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Hysteroscopy Newsletter is an opened forum to all professionals who want to contribute with their knowledge and even share their doubts with a word-wide gynecological community

Mixed Malignant Mullerian Tumors

Mixed Malignant Mullerian Tumors (MMMT) is biphasic neoplasms with endometrial epithelial and stromal components which are both malignant. The etiology is uncertain, although several immunohistochemical studies, based on changes in the p53 protein and staining with vimentin, cytokeratin, epithelial membrane antigen and other markers, support the theory of a common origin for both components from a single cell clone.

Macroscopically, they present as uterine masses generally friable and with a polypoid appearance, which usually arise at the bottom of the cavity or on one of the horns, usually progressing to extend to the cervix and into the vagina.

The average age of onset is 65 years, and similar to endometrial adenocarcinoma, hypertension, obesity and diabetes are frequently associated, but their causal role is not defined. The most common clinical manifestation is postmenopausal bleeding

 

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Hysteroscopic patterns of Endometrial Tuberculosis by Alka Kumar

 

Alka picture

According to our data from 1992 to 2016 , we have encountered some specific hysteroscopic markers which are common to cases of endometrial TB:

I) Bizzare endometrial character: where the endometrium loses its color, glands and starts to look dirty, pale, white powdery nibbled, and has flimsy adhesions.

II) Granulomas or tubercles: They appear as small pale white irregular objects either on the endometrium directly or attached to flimsy adhesion bands. The tubercles vary in size.

III) Adhesions: From flimsy adhesions to moderate to severe adhesion bands, and often when looked closely these adhesions have tubercles /granulomas that look like whitish colored irregular deposits that are attached on the adhesions. It is very important therefore to start doing hysteroscopy at very low flow rates so that the deposits do not get washed away with continuous fluid irrigation.

IV) Tubal ostia: Tubal ostia are commonly involved in endometrial TB. The minor endosalpigean folds are scarred, white, pale and usually devoid of the longitudionally arranged vascularity. The ostia usually do not show the normal opening and closing physiological motion at lower intrauterine pressures. Flimsy large adhesion bands may be seen surrounding the ostia. Sometimes the ostia are completely hidden behind adhesions. Flimsy adhesions can also be seen in the intramural part of the ostia.

 

Read the full interview at Hysteroscopy Newsletter

http://www.hysteroscopy.info

Chronic endometritis: Hysteroscopy Picture

Chronic endometritis is usually presents in a silent way, becoming an incidental finding when performing endometrial biopsy for other reasons.

The use of hysteroscopy with liquid distention media of the uterine cavity has been shown to be an effective method for the diagnosis of chronic endometritis. A common hysteroscopic finding in chronic endometritis is the presence of a thickened endometrial edematous mucosa. Also, a thin hyperemic micropolyps layer (less than 1 mm) that appears to float in the endometrial cavity can be seen.

Using these criteria, the hysteroscopic diagnosis of chronic endometritis has a sensitivity up to 93%.

 

Dysmorphic uterus: metroplasty with scissors.

Patient with two previous miscarriages. Diagnosis of dysmorphic uterus. Lateral and fundal metroplasty with scissors.

“When faced with a tubular uterine cavity or an increased smooth muscle component on the walls of a ‘T’ shaped uterus, the literature reports success with a resectoscopic technique designed to improve the volume and the morphology of the uterine cavity. The technique involves the use of a hooked loop which is meticulously guided by the surgeon placing parallel longitudinal incisions along the main axis of the uterine cavity. The aim is to decrease the centripetal force of muscle fibers and of any fibro-muscular rings that have contributed to the stenosis, and to promote a consecutive increase in the volume of the uterine cavity.”

Dr. A. Di Spiezo Sardo

Hysteroscopy Newsletter Vol. 1, Issue 3. P. 3-4

Gubbini Mini Hystero-Resectoscope

gubbini

The Gubbini Mini Hystero-Resectoscope offers a multitude of options for non-invasive diagnostic and therapeutical Gynaecology. The Gubbini Mini Hystero-Resectoscope System allows both, hysteroscopy and resectoscopy with reduced diameter of the shaft. The 16 Fr. Mini-Resectoscope with continuous flow and optional 5 Fr. working channel provides the possibility of a rapid and gentle endoscopic therapy for a wide range of endo-uterine diseases. By way of introducing miniature loops which are shaped ideally to the given anatomical proportions, the strain to female patients could be clearly reduced. The miniature loops are presently offered in two different patterns – with and without high frequency current for coagulation. The loop without HF current is typically used for blunt preparation.

 

Hysteroscopy Books Comprehensive Pocket Atlas of Hysteroscopy

vol-2-issue-4

Comprehensive Pocket Atlas of Hysteroscopy is an essential resourceproviding basic techniques involved in diagnostic and operative hysteroscopy for practicing clinicians and students.

This informative and visually appealing guide also provides an overview of the common pathology captured by hundreds of actual uterine procedures. Each pathological finding is presented in a clear, high quality photograph. This manual serves as a quick reference with authoritative guidance and includes a CD-ROM that demonstrates real time procedures.

 

Sushma Deshmukh and Hysteroscopy Newsletter

Sushma DeshmukhHysteroscopy has become a rewarding surgery nowadays because of the miraculous developments and research in endoscopic instruments. The gynaecologist should be well versed about it.

Hysteroscopy newsletter media is a wonderful source of information for the hysteroscopist to know what are the new happenings in the world and source of inspiration for the beginners. Along with this, hysteroscopy can be set and stepped up with the help of videos and work shops an academic presentations and publications.

To bring awareness to this amazing technology, I have organized the Nagpur Hysteroscopy Carnival – A national event in India in 2014 with Dr. Osama Shawki from Egypt. This year also I am organizing a conference “Uterus in Focus“ to be held on 9, 10 and 11 of December 2016.

This event will definitely try to fulfill the expectations about hysteroscopy. World known and respected hysteroscopist Dr. Osama Shawki is the brain behind this carnival. Along with him, other important expert hysteroscopists from our country will grace the carnival.

 

Female Genital tract congenital malformations

This book presents all uterine, cervical and vaginal anomalies in a systematic way and the new ESHRE/ESGE classification system utilised for their categorization. In addition, their embryogenesis and etiology are summarized.

The diagnostic work-up of women with female genital malformations is reviewed in an evidence-based fashion and taking into account the availability of new non-invasive diagnostic methods. The treatment strategy and the therapeutic alternatives to restore health and reproductive problems associated with their presence are critically reviewed.

 

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