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International Journal of Surgery Case... May 2024Embryonal Rhabdomyosarcoma is a rare form of sarcoma mainly seen in children and adolescents. In the specific case of the cervix, embryonal Rhabdomyosarcoma is an...
INTRODUCTION AND IMPORTANCE
Embryonal Rhabdomyosarcoma is a rare form of sarcoma mainly seen in children and adolescents. In the specific case of the cervix, embryonal Rhabdomyosarcoma is an extremely rare mesenchymal tumor, accounting for <1 % of all cervical cancers. This highly malignant tumor mainly affects adolescents and young adults.
CASE PRESENTATION
We describe the case of a 29-year-old woman with embryonal rhabdomyosarcoma of the cervix, which manifested as an exophytic cervical mass. Histopathological and immunohistochemical findings confirmed the presence of embryonal rhabdomyosarcoma of the cervix. This patient was successfully treated with a combination of neoadjuvant chemoradiotherapy, total abdominal hysterectomy with bilateral ovary transposition, and adjuvant chemoradiotherapy.
CLINICAL DISCUSSION
Embryonal Rhabdomyosarcoma of the cervix may manifest by vaginal bleeding, a cervical mass and pelvic symptoms. The diagnosis is confirmed by histopathology and immunohistochemistry. With multimodal treatment including surgery, chemotherapy and radiotherapy, outcomes improve for patients.
CONCLUSIONS
Uterine cervix embryonal RMS is an uncommon cancer in adult patients. While rare, it should be considered as a potential diagnosis in patients presenting with vaginal bleeding and a significant cervical polyp. Histopathology, complemented by relevant immunohistochemistry, is crucial for accurately detecting the tumor and guiding appropriate management strategies.
PubMed: 38759402
DOI: 10.1016/j.ijscr.2024.109742 -
PloS One 2024The cervix is the lower portion of the uterus, which connects this organ to the vagina through the endocervical canal.
BACKGROUND
The cervix is the lower portion of the uterus, which connects this organ to the vagina through the endocervical canal.
OBJECTIVE
This study aimed to determine the histopathologic patterns and factors associated with cervical lesions at Jimma Medical Center from September 12, 2017, to September 12, 2019.
METHODS
A 2-year facility-based cross-sectional study was conducted from May 1 to June 30, 2020.
RESULT
In this study, cervical cancer was the most common (71%) cause of cervical lesions. Squamous cell carcinoma was the most frequent cervical cancer diagnosed during the study, accounting for 96.4% of 331 cancerous cases, followed by adenocarcinoma (3.3%). High-grade squamous intraepithelial lesions were the most frequently diagnosed precancerous lesions, accounting for 68.4% of cases. Endocervical polyps were the most commonly diagnosed benign lesions, accounting for 59.3% of cases.
CONCLUSION
The maximum age distribution of cervical lesions was in the 41-50-year age range. Squamous cell carcinoma was the most frequent type of cervical cancer. High-grade squamous intraepithelial lesions were the most frequently diagnosed precancerous cervical lesions. The most common benign cervical lesions were endocervical polyps.
RECOMMENDATION
We recommend educating the community to improve health-seeking behavior and on possible preventive strategies for cervical cancer.
Topics: Female; Humans; Uterine Cervical Neoplasms; Cross-Sectional Studies; Ethiopia; Precancerous Conditions; Carcinoma, Squamous Cell; Squamous Intraepithelial Lesions; Uterine Cervical Dysplasia
PubMed: 38635603
DOI: 10.1371/journal.pone.0301559 -
Annals of Medicine and Surgery (2012) Apr 2024Fibroepithelial vaginal polyps (FEPV) are rare mucosal polypoid lesions primarily found in adult women. However, FEPV in paediatric patients, especially beyond the...
INTRODUCTION AND IMPORTANCE
Fibroepithelial vaginal polyps (FEPV) are rare mucosal polypoid lesions primarily found in adult women. However, FEPV in paediatric patients, especially beyond the neonatal period, is exceedingly uncommon. Documenting cases improves diagnosis and management. FEPV can mimic malignancy, posing challenges for interpretation. Early detection, treatment, and follow-up are crucial for optimal outcomes.
CASE PRESENTATION
The authors present the case of a 2-year-old girl with a recurrent FEPV. The patient had a painless, reddish, smooth, soft, rubbery polypoid vaginal mass measuring 2.3 × 1.5 cm. Physical examination revealed no concurrent systemic issues. Surgical excision of the polyps confirmed them as fibroepithelial polyps. Despite previous excisions, the polyps recurred within a month. The patient's postoperative recovery was uneventful, and subsequent follow-up showed no recurrence.
CLINICAL DISCUSSION
FEPV presents as mucosal polypoid lesions with a connective tissue core covered by benign squamous epithelium. It is rare before menarche and after menopause. Although the pathophysiology remains unclear, hormonal factors and local injuries may contribute. FEPV is usually asymptomatic but may cause pressure, obstruction, bleeding, or discharge. Differential diagnosis includes vaginal connective tissue malignancies. The diagnosis was confirmed by surgical excision and histopathology. Complete excision is crucial for preventing recurrence.
CONCLUSION
This case report highlights recurrent FEPV in a 2-year-old girl. Despite previous excisions, polyps recurred, emphasizing the need for complete excision. Documenting cases will enhance our understanding. Further research is needed to elucidate the pathogenesis of paediatric FEPV. Early detection, treatment, and follow-up are essential for optimal management.
PubMed: 38576976
DOI: 10.1097/MS9.0000000000001836 -
Journal of the West African College of... 2024Fibroepithelial polyps of the Vagina (FEPV) are mucosal polypoid lesions with a connective tissue core covered by a benign squamous epithelium. They are thought to be...
Fibroepithelial polyps of the Vagina (FEPV) are mucosal polypoid lesions with a connective tissue core covered by a benign squamous epithelium. They are thought to be rare as only a few cases are reported in the literature. Fibroepithelial stromal polyps are mesenchymal neoplasms that can occur in the vagina, vulva, and even on the cervix. These fibroepithelial stromal polyps have also been reported in rare sites such as breast and labia.
PubMed: 38562389
DOI: 10.4103/jwas.jwas_121_23 -
Cureus Feb 2024Vaginal fibroepithelial polyps are rare benign tumors of the mucosa of the anterior vaginal wall. In extremely rare cases, they may originate from the posterior vaginal...
Vaginal fibroepithelial polyps are rare benign tumors of the mucosa of the anterior vaginal wall. In extremely rare cases, they may originate from the posterior vaginal wall or be complicated by torsion. Our case concerns a 63-year-old patient who presented to the gynecology outpatient clinic of the General Hospital of Trikala with minor vaginal bleeding. On vaginal examination, a large pedunculated painless hemorrhagic polypoid mass was noticed, originating from the posterior vaginal wall. A torsion of the pedunculated vaginal tumor was suspected, leading to its surgical excision with clear resection margins. Due to extensive tissue necrosis, accurate histological identification of the vaginal neoplasm was not possible. Histological examination excluded vaginal malignancy. Based predominantly on the clinical and morphological features of the vaginal lesion, a diagnosis of vaginal fibroepithelial polyp with torsion was made, acknowledging its limitations. The patient was discharged from the clinic the same afternoon following the surgery. Three months later, no recurrence of the lesion in the vaginal wall was noted. Following the case presentation, this paper provides a brief literature review of this rare entity, focusing on the diagnostic and therapeutic approaches.
PubMed: 38558656
DOI: 10.7759/cureus.55157 -
Journal of Ultrasonography Feb 2024Abnormal uterine vascular pattern can be observed during transvaginal ultrasound examination used for investigating post-abortion bleeding and secondary postpartum...
AIM
Abnormal uterine vascular pattern can be observed during transvaginal ultrasound examination used for investigating post-abortion bleeding and secondary postpartum hemorrhage. The purpose of this series of cases was to evaluate almost all the rare causes of uterine vascular abnormalities linked to pregnancy complications, and determine how to arrive at the diagnosis to optimize patient management, which is crucial for preventing life-threatening massive vaginal bleeding.
MATERIAL AND METHODS
Retrospective observational case series study including 20 women with postpartum or post-abortion vaginal bleeding who were found to have an abnormal uterine vascular pattern during a transvaginal color duplex assessment.
RESULTS
The study yielded the following findings: 10 cases of enhanced myometrial vascularity, two cases of pseudoaneurysm in the uterine artery, one case of myometrial venous varix, one case of large uterine venous pseudoaneurysm, one case of uterine arteriovenous malformation, one case of retained placental polyp, one case of invasive vesicular mole, and three cases of subinvolution of the placental implantation site.
CONCLUSIONS
Transvaginal color duplex ultrasound plays a crucial role in detecting uterine vascular abnormalities as a cause of post-abortion or secondary postpartum hemorrhage and can help differentiate the pathologies responsible for the abnormal vascular pattern, which is highly recommended to optimize patient management.
PubMed: 38496787
DOI: 10.15557/jou.2024.0011 -
Hereditary Cancer in Clinical Practice Feb 2024Peutz-Jeghers syndrome (PJS), an autosomal dominant multiple cancerous disorder, is clinically characterized by mucocutaneous macules and multiple gastrointestinal...
Preoperative multimodal ultrasonic imaging in a case of Peutz-Jeghers syndrome complicated by atypical lobular endocervical glandular hyperplasia: a case report and literature review.
BACKGROUND
Peutz-Jeghers syndrome (PJS), an autosomal dominant multiple cancerous disorder, is clinically characterized by mucocutaneous macules and multiple gastrointestinal hamartomatous polyps. Gastric-type endocervical adenocarcinoma (G-EAC), a special subtype of cervical adenocarcinoma with non-specific symptoms and signs, is known to occur in approximately 11% of female patients with PJS.
CASE PRESENTATION
Here, we report a case of PJS in a 24-year-old female with multiple mucocutaneous black macules who complained of vaginal discharge and menorrhagia. Moreover, we first described the multimodal ultrasonographical manifestations of PJS-correlated G-EAC. The three-dimensional reconstructed view of G-EAC on 3D realisticVue exhibited a distinctive "cosmos pattern" resembling features on magnetic resonance imaging, and the contrast-enhanced ultrasound displayed a "quick-up and slow-down" pattern of the solid components inside the mixed cervical echoes. We reported the multimodal ultrasonographical characteristics of a case of PJS-related G-EAC, as well as reviewed PJS-related literature and medical imaging features and clinical characteristics of G-EAC to provide insight into the feasibility and potential of utilizing multimodal ultrasonography for the diagnosis of G-EAC.
CONCLUSIONS
Multimodal ultrasound can visualize morphological features, solid components inside, and blood supplies of the G-EAC lesion and distinguish the G-EAC lesion from normal adjacent tissues. This facilitates preoperative diagnosis and staging of PJS-related G-EAC, thereby aiding subsequent health and reproductive management for patients with PJS.
PubMed: 38419118
DOI: 10.1186/s13053-024-00275-7 -
Annals of Medicine and Surgery (2012) Feb 2024Endometrial polyps (EPs) result from the overgrowth of endometrial glands and stroma. Giant endometrial polyps, defined as those exceeding 4 cm, are rare, and their...
INTRODUCTION
Endometrial polyps (EPs) result from the overgrowth of endometrial glands and stroma. Giant endometrial polyps, defined as those exceeding 4 cm, are rare, and their association with phytoestrogen (PE) intake is infrequently reported.
CASE PRESENTATION
The authors present a case of a giant endometrial polyp in a 59-year-old post-menopausal woman from Nepal. The patient presented with lower abdominal pain and a history of vaginal spotting. She was not under any drugs or medications, including hormones, but had a regular intake of PE-rich foods. Imaging revealed a giant endometrial polyp and a uterine fibroid. Total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO) were performed and histopathology examination confirmed the diagnosis of endometrial polyp and fibroid.
DISCUSSION
In our case, the patient's increased age and PE-rich diet were identified as potential risk factors for the giant endometrial polyp. Giant endometrial polyps are rare, with limited cases reported to date, often associated with tamoxifen or raloxifene use. Phytoestrogens can exhibit oestrogenic effects, contributing to endometrial polyps. This case emphasizes the importance of further research to explain the relationship between phytoestrogen intake and giant endometrial polyps.
CONCLUSION
Giant endometrial polyps are uncommon, and their association with phytoestrogen intake remains underexplored. Clinicians should consider dietary factors in history while evaluating endometrial polyps, and further research is necessary to explore the potential role of phytoestrogens in the development of giant endometrial polyps.
PubMed: 38333296
DOI: 10.1097/MS9.0000000000001667 -
Gynecologie, Obstetrique, Fertilite &... May 2024To update the 2010 CNGOF clinical practice guidelines for the first-line management of infertile couples.
OBJECTIVE
To update the 2010 CNGOF clinical practice guidelines for the first-line management of infertile couples.
MATERIALS AND METHODS
Five major themes (first-line assessment of the infertile woman, first-line assessment of the infertile man, prevention of exposure to environmental factors, initial management using ovulation induction regimens, first-line reproductive surgery) were identified, enabling 28 questions to be formulated using the Patients, Intervention, Comparison, Outcome (PICO) format. Each question was addressed by a working group that had carried out a systematic review of the literature since 2010, and followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) methodology to assess the quality of the scientific data on which the recommendations were based. These recommendations were then validated during a national review by 40 national experts.
RESULTS
The fertility work-up is recommended to be prescribed according to the woman's age: after one year of infertility before the age of 35 and after 6months after the age of 35. A couple's initial infertility work-up includes a single 3D ultrasound scan with antral follicle count, assessment of tubal permeability by hysterography or HyFOSy, anti-Mullerian hormone assay prior to assisted reproduction, and vaginal swabbing for vaginosis. If the 3D ultrasound is normal, hysterosonography and diagnostic hysteroscopy are not recommended as first-line procedures. Chlamydia trachomatis serology does not have the necessary performance to predict tubal patency. Post-coital testing is no longer recommended. In men, spermogram, spermocytogram and spermoculture are recommended as first-line tests. If the spermogram is normal, it is not recommended to check the spermogram. If the spermogram is abnormal, an examination by an andrologist, an ultrasound scan of the testicles and hormonal test are recommended. Based on the data in the literature, we are unable to recommend a BMI threshold for women that would contraindicate medical management of infertility. A well-balanced Mediterranean-style diet, physical activity and the cessation of smoking and cannabis are recommended for infertile couples. For fertility concern, it is recommended to limit alcohol consumption to less than 5 glasses a week. If the infertility work-up reveals no abnormalities, ovulation induction is not recommended for normo-ovulatory women. If intrauterine insemination is indicated based on an abnormal infertility work-up, gonadotropin stimulation and ovulation monitoring are recommended to avoid multiple pregnancies. If the infertility work-up reveals no abnormality, laparoscopy is probably recommended before the age of 30 to increase natural pregnancy rates. In the case of hydrosalpinx, surgical management is recommended prior to ART, with either salpingotomy or salpingectomy depending on the tubal score. It is recommended to operate on polyps>10mm, myomas 0, 1, 2 and synechiae prior to ART. The data in the literature do not allow us to systematically recommend asymptomatic uterine septa and isthmoceles as first-line surgery.
CONCLUSION
Based on strong agreement between experts, we have been able to formulate updated recommendations in 28 areas concerning the initial management of infertile couples.
Topics: Humans; Female; Infertility, Female; Male; France; Infertility, Male; Gynecology; Obstetrics; Ovulation Induction; Reproductive Techniques, Assisted; Adult; Societies, Medical; Pregnancy; Obstetricians; Gynecologists
PubMed: 38311310
DOI: 10.1016/j.gofs.2024.01.014 -
Life (Basel, Switzerland) Dec 2023Atypical polypoid adenomyoma (APAM) is a rare polypoid benign tumor of the uterus that causes irregular vaginal bleeding in women of reproductive age. It has the...
Atypical polypoid adenomyoma (APAM) is a rare polypoid benign tumor of the uterus that causes irregular vaginal bleeding in women of reproductive age. It has the potential for malignant transformation, but it does not metastasize. APAM may coexist with endometrial hyperplasia and adenocarcinoma, usually leading to misdiagnosis. Histopathologically, it is a biphasic tumor, represented by the endometrioid glands with a complex histoarchitecture, with sometimes squamous morular metaplasia or cytologic atypia, interspersed with a fibromyomatous stroma. This tumor has a high incidence of recurrence. We present a very rare case of a 21-year-old patient, a virgin, without a significant medical history, with a bleeding mass occupying the vagina. The mass was excised using forceps, scissors, and a suture of the visible pedicle. After a four-year follow-up and no additional medical treatment, no relapse was observed. Given the risk of recurrence and progression, APAM might be treated via a hysterectomy in patients with no desire for pregnancy. Due to a lower recurrence rate, the conservative treatment of atypical polypoid adenomyoma performed via an operative hysteroscopy represents the best choice. Previously diagnosed in hysterectomy specimens, with the introduction of better-performing indirect imaging techniques, adenomyosis is a clinical entity that has the possibility of being diagnosed in the presurgical stage.
PubMed: 38137953
DOI: 10.3390/life13122352