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Objective: To evaluate the tolerability, side effects and complications of hysterosalpingocontrast sonography (HyCoSy).Design: Prospective study.Setting: University hospital.Patient(s): 669 infertile women.Intervention(s): All patients were examined with HyCoSy and monitored for 30 minutes after the procedure. A telephone interview was subsequently carried out to record possible late side effects and postprocedural complications.Main Outcome Measure(s): Tolerability to the procedure was evaluated by means of an 11-point (0 to 10) numeric rating scale of the pain experienced. Postprocedural fever, pelvic infections, peritonitis, hemorrhage were recorded.Result(s): Of 660 patients who completed the examination, 483 (73.2%) completed the telephone follow-up after a period of 14.7 +/- 9.9 months from the procedure. The mean patient age was 34.5 +/- 4.3 years, and mean infertility duration was 28.1 +/- 23.2 months. The mean numeric rating scale was 2.7 +/- 2.5, and 10 patients (2.0%) required postprocedural drug treatment for pain relief. Mild vasovagal reactions were experienced in 20 cases (4.1%), and four patients (0.8%) had a severe vasovagal reaction. No late complications were reported. No patients required hospital admission after the procedure.Conclusion(s): In our series, HyCoSy was a well-tolerated examination with a very low rate of side effects and no late complications that required no atropine or anti-inflammatory drugs. These data support the safety of HyCoSy when performed as described, but further work is needed to estimate the rate of late complications and side effects in other settings. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficiency of hysterosalpingo-contrast-sonography performed with air and saline (Hydro-HyCoSy) with HyCoSy performed with contrast media (SonoVue) and contrast-tuned imaging technology (CnTI-SonoVue-HyCoSy) considering hysterosalpingography (HSG) and laparoscopy (LPS) as reference tests and to evaluate the learning curve of this procedure.Design: Retrospective study.Setting: Reproductive unit of a university hospital.Patient(s): Forty-two infertile female patients.Intervention(s): HyCoSy were performed with a 2.4-mm intrauterine catheter. Patients underwent HSG or LPS as controls.Main Outcome Measure(s): Mean age, sensitivity, specificity, positive and negative predictive value, kappa value, and diagnostic accuracy were evaluated for statistical analysis.Result(s): Sensitivity, specificity, and positive and negative predictive values of Hydro-HyCoSy were 91%, 71%, 55%, and 95%, respectively, while for CnTI-SonoVue-HyCoSy they were 87%, 84%, 69%, and 94%. The diagnostic accuracy of Hydro-HyCoSy and of CnTI-SonoVue-HyCoSy were 77% and 85%, with a Cohen's kappa of 0.52 and 0.66, respectively. CnTI-SonoVue-HyCoSy does not require a learning curve period.Conclusion(s): CnTI-SonoVue-HyCoSy is more accurate than Hydro-HyCoSy for the assessment of fallopian tubes. The very high normal predictive value of Hydro-HyCoSy suggests that this procedure could be performed as a screening examination, whereas CnTI-SonoVue-HyCoSy could be used as a second-step technique. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between the expressions of leukemia inhibitory factor and the occurrence of tubal pregnancy. Design: Prospective observational study. Setting: University-based obstetrics and gynecology hospital. Patient(s): Thirty women undergoing salpingectomy for tubal pregnancy and 30 nonpregnant patients with benign uterine or appendix disease. Intervention(s): Oviduct tissues with ectopic gestation were separated into implantation sites and nonimplantation sites. Samples of ampullary fallopian tubes during midsecretory phase were collected as control groups. Immunohistochemical and Western blot analysis were performed. Main Outcome Measure(s): The differences of leukemia inhibitory factor expression between the implantation and nonimplantation sites of oviduct tissues and the normal and chronically inflamed fallopian tubes. Result(s): The expression of leukemia inhibitory factor in the implantation group is significantly higher than that in the nonimplantation group or in the normal group. A statistically significant difference was also found for leukemia inhibitory factor between the chronic inflammation group and the normal group by Western blot analysis but no difference between the chronic inflammation group and the implantation group or the nonimplantation group. Conclusion(s): Leukemia inhibitory factor might be one of the reasons that cause patients with salpingitis to be more susceptible to tubal pregnancy and might be involved in the implantation process of tubal pregnancy. [Copyright &y& Elsevier]

Introduction: Hysterosalpingography is defined as the sequent introduction in the uterus, fallopian tubes and abdominal cavity, of an opaque substance (non ionic iodized compound) with a probe, while external cervical orifice is obstructed and under supervised pressure, it is prescribed for uterine cavity and surroundings evaluation, being relevant the permeability demonstration of the uterine tubes in patients diagnosed with infertility and in some cases anexial pathology. Objective: Report incidence of ultra and linkages pathology reported by hysterosalpingography, stressing advantages and disadvantages of this method and making a description of observed findings. Material and methods: Longitudinal, retrospective study was made to 288 female patients, ages between 19 and 40 years old, with diagnosis of infertility and uterine anomalies and/or anexial, in the period comprised between January 2006 to January 2009. Test was performed to all patients between days 7 and 12 of menstrual cycle, in digital X-Rays room with fluoroscopy and G.E. Prestige II control. Taking AP projections, oblique, right side and emptying. Results: Endometrial cavities with normal aspect in 185 patients were found. Endometrial cavities with intraluminal filling defects in 103 patients, with respect to Fallopian tubes were found normal or permeable 142 patients and with tubaric bilateral obstruction 86 patients, unilateral obstruction 52 patients. Anatomic variants represented only 8.33%, being bi-horn unicoles, arcuate and septated uterus the most common, with anexial masses observed only in 2.7 % of the cases. Conclusions: Hysterosalpingography is considered still as one of imaging methods, allowing to identify tubarian pathologies, as well as of the endometrial, anexial cavity and alterations of uterine morphology, with a great impact in the diagnosis of tubarian obstruction, being this main indication in patients with of primary or secondary infertility diagnosis. Represent a simple, efficient and low-cost method of diagnostic imaging, with the only disadvantage of the ionizing radiation use. It is important that every Radiologist or specialist in fertility be familiar with imaging interpretation and findings described in each of the pathologies that can be observed by this imaging method. [ABSTRACT FROM AUTHOR]

Objective: To compare endometrial and subendometrial blood flows among patients with and without hydrosalpinx (HSP) during in vitro fertilization treatment as measured by a three-dimensional power Doppler ultrasound. Design: A prospective observational study. Setting: A tertiary assisted-reproduction unit. Patient(s): Twenty-one patients with HSP were compared with 42 matched controls without HSP. Intervention(s): None. Main Outcome Measure(s): Endometrial thickness, endometrial pattern, endometrial volume, pulsatility index (PI) and resistance index (RI) of uterine vessels, and the vascularization index (VI), flow index (FI), and vascularization flow index (VFI) of endometrial and subendometrial regions were measured on the day of oocyte retrieval. Result(s): The proportion of the non-multilayered endometrial pattern was significantly higher in the HSP group than in the non-HSP group. Patients in the HSP group had significantly lower endometrial and subendometrial VI and VFI. Endometrial thickness, endometrial volume, uterine PI, uterine RI, and endometrial and subendometrial FI were similar between the two groups. No significant differences were observed in endometrial and subendometrial VI, FI, and VFI among patients with unilateral and bilateral HSP. Conclusion(s): A change in endometrial pattern and a decrease in endometrial and subendometrial blood flows may be the reasons for impaired implantation in patients with HSP. [ABSTRACT FROM AUTHOR]

Worldwide, 5%-10% of infertility patients have FGTB. 24 infertile women with a pathological diagnosis of FGTB between April 2013 and Feb 2019 were identified and the clinical features and findings on transvaginal sonography (TVS) were investigated. Endometrial TB was pathological diagnosed in 15 women, the sonographic features were as follows: intrauterine adhesions 46.67% (7/15), endometrial polyps 13.33% (2/15), heterogeneous endometrium with subendometrial calcification 13.33% (2/15), and normal 26.67% (4/15). [Extracted from the article]

Objectives: Mycoplasma genitalium has been associated with cervicitis, endometritis, and tubal factor infertility. Because the ability of this bacterium to ascend and infect the fallopian tube remains undefined, we performed an investigation to determine the prevalence of M genitalium in fallopian tube, endometrial, and cervical specimens from women laparoscopically diagnosed with acute salpingitis in Nairobi, Kenya.Methods: Women presenting with pelvic inflammatory disease were laparoscopically diagnosed with salpingitis. Infection with M genitalium in genital specimens was determined by polymerase chain reaction (PCR).Results: Of 123 subjects with acute salpingitis, M genitalium was detected by PCR in the cervix and/or endometrium in nine (7%) participants, and in a single fallopian tube specimen. In addition, those infected with M genitalium were more often HIV infected than women not infected by M genitalium (seven of nine (78%) v 42 of 114 (37%), p<0.03).Conclusions: M genitalium is able to ascend into the fallopian tube, but its association with tubal pathology requires further investigation. [ABSTRACT FROM AUTHOR]

Objective: To study the apparent association between interstitial fallopian tube polyps and isthmic tubal dilatation. Design: Retrospective clinical study. Setting: Tertiary academic medical center. Patient(s): Sixty-five patients with normal hysterosalpingograms and 40 patients with interstitial tubal polyps (25 unilateral and 15 bilateral). Intervention(s): None. Main Outcome Measure(s): Proximal, medial, and distal isthmic diameters were measured digitally and normalized according to an internal standard. Polyp volumes were measured and divided into four groups according to increasing volume (<2 mm3, 2-5 mm3, 6-12 mm3, >12 mm3). Result(s): There was a significant increase in proximal isthmic tubal diameter in patients with interstitial polyps. Mean diameter increased from 0.6 mm to 0.9 mm. There was no significant change in more distal isthmic diameters. Larger polyps tended to be associated with larger luminal diameters. Conclusion(s): Interstitial fallopian tube polyps are associated with a significant increase in proximal isthmic luminal diameter as determined on hysterosalpingography. Although these polyps are nonobstructing and thus thought by most investigators not to affect fertility, their association with altered luminal diameter and perhaps altered function might be of clinical interest. [ABSTRACT FROM AUTHOR]

Background: Compared with their ovarian counterparts, serous borderline tumors of the fallopian tube are uncommon, with limited experience about their clinical behaviour. We present a case of serous borderline tumor of the fallopian tube with unusual presentation and summarise all the published cases to date. Case presentation: A case of serous borderline tumor of the fallopian tube in a 34-year old patient is presented, incidentally found during routine gynecologic examination. At laparoscopy the tumor was unusualy presented as hematosalpinx and was treated by salpingectomy. Cell-cycle analysis of the tumor tissue revealed a diploid DNA content and a low S-phase fraction. There was no evidence of the disease during the follow-up period of 4.6 years. Conclusion: The current case and review of the literature suggest salpingectomy as the optimal treatment for patients with serous borderline tumor of the fallopian tube. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although observational studies suggest that IVF is more effective than no treatment for women with Fallopian tube patency, this has not been tested rigorously in a randomized controlled trial (RCT). METHODS: Eligible consenting couples planning their first treatment cycle in five Canadian fertility clinics received either IVF, within 90 days of randomization, or a period of 90 days with no treatment. Random allocation was stratified by female age and sperm quality, and administered using numbered, opaque, sealed envelopes. Follow‐up assessed live birth and associated morbidity. RESULTS: Sixty‐eight couples were randomized to a first cycle of IVF and 71 couples had 3 months without treatment. The live birth rates were 20/68 (29%) and 1/71 (1%), respectively. The single delivery in the untreated group was of twins, as were six of the 20 IVF deliveries (30%). An average of 2.0 embryos were transferred and no triplet pregnancies resulted. The relative likelihood of delivery after allocation to IVF was 20.9‐fold higher than after allocation to no treatment [95% confidence interval (CI) 2.8–155]. The presence of abnormal sperm did not reduce this likelihood. Treating four women (95% CI 3–6) with one cycle of IVF is required to achieve a single additional birth. CONCLUSIONS: This study provides a valid and up‐to‐date comparison for policy makers and patients as they make choices around IVF, accurately measuring and confirming a major benefit from treatment. [ABSTRACT FROM AUTHOR]

Background: Studies carried out over the past 10 years have suggested that hydrosalpinges reduce the pregnancy rate in IVF. Here we report our observations of spontaneous pregnancies in patients who underwent salpingectomy (n = 18) or proximal tubal occlusion (n = 7) following diagnoses of unilateral hydrosalpinges and patent contralateral tubes.Methods: This multi-centre, retrospective study included 25 infertility patients with known unilateral hydrosalpinges with a patent contralateral Fallopian tube. Laparoscopic treatment of unilateral hydrosalpinges by either salpingectomy or tubal occlusion was performed in each patient. Rates of subsequently observed spontaneous pregnancy, and time to pregnancy, are reported.Results: The average duration of infertility in these patients was 3 years with a range of 1-10 years. Following laparoscopic surgical treatment, a total of 22 patients (88%) achieved intrauterine pregnancies, all without IVF treatment. Pregnancies occurred in an average of 5.6 months with a range of 1-21 months. There were no ectopic pregnancies in the study population.Conclusions: Selected patients with unilateral hydrosalpinges and a patent contralateral Fallopian tube may exhibit increased cycle fecundity after salpingectomy or proximal tubal occlusion of the affected tube and conceive without the need for IVF. [ABSTRACT FROM AUTHOR]

Background: Chlamydia trachomatis infections have been associated with tubal pathology. However, not all C.trachomatis-infected women actually develop tubal pathology. Recently, host genetic factors such as the interleukin-1 gene cluster have been linked to inflammatory and infectious diseases.Methods: Dutch Caucasian women were investigated for (i) the role of interleukin-1B (IL-1B) and interleukin-1 receptor antagonist (IL-1RN) gene polymorphisms in tubal pathology (group 1); and (ii) the presence of these gene polymorphisms in C.trachomatis IgG-positive women with and without tubal pathology (group 2). Group 1 consisted of women with (n = 40) or without (n = 95) tubal pathology, respectively, and group 2 of C.trachomatis IgG-positive women of whom 28 had tubal pathology at laparoscopy and 47 did not. IL-1B-511 and IL-1B+3954 gene polymorphisms were assessed by PCR-restriction fragment length polymorphism (RFLP), and the variable number of tandem repeats (VNTR) of the IL-1RN gene were assessed by a PCR-based assay.Results: Neither IL-1B-511, IL-1B+3954 nor IL-1RN genotypes, allele or carrier frequencies showed significant association with tubal pathology or C.trachomatis post-infection-based tubal pathology.Conclusions: The data obtained suggest that specific IL-1 gene polymorphisms are not associated with the tubal pathology risk or to the development of C.trachomatis-based post-infectious severe sequelae. [ABSTRACT FROM AUTHOR]

Background: The adverse effects of hydrosalpinx on the outcomes of IVF have been well documented, but the mechanisms of hydrosalpinx fluid formation remain unclear. This study compares the mRNA expression of vascular endothelial growth factor (VEGF) and its receptors (KDR and flt-1) in the hydrosalpinx with that in the healthy oviduct.Methods: Oviduct tissue was collected from 10 infertile women with hydrosalpinx and 10 parous women with healthy oviduct. The mRNA expression of VEGF and its receptors in isolated oviduct epithelial cells were analysed using semi-quantitative reverse-transcriptase PCR.Results: mRNA expression of VEGF and its receptor flt-1 in the hydrosalpinx was significantly higher than that in the healthy oviduct, but no significant difference was demonstrated for the KDR receptor.Conclusions: This study supports the notion that VEGF may play an important role in the hydrosalpinx fluid formation, possibly by promoting vascular and epithelial permeability and therefore serum transudation. [ABSTRACT FROM AUTHOR]

: ObjectiveTo evaluate the usefulness and prognostic value of transvaginal hydrolaparoscopy (THL) in infertile women.: DesignRetrospective study.: SettingJichi Medical School Hospital, Tochigi, Japan.: Patient(s)Thirty-six patients who were followed up for 6 months or longer after THL was performed.: Intervention(s)Transvaginal hydrolaparoscopy findings in comparison with hysterosalpingography (HSG).: Main outcome measure(s)Transvaginal hydrolaparoscopy findings, HSG findings, treatment strategy, and prognosis.: Result(s)Twenty of 36 patients (55.5%) became pregnant, including 7 by coitus, 7 by artificial insemination with the husband’s semen, and 6 by assisted reproductive technology (ART). In 11 of these pregnant patients, information obtained during THL differed from findings on HSG.: Conclusion(s)Transvaginal hydrolaparoscopy is useful in selecting a future treatment strategy. [Copyright &y& Elsevier]

Background: To establish the value of a new technique called transvaginal hydrolaparoscopy for exploration of the tubo-ovarian structures in the management of patients with unexplained infertility.Methods: A total of 120 women with primary or secondary infertility, and without obvious pelvic pathology, were included in the study. The first 14 patients received general anesthesia and underwent transvaginal laparoscopy immediately before standard laparoscopy. The remaining 106 patients had transvaginal laparoscopy performed under local anesthesia, with standard laparoscopy performed only on those with pathology, which required operative intervention. Information on pathology, complications, and successful access to the pouch of Douglas were recorded.Results: The successful rate of access was 93%. Pathology was found in 29 patients, of whom 15 required operative laparoscopy. Also, out of 19 patients with adhesions, 11 (58%) had normal dye test bilateral, and only two (11%) had bilateral occlusion of the tubes. No complications were observed.Conclusion: Transvaginal hydrolaparoscopy is a safe and well-tolerated method for investigating the tubo-ovarian structures in unexplained infertility. It is superior to hysterosalpingography for diagnosis of adhesions. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of hydrosalpinx fluid on the expression of HOXA10, an essential regulator of endometrial receptivity.Design: In vitro study.Setting: Academic medical center.Patient(s): Patients with unilateral or bilateral hydrosalpinx.Intervention(s): Hydrosalpinx fluid was aspirated from 10 patients at laparoscopy. The fluid was serially diluted in minimum essential medium. Ishikawa cells (an endometrial adenocarcinoma cell line, representative of endometrial epithelium) were incubated with this fluid at concentrations of 10% and 50% for 48 hours. Cells were also incubated in undiluted minimum essential medium (MEM) and in 10% serum as controls. After incubation, the cells were lysed in Trizol, and total RNA was extracted and analyzed by Northern blot using a 32P-labeled HOXA10 riboprobe. A 32P-labeled G3PDH probe was used as a control for loading.Main Outcome Measure(s): HOXA10 mRNA expression.Result(s): HOXA10 mRNA expression in endometrial cells decreased with increasing concentrations of hydrosalpinx fluid. Densitometric analysis of the northern blot revealed that HOXA10 mRNA expression was different from control at both concentrations (P<.007).Conclusion(s): HOXA10 is necessary for implantation in the murine model. HOXA10 expression is diminished by hydrosalpinx fluid. This effect on HOXA10 is a potential molecular mechanism by which implantation rates are diminished in women with hydrosalpinges. [Copyright &y& Elsevier]

Objective: To determine the effect of increasing experience in fluoroscopically guided selective salpingography and tubal catheterization on radiation doses and screening times, thus establishing a learning curve for the procedure.Design: Retrospective case note analysis.Setting: IVF center of an academic teaching hospital.Patients: Three hundred sixty-six patients with infertility seen over 3.5 years.Intervention(s): Fluoroscopically guided selective salpingography and tubal catheterization.Main Outcome Measure(s): Reductions in radiation doses and screening times for different categories of selective salpingography and tubal catheterization, expressed as percentage reductions during the study period and reductions per 10 procedures.Result(s): During the study period, The median dose of radiation decreased by 62.6%-71.9%, and the median screening time declined by 61.5%-78.5%. Reductions per 10 procedures were 2.5%-4.2% and 2.7%-5%, respectively.Conclusion(s): Significant reductions in radiation doses and screening times start early in a clinical team's practice of selective salpingography and tubal catheterization and continue even as trainees are added to the pool of operators. [ABSTRACT FROM AUTHOR]

We report a rare case with herniation of the uterus, fallopian tube, and ovary in a femoral hernia. A female patient was admitted with complain of the painful lump in the left groin. Clinical examination indicated strangulated femoral hernia, which necessitated an emergency surgery. During surgical procedure, the uterine tube, left fallopian tube and left ovary, were observed as the contents of the hernia. The contents were reduced back into the pelvic cavity, and the hernia was repaired. The patient made good recovery postsurgery. [ABSTRACT FROM AUTHOR]

Cancer of the fallopian tube accounts for <0.1% of all gynaecologic cancers. Primary adenocarcinoma of the fallopian tube is usually unilateral, extremely rare that clinically and histologically resembles epithelial ovarian cancer(EOC).It is more common for cancer to spread or metastasize from ovaries or endometrium, than for cancer to actually originate in the fallopian tubes. Some of the common symptoms are abnormal vaginal bleeding, abdominal pain, abnormal vaginal discharge and pelvic mass which are present in up to two-thirds of patients and may mimic those of other gynecological problems. So we are presenting a rare case of stage IB primary fallopian tube cancer which is difficult to diagnose early. [ABSTRACT FROM AUTHOR]

Simple Summary: Reliable predictive indicators of response to neoadjuvant chemotherapy of advanced-stage extrauterine high-grade serous carcinoma are still lacking. Moreover, changes evident in tumor samples from interval surgery are not well understood. Our retrospective study aimed to address the prognostic value of chemotherapy response score (CRS) and identify additional predictive features for the risk of progression and death. In a cohort of 245 patients, we demonstrate that the modified two-tier CRS was prognostic for survival, and this significance was independent of scoring site; our data support expansion of CRS use to the adnexal samples. In addition to the CRS, oncocytic change, inflammation, and desmoplasia were additional histopathologic parameters related to survival. We recommend using the two-tier CRS, together with the additional histological features serving as secondary criteria for scoring, to identify patients at high risk for recurrence, allow tailored adjuvant therapy strategies, or consider clinical trials. Background: The impact of chemotherapy response score (CRS) on prognosis has varied among studies. We addressed the prognostic significance of CRS and the prognostic value of previously undescribed histologic features using a cohort of 245 patients. Methods: Retrospective study in patients with advanced extrauterine high-grade serous carcinomas treated with neoadjuvant chemotherapy followed by interval tumor reductive surgery from 1990 to 2018 in our hospital. Gynecologic pathologists assessed tumor CRS and other histologic features. Clinical information was collected, and multivariate analyses were conducted. Results: A modified 2 tier CRS (CRS 1/2 versus CRS 3) was significantly associated, independent of scoring site (omental versus adnexal), with overall survival (OS) (omentum, p = 0.018; adnexa, p = 0.042; entire cohort, p = 0.002) and progression-free survival (PFS) (p = 0.021, p = 0.035, and p = 0.001, respectively). On multivariate survival analysis, 2 tier CRS, oncocytic change, inflammation, and desmoplasia were significant for OS (p = 0.034, p = 0.020, p = 0.007, and p = 0.010, respectively). Likewise, 2 tier CRS, inflammation, and desmoplasia were significant for PFS (p = 0.012, p = 0.003, p = 0.011, respectively). Conclusions: The modified 2 tier CRS was significantly associated with survival, independent of scoring site. Additional histologic features including oncocytic change, inflammation, and desmoplasia can also predict patient outcomes. [ABSTRACT FROM AUTHOR]

Discusses the influence of hydrosalpinges on in vitro fertilization-embryo transfer (IVF-ET) outcome. Mean number of oocytes retrieved; Factors needed to be considered when counseling patients with regard to their prognosis of a live birth after IVF-ET; Negative impact of the presence of hydrosalpinges on IVF-ET implantation and delivery rates.

Examines the risks and trends of ectopic pregnancy incidence among women population in Great Britain. Statistics of increased mean annual incidence of ectopic pregnancy; Assessment of development among women using contraceptives; Complications of salpingitis.

Introduction: fallopian tube choriocarcinoma coexistent with viable intrauterine pregnancy is an extremely rare condition. Case Report: we present the first case reported in literature of tubal choriocarcinoma coexistent with viable intrauterine pregnancy detected at early gestational age (20 weeks) and successfully managed by seriate monitoring of maternal and fetal health status until 31 weeks, then treated by cesarean section followed by etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMA-CO) chemotherapy protocol. Conclusions: the outcome was favorable for both the mother and her fetus. [ABSTRACT FROM AUTHOR]

In gynecology, endosalpingiosis is a benign condition in which the fallopian tube-like epithelium is found outside the fallopian tube. The thirty-four point five percent of endosalpingiosis cases have concurrent endometriosis and 40% of the endosalpingiosis group are in postmenopausal states. In contrast with endometriosis, there are no significant links between infertility, chronic pelvic pain and endosalpingiosis. The symptoms of endosalpingiosis are not yet settled. Endosalpingiosis is almost always an incidental finding; it is commonly found through microscopic examinations, and is then confirmed by pathologists for excision and biopsy. Therefore, the clinical differential diagnosis of an intramural mass is more important for clinicians when discussing further surgery with the patients. We report case of woman who has endosalpingiosis and is presented with vaginal bleeding. We first suspect the disease during physical examination. Under the impression of pelvic mass, laboratory tests and radiological images of contrast enhanced chest computer tomography are taken. Images show multisepted cystic masses in left adnexa. To rule out the pelvic mass, we executed exploratory laparotomy. Pathologic results show endosalpingiosis near the ovary section. But the endosalpingiosis, is not generally considered a pathology, and thus, no treatment is necessary. [ABSTRACT FROM AUTHOR]

An indirect inguinal hernia containing an incarcerated fallopian tube and ovary is extremely rare in adult females. The current report describes a woman of reproductive years presenting with an irreducible indirect hernia which required the surgical intervention of a general surgeon as well as counseling regarding future fertility by a gynecologist. The diagnosis was made by physical and sonographic examination and was confirmed by CT scan and surgical intervention. We suggest a multimodel and multidisciplinary approach in order to safely and efficiently preserve ovarian and fertility function in young women who present with an inguinal hernia containing reproductive organs. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to evaluate the fallopian tube of women with infertility and to observe whether there are any significant differences in the Hysterosalpingogram findings with regard to prevalence of tubal block in women with primary and secondary infertility. Methods: A retrospective study of unilateral and bilateral tubal obstruction in Hysterosalpingogram of women with primary and secondary infertility was carried out. Results: The frequencies of tubal obstruction were about 19% in women with primary infertility and 29% in secondary infertility. Chlamydia antigen positivity rate was similar in both groups. Ectopic pregnancy (p<0.01) and previous pelvic surgery (p<0.001) were higher in women with secondary infertility. Conclusion: Tubal obstruction is a cause of female infertility according to this study. Bilateral tubal obstruction was similar in primary and secondary infertility groups and previous pelvic surgery may be the cause of tubal obstruction in the secondary infertility group. [ABSTRACT FROM AUTHOR]

"To understand the actual world as it is, not as we should wish it to be, is the beginning of wisdom." - Bertrand Russell. [ABSTRACT FROM AUTHOR]

Pregnancy in non-communicating rudimentary horn is extremely rare and unpredictable in women who have had a vaginal delivery. It carries grave consequences for the mother and fetus. The pregnancy usually terminates by rupturing in second trimester. Therefore, excision of the rudimentary horn and associated fallopian tube advised when diagnosed. We present a case of ruptured rudimentary horn pregnancy where the diagnosis was missed by sonogram at 14 weeks gestation and presented as an acute abdomen and hypovolemic shock. She was managed through emergency lower midline laparotomy together with simultaneous resuscitation. Excision of the rudimentary horn and the right fallopian tube was done. The right ovary was conserved. Postoperative recovery was uneventful. [ABSTRACT FROM AUTHOR]

Isolated torsion of the Fallopian tube is a rare gynecological cause of acute lower abdominal pain, and diagnosis is difficult. There are no pathognomonic symptoms; clinical, imaging, or laboratory findings. A preoperative ultrasound showing tubular adnexal masses of heterogeneous echogenicity with cystic component is often present. Diagnosis can rarely be made before operation, and laparoscopy is necessary to establish the diagnosis. Unfortunately, surgery often is performed too late for tube conservation. Isolated Fallopian tube torsion should be suspected in case of acute pelvic pain, and prompt intervention is necessary. [ABSTRACT FROM AUTHOR]

Herniation of the pelvic structures into the uterine cavity (appendix vermiformis, small bowel, omentum, or fallopian tube) may occur after uterine perforation. In this paper, we describe one case of intrauterine fallopian tube incarceration treated by means of laparoscopic surgery. [ABSTRACT FROM AUTHOR]

Purpose: To report the world's first case of live monozygotic dichorionic diamniotic (DD) twins after a single vitrified-warmed blastocyst transfer in a cycle during which hormone supplements were given. Methods and results: The patient was a 39-year-old woman with tubal factor infertility. Six oocytes were retrieved and three blastocysts were vitrified after insemination with her husband's sperm. Two months later, a single warmed blastocyst was transferred on the fifth day after progesterone supplementation during the luteal phase. Two gestational sacs and fetuses with heartbeats showing lambda sign under ultrasonography were recognized at 7 weeks of gestation and the patient gave birth to two female infants at gestational 33 weeks. The pathological examination demonstrated that the DD twin placentas fused in the third trimester. Conclusions: This report suggests that the splitting of the transferred embryo took place after the blastocyst stage and the popular credo that the timing of embryo division governs the placental configuration of monozygotic twins (MZT) must be re-examined as to its veracity. [ABSTRACT FROM AUTHOR]

The endometrium of women with hydrosalpinx has an increased number of neutrophils and lower expression of elafin, an elastase inhibitor and natural antimicrobial molecule. These findings suggest that women with hydrosalpinx have a reduced antimicrobial and antielastase activity. [ABSTRACT FROM AUTHOR]

In a study on the influence of salpingectomy on the same patient ipsilateral ovarian response, 15 patients who were admitted to our department with the diagnosis of uni- or bilateral hydrosalpinges and who were successfully treated by laparoscopic salpingectomy were evaluated. The observed significant decrease in the ipsilateral ovarian response after salgingectomy, as reflected by the quantity of developing follicles during controlled ovarian hyperstimulation for IVF, should be presented to patients during the decision-making process, before offering salpingectomy for the treatment of hydrosalpinx. [ABSTRACT FROM AUTHOR]

Deletion in chemokine receptor CCR5 gene is reported to prevent development of tubal pathology among Dutch Caucasian C. trachomatisinfected women. Hence, a pilot study was undertaken, to evaluate the involvement of CCR5 gene in tubal pathology among Indian women with or without Chlamydia infection. Three hundred women with or without Chlamydia infection and with differentreproductive manifestations were screened for CCR5 gene using a standardized PCR. Only 6 C. trachomatis infected women without tubal block had heterozygous deletion for this gene. The rest had wild type CCR5 gene, that includes fertile women infected and non infected; infertile women infected and non infected with and without tubal block as well as infected women with history of recurrent spontaneous abortions. The study indicates no role of heterozygous CCR5 D32 gene deletion in prevention of tubal pathology in Chlamydiainfected Indian women. Only 2% heterozygous deletion in CCR5 gene is observed in the studied population. [ABSTRACT FROM AUTHOR]

In this prospective clinical study, ultrasound-guided transvaginal aspiration and sclerotherapy with 98% ethanol was performed before the IVF cycle in 33 patients with hydrosalpinx. The results showed that ultrasound aspiration and sclerotherapy could improve the endometrial receptivity and outcomes of IVF, with no recurring sign of the hydrosalpinx and no adverse effect on ovarian reserve or responsiveness during the IVF procedure. [ABSTRACT FROM AUTHOR]

Few data exist regarding IVF in women who have undergone bariatric surgery. Our experience with five patients suggests that IVF is a safe and effective fertility treatment for these women, although special considerations should be made when treating patients who have undergone bariatric surgery. Considering the type of bypass procedure the patient underwent is particularly important should a patient develop concerning symptoms during her IVF cycle. [ABSTRACT FROM AUTHOR]

Isolated fallopian tube torsion is rare and often difficult to diagnose. Definitive diagnosis is always made at laparoscopic or via laparotomy exploration performed for suspected ovarian torsion. Early diagnosis and conservative laparoscopic treatment especially in a reproductive age woman is warranted as a means of preserving fallopian tube integrity and maintaining fertility. Here, we describe a case with isolated right fallopian torsion being managed by conservative laparoscopic surgery. [ABSTRACT FROM AUTHOR]

In this retrospective study, we observed a total of 553 patients with tubal infertility who underwent microsurgical reconstructive surgery of the fallopian tubes (including adhesiolysis, anastomosis, fimbrioplasty, salpingostomy, and refertilization after former sterilization). The pregnancy (43.4%) and birth (29.2%) rates after microsurgery for acquired tubal damages (abortion: 6.4%; ectopic pregnancy: 7.9%) were higher than after single in vitro fertilization (28.4% and <20%, respectively; data from German IVF register). The pregnancy (73%) and birth (50.6%) rates after the reversal of sterilization also were higher (abortion: 15.7%; ectopic pregnancy: 6.7%). The advantages of reconstructive microsurgery over in vitro fertilization include the ideally permanent restoration of a woman''s ability to conceive naturally in every cycle that she ovulates, a high postoperative birth rate overall, and avoidance of multiple births. [Copyright &y& Elsevier]

Femoral hernias are more common in women and lead to a substantial higher rate for an emergency operation, due to strangulation. Incarcerated femoral hernia with fallopian tube as a content is an extremely rare condition. A 20-year-old woman presented to the emergency department complaining of a 6-day right groin swelling, which became painful and tender to palpation during the last 48 hours. Preoperative ultrasonography detected an oedematous hernia sac, above the femoral vessels, suggesting the presence of an incarcerated femoral hernia. The patient eventually underwent emergency surgery and the diagnosis of a strangulated femoral hernia sac, containing fallopian tube, was established. No resection of the uterine tube was performed and the hernia was repaired with polypropylene plug. The postoperative period was uneventful and the woman was discharged on the second postoperative day. [ABSTRACT FROM AUTHOR]

Based on a recent review of the medical literature, a clinical diagnosis of infertility may not agree with strict criteria. Standardized definitions of diagnostic categories are essential for accurate patient prognosis and future research. [Copyright &y& Elsevier]

Theoretically, total salpingectomy eliminates the risk of an ipsilateral tubal pregnancy. However, total salpingectomy is difficult to achieve using endoloops alone. We describe a situation where this resulted in an ipsilateral recurrence of tubal pregnancy which required emergency intervention and removal of the tubal remnants. [ABSTRACT FROM AUTHOR]

Ovarian cancer (OC) is one of the leading causes of cancer death in women, with high-grade serous ovarian cancer (HGSOC) being the most lethal gynecologic malignancy among women. This high fatality rate is the result of diagnosis of a high number of new cases when cancer implants have already spread. The poor prognosis is due to our inadequate understanding of the molecular mechanisms preceding ovarian malignancy. Knowledge about the site of origination has been improved recently by the discovery of tube intraepithelial cancer (TIC), but the potential risk factors are still obscure. Due to high tumoral heterogeneity in OC, the establishment of early stage biomarkers is still underway. Microbial infection may induce or result in chronic inflammatory infection and in the pathogenesis of cancers. Microbiome research has shed light on the relationships between the host and microbiota, as well as the direct roles of host pathogens in cancer development, progression, and drug efficacy. While controversial, the detection of viruses within ovarian malignancies and fallopian tube tissues suggests that these pathogens may play a role in the development of OC. Genomic and proteomic approaches have enhanced the methods for identifying candidates in early screening. This article summarizes the existing knowledge related to the molecular mechanisms that lead to tumorigenesis in the ovary, as well as the viruses detected in OC cases and how they may elevate this process. [ABSTRACT FROM AUTHOR]

Ovarian cancer is the deadliest gynecologic malignancy, accounting for more than 14,000 deaths each year. With no established way to prevent or screen for it, the vast majority of cases are diagnosed as International Federation of Gynecology and Obstetrics (FIGO) stage III or higher. Individuals with germline BRCA mutations are at particularly high risk for epithelial ovarian cancer and have been the subject of many risk-reducing strategies. In the past ten years, studies looking at risk-reducing salpingo-oophorectomy (RRSO) in this population have uncovered an interesting association: up to 8% of women with BRCA1 or BRCA2 mutations who underwent RRSO had an associated serous tubal intraepithelial carcinoma (STIC). The importance of this finding is highlighted by the fact that up to 60% of ovarian cancer patients will also have an associated STIC. These studies have led to a paradigm shift that a subset of epithelial ovarian cancer originates not in the ovarian epithelium, but rather in the distal fallopian tube. In response to this, many providers have changed their practice by expanding the role of routine salpingectomy, hysterectomy, and sterilization procedures. The American College of Obstetricians and Gynecologists (ACOG) has acknowledged opportunistic salpingectomy as a safe strategy to reduce the risk of epithelial ovarian cancer in Committee Opinion #774. It is thus important for pathologists and clinicians to understand the definition of STIC; how it is diagnosed; and, most importantly, its clinical significance. [ABSTRACT FROM AUTHOR]

Background/Aim. The glycoprotein of a high molecular weight CA-125, which is not a specific tumor marker of ovarian cancer, is secreted by the endothelial cells of most pelvic organs. Endometriosis, inflammatory processes in the pelvic cavity, as well as some nongynecoligical malignant diseases, could be followed by the increased values of CA-125. Serial assessment of the values of CA-125 makes it possible to avoid surgical treatment, and, by means of the used conservative treatment, to avoid malignant diseases not to be noticed. Methods. The study included 57 female patients hospitalized due to inflammable adnexal tumors. Besides following the values of serum CA-125 during and after the therapy, also performed were the transvaginal Doppler ultrasonography and the determination of the values of resistance index (RI). Results. In 27 patients (55.1%) the CA-125 values ranged from 38.8 U/ml to 794 U/ml, while in 30 of the patients they were within the range of normal. In this group of the patients, besides the increased values of CA-125, also increased were the values of leucocytes (119/l - 209/l), as well as the sedimentation rates (65-120) within the first hour. In all the 57 patients, transvaginal Doppler ultrasonography revealed the presence of adnexal tumor of inflammatory kind. The measured values of RI were within the range of 0.539-0.681. Eight of the patients were treated by the conservative -- triple antibiotic therapy, while in 49 patients explorative laparotomy was performed. Hystorectomy was done in 12 of the patients, and one-side adnexectomy in 37 of them. Conclusion. The method for the assessment of CA-125 is simple and available which facilitates the monitoring of surgical, conservative or the combined therapy that is particularly significant in younger patients with inflammable adnexal tumor developed on the basis of endometrosis. [ABSTRACT FROM AUTHOR]

Background: The malignant mixed Müllerian tumor (MMMT) is a very rare pathology, also called carcinosarcoma, representing a biphasic neoplasm composed of highgrade epithelial and mesenchymal elements. It broadly occurs in the tissues of the female genital tract, most commonly in the uterus, yet itmay arise in the cervix, ovaries or the fallopian tubes. There is a limited number of such cases reported in the medical literature, typically associating a poor prognosis. Objective: The aim of this presentation is to offer medical data regarding a rare condition. A case of a 65 years old female patient known with type II diabetes, obesity and grade II arterial hypertension, that also presents with postmenopausal bleeding, is described. During a clinical and ultrasound examination, an endometrial polyp and a suspicion of bilateral hydrosalpinx were seen, and the patient was sent for further investigations. Materials and methods: A hysteroscopic polypectomy, alongside with a diagnostic hysteroscopy, and a laparoscopic bilateral adnexectomy and adhesiolisis were performed, and the surgical specimen ws sent for frozen section. The pathogical examination proved tubal malignancy, and, in the same anesthesia, consequently, a total extracapsular hysterectomy together with pelvic and paraaortic lymphadenectomy, appendectomy and omentectomy were performed. The postoperative diagnosis was staged I A tubal cancer. Results: The postoperative recovery was uneventful. The final pathology result showed MMMT. Conclusions: Due to the rarity of this condition, reporting any occurance is of utmost importance. The peculiarity of this particular case was not only the presence of MMMT, but also its bilateral occurance in the fallopian tubes. Therefore, a larger case series could result, allowing physicians to obtain more accurate data on the matter. [ABSTRACT FROM AUTHOR]

To evaluate the microanatomy of gynecological specimens using microtomography (micro-CT). The construction process of 3D accurate virtual models starts with the 3D modeling volume built through the micro-CT slices sequentially mounted, followed by the segmentation process of selection of parts to be analysed. [Extracted from the article]

Isolated tubal torsions presenting to the emergency department are a very rare cause of pediatric acute abdominal pain. Since making the diagnosis early is of importance in terms of affecting tubal damage and fertility, we aimed to evaluate cases of isolated tubal torsions in light of the literature. This study included 10 patients under 18 years of age who presented to the emergency department with abdominal pain between January 2003 and December 2018. The mean age was 14.5 ± 1.43 years (range: 12–17 years). The demographic characteristics, surgical findings and techniques, and concomitant pathology results of these patients were retrospectively evaluated. The reason for presenting to the emergency department for the 10 patients included in the study was abdominal pain. The mean duration of hospital admission with pain was 4.97 days. The onset of pain was less than 24 h in seven patients (70%) and more than 24 h in three patients (30%). Of the patients, nine (90%) had tenderness in the lower abdominal quadrant, five (5%) had defense, and three (30%) had rebound. Nausea, vomiting and leukocytosis were present in 50% of the cases. Right and left tubal involvement of the cases was equal. Seven (70%) of the isolated tubal torsions were accompanied by paraovarian cysts. Eight patients (80%) underwent open surgery and two (20%) underwent laparoscopic intervention. Detorsion was performed on five (50%) patients and salpingectomy was performed on five (50%) patients. Isolated tubal torsion should be considered in children presenting with acute abdominal pain in early adolescence. Early diagnosis is important for the preservation of fertility. [ABSTRACT FROM AUTHOR]

We report a case of a 24-year-old woman who presented with abdominal pain, a tense abdomen, and rebound tenderness. A vague, ill-defined mass was palpated, and an ultrasound examination revealed a cystic lesion in the left adnexal region. At laparotomy, a slightly dilated fallopian tube was seen and excised. Light microscopy showed intact fallopian tube mucosa, with a diffuse infiltrate of foam cells in the lamina propria. There were no associated inflammatory cells. The foam cells were positive for CD68 and negative for AE1/AE3. Discontinuous areas of the epithelium also showed epithelial cells with "foamy cytoplasm." These cells were negative for CD68 but positive for AE1/AE3. To our knowledge, this represents the first case of a fallopian tube xanthelasma that shows a resemblance to lesions encountered in the stomach. Fallopian tube xanthelasma must be distinguished from xanthogranulomatous salpingitis, which is associated with an inflammatory cell infiltrate, often including giant cells. However, this lesion may share pathogenetic similarities with xanthogranulomatous salpingitis, since both processes are mediated by inflammation. [ABSTRACT FROM AUTHOR]