Gynecologic Lesions Research Articles

The Importance of Pathogenesis: A Molecular Investigation on A Solitary Choriocarcinoma Lung Lesion with No Primary Lesion

Abstract Introduction/Objective We present an exceedingly rare case of metastatic choriocarcinoma to the lung with no primary lesion. Notably, this is the only case where STR molecular studies have been conducted. Methods/Case Report A 43-year-old G1P1001 female with no past medical history presents with severe shortness of breath, left-sided back, and chest pain for severe shortness of breath, left sided back and chest pain. Patients pregnancy test was positive with a B-hCG of 17944 u/L. Transvaginal ultrasound was negative for IUP. CTAP showed no masses in the uterine cavity or ovaries. D-dimer was elevated at 623 ng/ml. However, CTA chest was negative for pulmonary emboli but revealed a RLL mass measuring 2.6 x 2.5 cm x 2.9 cm with lobulated areas suspicious for vascular structures and connection to the right pulmonary vein. Patient was treated with a complete right lower lobectomy. An endometrial biopsy was performed and was negative for malignancy with no significant findings. Grossly, the mass was well-circumscribe, hemorrhagic, and necrotic, measuring 3.5 cm. Microscopically, the malignant cells had highly pleomorphic and hyperchromatic nuclei. There were also multiple multinucleated cells and mitotic figures present. Some of the cells had nested architecture leading to us to suspect a pleomorphic lung adenocarcinoma with choriocarcinomatous differentiation. We performed IHC staining that demonstrated strong positivity of AE1/AE3, CK7, hCG and a high Ki-67 index. The neoplastic cells also had focal p63 and p40 positivity. Furthermore, TTF1 and SALL4 were both negative. This staining pattern as well as patient’s clinical history of no gynecological lesion, lead us to favor lung adenocarcinoma with choriocarcinomatous differentiation. However, due to the abundance of syncytiotrophoblastic and trophoblastic cells, metastatic choriocarcinoma could not be ruled out. Therefore, the case was sent out for external consultation and Short Tandem Repeat (STR) molecular testing. Surprisingly, the STR testing results showed some STR of paternal origin indicating a metastatic gestational choriocarcinoma. The patient’s surgery was highly successful and lead to a down trending of b-hCG from 17944 to 1768 after removal. Results (if a Case Study enter NA) NA Conclusion Performing STR testing was pivotal in this case as it revealed the presence of DNA of paternal origin, providing crucial evidence that the tumor was of gestational origin, guiding the diagnosis towards metastatic gestational choriocarcinoma.

Cervical stump leiomyomata after supracervical hysterectomy; a case report with review of literature

BackgroundDespite being a highly debated issue, subtotal or supracervical hysterectomy (SCH) is still considered a safe and effective treatment for women with benign gynecological lesions. Benign and malignant cervical diseases have been reported after SCH, with fibroids being the most frequently diagnosed lesions in the excised cervical stump. Recurrence of cervical disease after SCH usually presents with vaginal bleeding, pelvic mass, or abdominal pain; moreover, it may necessitate reoperation and resection of the cervical stump or trachelectomy. Trachelectomy is known to be a difficult surgical procedure that may be associated with significant intra- and post-operative morbidity.Case presentationWe presented here a case of a 41-year-old nulliparous woman with a pelvic mass related to the cervical stump presented 2 years after subtotal hysterectomy, performed due to interactable abnormal uterine bleeding, which was attributed to a multiple fibroid uterus. Six years ago, she complained of pelvic pain, excessive vaginal discharge, and spotting. A transvaginal sonography and magnetic resonance imaging with contrast were performed, which revealed a 10.2 × 7.6 × 6.5 cm heterogeneous pelvic mass with irregular borders and marked vascularity on color Doppler. Surgical exploration and resection of the mass with cervical stump excision were performed. Histopathology confirmed the diagnosis of cervical stump multiple benign leiomyomata with no atypical features.ConclusionRecurrence or De novo development of leiomyomata and other cervical lesions might occur after supracervical or subtotal hysterectomy; thus, thorough pre-operative counseling for women requesting a SCH regarding the pros and cons of the procedure compared with total hysterectomy should be optimized. Meticulous follow-up, including the continuation of routine cervical cytological smears, is mandatory for patients with a retained cervix.

Magnetic resonance imaging evaluation of gynecological mass lesions: A comprehensive analysis with histopathological correlation.

Evaluating gynecological mass lesions and reviewing their morphological characteristics based on their imaging appearance on magnetic resonance imaging (MRI), and correlating the MRI findings with histopathological findings, was the central theme of our study. This observational cross-sectional study was conducted on 60 female patients with clinically suspected gynecological mass lesions upon physical examination and/or ultrasonography, referred for MRI at a tertiary care hospital over a 1-year period between June 2022 and July 2023. A broad spectrum of differential diagnoses of gynecological masses was observed. In our study, the ratio of benign versus malignant disease was 1.6:1, with 37 benign and 23 malignant masses identified. The most common benign masses were uterine fibroids (n = 14; 23.3%), followed by endometriosis (n = 8; 13.3%), and ovarian dermoid cysts (n = 4; 6.6%). Among the malignant lesions, cervical cancer was the most common (n = 11; 18.3%), followed by endometrial carcinoma (n = 7; 11.6%), ovarian carcinoma (n = 3; 5%), and vaginal carcinoma (n = 2; 3%). Benign lesions mostly appeared hypo- to isointense on T1-weighted imaging and iso- to hyperintense on T2-weighted imaging, while malignant lesions appeared isointense on T1-weighted and hyperintense on T2-weighted imaging. Hemorrhage and fat were well appreciated on MRI and aided in diagnosis. T2 shading was present in 7 out of 8 endometriotic cysts, demonstrating a specificity of 100% and a sensitivity of 83%. For determining parametrial invasion in cervical carcinoma, MRI showed an accuracy of 91%, specificity of 100%, and positive predictive value, negative predictive value, and sensitivity of 100%, 75%, and 88%, respectively. In cases of endometrial carcinoma, MRI demonstrated a sensitivity and specificity of 87% and 91%, respectively, with a positive predictive value of 87% and a negative predictive value of 91% for identifying myometrial invasion greater than 50%. Compared to other modalities, MRI provided substantial information regarding uterine and adnexal masses and surrounding structures, facilitating accurate staging of lesions.

Feasibility evaluation of the Versius surgical system: robot-assisted hysterectomy for benign and malignant gynaecological lesions.

The application of minimally invasive surgery allows for radical and precise removal of the gynaecological lesion while simultaneously reducing the side effects and complications associated with surgical treatment. This paper aims to share our direct experience with the implementation of the CMR Versius robotic platform in the treatment of benign and malignant gynaecological lesions. This study included patients who underwent hysterectomy in the Department of Obstetrics, Gynaecology, and Gynaecologic Oncology at the Regional Polyclinical Hospital in Grudziadz, Poland. A total of 50 patients were included in the study: 29 underwent laparoscopic surgery and 21 underwent robot-assisted surgery using the CMR Versius system. It was found that in the case of non-radical hysterectomy, the duration of surgery differed significantly (96.5 vs. 134.6min, p < 0.01) in the groups of patients undergoing laparoscopic and robotic surgery. There were also no statistically significant differences in loss of blood parameters, rate of complications and conversions to other type of surgery after the laparoscopic and robotic surgeries. Both groups did not differ significantly in terms of hospitalisation time after surgery. Versius CMR surgical robot assistance provides safe and effective support for MIS procedures in gynaecology.

Depression, Ulcers and Confusion – A Clinical Case of Behçet’s Disease with Psychiatric Presentation

IntroductionBehçet’s disease, a rare autoimmune disorder, can present a challenging diagnostic puzzle, particularly when neuropsychiatric symptoms take the forefront. In this case study, we delve into the diagnostic process of a 43-year-old patient without prior psychiatric history, who initially presented with depressive and catatonic symptoms. The trajectory from psychiatric admission to a final diagnosis of Behçet’s disease with neuropsychiatric involvement underscores the importance of interdisciplinary collaboration and the consideration of rare diseases in psychiatric assessment. Clinical remission was achieved with immunosuppressive therapy.ObjectivesPresentation of a clinical case of Behçet’s disease with neuropsychiatric manifestations.MethodsReview of the patient’s clinical data in SOARIAN platform and research on UptoDate and Pubmed using the terms “Catatonia,” “Behçet disease,” “Neuro-Behçet,” and “Psychiatry.”ResultsWe present a clinical case of a 43-year-old patient, originally from India, not fluent in Portuguese or English, with no prior psychiatric history, who presented to the emergency department exhibiting mutism and was admitted to the psychiatry department with the diagnostic hypothesis of depressive episode with psychotic and catatonic symptoms. During hospitalization, severe vitamin deficiencies, gastrointestinal symptoms (vomiting, abdominal pain, and hematochezia), and gynecological symptoms (dyspareunia and vaginal discharge) were observed. From a psychiatric perspective, in addition to depressive and psychotic symptoms, atypical symptomatology incongruent with the initial diagnosis was identified, raising suspicion of an “organic” disease. There was an atypical fluctuation in symptoms, with periods of severe behavioral disorganization interspersed with periods of apathy and psychomotor retardation, significant alterations in attention and memory, and executive deficits. Additionally, there was a poor response to psychiatric medication and electroconvulsive therapy. A colonoscopy revealed ulcers at the ileocecal valve, and gynecological lesions suggestive of a vasculitic process were observed. Autoimmunity testing showed positivity for HLA B51/52. Given the neuropsychiatric, gastrointestinal, and gynecological manifestations, along with suggestive autoimmunity, the diagnosis of Behçet’s Disease with neurological involvement was established. Clinical remission was achieved only with immunosuppressive therapy. The case is enriched by the complex diagnostic journey, multiple complications encountered (including valproic acid-induced encephalopathy), and the challenges faced in treating neuropsychiatric manifestations.ConclusionsThis clinical case exemplifies the challenges in diagnosing a systemic disease with primary psychiatric presentation, as well as the therapeutic success resulting from multidisciplinary collaboration in a public hospital.Disclosure of InterestNone Declared

Gynecologic Adnexal Tumors and Tumor-Like Lesions in Children and Adolescents: Experience at a Cancer Center.

Introduction. Tumors and tumor-like lesions of the uterine adnexa in children and adolescents are uncommon but may carry devastating consequences. Methods. We conducted an observational retrospective cohort study, to describe patients aged 0 to 19 years diagnosed with tumors and tumor-like lesions of the uterine adnexa at our institution between 2000 and 2018. Results. Eighty-nine patients with 105 adnexal lesions were included. Thirty-seven (42%) patients presented with benign tumors, 13 (15%) with borderline tumors, 25 (28%) with malignant tumors and 14 (16%) with tumor-like lesions. Germ cell tumors (n = 45|43%) were the most frequent, followed by epithelial tumors (n = 30|29%). No significant differences were found in the age distribution of the lesions by malignant potential or histologic group. Most patients (n = 80|90%) were treated primarily with conservative surgery, including cystectomy (n = 25|28%) and unilateral oophorectomy/adnexectomy (n = 54|61%). Thirty-four (38%) underwent surgical staging (partial omentectomy and peritoneal biopsies). Twenty (23%) patients with borderline and malignant tumors were submitted to chemotherapy. Four (5%) patients with borderline or malignant tumors relapsed, one of whom died from disease. Conclusion. Gynecological lesions in children and adolescents encompass a wide range of rare histological tumor subtypes, requiring evaluation by experienced pathologists. Most tumors were diagnosed at early stages, with low relapse and mortality rates. Conservative management, with fertility sparing surgery and limited use of adjuvant chemotherapy, is of utmost importance.

Prevalence of precancerous gynecological lesions and gynecological cancer in patients undergoing vaginal hysterectomy for pelvic organ prolapse

Objectives This retrospective cohort study aimed to determine the prevalence of precancerous or malignant lesions of the cervix and/or endometrium among patients who underwent vaginal hysterectomy. Materials and methods Medical record of patients who had been diagnosed with pelvic organ prolapse (POP) and undergone vaginal hysterectomy from January 2009 to September 2018 in tertiary hospital was reviewed. The exclusion criteria included individuals who had previously received a diagnosis of gynecologic precancerous lesions or cancer, had abnormal preoperative findings, presented abnormal cervical cancer screening test results or abnormal results from preoperative endometrial biopsy, and had incomplete operative notes or pathological results. Results The electronic medical records of 530 patients were reviewed and included in the analysis. Nine of the 530 patients (1.7%) had precancerous or malignant lesions of the cervix and/or endometrium. The prevalence of atypical endometrial hyperplasia and endometrial carcinoma were 0.19% and 0.57%, respectively. All of the patients with endometrial cancer subsequently underwent complete surgical staging. Precancerous cervical lesions were found in five patients (0.95%): CIN II 0.38% and CIN III 0.57%. No cases of cervical cancer were identified. Conclusions It is possible to detect a minor prevalence of precancerous and malignant lesions following post-operative procedures in POP. The assessment of the elderly through the use of risk-based evaluation merits attention for the purpose of early identification. This study offers valuable insights that can be utilized in preoperative counseling and enhancing the preoperative evaluation process.

Effect of two different laparoscopic techniques on post-operative wound complications in patients with benign gynaecological diseases: A meta-analysis.

Single-port laparoscopy (SPL) has existed for several years. This meta-analysis was conducted to evaluate the efficacy of SPL compared with conventional laparoscopy (CL) in the treatment of benign gynecologic adnexal lesions. The purpose of this meta-analysis is to evaluate the superiority of SPL versus CL in the treatment of post-operative wound pain. The study looked for English-language publications from PubMed, Embase, Cochrane Library and the Web of Science until June 2023. The main result was the visual analogue scale (VAS) after 2, 4, 6, 8, 12, 24 and 48 h after operation. The paper contains 10 related papers by means of e-search. Of these, 4 were randomized controlled trials (RCTs), while 6 were non-RCTs. The results indicated that SPL and CL were significantly different after 2, 24 and 48 h after operation. SPL had lower post-operative pain after 2 h compared with CL (MD, -0.6; 95% CI, -0.98, -0.21; p = 0.002). After the operation, SPL also had a lower incidence of post-operative pain after 24 h compared with CL (MD, -0.59; 95% CI, -1.12, -0.06; p = 0.03). And the difference in pain was at 48 h after the most significant (MD, -0.49; 95% CI, -0.75, -0.23; p = 0.0002). But after 6, 8 and 12 h after operation, there was no significant difference in the degree of pain. Thus, SPL operations may result in a lower degree of pain than CL in both the post-operative and far post-operative phase.

Expression of ZEB1 in different forms of endometriosis: A pilot study

ObjectivesEpithelial-Mesenchymal Transition (EMT), a cellular process in which epithelial cells lose epithelial characteristics while acquire mesenchymal features, is believed to contribute to migration and invasion abilities of the endometriotic cells. Studies on gene expression of the transcription factor ZEB1, a crucial transcription factor of EMT, show that there is probably a modified expression in the endometriotic lesions.The aim of the study was to compare the expression levels of ZEB1 in types of endometriotic lesions with different biological behavior such as endometriomas and deep infiltrating endometriotic nodules. Study DesignWe have studied 19 patients with endometriosis and 8 patients with benign gynecological lesions without endometriosis.The endometriosis patient group included 9 women with only endometriotic cysts without deep infiltrating endometriotic lesion (DIE) and 10 women with DIE who had developed concurrent endometriotic cysts.The technique applied to investigate ZEB1 expression levels is Real-Time PCR. The results of the reaction were normalized by simultaneously investigating the expression of the house-keeping gene G6PD. ResultsAnalysis of the samples showed underexpression of ZEB1 in the eutopic endometrium of women with only endometriotic cysts when compared to normal endometrium. A tendency of higher ZEB1 expression, without reaching significant difference, was found between the endometriotic cysts and their paired eutopic endometrium.In women with DIE, no significant difference was found between their eutopic and normal endometrium. No significant difference was found between the endometriomas and DIE lesions.ZEB1 shows different expression profile in the endometriotic cysts of women with and without DIE when the cyst is compared to their paired eutopic endometrium. ConclusionsIt therefore appears that ZEB1 expression differs between different types of endometriosis. The expression levels of ZEB1 in the eutopic endometrium could affect the development of infiltrating lesions or not. However, the most important observation is the different ZEB1 expression profile of endometriomas between women with and without DIE. Although, they both share the same histologic characteristics, they show different ZEB1 expression indicating different pathogenetic mechanisms of endometriomas in cases with and without DIE. Therefore, future research on endometriosis should consider DIE and ovarian endometriosis as different diseases.

Preoperative renal function in women in Port Harcourt, Nigeria, with major gynecological lesions requiring urological and surgical interventions

Introduction: Preoperative renal function assessment is a prerequisite for many surgical procedures. This is because of the vital function of the kidneys in the regulation of serum electrolytes, and excretion of waste products or by-products of metabolic processes. Materials and Methods: This cross-sectional descriptive study was done at two university teaching hospitals in Port Harcourt, Nigeria, from January 2021 to December 2022. Case files of seventy-two (72) women scheduled for major gynecological surgeries were studied. Data obtained were analyzed using the SPSS, version 20, and the outcome was expressed using frequency tables and charts. Results: The mean age of the women in the study was 37.50 ± 1.22 years. Women with hyponatremias were 9 (12.5%); hypokalemia, 11 (15.3%); hyperkalemia, 3 (4.2%). Thirty-nine patients, 39 (54.2%) had acidosis, low serum bicarbonate (HCO3-). Low blood urea was found in 11 (15.3%) of the women. One of them (1.4%) had elevated blood urea. The rest had normal values. Hypocreatinaemia and hypercreatinaemia were detected in 29 (40.3%) and 2 (2.8%) patients respectively. Conclusion: Electrolyte derangement was found in 40 (55.6%) of the patients preoperatively. This finding suggests that renal function assessment is crucial in the preoperative evaluation of gynecological patients before major gynecological surgeries.

Automated Detection of Endometrial Polyps from Hysteroscopic Videos Using Deep Learning

Endometrial polyps are common gynecological lesions. The standard treatment for this condition is hysteroscopic polypectomy. However, this procedure may be accompanied by misdetection of endometrial polyps. To improve the diagnostic accuracy and reduce the risk of misdetection, a deep learning model based on YOLOX is proposed to detect endometrial polyps in real time. Group normalization is employed to improve its performance with large hysteroscopic images. In addition, we propose a video adjacent-frame association algorithm to address the problem of unstable polyp detection. Our proposed model was trained on a dataset of 11,839 images from 323 cases provided by a hospital and was tested on two datasets of 431 cases from two hospitals. The results show that the lesion-based sensitivity of the model reached 100% and 92.0% for the two test sets, compared with 95.83% and 77.33%, respectively, for the original YOLOX model. This demonstrates that the improved model may be used effectively as a diagnostic tool during clinical hysteroscopic procedures to reduce the risk of missing endometrial polyps.

Laparoscopic radical hysterectomy and total vaginectomy for vaginal malignant melanoma with cervical metastasis

The presented case is a 63-years-old multiparous woman admitted with the complaint of postmenopausal bleeding. On gynecologic examination multifocal lesions were detected, including 1 cm on lateral vaginal wall, 4 cm on posterior vaginal wall and 0.5 cm on the left lateral part of the cervix. Histopathology examination gave a diagnosis of epithelioid malignant melanoma. Consequently, laparoscopic radical hysterectomy and total vaginectomy with bilateral pelvic and inguinofemoral lymph node dissection were planned. On both sides, pararectal and paravesical spaces were created and the ureter was identified. Then, the vesicouterine and vesicovaginal spaces were developed. Uterine artery and superior vesical artery were coagulated, cut and the lateral parametrium was prepared. The left ureter was dissected and the ureteral tunnel was unroofed up to the bladder entrance. Subsequently, the anterolateral parametrium was transected. Then, the infundibulopelvic and sacrouterine ligaments were sealed and transected. At this time, the rectovaginal space was developed. Bilateral paracolpos were transected. The endopelvic fascia with the levator muscles were sealed and cut circumferentially. Anteriorly, the pubovesicocervical fascia was transected and the bladder was mobilized up to the uretrovesical junction. Thereafter, through a vaginal approach, the cervix and vagina were inverted by grasping the cervix with a tenaculum. An incision on the posterior vaginal wall at the introitus was made and the urogenital diaphragm was dissected to connect with the pelvic cavity. The vaginal entrance was cut circumferentially and the surgical specimen was extracted. In conclusion, laparoscopy can be considered as a feasible approach for radical hysterectomy and total vaginectomy in selected patients.

Abstract PD16-05: Systemic staging in breast cancer patients receiving neoadjuvant chemotherapy

Abstract Introduction Per NCCN guidelines, patients with stage I-III breast cancer should only have staging work up with CT chest, abdomen, and pelvis and bone scan if there are concerning symptoms, lab abnormalities, or physical exam findings. These patients do not require staging imaging because previous studies have documented the low incidence of metastatic disease found on systemic imaging, and the use of routine staging imaging has been shown to have a high false positive rate resulting in additional imaging and further work up with a low true positive rate. Despite the NCCN guidelines, extensive imaging is often performed prior to embarking on neoadjuvant therapy to look for evidence of metastatic spread of disease prior to surgery regardless of clinical stage and lack of symptoms. Methods We performed a retrospective analysis of patients at the University of Virginia diagnosed with invasive breast cancer who were recommended for neoadjuvant therapy and underwent systemic imaging to assess for the presence of distant metastatic breast cancer between 2012 and 2019. All receptor subtypes were included. Patients with signs/symptoms of metastatic disease at time of initial consultation were excluded. We evaluated the rate of metastatic breast cancer detected on systemic imaging. We also evaluated the rate of incidental findings on systemic imaging and how often this resulted in additional imaging or biopsy. Results 328 patients met inclusion criteria and were recommended for neoadjuvant chemotherapy and underwent systemic staging. Of these, 8 patients had bilateral breast cancer at time of diagnosis. Included patients were 54.2% hormone receptor (HR) positive, 35.4% triple negative, and 23.2% HER2 positive; 74.1% were node positive (Table 1). Metastatic breast cancer was identified in 9.1% (30 patients), which included 19 HR positive, 8 HER2 positive, and 7 triple negative patients. Of the patients found to have metastatic breast cancer, 80% had anatomic stage III disease at presentation and 93.3% were node positive. Two metastatic patients that were node negative had a cT2 or cT3 primary tumor. Systemic imaging identified incidental findings in 72.6% (238) patients. Most common incidental findings were pulmonary nodules (107), bone lesion or abnormality (71), hepatic lesions (55), and gynecologic lesions (50). Of the patients with incidental findings, 40.7% (98) underwent additional imaging for further work up or monitoring and 12.2% (29) underwent a biopsy or procedure for further work up. These biopsies identified benign or non-diagnostic results in 20 cases (69.0%) and identified an alternative malignancy in 9 cases (31%). Conclusions Within this study, asymptomatic metastatic disease was most commonly found in node positive stage III breast cancer, but was never or rarely found in stage I or II breast cancer patients. This validates NCCN recommendations that asymptomatic anatomic stage I or II breast cancer patients do not benefit from systemic staging. Yet, we did find a relatively high proportion of metastatic disease in asymptomatic patients with stage III breast cancer, indicating that systemic staging may be appropriate for this population. This must be balanced against the high probability of incidental findings with frequent additional imaging or biopsy, which has implications for patient anxiety, potential harm, and cost. Table 1: Patient Characteristics Citation Format: Courtney Lattimore, Squeo Gabriella, Christiana Brenin, Shayna Showalter, Trish Millard. Systemic staging in breast cancer patients receiving neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD16-05.

Diagnosis and screening for anal intraepithelial neoplasia in Belgium: position statement.

Anal cancer is an uncommon malignancy, comprising only 2.5% of all gastrointestinal malignancies and similar to cervical cancer, the human papillomavirus (HPV) is responsible for the majority of anal cancers. Over the last decades there has been an up to 3-fold increased incidence seen in specific populations at risk such as persons living with HIV (PLWH), men who have sex with men (MSM), woman diagnosed with HPV-related gynaecological precancerous lesions or cancer, solid organ transplant recipients (SOTR) and patients with autoimmune diseases. Although international practice is evolving increasingly towards active screening for and treatment of anal cancer precursors in at-risk groups, currently no organised screening program is in effect in Belgium. Currently, differerent screening options as well as treatment modalities are available. Before commencing a nationwide organised screening program, essential decisions on screening strategies need to be made, based on both scientific as well as financial and logistical facts.

Histogram-based diffusion metrics for differentiation of benign &amp;malignant gynecologic lesions

Purpose: To evaluate the ability of ADC based histogram parameters to differentiate between benign and malignant gynecologic lesions. Results: The study was performed on 100 cases having 66 benign lesions &amp;34 malignant lesions which were pathologically proved. There was statistically significant difference between benign and malignant lesions on qualitative diffusion weighted. The range of traditional partial slice mean ADC parameter for benign masses was (1.095 ± 0.315 x 10−3 mm2/s) and for malignant lesions was (0.791 ± 0.244 x 10−3 mm2/s) which was lower than the values of the benign lesions. there was statistically significant difference as regard mean and minimum ADC values (P = 0.01*, ) The cutoff mean &amp;minimum ADC values used to differentiate benign lesions from malignant lesions were 0.905 &amp; 0.680 x 10-3 mm2/s, respectively. We found that The sensitivity, specificity and accuracy of partial slice mean ADC were higher than histogram mean ADC. Conclusions: Mean &amp; minimum ADC can differentiate between benign and malignant gynecologic lesions with less diagnostic performance than traditional partial slice mean ADC.

Uterine pseudotumor detected in F-18 FDG PET/CT: dead fetus and intrauterine pregnancy products

F-18 fluorodeoxyglucose-positron emission tomography-computed tomography (F-18 FDG PET/CT) is frequently used in oncology patients. F-18 FDG PET/CT plays an important role in the detection and management of gynecological cancers, as in many different organ cancers. In addition, PET/CT helps the differentiation of benign and malignant gynecological lesions [1]. While evaluating uterine-derived lesions in premenopausal women, fetal and pregnancy-related structures should also be considered, and the patient should be evaluated in the terms of the possible FDG accumulation due to benign changes [2]. We present a case of pseudotumor in uterus with irregular vaginal bleeding and biochemical pregnancy.

Does diffusion weighted imaging have a prognostic value in differentiating gynecological diseases?

IntroductionApparent diffusion coefficient (ADC) values are effective in the diagnosis of different gynecological lesions. MethodsA retrospective evaluation was made of 12 patients with uterine cervix carcinoma and 151 patients with uterine lesions, comprising endometrial cancer, endometrial polyps, carcinosarcoma, submucous myoma, adenomyosis, endometrial hyperplasia, gestational trophoblastic neoplasm (GTN), and leiomyomas. As a control group, 20 healthy volunteers with normal endometrium and normal cervix were also evaluated. In three series, one-shot, spin echo, echo planar, b = 1000 s/mm2 value and diffusion-weighted imaging (DWI) were applied to all subjects and ADC values were obtained. ResultsThe mean ADC values of Group 1 (Endometrial carcinoma) were lower than those of all the other groups (P < 0.001) and the mean ADC value of group 6 (GTN) was higher than that all other groups (P < 0.001). A statistically significant difference was found between the groups in terms of the lesion-myometrium ADC ratios (P < 0.001). ConclusionThere are few studies in literature related to ADC measurements in GTN. The ADC values of GTN were found to be significantly higher than the other uterine lesions. These results will aid in the design of future studies and might be used to guide management of patients with GTN. Implications for practiceDiffusion-weighted MRI seems to be a promising imaging technique in differentiating different uterine lesions.

New Trends in the Detection of Gynecological Precancerous Lesions and Early-Stage Cancers.

Simple SummaryThis review deals with the prospects of early diagnostics in cervical, endometrial, and ovarian cancers. Progress in cancer research has enabled the rapid development of cancer diagnostics, treatments, and preventions. Indeed, the current situation in genital tract tumors reflects the trend in contemporary oncology that emphasizes cancer prevention and early diagnostics. Cervical cancer screening using cytological examination has a long tradition, is highly effective, and is now being complemented with HPV triage, allowing early diagnostics even in precancerous stages due to the relative ease of accessibility of the uterine cervix. Moreover, vaccination against HPV, which is major cause of cervical cancer, is now recommended for both girls and boys at an early age. In contrast, endometrial and, particularly, ovarian cancers are poorly accessible by sampling, and neither prevention nor screening methods readily exist. Thus, other options leading to their early diagnostics are discussed, in which circulating biomarkers play key roles.The prevention and early diagnostics of precancerous stages are key aspects of contemporary oncology. In cervical cancer, well-organized screening and vaccination programs, especially in developed countries, are responsible for the dramatic decline of invasive cancer incidence and mortality. Cytological screening has a long and successful history, and the ongoing implementation of HPV triage with increased sensitivity can further decrease mortality. On the other hand, endometrial and ovarian cancers are characterized by a poor accessibility to specimen collection, which represents a major complication for early diagnostics. Therefore, despite relatively promising data from evaluating the combined effects of genetic variants, population screening does not exist, and the implementation of new biomarkers is, thus, necessary. The introduction of various circulating biomarkers is of potential interest due to the considerable heterogeneity of cancer, as highlighted in this review, which focuses exclusively on the most common tumors of the genital tract, namely, cervical, endometrial, and ovarian cancers. However, it is clearly shown that these malignancies represent different entities that evolve in different ways, and it is therefore necessary to use different methods for their diagnosis and treatment.

Histopathological study of cervical lesions in a tertiary health care centre in south India

Cervix is vulnerable to many pathological changes ranging from inflammation to malignancy. Uterine cervix is gateway to several non-neoplastic and neoplastic gynaecological lesions.. Histopathological studies of cervix along with clinical correlation helps in early diagnosis of lesions as they have advantages of being relatively cheap and technically easy.To study the histopathological features of cervical lesions. A retrospective study was done in the department of Pathology at Vinayaka Mission’s Kirupananda Variyar Medical College and Hospital, Salem for duration of 05 years i.e., from April 2016 to March 2021in 550 cervical samples.Non neoplastic (92.1%) lesions of cervix were more commonly reported in our study and neoplastic lesions were about 7.8%. Histopathology study of cervical biopsy lesions is a valuable diagnostic procedure. Early detection of cervical lesions may provide an opportunity for appropriate interventions to prevent further complications such as progression from benign to malignant conditions. Adequate screening procedure with follow up cervical biopsies helps in early diagnosis and management of premalignant and malignant lesions.

Histomorphological Spectrum of Cervical Lesions in a Rural Hospital.

BackgroundPathologically the cervix is affected by infective, inflammatory, and neoplastic diseases. Non‑neoplastic lesions of the cervix are seen often in sexually active women. Inflammatory lesions include chronic granulomatous cervicitis, acute and chronic cervicitis. In India, cervical cancer is a significant health problem. Many factors contribute to the differences in the spectrum of cervical diseases in the rural population compared to urban areas, but the studies in these populations are scarce.Materials and methodsA retrospective analysis of all gynecological lesions over one year was studied. All case files were manually extracted, and the data was entered in an Excel sheet. The information included was clinical history (symptoms, signs, menstrual history, duration of illness, parity status), physical examination, per vaginal examination, investigations, including pathological diagnosis. The curated data was then analyzed using IBM SPSS for Windows version 22 (IBM Corp., Armonk, NY).ResultsThere were 164 women in the study, with a mean age of 46.07 ± 8.17 years. A majority (n = 124, 75.6%) presented with excessive bleeding. Two-thirds of the study population had a normal cervix on examination. Twenty-seven women had squamous metaplasia, six had low-grade (LSIL) and high-grade squamous intraepithelial lesions (HSIL), and one had malignancy. Excessive bleeding was significantly associated only with LSIL. Among the microscopic findings, only squamous metaplasia (p < 0.001) and dysplasia (p < 0.001) were significantly associated with the final diagnoses, such as LSIL, HSIL, and chronic cervicitis.ConclusionMost studies involving rural populations have involved the knowledge, attitude, and practices of the study cohort rather than the histomorphological spectrum of cervical lesions. Since these disorders are also influenced by education, parity, hygiene, and socioeconomic status, it behooves us to be aware of the spectrum of cervical lesions in a rural cohort who differ in these aspects when compared to urban populations. Most of such lesions of the cervix in the population that our medical institution served were benign in nature.