Endometrioid Adenocarcinoma Arising in Adenomyoma in a Woman with a Genital Prolapse - Case Report.

BACKGROUND: Endometrial cancer is the third-ranked genital malignancy in women and includes 3% of cancer deaths. There is a 2.8% chance of a woman developing endometrial cancer during her lifetime. Low-grade endometrioid adenocarcinomas are often seen along with endometrial hyperplasia, but high-grade endometrioid adenocarcinomas have more solid sheets of less-differentiated tumour cells, which are no longer organised into glands, often associated with surrounded atrophic endometrium. CASE REPORT: We present an unusual case of endometrial adenocarcinoma arising in adenomyoma in 74-year old woman presented with genital prolapse, without other clinical symptoms. Ultrasound evaluation revealed endometrium with 4 mm-thickness and atrophic ovaries. The cervical smear was normal. The patient underwent a total vaginal hysterectomy. The histopathology of the anterior uterine wall revealed an intramural adenomyoma of 4 mm in which some endometrial glands with malignant transformation of well-differentiated endometrioid adenocarcinoma without infiltration in surrounding myometrium and lymphovascular invasion were present. The endometrium lining the uterine cavity was predominantly atrophic, and only one focus of simplex and complex hyperplasia was found, with cell-atypia. According to AJCC/FIGO 2010, the tumour was classified: pTNM = pT1B pNX pMX G1 R0 L0 V0 NG1, Stage I. On dismiss, the near-future oncological consultation was recommended. CONCLUSION: We would like to point out the rare occurrence of such type of malignancy and the importance of meticulous histopathology evaluation, even after reconstructive surgery for genital prolapse.

Ovarian Strumal Carcinoid Tumour: Case Report.

BACKGROUND: Ovarian strumal carcinoid is a germ cell tumour characterised by a mixture of thyroid tissue and carcinoid. Ovarian struma is a very rare occurrence with 0.3-1% incidence of all ovarian tumours and 3% of mature teratomas. Primary carcinoid ovarian tumours are still uncommon as a part of mature teratoma or mucinous cystadenoma. There are four major variants of a carcinoid tumour: insular, trabecular, strumal and mucinous. A strumal carcinoid is an unusual form of ovarian teratoma composed of an intimate admixture of thyroid/carcinoid tissues. CASE REPORT: This is a case report of a 59-year old woman with a 5-year clinical history of perimenopausal uterine bleeding and three explorative curettages. Gynaecological and ultrasound examinations revealed ovarian enlargement with a diameter of 50 mm with hypoechoic zones suspected of benign teratoma. The diagnostic test such as Ca-125, AFP, free-T4 and TSH was in normal range. A smooth, solid right ovarian 50 an mm-size tumour, as well as small amount of fluid in the Douglas pouch, was found during the total abdominal hysterectomy, bilateral salpingo-oophorectomy and staging biopsy. The histopathology revealed teratoma with strumal carcinoid tumour IA stage according to AJCC 2010 of the right ovary and negative cytopathology of the fluid from the Douglas pouch. On the postoperative 2-year control, the patient was tumour free, and Ca-125, free-T4 and TSH were in normal range. CONCLUSION: We would like to point out those specific diagnostic tools, such as ultrasound and Ca-125 have low specificity and sensitivity in detection of this rare ovarian malignancy.

Pleated colposuspension: Our modification of Burch colposuspension.

INTRODUCTION: Burch colposuspension is a standard treatment for stress urinary incontinence. However, it is associated with recurrence and urinary retention. We describe a modification of this technique to overcome these problems and evaluate the results in comparison with the standard procedure. MATERIALS AND METHODS: A total of 145 patients with isolated stress urinary incontinence (SUI), underwent either our modified pleated colposuspension (PC); n = 97) or standard Burch colposuspension (BC) (n = 48). Description of PC: Three No. 0 non-absorbable sutures were placed in the side-to-side manner at the mid-urethral level with 0.5-1.0 cm distance between them using double bites and were passed through the Cooper's ligament. The patients were followed-up every 6 months for SUI and genital prolapse evaluation. Successful surgery was defined as (1) No self-reported SUI symptoms, (2) Negative Marshall's coughing test (MT), (3) No retreatment for SUI, (4) Absence of urodynamic SUI. In addition, failure was defined as the occurrence of urinary retention, use of catheter on 6-week visit, maximum flow rate >15 ml/s, flow time <60 s, or residual urine <100 ml. Data was compared using Student's paired test and Mantel-Haenzel's χ(2) test. P > 0.05 was considered significant. RESULTS: The mean follow-up after surgery for PC was 102.4 months and for BC was 103.6 months. At last follow-up, data suggesting failure (Stress score ≥7, urge score ≥7, Pad test with weight < 15 g/day and positive MT during lithotomic/upright position) were more frequent in BC group (P > 0.05; P > 0.0; P > 0.01; P > 0.05; P > 0.05, respectively). The incidence of recurrent SUI was 5.2% after PC and almost triple (14.6%) after BC. Residual urine <100 ml and weak stream were more frequent in the BC group (P > 0.05; P > 0.01, respectively). Detrusor over-activity on urodynamic studies, Flow time <60 s, urethral pressure profilometry positive for obstruction had a higher incidence in BC group (P > 0.01; P > 0.001; P > 0.01, respectively). CONCLUSION: Our modified pleated colposuspension showed improved outcomes when compared with standard Burch colposuspension.

Ultrasound Characteristics of Patients with Urinary Stress Incontinence with or without Genital Prolapse.

PURPOSE: The study purpose was to evaluate the clinical and ultrasound characteristics of women with urinary stress incontinence (USI) with or without genital prolapse (GP). MATERIALS AND METHODS: A total of 268 patients who underwent ultrasound perineal evaluation were divided into two groups: isolated USI (n=132) and USIGP (n=136) with USI/GP stage I/II. The latter group was additionally divided into two subgroups: USIGP(A) (n=78) with USI/GP stage I and USIGP(B) (n=58) with USI/GP stage II. RESULTS: Point Aa (pelvic organ prolapse quantification system), which is the projection of the bladder neck (BN) on the anterior vaginal wall, was situated higher in the rest position (RP) but moved lower during a Valsalva maneuver (VM) in the USI group than in the USIGP group (p<0.05). The ultrasound parameters α-angle and the distance Sy-BN (symphisis-bladder neck) decreased, whereas distance H increased, in the USIGP group during VM. The ultrasound parameters that gave the best insight into the range of BN movements were as follows: distance R→V and angle of rotation (ρ), which were significantly higher in the USI group than in the USIGP group during VM. CONCLUSIONS: According to the clinical and ultrasound findings, we can conclude that the BN is situated higher during the RP but moved lower during a VM in patients with isolated USI compared with those with concomitant USI/GP, which could be explained by the cystocele-immobilizing effect on the BN during the VM in the latter group but also by the deteriorated pubo-urethral ligaments in the former group.