Prevalence of uterine lesions associated with leiomyomas and role of endometrial biopsy in management

Background: Present study highlights association between symptomatic patients of fibroids and its coexistence with pathologies like endometriosis, adenomyosis, polyp, endometrial hyperplasia and carcinoma. The aim was evaluating role of endometrial biopsy before surgery.Methods: The study was observational cohort, conducted on women operated for fibroid or recently diagnosed with fibroid. 150 women were included. Histopathology reports of already operated were analysed for association between uterine pathology and fibroid. In prospective cases ultrasonography findings was noted and patients having leiomyoma underwent biopsy and reports studied for association. Chi-square test done to find association between qualitative variable and p value <0.05 considered significant.Results: Out of 150, 24.6% had adenomyosis, 14% had endometrial hyperplasia in which 2% had atypia and 12% without atypia, 8.6% had cervical polyp, 5.33% had endometrial polyp, 4% had endometriosis while 42.7% had no association.Conclusions: This study revealed increasing trend of coexistence of leiomyomas with uterine pathologies. Early identification of endometrial pathologies on clinical history and imaging helps in selection of high-risk patients who need biopsy to rule out malignancy thus avoiding routine D and C which is done for every case.

A rare case of extragonadal immature teratoma mimicking as subserosal pedunculated myoma

Immature teratomas are usually derived from a malignant transformation of mature teratoma. The pure immature teratoma accounts for less than 1% of all ovarian cancers. It is the second most common germ cell malignancy and accounts for 10-20% of all ovarian malignancies seen in women younger than 20 years of age. Extragonadal origin are extremely rare and the most common extragonadal site of these teratomas is the omentum. We hereby describe a case report of a 29-year-old lady who presented with abdominal pain and her imaging with an ultrasound revealed a mass with features suggestive of a subserosal fibroid. She underwent a laproscopic myomectomy. A histopathologic diagnosis of Immature teratoma was made following her primary surgery. She subsequently underwent a staging laparotomy which was followed by chemotherapy. Immature teratomas predominantly occur in young patients, and preservation of fertility is an important factor in its management. Treatment should be initiated as soon as possible after surgery, preferably within 7-10 days, in those patients who require chemotherapy.