Clinical Assessment Limitation in Extragastrointestinal Stromal Tumour of Rectovaginal Septum Diagnosis: A Case Report

@#Extragastrointestinal tumour of rectovaginal septum (rvGIST) is a rare malignancy that affects rectovaginal septum. We present a case of rvGIST that was initially managed as cervical eGIST based on clinical assessment. A 66-yearold woman presented with postmenopausal bleeding and constipation. Bimanual pelvic examination revealed an irregular mass occupying the vagina. CT thorax, abdomen and pelvis showed a 9.2 x 10.0 x 14.0 cm pelvic mass arising from cervix, extending superiorly to involve the uterus. The patient proceeded to undergo total abdominal hysterectomy, bilateral salpingo-oophorectomy, enucleation of rectovaginal septum mass, rectosigmoidectomy and permanent colostomy. Intraoperatively, there was a 9 x 7 cm mass arising from rectovaginal septum. Histopathological examination of surgical specimen revealed spindle cell tumour diffusely positive for CD34, CD117 and DOG1. The final diagnosis was rvGIST. In conclusion, the diagnosis of rvGIST require a combination of clinical assessment with intraoperative finding and histological assessment of the surgical specimen.

Diagnostic value of saline infusion sonohysterography for detecting endometrial lesion and comparing it with hysteroscopy and histopathology in postmenopausal bleeding

Background: Different diagnostic tools are available to evaluate endometrial lesion such as hysteroscopy, sonohysterography and transvaginal ultrasound. The present study aimed to determine the diagnostic value of saline infusion sonohystrography (SIS) in diagnosis of intrauterine lesions in women with postmenopausal bleeding (PMB).Methods: This cross-sectional study recruited 100 married women with chief complain of PMB referred to gynecologic clinics at the Zenana hospital, Jaipur from March 2019 to February 2020. All participants were in the post-menopausal period that showed abnormal endometrial thickness (>4 mm) or endometrial focal lesions through transvaginal ultrasound. Participants underwent SIS, hysteroscopy plus endometrial biopsy in order. The gold standard was the histopathology of endometrial specimen reported by pathologist.Results: Mean age of women was 57.14 years. It is evident that sensitivity, specificity, positive predictive value and negative predictive value of SIS for the diagnosis of endometrial atrophy was 79.16%, 100%, 100% and 83.87% respectively which is higher than that of hysteroscopy and equivalent to histopathology. SIS and hysteroscopy are equally efficient in diagnosing endometrial polyp and submucous fibroid. And are better than histopathology. Histopathology is better than SIS and hysteroscopy for the diagnosis of endometrial proliferation.Conclusions: Findings show that, SIS probably is a proper method for detecting endometrial focal lesion including polyps and myomas. Future studies may help to define further advantages of this procedure.

Evaluation of endometrial causes of postmenopausal bleeding with it's correlation with endometrial thickness and hysteroscopy findings and endometrial tissue histopathology

Background: Postmenopausal bleeding (PMB)accounts for 5% of gynecology visit. All with unexpected uterine bleeding should be evaluated for endometrial carcinoma since this potentially lethal disease is the cause of bleeding in approximately 10 percent patients (range 1 to 25 percent, depending upon risk factors). The aim of the study was to evaluate endometrial causes of postmenopausal bleeding (PMB) with it's correlation with endometrial thickness (ET)and hysteroscopy findings and endometrial tissue histopathology.Methods: A total 50 consecutive cases of PMB fulfilling the inclusion and exclusion criteria and giving informed consent were selected. Each patient was subjected to transvaginal sonography (TVS) in which uterus, adnexa and endometrial thickness (ET) was assessed. Then hysteroscopy and/or dilation and curettage was scheduled at subsequent visit. Endometrial sample was sent for histopathological examination. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy was calculated for ET by TVS and hysteroscopy findings, considering histopathological diagnosis as the gold standard.Results: Most common endometrial cause of PMB was atrophic endometrium (44%). The other causes were endometrial carcinoma (18%), endometrial hyperplasia (18%), endometrial polyp (12%), endometritis (4%), and leiomyoma (4%). The diagnostic accuracy of ET by TVS at a cut-off point of 5 mm was 94% with sensitivity 89.3%, specificity 100%, PPV 100% and NPV 88%. The diagnostic accuracy of hysteroscopy was 98% with sensitivity 96.4%, specificity 100%, PPV 100% and NPV 95.7%.Conclusions: Being relatively cheap, easily accessible, non-invasive, TVS with ET measurement should first line investigation in the evaluation of women with postmenopausal bleeding with suspected endometrial pathology. Although hysteroscopy is more specific and sensitive, in poor resource settings it should be limited to cases with ill-defined endometrial lining, recurrent/ persistent bleeding and cases with endometrial thickness greater than 5 mm irrespective of endometrial echotexture.

Correlation of clinical and ultrasonographic features with histopathology in post-menopausal bleeding

Background: Postmenopausal bleeding is generally regarded as an ominous alarm of genital pathologies which requires a thorough evaluation clinically and pathologically to exclude carcinoma as the cause and ensure a benign pathology. This study aims at finding out whether clinical diagnosis and ultrasonographic features can be reliable parameters for the diagnosis of causes and whether the findings correspond with histopathology reports.Methods: This observational study was conducted in a tertiary care centre in Pondicherry between January 2018 to August 2019. 114 women were enrolled for whom detailed history taking and clinical examination was done. All the patients were subjected to transvaginal ultrasonography. Patients with clinically visible lesions on cervix and vulva were subjected to biopsy and the rest underwent fractional curettage and the sample was sent for histopathological examination. Finally, histopathology report was compared with clinical and ultrasonographic findings.Results: With endometrial thickness cut off of 4 mm, the sensitivity, specificity, positive predictive value and negative predictive value in predicting malignancy by ultrasonography were 100%, 12.3%, 4.5% and 100%. Histopathology showed atrophic endometrium (43.8%), endometrial hyperplasia (8%), endometrial polyp (7.9%) and endometrial carcinoma (3%). Clinical and ultrasonographic findings did not show any statistical correlation with histopathology.Conclusions: Authors conclude that clinical findings and ultrasonographic features do not correlate with histopathology in cases of postmenopausal bleeding for which atrophic endometrium was the commonest etiology. However, ultrasound should be done routinely before endometrial sampling as the sensitivity for predicting malignancy was 100% for endometrial thickness cut off of 4 mm.

Evaluation of endometrial pathology in women with postmenopausal bleeding by saline infusion sonography and hysteroscopy

Background: Postmenopausal bleeding (PMB) is a common problem representing 5% of all gynaecological outpatient attendance. Objective of this study was to determine diagnostic performance of saline infusion sonography and hysteroscopy for evaluation of endometrial lesions in postmenopausal bleeding.Methods: Being a prospective cross-sectional study, the present study was conducted on 46 postmenopausal women with bleeding, admitted to department of obstetrics and gynecology VMMC and Safdarjang Hospital, New Delhi, India. After TVS, all patients with ET >4 mm underwent SIS and then scheduled for hysteroscopy when there was no active bleeding. Sensitivity, specificity, positive predictive value and negative predictive value were calculated to compare the diagnostic accuracy of SIS and hysteroscopy.Results: Most commonly found endometrial lesions were polyp (39.13%) and endometrial hyperplasia (28.26%) among our study population consisting of 46 postmenopausal women (mean age 56.72±6.6 years). Overall sensitivity rates were 86.84% for SIS and 97.37% for hysteroscopy, while the overall specificity rates were 50% for both SIS and hysteroscopy. Hysteroscopy had PPV and NPV of 90.24% and 80% respectively whereas PPV and NPV were 89.19% and 44.44% for SIS.Conclusions: As an easy to perform, safe and well tolerated procedure yielding high diagnostic accuracy, SIS seems to be comparable to hysteroscopy for endometrial evaluation.

A case of postmenopausal bleeding with an unusual finding

Authors report the case of a 55-year-old patient who presented with postmenopausal bleeding. On clinical evaluation uterus was 12 weeks size with a left sided adnexal cystic mass of 8 × 6 cm size. Further imaging studies revealed uterus size of 11.5 × 6.7 × 6.3 cm, left ovarian mass of size 8.4 × 6.7 × 6 cm and endometrial thickness of 17 mm on ultrasonography. She underwent endometrial biopsy to exclude endometrial cancer. The report of which came to be endometrial hyperplasia without atypia. Further MRI study confirmed the findings of USG of a complex cystic lesion of left adnexa 75 × 57 × 60 mm. Tumor marker for ovarian tumors were sent and inhibin B was found to be markedly raised. A provisional diagnosis of GCT (Granulosa cell tumour) was made and staging laparotomy was done. The uterus was found to be 12 × 8 cm size and a left sided ovarian cyst of 8-9 cm size with smooth wall and intact capsule was found. Patient had an uneventful postoperative recovery.

A rare case of steroid cell tumor of ovary: case report

Steroid cell tumors of the ovary account for less than 0.1% of all ovarian tumors. These tumors may present at any age with presentations related to the hormonal activity and virilizing properties of tumor. A 61-year-old postmenopausal women presented with complaints of postmenopausal bleeding for 15 days. Parity score of P3L3, not tubectomised. Menopaused 16 years back. History of weight loss noted. She is a known case of diabetes mellitus for 6 years not on any treatment and a known case of depressive disorder for 35 years on treatment on trihexphenidyl lurasidone. Had undergone sigmoid colon polyp removal in June 2018. On examination, P/A- mild gaseous distension (+). P/S- cervix flushed with vagina, pulled up cervix. P/V- uterus size and position couldn’t be made out, anterior fornix fullness (+). Ultrasonography showed bulky uterus with fibroid 4x4cm, endometrial thickness- 9 mm? Krukenberg tumor and posterior mediastinal lymph nodes. Patient underwent Total abdominal hysterectomy with bilateral salpingo-oophorectomy with frozen section on 01/07/19. Frozen section: 1. Ovaries: right ovary - fibrothecoma, left ovary- simple cyst. 2. Uterus- endometrial hyperplasia with atypia. 3. Myometrium- leiomyoma and adenomyosis. Postoperative period was uneventful. On microscopic examination, impression: right ovary- steroid cell tumor, uterus-endometrial hyperplasia with cytological atypia. Ovarian steroid cell tumors are grouped under sex chord stromal tumors and are usually benign, unilateral and characterized by a steroid cell proliferation. Steroid cell tumors are associated with androgenic changes with variable frequency, ranging from 12% to over 50% respectively. The primary treatment is surgical extirpation of the primary lesion and there are no reports of effective radiation or chemotherapy. In a young patient with stage IA disease, a unilateral salpingo oophorectomy is adequate.

A prospective study on the efficacy of Pipelle biopsy to diagnose endometrial pathology in patients with abnormal uterine bleeding

Background: Abnormal uterine bleeding is one of the most common problem encountered in gynaecology clinics. Assessment of endometrial pathology is recommended to rule out malignancy and premalignant conditions. Endometrial sampling can be done by Pipelle biopsy in outpatient units as well as by conventional dilatation and curettage in an operation theatre setup. Our study aims to find out the efficacy of office endometrial biopsy in terms of its sample adequacy, diagnostic accuracy and patient acceptability.Methods: 120 women presenting with abnormal uterine bleeding were included. A detailed history along with clinical examination findings are entered in the proforma. Ultrasound scan was done for all of them to identify pelvic pathology and endometrial thickness. Endometrial sampling was then done with Pipelle without anaesthesia. Histopathology reports are collected and sample adequacy and pattern were analysed. Patients are subsequently followed up for a period up to one year. Those who underwent hysterectomy are analysed for the endometrial pathology in hysterectomy specimen which is used as gold standard and compared with Pipelle endometrial sampling histopathology.Results: Sample adequacy for Pipelle biopsy was found to be 96%. Diagnostic accuracy for atypical hyperplasia and adenocarcinoma is 92.5% and 94% respectively. In hysterectomy specimens, carcinoma endometrium coexisted with atypical hyperplasia in 40% of cases with atypical hyperplasia in pipelle biopsy report.Conclusions: Thus, Pipelle endometrial biopsy is a cost-effective method for endometrial sampling except for focal lesions.

Fetal Doppler for prediction of adverse perinatal outcome in preeclampsia in a low resource setting

Background: Menopause is defined as the permanent cessation of menstruation resulting from loss of ovarian activity. Menopause normally occurs between the age of 45 to 50 years. The age of menopause varies with geographical, racial and nutritional factors. The objective of this study was to evaluate and to know the incidence of various cause of PMB.Methods: This was a prospective study of the patient with PMB attending the OPD or admitted for evaluation under Obstetrics and Gynecology department. Hi-Tech Medical College and Hospital, BBSR, Odisha from November 2016 to October 2018 who fulfilled the inclusion criteria with history clinical examination and investigation and informed consent from the patient. Data analyses will be done by appropriate statistical methods.Results: Maximum number of cases with PMB were found in age group 55-64 (52%). 57% of cases were malignant and rest 43% were benign origin. carcinoma cervix is most common  malignant lesion in 80% cases and atrophic endometrium is most common benign lesion (42%).Conclusions: In the present study the incidence malignancy causing PMB was 57% and benign cases was 43% Universal Screening of all PMB cases for genital tract malignancy is mandatory.

Hysteroscopy versus transvaginal ultrasonography: finding the better modality for evaluation of postmenopausal bleeding

Background: The most common cause of postmenopausal bleeding is benign pathology, but likelihood of malignancy must be promptly excluded. As excision of localized lesion has higher disease-free survival rate and lower morbidity as opposed to treatment for regional-stage disease. Commonly employed blind dilatation and curettage followed by histopathology is the current standard. A screening method with high sensitivity and specificity can help to prevent the invasive procedure and can also improve the accuracy of the biopsy. The objective of the present study was to study and compare the diagnostic accuracy of hysteroscopy and transvaginal ultrasonography in diagnosis of postmenopausal bleeding.Methods: 80 female patients with complaints of postmenopausal bleeding were enrolled and followed up for a period of 10 months. Each patient underwent transvaginal ultrasonography and hysteroscopy followed by endometrial biopsy. Result were analyzed to find sensitivity, specificity, accuracy, PPV and NPV taking histopathological diagnosis as gold standard.Results: Authors found that in 40 patients (50%), the cause of post-menopausal bleeding was caused atrophic endometrium followed by endometrial hyperplasia seen in 14 patients (17.5%). Hysteroscopy had higher overall sensitivity, specificity, NPV and accuracy as compared to transvaginal ultrasonography. Hysteroscopy was found to be highly accurate in diagnosing endometrial carcinoma (100%) and endometrial polyps (100%). However, both methods showed similar accuracy (97.5%) in diagnosis of proliferative endometrium and hyperplasia.Conclusions: Hysteroscopy is comparable to histopathology and superior to transvaginal sonography in the diagnosis of intrauterine causes for postmenopausal bleeding, it also offers the possibility of visualizing macroscopic or focal intra-uterine abnormalities.

Hysteroscopy: an effective tool in post-menopausal bleeding

Background: Postmenopausal bleeding is a condition where endometrial carcinoma is to be ruled out. Traditionally, D and C is the preferred method for diagnosis in such condition. Other diagnostic modalities like trans vaginal ultrasonography (TVS) and hysteroscopy are being used for diagnosis in the cases of PMB. The objective of this study is to evaluate the efficacy and accuracy of TVS and hysteroscopy in women with postmenopausal bleeding (PMB).Methods: One hundred postmenopausal women with vaginal bleeding underwent TVS and hysteroscopy. Endometrial tissue was obtained by curettage and sent for histopathology examination. The results of TVS and Hysteroscopy were compared against HP report.Results: Hysteroscopy was successful in 98 patients. Endometrial histopathology revealed proliferative, secretory and atrophic endometrium in 26, 7 and 23 patients respectively. Polyp was diagnosed in 13 patients. Endometrial hyperplasia was detected in 11 patients and endometrial malignancy in 14 patients. All patients with endometrial hyperplasia and malignancy had ET (endometrial thickness) more than 4 mm, except one patient with endometrial malignancy who had 4 mm ET. The sensitivity and specificity of TVS for suspecting endometrial pathology at ET 4mm were 93% and 69.6%, respectively. Hysteroscopy had sensitivity of 95.2%, specificity of 92.8%, with diagnostic accuracy of 93.8%.Conclusions: Hysteroscopy was found to be the more sensitive and specific than Transvaginal sonography for diagnosing endometrial pathologies. Hysteroscopy is safe and effective for detecting endometrial pathologies in patients with PMB.

Clinics in diagnostic imaging (199). Pyometra

A 92-year-old woman presented to the emergency department with urinary symptoms, fever and suprapubic tenderness. Her inflammatory markers were raised. Urine and blood cultures were negative. Computed tomography performed to look for a source of sepsis showed distension of the uterine cavity with high-attenuation fluid, an air-fluid level and gas locules along the uterine wall. The causes, clinical presentation and imaging features of pyometra are discussed.

Predictive value of three-dimensional energy ultrasound for endometrial cancer in women with postmenopausal bleeding / 西安交通大学学报(医学版)

Objective: To explore the predictive value of three-dimensional energy Doppler ultrasound for endometrial cancer (EC) in women with postmenopausal hemorrhage (PMB) so as to analyze the relationship between ovarian cyst and the risk of endometrial lesions. Methods: We selected 386 women with PMB diagnosed at The First Affiliated Hospital of Xi'an Jiaotong university from October 2015 to October 2018. The predictive value of endometrial thickness (ET), endometrial volume (EV), vascularization index (VI), flow index (FI) and vascularization flow index (VFI) for EC were analyzed according to the results of endometrial pathology. And the risk of endometrial lesions was compared between patients with ovarian cyst and those without ovarian cyst. Results: The pathological examination results of the 386 PMB women showed that normal endometrium accounted for 48.96%, benign endometrial lesions accounted for 40.93%, and EC accounted for 10.10%. ET, EV, VI, FI and VFI significantly differed between normal endometrial group, benign endometrial lesion group and EC group (P0.05). ET, EV, VI, FI and VFI in women with PMB accompanied with ovarian cyst were significantly higher (P<0.05); the prevalence of endometrial hyperplasia without atypia (EH) or atypical endometrial hyperplasia (AEH) was significantly higher than that of women without ovarian cyst (P<0.05). Conclusion: The predictive value of three-dimensional energy Doppler ultrasound for EC in women with PMB is better than that of endometrial thickness; among them FI has the highest predictive value. Ovarian cyst may increase the risk of endometrial lesions in women with PMB, which is worthy of attention in clinic.

Correlación entre hallazgos histeroscópicos y reportes histopatológicos en pacientes con sangrado uterino anormal / Correlation between hysteroscopic and histopathological reports in patients with abnormal uterine bleeding

Resumen OBJETIVO: determinar la sensibilidad, especificidad, valores predictivos positivos y negativos de la histeroscopia; evaluar su correlación con los reportes histopatológicos en pacientes con sangrado uterino anormal. MATERIALES Y MÉTODOS: estudio descriptivo y observacional, al que se incluyeron los registros de procedimientos histeroscópicos de pacientes con sangrado uterino anormal y posmenopáusico, atendidas en el Hospital Integral de la Mujer del Estado de Sonora (HIMES). Se clasificaron los hallazgos histeroscópicos e histopatológicos de las alteraciones endometriales. Para calcular la sensibilidad y especificidad de la histeroscopia las pacientes se agruparon en dos categorías: endometrio normal (mujeres sanas) y endometrio anormal (pacientes con pólipo endometrial, mioma submucoso, adenomiosis, hiperplasia endometrial, cáncer de endometrio, entre otras alteraciones). El análisis estadístico se realizó con el programa SPSS V. 22, para Windows 10.0. La sensibilidad y especificidad se calcularon con intervalos de confianza al 95%, para calcular el coeficiente de correlación se utilizó el método de Pearson. RESULTADOS: se registraron 400 pacientes, con media de edad de 45.2 (± 11.04) años; los diagnósticos más frecuentes fueron los pólipos (26%) y el cáncer endometrial (8%). Se registró una sensibilidad de 0.95 (IC95%: 0.93-0.97) y especificidad de 0.85 (IC95%: 0.82-0.89) para la histeroscopia. Para la detección de las causas de sangrado uterino anormal por histeroscopia se registró un valor predictivo positivo de 0.97 (IC95%: 0.95-0.98) y negativo de 0.79% (IC95%: 0.75-0.83). La correlación entre histopatología e histeroscopia fue de 77.8% (Pearson; p = 0.000), cuando el diagnóstico se establece como endometrio normal o anormal. CONCLUSIÓN: la histeroscopia es una técnica con elevada sensibilidad y especificidad para establecer el diagnóstico de alteraciones endometriales benignas y malignas; además, se observó excelente correlación entre los hallazgos histeroscópicos y los resultados histopatológicos.

Abstract OBJECTIVE: To determine the sensitivity and specificity, predictive value positive and negative and estimate the correlation coefficient between hysteroscopy and endometrial histopathological outcomes in patients with abnormal uterine bleeding. MATERIALS AND METHODS: Descriptive, observational, a series of consecutive cases was performed at the Hysteroscopy Clinic of the "Hospital Integral de la Mujer del Estado de Sonora" were included with abnormal uterine bleeding. The hysteroscopy and histopathological findings of the endometrial alterations were classified. In order to calculate the sensitivity and specificity of the hysteroscopy, the patients were grouped into two categories: normal endometrium (healthy women) and abnormal endometrium (patients with endometrial polyp, submucous myoma, adenomyosis, endometrial hyperplasia, endometrial cancer, among other alterations). Statistical analysis was performed using the SPSS program V. 22, for Windows 10.0; the sensitivity and specificity was calculated with 95% confidence intervals, the correlation coefficient was estimated by Pearson method. RESULTS: We registered 400 patients; the average age was 45.2 (±11.04). The most frequent diagnosis by hysteroscopy and histopathological was endometrial polyp. The sensitivity was 0.95 (95%CI = 0.93-0.97) and specificity of 0.85 (95%CI = 0.82-0.89) as cause of abnormal uterine bleeding by hysteroscopy, the positive predictive value was 0.97 95%CI = 95-98) and negative predictive value of 0.79%. (CI95% = 0.75-0.83). The Pearson correlation coefficient was 77.8% (p = 0.000) between hysteroscopy impression and histopathology diagnosis, when the result was classified as normal or abnormal. CONCLUSION: Hysteroscopy is a high sensitivity and specificity technique to diagnosis of benign and malignant endometrial alterations; in addition, an excellent correlation was observed between the hysteroscopy findings and the histopathological findings.

Common Causes of Postmenopausal Bleeding in Korean Women: 10-Year Outcomes from a Single Medical Center

The common causes of postmenopausal bleeding (PMB), according to the data from the western world, are atrophy, hormone replacement therapy (HRT), endometrial cancer, etc. We conducted a retrospective study to assess whether the causes of PMB in Korean postmenopausal women are similar to those already known. This retrospective study used 10-year medical records (March 2005 to December 2014) of 792 PMB women in the Yonsei University Health System. The data were divided into 2 categories by 5-year intervals to compare the differences between the 2 periods. The most common cause of PMB in Korean women was atrophy (51.1%). Polyps and HRT were the second, followed by anticoagulant medications, cervical cancer, and endometrial cancer. The proportion of patients with cervical cancer significantly decreased during the second half of the decade (8.7% vs. 5.2%; P = 0.048). Although no significant change was noted for HRT, its rank was higher during the latter 5-year period. Only the most common cause of PMB was the same as the conventional data. Interestingly, the proportion of patients with cervical cancer decreased during the latter half of the decade, reflecting the changes in the nation's cancer prevalence rate, while the use of HRT increased.

Role of Three-Dimensional Ultrasound and Three-Dimensional Doppler in Imaging of Endometrium for Diagnosis of Bleeding in Women with Post-Menopausal Bleeding.

Objective: To determine whether the Three-Dimensional Ultrasound and Three Dimensional Doppler have a role in detection of Endometrial lesions in woman with post menopausal bleeding. Methods: 36 woman in Zagazig University Obstetrics and Gynaecology Department outpatient clinics were recruited. Three-Dimensional Ultrasound and Doppler were done. Then after one week endometrial sampling was done & histological diagnosis was made. After tabulation, all data were analyzed using statistical procedures were carried with SPSS software. Result: Twenty four patients were negative for atypia or cancer and Twelve patients were positive for atypia or cancer. Mean age was 58.1 years in benign endometrium and 62.2 year in malignant endometrium (p=0.1). The mean BMI was 24 in benign and 31.75 in malignant endometrium (p<0.001). Mean endometrial thickness was 11.1 m.m in benign and 26 mm in malignant endometrium (p<0.001). The mean endometrial Volume was 5.6 cc in benign and 54.8cc in malignant endometrium (p<0.001). The VI was 2.24%and 19.5% in the two groups respectively (p<0.001). The FI was 6.7 and 27.2 in two groups respectively (p<0.001). The VFI was 3.3 and 11.5 in two groups respectively (p<0.001). In this study using endometrial volume, vascularization index percent (VI) %, flow index (FI) and vascularization-flow index (VFI) rather than endometrial thickness provided a greater sensitivity for predicting atypia or malignancy. Conclusion: The Three-Dimensional Ultrasound scanning of endometrial volume (3D-US) and Three-Dimensional Doppler Angiography (3D-DA) of the Vascular Indices (vascularization index percent, flow index, and vascularization-flow index), might predict endometrial cancer in women with postmenopausal bleeding and thickened endometrium at baseline ultrasound scanning.

Logistic regression analysis of risk factors in postmenopausal vaginal bleeding complicating cervical cancer / 重庆医学

Objective To analyze the risk factors of postmenopausal vaginal bleeding complicating cervical cancer .Methods Totally 43 cases of postmenopausal vaginal bleeding complicating cervical cancer were selected as the observation group ,while 52 cases of postmenopausal vaginal bleeding complicating non‐organic lesions and benign lesions were selected as the control group . Through the medical records and self‐developed questionnaire ,the risk factors of postmenopausal vaginal bleeding complicating cer‐vical cancer were investigated .Results There were no statistically significant differences in age of menopause ,age of IUD place‐ment ,usage of postmenopausal estrogen drugs ,smoking history ,complicating hypertension between the two groups (t= 0 .674 , 1 .156 ,χ2 =0 .283 ,0 .425 ,0 .281 ,P>0 .05);while the years of menopause to vaginal bleeding occurrence ,endometrial thickness and duration of vaginal bleeding in the observation group were more than those in the control group ,the differences were statistically significant (t=6 .717 ,5 .000 ,10 .754 ,P< 0 .05) .The univariate and multivariate Logistic regression analysis results showed that the risk factors of postmenopausal vaginal bleeding complicating cervical cancer were the years of menopause to bleeding ,endometri‐al thickness and duration of vaginal bleeding (P<0 .05) .Conclusion For the patients with postmenopausal bleeding ,the risk of complicating cervical cancer should be considered ,especially the years of menopause to bleeding ,endometrial thickness and duration of vaginal bleeding .

Transvaginal Sonography versus Histopathology in Postmenopausal Bleeding: A Prospective Study.

We compared Transvaginal Sonography (TVS) with histopathological results of the dilatation and curettage biopsies in 50 women with postmenopausal bleeding attending Gynaecology out-patient department of SMGS hospital, Jammu. These women underwent TVS followed by histopathological examination of endometrium. Endometrial lesions detected by histopathology in these women were: hormonal effects (proliferative and secretary endometrium) in 5 (10%), endometrial polyps in 4 (8%), endometritis in 2 (4%), endometrial hyperplasia in 9 (18%) and endometrial carcinoma in 5 (10%). A total of 21 (42%) showed atrophic endometrium and in 4 (8%) women, sample was insufficient. On TVS, 24 (48%) women had endometrial thickness (ET) < 5 mm and 26 (52%) women had ET > 5 mm. At a cut-off limit of > 5 mm for endometrial thickness indicating pathologic endometrium, the sensitivity and specificity of TVS was 100% and 80% respectively and a predictive value as a positive test, as a negative test and accuracy was 76.9%, 100% and 89% respectively. This study shows that TVS allows detection of endometrial pathology in vast majority of women and it is relatively easy, cheap, non-invasive and does not require anesthesia. It can be used as the first diagnostic step in the investigations of women with postmenopausal bleeding.

Adenocarcinoma de endometrio de patrón sertoliforme / Sertoliform carcinoma of the endometrium

Se presenta el caso de una paciente que consultó por metrorragia posmenopaúsica. En la biopsia histeroscópica dirigida se informó de adenocarcinoma de endometrio endometrioide bien diferenciado. Se practicó histerectomía, doble anexectomía y lavados peritoneales. Durante el acto quirúrgico se valoró el grado de infiltración miometrial, que al revelar afectación del útero hasta la serosa, implicó la realización de linfadenectomía de espacios pélvicos y paraaórtico. El diagnóstico definitivo anatomopatológico fue de adenocarcinoma de endometrio tipo endometrioide de patrón sertoliforme moderadamente diferenciado. El estadío FIGO fue IIIA, por lo que se indicó quimioterapia y radioterapia como tratamiento adyuvante. A los 2 años la paciente presenta recidiva ganglionar y metástasis pulmonares con progresión a pesar del tratamiento quimioterápico, por lo que finalmente fallece.

We report a case of a patient with postmenopausal bleeding. In hysteroscopic directed biopsy was reported endometrioid endometrial adenocarcinoma well differentiated, so that she underwent total hysterectomy, both salpingo-oophorectomy and peritoneal washings. In the surgery, we evaluated the miometrial infiltration, with report invasion until serosa, so we practised pelvic and paraaortic lymphadenectomy. The pathologic diagnosis was sertoliform endometrioid carcinoma of the endometrium with moderate differentiation. The FIGO stage was IIIA, and we indicated chemotherapy and radiotherapy. Two year after, the patient presented nodal recurrence and lung metastases with no response to the chemotherapy drugs, so she dies.

Uterine Sex Cord Tumour- Management Dilemma

Uterine sex cord tumour is a very rare tumour with uncertain management strategies and prognosis. A 61-year-old, nulliparous, who was not on hormone replacement therapy, presented with first episode of postmenopausal bleeding. A transvaginal scan revealed an enlarged uterus with thick endometrial lining and features of multiple degenerated fibroid. Endometrial biopsy was negative for malignancy. Computed tomography of the abdomen and pelvis confirmed the mass, with atrophic ovaries and incidental finding of bilateral hydronephrosis requiring stentings. Otherwise, there were no pelvic lymph nodes enlargement. Our impression was a uterine sarcoma and we decided for total abdominal hysterectomy with bilateral salpingooophorectomy. Surprisingly, the histology report confirmed uterine sex cord tumour. There are less cases of recurrence and there is no general consensus on the management. However, we decided for adjuvant chemotherapy (BEP regime) as the malignant cells infiltrated more than half of myometrial thickness, with good outcome.