited for the study. The number of antral follicles was rated by vaginal ultrasonography and the level of FSH was measured between days 1-3 of the menstrual cycle. The stage of the disease was established after laparoscopy with the rASRM scale. Results:No statistically significant correlation between the number of follicles(AFC), the level of FSH and the stage of endometriosis was found. Conclusions: Evaluation of the number of antral follicles and measurements of the FSH level do not allow to predict the ovarian reserve in women with endometriosis

Treatment efficacy for pain complaints in women with endometriosis of the lesser pelvis after laparoscopic electroablation vs. CO_{2} laser ablation

Endometriosis is a chronic disease affecting mainly women of the reproductive age. Its most common manifestations include impaired fecundity, pelvic pain, and dyschezia. Laparoscopic removal of endometriotic foci remains to be the gold standard for the treatment of endometriosis. More effective techniques of endoscopic approach—among others, laser application—are continually being developed. The aim of the study was to evaluate the efficacy of laparoscopic treatment with the use of CO(2) laser ablation vs. electroablation with regard to pain complaints in the affected patients. The study included 48 women (aged 22–42) with varying degrees of endometriosis of the lesser pelvis. The Numeric Rating Scale (NRS) was used to evaluate pain intensity before the surgery in all patients, followed by either laser ablation or electroablation of the endometriotic foci. The results of the laparoscopic treatment were monitored after 3 and 6 months postoperatively. p value of 0.05 was considered to be statistically significant. Patients from both groups reported less intensive pain before/during menstruation (dysmenorrhea) 6 months postoperatively, with more distinct tendency in the electroablation group (p = 0.004) as compared to the laser ablation group (p = 0.025). Despite the initial improvement reported at the 3-month checkup (p = 0.008), 6 months postoperatively, a statistically significant increase in pain intensity was noted in both groups (p = 0.016 and p = 0.032 for CO(2) laser ablation and electroablation, respectively). Both surgical methods seem to be effective only in the treatment of endometriosis-related dysmenorrhea, whereas the intensity of other pain complaints (dyspareunia, dysuria, dyschezia, pelvic pain syndrome (PPS)) has remained on the same level

Role of morphologic characteristics of the uterine septum in the prediction and prevention of abnormal healing outcomes after hysteroscopic metroplasty

STUDY QUESTION: Can morphologic measurements (width, length and surface area) of the uterine septum predict healing-dependent abnormal anatomic results [ARs; residual septum (RS) and intrauterine adhesions in other locations (IUA-OLs)] after complete hysteroscopic metroplasty (HM)? SUMMARY ANSWER: Significant predictors of ARs are the septal width and, to a lesser extent, septal surface area. WHAT IS KNOWN ALREADY: Anatomic results after hysteroscopic metroplasty have very large variation. A RS >1 cm and IUA-OLs can aggravate reproductive outcomes, resulting in the need for reoperation. New criteria for diagnosing a uterine septum according to the European Society of Human Reproduction and Embryology (ESHRE) and European Society for Gynaecological Endoscopy (ESGE) have been suggested (ESHRE-ESGE criteria). Autocross-linked hyaluronic acid gel (autocross-linked polysaccharide) has an antiadhesive effect. STUDY DESIGN, SIZE, DURATION: A prospective, observational cohort study was performed with 96 women consecutively enrolled between 2007 and 2012. PARTICIPANTS/MATERIALS, SETTING, METHODS: Women who had uterine septum and previous miscarriage or infertility presented for evaluation at a university hospital, private hospital or private medical center were included. Preoperative septal width, length and surface area were determined with three-dimensional sonohysterography. Women were treated by hysteroscopy in a standardized manner with three- or four-dimensional transrectal ultrasound guidance (complete resection). Patients received either no adhesion barrier (49 patients) or adhesion barrier with autocross-linked polysaccharide (47 patients). Anatomic results were assessed with three-dimensional sonohysterography and second-look hysteroscopy. Healing-dependent ARs were reported using both American Society of Reproductive Medicine (ASRM) criterion of RS length >1 cm (ASRM>1 cm criterion) and ESHRE-ESGE criteria. Univariate and multivariate logistic regression were used to identify predictors of RS, IUA-OLs and ARs. MAIN RESULTS AND ROLE OF CHANCE: In patients who had no adhesion barrier, ARs were diagnosed in 11 of 49 patients (23%) using the ASRM > 1 cm criterion and in 20 of 49 patients (41%) using the ESHRE-ESGE criteria for RS [odds ratio (OR)(ESHRE-ESGE:ASRM), 2.4, P = 0.05]. In the patients who had autocross-linked polysaccharide, ARs(ASRM) (>) (1 cm) were diagnosed in 2 of 47 patients (4%) and ARs(ESHRE-ESGE) in 4 of 47 patients (9%). RS(ESHRE-ESGE) was diagnosed significantly more often than RS(ASRM) (>) (1 cm) 19 of 96 (20%) versus 5 of 96 (5%) in all patients (OR(ESHRE-ESGE:ASRM) (>) (1 cm) = 4.5, P < 0.01). In patients who had no adhesion barrier, logistic regression with ASRM > 1 cm and ESHRE-ESGE criteria showed that the width and surface area were predictors of ARs. Models adjusted by patient group confirmed the significance of width as a predictor of ARs(ASRM) (>) (1 cm) [OR for width, 3.5 (P < 0.01); OR for group, 0.22 (P < 0.01)], width as a predictor of ARs(ESHRE-ESGE) [OR for width, 2.2 (P < 0.01); OR for group, 0.26 (P < 0.01)] and surface area as a predictor of ARs(ASRM) (>) (1 cm) [OR for surface area, 1.5 (P < 0.01)]; OR for group, 0.32 (P < 0.01). In patients who had autocross-linked polysaccharide, these predictors were not significant. Receiver-operating characteristic curves showed cutoff values for ARs(ASRM) (>) (1 cm) (septal width, 3.42 cm; septal surface area, 4.68cm(2)) and ARs(ESHRE-ESGE) (septal width, 3.42 cm; septal surface area, 3.51cm(2)). LIMITATIONS AND REASONS FOR CAUTION: Patients were enrolled in the adhesion barrier group in a time-dependent, consecutive and non-randomized manner. WIDER IMPLICATIONS OF THE FINDINGS: A wide septum and large surface area may be indications for adhesion barrier. The use of autocross-linked polysaccharide reduces the risk of ARs. The ESHRE-ESGE criteria may cause greater frequency of recognition of RS than the ASRM > 1 cm criterion, which could result in more frequent reoperations with use of the ESHRE-ESGE criteria, possibly without any significant effect on reproductive performance. STUDY FUNDING/COMPETING INTEREST(S): This work was supported by Jagiellonian University (grant no. K/ZDS/003821). The authors have no competing interest to declare