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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; Male; Myoma; Polyps; Precancerous Conditions; Uterine Diseases; Uterine Hemorrhage; Uterine Neoplasms
PubMed: 35152217
DOI: 10.1159/000522524 -
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 -
Cureus Sep 2021Although hymenal tags are not uncommon in newborn girls, there is a paucity of literature on this condition. Few photo images of hymenal tags have been published. We...
Although hymenal tags are not uncommon in newborn girls, there is a paucity of literature on this condition. Few photo images of hymenal tags have been published. We report the case of a four-month-old girl with a large hymenal tag noted at birth. Approximately 30% of hymenal tags may persist at three years of age. As the number of prepubertal girls who require evaluation for sexual abuse increases, physicians should familiarize themselves with the appearance of a hymenal tag to differentiate it from signs of sexual abuse, especially in older girls whose hymenal tags have not resolved.
PubMed: 34660122
DOI: 10.7759/cureus.17931 -
Journal of Pediatric and Adolescent... Apr 2022Non-puerperal uterine inversion is a rare condition with diagnostic and surgical challenges. Clinically, the inverted uterus appears as a mass protruding from the vagina...
BACKGROUND
Non-puerperal uterine inversion is a rare condition with diagnostic and surgical challenges. Clinically, the inverted uterus appears as a mass protruding from the vagina and is often misdiagnosed as a malignant tumor and surgically removed.
CASE
An 11-year-old girl was admitted to the emergency room due to spontaneous vaginal mass protrusion. The pudendum examination showed an irregular and dark red neoplasm protruding from the vagina. The final diagnosis was non-puerperal uterine inversion with an endometrial polyp.
SUMMARY AND CONCLUSION
MRI is the key to the diagnosis of uterine inversion. Our review confirmed that the 11-year-old girl was the youngest in the world to suffer from non-puerperal uterine inversion.
Topics: Child; Female; Humans; Magnetic Resonance Imaging; Polyps; Uterine Inversion; Uterine Neoplasms; Uterus
PubMed: 34610439
DOI: 10.1016/j.jpag.2021.09.007 -
Rare Tumors 2021Vaginal oligometastatic disease of colorectal primary is a rare malignancy with few reported cases in the literature and no standardized treatment paradigm. We report on...
Vaginal oligometastatic disease of colorectal primary is a rare malignancy with few reported cases in the literature and no standardized treatment paradigm. We report on the definitive management of an unusual case of an elderly woman with the aforementioned disease. A 78-year-old African-American woman presented with vaginal spotting and was found to have a vaginal lesion. Final pathology was consistent with moderately differentiated adenocarcinoma of colorectal primary. Extensive work up, which included endoscopies, pathologic analyzes, and imaging workup, did not reveal a primary gastrointestinal malignancy. The patient underwent partial vaginectomy and final pathology once again confirmed moderately differentiated adenocarcinoma of colorectal primary (CDX 2 and CEA positive, ER/PR, and CK 7 negative) with negative margins. She went on to receive adjuvant concurrent chemoradiation with 5-FU based chemotherapy. She received 45 Gy in 25 fractions to the whole pelvis followed by an HDR brachytherapy boost to 12 Gy in two fractions. Unfortunately, 10 months after completing radiation, she was found to have adenocarcinoma arising from a hepatic flexure colon polyp on colonoscopy. She required definitive surgical resection and was staged as mpT3N0M1. She received 12 cycles of 5-FU and at 2-year follow-up was found to be disease free with no evidence of locoregional recurrence or distant metastatic disease. Continued long-term follow up is warranted.
PubMed: 34589190
DOI: 10.1177/20363613211044566 -
International Cancer Conference Journal Oct 2021Endometrial stromal sarcoma (ESS) is a rare mesenchymal tumor of the uterus that accounts for 7-25% of uterine sarcomas and < 1% of uterine tumors. Previously...
Endometrial stromal sarcoma (ESS) is a rare mesenchymal tumor of the uterus that accounts for 7-25% of uterine sarcomas and < 1% of uterine tumors. Previously reported sites include the ovary, bowel wall, abdomen, peritoneum, pelvis, and vagina; however, ESS in the extrauterine area is rare. We report a rare case of endometrial stromal sarcoma that developed in the sigmoid colon along the gonadal vasculature, which was difficult to distinguish from colon cancer. A large polyp was found in the sigmoid colon of a 74-year-old woman during a routine medical examination and was diagnosed as tubular adenoma. On colonoscopy 7 months later, the tumor had grown and blocked the lumen, causing stenosis. She was referred to our hospital for surgery. Although detailed examination at our hospital did not yield a definitive diagnosis, bowel obstruction was considered likely and we performed laparoscopic low anterior resection under a preoperative diagnosis of sigmoid colon cancer. The tumor protruded into the sigmoid colon from the stump of the ovarian arteries and veins outside the intestinal tract. As the left ovarian artery and vein were involved in the tumor, we extracted them as a lump. The tumor was diagnosed as low-grade ESS (LG-ESS). She had a history of hysterectomy and left salpingo-oophorectomy for uterine myoma 25 years ago, and radiation therapy was performed after surgery for an unknown reason. The postoperative course was uneventful, and follow-up was continued at the request of the patient. We report a rare case of ESS infiltrating the sigmoid colon, which was probably a lesion derived from endometriosis of the ovarian arteriovenous stump remaining after surgery 25 years ago.
PubMed: 34567941
DOI: 10.1007/s13691-021-00493-z -
Iranian Journal of Pathology 2021Fibroepithelial polyps of the vagina (FEPV) are rare entities which normally manifest as one or more painless polyps sometimes with symptoms such as bleeding, vaginal...
Fibroepithelial polyps of the vagina (FEPV) are rare entities which normally manifest as one or more painless polyps sometimes with symptoms such as bleeding, vaginal discharge, and discomfort regarding the size of the mass. Despite their benign nature, they can be confused with other vaginal tumors due to their abnormal histology. In this report, we present a case of a 44-year-old woman with a giant pedunculated and symptomatic polyp of the vagina with anterior vaginal wall prolapse. The treatment method included a simple local excision of the polyp and anterior vaginal compartment repair. Histopathological examination revealed a polypoid lesion covered by squamous epithelium containing a central fibrovascular core without atypia. The patient experienced an uneventful postoperative recovery, with no complication, which implies that surgery is the most effective modality for managing such tumors.
PubMed: 34567198
DOI: 10.30699/IJP.2021.522689.2566