Findings In Asymptomatic Women Research Articles

Pathologic findings in reduction mammoplasty specimens: a surrogate for the population prevalence of breast cancer and high-risk lesions

Mammoplasty removes random samples of breast tissue from asymptomatic women providing a unique method for evaluating background prevalence of breast pathology in normal population. Our goal was to identify the rate of atypical breast lesions and cancers in women of various ages in the largest mammoplasty cohort reported to date. We analyzed pathologic reports from patients undergoing bilateral mammoplasty, using natural language processing algorithm, verified by human review. Patients with a prior history of breast cancer or atypia were excluded. A total of 4775 patients were deemed eligible. Median age was 40 (range 13-86) and was higher in patients with any incidental finding compared to patients with normal reports (52 vs. 39 years, p = 0.0001). Pathological findings were detected in 7.06% (337) of procedures. Benign high-risk lesions were found in 299 patients (6.26%). Invasive carcinoma and ductal carcinoma in situ were detected in 15 (0.31%) and 23 (0.48%) patients, respectively. The rate of atypias and cancers increased with age. The overall rate of abnormal findings in asymptomatic patients undergoing mammoplasty was 7.06%, increasing with age. As these results are based on random sample of breast tissue, they likely underestimate the prevalence of abnormal findings in asymptomatic women.

Pelvic congestion syndrome: the current state of the literature.

Pelvic congestion syndrome is an uncommon poorly understood and frequently misdiagnosed disorder of the pelvic venous circulation, which causes chronic pelvic pain in women in premenopausal age. This condition has typical features, such as pelvic varicosities, pelvic pain worsened by prolonged standing, coitus, menstruation, and pregnancy. The precise etiology of this syndrome remains uncertain, and it is probably multifactorial. Valvular insufficiency, venous obstruction, and hormones all may play a role in the development of congestion of the pelvic veins. Pelvic pain and venous varices are often both present in premenopausal women, but not necessarily causally related. Furthermore, incompetent and dilated pelvic veins are a common finding in asymptomatic women. As such, it is challenging but important to determine which patients have chronic pelvic pain specifically related to pelvic congestion syndrome in order to treat them properly. Once the syndrome has been accurately diagnosed, medical, surgical, or minimally invasive endovascular treatments can improve symptoms in a high percentage of cases. This updated nonsystematic review of the literature explores the pathophysiology, clinical features, diagnostic investigations, and treatment option of this complex condition that affects young women with considerable implications for their daily social and psychological condition.

Dynamic magnetic resonance defecography in 10 asymptomatic volunteers

Evaluation of the wide range of normal findings in asymptomatic women undergoing dynamic magnetic resonance (MR) defecography. MR defecography of 10 healthy female volunteers (median age: 31 years) without previous pregnancies or history of surgery were evaluated. The rectum was filled with 180 mL gadolinium ultrasound gel mixture. MR defecography was performed in the supine position. The pelvic floor was visualized with a dynamic T2-weighted sagittal plane where all relevant pelvic floor organs were acquired during defecation. The volunteers were instructed to relax and then to perform straining maneuvers to empty the rectum. The pubococcygeal line (PCGL) was used as the line of reference. The movement of pelvic floor organs was measured as the vertical distance to this reference line. Data were recorded in the resting position as well as during the defecation process with maximal straining. Examinations were performed and evaluated by two experienced abdominal radiologists without knowledge of patient history. Average position of the anorectal junction was located at -5.3 mm at rest and -29.9 mm during straining. The anorectal angle widened significantly from 93° at rest to 109° during defecation. A rectocele was diagnosed in eight out of 10 volunteers showing an average diameter of 25.9 mm. The bladder base was located at a position of +23 mm at rest and descended to -8.1 mm during defecation in relation to the PCGL. The bladder base moved below the PCGL in six out of 10 volunteers, which was formally defined as a cystocele. The uterocervical junction was located at an average level of +43.1 mm at rest and at +7.9 mm during straining. The uterocervical junction of three volunteers fell below the PCGL; described formally as uterocervical prolapse. Based on the range of standard values in asymptomatic volunteers, MR defecography values for pathological changes have to be re-evaluated.

Pelvic Examination Findings and Chlamydia trachomatis Infection in Asymptomatic Young Women Screened With a Nucleic Acid Amplification Test

Nucleic acid amplification tests (NAATs) allow chlamydia screening in asymptomatic women who otherwise may not have pelvic examinations. How often these women have examination findings that may prompt empiric therapy is unclear. The objective of this study was to assess the relationship of chlamydia with pelvic examination findings in asymptomatic women screened by NAAT. The authors conducted a retrospective analysis of clinical data from 577 young asymptomatic women screened by chlamydial transcription-mediated amplification (TMA). TMA was positive in 68 (11.8%). The most common examination finding was vaginal discharge (5.9%) followed by cervical ectopy (3.6%), endocervical mucopus (2.3%) or easily induced bleeding (2.3%), and cervical motion (1.4%) or adnexal (0.7%) tenderness. On multivariate analysis, only easily induced bleeding or mucopus predicted chlamydia (adjusted odds ratio [AOR] = 4.7; P = 0.010 and AOR = 4.4; P = 0.015, respectively). Abnormal pelvic examination findings were infrequent in asymptomatic young women screened by a chlamydial NAAT. However, endocervical bleeding or mucopus, when present, predicted chlamydia.

Reflux in the Left Ovarian Vein: Analysis of MDCT Findings in Asymptomatic Women

The aim of this study was to clarify the CT features of ovarian vein reflux in asymptomatic women and to determine the possible cause of the reflux. One hundred ten multiparous or uniparous and 41 nulliparous asymptomatic women were examined on MDCT. Degree, pathway, and associated findings of ovarian vein reflux were evaluated. We measured the diameters of the left renal vein (LRV), the ovarian veins, and the parauterine veins. Ratios of LRV diameters (lateral-aortomesenteric) were obtained. These data were then compared between the women with reflux and those without reflux. Reflux was found in 44% (48/110) of parous and 5% (2/41) of nulliparous women. Reflux flowed into the right ovarian vein through the parauterine and uterine veins in 25 women. Twenty-four of these 25 women were multiparous. In these cases, the parauterine veins showed varicose dilation (5.9 +/- 1.6 mm [mean +/- SD]). There was a statistically significant difference in left ovarian vein diameter (8.3 +/- 2.1 mm vs 4.9 +/- 1.3 mm, p < 0.0001) between parous women with reflux and those without reflux, respectively. The LRV diameter ratio (lateral-aortomesenteric) was also statistically significant (3.6 +/- 1.3 vs 1.7 +/- 0.7, p < 0.0001) between the same two groups. Reflux into the left ovarian vein is seen up into the contralateral ovarian plexus by passing through the dilated parauterine and uterine veins. This CT finding is common in asymptomatic multiparous women. Narrowing of the LRV at its aortomesenteric portion can be one of the causes of such reflux.

Review of laparoscopic sterilization and pathologic findings in asymptomatic women

Review of laparoscopic sterilization and pathologic findings in asymptomatic women

The significance of psammoma bodies in screening cervical cytologic smears

Objective: Although the presence of psammoma bodies in cervical cytologic smears has been associated previously with gynecologic malignancies, the clinical significance of this finding in asymptomatic women who undergo routine cervical cytologic screening has not been well defined. Study Design: For this retrospective clinicopathologic study, a search of the Virginia Mason Medical Center computerized cytology registry from 1993 through March 2002 identified 25 evaluable cervical cytologic smears that contained psammomatous calcifications. Slides were reviewed, and clinical information was obtained from medical records. Results: The median patient age was 36 years (range, 22-72 years). Nine women were postmenopausal. All cytologic smears were obtained for routine screening, and no abnormal cells that were diagnostic of malignancy were identified. Possible explanations for the psammoma bodies was determined for 11 women, including foci of calcifications in benign endometrial or endocervical tissue (4 women), polyps (3 women), marked atrophy (3 women), postpartum (2 women), and follicular cervicitis (1 woman). None of the 25 women had cancer. After excluding 1 woman who was to lost to follow-up, the remaining 24 women were followed up for a median of 3 years (range, 6 months-7 years) without the subsequent detection of cancer. Conclusion: Cancers that were reported in previous studies usually were diagnosed in women with malignant background cytology or abnormal symptoms, such as postmenopausal bleeding. In contrast, our study suggests that the presence of psammoma bodies in normal cytologic smears of asymptomatic women is an incidental finding. (Am J Obstet Gynecol 2003;188:1609-14.)

Quantitative assessment of subclinical spasticity in human T-cell lymphotropic virus type I infection.

To compare human T-cell lymphotrophic virus type I (HTLV-I) seropositive and seronegative women for symptoms and signs of spasticity. Infection with HTLV-I causes tropical spastic paraparesis/ HTLV-I-associated myelopathy (TSP/HAM). Certain populations, including female commercial sex workers (FSW), are at increased risk of developing this infection. Fewer than 5% of HTLV-I-seropositive persons develop TSP/HAM, which is typically associated with spasticity. Cross-sectional study of 255 registered FSW in Callao, Perú, involving a questionnaire detailing demographics and neurologic symptoms, standard neurologic examination, quantitative assessment of spasticity (QSA) of muscle tone, and serologic testing for HTLV-I. Participants and examiners were blinded to serology results. On the questionnaire and neurologic examination, none of the 32 HTLV-I-seropositive or 223 seronegative women had signs or symptoms of spasticity. However, mean values on QSA were significantly higher among seropositive women (27.1 Newton-meters/radian [N-m/r]) than among seronegative women (21.6 N-m/r, p = 0.01), indicating a subclinical increase in lower extremity tone. With values of QSA divided into tertiles, and the first tertile serving as the comparison group, the odds ratio for seropositivity was 1.4 (95% confidence interval [CI] 1.0 to 2.0) in the second and 3.1 (95% CI 2.2 to 4.3) in the third tertile, after adjusting for age and place of birth. Although a standard neurologic evaluation could not distinguish between women with and without HTLV-I infection, QSA indicated significantly increased lower extremity tone in those with infection. Long-term follow-up will determine whether these subclinical findings in asymptomatic women progress to overt TSP/HAM.

Fluid in the female pelvis: cyclic patterns.

A total of 254 pelvic sonograms were performed on 40 volunteers in order to determine a cyclic pattern, if any, of free fluid in the pelvis in asymptomatic premenopausal women. Free fluid was observed during all phases of the menstrual cycle. The highest percentage of positive-for-fluid sonograms was observed within 5 days preceding onset of menses in both oral contraceptive users and non-oral contraceptive users. The second highest percentage was observed between days 13 and 21 in non-oral contraceptive users.