ABSTRACT
OBJECTIVE: To ascertain the success of complex reconstructive vaginal surgery in older women. DESIGN: Retrospective review of hospital and outpatient records. SETTING: Rural tertiary care referral center, Pennsylvania State University Hospital, Hershey, Pennsylvania. PATIENTS: Twenty-four patients referred for massive erosion of the vagina and/or complete procidentia. MEASUREMENTS: Symptoms and anatomic correction of patients' complaints. RESULTS: After surgery, 83 percent were asymptomatic without pelvic relaxation, 4 percent were asymptomatic with pelvic relaxation, 4 percent were symptomatic without pelvic relaxation, and 9 percent were symptomatic with relaxation. CONCLUSIONS: Older women can undergo major vaginal reconstructive surgery with relief of symptoms and restoration of vaginal depth and axis.
Subject(s)
Gynecology/standards , Uterine Prolapse/surgery , Adult , Age Factors , Aged , Blood Loss, Surgical/statistics & numerical data , Female , Gynecology/methods , Hospitals, University , Humans , Length of Stay/statistics & numerical data , Middle Aged , Pennsylvania/epidemiology , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Retrospective Studies , Rural Population , Severity of Illness Index , Treatment Outcome , Uterine Prolapse/classification , Uterine Prolapse/pathologyABSTRACT
A patient with Peutz-Jeghers syndrome, a sex cord tumor with annular tubules, and an initially unrecognized adenoma malignum of the cervix is described. The patient presented with a mucinous adenocarcinoma in the vaginal apex. Review of the hysterectomy slides demonstrated an adenoma malignum of the cervix. In addition to a microscopic sex cord tumor with annular tubules of the right ovary, the left ovary contained mucinous cystadenomas. Adenoma malignum remains a difficult diagnosis and is frequently made only after hysterectomy for a presumed benign indication; pathology frequently demonstrates a deeply invasive, unusually well-differentiated adenocarcinoma of the cervix. Patients with Peutz-Jeghers syndrome need careful clinical and cytologic follow-up to exclude such lesions.
