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Clinical Case Reports Jan 2024Cavernous hemangiomas are rare and have various non-specific clinical presentations, such as menorrhagia. It can mimic different diseases such as endometrial polyps....
KEY CLINICAL MESSAGE
Cavernous hemangiomas are rare and have various non-specific clinical presentations, such as menorrhagia. It can mimic different diseases such as endometrial polyps. Pathologists and gynecologists should be aware of performing histopathological examinations of this neoplasm for accurate diagnosis and to avoid unwarranted therapeutic interventions.
ABSTRACT
Internal genital tract hemangiomas are rare and can be divided into capillary and cavernous. We present a rare case of cavernous hemangioma (CH) of the corpus in a young, non-pregnant woman. The patient was a 28-year-old woman who had complained of menorrhagia for 2.5 years. Sonography showed a hypoechoic intramural area measuring 35 × 23 mm. Histomorphology revealed neoplastic proliferation of dilated thin-walled arteries of various sizes within the myometrium. Due to the variable clinical presentations of CH, histopathological examination should be performed for an accurate diagnosis. It is a rare entity and we recommend training pathologists and gynecologists on this neoplasm for accurate diagnosis and to avoid unwarranted therapeutic interventions.
PubMed: 38188844
DOI: 10.1002/ccr3.8413 -
Clinical Cancer Research : An Official... Mar 2024Bintrafusp alfa, a first-in-class bifunctional fusion protein composed of the extracellular domain of TGFβ receptor II (a TGFβ "trap") fused to a human IgG1 mAb...
PURPOSE
Bintrafusp alfa, a first-in-class bifunctional fusion protein composed of the extracellular domain of TGFβ receptor II (a TGFβ "trap") fused to a human IgG1 mAb blocking programmed death-ligand 1 (PD-L1), was evaluated as treatment in patients with locally advanced or persistent, recurrent, or metastatic (P/R/M) cervical cancer.
PATIENTS AND METHODS
In this multicenter, open-label, phase Ib trial (NCT04551950), patients with P/R/M cervical cancer received bintrafusp alfa 2,400 mg once every 3 weeks plus cisplatin or carboplatin plus paclitaxel with (Cohort 1A; n = 8) or without (Cohort 1B; n = 9) bevacizumab; patients with locally advanced cervical cancer received bintrafusp alfa 2,400 mg every 3 weeks plus cisplatin plus radiation, followed by bintrafusp alfa monotherapy maintenance (Cohort 2; n = 8). The primary endpoint was safety; secondary endpoints included efficacy (including objective response rate) and pharmacokinetics.
RESULTS
At the data cutoff of April 27, 2022, patients in Cohorts 1A, 1B, and 2 had received bintrafusp alfa for a median duration of 37.9, 31.1, and 16.7 weeks, respectively. Two dose-limiting toxicities (grade 4 amylase elevation and grade 3 menorrhagia) unrelated to bintrafusp alfa were observed in Cohort 1B and none in other cohorts. Most treatment-emergent adverse events of special interest were grades 1-2 in severity, most commonly anemia (62.5%-77.8%) and bleeding events (62.5%-77.8%). Objective response rate was 75.0% [95% confidence interval (CI), 34.9-96.8], 44.4% (95% CI, 13.7-78.8), and 62.5% (95% CI, 24.5-91.5) in Cohorts 1A, 1B, and 2, respectively.
CONCLUSIONS
Bintrafusp alfa had manageable safety and demonstrated clinical activity, further supporting the investigation of TGFβ/PD-L1 inhibition in human papillomavirus-associated cancers, including cervical cancer.
Topics: Female; Humans; Uterine Cervical Neoplasms; B7-H1 Antigen; Cisplatin; Neoplasm Recurrence, Local; Immunologic Factors; Paclitaxel; Transforming Growth Factor beta
PubMed: 38165683
DOI: 10.1158/1078-0432.CCR-23-1829 -
Journal of Clinical Medicine Dec 2023This study aimed to introduce the clinical outcomes of conservative surgery for diffuse uterine leiomyomatosis, which also included the specialized surgical technique....
This study aimed to introduce the clinical outcomes of conservative surgery for diffuse uterine leiomyomatosis, which also included the specialized surgical technique. All patients with diffuse uterine leiomyomatosis underwent conservative surgery such as transient occlusion of the uterine arteries (TOUA) adenomyomectomy. All 17 surgeries were performed by a single surgeon between 2018 and 2021. The mean age of the 17 patients was 36.12 years old (range 29-48, SD = 5.4). Fourteen of the 17 patients received a previous myomectomy via a laparotomic (6, 35.3%), laparoscopic (6, 35.3%), or hysteroscopic (2, 11.8%) approach. The major symptom was menorrhagia (94.1%); the mean operation time was 97.06 min (70-160, SD = 22.71), and the mean estimated blood loss was 283.53 mL (20-1000, SD = 273.72). The mean hemoglobin level one day after the operation was 9.64 g/dL (7.2-13.1, SD = 1.85). The mean hospital stay was 6.47 days (6-8, SD = 0.62). The mean follow-up duration was 116.41 weeks (32-216, SD = 50.88). The recurrence rate was 5/17 (29.4%), and the recurrence-free interval was 50.6 weeks (27-87, SD = 23.71). In patients with diffuse uterine leiomyomatosis, who want fertility preservation and relief of disease-related symptoms, conservative surgery such as TOUA adenomyomectomy could be a good option to preserve the uterus. However, further studies are required to assess fertility outcomes with a long-term follow-up.
PubMed: 38137706
DOI: 10.3390/jcm12247638 -
BMC Women's Health Dec 2023Hysterectomy is a common surgery among reproductive-aged U.S. patients, with rates highest among Black patients in the South. There is limited insight on causes of these...
BACKGROUND
Hysterectomy is a common surgery among reproductive-aged U.S. patients, with rates highest among Black patients in the South. There is limited insight on causes of these racial differences. In the U.S., electronic medical records (EMR) data can offer richer detail on factors driving surgical decision-making among reproductive-aged populations than insurance claims-based data. Our objective in this cohort profile paper is to describe the Carolina Hysterectomy Cohort (CHC), a large EMR-based case-series of premenopausal hysterectomy patients in the U.S. South, supplemented with census and surgeon licensing data. To demonstrate one strength of the data, we evaluate whether patient and surgeon characteristics differ by insurance payor type.
METHODS
We used structured and abstracted EMR data to identify and characterize patients aged 18-44 years who received hysterectomies for non-cancerous conditions between 10/02/2014-12/31/2017 in a large health care system comprised of 10 hospitals in North Carolina. We used Chi-squared and Kruskal Wallis tests to compare whether patients' socio-demographic and relevant clinical characteristics, and surgeon characteristics differed by patient insurance payor (public, private, uninsured).
RESULTS
Of 1857 patients (including 55% non-Hispanic White, 30% non-Hispanic Black, 9% Hispanic), 75% were privately-insured, 17% were publicly-insured, and 7% were uninsured. Menorrhagia was more prevalent among the publicly-insured (74% vs 68% overall). Fibroids were more prevalent among the privately-insured (62%) and the uninsured (68%). Most privately insured patients were treated at non-academic hospitals (65%) whereas most publicly insured and uninsured patients were treated at academic centers (66 and 86%, respectively). Publicly insured and uninsured patients had higher median bleeding (public: 7.0, uninsured: 9.0, private: 5.0) and pain (public: 6.0, uninsured: 6.0, private: 3.0) symptom scores than the privately insured. There were no statistical differences in surgeon characteristics by payor groups.
CONCLUSION
This novel study design, a large EMR-based case series of hysterectomies linked to physician licensing data and manually abstracted data from unstructured clinical notes, enabled identification and characterization of a diverse reproductive-aged patient population more comprehensively than claims data would allow. In subsequent phases of this research, the CHC will leverage these rich clinical data to investigate multilevel drivers of hysterectomy in an ethnoracially, economically, and clinically diverse series of hysterectomy patients.
Topics: Female; Humans; United States; Adult; Insurance Coverage; Medically Uninsured; Hospitals; Surgeons; Hysterectomy; Insurance, Health
PubMed: 38114962
DOI: 10.1186/s12905-023-02837-8 -
Ultrasonography (Seoul, Korea) Jan 2024This study evaluated the value of contrast-enhanced ultrasonography (CEUS) in the ultrasound-guided microwave ablation (MWA) treatment of symptomatic focal uterine...
PURPOSE
This study evaluated the value of contrast-enhanced ultrasonography (CEUS) in the ultrasound-guided microwave ablation (MWA) treatment of symptomatic focal uterine adenomyosis.
METHODS
This retrospective study was conducted between March 2020 and January 2023, enrolling 52 patients with symptomatic focal uterine adenomyosis who had undergone MWA. All patients were examined with CEUS before and after MWA. The non-perfused volume (NPV) was compared between CEUS and dynamic contrast-enhanced magnetic resonance imaging (DCEMRI) following ablation. Therapeutic efficacy and safety were evaluated at 3-, 6-, and 12-month follow-ups. Additionally, this study explored the correlations between pre-treatment CEUS features and a volume reduction ratio indicating sufficient ablation, defined as 50% or more at the 3-month follow-up.
RESULTS
No significant differences in NPV were noted between CEUS and DCE-MRI immediately after MWA and during follow-up (all P>0.05). At the 3-month follow-up, the median VRRs for the uterus and adenomyosis were 33.2% and 63.9%, respectively. Sufficient ablation was achieved in 69.2% (36/52) of adenomyosis cases, while partial ablation was observed in the remaining 30.8% (16/52). The identification of non-enhancing areas on pre-treatment CEUS was associated with sufficient ablation (P=0.016). At the 12-month follow-up, significant decreases were observed in both the uterine and adenomyosis volumes (all P<0.001). Dysmenorrhea and menorrhagia were significantly alleviated at 12 months, and no major complications were encountered.
CONCLUSION
CEUS can be used to evaluate the ablation zone of focal adenomyosis that has been treated with MWA, similarly to DCE-MRI. The identification of non-enhancing areas on pretreatment CEUS indicates satisfactory treatment outcomes.
PubMed: 38109892
DOI: 10.14366/usg.23145 -
Journal of Pediatric and Adolescent... Apr 2024The aim of this review was to create an overview of available instruments used to evaluate the menstrual complaints of dysmenorrhea and heavy menstrual bleeding (HMB) in... (Review)
Review
STUDY OBJECTIVE
The aim of this review was to create an overview of available instruments used to evaluate the menstrual complaints of dysmenorrhea and heavy menstrual bleeding (HMB) in adolescents.
METHODS
The search was conducted in PubMed, Web of Science, Embase, and PsycINFO on December 1, 2022. Studies published in English reporting on menstrual complaints among girls aged 10-19 were included. The quality and bias risk was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2.
RESULTS
Of 8994 identified studies, 57 were included. In these studies, 19 instruments were described, of which 8 were validated in adolescents. One was difficult to use in daily practice, 1 had low sensitivity and specificity in the detection of HMB, 2 were validated by face validity, and 2 were not specifically developed to evaluate (the impact of) menstrual complaints. Therefore, only 2 were validated and feasible to measure adolescent menstrual complaints: the Period ImPact and Pain Assessment (PIPPA) and the Adolescent Menstrual Bleeding Questionnaire (aMBQ). Remarkably, the Pictorial Blood Loss Assessment Chart (PBAC) was the most frequently used instrument in adolescents. There was one modified version of the PBAC for adolescents, which had a lower cutoff value for HMB and low sensitivity and specificity.
CONCLUSION
We found that the PIPPA and aMBQ are suitable for assessing menstrual complaints and their impact on daily activities and health-related quality of life in adolescents. The PBAC, which is used frequently in adults, needs to be further assessed specifically for adolescents. In particular, the clinical relevance of the PBAC cutoff value for HMB should be determined for this age group. Considering the different interpretations, experiences, and limited knowledge of menstrual complaints, instruments suitable for adults may not be suitable for adolescents.
Topics: Adult; Female; Adolescent; Humans; Quality of Life; Menorrhagia; Sensitivity and Specificity; Menstruation; Dysmenorrhea
PubMed: 38104798
DOI: 10.1016/j.jpag.2023.11.011 -
PloS One 2023Uterine leiomyomas and adenomyosis are both common and often associated with abnormal uterine bleeding (AUB), including the symptom of heavy menstrual bleeding (HMB)....
BACKGROUND
Uterine leiomyomas and adenomyosis are both common and often associated with abnormal uterine bleeding (AUB), including the symptom of heavy menstrual bleeding (HMB). Understanding the prevalence of adenomyosis in women with uterine leiomyomas could inform clinicians and patients in a way that may improve therapeutic approaches.
OBJECTIVE
To explore the prevalence of adenomyosis in a group of women who underwent hysterectomy for AUB-L, to determine the prevalence of submucous leiomyomas, and to examine the utility of preoperative ultrasound to detect the presence of adenomyosis.
METHODS
The Kaiser Permanente Hysterectomy Database (KPHD) was searched for women aged 18-52 undergoing hysterectomy for leiomyoma-associated chronic AUB (AUB-L) in 2018 and 2019. A target sample of 400 comprised those with at least 3 years in the Health System. Radiologists evaluated preoperative pelvic ultrasound images to determine leiomyoma size and level 2 FIGO type (submucous or other), and the linked electronic medical record abstracted for clinical features, including histopathological evidence of adenomyosis.
RESULTS
Of the 370 subjects that met the study criteria, adenomyosis was identified via histopathology in 170 (45.9%). There was no difference in the adenomyosis prevalence with (47.1%) and without (43.0%) at least one submucous leiomyoma. Subgroup analysis of ultrasound images by an expert radiologist for the presence of adenomyosis demonstrated a positive predictive value of 54.0% and a negative predictive value of 43.4%.
CONCLUSIONS
Adenomyosis was present in almost half of this AUB-L cohort undergoing hysterectomy and was equally prevalent in those with and without submucous leiomyomas as determined by sonographic evaluation. The imaging findings are in accord with prior investigators and demonstrate that 2-D ultrasound is insensitive to the presence of adenomyosis when the uterus is affected by leiomyomas. Further research is necessary to determine the impact of various adenomyosis phenotypes on the presence and severity of the symptom of HMB.
Topics: Humans; Female; Adenomyosis; Retrospective Studies; Uterine Diseases; Leiomyoma; Uterine Neoplasms; Hysterectomy; Menorrhagia; Uterine Hemorrhage
PubMed: 38079406
DOI: 10.1371/journal.pone.0294925 -
Journal of Family Medicine and Primary... Oct 2023The term post-tubal sterilization syndrome has been used variously to include abnormal menstrual bleeding, pre-menstrual dysmenorrhea distress, hysterectomy, and...
BACKGROUND
The term post-tubal sterilization syndrome has been used variously to include abnormal menstrual bleeding, pre-menstrual dysmenorrhea distress, hysterectomy, and miscellaneous other conditions like the need for recanalization, the feeling of regret, and menopausal syndrome.
OBJECTIVES
To compare the menstrual disorders in post-tubal ligated and non-ligated women and also to compare the histopathology of endometrium in both post-tubal ligated and non-ligated groups in order to compare the menstrual disorders.
MATERIALS AND METHODS
It is a comparative cross-sectional study on 200 women between 30 and 50 years, divided into two groups and further into two sub-groups in each group. Group 1 includes cases (post-tubal ligated), and group 2 includes controls (non-tubal ligated); sub-group I includes patients with abnormal uterine bleeding (AUB), and sub-group II includes patients without AUB. Data were recorded using standard performa along with investigations and detailed examination.
RESULTS
In the case group (post-tubal ligated), maximum patients of 39.22% were having polymenorrhea and 29.41% patients had menorrhagia, whereas in the control group (non-tubal ligated), maximum patients of 38.78% had polymenorrhea and 30.61% had menorrhagia, respectively. However, the difference is statistically non-significant ( value = 1.00).
CONCLUSION
Our study suggests that the incidence of menstrual disorders did not differ significantly with tubal ligation. The patients worried about the effects of tubal ligation on their future life that must be counseled and that tubal ligation has no adverse effect on their life including their menstrual pattern. The findings of the study help family physicians in educating the clientele. We also recommend large studies with multiple centers so as to give statistically significant findings of associations.
PubMed: 38074221
DOI: 10.4103/jfmpc.jfmpc_880_23 -
Journal of Cytology 2023Endometrial aspiration (EA) is an economic, painless technique on an outpatient basis. Present study aimed at cytological evaluation of EA for (a) cellular yield and...
BACKGROUND
Endometrial aspiration (EA) is an economic, painless technique on an outpatient basis. Present study aimed at cytological evaluation of EA for (a) cellular yield and morphology and (b) utility of cell block (CB) and cytocentrifuge (CC) techniques.
MATERIALS AND METHODS
EA samples were divided into two aliquots. Colorless samples were processed (1000 rpm × 6 min) for conventional smear (CS) and CC, both stained by Papanicolaou. Hemorrhagic samples were processed for CS and CB (paraffin embedding, hematoxylin-eosin stain).
RESULTS
Endometrial aspirates from January 2021 to January 2022 were included. Indications comprised abnormal uterine bleeding (AUB; 87), prolapse (eight), and infertility (two). Among 77 hemorrhagic aspirates, the yield was 85.7% by CS and 90.9% by CB. Among 20 colorless aspirates, the yield was 55% by CS and 65% by CC. The yield was 85.7%, 84.4%, and 83.3% with endometrial thickness 1-5, 6-10, and 11-15 mm, respectively. The yield was 83.9%, 50%, and 0% in AUB, prolapse, and infertility, respectively. CS morphology showed the categories of benign (93.5%) and atypia (6.5%). All cases with benign morphology correlated with CB and CC. CB offered architectural evaluation, while CC had a shorter turnaround time.
CONCLUSION
Focusing on menorrhagia cases in secretory phase, nondilution of EA samples, and simultaneous endometrial biopsy can enhance cytology evaluation. In an era where "less should convey more," EA shows potential as a screening technique vis-à-vis invasive "dilatation-curettage" technique.
PubMed: 38058670
DOI: 10.4103/joc.joc_56_22 -
Frontiers in Endocrinology 2023The relationship between dyslipidemia and female reproductive endocrine diseases has been increasingly studied. The use of lipid-lowering drugs in treating various...
PURPOSE
The relationship between dyslipidemia and female reproductive endocrine diseases has been increasingly studied. The use of lipid-lowering drugs in treating various related diseases, including coronary heart disease, may affect female reproductive endocrine diseases. Therefore, our study aims to investigate the effects of lipid-lowering drugs on female reproductive endocrine diseases and provide a basis for the appropriate selection of drugs.
METHODS
In this study, we focused on three drug targets of statins, namely HMG-CoA reductase (HMGCR) inhibitors, proprotein convertase kexin 9 (PCSK9) inhibitors, and Niemann-Pick C1-Like 1 (NPC1L1) inhibitors. To identify potential inhibitors for these targets, we collected single nucleotide polymorphisms (SNPs) associated with HMGCR, PCSK9, and NPC1L1 from published genome-wide association study statistics. Subsequently, we conducted a drug target Mendelian randomization (MR) analysis to investigate the effects of these inhibitors on reproductive endocrine diseases mediated by low-density lipoprotein cholesterol (LDL-C) levels. Alongside coronary heart disease as a positive control, our main outcomes of interest included the risk of polycystic ovary syndrome (PCOS), premature ovarian insufficiency (POI), premenstrual syndrome (PMS), abnormal uterine bleeding (including menorrhagia and oligomenorrhea), and infertility.
RESULTS
PCSK9 inhibitors significantly increased the risk of infertility in patients (OR [95%CI] = 1.14 [1.06, 1.23], p<0.05). In contrast, HMGCR inhibitors significantly reduced the risk of menorrhagia in female patients (OR [95%CI] = 0.85 [0.75, 0.97], p<0.05), but had no statistical impact on patients with oligomenorrhea.
CONCLUSION
The findings suggest that PCSK9 inhibitors may significantly increase the risk of infertility in patients. On the other hand, HMGCR inhibitors could potentially offer protection against menorrhagia in women. However, no effects of lipid-lowering drugs have been observed on other reproductive endocrine disorders, such as PCOS, POF, PMS and oligomenorrhea.
Topics: Humans; Female; Proprotein Convertase 9; Polycystic Ovary Syndrome; Genome-Wide Association Study; Mendelian Randomization Analysis; Menorrhagia; Oligomenorrhea; PCSK9 Inhibitors; Hypolipidemic Agents; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Coronary Disease; Lipids; Infertility
PubMed: 38027179
DOI: 10.3389/fendo.2023.1295412