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Iranian Journal of Nursing and... 2020Abnormal vaginal bleeding is one of the complaints of women during menopause. Various diseases such as endometrial atrophy, polyps, and endometrial cancers may lead to...
Abnormal vaginal bleeding is one of the complaints of women during menopause. Various diseases such as endometrial atrophy, polyps, and endometrial cancers may lead to postmenopausal vaginal bleeding. This report describes a case of postmenopausal vaginal bleeding caused by pregnancy. A 54-year-old woman referred to the prenatal clinic in Arak, Iran, with postmenopausal vaginal bleeding in 2018. Transabdominal ultrasound revealed an uterine pregnancy. At 28 weeks of gestation, she referred to the health center and her prenatal care began in the midwifery clinic. She gave birth to a baby girl at 34 weeks through a cesarian section. This case reminds practitioners and midwives that pregnancy may be one of the etiologies of postmenopausal vaginal bleeding especially in women with sexual activity. Therefore, a free beta-subunit human chorionic gonadotropin (HCG) hormone measurement should be conducted and if found to be elevated, followed by appropriate imaging tests.
PubMed: 32724774
DOI: 10.4103/ijnmr.IJNMR_94_19 -
Journal of Pediatric and Adolescent... Oct 2020Polypoid endometriosis (PEM) is a rare type of endometriosis, frequently mimicking a malignant tumor. We report on a patient with PEM over a 10-year span who had...
BACKGROUND
Polypoid endometriosis (PEM) is a rare type of endometriosis, frequently mimicking a malignant tumor. We report on a patient with PEM over a 10-year span who had symptoms at age 16.
CASE
A 20-year-old woman presented with massive vaginal hemorrhage and spontaneous abortion, having symptoms of dysmenorrhea, anal distending pain, and vaginal bleeding since adolescence. Imaging showed multiple polypoid neoplasms of the rectum and vagina connecting to the huge mass in a cul de sac. After exploration and excision, the pathology revealed PEM.
Topics: Diagnosis, Differential; Endometriosis; Female; Humans; Ovarian Cysts; Polyps; Pregnancy; Rectal Diseases; Ultrasonography, Doppler; Uterine Hemorrhage; Vaginal Diseases; Young Adult
PubMed: 32544515
DOI: 10.1016/j.jpag.2020.06.006 -
Diagnostic and Interventional Radiology... May 2020We aimed to investigate the clinical and magnetic resonance imaging (MRI) characteristics of uterine adenomyosis, in which there is an extensive area of high signal...
PURPOSE
We aimed to investigate the clinical and magnetic resonance imaging (MRI) characteristics of uterine adenomyosis, in which there is an extensive area of high signal intensity in the myometrium on T2-weighted MRI.
METHODS
This retrospective radiographic study reviewed a case series of six patients (mean age, 36 years) with adenomyosis. These patients were selected because, unlike in classical adenomyosis, T2-weighted images showed a larger area of high signal intensity than that of low signal intensity in the myometrium. The morphology of the myometrial lesions, patterns of contrast enhancement (n=4), intramyometrial hemorrhaging, diffusion restriction (n=5), endometrial lesions, and imaging findings after treatment (n=3) were evaluated on MRI.
RESULTS
The patients' clinical symptoms included vaginal bleeding and severe anemia. Four were administered hormonal therapy, one underwent hysterectomy, and one underwent enucleation. On T2-weighted images, all showed endometrial thickening and a high signal intensity area in the myometrium that was divided up by a mesh of low signal intensity bands, with an appearance reminiscent of a fish caught in a net. Other findings included gradual centripetal enhancement with contrast defects in multicystic areas (4/4), an intramyometrial hemorrhage (1/6), and increased diffusion (5/5). Following hormonal therapy, the uteruses decreased in size and were similar to those of classical adenomyosis on MRI (3/3). The lesions were diagnosed as adenomyosis with a proliferation of adenomyotic glandular tissue and a proliferative endometrial polyp.
CONCLUSION
This case series suggests that there is a subgroup of uterine adenomyosis that shows a characteristic "fish-in-a-net" appearance on T2-weighted images.
Topics: Adenomyosis; Adult; Anemia; Cell Proliferation; Female; Hormones; Humans; Hysterectomy; Magnetic Resonance Imaging; Middle Aged; Myometrium; Retrospective Studies; Severity of Illness Index; Treatment Outcome; Uterine Hemorrhage; Uterine Neoplasms; Uterus
PubMed: 32209513
DOI: 10.5152/dir.2019.19252 -
SAGE Open Medical Case Reports 2020Alveolar soft part sarcoma is a rare malignant soft tissue tumor, mainly localized in the extremities and occurring principally in adolescents and young adults. Alveolar...
Alveolar soft part sarcoma is a rare malignant soft tissue tumor, mainly localized in the extremities and occurring principally in adolescents and young adults. Alveolar soft part sarcoma are uncommon in the female genital tract. We here report a case of alveolar soft part sarcoma in a 20-year-old nullipara, presenting with vaginal bleeding and profound anemia requiring blood transfusions. Ultrasonographic examination revealed a polyp in the lower uterine segment. Surgical resection of the polyp was performed, and pathological evaluation showed typical histological, immunohistochemical, and molecular features consistent with alveolar soft part sarcoma. Patient underwent for total hysterectomy. Currently, she follows up with her surgeon and has no new complains. Given the infrequency of alveolar soft part sarcoma, this case report raises the awareness of alveolar soft part sarcoma as one of the entities to consider when confronted with a uterine polyp in a young patient.
PubMed: 32180983
DOI: 10.1177/2050313X20910598 -
Gynecology and Minimally Invasive... 2020We report one of the first cases where an endometrial polyp was removed using a manual hysteroscopic tissue removal (HTR) device. The case showed its feasibility with...
We report one of the first cases where an endometrial polyp was removed using a manual hysteroscopic tissue removal (HTR) device. The case showed its feasibility with potential reduction in the required setup time and tubing required compared to routine HTR device. This technique is ideal in the removal of endometrial polyps, particularly within the outpatient settings.
PubMed: 32090011
DOI: 10.4103/GMIT.GMIT_116_18 -
Facts, Views & Vision in ObGyn Sep 2019Primary extranodal marginal zone B-cell lymphomas (MALToma) of the endometrium are rare tumors. We report a case of MALToma diagnosed within an endometrial polyp in a...
Primary extranodal marginal zone B-cell lymphomas (MALToma) of the endometrium are rare tumors. We report a case of MALToma diagnosed within an endometrial polyp in a patient presenting with postmenopausal vaginal bleeding. The patient underwent a conventional hysteroscopic procedure for intrauterine polyps. There was no suspicion of malignancy during the preoperative investigations or at surgery. Conventional bipolar resection of the polyps was performed. The present case demonstrates that conservative management of endometrial MALToma may be considered as a safe alternative to hysterectomy. Further data on long-term follow up is needed to confirm the safety of this conservative approach.
PubMed: 32082533
DOI: No ID Found -
Annals of Medicine and Surgery (2012) Mar 2020Metastatic cancer to the female genital organs is a very rare clinical presentation. The myometrium is more frequently affected than the endometrium. Prolonged use of...
Metastatic cancer to the female genital organs is a very rare clinical presentation. The myometrium is more frequently affected than the endometrium. Prolonged use of tamoxifen has been found to be associated with endometrial hyperplasia, endometrial polyp formation, and the development of endometrial adenocarcinoma in some cases. A 55-year-old lady with a history of invasive lobular carcinoma of the breast that had been operated upon with left mastectomy 7 years previously & who had also been treated with tamoxifen for 5 years presented with irregular vaginal bleeding and lower abdominal pain. The patient had a three cm uterine fibroid with an endometrial polyp. She had anemia with hemoglobin level 8 mg/dl. Laparoscopic hysterectomy with bilateral oophorectomy was performed for a polyp in the endometrium which proved to be a metastasis from her lobular carcinoma of the breast. Patients with breast cancer who present with abnormal vaginal bleeding should alert the physicians about the possibility of metastatic breast cancer to the uterus regardless the use of the hormonal therapy such as tamoxifen. The pathologists also should be aware of this possibility and they should examine the polyps very carefully to detect any metastatic foci especially if the patient has been treated with tamoxifen.
PubMed: 32071717
DOI: 10.1016/j.amsu.2020.01.008 -
Journal of Mid-life Health 2019The aim of this study is to investigate the clinical data from history and endometrial pathology by endometrial sampling in patients with postmenopausal bleeding and to...
A Clinicopathological Evaluation of Postmenopausal Bleeding and Its Correlation with Risk Factors for Developing Endometrial Hyperplasia and Cancer: A Hospital-Based Prospective Study.
OBJECTIVE
The aim of this study is to investigate the clinical data from history and endometrial pathology by endometrial sampling in patients with postmenopausal bleeding and to identify risk factors associated with future development of endometrial cancer (EC).
METHODS
We prospectively studied 76 postmenopausal women with vaginal bleeding and endometrial thickness (ET) >5 mm undergoing endometrial biopsy or dilatation and curettage. Patient characteristics and endometrial assessment of women with or without EC and hyperplasia were compared. Univariate and multivariate logistic regression identified factors associated with risks of endometrial neoplasia.
RESULTS
In this study, the mean age at the time of presentation was 57.17 ± 7.11 years, mean menopausal age was 49.18 ± 3.69 years, and mean thickness of endometrial was 11.13 ± 6.37 mm. The histopathological analysis showed atrophic endometrium (30.3%), proliferative endometrium (27.6%), EC (15.8%), endometrium hyperplasia (11.8%), disordered proliferative endometrium (9.2%), and endometrial polyp (5.3%). Women of EC and hyperplasia group were more likely to be multiparous, diabetic, hypertensive, obese or overweight, has a history of recurrent bleeding episodes or thick endometrium. Using multivariate logistic regression, we found ET (adjusted odds ratio [AOR] = 17.76, confidence interval [CI] 1.91-165.02, < 0.011, criterion ≥11 mm), recurrent episode of bleeding (AOR = 13.21, CI 1.10-158.91, < 0.042), diabetes (AOR = 8.03, CI 1.15-55.78, < 0.035) the best predictors of EC.
CONCLUSION
As clinical characteristics are possible predictors of EC, these should also be taken into account in risk estimations and in the formulation of management plans. This not only has benefit in the process of disease detection but also may result in improved the efficiency of care.
PubMed: 31942153
DOI: 10.4103/jmh.JMH_136_18 -
Pakistan Journal of Medical Sciences Jan 2020Intrauterine retention of fetal bones is a rare complication of unsafe abortion. Patients may present with infertility, chronic pelvic pain, menorrhagia and vaginal...
Intrauterine retention of fetal bones is a rare complication of unsafe abortion. Patients may present with infertility, chronic pelvic pain, menorrhagia and vaginal discharge. Here, we discuss a management of young female patient with uterine bleeding after miscarriage. Other causes of abnormal uterine bleeding such as infection, polyp, fibroid, malignancy were excluded. Retained intrauterine fetal bones were found as a sole cause of her complaint. Diagnosis was made with pelvic ultrasound and pelvic radiography. Dilatation and curettage was performed to remove the fetal bones with a good subsequent outcome.
PubMed: 31933614
DOI: 10.12669/pjms.36.ICON-Suppl.1719 -
Einstein (Sao Paulo, Brazil) 2020To investigate the prevalence and intensity of pain perception during diagnostic hysteroscopy in women and potential related factors.
OBJECTIVE
To investigate the prevalence and intensity of pain perception during diagnostic hysteroscopy in women and potential related factors.
METHODS
A total of 489 women were investigated at an infertility clinic. Fluid diagnostic hysteroscopy was performed without analgesia or anesthesia by gynecologists with different levels of experience in operative hysteroscopy, using a 2.9mm rigid scope. The Visual Analog Scale was used to score pain intensity after vaginal speculum insertion and after hysteroscopy. Data collected included age, ethnicity, body mass index, history of infertility and endometrial surgery (curettage and/or hysteroscopy), smoking habits, and hysteroscopy diagnosis. Only the state of anxiety was assessed by the State-Trait Anxiety Inventory given to each patient before the procedure.
RESULTS
Hysteroscopy median (25th to 75th) Visual Analog Scale scored 3.3 (3 to 5), and 41.7% of the women referred Visual Analog Scale score ≥4. Median (25th to 75th) State-Trait Anxiety Inventory score was 42 (38 to 45), and 58.3% of the women referred State-Trait Anxiety Inventory score >40. Hysteroscopy Visual Analog Scale score was significantly correlated to surgeon experience and to vaginal speculum insertion but not to State-Trait Anxiety Inventory score, ethnicity or abnormal hysteroscopic findings.
CONCLUSION
Diagnostic hysteroscopy was mostly perceived as a mild discomfort procedure by most women. Nevertheless, in a considerable number of cases, women perceived hysteroscopy as painful. Pain perception was linked to individual pain threshold and surgeon experience, but not to pre-procedural anxiety state levels, ethnicity or abnormal hysteroscopic findings.
Topics: Adult; Anxiety; Body Mass Index; Brazil; Female; Fertility Clinics; Humans; Hysteroscopy; Middle Aged; Pain Measurement; Pain Perception; Pain, Procedural; Polyps; Prevalence; Psychiatric Status Rating Scales; Reference Values; Statistics, Nonparametric; Uterine Diseases; Visual Analog Scale; Young Adult
PubMed: 31851226
DOI: 10.31744/einstein_journal/2020AO4916