Browsing by Author "Vasiljevic, M. (6603666911)"

This is the case of an advanced stage carcinosarcoma uteri, in a patient with limited therapy options. Carcinosarcomas (malignant mixed Mullerian tumors) are histologically composed of malignant epithelial and mesenchymal components. Sarcomatous component of this mixed tumor in the present patient was of heterologous-type chondrosarcoma. The primary treatment option for uterine carcinosarcomas is surgery, but adjuvant therapy is always necessary. The optimal treatment is still uncertain, as the histogenesis of this tumor remains controversial.

Purpose: Cone biopsy is the best treatment for high-grade premalignant cervical changes. Cervical intraepithelial changes do not show any clinical picture until the process develops into carcinoma. Method: This retrospective study included 395 women who underwent conization at Gynecology and Obstetrics Clinic "Narodni front" during 2009. The chi-square test was used for comparing results. Results: Pathohistological findings from biospy and conization were identical in 40.50% of patients, in 10.13%, the conization finding was more severe than the biopsy finding, while in 49.37% less severe than the biopsy finding. Resection margins status analysis showed that 12.66% of cones were positive. Comparison between cones with positive margins and operative techniques did not show any statistically significant difference; 64% of women with positive margins were over the age of 35. Conclusion: Operative conization techniques are equally represented. However in women over the age of 40 scalpel excision methods are recommended. In women over the age of 45 there is a statistically significant increase in the risk for positive resection margin with CIN3 and glandular lesions.

This is a case report of a diffuse malignant peritoneal mesothelioma in a 31-year-old woman. The patient presented with pains in the small pelvis followed by abdominal distension. By pelvic ultrasonography a tumorous mass of cystic architecture was verified in the small pelvis. She was submitted to laparoscopy. The diagnosis of the disease was established by histopathological examination of the material sample taken during laparoscopy. The patient was subsequently submitted to laparotomy upon which peritonectomy, omentectomy and appendectomy were performed. Postoperative combined chemotherapy was given. The patient has been well since completion of the treatment.

The purpose of this investigation was to evaluate changes in maternal renal arterial blood flow during pregnancy. Materials and Methods: The study included 40 non-pregnant, 200 pregnant, and 30 women after delivery. The authors measured pulsatility index (Pi) and resistance index (Ri) in the right and left renal arteries in the hilus. The authors compared the values between non-pregnant and women during first, second, and third trimester and post-partum period and tested correlation with gestational age. Results: The authors did not find a statistical difference in Pi and Ri between the right and left kidneys. There was no difference in Pi and Ri in pregnancy trimester compared to the non-pregnant state. There was no correlation between the values of Pi and Pi and gestational weeks. Conclusion: During pregnancy there are no changes in the values of maternal renal Pi and renal Ri. Unchanged total vascular resistance may result from physiological changes of the glomerular filtration rate.

This is a case of invasive endometrial carcinoma with ovarian metastases incidentally detected in a 30-year-old infertile woman. The patient was asymptomatic. Carcinoma was discovered during hysteroscopy. She was submitted to surgical treatment involving total hysterectomy, bilateral salpingo- oophorectomy and dissection of the pelvic and paraaortal lymph nodes. Postoperative irradiation therapy was performed. Since treatment the patient has been well.

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.

Purpose: This is a review of our 18-year experience with premenarchal girls with epithelial ovarian tumors. Special attention was focused on the predictive value of CA125 serum levels. Methods: Analysis of premenarchal patients with resected or biopsied ovarian masses from 1988 to 2005 was performed. Patient age, clinical presentation, operative procedures, histologic type of tumor, treatment and outcome were obtained. Results: Six premenarchal girls (aged from 6 to 14 years) were surgically treated for epithelial tumors, representing 13% of all ovarian tumors at this age. Histological findings revealed cystadenoma in four girls, one with a mucinous borderline tumor and one with undifferentiated carcinoma. Tumor volume was higher than 400 cm3 in four girls. Sensitivity, specificity and positive predictive value of CA125 level for ovarian malignant epithelial tumors were 0.50, 0.50, and 0.33, respectively. The premenarchal girl with undifferentiated carcinoma in Stage III died after six months in spite of chemotherapy. Conclusion: Ovarian epithelial tumors in premenarchal girls show important growth potential and a relatively high malignancy rate with great influence of borderline neoplasms. CA125 is a tumor marker with low sensitivity and specificity for detection of epithelial ovarian malignancy in this age group.

Objective: The aim of this study was to compare hemodynamic changes in the uterine and ovarian arteries between infertile women with moderate and/or severe endometriosis and healthy women. In this prospective study, 99 women in their generative age were subjected to color Doppler ultrasonography to measure hemodynamic parameters from July 2010 to January 2011. The examination was performed during the proliferative or ovulatory phase of the natural menstrual cycle in a random sample of 54 women treated for endometriosis-induced infertility and 45 healthy women were included in control examination procedure. Irrespective of considered stage, endometriosis was most often found in the ovaries, in the sacro-uterine ligaments, peritoneum, and rectovaginally. Resistance to blood flow expressed as the resistance index (RI) in the measured arteries, was significantly higher in severe endometriosis compared to moderate form. Average values of pulsation index (PI) and RI are significantly higher, in both endometriosis stages, compared to measured values in healthy women.

Purpose: The aim of this study was to determine the frequency of endometriosis in epithelial ovarian cancer patients. Methods: Patients who had undergone epithelial ovarian cancer surgery between 2000 and 2004 were subjected to a retrospective analysis. The analysis focused on the presence of ovarian endometriosis, histological types and stages of ovarian cancer, treatment types and five-year survival rate. Results: Out of the 210 operated ovarian cancer patients, 23 had coexisting ovarian endometriosis. Ovarian endometriosis was detected in 3.5% (4 of 113 patients) of cases with serous ovarian cancer, in 31.6% ( 12 of 38 patients) of cases with endometrioid, and in 36.8% (7 of 19 patients) of cases with clear cell ovarian cancer. The treatment of ovarian cancer patients was a combination of surgery and chemotherapy. Conclusion: Endometriosis was most frequently present in patients with clear cell (36.8%) and endometrioid ovarian cancers (31.6%). The five-year survival rate for ovarian cancer patients in all stages was 39.1%.

Purpose: To determine whether the presence of normal ovarian tissue could assist in the diagnosis of large benign ovarian neoplasms in young females and in choosing the laparoscopic treatment. Materials and Methods: A prospective study of 25 patients treated surgically for a cystic ovarian neoplasm measuring diameter more than ten cm or volume more than 500 ml and having normal ovarian tissue or ovarian crescent sign (OCS). Ultrasonography was performed at six weeks, then at three, six, nine, and 12 months postoperatively. Results: The mean age of patients was 15.3 ± 3.6 years, ranging between 6.5 and 19 years. The mean preoperative volume of the ovarian neoplasm was 1,686 ± 1,380 cm3, ranging between 550 and 6,000 cm3. The presence of OCS was visualized by ultrasonography in all 25 patients and serum tumor markers were negative in 22. No borderline tumors or malignancies were identified. There was a statistically significant difference between the volume of the affected ovary and the contralateral ovary during the first six weeks follow-up, but without significant difference after three months. Conclusions: Postoperative ultrasound revealed that the affected ovary resumed its normal volume within three months after surgery, despite the thinned appearance of the ovarian cortex present on ultrasound as the OCS. Laparoscopic ovarian preservation should be the preferred surgical approach for adolescents to ensure the conservation of the entire ovarian tissue.

Purpose of investigation: The aim of this study was to determine the rate of complications in pregnancy and during delivery, as well as neonatal outcomes, in women who underwent in vitro fertilization (iVF) and who are 40 years of age or older. Materials and Methods: This was a prospective study. The study group consisted of 29 women who underwent IVF. The control group consisted of 32 women who had a spontaneous pregnancy. Results: Pregnancy complications occurred in 86.21% of women in the study group, and in 46.87% of women in the control group. The proportion of cesarean sections (CS) was 84.62% in the study group, and 21.87% in the control group. Birth weight < 1,500 grams and < 2,500 grams was present in 17.16% and 22.86% of newborns in the study group, re-spectively. In the control group, birth weight < 1,500 grams and < 2,500 grams was present in 5.55% and 8.33% of newborns, respectively. Neonatal intensive care unit admissions included 22.86% newborns from the study group and 8.33% from the control group. Conclusion: Pregnancy, delivery, and neonatal complications were more frequent in the study (IVF) group.

The authors present a case of a 14-year-old premenarchal girl with a large solid tumor of the left ovary. The rim of normal ovarian tissue was visible around the tumor on ultrasonography scan. Although the levels of two tumor markers, LDH and CA125, were elevated, the authors performed an organ-sparing tumorectomy. The final pathology report revealed foci of immature neural tissue, with a final diagnosis immature teratoma Stage Ia.

Purpose: The aim of this study was to assess the accuracy of transvaginal ultrasound in detecting endometrial malignancy in perimenopausal women. Material and Methods: The cross-sectional study included 100 perimenopausal women who had changes on the endometrium discovered through a regular ultrasound check-up and were referred to Clinic of Gynecology and Obstetrics "Narodni Front" in Belgrade during the period from September 1, 2012 to September 1, 2013. Transvaginal ultrasound was performed on each participant in the study. Parameters of the ultrasound examination composed a score system. Result: The results of regression analysis showed that this transvaginal ultrasound score have independent prognostic value for detection of endometrial malignancy. Score system showed that the value 8 had the best validity for the detection of endometrial malignity, with the sensitivity of 0.857 and specificity of 0.785. Conclusion: The collected transvaginal ultrasound sample had high predictive value for the discovery of malign changes on endometrium.

We present a case of pregnancy after complete conservative surgical treatment in a young woman with malignant mixed germ-cell tumor of the ovary. She was submitted to surgical treatment involving only unilateral salpingo-oophorectomy, with infracolic omentectomy and dissection of the pelvic and paraaortal lymph nodes. Three years after the operation and chemotherapy the patient spontaneously conceived and gave birth to a healthy baby. A patient who has malignant germ-cell tumor of the ovary in early stage, can successfully preserve fertility by conservative surgical treatment.

A case of 56-year old women with double primary invasive cervical carcinoma, squamous cell carcinoma and endometrioid adenocarcinoma is presented. The patient was subjected to radical abdominal hysterectomy with pelvic and paraaortic lymphadenectomy. Surgery was followed by radiotherapy. Since the treatment the patient has been doing well and is free of any signs of relapse of the disease.

The authors present a case of a 33-year-old infertile woman with coincidental dermoid cyst and ovarian endometriosis in the same ovary. She was admitted to the Clinic because of cystic tumor of the left adnexa. Transvaginal ultrasound (TVUS) examination found a bilocular tumor of complex structure on the left ovary. Video-laparoscopy was also performed. On the left ovary, two adjacent cystic formations were found. Laparoscopic ovarian cystectomy was performed and a surgical specimen was sent for histopathologic analysis. The diagnosis was a dermoid cyst and ovarian endometriosis. Without complications, the patient was released from the hospital. The patient was treated with an analogue of gonadotropin releasing hormone (GnRH) for three months as a preparation for in vitro fertilization (IVF).

We present a case of successful pregnancy after effective uterovaginal anastomosis in a 26-years-old patient with congenital atresia of the cervix uteri. She spontaneously achieved pregnancy after four years of uterovaginal anastomosis. Gestation was at the eighth lunar month and the delivery was done by cesarean section due to rapidly progressing fetal asphyxia. The patient gave birth to a live healthy male, weighing 1,950 g, with an Apgar score of 5 and 8 at 1 and 5 min, respectively. The postoperative course was uneventful, and leakage of lochia was normal.

The authors present the case of a 28-year-old nulliparous woman, who successfully carried a term pregnancy in a unicornuate uterus with a solid non-communicating rudimentary horn, and a history of myomectomy, without cerclage placement or tocolytic therapy. The patient was admitted to the present clinic for uterine fibroids and menorrhagia. The patient underwent laparotomy, during which a myomectomy was performed. Twelve months after the surgery, the patient conceived spontaneously. Routine obstetric ultrasounds revealed normal intrauterine fetal development. Cerclage and tocolytic therapy were not indicated at any stage of the pregnancy. A live female neonate was delivered via cesarean section at 39 weeks’ gestation. © 2019 S.O.G. CANADA Inc. All rights reserved.

Purpose of investigation: To assess fertility and pregnancy outcomes in infertile patients after hysteroscopic myomectomy according characteristics of submucous fibroids. Materials and Methods: The authors included 56 infertile women, who were diagnosed with a submucous uterine fibroid, and assessed their fertility and pregnancy outcomes after hysteroscopic myomectomy, which was the exposure of interest. The control group consisted of 63 women who underwent a hysteroscopic polypectomy. The submucous fibroid and endometrial polyp were diagnosed preoperatively using 2D ultrasound, and the diagnosis was confirmed during hysteroscopy. All my-omectomies and polypectomies were performed using a resectoscope with a bipolar loop electrode. In the first postoperative year, the authors analyzed the rates of pregnancy, spontaneous abortion, preterm and term deliveries, as well as mode of delivery according to type, size, location, and number of submucous fibroids or polyps in each group. Results: In the first postoperative year, pregnancy occurred in 30.4% of patients. The greatest proportion of pregnancies occurred after removal of type 1 submucous fibroids, fibroids < 3 cm, and those localized on the posterior wall of the uterine corpus. Spontaneous abortion occurred in 7.1% of pregnancies, while delivery occurred in 19.6%. Term delivery occurred in 16.1%, while preterm delivery occurred in 3.6%. Vaginal delivery occurred in 14.3% of women, while caesarean section was performed in 5.4% of women. There were not significant differences in rates of pregnancy and delivery according to type, size, and localization of the fibroid or endometrial polyp. Conclusion: For infertile patients, in whom infertility is caused by a submucous fibroid, hysteroscopic myomectomy increases the pregnancy rate, and leads to good reproductive outcomes. © 2019 S.O.G. CANADA Inc. All rights reserved.

Fusion of the labia minora is a rare event in adult women and rarely seen as a clinical entity. We present a case of a 30-year-old woman with labial fusion, unmarried, a virgin, and sexually inactive with the complaint of discomfort during menstruation and difficulty in micturition since her puberty. The labia minora were fused in the midline with a pinpoint aperture for draining urine, while the clitoris could not be visualized. Previous history regarding a causal factor was perineal trauma in childhood. Effective surgical resection to separate the fusion was done by a radio frequency surgical knife. After the surgical separation, it was possible to expose the normal hymen behind the previously fused labia. We have shown that the separation of labial fusion in adult women with a radio frequency surgical knife, associated with topical application of estrogen cream, prevents re-fusion of the labia and leads to healing without scarring of the vulva.