Gynecologic Pathology Research Articles

Ovarian serous borderline tumors with recurrent or extraovarian lesions: a Japanese, retrospective, multi-institutional, population-based study.

Ovarian serous borderline tumors (SBT) are typically unilateral and are primarily treated using hysterectomy and bilateral salpingooophorectomy (SO). However, most young patients prefer fertility-sparing surgeries (FSS) with tumorectomy or unilateral SO. Micropapillary morphology and invasive implants have been designated as histopathological risk indicators for recurrence or metastasis, but their clinical impact remains controversial because of limitations like diagnostic inconsistency and incomplete surgical staging. A nationwide multi-institutional population-based retrospective surveillance was conducted with a thorough central pathology review to reveal the clinical features of SBT. Of 313 SBT patients enrolled in the Japanese Society of Clinical Oncology's Surveillance of Gynecologic Rare Tumors, 289 patient records were reviewed for clinical outcomes. The glass slides of patients at stage II-IV or with recurrence or death were re-evaluated by three gynecological pathologists. The 10-year overall and progression-free survival (PFS) rates were 98.6% and 92.3%. The median recurrence period was 40months and 77.0% was observed in the contralateral ovary within 60months. Patients aged ≤ 35years underwent FSS more frequently and relapsed more (p < .001). A clinic-pathological analysis revealed diagnosis during pregnancy, FSS, and treatment at non-university institutes as well as advanced stage and large diameter were independent risk factors of recurrence. Among patients having pathologically confirmed SBTs, PFS was not influenced by the presence of micropapillary pattern or invasive implants. The recurrence rate was lower in this cohort than previous reports, but the clinical impacts of incomplete resection and misclassification of the tumor were still significant on the treatment of SBT.

The Prognostic Significance of the Depth of Cervical Stromal Invasion in Women With FIGO Stage II Uterine Endometrioid Carcinoma.

The objective of this study was to investigate the prognostic significance of the depth of cervical stromal invasion (CSI) in women with FIGO stage II uterine endometrioid adenocarcinoma (EC). Our database of women with EC was quired for patients with stage II EC. Pathologic slides were retrieved and reviewed by gynecologic pathologists to determine cervical stromal thickness and depth of CSI as a percentage of stromal thickness (%CSI). Kaplan-Meier, univariate, and multivariate analyses were used to compare recurrence-free, disease-specific (DSS), and overall survival (OS) between women who had<50% versus ≥50% CSI. Univariate and multivariate analyses were used to assess other prognostic variables associated with survival endpoints. A total of 117 patients were included in our study who had hysterectomy between 1/1990 and 8/2021. Seventy-nine patients (68%) with <50% and 38 (32w%) with ≥50% CSI. After a median follow-up of 131 months, 5-year DSS was significantly worse for women with ≥50% CSI (78% vs. 91%; P =0.04). However, %CSI was not an independent predictor for any of the studied survival endpoints. Independent predictors of worse 5-year recurrence-free survival and DSS included FIGO grade 3 tumors ( P =0.02) and the presence of lymphovascular space invasion ( P =0.03). Grade 3 tumors were the only independent predictor of worse 5-year OS ( P =0.02). Our results suggest that deep CSI is not an independent prognostic factor for survival endpoints in women with stage II uterine endometroid adenocarcinoma. The lack of independent prognostic significance of the depth CSI needs to be validated in a multi-institutional analysis.

Menstrual cycle abnormalities in women with inflammatory bowel disease and effects of biological therapy on gynecological pathology.

Inflammatory bowel disease (IBD) is a chronic condition that affects young individuals in their reproductive years. It may have long-term implications on their reproductive, sexual, and mental health. IBD has been related to menstrual abnormalities. Furthermore, the administration of biological therapy can also result in gynecological issues in addition to the disease itself. The purpose of this review was to present potential menstrual cycle problems in patients with IBD, as well as the impact of adalimumab and other anti-tumor necrosis factor medications on gynecological pathology.

STRUCTURAL AND FUNCTIONAL PARAMETERS OF THE ENDOMETRIUM AND OVARIAN TISSUE IN PATIENTS WITH IMPAIRED REPRODUCTIVE POTENTIAL AND OBESITY

According to the WHO, every second woman has a problem with excess weight, while about 23% of women indicate a pathological body mass index, and excess weight (the so-called “pre-obesity”) is noted in 25% of women.&#x0D; The aim of the research was to evaluate the structural and functional parameters of the endometrium and ovarian tissue and to optimize the diagnostic algorithm and monitoring of the endometrium in women with obesity and impaired reproductive function.&#x0D; Materials and methods. 110 patients of reproductive age with impaired reproductive health underwent a comprehensive clinical and laboratory examination within the framework of this research. The main group included 64 patients with overweight and class 1 obesity, and the comparison group consisted of 46 women with a normal body mass index. The proposed diagnostic algorithm included a sonographic study of the structural parameters of the endometrium and ovaries, as well as an assessment of the features of the blood supply to the pelvic organs and statistical processing of the results.&#x0D; Research results and their discussion. The presented results allow us to note a significant percentage of comorbidity of somatic and gynecological pathology in overweight and obese patients. Pregnancy is accompanied by a higher percentage of early reproductive losses (14.0%), preterm birth (10.9%), preeclampsia (42.2%), placental dysfunction (46.4%) and low birth weight (17.2%). The main clinical forms of endometrial pathology in the main group were polyposis (32.8%), endometrial hyperplasia (23.4%) and dyschronosis of morphological changes of the endometrium (28.1%). The combination of endometrial hyperplasia with/or uterine leiomyoma, adenomyosis, benign ovarian tumors and retention formations was noted in 53.6% of observations in both groups; in 46.4% of women the isolated form was noted. The morphological characteristics of endometrial polyposis allowed us to note the dominance of glandular-fibrous polyps (45.2%) and in the case of a combination with myoma or ovarian retention cysts - glandular forms (32.3%). The most frequent sonographic marker of dysfunction of the endometrial potential (inconsistency of the ultrasound image of the endometrium with the phase of the menstrual cycle) was revealed in more than half of the cases (62.5%). Sonographic evaluation of the structural parameters of the endometrium and ovarian tissue showed an increase in the anterior-posterior size of the uterus and the thickness of the endometrium by 2.8 times, the volume of the ovary – by 2.0 times. It should be noted that the patients of the main group had a greater proportion of cysts and endometriomas. According to dopplerometry data, significantly lower parameters of the vascular resistance index were confirmed in the ovarian arteries and in the arteries of the stroma; in almost half of the observations, varicose veins of the parametrium were noted.&#x0D; Conclusions. Changes in steroidogenesis against the background of lipid metabolism disorders are accompanied by an increase in the volume of the endometrium and ovarian tissue, growing proportion of cystic formations in the appendages, an increase in the hemodynamic imbalance of blood flow in pelvic organs, which requires optimization of the monitoring program at the stage of preconception preparation and elimination of risk factors for placental dysfunction.

Other Pathologies Were Rarely Reported after Laparoscopic Surgery for Suspected Appendicitis: A Systematic Review and Meta-Analysis

Background: Diagnostic laparoscopy is often used when a patient is suspected of having acute appendicitis. The aim of this study was to assess the rate of other pathologies found during diagnostic laparoscopy for suspected acute appendicitis. Methods: This systematic search included studies with ≥100 patients who received laparoscopy for suspected acute appendicitis and reported on the histopathologic and other intra-abdominal findings. We performed a meta-analysis estimating the rate of other pathologies, and a sensitivity analysis excluding smaller cohorts (≤500 patients). Age groups, sex, specific findings, and geographic regions were investigated. Certainty of evidence was assessed with GRADE. Results: A total of 27 studies were included covering 25,547 patients and of these 793 had an unexpected pathology. The findings were benign pathology in the appendix (34%), malignancy (30%), gynecologic pathology (5%), gastrointestinal pathology (4%), or unspecified (27%). Meta-analysis showed an overall rate of unexpected findings of 3.5% (95% CI 2.7–4.3; moderate certainty), and the sensitivity analysis showed similar results. Malignancy found in the appendix when treating suspected acute appendicitis was 1.0% (95% CI 0.8–1.3%; high certainty). Conclusion: The rate of other histopathological findings in patients with suspected acute appendicitis was low and a malignancy in appendix was found in 1% of patients.

Evaluation of survivin expression in the endometrium and endometriotic lesions in patients with genital endometriosis, type 1 diabetes mellitus and their comorbidity

BACKGROUND: The prevalence of external genital endometriosis is high, yet there is insufficient understanding of its etiology and pathogenesis. This coupled with the challenges posed by its diagnosis and treatment, and its co-occurrence with type 1 diabetes mellitus, underscores the significance of this issue.&#x0D; AIM: The aim of this study was to evaluate the expression of survivin in the eutopic endometrium, endometriotic lesions, and their concomitant conditions in patients with external genital endometriosis and type 1 diabetes mellitus.&#x0D; MATERIALS AND METHODS: This study enrolled 43 female patients of reproductive age who were divided into four groups. The main group (n = 17) included women with surgically and histologically confirmed external genital endometriosis combined with type 1 diabetes mellitus. The external genital endometriosis group (n = 9) comprised women with isolated external genital endometriosis, while the type 1 diabetes mellitus group (n = 6) included patients with type 1 diabetes mellitus only. Finally, the control group (n = 6) consisted of women without any gynecological pathology. Biological specimens were collected during the follicular phase of the menstrual cycle, and morphological examination was carried out through histological and immunohistochemical evaluation of the endometrium and endometrioid heterotopias. Statistical analysis of the data was performed using the Jamovi software program, with statistical significance defined as p 0.05.&#x0D; RESULTS: Our findings indicate that patients with external genital endometriosis and comorbid type 1 diabetes mellitus exhibit a statistically significant increase in survivin expression in the endometrium compared to the control group or patients with type 1 diabetes mellitus only. However, no significant difference was observed in survivin expression in endometriotiс lesions between patients with external genital endometriosis and those with external genital endometriosis combined with type 1 diabetes mellitus.&#x0D; CONCLUSIONS: The data obtained suggest the role of survivin in the pathogenesis of external genital endometriosis, regardless of the presence of type 1 diabetes mellitus.

Infrared thermography as a method of diagnosing reproductive pathologies in animals

The development and practical implementation of unique instrumental methods for diagnosing obstetric, gynecological, and andrological pathologies remain relevant. In this regard, thermography shows promise as a non-contact remote diagnostic express method that allows detecting differences in the distribution and intensity of infrared radiation depending on the physiological or pathological state of the animal organism. In this regard, the purpose of the work was to present the possibility of using the infrared thermography method for diagnosing reproductive pathologies in animals. Assessing the functional state and conducting preventive diagnosis of pathological processes in the genitals using thermal imagers can be crucial in animal reproduction. In addition, exceptional safety, autonomy, and non-contact qualities make thermal imagers indispensable in veterinary medicine. Therefore, thermography provides identification and differentiation of the phases of the sexual cycle and preventive diagnosis of obstetric-gynecological and andrological pathologies at a pre- or subclinical stage of development, dystrophic or inflammatory. Practical utilization of thermal imagers enables, in some cases, to make a final diagnostic conclusion; in others, to receive only preventive information followed by thorough, further comprehensive and specific research.

Which combination cause less inflammatory response during laparoscopic hysterectomy? Ligasure plus monopolar cautery or harmonic plus bipolar cautery?

We aimed to compare the inflammatory response with alterations in hemogram parameters, in patients who underwent laparoscopic hysterectomy and bilateral salpingo-oophorectomy for benign gynecologic conditions with ligasure plus monopolar cautery or harmonic plus conventional bipolar cautery. Patients who underwent Laparoscopic hysterectomy with bilateral salpingo-oophorectomy between January 2017 and January 2022 for benign gynecologic pathology were identified. Patients were divided into two group, according to instruments used during surgery. Instruments were used according to surgeons preference. Preoperative and postoperative in the first 24 hours hematocrit (HCT), WBC, trombocyt, neutrophil- lymphocyte (NLR), platelet-lymphocyte (PLR) ratio, mean platelet volume- lymphocyte ratio (MPVLR) and red cell distribution width- platelet ratio (RPR) values were compared. During study period, a total of 462 patients underwent hysterectomy for benign gynecologic pathology. After exclusion, 212 patients were included in the study. İn the study group, 147 patients were operated with ligasure plus monopolar electrocauter and 65 with harmonic scalpel plus bipolar electrocautery. İn the postoperative period, regardless of the procedure, WBC and RPR count increase, hematocrit and trombocyt decrease in both group but the inflammatory markers lymphocyte count, neutrophyl, NLR, PLR and MPVLR count changed less in the harmonic plus bipolar cautery group which shows less inflamatuar response in this group. Ligasure plus monopolar cautery group compared with harmonic plus bipolar cautery group cause more inflammatory changes in complete blood count values. However, further studies are needed to show whether these changes in laboratory findings affect clinical situations.

Updates in the Use of Immunohistochemical Stains in Breast and Gynecologic Pathology.

The use of immunohistochemical stains in breast and gynecologic pathology has become increasingly complex, with various diagnostic, prognostic, and predictive applications. To provide an update and review of immunohistochemical stains used in the practice of breast and gynecologic pathology. Established and new entities are reviewed, with descriptions of histomorphology and immunohistochemical staining patterns and discussion of interpretive pitfalls. Data were obtained from review of the English-language literature and firsthand experience of the authors in breast and gynecologic pathology. Many entities in breast and gynecologic pathology benefit from evaluation with various immunohistochemical stains. These studies not only aid in the diagnosis and staging of tumors but also can provide prognostic and predictive information. Updated guidelines for recommended ancillary studies such as mismatch repair, p53, and human epidermal growth factor receptor 2 (HER2) studies in endometrium, as well as estrogen and progesterone receptors and HER2 in breast, are discussed. Finally, the use and interpretation of established and novel immunohistochemical stains are discussed in various breast and gynecologic malignancies.

THE ROLE OF HOMOCYSTEINE IN THE PATHOGENESIS OF GYNECOLOGICAL DISEASES

Despite the fact that homocysteine was first described in 1932, at present, the study of changes in the synthesis and content of this amino acid reveals new mechanisms for the disease development. It should be mentioned that studies confirming the correlation between elevated homocysteine levels and human pathologies (cardiovascular diseases, pregnancy complications, neuropsychiatric disorders) have appeared only recently. This indicates that hyperhomocysteinemia has not been resolved and deserves clinicians’ and researchers’ attention.&#x0D; Most publications present studies on hyperhomocysteinemia as part of the pathogenesis of cardiovascular diseases. However, more recently, elevated homocysteine level has been considered as a marker in preeclampsia and postoperative thromboembolism, including that after reproductive surgery. It was noted that in early pregnancy the activation of endothelial cells is changed in women with hyperhomocysteinemia and uterine fibroids. It increases thrombosis risks, and later, during the chorion formation, an endothelial defect can cause fetoplacental insufficiency, and in case of endotheliosis progression lead to preeclampsia and eclampsia. In recent years, some authors associate hyperhomocysteinemia with disorders of the female reproductive system and ovulatory abilities, possible pathogenesis of benign tumors, pregnancy pathologies and delivery issues.&#x0D; A detailed study of elevated homocysteine in women can help in solving a number of issues, such as the role of hyperhopmocysteinemia in the pathogenesis of gynecological diseases and development of reproductive disorders. &#x0D; There is much information on the role of homocysteine in the development of endothelial dysfunction and significant metabolic disorders. At the same time, there is not enough studies on the changes in folate metabolism, which cause hyperhomocysteinemia and directly affect the development of endocrine gynecological and obstetric pathologies. These problems require further analysis. The correlation between the hyperhomocysteinemia and development of gynecological pathologies is currently one of the promising scientific areas. Special attention is paid to the pathogenesis of uterine fibroids in terms of vascular theory. Despite ongoing research, there is only insufficient information on the role of excess homocysteine in the pathogenesis of uterine fibroids.

A case report of bilateral benign Ovarian Fibrothecoma coincidental with ascites: an unconventional co-occurrence.

We present the case of a 54-year-old female who presented complaining only of a slow progressive increase in the abdominal contour associated with vague abdominal pain. Our preoperative radiological imaging revealed multiple ovarian and uterine masses. Surgical intervention in the form of a hysterectomy with bilateral salpingo-oophorectomy was achieved. Histopathological analysis revealed bilateral benign ovarian fibrothecoma with benign uterine leiomyomas. The patient underwent an uneventful postoperative recovery. Ovarian Fibrothecoma is a rare gynecological pathology. The uniqueness of our case stems from the rarity of its bilateral occurrence and in rare occasions, their occurrence is accompanied by ascites. This kind of co-occurrence should be differentiated from other rare presentations, such as Meigs Syndrome. Therefore, documentation is necessary to circumvent misdiagnoses and to abate the resulting patient morbidity. To further highlight the value of our case, it is to the best of our knowledge, the first documented case of this pathology from our country.

ОСОБЕННОСТИ КЛИНИЧЕСКИХ ПРОЯВЛЕНИЙ ЗРЕЛОЙ ТЕРАТОМЫ ЯИЧНИКА

The study of the described clinical case is of undoubted interest, taking into account the peculiarities of the clinical picture. In this clinical case, there was an asymptomatic course of the disease, which did not manifest itself as the occurrence of clinical symptoms during the patient's pregnancies, despite the change in the architectonics of the pelvis. In addition, there were no complications associated with the presence of a mature ovarian teratoma. The patient was not regularly monitored by an obstetrician – gynecologist, despite the presence of fibroids and adenomyosis. A detailed ultrasound examination of the pelvic organs carried out earlier would have made it possible to diagnose this pathology and carry out treatment. Despite the low frequency of malignancy of this histological type of true ovarian tumors, such a probability is not completely excluded with their long-term existence. In addition, in the presence of a mature teratoma, complications such as infection, torsion or rupture of the formation capsule are often found. Such complications may occur suddenly and lead to vital complications, require emergency surgical intervention. At the same time, there may be no possibility of intraoperative histological examination of the removed drug, which in case of ovarian tumors may lead to an inadequate amount of surgical intervention. In addition, without surgical treatment and subsequent histological examination of the removed ovarian formation, it is impossible to carry out differential diagnosis of mature and immature teratomas as well as other true ovarian tumors, including malignant ones. Therefore, after conducting a study of this clinical case, the following conclusions can be drawn. It is necessary to carry out preventive examinations of patients without gynecological pathology and careful dispensary observation of patients with gynecological diseases carefully, with ultrasound of the pelvic organs, which will allow timely diagnosis and treatment, to avoid possible complications.

Рівень післяопераційних ускладнень при хірургічній патології органів черевної порожнини та порожнини таза в дівчат

The frequency of the development of adhesion disease after surgical interventions on the abdominal cavity is 63-93%. In women who have complications, in the form of confirmed adhesion disease, there is infertility and miscarriage, menstrual cycle disorders in 60% of cases. It should be noted that among women with adhesions, 8.02% had ectopic pregnancies. In addition, every fifth woman with adhesions in the abdominal cavity has endometriosis - 3.08% of cases. Postoperative complications in patients operated on for acute appendicitis are 4-15%, and the mortality rate of acute appendicitis is 0.1-10%. Purpose - to analyze the level of postoperative complications in girls operated on for acute surgical pathology of the pelvic organs by laparoscopic or laparotomy methods. Materials and methods. An analysis of the treatment of 297 girls who were undergoing inpatient treatment for surgical pathology of the pelvic organs at the Pediatric Surgery Clinic of National Pirogov Memorial Medical University, Vinnytsia, Ukraine on the basis of the Vinnytsia Regional Pediatric Clinical Hospital of the Vinnytsia Regional Council during 2018-2022. Results. In children who underwent laparoscopic appendectomy, the rate of postoperative complications was 8 times lower compared to open methods. The use of laparoscopic technologies in the treatment of gynecological pathology in girls, in particular, in teenagers, allowed to reduce the number of postoperative complications by 5 times. Conclusions. In general, it should be recommended, according to indications, to introduce into clinical practice laparoscopic methods of diagnosis and treatment of surgical pathology of the abdominal cavity and pelvic cavity. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the children’s parents was obtained for the research. No conflict of interests was declared by the authors.

Evaluation of Accuracy of Intraoperative Frozen Section and Imprint Cytology in Gynecological Neoplasms-A Descriptive Cross-Sectional Study of 50 Cases in Tertiary Care Center.

Aims and Objectives Gynecological neoplasms are among the most common cancers in female population of India and worldwide. Various new advances have been made to diagnose gynecological pathologies which include imprint cytology and frozen sections in addition to the histopathological techniques. The aim of the study was to assess the diagnostic accuracy of intraoperative diagnostic procedure with gold standard histopathology. Method The study included 50 patients who had suspected gynecological neoplasm in a time period of 12 months. Their intraoperative diagnosis was made on frozen section and imprint cytology to rule out benign or malignant lesions and compared with gold standard histopathology. Results Our study concludes that maximum cases of female genital tract neoplasms belonged to the age group of 19 to 76 years, with 60% cases in postmenopausal age group. Overall diagnosis of 62, 52, and 76% malignancies were made on imprint cytology, frozen section, and histopathological examination, respectively. Conclusion The study concludes that diagnostic accuracy by intraoperative imprint cytology is higher (80%) than frozen section (76%). True positive cases were maximally reported by histopathology. True negative and false positive cases were equally reported by both frozen and imprint cytology. False negative cases were reported by frozen section more than by imprint cytology. The kappa statistical value was lesser in frozen versus histopathology and more in imprint versus histopathology. The sensitivity, specificity, positive predictive value, and negative predictive value for imprint cytology were 77.5, 90.0, 96.9, and 50%, respectively, whereas for frozen section, it was 72.5, 90.0, 96.7, and 45.0%, respectively.

Interobserver Agreement on the Interpretation of Programmed Death-ligand 1 (PD-L1) Combined Positive Score (CPS) Among Gynecologic Pathologists.

The anti-programmed cell death (PD-1) checkpoint inhibitor pembrolizumab is approved for the treatment of cervical carcinoma with a programmed cell death-ligand 1 (PD-L1) Combined Positive Score (CPS) of ≥1. We assessed interobserver agreement in cervical carcinoma PD-L1 CPS to identify whether it may affect patient selection for immunotherapeutic candidacy. Twenty-nine cervical carcinomas were stained for PD-L1 (Dako 22C3), and slides were interpreted by 5 subspecialty-trained gynecologic pathologists with experience reading PD-L1 immunohistochemistry. Expression was scored using CPS and read out as positive (≥1) or negative (<1); in positive cases, a final score was assigned (1 to 100). There was consensus agreement across all 5 pathologists for 90% (26/29) (Fleiss Kappa value for interobserver agreement: 0.799). The 3 cases with disagreement were composed of 2 squamous cell carcinomas and 1 small cell carcinoma. Of the 26 with unanimous agreement, 88% (23/26) were positive and 12% (3/26) were negative. All (16/16) pure squamous cell carcinomas with full consensus were interpreted as positive, whereas tumors with glandular components were commonly consensus negative (33%, 3/9); this difference was significant ( P =0.037). Disagreements were attributable to low CPS versus negative reads (2 cases) and difficulty discerning glandular involvement from pushing invasion (1 case). In summary, experienced gynecologic pathologists showed substantial interobserver agreement in the interpretation of PD-L1 CPS at the Food and Drug Administration-approved treatment threshold, with the majority of tumors being classified as positive. Pure squamous histology was strongly associated with a consensus-positive read, whereas a subset of tumors with glandular differentiation was negative by all readers. Disagreements occurred in tumors with low versus negative CPS values and in the setting of limited invasion.

PD-L1 expression, morphology, and molecular characteristic of a subset of aggressive uterine tumor resembling ovarian sex cord tumor and a literature review

BackgroundUterine tumors resembling ovarian sex cord tumor (UTROSCT) is a rare neoplasm of unknown etiology and has undetermined malignant potential. The emergence of recurrent UTROSCT case reports has led to its initial identification as a tumor of low malignancy potential. Owing to its low incidence, we currently lack any in-depth studies regarding the subset of UTROSCTs that may be aggressive in nature. Here, we sought to identify unique characteristics in aggressive UTROSCT.Methods19 cases of UTROSCT were collected. Their histologic and tumor immune microenvironment were evaluated by three gynecologic pathologists. The gene alteration was also detected by RNA sequencing. For later analyses regarding differences between benign and malignant tumors, we supplemented our 19 included cases with additional reports from the literature.ResultsInterestingly, we found PD-L1 expression in stromal tumor-infiltrating immune cells (stromal PD-L1) was markedly higher in aggressive UTROSCT. Patients with high stromal PD-L1 (≥ 22.5 cells/mm2) had worse prognosis. When our cases were added with previous cases identified in the literature, we discovered that aggressive UTROSCT was more likely to have significant mitotic activity and NCOA2 gene alterations than benign UTROSCT. Consistence with those results, patients with significant mitotic activity and gene alteration of NCOA2 had worse prognoses.ConclusionsCollectively, high expression of stromal PD-L1, significant mitotic activity, and gene alteration of NCOA2 may be useful markers to predict aggressive UTROSCT.

Dr Richard L. Kempson: In Memorium.

*Department of Pathology, Stanford University, Stanford California, CA †Department of Pathology, Emory University, Atlanta, GA ‡Department of Pathology, University of Virginia Medical Center, Charlottesville, VA Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Correspondence: Teri A. Longacre, MD, Gynecologic Pathology Stanford Medicine & Stanford Cancer Center 300 Pasteur Drive, Room L235, Stanford, 94305 CA (email: [email protected]).

Predictive Factors for Morcellation during Total Laparoscopic Hysterectomy: A Cohort Study

ObjectivesOur objective was to identify predictors of morcellation during a total laparoscopic hysterectomy (TLH). MethodsA retrospective cohort study (Canadian Task Force classification II-2) taking place in a university hospital center in Quebec, Canada. Participants were women undergoing a TLH for a benign gynaecologic pathology from January 1, 2017, to January 31, 2019. All women underwent a TLH. If the uterus was too voluminous to be removed vaginally, surgeons favoured in-bag morcellation by laparoscopy. Uterine weight and characteristics were assessed before surgery by ultrasound or magnetic resonance imaging to predict morcellation. ResultsA total of 252 women underwent a TLH and the mean age was 46 ± 7 (30–71) years old. The main indications for surgery were abnormal uterine bleeding (77%), chronic pelvic pain (36%) and bulk symptoms (25%). Mean uterine weight was 325 (17–1572) ± 272 grams, with 11/252 (4%) uterus being >1000 grams and 71% of women had at least 1 leiomyoma. Among women with a uterine weight <250 grams, 120 (95%) did not require morcellation. On the opposite, among women with a uterine weight >500 grams, 49 (100%) required morcellation. In addition to the estimated uterine weight (≥250 vs. <250 grams; OR 3.7 [CI 1.8 to 7.7, P < 0.01]), having ≥ 1 leiomyoma (OR 4.1, CI 1.0 to 16.0, P = 0.01) and leiomyoma of ≥5 cm (OR 8.6, CI 4.1 to 17.9, P < 0.01) were other significant predictors morcellation in multivariate logistic regression analysis. ConclusionsUterine weight estimated by preoperative imaging as well as the size and number of leiomyomas are useful predictors of the need for morcellation.

13 - Analysis of the configuration and the port-training criteria of the Versius robotic system (CMR) in patients undergoing robotic surgery for benign gynaecological pathology: Preliminary report

13 - Analysis of the configuration and the port-training criteria of the Versius robotic system (CMR) in patients undergoing robotic surgery for benign gynaecological pathology: Preliminary report

Vaginal epithelial histology before and after fractional CO2 laser in postmenopausal women: a double-blind, sham-controlled randomized trial

Postmenopausal vaginal symptoms affect over 60% of women and may substantially impact a woman's quality of life. Since 2012, fractional CO2 laser has been suggested as a treatment for this indication. Structural assessment of vaginal epithelium using microscopic biopsy examination has been used as a primary outcome measure and surrogate determinant of success of vaginal laser in previous clinical studies. This study aimed to report the effects of laser compared with sham treatment on human vaginal epithelium from postmenopausal women using microscopic examination of tissue biopsies. This single-center double-blind, sham-controlled randomized controlled trial was performed in a tertiary hospital in Sydney, Australia. A total of 49 postmenopausal women who were symptomatic of at least 1 vaginal symptom (vaginal dryness, burning, itching; dyspareunia; or dryness) were randomized to either laser or sham treatment. For this nested histologic study, participants had a pre- and post-treatment vaginal wall biopsy collected. Biopsy samples were analyzed by 3 independent specialist gynecologic pathologists and categorized as Type 1 (well-estrogenized), 2 (poorly estrogenized), or 3 (combination) mucosae. Other outcomes assessed included symptom severity (visual analog scale for symptoms including most bothersome symptom, and Vulvovaginal Symptom Questionnaire) and Vaginal Health Index. Prespecified secondary analyses of data were performed. Categorical data were analyzed using the Pearson chi-square test (or Fisher exact test if <5 in any category) or related-samples McNemar test for paired nonparametric data. Nonparametric, continuous variables were assessed using Wilcoxon signed-rank test or Mann-Whitney U test, and parametric variables with t test or 1-way analysis of variance as appropriate. All analyses were performed using SPSS software version 26.0 (IBM Corp, Armonk, NY). There was no significant difference in microscopic features of vaginal epithelium following laser or sham treatment (P=.20). Further subgroup analyses of age, menopause type, duration of reproductive life, time since menopause and BMI, still demonstrated no significant difference between laser and sham groups in histological category of vaginal epithelium. Microscopic features at pre-treatment vaginal biopsy were Type 1 in 27% (13/49). There was no significant difference in VAS score for overall vaginal symptom between those classified as Type 1 vs. Type 2/3 (VAS score overall: Type 1 vs. Type 2/3, (48.1 [95% CI 27.0, 69.2] vs. 61.5 [95% CI 49.8, 73.3]; P=.166). Data from this double-blind, sham-controlled randomized controlled trial demonstrate that fractional CO2 laser and sham treatment have a comparable histologic effect on vaginal tissue that is not significantly different. Fractional CO2 laser is not significantly different from sham treatment and should not be recommended for clinical use for postmenopausal vaginal symptoms.