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ABSTRACT Introduction: breast cancer is the cancer with the highest incidence in women in Brazil, representing 29.7% of all cancers. More than two thirds of women with breast cancer show expression for hormone receptors, and in these cases, hormone therapy with tamoxifen is indicated, which may represent a risk factor for the development of endometrial cancer (four-fold greater relative risk). Objective: this study aimed to evaluate the association of tamoxifen and the development of endometrial disturbances and to assess possible other associated risk factors. Patients and method: a total of 364 breast cancer patients were evaluated, 286 who used tamoxifen and 78 who did not use this hormone therapy. Results: patients who used tamoxifen had a mean follow-up time of 51.42 months similar to those without hormone therapy (p=0.081). A total of 21 (7.3%) women who used tamofixen and no cases among women without hormone therapy presented endometrial changes during follow-up (p=0.01). Despite information regarding obesity was available for only 270 women, obesity was also significantly associated with the development of endometrial changes (p=0.008). Conclusion: furthermore, the association between tamofixen and endometrial changes remained significant (p=0.039) after adjusting for obesity.
RESUMO Introdução: o câncer da mama é o câncer de maior incidência no sexo feminino no Brasil, representando 29,7% de todos os cânceres. Mais de dois terços das mulheres com câncer da mama apresentam expressão para receptores hormonais, estando, nestes casos, indicada a terapia hormonal com tamoxifeno, que pode representar fator de risco para o desenvolvimento do câncer do endométrio (risco relativo quatro vezes maior). Objetivo: este trabalho teve como objetivo avaliar a associação entre o uso de tamoxifeno e o desenvolvimento de distúrbios endometriais bem como eventuais outros fatores associados. Pacientes e método: Estudo de coorte retrospectivo de 364 pacientes com câncer da mama, das quais 286 utilizaram tamoxifeno e 78 não utilizaram esta hormonioterapia. Resultados: pacientes que usaram tamoxifeno tiveram um seguimento médio de 51,42 meses, semelhante àquelas sem terapia hormonal (p=0,081). Um total de 21 (7,3%) mulheres que usaram tamofixeno e nenhuma mulher sem terapia hormonal apresentaram alterações endometriais durante o seguimento (p=0,01). Nas 270 mulheres que tinham informação sobre obesidade, esta se associou significantemente com o desenvolvimento de alterações endometriais (p=0,008). A associação entre tamofixeno e alterações endometriais permaneceu significante (p=0,039) após ajustar para interação com obesidade. Conclusão: o uso de tamoxifeno no tratamento do câncer da mama esteve associado ao maior risco para desenvolvimento de alterações endometriais especialmente quando associado à obesidade.
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Resumen ANTECEDENTES: Los leiomiomas son neoplasias benignas comunes durante la edad reproductiva. Su aparición en adolescentes es excepcional y un reto diagnóstico en menores de 18 años de edad. El caso aquí reportado se integra a los 26 casos asentados en la bibliografía y se trata del tumor más grande en la paciente más joven hasta ahora comunicado. CASO CLÍNICO: Paciente de 14 años, con inicio de sangrado uterino anormal, aumento del perímetro abdominal y tres semanas con hipermenorrea. El reporte inicial de la química sanguínea informó: anemia severa y el ultrasonido pélvico: un gran tumor anexial sólido. Luego de mejorar las condiciones hemodinámicas de la paciente por medio de transfusiones de concentrados eritrocitarios se practicó una laparotomía exploradora y se extirpó un leiomioma gigante, dependiente del útero. El informe histopatológico fue de: leiomioma de 16 cm de diámetro, con degeneración roja. La paciente cursó sin complicaciones posquirúrgicas y hasta la actualidad no ha experimentado datos de recurrencia ni sangrado uterino anormal. CONCLUSIÓN: La fisiopatología de la miomatosis uterina sigue aún sin comprenderse del todo. El tratamiento quirúrgico a una edad temprana debe tomar en consideración el deseo de embarazo y llevar a cabo un seguimiento estrecho para valorar: la fertilidad, recurrencia, atipia celular y trastornos menstruales.
Abstract BACKGROUND: Leiomyomas are common benign neoplasms during reproductive age. Its appearance in adolescents is exceptional and a diagnostic challenge in children under 18 years of age. The case reported here is one of the 26 cases reported in the bibliography and it is the largest tumor reported in the youngest patient to date. CLINICAL CASE: A 14-year-old patient with onset of abnormal uterine bleeding, increased abdominal circumference and three weeks with hypermenorrhea. Initial blood chemistry report: severe anemia and pelvic ultrasound: a large solid adnexal tumor. After improving the patient's hemodynamic conditions through transfusions of erythrocyte concentrates, an exploratory laparotomy was performed and a giant leiomyoma, dependent on the uterus, was removed. The histopathological report was: leiomyoma of 16 cm in diameter, with red degeneration. The patient had no postoperative complications and to date she has not experienced recurrence or abnormal uterine bleeding. CONCLUSION: The pathophysiology of uterine fibroids remains poorly understood. Surgical treatment at an early age should take into account the desire for pregnancy and carry out a close follow-up to assess: fertility, recurrence, cellular atypia and menstrual disorders.
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Objective:To investigate the clinical efficacy of total laparoscopic hysterectomy in the treatment of benign uterine diseases.Methods:Fifty patients who underwent hysterectomy because of benign uterine diseases in Huainan Maternal and Child Health Care Hospital from January 2019 to December 2020 were included in this study. They were randomly assigned to undergo either total laparoscopic hysterectomy (TLH group, n = 25) or conventional open surgery (COS group, n = 25). Amount of blood loss, operative time, postoperative time to first anal exhaust, intraoperative and postoperative complications, length of hospital stay were compared between the TLH and COS groups. Results:Operative time, postoperative time to first anal exhaust, length of hospital stay in the TLH group were (98.2 ± 19.3) minutes, (19.7 ± 3.9) minutes, and (9.2 ± 2.2) days, respectively, which were significantly shorter than those in the COS group [(125.0 ± 44.5) minutes, (44.9 ± 6.0) minutes and (10.9 ± 2.8) days, t = 2.757, 17.369 and 2.394, all P < 0.05]. The amount of blood loss in the TLH group was significantly less than that in the COS group [(61.6 ± 3.9) mL vs. (266.0 ± 31.2) mL, t = 3.259, P < 0.05]. There were no significant differences in intraoperative and postoperative complications between the two groups (both P > 0.05). Conclusion:Total laparoscopic hysterectomy for the treatment of benign uterine diseases has advantages including minimal invasion, rapid postoperative recovery, and controllable operation difficulty.
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Objective:To investigate the efficacy of transumbilical laparoendoscopic single-site supracervical hysterectomy in the treatment of benign uterine diseases.Methods:The clinical data of 39 patients with benign uterine diseases with the volume of uterus less than that at the 14 weeks of pregnancy who underwent supracervical hysterectomy in People's Hospital of Hechuan District of Chongqing, China between January 2018 and December 2019 were retrospectively analyzed. These patients were divided into transumbilical laparoendoscopic single-site supracervical hysterectomy group (single-site group, n = 21) and transumbilical laparoendoscopic multiple-site supracervical hysterectomy group (multiple-site group, n = 18) according to different surgical approaches. Operation time, specimen removal time, intraoperative blood loss, incision suture time, tissue debris shedding rate, postoperative off-bed time, length of hospital stay, pain score on postoperative day 1, time to anal exhaust, and the incidence of complications within 30 days after surgery were compared between the two groups. Results:Tissue debris shedding rate in the single-site group was significantly lower than that in the multiple-site group [0.00% (0/21) vs. 100.00% (18/18), χ2 = 39.00, P < 0.001]. Operation time in the single-site group was significantly longer than that in the multiple-site group [(74.20 ± 9.15) minutes vs. (62.90 ± 6.20) minutes, t = 3.323, P < 0.05). Specimen removal time and incision suture time in the single-site group were (11.10 ± 2.33) minutes and (3.90 ± 0.88) minutes, respectively, which were significantly longer than those in the multiple-site group [(4.90 ± 0.88) minutes, (2.90 ± 0.74) minutes, t = 7.97, 0.386, both P < 0.05]. There were no significant differences in intraoperative blood loss, postoperative off-bed time, pain score on postoperative day 1, length of hospital stay, time to anal exhaust, and the incidence of complications within 30 days after surgery between the two groups (all P > 0.05). Conclusion:Transumbilical laparoendoscopic single-site and multiple-site supracervical hysterectomy can acquire similar short-term surgical outcomes in the treatment of benign uterine diseases at the time of less than 14 weeks of pregnancy and transumbilical laparoendoscopic single-site supracervical hysterectomy can eliminate the long-term complications caused by tissue dissemination.
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Uterine tumors resembling ovarian sex-cord tumors (UTROSCT) are very rare tumors that occur mainly in the uterine fundus of women in reproductive age. These tumors can be classified into group 1 and group 2 by histological results. In group 1, epithelial-like differentiation is partially observed in the tumors. In group 2, sex-cord elements are predominant in uterine mural mass. We experienced UTROSCT group 1 in a 29-year-old woman who complained of severe abdominal pain that started one week after delivery and UTROSCT group 2 case in a 49-year-old woman who complained of dysfunctional uterine bleeding. We report two different types of UTROSCT cases that we experienced.
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Adult , Female , Humans , Middle Aged , Abdominal Pain , Metrorrhagia , Sex Cord-Gonadal Stromal Tumors , Uterine Diseases , Uterine NeoplasmsABSTRACT
Objective@#To investigate the effect of three-dimensional ultrasound in the diagnosis of uterine abnormalities.@*Methods@#From January 2017 to December 2017, 50 patients with uterine abnormalities admitted to the Maternal and Child Health Care Hospital of Cixi were selected.GE Voluson E8 high-resolution color Doppler ultrasound system were used for all patients to conduct two-dimensional ultrasound and three-dimensional ultrasound examinations.The results of the two methods, including the time taken for the inspection and the correctness of the inspection were compared.@*Results@#The time used for three-dimensional ultrasonic testing[(2.39±0.25)min] and the accuracy of inspection (100%) were better than two-dimensional ultrasonic testing[(5.77±0.66)min, 80%], the differences were statistically significant (t=33.864, χ2=11.111, all P<0.05).@*Conclusion@#Three-dimensional ultrasonography can accurately present the external contour of the uterus and the shape of the intima.The abnormal uterus can be timely discovered.At the same time, it has advantages of non-invasive and safe.
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Objective To investigate the effect of three -dimensional ultrasound in the diagnosis of uterine abnormalities.Methods From January2017 toDecember 2017,50 patients with uterineabnormalities admitted to the Maternal and Child Health Care Hospital of Cixi were selected .GE Voluson E8 high -resolution color Doppler ultrasound system were used for all patients to conduct two -dimensional ultrasound and three-dimensional ultrasound examinations.The results of the two methods ,including the time taken for the inspection and the correctness of the inspection were compared.Results The time used for three -dimensional ultrasonic testing[(2.39 ±0.25)min] and the accuracy of inspection (100％) were better than two -dimensional ultrasonic testing[(5.77 ±0.66)min, 80％],the differences were statistically significant (t=33.864,χ2 =11.111,all P <0.05).Conclusion Three -dimensional ultrasonography can accurately present the external contour of the uterus and the shape of the intima .The abnormal uterus can be timely discovered.At the same time,it has advantages of non -invasive and safe.
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Resumen OBJETIVO: Comunicar la nueva terminología del sangrado uterino anormal y de la clasificación PALM COEIN. MÉTODO: Búsqueda bibliográfica de artículos publicados en inglés o español con la palabra clave PALM COEIN. Desde el primer artículo publicado en 2010 hasta 2018 en las bases de datos MedLine, PubMed, Embase y Ovid. RESULTADOS: Se reunieron 64 artículos, pero solo 18 mencionaban el término, 24 eran repetidos. Se seleccionaron 22 que trataban el tema en estudio y eran referidos con la clasificación actual, de esos trabajos 6 eran de cohorte, 2 de revisión sistemática, 2 boletines y 12 revisiones de tema. CONCLUSIÓN: Esta nueva terminología facilitará el entendimiento y la comunicación, independiente del idioma y la cultura, además del acercamiento más entendible con nuestras pacientes. La clasificación PALM COEIN facilita la investigación epidemiológica, etiológica y el tratamiento de las pacientes con sangrado uterino anormal.
Abstract OBJECTIVE: To update the new terminology of abnormal uterine bleeding and the PALM COEIN classification METHOD: Bibliographic search of articles published in English or Spanish with the keyword PALM COEIN. From the first article published in 2010 to 2018 in the MedLine, PubMed, Embase and Ovid databases. RESULTS: 64 articles were collected, but only 18 mentioned the term, 24 were repeated. 22 were selected that dealt with the subject under study and were referred to with the current classification, of these works 6 were cohort, 2 systematic review, 2 newsletters and 12 theme reviews. CONCLUSION: This new terminology will facilitate understanding and communication, independent of language and culture, in addition to the most understandable approach with our patients. This classification of PALM COEIN facilitates the epidemiological, etiological investigation and treatment of patients with abnormal uterine bleeding.
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SUMMARY Uterine inversion is an uncommon complication of the puerperium and it is an even rarer complication of the non-puerperal period. In this way, uterine inversions are classified into two groups, being of puerperal origin due to obstetric problems and non-puerperal origin due to gynecological problems. In general, a non-puerperal uterine inversion occurs as a possible complication of a sub mucosal leiomyoma, after an expansive process, a dilation of the cervix occurs and thus its protuberance over the vaginal canal.
RESUMO A inversão uterina é uma complicação incomum do puerpério e é uma complicação ainda mais rara do período não puerperal. Dessa forma, as inversões uterinas são classificadas em dois grupos, sendo as de origem puerperal decorrentes de problemas obstétricos e as inversões de origem não puerperal decorrentes de problemas ginecológicos. Em geral, a inversão uterina não puerperal decorre como uma possível complicação de um leiomioma submucoso — após o processo expansivo, ocorre a dilatação do colo uterino e, dessa forma, a sua protusão sobre o canal vaginal.
Subject(s)
Humans , Female , Uterine Neoplasms/complications , Uterine Inversion/etiology , Leiomyoma/complications , Uterine Neoplasms/surgery , Uterine Neoplasms/diagnostic imaging , Treatment Outcome , Uterine Inversion/surgery , Uterine Inversion/diagnostic imaging , Leiomyoma/surgery , Leiomyoma/diagnostic imaging , Middle AgedABSTRACT
Objective@#To study influencing factors which cause the endometrial diseases in patients with breast cancer after operation.@*Methods@#A retrospective study was performed on 212 breast cancer post-operation patients with endometrial diseases between June 2006 and January 2018 in Women’s Hospital School of Medicine Zhejiang University to analyse the factors which influenced the endometrial diseases.@*Results@#The abnormal uterine bleeding and endometrial thickness were related to the severity of endometrial disease in patients with breast cancer, and they were independent risk factors for breast cancer patients to have endometrial cancer (P<0.05) . When the diagnostic cut off value of endometrial thickness was ≥0.49 cm, the sensitivity and specificity to endometrial cancer were 78% and 25%, respectively. The average endometrial thickness was (0.56±0.39) cm in patients who were treated by selective estrogen receptor modulator (SERM) after gynecological surgery, which was significantly thicker than that of aromatase inhibitor (AI) group [ (0.33±0.23) cm] and no treatment group [ (0.44±0.28) cm, P<0.05]. The endometrial disease recurrent rate and reoperation rate in SERM group were (26.2%, 14.3%) slightly higher than that of AI group (9.5%, 4.8%) and no treatment group (21.6%, 4.9%), but there were not significant differences (all P>0.05).@*Conclusions@#The clinical symptom of abnormal uterine bleeding and thickening endometrium are risk factors for breast cancer patients to have endometrial cancer. The endometrial thickness has high predictive value for breast cancer patients to diagnose endometrial cancer. The SERM treatment increases the endometrial thickness, recurrent rate and reoperation rate in post-operation patients.
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Objective To study influencing factors which cause the endometrial diseases in patients with breast cancer after operation. Methods A retrospective study was performed on 212 breast cancer post-operation patients with endometrial diseases between June 2006 and January 2018 in Women's Hospital School of Medicine Zhejiang University to analyse the factors which influenced the endometrial diseases. Results The abnormal uterine bleeding and endometrial thickness were related to the severity of endometrial disease in patients with breast cancer, and they were independent risk factors for breast cancer patients to have endometrial cancer (P<0.05). When the diagnostic cut off value of endometrial thickness was ≥0.49 cm, the sensitivity and specificity to endometrial cancer were 78% and 25%, respectively. The average endometrial thickness was (0.56 ± 0.39) cm in patients who were treated by selective estrogen receptor modulator (SERM) after gynecological surgery, which was significantly thicker than that of aromatase inhibitor (AI) group [(0.33 ± 0.23) cm] and no treatment group [(0.44 ± 0.28) cm, P<0.05]. The endometrial disease recurrent rate and reoperation rate in SERM group were (26.2%, 14.3%) slightly higher than that of AI group (9.5%, 4.8%) and no treatment group (21.6%, 4.9%), but there were not significant differences (all P>0.05). Conclusions The clinical symptom of abnormal uterine bleeding and thickening endometrium are risk factors for breast cancer patients to have endometrial cancer. The endometrial thickness has high predictive value for breast cancer patients to diagnose endometrial cancer. The SERM treatment increases the endometrial thickness, recurrent rate and reoperation rate in post-operation patients.
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ABSTRACT Objective: To evaluate the best surgical approach for the female urinary incontinence. Methods: Systematic review conducted in MEDLINE® Cochrane, EMBASE and LILACS database up to September 1st, 2017. Articles were selected according to study type, type of intervention and outcomes. Articles were selected by more than one researcher based on title, abstract and full text. The SIGN checklist was used for bias assessment. Results: A total of 165 articles were retrieved from MEDLINE® . Twenty-five studies were elected for full text reading, and 11 of them were selected for the final text analysis. The heterogeneity between questionnaires used in different studies precluded a meta-analysis of results. Conclusion: This study yielded evidences supporting the hypothesis that total and subtotal hysterectomy have different impacts on urinary function of patients with benign uterine diseases. Articles revealed higher frequency of urinary incontinence following subtotal compared to total hysterectomy.
RESUMO Objetivo: Avaliar qual a melhor conduta cirúrgica na incontinência urinária feminina. Métodos: Revisão sistemática conduzida no MEDLINE®, Cochrane, EMBASE e LILACS até 1º de setembro de 2017. Os artigos foram escolhidos de acordo com o tipo de estudo e de intervenção, e seus resultados. Os artigos foram selecionados por mais de um pesquisador, com base no título, no resumo e no texto completo. O checklist SIGN foi usado para avaliar vieses. Resultados: No MEDLINE®, foram recuperados 165 artigos. Foram escolhidos 25 estudos para leitura do texto completo, e somente 11 foram escolhidos para análise do texto final. Não foi realizada metanálise dos resultados devido à heterogeneidade dos questionários usados em cada estudo. Conclusão: Encontrou-se evidência que suporta a hipótese de que as histerectomias total e subtotal causam impactos diferentes na função urinária de pacientes com doença uterina benigna. Os artigos mostraram maior frequência de incontinência urinária após histerectomia subtotal quando comparada à total.
Subject(s)
Humans , Female , Postoperative Complications , Urinary Incontinence/etiology , Hysterectomy/adverse effects , Hysterectomy, Vaginal/adverse effects , Time Factors , Uterine Diseases/surgery , Randomized Controlled Trials as Topic , Surveys and QuestionnairesABSTRACT
Resumen OBJETIVO: Revisar la bibliografía de la prevalencia, factores de riesgo, síntomas, diagnósticos y tratamiento de las pacientes con istmocele. MÉTODO: Búsqueda electrónica en las bases de datos: PubMed, EMBASE y Google Scholar. Se utilizaron los siguientes términos, palabras y sus combinaciones: "Cesarean section defect, uterine niche, isthmocele, uterine sacculation, uterine diverticulum, uterine pouch, isthmocele diagnosis, segmentocele y isthmocele treatment". La variable primaria estudiada fueron los síntomas asociados con el istmocele. Las variables secundarias: prevalencia, factores de riesgo, diagnóstico y tratamiento. RESULTADOS: Se reunieron 549 artículos de los que se eliminaron 288 por duplicidad y 228 no cumplieron los criterios de inclusión; al final solo se analizaron 33 artículos. El istmocele tiene una prevalencia de 15 a 84% en mujeres con antecedente de cesárea. Su incidencia se correlaciona directamente con la cantidad de cesáreas previas. Su aparición puede ser sintomática o asintomática. La manifestación clínica más común es el sangrado uterino anormal, que sucede en 28.9 a 82% de los casos. Incluso 88% se diagnostican en el ultrasonido transvaginal. La histeroscopia quirúrgica se asoció con disminución de los síntomas en 56.9 a 100%. CONCLUSIONES: El istmocele suele identificarse de manera fortuita en el ultrasonido transvaginal y casi siempre es asintomático. Puede ocasionar sangrado uterino anormal e infertilidad secundaria. Su prevalencia depende del método diagnóstico utilizado. La histeroscopia es el método de tratamiento más efectivo.
Abstract OBJECTIVE: Review the literature on the prevalence, risk factors, symptoms, diagnoses and treatment of patients with isthmocele. METHOD: An electronic search was performed using the following databases: PubMed, EMBASE and Google Scholar. The following terms, words and their combinations were used: "Cesarean section defect, uterine niche, isthmocele, uterine sacculation, uterine diverticulum, uterine pouch, isthmocele diagnosis, segmentocele y isthmocele treatment". The primary outcome was the symptoms associated with a cesarean scar defect. The secondary outcomes were prevalence, risk factors, diagnosis and treatment of istomocele. RESULTS: 549 articles were collected, of which 288 were eliminated due to duplication and 228 did not meet the inclusion criteria; In the end, only 33 articles were analyzed. A prevalence of 15 to 84% was found in women with a previous caesarean section. The prevalence of this alteration is correlated with the number of cesarean sections; the greater the number of caesarean sections, the greater the risk of developing an isthmocele. Its presence can be symptomatic or asymptomatic. The most common symptom is abnormal uterine bleeding, occurring in a 28.9% to 82% of the patients. Up to 88% of cases are diagnosed by a transvaginal ultrasound. A surgical hysteroscopy was associated with a 56.9% to a 100% improvement of symptoms. CONCLUSIONS: Isthmocele is commonly identified incidentally through a transvaginal ultrasound and is usually asymptomatic. It can cause abnormal uterine bleeding and secondary infertility. Its prevalence depends on the diagnostic method used. A surgical hysteroscopy is the most effective treatment method.
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El objetivo de este artículo es revisar los criterios ecográficos de hiperplasia endometrial y evaluar los puntos de corte para indicar la realización de biopsia endometrial. Se reporta el caso de una mujer de 47 años, con cuadro clínico de 4 años de evolución de sangrado vaginal anormal tipo menorragia, metrorragia e hipermenorrea, en manejo con anticonceptivos orales, sin mejoría, y con ecografía transvaginal con diagnóstico de hiperplasia endometrial. Para el diagnóstico de patología endometrial en las mujeres posmenopáusicas con sangrado vaginal, los autores recomiendan un valor de corte del grosor endometrial por ecografía transvaginal entre 4-5 mm con sensibilidad del 98% y valor predictivo negativo del 99% debido a que valores superiores están altamente relacionados con carcinoma endometrial.
The aim of this article is to review the sonographic criteria of endometrial hyperplasia and define the cutoff value to indicate the completion of the endometrial biopsy due to its relationship with the risk of endometrial carcinoma. We report the case of a woman aged 47 with four years of vaginal bleeding characterized by menorrhagia, metrorrhagia, and hypermenorrhea being treated with oral contraceptives without improvement, and transvaginal ultrasound diagnosis of endometrial hyperplasia. For the diagnosis of endometrial pathology in postmenopausal women with vaginal bleeding, the authors recommend a cutoff value of endometrial thickness by transvaginal ultrasound of 4-5 mm with sensitivity of 98% and negative predictive value of 99% since higher values are closely related to endometrial carcinoma.
O objetivo deste artigo é revisar os critérios ecográficos de hiperplasia endometrial e avaliar os pontos de corte para indicar a realização de biopsia endometrial. Se reporta o caso de uma mulher de 47 anos, com quadro clínico de 4 anos de evolução de sangrado vaginal anormal tipo menorragia, metrorragia e hipermenorreia, em manejo com anticonceptivos orais, sem melhora, com ecografia transvaginal com diagnóstico de hiperplasia endometrial. Para o diagnóstico de patologia endometrial nas mulheres pós-menopáusicas com sangrado vaginal, os autores recomendam um valor de corte do espessura endometrial por ecografia transvaginal entre 4-5 mmcom sensibilidade de 98% e valor preditivo negativo de 99% devido a que valores superiores estão altamente relacionados com carcinoma endometrial.
Subject(s)
Humans , Female , Endometrial Hyperplasia , Uterine Diseases , Uterine Hemorrhage , Endometrial Neoplasms , MetrorrhagiaABSTRACT
Objective To explore the clinical application of transvaginal ultrasonography in the diagnosis of intrauterine adhesions .Methods 95 patients with suspected intrauterine adhesions were selected as the study subjects.All patients were treated with vaginal two -dimensional,three-dimensional ultrasound,and the results and hysteroscopy results were compared .The sensitivity,specificity,positive predictive value ,negative predictive value and accuracy of two -dimensional and three -dimensional ultrasonography were analyzed .Results Of 95 cases with suspected intrauterine adhesions ,vaginal two -dimensional ultrasound diagnosed 54 cases of intrauterine adhesions , including 30 cases of mild adhesion ,18 cases of moderate adhesion ,6 cases of severe adhesion ,22 cases of missed diagnosis or misdiagnosis.Compared with hysteroscopy ,the difference was statistically significant (χ2 =12.213,P=0.007).Three -dimensional ultrasound diagnosed intrauterine adhesions in 63 cases,including 20 cases of mild adhesion ,35 cases of moderate adhesion ,8 cases of severe adhesion ,only 7 cases of missed diagnosis or misdiagnosis . Compared with hysteroscopy ,the difference was not statistically significant (χ2 =0.630,P=0.889),suggested that the diagnosis of vaginal three -dimensional ultrasound and hysteroscopy results was consistent , and vginal three -dimensional ultrasound was superior than two -dimensional ultrasound , the difference was statistically significant (χ2 =8.848,P=0.003).The sensitivity of transvaginal two -dimensional ultrasonography in diagnosis of intrauterine adhesions was 67.65％,which of three-dimensional ultrasound was 89.71％,there was statistically significant differ-ence between the two groups (χ2 =9.861,P=0.002).The specificity of two-dimensional ultrasound was 70.37％, which of three-dimensional ultrasound was 92.59％,there was significant difference between the two groups (χ2 =4.418,P=0.036).The positive predictive value of two -dimensional ultrasound was 85.19％,which of three -dimensional ultrasound was 96.83％,there was statistically significant difference between the two groups (χ2 =5.040, P=0.025).The negative predictive value of two -dimensional ultrasound was 46.34％,which of three-dimensional ultrasound was 78.13％, there was statistically significant difference between the two groups (χ2 =7.583, P =0.006).The diagnostic accuracy of two -dimensional ultrasound was 68.42％,which of three -dimensional ultra-sound was 90.53％,there was statistically significant difference between the two groups (χ2 =14.228,P=0.000). Conclusion Transvaginal three-dimensional ultrasound in diagnosis of intrauterine adhesions is more accurate than two-dimensional ultrasound , and the result is consistent with hysteroscopy .Transvaginal three -dimensional ultra-sound can be used as the preferred method of intrauterine adhesions .
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Placental site nodule as a kind of benign trophoblastic disease is rare.The features of placental site nodule are known very little. Pathological diagnosis is the gold standard, while the pathological features of atypical placental site nodule are known very little. Here we report a case of mass in uterus with atypical placental site nodule, which can supplement our knowledge of this disease.
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Objeetive To evaluate the efficacy of moderate and severe intrauterine adhesion (IUA) following uterine arterial embolization (UAE) after hysteroscopic adhesiolysis.Methods A analysis of clinical efficacyl was performed.According to American Fertility Society (AFS) scoring system,60 cases following UAE were used for the observation group,60 cases without following UAE were used for the control group.Hysteroscopic adhesiolysis was performed in two groups.Second-look hysteroscopic examination was performed to all patients at 3 months postoperatively for evaluation of IUA.Primary endpoint was the reduction rate of IUA at 3months afer hysteroscopic adhesiolysis.The secondary endpoint includes total AFS score,and score of each individual AFS category.Results At 3 months after surgery,the observasion group resulted in significantly lower effective rate for reduction of adhesion,the effctive rate were 37.04％ (20/54) and 82.46％ (47/57) (P ＜ 0.05);the tatal AFS score of the observation group (6.06 ± 3.18),and significantly lower than that of the control group (3.88 ±3.01,P ＜0.05),meanwhile,with regard to their adhension area,adhension type,menstrual pattern,the score of the observation group (1.78 ± 1.37,2.50 ± 1.51,1.78 ± 0.74),and significantly lower than that of the control group (1.12 ± 0.93,1.89 ± 1.51,0.86 ±0.99) (P =0.004,0.037,0.01).The observation group had singnificantly lower proportion than that of the control group (P ＜ 0.05).Conclusions The women with moderate and severe intrauterine adhesion following UAE had singnificantly the lower effective rate for reduction of adhesion,the higher rate of re adhesion and the poorer outcome of regerenation after hysteroscopic adhesiolysis.Gynecologist strictly grasps indications of uterine arterial embolization.
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Objective To evaluate the value of transvaginal three -dimensional ultrasound(3D -TVS)in the diagnosis of uterine cavity lesions.Methods 100 patients with suspected uterine cavity lesions,firstly underwent transvaginal ultrasound examination,then underwent transvaginal three -dimensional ultrasonography,and the trans-vaginal ultrasound and transvaginal three -dimensional ultrasound examination was judged by hysteroscopy standard. The diagnostic methods and hysteroscopy examination results of the two groups were compared and analyzed,and the three -dimensional ultrasound imaging data were analyzed.Results The ultrasound findings of transvaginal two -dimensional showed that there were 91 cases in line with hysteroscopy(lesion 142),the accuracy was 64.54%,the differences were statistically significant(χ2 =4.872,4.913,8.198,13.254,10.137,all P <0.05).At the same time, the three -dimensional ultrasound examination results of vaginal showed consistent with hysteroscopy 132,the accuracy was 93.62%,the differences were statistically significant(χ2 =2.872,7.387,10.258,18.275,12.259,all P <0.05).Transvaginal three dimensional ultrasound examination of common uterine cavity lesions ultrasound image was clear,and the size,shape and location of the lesion were clearly visible.Conclusion Three dimensional ultra-sound in the diagnosis of uterine cavity lesions has high accuracy,its image data is more clear,and in the clinical diagnosis of uterine cavity lesions has high value of application,and it is worth of promoting.
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OBJECTIVE: Uterine leiomyosarcoma (LMS) is a rare and aggressive disease with poor outcome. Due to its rarity and conflict of data, investigation on finding prognostic factor is challenging. The aim of the study was to investigate the prognostic significance of preoperative ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) in uterine LMS. METHODS: This was a retrospective observational cohort study in 3 tertiary referral hospitals. We retrospectively evaluated data from patients with pathologically proven uterine LMS who underwent preoperative ¹⁸F-FDG PET/CT scans at 3 institutions. The prognostic implication of PET/CT parameters and other clinico-pathological parameters on disease-free survival (DFS) and overall survival (OS) was evaluated. RESULTS: Clinico-patholgical data were reviewed for 19 eligible patients. In the group overall, median DFS and OS were 12 and 20 months, respectively. As for the recurrence, large tumor size, and high tumor maximum standardized uptake value (SUVmax) were demonstrated as risk factors of recurrence. As for the OS, high tumor SUVmax was demonstrated as the unique risk factor. There were significant differences in tumor size, mitotic count, SUVmax, and DFS between patients with and without recurrence. Also, there were significant differences in tumor size, SUVmax, DFS, and OS between 2 subgroups stratified by cut-off SUVmax. CONCLUSION: SUVmax at preoperative ¹⁸F-FDG PET/CT was associated with worse outcome in patients with uterine LMS. In the preoperative setting, SUVmax can be a valuable non-invasive prognostic marker. Additionally, SUVmax can help identify highly aggressive uterine LMS and may help in adjusting standard treatment toward an individualized, risk-adapted treatment.
Subject(s)
Humans , Cohort Studies , Disease-Free Survival , Electrons , Fibrinogen , Fluorodeoxyglucose F18 , Leiomyosarcoma , Positron Emission Tomography Computed Tomography , Prognosis , Recurrence , Retrospective Studies , Risk Factors , Tertiary Care Centers , Uterine DiseasesABSTRACT
OBJECTIVE: To assess the prognosis of surgically-staged non-invasive uterine clear cell carcinoma (UCCC), and to determine the role of adjuvant therapy. METHODS: A multicenter, retrospective department database review was performed to identify patients with UCCC who underwent surgical treatment between 1997 and 2016 at 8 Gynecologic Oncology Centers. Demographic, clinicopathological, and survival data were collected. RESULTS: A total of 232 women with UCCC were identified. Of these, 53 (22.8%) had surgically-staged non-invasive UCCC. Twelve patients (22.6%) were upstaged at surgical assessment, including a 5.6% rate of lymphatic dissemination (3/53). Of those, 1 had stage IIIA, 1 had stage IIIC1, 1 had stage IIIC2, and 9 had stage IVB disease. Of the 9 women with stage IVB disease, 5 had isolated omental involvement indicating omentum as the most common metastatic site. UCCC limited only to the endometrium with no extra-uterine disease was confirmed in 41 women (73.3%) after surgical staging. Of those, 13 women (32%) were observed without adjuvant treatment whereas 28 patients (68%) underwent adjuvant therapy. The 5-year disease-free survival rates for patients with and without adjuvant treatment were 100.0% vs. 74.1%, respectively (p=0.060). CONCLUSION: Extra-uterine disease may occur in the absence of myometrial invasion (MMI), therefore comprehensive surgical staging including omentectomy should be the standard of care for women with UCCC regardless of the depth of MMI. Larger cohorts are needed in order to clarify the necessity of adjuvant treatment for women with UCCC truly confined to the endometrium.