-
Current Health Sciences Journal 2022Uterine hemangioma (UH) is a rare benign lesion involving the myometrium and cervix. UH often presents as an endometrial polypoid mass that mimics an endometrial polyp....
Uterine hemangioma (UH) is a rare benign lesion involving the myometrium and cervix. UH often presents as an endometrial polypoid mass that mimics an endometrial polyp. UH is commonly present in women of reproductive age with menorrhagia or pregnancy-associated complications. However, reported cases in postmenopausal women present with postmenopausal bleeding. The bleeding hemangiomatous polyps are treated with hysteroscopic polypectomy. We report the case of a 65-year-old postmenopausal woman with vaginal bleeding severe enough to seek emergency medical care. Transvaginal ultrasonography showed an endometrial thickness of 10.1mm but was otherwise unremarkable. Hysteroscopic examination revealed two endometrial polyps measuring 2.0cm, and 0.5cm. Surgeons had difficulty removing these polyps using usual methods, ultimately resorting to sharp excision. Microscopic examination showed scant endometrium without hyperplasia and a polypoid lesion with numerous CD31 positive capillaries entirely filling the stroma, supporting the diagnosis of capillary hemangioma. The contributing factor to UH in our case was unclear, which opens the door for future investigation of UH in post-menopausal women.
PubMed: 35911943
DOI: 10.12865/CHSJ.48.01.18 -
BioMed Research International 2022To investigate the effect of hysteroscopy surgery combined with Mirena on postoperative adverse reactions and recurrence rate of endometrial polyps (EP).
Effect of Hysteroscopic Polypectomy Combined with Mirena Placement on Postoperative Adverse Reactions and Recurrence Rate of Endometrial Polyps: Based on a Large-Sample, Single-Center, Retrospective Cohort Study.
OBJECTIVE
To investigate the effect of hysteroscopy surgery combined with Mirena on postoperative adverse reactions and recurrence rate of endometrial polyps (EP).
METHODS
A total of 312 patients who underwent hysteroscopic polypectomy of EP in our hospital from June 2017 to November 2020 were enrolled retrospectively. Among them, 42 patients did not take any treatment after the operation (control group), 156 patients were treated with levonorgestrel intrauterine birth control system (Mirena group), and 114 patients were treated with oral spironolone ethinylestradiol tablets (oral group). The clinical data of 312 patients were recorded and followed up regularly. All patients were followed up through an outpatient clinic or telephone to 12 months after the operation. The patients' age, disease course, number of pregnancies, clinical manifestations, endometrial thickness before the operation, duration of operation, amount of bleeding during the operation, and number and size of polyps were analyzed. The recurrence and postoperative side effects of EP in the three groups were followed up within 12 months after the operation.
RESULTS
There was no significant difference in endometrial thickness among the three groups before treatment ( > 0.05). After 3 months, 6 months, and 12 months of treatment, the endometrial thickness of the three groups decreased, while the decrease in the Mirena group and the oral group was better compared to the control ( < 0.05). The decrease in the Mirena group was better than that in the oral group ( < 0.05). There was no significant difference in hemoglobin levels among the three groups before treatment ( > 0.05). After 3, 6, and 12 months of treatment, the hemoglobin levels of the three groups increased to varying degrees, while the levels of the Mirena group and oral group were better compared to the control ( < 0.05). Three months after the operation, the improvement of clinical symptoms was similar in the three groups, and there was no significant difference among the three groups ( > 0.05). At 6 and 12 months after the operation, the improvement of clinical symptoms in the oral group and Mirena group was better compared to the control group ( < 0.05), but there was no significant difference between the oral group and Mirena group ( > 0.05). After the operation, some patients had complications such as lower abdominal pain, breast distension pain, irregular vaginal bleeding, and abnormal liver function. There was no significant difference in the number of complications among the three groups ( > 0.05). During the follow-up to 12 months after the operation, the recurrence rate in the oral group and Mirena group was lower compared to the control ( < 0.05), and the recurrence rate in the Mirena group was lower than that in the oral group ( < 0.05).
CONCLUSION
Placing Mirena immediately after hysteroscopic polypectomy of EP can reduce the recurrence rate of endometrial polyps, increase the level of hemoglobin, and reduce the thickness of the endometrium, which can be employed and popularized according to the condition of patients in clinical work.
Topics: Endometrium; Female; Humans; Hysteroscopy; Levonorgestrel; Polyps; Pregnancy; Retrospective Studies; Uterine Neoplasms
PubMed: 35528176
DOI: 10.1155/2022/1232495 -
Journal of Cancer Research and Clinical... Jul 2023The aim of the present study was to evaluate the incidence of unexpected uterine malignancies in patients undergoing hysterectomy for benign indications and to evaluate...
PURPOSE
The aim of the present study was to evaluate the incidence of unexpected uterine malignancies in patients undergoing hysterectomy for benign indications and to evaluate their clinical characteristics.
METHODS
We conducted a retrospective review of patients who underwent benign hysterectomy in the Department of Gynecology, the First Hospital of Shanxi Medical University from January 2015 to December 2020. The clinical data of these patients were retrieved and collected.
RESULTS
Their median age was 49.8 years (31-82 years). The mean parity was 1.86 ± 2.54. Their mean BMI was 27.5 ± 7.6 kg/m2. 42.90% were (2438/5683) postmenopausal. The benign indications of procedure were as follows: symptomatic uterine leiomyomas 2218/5683 (39.02%), pelvic organ prolapse 1406/5683 (24.74%), symptomatic endometriosis or adenomyosis 1132/5683 (19.91%), and 927/5683 (16.31%) to treat other benign conditions such as abnormal uterine bleeding, infection, polyps, and endometrial hyperplasia without atypia. In minimally invasive surgery subgroups, 1560/2621 (59.52%) specimens were removed by in-bag manual morcellation through vaginal cuff. The mean operative time of minimally invasive surgery with in-bag morcellation was shorter than abdominal hysterectomy (96.75 ± 35.7 vs. 140 ± 32.6, P < .001), and the estimated blood loss was also less than abdominal hysterectomy (47.35 ± 42.3 vs. 170 ± 60.4, P < .001). A total of 19/5683 (0.33%) unexpected uterine malignancies were recorded, of which 14/5683 (0.26%) were unexpected endometrial carcinomas and 5/5683 (0.08%) were unexpected uterine sarcomas.
CONCLUSION
Preoperative examination in the context of benign hysterectomy must be undertaken with care, and patients should be educated about the very slight possibility of a malignant diagnosis.
Topics: Female; Humans; Middle Aged; Incidence; Uterine Neoplasms; Hysterectomy; Leiomyoma; Endometrial Neoplasms; Retrospective Studies
PubMed: 36083311
DOI: 10.1007/s00432-022-04343-0 -
Zhong Nan Da Xue Xue Bao. Yi Xue Ban =... Sep 2019To investigate the clinical value of vaginal endoscopy in the diagnosis and treatment for vaginal and uterine diseases in young girls and adolescent girls. Methods:...
To investigate the clinical value of vaginal endoscopy in the diagnosis and treatment for vaginal and uterine diseases in young girls and adolescent girls. Methods: The clinical data of 156 young girls and adolescent girls treated with vaginoscopy from February 2000 to August 2017 were analyzed retrospectively. Results: Of the 37 cases of young girls, the clinical symptoms were the most common in vaginal hemorrhage, accounting for 40.5% (15 cases), the second one in vaginal foreign body, accounting for 29.7% (11 cases), the third one in abnormal vaginal secretion, accounting for 24.3% (9 cases), and the last one in low abdominal pain, accounting for 5.4% (2 cases). The final diagnosis of vaginal foreign body was 13 cases (35.1%). Of the 119 adolescent girls, the clinical symptoms of the visit were the most common in menstrual abnormalities or irregular vaginal bleeding, accounting for 75.6% (90 cases). The final diagnosis of abnormal uterine bleeding-ovulatory dysfunction was the most common with 59 cases (49.6%), following by 16 cases of abnormal uterine bleeding-polyp, 2 cases of abnormal uterine bleeding-malignancy and hyperplasia, and 1 cases of abnormal uterine bleeding-coagulopathy. There were 37 cases (31.1%) of reproductive tract malformation. All 156 patients successfully completed vaginal endoscopy and operation with only 1 case of urinary system infection. No other complications occurred and no damage in the hymen. Conclusion: Vaginal endoscopy is a safe, effective and near-noninvasive way for the diagnosis and treatment of vaginal or uterine diseases in young girls and adolescent girls. In the case of abnormal vaginal secretions and vaginal bleeding, it should be properly recommended to use the vaginal endoscopy for diagnosis and treatment.
Topics: Adolescent; Endoscopy; Female; Foreign Bodies; Humans; Retrospective Studies; Uterine Hemorrhage; Vagina
PubMed: 31645493
DOI: 10.11817/j.issn.1672-7347.2019.190441 -
IJU Case Reports May 2023Robot-assisted surgery is spreading across surgical specialities as a less invasive alternative to conventional laparoscopic and open surgery.
INTRODUCTION
Robot-assisted surgery is spreading across surgical specialities as a less invasive alternative to conventional laparoscopic and open surgery.
CASE PRESENTATION
In this report, robot-assisted total laparoscopic hysterectomy and robot-assisted nephroureterectomy were performed simultaneously for a 69-year-old Japanese female with giant cervical polyp and ureteral cancer. All specimens could be removed from the vagina. The operative time was 379 min, the estimated intraoperative blood loss was 29 mL, and the patient was discharged on the sixth postoperative day without complications.
CONCLUSION
We reported our experience with simultaneous robot-assisted nephroureterectomy and robot-assisted total laparoscopic hysterectomy. To our knowledge, this is the first report of simultaneous robot-assisted nephroureterectomy and robot-assisted total laparoscopic hysterectomy surgery.
PubMed: 37144083
DOI: 10.1002/iju5.12585 -
BMC Women's Health May 2021To investigate the clinical efficacy of the MyoSure hysteroscopic tissue removal system in the treatment of endometrial and cervical polyps in women with an intact hymen.
BACKGROUND
To investigate the clinical efficacy of the MyoSure hysteroscopic tissue removal system in the treatment of endometrial and cervical polyps in women with an intact hymen.
METHODS
Retrospective analysis was performed on the clinical data of 32 patients treated with the MyoSure hysteroscopic tissue removal system for endometrial and cervical polyps.
RESULTS
All the patients successfully completed the procedure. No intraoperative complications, such as cervical trauma, uterine perforation or TURP syndrome, were reported. The surgical time ranged from 5 to 35 min, with an average time of 19.3 min, and the intraoperative blood loss ranged from 2 to 50 ml with an average blood loss of 10.8 ml. After surgery, all patients were shown to have intact hymens. No residual polyp tissues were observed under the microscope, and abnormal uterine bleeding was relieved.
CONCLUSIONS
The MyoSure hysteroscopic tissue removal system can be a safe and effective treatment for endometrial and cervical polyps in women with an intact hymen.
Topics: Female; Humans; Hymen; Hysteroscopy; Polyps; Pregnancy; Retrospective Studies; Uterine Diseases; Uterine Neoplasms
PubMed: 34022866
DOI: 10.1186/s12905-021-01362-w -
Cureus Jul 2022Currently, the application of peritoneal washings as a diagnostic tool for endometrial cancer staging is not well defined. The case described aims to highlight the...
Currently, the application of peritoneal washings as a diagnostic tool for endometrial cancer staging is not well defined. The case described aims to highlight the current ambiguity surrounding the use of peritoneal washings in clinical practice. A 69-year-old G3P3003 presented to her gynecologist with complaints of new-onset heavy vaginal bleeding. The patient sought an endometrial biopsy, which suggested serous endometrial intraepithelial carcinoma (EIC) focally suspicious for invasive carcinoma, with the involvement of polyps. Based on these results, a robotic-assisted total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, bilateral sentinel lymph node dissection, and omentectomy were performed. Results from her final pathology exhibited a stage IA uterine serous carcinoma (USC) involving a polyp (4.2 cm in greatest dimension) with no myometrial or lymphovascular invasion, but washings were positive for adenocarcinoma. Based on her family history of malignancy, the patient underwent germline panel testing. The patient's somatic tumor testing demonstrated proficient DNA mismatch repair status, microsatellite stability, low tumor mutational burden (4 mut/Mb), low loss of heterozygosity (9%), amplification of the ERBB2 (HER2/neu) gene by both immunohistochemistry (3+, 20% positive) and fluorescence in-situ hybridization. Her tumor also had weakly positive estrogen receptor expression (1+, 10% positive); furthermore, some pathogenic variants in KRAS (c.37G>T), PIK3CA (c.263G>A), and TP53 (c.743G>A) were identified. Given the incongruent findings found with the positive peritoneal washing and negative lymph node involvement in addition to molecular testing, management for this patient was unclear. Ultimately, this case highlights a number of advances within the field of gynecological oncology but also emphasizes the persistent ambiguity and incongruency in the management of patients with early-stage high-risk histologies. Moving forward it will become increasingly important to be able to develop a more standardized process to assess how these diagnostic tools should inform prognosis and treatment plans.
PubMed: 35949786
DOI: 10.7759/cureus.26663 -
Taiwanese Journal of Obstetrics &... Jul 2019The feasibility of vaginoscopic hysteroscopy combined with office endometrial biopsy after ultrasonography for management of post-menopausal vaginal bleeding (PMB). (Observational Study)
Observational Study
OBJECTIVES
The feasibility of vaginoscopic hysteroscopy combined with office endometrial biopsy after ultrasonography for management of post-menopausal vaginal bleeding (PMB).
MATERIALS AND METHODS
A prospective observational study of with PMB whom attending the Outpatient Clinic of Kang Ning Hospital during a four months period (1st Feb to 31st May 2018) was included. Vaginoscopic hysteroscopy was performed with endometrial biopsy after the initial clinical pelvic examination and transvaginal ultrasound examination.
RESULTS
A total of 45 consecutive women with PMB was included. The hysteroscopy and endometrial biopsy were successful in 44 out of 45 (98%), a complete view in 82%, adequate tissue was in 91%, only one case was failed both procedures due to pain. The correlation between hysteroscopy and endometrial biopsy by was 100%. The mean operation time was 229 ± 68 s. The most common histological findings was atrophic endometrium 18 (42%). Five endometrial polyps and 2 submucosal leiomyomas were found. One rare case of endometrial carcinosarcoma (2%) was detected. Patients reported less pain for hysteroscopy than endometrial biopsy with rated VAS pain score was 3.5 ± 2.2, with 5 more score in 18%, and for endometrial biopsy 4.2 ± 2 and 33% respectively (p < 0.001). Six cases (13%) experienced vasovagal attacks immediately after the procedure. There is no other complication.
CONCLUSION
The Vaginoscopic hysteroscopy combined endometrial biopsy is safe and feasible for assessment of endometrial pathology with postmenopausal bleeding.
Topics: Aged; Biopsy, Needle; Cohort Studies; Endometrial Neoplasms; Endometrium; Endosonography; Female; Gynecological Examination; Humans; Hysteroscopy; Immunohistochemistry; Middle Aged; Minimally Invasive Surgical Procedures; Postmenopause; Prognosis; Prospective Studies; Severity of Illness Index; Taiwan; Treatment Outcome; Ultrasonography, Doppler; Uterine Hemorrhage
PubMed: 31307740
DOI: 10.1016/j.tjog.2019.05.012 -
The American Journal of Case Reports Mar 2021BACKGROUND Hairy polyps are rare tumors mainly comprising fatty tissues covered by skin and hair follicles, with varied localizations and sizes. Early excision of the...
BACKGROUND Hairy polyps are rare tumors mainly comprising fatty tissues covered by skin and hair follicles, with varied localizations and sizes. Early excision of the polyps by surgery is an effective treatment resulting in a permanent cure. We present a case of successful management of severe obstruction of the oropharynx in a newborn who presented with a large mass of congenital hairy polyp. CASE REPORT A vaginally delivered infant, weighing 3 kg, presented immediately after birth with cyanosis symptoms, failure of the first cry, and respiratory distress signs. The newborn was born to a mother with an uneventful pregnancy. Screening tests during the pregnancy reported no congenital anomalies. The newborn's hematological and biochemical test results were normal. After presenting these symptoms, the newborn was immediately intubated and put on a nasogastric feeding tube, which revealed a small portion of a polyp-like mass. A computed tomography (CT) scan further confirmed a large pedunculated mass, measuring 3×2 cm, arising from the soft palate, and obstructing the oropharynx. Histopathological examination confirmed the presence of a hairy polyp. The polyp was wholly removed transorally using the Covidien LigaSure device without the need for endoscopy. This procedure allowed safe extubation, and the baby was discharged home without symptoms 4 days after birth. CONCLUSIONS This case sheds light on the importance of considering hairy polyp in the differential diagnosis of pharyngeal mass with respiratory distress in pediatric patients. This report also describes our experience using the LigaSure surgical device without needing endoscopic visualization to successfully resect the hairy polyp without complications.
Topics: Airway Obstruction; Child; Endoscopy; Humans; Infant; Infant, Newborn; Palate, Soft; Polyps; Treatment Outcome
PubMed: 33762553
DOI: 10.12659/AJCR.930200 -
BMC Women's Health Oct 2023As an emerging surgical technology, tissue removal systems have been widely used in the treatment of endometrial polyps due to its characteristics of less endometrial...
As an emerging surgical technology, tissue removal systems have been widely used in the treatment of endometrial polyps due to its characteristics of less endometrial damage, shorter learning curve and clearer vision of the operative field. There are few cases in the literature reporting serious complications after endometrial polypectomy using tissue removal systems. As known, septic shock is a rare complication following hysteroscopic polypectomy. Now, we present the case of a 23-year-old woman who developed septic shock after polypectomy with tissue removal system. The patient had a history of recurrent vaginitis for more than half a year. Due to endometrial polyps, she was admitted to our hospital and scheduled to undergo hysteroscopic endometrial polypectomy. Three hours after the endometrial polypectomy using the tissue removal system, the patient had shock symptoms such as increased body temperature, decreased blood pressure and increased heart rate. Then, the patient was successfully treated and discharged after anti-infection and anti-shock treatments. The purpose of this case report is to remind clinicians to consider the possibility of serious infection and comprehensively evaluate the risk of infection before choosing hysteroscopic devices for endometrial polyps, especially for patients who choose the mechanical hysteroscopic tissue removal systems. Furthermore, the mechanical hysteroscopic tissue removal systems should be used with caution in patients with previous recurrent vaginitis.
Topics: Female; Humans; Young Adult; Endometrium; Polyps; Shock, Septic; Uterine Diseases; Uterine Neoplasms; Vaginitis
PubMed: 37872546
DOI: 10.1186/s12905-023-02690-9