Complaints Of Postmenopausal Bleeding Research Articles

A new method that facilitates the diagnosis of endometrial cancer: the ratio of endometrial thickness to the full thickness of the uterine wall and subcutaneous adipose tissue measurements.

The aim of the present study was to investigate the association between some risk factors and endometrial pathologies determined by transvaginal sonography (TVS), as well as the diagnostic predictive values of serum oestradiol (E2) levels, subcutaneous adipose tissue (SAT) thickness, endometrium thickness (ET), and the ratio of ET to uterine wall full thickness (UWT) in differential diagnosis of malignant, precancerous, and benign pathologies of endometrium in patients with postmenopausal bleeding (PMB) or with asymptomatic increased endometrial thickness. The study was conducted with 211 women who applied to the hospital with complaints of PMB or ET of 5 mm or more in their routine controls. Venous blood samples were taken for complete blood count and the measurement of E2 levels. Patients also underwent TVS; ET, UWT, and the ratio of ET to UWT were measured. Menopausal age and body mass index averages were significantly higher in atypical hyperplasia and endometrial cancer (EC) groups. Endometrial thickness and endometrial thickness/uterine wall full thickness ratio measured by TVS were significantly higher in all precancerous pathologies and EC. Subcutaneous adipose tissue thickness was significantly higher in all precancerous pathologies and EC. Oestradiol levels were higher in the atypical hyperplasia and EC groups. Postmenopausal bleeding is a common symptom of EC, but in some cases this disease may occur asymptomatically. Measurement of the endometrium thickness, and the ratio of endometrium thickness/uterine wall full thickness and SAT thickness by sonography has a high predictive value for this disease.

Histopathological spectrum of lesions in evaluating the women with postmenopausal bleeding

Postmenopausal bleeding occurs in approximately 10% of postmenopausal women. Postmenopausal bleeding requires complete assessment to ensure the absence of malignancy. The aim of the study is to know the causes of postmenopausal bleeding based on Histopathological findings and the percentages of various benign, pre malignant and malignant lesions.This study included 53 cases attending the obstetrics & gynaecology department of TMU&RC, Moradabad western Uttar Pradesh with complaint of post menopausal bleeding over a time period of 2 years from July 2017-june 2019.Among benign cases, the most common cause was atrophic endometrium (39.6%). Among malignant cases, the most common cause was cervical malignancy (28.3%). Out of 53 cases, 26 cases account for premalignant and malignant causes of PMB, carcinoma cervix accounts for 53.7% and carcinoma in situ accounts for 3.8%.The postmenopausal bleeding is an important symptom and require careful and timely assessment to eliminate the possibility of malignancy as soon as possible.

Evaluation of Hysteroscopic Findings and Histopathologic Report of Endometrium in Postmenopausal Bleeding

Background: Women with postmenopausal bleeding have 10%-15% chance of having endometrial carcinoma and therefore the diagnostic work is aimed at excluding uterine malignancy. For accurate diagnosis of cause of postmenopausal bleeding, endometrial abnormalities can be assessed by hysteroscopy and hysteroscopy directed biopsy or fractional curettage. Objective: To compare the hysteroscopic findings with histopathologic report of endometrium in postmenopausal bleeding. Methods: Cross sectional study was conducted in the department of gynaecological oncology in Bangabandhu Sheikh Mujib Medical University over 1 year from June 2019 to May 2020. Thirty women with the complaints of postmenopausal bleeding were enrolled. Each women underwent hysteroscopic evaluation and endometrial tissue was obtained by hysteroscopy directed biopsy as well as fractional curettage in some cases, then sent for histopathology. Results were analyzed to find out sensitivity, specificity, accuracy, positive predictive value and negative predictive value of hysteroscopy, taking histopathological diagnosis as gold standard. Analysis was carried out by using SPSS version 26. Results: Hysteroscopic examination findings and histopathology of endometrium in 30 postmenopausal women, 11(36.6%) cases were found normal both on hysteroscopy and histopathology, among them 4(13.3%) cases were proliferative endometrium, 1(3.3%) was secretory endometrium and 5(16.6%) cases were found atrophic endometrium and 1(3.3%) tissue was insufficient. Hysteroscopic view of normal endometrium showed a sensitivity 100%, specificity 100%, positive predictive value 100%, negative predictive value 100% and accuracy 100%. For Endometrial polyp showed sensitivity, specificity, positive predictive value, negative predictive value and accuracy 100%respectively. For Hyperplasia, hysteroscopy showed sensitivity 100%, specificity 96.2%, positive predictive value 80%, negative predictive value 100% and accuracy 96.7%. Endometrial carcinoma was found in 3(10%) cases and showed sensitivity of 100%, specificity of 96.3%, positive predictive value 75.0%, negative predictive value 100% and accuracy 96.7%. For the atrophic endometrium, sensitivity (100%), specificity (96.0%), positive predictive value (83.3%), negative predictive value (100%) and accuracy (96.7%). 1(3.3%) had in situ endometrial carcinoma and 2(6.6%) had adenomyosis on histopathology. Conclusion: The study concludes that hysteroscopy and directed biopsy or fractional curettage is a highly accurate, sensitive, specific, positive predictive value and negative predictive value for diagnosis of cause of postmenopausal bleeding. Bangladesh Medical Res Counc Bull 2023; 49(1): 1-14

Laparoscopic radical hysterectomy and total vaginectomy for vaginal malignant melanoma with cervical metastasis

The presented case is a 63-years-old multiparous woman admitted with the complaint of postmenopausal bleeding. On gynecologic examination multifocal lesions were detected, including 1 cm on lateral vaginal wall, 4 cm on posterior vaginal wall and 0.5 cm on the left lateral part of the cervix. Histopathology examination gave a diagnosis of epithelioid malignant melanoma. Consequently, laparoscopic radical hysterectomy and total vaginectomy with bilateral pelvic and inguinofemoral lymph node dissection were planned. On both sides, pararectal and paravesical spaces were created and the ureter was identified. Then, the vesicouterine and vesicovaginal spaces were developed. Uterine artery and superior vesical artery were coagulated, cut and the lateral parametrium was prepared. The left ureter was dissected and the ureteral tunnel was unroofed up to the bladder entrance. Subsequently, the anterolateral parametrium was transected. Then, the infundibulopelvic and sacrouterine ligaments were sealed and transected. At this time, the rectovaginal space was developed. Bilateral paracolpos were transected. The endopelvic fascia with the levator muscles were sealed and cut circumferentially. Anteriorly, the pubovesicocervical fascia was transected and the bladder was mobilized up to the uretrovesical junction. Thereafter, through a vaginal approach, the cervix and vagina were inverted by grasping the cervix with a tenaculum. An incision on the posterior vaginal wall at the introitus was made and the urogenital diaphragm was dissected to connect with the pelvic cavity. The vaginal entrance was cut circumferentially and the surgical specimen was extracted. In conclusion, laparoscopy can be considered as a feasible approach for radical hysterectomy and total vaginectomy in selected patients.

Intestinal type mucinous adenocarcinoma of the endometrium with signet ring cells (179)

<b>Objectives:</b> Endometrial cancer is the most common gynecological malignancy in the United States. In the 66,000 new cases reported annually, only 1-9% are reported to be mucinous adenocarcinomas of the endometrium (MACE). Intestinal type mucinous adenocarcinoma (iMACE) is a rare variant of mucinous carcinoma of the endometrium that may show focal features of very poorly differentiated adenocarcinomas of gastric, pancreatic, or intestinal origin by producing signet ring cells (SRC). To date, only two reported cases of SRC as a morphological feature of iMACE have been reported. The presence of SRC morphology in carcinomas of non-endometrial primary sites has been found to portend a worse prognosis. Alterations in E-cadherin expression have been linked to decreased cell-to-cell adhesion, increased metastatic potential, tumor de-differentiation, and deep myometrial invasion in endometrial carcinomas. The presence or absence of E-cadherin in iMACE with SRC has not been studied. Thus, we sought to analyze E-cadherin expression in this aggressive variant of endometrial carcinoma. <b>Methods:</b> After informed consent was obtained, we analyzed three cases of iMACE with SRC. Demographics and clinical outcomes were obtained for the three cases from the chart review. Immunohistochemical staining was performed for E-cadherin, CX20, CDX2, CK7, PAX-8, and ER expression on formalin-fixed paraffin-embedded tumor tissue. <b>Results:</b> Diagnosis of iMACE with SRC was rendered with the aid of immunohistochemical staining (Table 1) and histological analysis. The average age of diagnosis was 72 years, with all three women presenting with the complaint of post-menopausal bleeding. All three cases presented with late-stage disease, and two patients died of disease, with the third disease-free at three years post-therapy. Focal loss or weakly positive E-cadherin expression was seen in areas of SRC morphology in all three cases. No changes in E-cadherin expression were seen within the rest of the tumor (Table 1). <b>Conclusions:</b> A potential mechanism of action for the aggressive nature of iMACE with SRC morphology is the focal downregulation of E-cadherin expression. However, additional data is needed to corroborate these findings. Our data add to the current literature that supports the concept of divergent molecular profiles, including cell adhesion molecule expression, in different types of endometrial carcinoma.

Sacral insufficiency fracture after treatment for cervical cancer

A 61-year-old female patient was referred to the gynaecologic oncology clinic of the Regional Cancer Centre, Thiruvananthapuram, Kerala, India, in December, 2019, with complaints of postmenopausal bleeding and vaginal discharge with a cervical mass. She was diagnosed to have squamous cell carcinoma of the uterine cervix (stage IIIC1). She received radical radiotherapy using a four-field 2D conventional technique with concurrent weekly intravenous cisplatin 40 mg/m2 followed by high-dose-rate intracavitary brachytherapy, which was completed in January, 2020. She had a complete response to treatment and was on regular follow-up.

Small cell neuroendocrine carcinoma coexisting with adenocarcinoma of the uterine cervix - a rare entity

Squamous cell carcinoma and adenocarcinoma are the most common histological types of cervical cancer. The co-existence of two histological types is rare. Here we report a case of a 65-year-old woman with a complaint of postmenopausal bleeding and a history of foul-smelling discharge per vagina for 8 months. On examination cervix flared up with growth, bled on touch, parametrium was involved and adherent anteriorly with bladder &amp; posteriorly with the rectum. Cervical biopsy revealed small cell carcinoma coexisting with Adenocarcinoma. Later it was confirmed by immunohistochemistry.&#x0D;

Adenoid Basal Carcinoma of Uterine Cervix: A Case Report

Adenoid basal carcinoma of uterine cervix is a very rare entity that has been reported less than 100 cases in the literature. Although the origin of the carcinoma is controversial; the multipotential basal cell layer of cervix is the believed part for tumor growth. A 54 years-old white postmenopausal woman was referred to our clinic with the complaint of postmenopausal bleeding. Her pelvic examination revealed a tumor lesion of 1.5cm on the ectocervix. Her cervical and endometrial biopsies revealed an epithelial carcinoma and we performed a radical hysterectomy with bilateral salpingo-oophorectomy and bilateral pelvic-paraaortic lymph node dissection. The final pathology result revealed adenoid basal carcinoma. Distinction of adenoid basal carcinoma from adenoid cystic carcinoma and other aggressive basaloid pathologies of cervix is important for the clinical management of patients since adenoid basal carcinoma is benign in behaviour despite being a carcinoma.

Synchronous malignant mixed Müllerian tumor of the uterus with transitional cell carcinoma of the ovary

A 55-year-old woman presented with a complaint of post-menopausal bleeding per vaginum. Local examination revealed a mass, protruding from the cervical os, which detached spontaneously. An adnexal mass was felt through the pouch of Douglas on per vaginum examination. Histopathological examination of the avulsed specimen revealed a diagnosis of malignant mixed Müllerian tumor. The patient underwent surgical staging with total abdominal hysterectomy, bilateral salpingo-oophorectomy, left pelvic lymphadenectomy, infracolic omentectomy, and peritoneal wash cytology. Pathological examination revealed a second primary tumor, that is, a transitional cell carcinoma of the ovary. Both the uterine malignant mixed Müllerian tumor and the ovarian transitional cell carcinoma were staged as IA. Subsequently, the patient was treated with adjuvant chemotherapy followed by radiotherapy. The patient is in complete remission at 1 year following the treatment. Synchronous genital tract neoplasms constitute a therapeutic challenge and necessitate an effective multimodality therapeutic approach based on meticulous pathological examination and tumor staging.

Endometrial stromal sarcoma: Where only rarity prevails over obvious presentation

Introduction: Endometrial stromal sarcoma (Ess) is a rare malignancy arising from the endometrial stroma. the majority (90%) of patients present with abnormal uterine bleeding (AUb) followed by mass per abdomen and pelvic pain. However, rarity of this tumor limits the clinician to consider it even as a differential diagnosis despite of having its typical symptoms and only diagnosed by biopsy as a surprise. On analysis of age of presentation, clinical findings and various diagnostic modalities, endometrial stromal sarcoma (Ess) mimics other disorders such as leiomyoma, leiomyosarcoma and endometrial polyp. the diagnostic dilemma continues even on gross and microscopic features of Ess and above mentioned disorders. the role of immunomarkers like cD10, desmin, h-caldesmon, etc. has evolved for specific diagnosis. case report: A 60-year-old female was presented with a complaint of postmenopausal bleeding underwent hysterectomy with a provisional diagnosis of submucous myoma and histopathological examination revealed this as endometrial stromal sarcoma. conclusion: Endometrial stromal sarcoma is a rare

Peritoneal keratin granuloma associated with endometrioid adenocarcinoma of the uterine corpus

We present a 69-year-old woman with a chief complaint of postmenopausal bleeding. She was diagnosed as having an endometrioid adenocarcinoma by biopsy, and underwent a total abdominal hysterectomy. At the time of surgery, granulation tissue-like nodules were found on the peritoneal serosa of the uterus. In the intraoperative cytology of peritoneal washing, atypical cells were noted. The intraoperative frozen section of the peritoneal nodule revealed granulation tissue with proliferating mesothelial cells. Microscopic examination of the permanent section showed keratin granulomas without viable adenocarcinoma cells on the serosal surface of the ovaries, fallopian tubes and broad ligaments. Postoperative chemotherapy was administered. She has been alive with no evidence of recurrence for 6 months postoperatively. It should be noted that the prognosis of cases in peritoneal keratin granuloma without viable cancer cells is favorable, and that the histological examination is essential for its diagnosis.

Pelvic actinomycosis associated with long term use of intrauterine contraceptive device

A55-year-old woman presented with complaint of post menopausal bleeding for one month, which varied from spotting to mild bleeding. She had been investigated outside and diagnosed as a case of carcinoma of the endometrium. She had one full term vaginal delivery 30 years ago and used contraception thereafter. She got intrauterine contraceptive device (CuT) inserted 27 years ago which was changed thrice every three yrs. The last CuT was inserted 18 years back. The patient went to a doctor for its removal after three years and was informed that it was removed.

Psammoma bodies in cervical smear in association with keratinizing squamous cell carcinoma of cervix: A case report

The presence of psammoma bodies (PBs) in cervical smears is a rare finding. These structures have been identified in association with a wide range of benign and malignant conditions within the female genital tract. PBs in cervical smears have usually been associated with malignant serous epithelial ovarian tumors. However, many PBs associated with atypical squamous cells were detected in cervical smears of an 83-year-old woman with complaint of postmenopausal bleeding. Colposcopic examination revealed an ulceroinfiltrative growth in the cervix. Histological examination of the biopsy specimen from the growth revealed keratinizing squamous cell carcinoma with multiple and singly arranged PBs. This report suggests that cytologists should aware of the possibilities, on finding PBs associated with atypical cells in cervical specimens and report the cases accordingly.

Skeletal carcinomatosis in endometrial clear cell carcinoma at initial presentation: a case report

Bone metastasis is frequently seen in different solid tissue malignancies. However, it is a very rare entity in endometrial cancers and most of the previous reports were localized to a single bone. To the best of our knowledge, this is the first report of a case with disseminated bone metastasis from endometrial clear cell carcinoma. A 69-year-old, multiparous woman presented with the complaint of postmenopausal bleeding. Diagnostic workup revealed endometrial clear cell carcinoma. After comprehensive surgical staging, the patient was found to be at FIGO stage IIIC. Three weeks after the operation, an intractable back pain developed. Direct graphics of the lumbosacral region were suspicious of metastasis, and further evaluation of the patient revealed metastasis in multiple bones including calvarium, thoracolumbal vertebrae, pelvic bones, costae, collum of the right femur, and trochanter major of the left femur. Bone metastasis in endometrial clear cell carcinoma may be seen at initial presentation and may involve multiple bones. Whole-body scanning with scintigraphic evaluation is a reasonable approach to evaluate the extension of the bone involvement. Further studies are needed to elucidate the true incidence and management of bone metastasis in endometrial clear cell carcinoma.

CRITERIA FOR ROENTGEN DIAGNOSIS OF SUBMUCOSAL GASTRIC LIPOMA.

A review of the world literature shows that gastric lipoma is infrequent. To date, excluding those in this study, 103 cases have been reported, 56 of them in the English literature. Of tumors of the stomach, less than 5 per cent are benign, and of these 3 per cent are lipomas. Despite their relative rarity, they assume importance because, with the aid of the characteristic feature we are presenting, they can be diagnosed with reasonable certainty by radiologic means. The roentgen criteria of Moore (8) are referred to in nearly all articles reporting cases of gastric lipoma, but are for benign gastric tumors in genera1. They are, therefore, of no aid in the differentiation of lipoma from other benign lesions. Skorneck (13) in 1952, reporting a case of gastric lipoma, refers to a unique roentgen appearance enabling a preoperative diagnosis of lipoma, namely, an area of radiolucency not representing intestinal gas. His was a large lesion, and in our experience and study of the available literature, lipomas of such magnitude are the exception and the finding of radiolucency is rare. The majority of lipomas are relatively small, not of sufficient dimension for translucency on an abdominal film. Culver and Dobrak (4) reported a case in 1950 and pointed out a gliding movement of the filling defect, indicating the submucosal position of most lipomas. Rogers and Adams (12) in 1956 described a case manifesting as a filling defect with two ulcerations. A preoperative diagnosis of lipoma was made because the lesion appeared to be less dense than the adjacent tissues. Fiddian and Parrish (6), on the basis of 4 cases, commented that lipomas were characterized by “globular, smooth, regular, clear, and persistent shadows.” One of their patients showed ulceration. Of the cases reported (1–4; 6–7, 9–11; 14–15) preoperative diagnosis of gastric lipoma by the radiologist was most unusual, occurring only when the rather uncommon finding of an obvious decrease in density was noted. The following cases are presented to illustrate radiological findings which we feel are peculiar to lipoma. Case I: M. R., a 58-year-old woman, was admitted to the hospital in June 1955 with complaints of postmenopausal bleeding. Because admission history revealed food aversions and left upper abdominal pain of several years duration, gastrointestinal studies were ordered. Radiography of the stomach revealed an antral filling defect with a central ulceration, changing shape with peristalsis. Also, the tumor was relatively radiolucent (Fig. 1). At surgery a wedge resection of the middle portion of the greater curvature of the stomach was carried out. The gross pathologic specimen was described as a submucosal fatty tumor 7 cm. in diameter, surmounted in the center by a depressed ulceration 1.5 em, in depth. Surrounding mucosa appeared normal. Microscopic diagnosis: Submucosal lipoma with central ulceration.