From January 1, 1970 to December 31, 1979, 425 cases of endometrial carcinoma, FIGO stage I, were treated at the First Department of Obstetrics and Gynecology, University of Milan. Three different ...surgical approaches were used: total abdominal hysterectomy with bilateral salpingo-oophorectomy and selective pelvic lymphadenectomy was performed in 245 women, total abdominal hysterectomy and bilateral salpingo-oophorectomy without pelvic lymphadenectomy in 100, and vaginal hysterectomy with bilateral salpingo-oophorectomy in 80. Five-year survival was evaluated as a function of risk factors (histological grade, depth of myometrial invasion, metastatic nodes) in the three groups of patients, and we conclude that lymphadenectomy is useful for prognostic purposes but does not confer a therapeutic benefit.
We performed a follow-up hysteroscopy with multiple biopsies at different intervals after surgery in 19 women who underwent hysteroscopic septal incision. Seven days after operation the sectioned ...areas were very evident and not epithelialized (3 patients). At 14days, the incised zone was depressed with scattered epithelialization (5 subjects). At 1month, the sectioned surfaces were still depressed and uniformly covered by thin endometrium (5 cases). After 2months the uterine cavity was almost normal with minimal tendency to central fundal adhesions (6 women). Thus, spontaneous healing processes after hysteroscopic metroplasty progressed regularly and completely and there is probably no reason to delay attempts at pregnancy for longer than two cycles after surgery.
Pregnancy has long been considered to have beneficial effects on endometriosis. We describe a patient who underwent emergency exploratory laparotomy at gestation week 35 for rupture of an ovarian ...endometrioma.
To describe the conservative treatment of diffuse uterine leiomyomatosis.
Descriptive study.
Tertiary care centers.
Three premenopausal women with diffuse uterine leiomyomatosis associated to ...persistent menorrhagia, two with desire of becoming pregnant and one with desire of preservation of the uterus.
Preoperative ultrasound showed symmetrically enlarged uteri with innumerable, poorly defined and small-sized (0.5–3 cm) myomas involving all the myometrium. An “extreme” myomectomy was performed in two cases, including the removal of a large portion of corporal myometrium. One patient was treated only medically with GnRH analogues (GnRH-a).
Menstrual pattern and, when applicable, ability to conceive and pregnancy outcome.
Regular menses were restored in both patients who underwent surgery: one had no pregnancy desire and the other was not able to conceive after two IVF-ETs. The patient treated with GnRH-a conceived spontaneously as soon as medical treatment was discontinued; at 34 gestational weeks, an emergency cesarean section followed by hysterectomy was performed for vaginal bleeding and a healthy 2,400-g baby was born.
Our experience supports the idea that a conservative approach to uterine leiomyomatosis may result in restoration of normal cycles and eventually in the birth of a viable fetus.
