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Gynecologic Oncology Jan 2020To evaluate endometrial cancer (EC) risk assessment and early detection strategies in high-risk populations, we designed a large, prospective cohort study of women...
OBJECTIVE
To evaluate endometrial cancer (EC) risk assessment and early detection strategies in high-risk populations, we designed a large, prospective cohort study of women undergoing endometrial evaluation to assess risk factors and collect novel biospecimens for future testing of emerging EC biomarkers. Here we report on the baseline findings of this study.
METHODS
Women aged ≥45 years were enrolled at the Mayo Clinic from February 2013-June 2018. Risk factors included age, body mass index (BMI), smoking, oral contraceptive and hormone therapy use, and parity. We collected vaginal tampons, endometrial biopsies, and Tao brush samples. We estimated mutually-adjusted odds ratios (OR) and 95% confidence intervals (CI) using multinomial logistic regression; outcomes included EC, atypical hyperplasia, hyperplasia without atypia, disordered proliferative endometrium, and polyps, versus normal endometrium.
RESULTS
Subjects included 1205 women with a mean age of 55 years; 55% were postmenopausal, and 90% had abnormal uterine bleeding. The prevalence of EC was 4.1% (n = 49), predominantly diagnosed in postmenopausal women (85.7%). Tampons and Tao brushings were obtained from 99% and 68% of women, respectively. Age (OR 1.14, 95% CI 1.1-1.2) and BMI (OR 1.39, 95% CI 1.1-1.7) were positively associated with EC; atypical hyperplasia (OR 1.07, 95% CI 1.0-1.1; OR 2.00, 95% CI 1.5-2.6, respectively), and polyps (OR 1.06, 95% CI 1.0-1.1; OR 1.17, 95% CI 1.0-1.3, respectively); hormone therapy use and smoking were inversely associated with EC (OR 0.42, 95%, 0.2-0.9; OR 0.43, 95% CI, 0.2-0.9, respectively). Parity and past oral contraception use were not associated with EC.
CONCLUSIONS
Well-established EC risk factors may have less discriminatory accuracy in high-risk populations. Future analyses will integrate risk factor assessment with biomarker testing for EC detection.
Topics: Age Factors; Aged; Aged, 80 and over; Body Mass Index; Cohort Studies; Endometrial Neoplasms; Female; Humans; Metrorrhagia; Middle Aged; Prospective Studies; Risk Factors; United States
PubMed: 31718832
DOI: 10.1016/j.ygyno.2019.09.014 -
International Journal of Applied &... 2019Giant cervical polyps are rarely seen nowadays in routine day-to-day practice and are defined as a polyp with a size >4 cm. Giant cervical polyps protruding outside the...
Giant cervical polyps are rarely seen nowadays in routine day-to-day practice and are defined as a polyp with a size >4 cm. Giant cervical polyps protruding outside the vaginal canal causing diagnostic dilemma are rarely encountered in gynecologic practice. They masquerade as uterine inversion, prolapse, or cervical malignancy. Only a few cases have been reported in the literature. We hereby report a case of giant polyp of anterior lip of the cervix occurring in a multiparous woman and presented with something coming out per vagina. Histopathology of it came out to be angiomyomatous polyp (vascular leiomyoma) of the cervix that itself is a rare entity.
PubMed: 31681556
DOI: 10.4103/ijabmr.IJABMR_386_18 -
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 -
Cureus Aug 2019Endometrial polyps are a common cause of abnormal vaginal bleeding and infertility, which can be identified with different imaging methods. A lack of distention of the...
Endometrial polyps are a common cause of abnormal vaginal bleeding and infertility, which can be identified with different imaging methods. A lack of distention of the endometrial cavity is not a common presentation of endometrial polyps and is associated with endometrial carcinoma. In this article, we present a case of a 30-year-old patient with previous history of infertility and abnormal vaginal bleeding. During a hysterosalpingography (HSG), we were not able to distend the endometrial cavity. Therefore, we performed a transvaginal ultrasound (TVUS) and a pelvic magnetic resonance study, which showed an obstructive endometrial polyp adjacent to the internal cervical os. This structure was successfully removed through hysteroscopy by the gynecology department.
PubMed: 31620313
DOI: 10.7759/cureus.5385 -
Archives of Gynecology and Obstetrics Nov 2019Uterine adenosarcomas (UAs) account for 5-8% of cases of uterine sarcomas. Treatment includes total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy...
PURPOSE
Uterine adenosarcomas (UAs) account for 5-8% of cases of uterine sarcomas. Treatment includes total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO). Fertility preservation is an emerging concept in gynaecology oncology and is particularly relevant in UA, where cases are diagnosed as young as 15-year-old. This manuscript demonstrates a case of UA which was treated conservatively, achieved successful livebirths and underwent completion hysterectomy after two decades of follow-up.
METHOD
This was a retrospective case note review.
RESULTS
An 18-year-old nulliparous woman presented with abnormal vaginal bleeding. Ultrasound identified an endometrial polyp, which was histologically diagnosed as low-grade adenosarcoma. She was advised to undergo TAH and BSO, but instead decided to preserve her fertility and opted for conservative management. She was monitored with pelvic ultrasound, hysteroscopy and endometrial biopsy bi-annually, with annual pelvic magnetic resonance imaging for 10 years which was uneventful. 11 years post-operatively she conceived following in-vitro fertilization (IVF) but suffered a miscarriage at 16 weeks likely due to cervical incompetence. She subsequently conceived with twins. She delivered spontaneously preterm at 28 weeks. Both children are alive and well. After 20 years of follow-up, she underwent a laparoscopic hysterectomy with no evidence of recurrence. She remains disease free.
CONCLUSION
Whilst radical completion surgery should be advised in UA, this case, in addition to all published conservatively managed cases of UA, demonstrates that conservative management is possible in appropriately selected women. Intensive monitoring post-operatively is essential owing to the risk of recurrence; however, this may pose deleterious side effects which require consideration.
Topics: Adenosarcoma; Adolescent; Conservative Treatment; Female; Follow-Up Studies; Humans; Retrospective Studies; Time Factors; Uterine Neoplasms
PubMed: 31584132
DOI: 10.1007/s00404-019-05306-6