Accuracy of magnetic resonance imaging in diagnosis of adenomyosis and endometriosis.

Objective: To evaluate the utility of Magnetic Resonance Imaging (MRI) in the diagnosis of adenomyosis and endometriosis. Methods: Medical records of 38 women who underwent laparoscopy or laparotomy less than 4 weeks after preoperative MRI were reviewed. MRI results were evaluated for the diagnosis of adenomyosis of the uterus, ovarian endometrioma, peritoneal endometriotic implants, endometriosis of bladder, bowel and rectovaginal septum. Surgical and histological findings were used as a gold standard. Results: Adenomyosis was found in 7 (18.4%) of 38 patients. Endometriosis was diagnosed in 30 (78.9%) of 38 patients. The sensitivity, specificity, and accuracy of MRI for diagnosing adenomyosis were 85.7, 100, and 90.9% respectively. The sensitivity, specificity, and accuracy of MRI for the diagnosis of endometriosis in specific sites were as follows; endometrioma, 81.5, 96.6, and 93.4% respectively; peritoneal implants, 25, 100, and 60.5% respectively; bladder, 66.6, 100, and 97.3% respectively; rectovaginal septum, 90, 100, and 97.3% respectively; bowel, 71.4, 100, and 94.7%, respectively. Conclusion: MRI provides high accuracy in the diagnosis of adenomyosis and endometriosis with an exception for the diagnosis of peritoneal endometriotic implants.

Relationship between human papilloma virus infection and abnormal Pap smear in HIV-seropositive women at Siriraj Hospital.

The purpose of this prospective study was to determine the prevalence of human papillomavirus and abnormal Pap smear in HIV-seropositive women, particularly in HIV-seropositive women who undertook antiretroviral drug. The consecutive series of 178 HIV-seropositive women was enrolled in the Department of Obstetrics and Gynecology, Siriraj Hospital. All general information and laboratory results of the patients were recorded. Pap smears are obtained from the endocervix, cervical transformation zone and vagina by using a cotton tip stick and Ayre spatula, as described in the VCE technique. The patients were assigned into two groups, the AZT and non-AZT group. The comparison between the groups was calculated statistically. It was found that 88 of 178 HIV-seropositive women (49.4%) undertook Zidovudine. The prevalence of abnormal Pap smear in HIV-seropositive women, who had an abnormal Pap smear, was 59.6 per cent. However, the prevalence of human papillomavirus infection detected by Pap smear was reported in 17 patients (9.6%). There was no difference between the AZT and non-AZT group statistically. There was a significantly higher probability of finding an abnormal Pap smear for cervical dysplasia in HIV-seropositive women who were infected with human papillomavirus compared to. It is concluded that there is a higher risk of developing cervical dysplasia in HIV-seropositive women who carry the human papillomavirus.

Germ cell tumors of the ovary: A review of 644 cases.

This retrospective study reports 644 female patients with germ cell tumors of the ovary treated at Siriraj Hospital over a ten-year period from 1988-1997. The incidence was 38.7% of all ovarian tumors (1665 cases). Of the total, 608 patients (94.4%) had benign cystic teratomas and only 36 patients (5.6%) had malignant tumors. Dysgerminoma was the most common malignant germ cell tumor. Germ cell tumor was the most common malignant ovarian tumor in patients less than 20 years old. The mean age and parity of patients with benign tumor was significantly higher than those with malignant tumors (p<0.01). Benign tumors were often asymptomatic (35%) when the tumors were discovered but those with malignant tumors usually had symptoms and the most common symptoms was a palpable abdominal mass (47.2%). In the cases with benign tumors, more than two-thirds (73.7%) had a tumor less than 10 cm in length, but more than half (66.7%) of the patients with malignant tumors had an intermediate tumor between 11 and 20 cm long. Most of the patients in both groups had a unilateral tumor (p>0.05). Surgical treatment was conservative in 63.8% of patients with benign tumors, while only 30.6% of those with malignant tumors underwent conservative surgery (p<0.05).

Borderline epithelial ovarian tumor: A study of 48 cases.

Borderline epithelial ovarian tumor is a special entity of ovarian tumor. Compared with invasive epithelial ovarian cancer, borderline tumors have a much more favorable prognosis. Several issues remain unclear in the management of patients with borderline ovarian tumor. Objective : To review the clinical features, treatment and survival status of patients with borderline epithelial ovarian tumors. Materials and methods : A retrospective review of the records of 48 patients with borderline epithelial ovarian tumors registered at the Gynaecologic Oncology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University from January 1, 1986 - December 31, 1998 was performed. Results : Ninety percent of the patients had stage I disease. Mucinous cell type was found in 77.1% and serous cell type was found in 22.9%. All the patients received surgery and most of the patients received adjuvant chemotherapy. Mean follow up time was 38.94 months and the 10 - year survival rate was 97.92%. Three patients had recurrence of disease. All patients with recurrence did so within 12 months. Conclusion : The prognosis of patients with borderline epithelial ovarian tumor is good. Conservative surgery should be performed for stage I patients who wish to remain fertile.

Ovarian tumors in children and adolescents: A 10-year review.

This retrospective study reports on 99 young patients (under 20 years) with ovarian tumors treated at Siriraj Hospital over a ten-year period from 1988-1997. The incidence was 5.9% of all ovarian tumors (1,665 cases). Ninety-five patients (96%) were nulliparity. The common presenting symptom was either abdominal mass (42.4%) or abdominal pain (33.3%). More than half of the patients (58.6%) had tumors between 6 and 15 cm in greatest diameter and the bilaterality rate was 12.1%. Fifteen patients (15.2%) had complication of the tumors, 14 of which were torsion. No statistic significant difference in presenting symptom, tumor size, laterality, and complication between benign and malignant tumors was found. Of the total, 77 (77.8%) patients were benign, 18 (18.2%) were malignant and four (4%) were borderline tumors. The frequency of ovarian malignancy correlated inversely with age of the patient (p=0.006). Germ cell, common epithelium, and stromal cell tumors were found in 60.6%, 37.4%, and 2% of patients, respectively. Surgical treatment was conservative in 90.9% and radical in 9.1% of the patients.