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Malignant disease complicates pregnancy in up to 1 per 1,000-2,000 cases. Pregnancy itself does not constitute a predisposing factor for malignancy. Management and treatment of patients suffering from a malignancy during pregnancy still represents a challenge in everyday clinical practice. Recent advances in imaging, diagnostic and overall treatment modalities have tailored the management of patients, specifically those who wish to maintain the pregnancy. The aim of this review was to provide clinicians with concise information on the management of the most common malignancies during pregnancy. We performed a review of the current literature including review articles, original research articles and guidelines, which are used for the management of the most common malignancies during pregnancy. Breast, cervical and ovarian malignant tumours are the most common during pregnancy. However, the overall outcome and survival per stage for these cancers do not appear to be influenced by pregnancy. Ethical, emotional and treatment dilemmas may be encountered during treatment planning. Individualization of treatment planning should be made by a multidisciplinary team but the final decision rests with the parents. more...

Compared to laparotomy, laparoscopy has many benefits for patients, such as shorter recovery and lower morbidity rates. Port site metastases after laparoscopic approach in the treatment of gynecologic malignancies are uncommon. The purpose of this review is to identify and summarize possible risk factors for port-site metastases in patients undergoing laparoscopic surgery in the ambit of gynecologic oncology.The precise incidence of port-site metastases is not well known because many patients are not followed-up during the whole postoperative period. Possible risk factors that can increase the risk of port-site metastases can be the presence of large masses in the abdomen, especially in the presence of concomitant ascites and in patients treated for ovarian carcinomas. Different theories have been postulated in order to explain the development of port site metastases during laparoscopy for oncological patients.Patient selection is an essential factor that can influence the incidence of port site metastases in gynecological patients. Robust data regarding port site metastases in gynecologic oncology are needed. more...

Endometriosis is a common, estrogen-dependent, gynecological disease, which is defined as the presence of endometrial tissue outside the uterine cavity. Current data have associated endometriosis with specific malignancies, including ovarian and breast cancer.The purpose of our study is to summarize and present published literature providing evidence regarding the possible relationship between endometriosis and breast cancer.Pubmed and Scopus databases were searched systematically for studies that sought to identify a potential association of endometriosis and breast cancer. 15 relevant articles were retrieved and included in the present review.A small number of observational studies have shown a correlation of endometriosis and breast cancer. Other studies found that the risk of breast cancer increases with age. The scenario of an early interruption of the inflammatory process, derived from endometriosis, by oophorectomy and a possible consequent decrease in the risk of breast cancer has also been proposed. The hypothesis that both conditions could be related through common mutations on BRAC1 and BRAC2 genes has also been investigated.The available published evidence is inconclusive. Further studies are needed to evaluate the association of endometriosis and breast cancer and the possible pathogenetic pathways that relate the two disorders. more...

Local anesthetics combined with opioids are commonly used in labor epidural analgesic schemes. This study investigated if the addition of fentanyl to epidural ropivacaine can affect cervical dilation and progress of vaginal delivery.Sixty-two nulliparous parturients were randomized to receive epidurally 8 ml ropivacaine 0.2% combined with fentanyl 20 μg (F/R-group, n = 31) or with normal saline 0.4 ml (R-group, n = 31), every hour. Rescue doses of 5 ml ropivacaine 0.2% were also administered. Measurements were performed every 60 min until full cervical dilation. The primary end-point was the time to reach 10-cm cervical dilation. Secondary outcomes were Bishop scores, mode of delivery, total ropivacaine dose, pain, and satisfaction scores (numerical scale, 0-10).Data from 60 parturients (29 in the F/R and 31 in the R-group) were analyzed. The F/R-group had 26 vaginal deliveries (four instrumentally assisted), and three cesarean deliveries. The R-group had 27 vaginal deliveries (six instrumentally assisted) and 4 cesarean deliveries. Time to 10-cm cervical dilation did not differ between the groups (4 ± 2.4 h in the F/R-group vs 4.4 ± 2.1 h in the R-group, p = .341). The number of women remaining in the study every hour until full cervical dilation and Bishop scores for a 4-h period did not differ between the groups (p = .617). Total ropivacaine dose was comparable between the groups, but the F/R-group reported significantly lower pain (p = .01) and higher satisfaction scores (p = .001).The addition of fentanyl to ropivacaine 0.2% solution did not affect cervical dilation and progress of the first stage of labor, but improved both analgesia and satisfaction. more...

GnRH analogues are commonly used before hysteroscopic myomectomy to make surgery easier and safer, but they are expensive, have potential side effects and lack a robust evidence base to support this practice. We undertook a systematic review of the literature to determine whether, in women with submucous fibroids, pre-operative GnRH analogues were more effective than placebo/no treatment in terms of symptom relief, complications and ease of surgery. The outcomes were patient-reported relief of symptoms, complete resection of the fibroids, operative time and complications. Meta-analysis was performed where appropriate. Two trials including 86 women were identified. The assessment of symptom relief differed in the two trials: hence it was not possible to combine these data. The relative risk for completion of surgery and mean differences (95% confidence intervals) for operating time and fluid deficit were [0.94 (0.68-1.31); -5.34 min, (-7.55 min to -3.12 min) and -176.2 ml, (-281.05 ml to -71.5 ml)] respectively. Our results suggest that GnRHa may improve some outcomes but there is insufficient evidence to support their routine use prior to hysteroscopic resection of submucous fibroids. More randomised trials are needed to inform definitive conclusions. more...

Primary fallopian tube carcinoma (PFTC) is a rare gynaecological tumour that accounts for 0.14-1.8% of genital malignancies. The most common age of occurrence is between 40 and 65 years, and the mean age is 55 years. The factors that contribute to its appearance are not well known. Population studies show that the mean incidence of PFTC is 3.6 per million women per annum. Overall survival percentages for patients with PFTC are generally low, in the range of 22-57%. Pre-operative diagnosis is rare and PFTC is usually confirmed by a pathologist, but earlier diagnosis with early clinical manifestation and prompt investigation improves the prognosis. Both PFTC and epithelial ovarian cancer (EOC) are treated with similar surgical and chemotherapy methods. Studies have shown that the prognosis for PFTC is worse than that for EOC or other primary gynaecological tumours. This article reviews and presents the current updates of this rare gynaecological malignancy. more...

Triple-negative breast cancer (TNBC) lacks expression of estrogen receptor (ER), progesterone receptor (PR) and HER2 gene. It comprises approximately 15-20% of breast cancers (BCs). Unfortunately, TNBC's treatment continues to be a clinical problem because of its relatively poor prognosis, its aggressiveness and the lack of targeted therapies, leaving chemotherapy as the mainstay of treatment. It is essential to find new therapies against TNBC, in order to surpass the resistance and the invasiveness of already existing therapies. Given the fact that epigenetic processes control both the initiation and progression of TNBC, there is an increasing interest in the mechanisms, molecules and signaling pathways that participate at the epigenetic modulation of genes expressed in carcinogenesis. The acetylation of histone proteins provokes the transcription of genes involved in cell growth, and the expression of histone deacetylases (HDACs) is frequently up-regulated in many malignancies. Unfortunately, in the field of BC, HDAC inhibitors have shown limited effect as single agents. Nevertheless, their use in combination with kinase inhibitors, autophagy inhibitors, ionizing radiation, or two HDAC inhibitors together is currently being evaluated. HDAC inhibitors such as suberoylanilidehydroxamic acid (SAHA), sodium butyrate, mocetinostat, panobinostat, entinostat, YCW1 and N-(2- hydroxyphenyl)-2-propylpentanamide have shown promising therapeutic outcomes against TNBC, especially when they are used in combination with other anticancer agents. More studies concerning HDAC inhibitors in breast carcinomas along with a more accurate understanding of the TNBC's pathobiology are required for the possible identification of new therapeutic strategies. more...

With a lifetime risk estimated to be one in eight in industrialized countries, breast cancer is the most frequent type of cancer among women worldwide. Patients are often treated with anti-estrogens, but it is common that some tumors develop resistance to therapy. The causation and progression of cancer is controlled by epigenetic processes, so there is an ongoing interest in research into mechanisms, genes and signaling pathways associating carcinogenesis with epigenetic modulation of gene expression. Given the fact that histone deacetylases (HDACs) have a great impact on chromatin remodeling and epigenetics, their inhibitors have become a very interesting field of research. Aim: This review focused on the use of HDAC inhibitors as anticancer treatment and explains the mechanisms of therapeutic effects on breast cancer. We anticipate further clinical benefits of this new class of drugs, both as single agents and in combination therapy. Molecules such as suberoylanilide hydroxamic acid, trichostatin A, suberoylbis-hydroxamic acid, panobinostat, entinostat, valproic acid, sodium butyrate, SK7041, FTY720, N-(2-hydroxyphenyl)-2-propylpentanamide, Scriptaid, YCW1, santacruzamate A and ferrocenyl have shown promising antitumor effects against breast cancer. HDAC inhibitors consists an attractive field for targeted therapy against breast cancer. Future therapeutic strategies will include combination of HDAC inhibitors and chemotherapy or other inhibitors, in order to target multiple oncogenic signaling pathways. More trials are needed. more...

Malignant melanoma of the vagina is a rare, aggressive malignancy of poor prognosis. It principally affects post-menopausal women, with a mean age of 57 years, and the factors that contribute to its appearance are not well known. The first case of primary malignant vaginal melanoma was reported in 1887 and modern literature has noted about 500 cases, globally. Vaginal melanomas constitute 0.3% of all malignant melanomas and fewer than 3% of all vaginal carcinomas. To date there is no clear consensus regarding treatment. An early, accurate diagnosis and prompt investigation is essential in reaching appropriate treatment decisions. We present a clinical case of primary vaginal melanoma and review the literature briefly, presenting the current treatment plans and updates of this rare gynecological malignancy. Considerations, epidemiology, associated risk factors, response to therapy and expected outcome are also discussed. Conclusion: Primary malignant vaginal melanoma is a rare but aggressive melanoma that affects women in their 6th and 7th decade of life. The tumor appears as a dark node or spindle but can also be amelanotic. The size of the tumor is indicative of the prognostic factors. Surgery seems to be the only efficient treatment. Postoperative adjuvant therapy might help in preventing recurrence of the tumor. The survival rate is largely dependent on nodal and distant metastasis of the disease after initial tumor resection. There is a dire need to form a proper therapeutic regime to control this disease. more...

Operative laparoscopy compared with laparotomy has been established as the gold standard surgical approach in treating ovarian cysts. However, the safety of a laparoscopic cystectomy has been questioned in what has to do with the subsequent damage to the ovarian reserve of the operated ovary. One of the best available methods to determine ovarian reserve, due to its biochemical and pathological characteristics is anti-Mullerian hormone (AMH). With this study, we are reviewing currently available studies examining the effect laparoscopic operations have on AMH levels. more...

The needs of the uterus and the fetus for the provision of nutrients and oxygen, supplied by the blood flow, are understandably extremely high, with the circulatory system playing the most important role in this action. Abnormal vascular growth and transformation that create a high vessel resistance network have been associated with various pregnancy pathologies, including miscarriage, small for gestational age (SGA) fetuses with or without preeclampsia and intrauterine growth restriction (IUGR). Placental growth factor (PlGF) has a major role in vasculogenesis and angiogenesis in human placenta. Low concentrations of PlGF and high concentrations of its inhibitor-soluble Fms-like tyrosine kinase-1 (sFlt-1) are linked with impaired angiogenesis and placental development, leading to the above pregnancy complications. The activity of vascular endothelial growth factor (VEGF), which is the most potent of all angiogenic mediators, is partly modulated by PlGF. Although the mechanisms via which PlGF exerts its various effects are still under investigation, we herein discuss the known actions exerted by this major mediator together with its results on fetal growth. more...

The aim of the present study was to investigate the impact of anastrozole and letrozole supplementation following surgically induced menopause on bone metabolism and biomechanical properties. A total of 45 Wistar rats underwent ovariectomy and were then randomly allocated to receive no treatment, anastrozole or letrozole. At 2 and 4 months following the initiation of the present study, the serum levels of osteoprotegerin (OPG) and receptor activator of nuclear factor-κB ligand (RANKL) were determined, and the animals were sacrificed at the end of the 4-month period to assess the biomechanical properties of the femoral bones. The applied force and the deflection of the central section were recorded during the test. Taking advantage of these quantities, the fracture force, the stiffness of the bone and the energy absorbed until fracture were determined. At 2 months following the initiation of the experimental protocol, the mean OPG levels were significantly increased in the control group compared with the anastrozole-treated group (P more...

To evaluate the efficacy of misoprostol administrated vaginally on cervical priming and its complications prior to diagnostic or operative hysteroscopy in women who have undergone at least one cesarean section and who have never delivered vaginally before and/or had other transcervical procedure.A total of 55 patients undergoing hysteroscopy for various intra-uterine lesions were included in this study and were randomly allocated to two groups finally. Thirty patients in the study group were given 200 μg misoprostol vaginally 12 h before the procedure, whereas 25 patients in the control group did not receive any cervical priming. The countered outcome included the cervical width detected with Hegar dilatators and complication rates.Mean cervical width was greater in the study group (6.6 ± 1.3) than in the control group (5.1 ± 0.9). Complications and failure rates were lower in the study group.Application of 200 μg misoprostol vaginally 12 h before hysteroscopy softens the cervix, reduces cervical resistance and consequently the need for cervical dilatation, with only mild side effects. more...

To determine whether in vitro fertilization (IVF), frozen replacement cycles offer better outcomes than fresh cycles in order to support, or not, a possible shift towards total replacement of fresh IVF/intracytoplasmic sperm injection (ICSI) cycles from frozen elective transfers (FETs).Systematic review; opinion paper.Initial results seem to support a shift in current practice towards frozen cycles.Initial results may support replacement all fresh IVF/ICSI cycles with FETs, as this could be a safer and equally effective strategy. However, robust evidence from randomized controlled trials is needed if this will be generally applied. more...

Tuberous sclerosis (TS) or tuberous sclerosis complex (TSC), also known as Bourneville disease or Bourneville-Pringle disease, is an autosomal dominant disorder classically characterized by the presence of hamartomatous growths in multiple organs. A combination of symptoms may include seizures, developmental delay, behavioral problems, skin abnormalities, and lung and kidney diseases. The authors present a case of a 18 year-old female patient with a history of TS, epileptic episodes, mental retardation, and papillary formations in multiple organs located at the abdominal, axillary, cervical, facial, and genital region. more...

One of the most serious complications of assisted reproduction techniques is ovarian hyperstimulation syndrome (OHSS). OHSS not only increases morbidity and mortality in IFV cycles, but also causes significant other problems, as cancelled in vitro fertilization (IVF) cycles, prolonged hospitalization, causing emotional and sociofinancial consequences. Several treatments for OHSS have been proposed and among these Cabergoline (Cb2). Despite the above-mentioned beneficial effect, Cb2 has not been widely used in everyday's clinical practice. With our study, we try to review all studies with strong evidence examining Cb2 use for OHSS prevention. more...

Primary fallopian tube carcinoma (PFTC) is an uncommon gynecologic tumor, responsible for 0.14% to 1.8% of genital malignancies, with a mean incidence of 3.6 per million women per annum. The factors that contribute to its appearance are not well-known. Overall survival percentages for patients with PFTC are generally low. Although the preoperative diagnosis rarely occurs and it is usually first confirmed by the pathologist, an earlier diagnosis occurs with early clinical manifestation and prompt investigation leading to better prognosis. Both PFTC and epithelial ovarian cancer (EOC) are treated with similar surgical and chemotherapy methods. The authors report a case of a patient with bilateral high grade serous carcinoma of the fallopian tube, whose initial presentation was bilateral cystic adnexal masses and serosanguinous discharge, with no other pelvic involvement. This article also reviews in brief and presents updates of this rare gynecological malignancy. more...

Within the last decades, the percentage of diagnosed cervical cancer in women of reproductive age has increased. The possibility of diagnosing small cervical tumors (or = twocm) in childbearing age, can be explained due to the fact that many women, are aware of the benefits of Pap smear or colposcopy examination. Many demand a more conservative policy to handle such lesions in order to have an uneventful pregnancy in the near future. more...

Tuberous sclerosis (TS) or tuberous sclerosis complex (TSC), also known as Bourneville disease or Bourneville-Pringle disease, is an autosomal dominant disorder classically characterized by the presence of hamartomatous growths in multiple organs. A combination of symptoms may include seizures, developmental delay, behavioral problems, skin abnormalities, and lung and kidney diseases. The authors present a case of a 18 year-old female patient with a history of TS, epileptic episodes, mental retardation, and papillary formations in multiple organs located at the abdominal, axillary, cervical, facial, and genital region. more...

The objective of this study was to evaluate the effect oftamoxifen on the endometrium of45 postmenopausal women with breast cancer, as evidenced by hysteroscopic, ultrasound, histological methods, and by immunohistochemical investigation of the expression of Bcl-2 and Ki67.Forty-five postmenopausal women with breast cancer (ER and/or PgR positive) undergoing tamoxifen therapy for six to 48 months, were selected from the files of the 2nd Department of Obstetrics and Gynecology, University of Athens Aretaieion Hospital, among a total of 120 patients treated from 2004-2009.The ultrasound findings during the follow-up period revealed 18 cases of thickened endometrium, 14 cases of suspected polyps, one case with accumulation of endometrial fluid, and 12 cases of heterogeneous endometrial echo texture. The patients had undergone hysteroscopy because of thickened endometrium (18/45 patients), postmenopausal bleeding (14/45 patients), and polyps (13/45 patients). The endometrial tissue samples were examined in the Pathology Department of Aretaieion Hospital and showed in 23 cases with adenomatous endometrial polyps, 15 cases with endometrial cystic atrophy, two cases with adenomatous hyperplasia, and five cases with mucosal endometrial adhesions. Immunohistochemical investigation of Bcl-2 and KJ67 expression was undertaken on paraffin blocks and showed elevated expression in the cases with endometrial polyps and hyperplasia, in contrast to atrophic endometria.Long-term tamoxifen therapy of postmenopausal women with breast cancer is associated with uterine pathology. Ultrasonography alone is useful in asymptomatic patients selecting cases with increased endometrial thickness for further investigation. Hysteroscopy is an accurate method for diagnosing endometrial disease because it provides a direct view of the uterine cavity, reveals focal lesions, and enables targeted biopsies to be performed at the same time. Pathological findings show elevated expression of Ki67 and Bcl-2 in hyperplastic endometria and adenomatous polyps, consistent with an elevated glandular cell proliferation due to tamoxifen effect. more...

Introduction The issue of violence against women within the family, or as it is widely known domestic violence, is appearing now firmly as much in European policies as in Greek legislation in order to tackle and prevent this phenomenon. Unfortunately, European and Greek laws do not fully cover this important subject and as the respective studies show, domestic violence rates are increased. In the present review we are going to refer, briefly, to the historical background of the actions and the Greek legislation on this topic. Materials and Methods We investigated in libraries as well as on the web for “domestic violence”related articles and Greek court decisions on the matter in question for the last two decades. Access to sensitive data was obtained by every governmental body involved in our study. Results Before of the implementation of the proper legislation, no clear conceptual framework existed. We have to mention that the Greek law has become more specialized and sociallyorientated, aiming mostly at the cure of the revealed cases, rather than the punishment itself. Conclusion The issue of violence against women is very important and requires the participation of both the State, as well as the non-governmental non-profit organizations. Introduction The term of domestic violence is defined as violence in any form, whether it regards physical abuse, sexual abuse, neglect, gendered violence, emotional abuse (verbal), economic exploitation and trafficking. The complex nature of domestic violence, the various different interpretations of the phenomenon, the lack of sufficient recognition of the severity and several other factors led to the formation of stereotypes and the perpetuation of them, and as a result confusion about the nature and characteristics of the abuse within or outside the family1,2. The aim of this review was to discuss the history of actions as well as the evolution of legislation in Greece for domestic violence. Historical background Domestic violence is a very old phenomenon regarding its origins, while on the contrary, very recent as far as its social identification concerns. Social recognition of the phenomenon, its accession into the European agenda, the role of nongovernmental organizations as parts of the mechanism of influence and pressure and the feminist movement led to adoption of practices towards integration of the principle of equality in all EU policies. In particular, within the United Nations, one may identify International Research and Training Institute for the Advancement of Women (INSTRAW), United Nations Entity for Gender Equality and the Empowerment of Women (UNIFEM), Convention on the Elimination of all forms of Discrimination against Women (CEDAW), which in collaboration with the Division for the Advancement of Women (DAW) of the United Nations focus both on an effort to minimize the phenomenon and also to empower position of women in society3,4. The first draft of the Declaration of Violence against Women was constructed in 1992 and ratified in 1993. According to the United Nations any form of violence and circumvention of human rights, especially against women is condemned. Specifically in the article 1, the term violence against women means any act of violence based on gender and the article 2 includes physical or sexual violence within the family, rape within marriage as well as physical, sexual or emotional violence perpetrated or overlooked by the State in general5. At the same year, the United Nations Committee on the Elimination of Discrimination against Women (CEDAW) in accordance with the recommendation 19, condemned violence against women as the General Assembly of the United Nations in Vienna adopted the Declaration regarding the Elimination of Violence against Women6. In 1994, by decision of the Commission on Human Rights, specific measures to eliminate violence at national and international level were adopted through the causes and the consequences thereof, as well as the collection and analysis of data regarding to violence. The signalling that violence is no longer a private matter was established by the institution of the Special Rapporteur of the Commission on Human Rights on Violence against Women. According to article 4 of the UN Convention, the submission of national reports on government actions regarding the implementation of gender equality is *Corresponding author Email: kumusidi@doctors.org.uk 1 Family Planning Unit, 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Greece. more...

Debate is heating up whether or not to require girls to be vaccinated against the human papillomavirus (HPV), a leading cause of cervical cancer (CC). Prolepsis against this plague is mainly focused on early detection with Pap test (screening) and recently with administrating HPV vaccines in youths.To discuss the increased bioethical role of contemporary gynecologist in the young population, with the aim to contribute to the decrease of this malignancy.The authors searched the web (data-warehouse: articles, forums, etc., and data-mining: sequence analysis and classification) for HPV vaccination and related bioethical issues.HPV vaccines have already caused debates on whether they must be mandatory and on whether they cause a pseudo-safeness mental state, making youths "forget" necessary annual Pap tests or even worse, urging them in promiscuity, resulting in an increased occurrence of CC.Greece, in order to appropriately apply the Constitutional Law 5 Section 5 (All persons have the right to the protection of their health...), needs to train contemporary gynecologists in adequate youth consultation and proper family approaches regarding HPV vaccination issues. Enhancing the gynecologist's role, vaccination's effectiveness (sensitivity and specificity) will be increased and on the other hand, a rule of social law will be established in the country. more...

Introduction The percentage of couples around the world facing infertility problems is especially high, resulting in the acquisition of a child to become an unfulfilled desire. The medical definition of infertility is the failure of a couple to conceive following 12 months of free and frequent intercourse without any type of contraception. This review is divided into two subsections. In the first subsection, we briefly summarize the available methods of the assisted reproduction and deal with the medical procedures when an human immunodeficiency virus carrier wishes childbearing, and in the second subsection we discuss about the spread of AIDS through in vitro fertilization and the responsibility of the physician. Materials and methods We searched the medical literature and the relevant nomology on in vitro fertilization and human immunodeficiency virus. The information found in 19 sources of this search was uzed to form our narrative review. Results The main methods of assisted reproduction are discuszed: in vitro fertilization—intracytoplasmatic sperm injection,in vitro fertilization with surrogate motherhood, cryopreservation of genetic material and embryo, oocyte/sperm and embryo donation and preimplantation diagnosis for genital diseases. The issue of HIV and pregnancy was investigated. Conclusion Every decision should be taken with a resolution of all criteria, legal or clinical, and always taking into consideration the best service provision to the woman. more...

Primary fallopian tube carcinoma (PFTC) is a rare gynaecological tumour that accounts for 0.14-1.8% of genital malignancies. The most common age of occurrence is between 40 and 65 years, and the mean age is 55 years. The factors that contribute to its appearance are not well known. Population studies show that the mean incidence of PFTC is 3.6 per million women per annum. Overall survival percentages for patients with PFTC are generally low, in the range of 22-57%. Pre-operative diagnosis is-rare and PFTC is usually confirmed by a pathologist, but earlier diagnosis with early clinical manifestation and prompt investigation improves the prognosis. Both PFTC and epithelial ovarian cancer (EOC) are treated with similar surgical and chemotherapy methods. Studies have shown that the prognosis for PFTC is worse than that for EOC or other primary gynaecological tumours. This article reviews and presents the current updates of this rare gynaecological malignancy. (C) 2013 Elsevier Ireland Ltd. All rights reserved. more...

Verrucous carcinoma of the female genital tract is a rare lesion, primarily affecting postmenopausal women. We present a 78-year-old patient with verrucous carcinoma of the vulva, who was admitted to the “Aretaieion” Athens University Hospital. She had complained of vulvar itching during the last two years without visiting a specialist doctor. more...

To assess the diagnostic value of transvaginal sonography (TVS) measurement of the endometrium compared to hysteroscopic findings and histopathologic reports in order to facilitate clinical management in asymptomatic postmenopausal women with thickened endometrium.During the period between January 2000 and December 2008, a retrospective analysis was performed including cases of women who were preoperatively diagnosed with a sonographically thickened endometrium, while asymptomatic, and therefore underwent hysteroscopic and fractionated dilatation and curettage (DC) under general anesthesia at the Second Department of Obstetrics and Gynecology at Aretaieion Hospital in Athens, Greece. In the present study we compare US, hysteroscopic and pathologic findings.The mean age of the patients ranged between 54-74 years (mean age 65.2 +/- 6.8 years). In 108 cases, sonographically measured endometrial thickness ranged between 5 and 10 mm. In 59 cases, endometrial thickness ranged between 11 and 15 mm, whereas in 22 cases, between 16 and 20 mm and finally, in 13 cases endometrial thickness was more than 20 mm. Hysteroscopic examination revealed endometrial polyps in 161 cases, focal hyperplastic lesions in 28 cases, complete hyperplastic lesions in five cases while atrophy was found in five and cancer in three cases, respectively. Pathological results of the samples taken after hysteroscopy are as follows: in 169 cases (83.67%) in women with asymptomatic abnormal endometrial thickness, an endometrial polyp was present. Endometrial thickness in these cases patients was 10.9 +/- 7.5 mm. In patients with focal hyperplasia (22 cases), endometrial thickness was 7.2 +/- 0.5 mm but in patients with complete hyperplasia (5 cases) endometrial thickness was higher (12.3 +/- 5.1 mm). Finally, in three cases with endometrial carcinoma endometrial thickness was 15.5 +/- 7.8 mm. Six cases out of 28 described in our study were diagnosed as focal hyperplasia and two out of five cases as complete hyperplasia, whereas histological reports classified these cases as endometrial polyps. The other histological diagnoses confirmed hysteroscopic findings and thus provided the same results.We recommend hysteroscopy to follow gynecological TVS when a thickened endometrium is found in asyptomatic postmenopausal women for better diagnostic and, in a later stage, therapeutic efficacy. more...

To evaluate the effect of the presence of endometrial polyps (EP) on pregnancy rates and how polypectomy could affect pregnancy rates in women scheduled for intrauterine insemination (IUI).The study included patients who had attended the Second Department of Obstetrics and Gynecology of the University of Athens from April 2003 to October 2008 for infertility treatment and were candidates for IUI. In these women the presence of an endometrial polyp had been already diagnosed during the infertility evaluation. The study group consisted of 86 women who, following the diagnosis of endometrial polyp, had agreed to have the polyps removed hysteroscopically prior to the IUI. The control group consisted of 85 women, who despite the fact that the presence of an endometrial polyp had been previously diagnosed and its removal suggested, elected not to have the polyp removed. We used statistical analysis to check what effect the removal of the polyp had on the total number of pregnancies.There was a statistically significant difference in cumulative pregnancy rates between the two groups. The group that underwent polyp removal had higher pregnancy rates as compared to the one that the polyps were left intact.We propose that hysteroscopic polypectomy of any size appears to improve fertility in women with otherwise unexplained infertility. more...

Arthrogryposis multiplex congenita (AMC) refers either to a syndromic or to a nonsyndromic group of conditions with varied etiology and complex clinical features, including multiple congenital contractures in different body areas. Its etiology still remains unclear but generally any cause that leads to reduced fetal movement may lead to congenital contractures and in severe cases to fetal akinesia deformation sequence (FADS). It affects approximately 1 in 2-3000 live births with an approximately equal gender ratio. There are many known subgroups of AMC differing in signs, symptoms, and causes. The primary diagnosis is made when a lack of mobility and an abnormal position is noted in routine ultrasound scanning. Early diagnosis, prenatal evaluation, and further surveillance via image scanning (ultrasound and MRI) give the opportunity for family counseling concerning neonatal morbidity and mortality and labor or delivery planning. Better understanding of the ultrasound findings and the etiology of this clinical situation offers the opportunity for careful prenatal assessment. more...

Endometrial stromal sarcomas are rare tumors accounting for about 0.2% of all genital tract malignancies. They are considered to occur more often in premenopausal women. Endometrial stromal sarcomas are hormone sensitive tumors. A state of hyper-estrogenemia could act as a growth stimulus. Given the rarity of these tumors there are limited reports in the literature referring to the clinical management and final outcome of these cases.The patient, a 29-year-old woman, had a surgical history of myomectomy in another hospital three months before her referal to our department. The histological examination of the removed myoma showed an endometrial stromal sarcoma. Total abdominal hysterectomy, with bilateral salpingo-oophorectomy, omentectomy and elective pelvic lymphadenectomy were then performed as a second radical surgical approach.Endometrial stromal sarcomas are uncommon and their differential diagnosis from typical submucosal uterine myomas or benign endometrial polyps could be difficult. The hysteroscopic features of uterine sarcomas are often similar to those of endometrial polyps or submucosal myomas. The histological examination of the specimen is necessary to exclude malignancy and establish the final diagnosis. Total abdominal hysterectomy, bilateral salpingo-oopherectomy with pelvic lymphadenectomy is the optimal treatment in cases of endometrial stromal sarcomas. more...

An ectopic pregnancy is defined as cesarean scar pregnancy (CSP) when the products of conception are implanted within the myometrium in the area of a cesarean section scar. CSP can be a life-threatening condition and to date there is no clear consensus for CSP management. A medical approach joining high treatment rates with fertility preservation could be a safer and less invasive method of therapy.We present a case of CSP with a viable embryo that was successfully treated with a novel medical therapy combining multidose methotrexate (MTX) and mifepristone.No further additional invasive procedure was required since pregnancy products were dissolved and no major complications were experienced.Multidose MTX and mifepristone can be considered a safe and effective treatment for CSP. more...

It is with great interest that we have read the paper published in your journal by Kerimoglu et al. [1] which addresses an important clinical question: the decrease of daily administered Cetrorelix dose in controlled ovarian hyperstimulation (COH) cycles to avoid premature LH surge while improving pregnancy rates mainly by the subsequent modifications at a cellular level. However, the article reports somewhat precipitate ‘conclusions’, which have the potential for misinterpretation and are in contrast, in several ways, with some important studies published in the past (see Table 1). Firstly, a ‘dose-finding’ study cannot be, by definition, ‘‘retrospective’’. Therefore, it is premature to state that ‘there is no difference...’ between the two regimens, as there have been studies in the past (even referred in Kerimoglu’s et al. [1]), with a prospective and, sometimes, even with a randomized design that clearly state that the lowest daily effective dosage for pituitary down-regulation with Cetrorelix is 0.25 mg/day. Furthermore, in an important—because of its design— randomized controlled trial (RCT) (not mentioned in Kerimoglu’s et al. [1]), Chang and colleagues [2] compared efficacy and efficiency of Cetrorelix and found to be 0.2 and 0.15 mg, respectively; they concluded that even for Asian women (for whom BMI is known to be lower than the Caucasian population), the lowest daily dose of Cetrorelix (in achieving satisfactory pituitary down-regulation) was 0.2 mg, and thus stated that daily administration of 0.15 mg ‘is not suitable’ for pituitary down-regulation. In addition to this, Chen et al. [3] also suggest that for Asian population ‘the lowest effective daily dosage is that of 0.2 mg’ and not 0.25 mg; even if one disregards the design of the study (non-randomized observational), that dose is closer to the ‘established’ one (0.25 mg) than the dosage of 0.125 mg suggested by Kerimoglu et al. [1]. Closely related to this are the findings of a more recent and larger retrospective study by Hsieh et al. [4]. That study concludes that ‘even for individuals with lower body weight (\50 kg), participants required 0.25 mg Cetrorelix daily. Furthermore, Tzeng’s study protocol [5], mentioned in Kerimoglu’s et al. [1], is quite different from daily Cetrorelix administration of 0.125 mg as it depends on leading follicular size; however, even with that protocol, the mechanism for LH-surge avoidance (which is used in 3 patients to end with the one LH surge that is mentioned in the paper) was the increase of the Cetrorelix dose to 0.25 mg/day. Finally, we should acknowledge the (potential) first ‘dose-finding’ study by Albano et al. [6], which concluded that ‘the minimal effective dose of Cetrorelix’ to prevent premature LH surge is 0.25 mg/daily. If a decrease in dosage is to be considered, further larger RCTs need to be conducted before we can move with confidence, to change in current clinical practice. T. Kalampokas Division of Applied Health Sciences, Assisted Reproduction Unit, University of Aberdeen, Aberdeen, UK more...

OBJECTIVE: To compare the pregnancy rates (PRs) between intrauterine insemination (IUI) and intraperitoneal insemination (IPI) in women receiving comparable ovarian stimulation in couples who were infertile for various infertility conditions. METHOD: Fifty-four couples were treated. Of these, 25 were diagnosed as having unexplained infertility, 21 as having male infertility and 8 as having cervical mucus hostility. RESULT: Nine pregnancies occured with 89 cycles of IUI and 6 pregnancies with 85 cycles of IPI, giving an overall PR of 28%. Twelve of the 15 pregnancies occured during the first treatment cycle and three during the second treatment cycle. There was no significant difference in the (PRs) between the IUI and IPI (P > 0.25). CONCLUSION: Both procedures combined with superovulation proved to be simple, inexpensive safe and worthwhile for infertile couples with unexplained infertility, male infertility and cervical mucus hostility. more...

This study refers to 50 couples treated for subfertility. Twenty five of these patients were treated with TU (Testosterone Ur econoate), the remaining 25 received placebo. Sperm characteristics, including ejaculate volume, pH, sperm density, morphology, motility, total testosterone, FSH, LH, DHT and E2 were evaluated both before and after treatment. A statistically significant increase of DHT levels was noticed after TU administration, whereas a marginally significant improvement of sperm morphology was present. Serum FSH concentrations, decreased significantly in the TU group whereas serum LH presented a slight but not statistically significant decrease; 4 pregnancies were achieved by the TU group whereas none were achieved by the patients belonging to the placebo group. The administration of TU per os to patients with idiopathic oligospermia presents a demonstrably positive effect. more...