Routine Gynecologic Examination Research Articles

ACOG Committee Opinion No. 768: Genetic Syndromes and Gynecologic Implications in Adolescents.

As adolescents with a genetic syndrome transition to adult medical care, they may be referred to obstetrician-gynecologists for routine preventive or contraceptive services, screening, or counseling for sexually transmitted infection, or for menstrual management. Although some genetic syndromes have no physical or intellectual impairment, others have significant ones; therefore, education and gynecologic care should be based on a patient's intellectual and physical capabilities. It is important to remember that adolescents with or without a genetic syndrome are sexual beings. Thus, education about reproductive health, expectations for fertility, and healthy relationships is important when treating patients with genetic syndromes. Obstetrician-gynecologists must respect patient autonomy and avoid coercion in any discussions with a patient, including decisions about contraceptive choices, sexual activity, and pregnancy planning. Most patients who have genetic syndromes and are neurotypical can tolerate routine gynecologic examinations in the office, when necessary. A patient should not be forced to have an examination or be restrained for an examination. Obstetric care of adolescents and women with genetic syndromes can pose challenges and often requires a multidisciplinary approach from the time pregnancy is contemplated through the postpartum period. When caring for an adolescent with a genetic syndrome, individual patient and guardian concerns, medical diagnoses associated with the specific genetic syndromes, and medication interactions should be considered. Obstetrician-gynecologists are encouraged to seek out additional resources and expertise when caring for adolescents with underlying genetic syndromes.

ACOG Committee Opinion No. 768 Summary: Genetic Syndromes and Gynecologic Implications in Adolescents.

As adolescents with a genetic syndrome transition to adult medical care, they may be referred to obstetrician-gynecologists for routine preventive or contraceptive services, screening, or counseling for sexually transmitted infection, or for menstrual management. Although some genetic syndromes have no physical or intellectual impairment, others have significant ones; therefore, education and gynecologic care should be based on a patient's intellectual and physical capabilities. It is important to remember that adolescents with or without a genetic syndrome are sexual beings. Thus, education about reproductive health, expectations for fertility, and healthy relationships is important when treating patients with genetic syndromes. Obstetrician-gynecologists must respect patient autonomy and avoid coercion in any discussions with a patient, including decisions about contraceptive choices, sexual activity, and pregnancy planning. Most patients who have genetic syndromes and are neurotypical can tolerate routine gynecologic examinations in the office, when necessary. A patient should not be forced to have an examination or be restrained for an examination. Obstetric care of adolescents and women with genetic syndromes can pose challenges and often requires a multidisciplinary approach from the time pregnancy is contemplated through the postpartum period. When caring for an adolescent with a genetic syndrome, individual patient and guardian concerns, medical diagnoses associated with the specific genetic syndromes, and medication interactions should be considered. Obstetrician-gynecologists are encouraged to seek out additional resources and expertise when caring for adolescents with underlying genetic syndromes.

THE ENDOMETRIUM IN PATIENTS WITH METABOLIC SYNDROME

Introduction: Metabolic disorders can increase the risk of endometrial diseases and endometrial cancer. Patients with metabolic syndrome are at risk for endometrial pathologies. Advising routine gynecological examination even to the patients with metabolic syndrome having no gynecological complaints may be helpful in early diagnosis.Materials and Method: 120 patients diagnosed with metabolic syndrome in the Internal Diseases Outpatient Clinic were examined for endometrial diseases in the Gynecology Clinic. Data were analyzed using SPSS 16 statistical software, and Chi-square test was performed. p<0.05 was considered as statistically significant. Results: 36 patients had undergone a diagnostic curettage. There was no endometrial cancer in any patient. The rate of endometrial hyperplasia without atypia was found significantly increased in the patient group with abnormal uterine bleeding when compared to the patient group with menopause having postmenopausal bleeding and an increased endometrial thickness (p=0.001). Conclusion: Endometrial pathology was diagnosed in 15% of the patients with metabolic syndrome. It was concluded that the question of whether routine gynecological examination of metabolic syndrome patients is required in clinical practice could be answered by further studies including larger patient groups.

Laparoscopic Resection of Retroperitoneal Presacral Schwannoma: A Case Report

AbstractRetroperitoneal presacral schwannomas are uncommon and are usually diagnosed accidentally. We present here the case of a 23-year-old woman diagnosed with an expansive pelvic lesion during a routine gynecological examination. The precise location of the tumor, as well as its relation to adjacent structures, was determined through magnetic resonance imaging (MRI). The patient underwent laparoscopic lesion resection and the diagnosis was confirmed by immunohistochemistry. An MRI performed 2 months after surgery confirmed complete lesion resection.

Effects of Ovarian Pathologies and Uterine Inflammations on Adenomyosis in Bitches

Background: Adenomyosis is a non-neoplastic condition, characterized by the presence of endometrial glands or cells in the myometrium. Adenomyosis is defined by post-operative microscopic examination of uterine tissue and a rarely seen infertility problem in bitches. The process of transformation of healthy uterus into adenomiotic uterus is still a mystery. We aimed to determine role of ovarian pathologies and uterine inflammations on pathogenesis of uterine adenomyosis in bitches.Cases: After ovariohysterectomy, the uteri were fixed and processed by routine methods. Sections were stained with HematoxylinEosin, Masson’s trichrome and Periodic-Acid-Schiff and immunohistochemically; with p53 protein, Ki-67, α-smooth-muscle actin, cytokeratin-CK 8, 14, 19 antibodies, estrogen and progesterone receptors by Avidin-Biotin-Complex-Peroxidase method. Histopathologically, 7 of the collected tissue samples (n = 38) were diagnosed as adenomyosis. There were unilateral (n = 6) or bilateral (n = 1) adenomyosis in which endometrial glands had broken through the myometrium, and in some cases there were fibromyoma, inflammation, papillary hyperplasia and cysts in glands. Vaginal fibroma, fibromyoma and benign mix tumor (n = 1), simple carcinoma (n = 3), carcinosarcoma (n = 3) in mammary gland were determinated histopathologically. In addition to these findings, follicular cysts (n = 4), parovarian cyst (n = 1), adenocarcinoma and Rete ovarii adenoma were diagnosed in some ovaries. The CK 19 was scored at endometrial glands (n = 2) positively and also, muscle fibers were stained positively with α-smooth-muscle actin antibody (n = 7).Discussion: Adenomyosis is an infertility problem in adult dogs and is hard to detect with routine gynecological examinations. Adenomyosis can be seen unaccompanied by other gynecological problems such as endometritis or leiomyomas, while mammary tumors with adenomyosis have been previously reported in women and in only one case of a bitch. Little is known of the interrelationships between gross pathological and endocrine features of ovarian cysts in bitches. Due to the local hormonal imbalance, most of these ovarian tumors and cystic structures might be accompanied with uterine-vaginal and mammary gland pathologies, cystic endometrial hyperplasia-pyometra, adenomyosis, vaginal fibroma and mammary tumors. The hyperestrogenic metabolic state may promote both the invagination process and the overall spreading of adenomyosis into the myometrium. Adenomyosis is often associated with polyps, anovulation, hyperplasia without cytological atypia, and uterine leiomyoma which are produced by hyperestrogenic states. Prolactin appears to induce adenomyosis in mice and hyperprolactinemia may cause myometrial degeneration/weakness and subsequent endometrial invasion in the presence of ovarian steroids in women. Premature decline in progesterone, a problem ensues with prolactin release which can promote hyperprolactinemia or endogenous prolactin release. In addition to hormonal problems, uterine infections, immune factors and their products like cytokines and inflammatory mediators, oxidative stress and free radical metabolism also might have roles in the occurrence of adenomyosis. In the present study, four of seven adenomyotic uterine tissues had inflammation and 3 of 7 cases had pre-inflammatory changes. Changes in uterine tissues may increase cell infiltration and proliferation as well as the activity of immune cells which may promote development of adenomyosis in bitches. It is therefore possible that a defect in the p53 tumor suppressor gene may play an important role in the de novo neoplastic transformation of adenomyosis. In conclusion, adenomyosis can be observed bilaterally or unilaterally in dogs. Tissue damage under the influence of inflammation or hormonal disturbances might have a role in the occurrence of uterine adenomyosis.

Risk Factors of Vulvovaginal Candidiasis among Women of Reproductive Age in Xi'an: A Cross-Sectional Study.

Purpose. To explore risk factors of vulvovaginal candidiasis (VVC) among women of reproductive age in Xi'an district and then to offer reference for clinical prevention and treatment of VVC. Methods. Patients from the outpatient department of gynecology and obstetrics in the First Affiliated Hospital of Xi'an Jiaotong University from June 2016 to May 2017 were recruited strictly according to the inclusion and exclusion criteria. Participants diagnosed as simple VVC were assigned to the case group, while women who underwent routine gynecological examination and had normal vaginal microflora were assigned to the control group. Then we conducted a questionnaire survey of the two groups and used the logistic regression model to explore the related risk factors of VVC. Results. In the present study, ninety-seven cases were sample VVC patients and eighty-seven cases were healthy women. This cross-sectional study showed that occasionally or never drinking sweet drinks (odds ratio [OR] =0.161, 95% confidence interval [CI] =0.056-0.462, P=0.001), occasionally or never eating sweet foods (OR=0.158, 95%CI=0.054-0.460, P=0.001), and the use of condom (OR=0.265, 95%CI=0.243-0.526, P=0.001) were regarded as protective factors for VVC. In addition, sedentary life style (OR=7.876, 95%CI=1.818-34.109, P=0.006), frequently wearing tights (OR=6.613, 95%CI=1.369-27.751, P=0.018), frequent intravaginal douching (OR=3.493, 95%CI=1.379-8.847, P=0.008), having the first sexual encounter when under 20 years old (OR=2.364, 95%CI=1.181-7.758, P=0.006), the number of sexual partners being over two (OR=3.222, 95%CI=1.042-9.960, P=0.042), history of curettage (OR=3.471, 95%CI=1.317-9.148, P=0.012), history of vaginitis (OR=8.999, 95%CI=2.816-28.760, P<0.001), and not cleaning the vulva before or after sexual encounters (OR=13.684, 95%CI=2.843-65.874, P=0.001) were considered to be risk factors of VVC. Conclusion. In conclusion, risk factors of VVC are various, involving ages, hygienic habits, disease history, and other aspects.

Особливості тактики ведення пацієнток з ектопією шийки матки на тлі аеробного вагініту

Dysbiotic processes in the vagina, in particular aerobic vaginitis, are closely related to the local immune status violations, interfere the cervical epithelium physiological metaplasia, and also create favorable conditions for sexually transmitted infections accession, in particular the human papillomavirus. This complex of disorders is one of the determining factors for both the prolonged complicated course of cervical ectopy and its recurrence. The objective: was to optimize the treatment tactics in patients with cervical ectopy complicated by aerobic vaginitis. Materials and methods. It was carried out a comprehensive examination and treatment of 70 women of reproductive age (18–49 years) with cervical ectopy complicated by the aerobic vaginitis presence. All patients were questioned with a study of the reproductive anamnesis, bacterioscopic, cytological examination, simple and advanced colposcopy, pH-metry of vaginal environment, vaginal microbiota investigation. Depending on the treatment regimen, the patients were randomly divided into 2 groups. Group 1 (main group, n=35) – included patients treated according to the proposed scheme: on the first stage patients were prescribed vaginal suppositories containing dexpanthenol and chlorhexidine bigluconate – 1 suppository intravaginally twice a day and a complex multi-strain probiotic – 1 capsule twice a day for 2 weeks. On the second stage the patients were prescribed pessaries containing Triticum vulgare according to the scheme – 1 pessary intravaginally at night for 10 days a month (with the start of the use immediately after the next menstruation end) for 3 months. Group 2 (comparison group, n=35) – women who received treatment according to the current recommendations of the Ministry of Health of Ukraine. Group 3 (control group, n=30) included conditionally healthy women who have applied for routine preventive gynecological examination. Results. Clinical evaluation of the treatment first stage effectiveness showed a reduction in the complaints in patients of both study groups in 100% of cases. Both after the first and after the second stage of the proposed treatment scheme effective vaginal mucous membranes decontamination was revealed, conditionally pathogenic bacteria were not found in diagnostically significant titers, the number of leukocytes and the vaginal secret pH were normalized, and the average score on the Donders G. et al. scale showed no signs of aerobic vaginitis in the patients of the main group. The cytological norm of Pap-smear was reached by 91.43±7.43% of main group and 71.43±7.64% of the comparison group women (p&lt;0.05); and in case of evaluation using the Bethesda system (2001) – 97.14±2.82% of group 1 and 80.00±6.76% of group 2 patients (p&lt;0.05). After the second stage of treatment the average size of cervical ectopy significantly (p&lt;0.05) decreased in the patients of the main group compared to group 2 (by 32.68% compared to the average area before treatment). In 5 (14.29%) patients of the main group and 2 (5.71%) patients of the comparison group after the treatment cervical ectopy was not found during the control colposcopy. Сonclusion. In the part of women physiological cervical ectopy with the onset of sexual activity is complicated by the development of the vaginal dysbiotic processes and vaginitis, which create unfavorable conditions for the cervix epithelization and simultaneously increase the risk of sexually transmitted infections, in particular the human papillomavirus infection. Therapeutic measures aimed at normalizing the vaginal microbiota, recolonization of its lactoflora and the creation of favorable conditions for the physiological cervix epithelization are pathogenetically substantiated in this case. The proposed treatment scheme (complex application of vaginal antiseptic in combination with probiotic and on the next stage – of the reparative action drug) made it possible to reduce the complaints, eliminate the signs of aerobic vaginitis, normalize the vaginal microbiota state, reduce the cervical ectopy area, and in 14.29% cases – to achieve complete cervical epithelization. Key words: cervical ectopy, aerobic vaginitis, vaginal microbiota, vaginal suppositories, probiotic.

Role of transvaginal ultrasound in evaluation of ureteral involvement in deep infiltrating endometriosis.

To assess whether routine examination of the ureters on transvaginal sonography (TVS) can identify reliably potential silent ureteral involvement by endometriosis and should therefore be recommended in all patients with deep infiltrating endometriosis (DIE). This was a prospective study of 200 consecutive patients scheduled for surgery for DIE, evaluated between January 2012 and December 2014 at a tertiary endometriosis center at Fondazione Policlinico Universitario A. Gemelli, Rome, Italy. Routine TVS, abdominal ultrasound and gynecological examination were performed within 3 months before surgery, and patient history, signs and symptoms were recorded. Surgical and histological findings were compared with the preoperative ultrasonographic diagnosis. The main outcome of interest was the presence of ureteral dilatation or hydronephrosis caused by endometriosis. Of 200 patients with DIE, associated ureteral dilatation was diagnosed on TVS in 13 (6.5%) cases. Ureteral involvement was confirmed intraoperatively in all 13 cases by detection of ureteral dilatation caused by endometriotic tissue surrounding the ureter and causing stenosis. Of the 13 patients with ureteral dilatation, renal ultrasound detected six (46.2%) cases of hydronephrosis. Mean duration of visualization and study of dilated ureters was 5 min (range, 3-9 min). Ureteric diameter was ≥ 6 mm in all cases of ureteral dilatation, with a median diameter of 6.9 mm (range, 6-18 mm). Both ureters were identified on TVS in all 200 patients with DIE. Our study confirms a relatively high incidence of ureteral involvement in patients with DIE. TVS appears to be a reliable tool for the diagnosis of ureteral involvement and, additionally, it allows the detection of both the level and degree of obstruction. Our findings confirm that TVS examination is an accurate non-invasive diagnostic tool for the detection of ureteral involvement by endometriosis. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Identifying acute cervicitis in an era of less-frequent routine gynecologic examinations.

Acute inflammation of the uterine cervix can lead to serious problems such as pelvic inflammatory disease (PID), endometritis, and complications of pregnancy and childbirth. As intervals for routine gynecologic screening examinations lengthen, cervical infections, especially if asymptomatic, may be missed. Annual wellness examinations and other patient visits outside routine gynecologic cancer screening visits should include brief evaluation with sexual risk assessment and a gynecologic examination if indicated. If cervicitis persists after standard treatment for sexually transmitted infections (STIs), consider Mycoplasma genitalium. Clinicians should be sensitive to the fact that the unexpected presence of infection may cause distress.

KNOWLEDGE AND PRACTICE OF LADY HEALTH VISITORS REGARDING CERVICAL CANCER IN PUBLIC SECTOR MATERNAL AND CHILD HEALTH CENTERS IN LAHORE, PAKISTAN

Background: Globally cancer has grown as public health issue in developing and developed countries, especially swiftly spreading in low income areas because there are inadequate means for prevention, diagnosis and treatment. Methods: A hospital based cross-sectional research study was conducted from 11th December to 31st, 2016. There are total 52 centers in Lahore are working to provide the basic MCH health services in the community headed by Lady Heath Visitors. Hence; all Lady Heath Visitors were selected to participate in the study and were interviewed at their center by a trained research associate. Results: All respondents had basic knowledge about cervical cancer. 96.1% respondents were aware about speculums used in gynecology examination, and rests were not aware. 94.2% were familiar with indication of cervical cancer, 92.3% were aware about indication for doing a speculum examination and 82.7% told that they were able to diagnose cervical cancer in routine gynecological examination and same percentage reported that they had been taught how to do speculum examination. Conclusion: Majority of staff had insufficient knowledge regarding cervical cancer prevalence, treatment and prevention. Practices of the health providers were not up to minimum standard of any basic health services.

Clinical, laboratory and epidemiological aspects of HPV infection in a low-income population from South Bahia, Brazil.

The aim of this study was to determine the prevalence and risk factors for human papillomavirus (HPV) infection in the Southern region of the State of Bahia, evaluating the performance of alternative complementary methods for cervical lesion detection. Cervical samples from women who attended healthcare units were collected and diagnosed by visual inspection, cervical cytology and nested polymerase chain reaction (PCR). Moreover, hemi-nested PCR was performed to detect different HPV genotypes. The prevalence of HPV infection was 47·7%, with genotype 16 detected in most cases. Infection was associated with dyspareunia and bleeding (P < 0·001, odds ratio (OR) 5·6, 95% confidence interval (CI) 2·815-11·14) and hormonal contraceptive use (P = 0·007, OR 2·33, 95% CI 1·25-4·34). There was a positive correlation between positive PCR and positive visual inspection, cervical cytology and symptoms reported. Furthermore, visual inspection was twice as specific, and had a greater positive predictive value than cytology. We showed a high prevalence of HPV infection in Southern Bahia, with HPV 16 being the most common type, and visual inspection being most effective at detecting HPV lesions, corroborating the suggestion that it can be applied in routine gynecologic examinations for low-income populations.

Coercive Population Control and Asylum in the U.S.

In 1980, China implemented one of the most controversial population policies in modern times. China’s one-child policy shaped population politics for thirty-five years until its dissolution in 2015. During this time, many women were subjected to routine gynecological examinations, pregnancy testing, abortions, and sterilizations, which were often forced upon them by family planning officials. Some women fled China and sought refuge in the United States after having experienced a forced abortion or forced sterilization or feared that they would be subjected to a forced abortion or forced sterilization. This article focuses on how the U.S. government responded to China’s one-child policy through the passage of immigration laws and policies that made asylum a viable option for Chinese nationals who had been persecuted or feared persecution because of coercive population control policies. Based on observations of asylum hearings and interviews with immigration judges and immigration attorneys, this article uses feminist ethnographic methods to show how China’s one-child policy and U.S. asylum laws shape the gender politics of reproduction and migration.

Prevalence of human papillomavirus infection in women in the Autonomous Region of Inner Mongolia: A population-based study of a Chinese ethnic minority.

Human papillomavirus (HPV) is one of the most common sexually transmitted infectious pathogens. Persistent infection has been linked to cancer development, in particular to cervical cancer. This study aims to investigate the epidemiology of HPV infection in women in Inner Mongolia of China and to dissect the disparities between the Han and Mongolian ethnic populations. Cervical cell samples from 5655 women (17-68 years old) were collected during routine gynecologic examination. HPV infection was established using the HPV GenoArray kit detecting 21 HPV genotypes. The overall HPV prevalence was 14.5%. HPV16 (5.0%), HPV58 (2.2%), and HPV52 (1.5%) are the most common genotypes. Of the 21 genotypes investigated, high-risk HPV genotypes dominate in all age groups. HPV16 and HPV58 are the most common genotypes in patients with cervical lesions. HPV prevalence among Han women is 11.5% and the most common genotypes are HPV16 (4%) and HPV58 (2.1%). HPV prevalence is significantly higher in Mongolian women (32.6%), with the most common genotypes being HPV16 (10.7%), HPV31 (7.1%), and HPV52 (4.3%). The multiple infection rate in Mongolian participants (14.9%) is also higher than that of Han participants (4.3%). Urbanization, the number of sex partners, and PAP history appear as risk factors for HPV infection in Han, but not in Mongolian participants. HPV infection is highly prevalent in women in Inner Mongolia, China. HPV16 remains the most common genotype in this area. However, there are clear ethnical disparities in respect to the HPV epidemiology between the Han and Mongolian population.

Sexually Transmitted Infection Prevention With Long-Acting Reversible Contraception: Factors Associated With Dual Use.

Long-acting reversible contraception (LARC) is extremely effective in preventing pregnancy; however, it does not provide sexually transmitted infection (STI) prevention. Therefore, dual use is recommended for the prevention of STIs, in addition to pregnancy, by using LARC methods with condoms. This study assessed factors associated with LARC only use and dual-LARC and condom use among college women. The National College Health Assessment-II Fall 2012 to 2013 was used for this analysis. The analytic sample was restricted to women who used a LARC method (ie, intrauterine device or implant) (N = 1658). The main outcome was dual method use, LARC and condom, at last sex. An adjusted logistic regression model assessed sociodemographic factors (age, relationship, race), health care utilization (routine gynecological examination), and sexual behavior (number of partners) as factors associated with dual condom-LARC use at the last time of vaginal-sex. Prevalence ratios (PR) and 95% confidence intervals (CI) were estimated. Among women reporting LARC use, 24% used a condom. Dual users were less likely to have only 1 sexual partner (adjusted PR [aPR], 0.66; 95% CI, 0.54-0.81) and be in a relationship. Dual users were more likely than LARC-only users to be Hispanic (aPR, 1.34; 95% CI, 1.01-1.78), black (aPR, 1.40; 95% CI, 1.07-1.83), and biracial/multiracial (aPR, 1.38; 95% CI, 1.10-1.73). These findings illustrate differences between dual-condom LARC and LARC-only college users. It is likely that relationship status and number of partners influences perceived risk for STIs and decision making for dual use among this population.

Pleomorphic Rhabdomyosarcoma of the Uterus – Case Report and a Systematic Review of the Literature

Pleomorphic rhabdomyosarcomas of the uterus, mainly occurring in postmenopausal women with leading symptoms of vaginal bleeding and abdominal pain, are very rare malignant tumors of the female genital tract. Due to the inefficiency of the adjuvant therapy, the outcome remains poor in the majority of the reported cases. We present a case of a 73-year-old patient diagnosed with pleomorphic rhabdomyosarcoma of the uterus. Together with the case report, a systematic review of the literature is presented focusing on different treatment strategies and their outcome. The 95% confidence interval (CI) of the overall mean survival and the respective mean survival of each different treatment strategy was calculated using SAS Studio. In the presented case, the patient showed no symptoms and was admitted into hospital due to abnormal uterine findings during a routine gynecological examination. Vaginal ultrasound scans showed a severely enlarged and intracavitaryly filled uterus. The patient underwent hysterectomy, as well as bilateral salpingo-oophorectomy. Regarding the systematic review of the literature, patients with adjuvant chemotherapy show the best outcome with a mean survival rate of 15.8±7.3 months (one patient excluded), whereas with a mean survival rate of 4.1±5.2 months, patients with sole surgical treatment show the shortest survival after diagnosis. Although there is no standardized approach in the treatment of this rare disease, we present a differentiated overview.

Hematologic Malignancy Recurrence in Female Reproductive Tract Seen on Routine Gynecologic Screening [25J

INTRODUCTION: Patients who undergo hematopoietic stem cell transplantation to treat hematologic malignancy are at risk of recurrent disease including myeloid sarcoma, an extramedullary collection of leukemic cells. Isolated extramedullary relapse after transplant in the form of a myeloid sarcoma is rare (&lt; 1%). In women, the reproductive tract is often overlooked as a potential site of hematologic malignancy recurrence. METHODS: At our center, we assess women for symptoms of genital chronic graft-versus-host disease and conduct visual inspection of the lower reproductive tract, cervical cytology and human papillomavirus screening as part of post-transplant gynecology care. We present two cases of myeloid sarcoma occurring post-transplant isolated to the female reproductive tract and breast identified during routine gynecologic examination. RESULTS: The first case is a recurrence of mastocytosis manifesting as vaginal bleeding and cervical mass. The second is recurrent acute myeloid leukemia found in a large pelvic and bilateral breast granulocytic sarcoma. CONCLUSION: The sole manifestation of relapse of hematologic malignancy post-transplant may be a myeloid sarcoma in the reproductive tract or breast. Autopsies of women with acute myeloid leukemia show 36% and 40% involvement of the ovary and uterus, respectively — suggesting involvement of the female reproductive tract is more common than clinically suggested. Routine gynecologic care not only detects common post-transplant complications of human papillomavirus disease and genital graft-versus-host disease, but also is important to identify recurrent malignancy, potentially enabling earlier diagnosis and treatment.

Prevalence of breast and gynecological diseases in female workers in the administrative office and workshop of an automobile part factory

Objective: To investigate the prevalence of breast and gynecological diseases in female workers in the administrative office and workshop of an automobile part factory, and to provide a basis for promoting the health of female workers. Methods: In March 2015, color ultrasound examination of the breast, uterus, and bilateral adnexa was performed for all female workers, and routine gynecological examination, routine leucorrhea examination, and thinprep liquid-based cytology test were performed for married female workers. The detection rates of breast and gynecological diseases in female workers in the administrative office and workshop were analyzed. Results: In the 314 female workers, the overall detection rate of breast and gynecological diseases was 86.31%; the detection rate of abnormal breast ultrasound results was 72.93%, mainly breast hyperplasia; the detection rate of abnormal gynecological ultrasound results was 12.14%, mainly hysteromyoma, pelvic effusion, and uterus-rectum fossa effusion. The overall detection rate of cervicitis or vaginitis in married female workers was 66.86%. The univariate analysis showed that compared with those in the administrative office, the female workers in the workshop had significantly higher detection rates of breast hyperplasia and grade 2 breast lesions on the Breast Imaging-Reporting and Data System (BI-RADS) and significantly lower detection rates of hysteromyoma and grade 3 breast lesions on the BI-RADS (all P <0.05) . The multivariate analysis showed that age was a risk factor for hysteromyoma (OR=1.261) , age and working in the workshop were risk factors for breast hyperplasia (OR=1.065 and 1.834) , married status was a protective factor against breast hyperplasia and grade 2 breast lesions on the BI-RADS (OR=0.334 and 0.450) , and working in workshop was a risk factor for grade 2 breast lesions on the BI-RADS (OR=1.890) and a protective factor against grade 3 breast lesions on the BI-RADS (OR=0.355) . Conclusion: Female workers in an automobile part factory have high prevalence rates of breast and gynecological diseases. Night shifts for female workers in the workshop should be reduced as much as possible, and female workers, especially those in the administrative office, should be guided to release pressure and take a balanced diet.

Uterine perforation and small bowel incarceration 11 months after dilatation and curettage: sonographic and surgical findings

In 2014, a 33-year-old primiparous woman was referred by her physician to the emergency department of the Catholic University of Rome for abnormal uterine findings at routine gynecological examination, performed 11 months after vaginal delivery. She was breastfeeding and her menstrual cycle had not yet recommenced. She had undergone dilatation and curettage (D & C) 4 weeks after delivery because of retained membrane. Gynecological examination revealed a tender uterus with a closed cervix and normal adnexa. Laboratory findings were not significant, with a normal white blood cell count and negative for β-human chorionic gonadotropin. On referral to our department, we performed a transvaginal ultrasound examination using a GE Voluson E8 (GE Medical Systems, Zipf, Austria) ultrasound system. A tubular structure, with distinct multilayered appearance of normal intestinal wall1, was seen penetrating into the uterine cavity through the anterior wall of the uterine body (Videoclip S1). The presence of typical normal echostructure of intestinal wall and peristaltic movement suggested perforation of the uterus with penetration of the bowel. Color Doppler ultrasound examination confirmed this hypothesis (Videoclip S2). A small amount of anechoic free fluid was seen in the cul-de-sac. Laparoscopy revealed about 10 cm of small intestine prolapsed through the uterine perforation, adherent to the myometrial wall. The uterine fundus had a hole of approximately 4 cm in size (Videoclip S3). The bowel had penetrated through this gap, occupying the entire endometrial cavity and reaching the upper part of the cervix. Adhesions between the bowel and the endometrial cavity and myometrium were removed and the uterine structure was reconstructed. A perforation of 1 cm was detected on the surface of the entrapped bowel that was resected laparoscopically. The patient was discharged after 5 days with no postsurgical complication. Delayed presentation of uterine perforation after D & C, as reported here, is rare2. Treatment usually consists of laparotomic surgery3; the laparoscopic approach described in this case is, we believe, one of few reported in the medical literature. A. De Cicco†, F. Mascilini‡, M. Ludovisi‡, F. De Cicco†, G. Scambia‡ and A. C. Testa*‡ †Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy; ‡Division of Gynecology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy *Correspondence. (e-mail: atesta@rm.unicatt.it) Videoclips S1 and S2 Grayscale (S1) and color Doppler (S2) ultrasound videoclips showing hyperechogenic tubular structure penetrating through anterior wall of uterine body. Videoclip S3 Intraoperative videoclip demonstrating defect in fundal myometrium of uterus, through which small bowel is incarcerated. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Diagnostic Value of Visual Examination of Cervical Polypoid Lesions and Predictors of Misdiagnosis

This study reviews occasions when cervical polyps removed in an outpatient setting proved not to be cervical polyps histologically. We aimed to identify any anatomical and/or clinical characteristics that predict 'incorrect diagnosis" in general practice. A retrospective study of consecutive 345 patients who were initially diagnosed with cervical polyps based on a routine gynecological examination in an outpatient setting was included. After histopathological examination, the patients were divided into 2 groups: those with cervical (correct diagnosis, n = 307) and falsely diagnosed with cervical polyps (FDP, n = 38). These 2 groups were compared in terms of age, signs and symptoms, and size of the polypoid lesions. The initial clinical diagnosis was correct in 307, giving a positive predictive value of 89%. There were no significant difference between the groups with respect to age of patients (p = 0.59) and the size of the lesions (p = 0.42). According to our study, among misdiagnosed patients, nabothian cysts and cervicitis were the most common histological findings; FDPs were more often symptomatic (p < 0.001) and coexisted more frequently with inflammation or ulceration (p < 0.001). All FDPs were developing within the endocervical canal. There were no instances of FDPs that arise from ectocervix. Symptomatic polypoids have a higher risk of preliminary misdiagnosis (OR = 13.0; 95% confidence interval, 3.0-55.1). All cervical polypoid lesions must be sent to pathology because visual diagnosis is not sufficiently accurate to direct patient care.

Correlation between abnormal cytological findings and human papillomavirus infection of the uterine cervix in Bulgarian women

ABSTRACTThe aim of this study was to analyse the correlation between cases of human papillomavirus (HPV+/−) infection of the uterine cervix revealed through HPV typing and cytological results from Papanicolaou (Pap)-stained cervical smears. Cervical smears of 421 Bulgarian women attending routine gynaecological examinations during the three-year study period were stained by the Pap technique and classified by the Bethesda system. GenoFlow HPV Array Test Kit was used to analyse the HPV status in the collected cervical samples. The results showed that, of the 421 women, 177 (42%) were HPV(+) and 244 (58%) were HPV(−); 334 (79.3%) Pap smears were with normal morphology and 87 (20.7%) had high/low grade squamous intraepithelial lesion (LSIL/HSIL) changes. Of the 87 women with LSIL/HSIL changes, 54% (47/87) were HPV(−) and 46% (40/87) were HPV(+). There was no statistically significant correlation between the HPV(+) status and the cytological LSIL/HSIL findings (P > 0.05). Koilocytes were found in 30.4% (128/421) of the samples. Of the 128 women with koilocytosis, 59.4% (76/128) were HPV(−) and 40.6% (52/128) were HPV(+). There was no significant correlation (P > 0.05) between the presence of koilocytes in cervical smears and HPV infection. Our results suggest that HPV infection is frequent even in women with negative Pap-smear results, and polymerase chain reaction seems to be the only reliable test to diagnose this infection. However, the results from this study cannot be considered to fully support the replacement of cytology and colposcopy examination in cervical cancer screening with HPV genotyping tests only.