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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 -
European Journal of Gynaecological... 2011The female genital tract is rarely involved by metastatic tumors. The most common anatomic locations are the ovaries and the vagina. A case is presented of metastatic... (Review)
Review
INTRODUCTION
The female genital tract is rarely involved by metastatic tumors. The most common anatomic locations are the ovaries and the vagina. A case is presented of metastatic breast carcinoma to the vulva and endometrial polyp, both exceptional.
CASE REPORT
We report the case of an 83-year-old female who presented with vaginal bleeding. Lobular breast carcinoma was diagnosed earlier and during follow-up vulvar metastasis was detected. Hysteroscopic examination because of postmenopausal bleeding revealed an endometrial polyp which was resected. The morphology and immunohistochemistry of the polyp were consistent with lobular breast cancer: metastatic breast cancer to an endometrial polyp. After reviewing the literature 15 cases of metastatic breast carcinoma to endometrial polyps have been reported. The clinical presentation and course, risk factors, treatment and follow-up are discussed.
CONCLUSION
Metastasis of a breast carcinoma to the vulva and an endometrial polyp are extremely rare, but clinicians should be aware of both phenomena.
Topics: Aged, 80 and over; Breast Neoplasms; Carcinoma, Lobular; Disease-Free Survival; Endometrial Neoplasms; Female; Humans; Hysteroscopy; Polyps; Treatment Outcome; Vulvar Neoplasms
PubMed: 21614926
DOI: No ID Found -
Minimally Invasive Therapy & Allied... Oct 2021Hysteroscopy is the gold-standard procedure for evaluating the vagina, cervix, cervical canal and uterine cavity, with a great possibility of identifying lesions and...
Hysteroscopy is the gold-standard procedure for evaluating the vagina, cervix, cervical canal and uterine cavity, with a great possibility of identifying lesions and being able to treat them at the same time in a 'See and Treat' procedure. The presence of the operative channel allows directed biopsy and excision of part of the lesions. Hysteroscopic treatment can be offered in office and hospital settings. The main difference is the use of anesthesia for hospital hysteroscopy. Office hysteroscopy has as major challenge the patient's pain threshold and the size of the lesion base. The use of the appropriate technique allows the removal of lesions even in an outpatient setting. Hospital hysteroscopy allows the use of instruments with a larger diameter and with the use of associated energy. The development of new technologies has increased the spectrum of office hysteroscopy.
Topics: Biopsy; Cervix Uteri; Female; Humans; Hysteroscopy; Pregnancy; Uterus; Vagina
PubMed: 34505799
DOI: 10.1080/13645706.2021.1944218 -
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 -
Journal of Pediatric and Adolescent... Dec 2002Giant cervical polyps are rare entities, with only 8 reported cases in the international literature (MEDLINE 1966-2002). Of these cases, only one has been described in... (Review)
Review
Giant cervical polyps are rare entities, with only 8 reported cases in the international literature (MEDLINE 1966-2002). Of these cases, only one has been described in the pediatric population. There has been no report of a giant cervical polyp occurring in the older, although early, adolescent period. The discovery of a giant cervical polyp in a young adolescent is a gynecological oddity. The immense size of giant cervical polyps, together with their menacing appearance and unusual presentation, can simulate a malignant neoplasm. Care must be taken in their diagnosis and management so that the patient's fertility is not compromised. We report on a young adolescent girl with a previous history of a rhabdomyosarcoma (RMS), who presented with a giant cervical polyp protruding from the vaginal introitus. The literature on this entity is reviewed.
Topics: Child; Diagnosis, Differential; Female; Humans; Maxillary Neoplasms; Polyps; Rhabdomyosarcoma, Embryonal; Uterine Cervical Neoplasms
PubMed: 12547657
DOI: 10.1016/s1083-3188(02)00192-4 -
Obstetrics and Gynecology Jan 1973
Topics: Biopsy; Female; Hemorrhage; Humans; Leukorrhea; Middle Aged; Periodicity; Polyps; Uterine Cervical Neoplasms; Vaginal Diseases
PubMed: 4682621
DOI: No ID Found -
Urology Oct 2019Discussion, diagnosis, and management of fibroepithelial polyps in a newborn female.
Discussion, diagnosis, and management of fibroepithelial polyps in a newborn female.
Topics: Female; Humans; Infant, Newborn; Neoplasms, Fibroepithelial; Polyps; Vaginal Neoplasms
PubMed: 31255540
DOI: 10.1016/j.urology.2019.06.026 -
Radiologic Clinics of North America Jul 2003Transvaginal ultrasound with SIS is a cost-minimizing screening tool for perimenopausal and postmenopausal women with vaginal bleeding. Its use decreases the need for... (Review)
Review
Transvaginal ultrasound with SIS is a cost-minimizing screening tool for perimenopausal and postmenopausal women with vaginal bleeding. Its use decreases the need for invasive diagnostic procedures for women without abnormalities, and ultrasound increases the sensitivity of detecting abnormalities in women with pathologic conditions. Vaginal sonography is preferred over uniform biopsy of postmenopausal women with vaginal bleeding because it (1) is a less invasive procedure, (2) is generally painless, (3) has no complications, and (4) may be more sensitive for detecting carcinoma than blind biopsy. Transvaginal sonography is rarely nondiagnostic. Endometrial sampling is less successful in women with a thin endometrial stripe on ultrasound than in women with real endometrial pathologic condition. A limitation of ultrasound is that an abnormal finding is not specific: ultrasound cannot always reliably distinguish between benign proliferation, hyperplasia, polyps, and cancer. Although ultrasound may not be able to distinguish between hyperplasia and malignancy, the next step in the clinical treatment requires tissue sampling. Because of the risk of progression of complex hyperplasia to carcinoma, patients with this finding may benefit from hormonal suppression, dilatation and curettage, endometrial ablation, or hysterectomy, depending on the clinical scenario. The inability to distinguish these two entities based on ultrasound alone should not be seen as a limitation because tissue sampling is required in either case. Occasionally (in 5% to 10% of cases), a woman's endometrium cannot be identified on ultrasound, and these women also need further evaluation. Ultrasonography also may be used as a first-line investigation in other populations with abnormal uterine bleeding. In a multicenter, randomized, controlled trial of 400 women with abnormal uterine bleeding, the investigators found that transvaginal sonography combined with Pipelle endometrial biopsy and outpatient hysteroscopy was as effective as inpatient hysteroscopy and curettage. The subject, included women older than 35 years with PMB, menorrhagia, intermenstrual bleeding, postcoital bleeding, or irregular menses. Transvaginal sonography may be a cost-effective. sensitive, and well-tolerated method to evaluate most women with abnormal bleeding in combination with physical examination and endometrial biopsy and hysteroscopy us indicated. Hysteroscopy is likely to become the new gold standard in the future because of its ability to visualize directly the endometrium and perform directed biopsies as indicated. As office-based hysteroscopy becomes more practical and widespread, the technique may become more cost effective. An evaluation plan using transvaginal sonography as the initial screening evaluation followed by endometrial biopsy or, more likely, hysteroscopy is likely to become the standard of care (Fig. 12). It remains unproven whether certain patients at higher risk for carcinoma should proceed directly to invasive evaluation. Women on tamoxifen with persistent recurrent bleeding, women with significant risk factors for carcinoma, and women with life-threatening hemorrhage comprise this group. Further studies are still necessary to evaluate high-risk patients and determine whether ultrasound or biopsy is really the most cost-effective initial test.
Topics: Atrophy; Biopsy; Carcinoma; Diagnosis, Differential; Endometrial Hyperplasia; Endometrium; Female; Humans; Leiomyoma; Polyps; Postmenopause; Radiography; Ultrasonography; Uterine Hemorrhage; Uterine Neoplasms
PubMed: 12899491
DOI: 10.1016/s0033-8389(03)00060-5 -
Fetal and Pediatric Pathology Jun 2014Cervical polyps (CP) are quite common in adults, they are extremely rare in children and adolescents. CP containing mesonephric duct remnants (MDR) are few millimeters...
BACKGROUND
Cervical polyps (CP) are quite common in adults, they are extremely rare in children and adolescents. CP containing mesonephric duct remnants (MDR) are few millimeters in size and seldom grossly visible.
CASE
A 14-year-old female admitted with massive vaginal bleeding with an intact wide hymeneal opening. Pelvic MRI revealed 47 mm × 25 mm × 35 mm polypoid mass originating from the endometrial cavity. During vaginoscopy, a polypoid mass was detected at 9 o'clock position of right lip of ectocervix and was totally excised. Light microscopy showed CP including small round or branched glands containing inspissated eosinophilic secretions and patchy chronic inflammatory infiltrate. The patient was diagnosed as gaint CP containing MDR.
CONCLUSION
Giant CP is an uncommon variant of classical polyps and exhibit distinct clinical and pathologic features. However, MDR are benign lesions of cervix, detailed histopathological evaluation should be performed to all CP to differentiate malignant lesions.
Topics: Adolescent; Female; Humans; Polyps; Uterine Cervical Diseases; Uterine Hemorrhage; Wolffian Ducts
PubMed: 24601846
DOI: 10.3109/15513815.2014.890259 -
International Journal of Surgery... Jul 2017Polyps of the lower reproductive tract are found in 7.8-50% of women. It has been hypothesized that cytogenetic modifications on chromosomes 6, 7 and 12 as well as... (Review)
Review
Polyps of the lower reproductive tract are found in 7.8-50% of women. It has been hypothesized that cytogenetic modifications on chromosomes 6, 7 and 12 as well as epigenetic factors involving enzyme and metabolic activities may cause polyps to develop. Cervical polyps found in 2-5% of cases are of low clinical significance and can cause, although rarely, post coital bleedings. Cervical polyps grow during pregnancy and mucorrhoea. Trans vaginal ultrasound (TVU) provides an excellent diagnostic technique to diagnose the size and the anatomic location of endometrial polyps (EPs). In asymptomatic young woman with small EPs <10 mm in size, conservative management can be safely followed by monitoring the polyp growth. EPs located at the fundal and tubocornual regions mechanically affect fertility and disturb normal cellular function due to chronic inflammation. In cases where Eps are a cause of subfertility mechanical hysteroscopic resection is advisable. When the sole reason for infertility is an EP, the patient often becomes spontaneously pregnant shortly after removal. EP Detection in either peri- or post-menopausal age, in symptomatic or asymptomatic patients calls for meticulous hysteroscopic examination and polypectomy is mandatory. Endometrial curettage is also recommended to rule out sub clinical endometrial hyperplasia or cancer. Hysteroscopic surgery for large EPs using bipolar resectoscopes, hysteroscopic morcellators or shavers are considered equally efficient and safe under general anaesthesia. Recurrence rate of EPs after resection is unknown. The recent advances in TVU and hysteroscopy, however, should provide an accurate diagnosis and effective treatment of polyp in the female reproductive tract with minimal recurrence or surgery complications. The significantly increased incidence of colorectal polyps in cohorts that also had EPs might indicate that patients with EPs should be also referred for colonoscopy. EPs have the lowest incidence of malignant transformation as compared to colon, urinary bladder, oropharyngeal, nasal and laryngeal carcinomas.
Topics: Adult; Disease Management; Female; Genital Diseases, Female; Humans; Hysteroscopy; Middle Aged; Obstetric Surgical Procedures; Polyps; Pregnancy; Treatment Outcome
PubMed: 28483662
DOI: 10.1016/j.ijsu.2017.05.012