M. Ceccarini

Preoperative local staging of endometrial cancer: transvaginal sonography vs. magnetic resonance imaging.

To compare the accuracy of transvaginal sonography (TVS) and magnetic resonance imaging (MRI) in the preoperative staging of endometrial carcinoma.

A uterine wall defect after uterine artery embolization for symptomatic myomas

Fourteen months after the embolization, she presented with metrorrhagia; a CO2 diagnostic hysteroscopy demonstrated a defect 2 cm wide and 2 cm deep with regular, well-defined borders in the right uterine wall, covered by smooth irregular yellow tissue containing hard yellowish fibroid remnants covered by a film of clear secretion (Figs. 1, 2, 3). The defect was limited to the internal myometrium and did not lead to the peritoneal cavity. It opened into the uterine cavity through a 1.5-cm fistula of endometrium and myometrium. The uterine cavity was regular elsewhere and had a regular mucosa.

Transvaginal sonographic features of peritoneal carcinomatosis

Peritoneal carcinomatosis involves the dissemination of intra‐abdominal tumor tissue often associated with gynecological malignancies. The objective of this study was to describe the transvaginal sonographic appearance of this condition.

Uterine fistula induced by hysteroscopic resection of an embolized migrated fibroid: a rare complication after embolization of uterine fibroids

OBJECTIVE To describe a case in which hysteroscopic removal of a fibroid that had migrated through the uterine wall induced formation of a uterine fistula. DESIGN After embolization of uterine fibroids, an investigative clinical, sonographic, and hysteroscopic protocol was followed. SETTING Gynecologic clinic of a university hospital. PATIENT(S) A 38-year-old woman undergoing embolization of uterine arteries for uterine fibroids. INTERVENTION(S) Angiography-guided transcatheter bilateral embolization of uterine arteries, with clinical, sonographic, and hysteroscopic follow-up. MAIN OUTCOME MEASURE(S) Patient morbidity and satisfactory intercourse. RESULT(S) Six months after embolization of the uterine arteries, the patient presented migration of the fibroid through the uterine wall. Hysteroscopic removal of the fibroid induced posthysteroscopic formation of a uterine fistula. CONCLUSION(S) After embolization of the uterine arteries, thorough follow-up examination of the uterine cavity is strictly recommended. Diagnosis of a uterine wall perforation can identify an abnormal source of uterine bleeding, and patients should be counseled to avoid pregnancy until the lesion heals completely.

OC160: Three‐dimensional ultrasonography is of limited value in diagnosing fetal spina bifida

provided clinically/prognostically important information in five cases and additional clinically irrelevant information in four. In the former group, the ultrasound diagnoses were: MCM + inferior vermis defect (MRI: isolated MCM), hydrocephalus + partial ACC (MRI: hydrocephalus), borderline ventriculomegaly + craniosynostosis + hemimegalencephaly (MRI: borderline ventriculomegaly), hypoplasia of the CC splenium (MRI: normal CC) and corpus callosum lipoma (MRI: + lissencephaly). Overall, the prognosis of the lesion was changed by the MRI examination in 5/92 cases (5.4%), while it increased the confidence of the diagnosis in 21/92 cases (22.8%). Conclusions: Expert neurosonography is able to reach a conclusive diagnosis in most CNS abnormalities referred to a tertiary center. The use of MRI as a second-line diagnostic procedure has a specific place in the evaluation of selected fetal anomalies, following specific queries raised by the expert neurosonologist.

OC131: Preoperative local–regional staging of endometrial cancer: transvaginal sonography versus magnetic resonance imaging

prospective study. All women were subsequently assessed by 3DPDA. Endometrial volume, vascularity index (VI), flow index (FI) and vascularity–flow index (VFI) were calculated using the VOCAL method (Voluson 730, GE Systems, USA). Histological diagnoses were obtained in all cases. No patient taking tamoxifen or hormone replacement therapy was included. Cases with intrauterine fluid collection were also excluded. Results: Histological diagnoses were as follows: endometrial cancer 44 (50%), endometrial polyp 19 (22%), endometrial hyperplasia 12 (14%), endometrial cystic atrophy seven (8%) and submucous myoma five (6%). Endometrial volume, VI, FI and VFI were significantly higher in malignant than benign conditions (Table). All parameters showed similar area under the curve in ROC analysis.

P27.08: Umbilical cord cyst: our experience and review of the literature

We report one case of umbilical cord hemangioma. A heterogenous mass of the umbilical cord was discovered at 22 weeks. We describe – anatomical aspect with 3D ultrasound at 22 and 24 weeks – Doppler examination at different levels of the umbilical cord and in the fetus – high output cardiac decompensation – macroscopic and microscopic aspects of the tumour following intra-uterine fetal death at 25 weeks’. A total of 25 cases of umbilical cord hemangioma have been reported. The specificity of our case includes complete serial 3D ultrasound and fetal hemodynamic assessment.

OP11.01: Diagnosis of uterine congenital anomalies: 3D transvaginal sonography versus 2D‐3D saline infusion sonohysterography

Objectives: Twin–twin transfusion syndrome (TTTS) can be successfully treated by endoscopic laser ablation of communicating placental vessels, resulting in increased survival and decreased perinatal morbidity by delaying delivery in twin pregnancies in comparison to serial amniodrainages. Up to now experience in triplets has been limited, with only 16 cases reported in the literature. This study reports our experience with laser coagulation in triplet pregnancies with TTTS. Methods: Ten cases of triplet pregnancy with severe TTTS were treated with endoscopic laser ablation at our center. Seven of them were dichorionic and three cases were monochorionic. Perinatal outcome and follow-up was obtained in all cases. Results: Fetoscopic laser ablation was performed at a median gestational age of 19.6 (range 18–21) weeks. The median gestational age at delivery was 31 (range 27–33) weeks resulting in a median interval between intervention and delivery of 77 days (range 56–89). All three fetuses survived in four cases which were all dichorionic. At least two fetuses survived in eight pregnancies. In one dichorionic and one monochorionic pregnancy PPROM and miscarriage occurred. Conclusions: Endoscopic laser ablation is an effective treatment in triplet pregnancies with severe TTTS. However, the risk for severely premature delivery is higher than in affected twin pregnancies.

P08.06: Pre-operative staging of endometrial cancer: transvaginal sonography is the key

for adnexal masses in the asymptomatic and symptomatic pregnant population. Ultrasound is a valuable diagnostic tool utilized to stratify patient groups into expectant management versus those who require further diagnostic and management decisions. Familiarity with the natural history and sonographic features of common adnexal lesions such as simple cysts, hemorrhagic cysts, endometriomas, dermoid lesions and ovarian conditions specific to pregnancy may decrease the number of surgical interventions. The goal is to balance the risk of surgery against the risks of conservative treatment which may include torsion, rupture, hemorrhage or the rare spread of a malignant cancer. Atypical features or persistent large lesions should initiate a multidisciplinary team approach to optimize diagnostic and management strategy. Acute symptoms may precipitate emergency intervention at any point in the pregnancy. This exhibit will develop a diagnostic and management algorithm based on clinical symptoms, timing of detection, natural history and sonographic features.

OC149: Paraovarian cysts: diagnostic criteria at transvaginal sonography and sonographic‐pathologic correlation

and relate the results to studies on ultrasound diagnosis in view of necessity of surgical intervention. Material and Methods: Two-hundred and thirty-four ovaries of postmenopausal women, who had died from non-gynaecological diseases, were examined prospectively and consecutively, by the pathologist (G.P. Blom), for cystic structures. The results were compared to recent ultrasound studies of adnexal cysts. Results: Ovarian cysts were found in 15.4% of the women. Paraovarian cysts were found in 4.7% of the women. All cysts were benign, except for one woman, who had bilateral serous cystadenoma of borderline type. Macroscopically the borderline cysts were multilocular with mean diameters of 60 mm and 15 mm, respectively. Conclusions: The results were in agreement with diagnostic ultrasound studies. The fact that we found benign ovarian and paraovarian cysts in 21.1% of the women should in our opinion make the gynecologists reconsider the need for surgical intervention in favor of follow-up.