Journal of Clinical Gynecology and Obstetrics, ISSN 1927-1271 print, 1927-128X online, Open Access
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Review

Volume 11, Number 4, December 2022, pages 89-100


Pyometrium as an Early Indicator of Cervical Squamous Cell Carcinoma: A Systematic Review

Figures

Figure 1.
Figure 1. Multiple detached fragments of squamous cell carcinoma in the curettage material (H&E, × 10). H&E: hematoxylin and eosin.
Figure 2.
Figure 2. Fragments of glandular epithelium with numerous plasma cells in the curettage material (H&E, × 40). H&E: hematoxylin and eosin.
Figure 3.
Figure 3. Residual minute microscopic focus of squamous cell carcinoma, hysterectomy material (H&E, × 10). H&E: hematoxylin and eosin.
Figure 4.
Figure 4. Endometrium with severe acute, histiocytic and plasmocytic inflammation, hysterectomy material (H&E, × 40). H&E: hematoxylin and eosin.
Figure 5.
Figure 5. Flow diagram for article selection.

Table

Table 1. Characteristics of All Studies Included in the Systematic Review
 
Reference numberAuthorPatient ageWorkupTreatmentPathologyComplicationsOutcome
CT: computed tomography; EMB: endometrial biopsy; D&C: dilation and curettage; US: ultrasound; MRI: magnetic resonance imaging; abd XR: abdominal X-ray; CXR: chest X-ray; abx: antibiotics; TAH: total abdominal hysterectomy; BSO: bilateral salpingo-oophorectomy; TVUS: transvaginal ultrasound; POD: post-operative; TV: transcervical; LEEP: loop electrosurgical excision procedure; CIN: cervical intraepithelial neoplasia; VAIN: vaginal intraepithelial neoplasia; TLH: total laparoscopic hysterectomy; IUD: intrauterine device; HPV: human papillomavirus type 16.
[5]Zarour et al, 202168CT, EMB, D&CTotal hysterectomyNo malignancyNot rupturedLived
[7]Saini et al, 2020 (case 1)28US, MRIStaging laparotomyCulture: TuberculosisNot rupturedLived
[7]Saini et al, 2020 (case 2)21MRI pelvisStaging laparotomyCulture: Tubercle bacilli, dysgerminomaNot rupturedLived
[8]Walthall et al, 202180CT abd/pelvis, US pelvis EMB, D&CAbxNo malignancyNot rupturedLived
[9]Yildizhan et al, 200692CXR, CT abd, laparotomyTAH and BSONo malignancyRupturedLived
[10]Uno et al, 201690CT, TVUS, laparotomyTAH and BSONo malignancyRupturedLived
[3]Sirha et al, 201337US, CT pelvisTAHNo malignancyNot rupturedLived
[11]Tay et al, 201992CT, TVUSAbx, endometrial pipette drainageXNot rupturedLived
[12]Huang et al, 201872TVUS, CT, laparotomyTAH and BSO, abxNo malignancyRupturedLived
[13]Ikematsu et al, 199680CT, laparotomyTAHNo malignancyRupturedLived
[14]Reis et al, 201627Pelvic USAbx, endometrial pipette drainageXNot rupturedLived
[4]Yazawa et al, 2020 (case 1)88CT, laparotomyTAH and BSO, resection sigmoid colonNo uterine malignancy, adenocarcinoma sigmoid colonRupturedDied POD 189 d/t peritonitis and pneumonia
[4]Yazawa et al, 2020 (case 2)93CTTranscervical drainage, laparoscopic irrigation and drainageXNot rupturedLived
[15]Sala et al, 202175TVUSD&C, abxNo malignancyNot rupturedLived
[16]Konishi et al, 201664Colposcopic cervical biopsy, MRI, CTLaparotomy, peritoneal lavage and drainageSquamous cell carcinoma of the cervixRupturedLived
[17]Chisthti et al, 201977TVUS, MRI, chest CTTAH and BSO, TV drainage, abxZiehl stain: acid fast bacilli, no malignancyNot rupturedLived
[18]Hagiya et al, 201580CTTV drainage, abxCulture: E. coliNot rupturedLived
[19]Kutuk et al, 2013 (case 1)71CT abd, laparotomyXNo malignancyRupturedLived
[19]Kutuk et al, 2013 (case 2)75CT, laparotomyTAH and BSONo malignancyRupturedLived
[19]Kutuk et al, 2013 (case 3)68CT abd/pelvis, TVUS, laparotomyTAH and BSONo malignancyRupturedDied due to sepsis
[20]Gul et al, 201935TVUS, MRINeedle evacuationNo malignancyNot rupturedLived
[21]Shapey et al 201284CT, laparotomyTAHNo malignancyRupturedLived
[22]Gatongi et al, 200972TVUS, hysteroscopy, EMB, Pipelle EMBAbxCulture: Mycobacterium tuberculosisNot rupturedLived
[23]Pankaja et al, 201474MRI, hysteroscopy with drainage of pyometra and EMBAbxNo malignancyNot ruptured, diverticular mass with colouterine fistulaLived
[24]Kroon et al, 201665CT, laparotomyTAHSquamous cell cervical carcinoma (prior to pyometra)RupturedLived
[25]Gupta et al, 201250CT abdDrainage, abxCulture: positive cocci in pairs and short chainsNot rupturedLived
[26]Yahmadi et al, 201479CT, laparotomyTAH with BSO, abxNo malignancyNot rupturedLived
[27]Stunell et al, 201164CT, laparotomyTAH with BSONo malignancyNot rupturedLived
[28]Kim et al, 201080TVUS, CT, MRI, laparotomyTAH with BSO, abxNo malignancyRupturedLived
[29]Lodhi et al, 201132TVUS, MRI, laparotomySubtotal hysterectomyNo malignancyNot rupturedLived
[6]Vyas et al, 200960TVUS, CTPigtail drainage, abxPreviously diagnosed adenocarcinoma of the cervixRupturedLived
[30]Shahid et al, 200680TVUS, CT, laparotomyTAH and BSOCervical carcinoma with secondary pyometraRupturedLived
[31]Chan et al, 200664CT, TVUSTransrectal aspiration, LEEPSquamous epithelial fragments with severe dysplasia CIN III and VAIN IIINot rupturedLived
[32]Yang et al, 200664CT abdD&C, cervical biopsy, abxSquamous cell carcinoma with stromal invasion and staging IVaXX
[33]Chen et al, 201168US abd, X-ray abd, laparotomyTAH and BSONo uterine malignancy, adenocarcinoma of the colonRupturedLived
[34]Cheung et al, 2011102CT, Pap smear, cervical BxRadiation therapyStage 1B cervical cancer, pyometra after radiation treatmentsNot rupturedDied
[35]Hofmann et al 200329US abdAbx, EMB, aspirationNo malignancyNot rupturedLived
[36]Lee et al, 200760CXR, laparotomyTAH with BSO, abxPyometra with poorly differentiated cervical squamous cell carcinomaRupturedLived
[37]Zidi et al, 200375Pelvic USTAH with BSONo malignancyNot rupturedLived
[38]Chan et al, 200584TVUSHysteroscopy, uterine curettage, abxGranulomatous inflammation, Ziehl-Nelson: acid fast bacilliNot rupturedLived
[17]Chishti et al, 201977MRI pelvis, TVUS, CT chestTLH with BSO, abxZiehl-Nelson stain: acid fast bacilli, no malignancyNot rupturedLived
[39]Razquin et al, 199352Cervical biopsyTLH with BSOSquamous cell carcinoma in situ of the cervix associated with squamous cell carcinoma in situ of the endometriumXX
[40]Kaneko et al, 199456LaparotomyTLH with BSONo malignancyRupturedLived
[41]Iwase et al, 2001 (case 1)69Pelvic US, CT, laparotomyTAHCulture: anaerobes, no malignancyNot rupturedDied due to organ failure
[41]Iwase et al, 2001 (case 2)89CT, laparotomyTLH with BSOCulture: E. coli, no malignancyRupturedDied due to acute coronary syndrome
[42]Amin-Hanjani et al, 199547XIntrauterine drain, abxNo malignancyNot rupturedLived
[44]Dharmadhikari et al, 200744Abd US, abd XR, laparotomyTLH with right salpingo-oophorectomy and left salpingectomy with omentectomy, abxNo malignancyNot rupturedLived
[44]Kim et al, 200838XHysterectomy, IUD removal, abx, patient declined hysterectomyCervical cancerXDied due to cervical cancer progression
[45]Tai et al, 200779Abd XR, abd US, CT abdIUD removal, D&C, abxCultures: pseudomonas aeruginosaNot rupturedLived
[46]Sam et al, 199960TVUSEndometrial curetting, D&C, antibiotic therapyTwo fetal bone fragments found in endometrial cavity, culture: E. coli, no malignancyXX
[47]Urushidani et al, 202073US abd, CT abdDrainage via vaginaCulture: Fusobacterium nucleatum, no malignancyNot rupturedLived
[48]Larkin et al, 201081CT abd, laparotomyHartmann’s procedureXNot rupturedLived
[49]Emergui Zrihen et al, 201769TVUS, laparotomyPeritoneal lavage, AbxNo malignancyRupturedLived
[50]Noack et al, 200669US, CT pelvisCervical dilation and drainageNo malignancy, culture: Enterococcus and P. magnusNot rupturedDied due to peritonitis with signs of systemic inflammation
[51]Nikkhah-Abyaneh et al, 201043CT abd, MRI pelvis, laparoscopy and hysteroscopyTLH, abxCulture: vancomycin-resistant enterococci, no malignancyNot rupturedLived
[52]Dogan-Ekici et al, 200767TVUSEMB, TAH with BSONo malignancyNot rupturedX
[53]Hurst et al, 201360CT abdD&C, abxInvasive squamous cell carcinomaXX
[54]Shukla et al, 201265CT abdTAH and BSOCulture: Enterococcus faecalis, no malignancyXX
[55]Yasa et al, 201572CT abdTransabdominal drainage, TAH with BSO, upper vaginectomy, abxCulture: Escherichia coliNot rupturedLived
[56]Nakao et al, 200086Abd XR, US, CT, laparotomySupravaginal hysterectomyCulture: Clostridium sphenoides, no malignancyRupturedLived
[57]Orum et al, 201764TVUS, CT abdAbx, transvaginal drainageCulture: T. praeacuta and C. hastiforme, no malignancyNot rupturedLived
[58]Inui et al, 199988CXR, laparoscopyTLH with BSOCultures: E. coli, no malignancyRupturedLived
[59]Choudhary et al, 201465CXR, laparotomyXXRupturedX
[60]Chuang et al, 201278CT abd, US abd, laparotomyTAHCulture: Bacteroides fragilis and Streptococcus viridansNot rupturedLived
[61]Izumi et al, 201083CT abdTAH, drainageCulture: Bacteroides distasonis, Porphyromonas asaccharolytica, and Streptococcus oralis, no malignancyRuptured, postoperative pneumonia and subsequent respiratory insufficiencyLived
[62]Yin et al, 201667CT abd, laparotomyTAH with BSO, drainageCulture: Staphylococcus epidermidis, no malignancyRuptured, wound dehiscenceLived
[63]Shayya et al, 200978CT abd, US abdTransabdominal drainage, manual dilation of lateral vaginal tracts via 24-F catheters, abxCulture: Morganella morganii, no malignancyNot rupturedLived
[64]Ploteau et al, 2012 (case 1)23CT abd, laparotomySubtotal hysterectomyCulture: Escherichia coliNot rupturedLived
[64]Ploteau et al, 2012 (case 2)27CT abdAdhesion release, subtotal hysterectomyXNot rupturedLived
[65]Saha et al, 200860US abd, abd XR, laparotomySupravaginal hysterectomy with salpingo-ophorectomy and peritoneal lavage, abxCulture: Staphylococcus aureus, no malignancyRupturedLived
[66]Garanpayeh et al, 200663US abd, CT abd, LaparotomyTLH with BSO, abxNo malignancyRupturedLived
[67]Bagga et al, 200860Speculum and vaginal examinations, US abdTAHPrimary squamous cell carcinoma of endometriumXX
[68]Chao et al, 201360US abd, TVUS, CT abd, CT chest, laparotomyUterine drainage, subtotal hysterectomy with BSO, abxCulture: S. epidermidis, squamous cell carcinoma in situ, HPV 16+Not ruptured, bacteremiaDied due to septic shock and multiple organ failure caused by persistent bacteremia
[69]Cho et al, 201174Pelvic US, CT pelvisDrainage of vaginal canal, external beam radiotherapyStage 3 squamous cell carcinoma in the vaginaXX
[70]Kriplani et al, 199459Speculum and vaginal examinations, US abdLippes loop removed, D&C, abxCulture: Actinomyces israelii, no malignancyNot rupturedLived
[71]Kimura et al, 199472Abd XR, laparotomyTLH with BSONo malignancyRuptured, subcutaneous abscess and pneumoniaLived
[72]Chaopotong et al, 201288TVUS, laparotomyTLH with BSONo malignancyRupturedDied due to severe sepsis and multiple organ failure
[73]Roth et al, 200778Pelvic US, CT abd, laparotomyTAH with BSO and upper vaginectomyNo malignancyNot rupturedLived
[74]Deutchman et al, 201329Abd USPipelle catheter aspiration, abxCulture: group B strepNot rupturedLived
[75]Habek et al, 200584Pelvic US, laparotomyTLH with BSO, appendectomy, omentectomy, and drainage of the Douglas spaceCulture: Escherichia coli, no malignancyNot rupturedLived