Diagnosis Of Submucous Myoma Research Articles

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

Feasibility and long-term efficacy of hysteroscopic myomectomy for myomas with intramural development by the use of non-electrical “cold” loops

This study aimed to assess the feasibility and the short- and long-term efficacy of hysteroscopic myomectomy for submucous myomas with intramural development [grade 1 (G1) and grade 2 (G2)] by using non-electrical “cold” loops and to verify the role of preoperative variables on surgical outcomes. Symptomatic (bleeding and infertility) premenopausal patients with the diagnosis of submucous myoma at transvaginal sonography, and with G1 and G2 grading at sonohysterography, were included in this prospective study. Hysteroscopic myomectomy was performed by the combined monopolar electrical slicing and traction-and-leverage manoeuvres by non-electrical “cold” loops. One hundred fifty-nine patients were recruited, and 169 procedures were performed. Operating time, fluid deficit, complications and complete resection at first procedure (perioperative outcomes) and persisting symptoms and additional surgery for persisting symptoms (long-term outcomes) were not significantly different for G1 vs. G2 myomas. Perioperative outcomes were significantly different when comparing myoma mean diameter <3.0 vs. ≥3.0 cm (75th percentile). Multivariate analysis and multiple regression analysis proved that myoma mean diameter was the only significant variable for surgical outcomes. Hysteroscopic myomectomy by non-electrical “cold” loops is an effective and efficient treatment for submucous myomas with intramural development. Myoma mean diameter is the only significant preoperative variable for perioperative outcome, while myoma grading loses its role as a prognostic factor.

Modified Sonohysterography Immediately after Hysteroscopy in the Diagnosis of Submucous Myoma

Study Objective To report a new, convenient, inexpensive, office-based examination to evaluate submucous myomas before hysteroscopic myomectomy. Design Retrospective analysis (Canadian Task Force classification II-2). Setting University-affiliated teaching hospital. Patients One hundred seventy-nine consecutive women. Intervention Diagnostic flexible hysteroscopy and transvaginal ultrasonography. Measurements and Main Results Transvaginal ultrasonography was performed immediately after hysteroscopy. The size and depth of invasion of submucous myomas were clearly identified by retained fluid after hysteroscopy. Locations of myomas were as follows: anterior wall, 37 (20.7%); posterior wall, 52 (29.1%); lateral wall, 40 (22.3%); and fundus, 31 (17.3%); and multiple myomas, 19 (10.6%). Myomas with stalk were found in 101 patients (56.4%) and without stalk in 78 (43.6%). The mean myoma diameter was 2.95 ± 2.12 cm and mean weight was 30.2 ± 33.6 g. Conclusion It is important to obtain details as to size and depth of invasion of submucous myomas before hysteroscopic myomectomy. Sonohysterography immediately after hysteroscopy is superior to traditional diagnostic methods.

Transvaginal ultrasonography versus hysteroscopy in the diagnosis of uterine submucous myomas

Seventy-one women with symptomatic uterine myomas, hospitalized for hysterectomy, underwent preoperative transvaginal ultrasonography and hysteroscopy to compare their reliability in the diagnosis of submucous myomas. After the operation, the surgical specimen was studied carefully and the results were compared with the preoperative diagnostic findings. Transvaginal ultrasonography had a sensitivity of 100% and specificity of 94%; the predictive value of an abnormal ultrasound scan was 81% and that of a normal one was 100%. The sensitivity of hysteroscopy was 100% and the specificity 96%; the predictive value of an abnormal hysteroscopic finding was 87% and that of a normal result was 100%. Mapping of uterine myomas is more precise with transvaginal ultrasonography than with hysteroscopy, but the former method cannot distinguish between a myoma and an endometrial polyp.