1/7. Mucinous endometrial adenocarcinoma simulating microglandular hyperplasia of the cervix.A case of endometrial adenocarcinoma simulating microglandular hyperplasia (MGH) of the cervix is presented. A postmenopausal 53-year-old woman, with no previous history of taking exogenous hormones, presented with vaginal bleeding. An endometrial biopsy exhibited a tumor composed predominantly of a microglandular proliferation of tightly packed glands with mild to moderate atypia and mitotic figures. The majority of the tumor cells contained intracytoplasmic mucin. There were numerous neutrophils within the microglandular lumens and in the stroma. The tumor was focally positive for carcinoembryonic antigen and vimentin. The MGH-like proliferation, focally, had a transition to a conventional mucinous adenocarcinoma. hysterectomy specimens showed a residual mucinous endometrial adenocarcinoma with no myometrial invasion, the uterine cervix was unremarkable. Four years following her hysterectomy the patient was well, with no evidence of disease. Pathologists need to be cautious about MGH-like changes in the endometrial biopsy of postmenopausal women and be aware of this type of endometrial cancer as it may be misdiagnosed.- - - - - - - - - - ranking = 1keywords = embryo (Clic here for more details about this article) |
2/7. Successful pregnancy in an infertile woman with endometrial hyperplasia and embryo transfer. A case report.BACKGROUND: Successful pregnancy in a woman with complex endometrial hyperplasia with atypia was treated conservatively with gestagens. CASE: The patient was initially diagnosed with complex hyperplasia of the endometrium with atypia by endometrial curettage and treated with several cycles of different gestagens. After repeated endometrial curettage, in vitro fertilization and embryo transfer were introduced for immediate treatment of the patient's infertility in order to avoid the risk of recurrent hyperplasia of the endometrium from estrogens. A single pregnancy was achieved after transfer of embryos obtained from intracytoplasmic sperm injection. This was performed due to poor semen characteristics. The patient delivered a normal, healthy male infant at term. CONCLUSION: Conservative treatment of complex endometrial hyperplasia with atypia in young women wishing to preserve fertility should be considered in carefully selected cases.- - - - - - - - - - ranking = 6keywords = embryo (Clic here for more details about this article) |
3/7. Implantation despite an extensive endometrial defect after hysteroscopic resection of symptom-free residual trophoblastic tissue 15 months after cesarean section.Successful implantation occurred after embryo transfer in the presence of an extensive endometrial defect after hysteroscopic resection of residual trophoblastic tissue 15 months after cesarean section. At the end of hysteroscopic surgery the anterior uterine wall seemed smooth, although ultimately no endometrium was left in that part and in parts of the fundus. Thus implantation is possible even with extensive endometrial defects. Interesting facts in this case were, first, the long symptom-free period with residual trophoblastic tissue in the uterus, and, second, successful implantation, pregnancy, and delivery despite at least 30% of endometrial surface being irreversibly destroyed. We suggest hysteroscopic resection as the method of choice for exact and minimally traumatic removal of especially older residual trophoblastic tissue.- - - - - - - - - - ranking = 1keywords = embryo (Clic here for more details about this article) |
4/7. Two successful pregnancies after in vitro fertilization and embryo transfer in a patient with endometrial atypical hyperplasia bordering on adenocarcinoma treated conservatively with high-dose progesterone.women suffering from anovulatory infertility may develop endometrial hyperplasia and adenocarcinoma due to the unopposed estrogen effect. We present the case of a young infertile woman with endometrial atypical hyperplasia bordering on adenocarcinoma who refused hysterectomy and bilateral salpingo-oophorectomy and achieved two successful pregnancies after conservative treatment with high-dose progesterone followed by in vitro fertilization and embryo transfer. It is concluded that conservative treatment with high-dose progesterone for endometrial hyperplasia and well-differentiated early-stage adenocarcinoma followed by assisted reproductive technologies is an appropriate means for achieving pregnancy. However, the issue of hysterectomy and bilateral salpingo-oophorectomy after delivery or after fertility being no longer required is controversial. If surgery is not performed, close observation with endometrial sampling every 6 months is advisable.- - - - - - - - - - ranking = 5keywords = embryo (Clic here for more details about this article) |
5/7. Unusual presentation of a woman with polycystic ovaries and complex endometrial pathology.A 28-year-old woman with polycystic ovarian syndrome (PCOS) had attempted four assisted conception treatments, all of which were complicated by lack of response of the endometrium to the hypo-oestrogenic state induced with gonadotrophin releasing hormone analogue (GnRHa). Consequently, two treatment cycles were abandoned, one prior to the ovulation induction of a fresh IVF treatment and the other prior to oestrogen replacement for a frozen-thawed embryo transfer treatment cycle. Extended down-regulation eventually resulted in endometrial thinning and allowed completion of the other two treatments, but the outcome was negative. A targeted mid-cycle ultrasound scan in a natural cycle at follow-up showed thick, non-homogenous endometrium. A repeat hysteroscopy on this occasion showed abnormal endometrium with chalk-like deposits. Histological diagnosis was chronic endometritis and endometrial hyperplasia with focal atypia. Microbiological tests, including those for mycobacterium tuberculosis, were negative. Because of atypical endometrial hyperplasia, this patient is currently under close follow-up by the original referring team. This case highlights inherent endometrial pathology presenting as non-responding endometrium to hormonal down-regulation, the limitations of conventional ultrasound scans, and the complimentary role of concomitant hysteroscopy in the correct identification of endometrial lesions that may negatively affect the assisted conception treatments.- - - - - - - - - - ranking = 1keywords = embryo (Clic here for more details about this article) |
6/7. Diffuse laminar endocervical glandular hyperplasia.A case is reported of diffuse laminar endocervical glandular hyperplasia, which is very rare among pseudoneoplastic endocervical glandular lesions. The patient was a 54 year old woman who had been suffering from watery vaginal discharge for about 7 years, and the lesion was found in the cervix of the hysterectomy specimen. Microscopically, the lesion showed a diffuse, laminar proliferation of hyperplastic endocervical glands, sharply demarcated from the underlying stroma. The significant nuclear atypia was absent. Inflammatory response was mild. Immunohistochemically, carcinoembryonic antigen was negative. Differential diagnosis from other non-neoplastic conditions and well differentiated adenocarcinoma is discussed.- - - - - - - - - - ranking = 1keywords = embryo (Clic here for more details about this article) |
7/7. Microglandular adenocarcinoma of the endometrium: a form of mucinous adenocarcinoma that may be confused with microglandular hyperplasia of the cervix.Microglandular adenocarcinoma of the endometrium may cause diagnostic problems because of its bland cytologic appearance and its histologic similarity to benign microglandular hyperplasia of the cervix. We present two cases of microglandular adenocarcinoma and discuss the clinical, pathologic, and immunohistochemical findings. Both patients were postmenopausal women, one of whom was taking exogenous hormones. Endometrial biopsy specimens contained polypoid tissue fragments, within which were microcystic spaces lined by flattened, cuboidal, or columnar cells. Solid nests or sheets of tumor cells surrounded glands in some tissue fragments. The nuclei were uniform and bland, and mitotic figures, although readily identifiable, were infrequent (1 per 10 high-power fields). A majority of tumor cells contained intracytoplasmic mucin. Numerous neutrophils were present in gland lumens and tissues. Immunohistochemical stains for carcinoembryonic antigen and TAG72 (B72.3) revealed focal moderate to intense apical and cytoplasmic staining; immunostains for p53 protein were negative. One carcinoma was confined to the endometrium, whereas the other invaded into the inner one-third of the myometrium. Both patients were well after a limited follow-up of 1 year. Microglandular adenocarcinoma is a distinctive variant of endometrial carcinoma that is most likely a form of mucinous adenocarcinoma.- - - - - - - - - - ranking = 1keywords = embryo (Clic here for more details about this article) |