Pathologic diagnosis
of tumor type and grade forms the basis for treatment and prognosis. Sex cord–stromal neoplasms are staged according to the FIGO/TNM system. For a complete review of the pathology of ovarian germ cell tumors (see Crum and Lee).
1
URINARY TRACT INFECTIONS
See Chapter
7
PELVIC INFLAMMATORY DISEASE
*
CHORIOAMNIONITIS
Definition
Pelvic inflammatory disease (PID) refers to infection of the upper genital tract of women. It may include the endometrium, myometrium, parametrium, uterine tubes, and ovaries. Other pelvic and abdominal organs may be secondarily infected (e.g., peritonitis, perihepatitis).
Who Should Be Suspected?
PID is most commonly caused as a complication of STIs (85%); 15% of cases arise postoperatively or as a complication of childbirth. Factors for increased risk for PID include risk factors associated with STI: Age <25 years and young age at onset of sexual activity; new or multiple sex partners, especially partners with STI symptoms; unprotected sexual activity; and history of STI. Additional factors may include IUD use, douching, and bacterial vaginosis.
Clinical features:
PID describes infection in any of various organs, including the uterus, ovaries, and adjacent abdominal organs. Clinical presentation depends on the primary sites and severity of infection.
Diagnosis should be strongly considered in women presenting with abdominal pain if physical examination reveals cervical or adnexal tenderness. Diffuse, subacute abdominal pain is typical. Abdominal tenderness, sometimes with subtle peritoneal signs, and onset during menses are commonly described. Abnormal uterine bleeding is reported frequently. Nonspecific symptoms, like fever and lower genital tract symptoms, may be reported; other causes should be investigated if symptoms related to the GI or urinary tract are predominant.
Laboratory Findings
There is no gold standard for the diagnosis of PID. Evaluation must consider findings on physical examination and laboratory testing. Additional testing may be required, including imaging studies, laparoscopy, and histopathology.
Serum pregnancy test should be performed to rule out ectopic pregnancy or other complication of pregnancy.
A positive result of NAAT for
Neisseria gonorrhoeae
or
Chlamydia trachomatis
, with compatible clinical presentation, confirms a diagnosis of PID.
The quality and wet mount/Gram stain of cervical/vaginal fluid should be examined for increased WBCs or other abnormality. Abnormal secretions or increased WBCs (≥3 WBC per high-power field) support a diagnosis of PID.
Positive results for peripheral blood WBC, ESR, or CRP support a diagnosis of PID.
Supplemental tests: Inflammation of upper genital or adjacent organs, detected by laparoscopy, biopsy, peritoneal fluid analysis, or positive culture from normally sterile upper genital sites, confirms a clinical diagnosis of PID.
