Sclerosing stromal tumor of the ovary: a case report.

A case of a rarely occurring ovarian tumor, sclerosing stromal tumor of the ovary, in an 11-year-old girl treated laparoscopically is described.

MR rectography evaluation of rectoceles with oral gadopentetate dimeglumine and polyethylene glycol solution.

BACKGROUND: We assessed the value of magnetic resonance (MR) rectography in diagnosing rectocele by using a combination of oral gadopentetate dimeglumine and polyethylene glycol solutions. METHODS: T1-weighted, breath-hold, fast low-angle shot sequences were made in 22 patients in resting and straining states in the supine position before and after administration of oral paramagnetic contrast. Twelve patients received polyethylene glycol solution in addition to contrast, and 10 received contrast only. The pubococcygeal line was the reference used for diagnostic measurements. The quality of each sequence was graded. Paired t test, chi-square test, and the Kolmogorov-Smirnov test were applied for statistical analysis. RESULTS: The results of noncontrast images were inconclusive. There was a statistically significant difference between MR imaging diagnosis of rectocele in patients in the straining position without and with contrast ( p < 0.05), and the difference was more prominent in patients using polyethylene glycol solution ( p < 0.001). Using oral contrast plus polyethylene glycol produced significantly better MR examinations in the resting and straining positions ( p < 0.05). CONCLUSION: The combination of oral contrast and polyethylene glycol solution improves the diagnostic value of MR rectography and is particularly useful when noncontrast examinations are inconclusive.

Atypical squamous cells of undetermined significance. Clinical experience in a Turkish university hospital.

OBJECTIVE: To assess the significance of atypical squamous cells of undetermined significance (ASCUS) in predicting the presence of underlying squamous intraepithelial lesion (SIL) of the uterine cervix, and to determine the best follow-up method for these patients. STUDY DESIGN: We reviewed 76 cases with cervical smears that had been labeled ASCUS over a 41-month period, 64 of which were also examined colposcopically. RESULTS: The 76 reported ASCUS cases represented 1.2% of all gynecologic cases diagnosed at our center during the same time period. Of the 64 patients who underwent colposcopy, 9 (14%) had low-grade SIL and 7 (11%) had high-grade SIL. CONCLUSION: Based on this study, ASCUS on a cervical smear is a good marker for detecting underlying SIL, and immediate colposcopy and directed biopsy are the most appropriate follow-up procedures.

Non-invasive early prenatal diagnosis using fluorescent in situ hybridization on transcervical cells: comparison of two different methods for retrieval.

OBJECTIVE: We compared the efficiencies of uterine and endocervical lavage to retrieve fetal cells from first trimester pregnancies for further analysis with fluorescent in situ hybridization (FISH). STUDY DESIGN: Transcervical cell (TCC) samples were collected at 7-10 weeks of gestations by uterine lavage (13 women) and by endocervical lavage (12 women) who were scheduled for volunteer termination of pregnancy. A sample of placenta was also obtained for cytogenetic analysis to confirm the sex or genotype in the end of the procedure. FISH was performed using probes for the chromosomes 18, X and Y in a three color hybridization protocol. The statistical analysis included chi(2)-analysis, and t-test. RESULTS: Sufficient cells were obtained in 12 of the 13 (92.3%) in uterine lavage and 10 of the 12 (83.3%) in endocervical lavage group for FISH procedures for fetal sex prediction. The mean success rate of signal detection for FISH procedure was 91.7% (range 83-97%). Fetal sex was correctly predicted in 11 of 12 (91.6%) with uterine lavage and 8 of 10 (80.0%) in endocervical lavage and the difference was statistically insignificant. CONCLUSION: This study demonstrated that there are available cells of fetal origin in the lower part of the uterus and these cells may be collected successfully as early as 7 weeks of the gestation. In addition, our results show that endocervical lavage method is as effective as uterine lavage. FISH has been successfully used to detect status of aneuploidy and sex of the fetus from TCC.

GnRHa for adhesion formation after uterine serosal injury in an euestrogenic milieu.

OBJECTIVE: To assess whether the adhesion-preventing effect of gonadotropin-releasing hormone agonist (GnRHa) is through hypoestrogenism. STUDY DESIGN: Four groups of previously ovariectomized rats received various combinations of depot leuprolide acetate injection (3.75 mg/kg/mo) subcutaneously, conjugated equine estrogens (50 micrograms/kg/d) orally and phosphate-buffered saline injection subcutaneously, yielding group 1, saline only; group 2, saline and conjugated equine estrogens; group 3, depot leuprolide acetate only; and group 4, depot leuprolide acetate and conjugated equine estrogens. Surgical adhesions were induced by monopolar cautery on the right uterine horn through laparotomy and were then scored on day 21 after surgery. RESULTS: Adhesion scores for rats that received conjugated equine estrogens and saline were significantly higher than scores of those given conjugated equine estrogens and depot leuprolide acetate, depot leuprolide acetate only and saline only (P = .019, .026 and .027, respectively). However, there was no significant difference in the adhesion scores for these three groups. CONCLUSION: Hypoestrogenism results in the development of fewer peritoneal adhesions postoperatively. Our findings also indicated that other mechanisms, in addition to those inducing hypoestrogenism, are at work in the adhesion-preventing effects of GnRHa therapy.

Vaginectomy and laparoscopically assisted vaginal hysterectomy as adjunctive surgery for female-to-male transsexual reassignment: preliminary report.

OBJECTIVE: Reassignment surgery of the female-to-male transsexual is a rarely performed surgical procedure that should involve a gynecologist's consultation and expertise. This study examines the experience with this type of surgery at Baskent University Hospital, Ankara, Turkey, from the gynecologists' point of view. STUDY DESIGN: Eight patients underwent laparoscopically assisted vaginal hysterectomy, bilateral salpingo-oophorectomy and total vaginectomy, followed by phallic construction. Patients were followed up for 9 to 30 months post-surgery. RESULTS: The average operative time for total vaginectomy and laparoscopically assisted vaginal hysterectomy and bilateral salpingo-oophorectomy was 2 h and 20 min. The estimated average blood loss was 250 ml. Other than one bladder perforation, which was repaired immediately and healed uneventfully, we encountered no operative or postoperative complications linked to the gynecologic surgery. CONCLUSION: Laparoscopy seems to be useful in female-to-male transsexual surgery in allowing the preservation of structures vital for phallic construction, such as inferior epigastric vessels and the rectus abdominis muscle. The application of vaginectomy awaits justification through long-term follow-up studies of transsexuals who have undergone colpocleisis.

Desmoid tumor of the vulva. A case report.

BACKGROUND: Extraabdominal desmoid tumors are very rare; primary vulvar desmoid tumors are even rarer. CASE: A desmoid tumor involving the right labium majus, extending upward along the vaginal wall, was excised completely. CONCLUSION: These rare tumors, which may enlarge rapidly during pregnancy, are difficult to diagnose before surgery.

Malignant mixed mesodermal tumor arising in a benign cystic teratoma.

The occurrence of sarcoma in a benign cystic teratoma is very rare. We report the first poorly differentiated, malignant mixed mesodermal tumor with a component of rhabdomyosarcoma to arise in a benign cystic teratoma of the ovary. The tumor was staged as FIGO IC due to capsule invasion. Although combination chemotherapy of cisplatin, ifosfamide and mesna, was instituted, the disease took a rapidly progressive course. After an unusual metastasis to the scapula was detected, the patient deteriorated and died in the forth postoperative month.

Silver nitrate for Bartholin gland cysts.

The management of Bartholin cysts by inserting a silver nitrate stick into the cyst cavity was performed in 15 patients. The cyst wall was expelled in 14 (93%) with no recurrence in a year. The only complication was the cauterization of the surrounding mucosa (20%). This technique seems to offer benefit over conventional treatment modalities.

Endometrial response to unopposed estrogens remains unaltered in patients with chronic renal failure receiving hemodialysis.

Most patients with chronic renal failure who are on maintenance hemodialysis are anovulatory and have menstrual abnormalities. This study was designed to determine the prevalence of organic causes of abnormal uterine bleeding in this group of patients exposed to unopposed estrogens. Eighteen patients with chronic renal failure and abnormal uterine bleeding underwent vacuum curettage. The histopathologic findings were compared with a group of 154 premenopausal women who had abnormal uterine bleeding without detectable organic causes. Excluding patients with secretory and atrophic endometrium, only 2 of 8 patients (25%) with chronic renal failure had endometrial lesions while 44 of 131 patients (33.6%) had either endometrial polyp, simple or atypical endometrial hyperplasia or endometrial carcinoma (p > 0.05). The uremic environment caused by chronic renal failure does not alter the endometrial responsiveness to unopposed estrogens and may lead to the development of endometrial lesions.

Extragenital malignant mixed mesodermal tumor: case report and review of the literature.

Malignant mixed mesodermal tumors rarely occur in extragenital sites. An 80-year-old patient presented with a malignant mixed mesodermal tumor, consisting of papillary serous adenocarcinoma and chondrosarcomatous components. The patient refused further treatment following surgery and died of disease 2.5 months later. Based on the present case and a review of the literature, primary extragenital malignant mixed mesodermal tumors prove to be rare but highly malignant neoplasms. Further data is yet to be gathered in order to determine the exact origin and behavior of these tumors.

Pregnancy outcome after hydatidiform mole, initial and recurrent.

Pregnancy outcome after complete and partial hydatidiform mole was evaluated in 170 patients. Of the 170 patients, 143 became pregnant a total of 250 times. Patients with incomplete hydatidiform mole had 232 subsequent pregnancies that resulted in 169 (72.8%) term deliveries, 30 (12.9%) spontaneous abortions, 7 (3.0%) induced abortions, 6 (2.6%) stillbirths, 13 (5.6%) preterm deliveries, 6 (2.6%) recurrent moles and one (0.4%) ectopic pregnancy. Of the subsequent pregnancies in patients with partial hydatidiform mole, full-term delivery, spontaneous abortion and recurrent mole occurred in 10 (55.6%), 5 (27.8%) and 3 (16.7%) of the patients, respectively. Among the 9 patients with recurrent hydatidiform mole, viable term pregnancy was achieved in 4. Even patients with recurrent hydatidiform mole can be assured that they can have a normal subsequent pregnancy.

Pregnancy after chemotherapy for gestational trophoblastic disease.

Forty-nine women who had received chemotherapy for gestational trophoblastic disease subsequently became pregnant a total of 65 times. Of these 65 pregnancies, 42 (64.7%) terminated in term births, 4 (6.1%) in premature births, 1 (1.5%) in stillbirth, 8 (2.3%) in spontaneous abortion and 7 (10.8%) in elective abortion, while 3 patients (4.6%) had repeat molar pregnancies. No congenital malformations or obstetric complications were observed. Treatment of gestational trophoblastic disease with chemotherapy is compatible with the preservation of fertility and is not associated with any increase in congenital fetal malformations.

Effects of prophylactic chemotherapy for postmolar trophoblastic disease in patients with complete hydatidiform mole.

An analysis of 233 patients with complete hydatidiform mole admitted to Hacettepe University Hospital between 1964 and 1988 has been carried out. Methotrexate was administered prophylactically to 19 of 120 low-risk and to 52 of 113 high-risk patients. The difference in the incidence of postmolar gestational trophoblastic disease between prophylactically untreated and treated groups of either low-risk (13.9% versus 5.3%, P greater than 0.01) or high-risk (26.2% versus 25.0%, P greater than 0.01) patients was found to be statistically insignificant. Drug toxicity and mortality rates were 16.9% and 2.8%, respectively. It is concluded that prophylactic chemotherapy is not highly effective in the prophylaxis of postmolar gestational trophoblastic disease. Strict follow-up through sensitive betahuman chorionic gonadotropin assays should be the standard management of postmolar patients.