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Molecular and Clinical Oncology Mar 2017Vaginal melanoma is a rare tumor, accounting for <1% of all melanomas and ~1-5% of all vaginal malignant tumors. The prognosis of vaginal melanoma is extremely poor, as...
Vaginal melanoma is a rare tumor, accounting for <1% of all melanomas and ~1-5% of all vaginal malignant tumors. The prognosis of vaginal melanoma is extremely poor, as it is often resistant to chemotherapy and radiotherapy, and metastases may develop in the early stages of the disease. The present study investigated 5 patients with vaginal melanoma treated at the Department of Gynecology of Osaka City University Hospital (Osaka, Japan) between October, 2000 and April, 2014. All the cases presented with abnormal genital bleeding as the main complaint. Notably, in 3 of the 5 cases the tumors appeared as non-pigmented polyps. Local resection was performed as the primary treatment in all 5 cases. After surgery, dermal injection of interferon β (feron maintenance therapy) was performed in 3 cases, and dacarbazine, nimustine, vincristine and interferon β (DAVFeron therapy) was administered in 1 case as adjuvant therapy. All 5 cases recurred within 1 year. The site of recurrence varied, and included the vaginal wall, liver, brain and lung. The median overall survival was 419 days and the median progression-free survival 177 days. In this cohort, all the cases presented with abnormal genital bleeding as the main complaint. Therefore, malignant melanoma of the vagina must be considered along with other gynecological malignancies in patients with abnormal genital bleeding. In this study, over half of the cases had a non-pigmented polypoid lesion of the vagina. Therefore, malignant melanoma of the vagina must be considered when a polypoid lesion is identified on the vaginal wall.
PubMed: 28451415
DOI: 10.3892/mco.2017.1158 -
The Canadian Veterinary Journal = La... Jul 2022A 6-year-old, intact female, domestic short-hair cat had a 3-month history of obstipation. On physical examination and diagnostic imaging, megacolon secondary to a...
A 6-year-old, intact female, domestic short-hair cat had a 3-month history of obstipation. On physical examination and diagnostic imaging, megacolon secondary to a large, intrapelvic vaginal mass was diagnosed. An ovariohysterectomy and a complete vaginectomy a ventral midline celiotomy and bilateral pubic and ischial osteotomies were performed. This approach allowed excellent exposure of the entire genital tract necessary to excise the large vaginal mass. The mass was histologically diagnosed as a vaginal fibrous stromal polyp. Obstipation resolved 12 h after surgery. On radiographic recheck 11 d after surgery, the colon had returned to normal size. No major surgical complications were observed. This is the first case report of a complete vaginectomy the ventral approach with a pelvic osteotomy in a cat. Furthermore, this report describes the different surgical techniques used in animals affected by a large vaginal mass and provides evidence that an aggressive surgical approach and excision can be considered for the management of extensive intrapelvic vaginal masses in cats.
Topics: Abdomen; Animals; Cats; Colpotomy; Constipation; Female; Hysterectomy; Osteotomy; Pregnancy; Pubic Bone
PubMed: 35784779
DOI: No ID Found -
Asian Journal of Surgery Feb 2023
Topics: Female; Humans; Hymen; Cervix Uteri; Vagina; Polyps
PubMed: 35973896
DOI: 10.1016/j.asjsur.2022.07.079 -
American Journal of Obstetrics and... Jul 2017The selective estrogen receptor modulator tamoxifen is now widely used for the treatment and prevention of breast cancer. Tamoxifen use has been associated with a... (Comparative Study)
Comparative Study
BACKGROUND
The selective estrogen receptor modulator tamoxifen is now widely used for the treatment and prevention of breast cancer. Tamoxifen use has been associated with a variety of gynecologic problems. Despite the frequency with which hormonal therapy is used for the treatment of breast cancer, limited population-level data are available to describe the occurrence of gynecologic conditions and the use of surveillance testing in women receiving tamoxifen and aromatase inhibitors.
OBJECTIVE
We performed a population-based analysis among women with breast cancer receiving hormonal therapy with tamoxifen, a drug commonly used in premenopausal and sometimes postmenopausal women, to determine the frequency of gynecologic abnormalities and use of diagnostic and surveillance testing. We compared these findings to women treated with aromatase inhibitors, agents commonly used in postmenopausal women.
STUDY DESIGN
The MarketScan database was used to identify women diagnosed with breast cancer from 2009 through 2013 who underwent mastectomy or lumpectomy. Women receiving tamoxifen (age <50 vs ≥50 years) were compared to women ≥50 years of age treated with aromatase inhibitors. We examined the occurrence of gynecologic symptoms and diseases (vaginal bleeding, endometrial polyps, endometrial hyperplasia, and endometrial cancer) and gynecologic procedures and interventions (transvaginal ultrasound, endometrial biopsy, hysteroscopy/dilation and curettage, and hysterectomy). Time-dependent analyses were performed to examine symptoms and testing.
RESULTS
A total of 75,170 women, including 15,735 (20.9%) age <50 years treated with tamoxifen, 13,827 (18.4%) age ≥50 years treated with tamoxifen, and 45,608 (60.7%) age ≥50 years treated with aromatase inhibitors were identified. The cumulative incidence of any gynecologic symptom or pathologic diagnosis during the study period was 20.2%, 12.3%, and 3.5%, respectively (P < .001), while the cumulative incidence of any gynecologic procedure or intervention during the study period was 34.2%, 20.9%, and 9.0%, respectively (P < .0001). Among women without symptoms or pathology, interventions were performed in 20.0%, 11.0%, and 6.8%, respectively (P < .0001).
CONCLUSION
Compared to women taking aromatase inhibitors, gynecologic symptoms, procedures, and pathology are higher for both premenopausal and postmenopausal women with breast cancer on tamoxifen. Increased efforts to curb use of gynecologic interventions in asymptomatic women are needed.
Topics: Adult; Aged; Antineoplastic Agents, Hormonal; Aromatase Inhibitors; Breast Neoplasms; Chemotherapy, Adjuvant; Endometrial Hyperplasia; Endometrial Neoplasms; Female; Genital Diseases, Female; Humans; Middle Aged; Postmenopause; Premenopause; Risk Factors; Tamoxifen; Uterine Neoplasms
PubMed: 28341383
DOI: 10.1016/j.ajog.2017.03.011 -
Reproductive Sciences (Thousand Oaks,... Apr 2017To evaluate the incidence of infectious complications and effect of prophylactic antibiotic administration during operative hysteroscopic procedures. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To evaluate the incidence of infectious complications and effect of prophylactic antibiotic administration during operative hysteroscopic procedures.
METHODS
A multicentric randomized controlled trial was conducted between January 2012 and December 2013. Women (n = 180) affected by endometrial hyperplasia, myomas, or endometrial polyps undergoing operative hysteroscopy were randomized to receive cefazolin 2 g intravenously 30 minutes prior to the procedure (n = 91) and no treatment (n = 89).
RESULTS
No statistical difference in terms of postoperative fever (2.4% vs 2.3%, P = .99), endometritis (0% vs 0%), pain (6.0% vs 10.4%, P = .40), cervicitis-vaginitis (0% vs 0%), pelvic abscess (0% vs 0%), pelvic inflammatory disease (0% vs 0%), and bleeding (0% vs 0%) was noticed. No statistical difference in terms of side effects attributable to antibiotic prophylaxis such as allergy (0% vs 4.8%, P = .12), nausea (10.7% vs 17.4%, P = .27), vomiting (3.6% vs 4.6%, P = .99), diarrhea (4.8% vs 5.4%, P = .99), cephalea (9.5% vs 3.5%, P = .13), dizziness (4.8% vs 2.3%, P = .44), and meteorism (5.4% vs 3.4%, P = .99) was noticed.
CONCLUSION
The results of the current study support the recommendation not to prescribe routine antibiotic prophylaxis prior to operative hysteroscopy.
Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cefazolin; Endometrial Hyperplasia; Female; Humans; Hysteroscopy; Leiomyoma; Middle Aged; Polyps; Treatment Outcome; Uterine Neoplasms
PubMed: 27470152
DOI: 10.1177/1933719116660848 -
Archives of Gynecology and Obstetrics Feb 2023Some proliferative and neoplastic changes can be seen in the endometrium of breast cancers using tamoxifen adjuvant therapy (TMX-BC). Identifying risk groups is crucial,...
PURPOSE
Some proliferative and neoplastic changes can be seen in the endometrium of breast cancers using tamoxifen adjuvant therapy (TMX-BC). Identifying risk groups is crucial, but methods and frequency of endometrial follow-up are still controversial. This study aimed to investigate the clinical, ultrasonographic, and inflammatory factors to differentiate pathological endometrium in TMX-BC.
METHODS
This study retrospectively analyzed endometrial biopsy results of TMX-BC (n 361). Normal endometrium (Group I, n 237) and pathological endometrium (Group II, n 124) were compared for clinical, ultrasonographic, and inflammatory features. Neutrophil and platelet to lymphocyte ratio (NLR; PLR), mean platelet volume (MPV), platelet distribution width (PDW), red blood cell distribution width (RDW), and lymphocyte-monocyte ratio (LMR) were the inflammatory markers.
RESULTS
The majority of TMX-BC with endometrial biopsy were asymptomatic (72.6%) and had normal endometrium (65.7%). Pathologic endometrium included endometrial polyp (31.9%), endometrial hyperplasia (1.7%), and endometrial cancer (0.8%). The duration of tamoxifen, cancer stage, vaginal bleeding, and menopause was similar in Group I and Group II (p > 0.05). Group II had increased endometrial thickness (11.22 ± 5.44 mm) compared to Group I (8.51 ± 3.43 mm). Group II had higher RDW and PDW than Group I (p < 0.05). Endometrial thickness ≥ 10 mm had significant diagnostic potential in postmenopausal women (AUC 0.676, p 0.000, CI 0.5-0.7), but not in premenopause.
CONCLUSION
PDW and RDW may be promising markers for pathological endometrium differentiation, but these preliminary findings should be validated by clinical studies. Measurement of endometrial thickness in asymptomatic patients may predict high-risk women with pathological endometrium in postmenopausal women. Further studies are needed in premenopausal women and those using tamoxifen for more than 5 years.
Topics: Humans; Female; Tamoxifen; Breast Neoplasms; Retrospective Studies; Endometrium; Endometrial Neoplasms; Ultrasonography; Antineoplastic Agents, Hormonal
PubMed: 35650257
DOI: 10.1007/s00404-022-06608-y -
Climacteric : the Journal of the... Apr 2015The aim of this study was to determine the rate of unexpected uterine pathology in postmenopausal women admitted to a gynecology clinic with symptoms other than vaginal...
OBJECTIVE
The aim of this study was to determine the rate of unexpected uterine pathology in postmenopausal women admitted to a gynecology clinic with symptoms other than vaginal bleeding and who were scheduled to undergo hysterectomy.
MATERIALS AND METHODS
We reviewed retrospectively the medical records of 283 postmenopausal patients who had gynecological surgery between September 2007 and January 2014. We reviewed their presenting symptoms on admission, the indications for surgery, and their transvaginal ultrasonographic findings. Postoperative histopathological results based on uterine specimens were also recorded. The results were analyzed statistically.
RESULTS
Of 283 patients who had surgery, 209 had no vaginal bleeding at the time of admission. From this group, 75.6% were found to have unsuspected pathology, including endometrial hyperplasia, endometrial polyps, uterine fibroids, adenomyosis, and one case of endometrial carcinoma (0.5%). The remaining 74 patients had experienced postmenopausal bleeding and in 87.8% there were pathological findings including 13 cases (17.6%) of endometrial cancer (p = 0.0001).
CONCLUSION
Vaginal bleeding in postmenopausal women is indicative of a wide array of gynecological pathologies, including endometrial carcinoma. However, uterine fibroids, pelvic masses, or even endometrial cancer may develop without co-morbid vaginal bleeding. Therefore we advocate that postmenopausal women should undergo yearly screening and consultation, without waiting for an episode of vaginal bleeding.
Topics: Adenomyosis; Adult; Aged; Aged, 80 and over; Endometrial Hyperplasia; Endometrial Neoplasms; Endometrium; Female; Humans; Hysterectomy; Leiomyoma; Middle Aged; Polyps; Postmenopause; Ultrasonography; Uterine Diseases; Uterine Hemorrhage; Uterine Neoplasms
PubMed: 25017611
DOI: 10.3109/13697137.2014.944152 -
The Pan African Medical Journal 2023Serous endometrial intraepithelial carcinoma (SEIC) is a rare but highly aggressive form of uterine endometrial cancer. We report two cases of post-menopausal,...
Serous endometrial intraepithelial carcinoma (SEIC) is a rare but highly aggressive form of uterine endometrial cancer. We report two cases of post-menopausal, 58-year-old patients with abundant vaginal bleeding and pelvic pain. The first patient had a history of surgical hysteroscopy in 2019 for an endocervical polyp. The second patient had a history of breast resection, axillary lymph node dissection, chemotherapy, radiation therapy, and tamoxifen therapy for breast carcinoma 6 years ago. An abdominal hysterectomy was performed in both patients. The pathological assessment showed serous endometrial intraepithelial carcinoma. Diagnosis of a serous proliferation of the uterus implies the exploration of other genital tract organs as well as distant locations in search of metastatic disease.
Topics: Female; Humans; Middle Aged; Uterine Neoplasms; Endometrial Neoplasms; Cystadenocarcinoma, Serous; Uterus; Carcinoma in Situ
PubMed: 37275288
DOI: 10.11604/pamj.2023.44.122.37712 -
Iranian Journal of Nursing and... 2020Abnormal vaginal bleeding is one of the complaints of women during menopause. Various diseases such as endometrial atrophy, polyps, and endometrial cancers may lead to...
Abnormal vaginal bleeding is one of the complaints of women during menopause. Various diseases such as endometrial atrophy, polyps, and endometrial cancers may lead to postmenopausal vaginal bleeding. This report describes a case of postmenopausal vaginal bleeding caused by pregnancy. A 54-year-old woman referred to the prenatal clinic in Arak, Iran, with postmenopausal vaginal bleeding in 2018. Transabdominal ultrasound revealed an uterine pregnancy. At 28 weeks of gestation, she referred to the health center and her prenatal care began in the midwifery clinic. She gave birth to a baby girl at 34 weeks through a cesarian section. This case reminds practitioners and midwives that pregnancy may be one of the etiologies of postmenopausal vaginal bleeding especially in women with sexual activity. Therefore, a free beta-subunit human chorionic gonadotropin (HCG) hormone measurement should be conducted and if found to be elevated, followed by appropriate imaging tests.
PubMed: 32724774
DOI: 10.4103/ijnmr.IJNMR_94_19 -
Journal of Pediatric and Adolescent... Dec 2014To present the clinical appearance, differential diagnosis, long-term follow-up, and the surgical result of single-center experience with female urethral polyps...
STUDY OBJECTIVE
To present the clinical appearance, differential diagnosis, long-term follow-up, and the surgical result of single-center experience with female urethral polyps presenting as an interlabial mass, and to report the common causes of interlabial masses in infants.
DESIGN
All 12 girls who presented with an interlabial mass and intermittent bleeding have been included in this study; however, the benign urethral polyps are discussed in detail and are the subject of this study.
SETTING
All patients were referred to our national referral pediatric urology center with initial impression of vaginal bleeding; however, rhabdomyosarcoma of bladder and urethra (n = 2) or vagina (n = 3) and urethral polyp (n = 7) was the final diagnosis.
PARTICIPANTS
The records of 12 girls who presented with external genitalia bleeding were retrospectively reviewed. Among them, 7 had fibroepithelial polyps and underwent initial polypectomy between 2001 and 2011with mean age of 21.5 months (range: 1-90 mo). All girls underwent endoscopic surgical removal of polyps.
MAIN OUTCOME MEASURES
No postoperative polyp recurrence was observed following endoscopic polyp resection.
RESULTS
The postoperative period was uneventful except in 1 girl who had immediate postoperative urethral bleeding which stopped spontaneously. There was no major complication or polyp recurrence after operation during the long-term follow-up.
CONCLUSIONS
The interlabial mass must be considered as a urethral polyp and should be differentiated from the vaginal rhabdomyosarcoma with protrusion of vaginal tumor from the vaginal outlet or other benign lesions. Physical examination in frog legged position or examination under anesthesia with urethrocystoscopy may confirm the final diagnosis.
Topics: Child; Child, Preschool; Cystoscopy; Diagnosis, Differential; Female; Humans; Infant; Neoplasm Recurrence, Local; Physical Examination; Polyps; Retrospective Studies; Rhabdomyosarcoma; Urethral Diseases; Urinary Bladder Neoplasms; Uterine Hemorrhage; Vaginal Neoplasms
PubMed: 25256883
DOI: 10.1016/j.jpag.2014.01.001