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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 -
CMAJ : Canadian Medical Association... May 2023
Topics: Female; Humans; Endometriosis; Vaginal Diseases; Polyps
PubMed: 37127308
DOI: 10.1503/cmaj.220466 -
Systems Biology in Reproductive Medicine Aug 2023For decades, the endometrium was considered to be a sterile environment. However, now this concept is disputed, and there is growing evidence that microbiota composition...
For decades, the endometrium was considered to be a sterile environment. However, now this concept is disputed, and there is growing evidence that microbiota composition might affect endometrial receptivity. Routine clinical management of infertility is still limited to a microbiological assessment of the lower reproductive tract. The purpose of this study was to compare the abundance of various bacterial, fungal, and viral species, qualitatively and quantitatively, in vaginal, cervical, and endometrial biomaterial of infertile patients. A total of 300 samples from 100 infertile patients of a private assisted reproduction clinic were analyzed. A broad real-time polymerase chain reaction panel was used to identify 28 relevant microbial taxa as well as three members of the Herpesviridae family. All patients underwent endometrial biopsy for further histopathological evaluation. Analysis of the microbial diversity (within the boundaries of the detection panel) revealed that Shannon indexes in the cervix and vagina were similar (1.4 × 10 (1.6 × 10 - 6.5 × 10) vs 1.9 × 10 (2.3 × 10 - 5.3 × 10), respectively, = 0.502), whereas endometrial indexes differed significantly from both regions (0 (0 - 1.4 × 10), < 0.0001). Surprisingly, 17 microbial and viral taxa were detected in at least one sample. Endometrium exhibited a quite distinct microbiological profile, being different at the detection rates of 14 taxa ( < 0.05). Remarkably, 4% and 2% of endometrial samples were positive for Cytomegalovirus and , respectively, while these were undetectable in corresponding cervical and vaginal samples. Prevalence of the + + group in endometrium was associated with a low abundance of . ( = 0.039). No noteworthy associations were identified between various microbiota characteristics and clinical parameters, such as chronic endometritis, uterine polyps and adhesions, endometriosis, and a history of sexually transmitted infections. These findings indicate that the microbiological profile of the endometrium is unique, and the analysis of the lower reproductive tract should supplement, rather than be a substitute for it.
Topics: Female; Humans; Cervix Uteri; Endometrium; Infertility; Vagina; Gardnerella vaginalis
PubMed: 37105537
DOI: 10.1080/19396368.2023.2195040 -
The Journal of International Medical... Apr 2023Endometrial vascular dystrophy is quite rare, and there is very little literature regarding this subject. We present the unusual case of a 38-year-old woman who...
Endometrial vascular dystrophy is quite rare, and there is very little literature regarding this subject. We present the unusual case of a 38-year-old woman who experienced vaginal bleeding after menstruation for 3 months. Hysteroscopically, the uterine cavity was filled with tiny, curved blood vessels, the bottom of the cavity was obvious, and polyps were visible. No curved vessels or polyps were identified after curettage. The diagnosis was endometrial hemodystrophy with endometrial polyps. Endometrial vascular dystrophy is a hysteroscopically uncommon benign lesion of the endometrial vessels.
Topics: Pregnancy; Female; Humans; Adult; Hysteroscopy; Endometrium; Uterine Hemorrhage; Uterus; Uterine Neoplasms; Polyps
PubMed: 37050885
DOI: 10.1177/03000605231166261 -
Journal of Obstetrics and Gynaecology... Feb 2023A 59-year-old post-menopausal female presented with complaints of per vaginal spotting for 3 months. Histopathological examination of contents of dilation and curettage...
A 59-year-old post-menopausal female presented with complaints of per vaginal spotting for 3 months. Histopathological examination of contents of dilation and curettage revealed endometrial carcinoma (FIGO stage I), along with benign endocervical polyps. MRI also showed presence of left-sided structure indicative of ectopic pelvic kidney. The patient underwent laparoscopic radical hysterectomy, bilateral salpingo-oophorectomy and bilateral ilio-obturator lymph node dissection. Dissection was started along the left pelvic plane. The left pelvic kidney was seen, and left ureter was located and confirmed below the uterus. The patient withstood the procedure well. Anomalies of pelvic anatomy, such as a malpresentation of the kidney and ureter, may prove as surgical challenges while performing open and laparoscopic surgery. However, in depth preoperative imaging, meticulous intraoperative dissection and proper identification of surrounding structures reduces the risk of such complications.
PubMed: 36879935
DOI: 10.1007/s13224-022-01721-z -
Archives of Gynecology and Obstetrics Aug 2023Persistent high-risk human papillomavirus (hrHPV) infection is associated with most cervical cancers. This study aims to investigate the prevalence of and independent...
OBJECTIVE
Persistent high-risk human papillomavirus (hrHPV) infection is associated with most cervical cancers. This study aims to investigate the prevalence of and independent risk factors for hrHPV infection among women residing in rural areas of Shanxi Province, China.
METHODS
Data from the records of the cervical cancer screening programs for rural women in Shanxi Province were retrospectively collected. Women receiving primary HPV screening between January 2014 and December 2019 were included. The detection rate of hrHPV was calculated, and the independent risk factors for hrHPV infection were analyzed by multivariate logistic regression.
RESULTS
Among the women included, the overall infection rate of hrHPV was 14.01% (15,605/111,353), with the top five subtypes being HPV16 (24.79%), HPV52 (14.04%), HPV58 (10.26%), HPV18 (7.25%), and HPV53 (5.00%). The independent risk factors for hrHPV infection were specific geographical regions, testing years, older age, lower education level, inadequate previous screening, bacterial vaginosis, trichomonas vaginitis, and cervical polyps.
CONCLUSION
Rural women over 40 years of age, especially those who had never received screening, have a significantly increased risk for hrHPV infection and should be the target population with priority in cervical cancer screening.
Topics: Case-Control Studies; China; Early Detection of Cancer; Genotype; Human Papillomavirus Viruses; Papillomavirus Infections; Prevalence; Retrospective Studies; Risk Factors; Rural Population; Uterine Cervical Neoplasms; Humans; Female; Adult; Middle Aged
PubMed: 36814027
DOI: 10.1007/s00404-023-06959-0 -
Autopsy & Case Reports 2023Embryonal rhabdomyosarcoma (RMS) of the female genital tract is an uncommon malignancy, presenting mainly in the pediatric and adolescent populations, primarily... (Review)
Review
Embryonal rhabdomyosarcoma (RMS) of the female genital tract is an uncommon malignancy, presenting mainly in the pediatric and adolescent populations, primarily affecting the first two decades of life. This malignancy presentation in adulthood is rare and is seldom seen. The incidence of this tumor affecting adult females is approximately 0.4 - 1%, with the common site being the vagina. This tumor infrequently involves the cervix. RMS has a poor survival rate and once diagnosed, it requires aggressive management by radical surgery accompanied by chemoradiation. We present a case of an anaplastic variant of embryonal RMS of the uterine cervix presenting as a cervical polyp in a 36-year-old female who complained of dyspareunia and post-coital bleeding.
PubMed: 36777814
DOI: 10.4322/acr.2023.419 -
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 -
Acta Informatica Medica : AIM : Journal... 2023Tamoxifen has been successfully administered as adjunctive therapy for breast cancer. However, the effect of tamoxifen as an estrogen agonist and antagonist can cause...
BACKGROUND
Tamoxifen has been successfully administered as adjunctive therapy for breast cancer. However, the effect of tamoxifen as an estrogen agonist and antagonist can cause pathological changes in the uterus. The agonist effect may stimulate endometrial proliferation leading to endometrial polyps, hyperplasia, and, rarely, endometrial cancer.
OBJECTIVE
We present the case of tamoxifen-treated breast cancer case to better understand one of the most serious consequences, endometrial cancer.
CASE PRESENTATION
A 37-year-old woman came to our centre with complaints of abnormal vaginal bleeding. She has diagnosed with grade I infiltrative ductal carcinoma in 2018, with primary complaints of right breast mass and axillary lymphadenopathy. During this period, adjuvant chemotherapy was given tamoxifen 20 mg once daily. There were no complaints or relapses at a six-month follow-up over three years. In the fourth year, the patient complained of vaginal bleeding. A vaginal biopsy was performed, and the results showed low-grade endometrioid-type endometrial carcinoma. Total hysterectomy and bilateral salpingo-oophorectomy were performed with the resultant mass of up to half of the myometrial lining with metastatic negative parallax lymph nodes.
CONCLUSION
Following tamoxifen therapy, endometrial cancer is more likely to occur in patients. Patients who experience irregular vaginal hemorrhage should have hysteroscopy or uterine ultrasound performed, and if the cause is unknown, a biopsy should be performed.
PubMed: 38585594
DOI: 10.5455/aim.2024.32.85-87 -
BMJ Case Reports Dec 2022Although uncommon, vaginal fibroepithelial polyps can present as prolapsing vaginal tissue, causing discomfort and anxiety. Surgical excision of the polyps can provide a...
Although uncommon, vaginal fibroepithelial polyps can present as prolapsing vaginal tissue, causing discomfort and anxiety. Surgical excision of the polyps can provide a minimally invasive solution. In this case, we describe a nulliparous female in late adolescence who presented for evaluation of tissue protruding through the vagina. On exam, a 5×4 cm fibroepithelial polyp was extending from the distal posterior vagina on a broad stalk. Successful transperineal surgical excision was performed. Fibroepithelial polyps, although uncommon, can be a cause for prolapsing vaginal tissue and should be part of the differential diagnosis, especially in patients who have no risk factors for pelvic organ prolapse. They can be excised vaginally, alleviating symptoms and distress. Because they sometimes recur, continued surveillance with gynaecological exams is recommended.
Topics: Humans; Female; Neoplasm Recurrence, Local; Pelvic Organ Prolapse; Neoplasms, Squamous Cell; Vaginal Neoplasms; Polyps
PubMed: 36549754
DOI: 10.1136/bcr-2022-250967