Lesions In Postmenopausal Women Research Articles

Diagnostic and Therapeutic Advantages of Hysteroscopic Surgery in Management of Intrauterine Lesions in Postmenopausal Women

Study Objective To determine the value of hysteroscopic surgery in the management of intrauterine lesions in postmenopausal women. Design Descriptive study (Canadian Task Force classification II-2). Setting Tertiary care university hospital. Patients Fifty postmenopausal women, most with vaginal bleeding, all with intrauterine lesions (leiomyomas, polyps, adhesions) on hysteroscopy or ultrasound. Intervention Hysteroscopic operations consisting of myomectomy, polypectomy, and adhesiolysis. Measurements and Main Results Forty-seven procedures were completed successfully by hysteroscopy; partial myomectomies were performed in three women for large or deeply embedded leiomyomas. The only complication was one case of fluid overload. Median operating time was 20.0 minutes (range 5.0–60.0 min) and median postoperative hospital stay was zero days (range 0–2 days). Eight patients (16%) subsequently underwent hysterectomy, mostly for uterine malignancy or premalignancy. In two cases, the operative specimen included malignant elements that were not evident on preoperative endometrial biopsy. During mean follow-up of 33.1 months (range 6–72 mo), 95.2% of women without hysterectomy were free of symptoms. Conclusion Hysteroscopic surgery is an effective and safe option for postmenopausal women with intrauterine lesions. It allows the correct diagnosis to be made, reduces the need for major and unnecessary surgery, and is therapeutic in most patients.

Cytohistologic Correlation Between AGUS and Biopsy-Detected Lesions in Postmenopausal Women

OBJECTIVE: To evaluate histologic findings in patients aged 50 and older whose cervical smears revealed atypical glandular cells of undetermined significance (AGUS). STUDY DESIGN: Computerized records spanning a four-year period were retrospectively analyzed. Thirty patients over age 50 had cervical smears interpreted as AGUS and had follow-up biopsies within 12 months following the abnormal smear. The most important histologic diagnosis from the biopsy specimens was correlated with the subcategory of the cervical smear. RESULTS: Five smears interpreted as AGUS, favor reactive, revealed abnormal histology in four cases: three endometrial polyps and one squamous carcinoma. Two smears interpreted as AGUS, favor dysplasia, revealed squamous intraepithelial lesions on biopsy in both cases. Seventeen smears interpreted as AGUS, favor endometrial cells, revealed abnormal histology in 13 cases: 1 endocervical polyp, 6 endometrial polyps, 3 endometrial hyperplasias and 3 adenomyosis. Six patients with smears interpreted as AGUS, unclassifiable, revealed abnormal histology in five cases: two endocervical polyps, one endometrial polyp, one endometrial carcinoma and one ovarian carcinoma. CONCLUSION: The presence of AGUS in cervical smears from women over 50 was highly predictive of abnormal lesions detected by histologic examination. Although three cancers were detected on histologic follow-up, the most common lesions detected were endometrial polyps.

Cytohistologic Correlation Between AGUS and Biopsy-Detected Lesions in Postmenopausal Women

To evaluate histologic findings in patients aged 50 and older whose cervical smears revealed atypical glandular cells of undetermined significance (AGUS). Computerized records spanning a four-year period were retrospectively analyzed. Thirty patients over age 50 had cervical smears interpreted as AGUS and had follow-up biopsies within 12 months following the abnormal smear. The most important histologic diagnosis from the biopsy specimens was correlated with the subcategory of the cervical smear. Five smears interpreted as AGUS, favor reactive, revealed abnormal histology in four cases: three endometrial polyps and one squamous carcinoma. Two smears interpreted as AGUS, favor dysplasia, revealed squamous intraepithelial lesions on biopsy in both cases. Seventeen smears interpreted as AGUS, favor endometrial cells, revealed abnormal histology in 13 cases: 1 endocervical polyp, 6 endometrial polyps, 3 endometrial hyperplasias and 3 adenomyosis. Six patients with smears interpreted as AGUS, unclassifiable, revealed abnormal histology in five cases: two endocervical polyps, one endometrial polyp, one endometrial carcinoma and one ovarian carcinoma. The presence of AGUS in cervical smears from women over 50 was highly predictive of abnormal lesions detected by histologic examination. Although three cancers were detected on histologic follow-up, the most common lesions detected were endometrial polyps.

Detection of Human Papillomavirus in Warty Carcinoma of the Uterine Cervix: Comparison of Immunohistochemistry,In Situ Hybridization and In Situ Polymerase Chain Reaction Methods

Warty carcinoma of the uterine cervix is a very rare specific variant of invasive squamous cell carcinoma, usually described as a hybrid feature of condyloma with invasive squamous cell carcinoma. Besides having the koilocytes and maturation of squamous epithelium, there is unequivocal stromal invasion. The feathery surface seems to be characteristic of warty carcinoma, differentiating it from condylomata acuminata or verrucous carcinoma. Using in situ polymerase chain reaction (IS-PCR) and in situ hybridization (ISH) as well as an immunohistochemical technique (IHC), we determined the amplification and expression of several human papilloma virus (HPV) types (6, 11, 33, 16 and 18) in nine warty carcinomas of the uterine cervix. We found amplified HPV predominantly in the nuclei of the feathery surface in all cases only when IS-PCR was applied, while it was detected only in five (55.6%) or six cases (66.7%) by conventional IHC or ISH, respectively. We found multiple types in the same lesion in six cases (66.7%) by IS-PCR, in comparison with ISH which detected a lower incidence (22.2%). This finding of coinfection is more consistent with that seen in low-grade squamous intraepithelial lesions (LSILs) of the uterine cervix than in high SIL. It is important to be aware of these distinct lesions in postmenopausal women with their characteristic feathery and thin surface, as well as a hybrid form of exophytic condyloma and stromal invasion, and frequent coinfection of multiple different HPVs as a type of LSILs.

P336 Hysteroscopic resection of benign intrauterine lesions in post-menopausal women

P336 Hysteroscopic resection of benign intrauterine lesions in post-menopausal women

Transvaginal ultrasonography of pelvic masses: Evaluation of B-mode technique and Doppler ultrasonography

OBJECTIVE: The purpose of this study was to evaluate pelvic masses by B-mode and Doppler ultrasonography for identification of ovarian malignancies. STUDY DESIGN: A previously described scoring system for pelvic masses was applied in 310 women, and the lesions were classified into four groups according to the ultrasonographic structure. Pulsatility index values of vessels within the tumor and the contralateral ovary and of both uterine arteries were determined. RESULTS: A total of 259 masses were benign and 51 were malignant. The scoring system and classification into morphologic groups revealed similar sensitivity, specificity, and positive and negative predictive values. Intratumoral and opposite ovarian blood flow and ipsilateral and contralateral uterine blood flow did not differ in benign and malignant masses except in cases of benign lesions in postmenopausal women. In malignant lesions a lower pulsatility index (0.94 ± 0.4) was measured than in benign lesions (1.06 ± 0.4, p < 0.05), although a remarkable overlap was found. CONCLUSION: The results suggest that further refinement of assessment of pelvic masses with Doppler ultrasonography is needed. (Am J Obstet Gynecol 1996;175:97-104.)

Die Wertigkeit verschiedener Parameter zur sonographischen Beurteilung des postmenopausalen Endometriums hinsichtlich benigner und maligner Neoplasien

In 101 postmenopausal patients, ultrasonic findings of endometrium were compared with the histopathology. Object of this study was the evaluation of several sonomorphological parameters for detection of benign and malignant endometrial neoplasms in order to derive criteria for an ultrasonic screening of these lesions in postmenopausal women. The maximum endometrial sonographic thickness was found to be the main parameter, yet was itself too insensitive and unspecific as a single parameter. Homogeneity, echogeneity and presence of a median echo, represent important additional parameters. The sonographic longitudinal diameter of the uterus cannot serve as a screening parameter similar to the amplified ultrasonic intensity through the endometrium and the low resonant subendometrial zone, but defines a collective risk referring to endometrial neoplasms and hyperplasias. The criteria derived from this are very sensitive and specific in our sample. That is the reason, why we think, that ultrasonic examination of the endometrium is an important step in early diagnosis of endometrial carcinoma.