A clinicopathological study of ovarian endometriotic cysts

Endometriosis is an important gynecologic disorder with multifactorial causes, primarily affecting women during their reproductive years. Pathologically, it is the result of functional endometrium located outside the uterus which may vary from microscopic endometriotic implants to large cysts. Endometriotic cysts and infertility is a well-known association. Some patients are asymptomatic while others present with disabling pelvic pain, infertility, or adnexal masses. Cyst aspiration, fenestration and ablation of cyst wall are commonly performed surgical procedures. Excision of the cyst wall is an accepted surgical treatment owing to the low recurrence rates. A total of 35 patients who underwent ovarian cystectomy for endometriotic cysts between January 2019 and December 2020 were retrospectively identified. The clinical findings, gross and histopathological features were noted in each case. Microscopically, the presence or absence of ovarian tissue adjacent to the cyst wall was evaluated. If ovarian tissue was present, the morphologic characteristics were graded on a semi-quantitative scale of 0-4 as described by Muzii et al. The age group of patients ranged between 22-28yrs. Right side cysts accounted for the majority, however 6 cases had bilateral endometriotic cysts. Majority of patients presented with primary infertility (46.2%). The maximum weight recorded for these cysts was 35gm, size ranging between 4.5 to 18cm and median thickness of the cyst wall being 0.7cm. 68% of the cysts showed a lining epithelium, few showing atypia and oncocytic change. Fibrosis and hemosiderin laden macrophages were present in more than 70% of cases and endometrial glands and stroma in more than 50%. Inflammation when present was predominantly lymphocytic. On evaluation of the ovarian tissue, 42.8% of cases showed no follicles and the rest showing grades ranging from 1 to 4, with grade 1 accounting for majority. The present study further emphasizes endometriosis to be an important cause of primary infertility which needs to be recognized and treated appropriately. Recognition of these cysts on histopathological examination can be challenging at times when endometrial stroma is scant and in cases of tubo-ovarian masses where these lesions could mimic malignancy. The excision of endometriotic cyst wall may cause loss of functional ovarian tissue in patients with primary infertility and thus could effect the response to ovarian stimulation, ocyte recovery, implantation and fertilization rates in these patients.

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Over view of clinical presentation, management and outcome of cervical cancer: A tertiary cancer centre experience

10.1055/s-0039-1685265 ◽

2016 ◽

Author(s):

H. Shukla ◽

K. Batra ◽

R. Sekhon ◽

S. Giri ◽

S. Rawal

Keyword(s):

Cervical Cancer ◽

Local Recurrence ◽

Radical Hysterectomy ◽

Gynecological Cancer ◽

Age Group ◽

Recurrence Rates ◽

Oncological Safety ◽

Robotic Radical Hysterectomy ◽

Time Period ◽

Hospital Registry

Objectives: (a) To understand the profile of cervical cancer patients attending our hospital from January 2011 till January 2015. (b) To audit the type of care given to the patients with respect to their stage at presentation. (c) To compare the outcomes of open v/s robotic radical hysterectomy done for cervical cancer. Methods: We prospectively analyzed all cases of cervical cancer from January 2011 to January 2015 presenting at our institute. Data was retrieved from patient’s records and institute’s tumor registry. We compared all patients undergoing open v/s robotic RH. All the data were analysed using SPSS version 21. Results: A total of 562 patients were treated for cervical cancer during the time period between 2011-2015. Of these there were 316 (56%) cases taken up for surgery-212 robotic RH, 104 open radical hysterectomy and rest 246 (44%) patients received definitive CCRT. Most common age group was 40-54 yrs. IB1 stage was most common presenting stage. SCC was most common histology (75%). Immediate post op complication and oncological safety in terms of local recurrence was same in both groups. However length of stay and post operative blood requirement was significantly lower in robotic RH group. 45% of all patients who underwent surgery did not require adjuvant therapy in post op period while 35% patient required post op RT and 20% CCRT. 2.2% patient had local recurrence and most of the patients were in stage IIA1 at presentation. Conclusion: Cervical cancer is the most common gynecological cancer in our hospital registry. Mostly women were in the age group of 40-54 years. Most common stage at presentation was 1B and the histology being SCC. Not many differences seen in open v/s robotic techniques of radical hysterectomy except for shorter hospital stay and less need of blood transfusion in the robotic group. Local recurrence rates are comparable in both open and robotic groups.

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Histopathological Analysis of Endometrial Biopsy in Gandaki Medical College Teaching Hospital, Pokhara, Nepal

Journal of Gandaki Medical College-Nepal ◽

10.3126/jgmcn.v12i1.22608 ◽

2019 ◽

Vol 12 (1) ◽

pp. 25-30

Author(s):

B Parajuli ◽

G Pun ◽

S Ranabhat ◽

S Poudel

Keyword(s):

Histopathological Examination ◽

Hydatidiform Mole ◽

College Teaching ◽

Histopathological Diagnosis ◽

Age Group ◽

Medical College ◽

Dilatation And Curettage ◽

Partial Mole ◽

Proliferative Endometrium ◽

The Common

Objective: To study the spectrum of histopathological diagnosis of endometrial lesions and their distribution according to age. Methods: All the endometrium samples obtained by the procedure of dilatation and curettage and hysterectomy sent for histopathological examination at Pathology Department of Gandaki Medical College Teaching Hospital, Pokhara, Nepal. The study duration was total 12 months ranging from July 2016 to June 2017. All the endometrial samples were processed, sectioned at 4 - 6 μm and stained with routine H & E stain. Patient’s data including age, sex, procedure of the biopsy taken and histopathological diagnosis were noted. A pathologist, using Olympus microscope, reported the slides. Cases were reviewed by a second pathologist whenever necessary. Results: A total of 128 cases were studied. The most common histopathological diagnosis was proliferative endometrium (28.9%) followed by disorder proliferative endometrium (15.65%). Most of the patients were in age group 36 - 45 years comprising 32.03%. Hydatidiform mole comprised of 7.03% and among Hydatidiform mole, partial mole was more common. Dilatation and curettage (82.8%) was the common procedure in compare to hysterectomy for the evaluation of endometrial lesions. Conclusions: In this study, we observed a variety of endometrial lesions. Most of them are benign; among benign, proliferative endometrium was the common histopathological diagnosis followed by disorder proliferative endometrium. Most common presenting age group was found to be at 36 - 45 years. In evaluation of hydatidiform mole, partial mole was more frequent in compare to complete mole. Conventional dilatation and curettage is the preferred method in developing countries with limited resource to screen endometrial lesion and therefore biopsy should be sent for histopathological examination. Thus histopathological examination of routinely stained hematoxylin and eosin is readily available and widely accepted standard technique for evaluation of the endometrial lesions.

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Abnormal Uterine Bleeding in Perimenopausal Age: Different causes and its relation with histopathology

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v13i2.18295 ◽

2014 ◽

Vol 13 (2) ◽

pp. 135-139 ◽

Cited By ~ 1

Author(s):

Nazlima Nargis ◽

Iqbal Karim ◽

Khondaker Bulbul Sarwar

Keyword(s):

Histopathological Examination ◽

Medical Science ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Transvaginal Sonography ◽

Age Group ◽

Histopathological Findings ◽

Medical College ◽

Gynecology And Obstetrics ◽

Study Results

Background: Abnormal uterine bleeding (AUB) is the most common reason for gynecological visits for perimenopausal bleeding and may account for more than 25% of all hysterectomies. Objective: This study was aimed to review the causes of abnormal uterine bleeding in perimenopausal women establishing the correlation with ultrasonographic and histopathological examinations. Study Method: This descriptive study was conducted in the department of gynecology and obstetrics, Ibn Sina Medical College, Dhaka during January to December 2012. Two hundred and eleven women were selected for this study, who admitted into the hospital with abnormal uterine bleeding in perimenopausal age. The clinical, ultrasonographic and histopathological findings of these women were evaluated in this study. Results: Menorrhagia was the major symptom (52.6%) irrespective of age and parity. All these women underwent D&C followed by either medical management or hysterectomy depending upon the diagnosis. The histopathological findings of endometrium were analyzed and confirmed as fibroid uterus (58.28%) and DUB (17.58%) correlated well with transvaginal sonography (TVS) and histopathological examination. Hysterectomy conferred other uterine lesions as adenomyosis (18.71%), endometrial polyp (4.81%) and malignancy (1.06%). Conclusion: Abnormal uterine bleeding in perimenopausal age group is a common but ill-defined entity which needs proper evaluation. Accurate diagnosis of the causative factors of AUB in this age group is of utmost importance so that appropriate management can be established early that leads the minimization of the patients sufferings. DOI: http://dx.doi.org/10.3329/bjms.v13i2.18295 Bangladesh Journal of Medical Science Vol.13(2) 2014 p.135-139

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O-071 The ovarian endometriotic cyst

Human Reproduction ◽

10.1093/humrep/deab126.017 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

M Nisolle

Keyword(s):

Ovarian Reserve ◽

Cyst Wall ◽

Ovarian Tissue ◽

Young Patients ◽

Childbearing Age ◽

Excessive Bleeding ◽

Ovarian Cortex ◽

Ablative Surgery ◽

Endometriotic Cyst ◽

Combined Technique

Abstract text "The ovarian endometriotic cyst” Ovarian endometriomas affect 17 to 44% of women with endometriosis, and are often associated with pelvic pain and infertility. Patients suffering from endometriosis frequently present an already reduced ovarian reserve, assessed by AMH dosage or by antral follicular count during TVS. Pain and infertility are the main indications for endometrioma surgery which is a complex procedure as endometriosis leads to inflammation around the lesions, causing fibrosis. Three main surgical procedures have been described: the ovarian cystectomy, the endometrioma ablation or the combined technique. During the cystectomy, after ovarian mobilization and adhesions lifting, an incision of the cortex is realized to find a cleavage plane between the cyst wall and the ovarian cortex. Traction and countertraction movements are performed to carefuly dissociate the cyst from the ovarian cortex. It is crucial to handle the ovarian tissue as atraumatically as possible. With this technique, the cyst wall as well as the surrounding fibrosis are excised with the risk of oocytes removal responsible for decreased ovarian reserve. The ablative surgery is defined by the fenestration and vaporization of the endometrioma cyst. The ablation is carried out using a laser or plasma energy or electrocoagulation. Once the endometrial cyst has been emptied of its contents, the entire internal surface of the endometrioma must be sprayed or evaporated using the different chosen techniques. Where feasible, the cyst may be turned inside out to facilitate further treatment. The combined technique associates partial cystectomy (80-90%) and ablation of the 10-20% remaining endometrioma. This method is especially useful while operating large endometriomas. It prevents excessive bleeding or damage to the ovarian tissue. In cases of large ovarian endometrioma, the three-step approach has been proposed, consisting on an opening and drainage of the cyst followed by a 3 months’ administration of Gn-RH agonists in order to reduce its diameter and vascularization. A second surgical procedure is then scheduled to ablate the remaining cyst wall. In conclusion, it is crucial to keep in mind that endometriosis and especially the presence of endometrioma reduce fertility whereas in the majority of cases, the ovarian reserve is already diminished in relation to the patient's age. Ovarian preservation must be one of our priorities in young patients of childbearing age and it is therefore really important to carry out surgeries that are as atraumatic as possible. Trial registration number: Study funding: Funding source:

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Ewing sarcoma: Analysis of epidemiological parameters and their relation to clinical characteristics

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0608310s ◽

2006 ◽

Vol 134 (7-8) ◽

pp. 310-314

Author(s):

Vladan Stevanovic ◽

Zoran Vukasinovic ◽

Dusko Spasovski

Keyword(s):

Ewing Sarcoma ◽

Orthopedic Surgery ◽

Clinical Characteristics ◽

Clinical Findings ◽

Tumor Localization ◽

Age Group ◽

Serious Illness ◽

Success Of Treatment ◽

Epidemiologic Features ◽

Epidemiological Parameters

The purpose of this investigation was to evaluate epidemiologic features of Ewing sarcoma in children treated in the Institute for Orthopedic Surgery "Banjica", as well as to establish relation of these features to clinical findings. Study involved 78 patients treated over 20-year period (1980-2000). Analysis included standard epidemiologic data (age, sex, tumor localization) and diagnostic clinical features on presentation (major symptoms, time elapsed between presentation and diagnosis, presence of metastases). Most of the patients were in the age group of 15-18 years (50.0%), predominantly males. In general, the results of our study were consistent with data reported in literature. Nevertheless, this investigation revealed slightly higher incidence in patients younger than four years of age (5.1%); localization on the upper extremity was found to be more frequent (upper to lower extremity ratio was nearly 3:1 in our study), and the time lost between presentation and diagnosis was markedly reduced (average time elapsed between presentation and diagnosis was 2.5 months). The results of our study may improve efficiency and success of treatment, thus providing the basis of better prognosis in management of such a serious illness.

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Coronavirus disease 2019 infection and pituitary apoplexy: A causal relation or just a coincidence? A case report and review of the literature

Surgical Neurology International ◽

10.25259/sni_401_2021 ◽

2021 ◽

Vol 12 ◽

pp. 317

Author(s):

Walaa A. Kamel ◽

Mustafa Najibullah ◽

Mamdouh S. Saleh ◽

Waleed A. Azab

Keyword(s):

Mr Imaging ◽

Causal Relation ◽

Histopathological Examination ◽

Case Reports ◽

English Literature ◽

Clinical Findings ◽

Oculomotor Nerve Palsy ◽

Future Research ◽

Endoscopic Endonasal ◽

Transsphenoidal Resection

Background: Pituitary tumor apoplexy (PA) is an emergency condition caused by hemorrhage or infarction of the preexisting adenoma. Many factors are currently well-known to predispose to PA. However, during the period of coronavirus disease 2019 (COVID-19) pandemic, case reports of PA associated with COVID-19 infection have been sequentially published. To the best of our knowledge, four cases have been reported so far in the English literature. We herein report the fifth case of this association and review the pertinent literature. Case Description: A 55-year-old male patient with confirmed COVID-19 infection presented by progressive decrease in visual acuity and oculomotor nerve palsy. His medical history is notable for diabetes mellitus, hypertension, and pituitary macroadenoma resection 11 years ago. He was on hormonal replacement therapy for panhypopituitarism that complicated the surgery. Previous magnetic resonance (MR) imaging studies were consistent with enlarging residual pituitary adenoma. During the current hospitalization, computed tomography revealed hyperdensity of the sellar and suprasellar areas. MR imaging revealed PA in a recurrent large adenoma. Endoscopic endonasal transsphenoidal resection was uneventfully undertaken with near total excision of the adenoma and partial improvement of visual loss and oculomotor palsy. Histopathological examination demonstrated classic features of PA. However, his chest condition progressed and he had to be transferred to COVID-19 intensive care unit in the referring hospital where he was intubated and put on mechanical ventilation. One week later, the patient unfortunately passed away due to complications of severe COVID-19 pneumonia. Conclusion: We report the fifth case of PA associated with COVID-19 infection. Based on our patient’s clinical findings, review of the other reported cases, as well as the available literature, we put forth a multitude of pathophysiological mechanisms induced by COVID-19 that can possibly lead to the development of PA. In our opinion, the association between both conditions is not just a mere coincidence. Although the histopathological features of PA associated with COVID-19 are similar to PA induced by other etiologies, future research may disclose unique pathological fingerprints of COVID-19 virus that explains its capability of inducing PA.

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The Confusion between Pustular Psoriasis and Acute Generalized Exanthematous Pustulosis as a Cause of Exfoliative Dermatitis: A Case Report

Berkala Ilmu Kesehatan Kulit dan Kelamin ◽

10.20473/bikk.v33.3.2021.224-231 ◽

2021 ◽

Vol 33 (3) ◽

pp. 224

Author(s):

Desiana Widityaning Sari ◽

Cita Rosita Sigit Prakoeswa ◽

Damayanti Damayanti ◽

Sylvia Anggraeni ◽

Menul Ayu Umborowati ◽

...

Keyword(s):

Histopathological Examination ◽

Clinical Manifestations ◽

Clinical Findings ◽

Pustular Psoriasis ◽

History Taking ◽

Exfoliative Dermatitis ◽

Acute Generalized Exanthematous Pustulosis ◽

Physical Examinations ◽

Erythematous Skin ◽

Exanthematous Pustulosis

Background: Pustular psoriasis and Acute Generalized Exanthematous Pustulosis (AGEP) are grouped under pustular diseases, in which their clinical manifestations are similar. Those diseases can lead to exfoliative dermatitis. Purpose:To evaluate a specific histopathological examination in differentiating Pustular Psoriasis and AGEP. Case: A 55-year-old woman presented with sudden redness and diffused scaly skin with multiple pustules and also fever. She had taken Cefadroxil 2 days before the scales and pustules appeared. Leukocytosis and histopathological examination results from biopsy supported the diagnosis of AGEP. The patient was then hospitalized and received steroid therapy. Within the first week of tapering off, the scales disappeared but the pustules increased. After such clinical findings, the histopathological examination results were revisited and reassessed. Thus, we considered changing the diagnosis to Pustular Psoriasis, and the therapy was switched to Methotrexate. The patient had a better outcome, and the pustules slowly disappeared entirely. Discussion: It is often difficult to differentiate between the pustules in pustular psoriasis and AGEP unless by thorough history-taking and physical examinations. AGEP is characterized by a widespread of pustules with an acute febrile onset; while pustular psoriasis is an acute variant of psoriasis where pustules are spread over erythematous skin and accompanied by high fever and leukocytosis. Conclusion: Histopathological examination is the gold standard for the establishment of pustular psoriasis diagnosis. The histopathological characteristics of pustular psoriasis and AGEP are difficult to differentiate. Therefore, we need detailed history-taking and physical examination to establish the diagnosis.

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Cardiac tamponade secondary to hemorrhagic pericardial effiision in five dogs

Journal of the Hellenic Veterinary Medical Society ◽

10.12681/jhvms.15064 ◽

2017 ◽

Vol 56 (1) ◽

pp. 9

Author(s):

C. G. HATZIGIANNAKIS (Χ.Γ. ΧΑΤΖΗΓΙΑΝΝΑΚΗΣ) ◽

M. E. MYLONAKIS (Μ. Ε. ΜΥΛΩΝΑΚΗΣ) ◽

M. N. SARIDOMICHELAKIS (Μ.Ν. ΣΑΡΙΔΟΜΙΧΕΛΑΚΗΣ) ◽

M. PATSIKAS (Μ. ΠΑΤΣΙΚΑΣ) ◽

D. PSALLA (Δ. ΨΑΛΛΑ) ◽

...

Keyword(s):

Ultrasound Examination ◽

Histopathological Examination ◽

Clinical Findings ◽

Pericardial Fluid ◽

Exercise Intolerance ◽

Right Atrial ◽

Atrial Wall ◽

History Of ◽

Cardiac Silhouette ◽

The Right

A 7-year old female collie (case 1), a 3-year old male Caucasian-cross (case 2) and three male German shepherds with an age of 11 (case 3), 8.5 (case 4) and 10 (case 5) years, respectively, were admitted with a history of decreased appetite, depression, exercise intolerance, dyspnea and progressive abdominal enlargement, for the last 10 to 60 days. Poor body condition (5/5), muffled heart sounds (5/5), weak femoral pulse (5/5), ascites (5/5), inspiratory or inspiratory-expiratory dyspnea (5/5), pulsus paradoxus (2/5) and jugular vein distension (2/5) were the prominent clinical findings, while mature neutrophilic leukocytosis (3/5), lymphopenia (3/5), eosinopenia (3/5), hypoproteinemia (5/5) and increased urea nitrogen (3/5) were the most prevalent clinicopathologic abnormalities. Apart from a space-occupying lesion onto the right atrial wall of one dog (case 4), radiographic and ultrasound examination showed a globe-shaped cardiac silhouette (5/5), pericardial effusion (5/5), ascites (5/5) and pleural effusion (4/5). A large amount of non-clotting hemorrhagic effusion was drained during pericardiocentesis, resulting in rapid clinical recovery. Physical, chemical and cytological evaluation of the pericardial fluid was non-contributory in the differentiation between neoplastic and non-neoplastic causes of these effusions. Case 3 died 25 days post-pericardiocentesis; right atrium hemangiosarcoma and pulmonary metastases were documented on post mortem histopathological examination. Another dog (case 5) died of unknown causes one month after pericardiocentensis. On the contrary, dogs 1, 2 and 4 were still clinically healthy for a followup period of 16, 2 and 8 months, respectively.

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ENLARGEMENT OF THE SUBMAXILLARY SALIVARY GLANDS IN CYSTIC FIBROSIS

PEDIATRICS ◽

10.1542/peds.29.5.788 ◽

1962 ◽

Vol 29 (5) ◽

pp. 788-793

Author(s):

Giulio J. Barbero ◽

Maarten S. Sibinga

Keyword(s):

Cystic Fibrosis ◽

Salivary Glands ◽

Diagnostic Value ◽

Clinical Findings ◽

Age Group ◽

Pediatric Age ◽

Normal Children ◽

Submaxillary Glands ◽

Pediatric Age Group

A survey for submaxillary enlargement was carried out in 106 children with cystic fibrosis and 300 normal children. Submaxillary enlargement was found in 2% of the normal children and 92% of the children with cystic fibrosis. Chronic enlargement of the submaxillary glands is one of the clinical findings frequently present in children with cystic fibrosis, and it may also have diagnostic value. Cystic fibrosis must be considered as an important cause of chronic enlargement of the submaxillary glands in the pediatric age group.

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HISTOPATHOLOGICAL STUDY OF UTERINE LEIOMYOMA IN HYSTERECTOMY SPECIMENS

10.36106/ijsr/9133056 ◽

2021 ◽

pp. 77-79

Author(s):

Satyendra Kumar ◽

Archana Jha ◽

[Prof.] Ravi Kant Mishra ◽

Debarshi Jana

Keyword(s):

Uterine Leiomyoma ◽

Histopathological Examination ◽

Benign Neoplasm ◽

Reproductive Age ◽

Degenerative Changes ◽

Histopathological Study ◽

Age Group ◽

Common Location ◽

Proliferative Endometrium ◽

Malignant Lesions

Background: Uterine leiomyoma is the most common benign neoplasm in women of reproductive age group. Hysterectomy is a mode of therapy in uterine Leiomyoma. The objective of this study was to evaluate the histopathological changes in hysterectomy specimens with uterine leiomyomas. This is a retrospective study of one hundred sixty eight patients w Methods: ho underwent hysterectomy for uterine leiomyoma. Results: Uterine leiomyoma was most common in the age group of 41-50 years (54.76%). Most common location of leiomyoma was intramural (51.2%). Degenerative changes were seen in 10.72% cases. Hyaline degeneration was the most common type of degenera-tion (7.14%). Proliferative endometrium was the most common endometrial pattern (63.1%) in uterine leiomyoma. Associated malignant lesions were observed in 1.8 % cases of uterine leiomyoma. Uterine leiomyoma is associated wi Conclusion: th degenerative changes and coexistent benign and malignant patholologies. Histopathological examination of hysterectomy specimens should be done to conrm the diagnosis and rule out other pathologies, especially malignant lesions.

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