Endometrijski karcinom najčešća je invazivna neoplazma ženskoga genitalnog trakta s rastućom incidencijom u posljednjim desetljećima. Cilj je ovog rada upozoriti na učinkovitost metode materničnog ...četkanja
(uterobrush) pri dobivanju uzoraka materništa i postavljanju citološke dijagnoze endometrijskih lezija. Materijal i metode: Tijekom godine dana četkicom su uzeti uzorci materništa od 162 simptomatske bolesnice u perimenopauzi i postmenopauzi koje su došle u Kliniku za ženske bolesti i porode KB-a Merkur. Patohistološke dijagnoze,
dobivene nakon frakcionirane kiretaže (n = 36 ) ili nakon kirurškog zahvata (n = 16), usporedilo se s postavljenim citološkim dijagnozama, a 97 bolesnica pratilo se godišnjim ultrazvučnim pregledima. Iz istraživanja su isključeni uzorci neadekvatni za analizu. Rezultati: Citološka dijagnoza postavljena s pomoću metode materničnog četkanja
bila je u skladu s patohistološkom dijagnozom u 69,2% (36/52) bolesnica. Citološki i histološki potvrđeni su: sedam karcinoma, ukupno 13 hiperplazija endometrija, jedan polip te 14 nalaza s benignim promjenama. Pacijentice praćene ultrazvukom nisu više imale ginekoloških simptoma. Zaključak: Uporaba maternične četkice omogućuje dobivanje prikladnog i reprezentativnog uzorka materništa za prepoznavanje lezija endometrija i sudjeluje u postupniku obrade simptomatskih bolesnica.
Primarni karcinom endometrija najčešća je maligna neoplazma ženskoga spolnog sustava. Prvotni simptomi, kada se i dijagnosticira u početnom stadiju bolesti, jesu nepravilna i/ili produljena krvarenja ...u premenopauzi ili krvarenja u postmenopauzi. Ostali su simptomi boli u zdjelici ili abdomenu ili abnormalni Papanicolaouov test. Bolesnice su najčešće u postmenopauzalnom razdoblju, ali ni žene generativne dobi nisu isključene. Radovi su pokazali da žene generativne dobi s dijagnosticiranim karcinomom endometrija imaju povišen rizik i od
istodobne bolesti karcinoma jajnika i nasljednoga nepolipoznog karcinoma kolona. Upravo je entitet istodobnoga primarnog karcinoma endometrija i jajnika velika dijagnostička zamka jer ne postoje jedinstveni histološki algoritam ni kirurški postupnik, a potrebno ga je odvojiti od primarnog karcinoma jajnika i metastatskog širenja karcinoma endometrija u jajnik radi povoljnije prognoze i mogućnosti poštednijega kirurškog zahvata u mlađih bolesnica te očuvanja fertiliteta. U radu prikazujemo bolesnicu u dobi od 49 godina, s anamnestičkim podacima o obilnijim krvarenjima i postojanju ciste na jajniku, kod koje se nakon intenzivnih i naglih boli te zbog sumnje na rupturu ciste pristupilo hitnom laparoskopskom zahvatu. Zbog intraoperativnoga citološkog nalaza sa sumnjom na maligni proces i pozitivnoga patohistološkog nalaza operacija je konvertirana u laparotomiju. Detaljnom patohistološkom analizom uz imunohistokemijsku dopunu dijagnosticirana je rasadnica (metastaza) endometrioidnog adenokarcinoma endometrija.
Kada se govori o citološkoj dijagnostici endometrijskih poremećaja, tada razmatramo mogućnosti vizualizacije stanja i promjena u tijelu maternice direktnom metodom uzorkovanja materništa četkicom ...(uterobrush). Uzorkovanje se izvodi ambulantno, bez anestezijskih postupaka, s manjom nelagodom za pacijentice, a citološki nalazi s reprezentativnim uzorcima omogućuju usmjeravanje na daljnju dijagnostiku, praćenje bolesnica s endometrijskim promjenama te izdvajanje onih kod kojih su potrebne daljnja obrada i dijagnostika. Cilj je ovog rada pokazati vrijednost metode materničnog četkanja i citološke dijagnostike prikazima triju bolesnica: jedne s atipičnom hiperplazijom endometrija pod suprimirajućom terapijom gestagenom, druge u koje je dijagnosticiran pločasti karcinom i treće s granulomatoznom upalom u aspiratu materništa. Želimo pokazati da se metodom materničnog četkanja dobivaju zadovoljavajući uzorci na kojima se mogu detektirati patološke promjene materništa, da je ta metoda pogodna za neinvazivno praćenje pacijentica te da bi trebala zauzeti odgovarajuće mjesto u postupniku obrade bolesnica s endometrijskim poremećajima.
Cancer of the cervix is one of the most predictable and preventable types of cancer, however, it is still one of the most common malignancies. Due to a lack of information available to women about ...the causes of the disease, accessibility of screening programs, and limitations to the existing screening techniques, cervical cancer is the second most common type of cancer in women worldwide. Detection and follow-up of pre-cancer stages of the disease are based on the Pap test, which is now well established as a basic method of secondary prevention. Relative low sensitivity of the Pap test has initiated the development of additional technologies and methods towards enhanced screening quality and error elimination not only in the process of sample taking and analysis but also in screening and interpretation. Immunocytochemical methods and liquid based cytology are the new diagnostics possibilities in secondary prevention. In order to decrease morbidity, thus mortality too, it is necessary that the primary prevention (vaccination) be also implemented.
The purpose of the study is to present technique of punction and conservative treatment of cystic ovarian lesions. The following criteria were included: 1) Cyst should be unilocular, sonolucent, with ...a smooth inner wall of capsule, without septa and without neovasculariation on transvaginal color and power Doppler. 2) Serum CA-125 levels must be lower than 35 U/mL. The capsule of the cyst was punctured with a 18 gauge needle under the control of 5 MHz transvaginal probe. Cyst fluid was sent for cytologic examination. After complete emptying of the cyst, we injected sterile 95% ethanol in the 50-75% of the evacuated liquor amount. The alcohol remain in the cyst from 5 to 20 minutes and was then aspirated completely. We punctured cysts in 366 patients aged from 18 to 65 years, volume of cyst being between 40 and 300 mL. Patients were monitored for 24 hours and follow-up examinations were 3, 6 and 12 months after the procedure. Three cysts were ruptured (0.8%) and alcohol split in the Douglas cavity. Intensive pelvic pain had 8.1% and relapse appeared in 8.2% of the patients. Technique ofpunction is simple and easily performed. Method of treating by 95% alcohol has demonstrated good results. Relapse we treated by laparoscopy or laparotomy.
Vulvar Morbus Paget (MP) represents a rare intraepithelial adenocarcinoma. It accounts for less than 1% of all vulvar neoplasia and usually appears in postmenopausal women. Histologically it is ...analogous to Paget's disease of the breast. The most common clinical symptom is pruritus. The lesion appears as an erythematous or as an eczematous lesion with islands of hyperkeratosis. Occasionally, single anaplastic Paget's cells can be found on the vulvar smears which make cytological diagnosis of the disease possible. However, the disease can be diagnosed only by biopsy. We present a case of 49-year old woman with vulvar symptoms of pruritus, who had liver and kidney transplantation two years ago. During the standard gynecological examination the vulvar smear was taken for cytological evaluation. The smear was scanty, with inflammatory background, overloaded with squamae. There were two types of cells: dysplastic squamous cells from lower layer of the epithelium and the single, anaplastic cells with a high nuclear:cytoplasmic ratio who possessed eccentric, large nucleus. Nucleoli were rare. Cytoplasm varied from pale and delicate to densely basophilic. Accordingly, cytological diagnosis vulvar intraepithelial neoplasia (VIN III) with differential diagnosis of vulvar Paget's disease was made. The pathological verification supported the diagnosis of MP and an immunohistochemistry panel confirmed type III of Paget's disease and an evaluation of bladder was suggested.
Carcinoma of the fallopian tube is a rare, extremely aggressive neoplasm that is uncommonly diagnosed in early stages of the disease. We present a case of a 56-year-old nulliparous patient with tubal ...carcinoma stage Ic (FIGO). Preoperatively, the only suspect finding were atypical glandular cells of extrauterine origin presented on a routine Papanicolaou smear. Histopathologic finding of D&C implicated the same suspicion of extrauterine genital malignancy. After hysterectomy with bilateral adnexectomy and omentectomy, histopathology confirmed stage I primary adenocarcinoma of the right fallopian tube (alveomedullary type) with positive intraoperative cytology of Douglas pouch lavage. As the patient had bilateral occlusion of the tubes, we presumed that tumor cells were leaking through the uterus into the vagina, and we were luckily alerted within the pathological cervical smear to the possible presence of a malignancy in the abdomen. The patient received 6 courses of cyclophosphamide and cisplatin chemotherapy postoperatively. Two years after the diagnosis, the patient is healthy, without a trace of primary malignant disease. Cytology undoubtedly plays a vital role as a screening tool in the detection of premalignant and malignant diseases of the female genital tract, particularly lesions in the uterine cervix. However, its role in clinical staging of gynecologic diseases should not be underestimated either, due to its ability to detect malignant epithelial cells in peritoneal samples as well as for its detecting and diagnostic value in other malignant gynecologic diseases.
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