Primary vaginal non-Hodgkin lymphoma: gynecologic diagnosis of a hematologic malignancy.

BACKGROUND: Non-Hodgkin lymphoma (NHL) predominantly affects the lymph nodes and bone marrow. Extranodal sites of NHL include the thymus, spleen, and Waldeyer ring. Very rarely NHL affects the gynecologic tract (<0.5%), and secondary spread is more common than primary involvement. CASE REPORT: We report a case of primary NHL of the vagina diagnosed in a young woman who presented with a painless vaginal mass. Although the initial clinical diagnosis was that of an inflamed Gartner duct, atypical presentation of the mass prompted further imaging, such as pelvic ultrasonographic imaging and magnetic resonance imaging. The latter showed presence of similar masses in the posterior cervix and vagina, and after a multidisciplinary team discussion, biopsy of the mass showed primary vaginal NHL. Subsequently, we referred her to hematologists who commenced chemotherapy. Only 57 cases of primary vaginal NHL have been reported in the literature, and our case elucidates the workup of atypical vaginal masses to facilitate a diagnosis and appropriate management. CONCLUSIONS: NHL of the female genital tract is uncommon. Early diagnosis translates to better survival for these women because extranodal NHLs bear a worse prognosis when compared with that of nodal lymphomas mainly owing to delay in diagnosis.

Colposcopy: the scientific basis.

Colposcopy was first introduced in 1925 in Germany by Hans Hinselman. A colposcopeworks on the hypothesis that by magnifying the cervix and applying good illumination, early stages of cervical cancer could be picked -up. Other workers in the field include Schiller, Papanicolou, and Ayres who all contributed to the early detection of cervical cancer. The basic issue is the transformation zone (TZ). It is an area that forms from squamous metaplasia of columnar epithelium. The area where the two epithelia meet is referred to as the squamo-columnar junction SCJ. It is the most important landmark in cytology and colposcopy, where 90% of cervical neoplasm originates. More units are incorporating colposcopy into their practice so as to improve care of women with abnormal smears. Therefore, understanding of the scientific basis of colposcopy is important in carrying out the procedure according to agreed international standards.

Outcome of repeat surgery for genital prolapse using prolift-mesh.

INTRODUCTION: Urogenital prolapse can have a significant impact on quality of life. The life time risk of requiring surgery for urogenital prolapse is 11%. Prolift mesh has recently been introduced to reduce repeat operation rate and for long-term benefit. OBJECTIVE: To evaluate the outcome of the treatment of urogenital prolapse with synthetic mesh. METHODS: A retrospective review of case notes of all women who underwent prolift mesh insertion for prolapse between July 2004 and June 2005, at Royal Alexandra Hospital Paisley UK. We looked at the presenting complaints, previous operation, intraoperative complications and complications at six weeks and six months follow-up. RESULTS: Twenty-two procedures were carried out in the twelve months period. Age of the patients ranged from 55 to 82 years (median 64 yrs). Eleven had anterior Prolift (50%), Seven had posterior Prolift 31.8% and four total Prolift 18%. There were no intraoperative complications. All the patients had previous surgery for prolapse. Eight patients had anterior repair, six patients had posterior repair, and three patients had abdominal hysterectomy. Vaginal hysterectomy was carried out with mesh insertion as a concomitant procedure in seven cases (31.25%). All patients were seen at six weeks and six months after the surgery. Complications rate included mesh erosion one patient and suture material protruding in the vagina one patient, one patient had failed prolift operation. All the twenty-one patients were cured giving 95.4% success rate. CONCLUSION: The use of prolene mesh in pelvic reconstructive surgery was associated with good outcome and minimal complications in this study.

Diagnosis and management of adnexal masses in pregnancy.

Widespread use of ultrasound in early pregnancy has led to the detection of incidental adnexal masses more frequently. This article reviews the diagnosis and management options for adnexal masses in pregnancy. The availability of high-resolution ultrasound has made observation to be a viable option in some cases. However, for those masses suspicious of malignancy, at risk of torsion, rupture, or clinically symptomatic, surgical treatment is warranted. Laparoscopy has been successfully used in pregnancy and is safe in experienced and trained hands in properly equipped units.