Thick “Swiss Cheese” Appearance of Uterine Endometrium in Postmenopausal Women with Different Gynecologic Conditions

OBJECTIVES: To uncover gynecologic conditions with similar transvaginal sonographic findings of thick uterine endometrium with honeycomb appearance in pre-and postmenopausal women.METHODS: We retrospectively reviewed cases of patients with endometrial tissue biopsy from January 2010 to December 2016. We also collected office flexible hysteroscopic findings and surgical pathologic results. We analyzed data from 393 patients with confirmed endometrial pathology. Among these patients, 69 had transvaginal ultrasonographic images with thick uterine endometrium and honeycomb or “Swiss cheese” appearance.RESULTS: We found gynecologic conditions such as submucosal leiomyoma with degeneration, endometrial polyp, pseudocystic endometrial change associated with tamoxifen use, progesterone associated endometrial change, pyometra, retained placenta, and uterine synechiae manifested with similar thick endometrium with “Swiss cheese” appearance in transvaginal sonographic images. The most common diagnosis in postmenopausal women was atrophic endometritis, followed by endometrial cancer and endometrial polyps. The most common diagnosis in premenopausal women was abnormal uterine bleeding without pathologic conditions.CONCLUSIONS: Sonographic findings of thick uterine endometrium with “Swiss cheese” appearance need to be considered together with a thorough review of the patient's history and chief complaint before making a tentative diagnosis due to the various conditions sharing the feature.

Guideline for management of heavy menstrual bleeding / 대한산부인과학회지

Heavy menstrual bleeding (HMB) is a common problem in primary care clinic of gynecology. HMB could cause adverse effect on the quality of life of many women. This guideline will provide evidence based information concerning diagnosis and management of HMB. Constructive dialogue should allow patients to be able to trust the advice given by their practitioner as they will be confident that they have and will be able to use it to inform this decision-making process. This guideline has been developed with the aim of providing guidance on HMB. The effectiveness of the various treatments as well as their risks and benefits are discussed in relation to their use in the treatment of HMB. We wish the information contained in this guideline will help clinicians reach a reasonable and beneficial decision with the latest information.

A case of successful treatment of stroke with intracardiac thrombi in a patient with severe ovarian hyperstimulation syndrome / 대한산부인과학회지

Thromboembolism is a rare complication of ovarian hyperstimulation syndrom (OHSS). According to the numerous reports, it most commonly occurs in upper extremities, head, and neck vein. It is also well known that acute cerebral infarction, once occurred, is mainly caused by the occlusion of large arteries, especially middle cerebral artery (MCA) in most cases. Administration of heparin has been considered as the best treatment option, but many studies have been reporting successful treatment results from administrating thrombolytics in patients with cerebral infarction. Although administration of thrombolytics is invasive and has some potential side effects including bleeding or hematoma, it still has been used for treating patients with cerebral infarction. We report a case of patient with intracardiac thrombi and manifested symptoms of acute cerebral infarction originally caused by OHSS followed by the occlusion of MCA. We administered thrombolytics within one and half hours of showing left hemiparesis caused by the occlusion of right MCA, and identified reperfusion of MCA. There was no evidence of complications associated with the administration of thrombolytics on CT scan, which was taken 24 hours later. Thrombi in IVC, right atrium, and right ventricle were found on chest CT with pleural effusion, but soon were disappeared after administrating heparin anticoagulation. We report this case to show that thrombolytics and anticoagulation can be safely used to treat a patient with cerebral infarction and thrombi caused by OHSS without any side effects or complications.

A case of pulmonary endometriosis presenting with catamenial pneumothorax / 대한산부인과학회지

Endometriosis is a relatively common gynecologic disease. However thoracic endometriosis syndrome is exceedingly rare among various types of external endometriosis. We experienced a case of 35-year-old woman who presented with recurrent episodes of spontaneous right-sided pneumothorax that occurred during her menstrual periods. After the localization of the disease site by means of chest radiography and computed tomography of the thorax, a chest tube was inserted after which bullectomy and pleurodesis using doxycycline were performed. A hormonal treatment with gonadotropin-releasing hormone (GnRH) agonist for 12-months was also conducted. However, right-sided pneumothorax recurred two times after these procedures. Subsequently, surgical excision of diaphragmatic lesion along with pleurodesis was underwent. To prevent recurrence, we maintained long-term GnRH agonist administration with add back therapy using low dose estrogen-progesterone. Menstruation stopped, and the chest pain disappeared. During a 19-months follow-up period, pneumothorax did not recur. We report this case with a brief review of the concerned literatures.