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PubMed1978

[Hemifacial microsomia and cardiac malformations. Apropos of 2 cases].

The authors report two cases of infants with complex heart disease comprising transposition of the great vessels, and a major unilateral facial anomaly involving the ear and the mandible, conforming to the description of hemifacial microsomia. The facial anomalies seen are defined and placed in the classification of known syndromes. The incidence of heart disease associated with facial microsomia is about 20% and in 2/3 of cases it is a ventricular septal defect or a tetralogy of Fallot. An analysis of aetiological factors shows that syndromes of the first two branchial arches are usually sporadic and that they may be the result of intra-uterine disease. The mechanism of the facial lesions is probably vascular.

Abnormalities, Multiple↗
PubMedDate not supplied

Value of histiocyte detection in Pap smears for predicting endometrial pathology. An institutional experience.

OBJECTIVE: To determine the clinical implications of the finding of histiocytes in Pap smears in 1 patient population. STUDY DESIGN: The medical records and Pap smears which the presence of histiocytes was mentioned in the diagnosis between August 1996 and August 2001 were reviewed in conjunction with follow-up surgical findings. The positive predictive value (PPV) for significant endometrial pathology for the isolated finding of histiocytes on Pap smear was determined. RESULTS: Of the 238,225 women screened over a 60-month period, 325 were reported to have histiocytes in their Pap smears. Of them, 238 (73.2%) had subsequent endometrial sampling, hysterectomy or both, and follow-up Pap smears. Two hundred seven smears (87%) failed to disclose endometrial pathology. Thirty-one cases (13%) resulted in significant histopathologic findings, including 12 uterine malignancies, 8 endocervical polyps, 7 endometrial polyps, 2 submucosal leiomyomata, 1 simple hyperplasia without atypia and 1 case of tamoxifen-related changes. Upon review of the clinical records, 58% (18/31) of those patients had other significant clinical and/or cytologic findings. Five of the 18 patients (27.8%) had associated postmenopausal bleeding, 11 had additional abnormal Pap smear findings (atypical glandular cells, 6/18, or 33.3%; endometrial cells, 5/18, or 27.8%), and another 2 had both postmenopausal bleeding and atypical glandular cells (2/18, or 11.1%). The PPV for significant uterine pathology for women with the isolated finding of histiocytes on a Pap smear was 5.5% and 60% with additional clinical and/or Pap smear findings. The PPV for endometrial cancer was 1.3% in women with the isolated finding of histiocytes on a Pap smear but 20% for women with histiocytes and additional clinical/or Pap smear findings. CONCLUSION: Based on the findings of this study and recently published data, we conclude that the isolated finding of increased histiocytes in the absence of postmenopausal bleeding, endometrial cells or atypical glandular cells on a Pap smear is a poor indicator of uterine disease.

Adenocarcinoma↗
PubMed1990

Endometrial biopsy technique and uterine pathologic findings in llamas.

Uterine tissue specimens from 90 llamas with history of infertility were examined and graded microscopically; 83 specimens were obtained by endometrial biopsy and 7 specimens were obtained at necropsy. Fifteen llamas (16.7%) had a normal uterus, which was graded 1A. Twenty-three llamas (25.6%) had minor uterine abnormalities that were graded 1B. Forty-five llamas (50.0%) had appreciable endometritis that was graded 2A. Three llamas (3.3%) had endometritis with gland fibrosis that was graded 2B. Two llamas (2.2%) had notable uterine gland fibrosis that was graded 3A. Two llamas (2.2%) had uterine neoplasia that was graded 3B. Thirty-six llamas had follow-up evaluation; 22 became pregnant, most after some form of treatment. Uterine biopsy in llamas was readily performed without complications and was valuable in identifying a wide range of uterine diseases, most of which were amenable to treatment.

Adenocarcinoma↗
PubMed1993

[Sequential MR images of the uterus after Gd-DTPA injection--studies of normal volunteers and uterine endometrial malignant tumors].

To investigate the sequential changes in signal intensity (SI) of normal and abnormal uteri, T1 WIs were taken repeatedly after the injection of Gd-DTPA. Six volunteers and 19 patients with known uterine body malignancy (18 carcinomas, one carcinosarcoma) were examined. The results in volunteers were as follows. In the secretory phase, SI of the endometrium was stronger in the late images than in the early ones, whereas in the proliferative phase, SI was stronger in the early images. SI of the myometrium decreased rapidly and there were no differences in SI between menstrual phases. In 17 of 18 endometrial carcinomas, the tumors showed hypointensity relative to the myometrium, and the contrast between the tumor and the myometrium was better in the early images. In the remaining two cases, the tumor showed hyperintensity and the contrast was better in the late images. After the injection of Gd-DTPA, the endometrium appeared differently according to the menstrual cycle in normal volunteers, and the appearance of uterine structures and endometrial malignant tumors changed sequentially. These findings must be kept in mind when evaluating uterine diseases by Gd-DTPA enhanced MRI.

Adult↗
PubMedDate not supplied

Therapeutic hysteroscopy.

It is the responsibility of physicians in gatherings such as ours to set the tone and speak forthrightly about accomplishments and limitations. The fundamentals of diagnostic hysteroscopy are well known and now is the time for us to push forward to ascertain whether this endoscopic approach, in selected patients, is more innocuous than the conventional laparotomy. I have tried to indicate the clinician's dilemma in the search for the proper approach to several types of uterine abnormalities. As enthusiastic hysteroscopists, we must continue to analyze and document our findings, with careful concern so as to avoid poorly substantiated claims.

Catheterization↗
PubMed1998

Comparison of classic intrafascial supracervical hysterectomy with total laparoscopic and laparoscopic-assisted vaginal hysterectomy.

STUDY OBJECTIVE: To evaluate the efficacy of laparoscopic hysterectomy and compare classic intrafascial supracervical hysterectomy (CISH) with total laparoscopic hysterectomy (TLH) and laparoscopic-assisted vaginal hysterectomy (LAVH). DESIGN: Retrospective review (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: Six hundred fifty women who underwent laparoscopic hysterectomy from August 1993 to August 1996. INTERVENTIONS: Charts of 231 women undergoing CISH, 102 TLH, and 317 LAVH were reviewed regarding patient characteristics, indications, uterine weight, associated procedures, estimated blood loss, operating time, and complications. MEASUREMENTS AND MAIN RESULTS: Among the three groups, despite having the largest specimen weight and highest number of associated procedures, women undergoing CISH had the lowest complication rate and smallest amount of estimated blood loss (p <0.05). The next lowest was the TLH group (p <0.05). Although LAVH was associated with shortest operating time, there were no statistically significant differences among groups (p >0.05). The CISH group had relatively shorter operating times when compared with similar average specimen weights. Patients who underwent total hysterectomy by either TLH or LAVH had more postoperative visits than those having CISH (p <0.05, Fisher's exact test); the LAVH group had the highest number of postoperative visits. The overall complication rate appeared to be highest in the LAVH group (p <0.05, Fisher's exact test). CONCLUSION: Among the three groups, CISH resulted in lowest blood loss and fewest complications; these values were also lower for TLH than for LAVH. If the cervix is removed along with the uterus, TLH is recommended. In our opinion, CISH is preferred in cases of benign uterine diseases because it lowers major operative complications, especially in women who have large masses with no pathologic lesions of the cervix.

Adult↗
PubMed2006

Primary Burkitt lymphoma of the uterine corpus.

This study reports the first well-documented case of sporadic Burkitt lymphoma arising in and confined to the uterine corpus in a 40-year-old woman who presented with vaginal bleeding. Endometrial curettings showed a diffuse infiltrate of medium sized lymphocytes with the characteristic morphologic and immunophenotypic features of Burkitt lymphoma. Fluorescence in-situ hybridization demonstrated the t(8;14)(q24;q32) translocation. There was no evidence of extra-uterine disease and the patient is alive without disease 10 months after hysterectomy and chemotherapy. This report demonstrates that Burkitt lymphoma can present as isolated, organ confined disease at unusual sites and with protean symptoms.

Adult↗
PubMed1996

Surgical staging and high dose rate brachytherapy for endometrial cancer: limiting external radiotherapy to node-positive tumors.

OBJECTIVE: To evaluate the efficacy and morbidity of surgical staging and high dose rate brachytherapy for women with stage I-IIIA endometrial cancer. METHODS: Sixty consecutive patients underwent surgical staging consisting of total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal cytology, bilateral pelvic lymphadenectomy, periaortic lymphadenectomy, and omentectomy. High dose rate brachytherapy was delivered postoperatively in three fractions for a total of 2100 cGy. Only patients with nodal metastasis received external radiotherapy. RESULTS: Twenty-two tumors (37%) were considered high-risk uterine disease because of deep invasion (stage IC), cervical involvement (stage II), positive peritoneal cytology (stage IIIA), or poor differentiation (grade 3). Lymph node metastases were detected in five patients. There was no surgical mortality, and morbidity from surgery and high dose rate brachytherapy was minimal. At a median follow-up of 3 years, there has been one recurrence. The conventional practice of postoperative external radiotherapy was altered in 23 of 60 patients (38%): 22 women with high-risk uterine factors did not receive external radiotherapy, and one patient with low-risk uterine factors (less than 50% myometrial invasion, grade 2) received external radiotherapy because of microscopic pelvic lymph node metastasis. CONCLUSION: Surgical staging and high dose rate brachytherapy without external radiotherapy for stage I-IIIA endometrial cancer were associated with minimal morbidity and produced excellent survival.

Adenocarcinoma↗
PubMed1999

Studies on the origin of ovarian interstitial tissue and the incidence of endometrial hyperplasia in domestic and feral cats.

Ovarian interstitial cells (OICs) are a common feature of mammalian gonads but little is understood concerning their origin or functional significance. This study investigated the development and steroidogenic potential of OIC in feral and colony-reared feline queens. Reproductive tracts, collected from a total of 50 female colony and feral cats, were fixed and analyzed by morphometry. Ovarian sections were also immuno-stained for the expression of the steroidogenic enzymes 17alpha-hydroxylase/17,20 lyase cytochrome P450 (P450c17), 3beta-hydroxysteroid dehydrogenase/Delta5-Delta4 isomerase (3beta-HSD), and aromatase. These findings were related to serum estradiol and testosterone concentrations and to the degree of existing cystic endometrial hyperplasia (CEH). Feral cats had three times as many OICs as colony-reared queens (2713 +/- 855 vs 744 +/- 494 cells/mm(2), P < 0.01). These cells were lipid laden and expressed both P450c17 and 3beta-HSD at levels that were higher than those seen in the theca interna of adjacent follicles. Aromatase expression was undetectable. The pattern of enzyme expression was consistent with development of interstitial tissue from atretic follicles and the potential for continued steroid secretion during the anestrum. The incidence of CEH was higher in older (>5 years old; 88.2%) than in younger (2-4 years; 30%) colony queens (P < 0. 01), whereas no such disease was evident in any of the feral cats. Estradiol levels were higher in colony-reared than in feral cats, but testosterone levels were not different. These data are consistent with the transformation of the theca interna of atretic follicles in cats into OICs that retain a similar, or even enhanced, steroidogenic phenotype. Colony-reared cats exhibit a predisposition to CEH compared with feral queens that is associated with elevated serum estradiol concentrations. Whether or not OICs somehow prevent the development of uterine disease or otherwise reflect a gonadal response to reduced negative feedback on the hypothalamic-pituitary axis remains to be determined.

3-Hydroxysteroid Dehydrogenases↗
PubMed1998

Lymphocytes and dendritic cells in the normal uterine cervix. An immunohistochemical study.

OBJECTIVE: Assessment of the appearance, distribution and numerical density of immune cell populations in the normal human uterine cervix. STUDY DESIGN SETTING: University Hospital Gasthuisberg. SUBJECTS: 29 healthy women undergoing total hysterectomy for non-cervical benign uterine disease. ANALYSIS: Immunohistochemistry and morphometrical analysis on histological sections containing ectocervix, transformation zone and endocervix, using antibodies against the following antigens: HLA-DR, CD4, CD22, CD1a and CD8. STATISTICAL ANALYSIS: Wilcoxon rank sum test. RESULTS: Lymphocytes in the epithelial and stromal compartments are predominantly T-lymphocytes. Intraepithelial T-lymphocyte and Langerhans' cell densities and their distribution are not influenced by the menstrual cycle and are the same in both ectocervix and transformation zone. CONCLUSION: The wide variation of T lymphocyte subpopulations and Langerhans' cell densities in the normal epithelium of the uterine cervix is stressed. We are the first to present a large and well-defined control series, which is indispensable to study the effect of smoking and other factors on the cervical immune system.

Adult↗
PubMed2006

Association of two polymorphisms in the peroxisome proliferator-activated receptor-gamma gene with adenomyosis, endometriosis, and leiomyomata in Japanese women.

OBJECTIVE: The peroxisome proliferator-activated receptor-gamma (PPAR-gamma) is a nuclear hormone receptor that plays an important role in many diseases. This study investigated whether two polymorphisms (Pro12Ala in exon B and C161T in exon 6) of the PPAR-gamma2 gene are related to adenomyosis, endometriosis, or leiomyomata. METHODS: A total of 390 patients with adenomyosis, endometriosis, and/or leiomyomata were classified into four groups: 103 patients with adenomyosis (21 adenomyosis only and 82 adenomyosis with endometriosis and/or leiomyomata), 95 patients with endometriosis only, 100 patients with leiomyomata only, and 92 patients with endometriosis and leiomyomata. RESULTS: There was no association between distribution of genotype or allele frequencies for the PPAR-gamma Pro12Ala polymorphism and the presence of adenomyosis, endometriosis, and/or leiomyomata. However, compared with results for controls, the PPAR-gamma 161CC genotype and 161C allele frequencies were significantly increased in patients with adenomyosis (genotype: chi2 = 8.185, corrected P value [Pc] = .0169; allele: chi2 = 8.337, Pc = .0155) and in patients with endometriosis (genotype: chi2 = 6.748, Pc = .0375; allele: chi2 = 6.413, Pc = .0453). CONCLUSION: The results suggest that the PPAR-gamma 161CC genotype could be a genetic risk factor for adenomyosis and endometriosis, whereas the Pro12Ala polymorphism was not associated with these estrogen-dependent benign uterine diseases in a Japanese population.

DNA↗
PubMedDate not supplied

[Endometrial surveillance of women on tamoxifen].

Tamoxifen estrogenic action in the uterus induces several uterine diseases, benign and/or malignant ones. The risk of endometrial adenocarcinoma is multiplied by two to three in post-menopausal women. It is mainly linked with the doses and the length of the treatment. However, the global benefit of that drug is not questioned anymore. What matters now though is to find the best way to follow patients on tamoxifen. As a matter of fact, there is no such thing as a consensus that would include specific tests, nor a surveillance protocol in women on tamoxifen. Most teams do not propose any special follow-up. Some patients already show uterine anomalies prior to the beginning of tamoxifen treatment. A yearly gynecologic examination, together with a cervico-vaginal smear, is enough when there are no specific endometrial adenocarcinoma risk factors, nor anomalies detected during the pre-therapeutical evaluation, nor clinical symptomatology. In case of risk factors, or cervical stenosis, or again initial abnormalities though, a yearly transvaginal sonography may be proposed. There is no need for other exploratory examinations if the results are satisfying. In case of symptoms, anomalies in the cervico-vaginal smears, intra-uterine liquid retention with a stenosed cervix, or suspicious endometrial thickness, then an endometrial sampling must be carried out. MRI could be of interest in asymptomatic patients with unclear ultrasonography images. Follow-up must be continued after interruption of tamoxifen. It is important to inform patients about the additional risks of developing an endometrial cancer because of tamoxifen, while still being reassuring. Besides, it is absolutely necessary to recommend them to take quickly medical advice in case of gynecologic symptoms.

Adenocarcinoma↗
PubMed1997

Uterine artery atherosclerotic disease: histologic features and clinical correlation.

OBJECTIVE: To determine whether uterine artery atherosclerosis is associated with known cardiovascular risk factors in women undergoing hysterectomy. METHODS: Seventy-four women undergoing hysterectomy between September 1995 and March 1996 were evaluated. Following hysterectomy, samples of the uterine artery were collected for histologic evaluation. Plaque complexity and histologic measurements were compared with regard to known cardiovascular risk factors. RESULTS: Among the 59 premenopausal women, 55.9% had intimal thickening 40.7% had simple plaques, and 3.7% had complex lesions in the uterine artery samples. Among postmenopausal women, 40% had intimal fibrosis, 20% had simple plaques, and 40% had complex lesions. Postmenopausal status was correlated strongly with the presence of advanced atherosclerotic disease (P < .001). Postmenopausal women had significantly greater intimal area (P = .01), intimal area/medial area (P = .002), intimal area/vessel area (P = .002), maximal intimal thickness/medial thickness (P = .01), and significantly less medial thickness (P < .001). A significant linear correlation existed between age and the intimal/medial ratio among premenopausal women (P = .04) and postmenopausal women (P = .01). Patients with electrocardiogram (ECG) abnormalities had significantly greater intimal/medial area as well (P = .02). Hypertension was associated with complex lesions among the postmenopausal patients (P = .01). Preoperative cholesterol levels greater than 200 mg/dL were associated with greater intimal thickness (P = .05) and intimal thickness/medial thickness (P = .03). CONCLUSION: The severity of uterine artery atherosclerosis is significantly correlated with known risk factors for cardiovascular disease: increasing age, postmenopausal status, ECG abnormalities, and hypertension. Uterine artery histologic analysis may provide a means of assessing the degree of atherosclerosis in other, critical, vascular beds.

Adult↗