Técnica morfométrica en el diagnóstico diferencial de hiperplasia endometrial compleja y adenocarcinoma endometroide. Matanzas; 2014-2015 / Morphometric technique in the differential diagnosis of complex endometrial hyperplasia and endometroid adenocarcinoma. Matanzas; 2014-2015

RESUMEN Introducción: la función del endometrio está regida por el eje hipotálamo hipofisario mediante las hormonas sexuales por lo que es vulnerable a los desórdenes de este sistema los que provocan diferentes trastornos funcionales que se traducen en alteraciones morfológicas. Es fundamental su estudio para el diagnóstico de patologías que son un problema de salud en la población femenina. Objetivo: determinar las diferencias morfométricas para el diagnóstico histopatológico diferencial entre la hiperplasia endometrial compleja, el adenocarcinoma endometrioide y en el endometrio proliferativo normal, en el municipio Matanzas, enero2014 -2015. Material y Métodos: se realizó un estudio observacional descriptivo de corte transversal y se aplicó morfometría a una muestra de 30 biopsias endometriales, con el objetivo de determinar las diferencias morfométricas para el diagnóstico histopatológico diferencial entre la hiperplasia endometrial compleja, el adenocarcinoma endometrioide y en el endometrio proliferativo normal. Resultados: el área total de la glándula fue la variable analizada que mostró mayores valores y reflejó marcadas diferencias entre la hiperplasia endometrial compleja, el adenocarcinoma endometrioide y el endometrio proliferativo normal, seguida por la altura del epitelio por tanto existen diferencias cuando se estudian variables que tiene en cuenta la morfología glandular. Conclusiones: existen diferencias morfométricas entre la hiperplasia endometrial y el adenocarcioma endometroide cuando se estudian variables que tienen en cuenta la morfología y arquitectura glandular (AU).

SUMMARY Introduction: the endometrium function is ruled by the pituitary- hypothalamus axis by means of sexual hormones; therefore it is vulnerable to the disorders of this system provoking different functional disorders resulting in morphological alterations. It is very important to study them for the sake of the diagnosis of diseases that are a health problem in female population. Objective: to determine the morphometric differences for the differential histopathological diagnosis among the complex endometrial hyperplasia, the endometrioid adenocarcinoma and the normal proliferative endometrium e, in the municipality of Matanzas, in the period January 2014-2015. Methods: a cross-sectional descriptive observational study was carried out applying morphometry to a sample of 30 endometrial biopsies, with the objective of determining the morphometric differences for the differential histopathological diagnosis among the complex endometrial hyperplasia, endometrial adenocarcinoma and normal proliferative endometrium. Results: the gland total area was the used variable showing more values and revealed stark differences among complex endometrial hyperplasia, endometrioid adenocarcinoma and normal proliferative endometrium, followed by the epithelium height; hence there are differences when variables are studied taking into account glandular morphology. Conclusions: there are morphometric differences between endometrial hyperplasia and endometrioid adenocarcinoma when there are studied variables taking into account glandular morphology and architecture (AU).

Sangrado y terapia hormonal en la menopausia (THM) / Bleeding during menopause hormone therapy (MHT)

La definición de sangrado ginecológico anormal durante terapia hormonal de la menopausia es aquel sangrado no programado durante el uso de la terapia. Este artículo es un pauteo que describe: 1) cuándo diagnosticar unsangrado anormal, ya que difiere según el tipo de esquema hormonal utilizado; 2) eldiagnóstico diferencial del origen del sangrado anormal; 3) los métodos de evaluación para diagnosticar el origen del sangrado. Se destacan los aspectos principales para el diagnóstico diferencial entre patología orgánica versus disrupción endometrial debida al tratamiento hormonal. Además, se describen los ajustes posibles para resolver el sangrado cuando éste se debe a disrupción del endometrio.

Abnormal bleeding related to menopausal hormone therapy is defined as unscheduled bleeding during the use of the therapy. This article outlines when to diagnose an abnormal bleeding -as this differs according to the type of hormonal scheme used-, the differential diagnosis of the origin of abnormal bleeding, and the methods of evaluation to assess the origin of the bleeding. The main aspects are highlighted on the differentiation of organic pathology versus disruption of the endometrium due to treatment. Also, treatment adjustments to resolve bleeding when it is due to disruption of the endometrium are outlined.

Recurso morfométrico para el diagnóstico de hiperplasia endometrial compleja y adenocarcinoma endometrioide. Matanzas 2014-2015 / Morphometric resource for the diagnosis of complex endometrial hyperplasia, and endometrial adenocarcinoma. Matanzas 2014-2015

Introducción: el endometrio es fundamental para el diagnóstico de entidades que constituyen problemas de salud para la población femenina. Resulta de vital importancia para el patólogo el hallazgo de diferencias entre la morfología del endometrio de la hiperplasia endometrial y el adenocarcinoma endometrioide que le permitan realizar el diagnóstico diferencial ente estas dos entidades. Objetivo: determinar las diferencias morfométricas para el diagnóstico histopatológico diferencial entre la hiperplasia endometrial compleja, el adenocarcinoma endometrioide y en el endometrio proliferativo normal. Materiales y métodos: se realizó un estudio observacional descriptivo de corte transversal y se aplicó morfometría a una muestra de 30 biopsias endometriales, con el objetivo de determinar las diferencias morfométricas para el diagnóstico histopatológico diferencial entre la hiperplasia endometrial compleja, el adenocarcinoma endometrioide y en el endometrio proliferativo normal. Se utilizó sistema morfométrico IMAGEN J 1.44p, se estudiaron las glándulas endometriales a las que se les halló la altura del epitelio glandular. Resultados: la altura del epitelio en las glándulas de tamaño menor, intermedio y mayor, expresaron estrechas diferencias entre la hiperplasia endometrial compleja, el adenocarcinoma endometrioide y en el endometrio proliferativo normal y que existen diferencias entre la hiperplasia endometrial y el adenocarcinoma endometrioide cuando se estudian variables que tiene en cuenta la morfología glandular. Conclusiones: se concluyó que existen diferencias entre la hiperplasia endometrial y el adenocarcinoma endometrioide cuando se estudian variables que tiene en cuenta la morfología glandular (AU).

Introduction: the endometrium is fundamental for the diagnosis of entities that are a health problem for female population. It is very important for the pathologist to find differences between the morphology of the endometrium of the endometrial hyperplasia and the endometrial adenocarcinoma allowing to perform the differential diagnosis between these two entities. Objective: to determine the morphometric differences for the differential histopathological diagnosis between the complex endometrial hyperplasia, the endometrial adenocarcinoma and the normal proliferative endometrium. Materials and methods: a cross-sectional, descriptive, observational study was applied and the morphometry was applied to a sample of 30 endometrial biopsies, with the objective of determining the morphometric differences for the histopathological differential diagnosis among complex endometrial hyperplasia, endometrial adenocarcinoma and normal proliferative endometrium. The morphometric system IMAGEN J 1.44p was used and the endometrial glands were studied and the height of their glandular epithelium was calculated. Results: the minor, intermediate and higher height of the epithelium in the glands expressed tight differences among complex endometrial hyperplasia, endometrial adenocarcinoma and normal proliferative endometrium, and showed that there are differences between endometrial hyperplasia and endometrial adenocarcinoma when the studied variables take into account the glandular morphology. Conclusions: there are differences between endometrial hyperplasia and endometrial adenocarcinoma when there are studied variables taking into account the glandular morphology (AU).

Síndrome de ovario poliquístico / Polycystic ovary syndrome

El síndrome de ovario poliquísticos (SOP) representa una de las endocrinopatías más frecuentes en la mujer y es la principal causa de hiperandrogenismo (HA). Se trata de un trastorno complejo, multifactorial, poligénico con influencias ambientales. Aunque se han propuestos diferentes criterios para su diagnóstico, se prefiere el uso del más abarcativo (Criterio de Rotterdam) con la presencia de 2 de 3 de los siguientes: 1) HA clínico o bioquímico, 2) oligoanovulación crónica (OA), 3) poliquistosis ovárica por ecografía, excluyendo otras etiologías. Es frecuente su asociación con comorbilidades metabólicas (obesidad, diabetes 2, dislipidemia, apnea del sueño, etc.) y trastornos reproductivos (hiperplasia endometrial e infertilidad), sobre todo en los fenotipos clásicos, con HA y OA. El tratamiento estará orientado a las características clínicas de cada paciente y al deseo reproductivo. La pérdida de peso en aquellas con sobrepeso u obesidad o ambos factores puede restaurar los ciclos menstruales y disminuir el riesgo metabólico y representa la primera línea de tratamiento. Los anticonceptivos orales (ACO) son el tratamiento farmacológico de elección ya que atenúan las manifestaciones de HA y ofrecen protección endometrial. En las pacientes con oligoanovulación que buscan embarazo, el citrato de clomifeno es el tratamiento aconsejado en primera instancia. La metformina podría usarse en aquellas con intolerancia a la glucosa o diabetes 2 y también como segunda línea de tratamiento para restaurar los ciclos e inducir la ovulación. (AU)

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women, the main cause of hyperandrogenism (HA). It is a complex, multifactorial polygenic disorder with environmental influences. Although there have been proposed different criteria for diagnosis, using the most comprehensive (Criteria Rotterdam) with the presence of 2 of 3 of the following is preferred: 1) HA clinical or biochemical, 2) oligo-anovulation chronic (OA), 3) polycystic ovaries by ultrasound, excluding other etiologies. It is frequently associated with metabolic comorbidities (obesity, type 2 diabetes, dyslipidemia, sleep apnea, etc.) and reproductive disorders (endometrial hyperplasia and infertility), especially in the classical phenotypes, with HA and OA. The treatment will be oriented to the clinical characteristics of each patient and reproductive desire. Weight loss in those who are overweight and / or obesity can restore menstrual cycles and decrease metabolic risk and represents the first line of treatment. Oral contraceptives (OC) are the pharmacological treatment of choice as it attenuates the manifestations of HA and offer endometrial protection. In patients seeking pregnancy with oligo-anovulation, clomiphene citrate would be used at first instance. Metformin may be used in those with impaired glucose tolerance or type 2 diabetes and also as a second-line treatment to restore cycles and induce ovulation. (AU)

Histerectomía laparoscópica tipo IV: Servicio Cirugía II Hospital Universitario de Caracas / Laparoscopic hysterectomy type IV: Servicio Cirugia II Hospital Universitario de Caracas

Evaluar la histerectomía laparoscópica en comparación con las histerectomías abiertas. Estudio prospectivo descriptivo realizado entre los años 2007-2009, con una población de 32 mujeres a las que se les realizó una histerectomía totalmente laparoscópica (tipo IV según la Asociación de Ginecólogos Americanos). Las variables evaluadas fueron edad, índice de masa corporal, cirugías previas, diagnóstico preoperatorio, cirugía asociada, sangrado, tiempo quirúrgico, complicación, hospitalización, dolor medido por la escala analógica del dolor. En el Hospital Universitario de Caracas, Servicio de Cirugía II. La edad promedio de la población fue de 47,7 años y el índice de masa corporal de 25,8 kg/m2, con un tamaño uterino promedio menor a 14 semanas de gestación. El diagnóstico preoperatorio fue de miomatosis uterina en 25 pacientes (78,12 por ciento), en dos casos hubo hiperplasia endometrial (6,25 por ciento), un pólipo endometrial (3,12 por ciento), una paciente con NIC III (3,12 por ciento), 3 casos con histerocele (9,37 por ciento). Hubo cirugía asociada en 5 pacientes. El sangrado fue menor de 50 mL, con un tiempo quirúrgico promedio de 84,6 minutos. No se presentaron complicaciones inherentes a la cirugía y tuvimos un tiempo de hospitalización promedio de 33,39 horas. Escala analógica del dolor promedio 3. La histerectomía laparoscópica tipo IV es una técnica segura con resultados satisfactorios y superior en algunos aspectos en comparación con la histerectomía abierta convencional

To evaluate laparoscopic hysterectomy compared with open hysterectomy. Prospective descriptive study conducted between 2007-2009, with a population of 32 women that underwent total laparoscopic hysterectomy (type IV according to the of American Gynecologists Association). The variables assessed were age, body mass index, previous surgeries, preoperative diagnosis, associated surgery, bleeding, surgical time, complications, hospitalization, pain measured by the visual analog scale of pain. Hospital Universitario de Caracas, Servicio de Cirugi a II. The average age of the population was 47.7 years and body mass index of 25.8 kg/m2, with an average uterine size less than 14 weeks gestation. The preoperative diagnosis was uterine fibroids in 25 patients (78.12 percent), two cases had endometrial hyperplasia (6.25 percent), endometrial polyp (3.12 percent), one patient with CIN III (3.12 percent ), 3 cases with hysterocele (9.37 percent). Surgery was associated in 5 patients. The bleeding was less than 50 mL, with a mean operative time was 84.6 minutes. There were no complications due to surgery and had a mean hospital stay of 33.39 hours. Average pain analog scale 3. Laparoscopic hysterectomy type IV is a safe technique with satisfactory results and in some respects superior compared to conventional open hysterectomy

Letrozole as an appropriate therapeutic modality for infertile women with endometrial hyperplasia

To evaluate the impact of oral letrozole therapy for 3-months on infertile patients with pathologically confirmed endometrial hyperplasia [EH]. The study comprised 17 infertile patients with EH. All patients underwent full clinical examination, transvaginal ultrasonography [TVU] to determine endometrial thickness [ET] and estimation of serum E2 levels. All patients were prescribed letrozole 2.5 mg tablets once daily for 3 months and underwent endometrial biopsy at end of treatment. The study outcome was defined as regression of EH to histologically normal endometrium at end of treatment. At the end of the 3-months treatment period, all patients showed significant reduction of preliminary endometrial thickness and decrease of serum E2 levels. All cases with simple EH without atypia [n=10] showed good response with a mean regression rate of ET of 70.2%, while was 59.3% in cases of complex EH without atypia [n=5] and 53% in cases of complex EH with atypia [n=2]. The overall pathological success rate was 88.2%; 100% in simple EH without atypia, 80% in complex EH without atypia and 50% in EH with atypia. For EH without Atypia in infertile patients oral letrozole therapy for 3-months resulted in high regression rate of endometrium and high pathological success rate. However, further large scale studies with dosage modification are needed to determine its true efficacy in EH with atypia in infertile patients

Labial aggressive angiomyxoma associated with endometrial hyperplasia and uterine leiomyoma: a case report and review of the literature.

A case of aggressive angiomyxoma of the left labia majora in a 48-year-old woman with clinically presenting progressive enlarged labial mass is reported. The histopathological examination of the lesion characterized was by fibroblasts, myofibroblasts in the myxoid stroma with prominent thick-walled blood vessels. The uterus showed intramural leiomyomata with simple hyperplastic endometrium. The labial mass, uterine leiomyoma and endometrial hyperplasia were immunoreactive for estrogen and progesterone receptors. Clinical and pathologic features with briefly reviewed relevant literatures were discussed. This is the first reported description in the literature of synchronous labial angiomyxoma, endometrial hyperplasia, and uterine leiomyoma.

Emabarazo luego de tratamiento conservador de hiperplasia endometrial atípica compleja con goserelina: caso clínico / Pregnancy after conservative treatment of a complex atypical endometrial hyperplasia with goserelin: case report

Se presenta el caso de una paciente de 28 años de edad que consultó por deseos de embarazo luego de dos abortos consecutivos. La biopsia de endometrio reportó hiperplasia glandular simple con atipias focales. Se le indica medroxiprogesterona (60mg diarios) por 3 meses. Al finalizar el tratamiento se le realiza histeroscopia en la que se observa lesión sospechosa en cara anterior del endometrio que la biopsia reporta progreso de la lesión a hiperplasia endometrial glandular compleja con atipias. Recibe goserelina (Zoladex ®) 3.5 mg vía subcutánea mensual durante 6 meses después presenta una gestación sin complicaciones, que culmina en cesárea. Se realiza nueva biopsia del endometrio, y no presentó evidencias de la enfermedad. Una histeroscopia realizada 3 meses más tarde no se observa la lesión endometrial. La hiperplasia compleja con atipias puede ser tratada de forma conservadora con análogos de GnRH en pacientes con deseos de su procreación y bajo seguimiento histeroscópico.

Factores de riesgo de hiperplastia endometrial HEODRA 2006-2008 / Factors of risk of hiperplastia endometrial HEODRA 2006-2008

El propósito de este estudio es identificar y evaluar factores de riesgo de hiperplasia endometrial en las pacientes que acuden al HEODRA con historia de sangrado uterino anormal. Se estudiaron 59 parejas (casos y controles), los casos fueron aquellas pacientes con diagnósticos de hiperplasia endometrial confirmados por anatomopatología y los controles serían mujeres que también acudieron al mismo hospital pero sin evidencia clínica de hiperplasia endometrial, aunque con edades que no diferían en más de tres años la edad de los casos. La información se obtuvo mediante la entrevista con cada paciente previo consentimiento. Los resultados del estudio en nuestro medio demuestran que enfermedades como: la obesidad (OR 3.2, IC 95 porciento 1.18 – 8.74), la hipertensión (OR 3.25, IC 95 porciento 1.06 – 9.97) y los ovarios poliquísticos (OR 19, IC 95 porciento 1.11 – 326.46) tuvieron asociación estadísticamente significativa con la hiperplasia endometrial, siendo la hiperplasia simple sin atipia el diagnóstico histológico más común, no obstante las hiperplasias atípicas representaron una cuarta parte de los diagnósticos. Así mismo se observó que el 27.4 porciento de las hiperplasias endometriales se atribuyen a la obesidad de las pacientes, el 41.8 porciento a la hipertensión y el 79.8 porciento a aquellas pacientes con diagnóstico histológico de ovarios poliquísticos. Se concluye por tanto que la obesidad, la hipertensión y los ovarios poliquísticos son potenciales factores de riesgo para hiperplasia endometrial en las pacientes de nuestro medio. Debido a lo que recomendamos educar a la población para la prevención de las principales condiciones que han sido identificadas como factores de riesgo de la hiperplasia endometrial...

A Case of Cushing's Syndrome Presenting as Endometrial Hyperplasia

We describe here the case of a 39-year-old woman with a cortisol-producing adrenal adenoma and she presented with endometrial hyperplasia and hypertension without the specific characteristics of Cushing's syndrome. The patient had consulted a gynecologist for menometrorrhagia 2 years prior to her referral and she was diagnosed with endometrial hyperplasia and hypertension. Her blood pressure and the endometrial lesion were refractory despite taking multiple antihypertensives and repetitive dilation and curettage and progestin treatment. On admission, the clinical examination revealed mild central obesity (a body mass index of 22.9 kg/m2, a waist circumference of 85 cm and a hip circumference of 94cm), but there was no hirsutism and myopathy. She showed impaired glucose tolerance on an oral glucose tolerance test. The biochemical hypercortisolemia together with the prolactin and androgen levels were evaluated to explore the cause of her anovulation. Adrenal Cushing's syndrome was confirmed on the basis of the elevated urinary free cortisol (454 microgram/24h, normal range: 20-70) with a suppressed ACTH level (2.0 pg/mL, normal range: 6.0-76.0) and the loss of circadian cortisol secretion. A CT scan revealed a 3.1 cm, hyperechoic, well-marginated mass in the left adrenal gland. Ten months post-adrenalectomy, the patient had unintentionally lost 9 kg of body weight, had regained a regular menstrual cycle and had normal thickness of her endometrium.

Microglandular hyperplasia of the cervix: frequency in cone specimens, histological patterns, clinical aspects and immunohistochemical markers for differential diagnosis with adenocarcinoma

Although endocervical microglandular hyperplasia (MGH) is a common diagnosis, it can be confused with adenocarcinoma (ACa), mainly of the clear cell type. OBJECTIVES: Evaluate the frequency of MGH diagnosis in conization specimens, their histological patterns and characterize the differential diagnosis between MGH and ACa through immunohistochemical markers, as well as some clinical aspects. METHODS: We reviewed 223 cervical cones and 50 ACa in cervical biopsies in order to: 1) assess the frequency of MGH in cones; 2) verify immunohistochemical expression of p53, carcinoembryonic antigen (CEA) and Ki67 in both lesions; 3) correlate the findings to age, parity and hormonal status. RESULTS: We found 35 cases of MGH (15.7 percent), of the following patterns: 21 glandular (60 percent); 7 reticular (20 percent); 6 trabecular (17.1 percent) and one solid (2.8 percent). Average age was 36 years and mean parity was three children. Of the MGH patients, 51.42 percent were pregnant or made use of some hormonal therapy. ACa occurred in older patients (mean: 53 years), multiparous and with no hormonal history. CEA was negative in MGH and positive in 62 percent of ACa. Ki67 was weakly positive (5 percent-10 percent stained nuclei) in 8.6 percent of MGH and strong (> 40 percent stained nuclei) in 80 percent of ACa. p53 expression was negative in MGH and only present in 10 percent of ACa. CONCLUSIONS: MGH was common in cones, mainly in young women. Half of the cases were associated with hormonal therapy or pregnancy. CEA and Ki67 were useful but p53 expression was not important for the differential diagnosis with adenocarcinoma.

Embora a hiperplasia microglandular da endocérvice (MGH) seja um diagnóstico freqüente, algumas vezes pode ser confundida com adenocarcinoma (ACa), principalmente de células claras. OBJETIVOS: Avaliar a freqüência da MGH em cones de colo uterino, seus padrões histológicos e o diagnóstico diferencial entre MGH e ACa, através de marcadores imuno-histoquímicos e de alguns aspectos clínicos. MÉTODOS: Foram revisados 223 cones, bem como 50 biópsias cervicais com o diagnóstico de adenocarcioma para: 1) verificar a freqüência de MGH nos cones; 2) avaliar a expressão de p53, antígeno carcinoembrionário (CEA) e Ki67 nas lesões; 3) correlacionar as lesões com idade, paridade e estado hormonal. RESULTADOS: MGH ocorreu em 35 cones (15,7 por cento), com os padrões glandular (21 [60 por cento]); reticular (7 [20 por cento]); trabecular (6 [17,1 por cento]) e sólido (um [2,8 por cento]). A média de idade foi 36 anos e de paridade, três filhos; 51,42 por cento estavam grávidas ou usavam terapia hormonal. O ACa ocorreu em pacientes mais velhas (média: 53 anos), multíparas e sem história hormonal. CEA foi negativo em todas MGH e positivo em 62 por cento dos ACa. Ki67 apresentou reatividade baixa (5 por cento a 10 por cento dos núcleos corados) em 8,6 por cento das MGH e alta (> 40 por cento dos núcleos corados) em 80 por cento dos ACa. p53 foi negativo na MGH e positivo em apenas 10 por cento dos ACa. CONCLUSÃO: MGH foi freqüentemente encontrada em cones, principalmente em jovens, sendo metade dos casos associada a terapia hormonal ou gravidez. As expressões do CEA e do Ki67 foram importantes no diagnóstico de ACa, porém o p53 não contribuiu para diferenciar as lesões.

Biomonitoring environmental stresses in female endometrial carcinoma versus hyperplasia using HSP70 and HER-2/neu proteins

The intracellular distribution of heat shock or stress-response proteins [HSP], that are triggered to be induced when a cell undergoes environmental stresses, has presumably protective function to enable cells to increase resistance to the harmful effects of pathogens, heavy metal, heat shock, chemical mutagens or carcinogens. HER-2/neu proto-oncogene is a member of epidermal growth factor receptor or erb gene family that plays a key role in the regulation of normal oncogenic cell growth and has been linked to prognosis and response to therapy. To examine the in vivo environmental stresses in female endometrial carcinoma versus hyperplasia using immunohistochemical staining of HSP70 and HER-2/neu proteins. In the present study, 25 cases of formalin-fixed, paraffin embedded human endometrial tissue sections were examined for the expression of HSP70 and HER-2/neu by immunohistochemistry using a rabbit antihuman HSP70 monoclonal antibody and a rabbit anti-human HER-2/neu polyclonal antibody, respectively. The tissue specimens comprise samples of endometrial hyperplasia and cancers, of which five cases were normal control, four cases were simple hyperplasia, five cases were complex hyperplasia with two cases having atypia, five cases were well differentiated endometrial carcinoma [EC], three cases were moderately differentiated EC, and the last three cases were poorly differentiated EC. Positive staining for HSP70, seen as fine dark brown granules mainly confined to the cytoplasm, was observed in all sections examined. There was marked cellular heterogeneity, ranging from cells completely devoid of staining or with faint staining in poorly differentiated endometrial carcinoma to cells with very intense nuclear and cytoplasmic staining [4+] in normal tissue adjacent to the dysplastic epithelium and in cases of simple endometrial hyperplasia, suggesting a possible protective role of HSP70 in the different stages of carcinogenesis. On the other hand, immunoreactivity for HER-2/neu showed different pattern. Positive strong staining was identified cytoplasmic and/or in cell membrane in poorly, moderately and well differentiated endometrial carcinomas. No immunostaining was observed in normal epithelium and in two cases of simple endometrial hyperplasia. The results suggest that HER-2/neu expression may play a role in the pathogenesis and progression of endometrial carcinoma and together with HSP70 could prove useful biomarkers for diagnosis or disease stratification

Estudo da doença endometrial em mulheres na pós-menopausa sob uso contínuo de estrógenos combinados ao acetado de medroxiprogesterona semestral / Study of endometrial disease in post menopausal women using estrogen continuously combined to medroxi progesterona acetate each 6 months

Estudaram-se 129 mulheres na pós-menopausa usando estradiol (E2), contínuo via oral e transdérmica, por 1 ano, mais acetato de medroxiprogesterona (AMP), oral semestral. Realizou-se monitorização ultra-sonografia, histeroscópica e histopatológica em 5 tempos, na procura de doença endometrial O AMP nos esquemas empregados mostrou-se ineficaz para proteger o endométrio. Evidenciando-se... / We studied 129 women in post menopause using estradiol (E2) continuously taken in oral or transdermal way, during one year, and medroxi progesterone acetate each 6 months. Monitorization was performed for 5 times in this period in search of endometrial disease. The schemes showed to be not efficient in protecting the endometrium...

Abnormal uterine bleeding: Diagnostic value of hysteroscopy

To determine the specificity, sensitivity and predictive value of hysteroscopic impression versus histological diagnosis of endometrial curettings in evaluating patients with abnormal uterine bleeding. In addition, to determine whether office hysteroscopy can eliminate hospital diagnostic dilatation and curettage for patients with abnormal uterine bleeding. A retrospective study of 556 patients who underwent hysteroscopy and dilatation and curettage for abnormal uterine bleeding between January 1995 and December 1998 at the Salmaniya Medical Complex in Bahrain. A comparison was made between hysteroscopic impression and histological examination. Out of 556 patients who were included in the study, 53 were diagnosed to have endometrial polyps hysteroscopically, however only 13 patients [24.5%] were confirmed to have polyps histologically. Hysteroscopy had revealed submucous leiomyoma in 33 women but none of these were diagnosed histologically. Hysteroscopy was highly specific for diagnosis of both endometrial hyperplasia and endometrial carcinoma [specificity was 85% for endometrial hyperplasia and 99.5% for endometrial carcinoma], however the sensitivity of hysteroscopy for diagnosing endometrial cancer was 40% and 30% for endometrial hyperplasia. Hysteroscopy was more sensitive than curettage in detecting endometrial polyps and submucous fibroids, but less sensitive than curettage in detecting endometrial hyperplasia and endometrial carcinoma. Hysteroscopy should be carried out in conjunction with curettage for evaluating women with abnormal uterine bleeding. Office hysteroscopy with directed biopsies could be carried out, to reduce hospital diagnostic dilatation and curettage

Concordancia clínica, ultrasonográfica e histopatológica de las tumoraciones benignas del útero en pacientes del servicio de Ginecología del HEODRA durante el período de junio a agosto de 1999

El presente estudio se realizó en el Hospital Escuela Oscar Danilo Rosales Argüello de la ciudad de León-Nicaragua. De las 60 pacientes estudiadas se encontraon los siguientes resultados: en relación a la edad de las pacientes, la mayoría 46.6 porciento se encontra entre los 41 y 50 años, y el menor porcentaje 1.7 porciento menores de 30 años. En cuanto a la escolaridad, la mayoría 63.4 porciento de la pacientes tienen estudios primarios, y el 3.3 porciento con estudios universitarios. De acuerdo a la paridad la mayoría de las pacientes 71.6 porciento son multíparas y un 16.7 porciento son nulpíparas. Según el diagnóstico prequirúrgico a su ingreso a la mayoría 61.7 porciento se le diagnosticó miomatosis uterina, y el menor porcentaje 1.7 porciento con diagnóstico de dolor pélvico crónico y retroversión uterina, por ultrasonido el mayor porcentaje 77.2 porciento se diagnosticó miomatosis uterina y el menor porcentaje 2.3 porciento con retroversión uterina y quiste de ovario. En relación al diagnóstico histopatológico de las pacientes, el 56.7 porciento le correspondió a la miomatosis uterina y el 43.3 porciento a la adenomiosis uterina. Al hacer relación entre el diagnóstico prequirúrgico y ultrasonográfico en cuanto a la sensibilidad para detectar tumoraciones hay una sensibilidad del 100 porciento y una concordancia de 86.4 porciento. Al relacionar diagnóstico prequirúrgico e histopatológico, la sensibilidad es de 73.3 porciento y la concordancia del 73.3 porciento y al relacionar lso diagnósticos ultrasonográficos e histopatológicos, se encontró una sensiblidad y concordancia del 86.4 porciento. Al hacer relación entre diagnóstico prequirúrgico y ultrasonográfico, diagnóstico prequirúrgico e histopatológico, y diagnóstico ultrasonográfico e hisotopatológico se aplicó la prueba de concordancia encontrando una concordancia del 100, 70, y 71 porciento respectivamente

Valor diagnóstico de la imagen endometrial en histeroscopía ambulatoria / Diagnostic value of the endometrial image in ambulatory histeroscopy

Objetivo: determinar las características de la mucosa endometrial para evaluar la necesidad de obtener una biopsia y descartar la presencia de hiperplasia endometrial con la sola visualización histeroscópica. Material y método: se seleccionaron 132 histeroscopias ambulatorias realizadas entre 1997 y 1999, que presentaron un endometrio dentro de límites normales a la imagen histeroscópica y en las cuales además se obtuvo una muestra histológica. A la visualización histeroscópica los endometrios normales fueron clasificados como atróficos, irregulares, proliferativos y gruesos, siendo comparados posteriormente con el resultado de la biopsia, evaluando la presencia de atrofia, hiperplasia u otras anormalidades endometriales. Resultados: de los 132 casos se encontraron a la biopsia endometrial 17 casos de atrofia, 70 endometrios de tipo proliferativo, 22 endometrios irregulares y 23 endometrios gruesos. Del total de histeroscopias normales un 8,3 por ciento presentó hiperplasia endometrial; sin embargo ninguno de estos casos de hiperplasia se encontró dentro de la categoría de endometrios atróficos. Conclusión: se puede concluir en este trabajo que la única impresión diagnóstica que no obliga a realizar una biopsia dirigida por histeroscopia es la atrofia endometrial. Sin embargo en pacientes sintomáticas la impresión de normalidades frente a un endometrio engrosado, irregular o proliferativo obliga a efectuar siempre la biopsia dirigida para un adecuado diagnóstico histeroscópico