Importância do diagnóstico por imagem em pacientes com sangramento uterino anormal / Importance of diagnostic imaging in patients with abnormal uterine bleeding

O sangramento uterino anormal é diagnóstico sindrômico comum no consultório do ginecologista e pode comprometer substancialmente a qualidade de vida. O objetivo no diagnóstico de sangramento uterino anormal é distinguir pacientes com causas estruturais (anatômicas), como pólipo, adenomiose, leiomioma, malignidade e hiperplasia, de pacientes que apresentam anatomia normal, nas quais o sangramento pode ser devido a alteração dos mecanismos de coagulação, distúrbios ovulatórios, distúrbios primários do endométrio, iatrogenia, ou ter outra causa não classificada. O diagnóstico se inicia a partir de anamnese detalhada e exame físico geral e ginecológico completos, seguidos da solicitação de exames complementares (laboratoriais e de imagem), conforme indicado. O exame de imagem de primeira linha para identificação das causas estruturais inclui a ultrassonografia pélvica. Histerossonografia, histeroscopia, ressonância magnética e amostragem endometrial para exame de anatomia patológica são opções que podem ser incluídas no diagnóstico a depender da necessidade. O objetivo deste artigo é apresentar a relevância dos exames de imagem na investigação das causas de sangramento uterino anormal.

Abnormal uterine bleeding is one of the commonest presenting complaints encountered in a gynecologist's office and may substantially affect quality of life. The aim in the diagnosis of abnormal uterine bleeding is to distinguish women with anatomic causes such as polyp, adenomyosis, leiomyoma, malignancy and hyperplasia from women with normal anatomy where the cause may be coagulopathy, ovulatory disorders, endometrial, iatrogenic and not otherwise classified. Diagnosis begins with a thorough history and physical examination followed by appropriate laboratory and imaging tests as indicated. The primary imaging test for the identification of anatomic causes include ultrasonography. Saline infusion sonohysterography, magnetic resonance, hysteroscopy, endometrial sampling are options that can be included in the diagnosis depending on the need. The aim of this article is to present the relevance of imaging exams in the investigation of the causes of abnormal uterine bleeding.

Embarazo con miomatosis uterina complicado con isquemia intestinal: reporte de un caso / Pregnancy with uterine myomatosis complicated by intestinal ischemia: case report

Resumen Los miomas uterinos, también conocidos como fibromas o leiomiomas, son los tumores uterinos benignos más prevalentes. Afectan a las mujeres principalmente durante sus años reproductivos y se diagnostican hasta en un 70% de las mujeres blancas y en más del 80% de las mujeres de ascendencia africana durante su vida, con una prevalencia durante el embarazo del 2% al 10%. Pueden ser asintomáticos hasta en un 70% de las pacientes, y se estima que pueden ocurrir complicaciones en aproximadamente una de cada 10 mujeres embarazadas. Se han asociado a complicaciones y resultados adversos del embarazo, según su tamaño y ubicación en el útero, y pueden manifestarse de diferentes formas. Presentamos el caso de una mujer de 30 años, con embarazo en el tercer trimestre, quien consultó por dolor abdominal, con ecografías obstétricas durante su control prenatal que reportaban miomatosis uterina, quien presentó isquemia intestinal por un vólvulo de intestino delgado versus compresión extrínseca.

Abstract Uterine fibroids, also known as fibroids or leiomyomas, are the most prevalent benign uterine tumors, affecting women mainly during their reproductive years and are diagnosed in up to 70% of white women and more than 80% of women of African descent during their lifetime, with a prevalence during pregnancy of 2% to 10%; they may be asymptomatic in up to 70% of patients, and it is estimated that complications may occur in approximately one in 10 pregnant women. They have been associated with complications and adverse pregnancy outcomes, depending on their size and location in the uterus, they can manifest in different ways. We present the case of a 30-year-old woman, pregnant in the third trimester, who consulted for abdominal pain, with obstetric ultrasound scans during her prenatal check-up reporting uterine myomatosis, who presented intestinal ischemia due to small bowel volvulus versus extrinsic compression.

Principais causas ginecológicas de dor pélvica aguda em mulheres / Main gynecological causes of acute pelvic pain in women

Este trabalho buscou reunir dados essenciais sobre as etiologias de dor pélvica aguda, uma queixa constante nos serviços de emergências e ambulatórios de ginecologia, responsável por grande desconforto e impacto na qualidade de vida de pacientes mulheres. É uma condição laboriosa por causa de seu amplo espectro de causas, devendo ser abordada com cuidado e atenção pelo profissional médico, o qual deve considerar os diversos diagnósticos diferenciais, sendo a ultrassonografia o exame de maior importância para auxiliar em seu diagnóstico. As principais etiologias não obstétricas podem ser não ginecológicas e ginecológicas; essas últimas são divididas em anexiais e uterinas. Entre as causas ginecológicas, devem- -se investigar cistos ovarianos, torções anexiais, leiomiomas, doença inflamatória pélvica, abscesso tubo-ovariano, dismenorreia e complicações de dispositivos intrauterinos. A maioria das causas tem tratamento eficaz, com retorno da função do órgão e melhora da qualidade de vida, sem complicações, especialmente se diagnosticada precocemente.(AU)

The aim of this study was to gather important data on acute pelvic pain etiologies, a usual complaint in the emergency services and gynecology outpatient clinics, responsible for great discomfort and impact on quality of life in female patients. It is a laborious condition due to its wide spectrum of causes, which needs to be approached with attention by the physician, who must consider all the possible diagnoses, being the ultrasonography the most important exam to detect it. The main non-obstetric etiologies can be non-gynecological and gynecological, which are separated in adnexal and uterine causes. Among the gynecological causes, ovarian cysts, adnexal torsions, leiomyomas, pelvic inflammatory disease, ovarian tube abscess, dysmenorrhea and complications of intrauterine devices should be investigated. Most causes can be effectively treated, with return of organ function and improved quality of life, without complications, especially if diagnosed early.(AU)

Non-puerperal uterine inversion associated with myomatosis

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.

Necrobiosis séptica de un fibroma uterino / Septic Necrobiosis of Uterine Fibroma

Los miomas o fibromas, son tumores benignos que aparecen frecuentemente en el útero, y aunque a veces pueden ser asintomáticos, en muchas mujeres son la razón más común de las intervenciones ginecológicas. Algunos autores consideran que la causa es desconocida, otros le dan valor al estímulo estrogénico mantenido o aumentado, que activa los genitoblastos, mesodérmico y celular embrionario que responden a este estímulo. Se presenta el caso de un fibroma uterino complicado con una necrobiosis séptica diagnosticada en una paciente de 63 años de edad. El apoyo diagnóstico con ultrasonografía es de vital importancia en la sospecha diagnóstica de este tipo tumor y sus complicaciones.

Myomas or fibroids are benign tumors that frequently appear in the uterus, and although they can sometimes be asymptomatic, in many women they are the most common reason for gynecological interventions. Some authors consider that the cause is unknown. Others give value to the maintained or increased estrogenic stimulus, which activates the embryonic cell, mesodermal and genitoblasts that respond to this stimulus. We present the case of a complicated uterine fibroid with a septic necrobiosis diagnosed in a 63-year-old patient. Ultrasonography is of vital importance in the diagnosis when there is suspicion of this type of tumor and its complications.

Translation and validation of the Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire for the Brazilian Portuguese language / Tradução e validação do questionário Uterine Fibroid Symptom and Quality of Life (UFS-QOL) para a língua portuguesa brasileira

ABSTRACT CONTEXT AND OBJECTIVE: Uterine fibroids (UF), also known as leiomyomas, are the most prevalent gynecological tumors. The Uterine Fibroid Symptoms and Quality of Life (UFS-QOL) is the only specific questionnaire that assesses symptom intensity and quality-of-life issues for women with symptomatic UF; however, it only exists in the English language. Thus, we aimed to translate and culturally validate the UFS-QOL questionnaire for the Brazilian Portuguese language. DESIGN AND SETTING: Cross-sectional study, Department of Gynecology and Obstetrics, FMRP-USP. METHODS: 113 patients with UF (case group) and 55 patients without UF (control group) were interviewed using the UFS-QOL questionnaire after translation and cultural adaptation. The Short Form-36 questionnaire was used as a control. Demographic and psychometric variables were analyzed. RESULTS: Women with UF presented higher mean age, body mass index, weight, parity and comorbidities than the control group (P < 0.05). The most prevalent complaints were abnormal uterine bleeding (93.8%), pelvic pain (36.3%) and extrinsic compression (10.6%) and these presented adequate construct validity regarding UFS-QOL severity (P < 0.05). The UFS-QOL questionnaire presented good internal consistency regarding symptom severity and quality-of-life-related domains (intraclass correlation coefficient, ICC = 0.82/0.88). Structural validity presented correlation coefficients ranging from 0.59 to 0.91. Test-retest comparison did not show differences among the UFS-QOL subscales. After treatment, women with UF presented improvements on all subscales. CONCLUSION: The UFS-QOL questionnaire presented adequate translation to the Brazilian Portuguese language, with good internal consistency, discriminant validity, construct validity, structural validity and responsiveness, along with adequate test-retest results.

RESUMO CONTEXTO E OBJETIVO: O leiomioma uterino (LU) é o tumor ginecológico mais comum. Existe apenas um questionário específico que avalia a intensidade de sintomas e qualidade de vida de mulheres com LU sintomático, o Uterine Fibroid Symptom and Quality of Life (UFS-QOL), porém somente na língua inglesa. Dessa forma, objetivamos traduzir e validar culturalmente o questionário UFS-QOL para a língua portuguesa brasileira. TIPO DE ESTUDO E LOCAL: Estudo transversal, Departamento de Ginecologia e Obstetrícia da FMRP-USP. MÉTODOS: 113 pacientes portadoras de LU (grupo caso) e 55 pacientes-controle foram entrevistadas com o questionário UFS-QOL após tradução e adaptação cultural. O questionário Short Form-36 foi utilizado para controle. Variáveis demográficas e psicométricas foram analisadas. RESULTADOS: As mulheres com LU apresentaram maior média de idade, índice de massa corporal, peso, paridade e comorbidades do que o grupo controle (P < 0,05). As queixas mais prevalentes foram sangramento uterino anormal (93,8%), dor pélvica (36,3%) e compressão extrínseca (10,6%) e estas apresentaram adequada validade de constructo com a gravidade indicada pelo UFS-QOL (P < 0,05). O questionário UFS-QOL apresentou boa consistência interna com a gravidade dos sintomas e com os domínios relacionados a qualidade de vida (coeficiente de correlação intraclasse, CCI = 0,82/0,88). A validade estrutural mostrou coeficientes de correlação variando de 0,59 até 0,91. A comparação teste-reteste não mostrou diferença entre as subscalas do UFS-QOL. Depois do tratamento, as mulheres com LU apresentaram melhora em todas as subscalas. CONCLUSÃO: O questionário UFS-QOL apresentou adequada tradução para a língua portuguesa brasileira, com boa consistência interna, validade de constructo/discriminatória, estrutural e responsividade, assim como adequados resultados teste-reteste.

Lower Uterine Segment Fibroid Complicating Pregnancy: A Case Report.

Th e uterine fi broids are very common in the reproductive age group. During pregnancy, it may undergo rapid growth and red degeneration. It may get infected during puerperium. Most of the fi broids are asymptomatic. Women with fi broids may have infertility, a tendency for miscarriage, pre-term labor, placental abruption, placenta previa, fetal growth restrictions, fetal anomalies, postpartum hemorrhage, uterine dystocia, malpresentations and increased risk of caesarean. Here, we present 26-year-old primigravida who was admitted with 9 months of amenorrhea and anterior lower uterine segment intramural fi broid of size 7.2 cm × 7.1 cm on the right side. She conceived immediately after marriage. All Investigations were normal. She was delivered by a cesarean section. An alive female baby of 2.5 kg with good Apgar score. Th e indication was lower uterine segment fi broid. Th e liquor was meconium stained. Th ere was no sign of intrauterine growth restriction of the baby. Th e Doppler study, cardio-topography was normal before section. Th e post-operative period was uneventful. Th e patient was discharged and came for follow-up after a month and was found to be alright.

Leiomyoma of the urinary bladder: a case report

The case of a 71-year-old woman who presented with one year history of pelvic pain and occasional dysuria is reported. Computed tomography and Magnetic Resonance Imaging revealed a well defined intramural bladder mass. The histological findings of the surgical specimen confirmed a leiomyoma of the urinary bladder. The clinical presentation, imaging findings and management of this relatively rare benign tumor are discussed.

An Incidentally Found Inflamed Uterine Myoma Causing Low Abdominal Pain, Using Tc-99m-Tektrotyd Single Photon Emission Computed Tomography-CT Hybrid Imaging

We report the case of a 50-year-old woman presented with a history of right hemicolectomy due to an ileocecal neuroendocrine tumor and left breast metastasis. Owing to a slightly elevated chromogranin A-level and lower abdominal pain, single photon emission computed tomography-computer tomography (SPECT-CT) was performed. There were no signs of recurrence on the SPECT-CT scan, but the patient was incidentally found to have an inflamed intramural myoma. We believe that the slightly elevated chromogranin A-level was caused by the hypertension that the patient presented. In the clinical context, this is a report of an inflamed uterine myoma seen as a false positive result detected by TC-99m-Tc-EDDA/HYNIC-Tyr3-Octreotide (Tektrotyd) SPECT-CT hybrid imaging.

Degeneration of Leiomyoma in Patients Referred for Uterine Fibroid Embolization: Incidence, Imaging Features and Clinical Characteristics

PURPOSE: Imaging features and clinical characteristics of degenerated leiomyoma in patients referred for uterine fibroid embolization (UFE) were analyzed to assess the incidence of degenerated leiomyoma. MATERIALS AND METHODS: Patients referred for UFE between 2008 and 2009 were retrospectively analyzed (n=276). Patients ranged in age from 27 to 51 years (mean 38.0 years). All patients underwent screening MRI with contrast enhancement. Medical histories and clinical symptoms were evaluated. RESULTS: Among the 276 patients who underwent MRI, 14 (5.1%) showed degenerated leiomyomas. Symptoms were abdominal pain (n=4, 26.7%), menorrhagia (n=5, 35.7%) and bulk-related symptoms (n=5, 35.7%) and no symptoms (n=5, 35.7%). Of the 14 patients with degenerated leiomyomas, 5 (42.9%) had a history of pregnancy in the past two years. For T1-weighted imaging (T1WI), a high signal intensity (SI) of the leiomyoma was the most common finding (n=9, 64.3%) and a hyperintense rim (n=4, 28.6%) was the second most common. On T2-weighted imaging (T2WI), a low SI of the leiomyoma was found in six patients (42.9%), a high SI in four (28.6%) and a heterogeneous SI in four (28.6%) patients. Conservative management was performed in 11 (78.6%) patients, surgery in 3 (21.4%) and uterine artery embolization in one (7.1%) patient. CONCLUSION: The incidence of degeneration of leiomyoma in patients referred for UFE was 5.1%. Patients presented with variable clinical symptoms with or without a history of pregnancy. MR imaging showed a high SI on T1WI and various SIs on T2WI without contrast enhancement. An understanding of the degeneration of leiomyomata is essential when considering UFE.

Extrauterine leiomyomata presenting with sepsis requiring hemicolectomy / Leiomiomas extrauterinos com sepse que exigem hemicolectomia

Extrauterine leiomyomas are rare, benign, and may arise in any anatomic sites. Their unusual growth pattern may even mimic malignancy and can result in a clinical dilemma. Occasionally, uterine leiomyomas become adherent to surrounding structures. They also develop an auxiliary blood supply, and lose their original attachment to the uterus, thus becoming 'parasitic'. Parasitic myomas may also be iatrogenically created after uterine fibroid surgery, particularly if morcellation is used. This report presented two cases of parasitic myomas with sepsis, both requiring right hemicolectomy. It reviewed the pertinent literature.

Leiomiomas extrauterinos são raros e benignos e podem surgir em qualquer local anatômico. O padrão de crescimento não-usual destas lesões pode até mesmo imitar malignidade e resultar em dilema clínico. Ocasionalmente, os leiomiomas uterinos aderem-se às estruturas circunvizinhas, desenvolvem suprimento sanguíneo auxiliar e perdem sua ligação original ao útero, tornando-se assim "parasíticos". Os miomas parasíticos podem também ser criados iatrogenicamente após cirurgia fibroide uterina, especialmente se for utilizada morcelação. Este relato apresentou dois casos de miomas parasíticos com sepse, ambos exigindo hemicolectomia à direita, bem como revisão da literatura pertinente.

Hysteroscopic findings in patients with post-menstrual spotting with prior cesarean section / Achados histeroscópicos em pacientes com sangramento pós-menstrual tipo escape com cesárea anterior

Objective: To identify uterine hysteroscopic findings among patients with prior cesarean section and whom had post-menstrual bleeding spotting type. Methods: We conducted a descriptive and prospective study between June 2008 and December 2009 involving women admitted to our clinic in Ji-Paraná (RO), Brazil, and who complained of prolonged genital bleeding after menstrual period. A total of 20 women with the simultaneous following characteristics were selected: at least one prior cesarean section, aged between 18 and 45 years, no use of hormonal contraceptives, and no history of uterine surgery that could change the cavity anatomy. All participants underwent a hysteroscopic examination. Results: During hysteroscopy, in 90% of the patients, the presence of a cesarean section scar was observed in the last third of the cervix. This scarring causes an anomaly in the uterine cavity anatomy, characterized by the viewing of an enlargement followed by a retraction of the anterior wall, which affords the presence of a pseudocavity with depth and lumen narrowing in variable degrees. Two patients did not present the pseudocavity. Conclusion: Pseudocavities in cesarean section scar are usually found in hysteroscopic examination of patients with prior cesarean section and abnormal uterine spotting.

Objetivo: Identificar os achados histeroscópicos uterino em grupo de pacientes com operação cesariana anterior e sangramento pós-menstrual tipo escape. Métodos: Foi realizado um estudo descritivo e prospectivo, com mulheres que compareceram em consultório em Ji-Paraná (RO), entre junho de 2008 e dezembro de 2009, com queixa de sangramento genital prolongado tipo escape após período menstrual. Destas, foram selecionadas 20 mulheres que apresentavam, simultaneamente, as seguintes características: ao menos uma cesárea prévia; idade entre 18 e 45 anos; sem uso de método anticoncepcional hormonal; e ausência de qualquer outra cirurgia uterina capaz de alterar a anatomia da cavidade. As pacientes selecionadas foram submetidas a exame histeroscópico. Resultados: À histeroscopia, em 90% das pacientes, observou-se, no terço final do colo, a presença da cicatriz de cesárea. Essa cicatriz causa, no interior da cavidade uterina, uma anomalia em sua anatomia, caracterizada pela visualização, na parede anterior, de uma dilatação seguida de retração, que proporciona a presença de pseudocavidade com profundidade e oclusão da luz em graus variáveis. Já em duas pacientes, não foi detectada a pseudocavidade. Conclusão: A pseudocavidade na cicatriz da cesariana é o achado mais freqüente à observação histeroscópica em pacientes com cesárea prévia e sangramento uterino anormal pós-menstrual tipo escape.

Histeroscopia ambulatorial em casos de abortamento consecutivo / Office hysteroscopy study in consecutive miscarriage patients

OBJETIVO: Avaliar a prevalência de alterações anatômicas uterinas diagnosticadas através da histeroscopia ambulatorial em uma população de pacientes com mais de dois abortamentos consecutivos. Comparar a prevalência de alterações uterinas entre as pacientes com dois abortos em relação as pacientes com três ou mais abortamentos de repetição. MÉTODOS: Foi realizado um estudo transversal em 66 pacientes com diagnóstico de dois ou mais abortamentos de repetição. As pacientes foram divididas em dois grupos: Grupo A (até dois abortamentos, 23 pacientes) e Grupo B (três ou mais abortamentos, 43 pacientes), sendo submetidas à histeroscopia diagnóstica ambulatorial em que foram identificadas alterações congênitas e adquiridas da cavidade uterina. RESULTADOS: Foram encontradas em 22 (33,3 por cento) pacientes alterações uterinas, sendo em nove casos alterações congênitas [útero arqueado (quatro casos), septo uterino (dois casos) e útero bicorno (um caso)] e em 13 pacientes alterações adquiridas [sinéquia (sete casos), pólipo endometrial (quatro casos) e mioma uterino (dois casos). Não houve diferença significativa entre grupos em relação às alterações uterinas adquiridas e congênitas. Foi encontrada uma correlação positiva entre alterações anatômicas na histeroscopia e número de abortamentos (r = 0,31; p = 0,02). CONCLUSÃO: As pacientes com mais de dois abortamentos apresentam uma alta prevalência de alterações uterinas diagnosticadas por histeroscopia. No entanto não há diferença na prevalência ou na distribuição das lesões em relação ao número de abortamentos.

OBJECTIVE: To assess the prevalence of uterine anatomical abnormalities found by office diagnostic hysteroscopy in a population of patients experiencing more than two consecutive miscarriages and compare the prevalence of uterine abnormalities between patients with two miscarriages and those with three or more consecutive miscarriages. METHODS: A cross-sectional study of 66 patients with two or more consecutive miscarriages diagnosis was conducted. Patients were divided into two groups: Group A (up to two miscarriages, 23 patients), and Group B (3 miscarriages, 43 patients). They underwent an outpatient diagnostic hysteroscopy study, with either congenital or acquired abnormalities of the uterine cavity being identified. RESULTS: Uterine changes were found in 22 (33.3 percent) patients, with 9 cases of congenital changes [arcuate uterus (4 cases), septate uterus (2 cases), and bicornuate uterus (1 case)], and 13 patients with acquired changes [intrauterine adhesions (7 cases), endometrial polyp (4 cases), and uterine leiomyoma (2 cases)]. No significant differences were found between the groups as regarding both acquired and congenital uterine changes. A positive correlation was found between anatomical changes on hysteroscopy and number of miscarriages (r = 0.31; p = 0.02). CONCLUSION: Patients with more than two miscarriages have a high prevalence of uterine cavity abnormalities diagnosed by hysteroscopy; however there are no differences in prevalence or distribution of these lesions related to the number of recurrent miscarriages.

Cesárea corporal y miomectomía: indicaciones actuales / Classic cesarean section and myomectomy

Actualmente, tanto la realización de una cesárea corporal como la práctica de una miomectomía en el transcurso de una cesárea, suponen dos hechos muy infrecuentes. No obstante, en determinados casos, ambos procedimientos pueden ser necesarios. La cesárea corporal es una técnica quirúrgica poco menos que abandonada, si bien aún mantiene algunas indicaciones; y la exéresis de un mioma durante una cesárea está clásicamente contraindicada, salvo en circunstancias muy concretas. Sin embargo, hay que destacar que en los últimos años se está constatando un incremento significativo de ambos procedimientos, siendo las razones muy diversas (aumento de las gestaciones pretérmino que se finalizan por vía abdominal, incremento de la edad materna, mayores tasas de cesáreas, etc.). Se presenta el caso clínico de una gestante con un gran mioma localizado en segmento inferior uterino y en la que fue preciso llevar a cabo una cesárea corporal, seguida de una miomectomía.

Nowadays, it is very rare to perform both classic cesarean section or myomectomy during cesarean section. However, sometimes it is necessary to do them. The classic cesarean section is a very uncommon chirurgical technique, however, it still has some indications. The performance of a myomectomy during a cesárea section although it is to be avoided, it might be necessary under specific circumstances. However, it is necessary to emphasize that in recent years it is more and more frecuent to performe these chirurgical techniques, due to different reasons such as the increasing of preterm pregnancies that are finished by an abdominal delivery, the increasing of the age of pregnancy and higher cesarean rates. We present a case report of large myoma situated at the lower uterine segment. Classic caesarean section followed by myomectomy was performed to allow the delivery.

A Five-year review of uterine fibroids at the University of Uyo Teaching Hospital, Nigeria

Background: Uterine fibroids are benign tumours that arise from myometrial smooth muscle cells. They are the most common tumours found in humans and are particularly common in Negros. We determined the prevalence modes of presentation and treatment modalities of uterine fibroid at the University of Uyo Teaching Hospital; Uyo; Nigeria. Methods: The case notes of all patients with uterine fibroids over a 4-year period were studied. Results: Uterine fibroids accounted for 7.1of gynaecological admissions and 21.2of major gynaecological surgeries. The patients' age ranged from 21 to 55 years with modal age group being 31-40 years (38.8). Majority of the patients were of low parity (75.4). The most common presenting complaints were abdominal swelling (25.5) and infertility (21.4). Myomectomy was the most common surgical procedure performed (77.6) and the most common post operative omplications were anaemia (21.4) and pyrexia (18.4). Conclusion: Uterine fibroids are common in our environment. The patients are predominantly of low parity and myomectomy is the most common surgical procedure performed

Endobronchial leiomyoma: an unusual non-defining neoplasm in a patient with AIDS / Leiomioma endobronquial: rara neoplasia não definida em paciente com AIDS

Smooth muscle neoplasms are more frequent in human immunodeficiency infected children than in HIV seropositive adults. Endobronchial leiomyoma is a rare benign tumor in HIV infected adult patients. Epstein-Barr virus (EBV) has been implicated in the pathogenesis of these tumors. Here we describe an adult patient with HIV infection with atelectasis of the left upper pulmonary lobe as the first clinical expression of an intrabronchial leiomyoma. In this case, we can not show the association with EBV. Our report suggests that smooth muscle tumors as leiomyoma should be included in the differential diagnosis of endobronchial masses in AIDS patients.

Neoplasmas da musculatura lisa são mais freqüentes em crianças infectadas pelo vírus da imunodeficiência humana do que em adultos HIV-soropositivos. Leiomioma endobronquial é um tumor benigno em pacientes adultos infectados por HIV. Vírus Epstein-Barr (EBV) tem sido implicado na patogenia destes tumores. Descrevemos paciente adulto infectado pelo HIV com atelectasia do lobo pulmonar superior esquerdo como primeira manifestação clínica de leiomioma intrabronquial. Neste caso não pudemos demonstrar a associação com EBV. Nosso relato sugere que tumores de musculatura lisa como leiomioma deveriam ser incluídos no diagnóstico diferencial de massas endobronquiais em pacientes com AIDS.

Primary bilateral tubal adenocarcinoma associated with uterine leiomyomas.

Primary adenocarcinoma of the fallopian tube is the least common primary malignant tumor of the female genital tract. Bilaterality is also rare. Often the diagnosis is mistaken for ovarian tumor or tubo-ovarian mass. A case of bilateral primary tubal adenocarcinoma of serous type associated with uterine leiomyomas, without evidence of metastasis occurring in a postmenopausal woman is being reported.

Uterine inversion; a case report

The puerperal uterine inversion is a rare and severe complication occurring in the third stage of labour. The mechanisms are not completely known. However, extrinsic factors such as oxytocic arrests after a prolonged labour, umbilical cord traction or abdominal expression are pointed. Other intrinsic factors such as primiparity, uterine hypotonia, various placental localizations, fundic myoma or short umbilical cord were also reported. The diagnosis of the uterine inversion is mainly supported by clinical symptoms. It is based on three elements: haemorrhage, shock and a strong pelvic pain. The immediate treatment of the uterine inversion is required. It is based on a medical reanimation associated with firstly a manual reduction then surgical treatment using various techniques. We report an observation of a 25 years old grand multiparous patient with a subacute uterine inversion after delivery at home

Gastric corpus polyps associated with proton pump inhibitors therapy

The prevalence of Gastroesophageal Reflux Disease [GERD] is rapidly rising in Asia. We describe here a case of 51 years old man who had surgery for esophageal leiomyoma and received long-term therapy with Proton Pump Inhibitors [PPIs] for persisting reflux symptoms. On Esophago-Gastroduodenoscopy [EGD] several sessile polyps were seen in the gastric corpus. Earlier EGD done 15 years back had not demonstrated those polyps. Sections revealed polypoid fragments of glandular epithelium with dilated glands and negative histology for H. pylori. Polymerase chain reaction for 16S ribosomal RNA gene [16S rRNA PCR] of H. pylori was also negative. This is the first report originating from an Asian country describing Fundal Gland Polyps [FGPs] in the corpus of stomach rather than fundus in a patient on long-term PPI therapy