Search

Background: The lower uterine segment (LUS) may become involved in cervical and endometrial lesions. In addition, some lesions are unique to the LUS, and identifying carcinomas in this region may have prognostic significance. Objectives: The aim of this review is provide useful coverage of the scope of lesions affecting the LUS. Methods: A Medline® search was conducted, using the term lower uterine segment. Reported lesions of the LUS were reviewed. Results: Adenocarcinomas arising in the LUS can be associated with Lynch syndrome. Endometrial adenocarcinoma spreading to the LUS may indicate an increased risk of lymph-nodal involvement. Endometrial carcinomas arising from—as well as spreading to—the LUS may have prognostic significance. Conclusions: Understanding the scope of LUS lesions, as presented in this review, will assist in developing a differential diagnosis if a patient with such a lesion is encountered. (J GYNECOL SURG 32:1)

Background: The female rectovaginal septum may become involved by a variety of mass-like lesions, which may be challenging to providers who treat women. Objectives: To review the scope of lesions affecting the rectovaginal septum. Methods: A literature review was conducted. A Medline search was used, using the terms Vaginal diseases, Vaginal neoplasms, Rectal diseases, and Rectal neoplasms. Results: Reported lesions of the rectovaginal septum were reviewed. Many of these lesions can be mistaken for each other clinically. Conclusions: A review of the scope of rectovaginal lesions is presented to assist in developing a differential diagnosis if a patient with such a lesion is encountered. (J GYNECOL SURG 31:303)

Background: Lesions arising in the round ligament and canal of Nuck are uncommon and may prove challenging to clinicians. Objectives: To review the scope of lesions affecting the round ligament and canal of Nuck. Materials and Methods: A literature review was conducted. A Medline search was used, using the terms round ligament, canal of Nuck, and uterine neoplasms. Results: Reported lesions of the round ligament and canal of Nuck were reviewed. Many of these lesions can be mistaken for each other clinically. Conclusions: A review of the scope of rectovaginal lesions is presented to assist in developing a differential diagnosis if a patient with such a lesion is encountered. (J GYNECOL SURG 31:245)

Background: The anus and perianus may be affected by a variety of conditions. As providers of gynecologic health care branch out into the evaluation of anal neoplasia, familiarity with other anal and perianal lesions will be helpful if a patient with such a lesion is encountered. Objective: A brief discussion of anal anatomy and histology is provided. This review, then, discusses the more common lesions found in this area of the body. A list of less-common anal lesions is also provided. Conclusions: Familiarity with anal lesions will help gynecologic practitioners who are screening for anal neoplasia when it is encountered, and facilitate communication and appropriate referrals if necessary. (J GYNECOL SURG 31:123)

Objectives: Neoadjuvant chemotherapy is being used increasingly prior to debulking for ovarian serous carcinoma. There can be significant histopathologic alterations, sometimes making the pathologic diagnosis challenging. Methods: A MEDLINE search was performed, and articles describing the histologic changes associated with neoadjuvant chemotherapy, as well as any possible clinical impact, were reviewed. Results: The scope of histopathologic changes seen after neoadjuvant chemotherapy for ovarian serous carcinoma, as well as their possible clinical significance, is presented. Histopathologic changes included degenerative changes, increased atypia, and alterations that can make pathologic interpretation difficult, particularly if there is a lack of familiarity with these changes and lack of an available clinical history. Conclusions: More research is needed to assess whether or not there is any prognostic significance to these alterations. (J GYNECOL SURG 33:1)

Objective: Chronic endometritis can be associated with abnormal uterine bleeding and infertility. The “gold standard” of diagnosing chronic endometritis is the identification of plasma cells, but this can be difficult. Immunohistochemical staining using CD 138 is helpful for identifying plasma cells but adds time and expense to the diagnostic process. It has been suggested that the more easily identified eosinophils comprise a surrogate marker for plasma cells. The current authors hypothesized that eosinophils are not a specific marker of chronic endometritis. Materials and Methods: The pathology database of the University Hospital, Newark NJ, was searched for cases of chronic endometritis from January 1, 1991 to August 1, 2015. Controls were endometrial biopsies that showed proliferative endometrium or disordered proliferative endometrium. Atrophy, pregnancy, secretory endometrium, and malignancy were exclusion criteria. Slides were evaluated to confirm the prior diagnosis and to determine the p...

Background: Steroid-cell tumors of the ovary are very rare, especially during pregnancy, and they must be distinguished from luteoma of pregnancy. Case: An 18-year-old female, gravida 3, para 1-0-1-1, at 38 weeks' of gestation, had an adnexal mass that was discovered incidentally during a Caesarean section. The tumor was excised and her male infant was normal. Results: Histologic workup revealed the tumor to be a steroid-cell tumor, which is exceedingly rare in pregnancy. Conclusions: Ovarian steroid-cell tumors, which are malignant one-third of the time, are difficult to distinguish from luteoma of pregnancy. (J GYNECOL SURG 32:351)

Background: Greater gestational age at presentation is associated with a higher risk of rupture of ectopic pregnancy. However, the predictive value of levels of β–human chorionic gonadotropin (β-hCG) and durations of symptoms are more controversial. Objective: The hypothesis for this research was that higher levels of β-hCG and greater gestational age and duration of symptoms are more likely to be associated with tubal rupture. This study was undertaken to test this hypothesis. Materials and Methods: This retrospective review was of medical records of all women who had ectopic pregnancy and were treated at the University Hospital, in Newark, NJ, between January 1, 2005 and February 6, 2013. The collected data were not normally distributed, and statistical assessment was performed using Mann-Whitney–U tests. Results: For this study, 269 medical records were found for review. There were 108 patients with rupture and 161 without rupture. The median duration of symptoms in the group with rupture was ...

Background: Cervical carcinosarcoma is extremely rare. A case of cervical carcinosarcoma is presented and the literature is reviewed. Case: A multiparous woman in her mid-40s, with multiple medical comorbidities, including a body mass index of 48, had an adenocarcinoma identified on routine cervical cytology testing. The cytology was human papilloma virus p16/18–negative, raising suspicion of a primary endometrial rather than a cervical carcinoma but a cervical mass was detected. This patient underwent a robotic-assisted radical hysterectomy and pelvic lymph-node dissection for stage IB1 cervical carcinosarcoma. Results: This patient's postoperative course was complicated by ileus, which resolved spontaneously. Conclusions: Because of the rarity of this lesion, there are no specific treatment protocols. Spread from a uterine primary needs to be ruled out. (J GYNECOL SURG 32:354)

Background: Skin adnexal neoplasms of the vulva are uncommon, and malignant adnexal neoplasms of the vulva are rare. A case of syringomatous eccrine carcinoma (SEC) arising in the perineum is presented, and the literature reviewed. Case: A woman in her mid-70s presented with a perineal mass. After biopsy confirmation of the diagnosis, she underwent wide local excision of a 6.0 × 5.0 × 3.0 cm solid mass. The lesion came within 2 mm of the resection margin, and had lymph vascular space involvement. She was subsequently referred for radiation therapy. Results: Pathology testing showed that the multinodular yellow–tan lesion had eroded through the surface epithelium. Histologically, the tumor was composed of nests and sheets of poorly differentiated epithelial cells. At the periphery of the tumor, a spray pattern of keratinizing infiltrating eccrine ducts confirmed the diagnosis of SEC. Conclusions: Nonsquamous malignancy of the vulva should be considered when there are vulval lesions. All suspicious...