Browsing by Author "Dotlic, J. (6504769174)"

Purpose: To report a case of extremely rare anaplastic T-cell lymphoma of the urinary bladder in an advanced stage, with completely unspecific radiological features and symptomatology mimicking necrotic myomas. Case Report: A 38-year-old women was admitted for pelvic pain, dysuria, enlarged uterus, subfebrile temperature, but without vaginal bleeding and hematuria. On ultrasound scan necrosis of the uterine myomas was suspected. Magnetic resonance imaging revealed an anteuterine tumor (9×9×11 cm) infiltrating the uterus and urinary bladder and retrouterine formation (7×5×7 cm) adhering to the posterior uterine wall and rectum, right kidney hy-dronephrosis, and parailiac lymphadenopathy. Cystoscopy confirmed the presence of the tumor on the posterior bladder wall and bladder roof infiltrating the right ureteral orifice. Histopathological and immunohistochemical analyses of tumor biopsy confirmed the presence of T-cell anaplastic ALK+ non Hodgkin’s lymphoma of the urinary bladder. Conclusion: This case report shows that pelvic pain and dysuria alone can imply on urinary bladder tumors even in the absence of hematuria. Additionally, uniqueness of this case lies in the younger age of the female patient. Moreover, the authors showed for the first time that lymphomas could spread locally into both uterus and intestines, without systemic dissemination. © 2019 S.O.G. CANADA Inc.. All rights reserved.

Purpose: The study aim was to report an unusual case of a misplaced IUD in isthmico-cervical region causing partial uterine perforation and discuss literature data regarding such a condition. Case Report: A 50-year-old women was referred to the present institution for IUD extraction. She was diagnosed with spontaneously misplaced IUD located in isthmico-cervical region of the uterus causing partial perforation. The time of dislocation was unknown, as she was completely asymptomatic for ten years after IUD application. Moreover, she had no risk factors for device misplacement. The removal of IUD was uneventful. Conclusion: Isthmico-cervical misplacement of IUD, although rare, can occur at any time and can be asymptomatic. Thus, women with IUD should be annually checked-up in order to prevent possible IUD complications.

Purpose: The study aim was to investigate clinical characteristics of endometrial polyps in women with and without infertility. Materials and Methods: Study included all patients of reproductive age who had a hysteroscopy due to endometrial polyps during 30 months. Patients were divided according to infertility problems. Detailed medical history was taken from all patients (age, BMI, parity, comorbidities, symptoms/signs, and polyp recurrence). On ultrasound scan, the polyp's largest diameter and endometrial thickness were assessed. During hysteroscopy localization of polyps and other intrauterine formations were registered. Removed polyps were histopathologically analyzed (size and histological type). Results: Study involved 257 patients (average 38.5 years of age), out of which 79 had infertility problem, while 178 patients constituted the control group. There were no significant differences regarding patient's BMI, age in decades, number of abortions, presence of comorbidities, taking hormone therapy, symptoms/signs, localization or diameters of polyps, polyp recurrence, other intrauterine findings, and histopathological types of polyps between women with and without infertility problems. Conclusion: Clinical characteristics of endometrial polyps are quite similar in women with and without infertility problems. © 2018 S.O.G. CANADA Inc. All rights reserved.

Objectives: The aim of the study was to assess the impact of soy- and red clover-derived isoflavones on serum lipid levels in postmenopausal women and to compare the effects to the lipid levels of healthy postmenopausal women without phytoestrogen supplementation. Materials and Methods: Blood levels of triglycerides, total cholesterol and cholesterol fractions were assessed. Measurements were performed before treatment and at 6-month intervals over a period of 18 months. The investigation included 74 healthy postmenopausal women randomized into three groups according to treatment. The first group of 23 patients received soy-derived isoflavones, the second group (26 patients) was given red clover-derived phytoestrogens, while the third control group (25 patients) received no supplements. Results: Mean triglyceride, cholesterol and LDL levels of patients in the control group were significantly higher than in both the soy and the red clover groups (p < 0.001) at all three time points, while mean values did not differ significantly between the soy and the red clover groups. The mean HDL levels of patients in the control group was significantly lower than in both the soy and the red clover groups (p < 0.001). Conclusions: Phytoestrogen supplementation had a positive metabolic effect on serum lipid levels in postmenopausal women. The impact on serum lipids levels was similar for soy and red clover. © 2018 Georg Thieme Verlag KG Stuttgart.New York.

Objectives: The aim of the study was to assess the impact of soy- and red clover-derived isoflavones on serum lipid levels in postmenopausal women and to compare the effects to the lipid levels of healthy postmenopausal women without phytoestrogen supplementation. Materials and Methods: Blood levels of triglycerides, total cholesterol and cholesterol fractions were assessed. Measurements were performed before treatment and at 6-month intervals over a period of 18 months. The investigation included 74 healthy postmenopausal women randomized into three groups according to treatment. The first group of 23 patients received soy-derived isoflavones, the second group (26 patients) was given red clover-derived phytoestrogens, while the third control group (25 patients) received no supplements. Results: Mean triglyceride, cholesterol and LDL levels of patients in the control group were significantly higher than in both the soy and the red clover groups (p < 0.001) at all three time points, while mean values did not differ significantly between the soy and the red clover groups. The mean HDL levels of patients in the control group was significantly lower than in both the soy and the red clover groups (p < 0.001). Conclusions: Phytoestrogen supplementation had a positive metabolic effect on serum lipid levels in postmenopausal women. The impact on serum lipids levels was similar for soy and red clover. © 2018 Georg Thieme Verlag KG Stuttgart.New York.

Purpose: The study aim was to report diagnostic and therapeutic challenges in treatment of a patient with cervical dysplasia and congenital uterine anomaly. Case Report: A 53-year-old women with Mullerian anomaly - uterus duplex (bicorporal septate uterus) and Yshaped endocervical canal was referred due to repeated abnormal Pap smears. She underwent endocervical curettage of both canals and the endocervical septum biopsy which revealed presence of cervical intraepithelial neoplasia (CIN) III. Cervical conization was considered technically unfeasible because of abnormal cervical anatomy (lesions deep in the cervical canal on the cervical bifurcation where the cervical wall is the thickest). Classical open abdominal hysterectomy was performed. Patient had two almost equally-sized, symmetrical uterine bodies connected in the isthmico-cervical region, with normal left and obstructed right hemi-vagina. Postoperative histopathological findings confirmed that dysplasia was located in the region where two endocervical canals conjoined. Conclusion: Diagnostic and therapeutic approach to patients with uterine anomalies has to be individualized, based on anomaly type, patient's age, reproductive history, and patient's preferences.

Objective: The study aimed to assess the psychometric properties of the Menopause-specific Quality of Life Questionnaire (MENQOL) in Serbian climacteric women. Methods: Two hundred mid-aged (40–65 years) women filled out a general sociodemographic and medical questionnaire, the MENQOL, the Short Form-36 questionnaire (SF-36), and Beck’s Depression Inventory (BDI). The MENQOL was translated according to recommended methodology and its psychometric properties (internal consistency, discriminant, construct and criterion validity, factor and Rasch analyses) were assessed. Results: Cronbach's alpha coefficient for the Serbian MENQOL was 0.957 (Vasomotor =0.917, Psychosocial =0.907, Physical =0.928, Sexual =0.913). Corrected item–total correlation coefficients were >0.50 for all items. Factor analysis extracted six domains with total variance of 72.02%. Beside the four original domains, two new domains were observed: Attractiveness and Pain. Factor loadings for all items were appropriate (>0.4). The MENQOL correlated with the SF-36 and BDI total scores, suggesting good criterion validity. Rasch analysis showed adequate reliability (item =0.91; person =0.79) and separation (item =1.95; person =3.21) indexes, proving good reproducibility and reliability of the Serbian MENQOL. All items had infit and outfit mean squares in the standard accepted range. Conclusion: Principal component analysis showed somewhat different constructs from the original scale. However, Rasch analysis confirmed that the MENQOL represents a good metric instrument for menopausal symptoms. © 2018, © 2018 International Menopause Society.

Introduction: The authors present an interesting case of large ovarian carcinoma challenging for diagnosis (with lymphonodal and umbilical subcutaneous metastases, but without infiltrating intestines and therefore causing few symptoms). Case Report: A 63-year-old patient, almost completely asymptomatic, presented with large bilateral adnexal masses. ROMA index was elevated. Abdominal and pelvic MRI scan showed presence of 20-cm mixed-consistency tumors of both ovaries and lymphedema in periumbilical subcutis. Only two parailiacal lymph nodes were enlarged. Patient had total hysterectomy with bilateral adnexectomy, selective lymphadenectomy, and excision of subcutaneous tumor. The right tumor formed the incarceration of the intestines, without infiltrating the intestinal wall. Histopathological analysis diagnosed ovarian serous papillary adenocarcinoma with metastases in lymph nodes and umbilical region subcutis. Conclusion: This report highlights that, although very rare, one of the first ovarian carcinoma manifestations can be its subcutaneous/cutaneous metastases. Additionally, lack of clear symptoms can exist in even at the advanced stage. © 2018 S.O.G. CANADA Inc. All rights reserved.

Purpose: The purpose of this report was to confirm that endometriosis, although a benign gynecological disease, in some patients, can give rise to ovarian cancers. Case Report: The authors report a case of clear cell carcinoma in a patient suffering of endometriosis. The patient, a 38-year old nullipara, had a history of bilateral ovarian cysts diagnosed on routine check-up by ultrasound scan four years ago. After admission to hospital, due to cramping lower abdominal pain, MRI showed tumorous mass, with solid and cystic components, located between abdominal wall, lateral pelvic walls, and lumbosacral part of spine belonging to ovaries. The patient underwent appropriate extensive surgery. Histopathological investigation revealed ovarian clear cell adenocarcinoma Stage IIIa, along with endometriotic cyst found on the contralateral side. Conclusion: This report confirms the strong link between endometriosis and ovarian cancer and sends an appeal for urgent and precise definition of parameters relevant for determination of patients’ groups with the risk for malignancy. © 2019 S.O.G. CANADA Inc. All rights reserved.

Purpose of investigation: Assesment of biomarkers of the ovarian reserve for ovarian response prediction using different controlled ovarian stimulation (COS) treatments. Materials and Methods: A retrospective cohort study included 363 patients who underwent assisted reproduction at the Clinic of Gynecology and Obstetrics, Belgrade, Serbia. Antral follicle count (AFC), serum AMH, inhibin B, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and progesterone were measured on the second cycle day prior to stimulation commencement. Three types of ovulation stimulation protocols were used. The number and quality of obtained oocytes were used for evaluation of the ovarian response. Results: Patients' age, number of antral follicles, AMH level, and FSH/LH ratio were confirmed as predictors of the number of obtained oocytes. The AFC was the main parameter that influenced the number of obtained oocytes regardless of selected stimulation protocol. Conclusion: The individualization of stimulation protocols may be further improved by using both AFC- and AMH-tailored approach.

Introduction: Good preoperative tumor triage is essential for choosing the appropriate approach. Objective: The study aim was to identify factors from standard preoperatively collected data, which could predict the nature of adnexal masses prior surgery. Material and Methods: The study involved all women treated in the Clinic for Gynecology and Obstetrics Clinical Center of Serbia for adnexal tumors throughout a period of 18 months. On admission, detailed anamnestical and laboratory data were obtained and ultrasound scans were performed. Obtained data were compared with hystopathological findings of tumors. Methods of correlation and logistic regression were applied to create association models. Results: Three new models for predicting tumor nature were achieved from anamnestical data, characteristics of women and tumors, and laboratory analyses. Two statistically significant (p = 0.000) equations were obtained for anamnestical data and characteristics of women and tumors, while three were made for laboratory analyses. Sensitivity of anamnestical malignancy index (AMI) was 73.33%, specificity 72.87%, positive predictive value (PPV) 39.49% and negative predictive value (NPV) 91.88%. Sensitivity of characteristic malignancy index (CMI) was 92.38%, specificity 67.36%, PPV 40.59% and NPV 97.34%. Sensitivity of laboratory malignancy index (LMI) was 56.45%, specificity 90.24%, PPV 68.63%, and NPV 84.57%. Conclusions: The best predictors of malignancy are menopausal status, body mass index (BMI), age, metastases, ascites, tumor marker CEA level, and erythrocyte sedimentation rate (ESR). Along with the risk of malignancy index (RMI), for more reliable triage and preoperative tumor evaluation the authors propose introduction of another three indexes (AMI, CMI, LMI) in clinical practice.

Objective The aim of this study was to translate the Women's Health Questionnaire (WHQ) into the Serbian language and assess its validity and reliability in a population of Serbian menopausal women. Methods The study included peri- and postmenopausal women from two Community Health Centers in Belgrade. Women filled out the WHQ, the Short Form-36 questionnaire (SF-36) and Beck's Depression Inventory (BDI). The WHQ was translated according to recommended methodology for cultural adaptation of questionnaires and its psychometric characteristics (internal consistency, inter-rater reliability, factor analysis, sensitivity, discriminant, construct and criterion validity) were tested. Results In the Serbian population, the mean values of the WHQ domains were mostly comparable with reference Mediterranean countries. Whole-scale Cronbach's α was 0.838. Moreover, five WHQ domains had a value of Cronbach's α above the acceptable limit. There were no significant differences in WHQ scores between our two investigators. On exploratory factor analysis, we obtained ten factors (two items formed a new factor-'Menstrual pathology'). Almost all SF-36 domains were significantly associated with WHQ domains, while the BDI was associated with domains: depressive mood, anxiety and sleep problems. Based on ROC analysis, WHQ is slightly more reliable for perimenopausal than postmenopausal Serbian women. Conclusion The Serbian version of the WHQ showed very good reliability and validity in assessment of quality of life among menopausal women. The WHQ is applicable for both peri- and postmenopausal women. © 2014 International Menopause Society.

Granulosa cell tumors (GCTs) are characterized by slow growth, local spread, and late recurrence. The authors report the case unique for both unusually large dimensions of the recurring tumor and the fact that it was confined only to the omentum, where it has recurred 41 years after the initial surgery including salpingo-oophorectomy. This is the longest reported period from initial diagnosis to the recurrence of GCT. This case report is important as it proves that recurrence of GCT is possible even after an extremely long period of time after the initial surgery, due to the nature of this tumor, and the inhibition of apoptosis process. © 2018 S.O.G. CANADA Inc. All rights reserved.

A primigravid woman at 29th gestational week with placental abruption causing fetal death, that underwent instant cesarean section, developed a disseminated intravascular coagulation (DIC), revealed by hemoperitoneum and hematoma of the abdominal wall. After re-laparotomy and transfusion of blood, fresh plasma, and platelets, the patient was discharged from hospital on the 14th postoperative day completely recovered. To conclude, conservative surgical approach for DIC treatment is possible and safe. Novel antifibrinolitic drugs are recommended for obstetrical patients with DIC to enable a healthy subsequent pregnancy.

This report shows that even extremely large nascent uterine myomas can be removed vaginally. A 25-year-old nulligravid and nulliparous patient with malaise, hypermenorrhea, and intermittent cramping pain in the lower abdomen was referred to our clinic. Gynecological examination revealed a round cauliflower-like tumor, 7 cm in diameter, originating from the external cervical os with a rough surface and without a palpable stalk or base. Ultrasound scan showed a hyperechogenic mass within the uterine cavity with two distinct subunits: one (55 × 44 mm) well-demarcated from the surrounding structures and the other (43 × 38 mm) in close proximity to the lower part of the anterior uterine wall and in continuity with the myometrium. At surgery, the myoma was completely removed vaginally. Recovery was prompt, complete, and uneventful. Follow-up at one and three months confirmed normal gynecological and sonographic findings. In conclusion, vaginal myomectomy is the treatment of choice for prolapsed pedunculated submucous myoma; even extremely large nascent myomas can be efficiently removed vaginally. © Georg Thieme Verlag KG Stuttgart New York.

This report shows that even extremely large nascent uterine myomas can be removed vaginally. A 25-year-old nulligravid and nulliparous patient with malaise, hypermenorrhea, and intermittent cramping pain in the lower abdomen was referred to our clinic. Gynecological examination revealed a round cauliflower-like tumor, 7 cm in diameter, originating from the external cervical os with a rough surface and without a palpable stalk or base. Ultrasound scan showed a hyperechogenic mass within the uterine cavity with two distinct subunits: one (55 × 44 mm) well-demarcated from the surrounding structures and the other (43 × 38 mm) in close proximity to the lower part of the anterior uterine wall and in continuity with the myometrium. At surgery, the myoma was completely removed vaginally. Recovery was prompt, complete, and uneventful. Follow-up at one and three months confirmed normal gynecological and sonographic findings. In conclusion, vaginal myomectomy is the treatment of choice for prolapsed pedunculated submucous myoma; even extremely large nascent myomas can be efficiently removed vaginally. © Georg Thieme Verlag KG Stuttgart New York.