Search

A sarcomatoid squamous cell carcinoma of the vul-va is a very rare malignancy of the female genital tract . It has been characterized as an aggressive disease typically associated with early development of local recurrences as well as distant metastases.A 77-year old woman presented to our hospital with an aggravated vulvar mass, complaining about pruritus and pain. The patient underwent a radical vulvectomy with bilateral inguinal lymph node dissection and bilateral pelvic lymph node sampling. The histo-pathologic examination was consistent with a sarcomatoid squamous cell carcinoma of the vulva with an identical microscopic and im-munohistochemical appearance. The FIGO stage was IB and further management was decided to be radiotherapy.A sarcomatoid squamous cell carcinoma is a rare entity with an aggressive biological behavior. To date, there have been only a few cases of the disease reported in the literature. Therefore a more systematic collection and closer study of such cases would be helpful for achieving an early diagnosis and more effective therapeutic strategies in the future.

Introduction/Background* All surgeons are in concern for thromboembolic events especially following a major operation for cancer. The aim of this audit is to report the incidence of PE in our oncology department, to identify risk factors and help us design future studies in order to reduce the incidence of PE and provide the best healthcare services in our patients. Methodology The Metaxa anti-cancer hospital database was reviewed to identify patients who had surgery performed for gynecologic malignancy from March 2019 to March 2021. Age, BMI, smocking status, final pathologic diagnosis, FIGO stage, surgical procedure(s) were recorded. Result(s)* We identified 174 patients who had gynecologic surgery for malignancy between March 2019 and March 2021 in our department. The incidence of PE among these patients was 4% (7/174) (table 1). Within the cohort of minor cases, 2 of 64 (3.1%) developed PE in the postoperative period. Within the cohort of major cases 5 of 110 (4.5%) developed PE. Among 110 cancer patients with major procedure, 38 of them temporally interrupted LMWH day 0 and 72 of them did not. 2 of the first group and 3 of the second developed PE (2/38=5.2% vs 3/72=4.1 respectively). Most of the cases of PE developed in patients with high stage ovarian cancer with BMI>30 (table 2). Conclusion* Gynecologic oncology patients who had abdominal surgery have higher risk of venous thromboembolism. Ovarian cancer patients are in greater danger among the rest. As far as the interruption of prophylactic thromboembolic dose of LWMH the Day 0 seems to have no increased risk in PE development but in order to conclude safer results we need to design a randomized control trial to compare the two arms. In order to reduce PE risk we also need to analyze the data from MeThos trial, in which our department participates and it is still running.

Introduction/Background* Paraaortic lymph node dissection is a challenging surgical procedure. Recent data mentioned that bulky nodal disease in ovarian/fallopian tube cancer patients stage IIB and above should be dissected in fallopian tube cancer patients that optimal primary cytoreduction has been achieved. Methodology A challenging paraaortic lymph node dissection of a nodal block arising from fallopian tube cancer in a 76 years old patient is presented in this surgical video. Patient has been diagnosed with ovarian/fallopian tube cancer. Her CA 125 was 2161 IU/ml and her preoperative imaging has revealed a mass of right adnexa 7 x 3 cm, a metastatic abdominal mass involving the transverse colon and paraaortic lymph node 6 cm in dimension. Result(s)* Abdominal hysterectomy, omentectomy, resection of the transverse colon, peritonectomies and dissection of the paraaortic nodal mass took place. No macroscopic residual disease was observed at the end of the procedure. Conclusion* Removal of bulky nodal disease is indicated for patients with advanced ovarian/fallopian tube cancer. As applies in any paraaortic/retroperitoneal lymph node dissection resection of bulky lymph nodes can lead in intra or postoperative complications. Therefore, awareness of anatomical landmarks and anatomic variation are of paramount importance.

Introduction Compared to benign disease, gynecologic cancer surgery has 6-fold higher risk for DVT and 14-fold for PE. Estimated DVT risk was reported 15–40% in major gynecologic procedures without thromboprophylaxis. Methods MeTHOS is a prospective observational study aiming to evaluate a possible reduction of VTE risk in High Thrombotic Burden (HTB) gynecological cancer patients undergone surgery. Women receiving postoperatively tinzaparin (8.000 Anti-Xa IU, OD) were enrolled after signing informed consent. Results Intermediate results from 97 women are reported. Major characteristics are depicted in table 1. Major operations were performed in women with higher BMI (p=0.0067) while severe and extremely severe ones in women with lower BMI, and younger age (p=0.0257) (see figure 1). Extended duration surgeries required in FIGO III-IV stages compared to I-II (70%, 53% respectively, OR:2.1, p=0.1366), in ovarian and endometrial cases (73%, 47% respectively, OR:3.1, p=0.0317). Median thromboprophylaxis duration was 31 days (27–35) and was not related to surgery duration (p>0.05). Three PE events occurred (3%), two in women >70 years and BMI >30 and one in a severe surgery. No bleeding events related to thromboprophylaxis were recorded. Conclusions Higher BMI limited the possibilities to achieve extended surgical goals while younger age favored it. Intense postoperative thromboprophylaxis with tinzaparin (8,000IU) for 1 month, for women with active gynecological cancer and HTB (high BMI & age, >2 hours surgery, comorbidities, advanced FIGO stage) was effective and safe. Further research is needed.

Introduction/Background Pelvic and para-aortic lymphadenectomy has been considered a standard procedure in encountering and treating patients with various gynecological malignancies. On the other hand, formation of lymphoceles are considered the most common early or late lymphadenectomy-related complications. The present study aimed to evaluate the safety and efficacy of application of fibrin-collagen sealants on lymphadenectomy areas in the formation of lymphocele after lymphadenectomy in patients with gynecological malignancies. Methodology A systematic search of 6 electronic databases for articles published up to April 2019, along with the reference lists of articles which were retrieved in full text, was performed. All randomised controlled clinical trials (RCTs) which evaluated the effect of fibrin sealant patches in the prevention of lymphocele, were considered eligible for inclusion in the present meta-analysis. Statistical meta-analysis was performed using the RevMan 5.3 software. Results Six RCTs with a total of 481 patients were finally recruited. Among them, 178 patients were treated with fibrin sealant while the remaining 192 women underwent lymphadenectomy without application of fibrin sealant. A significant decline was observed either in the total amount of fluid which was postoperatively drained or in mean duration of drainage in fibrin sealant group, compared to control, (187 women MD -86.40 ml 95% CI -100.2 to -72.60 p Conclusion According to the findings of the present meta-analysis, the application of fibrin sealants in pelvic and/or para-aortic areas after lymphadenectomy due to gynecologic cancer is safe and efficient. However, its benefit still remains elusive. In that setting, despite associated with significant decrease in the duration and volume of drainage, it was not proved efficient in minimising the incidence of lymphocele. Disclosure Nothing to disclose

Introduction/Background The prevalence of obesity has been rising during the past decades, Greece´s population is not an exception. The treatment of obese female patients with gynaecologic cancer is a challenging task for surgeons. Panniculectomy is a safe procedure that offers better visualization of pelvic anatomy and thus increased lymph node exposure and less intraoperative complications. Methodology A retrospective institutional surgical database was used to identify obese women who underwent surgical treatment for gynaecologic cancer with concurrent panniculectomy between January of 2015 and December of 2018. Major intraoperative or postoperative complications as well as wound surgical complications were documented. Results Seven obese women were treated with concurrent panniculectomy at the time of gynaecologic surgery for cancer in a single institution. Median age was 55 years old, median blood loss was 228 ml and median operative time was 195 minutes. Three patients had endometrial cancer, two patients complex atypical endometrial hyperplasia, one patient borderline ovarian cancer and one adult granulosa ovarian tumour. One patient suffered from wound infection and was treated with antibiotics and one patient died after wound infection, wound dehiscence and renal failure. Conclusion For selected obese patients concurrent panniculectomy with surgical treatment of gynaecological cancer is a safe and efficient procedure. Disclosure Nothing to disclose.

Introduction/Background Endometrial cancer is the most common cancer of the female reproductive tract in developed countries. Peritoneal metastases from endometrial cancer as advanced stage disease or as a recurrence is not rare. The aim of the present study was to evaluate the efficacy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with peritoneal disease from endometrial cancer. Methodology A systematic search of the literature for articles published up to February 2019 was performed. All studies that reported outcomes after cytoreduction and hyperthermic intraperitoneal therapy for peritoneal metastases in patients treated for endometrial cancer were independently evaluated by two authors and the discrepancies were resolved by team consensus. Results A total of 6 studies were eligible for our review and were included in the present study. 63 patients were recruited by these studies. 11 patients were treated primary with debulking surgery and hyperthermic intraperitoneal chemotherapy while 52 patients underwent this procedure for recurrent disease after their primary treatment. Histologic type, FIGO staging, peritoneal carcinomatosis index, cytoreduction completeness, adjuvant treatment and mean follow up period were documented. Of 63 patients 21 (33.3%) were reported to be disease free at the time of study publication. Conclusion Cytoreduction and hyperthermic intraperitoneal chemotherapy in selected patients with peritoneal carcinomatosis from endometrial cancer achieves promising outcomes concerning the disease free and overall survival. Disclosure Nothing to disclose.

Introduction/Background Endometrial cancer is estimated to be most common female cancer. Among other predictive factors, inflammation biomarkers resulting from white blood cell and platelet counts ratios have been introduced in the assessment of endometrial cancer. Methodology Preoperative NMR, LMR, NPR, LPR and MPR ratios in 154 patients of the gynecological department of Metaxa Memorial Cancer Hospital were calculated. Results PLR was significantly different between women with negative and women with positive lymph nodes, women with mucinous histology type and those with serous histology type and between patients with stage I and patients with stage III disease. MPR was significantly different between women with stage I and women with stage III too but also between women with stage III and women with stage IV disease as well as patients with positive and patients with negative lymph nodes. LMR was found to be significantly different between patients with negative and patients with positive disease in the upper abdomen, between endometrioid and serous type of histology, grade 1 and grade 3 disease, women with stage I and women with stage IV and between women with stage II and women with stage IV. NPR was significantly different between women with stage I and women with stage III cancer and between women with stage III and women with stage IV cancer and patients with negative and patients with positive lymph nodes. Finally, NLR was significantly different between women with mucinous histology and those with serous histology and between women with stage I and stage IV. Conclusion NPR and MPR were associated with the nodal status while NLR and PLR were correlated with serous or mucinous histology. Upper abdomen metastases and endometrioid histology seem to have an effect on LMR and all of the profiles were found to be affected by the stage and the grade of the tumor. Disclosure Nothing to disclose.

Introduction/Background This research sought to understand Gynaecologists Oncologists knowledge of, experience with, and attitudes toward the use of HIPEC in ovarian cancer patients. Methodology A 17-question, self-report survey request was emailed to Gynaecologists Oncologists prior to PSOGI International Symposium on Advanced Ovarian Cancer, Athens April 11th–13th 2019. Doctors submitted responses on the relevant website. Results Survey responses were completed by 132 Gynae-Oncologist and reported as a proportion for each query. Sixty percent of the responders were European, 75% male doctors and only 6% were operating on more than 50 patients per year. Ninetyfive percent identified a possible role of pelvic/paraaortic lymphadenectomy during debulking surgery while 48% during fertility sparing operations. Only 25% of the responders check always the BRCA status of their patients however 94% suggest the management can differentiate based on molecular profiling. Sixteen per cent and 9% avoid primary debulking in ovarian cancer patients with mesenteric disease and upper abdominal disease respectively. Fortyseven per cent consider acceptable to administer neoadjuvant chemotherapy based on positive cytology. Fortyeight per cent recognise a possible role of HIPEC during interval debulking, 44.7% the value of surgery in cancer recurrence and 68% the role of HIPEC in recurrent cases. Fortytwo percent are not aware of any evidence regarding the possible role of PIPAC in ovarian cancer. Seventyfive per cent prefer interval debulking for advanced ovarian cancer but only 3% use HIPEC. Tumor resectablility is assessed by 48.5% with upfront laparoscopy. Only 45.5% recognise a survival benefit in patients undergoing extended surgical procedures while the main areas of residual tumor after primary debulking are either mesenteric disease (59.8%) or at porta hepatis (20.5%). Regarding prevention only 18.2% suggest a prophylactic salpingectomy. Conclusion We present the findings of our survey which are possibly mirroring the everyday approach of ovarian cancer patients from the Gynae-Oncologists perspective. Disclosure Nothing to disclose.

Introduction/Background Muir-Torre Syndrome (MTS) is a rare autosomal dominant inherited disease that appears to be a variation of non polyposis colorectal carcinoma-HNPCC, known as Lynch syndrome. Current criteria for its diagnose include at least one sebaceous malignancy and a visceral cancer, most commonly colonic and genitourinary. Methodology We report a very interesting case of a 73-year old European woman that presented with four different types of neoplasms. These neoplasms encompass two types of sebaceous tumors, as well as vulvar and urothelial cancer. Results As far as we know, concerning vulvar cancer while coexisting with MTS, this case is the first to be described in literature. Conclusion Although MTS is very rare, we should pay considerable attention when dealing with more than one malignancy, including sebaceous tumor. Then, we should take a detailed family history as well as advise the family members to undergo genetic counseling about the risk of possible occurrence. Disclosure Nothing to disclose

Introduction/Background Carcinogenesis and systemic inflammation have been correlated and the ratios of white blood cell and platelet counts have been suggested to have a prognostic significance in ovarian tumor patients. The purpose of our study was to estimate the prognostic value of inflammation biomarkers in ovarian mass patients. Methodology We retrospectively assessed the potential relationship between neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), lymphocyte-to-monocyte (LMR), neutrophils-to-monocyte (NMR), and monocytes-to-platelets (MPR) and malignancy in patients admitted in the Department of Gynaecology of Metaxa Memorial Cancer Hospital due to adnexal mass. Results NLR and PLR were found to be significantly higher and LMR significantly lower in patients with malignancy. Platelet and lymphocyte count was also higher in these patients in comparison with those in patients with borderline tumors. On the other hand, white blood cell count, neutrophil-to-monocyte ratio, platelet-to-neutrophil ratio and platelet-to-monocyte ratio did not differ significantly. Cut-off points for identifying malignancy were estimated to be ≥2.4 for NLR, ≥181.1 for PLR and ≤4.55 for LMR. Conclusion Differential diagnosis between malignant and benign adnexal masses can be assisted by inflammation biomarkers. Larger prospective studies are needed in order to confirm these findings and strengthen the use of these inexpensive and easy to calculate ratios. Disclosure Nothing to disclose.

Introduction/Background Microcystic, elongated, fragmented (MELF) pattern of myometrial invasion is a recently introduced histological pattern detected in some specimens from patients with endometrial carcinoma (EC) with debatable prognostic and predictive effect. The aim of the present study is to examine the role of MELF in the prognosis and survival of patients with EC. Methodology A total of 4 electronic databases (Medline, Scopus, Google Scholar, and Clinicaltrials.gov) were searched for articles published up to May 2019, along with the references of all articles. All prospective and retrospective trials which reported outcomes of cases with EC who were examined for the presence of MELF pattern were included in the present systematic review. Results Of the 224 records screened, 15 were considered eligible. Fifteen studies which comprised 785 women were finally included in the systematic review. The correlation between MELF pattern and patients‘ age, tumor grade and stage remained controversial among the included studies. Patients with MELF (+) were detected with larger tumors while lymph node metastasis, lymphovascular space invasion and >50% myometrial invasion were significantly associated with MELF positivity. None of the included studies noted significant difference with regards to disease free survival (DFS) and disease specific survival (DSS) as well as in terms of vaginal recurrence rates. On the other hand, MELF (+) was highlighted as a significant indicator of overall survival. Conclusion The present study indicates the potential critical role of MELF pattern of myometrial invasion in the detection of lymphovascular space invasion and lymph node metastasis in patients with EC. Regardless, its implication in survival and recurrences still remains elusive and further studies are needed in the field in order to clarify the exact role of MELF in the prognosis and management of EC patients. Disclosure Nothing to disclose.

Introduction/Background Para-aortic lymphadenectomy is performed for disease staging to tailor the optimal treatment in a plethora of gynecological malignancies such as in advanced cervical, ovarian and high-risk endometrial cancer. With the advances in minimally invasive procedures, laparoscopic lymphadenectomy approaches have become the gold standard. The present study aimed to evaluate the impact of laparoscopic transperitoneal (TLL) and extraperitoneal (ELL) lymphadenectomy in patients with gynecological malignancies. Methodology The Medline, Scopus, Google Scholar, Cochrane CENTRAL Register of Controlled Trials and Clinicaltrials.gov databases were searched for articles published up to April 2019. Prospective and retrospective trials reporting outcomes for women with gynecological malignancies who underwent laparoscopic extraperitoneal or transperitoneal lymphadenectomy were enrolled. Statistical meta-analysis was performed using the RevMan 5.3 software. Results Of the 137 records screened, 7 were eligible for meta-analysis. A total of 608 women (329 TLL and 279 ELL) were included in the meta-analysis. Despite the fact that a significantly prolonged lymphadenectomy time was observed in TLL when compared to ELL (284 patients MD 35.18 min 95% CI 5.59 to 64.76 p=0.02) total operative time was not different among the two groups (407 patients MD -10.43 min 95% CI −20.55 to 41.42 p=0.51). No difference was observed with regards to postoperative complications, hospital stay and mean number of resected lymph nodes. Conclusion ELL is a safe and feasible. It presents with favorable outcomes in terms of shorter lymphadenectomy times and improved intraoperative outcomes as well as comparable to TLL lymph node yield. Further larger-volume studies are warranted to define the optimal approach in patients with gynecological malignancies. Disclosure Nothing to disclose.

Introduction/Background Ovarian epithelial cancer presents in advanced stages (III/IV) and is typically managed by combination of cytoreductive plus adjuvant chemotherapy. Cytoreduction increases the postoperative sensitivity of adjuvant chemotherapy and longer free-disease interval. Methodology Our case describes an aggressive surgical primary cytoreductive surgery including total abdominal hysterectomy, bilateral salpingo-oophorectomy, appendicectomy, total omentectomy, extended right colectomy, partial pelvic peritonectomy, diaphragm peritonectomy, splenectomy partial pancreatectomy and resection of round ligament of liver (CC=0) followed by 6 cycles of adjuvant chemotherapy carbo/taxol. After 12 months recurrent disease was detected by increased levels of tumor markers and PET scan showing distal metastasis (segment II of liver, enlargement of paraortic lymph nodes). Results The patient had a secondary complete cytoreductive surgery followed by HIPEC using cisplatin. After three months of the second debulking operation our patient performed an other PET scan that showed off reccurence of disease in multiple peritoneal sites. Conclusion Concluding, HIPEC has promising role in ovarian cancer recurrence. However early relapse can be found even after maximum secondary cytoreduction plus HIPEC. Disclosure Nothing to disclose.

The aim of our opinion letter is to highlight the recent findings in the field of hyperthermic intraperitoneal chemotherapy (HIPEC) use in ovarian cancer management. Two recent studies reveal that ovarian cancer patients treated with HIPEC can extend their survival independently of the timing offered—either at the initial cytoreductive effort or at the time of disease relapse. The research field is flourishing and further data are awaited from randomised control trials. Although, HIPEC is not considered yet as the standard of care in the management of ovarian cancer patients, the initial findings of its use are promising.

The objective is to present a rare case of late diagnosis of Cornelia de Lange syndrome. A 27-year-old pregnant woman (gravida 1, para 0) was referred to our Fetal Medicine Department during her 33rd week of gestation due to intrauterine growth restriction (IUGR) and polyhydramnios. The ultrasound scanning confirmed the findings and furthermore, the 3-D examination revealed minor facial dysmorphisms, limb abnormalities, and hypertrichosis. The fetus died 1 week post-diagnosis due to unknown reason and the woman underwent an induction of labor. Postmortem examination confirmed the diagnosis of Cornelia de Lange syndrome. The prognosis of the syndrome is severe. Termination of pregnancy before viability is proposed. Genetic counseling is necessary.

Atypical squamous cells of undetermined significance (ASCUS) are a cervical cytologic finding category suggestive but not definitive of squamous intraepithelial lesions. ASCUS remains an incompletely described entity and accounts for even 5%-10% of reported Papanicolaou (Pap) smears. The management of women with such cytologic findings remains controversial. The aim of this study was to evaluate the cytology laboratory findings with regards to ASCUS diagnosis, using cervical Pap smears, and colposcopic biopsies, as well as their management.This is a retrospective study of patients with ASCUS Pap smears taken during the period January 2010 - December 2010 in the Second Department of Obstetrics and Gynecology, Aretaieion Hospital.During the study period, 657 Pap smears were examined at the Aretaieion Hospital; moreover, seven patients, whose Pap smears were cytologically diagnosed with ASCUS, were referred from other clinics, providing a total of 42 cases with a descriptive diagnosis of ASCUS for review. Of the 42 cases, eight were not studied because they were either lost in follow-up or they did not have available data. The remaining 34/42 patients were evaluated by colposcopic examination and directed biopsies where necessary. The ratio of ASCUS to low-grade squamous intraepithelial lesion (LGSIL), high-grade squamous cell intraepithelial lesion (HGSIL) or squamous cell carcinoma (SCC) was 5/34, 1/34, and 0/34, respectively. In the 34 ASCUS cases evaluated by colposcopy, the age distribution varied from 22 to 54 years. Eight of 34 cases did not have a child, 7/34 were primigravida, 18/34 were secondi-gravida, and 1/34 had four children. Four out of 34 cases were postmenopausal, 3/34 referred no history of abnormal bleeding, 21/34 were smokers, 6/34 used oral contraceptives, 2/34 used intrauterine devices, 1/34 took replacement of hormones, 4/34 had prior abnormal Pap smears human papillomavirus (HPV), or 1/34 had previous cancer (breast cancer). Colposcopy was inconclusive in 4/34 patients, while 8/34 cases were negative for Schiller and acetic acid tests and also had normal colposcopy. Infectious organisms were found in 8/34 patients with ASCUS, including actinomyces (1/8), trichomonas (5/8), and candida albicans (2/8). Histologic tests revealed 16/34 koilocytosis cases, 5/34 LGSIL, 1/34 HGSIL, and 0/34 SCC.The dilemma in the management of patients with an ASCUS diagnosis still exists as a significant problem for clinicians.

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.

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.

The number of migrants and refugees with a female genital mutilation (FGM) living in Greece is rising. This study explores the characteristics and psychosexual issues of women with FGM who were examined in the 2nd Department of Obstetrics and Gynecology, University of Athens Medical School, Greece during the year 2009. The women were asked to fill out an anonymous questionnaire asking for demographic data, obstetric history, current complaints, and psychosexual problems. The results are presented and discussed, as FGM is a new reality for Greece. Healthcare providers have to familiarize themselves with issues related to FGM and improve their skills in transcultural care, so as to manage and support women with FGM adequately.

Abdominal wall metastasis either incisional, drain, or port is rather rare in patients treated for cervical carcinoma. We present a case of a patient who underwent an abdominal radical hysterectomy for a moderately differentiated cervical adenocarcinoma stage Ib1 and presented an incisional site metastasis 36 months after her operation. Moreover, we performed a literature search for abdominal wall metastases after radical hysterectomy for cervical cancer, and we present a table of the relative case reports. After our literature search, we clarified that the median time of recurrence was 14 months (range 1.5 month to 45 months). Thirty-three out of 42, 8/42, and 1/42 were squamous, adeno-, and adenosquamous carcinomas, respectively. Wide excision was performed in 30/37 cases of which we have information regarding the treatment option, while 11/37 and 13/37 underwent radiotherapy and chemotherapy, respectively. The possible mechanism of such a metastasis as well as the treatment options is discussed.

This is a case of a 43-year-old primigravida primipara woman who presented in our Department in 36 weeks gestational age and underwent caesarean section due to preeclampsia. From her history, it was known that her pregnancy was an in vitro fertilization (IVF) result. She also received low molecular weight heparin because of thrombophilia (protein S insufficiency). We present this case of postpartum thrombocytosis and discuss the differential diagnosis of this condition through the presentation of its management.

Uterine tamponade with the Bakri catheter is effectively used as a treatment in postpartum hemorrhage and as a means to prevent fertility.We present a case of a 40-year-old pregnant woman who had a massive hemorrhage during cesarean section who was successfully treated with a tamponade balloon. Furthermore, we comment on a similar technique--Logothetopoulos pack--which was first developed and used in our department in the early years of the previous century.A conservative technique such as the Bakri catheter is an alternative intermediate step to control postpartum hemorrhage when pharmaceutical methods fail and before proceeding to obstetric hysterectomy.

Verrucous carcinoma of the vulva is a rare type of squamous cell neoplasm with distinct morphology, pathogenesis and special therapeutic management. A case of a 72-year-old patient who developed verrucus carcinoma of the vulva is reported. Data regarding the diagnosis, management and treatment of this neoplasm are presented, and a review of the literature is performed.

Our objective was to show the way the classic CAH presents after birth as a severe condition and develops to the adult life, effecting growth, height and weight, appearance, fertility, relationships and quality of life.We report the case of a 23-years-old female with the classic Congenital Adrenal Hyperplasia (CAH) from birth, diagnosed due to genital pigmentation, clitoromegaly and salt-wasting crisis, treated with glucocorticoid replacement (hydrocortisone, fludrocortisone and NaCI), followed by genital surgery, until the adult life when she continues treatment with fludrocortisone and prednisolone.A treatment challenge is to effectively control the excess androgen symptoms by using the lowest possible glucocorticoid dose. Patients well-being can be accomplished by team work, adapted therapy, continues follow-up and patient's compliance (Ref. 15).

24 cases of single umbilical artery (SUA) are presented and the related histopathological findings of the fetuses and placentas examined. SUA is the most common congenital anomaly of the umbilical cord, resulting in the absence of one of the two umbilical arteries. It has an incidence of approximately 2.1% in autopsy material and there is evidence that is associated with anomalies of the fetus and placenta.The files were reviewed of 24 cases with SUA, out of 1,570 autopsies of fetuses and placentas performed in the Pathology Laboratory of Aretaieion Hospital, due to spontaneous or induced abortions after written parental consent.The incidence of SUA was 1.6%. Gestational age ranged between the 15th and 33rd week and mother's age ranged from 17-44 years. Three of 24 cases were twin pregnancies; 17/24 fetuses were male. In 21/24 cases complex congenital anomalies were observed and in five of 24 cases chromosomal anomalies were detected. In eight of 24 placentas extensive infarcts were observed; 7/24 dysmaturity, 5/24 severe chorioamnionitis, 3/24 extensive fibrin accumulation and 1/24 chorioangiosis.SUA is an umbilical congenital anomaly associated with severe fetal congenital anomalies and once detected with ultrasound techniques, further and more detailed control of the fetus is considered mandatory.

The investigation of potential predisposing factors of breast cancer, a disease accounting for almost one-third of malignancies in women, is necessary in order to reduce the incidence.We interviewed 405 female patients who had been diagnosed with breast cancer and who also reported having used oral contraceptive pills before. They were categorized into two groups (group A7 years OC use and group B7 years OC use).Statistical analysis revealed a small (p0.02) but significant increased risk of the disease to BRCA mutation carriers, as well as to the women with a significant medical or family history of breast, ovarian or colon cancer who had also previously used oral contraceptive pills for more than seven years.Breast cancer seems to be positively dependent on prolonged oral contraceptive use.More research is needed to establish the hypothesis that the human genome is vulnerable to oral contraceptives.

Endometrial brush cytology is a widely accepted method for the detection of endometrial lesions. The aim of this study was to evaluate the role of cytological sampling using Uterobrush in the screening of endometrial pathology.This is a prospective double-blind study evaluating the efficacy of the Uterobrush method (Cooper Surgical, Trumbull, USA) in the detection of endometrial abnormalities. Endometrial cytology was performed during the period January 2009 to April 2010 in all symptomatic patients that underwent dilatation and curettage. The collected samples were firstly smeared directly onto a glassslide and consequently into Thin-Prep buffer. Cytologic features were evaluated according to the criteria of Tao. The main objective was to evaluate the efficacy of Uterobrush method comparing the results of cytologic and histopathologic examination.The sample of the study consisted of 100 women aged 55.8 years (range 38-78 years) with recorded data regarding Uterobrush test and classic histologic examination. Fifty-five patients were postmenopausal. A total of 92% of the samplings were performed by trainees. Endometrial carcinoma was cytologically diagnosed in 8/9 patients, whereas endometrial polyps were diagnosed in 5/34 patients (14.7%). All the patients with simple hyperplasia were correctly diagnosed with the Uterobrush method, whereas the diagnosis of complex hyperplasia with or without atypia was correct in 85.7% and 100% of patients, respectively. Regarding endometrial carcinoma, the sensitivity, specificity, positive and negative predictive values were 88.9%, 100%, 100% and 98.9%, respectively. On the other hand, regarding endometrial polyps, the sensitivity, specificity, positive and negative predictive values were 14.7%, 100%, 100% and 69.5%, respectively.Uterobrush is a reliable direct intrauterine sampling for detecting endometrial abnormalities especially endometrial carcinoma and hyperplasia, but not endometrial polyps. It is a well-tolerated, easy to use method, which provides generous endometrial sampling without contamination from the endocervix or the vagina.

Peutz-Jeghers syndrome is a rare syndrome which is inherited in a dominant manner. It is characterized by hamartomatous polyps of the gastrointestinal tract, hyperpigmented macules of the oral mucosa and an increased risk of developing neoplasms in the gastrointestinal tract, pancreas, breast and genital system. Women with Peutz-Jeughers syndrome often develop an ovarian sex cord tumor and cervical adenocarcinoma of minimal deviation adenoma malignum type. A case of a 58-year-old patient with Peutz-Jeghers syndrome and history of multiple malignancies (thyroid, breast and colon cancer) who presented with metrorrhagia is reported. The dilatation and curettage revealed endometrial adenocarcinoma. The patient underwent total abdominal hysterectomy with bilateral oophorectomy. The histologic examination showed an endometrioid endometrial adenocarcinoma that developed in atypical endometrial hyperplasia. The histologic examination of the right ovary revealed a sex cord tumor with annular tubules, measuring 3 cm. Sex cord tumors with annular tubules in patients with Peutz-Jeghers syndrome are usually small, bilateral tumors of the ovaries which have common characteristics with granulosa cell tumor and Sertoli cell tumor. Hyperestrogenism is a rather common finding with development of estrogen-dependent lesions.

We present the clinicopathological findings of a rare case of a monodermal teratoma of the right ovary with functional ovarian stroma and extensive decidualization in a 74-year-old woman. The patient presented with vaginal bleeding. Ultrasound scan revealed a pelvic mass measuring 9.5 cm in the lower right abdomen. A right oophorectomy was performed. The tumor was cystic and multilocular filled with colloid material. Histological examination revealed follicles of thyroid type, and stromal clusters of fusiform or polygonal cells were found in the stroma. An extensive decidual reaction was observed. Morphological and immunohistochemical examination of the tumor revealed cystic struma ovarii with functional ovarian stroma and ectopic decidua. Total abdominal hysterectomy with oophorectomy was performed. A benign endometrial polyp, proliferative endometrium, two fibroids, and an ovarian cyst were observed.

Clear cell cervical adenocarcinoma (CCA) is a rather rare malignancy of the genital tract. We report six cases of CCA, diagnosed in our laboratory during a 15-year period: five patients with sporadic primary CCA and one young patient with CCA and a history of in utero exposure to DES. The possible DES exposure, clinicopathological findings as well as the differential diagnosis and the the prognosis of such patients are presented in a mini-review of the literature.

The aim of this study was to compare radio wave cone biopsy to the LLETZ method in patients with high-grade squamous intraepithelial lesions. METHOD-RESULTS: This was a retrospective study of 186 patients diagnosed with HGSIL who underwent cone biopsy either with the LLETZ method (82/186) or with the radio wave method (104/186) in the 2nd Obstetrics and Gynecology Department, University of Athens, Aretaieion Hospital, Athens, Greece during the period January 1999 to December 2008. The mean age of the patients was 31 years (range 23 to 53 years). The volume of cone ranged from 1.2 x 2 cm up to 3 x 3.6 cm in both techniques. Histopathological analysis revealed focal or extensive high-grade squamous intraepithelial neoplasia extending into the underlying endocervical glands in 128/186 patients. Concomittent low-grade squamous intraepithelial lesions were observed in 160/186 patients and coilocytic atypia was observed in 172/186 patients. The endocervical margins were free of disease in 172/186 cases. In seven cases the neoplastic lesions were at least 0.1 cm from the margin and in seven cases they extended to the margin. In all cases a degree of tissue coagulative change was observed, but not extensive to the point of obscuring the diagnosis.4.0 MHz radio wave surgery is an excellent alternative in the treatment of HGSIL. Clear surgical margins due to decreased heat and tissue damage, controlled hemostasis, faster healing, and patient and doctor satisfaction are notable advantages.

Unwanted pregnancies and the subsequent induced abortions are common problems of our youths in modern Greece. The aim of this study was to recognize the risk factors of the problem in an effort to find the best possible solution out of this social dead end.We interviewed 1,320 young female individuals and analyzed their answers using statistical analysis.Several useful conclusions were reached concerning the forces that are involved in unwanted pregnancy/induced abortions.We have tried to underline the strategy to combat the problem.Sexual education and the proper use of contraception remain the essential tools in this effort.

A case of a male embryo aborted at the 20th week of gestation with extensive ascites, hydrothorax, pulmonary lymphangiectasia and pulmonary hypoplasia is presented together with the pathological findings, the etiology, differential diagnosis, course and therapy of this pathologic entity. Also a short review of the literature is discussed.

Two cases of mixed germ cell and epithelial primary ovarian tumors which developed in women 47 and 57 years of age are reported. In both cases, large teratomas measuring 20 and 21 cm were observed in combination with carcinoids and malignant mucinous neoplasms. A possible common oncogenic mechanism is discussed and a literature review is presented.

Strong evidence implicates chronic intraamniotic inflammation in the etiology of preterm delivery. The purpose of this study was to determine whether amniotic fluid IL-1β, IL-10 and IL-18 concentrations in women undergoing mid-trimester amniocentesis can identify those at risk for preterm labor or preterm rupture of membranes.A case-control study was conducted to compare mid-trimester concentrations of amniotic fluid IL-1β, IL-10 and IL-18 in women delivering at term or preterm. Out of 362 women included in the study, 38 presented with preterm labor. Thirty-eight women with term delivery, matched for chronological and gestational age served as controls. Women with abnormal fetal karyotypes or major anomalies were excluded. IL-1β, IL-10 and IL-18 concentrations were determined by ELISA. Conditional logistic regression was applied in the statistical analysis.IL-1β was found to be positively and significantly associated with preterm delivery. Specifically, for every unit increase in IL-1β, women were on average 7.2 (OR: 7.2, CI: 1.94-26.77, p=0.003) times more likely to deliver preterm. IL-18 levels as well as gender were significantly associated with preterm delivery. Specifically, for every unit increase in IL-18, women were on average 1% less likely to have a preterm delivery (OR: 0.99, CI: 0.98-0.99, p=0.04). On the other hand, IL-10 was not significantly associated with preterm delivery.Mid-trimester IL-1β concentrations are positively associated with preterm delivery. Therefore, IL-1β, determined on the occasion of mid-trimester amniocentesis could possibly serve as a marker of preterm delivery. In contrast, IL-10 and IL-18 concentrations are not elevated in mid-trimester amniotic fluid and probably cannot serve this purpose.