Successful pregnancy after hysteroscopic removal of grade I endometrial carcinoma in a young woman with Lynch syndrome.

In a woman at the age of 30, carcinoma of the endometrium was diagnosed after hysteroscopic polypectomy. Her family history fulfilled Bethesda diagnostic criteria for Lynch syndrome or hereditary nonpolyposis colon cancer. Conservative treatment was chosen based on the tumor grade, her age, and her desire for pregnancy. Three months after high-dose progesterone treatment successful conception was achieved. In this report, we suggest that individual approach should be considered in young women with low-grade endometrial carcinoma, positive family history, and unfulfilled motherhood.

Preoperative evaluation of pelvic tumors by Doppler and three-dimensional sonography.

OBJECTIVE: To study a spectrum of systems (two-dimensional transvaginal, transvaginal color Doppler, three-dimensional, three-dimensional power Doppler, and contrast-enhanced three-dimensional power Doppler sonography) for preoperative evaluation of pelvic tumors. METHODS: Two hundred ninety-two patients were evaluated by the 5 complementary methods in preoperative sonographic assessments. We examined adnexal and endometrial morphology, thickness, and volume by two- and three-dimensional sonography and analyzed blood flow by transvaginal color, pulsed Doppler, and three-dimensional power Doppler sonography in all examined patients. In 89 patients with complex adnexal lesions of uncertain malignancy, contrast-enhanced three-dimensional power Doppler sonography was performed. RESULTS: Morphologic assessment by three-dimensional sonography yielded additional information in 58% of cases compared with two-dimensional sonography. Furthermore, this modality was superior to two-dimensional sonography in accurate depiction and diagnosis of 2 cases of fallopian tube carcinoma. Combined morphology and vascular indexing reached sensitivity of 97% and specificity of 99%. Endometrial volume in patients with malignant disease was significantly different (28.2 +/- 0.02 cm3) from that in those who had hyperplasia (7.81 +/- 0.03 cm3), polyps (3.5 +/- 0.02 cm3), or normal endometria (0.8 +/- 0.02 cm3). With combined morphologic and three-dimensional power Doppler examination of endometrial lesions, sensitivity and specificity reached 89% and 97%, respectively. CONCLUSIONS: Combined morphologic and vascular imaging improves preoperative assessment of gynecologic tumors.

Histologic architecture and vascularization of hysteroscopically excised intrauterine septa.

STUDY OBJECTIVE: To investigate histologic structures of intrauterine septa resected hysteroscopically. DESIGN: Prospective, consecutive study (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: Seventy-six women evaluated for uterine septa and infertility. INTERVENTIONS: All patients with diagnosis of uterine septum detected by transvaginal color Doppler (TVCD) underwent operative hysteroscopy in which the most prominent part of the septum was encircled with a hysteroscopic loop electrode and removed. Specimens were sent for histopathologic evaluation. The rest of the septum was divided by monopolar needle electrode until the uterine cavity assumed a globular shape. MEASUREMENTS AND MAIN RESULTS: In 63 women (82.8%) preoperative TVCD revealed septal vascularity typical for radial arteries with mean resistance flow of 0.64 +/- 0.06, and enlarged sunusoidal and capillary spaces. Histopathologic results revealed fibromuscular tissue with moderately more connective tissue in 55 cases (72.3%) and myometrial tissue in 21 (27.6%). There was no statistically significant difference (p >0.05) in frequency of septa between patients with primary and secondary infertility. CONCLUSION: Intrauterine septa consisted of the same type of tissue as normal myometrium, with many muscular fibers. We suspect that muscular tissue within the uterine septum is a potential cause of irregular contractility and consequently increased abortion rate in these patients. (J Am Assoc Gynecol Laparosc 8(1):111-116, 2001)

What do contrast media add to three-dimensional power Doppler evaluation of adnexal masses?

AIM: To investigate the potential usefulness of contrast-enhanced three-dimensional (3D) power Doppler sonography in the differentiation of benign and malignant adnexal lesions. METHODS: Thirty one patients with complex adnexal lesions of uncertain malignancy at transvaginal B-mode and/or color Doppler sonography were prospectively evaluated with three-dimensional power Doppler sonography before and after injection of a contrast agent. Presence of a penetrating pattern and a mixed penetrating and/or peripheral pattern suggested adnexal malignancy. The results were compared with histopathologic findings. RESULTS: There were 10 cases of ovarian malignancy and 21 benign adnexal lesions. Of 10 ovarian cancers, 6 showed vascular distribution suggestive of malignancy at nonenhanced 3D power Doppler sonography. After injection of contrast agent, a penetrating vascular pattern and/or mixed penetrating and peripheral pattern were detected in all cases of ovarian malignancy as well as in 2 benign lesions (fibroma and cystadenofibroma), which were misdiagnosed as malignant. The use of contrast agent with three-dimensional power Doppler sonography showed diagnostic efficiency of 96.7%, superior to that of nonenhanced 3D power Doppler sonography (93.5%). CONCLUSION: Contrast-enhanced 3D power Doppler sonography provides better visualization of tumor vascularity in complex adnexal masses. If used together with 3D morphological ultrasound assessment, enhanced 3D power Doppler imaging may precisely discriminate benign from malignant adnexal lesions.

Three-dimensional ultrasonographic and power Doppler characterization of ovarian lesions.

OBJECTIVE: To determine whether three-dimensional ultrasound (3D US) and 3D power Doppler can improve the ability to differentiate benign from malignant ovarian lesions. METHODS: Transvaginal ultrasound, transvaginal color Doppler, 3D US and 3D power Doppler were performed on 90 patients with ovarian lesions during the week prior to surgery. Four independent sonographers were blinded to the results of other ultrasound studies. RESULTS: Color Doppler studies added to transvaginal gray-scale characterization of ovarian lesions resulted in sensitivity of 88.89% and specificity of 97.53% in diagnosing ovarian malignancy. Qualitative analysis of tumor vascularity by 3D power Doppler added to morphological features obtained by 3D US is clinical pertinent and reached sensitivity and specificity of 100 and 98.76%, respectively. CONCLUSION: Three-dimensional ultrasound and power Doppler can enhance and facilitate the morphologic and functional evaluation of both benign and malignant ovarian lesions. Introduction of the 3D quantitative technique for measurements of blood flow and vascularization may increase clinical relevance of these studies.

[Tumoral angiogenesis--hot topic in science again]. / Tumorska angiogeneza--ponovno vruca znanstvena tema.

Angiogenesis is the formation of new capillary blood vessels. It has a very important role not only in physiological conditions but in the process of malignant tumors growth. Weak muscular layer, chaotical branching and irregular shape, are the characteristics of newly formed tumorous vessels. The number and arrangement of blood vessels differ between benign and malignant tumors. Latest data suggesting that drugs inhibiting angiogenesis can stop growth of malignant tumors made the research on tumorous angiogenesis a hot topic recently. Although reliable in differentiating benign from malignant tumors, two-dimensional ultrasound with color and pulsed Doppler, can not make spatial image of vascular architecture. Three-dimensional (3D) ultrasound with color Doppler allows the investigator to have a three-dimensional architectural picture of tumorous vascular network, and according to the findings it is possible to detect malignant tumors even in doubtful cases.

Preoperative diagnosis of primary fallopian tube carcinoma.

INTRODUCTION: Transvaginal color and pulsed Doppler can detect areas of neovascularization within the tubal carcinoma and can distinguish it from other benign adnexal pathology. SUBJECTS AND METHODS. During a 7-year period eight cases of Fallopian tube carcinoma were detected using transvaginal color and pulsed Doppler. RESULTS: Transvaginal sonography revealed complex, sausage-shaped, and/or cystic structures in the adnexal region. Additional color Doppler examination depicted low vascular impedance (RI ranged from 0.29 to 0.40). Histopathology reported different types of Fallopian tube carcinoma. CONCLUSION: Transvaginal color Doppler may aid in diagnosis of Fallopian tube malignancy more reliably than using other costly diagnostic procedures.