Operative treatment of gynaecologic diseases in puberty: seven years of experience

PURPOSE OF INVESTIGATION

The aim of this study is to present the incidence and surgical management of gynaecologic pathology in adolescence in the 1st Obstetrics and Gynecology Department of Aristotle University of Thessaloniki.

METHODS

After a retrospective review of the medical records of over a seven year period (2004-2011), 32 adolescent patients with reported surgical gynaecologic procedures were identified and analysed.

RESULTS

Fourteen out of the 16 adolescents with ovarian masses (eight neoplastic and eight non-neoplastic) were treated by laparoscopy. Congenital anomalies were diagnosed in seven patients and only one of them was treated by laparotomy. The rest were surgically treated for uterine leiomyoma (1), ectopic pregnancy (2), pelvic abscess (1), mesosalpingeal cysts (2), mesenterian cyst (1) and investigation of chronic pelvic pain.

DISCUSSION

Although benign ovarian cysts and congenital anomalies represent the major indication for operative treatment of gynaecologic diseases in puberty, laparoscopy and/or hysteroscopy should be the gold standard procedure after careful preoperative investigation.

Obstetric outcome in adolescence: a single centre experience over seven years

PURPOSE OF INVESTIGATION

The aim of this study was to compare the obstetric outcome of adolescent pregnant women (aged < or = 18) with the outcome of adult pregnant women who delivered in a tertiary university hospital.

MATERIALS AND METHODS

Delivery files from 2004 to 2011 were reviewed concerning age of the pregnant women, parity, gestational age, mode of delivery and birth weight of the neonates.

RESULTS

During the study period 119 (0.94%) out of 10,483 deliveries were performed in adolescent women. Caesarean section was the mode of delivery in 41 adolescent patients (34.45%), while the corresponding rate was 53.6% (5,556 cases) in adult pregnant women. The preterm labour rate in the adolescent group was 13.44% (16 cases) while in the adult group it was 21% (2,201 cases). The most frequent indication of caesarean section in the adults was previous caesarean section (21%).

DISCUSSION

In adolescent pregnancies the caesarean section rate was lower than in adult pregnancies. As far as the prevalent cause of caesarean section is concerned, it was repeat caesarean section for adults while in adolescents it was failure of labour to progress.

Vulvodynia: a case series of a poorly recognized entity

Vulvodynia remains a poorly recognized entity with unclear pathogenesis. In a case series of six patients with vulvodynia over a five-year period in a tertiary university hospital, we describe the clinical features, the diagnostic procedures, the impact on each patient's emotional status and discuss the necessity and efficacy of the chosen treatment options in accordance with the current therapeutic guidelines.

Hormone therapy for postmenopausal endometrial cancer survivors: a survey among Greek obstetricians-gynaecologists

PURPOSE OF INVESTIGATION

In this study we evaluated the prescription attitude of Greek obstetricians-gynaecologists towards hormone replacement therapy (HRT) for endometrial cancer survivors.

METHODS

An anonymous questionnaire was sent to 900 members of the Hellenic Society of Obstetrics and Gynaecology, presenting a hypothetical case of an endometrial cancer survivor with indications for HRT, followed by a series of relevant questions.

RESULTS

Three hundred and three valid responses were received and analysed according to age, gender and practice setting. HRT would be prescribed by 30.4% of gynaecologists; as far as type of regimen is concerned, 67.4% would prescribe tibolone, 22.8% estrogen-only and 9.8% estrogen plus progestagen. In contrast, 69.6% would not prescribe HRT due to the fear of endometrial cancer recurrence (88.2%), development of breast cancer (2.8%) or both (4.7%); among them, 28.4% would prescribe central nervous system (CNS) medications, selective estrogen receptor modulators (SERMs), phyto-oestrogens or biphosphonates, as alternates.

CONCLUSIONS

One out of three Greek gynaecologists would prescribe HRT to endometrial cancer survivors. Alternative therapies, mainly CNS medications, would be suggested by the opposers.

Comparison of single versus multiple courses of antenatal betamethasone in patients with threatened preterm labor

PURPOSE OF INVESTIGATION

To compare single versus multiple courses of antenatal betamethasone administration with regards to the morbidity and mortality of preterm neonates.

METHODS

One-hundred and twenty-two women with threatened preterm labor were allocated to three different betamethasone schedules: 1) two doses of betamethasone 12 mg, intramuscularly, 24 hours apart (standard treatment) (n = 41); 2) standard treatment plus a third dose of 12 mg after seven days (n = 41); and, 3) standard treatment plus one dose of 12 mg every seven days until delivery (n = 40). Neonatal morbidity and mortality as well as maternal morbidity were evaluated.

RESULTS

Neonatal parameters, such as frequency of respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, sepsis and neonatal mortality were not significantly different among the three groups for both singleton and multiple pregnancies. Similarly, maternal parameters were not significantly different among the three groups.

CONCLUSION

The administration of multiple betamethasone courses in threatened preterm labor is not superior to single courses with regards to neonatal morbidity and mortality, as well as to maternal morbidity.

A rare case of renal cell carcinoma metastasizing to the uterine cervix

Metastatic tumors to the uterine cervix originating from malignancies in other organs are very rare. A case of a 45-year-old white woman presenting with vaginal bleeding, due to renal cell carcinoma metastasizing to the cervix, is reported. The patient had been treated four years and five months earlier due to two primary malignancies: colon adenocarcinoma and renal cell carcinoma. After D&C, microscopic examination and immunohistochemical staining showed that the tumor was metastatic, originating from the renal cell carcinoma. Radical hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph node resection followed, and postoperatively the patient received targeted therapy with sutinib malate. The possibility of metastasis from another primary should be considered in the differential diagnosis of tumors of the uterine cervix in order to plan optimal management.

Primitive neuroectodermal tumor (PNET) of the uterine isthmus

Primitive neuroectodermal tumors (PNETs) of the uterus are very rare. The histogenesis of these tumors is still unknown and the differential diagnosis includes a wide variety of tumor entities. We describe a rare case of a 68-year-old female who presented with persistent vaginal bleeding. Physical examination and CT-scan revealed a large tumor in the uterus. Macroscopically the tumor involved the uterine isthmus. Histological and immunohistochemical examination showed that the tumor fulfilled the diagnostic criteria set for PNET. Only a very small number of cases of PNETs of the uterus have been reported in the literature, thus no definitive conclusions concerning the therapeutic management and prognosis have been ascertained.

Synchronous primary neoplasms of the uterine corpus and the ovary: a case report

OBJECTIVE

To determine the frequency of synchronous primary neoplasia of the ovaries in patients with primary malignant neoplasia of the uterus, and to analyze the clinical and histological characteristics of these cases.

MATERIALS AND METHODS

Clinicopathological data from a series of patients treated for primary malignant neoplasia of the uterus between 1985 and November 2003 have been studied retrospectively.

RESULTS

Synchronous primary neoplasia of the ovaries was found in 13 out of 173 patients (7.5%) treated for primary malignant neoplasia of the uterus. In four patients (2.3%) the histological findings suggested ovarian metastases from primary endometrial adenocarcinoma. In four other cases (2.3%) there was extension of the primary uterine sarcoma to the ovaries. In the remaining five cases (2.9%) primary endometrial adenocarcinoma coexisted with: a) ovarian cystadenocarcinoma in two cases, b) ovarian fibromathecoma in two cases, and c) ovarian tumor of borderline malignancy in one case.

CONCLUSIONS

Coexistence of distinct primary neoplasias in the uterus and ovaries is rare. Diagnosis of two primary malignancies in the uterus and ovaries should be based on histological examination. Treatment should be appropriate for both tumors, taking into consideration that treatment of one tumor will not lead to subtreatment of the other.

Primary myxoid chondrosarcoma of the uterus: report of a case with immunohistochemical study

Chondrosarcoma of the uterus is an extremely rare type of pure heterologous uterine sarcoma. In the present report a case of myxoid chondrosarcoma that occurred in the uterine corpus of a 46-year-old woman is described together with a brief review of the cases of uterine chondrosarcoma previously reported in the literature.