The Outcome of Fertility-Sparing and Nonfertility-Sparing Surgery for the Treatment of Adenomyosis. A Systematic Review and Meta-analysis.

OBJECTIVE: The purpose of this systematic review was to identify the operative issues and specific dysmenorrhea and menorrhagia outcomes in women who had undergone fertility-sparing surgery, as well as determine the expected outcome for extirpative surgery. DATA SOURCES: PROSPERO (ID no. 125692). Search was conducted for eligible studies up to March 31, 2019, on MEDLINE/PubMed (1966-2019), Scopus/Elsevier (1950-2019), and Google Scholar (up to 2019). The search terms applied for the search strategy were as follows: adenomyosis, adenomyomas, uterus-sparing surgery, fertility-sparing surgery, pain, dysmenorrhea, menorrhagia, uterine volume, adenomyotic volume, case-control studies, cohort studies, and prospective studies. METHODS OF STUDY SELECTION: A total of 443 studies were initially identified. Exclusion criteria was as follows: (1) inadequate description of preoperative adenomyosis or absence of postoperative histology confirmation of adenomyosis, (2) no statement of use of a standardized instrument for measurement of pain, bleeding, or adenomyotic/uterine volume, (3) follow-up <12 months postoperatively, (4) study population <20 women, and (5) non-English language. TABULATION, INTEGRATION, AND RESULTS: Nineteen studies with a total of 1843 patients with adenomyosis were included. Twelve studies were further analyzed in the meta-analysis. Complete excision of adenomyosis was associated with improvement in pain, menorrhagia, and reduction of uterine volume by a factor of 6.2, 3.9, and 2.3, respectively; the partial excision of adenomyosis was associated with improvement in pain, menorrhagia, and reduction of uterine volume by a factor of 5.9, 3.0, and 2.9, respectively; the studies with a mixed volume of patients with complete and partial excision of adenomyosis reported improvement in pain, menorrhagia, and reduction of uterine volume by a factor of 4.0, 6.3, and 5.1, respectively. CONCLUSION: The surgical treatment of adenomyosis results in the satisfactory control of pain and bleeding, as well as in the reduction of uterine volume. Further research is warranted to investigate the long-term control of symptoms to identify any parameters related to the recurrence of adenomyosis, as well as to compare the conservative surgical treatment of adenomyosis with other treatment options.

Hashimoto's thyroiditis and papillary thyroid carcinoma. Are cytokeratin 19 and P63 proteins of any diagnostic value?

BACKGROUND: The relation between Hashimoto's thyroiditis (HT) and papillary thyroid carcinoma (PTC) remains controversial. We aimed to study the coexistence of PTC and HT and the diagnostic utility of cytokeratin19 and P63 proteins expression in all positive for PTC cases of HT. SUBJECTS AND METHODS: We analyzed data from 343 patients who underwent fine needle aspiration cytology followed by thyroid surgery over a six years period. Thyroid scans and blood measurements for anti-thyroid peroxidase antibodies (TPOAb), thyroid stimulating hormone (TSH), anti-thyroglobulin antibodies (TgAb) and free thyroid hormones were performed. We assessed the expression of monoclonal antibodies against cytokeratin 19 (CK19) and factor P63 in all positive for PTC patients. RESULTS: Hashimoto's thyroiditis was diagnosed by histology in 93 patients. They were: 90 female and 3 male patients. Both HT and PTC were present in 6 female patients (6,7%). All their thyroid scans showed heterogeneous distribution of the tracer with a cold nodule. Laboratory examination showed high levels of TSH as well as of TPOAb in all PTC patients. Cytokeratin 19 showed positive expression in all PTC patients, whereas P63 showed focal positivity in 4/6 cases. We did not estimate the duration of HT in our study. CONCLUSION: This study showed that 6,7% of female patients with HT also had PTC and all had elevated serum TSH, which may be a risk factor for PTC. The age of PTC patients was between 19-42 years.