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ABSTRACT: To review the results of patients who were referred for posthysterectomy of abnormal cytology based on screening indications.
We performed a retrospective review of 64 patients who have been referred for posthysterectomy vaginal colposcopy to the gynecologic oncology service. Patients' demographics, clinical features, reason for screening, and final diagnosis were recorded. Patients were divided into 2 groups based on posthysterectomy screening guidelines. Group A was considered to have undergone unnecessary screening based on national guidelines, and group B had risk factors that appropriately called for continued surveillance. The number of colposcopic examinations and the incidence of neoplasia were recorded for each group.
The mean age of the patients was 65 years (range = 35-95 y). Group A included 22 patients with history of abnormal cytology posthysterectomy for benign disease. Of the 22 abnormal cytology results, 21 were low-grade squamous intraepithelial lesion (n = 14) or atypical squamous cells of undetermined significance (n = 7) with 1 high-grade squamous intraepithelial lesion. After referral and colposcopy of this group, no neoplasia was found. Group B included 42 total patients. Of these 42 patients, 20 (48%) had a history of cervical intraepithelial neoplasia, 12 (28%) had a history of vaginal intraepithelial neoplasia, 6 (14%) had history of cervical cancer, 2 (5%) had history of diethylstilbestrol exposure, and 2 (5%) had a history of radiation therapy. In group B, 8 (9%) and 1 (2%) of the patients had vaginal intraepithelial neoplasia 2/3 and squamous cell carcinoma, respectively.
Current national guidelines are appropriate. Adherence to these guidelines will decrease intervention and not affect the detection of vaginal neoplasia. Patients with risk factors for lower genital tract neoplasia warrant continued screening after hysterectomy.
Journal of Lower Genital Tract Disease 01/2012; 16(1):45-8. · 1.07 Impact Factor
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ABSTRACT: Primary gynaecologic non-Hodgkin's lymphomas are rare. We present a case of primary large B-cell lymphoma localized to the lower uterine segment and endocervical stroma that was successfully treated with chemotherapy and immunotherapy. Treatment was followed by a disease-free interval and successful term vaginal delivery.
A 21-year-old nulliparous woman presented with dysfunctional uterine bleeding. Radiologic assessment of a posterior lower uterine segment mass and pathologic evaluation of cervical biopsies demonstrated diffuse large B-cell lymphoma involving the endocervical stroma. The patient was treated with chemotherapy and immunotherapy. She had a normal, uncomplicated full-term pregnancy and spontaneous vaginal delivery six years after treatment.
Aggressive diagnosis and treatment of primary non-Hodgkin's lymphomas of the cervix do not preclude the possibility of a successful pregnancy and term vaginal delivery.
Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 06/2011; 33(6):620-4.
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ABSTRACT: Placenta percreta with pelvic organ invasion carries a high mortality for mother and fetus. Appropriate multidisciplinary consultation, strategy, and preoperative planning for Cesarean hysterectomy permitted caregivers to provide a maternal-infant bonding experience, surgical hemostasis, preservation of bladder function, and a healthy, vigorous neonate.
Journal of clinical anesthesia 05/2010; 22(3):209-12. · 1.32 Impact Factor
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ABSTRACT: Substance abuse in pregnancy has increased over the past three decades in the United States, resulting in approximately 225,000 infants yearly with prenatal exposure to illicit substances. Routine screening and the education of women of child bearing age remain the most important ways to reduce addiction in pregnancy. Legal and illegal substances and their effect on pregnancy discussed in this review include opiates, cocaine, alcohol, tobacco, marijuana, and amphetamines. Most literature regarding opiate abuse is derived from clinical experience with heroin and methadone. Poor obstetric outcomes can be up to six times higher in patients abusing opiates. Neonatal care must be specialized to treat symptoms of withdrawal. Cocaine use in pregnancy can lead to spontaneous abortion, preterm births, placental abruption, and congenital anomalies. Neonatal issues include poor feeding, lethargy, and seizures. Mothers using cocaine require specialized prenatal care and the neonate may require extra supportive care. More than 50% of women in their reproductive years use alcohol. Alcohol is a teratogen and its effects can include spontaneous abortion, growth restriction, birth defects, and mental retardation. Fetal alcohol spectrum disorder can have long-term sequelae for the infant. Tobacco use is high among pregnant women, but this can be a time of great motivation to begin cessation efforts. Long-term effects of prenatal tobacco exposure include spontaneous abortion, ectopic pregnancy, placental insufficiency, low birth weight, fetal growth restriction, preterm delivery, childhood respiratory disease, and behavioral issues. Marijuana use can lead to fetal growth restriction, as well as withdrawal symptoms in the neonate. Lastly, amphetamines can lead to congenital anomalies and other poor obstetric outcomes. Once recognized, a multidisciplinary approach can lead to improved maternal and neonatal outcomes.
Journal of Addictive Diseases 04/2010; 29(2):175-91. · 1.46 Impact Factor
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ABSTRACT: Squamous cell carcinoma of the vulva has predominantly been a disease of the older people. The incidence of invasive vulvar carcinoma has been increasing in women younger than 40 years. It has been rarely described in pregnancy. Our limited knowledge of vulvar cancer in pregnancy presents physicians with a therapeutic dilemma. The literature available to date is limited to 26 case reports.
Treatment options during pregnancy based on case reports include conservative management, vulvectomy, radical vulvectomy, wide excision, local excision, and palliative radiation therapy during the postpartum period. In the attempt to reduce morbidity of surgical dissection, sentinel lymph node biopsy has been shown to be an effective technique in vulvar cancer outside pregnancy. Although not well established, the lymphatic mapping and sentinel lymph node detection are feasible during pregnancy.
Journal of Lower Genital Tract Disease 09/2009; 13(4):264-268. · 1.07 Impact Factor
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Prenatal Diagnosis 09/2009; 29(11):1091-3. · 2.11 Impact Factor
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ABSTRACT: Mallory-Weiss tears occur rarely during pregnancy, labour and delivery, and the puerperium, despite the increased frequency of retching and vomiting.
We describe a Mallory-Weiss syndrome diagnosed during the immediate postpartum period in a 34-year-old primigravida. The syndrome initially manifested as lower gastrointestinal bleeding and melena.
If unrecognized, this complication may lead to life-threatening internal bleeding. It is important to look for an occult bleeding source with such a presentation, and prompt intervention is essential.
Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 08/2009; 31(8):740-3.
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ABSTRACT: To compare the results of cold knife conization (CKC) and loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia to determine if excisional method has effects on pathologic interpretation.
Retrospective review of the perioperative medical records of patients who had a CKC and electrosurgical loop excision of cervix. Patients selected had either primary treatment for cervical intraepithelial neoplasia, suspected invasion, glandular abnormalities or discordant cytology.
Among the eligible patients, 61 had CKC and 96 had LEEP. Overall, CKC specimens had interpretable surgical margins more frequently than LEEP (95% vs 85%); however, it was not statistically significant (p=.1). Margins were less likely to be involved with neoplasia in CKC specimens (16% vs 38%; p=.005). Loop electrosurgical excision procedure specimens were less likely to yield a single intact specimen (1.1 vs 1.9; p=.000). Logistic regression showed a significant effect of specimen number (p=.04) on interpretability.
Current American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines for diagnostic excisional procedure used for glandular lesions suggest that the procedure provides "an intact specimen with interpretable margins." Loop electrosurgical excision procedure in the current study was associated with an increased number of specimens that limited interpretability and an increased number of positive margins. Cold knife conization is preferred in cases where margin status is critical, such as glandular lesions and suspected microinvasion. If LEEP is performed, clinicians should attempt to obtain a single surgical specimen maximizing the pathologic interpretation and disease-free margins.
Journal of Lower Genital Tract Disease 02/2009; 13(1):10-2. · 1.07 Impact Factor
