Correlación clínica, imagenológica e histológica en patología endometrial: experiencia en el hospital Dr. Francisco Antonio Rísquez (2006-2016) / Clinical, imaging and histological correlation in endometrial pathology: experience in the hospital Dr. Francisco Antonio Rísquez (2006-2016)

Para el estudio y diagnóstico de la patología endometrial se cuenta con el ultrasonido transvaginal y la biopsia de endometrio. Objetivo: Determinar la correlación clínica, ultrasonográfica e histológica en patología endometrial, en pacientes tratadas en el Servicio de Cirugía del Hospital Dr. Francisco Antonio Rísquez, entre 2006 y 2016. Métodos: Estudio retrospectivo, transversal. Se incluyeron las pacientes intervenidas quirúrgicamente por patologías uterinas, que contaron con información completa en la historia clínica. Se utilizó estadística descriptiva, sensibilidad, especificidad y coeficiente de correlación. Resultados: El grupo etario más afectado fue el de 41 a 50 años, con 62,73 %, el motivo de consulta más frecuente fue sangrado genital con 52 casos (47,3 %), 52 pacientes (47,3 %) presentaron sangrado menstrual abundante y 40 (36,4 %) refirieron sangrado abundante y prolongado. Ecográficamente, el diagnóstico más frecuente fue leiomiomatosis uterina (87 casos, 79,1 %). La línea endometrial estuvo entre 1,3 y 11,3 mm en 80,9 %; en 54 casos (49,1 %) la biopsia de endometrio reportó secretor sin atipia. No se observó correlación estadística entre la clínica y la biopsia de endometrio (p=0,478 Kappa=0,00). La correlación estadística entre el ultrasonido y la biopsia de endometrio fue casi perfecta (p=0,000 Kappa=0,947) y entre la biopsia preoperatoria y la definitiva fue moderada (p=0,000 Kappa 0,542). La sensibilidad del ultrasonido es de 100 % y especificidad de 90,91 %. Conclusiones: La sensibilidad y especificidad del ultrasonido respecto a la biopsia de endometrio fue elevada. La frecuencia de patología endometrial en la biopsia endometrial fue baja(AU)

For the study and diagnosis of endometrial pathology it has with transvaginal ultrasound and endometrial biopsy. Objective: To determine the correlation of clinical, ultrasound and histological endometrial pathology in patients treated in the service of surgery of the Hospital Dr. Francisco Antonio Rísquez, between 2006 and 2016. Methods: Retrospective, cross-sectional study. Included patients surgically treated by uterine pathologies, which counted with complete information in the medical record. We used descriptive statistics, sensitivity, specificity, and correlation coefficient. Results: The most affected age group was that of 41 to 50 years, in 62,73%, the reason for more frequent consultation was bleeding genital with 52 cases (47.3%), 52 patients (47.3%) they had heavy menstrual bleeding and 40 (36.4%) abundant and prolonged bleeding was referred. Ecograficamente, the most frequent diagnosis was uterine leiomyomatosis (87 cases, 794.1%). The endometrial line was between 1.3 and 11.3 mm 80.9%; in 54 cases (49.1%) the endometrial biopsy reported secretory without atypia. No statistical correlation between the clinic and the endometrial biopsy was observed (p = 0, 478 Kappa = 0, 00). The statistical correlation between ultrasound and endometrial biopsy was almost perfect (p = 0, 000 Kappa = 0, 947) and between preoperative biopsy and the final was moderate (p = 0, 0000,542 Kappa). The sensitivity of ultrasound is 100% and specificity of 90.91%. Conclusions: The sensitivity and specificity of ultrasound for endometrial biopsy was high. The frequency of endometrial pathology in endometrial biopsy was low(AU)

El síndrome del cerebro descalificado: redivivo / The disquality brain syndrome: revivified

Se describe una nueva patología nostra-de nosotros los médicos-un nuevo síndrome que afecta al médico moderno en su relación con sus pacientes y enfermedades. Se postula que el ente mórbido toma su origen en la servil sumisión del facultativo ante la ¨Deidad Máquina¨ a quien concede, entre otros atributos, omnisciencia y omnipotencia. Como resultado de su fantasía, con mucha frecuencia ¨descalifica su cerebro¨ y abdica su juicio clínico a favor de los dictados erróneos de aquella, con el consiguiente perjuicio para el paciente. Como ilustración de la condición se narran las vicisitudes de algunos enfermos y el tortuoso camino del diagnóstico de sus condiciones patológicas

The ¨dysqualified¨ brain syndrome. The author describes a hitherto undescribed syndrome which affects the modern physician and his/her relationship with patients and their diseases. He postulates that the morbid entity takes its origin from the doctor’s submission to the ¨Machine Deity¨ to whom he concedes, among other attributes, those of omnipotence and omniscience. As a result of this fantasy, physicians frequently ¨disqualify¨ his/her brain,and abdicate their clinical judgment in its favor with the ensuing disservice to their patients. As an illustration of such condition, the difficulties of several patients are presented, whose diagnostics were abusive, erroneous or delayed due to deficient clinical histories

Eficiencia de los métodos diagnósticos en el estudio del sangrado uterino anormal en la peri y postmenopausia / Diagnostic methods in peri and potmenopausal women with abnormal uterine bleeding

El sangrado uterino anormal es un importante síntoma que puede indicar la presencia de cáncer o hiperplasia endometrial. El objetivo de este estudio es evaluar la eficiencia de los diversos métodos diagnósticos en pacientes peri y postmenopáusicas con sangrado uterino anormal y proponer una vía de manejo en estas pacientes. Diferentes métodos diagnósticos serán evaluados, incluyendo ecografía transvaginal, sonohisterografía, Doppler, resonancia magnética nuclear, biopsia por Pipelle, dilatación y curetage e histeroscopia. Está demostrado que la ecografía transvaginal tiene una alta eficiencia para el reconocimiento de lesiones difusas, mientras que sonohisterografía tiene una alta eficiencia para identificar lesiones focales. Por otro lado, la biopsia por Pipelle ha demostrado descartar patología difusa con una alta eficiencia. Se concluye que la mejor vía para el estudio de pacientes con sangrado uterino anormal es realizar una ecografía transvaginal y una histerosonografía en el mismo momento, seguido por una biopsia mediante Pipelle. Finalmente, puede ser sugerido que por esta vía es altamente probable que todos los casos de cáncer e hiperplasia endometrial puedan ser identificados.

Abnormal uterine bleeding is an important symptom that can mean presence of endometrial cancer or endometrial hyperplasia. The aim of this study is to assess the effectiveness of selected diagnostic methods in peri and potmenopausal women with abnormal uterine bleeding, and to propose a way to manage in these patients. Different diagnostic methods are assessed, which include transvaginal ultrasonography, sonohysterography, Doppler technique, magnetic resonance images, biopsy by Pipelle, dilatation and curettage, and hysteroscopy. It is founded that ultrasonography has a high efficiency when it comes for identifying diffuse lesions, while sonohysterography has a high efficiency for identify focal lesions. On the other hand biopsy by Pipelle has demonstrated to rule out diffuse pathology with a high efficiency. It is concluded that the best way to manage patients with abnormal uterine bleeding by performing ultrasonography and sonohysterography at the same time followed by a Pipelle biopsy. Finally, it can be suggested that by this way it is highly probable that all cases with endometrial carcinoma and endometrial hyperplasia can be identified.

Abnormal uterine bleeding; hysteroscopic findings in patients

To determine the frequency of the various uterine pathologies detected during hysteroscopic examination in women with abnormal uterine bleeding. Descriptive - case series. This study was conducted at Nishtar Hospital Multan in the Department of Obstetrics and Gynaecology Unit II from July 2005 to July 2006. A total of 70 patients admitted through gynecology outpatient department with complaint of abnormal uterine bleeding were evaluated. 40 patients were selected by non- probability purposive sampling. Assessment included detailed history, clinical examination, baseline investigations and pelvic ultrasound in all patients. ECG and X-ray chest of patients above 40 years was done. Diagnostic hysteroscopies were performed and findings were noted. A total of 40 patients underwent diagnostic hysteroscopy. Most of the women were in perimenopausal age group with presenting complaint of irregular and heavy bleeding per vaginum. General anesthesia was used in all patients with saline as distension medium. Pathology was diagnosed in 52.5% with the help of hysteroscope. The most common pathology was endometrial polyp 27.5% followed by submucous fibroid 25%. No early or late complication was observed. Incidence of focal endometrial lesions in patients with AUB is high. Hysteroscopy provides direct visualization of endometrial cavity and hence accurately detects intrauterine pathology. It is safe, effective and successful investigation and should be considered a procedure of choice for evaluation of abnormal uterine bleeding

Correlation of endometrial ultrasonography and endometrial histopathology in patients with postmenopausal bleeding.

A retrospective study of 49 cases with persistent postmenopausal vaginal bleeding undergoing hysterectomy in the absence of postoperatively evident diagnosis of genital malignancy was carried out. Normal endometrium was the source of bleeding in 24 cases (48.9%) while 11 cases (22.4%) had evidence of endometritis. Endometrial hyperplasia and polyps were present in 12 cases (24.4%). Two cases were found to have malignancy in the surgical specimen, which were not evident on pre-operative endometrial biopsy. However, there was high degree of suspicion of malignancy in these 2 cases based on the endometrial histopathology and ultrasonographic endometrial thickness. By careful correlation of clinical findings, endometrial histopathology and ultrasound measurement of endometrial thickness, most cases with postmenopausal bleeding can be managed conservatively.

Estudo comparativo entre o diagnóstico histeroscópico e o anatomopatológicode pacientes com sangramento uterino anormal, na menacme / Comparative study between the hysteroscopic and histological diagnosis of patients with abnormal uterinebleeding during menacme

O objetivo deste trabalho foi avaliar a exeqüibilidade e as propriedades diagnósticas da histeroscopia em uma população de pacientes com queixa de sangramento uterino anormal, namenacme, comparando os achados endoscópicos com os resultados dos exames anatomopatológicos. Foram analisados de maneira retrospectiva os resultados de 314 histeroscopias, realizadas em igual número de pacientes, no ambulatório sem necessidade de internação hospitalar. Fez-se em todas as pacientes biópsia endometrial orientada, com cureta de Novak de 3 ou de 5 mm. Os histeroscópios utilizados foram de3 ou de 5 mm de calibre com visualização da imagem em monitorde televisão por endocâmera. Os resultados do exame histeroscópico foram comparados com os achadosanatomopatológicos. Em 151 (48%) das pacientes não foi detectada qualquer afecção da cavidade do útero. A alteração mais freqüentemente encontrada foi o miomasubmucoso em 45 (14,3%) casos. Diagnosticou-se malignidade em nove pacientes, com confirmação anatomopatológica em sete. Para a detecção de anormalidades da cavidade do útero, a sensibilidade e a especificidade da histeroscopia foram,respectivamente, 86,4% e 75,9%. Para o diagnóstico de malignidade, foram de 100% e 99,3% e, para o diagnóstico dehiperplasias endometriais, de 57,7% e 88,5%. Em 5 (6,6%) pacientes o exame histeroscópico não pôde ser realizado devido à estenose do canal do colo. Em 2% houve reações vagais, como sudorese, náuseas e tonturas, com recuperação após alguns minutos. A histeroscopia diagnóstica deve ser somada ao exame anatomopatológico da biópsia endometrial para aferir ao método mais sensibilidade e especificidade. Estaconduta deve ocupar lugar privilegiado na propedêutica das pacientes na menacme com queixa clínica de sangramento uterino anormal.

[Comparison of the diagnostic accuracy of pipelle biopsy, dilatation and curettage and hystrectomy in detection of endometrial lesions]

The current study has been designed to compare the diagnostic value of pipelle sampling as a simple and cost effective method with that of more complicated and expensive methods in the detection of pathologies in abnormal uterine bleedings. In 60 patients scheduled for hysterectomy due to persistent uterine bleeding, endometrial sampling was done twice, once with pipelle and then by D and C prior to the hysterectomy. First the pathological reports of pipelle and D and C specimens were compared with each other and then both were compared with hysterectomy as the gold standard. In all cases pipelle was passed to the uterine cavity without any need for cervical dilatation and anesthesia. The most frequent results in all tree kinds of sampling were proliferate endometrium and early secretary phase respectively. According to the pathological reports, pipelle and D and C in 89% of the cases, pipelle and hysterectomy in 80% of the cases and D and C and hysterectomy in 90% of the cases showed agreement, that shows so significant difference in diagnostic accuracy among three methods. Considering high agreement between pathological reports of pipelle biopsy as an outpatient method and those of D and C and hysterectomy, pipelle sampling is suggested as the first diagnostic procedure, while D and C and hysterectomy that necessitate anesthesia and take more time and expense should be reserved for just special cases

Histological and histochemical study of endometrium in dysfunctional uterine haemorrhage.

Menstrual disorder is one of the most frequently encountered and perplexing conditions in adult women. Dysfunctional uterine haemorrhage (DUH) includes scanty, excessive or irregular bleeding, the primary cause of which is yet to become clear. A total of 100 cases of DUH were studied by histological and histochemical evaluation of endomertium with an object to find out the pathophysiology of DUH. Twenty cases of the similar age group without DUH acted as control. Irregular excessive bleeding was found to be the highest in multiparous women in their 4th decade of life. The material from endometrium was studied by haematoxylin and eosin statin, alcian blue, periodic acid Schiff's reaction and alkaline phosphatase activity. Histological examination of the study group revealed normal endometrium in 66% of cases and abnormal in 34% cases while histochemical behaviour was normal in 54% cases and abnormal in 46% cases. Hormonal imbalance is the chief factor in the pathogenesis of DUH and this abnormal hormonal status can better be revealed by a combined study of histological and histochemical evaluation of endometrium.

Histopathological findings in women with postmenopausal bleeding in Jamaica

We investigated the histopathological findings in women presenting with postmenopausal bleeding in a population predominantly of African descent by conducting a six-year retrospective study of 716 gynaecological surgical specimens from 629 women accessed in the Department of Pathology, The University of the West Indies, Jamaica. Histopathological diagnoses were correlated with patients age, specimen volume, duration of bleeding and length of postmenopausal interval at presentation using t-tests and linear regression models. The mean (SD) age was 63.6 (9.3) years. The frequency of the main causes of postmenopausal bleeding was: endometrial hyperplasia (22.3); endometrial atrophy (21.3); non-diagnostic (19.9); endometrial carcinoma (9.5); cervical carcinoma (6.8); cervical polyps (4.5); endometrial sarcoma (3.5); proliferative endometrium (3.2). Mean (SD) duration of bleeding was 6.9 (12.7) months. The percentage of women with malignant lesions was two to three times greater than those reported in the United States of America and Europe subsequent to 1980. The delay between the onset of bleeding and presentation is worrisome and suggests the need for public educatio

DNA pattern and estrogen receptor content in perimenopausal dysfunctional uterine bleeding

This study was performed on 50 endometrial biopsies divided into two groups: Non-hyperplastic group [25 cases] including normal proliferative, secretory, irregular shedding, disordered proliferative and atrophic endometria and hyperplastic group [25 cases] including simple, complex and atypical hyperplastic endometria. The study aimed to correlate between estrogen receptors, DNA activity and histologic pattern in order to give an idea on the most likely type to carry the higher risk of neoplastic transformation. There was no significant association between estrogen receptor [ER] immunoreactivity and proliferative activity except for cases with atypical hyperplasia showing lower ER immunostaining and increasing S-phase fraction. Also, all types of hyperplasia had significantly higher S-phase fraction and proliferative, secretory, irregular shedding, disordered proliferative and atrophic endometria

Diagnostico histopatologico de la hemorragia uterina anormal (HUA) / Histopathologic diagnosis of abnormal uterine hemorrhage (AUH)

Sobre un total de 2151 biopsias registradas en el Departamento de anatomia patologica y citologia en el tiempo establecido, 715 corresponden a biopsias ginecologicas remitidas por el Hospital de la mujer, con diferentes diagnosticos; de las cuales 140 presentaron el sintoma clinico de hemorragia uterina anormal HUA, las mismas fueron objeto de estudio histopatologico, determianadose su etiologia en mujeres de 20 a 40 años, en relacion con diferentes factores causales como ser: edad, paridad, metodo de anticoncepcion, terapia hormonal, etc. Los resultados obtenidos fueron objeto de analisis cualitativos, el mayor numero de casos se presento en mujeres de 40 años, multiparas, que no utilizaban ningun metodo de anticoncepcion ni recibian terapia hormonal; cuyo analisis histopatologico revelo hiperplasia simple de endometrio. Solo un 8 por ciento del total considerado correspondio a carcinomas en sus diferentes variedades

Patología endometrial en pacientes pre y postmenopaúsicas con hemorragia uterina anormal / Endometrial pathology in pre and postmenopausic patients with normal uterine hemorrage

Se presenta una serie retrospectiva de 226 pacientes (pre y postmenopáusicas) de hemorragia uterina anormal y biopsia de endometrio, con la finalidad de determinar los hallazgos clínicos e histopatológicos más frecuentes. Se revisaron las biopsias coloreadas con hemotoxilina-eosina y se clasificaron en base a los criterios de la Organización Mundial de la Salud. La mayoría de las pacientes fueron premenopáusicas y el mayor porcentaje se ubicó en la 5ta década de la vida. En las postmenopáusicas, la mayoría correspondió a la 6ta década de la vida. En ambos grupos, el mayor porcentaje de manigtud de sangramiento fué moderado y los patrones de sangramiento más frecuentes correspondieron a hipermenorrea, metrorragia y menometrorragia. Los diagnósticos anatomopatológicos más frecuentes en ambos grupos, fueron endometrosis de patrón proliferativo, secretro e hiperplasia simple sin atipia

Correlation between endometrial thickness as measured by endovaginal ultrasongraphy and histopathological finding in abnormal uterine bleeding

The present study was proposed to find if there is a correlation between endometrial thickness as measured by Endovaginal Ultrasonography and Histopathological Finding in Abnormal uterine bleeding. [40] patients participated in this study divided into two groups, [30] patients in the study group with abnormal uterine bleeding with special criteria, and control group of [10] patients having no abnormal uterine bleeding. Their ages ranged from [25] to [50] years. Where measuring of endometrial thickness with the use of endovaginal sonography were done and one day later endometrial biopsy and histopathological examination were done. Finally, the sonographically measured endometrial thickness and histopathology obtained were correlated with each other and statistically analysed. From this study it is concluded that when endometrial thickness is >/= 6 mm in post menopausal women or >/= 10 mm in perimenopausal women or >/= 13 mm at child bearing age is considered abnormal necessitating diagnostic curettage and histopathological examination

Correlaçäo entre achados histeroscópicos e histopatológicos no sangramento uterino anormal / Correlation between the hysteroscopic and hystopathologic findings in the abnormal uterine bleeding

OBJETIVOS: Determinar as patologias endometriais que mais freqüentemente apresentam-se com sangramento uterino anormal, correlacionar os achados histeroscópicos e histopatológicos, e determinar a sensibilidade e especificidade do método. PLANO DE ESTUDO: Estudo retrospectivo de 117 pacientes com sangramento uterino anonnal, provenientes de clínica privada, pelo Donna Centro de Diagnóstico Ginecológico, Caxias do Sul. MÉTODOS: Foi utilizado um histeroscópio de Hamou II com óptica de 5 mm e histeroinsuflador de CO2 para avaliar a cavidade uterina. Os exames foram ambulatoriais, sem anestesia, seguidos de biópsia endometrial. RESULTADOS: O diagnóstico histeroscópico mais frequente foi o de endométrio normal nas mulheres na pré-menopausa e de endométrio atrófico naquelas na pós-menopausa. A sensibilidade do exame, quando comparado à histopatologia, foi de 90 por cento, e a especificidade, de 91 por cento. CONCLUSOES: A acurácia diagnóstica da histeroscopia representou 91 por cento, confirmando ser um método propedêutico de real valor.

Endometrial feature and uterine blood flow in abnormal uterine bleeding.

We used the transvaginal ultrasound examination in women with abnormal uterine bleeding prior to conventional D&C. It is a simple, non-invasive technic, convenient and accepted by all patients. The endometrial thickness of less than 6 mm is compatible with atrophic endometrium, but of more than 17.7 mm will be malignancy. A cut-off value for endometrial abnormality of 17 mm yielded a sensitivity of 100 per cent, specificity of 96.9 per cent and a positive predictive value of 85.7 per cent respectively (Fisher exac test). When endometrial thickness is more than 17 mm, intratumor flow mean resistance indices can be used to reduce false positive rate.

Estudio histeroscópico en pacientes con hemorragia uterina anormal / Histeroscopic study in patients with abnormal uterine bleeding

Se presenta la experiencia de las histeroscopías efectuadas en nuestro Servicio en los casos de hemorragia Uterina Anormal (HUA) con el objetivo de demostrar la utilidad de este procedimiento como método diagnóstico y comparar el resultado con la Dilatación y Curetaje (DC). Se estudiaron 85 pacientes sometidos a histeroscopía diagnóstica seguida de dilatación y curetaje; 54 pacientes eran postmenopáusicas (63,6 por ciento) y 31 eran premenopáusicas (36,4 por ciento). El medio de distensión utilizado fue líquido. En 47 pacientes (55,2 por ciento) el diagnóstico histeroscópico fue de endometrio normal y/o atrófico, en 16 pacientes (18,8 por ciento) fue de hiperplasia, en 17 pacientes (20 por ciento) fue pólipo endometrial, en 4 casos (4,7 por ciento) fue de cáncer y en 1 caso (1,3 por ciento) se diagnosticó metaplasia ósea. Se comparó estos resultados con la histología del curetaje dando un 93 por ciento de concordancia. Los resultados confirman el excelente rendimiento de este procedimiento como método diagnóstico en las hemorragias uterinas por su alta especificidad y sensibilidad