Ramón Labastida

Endometrial hyperplasia with secretory changes

OBJECTIVE Secretory changes in endometrial hyperplasia are uncommon. The aim of this study is to review the morphologic and clinical findings of 24 cases of endometrial hyperplasia with secretory changes. METHODS In 24 patients diagnosed with endometrial hyperplasia with secretory changes during 6 years, clinical characteristics such as menopausal status and hormone treatment were correlated with morphological features. A matched age control group of 24 women with conventional endometrial hyperplasia was used to compare the hormonal effect. RESULTS Nineteen patients were premenopausal. Nine women showed simple hyperplasia without atypia and 15 complex hyperplasia, 7 of them with atypia. Seventeen women were under hormonal treatment at the time of diagnosis, 10 of them with progestins. In 7 patients endometrial adenocarcinoma could be seen, 5 coexisting with endometrial hyperplasia with secretory changes and in 2 appearing after 1 and 4 months. In control group only 2 patients were undergoing progestin hormonal treatment. CONCLUSIONS Secretory changes can be found in hyperplastic endometrium, particularly in premenopausal women under hormonal treatment with progestins, with the risk of misdiagnosis.

Método Essure: contracepción definitiva por vía histeroscópica

Resumen Objetivo Describir el procedimiento Essure de contracepcion por via histeroscopica y compararlo con los ya existentes en el armamentario actual de contracepcion definitiva. Sujetos y metodo Se han analizado tanto los estudios multicentricos previos a su aprobacion como la experiencia referida en trabajos posteriors de grupos expertos en histeroscopia. Resultados Los resultados de dos estudios multicentricos internacionales, prospectivos y aleatorizados publicados en 2003 demuestran que el metodo Essure presenta una elevada eficacia en la prevencion del embarazo, superior al 99% con tasas de complicaciones menores inferiores al 3%. Conclusiones La contracepcion definitive mediante el metodo Essure, apoyada en una curva de aprendizaje y en una adecuada experiencia en histeroscopia permiten convertirlo en una tecnica factible en regimen de consulta y exitosa en el 95% de los casos.

Adenocarcinoma endometrioide en pólipo endometrial

Resumen Introduccion En raras ocasiones se diagnostica un adenocarcinoma originado en un polipo endometrial. Material y metodos De un total de 1.989 polipos endometriales diagnosticados en 8 anos y medio, 6 presentaban un adenocarcinoma endometrioide. Se analizan sus caracteristicas clinicopatologicas y evolucion. Resultados La histeroscopia diagnostico un polipo en todas las pacientes, y en 3 de ellas con signos sospechosos de malignidad. En todas las ocasiones la lesion estaba confinada al polipo y no se observo infiltracion miometrial en ningun caso. Los carcinomas fueron de la variedad endometrioide, y el endometrio adyacente era normal. Todas las pacientes estan vivas y libres de enfermedad tras un seguimiento medio de 45 meses (entre 6 y 96 meses). Conclusion Los polipos endometriales pueden albergar un adenocarcinoma que en muchas ocasiones esta confinado al polipo, y que es de bajo grado de malignidad, por lo que se puede plantear un tratamiento conservador.

Microcolpohysteroscopy: myth or reality?

Objectives Our aim was to compare the diagnostic accuracy of microcolpohysteroscopy (MCH) and colposcopy-directed biopsies in the detection of precancer and cancer of the uterine cervix. Patients and Methods Between January and December 1994, a total of 174 patients underwent colposcopic and MCH examinations. Direct biopsies were obtained under colposcopic and MCH guidance. Diagnostic accuracies of the two methods were compared using the chisquare test and the kappa coefficient. Results Colposcopy showed an overall diagnostic accuracy of 39.7% (69 of 174) with a sensitivity of 50.5%, specificity of 23.2%, positive predictive value of 50%, and negative predictive value of 23.5%. The percentage of agreement between MCH diagnosis and histological findings was 92.4% for cervical intraepithelial neoplasia lesions, 92.5% for human papillomavirus, and 100% for invasive cancer. Of the total 174 cases, colposcopy examination was considered satisfactory in 134 (77%) and unsatisfactory in 40 (23%). In the 40 cases when the limits of the squamocolumnar epithelium could not be seen at colposcopy, satisfactory MCH examinations were obtained in cervical lesions measuring no more than 10 mm in endocervical depth (29 cases), and unsatisfactory MCH examinations were obtained in cervical lesions measuring at least 10 mm of endocervical depth (11 cases). The overall MCH failure rate was 6.3% (11 of 174). Conclusions MCH appears more reliable than colposcopy and is capable of showing lesions undetectable by colposcopy.

P30.04: Power Doppler ultrasound features of a minimal deviation adenocarcinoma of the uterine cervix

Objectives: Report of pregnancy and term vaginal delivery following MR guided focused ultrasound treatment of uterine fibroids. Methods: A 40 year-old patient with a history of fibroids and infertility selected MRgFUS as a treatment for her fibroids. The patient had three fibroids with a total fibroid volume of 452 cc. One of the fibroids (60 cc) was necrotic and not treated. The other two fibroids measuring 52 and 340 cc were treated in a 180 minute procedure with 56 sonications ranging in energy between 2160 and 2480 J. The patient was given fentanyl and versed for conscious sedation during the treatment. Post-contrast MRI images showed that the treated fibroid load obtained a non-perfused volume of 86%, an indication of a successful treatment. The patient required no post-operative care and recovered from sedation within an hour following the outpatient procedure. Results: The patient became pregnant within one month after the MRgFUS procedure as confirmed by first-trimester ultrasound, and ultrasound scans during the pregnancy showed normal fetal development. The patient delivered vaginally at 36 gestational weeks without obstetrical complications. The baby was a healthy girl with a mass of 2898 grams. Eight months after the delivery, the patient had a follow-up MRI which indicated that the total fibroid volume had been reduced by 53% (at 18 months post-MRgFUS). Conclusion: Although MRgFUS is currently commercially available for candidates who have completed childbearing, it proved to be a treatment which enabled a patient to conceive and deliver a healthy baby. As a uterine sparing fibroid treatment, MRgFUS has the potential to be used in patients whose fibroids may be hindering fertility.

Leiomiomatosis difusa del útero: aspectos clinicopatológicos en 5 casos

Resumen Introduccion La leiomiomatosis difusa del utero es una entidad rara que cursa con un aumento del tamano uterino. Descripcion de los casos Se revisan las caracteristicas clinicopatologicas de 5 casos. La sintomatologia mas frecuente fue por sangrado uterino. Tres de las pacientes tenian hijos, y 2 de ellas habian tenido algun aborto. En 3 ocasiones se efectuo una histerectomia subtotal. En las otras 2 se practico una reseccion parcial por deseos de la paciente de conservar la fertilidad. Conclusion La leiomiomatosis difusa uterina es una lesion benigna que puede afectar a la fertilidad o complicar de forma significativa el parto.

Complicaciones en la laparoscopia

Resumen Objetivo Determinar la incidencia de complicaciones de la tecnica quirurgica laparoscopica Diseno Estudio retrospectivo observacional Metodo Revision del historial ginecologico de las pacientes sometidas a una laparoscopia quirurgica desde enero de 1991 hasta diciembre de 1999. Se detallan el tipo de intervencion quirurgica y de complicacion. Se considera como complicacion cualquier acontecimiento intraoperatorio o postoperatorio no planificado que precise de tratamiento posterior Resultados Se han realizado un total de 3.504 procedimientos laparoscopicos, 2.135 (60,7%) laparoscopias quirurgicas, 1.026 (20,2%) laparoscopias diagnosticas y 343 (9,8%) esterilizaciones tubaricas. La morbilidad total ha sido del 8,56% (30 complicaciones), y no se ha producido ningun fallecimiento. El porcentaje de complicaciones en la laparoscopia quirurgica ha sido del 13,58% (29),del 0,28% (1) en las laparoscopias diagnosticas y no se ha descrito ninguna complicacion en las esterilizaciones tubaricas. En 10 casos, la complicacion quirurgica requirio la conversion a laparotomia (2,85%), siendo la principal causa las lesiones intestinales. Cuatro pacientes (1,14%) fueron reintervenidas, tres de ellas por lesion intestinal y una por lesion ureteral Conclusiones La laparoscopia es una tecnica que no esta exenta de riesgos. La mayoria ocurren durante el procedimiento quirurgico. La diversidad de cirujanos y el programa de formacion de residentes incrementa el porcentaje de complicaciones, principalmente en la realizacion del neumoperitoneo por la insercion de la aguja de Veress y del primer trocar. Por todo ello, es necesario sistematizar la tecnica laparoscopica y seleccionar a las pacientes para reconocer a aquellas con mayor riesgo, con el fin de extremar las precauciones y evitar las complicaciones quirurgicas

P141Benign mucinous ovarian cysts: transvaginal sonography with color Doppler features

Aim