Propuesta de protocolo diagnóstico, estadificador y quirúrgico para el cáncer de endometrio / Proposal for a diagnostic, staging and surgical protocol for endometrial carcinoma

El carcinoma de endometrio es la neoplasia más frecuente del tracto genital de la mujer en el mundo occidental es una patología que va en ascenso en los países en vías de desarrollo. En general, el pronóstico de carcinoma endometrial es bueno, con una supervivencia global de alrededor del 80 %. Se pueden definir tres grupos de acuerdo al riesgo de recurrencia, en alto, medio y bajo. Se realiza revisión bibliográfica y casuística para proponer protocolo de manejo quirúrgico en pacientes con cáncer de endometrio. Se definen tres etapas durante el protocolo: clínica, patológica y quirúrgica. Se realizan recomendaciones basados en la vía de abordaje, tipo de histerectomía, lavado peritoneal, linfadenectomía, omentectomía, y cito-reducción. Se plantean situaciones especiales y la importancia del ganglio centinela. La realización de protocolos quirúrgicos para el manejo de carcinoma endometrial permite la unificación de criterios, mejora la evaluación de respuesta rapéutica y facilita revisiones y mejoras a futuro.(AU)

The endometrial carcinoma is the most common neoplasia in the genital tract of women in the western world and is a condition that is increasing in the developing countries. In general, the rognosis of endometrial carcinoma is good, with an overall survival of about 80 %. It can define three groups according to the risk of the recurrence in high, medium and low. The literature review and case mix is performed to propose the surgical management protocol in patients with endometrial cancer. Three stage the clinical, the pathological and the surgical defined for the protocol. The recommendations based on the approach, type of the ysterectomy, te peritoneal washing, the lymphadenectomy, the omentectomy, and the debulking are made. The special situations and the importance of sentinel node arise. Performing the surgical protocol for the management of endometrial carcinoma allows the unification of criteria, the improved therapeutic response assessment and facilitates future revisions and improvements.(AU)

The Short Physical Performance Battery is a discrimi-native tool for identifying low quality of life in gynecological postmenopausal cancer survivor / O Short Physical Performance Battery é uma ferramenta discriminativa para identificar baixa qualidade de vida em mulheres na pós-menopausa sobreviventes do câncer ginecológico

Adverse events due to cancer treatment (changes in weight, reduced muscle capacity and mobility) hinder the quality of life (QoL) of cancer survivors. Nevertheless, the identification of discriminative predictors of QoL in post-menopausal women (PW) survivors of gynecological cancer (PW-SGC) has been ignored. Objective: The purpose of the present study was to examine the role of muscle capacity, mobility and body mass index (BMI) on the deterioration of QoL in PW (n=35; 62.1±8.2 years) and PW-SGC (n=51; 60.8±11.4 years). Methods: The QoL questionnaire (SF-36), anthropometrical evaluation (BMI), hand-held dynamometry (HHD) and short physical performance battery (SPPB) were applied in all volunteers. Results: The participants had overweight, low SF-36 scores and normal HHD, and no significant differences were found between both groups, however the SPPB score was higher in the PW group (p<0.001). Linear regression analyses for QoL indicated the BMI (beta=-0.27) and the SPPB (beta=0.57) were the strongest and most significant predictors in PW and PW-SGC, respectively. The area under the curve (AUC) for the SPPB score was 0.74 (95% CI: 0.57-0.87; P=0.015) in the PW-SGC group and 0.62 (95% CI: 0.47-0.75; P = 0.181) in PW. Conclusion: The present study showed that the importance of BMI and mobility (SPPB) for QoL differ between PW and PW-SGC. For PW-SGC, the strongest independent predictor of QoL was mobility (SPPB), whereas BMI was the strongest contributor in PW. Moreover, the SPPB test is a discriminative predictor (or assessment tool) for identifying the low quality of life in postmenopausal women survivors of gynecological cancer.

Efeitos adversos do tratamento (modificações da massa corporal e reduções da capacidade muscular e mobilidade) podem modificar a qualidade de vida (QV) de sobreviventes de câncer. Semelhantemente, a menopausa e o envelhecimento podem promover alterações antropométricas e da função física. Portanto, torna-se necessário o levantamento de ferramentas para predizer, distintamente, a QV em mulheres na pós menopausa (PM) e em mulheres na pós menopausa sobreviventes de câncer ginecológico (PMSCG). Objetivo: Examinar a contribuição da força, mobilidade e do índice de massa corporal (IMC) sobre as alterações da QV em PM (n = 35; 62,1±8,2 anos) e PMSCG (n = 51; 60,8±11,4 anos). Métodos: Aplicou-se questionário de QV (SF-36), avaliação antropométrica (IMC), dinamometria de preensão manual (DPM) e short physical performance battery (SPPB). Resultados: Participantes apresentaram sobrepeso, baixo score em SF36 e DPM normal, sem diferenças entre os grupos. O score de SPPB foi maior em PM (p<0,001). Análise de regressão linear de QV, indicou IMC (beta = -0,27) e o SPPB (beta = 0,57), como os mais fortes preditores em PM e PMSCG, respectivamente. A área sob a curva para o score do SPPB foi 0,74 (95% CI: 0,57-0.87; P = 0,015) em PMSCG e 0,62 (95% CI: 0,47-0,75; P = 0,181) em PM. Conclusão: O presente estudo demonstrou que para PMSCG o principal preditor da QV foi a mobilidade (SPPB), enquanto o IMC foi o mais forte contribuidor em PM. Portanto, o SPPB é um teste específico para identificar reduções na QV pacientes sobreviventes de câncer ginecológico.

Fibrinogen, bFGF and VEGF levels during antibiotic therapy in gynecologic cancer: A preliminary report.

The role of angiogenesis in the development of neoplasia has been identified and characterized. However, anti-angiogenic therapeutic intervention still requires more evidence to become recognized and successful. The aim of this study was to evaluate levels of selected proangiogenic factors, such as fibrinogen, vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) in serum of patients with the gynecologic cancer on the first, third and sixth day of antibiotic therapy, routinely administered as a perioperative treatment. In addition, serum concentrations of γ-γ dimers and α-polymers of cross-linked fibrin structure and the degree of bFGF binding with the fibrin network were investigated. Immunohistochemistry staining of the excised tumor tissue was also performed. We observed higher levels of bFGF, VEGF, as well as fibrinogen in patients with gynecologic malignancy, as compared to healthy women. In cancer patients, the concentration of α-polymers and γ-γ dimers of fibrin network increased. Further only γ-γ dimers fraction of fibrin was found to bind to bFGF. Immunohistochemical analysis indicated the presence of bFGF in an excised tumor tissue. In conclusion, the decrease of proangiogenic bFGF and fibrinogen levels in a clinical trial of gynecologic patients may confirm anti-angiogenic properties of selected antibiotic therapy.

Extramammary Paget's disease: Analysis of 17 Chinese cases.

Background/Objective: Extramammary Paget’s Disease (EMPD) seems to be more common in Caucasians than Chinese. We report the clinical manifestations, management, and prognostic characteristics in 17 Chinese patients. Methods: Medical records and biopsies of 17 patients who had been treated at a large university hospital in China between March 2005 and January 2012 were reviewed. Results: Of the 17 patients, 14 were men. They had lesions on the scrotum and the penis. Of the three women, two had vulvar and one had inguinal lesions. All patients underwent Mohs micrographic surgery (MMS). Three men had metastasis to the inguinal lymph nodes and underwent an extensive local excision with inguinal lymphadenectomy. Eight patients who had positive excision margins received additional radiation therapy. The mean follow-up duration was 54 months (4-85 months). One patient had two recurrences. Three had metastasis to the inguinal lymph node. One had metastasis to the bone and concomitant prostate cancer. Two patients died of the disease. Conclusion: A striking difference in presentation of EMPD in Chinese compared with Caucasians is the male predominance and location on the penis and scrotum. Mohs micrographic surgery followed by radiotherapy is an effective treatment. Long-term follow-up suggests that the disease has a good prognosis when it does not metastasise.

Frequency and clinicopathological presentation of gynaecological malignancies

To describe the frequency and clinicopathological presentation of malignancies of the female genital tract presenting to a tertiary care hospital. This descriptive study was carried out at Department of Obstetrics and Gynaecology, Unit A of Khyber Teaching Hospital, Peshawar from January 2008 to December 2012. A total of 4657 patients were admitted during the study period and all the patients having genital tract malignancies were included. Detailed history was taken and relevant examinations and investigations were carried out. Surgical procedures were performed where needed and specimens were sent for histopathology. Clinical and surgical staging was also carried out. All the details were noted down on a semi-structured proforma. There were 43 cases of gynaecological malignancies with mean age of 43.74 +/- 15.51 years. Ovarian cancer was the most common [n=22, 51.22%] followed by uterine cancer [n=10, 23.33%]. The majority of patients diagnosed with ovarian cancers [n=9/22, 40.94%] were nulliparous, whereas the majority of uterine and cervical cancers were multiparous [n=7/10, 70.0%] and grand multiparous [n=7/9, 77.78%], respectively. Ovarian cancers mostly presented with an abdominal mass [n=16/22, 72.7%] while uterine and cervical cancer presented with irregular cycles [n=7/10, 70.0%] and post coital bleeding [n=4/10, 40%]. Advanced stage cancer cases were 19/43 [44.22%]. Serouscystadeno carcinoma was the most common ovarian malignancy [n=16/22, 72.73%] while endometrioid adenocarcinoma [n=9/10, 90%] was the most common uterine carcinoma and squamous cell carcinoma was the most common cervical carcinoma [n=7/9, 77.88%].Conclusions: Ovarian cancer was the most commonly encountered malignancyal though all gynaecological malignancies are rare

Prevention of lymphocele development in gynecologic cancers by the electrothermal bipolar vessel sealing device / 부인종양

OBJECTIVE: A number of new techniques have been developed to prevent lymphocele formation after pelvic lymphadenectomy in gynecologic cancers. We assessed whether the electrothermal bipolar vessel sealing device (EBVSD) could decrease the incidence of postoperative lymphocele secondary to pelvic lymphadenectomy. METHODS: A total of 321 patients with gynecologic cancer underwent pelvic lymphadenectomy from 2005 to 2011. Pelvic lymphadenectomy without EBVSD was performed in 134 patients, and pelvic lymphadenectomy with EBVSD was performed in 187 patients. We retrospectively compared the incidence of lymphocele and symptoms between both groups. RESULTS: Four to 8 weeks after operation, 108 cases of lymphocele (34%) were detected by computed tomography scan examination. The incidence of lymphocele after pelvic lymphadenectomy was 56% (75/134) in the tie ligation group, and 18% (33/187) in the EBVSD group. We found a statistically significant difference in the incidence of lymphocele between both groups (p<0.01). To detect the independent risk factor for lymphocele development, we performed multivariate analysis with logistic regression for three variables (device, number of dissected lymph nodes, and operation time). Among these variables, we found a significant difference (p<0.001) for only one device. CONCLUSION: Use of the EBVSD during gynecological cancer operation is useful for preventing the development of lymphocele secondary to pelvic lymphadenectomy.

Clinicopathological spectrum of 19 adenosarcomas of female genital tract, including uncommon clinical associations and immunohistochemical profile, reviewed at a single institution.

Background: Adenosarcomas of the female genital tract have been rarely documented as case series from our continent. Materials and Methods: Over a seven-year period, 19 adenosarcomas were critically reviewed. Results: Nineteen tumors occurred in the age range of 21-65 years (mean: 43), in the endometrium (8), endometrium and cervix (4), cervix (4), and ovary (3). Four cases displayed coexisting leiomyomas; two, adenomyosis; two on background endometriosis; and one in post-treated cervix carcinoma. Histopathologically, the tumors were low grade (10; 52.6%) and high grade (9; 47.3%), the latter with sarcomatous overgrowth (SO) (7/9 cases). Dedifferentiation (8, 42.1%) and conspicuous decidualization (2) were noted. Immunohistochemically, the tumors focally expressed CD10 (4/6), smooth muscle actin (SMA) (3/8), desmin (8/11); diffuse vimentin (7/7), and estrogen receptor/progesterone receptor (ER/PR) (2/4). Ki-67 (6 cases) varied 5-20%. Seventeen patients underwent surgery and four received adjuvant treatment (3/4 high-grade tumors). Five tumors recurred (4 high-grade tumors with SO) and one metastasized. Among 11 patients, five were alive with disease (AWD) (mean: 29.4 months) and six, free of disease (FOD) (mean: 15 months), the latter mostly with low-grade type tumors (83.3% cases). Conclusions: Diverse clinicopathological spectrum was noted within adenosarcomas. Low-grade tumors were less aggressive than high-grade ones, with SO. Immunohistochemically, lower CD10 and ER/PR positivity was noted in high-grade tumors. Surgery formed the mainstay of treatment. Adjuvant treatment was offered in high-grade subtypes, including in tumors with SO.

Relevancia de la apoptosis en la reproducción femenina / Relevance of apoptosis in the female reproductive system

La apoptosis es un proceso genéticamente controlado mediante el cual las células inducen su propia muerte. Mensualmente y en forma cíclica, el ovario, el endometrio y la glándula mamaria atraviesan por ciclos de proliferación celular y apoptosis respondiendo a los cambios en la secreción hormonal. Durante el desarrollo embrionario, la apoptosis está implicada en procesos relacionados con la escultura de los diferentes órganos, a través de la eliminación de estructuras innecesarias y con el control de las células defectuosas. Asimismo, la apoptosis juega un papel fundamental en la función ovárica. La reserva folicular se establece durante la vida fetal y luego se va eliminando gradualmente. La apoptosis está involucrada tanto en la muerte celular durante el proceso de reclutamiento del folículo dominante, como en la luteólisis. Durante la pubertad la apoptosis contribuye a la formación del espacio luminal de los ductos terminales de la mama. A su vez, el proceso de involución mamaria luego de la lactancia se caracteriza por una apoptosis masiva de las células epiteliales secretoras. Así como la apoptosis está involucrada en los cambios fisiológicos que ocurren a nivel endometrial, también se ha asociado a la muerte celular programada con procesos patológicos, especialmente en aquellos caracterizados por el incremento en el crecimiento celular como es el caso de la endometriosis. El delicado balance entre la apoptosis y la proliferación celular es fundamental ya que permite que los tejidos puedan responder en forma cíclica a los cambios hormonales fisiológicos y prevenir procesos de transformación neoplásica.

Apoptosis is a genetically controlled form of cell suicide. Due to the cyclic nature of the female reproductive system, the ovary, the endometrium and the mammary gland sustain continuous cycles of cell growth and apoptosis in response to hormonal changes. Apoptotic cell death plays multiple roles during embryonic and organ development. It is involved in sculpturing tissues and serves to delete structures that are no longer required. It is clear that apoptosis plays an active and important role in ovarian physiological functions. Apoptosis plays a major role during folliculogenesis and dominant follicle selection and also plays part in corpus luteum regression. In addition, it has been shown that programmed cell death plays important roles in the mammary gland development and ductal morphogenesis. During puberty, lumen formation is associated with the selective apoptosis of centrally located cells. In turn, postlactational involution of the mammary gland is characterized by the secretory epithelial cells undergoing programmed cell death. Apoptosis has also been associated with physiological, as well as pathological, endometrial processes such as cancer and endometriosis. The delicate balance between apoptosis and cell proliferation is essential in controlling the cyclical growth of the reproductive tissues and plays an important role in the prevention of neoplastic transformation.

Leucocitúria em pacientes submetidas a quimioterapia e coleta de urina / Leucocituria in patients submitted to chemoteraphy and urine collection / Leucocitúria en pacientes sometidas a quimioterapia y recolección de orina

O objetivo do estudo foi verificar a freqüência de leucocitúria em portadoras de câncer ginecológico em quimioterapia (QT) e avaliar as práticas na coleta de urina para exame. Pesquisa descritiva, transversal realizada com mulheres portadoras de câncer ginecológico, durante seções de QT. Com entrevista semi-estruturada foi identificada técnica da coleta de urina e verificados os resultados dos exames realizados antes das seções de QT. Das 30 entrevistadas, 80 por cento relataram coletar corretamente urina, 100 por cento apresentaram pelo menos um erro durante o processo. A frequência de leucocitúria foi de 30 episódios. Os erros ocorreram principalmente na higienização genital e coleta do jato urinário. Infere-se que a forma errônea na coleta de urina somada a neutropenia sejam responsáveis pela leucocitúria.

The proposal of the study was to verify leucocituria frequency in carriers of gynecological cancer in chemotherapy (CT) and to identify practices in urine collection for exam. Descriptive transversal study carried out with ginecologyc cancer patients during chemotherapy sections. With semi-structured interview, it was identified urine collection technique and verified the results of exams accomplished before chemotherapy sections. Among 30 interviews, 80 percent related to collect urine correctly, 100 percent presented at last a mistake during the process. Leucocituria frenquency was 30 episodes. The mistakes occurred mostly in genital cleaning and collection of the urinary jet. It infers that the erroneous form in the collection in addition to the neutropenia can be responsible for the leucocituria.

El objetivo del estudio fue verificar la frecuencia de leucocitúria en portadoras de cáncer ginecológico en quimioterapia (QT) e identificar las prácticas en la colecta de orina para examen. Pesquisa descriptiva transversal realizada con portadoras de cáncer ginecológico, durante las secciones de QT. Por medio de entrevista semi-estructurada fue identificada técnica de colecta de orina y verificados los resultados de los exámenes realizados antes de las secciones de QT. De las 30 entrevistadas, 80 por ciento relataron colectar correctamente la orina, 100 por ciento presentaron por lo menos un error durante el proceso. La frecuencia de leucocitúria fue de 30 episódios. Los errores ocurrieron principalmente en la higienización genital y colecta del chorro urinario. Se infiere que la forma errada en la colecta de orina sumada a la neutropénia sean responsables por la leucocitúria.

Edema maciço de ovário / Massive ovarian edema

O edema maciço de ovário é uma condição benigna rara caracterizada pelo aumento tumoral símile do ovário comprometido. As doenças ovarianas de importância cirúrgica da infância não são frequentes e podem ser divididas em lesões neoplásicas, em cistos não neoplásicos e em alterações inflamatórias. Os autores descrevem um caso de edema maciço de ovário em uma paciente de treze anos que referia dor abdominal associada a uma lesão sólido-cística do ovário direito, avaliada como neoplasia pela ultrassonografia. Ao exame macroscópico, o ovário era bocelado e estava aumentado de volume, medindo 9,5×6,0×5,0 cm e apresentando uma lesão sólida com áreas císticas à superfície de corte. O aspecto microscópico fundamental desse processo era a presença de edema acentuado e difuso do estroma, envolvendo folículos, e associado a uma camada cortical com espessamento fibroso superficial. O conhecimento dessa entidade é fundamental para auxiliar no diagnóstico durante a avaliação ultrassonográfica de tumores ovarianos e prevenir tratamentos incorretos.

Massive ovarian edema is a rare benign condition characterized by similar tumor growth of the affected ovary. The ovarian disorders of surgical importance of childhood are not frequent and can be divided into neoplastic lesions, non-neoplastic cysts, and inflammatory alterations. Here the authors describe the case of a massive ovarian edema in a 13-year-old female patient who reported abdominal pain associated with a solid-cystic lesion of the right ovary evaluated as a neoplasm by ultrasonography. The macroscopic examination showed ovary with increased volume, measuring 9.5×6.0×5.0 cm, and presenting a solid lesion with cystic areas at the cutting surface. The key microscopic feature of this process was the presence of pronounced diffuse edema of the stroma, involving follicles and associated with a cortical layer with superficial fibrous thickening. Knowledge of this entity is key in aiding the diagnosis during the ultrasonographic evaluation of ovarian tumors and preventing improper treatments.

A Structural Equation Model on Sexual Function in Women with Gynecologic Cancer

PURPOSE: This study was designed to construct and test a structural equation model on sexual function in women with gynecologic cancer. METHODS: The model was constructed and tested under the hypotheses that women's physical changes in sexual function after gynecologic cancer treatment did not automatically lead to sexual dysfunctions. Women's psychosocial factors were considered to be mediating variables. Two hundred twelve women with cervical, ovarian, and endometrial cancer were recruited and asked to complete a survey on their physical factors, psychosocial factors and sexual function. Data was analyzed using SPSS WIN 12.0 and Amos WIN 5.0. RESULTS: Predictors of sexual function in the final model were sexual attitude affected by physical distress and couple's age, sexual information affected by physical distress and couple's age, depression affected by physical distress, and marital intimacy affected by physical distress. Tumor stage and time since last treatment directly affected women's sexual function without any mediating psychosocial variables. However, body image did not affect women's sexual function. CONCLUSION: Nursing professionals should develop a tailored educational program integrating both physical and psychosocial aspects, and apply it to women and their spouses in order to promote sexual function in women with gynecologic cancer.

Retrospective histopathological analysis of various neoplasms of the female reproductive system (FRS) seen at the Kathmandu University Teaching Hospital, (KUTH) Dhulikhel, Nepal.

OBJECTIVE: To find out the spectrum of various histopathological types of primary neoplasms of different parts/organs of the female reproductive system seen at the Kathmandu University Teaching Hospital (KUTH) as there exists a worldwide wide variation in the distribution of various neoplasms, which appears largely due to exogenous factors rather than due to inherent differences between populations. MATERIAL AND METHOD: This was a retrospective study. It was carried out at KUTH. All neoplasms of the female reproductive system seen at the KUTH during the period of 20 months from 1st January 2004 to 31st August 2005 were included in this study and examined by light microscope (LM). RESULTS: A total number of 60 cases of neoplasms of the female reproductive system were seen. Out of these, 1 (1.7%) was of the vagina (squamous cell carcinoma, papillary variant); 16 (26.7%) were of the cervix of the uterus (all squamous cell carcinoma in advanced stage); none were of the endometrium; 20 (33.3%) were of the body of the uterus/uterine muscle (all liomyomas); 16 (26.7%) were of the ovary, (11 benign, consisting of nine mature cystic tertoma, also known as dermoid cyst, one serous papillary cystdenoma and one mucinous cystadenoma; and, five malignant, consisting of two serous cystadenocarcinoma, two mucinous cystadenocarcinoma and one mixed mucinous and serous cystadenocarcinoma); and, 7 (11.6%) were of the breast (two benign, consisting of fibroadenoma and five malignant, all consisting of infiltrating ductal carcinoma in advanced stage). CONCLUSION: There were relatively a large number of cases of advanced stage of cancer of uterine cervix. All breast cancers seen were also in advanced stage. Endometrial carcinoma was conspicuously absent in our this small series of cases.

Adnexal mass: Pre operative characterization in the emergency department transvaginal color Doppler sonographic early diagnosis and serial assessment: Best predictor

This prospective cohort study aimed at evaluating the value of transvaginal color doppler sonography [TV-CDS] in the early detection and serial assessment of adnexal masses. Serial TV-CDS was performed on 102 women with adnexal masses referred over 18 months. 66 women having adnexal masses with negative pregnancy test were examined at 3, 6, 12 weeks after initial examination [group I]and 36 women hating positive pregnancy test with ectopic pregnancies [EPs] were examined [4-11] weeks [mean 6.3w] postmenstrual [group II]. 83% of high impedance flow masses underwent regression whereas only 22% of lesions with low impedance flow did. 20% of lesions that regressed had a significant drop in pulsatility index [PI] Probability of regression was the greatest in young women [less than 40 years of age] and in masses < 5cm. Changes in PI were more predictive of regression than morphology or patient age. 91% of women received progestational suppression demonstrated regression with decrease of PI and peak systolic velocity [PSV] and the rest of patients completed regression on 6 months follow up treatment. The mean systolic velocity of the EPs seas 35.4 cm/s compared with 28.4 cm/s in corpus luteum cysts [CLCs] with no significant statistical difference [P = 0.1]. The resistive index [RI] of BPs ranged front 0.15 to 1.6 [mean +/- SD. 0.61 +/- 0.24] compared with 0.4 to 0.7 [mean +/- SD. 0.52 +/- 0.10] in CLCs with a significant statistical difference [P = 0.003]. The RI of less than 0.4 had a specificity of 100% and a positive predicative value PPV of 100% for diagnosing EP but was present in only [sensitivity] 15% [confidence interval 7% - 23%] of EPs. A RI of greater than 0.7 had a specificity of 100% and a PPV of 100% for diagnosing EP and was present in only 31% [confidence interval 21% - 41%] of EPs. Serial TV - CDS is a useful non-invasive parameter in early detection of adnexal lesions.starting serious acute abdomen and those lesions which may spontaneously regress avoiding unnecessary surgeries. Changes in PI were predictive of regression [90%] than morphology or patient age. Bath low and high RI discriminate EP from a CLC before management

Diagnostic accuracy of transabdominal sonography in the evaluation of pelvic mass of gynecological origin.

A study of 97 cases having clinical manifestations of pelvic mass in female was carried out in the department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University with the cooperation of the department of Obstetrics and Gynecology. This study was designed to determine accuracy of transabdominal sonography in the diagnosis of pelvic mass in female. The findings of transabdominal sonography were compared with histopathological examination. Transabdominal sonography had 87.6% accuracy, but only 3.1% false positive and 9.3% false negative rates. It can be concluded that ultrasonographic findings of different pelvic masses are highly dependable, can be used for preoperative decision making.

Gynaecologic cancer incidence, Kingston and St Andrew, Jamaica, 1973-1997, and gynaecologic cancer mortality, Jamaica, 1999

The incidence of gynaecologic cancers in women from Kingston and St Andrew for the period 1973-1997 were reviewed by analyzing data previously published by the Jamaica Cancer Registry. Gynaecologic cancer-related mortality statistics for the entire island for 1999 were compiled from data obtained from the Registrar General's Department (RGD) and the Statistical Institute of Jamaica (STATIN). Data were compared to gynaecologic cancer statistics for women from the United States of America for 1973-1997. A total of 2862 gynaecologic cancers were registered for the years 1973-1997, which represents 26.8 of all female cancers from Kingston and St Andrew. Cervical cancer accounted for 62 of these gynaecologic cancers. The 268 cancer-related deaths (168 due to cervical cancer) registered in Jamaican women for 1999 represent approximately 15 of all female cancer-related deaths. The present incidence (27.9 per 100,000) and mortality rate (15.8 per 100,000) of cervical cancer are much higher than that documented for American women--both African Americans and Caucasians--and signify the limited success, to date, of efforts to decrease the incidence and mortality of cervical cancer by the implementation of cervical cancer screening programmes. For the time period reviewed, an increase was noted in the incidence of cancer of the corpus uteri while decreases were recorded for the incidence of choriocarcinoma, ovarian cancer and cancers arising from the vulva, vagina and fallopian tube

Lymph Node Metastasis in a Gynecologic Malignancy

A radical hysterectomy was performed on patients with stage IA2 to IIB cervical cancer. For these patients, many histopathological parameters have been reported to be prognostic factors of cervical cancer, such as a pelvic lymph node (PLN) metastasis, the histological subtype, the tumor diameter, the depth of the stromal invasion, a lymph-vascular space invasion (LVSI), a parametrial invasion, a corpus invasion and a vaginal invasion. Ovarian cancer is normally treated with cytoreductive surgery followed by chemotherapy. Although physicians have paid a great deal of attention to intraperitoneal disease, a substantial number of ovarian cancers have reported to involve the retroperitoneal lymph nodes. Therefore, a lymph node metastasis has been introduced into FIGO staging. However, the prognostic significance of a lymph node metastasis is controversial. In order to determine the possibility of individualizing a pelvic lymph node (PLN) dissection in patients with endometrial cancer, the relationship between PLN metastasis and the various prognostic factors was investigated. In this paper, various prognostic variables including a lymph node metastasis were analyzed in cervical cancer, enodometrial cancer, and ovarian cancer.

Screening rápido en citodiagnóstico ginecológico / Quick screening in gynecological cytodiagnosis

El screening rápido para citología ginecológica se ha demostrado, como uno de los mejores métodos de control de calidad para el Laboratorio de citología ginecológica, sin embargo, existe escasa información respecto de su utilidad como técnica de screening rutinario. El objetivo de este trabajo es evaluar el screening rápido como método de diagnóstico y compararlo con el método actualmente utilizado. Se sometió a screening rápido de 40 segundo a todas las citologías ginecológicas del Laboratorio por un período de cinco semanas. Se examinaron un total de 4.933 citologías ginecológicas en forma independiente mediante dos métodos (screening rápido y de rutina). Una vez realizados los diagnósticos se procedió a reexaminar el 100 por ciento de las láminas negativas. El screening rápido detectó 378 citologías sospechosas (8 por ciento), de las cuales 130 resultaron finalmente positivas (2,6 por ciento). En 78 casos correspondieron a lesiones de bajo grado, 15 a lesiones de alto grado, 6 casos de carcinomas epidermoide y 31 frotis atípicos. El screening realizado en forma rutinaria detectó 135 casos positivos (2,7 por ciento). Todas las lesiones detectadas en el screening rutinario fueron diagnosticadas en el screening rápido a excepción de 5 casos (4 lesiones de bajo grado y una lesión de alto grado). La revisión del 100 por ciento de láminas negativas demostró 21 casos positivos (falso negativos) (0,4 por ciento), de los cuales 16 eran lesiones de bajo grado, una lesión de alto grado y cuatro frotis atípicos. No se observó diferencias significativas entre los diagnósticos del screening rápido respecto del screening rutinario, con una sensibilidad de un 86 por ciento, especificidad de 100 por ciento y un valor predictivo negativo de un 99 por ciento. Nuestro resultados demuestran la utilidad del screening rápido como método de detección inicial de lesiones positivas, pudiendo ser una alternativa en aquellos laboratorios que presenten considerable, o bien, para reemplazar el método actualmente utilizado