Transvaginal ultrasonography combined with pelvic examination in the diagnosis of ovarian endometrioma.

The aim of this retrospective study was to evaluate the efficacy of TVS and TVS combined with pelvic examination for the diagnosis of ovarian endometrioma. Three hundred and five ovarian masses of 244 patients with either pre-operative or post-operative diagnosis of ovarian tumor and received TVS between January 1, 1996 and December 31, 1998 were included in the study. Of 305 masses, 221 endometriomas of 164 patients were diagnosed histologically. The efficacy of TVS was 84.9 per cent with a sensitivity of 92.3 per cent and specificity of 70.2 per cent. LR+ and LR- were 3.1 and 0.1 respectively. The combination of TVS and pelvic examination with either positive test had a higher sensitivity (98.8%) but lower specificity (26.6%). This combination dramatically improved NPV (97.5%) and LR- (0.05), whereas, the combination with both positive tests had a sensitivity of 78.1 per cent, and specificity of 81.5 per cent. LR+ and LR- were not different from those using TVS alone. In conclusion, the study has shown the role of TVS in the diagnosis of ovarian endometrioma. The combination of TVS and pelvic examination may be useful in ruling out the disease. However, a further prospective study should be performed to confirm the efficacy of the combination.

Congenital nasopharyngeal teratoma (epignathus).

The case report of a congenital nasopharyngeal teratoma presented as an intra-amniotic sac mass was described. Histologically, the tumor was composed of highly differentiated tissue derived from three germ layers. Those tissues were partially developed as infant organs with a central core made up by bone. Haphazardly arrangement of such tissues with disorganized sketal axis helped in differentiating the mass from an asymmetric twins. The evidence of tumor attachment was seen at the retro-uvular region.

Female genital tuberculosis: clinical features and trend.

A retrospective study of genital tuberculosis in women attending the Department of Obstetrics and Gynecology between January 1986 and December 1997 revealed 11 patients with a mean age of 38 years (range 23-77). Two patients had genital tuberculosis and tuberculous peritonitis. The incidence was 0.01 per cent of outpatients and 0.05 per cent of inpatients. Eight cases occurred during the last six years. Although the incidence was quite low, a rising trend was observed. Of the clinical features, infertility was the commonest initial symptom (3 cases). The most common site of infection was the endometrium (5 cases) followed by fallopian tube and ovary (3 cases). Chest X-ray of all patients showed no lung infiltration while AFB staining and PCR for tuberculosis were positive in two out of five and one out of two respectively. Six patients received medical treatment only, and three were treated with antituberculous drugs after surgery; all with good results. Tubal reconstructive surgery was performed in two patients without medical treatment. Gynecologists should be aware of this disease to facilitate early diagnosis and treatment.

Naegleria meningomyeloencephalitis.

A case of primary amebic meningoencephalitis (PAM) with severe spinal cord involvement was documented in a 12 year-old boy from Samut Prakan Province, Thailand. This is the first reported case of Naegleria meningomyeloencephalitis in Thailand. He had a history of swimming in the canal nearby his house prior to the fever, headache and convulsion which rapidly progressed into a comatose state. PAM was only detected at post-mortem. The findings included suppurative exudates and necrosis of the olfactory bulbs and the basal parts of the frontal, temporal lobes, pons, cerebellum, medulla and the spinal cord. Numerous Naegleria trophozoites were present in the brain and spinal cord. Foci of neuronal degeneration and demyelination were noted.

Malignant Brenner tumor: a case of aggressive clinical course and cutaneous metastases.

Malignant Brenner tumor is a very rare ovarian tumor of which the definition of this entity and its biologic behavior remain controversial to this day. In this case report a 30-year-old patient with malignant Brenner tumor was presented with an aggressive clinical course and cutaneous metastases. The disease progressed from apparently unilateral ovarian involvement to intraabdominal, lung and cutaneous metastases. She expired within two months of diagnosis of disease. The histopathology of the ovarian tumor and the metastatic skin lesion are illustrated. In the authors' opinion this case should be categorized as a transitional cell carcinoma of the ovary.

Blue nevus of the uterine cervix.

A case of an incidentally detected blue nevus of endocervix is presented. The nevus cells contained premelanosome and melanosomes. Pinocytotic activity, and interrupted basal lamina were disclosed by electron microscopic study. The histogenesis of these nevus cells from perineurial cells is discussed.

Final diagnosis of "suspicious for malignancy" from bronchial washing cytology.

Our study showed that patients whose first bronchial washing cytology was reported "suspicious for malignancy" had 82 per cent positive predictive value for malignancy. Repeat bronchoscopy should be offered to those with a visible endobronchial mass, and transthoracic needle aspiration should be performed in patients with peripheral lesions.

Assessment of endocervical curettage in colposcopy.

Colposcopy has become an accepted diagnostic procedure in the management of patients with abnormal cervical cytology. To assess the value of the endocervical curettage in colposcopy, a retrospective review of 125 cases who had the procedure done during the 20-month period (January 1986-August 1988) was carried out. The ECC were positive in 3 out of 57 (5.3%) patients with satisfactory examination and 24 out of 68 (35.3%) patients with unsatisfactory examination. In all 27 cases, there was insufficient tissue to make a diagnosis of invasive carcinoma. Of the 125 patients studied seventy-two (29 in the satisfactory group and 43 in the unsatisfactory group) underwent conization and/or hysterectomy. Endocervical curettage did not eliminate the need for cone biopsy in all cases of unsatisfactory colposcopy. The tissue diagnosis on ECC did not increase the diagnostic accuracy derived from the colposcopic directed biopsies in either group. There were 20 cases of invasive carcinoma (13 MIC, 7 invasive) in this study, the ECC were positive in 9. We concluded that the ECC has limited value in colposcopy.