Endometrial Adenocarcinoma Presenting as Hematometra with Underlying Thickened Endometrial Lining in a Postmenopausal Woman - A Case Report.

BACKGROUND: Although most postmenopausal women diagnosed with endometrial cancer usually present with vaginal bleeding, when complete cervical stenosis is present, this sign may be missing. In these cases, the patient usually complaints for pelvic or abdominal pain while the transvaginal ultrasonography might reveal the presence of an intrauterine fluid collection in association with a thickened endometrial lining. CASE REPORT: We present the case of a 65-year-old patient who presented with association of pelvic pain, enlarged uterine cavity with an underlying hematometra and an irregular, thickened endometrium who was submitted to surgery for total histerectomy, bilateral adnexectomy, pelvic and para-aortic lymph node dissection. CONCLUSION: Histopathological studies revealed the presence of a well-differentiated endometrial adenocarcinoma. At three years of follow-up, the patient is free of any recurrent disease.

Cervical dysgenesis with transverse vaginal septum with imperforate hymen in an 11 year old girl presenting with acute abdomen.

This case highlights the importance of careful evaluation of girls presenting with imperforate hymen as this is accompanied by other female reproductive tract anomalies. It is of utmost importance that a correct timely diagnosis is made so that the right treatment can be chosen with the perspective of future fertility. Cervical dysgenesis associated with vaginal septum and imperforate hymen has not been reported in literature so far. Present case highlights the simple mode of management with a successful outcome.

An unusual case of hematometra in a postmenopausal woman associated with Manchester repair.

BACKGROUND: Hematometra is a rare condition caused by obstruction of the lower female genital tract resulting in an accumulation of menstrual fluid in the uterine cavity. Although most commonly a result of congenital abnormalities, in older women, the obstruction is usually acquired and occurs at the level of the cervix.The Manchester repair procedure, done for uterocervical prolapse as an alternative to vaginal hysterectomy, carries a risk of cervical scarring resulting in stenosis and hematometra. CASE REPORT: A 61-year-old woman presenting with acute pelvic pain on a background of chronic pelvic pain and urinary retention was found to have a pelvic mass. She underwent magnetic resonance imaging, and her case was discussed in the gynecologic oncology multidisciplinary meeting. She underwent a midline laparotomy and was found to have hematometra. This was a result of the post-Manchester repair amenorrhea being considered as menopause, leading to a gradually accumulating hematometra. CONCLUSIONS: Very few Manchester repairs are being carried out these days. Although advocated as a safe alternative to vaginal hysterectomy, clinicians doing this procedure should be aware of long-term complications like cervical stenosis.

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Pathologic characteristics of hysterectomy specimens in women undergoing hysterectomy after global endometrial ablation.

STUDY OBJECTIVE: To describe uterine pathologic features in women who underwent hysterectomy because of failed global endometrial ablation (GEA). DESIGN: Retrospective cohort study from 1998 through 2005 (Canadian Task Force classification III). SETTING: Tertiary referral center. PATIENTS: Sixty-nine women who underwent hysterectomy because of GEA failure. INTERVENTIONS: Pathology reports were available for 67 patients. Descriptions of hysterectomy specimens after GEA were reviewed. MEASUREMENTS AND MAIN RESULTS: Rates of pathologic findings in hysterectomy specimens after failed GEA were determined. Reasons for hysterectomy in the 67 patients with available pathology reports were bleeding in 34 (51%), pain in 19 (28%), and bleeding and pain in 14 (21%). The pathology reports of these specimens showed leiomyomas in 33 specimens (49%); intramural myomas were present in 15 women (44%) who underwent hysterectomy because of bleeding and 8 women (42%) who underwent hysterectomy because of pain. Hematometra was identified in 7 pathologic specimens (10%). Specifically, hematometra was identified in specimens from 5 of 19 women who underwent hysterectomy because of pain (26%). CONCLUSION: Hematometra was a significant finding in women who underwent hysterectomy because of persistent pain after GEA. A possible pathologic predictor of GEA failure may be intramural leiomyomas.

Uterine avulsion: a rare cause of cryptomenorrhea.

BACKGROUND: Cryptomenorrhea at menarche is commonly due to mullerian duct anomalies. Uterine avulsion due to blunt pelvic trauma is a very rare cause of cryptomenorrhea. But so far no case of uterine avulsion has been reported due to a childhood trauma without pelvic fracture. CASE: A 15-year-old young girl was evaluated for delayed menarche and the diagnosis of hematometra with obstruction at the level of internal cervical os was made on radiological examination. Detailed history revealed significant childhood blunt pelvic trauma when at the age of 3 years she was run over by a tractor. But the presence or absence of pelvic fracture was never documented as no radiographs were obtained. On abdominopelvic exploration cervix was well formed. Uterine body was found to be separated from the supravaginal cervix and there was a peritoneal window in between. During surgery hematometra was drained and the continuity of the uterine outflow tract was restored. Post surgery patient started having normal periods. SUMMARY AND CONCLUSIONS: Though very rare, uterine avulsion during pelvic trauma may cause cryptomenorrhea. Therefore such history should be sought in all cases of obstruction of the cervical canal because cryptomenorrhea has a much better prognosis than cervical congenital dysgenesis.

Hysterectomy for hematometra in a 15-year-old mentally handicapped girl with congenital cervicovaginal agenesis and concomitant ovarian adenoma.

We report a case of hematometra and bilateral hematosalphinx in a 15-year-old mentally handicapped adolescent girl, complicated by vaginal agenesis over cervical atresia in the presence of an ovarian adenoma. The case was managed by abdominal hysterectomy and bilateral salphingectomy of the hematosalphinx, which had formed a tubo-ovarian mass. One ovary was preserved. This case also considers the management of the mentally handicapped patient unable to comprehend pain arising from cryptomenorrhea.

A new approach to preserve fertility by using a coated nitinol stent in a patient with recurrent cervical stenosis.

OBJECTIVE: The incidence of hematometra caused by cervical stenosis after conization is <1%. Nevertheless, if dilatation was unsuccessful, further therapy often remains unclear, and the clinical consequences can be severe, including hysterectomy. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 33-year old patient who developed recurrent cervical stenosis with consecutive hematometra after two conizations during lactation amenorrhea that could not be treated by dilatation and insertion of a temporary plastic catheter according to the manufacturer's instructions. INTERVENTION(S): Insertion of a coated nitinol stent in the cervical canal after dilatation and hysteroscopic removal of the hematometra. MAIN OUTCOME MEASURE(S): Normal menstruation, future pregnancy. RESULT(S): The patient was free of symptoms, had a normal menstruation, and has become pregnant. CONCLUSION(S): The insertion of a coated vessel stent in the uterine cervix appears to be a valid alternative in patients with recurrent cervical stenosis and hematometra after conization to preserve childbearing function.

Occlusion of the external cervical os after conization in a postpuerperal amenorrheic woman.

INTRODUCTION: Complete occlusion of the cervical canal following conization is an uncommon complication. CASE REPORT: We encountered a case in a woman with lactation amenorrhea who after conization to treat cervical intraepithelial neoplasia (CIN) 3 developed hematometra and did not resume menstruation. This case was diagnosed early by ultrasonic tomography and magnetic resonance imaging (MRI). CONCLUSION: Postpuerperal amenorrheic women should be managed with care because of the increased risk of occlusion of the cervical duct after conization.

[Uterine myomatosis with senile hematometra in a 101-year-old patient]. / Uterus myomatosus mit seniler Hämatometra bei einer 101-jährigen Patientin.

A 101-year-old patient presented with uterine myomatosis and bleeding associated with a large hematometra. An abdominal hysterectomy with adnexectomy was performed following an in-depth consultation with the patient and her daughter. The patient was discharged on the 12(th) postoperative day after a complication-free course. This case report demonstrates not only the current possibilities in the gynecological treatment of very old patients but also the hidden reserves in the gynecological care ot these women.

Late-onset hematometra and hematosalpinx in a woman with a noncommunicating uterine horn. A case report.

BACKGROUND: Noncommunicating uterine horns are rare, occasionally presenting with functional endometrial cavities. Surgical removal of the noncommunicating horn is commonly performed to prevent endometriosis in these patients. CASE: A 41-year-old woman with a unicornuate uterus and noncommunicating uterine horn presented with a three-month history of right-sided pelvic pain. She had previously undergone multiple assisted reproductive technique attempts with superovulation and supraphysiologic serum estradiol levels and no apparent symptomatology or evidence of hematosalpinx during laparoscopy. Shortly after completing a donor oocyte recipient cycle, she developed acute right-sided pelvic pain. Diagnostic laparoscopy and subsequent laparotomy confirmed a right hematosalpinx and hematometra of the noncommunicating horn, with stage III endometriosis. CONCLUSION: Consideration of prophylactic resection of a noncommunicating uterine horn with a cavity should be considered in an asymptomatic, reproductive-age patient with this rare müllerian anomaly.

Hematometra in an unattached rudimentary uterine horn and ipsilateral renal agenesis.

This report describes an adolescent female with a functioning unattached rudimentary blind uterine horn who presented with dysmenorrhea, severe lower abdominal pain and a pelvic mass. She had been unsuccessfully treated with prostaglandin inhibitors, and in her past history several episodes of urinary tract infections were reported. Removal of the uterine horn afforded complete relief of symptoms.