Vaginal Resection Research Articles

Surgical management of 12-year-old with complete septate uterus with duplicated cervices and obstructed left hemivagina: A case report

Introduction: When a patient with an obstructed hemivagina presents in childhood, either hormonal suppression or a staged procedure is proposed for management of the obstruction. Case Report: This case report is a 12-year-old patient presenting for evaluation of hematocolpos with a complete septate uterus, duplicate cervices, bilateral kidneys, and obstructed left hemivagina who was surgically managed with a complete vaginal septum resection and hysteroscopic metroplasty in one procedure shortly after diagnosis. Conclusion: This anomaly is not only rare, and the first presented in the literature, but it also importantly demonstrates that if desired by the family after a consideration of benefits and risks, resection of both vaginal and uterine septa can be safely performed in a young post-menarchal patient without the need for a staged procedure later in life.

Uterus Didelphys with Hematocervix in the Unilateral Obstructed Hemivagina and Ipsilateral Renal Agenesis: A Case Report of Herlyn–Werner–Wunderlich Syndrome

Background: Mullerian duct anomalies include a broad spectrum of genital tract defects that arise from developmental abnormalities of the genital tract. Herlyn–Werner–Wunderlich syndrome (HWWS) refers to the combination of uterus didelphys, blind hemivagina and ipsilateral renal agenesis. In the literature, the syndrome often appears as a few sporadic case reports. Case: We report a case of symptomatic Herlyn–Werner–Wunderlich syndrome diagnosed by transavaginal scan and MRI and successfully treated with a laparoscopic-assisted hysteroscopic vaginal septum resection. The postoperative course was without complications, and clinical symptoms completely resolved the surgery. Summary and Conclusions: Combination of laparoscopy and hysteroscopy was found to be an easy, safe, effective and appropriate approach for patients with HWWS.

The study of vaginal wall thickness in adults based on histopathological measurements

To accurately measure the vaginal mucosa thickness across different age groups using histopathologic techniques and investigate the factors that may influence the thickness changes. This study aims to provide clinicians with objective evidence of variations in vaginal mucosal thickness, facilitating personalized medical decisions for patients. A retrospective analysis was conducted on clinical data from 348 patients who underwent local vaginal wall resection at the West China Second University Hospital, Sichuan University, from January 2021 and May 2022. The thickness of vaginal mucosa, epithelium and lamina propria was measured precisely under the microscope. And the 10th, 25th, 50th, 75th, and 90th percentile values of vaginal mucosa thickness across different age groups were counted and charted a dot-line plot. The percentile values for vaginal mucosa thickness exhibited a decreasing trend with increasing age; vaginal mucosa thickness showed significant correlations with times of delivery (P = 0.031) and age (P < 0.001), both of which were negatively associated. And vaginal mucosa thickness demonstrated no significant correlation with body mass index (BMI) (P = 0.325), times of abortions (P = 0.511), times of gestation (P = 0.101), menstrual cycle (P = 0.533), or types of delivery (P = 0.056); epithelial thickness showed significant associations with age (P < 0.001) and types of delivery (P = 0.017), both of which were negative correlations. Moreover, BMI (P = 0.429), times of abortions (P = 0.764), delivery (P = 0.079), gestation (P = 0.475), and menstrual cycle (P = 0.950) were nonassociated with epithelial thickness; lamina propria thickness displayed a significant correlation only with age (P = 0.002), and there were no obvious correlations observed between lamina propria thickness and BMI (P = 0.374), times of abortion (P = 0.417), delivery (P = 0.053), gestation (P = 0.101), types of delivery (P = 0.132) and menstrual cycle (P = 0.495). Moreover, when the age segmentation was thresholded at 35 and 50 years, both epithelial thickness and vaginal mucosa thickness were significantly correlated with age (P < 0.05). Lamina propria thickness was associated with age when the age threshold was set at 35 years (P = 0.007), whereas it showed no strong link with age when the age threshold was 50 years (P = 0.072). This study has innovatively established percentile reference values for vaginal mucosa thickness based on histopathology, furnishing clinicians with objective evidence of variations in vaginal mucosal thickness to facilitate personalized medical decisions for patients. The findings demonstrated a strong link between vaginal mucosa thickness and age, with epithelium likely playing a predominant role, while the association with lamina propria appeared to be less significant. Further research involving a larger sample size is warranted to elucidate the potential relationship with the lamina propria.

Ohvira syndrome with rare presentations – A case report

Herlyn Werner Wunderlich syndrome is a very rare congenital anomaly of the urogenital tract involving Mullerian ducts and mesonephric ducts. It is synonymous with OHIVRA syndrome which is Obstructed Hemivagina with Ipsilateral Renal Agenesis syndrome. Very few case reports have been reported regarding the syndrome. Herein, we report a case of 20 year old unmarried female with unusual presentation of OHVIRA syndrome with complaints of spotting per vagina and with vaginal cyst on examination. Diagnosis was confirmed by MRI which showed features of OHVIRA with pyometra caused by the obstructed hemivagina. She was managed surgically by diagnostic laparoscopy and per vaginal resection of the vaginal septum and drainage of around 50cc of pyometra followed by visualisation of two separate cervical canals post procedure. As a rare entity, a high degree of clinical suspicion is necessary to diagnose and intervene at the right time to ensure optimum results and prevent complications and preserve fertility.

Surgical Approaches for Vaginal Septum Resection in OHVIRA Syndrome Cases

Surgical Approaches for Vaginal Septum Resection in OHVIRA Syndrome Cases

Herlyn-Werner-Wunderlich syndrome: Challenges in diagnosis and management.

Herlyn-Werner-Wunderlich syndrome (HWWS), also known as OHVIRA syndrome (obstructed hemivagina and ipsilateral renal anomaly) is a complex congenital malformation characterized by a triad including uterine didelphys, hemivaginal obstruction, and ipsilateral renal agenesis. In this case report, we present a case of HWWS along with the challenges in diagnosis and multi-step treatment processes. A 25-year-old woman presented to Dr. Zainoel Abidin Hospital in Banda Aceh, Indonesia with a chief complaint of lower back pain for the past six months (two months after the marriage). The patient also complained of late menstruation, followed by thick yellow vaginal discharge resembling malodorous pus occurring after menstruation. Additionally, a history of fever and pain during intercourse was reported. Vaginal examination revealed purulent fluid emerging from a pinpoint hole on the right vaginal wall. Vaginal palpation revealed a two-branched uterus, along with a palpable cystic mass on the right vaginal wall. Ultrasound examination indicated the presence of the right and left hemi-uteri, measuring 4.7x1.35 cm and 5.7x1.26 cm in size, respectively with both ovaries appearing normal. Fluid accumulation was observed in the right hemivagina, while the left kidney exhibited normal features, and the right kidney showed signs of hypoplasia. The patient was diagnosed with uterus didelphys, fluid accumulation in the hemivagina, and right kidney hypoplasia. Magnetic resonance imaging (MRI) confirmed uterus didelphys and revealed narrowing of the right hemivagina, suggestive of HWWS. Hysteroscopy was performed to resect the vaginal septum with laparoscopic guidance, along with drainage of hematocolpos, pyocolpos and placement of an intracervical mold. Despite HWWs having conservative gradual management, it was opted to perform vaginal septum resection, hematocolpos and pyocolpos drainage and placement of an intracervical mould in this case, in order to relieve symptoms and restore the reproductive and sexual functions.

Diagnosis, Treatment and Prognosis of Mesonephric Adenocarcinoma of the Vagina: A Literature Review and a Case Report.

Mesonephric adenocarcinoma (MA) of the vagina is a rare tumor that arises from mesonephric remnants (Wolffian) in the female genital tract. It is a neoplasm with no significant evidence about its diagnosis, treatment, follow-up and prognosis. Systematic research of the literature was conducted in Scopus, PubMed/MEDLINE, ScienceDirect and the Cochrane Library, including observational prospective and retrospective studies, case series and case reports. We collected data regarding studies related to diagnosis and treatment options evaluating the following aspects: study design, population, treatment type, rate of surgical complications and fertility outcome. We further included a case report of laparoscopic management of MA with pictorial assays. Thirteen cases of MA of the vagina are available in the literature, including our case report. The median age at diagnosis was 52 years old; the majority of patients reported vaginal bleeding as a symptom (38%); and ultrasound, followed by a magnetic resonance and CT scan were the diagnostic tools most used. In 54% of the cases, a surgical biopsy was performed, and 92% of the patients underwent upfront surgery with an open access or vaginal resection except one case fully managed by minimally invasive surgery. Most of the patients (68%) received adjuvant treatment with chemotherapy or radiotherapy or a combination of them. The mean follow-up period was 6 years. Despite the rarity of this cancer and bizarre location, a minimally invasive approach seems feasible after multidisciplinary evaluation. According to the rarity of this tumor, any future case and follow-up data must be reported in the literature in order to enlarge the knowledge about it.

Pneumovaginal endoscopic surgery: a new approach to vaginal septum resection. In this video, we demonstrate the stepby- step procedure for vaginal septum resection by pneumovaginal endoscopic surgery.

Pneumovaginal endoscopic surgery: a new approach to vaginal septum resection. In this video, we demonstrate the stepby- step procedure for vaginal septum resection by pneumovaginal endoscopic surgery.

Pneumovaginal endoscopic surgery to vaginal septum resection: a case report and literature review

Pneumovaginal endoscopic surgery to vaginal septum resection: a case report and literature review

Laparoscopic Abdominoperineal Resection with En Bloc Vaginal Resection and Immediate Neovaginal Reconstruction with Colonic Flap and Pelvic Floor Reconstruction with Mucosa-Removed Colonic Flap.

Bunyajetpong, Sumet M.D.1,2; Sahakitrungruang, Chucheep M.D., M.Sc.1 Author Information

Hydrocelectomy Under Local Anesthesia in Rural Areas

The aim of the study was to describe hydrocelectomy under local anesthesia in the health district of Kolondièba. This was a cross-sectional (analytical) study by exhaustive survey. The study took place in two phases: a collection phase from November 6 to 13, 2017 and a phase devoted to encoding, entry, purification, data analysis and writing from November 20 to November 15. December 2017. Included in this study are all patients operated on for filarial hydrocele, i.e. 42 patients. We proceeded by a purposive sampling by taking all patients with a filarial hydrocele whose age is greater than 11 years. The average age was 59 years old and 78.6% were married men. Farmers accounted for 69%. The duration of evolution of the hydrocele varied between 5 to 10 years. Half of the patients had grade 2 hydroceles. The impact of the hydrocele on their patients' work was found in 69% of cases and 73.8% had an impact on their sexual life. Total vaginal resection using the Winckelmann technique was performed in 90.5% of cases. The average duration of hydrocelectomy was 30 minutes in 97.6% of cases. A significant link between the quantity of fluid and the impact of hydrocele on work was found (P= 0.010 which is less than 5%). Filaricele surgery requires a good knowledge of the anatomy of the male reproductive system, mastery of surgical techniques, potential complications that may arise during the operation and adequate equipment. The vaginal resection technique is the one commonly used, recommended by WAHO and WHO.

Clinical features of 102 patients with different types of Herlyn-Werner-Wunderlich syndrome.

Herlyn-Werner-Wunderlich syndrome (HWWS) is a rare female genital tract malformation, and there are few large sample studies reported at home and abroad. The clinical manifestations of this syndrome are diverse, and insufficient understanding may delay the diagnosis and treatment of the patients. This study aims to analyze the clinical characteristics of different types of HWWS patients, and to improve the diagnosis and treatment of HWWS. The clinical data of patients with HWWS who were hospitalized in the Department of Obstetrics and Gynecology, Third Xiangya Hospital of Central South University from October 1, 2009 to April 5, 2022 were retrospectively analyzed. The age, medical history, physical examination, imaging examination and treatment of the patients were collected for statistical analysis. The patients were divided into an imperforate oblique vaginal septum type, a perforate oblique vaginal septum type, and an imperforate oblique vaginal septum and cervical fistula type. The clinical characteristics of different types of HWWS patients were compared. A total of 102 HWWS patients were enrolled, with age of 10-46 years old, including 37 (36.27%) patients with type I, 50 (49.02%) type II, and 15 (14.71%) type III. All patients were diagnosed after menarche, with an average age of (20.5±7.4) years. There were significant differences in the age of diagnosis and course of disease among the 3 types of HWWS patients (both P<0.05). Patients with type I had the youngest age of diagnosis [(18.0±6.0) years] and the shortest course of disease (median course of 6 months), while patients with type III had the oldest age of diagnosis [(22.9±9.8) years] and the longest course of disease (median course of 48 months). The main clinical manifestation of type I was dysmenorrhea, and the main clinical manifestation of type II and type III was abnormal vaginal bleeding. Of the 102 patients, 67 (65.69%) patients had double uterus, 33 (32.35%) had septate uterus, and 2 (1.96%) had bicornuate uterus. The vast majority of patients had renal agenesis on the oblique septum, and only 1 patient had renal dysplasia on the oblique septum. The oblique septum located on the left side in 45 (44.12%) patients and on the right side in 57 (55.88%) patients. There were no significant differences in uterine morphology, urinary system malformation, pelvic mass, and oblique septum among the 3 types of HWWS patients (all P>0.05). Six (5.88%) patients had ovarian chocolate cyst, 4 (3.92%) patients had pelvic abscess, and 5 (4.90%) patients had hydrosalpinx. All patients underwent vaginal oblique septum resection. Among them, 42 patients underwent hysteroscopic incision of the oblique vaginal septum without destroying the intact hymen because they had no sexual life history, and the remaining 60 patients underwent traditional oblique vaginal septum resection. Among the 102 patients, 89 patients were followed up for 1 month to 12 years. The symptoms of vaginal oblique septum in 89 patients such as dysmenorrhea, abnormal vaginal bleeding and vaginal discharge were improved after operation. Among the 42 patients who underwent hysteroscopic incision of the oblique vaginal septum without destroying the intact hymen, 25 patients underwent hysteroscopies again 3 months after operation, and there was no obvious scar formation at the oblique septum incision site. Different types of HWWS have different clinical manifestations, but all can be manifested as dysmenorrhea. The patient's uterine morphology can be manifested as double uterus, septate uterus, or bicornuate uterus. The possibility of HWWS should be considered if uterine malformation is combined with renal agenesis. Vaginal oblique septum resection is an effective treatment.

“A Space Odyssey” on Laparoscopic Segmental Rectosigmoid Resection for Deep Endometriosis: A Seventeen-year Retrospective Analysis of Outcomes and Postoperative Complications among 3050 Patients Treated in a Referral Center

To evaluate the feasibility of laparoscopic rectosigmoid resection for bowel endometriosis (RSE), reporting surgical and short-term postoperative outcomes in a consecutive large series of patients. A retrospective cohort study. Third-level national referral center for deep endometriosis (DE). 3050 patients with symptomatic RSE requiring surgical treatment. Nerve-sparing laparoscopic resection for RSE perfomed by a multidisciplinary team. After collecting intraoperative surgical characteristics, postoperative complications were collected by evaluating the risk factors associated with their onset. Clavien-Dindo IIIb postoperative complications were noted in 13.1% of patients, with anastomotic leakage and rectovaginal fistula accounting for 3.0% and 1.9%, respectively. Postoperative bladder impairment was observed in 13.9% of patients during hospital discharge but spontaneously decreased to 4.5% at the first evaluation after 30 days, alongside a statistically significant change towards global symptom improvement. Multivariate analyses were done to identify the risk factors for segmental bowel resection in terms of occurrence of postoperative major complications. Ultralow (≤5 cm from the anal verge), low rectal anastomosis (<8 cm, >5 cm), parametrectomy, vaginal resection, and previous surgeries seemed more related to anastomotic leakage, rectovaginal fistula, and bladder retention. Laparoscopic rectosigmoid resection for RSE seems an effective and feasible procedure. The surgical complication rate is not negligible but could be reduced by implementing a multidisciplinary approach, an endless improvement in nerve-sparing techniques and surgical anatomy, as well as technological enhancements. Real future challenges will be to reduce the time for the first diagnosis of DE and the likelihood of surgical indications.

Hysterectomy through Minimally Invasive Surgery for Cervical High-grade Intraepithelial Neoplasia: Reassessment of the Specimens' Eligibility for Histological Examination.

The objective was to investigate the microscopic artifacts made in the uterus of cervical high-grade squamous intraepithelial lesion (HSIL) resected by hysterectomy through minimally invasive (H-MI) procedures and to verify whether these specimens are suitable for histopathological assessment. This single-center retrospective study analyzed 28 patients with cervical HSIL, consisting of 21 premenopausal and seven postmenopausal women, who underwent H-MI. The proportion of the cervical mucosa covered by intact surface epithelium (residual ratio [RR]) was measured on microscopically. Surgical margin's status was also verified. All cases developed detachment of the cervical surface epithelium to a varying extent. The RR was significantly higher in the premenopausal patients (median: 75.5%) than in the postmenopausal patients (median: 37.6%). Among the premenopausal patients, the RR was lower in the cases on whom uterine manipulator (UM) was used (median: 70.5%) than in the cases without UM use (median 92.7%). Among the 21 cases whose resected uterus contained HSIL, the vaginal resection margin was not assessable in three (14.2%) of the seven postmenopausal cases due to the artifact. Although transvaginal manipulation of the uterus causes detachment of the cervical surface epithelium, H-MI for cervical HSIL provides an acceptable specimen for histological assessment in premenopausal patients, even if UM is used. In postmenopausal women, H-MI easily develops artifactual loss of cervical surface epithelium, sometimes providing an unfavorable specimen for microscopic assessment.

A RARE CASE REPORT OF OHVIRA SYNDROME IN A MENTALLY RETARDED GIRL

Obstructed Hemi vagina &amp; Ipsilateral renal agenesis or Herlyn werner Wunderlitch syndrome is a rare Mullerian duct anomaly with uterus didelphys, Unilateral Obstructed Hemi vagina &amp; Ipsilateral renal agenesis. Patients can usually presents soon after menarche and mayshow non - specific and variable symptoms with resultant delay in diagnosis. The most common presentation is dysmenorrhoea , abdominal mass in the lower abdomen secondary to hematocolpos and or haematometra. Here presenting a case of 14 years old mentally retarded female presented with pain abdomen &amp; mass per abdomen and was diagnosed as OHVIRA syndrome based on Ultrasonography &amp; MRI pelvis. She was treated with hemi vaginal septal resection and was under follow up.

7986 Laparoscopic Left Adnexal Cystectomy in a Pediatric Patient with Infected Ohvira

<h3>Study Objective</h3> Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) is an abnormality of Mullerian development typically diagnosed after menarche with painful menses due to the obstructed outflow of one hemivagina. Microperforations may occur in the vaginal septum which can lead to infected hematometrocolpos, intermenstrual bleeding, and abnormal discharge. <h3>Design</h3> We present a video demonstrating the case of a twelve-year-old girl with history of renal anomaly and painful menses with intermenstrual bleeding and persistent discharge. Preoperative imaging suggested OHVIRA with an eight-centimeter adnexal cyst on preoperative imaging. Differential diagnosis of the adnexal cyst included tubo-ovarian abscess, ovarian or paratubal cyst, and ectopic ureter leading to a fluid collection. <h3>Setting</h3> Concurrent laparoscopic and vaginal surgery at an academic children's hospital medical center. <h3>Patients or Participants</h3> Twelve-year-old girl with history of renal anomaly and gynecologic symptoms. <h3>Interventions</h3> The vaginal septum was removed in the operating room, revealing purulent hematocolpos consistent with infection. Laparoscopy allowed for diagnosis of paratubal cyst with adnexal inflammation and concurrent cystectomy, in addition to permitting confirmation of uterine anatomy for future guidance. <h3>Measurements and Main Results</h3> Postoperatively, the patient healed well from laparoscopy. Her vaginas were unified, and she was counseled that she has two cervices and hemi-uteri for future gynecologic planning. <h3>Conclusion</h3> While a majority of cases of OHVIRA may be surgically corrected with vaginal surgery alone, the addition of laparoscopy allowed for diagnosis and treatment of the concurrent paratubal cyst at the time of vaginal septum resection.

TOTAL VAGINECTOMY FOR RECURRENT GYNECOLOGICAL CANCER: A SERIES OF CLINICAL CASES

Relevance: Treating vaginal recurrence of gynecological cancer remains a complex clinical problem. Surgery is an effective and relatively safe strategy for these cases. Vaginectomy is a method of surgical treatment of gynecological cancer local recurrence. Although vaginectomy is considered an effective treatment for a vaginal recurrence of cervical, ovarian, or endometrial cancers, only a few published&#x0D; reports of vaginal resections have been found. In most cases, vaginal resections were performed by vaginal and/or/or open access. Several&#x0D; reports on laparoscopic vaginal resection for recurrence in gynecological cancer were found.&#x0D; The aim was to study the effectiveness of vaginectomy in recurrent gynecological cancer.&#x0D; Methods: Clinical cases of seven patients after vaginectomy were analyzed.&#x0D; Results: The patients were 42 to 62 years (median – 53 years). The duration of the operation varied from 240 to 480 minutes&#x0D; (median – 317 min), the volume of blood loss was from 90 to 220 ml (median 140 ml), and resection margins were negative in all&#x0D; cases. A ureteral catheter was installed in 2 cases. The Foley catheter was removed after ten days on average (1-11 days). The&#x0D; patients stayed in the hospital for 7-14 days (median – 7 days). No intraoperative complications were registered. All patients after&#x0D; vaginectomy are alive.&#x0D; Conclusion: Vaginal recurrence is the most common local recurrence in gynecological cancer, and there is no consensus regarding&#x0D; its treatment tactics. Although this article is somewhat limited in the number of patients, our results show the efficacy of vaginectomy in&#x0D; recurrent vaginal gynecological cancer

TOTAL VAGINECTOMY FOR RECURRENT GYNECOLOGICAL CANCER:&#x0D; A SERIES OF CLINICAL CASES

Relevance: Treating vaginal recurrence of gynecological cancer remains a complex clinical problem. Surgery is an effective and relatively&#x0D; safe strategy for these cases. Vaginectomy is a method of surgical treatment of gynecological cancer local recurrence. Although vaginectomy is&#x0D; considered an effective treatment for a vaginal recurrence of cervical, ovarian, or endometrial cancers, only a few published reports of vaginal&#x0D; resections have been found. In most cases, vaginal resections were performed by vaginal and/or/or open access. Several reports on laparoscopic&#x0D; vaginal resection for recurrence in gynecological cancer were found.&#x0D; The aim was to study the effectiveness of vaginectomy in recurrent gynecological cancer.&#x0D; Methods: Clinical cases of seven patients after vaginectomy were analyzed.&#x0D; Results: The patients age ranged from 42 to 62 years (median 53 years). The duration of the operation varied from 240 to 480 minutes (median&#x0D; 317 min), the volume of blood loss – from 90 to 220 ml (median 140 ml), and resection margins were negative in all cases. An ureteral catheter was&#x0D; installed in 2 cases. The Foley catheter was removed after 10 days on average (from 1 to 11 days). The patients stayed in the hospital for 7-14 days&#x0D; (median – 7 days). No intraoperative complications were registered. All patients after vaginectomy are alive.&#x0D; Conclusion: Vaginal recurrence is the most common local recurrence in gynecological cancer, and there is no consensus regarding its treatment tactics. Although this article is somewhat limited in the number of patients, our results show the efficacy of vaginectomy in recurrent vaginal&#x0D; gynecological cancer

OHVIRA (Obstructed Hemivagina and Ipsilateral Renal Anomaly or Herlyn-Werner-Wunderlich syndrome): Is it time for age-specific management?

BackgroundOHVIRA (Obstructed Hemivagina and Ipsilateral Renal Anomaly or Herlyn-Werner-Wunderlich syndrome) is a rare Müllerian malformation. Usually, symptoms begin with worsening dysmenorrhea in post-menarche adolescents. The management in pre-menarche period is controversial and has only recently been subject of study. AimsTo review the experience of a pediatric tertiary center and to propose an age-specific management protocol for patients diagnosed before menarche. MethodsA retrospective cohort study (review of medical records - period 2009–2021). ResultsTwenty-eight patients were diagnosed (mean age 11.9 years), seven (25%) before menarche, one (3%) perinatally. One patient had Floating-Harbor syndrome. Twenty-three patients had ipsilateral renal agenesis, while five had a multicystic-dysplastic kidney. The contralateral kidney showed hypertrophy in 25 patients, pelvicalyceal ectasia in 8 and dysplasia in 1. Twenty-four patients were symptomatic. Three of the seven diagnosed prior to menarche had symptoms. All post-menarche diagnosed patients were symptomatic. Twenty-six patients underwent surgery (one-stage drainage, vaginal septal resection, and vaginoplasty). Asymptomatic pre-menarche patients were followed-up until surgery after menarche onset. No patient underwent surgery prior to menarche solely for OHVIRA diagnosis. At follow-up (median 3.5 years, 3 lost to follow-up), eighteen patients were asymptomatic, one developed endometriosis, one had impaired renal function, two needed reoperations. ConclusionsPre-menarche OHVIRA patients, without symptoms, should undergo regular follow-up until the onset of menarche. Surgery must be considered in post-menarche or symptomatic patients. Post-operative, long-term follow-up is required, evaluating both renal and gynecological issues. Level-of-EvidenceIV.

Revised German guidelines on the diagnosis and treatment of carcinoma of the uterine cervix-what's new for pathologists in 2021?

In 2021, the 2015 German consensus guideline for the diagnosis and treatment of uterine cervical carcinoma was updated. The present article summarises the new recommendations for pathologists: the incorporation of the International Endocervical Adenocarcinoma Classification (IECC), which morphologically separates HPV-associated and non-HPV-associated adenocarcinomas, as well as the reporting of the prognostic relevant growth pattern of the adenocarcinoma of the endocervical subtype (Silva pattern). Histologically, multifocality has been defined as the presence of clearly invasive foci with a minimum distance between each focus of 0.2 cm. Because of its intratumoural heterogeneity, all carcinomas ≤ 2 cm in their largest dimension should be processed completely, and tumours > 2 cm should be processed with one block per centimetre of their greatest dimension. In cases of (radical) trachelectomy/hysterectomy, the distal vaginal resection margin and all parametrial tissue should be processed completely. Sentinel lymph nodes have to be processed completely by lamellation along its long axis in 0.2 cm intervals. Immunohistochemical ultrastaging is mandatory. Staging should be performed using the 2009 FIGO classification and 2017 TNM classification. Reporting the revised 2018 FIGO classification is optional. To date, molecular markers have not been relevant for prognostication and treatment decision making.