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A 62 year old woman presented with post-menopausal bleeding occurring at least for three months. The patient underwent an echography which showed a multiple myomatous uterus with enhanced thickening of the endometrium uper than 20mm.After hysterectomy, gross examination showed a myomatous uterine-body lined in some places by a friable thickened process(arrow-a) distant of the cervix. Histological examination found, in addition to interstitial myomas, a process consisted of papillary structures with fibro vascular cores covered by several cell layers with large amounts of cytoplasm and pleomorphic hyper chromatic nuclei (b-c).Nucleoli was inconspicuous. The invasive front of the tumor was of the pushing type, and the deeply located neoplastic cells were ovoid with a pale eosinophilic cytoplasm, resembling urothelial cells (d) these cells represented 15% of the total tumor volume. No glandular endometrioid component was found: A diagnosis of papillary squamous cell carcinoma with foci of transitional cell differenciation was made. The tumor did not reach the cervix or the adnexa which were entirely examined microscopically. Transitional cell differenciation in endometrial carcinomas is extremely uncommon, with fewer than 15 cases reported. Lower transitional cell differenciation qualifies the tumor as a mixed carcinoma with transitional cell differenciation. A pure transitional cell carcinoma of the endometrium is a carcinoma in which 90% of more of the neoplastic cells resemble the urothelial transitional cells: an uncommon condition with seventy cases reported.

The assessment of the uterine cavity in patients with infertility is essential as many intrauterine lesions can be detected. Transvaginal ultrasound (TVE) is a front-line testing for female infertility. It allows assessment of the uterine cavity for detection of abnormalities responsible for fertility disorder as well as of lesions that may lead to transfer or implantation failures. It is an easily perfomable and reproducible exam. The purpose of our study is to describe endometrial lesions detectable on TVE in order to highlight the role of TVE in the evaluation of infertility. [ABSTRACT FROM AUTHOR]

The advances in embryo culture and cryopreservation techniques associated with the potential deleterious effects of ovarian stimulation (SO) on endometrial receptivity and the risk of ovarian hyperstimulation syndrome (SHSO) has allowed the emergence of the "freeze all" strategy. It consists in delaying the transfer of embryos during a cycle without SO and therefore not exposed to supra physiological levels of hormones. Theoretically, this strategy would improve the outcome in terms of efficacy and safety for all patients who undergo OS for IVF/ ICSI. However, according to the recent publications, it appears that, in clinical practice, the strategy of freeze all would be beneficial only for some subgroups of patients: women at risk of OHSS, hyper-responders and candidates for preimplantation genetic diagnosis. In these situations, the freeze all strategy is justified and even recommended. In other situations, freeze all does not seem to bring any improvement in clinical or obstetric or neonatal outcomes. [ABSTRACT FROM AUTHOR]

Tuberculosis is a public health problem, especially in the developing countries. Bacillary pulmonary tuberculosis is the most common form of tuberculosis while genital tuberculosis is rare and underdiagnosed. We here report a case of endometrial tuberculosis. The study involved a 72-year old female patient with SC hemoglobinopathy consulting her gynecologist because of chronic leukorrhea. Cytobacteriologic assessment of vaginal swabs showed Streptococcus agalactatiae. Despite suitable antibiotic therapy, the evolution was marked by the persistence of leukorrhea. Pelvic ultrasonography objectified thickened endometrium, appearing as hyperechoic at the base of the uterus. This was suggestive of endometrial cancer. Anatomo-pathological examination of endometrial curettage samples showed granulomatous endometritis suggesting follicular tuberculosis. Outcome was favorable under antituberculosis treatment. In TB endemic areas, genital tuberculosis is not exceptional and should be suspected in patients with chronic leukorrhea despite suitable treatment. [ABSTRACT FROM AUTHOR]

Although it is known that breast cancer can metastasize to many organ sites, metastasis to the uterus is uncommon and usually occurs during widespread metastatic disease. Lobular carcinoma is not the most common histological subtypes of breast carcinoma, but it is the most frequent histologic type that causes gastrointestinal, gynecological and peritoneal metastases. The main symptoms of the uterine metastasis depend on the anatomic involvement site. Abnormal uterine bleeding is by far the most important symptom.We highlight the importance of the follow up of patient with breast cancer. A rapid endometrial sampling for confirmation of the diagnosis, should be performed when the routine gynecological follow-up revealed any abnormality. We report two original observations of endometrium metastases of invasive lobular carcinoma of the breast which we detected during follow-up.

In this paper, we report a case of primary squamous cell carcinoma of the endometrium (PSCCE) with a literature review. A 64-year-old woman, was admitted because postmenopausal bleeding. The gynecological exam found bleeding from the endocervix. The pelvic ultrasound objectified uterine regular contours, endometrial thickened was 10 mm, the presence of an intra cavitary lesion mesuring 56/70 mm. The diagnostic hysteroscopy revealed a whitish appearance taking all the uterine cavity making evoke a tumor of the endometrium. Pelvic MRI showed a tumor limited to the uterine corpus endometrium (invasion by more than 50% of the myometrium) without invasion of the cervix. Radical hysterectomy, bilateral salpingo-oophorectomy, and lymph nodes dissection were performed. Grossly, the endometrial carcinoma was polypoid tumor occupying the entire uterine cavity. Histologically, the diagnosis of SCC was retained. No adenocarcinoma element was recognized. Neither squamous metaplasia nor dysplasia was recognized. No ectopic cervical tissue was found. The SCC was found to invade into deeper one half of the myometrium. No tumor cells were seen in other sites including the cervix, ovaries, parametres, and lymph nodes. The patients was FIGO 2009 stage IB (pT1B, N0), and was treated with adjuvant radiation. The patient had a disease progression in the pelvis 3 months after the irradiation. We reported a case of PSCCE which can help to enrich the literature for the treatment and prognosis of this disease.

Résumé Les traitements hormonaux de la ménopause (THM) estroprogestatifs sont reconnus cancérogènes pour l’humain. Dans cette mise au point, les associations entre la prise de THM et la survenue de cancers du sein, de l’ovaire et l’endomètre sont présentées, notamment en fonction des modalités de traitement. Si un THM doit être prescrit, il est préférable d’utiliser la dose la plus faible pendant une durée la plus courte possible. Il est recommandé de discuter avec la patiente des bénéfices et des risques du traitement, et de faire un suivi gynécologique régulier. Estrogen-progestagen menopausal hormonal therapy (MHT) is recognized as carcinogenic to humans. The article presents the associations between MHT and breast, ovary and endometrial cancer risks, in particular according to treatment modalities. If MHT must be prescribed, it is recommended to use the lowest dose for the shortest possible duration. Discussing with the patient the benefits but also the risks and making regular gynecological follow-up are strongly encouraged. [ABSTRACT FROM AUTHOR]

Endometrial cancer is the most common gynecological cancer in the Western world. It affects mainly postmenopausal women. The aim of our study is to report the experience of the radiotherapy department of the National Oncology Institute (INO) in the treatment of endometrial cancer. We retrospectively analyzed 52 cases of endometrial cancer treated in the INO radiotherapy department between 2007-2009. Data obtained from the patient medical records were related to the epidemiologic, clinical, therapeutic and evolutionary aspects of this cancer. The median age of the patients was 57 years, 87% were postmenopausal. The median of consultation time was six months. The main symptom was metrorrhagia (51 patients). Histological diagnosis was based on biopsic curettage of uterine endometrium in 51% of the cases. Anatomo-pathological examination showed an endometrioid adenocarcinoma in 92% of the cases. After the assessment, 27% of the patients were stage I, 30% stage II, 20% stage III and 1% stage IVA, according to the International Federation of Gynecological and Obstetrics (FIGO) stage classification. After surgery, 51% of the patients received postoperative external radiotherapy. The delivered dose was 46 Gray (Gy). All patients received internal vaginal brachytherapy. From an evolutionary perspective, 83% of the patients had no recurrences during the follow-up period, 8% of patients had a local recurrence and 4% of patients had distant metastases. Therefore, surgery is the main treatment for endometrial cancer. Radiotherapy is the primary adjuvant treatment. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Cancer / Journal Africain du Cancer is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Carcinosarcoma of the uterus is a rare tumor representing 2-4% of uterine malignancies. Its prognosis is poor with a 5 years survival rate of 10-30%. We report a first documented case of carcinosarcoma occurring in a 62 years old woman who presented with postmenopausal vaginal bleeding for one year. The preoperative biopsy of endometrium revealed a leiomyosarcoma. Total body Computerized Tomography (CT) Scan revealed a mass limited to the uterus without other abnormalities. We carried out a total abdominal hysterectomy with bilateral salpingo-oophorectomy. Post operative histology of the specimen found a carcinosarcoma. The patient underwent a course of radiotherapy and a total body CT Scan done eight months later revealed no signs of recurrence or metastasis. Clinicopathological aspects, treatment options and prognosis of this aggressive neoplasm are reviewed. We recommend practitioners to be aware of this lesion for an early diagnosis and appropriate treatment.

A rare case of tubercular endometritis occurred in a 55-year-old Para 7, postmenopausal woman, who presented herself for cervical smear at the Medical Womens Centre in Enugu, the capital of Enugu State of Nigeria. The senior author (WO) observed at microscopy the diagnostic Langhans giant cells. This was the only case encountered among 3,267 smears examined between 1993 and 2010. Subsequently, laboratory tests were carried out. The Mantoux test was positive at 14 mm. The ESR measured 52 mm in the first hour. The Total White Count was 7,200/mm. The differential count showed Neutrophils 51%, Lymphocytes 35%, Eosinophils 13%, and Monocytes 1%. Treatment for tuberculosis was instituted and the follow up has been successful.

Résumé: Les selective progesterone receptor modulators (SPRM) sont des molécules agonistes et/ou antagonistes du récepteur de la progestérone. Ils sont responsables d’une anovulation, d’une aménorrhée et d’une baisse des prostaglandines, ce qui entraîne une amélioration des douleurs et une régression des lésions dans l’endométriose. Au niveau endométrial, un aspect particulier, le progesterone receptor modulator-associated endometrial change (PAEC), suscite des études complémentaires pour vérifier son innocuité. Cependant, du fait de l’absence d’hypo-œstrogénie et d’effet métabolique avec ces molécules, il est très probable que les SPRM prendront dans un futur proche une place primordiale dans le traitement de l’endométriose. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: Évaluer les bénéfices de la cryopréservation embryonnaire en situation d’hyper-réponse en termes de prévention de l’OHSS et de taux de grossesses clinique. Patients et méthodes: Cette étude rétrospective a concerné 66 patientes réparties en deux groupes. Groupe 1 (n =24), cryopréservation de l’ensemble de la cohorte embryonnaire en raison du risque du syndrome d’hyperstimulation ovarienne (OHSS). Groupe 2 (n =42), transfert embryonnaire frais réalisé malgré une hyper-réponse ovarienne (E2 JhCG>4000pg/mL). L’issue des tentatives (incidence de l’OHSS tardive, taux d’implantation, taux de grossesses cliniques, de naissances vivantes et de fausses couches spontanées précoces (FCS) a été comparée dans ces deux groupes. Résultats: Aucun cas d’OHSS tardive n’a été observé dans le groupe 1 alors que l’incidence a été de 40,5 % dans le groupe 2. Les résultats obtenus dans le groupe 2 après transfert frais ont été les suivants : taux d’implantation : 12,9 % ; taux de grossesses cliniques par transfert : 21,4 % et taux de FCS précoces : 22,2 %. En revanche, après décongélation embryonnaire, les résultats étaient comparables pour les deux groupes concernant les taux d’implantation et de grossesses cliniques. Il existait néanmoins une différence significative en faveur du groupe 1 concernant les taux de FCS précoces (15,4 % vs 67 %, p =0,04) et de naissances vivantes (27 % vs 11,4 %, p <0,01) Discussion et conclusion: Les effets délétères de l’hyperestrogénie semblent se limiter à l’endomètre sans impact déterminant sur la qualité ovocytaire et/ou embryonnaire. L’annulation du transfert frais associée à la cryopréservation embryonnaire est une stratégie efficace pour prévenir l’OHSS sans altérer les taux de grossesses et de naissances vivantes lors des cycles de décongélation ultérieurs. [ABSTRACT FROM AUTHOR]

Abstract: Oocyte donation is offered to patients with premature ovarian failure to achieve pregnancy when no other assisted reproductive technology is possible. Some clinical and biological factors have been identified for influencing the outcome of oocyte donation cycles. Embryo implantation depends on embryo quality, method for the embryo transfer, and endometrial differentiation. In our center, the oocyte recipients receive for the endometrial preparatory cycle the same treatment that for the patients undergoing frozen embryos transfers, with good clinical pregnancy rates, about 35% per transfer. Estrogen and progesterone supplementation with GnRH agonist down regulation are used in synchronized protocols or for frozen embryos transfers. The synchronization between recipient''s endometrium and donor''s ovarian stimulation is very restrictive. Nowadays, the oocytes vitrification lithens the oocyte donation process: the endometrial preparation has a limited duration and is well controlled, and embryos that are transferred are all fresh embryos. [Copyright &y& Elsevier]

Abstract: Mild stimulation is the administration of low doses (150IU/day) of FSH, continuously, from the fifth day of the cycle, associated with the administration of GnRH antagonists. Despite the lower number of oocytes collected during mild stimulation, they are better for pregnancy rates on with an endometrium nearest closer to the natural cycle, and reducing the risk of ovarian hyperstimulation. Although the number of IVF±ICSI attempts is limited to 4 in France, the Mild stimulation may be proposed in young women, those with a polycystic ovary syndrome or “low responder” women. [Copyright &y& Elsevier]

Abstract: The ectopic decidua is a common occurrence during pregnancy, corresponding to the presence of decidual tissue outside the endometrium. The pathophysiology of these lesions is not yet fully elucidated. The phenomenon is most often benign, with a favourable outcome in the post-partum and without follow-up. Because of the wide range of clinical presentations, from localized peritoneal granulation to large pelvic mass, the clinical diagnosis of ectopic decidua is difficult. Furthermore, imaging is not specific. The discovery of such lesions should lead to the realization of systematic biopsies for histological examination and rule out other causes such as lesions of tuberculosis or carcinomatosis. Immunohistochemical studies are helpful in differentiating deciduosis from malignant deciduoid mesothelioma, its main differential diagnosis with a catastrophic prognosis. [Copyright &y& Elsevier]

Abstract: Objectives: To study the evolution of subendometrial vascularization flow index (VFI) in controlled ovarian hyperstimulation (COH+IIU) cycles and compare its dynamic changes in pregnant and non pregnant women. Patients and methods: This is a retrospective study on 61 couples. To determine the profile of IVF just before ovulation, patients had 3D-Power Doppler angiography (3D-PDA) in this precise preovulatory phase. Results: We observed a decreasing profile of VFI in 52% (32/61) of the main group cycles, in 45% (14/31) of the subgroup with spontaneous peak of LH (luteinizing hormone), and in 60% (18/30) of the hCG (human chorionic gonadotropin) trigger subgroup. There were ten conceptions, (10/61, 16.4%), including eight (8/32, 30%) that were associated with a decreasing profile of VFI versus two (2/29, 7%) that were associated with an increasing profile (NS). In the detection of LH peak subgroup, we observed five conceptions (5/14, 36%) associated with a decreasing profile versus one conception (1/17, 6%) associated with an increasing profile of VFI (OR: 8.3; confidence interval [CI] 95%: 0.8–444; P =0.06 in favor of a of decreasing VFI profile). In the hCG subgroup, there were three conceptions in the decreasing VFI profile (3/18, 17%) and one conception with increasing VFI (1/12, 17%, P =0.6). Discussion and conclusion: In controlled ovarian hyperstimulation, a decreasing VFI profile is more common compared to an increasing one. Such au profile seems to be associated with a higher conception rate in cycles with spontaneous LH surge. [Copyright &y& Elsevier]

Copyright of African Journal of Cancer / Journal Africain du Cancer is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Localisation of endometriosis on the sciatic nerve is exceptional. We report the case of a patient presenting an endometriotic nodule of the left ischio-rectal excavation, with an extension contiguous to the sciatic nerve, responsible of invalidating sciatalgia. Two laparoscopies did not allow to localise the lesion. Finally the endometriotic nodule was treated by a direct access of the left ischio-rectal excavation through a pararectal incision. In this article we discuss the means to localise such lesion and the surgical approach to propose. [Copyright &y& Elsevier]

Abstract: Deep infiltrating endometriosis is a well-known female disease responsible for chronic pelvic pain, urinary dysfunction, infertility, and altered quality of life. Endometriosis and infertility are complex entities and the optimal choice of management of both of them remains obscure. Mechanism of development of the disease has to be understood to optimize patients care. The link between barrenness and endometriosis is well known, but there is no direct link between bladder lesion and infertility. Bladder endometriosis is a deeply infiltrating endometriosis lesion. Its management is first diagnostic and then remedial. In case of ineffectiveness of medical strategy, surgical treatment is indicated. However, for patient suffering from symptomatic isolated bladder endometriosis, surgical management can be offered in first intention. Isolated bladder injuries due to endometriosis are mostly treated by conservative laparoscopic surgery, after a complete evaluation of endometriosis disease and barrenness by clinical exam and imaging techniques. [Copyright &y& Elsevier]

Abstract: Endometriosis, defined by the development of endometrial tisue outside the uterus, is a benign disease responsible for infertility and pelvic pain. The diagnosis based on a detailed gynecological history and a careful clinical examination should be done as early as possible in order to treat patients correctly. Medical treatment is not appropriate in all cases and surgical treatment should be proposed but morbidity is related to the severity of the lesion. Ectopic implantation of endometrial cells needs complex interactions between host tissue and epithelial endometrial cells. The conditions for the development of endometriosis are estrogeno-dependent growth of endometrial cells, induction of angiogenesis and lymphangiogenesis. Principal cellular and molecular factors of angiogenesis, lymphangiogenesis and fibrosis should be identified in order to develop new therapeutic strategies of endometriosis. [Copyright &y& Elsevier]

The infertility in women with an abnormal uterus seems a subject of controversy. The prognosis of in vitro fertilization among these patients with such an anomaly is even less founded. The results of in vitro fertilization have been only studied with few patients and recently. Through the literature, we will focus step by step, on the impact of uterine anomalies on natural reproduction, then the impact of metroplasty on natural reproduction, the role of anomalies on the endometrium quality and lastly, the results of Assisted Rerpoductive Techniques with women with such an anomaly. It seems that the main risk is obstetric complications such as spontaneous abortion or premature delivery, not implantation failure. However, when infertility exists, surgical treatment tends to improve the pregnancy rate for some. [Copyright &y& Elsevier]

This study reports the case of a 46-year old multiparous patient with no particular past medical history, who had given birth vaginally twice, presenting with abnormal isolated inter-menstrual bleeding with well-defined bluish cyst at the level of the anterior labia of the cervix, measuring 4mm in diameter on speculum examination. Pelvic ultrasound showed adenomyosis. A biopsy of the lesion was performed, which showed dark brown chocolate colour liquid. Histological study objectified endometrium embedded under the epithelium, suggesting endometriosis of the uterine cervix. Endometriosis of the uterine cervix can involve the endocervix and the ectocervix. Primary endometriosis of the uterine cervix can develop in the cervix while secondary endometriosis can result from neighboring endometriosis. Trauma is the main cause of these lesions. The de-epithelialization caused by trauma would allow for endometrial transplantation during menstruation. Endometriosis of the uterine cervix is usually asymptomatic. It is usually discovered during a careful systematic examination of the uterine cervix. Rarely, it manifests as minimal, spontaneous metrorrhagias in the premenstrual period. Sometimes, metrorrhagias occur during menstruations and are persistent or are caused by sexual intercourses. Isolated endometriosis of the uterine cervix never causes pain. The treatment of this benign condition is based on the destruction or removal of the endometriosis foci. Diathermocoagulation is the most used procedure. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of this survey was to value the contribution of saline infusion sonography (SIS) to endometrial pathologies diagnosis in a context of work where hysterography is the reference exam rather than hysteroscopy. Patients and methods: A prospective comparative cohort survey led at Yopougon''s teaching hospital, from July 1st to April 30th 2003. This study concerned 65 patients. The sensitivity, the specificity, and the Kappa test have been calculated from the morbid results. Results: The SIS has been successfully carried out among 63 patients (96,8%). The polyps (23,8%), and the mucous myomas (14%) dominate the endometrial pathologies. The analysis of the results indicated sensitivity and a global specificity respectively of 100% and 76,5%. The dissonant diagnoses have been decided in 82% of the cases in favour of SIS. Besides, SIS permits to save 31.67 Euros/patient. Discussion and conclusion: SIS could therefore constitute a tool of choice for the exploration of the uterine cavity in the developing countries. [Copyright &y& Elsevier]

Copyright of EMC-Gynecologie--Obstetrique is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: The objective of this short review is to identify the particularities of women with endometriosis, especially those complaining of pain and with the most severe lesions. Genetic aberrations play, with a high probability, a major role in the development of this disease, its severity, its tendency to recur and also in its capacity to degenerate. The abnormalities of the endometrium, with exacerbated biological activities, are an example. The woman with endometriosis seems more sensitive to pain through various mechanisms, such as central hypersensitivity and decrease threshold to somatoceptive pain and several associated psychological disorders. Endometriosis is often associated with other painful conditions such as irritable bowel syndrome, interstitial cystitis and fibromyalgia. Finally, also appears also to have a higher risk to develop non Hogkin''s lymphoma or ovarian cancer. These particularities, some of them being still speculative or controversial, should be known in routine practise, in order to offer a better multidisciplianry managament, not only for short term, but also long term issues. [Copyright &y& Elsevier]

Embryo implantation is a multifactorial event. Biochemical factors are implicated in the quality of the endometrium and in its vascularization. The non-invasive vaginal scan studies the endometrial morphology whereas color and power Doppler studies its vascularity. Through an analysis of the literature, we point out the interest of those techniques in ART. [Copyright &y& Elsevier]

We report four cases of mixed mu¨llerian tumors of the endometrium arising in postmenopausal women taking tamoxifen for breast carcinoma. Various histopathologic features were encountered: one mu¨llerian adenosarcoma and three malignant mixed mu¨llerian tumors so called carcinosarcomas (in one case the sarcomatous component was homologous composed of tissues normally found in the uterus, while the others were heterologous because they were containing some elements normally not found in the uterus). Concern has been raised about prolonged tamoxifen treatment and subsequent occurrence of endometrial adenocarcinoma.  Then, attention has been drawn through high-risk histologic subtypes including poorly differentiated patterns, uterine sarcomas and such mixed mu¨llerian tumors. There is no consensus regarding internal surveillance of women receiving tamoxifen. The usefulness of pelvic sonography has not been demonstrated. [Copyright &y& Elsevier]

Tamoxifen estrogenic action in the uterus induces several uterine diseases, benign and/or malignant ones. The risk of endometrial adenocarcinoma is multiplied by two to three in post-menopausal women. It is mainly linked with the doses and the length of the treatment. However, the global benefit of that drug is not questioned anymore. What matters now though is to find the best way to follow patients on tamoxifen. As a matter of fact, there is no such thing as a consensus that would include specific tests, nor a surveillance protocol in women on tamoxifen. Most teams do not propose any special follow-up. Some patients already show uterine anomalies prior to the beginning of tamoxifen treatment. A yearly gynecologic examination, together with a cervico-vaginal smear, is enough when there are no specific endometrial adenocarcinoma risk factors, nor anomalies detected during the pre-therapeutical evaluation, nor clinical symptomatology. In case of risk factors, or cervical stenosis, or again initial abnormalities though, a yearly transvaginal sonography may be proposed. There is no need for other exploratory examinations if the results are satisfying. In case of symptoms, anomalies in the cervico-vaginal smears, intra-uterine liquid retention with a stenosed cervix, or suspicious endometrial thickness, then an endometrial sampling must be carried out. MRI could be of interest in asymptomatic patients with unclear ultrasonography images. Follow-up must be continued after interruption of tamoxifen. It is important to inform patients about the additional risks of developing an endometrial cancer because of tamoxifen, while still being reassuring. Besides, it is absolutely necessary to recommend them to take quickly medical advice in case of gynecologic symptoms. [Copyright &y& Elsevier]

Endometrial adenocarcinomas rank third as tumoral sites en France. The tumors are confined to the uterus in 80% of the cases. Brachytherapy has a large place in the therapeutic strategy. The gold standard treatment remains extrafascial hysterectomy with bilateral annexiectomyand bilateral internal iliac lymph node dissection. However, after surgery alone, the rate of locoregional relapses reaches 4–20%, which is reduced to 0–5% after postoperative brachytherapy of the vaginal cuff. This postoperative brachytherapy is delivered as outpatients treatment, by 3 or 4 fractions, at high dose rate. The uterovaginal preoperative brachytherapy remains well adapted to the tumors which involve the uterine cervix. Patients presenting a localized tumor but not operable for general reasons (< 10%) can be treated with success by exclusive irradiation, which associates a pelvic irradiation followed byan uterovaginal brachytherapy. A high local control of about 80–90% is obtained, a little lower than surgery, with a higher risk of late complications. Last but not least, local relapses in the vaginal cuff, or in the perimeatic area, can be treated by interstitial salvage brachytherapy, associated if possible with external beam irradiation. The local control is reached in half of the patients, but metastatic dissemination is frequent. We conclude that brachytherapy has a major role in the treatment of endometrial adenocarcinomas, in combination with surgery, or with external beam irradiation for not operable patients or in case of local relapses. It should use new technologies now available including computerized afterloaders and 3D dose calculation. [Copyright &y& Elsevier]

Objective. - To evaluate the risk of discovering an endometrial cancer when atypical hyperplasia was diagnosed by either endometrial samples using the pipelle device or hysteroscopic resection products. Patients and method. - A retrospective monocentric study from january 1990 to july 2000. Twenty-three patients with atypical hyperplasia were included. Initial endometrial status was provided by endometrial biopsyduring diagnosis hysteroscopy (12 cases) or by operative hysteroscopic resection products (11 cases). For 23 patients, operative hysteroscopy and analyse of products resected were performed. For all patients, there was no hysteroscopical aspect evocative of adenocarcinoma. For 23 patients, histopathological analysis of the hysterectomy piece precised the final diagnosis. Results. - Among the 23 hysterectomy pieces, 7 adenocarcinomas were diagnosed (30.4%). Risk for discovering adenocarcinoma when atypical hyperplasia was diagnosed by means of the pipelle biopsy device was 50% (6/12). Risk for discovering adenocarcinoma when atypical hyperplasia was diagnosed by means of operative hysteroscopy resection products was 5.9 % (1/17). Discussion and conclusion. - Atypical endometrial hyperplasia evidenced by pipelle biopsy device is often associated with adenocarcinoma. Diagnosis hysteroscopy however does not show evident pathological aspect of adenocarcinoma in such cases. Operative hysteroscopy allows in most cases correction of endometrial status. Risk of omitting adenocarcinoma when atypical hyperplasia is discovered on hysteroscopic resection pieces is low. [ABSTRACT FROM AUTHOR]

Estrogens act through specific receptors located in the nuclei of epithelial and stromal cells of the endometrium. Estrogens stimulate the synthesis of these receptors and the progesterone inhibits their synthesis. Estrogens induce the proliferation of the mucosa during the proliferative phase. They also stimulate the synthesis of receptors for the progesterone, which is a prerequisite for progesterone activity. Hyperplasias most of the time do not contain cytological atypia and are developed under a hyperestrogenic background. They contain receptors for estrogen and progesterone, and are able to respond to progestogens. Hyperplasias with cytological atypia are precancerous lesions, associated with an hyperestrogenic or atrophic background. In the later case, they may be focal and are better diagnosed by hysteroscopy. They are best managed by simple hysterectomy. Progesterone may be used if the patient desires to conceive. Endometrial cancers are either associated with an hyperestrogenic or atrophic background. In the later case, they are often of serous or clear cell type. Endometrial effects of antiestrogens are known only for tamoxifene. Tamoxifene has an atrophic effect but sometimes may induce an estrogenic stimulation of the endometrial mucosa through the α and β estrogenic receptors. Polyp is the most frequent abnormality diagnosed but endometrial cancer is significantly more frequently diagnosed than in a control population. It is well differentiated and does not modify the survival of the patient. [Copyright &y& Elsevier]

Hysterosonography, which consists in the injection of some cc of saline in the uterine cavity during sonography, allows an exploration of the uterine cavity and of the endometrium. Accuracy of hysterosonography is similar to that of office hysteroscopy. Hysterosonography distinguishes normal cavities from pathologic ones, endometrial atrophy from mucosal anomalies, polyps from myomas. Conversely, endometrial biopsy is still necessary for diagnosis of hyperplasia or cancer. Hysterosonography can also be proposed for first trimester bleedings, trophoblast retention or ectopic pregnancy. In the near future it could be applied to therapeutic goals such as sonographic section of polyps. [Copyright &y& Elsevier]

Adenomyosis is a chronic benign uterine disease characterized by the presence of endometrial glands and stroma within the myometrium. It is a heterogeneous disease, presenting various clinical forms, depending on the location of the ectopic lesions within the myometrium. Adenomyosis can be responsible for several symptoms such as dysmenorrhea, abnormal uterine bleeding and/or infertility. Its pathophysiology is a real conundrum and several theories have been proposed: development of adenomyosis lesion could initiate de novo from Mullerian rests or from stem cells. Moreover, multiple factors could be involved in initiating lesions, including specific hormonal, immune and/or genetic changes. The objective of this review is to provide an update on adenomyosis pathophysiology, in particular on the various theories proposed concerning the invasion of the myometrium by endometrial cells and the inducing mechanisms, and to study the link between the physiopathology, the symptoms and the medical treatments., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Synechiae are intrauterine adhesions that affect the fertility of women. They are most often of post-traumatic origin. The management of pregnancy abortions in the first trimester and post-delivery retention are the main contributing factors. Synechiae is responsible for cycle disorders and repeated pregnancy loss. Hysteroscopy is the reference method for its diagnosis and treatment. The surgical objective is the restoration of a normal sized cavity and a functional endometrium to allow fertilization and implantation. The use of small diameter (5mm) hysteroscopes and no energy or bipolar energy instruments are recommended. Echo guidance facilitates the treatment of severe synechiae and limits the risk of intraoperative perforation. The main risk of treatment is recurrence, particularly in severe cases where multiple operating times are sometimes necessary. An office hysteroscopy at 6 weeks is recommended to identify and treat these recurrences. Different physical, molecular or cellular methods are studied as primary and secondary prevention of postoperative synechiae. The objective of this review is to provide an update on the treatment of synechiae in the context of infertility., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Diffuse adenomyosis, focal adenomyosis, ovarian endometrioma, superficial endometriosis and deep infiltrating adenomyosis are all defined by the presence of an endometrioid tissue in an ectopic location that is at distance from the endometrium. Although frequently associated, these lesions represent different clinico-pathological entities that the pathologist should recognized. Herein, we review the clinical and pathological features of these entities, as well as related current physiopathological understandings and differential diagnoses that could be raised by some morphological variants. The statistical association between endometriosis and several ovarian tumors, mainly endometrioid and clear cell carcinomas and seromucinous borderline tumors is well established and we present some molecular and morphological features that support this transformation potential., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)