Comparison of repeat smear, colposcopy, and colposcopically directed biopsy in the evaluation of the mildly abnormal smear

Repeat smear, colposcopy, and colposcopically directed biopsy were performed in 161 patients referred to our department because of a Pap smear showing mild dysplasia (CIN 1). Colposcopically directed biopsies revealed the presence of CIN of different grades in 61 cases (37.5%). In 33 (20.4%) the CIN grade found at biopsy was higher than 1. Repeat smear confirmed the presence of CIN 1 in 67 women (47.2%). In this group of patients colposcopically directed biopsies showed a CIN grade greater than 1 in 12 cases (17.9%). The repeat smear was negative in 59 patients (41.5%). In this group, biopsy showed varying grades of neoplasia in 12 cases. Colposcopic examination indicated no dysplasia but the presence of minor cervical abnormalities in 76 women (47.2%): at biopsy a CIN grade higher than 1 was found in 9 cases (11.5%). These data suggest that the mildly atypical smear identifies a group of patients at increased risk of CIN but gives little or no information on the disease severity. Repeat smear and colposcopic examination alone appear inadequate to demonstrate the severity of the cervical lesion. Due to the high proportion of CIN 2 and 3 in patients with a mildly abnormal smear, the systematic biopsy of any colposcopically abnormal area seems essential to proper management of the patient.

Successful pregnancy in a patient with congenital partial cervical atresia

Successful pregnancy in a patient with isolated congenital partial cervical atresia is reported for the second time. She presented with primary amenorrhea, abdominopelvic pain, and endometriosis. After a late diagnosis, successful repair of the cervix, and multiple treatments for endometriosis, she eventually conceived. The pregnancy was complicated by repeated antepartum hemorrhage and complete placenta previa. A normal male infant was delivered by elective cesarean section.

Twin pregnancy in the right horn of a uterus didelphys: a case report

A rare case of a twin pregnancy occurring in the right horn of a uterus didelphys (double uterus, double cervix and septate vagina) is reported. The occasional diagnosis of this uterine anomaly was made after the pregnancy was detected. Both embryos, with cardiac actions which proved the viability of the gestation from the very early stage of pregnancy, were detected by transvaginal ultrasonography. Two male infants were delivered by Cesarean section in the 34th week. The importance of the transvaginal sonography and the handling of the case during this high-risk pregnancy are reported.

Cervical and vaginal agenesis: a case report

An 18-year-old single female presented with primary amenorrhea and cyclic lower abdominal pain. Pelvic examination revealed normal appearing external genitalia but absent vagina. Pelvic sonogram was compatible with cervical and vaginal agenesis, which was confirmed at operation. Hysterectomy and construction of a new vagina by the McIndoe's technique were performed. Clinical features and management of this rare Mullerian anomaly were reviewed and discussed.

Surgical reconstruction of the congenitally atretic cervix: two cases

Two patients diagnosed at the University of Missouri Hospital underwent reconstructive surgery utilizing the atretic cervix as a conduit for the formation of an endometrial-vaginal fistula. A total of three surgeries was performed with both patients experiencing the onset of cyclic menses. One patient, followed for 22 years, never attempted to conceive and eventually succumbed to hysterectomy for pelvic pain and endometriosis. The other has been followed for 44 months and continues to have regular menses with mild dysmenorrhea. Less than 50 cases of congenital cervical atresia have been reported in the literature. The operative procedures and literature experience are provided.

Uterus didelphys with obstructed hemivagina and pyocolpos, ipsilateral tubal occlusion and renal agenesis, and bilateral cervical hypoplasia. A case report

The diagnosis of uterus didelphys with an obstructed hemivagina and ipsilateral renal agenesis is uncommon prior to menarche. The rarity and unusual presentation of the condition may contribute to a diagnostic delay for months to years after menarche. We encountered such a patient, who also had a microscopic communication between the uterine horns, hypertrophy of the right uterine horn, apparent ipsilateral occlusion of the fallopian tube and bilateral cervical hypoplasia, a finding not previously noted in similar cases. The inability to utilize the cervix as a landmark, associated findings and the presence of chronic inflammation precluded definitive treatment during initial hysteroscopy and laparoscopy. Laparotomy was performed to fully ascertain the status of the right uterine horn and to determine which structures to resect.

[A case report of cervical agenesis combined with vaginal agenesis diagnosed by MRI]

This disease was reported 46-cases in the world literature. We stressed that the diagnosis of a cervicovaginal atresia by MRI offer this advantage of diagnosis in a noninvasive manner prior to surgical intervention.

Hysterosalpingographic diagnosis of a single cervical ectopic ureter

Single ectopic ureters terminating in the female genital tract are rare congenital anomalies caused by an abnormally lateral origin of the ureteric bud from the mesonephric duct in the three- to four-week embryo. The ureter remains intimately involved with mesonephric duct remnants, which acquire a communication with müllerian structures. Hysterosalpingography in a continent infertile patient outlined a single cervical ureter from a hypoplastic kidney draining into Gartner's duct remnants. No previous case of single cervical ectopic ureter has been reported without a müllerian anomaly, nor has a single cervical ureter been demonstrated on hysterosalpingography.

Communicating uteri: description and classification of a new type

A case of bicornuate-bicervical communicating uterus with atresia of the right hemicervix is reported. This cannot be included in any of the nine groups of Toaff's classification of uterine malformations proposed in 1984, and should be classified as a new, tenth type.

Pregnancy following repair of a congenital atresia of the uterine cervix and upper vagina

A case of congenital atresia of the uterine cervix combined with atresia of the upper vagina and without any other anomalies is reported. Direct anastomosis of cervix and vagina resulted in a restoration of reproductive function. The patient conceived 6 years afterward and delivered a healthy boy by cesarean section at 31 weeks of gestation. Therapeutic reconstructing options for this kind of genital tract malformation with respect to reproductive function are discussed.

[Cervical and high vaginal aplasia with a functioning uterus. Surgical technic]

The authors describe the conservative surgical treatment of a cervical and high vaginal aplasia with functional uterus. They insist on complete resection of the aplasic area, key of the utero-vaginal continuity.

Genital tract reconstruction in a patient with congenital absence of the vagina and hypoplasia of the cervix

A 15-year-old female presented with congenital absence of the vagina and a blind ending hypoplastic cervix. The uterine cavity appeared normal by ultrasound examination, and the patient experienced molimina. Cognizant of risks and failures of described attempts at correction, reconstruction was performed using a series of stents covered with skin grafts. At 21 months postoperatively, the patient now has a functioning vagina and menstruates regularly. The desire to avoid a hysterectomy coupled with new alternatives in the management of the infertile patient resulted in the approach described.

An update on DES in the field of reproduction

The general consensus is that a DES daughter is about 35% less likely than a non-DES-exposed woman of equivalent age and health to have a noneventful pregnancy. It is important to state that fertility rates refer to couples. The male partner is responsible for 40% to 50% of infertility problems. Age is also an important factor, and female fertility is known to decrease with age from the early 20s. These two factors receive little consideration in most articles. However, it can be said that if there are no marked congenital anomalies present in the cervix and the uterus, then the probability that a DES-exposed daughter will have a normal child is quite good.

Bilateral and synchronous squamous cell carcinoma of the cervix in a patient with uterus didelphys

Reported herein is the case of a 30-year-old white woman who had a congenitally double uterus with two cervixes (uterus didelphys). Each cervix was diffusely involved by squamous cell carcinoma in situ that had progressed to a microinvasive stage of the same depth (0.8 mm) on each side. This coincidence was the more remarkable because it had taken place synchronously. A transmissible coital factor of a viral nature, ie, human papillomavirus infection, was suggested by the presence of koilocytotic atypia in both uterine cervixes.

Vaginoplasty using amnion

Fifteen patients with various developmental and acquired abnormalities of the vagina were treated by the application of human amnion over a mold after surgical dissection of a space for the new vagina or enlargement of an existing but strictured one. Excellent results were achieved in cases of complete and partial vaginal agenesis, and there was improvement in all of the patients with vaginal strictures.

Hysteroscopic treatment of the septate uterus

Twelve patients with symptomatic septate uteri underwent hysteroscopic division of the uterine septum, monitored by concomitant laparoscopy, over a six-year period. The preoperative reproductive performance included 42 pregnancies, with only three viable deliveries. Ten of the 12 patients conceived within one year after therapy, and eight of these patients delivered a live infant at term. Two patients had a spontaneous abortion at six and eight weeks after therapy, respectively, but in each, a subsequent pregnancy was carried to term. Three patients are currently pregnant (eight, 12, and 18 weeks). Two patients have not as yet conceived. Two patients required a second hysteroscopic operation because a partial residual septum was observed on the posttreatment hysterogram.

[Colposcopy in dysplasia, carcinoma in situ and microinvasive cancer of the cervix--systematic diagnosis]

Recently colposcopy has come to be increasing used in the diagnosis of the early cervical cancer. We studied colposcopic findings (epithelial, vascular and glandular findings) of dysplasia, carcinoma in situ and microinvasive cancer of the uterine cervix. The results were as follows. We could classify the cases without white epithelium into microinvasive cancer and carcinoma in situ according to elevation or hollowness and roughness and the cases with I grade white epithelium (thin white epithelium) into severe dysplasia and mild or moderate dysplasia according to the existence of elevation, roughness, II type vessels and elevation of gland opening. Among the cases with II grade white epithelium (thick white epithelium) those without roughness, II type vessels and increased gland opening were mild or moderate dysplasia and most case with III or IV type vessels were microinvasive cancer. We concluded that more than half of the cases without III or IV type vessels spread to transverse pollution of white epithelium and lack or indefiniteness of gland opening, severe dysplasia with 0 finding, carcinoma in situ with 1 or 2 finding and microinvasive cancer with 3 findings. With these criteria, we were able to obtain high (93.4% with mean) correct diagnostic ratios.