Malignant Gynecologic Conditions Research Articles

Microscopic Heterotopic Extraovarian Sex Cord-Stromal Proliferations: Expanding the Histologic Spectrum.

Microscopic, heterotopic extraovarian sex cord-stromal proliferations have only recently been reported in the literature. We describe the largest series to date, of 30 cases of microscopic, incidentally detected, heterotopic extraovarian sex cord-stromal proliferation, in women aged 25-79 yr who had undergone surgery for a range of benign and malignant gynecologic conditions. In 14 patients the foci of proliferation comprised ovarian cortical stroma, in some cases with an ovarian fibroma-like appearance. Ten cases of adenofibroma and cystadenofibroma were also identified, including 1 Brenner adenofibroma; 2 cases comprised both ovarian cortical stroma and serous cystadenofibroma; 4 cases showed sex cord proliferation resembling microscopic adult granulosa cell tumors. Immunohistochemistry, where possible, confirmed the sex cord nature of the heterotopic proliferations. The foci of proliferation were <1-7 mm, and most were at the fimbrial end of the fallopian tube. These proliferations are likely to be encountered with increasing frequency as we sample the adnexa more extensively. Previous reports postulated that the proliferations probably represent embryonic rests caused by anomalous migration but we suggest that incorporation of exposed ovarian parenchymal tissue into the fimbrial stroma at the time of ovulation may be another possible cause.

Readmission After Gynecologic Surgery

To compare 30-day postsurgical readmission rates and associated risk factors for readmission among women undergoing gynecologic surgery for benign and malignant conditions. In a retrospective cohort study, we identified patients after surgery for benign and malignant gynecologic conditions in the National Surgical Quality Improvement Program database between January 1, 2011, and December 31, 2012. Data collected included surgical factors, perioperative characteristics, surgical complications, and 30-day readmissions. The primary study outcome was readmission rates after gynecologic surgery for benign and oncologic conditions. Secondary study outcomes were risk factors associated with readmission among gynecologic surgeries performed for benign and oncologic conditions. Approximately 3% (1,444/46,718) compared with 8.2% (623/7,641) of patients who underwent gynecologic surgery for benign and malignant indications, respectively, were readmitted (P<.01). Compared with patients with benign surgical indications, those with uterine cancer (readmission rate 6.6%; odds ratio [OR] 2.21, 95% CI 1.95-2.51), ovarian cancer (readmission rate 10.9%; OR 3.82, 95% CI 3.29-4.45), and cervical cancer (readmission rate 10.1%; OR 3.51, 95% CI 2.71-4.53) were more likely to be readmitted. In multivariable models, independent risk factors for readmission for gynecologic cancer surgery included worse preoperative conditions (OR 1.49, 95% CI 1.17-1.90) and major complications (OR 17.84, 95% CI 14.19-22.43). In comparison, independent risk factors for readmission after surgery for benign indications included comorbid conditions (OR 1.36, 95% CI 1.18-1.57), operative time (15-59 minutes: referent; 60 minutes or greater: 1.37, 95% CI 1.14-1.63) and major complications (OR 53.91, 95% CI 46.98-61.85). Among gynecologic surgeries, those performed for oncologic indications were associated with readmission rates 2.8 times that of surgeries performed for benign indications. In adjusted models, worse preoperative conditions and surgical complications remained independent risk factors associated with the higher rate of readmission among patients with gynecologic cancer.

Vaginal Cuff Dehiscence after Hysterectomy and One Minute Technique of Laparoscopic Vault Closure

Aims: This study was done to observe the rate of vaginal cuff dehiscence of one minute technique of laparoscopic vault closure in laparoscopic hysterectomy.Methods: It was a descriptive study performed in Birat Hospital among 1012 patients undergoing total laparoscopic hysterectomy for both benign and malignant gynaecological conditions between 2012 to 2013. Monopolar cautery was used for laparoscopic colpotomy and vault was closed by laparoscopic single running suture, that is, one-minute laparoscopic vault closure technique. Patients were followed up for vaginal cuff dehiscence and the dehiscence rate was compared with other techniques of laparoscopic vault closure in laparoscopic hysterectomy.Results: This study showed that the rate of vaginal cuff dehiscence after one minute technique of laparoscopic vault closure in laparoscopic hysterectomy was 1/1012 patients (0.09%) which was significantly less as compared to other techniques of laparoscopic vault closure in laparoscopic hysterectomy quoted in the literature.Conclusions: One minute technique of laparoscopic vault closure after colpotomy with monopolar cautery using single running suture has encouraging results. It is a noble technique of laparoscopic vault closure with excellent support. It can be practiced in low resource setting also.

Lesbian and bisexual women's gynaecological conditions: a systematic review and exploratory meta-analysis.

BackgroundLittle is known about the gynaecological health of lesbian and bisexual (LB) women.ObjectivesTo examine differences in incidence and/or prevalence of gynaecological conditions in LB compared with heterosexual women.Search strategyThe systematic review protocol was prospectively registered (PROSPERO‐CRD42015027091) and searches conducted in seven databases.Selection criteriaComparative studies published 2000–2015, reporting any benign (non‐infectious) and/or malignant gynaecological conditions with no language or setting restrictions.Data collection and analysisInclusions, data extraction and quality assessment were conducted in duplicate. Meta‐analyses of condition prevalence rates were conducted where ≥3 studies reported results.Main resultsFrom 567 records, 47 full papers were examined and 11 studies of mixed designs included. No studies directly addressing the question were found. Two chronic pelvic pain studies reported higher rates in bisexual compared with heterosexual women (38.5 versus 28.2% and 18.6 versus 6.4%). Meta‐analyses showed no statistically significant differences in polycystic ovarian syndrome, endometriosis and fibroids. There was a higher rate of cervical cancer in bisexual than heterosexual women [odds ratio (OR) = 1.94; 95% CI 1.46–2.59] but no difference overall (OR = 0.76; 95% CI 0.15–3.92). There was a lower rate of uterine cancer in lesbian than heterosexual women (OR = 0.28; 95% CI 0.11–0.73) and overall (OR = 0.36; 95% CI 0.13–0.97), but no difference in bisexual women (OR = 0.43; 95% CI 0.06–3.07).ConclusionsMore bisexual women may experience chronic pelvic pain and cervical cancer than heterosexual women. There is no information on potential confounders. Better evidence is required, preferably monitoring sexual orientation in research using the existing validated measure and fully reporting results.Tweetable abstractLesbians have less uterine cancer than heterosexual women; bisexuals have more pelvic pain and cervical cancer.

Ultrasonography in Gynecology

Ultrasonography is the gold standard as a simple, safe, non-invasive, cost effective, reliable method in evaluation of gynecological diseases especially in infertility assessment and management. This unique new book “Ultrasonography in Gynecology” offers extensive coverage of technique of USG and comparison with other imaging technology and operative procedures. It highlights the importance of legal counseling and all benign and malignant gynecologic conditions with wonderful pictorial comparison of sonographic findings with actual pathologies. Intelligently selected topics in each section are comprehensive and cover all clinical aspects and different approaches in the ultrasonographic evaluation—including 3D ultrasonography, 3D sonohysterography, Doppler imaging, and pelvic floor imaging. The book is easy to read and the practical emphasis is reflected in the structure of the chapters. The fifth section of this book Ultrasonography in infertility is so detailed and that is why it is a must-read book for trainees, beginners, and also for practitioners in Infertility Gynecology and Radiology. “One Stop” fertility diagnosis and management is convenient and cost effective to patients. Every detail of sonologic assessment and management of an IVF cycle is written in the last fifteen chapters of this book. It explores the application of ultrasonography for determining ovarian reserves by 2D as well as 3D ultrasound, calculating ovarian volume using Virtual Organ Computer-aided Analysis (VOCAL) to obtain automated follicular measurement using a software program while monitoring follicular growth in oocyte retrieval and transabdominal as well as transvaginal embryo transfer. By describing ultrasound-guided fallopian tube catheterization, hysteroscopic myomectomy under ultrasound guidance, MRI-guided focused ultrasound, and percutaneous ultrasound-guided radiofrequency ablation, it emphasizes the therapeutic value of ultrasound in infertility. It introduces the concept of self-operated vaginal ultrasound as the future for monitoring follicular growth. There are certain chapters which are the highlight of this book like the chapter on Pelvic floor ultrasound which recommends the use of ultrasound as the method of choice for the assessment of pelvic organ prolapse most notably in the differential diagnosis of posterior compartment prolapse. The chapter is written in a very logical format where the functional assessments of the pelvic floor musculature, the imaging of anterior and posterior compartment, and diagnosis of their defects are made easy with the help of well-labeled high-resolution images to aid visual learning. The editorial team of two eminent editors Botros Rizk and Elizabeth Puscheck along with the world-renowned international contributors have combined their expertise and clinical experience to this outstanding book which is hugely referenced, comprehensive, and written step by step from the basic to most complicated case.

Vaginal hysterectomy for uterovaginal prolapse: what is the incidence of concurrent gynecological malignancy?

Vaginal hysterectomy (VH) is a commonly performed procedure for the operative treatment of uterovaginal prolapse (UVP). The reported incidence of unexpected gynecological cancer in cases of VH for UVP ranges between 0.3 and 0.8 %. Aim of the study is to assess the incidence of malignant and premalignant gynecological histopathological findings among women who underwent a VH for UVP and had a normal preoperative workup. The histopathology reports of women who underwent VH for the treatment of UVP were retrospectively assessed. All women had a history of normal cervical smear tests and a normal preoperative transvaginal scan. Patients with a history of a premalignant or malignant gynecological pathological condition and women with abnormal uterine bleeding were excluded. Overall, 14 out of 333 women who underwent VH (4.2 %) were found to have abnormal histopathological findings of the uterus. Among them, there were 9 cases of endometrial hyperplasia of any type (2.7 %), 1 case of cervical cancer (0.3 %), 1 case of cervical intraepithelial neoplasia (CIN) III (0.3 %), and 3 cases of CINI (0.9 %). No cases of endometrial cancer were detected. Among women who underwent salpingo-oophorectomy (n = 86) three simple serous cysts (3.5 %) were found, with no cases of ovarian cancer. The incidence of unexpected premalignant or malignant gynecological pathological conditions among asymptomatic women who underwent VH, with a history of normal cervical smear tests and normal preoperative TVS, was low but not negligible. This information should be included in the preoperative counseling of women planning to undergo surgery for UVP.

Gynecologic robotic laparoendoscopic single-site surgery: prospective analysis of feasibility, safety, and technique

Multiple reports suggest that laparoendoscopic single-site surgery is technically feasible, safe, and effective in treating a variety of gynecological disease processes. The study purpose was to assess the feasibility and safety of a novel robotic single-site platform (R-LESS) for the surgical treatment of benign and malignant gynecological conditions. A single-institution, prospective analysis of 40 women treated with R-LESS on the gynecology and gynecological oncology services from June 2013 through March 2014. Women undergoing hysterectomy or adnexal surgery for either a benign or malignant gynecological condition were offered robotic single-site surgery during the study period of June 1, 2013, through April 1, 2014. Patients underwent surgery through a single 2.5-3.0 cm umbilical incision with a multichannel port and utilizing the da Vinci robotic single-site platform. Two surgeons with extensive laparoendoscopic single-site experience participated. Forty patients had R-LESS performed. Procedures included total laparoscopic hysterectomy, laparoscopic supracervical hysterectomy, salpingo-oophorectomy, ovarian cystectomy, excision of endometriosis, and a combined case of total laparoscopic hysterectomy and cholecystectomy. Median age and body mass index were 42 years and 28.2 kg/m(2), respectively. Median operating time, defined as the interval between incision start to closure, was 134 minutes (range, 84-311 minutes). Median vaginal cuff closure was 21 minutes (range, 9-77 minutes). Overall, there appeared to be a linear relationship between vaginal cuff closure time, console time, and operating time with number of cases performed. Procedures were successfully performed via R-LESS in 92.5% of cases; 2 cases required 1 additional port and there was 1 conversion to traditional multiport robotic surgery. There was 1 major postoperative complication (2.5%) and 1 readmission (2.5%). After a median follow-up period of 230 days (range, 61-256), there have been no postoperative hernias diagnosed. We present one of the first series of robotic laparoendoscopic single-site surgery for the treatment of various gynecological conditions. When performed by experienced minimally invasive surgeons, R-LESS is feasible and safe in select patients. Further studies are needed to better define the ideal gynecological procedures to perform using robotic single-site surgery and to assess the benefits and costs of R-LESS compared with multiport robotic and conventional laparoscopic approaches.

Milestones to Optimal Adoption of Robotic Technology in Gynecology

Minimally invasive technology, especially robotics, is gaining widespread acceptance and is becoming the standard approach for the treatment of both benign and malignant gynecologic conditions in centers across the country. However, there are challenges on a systems-based level to the implementation of a robotic program. Prominent among the concerns is the length of the learning curve, team-building, quality of life, and financial and various organizational challenges. The purpose of this review article is to address those challenges as milestones on the progress to a successful robotics program and explore possible solutions.

The role of interventional radiology in management of benign and malignant gynecologic diseases.

This article focuses on the role of interventional radiology in the therapeutic and diagnostic management of benign and malignant gynecologic conditions. The subspecialty of interventional radiology utilizes minimally invasive advanced image-guided percutaneous techniques in gynecology that include central venous catheter placement, fluid aspiration, drainage catheter placement, tissue biopsy, inferior vena cava filter placement, and pelvic arterial embolization. Central venous catheters, such as ports, peripherally inserted central catheters, and tunneled catheters, are placed for intermediate to long-term intravenous chemotherapy or total parental nutrition or antibiotics. Patients with refractory malignant ascites or pleural effusion from seeding of advanced gynecologic cancers may benefit by percutaneous aspiration of fluid collections or placement of drainage catheters. Postoperative fluid collections including abscess, seroma, or lymphocele are managed by percutaneous drainage catheter insertion. Pelvic, peritoneal, or retroperitoneal masses can be sampled by image-guided percutaneous biopsy or aspiration of fluid to determine a pathologic diagnosis. Certain patients are at risk for deep venous thrombosis with pulmonary embolism and may benefit from an inferior vena cava filter. Patients with uncontrolled postoperative or postpartum bleeding can be effectively managed with emergent transarterial pelvic embolization. Each of the aforementioned interventions with indications, expected benefits, and complications is described including a published literature.

POSTCOITAL RUPTURE OF VAGINAL VAULT AND PROLAPSE OF BOWEL FOLLOWING HYSTERECTOMY- A CASE REPORT

Hysterectomy is one of the commonest major gynecological surgical procedure performed all over the world. It is performed either for benign or malignant gynecological conditions, through abdominal or vaginal route. Hemorrhage,accidental injury to the adjacent organs, wound dehiscence and sepsis are some of the major complications associated with this procedure . We report a rare case of a young woman, who presented with post coital rupture of vaginal vault and prolapse of bowel loop, three months following abdominal hysterectomy for benign condition. Her condition was stable at admission. A rent in the vaginal vault, measuring 4 to 5 centimeters was sutured by vaginal route, in two layers under general anesthesia, after reposition of bowel. She had uneventful postoperative period. She was followed up for a period of one year following repair, for re occurrence of this rare complication. Incidence, causative factors and preventive measures for this condition are discussed in the report.

Late onset hemorrhage caused by ruptured uterine artery pseudoaneurysm after robotic-assisted total hysterectomy

Robotic surgery has been used increasingly for the management of benign or malignant gynecologic conditions. Vaginal hemorrhage after hysterectomy is fairly uncommon. Uterine artery pseudoaneurysm is a rare phenomenon causing late onset hemorrhage that could be potentially life-threatening. This case describes the management of vaginal bleeding due to ruptured uterine artery pseudoaneurysm after robotic-assisted total hysterectomy. This is the first known reported case of a ruptured uterine artery pseudoaneurysm after a robotic-assisted hysterectomy.

Laparoendoscopic single-site surgery in gynaecology: A new frontier in minimally invasive surgery.

REVIEW OBJECTIVE:To review the recent developments and published literature on laparoendoscopic single-site (LESS) surgery in gynaecology.RECENT FINDINGS:Minimally invasive surgery has become a standard of care for the treatment of many benign and malignant gynaecological conditions. Recent advances in conventional laparoscopy and robotic-assisted surgery have favorably impacted the entire spectrum of gynaecological surgery. With the goal of improving morbidity and cosmesis, continued efforts towards refinement of laparoscopic techniques have lead to minimization of size and number of ports required for these procedures. LESS surgery is a recently proposed surgical term used to describe various techniques that aim at performing laparoscopic surgery through a single, small-skin incision concealed within the umbilicus. In the last 5 years, there has been a surge in the developments in surgical technology and techniques for LESS surgery, which have resulted in a significant increase in utilisation of LESS across many surgical subspecialties. Recently published outcomes data demonstrate feasibility, safety and reproducibility for LESS in gynaecology. The contemporary LESS literature, extent of gynaecological procedures utilising these techniques and limitations of current technology will be reviewed in this manuscript.CONCLUSIONS:LESS surgery represents the newest frontier in minimally invasive surgery. Comparative data and prospective trials are necessary in order to determine the clinical impact of LESS in treatment of gynaecological conditions.

Laparoendoscopic single-site surgery in gynecology

To review the contemporary literature on laparoendoscopic single-site surgery (LESS) advances in gynecology. Minimally invasive surgery has become a standard of care for the treatment of many benign and malignant gynecologic conditions. Both conventional laparoscopy and robotic assisted surgery have impacted the entire spectrum of gynecologic surgery. Ongoing efforts to improve upon the morbidity and cosmetic sequelae of laparoscopic surgery have led to minimization of size and number of ports required for these procedures. LESS surgery is a recently coined surgical term used to describe various techniques that aim at performing laparoscopic surgery through a single, small skin incision concealed within the umbilicus.LESS surgery is not a new endeavor but recent developments in surgical technology and techniques have resulted in an exponential increase in utilization of LESS across many surgical subspecialties. Recently published outcome data demonstrate feasibility, safety and reproducibility for LESS in gynecology. The contemporary LESS literature, gamut of gynecologic procedures and limitations of current technology will be reviewed in this article. LESS represents the latest innovation in minimally invasive surgery but comparative data and prospective trials are required to determine the clinical impact of LESS in treatment of gynecologic conditions.

Complications of laparoscopic surgery

Laparoscopic surgery has become the mainstay of surgical management of many benign and some malignant gynaecological conditions. Safety is of the highest priority in any surgical procedure and the next generation of laparoscopic surgeons require both practical and theoretical training in order to maximise surgical success and minimise complications. Training has become more structured and credentialed, with input from the Royal College of Obstetricians and Gynaecologists and other bodies to devise comprehensive educational objectives and guidance. These case-based scenarios illustrate some of the common problems encountered in laparoscopic surgery and highlight ‘best practice’ in the speciality.

Human Papillomavirus Infection in Malignant and Benign Gynaecological Conditions: A Study in Greek Women

HPV infection is by far the most frequent sexually transmitted disease. Our aim in this prospective nonrandomized study was to investigate the frequency with which different subtypes of the human papillomavirus (HPV) are found in gynaecological malignant and benign conditions and to compare the rate of infection between them. Detailed data of 195 women were selected and divided into three groups. The first group consisted of specimens from 68 women with cervical cancer. The second group consisted of specimens from 43 women with endometrial and ovarian cancer. The third group consisted of 84 specimens from women who were operated on for benign gynaecological diseases. Seven oncogenic types of HPV (6, 11 [low-risk subtypes] 16, 18, 31, 33, and 51 [high-risk subtypes]) were investigated by using the in situ hybridization technique. The HPV detection rate was higher in the cervical cancer group (74.8%), compared with the second (27.9%) and third (45.2%) groups. The most common HPV subtypes in the first group were 16 and 18. The most common subtypes in the second group were the 31, 33, and 51, and in the third group the 6 and 11 subtypes. Women developed cervical cancer at a younger age than endometrial or ovarian cancer. Smoking and exposure to multiple sexual partners appeared related to the development of cervical cancer. The use of contraceptive pill, dietary habits, and diabetes did not seem to increase the risk of HPV infection in this population. As it is common in other populations, in this selected population of Greek women we were able to confirm that in women with cervical cancer the most common HPV subtypes are 16 and 18. Education of adolescents on the epidemiological association of smoking and unprotected intercourse with cervical cancer will certainly help to reduce the rates of development of preinvasive and invasive cancer of the cervix in young women.

Applications of polymorphisms and pharmacogenomics in obstetrics and gynecology.

The number of reports investigating disease susceptibility based on the carriage of low-penetrance, high-frequency polymorphisms has steadily increased over the last years. Evidence based on meta-analyses of individual case-control studies is accumulating, defining specific individual variations in disease susceptibility. For example, genetic variations of the estradiol metabolism have been described as significant contributors to disease susceptibility with variations depending on ethnic background. In the field of obstetrics and gynecology, the genetic contribution of polymorphic markers to a series of disorders has been characterized. These disorders include recurrent pregnancy loss, pre-eclampsia, endometriosis, breast cancer, and hormone replacement therapy (HRT)-related complications such as thrombosis. Among other genetic markers, thrombophilic genetic variants, such as the Factor V Leiden and prothrombin G20210A polymorphisms, as well as genetic variants of cytochrome P450 (CYP) enzymes, for example, CYP19 and CYP1B1, have been established as genetic risk markers and disease modifiers of recurrent and sporadic pregnancy loss and HRT-independent and -dependent breast cancer, respectively. In addition, meta-analyses of data in the literature established the TGFBR1*6A, GSTP I105V, and TP53 R72P polymorphisms, as well as the GSTM1 gene deletion as low-penetrance genetic risk factors of sporadic breast cancer. With respect to genetic modulation of therapeutic effects, beneficial effects of estrogen replacement therapy and HRT are modulated by the carriage of single nucleotide polymorphisms, for example, osteoprotection and blood lipid changes by the estrogen receptor-alpha (ER-a) PvuII polymorphism. Polymorphisms of the catechol-O-methyltransferase (COMT), ER-alpha, IL-1 receptor antagonist, and Factor V genes have been demonstrated to modulate the timing of natural menopause. Lastly, a strong genetic contribution of polymorphisms to the development and the clinical course of endometriosis has been established with data pointing to polymorphisms of the COMT, GST, NAT-2, and ER-alpha genes as susceptibility markers. In summary, the available evidence points to a number of polymorphisms of a wide variety of genes as strong hereditary determinants of the susceptibility to benign and malignant gynecologic and obstetric conditions.

Uterine and ovarian aryl hydrocarbon receptor (AHR) and aryl hydrocarbon receptor nuclear translocator (ARNT) mRNA expression in benign and malignant gynaecological conditions.

The transcriptional regulators aryl hydrocarbon receptor (AHR) and aryl hydrocarbon receptor nuclear translocator (ARNT) modulate the transcription of genes involved in cellular differentiation and proliferation. In this study, we investigated the expression of these transcriptional regulators in the female reproductive tract. AHR and ARNT mRNA transcripts were readily detected by a ribonuclease protection assay in all reproductive tissues examined. The expression of these factors in the endometrium and myometrium did not vary during the menstrual cycle, and was not different in pre- versus post-menopausal women. However, post-menopausal women on continuous hormone replacement therapy had greater expression of AHR but not of ARNT in the endometrium and myometrium when compared with women not taking hormones. Leiomyomas expressed significantly less AHR and ARNT mRNA compared with normal myometrium. The ovaries expressed both AHR and ARNT mRNA, and expression was unaffected by age. Endometriotic ovarian cysts expressed more AHR but not more ARNT mRNA compared with healthy ovarian tissue. However, there were no changes in the expression of AHR or ARNT mRNA in ovarian cancer. In conclusion, the female reproductive tract expresses mRNA for the transcription factors AHR and ARNT, and changes in their expression at select target sites in specific pathological conditions such as endometriosis and uterine leiomyomas suggest a potential role for these factors in the pathogenesis of these conditions.

Human uterine and ovarian expression of growth hormone–releasing hormone messenger RNA in benign and malignant gynecologic conditions

Objective: To determine uterine and ovarian expression of growth hormone–releasing hormone (GHRH) messenger RNA (mRNA) in benign and pathologic gynecologic states. Design: Case–control study. Setting: Tertiary-care academic department. Patient(s): Women undergoing hysterectomy for benign or malignant gynecologic conditions. Intervention(s): Ovarian and uterine tissue was obtained for measurement of GHRH mRNA levels by reverse transcription polymerase chain reaction. Main Outcome Measure(s): Levels of GHRH mRNA in normal tissues were compared with those in tissues with pathologic abnormalities. Result(s): Growth hormone–releasing hormone mRNA was detectable in the ovary, endometrium, myometrium, fallopian tubes, and placenta. Levels of GHRH mRNA were significantly increased in secretory endometrium compared with proliferative endometrium. Hormone replacement therapy did not affect endometrial GHRH mRNA levels. Uterine myomas expressed similar levels of GHRH mRNA as normal myometrium. No changes in endometrial GHRH mRNA were detected in endometrial cancers compared with normal endometrium or myometrium obtained from the same patient; however, these levels were higher than those in noncancerous myometrial tissue obtained from other patients with benign gynecologic disease. In ovarian tissue, no differences in GHRH mRNA were found between premenopausal and postmenopausal women. Ovarian GHRH mRNA was significantly decreased in endometriotic cysts, whereas significantly greater GHRH expression occurred in ovarian cancer compared with normal ovarian tissue. Conclusion(s): Endometrial and ovarian GHRH gene transcription are altered in selective physiologic and pathologic states and are influenced by such factors as ovarian hormones. Because it is a growth factor, GHRH may promote endometrial proliferation and may be involved in the pathogenesis of ovarian and endometrial cancer and endometriosis.

Deep venous thrombosis: prophylaxis in gynecology.

Thromboembolism remains a serious concern for women undergoing surgery for benign and malignant gynecologic conditions. Attempts at perioperative thromboprophylaxis have probably reduced the incidence of DVT considerably. Both heparin and mechanical devices offer effective and safe treatment. However, even though unfractionated heparin and LMWH compounds are easy to administer and are well tolerated by patients, mechanical compression devices avoid the bleeding complications that may be encountered with anticoagulation therapy. Individual patient risks and circumstances should be taken into consideration when choosing which therapy to use (Table 1). Those patients at greatest risk may benefit from aggressive combination therapy.

Serum levels of tumour associated glycoprotein (TAG 72) in patients with gynaecological malignancies

Serum levels of TAG 72 were measured in 726 serum samples from patients with benign and malignant gynaecological conditions in order to evaluate the clinical usefulness of TAG 72 alone or in combination with other tumour markers. Sixty-six per cent of patients with ovarian cancer showed abnormal concentrations of TAG 72 antigen. A good correlation was also found between serial TAG 72 values and the clinical course of disease during chemotherapy and follow-up. In cervical and endometrial cancer abnormal TAG 72 values occurred in 23% and 14% of cases, while none of the patients with breast cancer had abnormal TAG 72 levels. Among patients with benign disease only one out of 12 patients (8%) with benign ovarian tumours and one of 15 patients with uterine fibromyomatosis (7%) showed high TAG 72 serum levels. However, the determination of TAG 72 did not increase the sensitivity of CA 125 and squamous cell carcinoma antigen (SCC), in ovarian and cervical cancer, respectively. The systemic administration of recombinant interferon alpha-2b to 15 patients with ovarian cancer and different basal levels of TAG 72 did not increase serum levels of the antigen.