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PubMedDate not supplied

Simple hysterectomy in the presence of invasive cervical cancer in Iran.

The objective of this study was to determine the reasons leading to an inappropriate simple hysterectomy in the presence of invasive cervical cancer. During 1997-2001, 62 cases of invasive cervical carcinoma that had been treated by simple hysterectomy were referred to the gynecology oncology service in Vali-e-Asr hospital, Tehran, Iran. Five had microinvasive carcinoma. The remaining 57 women had either adenocarcinomas or squamous cell carcinoma (SCC). Medical records were reviewed retrospectively to determine the reasons for inappropriate hysterectomy. Reasons for inappropriate hysterectomy were as follow: lack of preoperative Pap smear (P/S) (29%), deliberate hysterectomy for biopsy-proven cancer (25.8%), negative P/S (6.5%), inadequate evaluation of abnormal P/S (6.5%), failure to perform an indicated conization (3.2%), and emergent operation because of uterine perforation (1.6%). Reasons for inappropriate hysterectomy in the remainder of patients (27.4%) were not found because of lack of sufficient information. Although 45.2% of these patients had complained for vaginal bleeding, only four of them had preoperative endocervical and endometrial sampling. Despite the increasing emphasis on performing cervical cancer screening before hysterectomy, only 18 (29%) referral patients had preoperative P/S. We conclude that by close adherence to the cervical cancer screening guidelines and appropriate evaluation of the presenting symptoms, we may avoid inappropriate management of cervical carcinomas with simple hysterectomy. Many cases of simple hysterectomy in the presence of biopsy-proven squamous cell carcinoma of the cervix necessitates some reconsideration of gynecology oncology postgraduate courses for general gynecologists.

Adenocarcinoma↗
PubMed2001

Adenocarcinoma in situ of the cervix-controversies in diagnosis and treatment.

Adenocarcinoma in situ (AIS) of the uterine cervix is a rare condition. Pap smear screening is unsatisfactory, and the disease has no morphologic reliable colposcopic features. Diagnosis is often made by chance during the treatment of squamous pre-invasive disease, which commonly coexists with AIS. Although the entire endocervical canal can be the site of disease, most lesions lie within 1 cm of the squamocolumnar junction. Skip lesions are rare, making fertility-sparing surgery a possibility under certain conditions. Recurrent disease occurs in 14% of cases when cone margins are free of disease and rise to more than 50% if the margins are involved. The method of conization is immaterial provided a large enough specimen is taken and that the endocervical margins can be evaluated by the pathologist. Follow-up of conservatively managed women is not defined; however, we recommend that regular endocervical cytology be performed in addition to conventional cytology and colposcopy.

Journal Article↗
PubMed1988

[Genital infections and the course of pregnancy: a prospective study].

The reported study investigates the relationship of genital infections, pathobiochemical findings and demographic data to preterm labor, premature rupture of membranes (PROM) and premature delivery. The predictability of chorioamnionitis, puerperal and neonatal infections by these parameters was evaluated concurrently. 301 patients were included in this study between July 1985 and June 1986. 147 of these patients were studied longitudinally during pregnancy, delivery and puerperium (longitudinal group). A second group consisted of 154 women who presented themselves on start of labor to the labor and delivery unit of our Department (peripartal group). The incidence of preterm labor and of PROM was 26%. The incidence of premature delivery, chorioamnionitis, puerperal and neonatal infection was 11.4%, 5.5%, 7.6% and 3% respectively. Cervical colonization with Mycoplasma hominis correlated positively with PROM (relative risk 2.2), premature delivery (3.9) and neonatal infection (6.9). Chorioamnionitis, premature delivery and puerperal infection were also significantly increased in patients with positive vaginal Ureaplasma urealyticum cultures during pregnancy and delivery. Premature delivery (2.8) and puerperal infection (4.0) were associated with a vaginal group B-Streptococci (GBS) colonization during pregnancy, as was a positive GBS culture during delivery associated with puerperal infection. Bacterial vaginosis also correlated positively with premature delivery (5.6) and puerperal infection. Preterm labor correlated negatively with the socioeconomic level, PROM correlated negatively with the marital status, positively with age, a history of cervical cerclage, conization or PROM during former pregnancies. Sexual intercourse more often than once weekly during the last month of pregnancy was also associated with an increased number of PROM. Gardnerella vaginalis, Candida and Trichomoniasis during pregnancy and delivery were associated with preterm labor and puerperal infections. Levels of maternal plasma fibrinogen concentrations in patients with PROM were elevated 48 hours after delivery in accordance to the characteristics of acute phase proteins. In contrast, the maternal PMN-granulocyte-elastase concentration was significantly elevated at time of delivery and 24 hours thereafter in those patients who developed puerperal infections. The derived positive predictive value was 26%, the negative 94.7%, respectively. The overall accuracy of the prediction was 83.1%. Six out of seven mothers with neonates treated because of neonatal infection showed significantly elevated plasma concentration of PMN-granulocyte-elastase.(ABSTRACT TRUNCATED AT 400 WORDS)

Bacterial Infections↗
PubMed1981

[The problem of so-called conservative treatment of the atypical cervical epithelium (author's transl)].

There is an increasing tendency of a so-called conservative treatment of intraepithelial atypia. The new term of cervical intraepithelial neoplasia (CIN) supposedly called for a new concept of treatment. However, the term CIN replaces only the ambiguous terms of Carcinoma in situ and Dysplasia. The term CIN expresses the latter two being principally identical changes that are distinguishable only by differentiation. Persistent dysplasia is nothing but a highly differentiated Carcinoma in situ and must be treated as such. - For final diagnosis of CIN not only the histological pattern must be known but above all the relationship to the stroma and the extent of changes. NEither cytology nor colposcopy and directed biopsy or a combination of these can define the lesions with such accuracy as is necessary as a basis for a really adequate treatment. It could be proved that treatment results of Carcinoma in situ depended on the quality of primary diagnosis. Out of 390 cases that were treated after limited biopsy, eight died of cancer. After treatment of 1012 cases with conization alone there was not one fatal case. The danger of so-called conservative treatment lies not only in unrecognized invasive lesions but above all in preinvasive lesions remaining in deeply situated glands. Their discovery may fail in spite of regular follow-ups. They will reappear possibly only after a long latency period as invasive cancer.

Biopsy↗
PubMed1981

[On the rising operation rate in gynaecology: report on 13 years (author's transl)].

Report on 10,050 gynaecological operations from 1966 to 1978. The operation rate rose from 691 cases in 1966 to 917 cases in 1978. Whereas the rate of vaginal operations remained approximately the same at about 300 cases per year, the rising operative rate consisted of abdominal operations. Contributing were the increasing rate of Caesarean sections, which rose from 2% in 1966, to 8,25% in 1978, and the introduction of diagnostic and therapeutic laparoscopy especially laparoscopic tubal sterilizations. Liberalization of the indications for operation by Kindermann did not occur in our department. A real escalation in the rate of operation did not occur. We do not consider this required nor clinically justifiable. The same is true for our minor gynaecological procedures which did not show significant increases in their rates despite the relative increase in cerclages, conizations and therapeutic abortions. The total mortality was 0.15% and therefore low despite the relatively high incidence of geriatric surgery (9.3%).

Adult↗
PubMed2001

Microsatellite alterations in exfoliated cervical epithelia deoxyribonucleic acid as a marker for high-grade dysplasia.

OBJECTIVE: The purpose of this study was to evaluate the feasibility of the use of deoxyribonucleic acid microsatellite alterations in cervical epithelia in the prediction of high-grade dysplasia and to compare it with a strategy based on human papillomavirus testing. STUDY DESIGN: Our prospective study subjects were from a cohort of 498 women with minimally abnormal Papanicolaou test results including atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion who had documented repeated Papanicolaou and human papillomavirus tests. Of these, 52 eligible patients having conizations or hysterectomies as their histologic outcomes were subjected to tests of loss of heterozygosity on a panel of 5 microsatellites (D3S1110, THRB, D3S1228, D6S291, D3S1289) within the deoxyribonucleic acid of exfoliated cervical epithelia. These genetic alterations were analyzed through fluorescence polymerase chain reaction by comparison of allele ratios of exfoliated cells with those of normal control tissue. Predictive values for high-grade cervical dysplasia and cancer between this deoxyribonucleic acid marker and human papillomavirus status were compared. RESULTS: With the use of loss of heterozygosity in at least one locus for predicting high-grade cervical neoplastic lesion, the sensitivity, specificity, positive predictive value, and negative predictive value were 96.7%, 59.1%, 76.3%, and 92.9%, which were superior to those of the human papillomavirus test (80%, 59.1%, 72.7%, and 92.9%). As a triage for atypical squamous cells of undetermined significance, its sensitivity and negative predictive value were up to 100%. CONCLUSION: The promising results on determining microsatellite alteration in dysplastic lesions might imply that it is possible to detect the earliest changes by potential molecular markers with exfoliated cervical epithelial cells.

Adolescent↗
PubMed2001

Final results of the Cervical Incompetence Prevention Randomized Cerclage Trial (CIPRACT): therapeutic cerclage with bed rest versus bed rest alone.

OBJECTIVE: To compare preterm delivery rates (before 34 weeks of gestation) and neonatal morbidity and mortality in patients with risk factors or symptoms of cervical incompetence managed with therapeutic McDonald cerclage and bed rest versus bed rest alone. STUDY DESIGN: Cervical length was measured in patients with risk factors or symptoms of cervical incompetence. Risk factors for cervical incompetence included previous preterm delivery before 34 weeks of gestation that met clinical criteria for the diagnosis of cervical incompetence, previous preterm premature rupture of membranes before 32 weeks of gestation, history of cold knife conization, diethylstilbestrol exposure, and uterine anomaly. When a cervical length of <25 mm was measured before a gestational age of 27 weeks, a randomization for therapeutic cerclage and bed rest (cerclage group) or bed rest alone (bed rest group) was performed. The analysis is based on intention to treat. RESULTS: Of the 35 women who met the inclusion criteria, 19 were allocated randomly to the cerclage group and 16 to the bed rest group. Both groups were comparable for mean cervical length and mean gestational age at time of randomization, mean overall 20 mm and 21 weeks. Preterm delivery before 34 weeks was significantly more frequent in the bed rest group than in the cerclage group (7 of 16 vs none, respectively; P =.002). There was no statistically significant difference in neonatal survival between the groups (13 neonates survived in the bed rest group vs all in the cerclage group). The compound neonatal morbidity, defined as admission to the neonatal intensive care unit or neonatal death, was significantly higher in the bed rest group than in the cerclage group (8 of 16 vs 1 of 19, respectively; P =.005; RR = 9.5, 95% CI, 1.3-68.1). CONCLUSIONS: Therapeutic cerclage with bed rest reduces preterm delivery before 34 weeks of gestation and compound neonatal morbidity in women with risk factors and/or symptoms of cervical incompetence and a cervical length of <25 mm before 27 weeks of gestation.

Bed Rest↗
PubMed2002

Recrudescence of cervical dysplasia among women who are infected with the human immunodeficiency virus: a case-control analysis.

OBJECTIVE: The purpose of this study was to compare the recurrence rates of cervical dysplasia after ablation therapy and hysterectomy for women who are positive for the human immunodeficiency virus and for women who are negative for the human immunodeficiency virus. STUDY DESIGN: Forty-three women who were positive for the human immunodeficiency virus were compared with 103 patients who were negative for the human immunodeficiency virus after cryotherapy, laser ablation, loop electrosurgical excision procedure, conization, and hysterectomy for cervical dysplasia. All patients were followed up for at least 24 months. Patients with preexisting cervical cancer or with positive margins after treatment were excluded. RESULTS: Recurrence was higher in the HIV positive group for all modalities (73% vs 27%; P =.019). Higher recurrence rates were seen with CD4 counts <200 cells/mm3 (55% vs 26%). CONCLUSION: Hysterectomy fared better than standard therapy (50% vs 86%), but recurrences were significant.

CD4 Lymphocyte Count↗
PubMed1990

Pregnancy after laser therapy for the treatment of uterine cervical neoplasia.

Three hundred and twenty-four patients with cervical intraepithelial neoplasia (33 mild dysplasia, 109 moderate dysplasia, 118 severe dysplasia, 64 carcinoma in situ) underwent laser vaporization with the CO 2 laser. Eighty-two patients with CIN (mild dysplasia 7, moderate dysplasia 10, severe dysplasia 16, carcinoma in situ 46) and microinvasive cancer (3) underwent laser excisional conization with the YAG laser. Their first cure rates showed 93.5% and 98.8%, respectively, for the follow-up period 6 months to 7 years. During the same period, 36 pregnancies in 34 patients occurred. Of these patients, 14 underwent dilatation and curettage, 6 terminated by spontaneous abortion in the first trimester and 1 in the second trimester (previous MacDonald's suture), and 1 had fetal death at 13 weeks of gestational age. There were 13 deliveries, 2 by cesarean section (either postenucleation of uterine myoma or premature rupture of the membranes and fetal distress), 3 by vacuum extraction, 1 by breech delivery, and 7 by normal vaginal delivery. One patient is currently in her 22nd week of pregnancy. Our laser therapies are good conservative methods for the treatment of CIN because of favorable cure rates and no effect on succeeding pregnancy and delivery.

Adult↗
PubMed1992

Clinical investigation with KTP/YAG laser for lower genital tract disease.

The KTP/YAG laser (Laserscope) was clinically investigated in treatment of 54 patients, 28 of whom had cervical intraepithelial neoplasia (CIN), 11 who had cervical polyp, 4 with cervical myoma, 9 with condyloma acuminata, and 2 with vulvar tumors. All patients were treated on an outpatient basis with local anesthesia. The procedure was performed in contact and noncontact irradiation modes with the tissue by using a bare fiber held in a handpiece with a power setting of 10-15 watts. Laser excisional conization was carried out for the treatment of CIN, laser excision was used for the treatment of condyloma of the cervix, cervical polyp, cervical myoma, and benign tumor of the vulva, and laser vaporization was used for condyloma of the vulva. The first cure rates were all satisfactory for the follow-up periods of 4-10 months. Complications during and post operation were minimal. The KTP laser provided good vaporizing ability compared with CO 2 and YAG lasers. When massive bleeding occurred which could not be stopped with the KTP laser, the YAG laser was used.

Evaluation Studies as Topic↗
PubMed1990

Conservative treatment of CIN: a review.

This review examines the indications for and the various therapeutic techniques used in the management of CIN. There is an extensive review of the literature. We believe that conization should be the long-term therapy of choice in over 90% of patients with CIN.

Carcinoma in Situ↗
PubMed1994

Sampling of radical prostatectomy specimens. How much is adequate?

Prostate glands from 52 patients with clinical stage B carcinoma were examined using two sampling techniques. After fixation and conization of the apical portions, each gland was serially sectioned with sections mounted whole on oversized glass slides and examined for pathologic features of prognostic importance. A second examination was subsequently conducted on the same tissue using only alternate sections. No differences in tumor type, grade, Gleason score, multiplicity, or capsular penetration were detected in 75% of cases. The discrepancies that did occur were most often minor variations in multiplicity and Gleason score. Of the 20 glands with capsular penetration observed with the serial sectioning method, 17 (85%) were detected using alternate sectioning. The surgical margin was involved in two of the three invasive foci that would have been missed. Although the topography is better displayed, the authors' examinations indicated no significant advantage to whole mount sections compared with sections mounted on standard-sized glass slides. Considering the most effective use of resources, as well as the current modalities available for patient monitoring, the results support the use of an alternate sectioning method for pathologic examination of specimens removed for clinically localized prostate cancer.

Carcinoma↗
PubMed1975

In-situ and microinvasive adenocarcinoma of the uterine cervix. A clinical, cytologic and histologic study of 14 cases.

In-situ and microinvasive adenocarcinoma of the uterine cervix. A clinical, cytologic and histologic study of 14 cases. Am J Clin Pathol 64: 155-70, 1975. The clinicopathologic features of 14 cases of in-situ and microinvasive adenocarcinoma of the cervix, encountered during the period 1961-1974, form the basis of this report. Seven cases represent examples of in-situ and seven, microinvasive adenocarcinoma. Severe dysplasia and carcinoma in-situ of the squamous epithelium were coincidental finds in 12 patiients. Papanicolaou smears were abnormal in all 14 patients. In nine, malignant glandular cells were identified. Five smears contained both malignant squamous and glandular cells. The mean age of the 14 patients was 38.4 years. Thirteen patients had borne one to six children. Two were pregnant at the time of diagnosis, and four were on birth control medication. Thirteen of the patients underwent conization biopsy. Hysterectomy in one form or another was curative in all. The relatively infrequent occurrence of in-situ adenocarcinoma is probably due to the low incidence of cervical adenocarcinoma and to the fact that the lesion is focal and easily overlooked. Five of the cases in the present series were a chance finding in a review of 200 consecutive cone biopsies of the cervix. The resemblance of the in-situ lesions to carcinoma and the presence of morphologically similar glandular tissue adjacent to foci of microinvasion suggests that the in-situ lesion is the precursor of invasive adenocarcinoma of the cerivs.

Adenocarcinoma↗
PubMed2005

Fertility-sparing surgery for malignancies in women.

Never before have women with newly diagnosed gynecologic malignancies had more options for preservation of fertility. Girls or women of childbearing age with several ovarian cancer subtypes have a high probability of unilateral ovarian involvement, and, thus, may be candidates for fertility-sparing surgery with preservation of a contralateral normal ovary and uterus. These subtypes include ovarian tumors of low malignant potential, malignant ovarian germ cell tumors, and ovarian sex cord-stromal tumors. For women with invasive epithelial ovarian cancer who have early-stage disease, fertility-sparing surgery may be an option. In some cases, fertility-sparing surgery may be followed by postoperative chemotherapy. For women with invasive cervical cancer, fertility-sparing surgery may be possible. Options include conization alone for stage IA1 or IA2 disease, radical trachelectomy with stage IA2 or IB disease, or ovarian transposition for women undergoing chemoradiation. Non-operative options, such as hormonal therapy, may be considered for women with early-stage, low-grade endometrial cancer. For all women of childbearing age with gynecologic malignancies, in vitro fertilization techniques or cryopreservation of ovarian tissue may be an option prior to definitive treatment.

Adult↗
PubMed1988

Cervical surgery in infertility.

We wish to stress three original techniques among the numerous operations which can be performed on the uterine cervix for the treatment of infertility. The first treatment is for cervical dysplasia of the cervix, a conization performed by electrosurgery under local anaesthesia, using a metallic handle of 23 mm, associated with vaporization by a CO2 laser at the edges of the resection. This technique, used for 125 patients, has permitted adequate resection. The rate of incomplete resection is less than 10%. This method has preserved the possibility of pregnancies without abortion. The second technique is the surgical repair of a large post-obstetrical split of the cervix by an abdominal exposure. After dissection of the bladder, the vagina is opened longitudinally, the cervix exposed and repaired carefully. Four patients who had previously had four to six abortions between 4 and 6 months of gestation, succeeded in achieving a full-term pregnancy by this technique. The third technique is the resection of the isthmic septum by microscissors or micro-electrocautery under local or general anaesthesia by hysteroscopy. Twelve cases, five with primary infertility, seven with second infertility and habitual abortions, were operated on by this technique in 1986-87. Four pregnancies have resulted.

Adult↗
PubMed1990

Cystic endocervical tunnel clusters. A clinicopathologic study of 29 cases of so-called adenomatous hyperplasia.

The clinical and histologic features of cystic endocervical tunnel clusters (CETC) are not well known. Unwary pathologists have sometimes mistaken CETC for endocervical adenocarcinoma or interpreted them as "adenomatous hyperplasia." In this study, CETC were identified in 19 (5.9%) of 322 consecutive hysterectomy specimens and three (9.7%) of 31 consecutive cervical conization specimens accessioned during a 1-year period. These 22 cases were analyzed along with seven consultation cases. The 29 patients' ages ranged from 33 to 72 years (mean, 55). All but one (96.6%) were multigravida. Almost 80% of the patients had had at least three previous pregnancies. The mean gravidity and age of the hysterectomy patients with CETC were significantly greater than those without them. CETC typically were discovered incidentally during routine examination of the cervix. The clusters ranged from 0.5 to 18.8 mm (mean, 2.4 mm) in greatest dimension; they were multifocal in 82.8% of cases. CETC consisted of orderly, lobular aggregates of closely packed, dilated tubular endocervical "glands" within the superficial endocervix. The deepest clusters extended to a depth of 9.0 mm. They were commonly associated with multiple Nabothian cysts, which occasionally also penetrated deeply. The lining epithelium was a single layer of flattened or cuboidal endocervical cells. Mitotic figures and significant cytologic atypia were absent. None of the cases had intracytoplasmic CEA immunoreactivity, but in 52% focal positive CEA staining was noted along the luminal border of the endocervical cells. CETC are believed to result from subinvolution of previous episodes of physiologic hyperplasia of the endocervical mucosa, usually due to prior pregnancies. They are unrelated to cervical neoplasms and must be distinguished from adenocarcinoma and other glandular lesions of the endocervix.

Adult↗
PubMed1992

Surgery for gynecologic malignancies.

The surgical management of invasive and preinvasive gynecologic malignancies continues to evolve at a brisk pace. Several good techniques are available for the treatment of preinvasive cervical disease, including cryotherapy, loop electrocautery excision, laser therapy, and standard knife conization. The use of radical surgery for early invasive cervical cancer has been extended to older women, and complications have been minimized. There has been a significant trend toward more conservative surgery in the management of invasive vulvar cancer. The new surgical staging system for endometrial cancer has generated much controversy. The importance of thorough surgical staging for ovarian cancer is clear, and our understanding of the role of cytoreduction has increased. The role of new techniques, including operative laparoscopy, is being defined in the management of gynecologic cancers.

Endometrial Neoplasms↗
PubMed1998

Surgery for gynecologic malignancies.

Surgery continues to play a primary role in the investigation and treatment of gynecologic neoplasia. Cold-knife conization is still preferable for diagnosis and treatment of more problematic preinvasive cervical lesions. Newer reconstructive techniques can improve quality of life in exenteration patients. Efforts continue to reduce morbidity associated with vulvar surgery and groin node dissection. Accurate staging and maximum cytoreduction remain essential goals in primary surgery for ovarian cancers. The utility of secondary surgery for disease assessment or further treatment is controversial. Laparoscopy at present has a limited role in gynecologic oncology but may be useful for prophylactic oophorectomy in selected individuals.

Endometrial Neoplasms↗