-
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 -
The Medical Journal of Malaysia May 2022Abnormal uterine bleeding (AUB) is one of the commonest complaints of women in reproductive age and non-gravid state that brings them to the attention of the primary...
Abnormal uterine bleeding (AUB) is one of the commonest complaints of women in reproductive age and non-gravid state that brings them to the attention of the primary care doctor or the gynaecologist. Anovulation without any medical illness or pelvic pathology seems to be the common cause. Bleeding due to a wide variation in pathology both inside and outside the reproductive tract can be termed as anovulatory bleeding. Therefore, it is mandatory to elicit a focused menstrual history and appropriate evaluation followed by a pelvic examination. This includes a vaginal speculum examination to differentiate anovulatory bleeding from other causes of bleeding. In contrast, Heavy menstrual bleeding (HMB) is referred to as an ovulatory bleeding exceeding 8 days duration and is often caused by uterine fibroids or adenomyosis, a copper IUD or coagulation disorders. PALM-COEIN classification is a system designed by the Federation Internationale de Gynaecologie et d'Obstetrique to define the precise underlying causes of AUB. Aetiology of AUB can be classified as the following acronym "PALM-COEIN": Polyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia, Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic and Not yet classified. AUB describes a range of symptoms, such as HMB, intermenstrual bleeding (IMB) and a combination of both heavy and prolonged menstrual bleeding (MB). Dysfunctional uterine bleeding (DUB) and menorrhagia are now better described as AUB. Newborn girls sometimes spot for a few days after birth, due to placental oestrogenic stimulation of the endometrium in utero.
Topics: Adenomyosis; Female; Humans; Infant, Newborn; Leiomyoma; Menorrhagia; Placenta; Pregnancy; Uterine Hemorrhage
PubMed: 35638495
DOI: No ID Found -
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 -
Open Medicine (Warsaw, Poland) 2022Uterine inversion is a rare disease that is particularly uncommon among non-puerperal women. Herein we reported the only case of uterine inversion known to us that was...
Uterine inversion is a rare disease that is particularly uncommon among non-puerperal women. Herein we reported the only case of uterine inversion known to us that was caused by the endometrial thickening and changes in the polypoid lesion in early puberty. The patient was admitted to our hospital because of massive vaginal bleeding, abdominal pain, and a protruding mass from the vagina. We obtained the patient history by collecting the results of various examinations (including magnetic resonance imaging and color Doppler ultrasound), accurate diagnosis was performed, and a reasonable treatment protocol was developed. She was subjected to laparoscopic uterine-sparing surgery to preserve her fertility. Uterine inversion is a rare disease, and early diagnosis and selection of appropriate treatment options are essential for patients with fertility requirements.
PubMed: 35415248
DOI: 10.1515/med-2022-0425 -
Frontiers in Microbiology 2022The vaginal microbiome protects the female genital tract from various diseases, such as vaginitis, a vaginal inflammation characterized by abnormal discharge, itching,...
OBJECTIVE
The vaginal microbiome protects the female genital tract from various diseases, such as vaginitis, a vaginal inflammation characterized by abnormal discharge, itching, and pain. To evaluate the clinical relationship between the vaginal microbiome and the pathophysiology of recurrent vaginitis (RV), we investigated the microbiome taxonomic profile (MTP) in the vaginal samples of Korean female patients with RV.
METHODS
Forty women of reproductive age diagnosed with RV were enrolled. The vaginal MTP of patients was analyzed using 16S ribosomal RNA gene sequencing, and the results were compared with that of healthy women ( = 100). Further, the association of the vaginal community state type (CST) with the clinical characteristics was analyzed.
RESULTS
The species abundance of MTP was significantly lower in patients with RV than in healthy women ( < 0.05), whereas species evenness and diversity were significantly higher in patients with RV than in healthy individuals ( < 0.05). The proportion of the most common vaginal spp. was significantly lower in the MTP of patients with RV than healthy women ( < 0.01). The beta diversity distance was also significantly different between patients with RV patients and healthy individuals ( = 0.001). Based on the CST, the MTP of 40 RV samples was categorized as follows: 21 (52.5%) for CST IV, 8 (20.0%) for CST III, 5 (12.5%) for CST I, 2 (5.0%) for CST II, 1 for (2.5%) for CST V, and 3 (7.5%) for mixed CST. Patients with underlying uterine diseases (uterine leiomyoma, adenomyosis, and endometrial polyps; = 17) showed higher species richness and diversity than those without ( = 23; < 0.05).
CONCLUSION
Changes in the species abundance and microbial diversity in the vagina were strongly associated with RV. A low proportion of spp. was found in patients with RV than in healthy women. The abundance and diversity of bacterial taxa were significantly higher in patients with underlying gynecologic disease than those without. Our study offers an insight into the nature of the vaginal microbiome and proposes that surveying the vaginal microbiome is valuable for detecting and treating gynecologic diseases in the future.
PubMed: 35250962
DOI: 10.3389/fmicb.2022.851670 -
Gynecologic and Obstetric Investigation 2022The aim of this study was to develop a model that can discriminate between different etiologies of abnormal uterine bleeding.
OBJECTIVES
The aim of this study was to develop a model that can discriminate between different etiologies of abnormal uterine bleeding.
DESIGN
The International Endometrial Tumor Analysis 1 study is a multicenter observational diagnostic study in 18 bleeding clinics in 9 countries. Consecutive women with abnormal vaginal bleeding presenting for ultrasound examination (n = 2,417) were recruited. The histology was obtained from endometrial sampling, D&C, hysteroscopic resection, hysterectomy, or ultrasound follow-up for >1 year.
METHODS
A model was developed using multinomial regression based on age, body mass index, and ultrasound predictors to distinguish between: (1) endometrial atrophy, (2) endometrial polyp or intracavitary myoma, (3) endometrial malignancy or atypical hyperplasia, (4) proliferative/secretory changes, endometritis, or hyperplasia without atypia and validated using leave-center-out cross-validation and bootstrapping. The main outcomes are the model's ability to discriminate between the four outcomes and the calibration of risk estimates.
RESULTS
The median age in 2,417 women was 50 (interquartile range 43-57). 414 (17%) women had endometrial atrophy; 996 (41%) had a polyp or myoma; 155 (6%) had an endometrial malignancy or atypical hyperplasia; and 852 (35%) had proliferative/secretory changes, endometritis, or hyperplasia without atypia. The model distinguished well between malignant and benign histology (c-statistic 0.88 95% CI: 0.85-0.91) and between all benign histologies. The probabilities for each of the four outcomes were over- or underestimated depending on the centers.
LIMITATIONS
Not all patients had a diagnosis based on histology. The model over- or underestimated the risk for certain outcomes in some centers, indicating local recalibration is advisable.
CONCLUSIONS
The proposed model reliably distinguishes between four histological outcomes. This is the first model to discriminate between several outcomes and is the only model applicable when menopausal status is uncertain. The model could be useful for patient management and counseling, and aid in the interpretation of ultrasound findings. Future research is needed to externally validate and locally recalibrate the model.
Topics: Atrophy; Endometrial Hyperplasia; Endometrial Neoplasms; Endometritis; Endometrium; Female; Humans; Hyperplasia; Myoma; Polyps; Precancerous Conditions; Uterine Diseases; Uterine Hemorrhage; Uterine Neoplasms
PubMed: 35152217
DOI: 10.1159/000522524 -
BJU International Jul 2022To analyse our experience in pelvic fracture urethral injury (PFUI) in children and adolescents, with various anastomotic urethroplasties (AUs) used to accomplish...
OBJECTIVE
To analyse our experience in pelvic fracture urethral injury (PFUI) in children and adolescents, with various anastomotic urethroplasties (AUs) used to accomplish tension-free anastomosis described and their surgical outcomes evaluated.
PATIENTS AND METHODS
From 2008 to 2019, 192 cases including both primary and redo PFUI, which comprised 181 boys and 11 girls aged ≤18 years. The results are presented separately according to gender. Moreover, the two populations were divided in two age-related sub-groups for sensitivity analyses: Group 1 (children) aged ≤11 years and Group 2 (adolescent) aged 12-≤18 years.
RESULTS
The median (interquartile range [IQR]) age at presentation in our series was 14 (9-17) years for boys and 9 (6-10) years for girls. Primary vs redo cases were 85 (47%) vs 96 (53%) in boys and 10/11 vs one of 11 in girls. In the primary male cases (85), the bulbo-membranous junction was the commonest site of injury (63, 74.1%). In boys, transperineal AU (TPAU) was performed in 160 (88.4%) and transpubic urethroplasty (TPU) in 17 (9.4%). In girls, TPU was utilised in nine cases, where two received meatoplasty and vaginal episiotomy. In boys, the overall success rate for TPAU was 81.2% and in primary PFUI cases success for TPAU was 88.3%. Overall success for TPU was 64.7%. In girls, the success rate for TPU was 100%. In boys and girls, the success rates for various AUs utilised between the child and adolescent groups were comparable. The median (IQR) hospital stay was 3 (3-4) days for boys and girls. The median (IQR) follow-up duration was 25 (16-33) months and 20 (17-27) months for boys and girls, respectively. Secondary procedures were performed in 39 boys and one girl, which comprised laser optical internal urethrotomy in 26 (14.4%) boys and redo surgery in 13 (7.2%) boys and one (9.1%) girl. Of all patients, four of the 11 girls and 74 boys (38.5%) were lost to follow-up.
CONCLUSIONS
Most paediatric PFUI can be addressed via a transperineal approach with reasonable long-term outcomes. In challenging cases salvage procedures utilising vascular-based flaps as a urethral substitute give satisfactory results. Even young children can be managed with a high success rate in expert hands and these injuries should be addressed by specialist reconstructive urologists.
Topics: Adolescent; Anastomosis, Surgical; Child; Child, Preschool; Female; Fractures, Bone; Humans; Male; Pelvic Bones; Plastic Surgery Procedures; Retrospective Studies; Treatment Outcome; Urethra; Urethral Stricture
PubMed: 35044050
DOI: 10.1111/bju.15686 -
The American Journal of Case Reports Jan 2022BACKGROUND Reproductive health is closely related to long-term quality of life and maternal well-being in obstetrics. The overall incidence of fibro-epithelial polyps in... (Review)
Review
BACKGROUND Reproductive health is closely related to long-term quality of life and maternal well-being in obstetrics. The overall incidence of fibro-epithelial polyps in the general population is about 46%, but a location on the vulva is quite rare, and is very rare when the size is more than 5 cm. CASE REPORT A 23-year-old woman reported irregular bleeding and a mass on the vulva. After anamnesis, physical examination, biopsy, and radiology imaging, the patient was diagnosed with uterine myoma, primary infertility, and a large solid and benign mass on the vulva. The mass found on the vulva was apparently unrelated to intra-abdominal organs and urogynecology. After performing an excision accompanied by a laparoscopic myomectomy, the histopathological results showed that the mass on the vulva was a 16×11×6 cm fibroepithelial polyp weighing 700 g. After 7 months of therapy, the submucosal uterine myoma recurred. Submucosal uterine myomas were found rooted into the vaginal canal, so the surgeon performed an extirpation operation. Eight months later, the patient succeeded in having a pregnancy that ended in delivery by cesarean section. CONCLUSIONS Giant fibroepithelial polyps are very rare. Management is by excision accompanied by a laparoscopic myomectomy. They affect reproductive health and require appropriate management and diagnosis.
Topics: Adult; Cesarean Section; Female; Humans; Infertility; Myoma; Neoplasm Recurrence, Local; Pregnancy; Quality of Life; Uterine Myomectomy; Uterine Neoplasms; Vulva; Young Adult
PubMed: 35034088
DOI: 10.12659/AJCR.933198 -
Cureus Oct 2021No definitive management guidelines exist for cervical polyps during pregnancy. Ultrasound can aid in creating a treatment plan by assessing the type of polyp and source...
No definitive management guidelines exist for cervical polyps during pregnancy. Ultrasound can aid in creating a treatment plan by assessing the type of polyp and source of symptomatology. Three pregnant patients in the first, second, and third trimesters of pregnancy presented with polyps. On examination, the polyps ranged from 2 to 6 cm in size. In all cases, the origin of the cervical polyps was first identified on ultrasound. Polypectomies were performed with no complications. All patients subsequently had uncomplicated normal spontaneous vaginal deliveries at term. Ultrasounds can help localize the source of symptomatology to polyps versus placental pathology. Additionally, ultrasound can determine the origin and type of polyp for creating an individualized, safe treatment plan during pregnancy.
PubMed: 34790459
DOI: 10.7759/cureus.18702 -
Journal of Mid-life Health 2021Endocervical polyps are a common occurrence in the postmenopausal age group and many reports have described the presence of heterologous elements in the stroma of such...
Endocervical polyps are a common occurrence in the postmenopausal age group and many reports have described the presence of heterologous elements in the stroma of such polyps. The presence of mature adipose tissue in the stroma has been hypothesized to be arising from the perivascular fat or metaplastic transformation of the smooth muscle cells posttrauma. A 75-year-old female presented with spotting per vagina. Colposcopic examination revealed an endocervical polyp which was excised. Microscopic examination showed an ulcerated epithelium with metaplastic changes along with sheets of mature adipose tissue with focal S100 positivity conferring a diagnosis of choristomatous endocervical polyp with heterologous adipose tissue. The primary clinical concern of a malignant cause in this age group is alleviated by the diagnosis of this rare benign entity. Only three such cases have been reported in the English literature so far, and the present case accounts for the fourth such case.
PubMed: 34759708
DOI: 10.4103/jmh.JMH_96_20