51/63. Endometrial ablation. A report of four cases. Three women had evidence of atypical endometrial hyperplasia at the time of endometrial ablation, discovered because they had mechanical preparation of the endometrium rather than medical preparation. In one of these patients, a frozen section revealed atypical endometrial hyperplasia, and the ablation was cancelled. A fourth woman had an unsuccessful endometrial ablation; repeat ablation was followed by nine months of amenorrhea, at which time she began spotting and requested a hysterectomy. The pathology report on the hysterectomy specimen revealed adenomatous hyperplasia. Gynecologists must be vigilant in their evaluation of the endometrium before, during and after endometrial ablation. ( info) |
| Two patients with endometrial neoplasia developed severe hyperglycemia secondary to megestrol acetate. patients who receive progestational therapy with megestrol acetate for endometrial neoplasia should be monitored closely for potentially severe hyperglycemia, especially if they have a history of abnormal glucose metabolism. ( info) |
53/63. Functional lutein cyst in a postmenopausal woman. A postmenopausal woman presented with enlarged breasts, increased vaginal mucus, and elevated serum estrogen and normal progesterone levels. A laparotomy was performed and revealed a cystic right ovary. Histologic examination of the ovary demonstrated a cyst lined by stratified lutein cells with abundant eosinophilic cytoplasm. The endometrium showed cystic and adenomatous hyperplasia. The diagnosis was functional lutein cyst. Removal of the cystic ovary reduced the estrogen levels, and the clinical picture reverted to that of a normal postmenopausal state. ( info) |
54/63. Prevention and treatment of endometrial disease in climacteric women receiving oestrogen therapy. The treatment regimens are described in 74 patients with endometrial disease among 850 climacteric women receiving oestrogen therapy. Cystic hyperplasia was associated with unopposed oestrogen therapy without progestagen. Two courses of 21 days of 5 mg norethisterone daily caused reversion to normal in all 57 cases of cystic hyperplasia and 6 of the 8 cases of atypical hyperplasia. 4 cases of endometrial carcinoma referred from elsewhere demonstrated the problems of inappropriate and unsupervised unopposed oestrogen therapy and the difficulty in distinguishing severe hyperplasia from malignancy. Cyclical low-dose oestrogen therapy with 7--13 days of progestagen does not seem to increase the risk of endometrial hyperplasia or carcinoma. ( info) |
55/63. 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. ( info) |
56/63. Microglandular endocervical hyperplasia and tubal metaplasia: pitfalls in the diagnosis of adenocarcinoma on cervical smears. The detection of atypical glandular cells of undetermined significance (AGUS) has risen recently due to the use of new endocervical canal sampling devices, in particular the cytobrush. From April 1993-June 1994, a diagnosis of AGUS ranging from adenocarcinoma in situ (AIS) to invasive adenocarcinoma was initially made on cervical smears from 6 women for whom histologic follow-up data were available. The purpose of this study was to determine if benign cervical glandular lesions can be reliably distinguished from adenocarcinoma on cytology. review of the smears and histologic slides from 3 patients showed microglandular endocervical hyperplasia on cervical cone specimens. Cervical smears from 2 of these patients showed clusters of small-to-medium-sized cells with nuclei containing coarse, granular chromatin and prominent nucleoli. Cytoplasmic vacuoles and engulfment of neutrophils were present, findings suggestive of endometrial adenocarcinoma. The third patient's smear showed clusters of large cells with ample, vacuolated cytoplasm and vesicular nuclei containing prominent nucleoli, findings suggestive of endocervical adenocarcinoma. In 3 cases evaluated by cervical conization, histologic slides showed tubal metaplasia. The cervical smears showed clusters and sheets of cells with round-to-oval-shaped nuclei containing evenly distributed, finely granular chromatin and inconspicuous nucleoli. Pseudoglandular formation was present in 2 cases, a finding suggestive of AIS. Since the cytologic features of microglandular endocervical hyperplasia and tubal metaplasia overlap those of adenocarcinoma, a differential diagnosis is prudent on cytologic smears of AGUS. ( info) |
57/63. Not so benign endometrial hyperplasia: endometrial cancer after endometrial ablation. The masking or development of endometrial cancer after endometrial ablation is a concern often alluded to in discussions of complications of endometrial ablation. It is necessary to look for a common factor when this complication occurs. Six cases published in peer-reviewed literature were collected to establish a link between the development of endometrial cancer and endometrial ablation. Preexisting endometrial hyperplasia seems to be the common denominator, and should be considered a contraindication to endometrial ablation until more data are collected. ( info) |
58/63. Huge ovarian endometrial cyst: a case report. We are reporting a rare case of a huge ovarian endometrioma, one as large as an adult head, and the difficulty of differential diagnosis regarding this ovarian tumor. ( info) |
59/63. Origin of estrogen in a postmenopausal woman with a nonendocrine tumor of the ovary and endometrial hyperplasia. The origin and quantity of estrogen and androgen were measured in a postmenopausal woman with clinical signs of estrogen excess and a nonendocrine tumor of the ovary. The plasma androstenedione production rate was elevated 5-fold. The estrone production rate was also five times that normally expected for a postmenopausal women and could be accounted for totally by the extraglandular conversion of plasma and androstenedione. Following removal of the tumor, the concentration of plasma androstenedione and the estrone production rate fell dramatically to normal postmenopausal levels. It is concluded that this markedly increased androstenedione production was the result of excessive secretion of androstenedione by the hyperplastic stromal cells of the ovary containing the mucinous cystadenocarcinoma. The excessive prehormone production together with its normal extraglandular conversion to estrone resulted in the massive increase in endogenous estrogen formation. ( info) |
60/63. Endometrial cytoloty. Using the Milan-Markley Technic. Increased attention has been given to cytologic and histopathologic technic in the detection of endometrial lesions because of an increasing incidence of endometrial malignancy. The cervical-vaginal smear as performed by most clinicians is inadequate for the detection of endometrial neoplasia. Existing technics for the detection of endometrial lesions are costly and time consuming. An effective, reliable and economical technic has been developed for rapid smearing and fixation of endometrial cells. The routine endometrial screening of 739 patients (1143 specimens) using the Milan-Markley technic detected 4 cases of endometrial carcinoma, 1 case of carcinoma of the tube, 22 cases of endometrial hyperplasia, and 9 of endometrial polypi. It is hoped that this cytologic method will complement existing histologic detection procedures. ( info) |