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Longworth A.,Birmingham Womens Hospital
International Journal of Gynecological Pathology | Year: 2017

Microscopic, heterotopic extraovarian sex cord–stromal proliferations have only recently been reported in the literature. We describe the largest series to date, of 30 cases of microscopic, incidentally detected, heterotopic extraovarian sex cord–stromal proliferation, in women aged 25–79 yr who had undergone surgery for a range of benign and malignant gynecologic conditions. In 14 patients the foci of proliferation comprised ovarian cortical stroma, in some cases with an ovarian fibroma-like appearance. Ten cases of adenofibroma and cystadenofibroma were also identified, including 1 Brenner adenofibroma; 2 cases comprised both ovarian cortical stroma and serous cystadenofibroma; 4 cases showed sex cord proliferation resembling microscopic adult granulosa cell tumors. Immunohistochemistry, where possible, confirmed the sex cord nature of the heterotopic proliferations. The foci of proliferation were <1–7 mm, and most were at the fimbrial end of the fallopian tube. These proliferations are likely to be encountered with increasing frequency as we sample the adnexa more extensively. Previous reports postulated that the proliferations probably represent embryonic rests caused by anomalous migration but we suggest that incorporation of exposed ovarian parenchymal tissue into the fimbrial stroma at the time of ovulation may be another possible cause. ©2017International Society of Gynecological Pathologists


Khan A.T.,Birmingham Womens Hospital | Shehmar M.,Birmingham Womens Hospital | Gupta J.K.,University of Birmingham
International Journal of Women's Health | Year: 2014

Uterine fibroids are a major cause of morbidity in women of a reproductive age (and sometimes even after menopause). There are several factors that are attributed to underlie the development and incidence of these common tumors, but this further corroborates their relatively unknown etiology. The most likely presentation of fibroids is by their effect on the woman's menstrual cycle or pelvic pressure symptoms. Leiomyosarcoma is a very rare entity that should be suspected in postmenopausal women with fibroid growth (and no concurrent hormone replacement therapy). The gold standard diagnostic modality for uterine fibroids appears to be gray-scale ultrasonography, with magnetic resonance imaging being a close second option in complex clinical circumstances. The management of uterine fibroids can be approached medically, surgically, and even by minimal access techniques. The recent introduction of selective progesterone receptor modulators (SPRMs) and aromatase inhibitors has added more armamentarium to the medical options of treatment. Uterine artery embolization (UAE) has now been well-recognized as a uterine-sparing (fertility-preserving) method of treating fibroids. More recently, the introduction of ultrasound waves (MRgFUS) or radiofrequency (VizAblate™ and Acessa™) for uterine fibroid ablation has added to the options of minimal access treatment. More definite surgery in the form of myomectomy or hysterectomy can be performed via the minimal access or open route methods. Our article seeks to review the already established information on uterine fibroids with added emphasis on contemporary knowledge. © 2014 Khan et al.


Maher E.R.,University of Birmingham | Maher E.R.,Birmingham Womens Hospital
Seminars in Cancer Biology | Year: 2013

Kidney cancer accounts for about 2% of all cancers and worldwide >250,000 new cases of kidney cancer are diagnosed each year. Renal cell carcinoma (RCC) is the most common form of adult kidney cancer and this review describes our current knowledge of the genetic and epigenetic basis of sporadic RCC. Though to date major advances in understanding the underlying the molecular basis of renal cell carcinoma (RCC) have often been derived from studies of rare familial forms of renal cell carcinoma, large-scale genomic and epigenomic studies of sporadic tumours are beginning to provide clearer pictures of the genomic and epigenomic landscape of RCC and the key pathways implicated in the initiation and progression of the disease. Although current knowledge of the molecular pathogenesis of RCC is incomplete, and mostly relates to clear cell (conventional) RCC, the next five years will see an unprecedented flood of genomic and epigenomic data and the key future challenges will relate to the utilisation of this data to develop novel genetic and epigenetic markers for diagnosis and prognosis and to develop novel targeted therapies in order to enable an age of personalised medicine. © 2012.


Gallos I.D.,University of Birmingham | Krishan P.,University of Birmingham | Shehmar M.,University of Birmingham | Ganesan R.,Birmingham Womens Hospital | Gupta J.K.,University of Birmingham
Human Reproduction | Year: 2013

Study Questio: NWhat is the risk of relapse for women with endometrial hyperplasia treated with levonorgestrel-releasing intrauterine system (LNG-IUS) or oral progestogens? Summary Answer: Relapse of complex endometrial hyperplasia after initial regression occurs often and it occurs less often in women treated with LNG-IUS than with oral progestogens. What Is Known Already: The LNG-IUS and oral progestogens are used to treat women with endometrial hyperplasia and achieve regression. There is uncertainty over whether further surveillance for these women is necessary as the risk for relapse is unknown.STUDY Design: , SIZE, DURATIONA cohort study of 219 women with complex non-atypical or atypical endometrial hyperplasia who were treated and achieved initial regression with LNG-IUS (n = 153) or oral progestogens (n = 66) from August 1998 until December 2007 and followed up for >5 years. The mean length of follow-up was 74.7 ± SD 31.8 months for the LNG-IUS versus 87.6 ± SD 42.2 months for the oral progestogen group. Participants/Materials, Setting, Methods: We evaluated the proportion of women who relapsed or had hysterectomy after initial regression with LNG-IUS compared with oral progestogens by logistic regression and adjusting for confounding. The time from regression to relapse was explored through a survival analysis. Main Results and the Role of Chance: Relapse of hyperplasia occurred in 13.7% (21/153) of women treated with LNG-IUS compared with 30.3% (20/66) of women treated with oral progestogens [adjusted odds ratio (OR) = 0.34, 95% confidence interval (CI): 0.17-0.7, P = 0.005]. Relapse rates over long-term follow-up were lower for complex non-atypical hyperplasia compared with atypical hyperplasia for both LNG-IUS (12.7%, 18/142 versus 27.3%, 3/11, respectively; P ≤ 0.001) and oral progestogens (28.3%, 17/60 versus 50%, 3/6, respectively; P ≤ 0.001). The survival analysis indicates that relapse occurred less often with LNG-IUS at 12, 24, 36, 48, 60 and >60 months of follow-up (hazard ratio 0.37, 95% CI: 0.2-0.7, P = 0.0013). There were no events of relapse after 48 months from regression with oral progestogens, but 5 women treated with LNG-IUS relapsed after 60 months when treatment was discontinued. Hysterectomy rates were lower in the LNG-IUS than oral progestogen group during follow-up (19.6%, 30/153 versus 31.8%, 21/66, respectively, OR = 0.52, 95% CI: 0.27-1, P = 0.05). Endometrial cancer was diagnosed in 2 (11.8%) women who had hysterectomy (n = 17) because of relapse.LIMITATIONS, REASONS FOR CAUTIONWe are unable to accurately estimate the cancer risk in women who relapse during follow-up as only 17 out of 41 who relapsed underwent hysterectomy. Wider Implications of the Findings: Relapse of endometrial hyperplasia after initial regression occurs often and long-term follow-up is advised. Study Funding/Competing Interest: (S)Ioannis D. Gallos and this study were funded through a grant from Wellbeing of Women (ELS022). No competing interests. © 2013 The Author.


Morris M.R.,University of Birmingham | Maher E.R.,University of Birmingham | Maher E.R.,Birmingham Womens Hospital
Genome Medicine | Year: 2010

Aberrant DNA methylation, in particular promoter hypermethylation and transcriptional silencing of tumor suppressor genes, has an important role in the development of many human cancers, including renal cell carcinoma (RCC). Indeed, apart from mutations in the well studied von Hippel-Lindau gene (VHL), the mutation frequency rates of known tumor suppressor genes in RCC are generally low, but the number of genes found to show frequent inactivation by promoter methylation in RCC continues to grow. Here, we review the genes identified as epigenetically silenced in RCC and their relationship to pathways of tumor development. Increased understanding of RCC epigenetics provides new insights into the molecular pathogenesis of RCC and opportunities for developing novel strategies for the diagnosis, prognosis and management of RCC. © 2010 BioMed Central Ltd.


Chan Y.Y.,University of Nottingham | Jayaprakasan K.,University of Nottingham | Zamora J.,Ramon y Cajal Hospital | Thornton J.G.,University of Nottingham | And 2 more authors.
Human Reproduction Update | Year: 2011

Background: The prevalence of congenital uterine anomalies in high-risk women is unclear, as several different diagnostic approaches have been applied to different groups of patients. This review aims to evaluate the prevalence of such anomalies in unselected populations and in women with infertility, including those undergoing IVF treatment, women with a history of miscarriage, women with infertility and recurrent miscarriage combined, and women with a history of preterm delivery. Methods: Searches of MEDLINE, EMBASE, Web of Science and the Cochrane register were performed. Study selection and data extraction were conducted independently by two reviewers. Studies were grouped into those that used 'optimal' and 'suboptimal' tests for uterine anomalies. Meta-analyses were performed to establish the prevalence of uterine anomalies and their subtypes within the various populations. Results: We identified 94 observational studies comprising 89 861 women. The prevalence of uterine anomalies diagnosed by optimal tests was 5.5% [95% confidence interval (CI), 3.5-8.5] in the unselected population, 8.0% (95% CI, 5.3-12) in infertile women, 13.3% (95% CI, 8.9-20.0) in those with a history of miscarriage and 24.5% (95% CI, 18.3-32.8) in those with miscarriage and infertility. Arcuate uterus is most common in the unselected population (3.9%; 95% CI, 2.1-7.1), and its prevalence is not increased in high-risk groups. In contrast, septate uterus is the most common anomaly in high-risk populations. Conclusions: Women with a history of miscarriage or miscarriage and infertility have higher prevalence of congenital uterine anomalies compared with the unselected population. © The Author 2011. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.


Gray J.W.,Birmingham Womens Hospital | Suviste J.,Birmingham Womens Hospital
Journal of Hospital Infection | Year: 2013

There are few data on meticillin-resistant Staphylococcus aureus (MRSA) screening in obstetrics, a largely healthy population that should be at lower risk for MRSA than most hospitalized populations. From January 2009 to December 2011 nose swabs were screened from 5548 of 21,770 (25.5%) women who delivered at Birmingham Women's Hospital. Only 29 (0.5%) were MRSA positive: MRSA infections occurred later in three cases. MRSA infections occurred in a further 13 mother-infant pairs, including six cases where mothers were MRSA screen negative. Seventeen mothers had risk factors for MRSA. MRSA is not widespread in obstetrics, and large-scale screening of nasal swabs is of limited value in preventing MRSA-related morbidity in this population. © 2012 The Healthcare Infection Society.


Toozs-Hobson P.,Birmingham Womens Hospital
Obstetrics, Gynaecology and Reproductive Medicine | Year: 2010

Overactive bladder (OAB) is a term describing a symptom complex accepted by the International Continence Society in 2002. The symptom complex describes a collection of irritative symptoms with urgency, as the key symptoms and is has been adopted in the latest guidance on terminology.The condition affects around 17% of the population with 2.4% having clinically significant, bothersome and socially disabling symptoms which have a significant impact on quality of life. In the UK the NICE guidelines highlight the importance of proper history taking and investigation including frequency-volume charts. Treatment should be based on lifestyle changes supplemented by pharmacotherapy.Anticholinergics remain the mainstay of drug therapy. Recent changes in the number of preparations and routes of administration may offer some advantages in reducing side effects and maximizing efficacy. In 20% of cases the patient will remain refractory and in such cases either Botulinum toxin or neuromodulation may confer an advantage. © 2010.


Qureshi N.S.,Birmingham Womens Hospital
Journal of Obstetrics and Gynaecology | Year: 2013

Certification in Colposcopy by the British Society for Colposcopy and Cervical Pathology (BSCCP) and the Royal College of Obstetricians and Gynaecologists is a formal pre- requisite to the practice of colposcopy within the UK. This certification is awarded after passing an Objective Structured Clinical Examination (OSCE). The aim of the project is to explore examiners' perceptions of the OSCE examination in colposcopy and consider whether it is the right tool to differentiate between safe and unsafe practice in colposcopy. A case study research methodology was employed for the project, and questionnaires were sent to 30 examiners for OSCE in Colposcopy. The project also included conducting semi-structured interviews with two examiners, two trainees and a senior manager of the BSCCP. The questionnaire had a response rate of 28 (94%). The satisfaction rate among the examiners about the standard of questions in OSCE in Colposcopy was 93%, and 89% of the examiners would allow a candidate passing the examination to carry out a clinic in their absence. A total of 26 (94%) examiners thought that the examination was fit for purpose. It was suggested that testing of practical skills should also be made part of the examination. It seems OSCE in Colposcopy is perceived well both by the examiners and the candidates. © 2013 Informa UK, Ltd.


Vella J.E.O.,Birmingham Womens Hospital
International Journal of Gynecological Pathology | Year: 2016

Review of pulmonary biopsies received by Birmingham Women’s Hospital to identify which gynecologic tumors most commonly metastasize to lung or pleura, and which may first present with pulmonary metastases. We reviewed all pulmonary biopsies over a 14-yr period. There were 25 lung and 9 pleural biopsies, from 33 patients. Twenty-one patients had known gynecologic tumors (1 vulval, 1 cervical, 9 endometrial, 4 uterine mesenchymal, and 6 ovarian). Eighteen of the 21 biopsies had been referred from other hospitals; in 4 cases review lead to an altered diagnosis. Three of the 21 biopsies had been sent directly to Birmingham Women’s Hospital. The interval between primary diagnosis and pulmonary metastasis was known in 18/21 cases and ranged from 1 to 17 yr. Nine of 21 (43%) had metastatic endometrial carcinoma; the International Federation of Gynecology and Obstetrics (FIGO) stage was known in 7/8 cases: Stage I in 5, and II and IIIA in the remaining 2 cases. Of the further 12 patients with no history of gynecologic malignancy, 4 had pleural metastases from ovarian carcinoma, 3 had primary lung carcinoma, 3 had carcinoma of unknown primary, 1 had endometrial stromal sarcoma, and 1 with a suspected Müllerian tumor was lost to follow-up. Pulmonary metastasis can occur many years after a diagnosis of gynecologic neoplasia—usually endometrial carcinoma, even after initial presentation at low stage. It may also be the initial manifestation in some cases—particularly ovarian carcinoma with pleural involvement. Specialist review of lung and pleural biopsies is important to confirm the diagnosis and optimize patient management. ©2016International Society of Gynecological Pathologists

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