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Journal of Ultrasound in Medicine :... Jun 2021To explore the diagnostic value of time-intensity curve parameters from contrast-enhanced ultrasound (CEUS) examinations of endometrial lesions.
OBJECTIVES
To explore the diagnostic value of time-intensity curve parameters from contrast-enhanced ultrasound (CEUS) examinations of endometrial lesions.
METHODS
Fifty-two patients with suspected endometrial lesions who received vaginal CEUS examinations were divided into a polyp group (n = 36), a malignant group (n = 11), and a normal control group (n = 5) based on the pathologic diagnosis. The midpoint of the myometrium at the same depth as the endometrial lesion was used as the reference point. The initial increase time, time to peak, area under the curve, and peak intensity were determined by the time-intensity curve. The relative parameters, namely, the initial increase time difference, peak time difference, area ratio, and peak intensity ratio, were also calculated and analyzed statistically.
RESULTS
The comparison results of the relative parameters among the groups showed that the differences in the time difference, intensity ratio, and area ratio were statistically significant. The differences in the intensity ratio and time difference between the malignant and normal groups were statistically significant (P < .001). The differences in the intensity ratio, area ratio, and time difference between the malignant and polyp groups were statistically significant (P < .001). The diagnostic value of the intensity ratio and area ratio was confirmed by a receiver operating characteristic curve. The sensitivity and specificity of the intensity ratio and area ratio in the groups were 100% and 77.5% and 85.7% and 85.0%, respectively.
CONCLUSIONS
The relative CEUS parameters in endometrial lesions provide more diagnostic value in differential diagnosis of benign and malignant lesions than the absolute parameters.
Topics: Contrast Media; Diagnosis, Differential; Female; Humans; ROC Curve; Sensitivity and Specificity; Ultrasonography
PubMed: 32930398
DOI: 10.1002/jum.15492 -
Obstetrics and Gynecology Aug 2016The primary goal of sonohysterography is to visualize the endometrial cavity in more detail than is possible with routine transvaginal ultrasonography. Sonohysterography...
The primary goal of sonohysterography is to visualize the endometrial cavity in more detail than is possible with routine transvaginal ultrasonography. Sonohysterography also can be used to assess tubal patency. The indications for sonohysterography include, but are not limited to, evaluation of the following: abnormal uterine bleeding; uterine cavity, especially with regard to uterine leiomyomata, polyps, and synechiae; abnormalities detected on transvaginal ultrasonography, including focal or diffuse endometrial or intracavitary abnormalities; congenital abnormalities of the uterus; infertility; recurrent pregnancy loss; and suboptimal visualization of the endometrium on transvaginal ultrasonography. Sonohysterography should not be performed in a woman who is pregnant or who could be pregnant. Credentialing obstetrician-gynecologists to perform or supervise diagnostic sonohysterography should be based on education, training, experience, and demonstrated competence in performing and interpreting trans-vaginal ultrasonography and sonohysterography. The obstetrician-gynecologist should be skilled in the transcervical placement of catheters. The sonohysterography procedure, including benefits and risks, should be explained fully to the patient before the procedure is performed.
Topics: Contraindications; Documentation; Endosonography; Female; Humans; Patient Selection; Physician's Role; Technology Assessment, Biomedical; Uterus
PubMed: 27454735
DOI: 10.1097/AOG.0000000000001588 -
Journal of Medical Cases Jan 2023Uterine inversion may be puerperal or non-puerperal. Puerperal uterine inversion is a rare obstetrics complication, with an estimated incidence of 1 in 30,000...
Uterine inversion may be puerperal or non-puerperal. Puerperal uterine inversion is a rare obstetrics complication, with an estimated incidence of 1 in 30,000 deliveries. The occurrence of non-puerperal uterine inversion is even rarer such that there is no good estimate of its incidence. It is challenging to make the diagnosis of non-puerperal uterine inversion and a high index of suspicion needs to be present. Malignancy is an uncommon cause for non-puerperal uterine inversion, but it is important to keep it in mind so as to counsel patients appropriately and prevent repeat surgery wherever possible. There are also unique complexities in the assessment of a virgo intacta patient which needs to be overcome through the use of different approaches in physical examination and imaging. In this case report, there is a unique interplay of multiple complicating factors in a virgo intacta patient presenting with abnormal uterine bleeding secondary to a malignant fibroid polyp that had prolapsed out of the vagina causing uterine inversion. She eventually required two open surgeries in the management of her condition.
PubMed: 36755999
DOI: 10.14740/jmc4023 -
Human Pathology May 2020Fibroepithelial stromal polyps (FESPs) are benign polypoid mesenchymal lesions thought to arise from desmin-positive specialized stromal cells of the female genital...
Fibroepithelial stromal polyps (FESPs) are benign polypoid mesenchymal lesions thought to arise from desmin-positive specialized stromal cells of the female genital tract. Although most cases are easily diagnosed by morphology alone, the morphology of FESPs is variable and in some instances can contain hypercellular stroma with numerous atypical desmin-positive cells, simulating botryoid embryonal rhabdomyosarcoma (ERMS). Recently, we encountered a cellular FESP showing desmin expression as well as nuclear immunoreactivity for the skeletal muscle-associated transcription factor MyoD1. Although these lesions are widely known to express desmin, there are very few studies examining expression of the more specific markers of skeletal muscle differentiation, myogenin and MyoD1. The aim of our study was to examine desmin, MyoD1, and myogenin expression in a series of 25 FESPs. Of the 25 cases, desmin expression was present in 23 (92%), at least focal MyoD1 expression was present in 10 (40%), and all cases were negative for myogenin. Follow-up data were available for all 25 cases, and none recurred or behaved in a malignant fashion. Awareness of this potential immunohistochemical pitfall and careful morphologic evaluation should allow for the confident distinction of MyoD1-positive FESP from botyroid ERMS in almost all instances.
Topics: Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Diagnosis, Differential; Female; Humans; Immunohistochemistry; Middle Aged; MyoD Protein; Neoplasms, Fibroepithelial; Polyps; Predictive Value of Tests; Prognosis; Stromal Cells; Vaginal Neoplasms; Vulvar Neoplasms
PubMed: 32217091
DOI: 10.1016/j.humpath.2020.03.006 -
Computational and Mathematical Methods... 2022In order to explore the ability of vaginal ultrasound combined with bleeding pattern to predict factors related to abnormal uterine bleeding (AUB), a total of 205...
In order to explore the ability of vaginal ultrasound combined with bleeding pattern to predict factors related to abnormal uterine bleeding (AUB), a total of 205 patients with abnormal uterine bleeding were selected as experimental subjects. According to the corresponding diagnostic criteria, patients were divided into the endometrial polyp group (56 cases), endometrial hyperplasia and canceration group (84 cases), and normal cycle endometrial group (65 cases). The efficiency of the method was determined by comparing the prediction efficiency of the single/joint model. The results showed that there were statistically significant differences in the body mass index, dysmenorrhea, endometrial thickness, diabetes, hypertension, and polycystic ovary syndrome among the three groups, < 0.05. The sensitivity, specificity, positive predictive value, negative predictive value, and Youden index of endometrial polyp diagnosis were 86.89%, 88.12%, 83.54%, 90.11%, and 0.74, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and JordAn index in diagnosing endometrial hyperplasia and canceration were 96.71%, 98.40%, 96.54%, 98.24%, and 0.96, respectively. In summary, the body mass index, dysmenorrhea, endometrial thickness, diabetes, hypertension, and polycystic ovary syndrome were related factors, and the combination of vaginal ultrasound and bleeding pattern had a stronger predictive power for abnormal uterine bleeding.
Topics: Dysmenorrhea; Endometrial Hyperplasia; Endometrium; Female; Humans; Hypertension; Polycystic Ovary Syndrome; Polyps; Sensitivity and Specificity; Ultrasonography; Uterine Hemorrhage; Uterine Neoplasms
PubMed: 35799665
DOI: 10.1155/2022/5653250 -
Acta Medica Lituanica 2021This is the first case describing vaginal papillomatosis with a fibroepithelial polyp of the vulva in a prepubertal girl and vaginal papillomatosis in her twin sister....
This is the first case describing vaginal papillomatosis with a fibroepithelial polyp of the vulva in a prepubertal girl and vaginal papillomatosis in her twin sister. Parents contacted pediatric urologist regarding their eight-year-old daughter (twin A), who had a growth next to the external urethral meatus. The girl was referred to a pediatric surgeon. The exophytic 3 cm long structure with necrosis on top was found. After obtaining informed consent from girl parents, pediatric surgeon removed the exophytic structure and perform cystoscopy and vaginoscopy for possible changes in the bladder and vagina. Cystoscopy findings were normal. On vaginoscopy, numerous macroscopic papillomatous structures were identified on the cervix and vaginal walls. Vaginal biopsies were performed on the areas affected by papillomatosis. Histopathologic examination showed a fibroepithelial polyp with a central fibrovascular core covered by squamous epithelium and vaginal squamous papillomatosis. The decision was made to perform vaginoscopy on her twin sister (twin B), too. On vaginoscopy, solitary small vaginal papillomas were also found. In this case manifestation of vaginal papillomatosis in twins might have been influenced by inheritance and the same bacterial and viral environment.
PubMed: 35474933
DOI: 10.15388/Amed.2021.28.2.18 -
Pathologica Dec 2017Vaginal rhabdomyoma is an extremely rare tumor which presents as a vaginal polypoid masses. It is essential to differentiate it from benign and malignant mimickers so... (Review)
Review
Vaginal rhabdomyoma is an extremely rare tumor which presents as a vaginal polypoid masses. It is essential to differentiate it from benign and malignant mimickers so that appropriate therapy may be provided. The present report describes a vaginal wall nodule of a symptomatic 24-year-old woman. Local excision and subsequent pathological examination were performed. The final diagnosis was vaginal rhabdomyoma. The literature is reviewed and differential diagnosis are discussed.
Topics: Diagnosis, Differential; Female; Humans; Polyps; Rhabdomyoma; Vaginal Neoplasms; Young Adult
PubMed: 29449728
DOI: No ID Found -
American Journal of Obstetrics and... Dec 2022Cervical polyps removed during pregnancy have been reported to be associated with preterm birth; however, the association between unremoved cervical polyps and preterm...
BACKGROUND
Cervical polyps removed during pregnancy have been reported to be associated with preterm birth; however, the association between unremoved cervical polyps and preterm birth has not been elucidated.
OBJECTIVE
This study aimed to clarify the relationship between cervical polyps detected before 12 weeks of gestation managed expectantly and spontaneous preterm birth.
STUDY DESIGN
This retrospective cohort study included pregnant women who visited a tertiary perinatal center before 12 weeks of gestation between January 2015 and December 2019. The exclusion criteria were as follows: multiple gestations, loss or termination of pregnancy before 12 weeks of gestation, major fetal anomalies, fetal chromosomal abnormalities, fetal demise, having undergone removal of cervical polyps before the first visit to our hospital, and moving to other hospitals before delivery. A vaginal speculum examination was routinely performed during a prenatal visit before 12 weeks of gestation. When a cervical polyp was detected on speculum examination, it was managed expectantly, unless gynecologic malignancy was suspected. Relationships between cervical polyps and spontaneous preterm birth before 34 weeks of gestation were evaluated using logistic regression analysis and Cox proportional-hazards analysis adjusted for known confounders for spontaneous preterm birth.
RESULTS
A total of 4172 pregnant women were included, of whom 92 (2.2%) had a cervical polyp detected before 12 weeks of gestation. None of the women underwent polypectomy during pregnancy. The incidence of spontaneous preterm birth before 34 weeks of gestation was higher in pregnant women with cervical polyps than in those without them (5.4% vs 0.7%; P<.01). Logistic regression analysis revealed that cervical polyps were an independent risk factor for spontaneous preterm birth before 34 weeks of gestation (adjusted odds ratio, 4.09; 95% confidence interval, 1.70-9.81; P<.01). The adjusted hazard ratio for spontaneous preterm birth before 34 weeks of gestation among women with vs without cervical polyps was 2.95 (95% confidence interval, 1.32-6.62; P<.01).
CONCLUSION
Cervical polyps detected before 12 weeks of gestation managed expectantly are a significant risk factor for spontaneous preterm birth before 34 weeks of gestation.
Topics: Female; Infant, Newborn; Pregnancy; Humans; Premature Birth; Cervix Uteri; Retrospective Studies; Pregnancy Trimester, Second; Prenatal Care; Polyps; Uterine Cervical Neoplasms
PubMed: 35841937
DOI: 10.1016/j.ajog.2022.06.064 -
Rhinology Jun 2016Management of rhinosinusitis during pregnancy requires special considerations. (Review)
Review
BACKGROUND
Management of rhinosinusitis during pregnancy requires special considerations.
OBJECTIVES
1. Conduct a systematic literature review for acute and chronic rhinosinusitis (CRS) management during pregnancy. 2. Make evidence-based recommendations.
METHODS
The systematic review was conducted using MEDLINE and EMBASE databases and relevant search terms. Title, abstract and full manuscript review were conducted by two authors independently. A multispecialty panel with expertise in management of Rhinological disorders, Allergy-Immunology, and Obstetrics-Gynecology was invited to review the systematic review. Recommendations were sought on use of following for CRS management during pregnancy: oral corticosteroids; antibiotics; leukotrienes; topical corticosteroid spray/irrigations/drops; aspirin desensitization; elective surgery for CRS with polyps prior to planned pregnancy; vaginal birth versus planned Caesarian for skull base erosions/ prior CSF rhinorrhea.
RESULTS
Eighty-eight manuscripts underwent full review after screening 3052 abstracts. No relevant level 1, 2, or 3 studies were found. Expert panel recommendations for rhinosinusitis management during pregnancy included continuing nasal corticosteroid sprays for CRS maintenance, using pregnancy-safe antibiotics for acute rhinosinusitis and CRS exacerbations, and discontinuing aspirin desensitization for aspirin exacerbated respiratory disease. The manuscript presents detailed recommendations.
CONCLUSIONS
The lack of evidence pertinent to managing rhinosinusitis during pregnancy warrants future trials. Expert recommendations constitute the current best available evidence.
Topics: Administration, Intranasal; Adrenal Cortex Hormones; Anti-Bacterial Agents; Cerebrospinal Fluid Rhinorrhea; Cesarean Section; Chronic Disease; Delivery, Obstetric; Disease Management; Female; Humans; Leukotriene Antagonists; Nasal Polyps; Otorhinolaryngologic Surgical Procedures; Paranasal Sinuses; Practice Guidelines as Topic; Preconception Care; Pregnancy; Pregnancy Complications, Infectious; Rhinitis; Sinusitis
PubMed: 26800862
DOI: 10.4193/Rhino15.228 -
BJR Case Reports Mar 2022A fibroepithelial stromal polyp is a benign soft tissue tumour that can occur in the vagina, vulva and uterine cervix. Magnetic resonance imaging (MRI) findings have...
A fibroepithelial stromal polyp is a benign soft tissue tumour that can occur in the vagina, vulva and uterine cervix. Magnetic resonance imaging (MRI) findings have been reported in patients with vulvar fibroepithelial stromal polyps, not in those with vaginal polyps. We present MRI findings of vaginal fibroepithelial stromal polyp in a postmenopausal female. A 1 to 2 cm firm vaginal mass arising from the left side of the vaginal wall with hypointense signal changes on T1W MRI was identified. A well-defined vaginal mass (1 cm diameter) was detected with inhomogeneous signal intensity on T2W images. However, a major portion had high signal intensity on diffusion-weighted images. A benign vaginal lesion with oedematous changes or myxoid degeneration was suspected. Vaginal resection was performed, and fibroepithelial stromal polyp was pathologically diagnosed. MRI may be a useful non-invasive modality for preoperatively diagnosing vaginal fibroepithelial stromal polyps.
PubMed: 36177268
DOI: 10.1259/bjrcr.20210189