History Of Abnormal Uterine Bleeding Research Articles

Postmenopausal pregnancy? Evaluation of elevated hCG in a 59-year-old woman

Slightly elevated serum human chorionic gonadotropin (hCG) can be a normal finding in postmenopausal women. We report a case of a 59-year-old woman with a history of abnormal uterine bleeding...

Hysterosonography and Transvaginal Ultrasonography for Detection of Intrauterine Lesions in Women with Abnormal Uterine Bleeding

<p>Abnormal Uterine bleeding (AUB) is one of the frequent complaints of female patients of all ages. AUB is present in 33% of women referred to gynecologists and this increases to 69% in perimenopausal and postmenopausal women. About 10 % of postmenopausal bleeding results from endometrial cancer and imaging is the mainstay for its identification. Imaging plays a vital role in differentiating structural lesions like endometrial carcinomas, myomas and polyps which require surgical management from functional disorders requiring medical management. Transvaginal Ultrasonography (TVUS) is the first line imaging modality for AUB after selecting the patients with inconclusive pelvic ultrasonographic results. Hysterosonography (HSG) also plays a pivotal role.</p><p><strong>Objectives</strong><strong>:</strong> To compares between TVUS and HSG in the detection and identification of intrauterine lesions in patients with abnormal uterine bleeding, and comparing the sensitivity and specificity of the respective methods in the detection of such lesions.</p><p><strong>Methods: </strong> Thisstudy was conducted in Department of Radiology, Mayo Hospital Lahore. Fifty women presented with history of abnormal uterine bleeding were included in this study. Pregnancy was ruled out by transabdominal scan. Transvaginal ultrasound and hysterosonography were performed in all the patients. All the data were coded and analyzed using SPSS version 20.</p><p><strong>Results: </strong>Out of 50 patients, 10 patients had intramyometrial fibroid, 11 had submucosal fibroid, endometrial polyp was found in 17 patients and 2 patients had thickened endometrium (thickness > 8mm). The sensitivity and specificity of TVUS was found to be 83.2% and 82.7% respectively whereas HSG showed sensitivity and specificity of 95.4% and 91.5% respectively. In the detection of the submucosal fibroid and endometrial polyp, HSG showed highest sensitivity and specificity as compared totransvaginal ultrasound.</p><p><strong>Conclusion: </strong>Both the TVUS and HSG have comparable sensitivity and specificity in the detection of endometrial disease in patients presented with abnormal uterine bleeding however HSG is more sensitive in the detection of polyps.</p>

Potential of a Pharmacogenetic-Guided Algorithm to Predict Optimal Warfarin Dosing in a High-Risk Hispanic Patient: Role of a Novel NQO1*2 Polymorphism.

Deep abdominal vein thrombosis is extremely rare among thrombotic events secondary to the use of contraceptives. A case to illustrate the clinical utility of ethno-specific pharmacogenetic testing in warfarin management of a Hispanic patient is reported. A 37-year-old Hispanic Puerto Rican, non-gravid female with past medical history of abnormal uterine bleeding on hormonal contraceptive therapy was evaluated for abdominal pain. Physical exam was remarkable for unspecific diffuse abdominal tenderness, and general initial laboratory results—including coagulation parameters—were unremarkable. A contrast-enhanced computed tomography showed a massive thrombosis of the main portal, splenic, and superior mesenteric veins. On admission the patient was started on oral anticoagulation therapy with warfarin at 5 mg/day and low-molecular-weight heparin. The prediction of an effective warfarin dose of 7.5 mg/day, estimated by using a recently developed pharmacogenetic-guided algorithm for Caribbean Hispanics, coincided with the actual patient’s warfarin dose to reach the international normalized ratio target. We speculate that the slow rise in patient’s international normalized ratio observed on the initiation of warfarin therapy, the resulting high risk for thromboembolic events, and the required warfarin dose of 7.5 mg/day are attributable in some part to the presence of the NQO1*2 (g.559C>T, p.P187S) polymorphism, which seems to be significantly associated with resistance to warfarin in Hispanics. By adding genotyping results of this novel variant, the predictive model can inform clinicians better about the optimal warfarin dose in Caribbean Hispanics. The results highlight the potential for pharmacogenetic testing of warfarin to improve patient care.

Clinicopathological Study of Abnormal Uterine Bleeding in North Indian Patients

Abnormal uterine bleeding is the common presenting complains in the Gynaecology outpatient department in all age groups. Histopathological evaluation of the endometrial samples plays a significant role in the diagnosis of abnormal uterine bleeding. The study is planned to evaluate the pathological conditions in endometrium of the patients having abnormal uterine bleeding and its correlation with clinical condition. The 50 women’s having age from 20-60 history of abnormal uterine bleeding was studied. Endometrial tissue collected by sampling procedure such as Dilatation and Curettage (D&C),endometrial biopsies had been sent to the pathology lab for evaluation. The histopathological study of the endometrium showed Proliferative Endometrium as prominent histopathological pattern in 18 patients. Secretory Phase was seen in 12 womens, Endometrial Hyperplasia is seen in 8, Menstrual Phase observed in 3 patients. Atrophic Endometrium was followed in 7 patients followed by Endometrial Metaplasia in 2 patients.

Endometrial Hyperplasia: a 5-Years Retrospective Study

Background: The Endometrium is constantly engaged in the dynamics of shedding and re-growth during active reproductive life. It is controlled by the rise and fall of pituitary and ovarian hormones. This control is executed by proper timing of hormonal release in both absolute and relative amounts. Alterations in the fine tuning mechanism may result in a spectrum of disturbances and Endometrial Hyperplasia is most important among them. Objective: To study the histopathology of endometrial hyperplasia. Methods: The present retrospective study on Endometrial Hyperplasia was undertaken over a period of 5 years. Specimens for the study consisted of Endometrial curetting, fractional Curettage and Hysterectomy specimen with history of abnormal uterine bleeding sent for histopathology examination to the pathology department from Gynecology department. The specimen was received in 10% formation. After adequate fixation bits were taken for tissue processing and H&E staining. Wherever necessary, special stain such as reticulin staining, and PAS were done. Results: Incidence of Endometrial Hyperplasia found to be more in the 4th decade of life followed by 3rd decade. Majority of the Patients with endometrial Hyperplasia are of para 1. Simple Hyperplasia was most common in 788 (86.21%). Conclusion: Among the cases of endometrial hyperplasia, simple hyperplasia was the commonest lesion found followed by complex hyperplasia. Most cases were seen in 4th decade. Key words: Endometrial hyperplasia, Lesion, cases

Role of transvaginal sonography and diagnostic hysteroscopy in abnormal uterine bleeding.

Introduction : A prospective study was carried out in Department of Obstretics and Gynaecology in KIMS Hospital Bangalore, India, for a period of 18 mnth from 2005-2008. Sixty cases were selected for this study from patients who were above the age of 40 y and who were presented with a history of abnormal uterine bleeding (after excluding pregnancy and its complications, Patients with local causes of bleeding, patients with carcinoma cervix and PID). All women underwent transvaginal sonography and hysteroscopy. Dilatation and curettage was done in cases with abnormal endometrial findings and sample sent for histopathology examination. Performance of TVS pick up rate in relation to hysteroscopy were analysed by various statistical methods. In the present study, transvaginal ultrasound showed an accuracy of 83.3% in detecting the proliferative phase and 66.67% in detecting the secretory phase. TVS has a sensitivity of 0% for a local lesion (intra-cavitary) of endometrial cavity. TVS was also preferable in case of post-menopausal patients with endometrial thickness less than 4mm. Both TVS and hysteroscopy can detect endometrial intracavitary abnormalities with varying accuracies. These can supplement and enhance the accuracy of tissue diagnosis. Thus, the first procedure to which patients with AUB are to be subjected should be TVS followed by hysteroscopy and hysteroscopically directed biopsy, wherever required.

Endometrial surveillance in tamoxifen users: role, timing and accuracy of hysteroscopic investigation: observational longitudinal cohort study

To determine the role, timing and indications for endometrial hysteroscopic investigation in relation to the clinical, ultrasound and histological features of the endometrium during tamoxifen (TAM) use. We performed an observational longitudinal cohort study (years 2007-2012) that investigated the endometria of 151 TAM users with hysteroscopy and histology. For all patients, gynaecological history, years of adjuvant treatment, ultrasound endometrial thickness measurement and indications for hysteroscopy were recorded. Hysteroscopic findings showed that 100% of patients referred for simple follow-up had no evidence of endometrial disease. We found a strong correlation between previous history of abnormal uterine bleeding (with or without endometrial thickening) and hysteroscopic suspicion of endometrial atypia that was confirmed by histology. Hysteroscopy had 83.3% sensitivity, 99% specificity, 83.3% positive predictive value (PPV) and 99% negative predictive value (NPV) in detecting endometrial atypia. No significant correlation was found between endometrial thickening to >5 mm without bleeding and histological atypia. Similarly, the duration of treatment was not related to endometrial thickening and histological atypia. Endometrial stromal hyperplasia was detected by histology in 70.5% of patients with endometrial thickness measurements ranging from 5 to 10 mm. In contrast, no atypia was detected when endometrial thickness was <5 mm. Ultrasound performed using a 5-mm cut-off threshold for endometrial thickness resulted in 100% sensitivity, 15% specificity, 4% PPV and 100% NPV in detecting endometrial atypia, while a 10-mm cut-off threshold resulted in 84% sensitivity, 69% specificity, 10% PPV and 99% NPV. Low-risk TAM users do not require different endometrial surveillance than the general population. Hysteroscopy could play a fundamental role in determining the endometrial status of patients before the initiation of TAM treatment and in assessing the endometrial status of patients when bleeding occurs.

Coexisting carcinoma in endometrial hyperplasia: does more risk factor mean better discrimination?

See accompanying article on page 14. Few gynecologists would argue against that nuclear atypicality and glandular complexity in endometrial hyperplasia are associated with an increased risk of endometrial cancer [1,2]. Moreover, the possible existence of occult endometrial carcinoma or the risk of progression to carcinoma in complex or atypical endometrial hyperplasia has been a rationale to offer invasive surgery when a patient was found to have these histologic features [1]. Interestingly, a recent long-term observational study reported that the progression to carcinoma was observed in only 1.9% for non-atypical endometrial hyperplasia after 4 years follow-up [3]. The data reassure us that the risk of progression to carcinoma including coexistence of carcinoma may be negligible when no atypia was found. Also this low rate supports nonsurgical management of non-atypical endometrial hyperplasia. However, in cases with atypia, things go different. For atypical hyperplasia, the 4-year cumulative risk increased to 8.2%. After 9 years, the cumulative progression risk further increased to 12.4%. Should we offer decisive hysterectomy in all patients with atypia? Is there any room for individualized management in patients with atypical endometrial hyperplasia? In this issue of Journal of Gynecologic Oncology, an observational study from the Taiwanese Gynecologic Oncology Group (TGOG) provided several risk factors that we should take into consideration in planning treatment of endometrial hyperplasia. First, the authors confirmed that several clinical variables, such as older age, menopausal status, history of diabetes, history of abnormal uterine bleeding, and high body mass index (BMI) were independent risk factors. Second, they tried to improve the accuracy in the prediction of coexisting carcinoma using these clinical risk factors. Did they success in improving the accuracy of the model? Unfortunately, it seems not. When the authors integrated atypia with other clinical risk factors, the discrimination performance did not increased significantly. Thus, it may not be surprising that the authors emphasized no risk factors but only atypia in the conclusion. Then, what would be the scientific merit of this multi-center study? First, in the authors' data, positive likelihood ratios were high when a patient with atypical endometrial hyperplasia had high BMI or in her menopause. Especially, when a patient with atypical hyperplasia was in her menopause, a positive likelihood ratio was increased to more than 5.0. This indicates the presence of risk factors other than atypia, such as high BMI or menopause, may represent high likelihood of coexisting carcinoma. Therefore, if we find that a patient with atypical hyperplasia has other risk factors, especially menopause, a pathologist should examine the specimen more carefully, and a surgeon should offer adequate information to a patient and allow her to choose decisive treatment. Because the authors used logistic modeling, it is evident that the probability of coexisting carcinoma would increase further if a patient has additional risk factors. Second, it is surprising that 25 out of 191 patients (13%) with non-atypical endometrial hyperplasia were found to have coexisting carcinoma. In general, it has been believed that the risk of progression to carcinoma is less than 4% in non-atypical hyperplasia [2]. Correspondingly, a recent large-scale study showed that cumulative progression risk was only 1.9% through 9 years of observation in patients with non-atypical hyperplasia [3]. In contrast to previous knowledge, the TGOG report alerts that substantial proportion of patients with non-atypical hyperplasia has coexisting carcinoma. If the results from TGOG were not affected from serious selection bias, the results suggest that coexisting carcinoma may not have a significant role in the clinical progression to carcinoma in non-atypical hyperplasia. However, we should remember that the natural history of endometrial hyperplasia is difficult to define because of the unstable reproducibility of pathologic examination or the diversity in sampling methods. Therefore, it may be immature to interpret the TGOG data as a recommendation for aggressive treatment in non-atypical hyperplasia. Rather, despite the incidence rate of coexisting carcinoma, hormone treatment should be recommended first based on its excellent outcome in the patients with non-atypical hyperplasia [4,5]. Although the TGOG data did not provide a decisive prediction model to help an individualized treatment in atypical endometrial hyperplasia, I believe that gynecologic oncologists should keep trying to find an efficient risk model for these patients. Above all, more effort should be directed toward the estimation of clinical effectiveness of hormone treatment in atypical endometrial hyperplasia, because majority of these patients are subjected to aggressive surgical treatment. Considering its low progression rate and good response rate to hormonal therapy, the role of hormonal treatment should be explored as an ideal treatment option regardless of women' s desire for fertility. To establish an individualized treatment in these patients, Asian society should continue to communicate and collaborate further.

Factors associated with the need for blood transfusion during hysterectomy

ObjectiveTo identify the preoperative clinical conditions associated with the need to perform a blood transfusion among patients undergoing hysterectomy. MethodsIn a retrospective, comparative, case–control trial at the University Hospital, Nuevo León, Mexico, the records of patients who underwent elective hysterectomy between 2007 and 2009 were reviewed. Patients were grouped depending on whether or not they required blood transfusion. Clinical features were compared and statistical analysis was performed via the χ2 test. ResultsAmong 794 patients who underwent hysterectomy, 89 (11.2%) required transfusion. The factors significantly associated with transfusion were history of abnormal uterine bleeding (67.0% versus 52.1%), preoperative hemoglobin level (10.1g/dL versus 12.3g/dL), magnitude of intra-operative bleeding (410mL versus 298mL), and operative time (172min versus 144min); P<0.001. A significant number of patients who underwent transfusion had increased preoperative prothrombin levels; P=0.04. ConclusionHemoglobin level before surgery and a history of abnormal uterine bleeding can be identified preoperatively and might warn about the possibility of a need for transfusion among patients undergoing hysterectomy. For young patients, alterations in clotting mechanisms should be ruled out.

Role of diagnostic hysteroscopy in abnormal uterine bleeding and its histopathologic correlation

Aims and Objectives:To study the accuracy of hysteroscopy in evaluation of abnormal uterine bleeding and to correlate hysteroscopic findings with histopathologic findings.Materials and Methods:A prospective study was carried out in the Department of Obstetrics and Gynecology at AVBRH and JNMC, Sawangi (M), Wardha, from May 2006 to September 2008. One hundred cases were selected for this study from patients of age group 18 and above, who were admitted with the history of abnormal uterine bleeding. Hysteroscopic examination was done in all patients post-menstrually, whenever possible, except in those cases where menstrual cycles were grossly irregular or patients came with continuous bleeding per vaginum. The patients then underwent dilatation and curettage and endometrium was sent for histopathologic examination. The correlation between findings on hysteroscopy and histopathologic examination was tabulated.Results:Following were the findings on hysteroscopy: proliferative 34%, secretary 16%, hyperplasia 18%, atrophic 8%, endometrial polyp 9%, submucous myoma 11%, carcinoma of endometrium 03%, misplaced Cu-T 1%.Conclusion:In patients with abnormal uterine bleeding, hyster-oscopy provides more accurate dia-gnosis than dilatation and curettage.

Endometrioid carcinoma of the endometrium with choriocarcinomatous differentiation: a case report and review of the literature

An endometrioid adenocarcinoma (EAC) with true trophoblastic differentiation is a rare event with a highly aggressive clinical course. We report an endometrioid adenocarcinoma of the endometrium in which there was a morphologically conventional-appearing EAC component admixed with multinucleated giant cells and large pleomorphic tumor cells that resembled a choriocarcinoma without an elevated serum level of human chorionic gonadotropin (hCG) in a 42-year-old unmarried woman with a history of abnormal uterine bleeding. A total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection were performed. Histopathologic study of the specimen showed endometrioid adenocarcinoma extended to the deep myometrium with a focus of hemorrhagic and necrotic tumor composed of multinucleated giant cells, large pleomorphic tumor cells, suggesting choriocarcinomatous differentiation (CD). Immunohistochemical studies demonstrated intense reactivity of tumor cells for human chorionic gonadotropin (hCG) confirming the diagnosis. A complete clinical workup ruled out metastatic spread to the brain, lungs, skeleton, or abdomen. The patient was alive with no evidence of disease 6 months later. Although endometrioid adenocarcinoma with choriocarcinomatous differentiation is known to behave in a more aggressive course, this disease may have a good prognosis with a clinically indolent course when it is small, and without elevated serum hCG levels.

Polypoid endometrium on three‐dimensional saline contrast sonohysterography

Endometrial abnormalities are often diagnosed in women with a history of abnormal uterine bleeding. The differential diagnosis between focal and global endometrial lesions has been facilitated by the use of saline contrast sonohysterography, which has proved to be more effective than has non-enhanced B-mode transvaginal ultrasound1. The most common focal endometrial lesions are benign endometrial polyps. However, endometrial carcinoma may also present as a focal polypoid lesion within the uterine cavity. In premenopausal women, the differential diagnosis also includes submucous fibroids, which sometimes protrude into the uterine cavity, forming polyp-like lesions. Multiple endometrial polyps are found in approximately 20% of cases2. It is unusual, however, to find more than two to three polyps in individual cases. A large number of concomitant polyps, which is sometimes referred to as ‘endometrial polyposis’, are a rarity. Here, we present a case of polypoid endometrium, which resembled endometrial polyposis on transvaginal ultrasound examination. A 39-year-old woman attended for an ultrasound scan with a history of intermenstrual bleeding and primary infertility. Twelve years previously she had undergone a colposcopy and cervical biopsy, but her smear tests were normal following this. In 2001 she underwent a hysteroscopy and polypectomy. She continued to experience intermenstrual bleeding, but another hysteroscopy in 2003 revealed no endometrial abnormalities. She was in good general health and she was not on any regular medication. Her baseline hormone profile was normal. On ultrasound examination, a small subserous fibroid was noted, which was not affecting the uterine cavity. On B-mode examination, the endometrium appeared irregular and the midline echo was disrupted. On Doppler examination, the endometrium appeared poorly vascularized. The ovaries were normal. Three-dimensional saline contrast sonohysterography was performed, revealing more than 20 polypoid lesions arising from the endometrium (Figure 1). A Figure 1 Coronal section of the uterus obtained on three-dimensional saline contrast sonohysterography showing multiple polyp-like lesions within the endometrial cavity.

Carcinoma adenoescamoso do colo uterino mimetizando carcinoma adenóide basal: relato de um caso e revisão da literatura

O carcinoma adenoescamoso do colo uterino e definido como um tumor que contem uma mistura de celulas malignas com diferenciacao escamosa e glandular. A literatura salienta a importância de se fazer esse diagnostico, uma vez que, quando os componentes nao sao bem diferenciados ou nao se encontram evidentes na amostra analisada, esse tumor pode ser erroneamente interpretado como carcinoma escamoso ou adenocarcinoma. O presente trabalho descreve a apresentacao pouco comum de um carcinoma adenoescamoso. Apos sucessivos diagnosticos citologicos nao concordantes e complicados por uma historia de sangramento uterino anormal ocasionado por endometriose cervical, a paciente de 47 anos foi submetida a histerectomia total, obtendo diagnostico definitivo. Esse particular tumor aqui relatado foi diagnosticado como carcinoma adenoescamoso, mas em muitos aspectos apresentou-se semelhante ao carcinoma adenoide basal. Elementos caracteristicos do carcinoma adenoide basal, como presenca de lesao intra-epitelial escamosa na superficie, diferenciacao escamosa e glandular no centro dos blocos neoplasicos e celulas basaloides na profundidade da lesao, foram observados em nosso caso. Em contrapartida, os seguintes elementos normalmente nao observados no carcinoma adenoide basal estavam presentes: atipias e figuras de mitose nas celulas indiferenciadas da profundidade do tumor e lesao intra-epitelial escamomucinosa (SMILE) na superficie. Fatores epidemiologicos e clinicos, como idade (47), raca (branca) e forma de apresentacao clinica (massa visivel na inspecao cervical), tambem colaboraram para afastar esse diagnostico diferencial. Outros diagnosticos diferenciais do carcinoma adenoescamoso do colo uterino incluem o carcinoma puramente escamoso ou glandular, o tumor de colisao e o adenocarcinoma de endometrio com diferenciacao escamosa invadindo o colo uterino.

Repercussões hemodinâmicas do posicionamento em litotomia exagerada para histerectomia vaginal em paciente cardiopata: relato de caso

Vaginal hysterectomy shortens surgery duration and may be performed with neuraxial block, which promotes better postoperative analgesia and lower systemic response to surgical procedure. This report aimed at describing hemodynamic changes promoted by exaggerated lithotomy position in cardiac patient.Female patient, 33 years old, with history of abnormal uterine bleeding and anemia. Ultrasound revealed myomas of approximately 420 cm(3). Patient had thrombophilia and dilated cardiomyopathy, with history of two ischemic strokes and two acute myocardial infarction. Monitoring consisted of invasive blood pressure and pulmonary artery catheter for continuous cardiac output measurement. Spinal anesthesia was performed with hyperbaric bupivacaine and morphine. Patient was placed in exaggerated lithotomy position being total hysterectomy performed by the Heaney technique and bilateral salpingectomy. Intraoperative intercurrences were post-positioning decreased cardiac output and increased right chambers pressure requiring dobutamine.Exaggerated lithotomy position may promote hemodynamic changes which should be considered when choosing the surgical technique.

Menstrual Issues in a Teenager with Developmental Delay

The patient is a 14-year-old black female who presents with a 1-year history of abnormal uterine bleeding. She started her menses at age 13. Her cycles range from 2 to 8 weeks in length. The periods last from 3 day to 3 weeks with occasional very heavy bleeding. She is not able to do her own hygiene as she cannot understand what to do with her pads. She takes them out and does not put a new one in. She lives with her father mother and two brothers. She goes to school with special ed classes. She has a complicated medical history with the following issues: Diabetes mellitus type1 grand mal seizures chronic hypertension autism mental retardation gastro-esophageal reflux congenital hiatal hernia. Her medications include: Insulin Glucophage Propulsid Prilosec and Lotensin. (excerpt)

Abnormal uterine bleeding and prognosis of endometrial cancer

Objectives: The aim of this study was to analyze the relationship between the period of abnormal uterine bleeding (AUB) and the prognosis of endometrial cancer. Methods: We reviewed 304 endometrial cancer patients who were diagnosed and treated between 1985 and 1998 in our hospital, and whose history of AUB and clinical parameters were clearly available from their charts. Pathological data and overall survival were compared between groups having different periods of AUB. Results: Duration of AUB had no impact on the prognosis of endometrial cancer. Patients diagnosed with endometrial cancer without AUB showed a significantly better 5-year overall survival rate than the patients diagnosed after the onset of AUB. The distribution of clinical stages and histological grades did not differ depending on AUB status. Conclusions: The prognosis of endometrial cancer was determined by the histopathological character of the tumor. However, the diagnosis and treatment of endometrial cancer with some suspicious signs other than AUB might improve the prognosis.

Comparison of hydrosonography and transvaginal ultrasonography in the detection of intracavitary pathologies in women with abnormal uterine bleeding

BackgroundThe aim of the study was to compare the accuracy of hydrosonography with that of transvaginal ultrasonography in detection of intracavitary pathologies in patients with history of abnormal uterine bleeding.Study designProspective, randomized, and unblinded study.Material and methodsA total of 197 women (n = 130 premenopausal and n = 67 postmenopausal) aged between 23 and 71 years (mean age 45.7 ± 8.9) presenting with a history of abnormal uterine bleeding were included into the study. Hydrosonography was carried out by experienced gynecologists, on the same setting in an outpatient clinic immediately after the performance of transvaginal sonography. The finally obtained surgical-pathologic findings were compared with the results obtained from transvaginal sonography and hydrosonography. Sensitivity, specificity, positive, and negative predictive values were calculated for each procedure.ResultsThe surgical-pathologic examination confirmed normal physiologic endometrium in 50 (48%) of 104 women who were said to have normal endometrium on transvaginal sonography. Seventy (75%) of 93 women diagnosed of intracavitary pathologies on transvaginal sonography were confirmed by surgical-pathologic findings. The sensitivity, specificity, positive predictive value, and negative predictive value of transvaginal sonography in the detection of intracavitary pathology were 56, 68, 75, and 48%, respectively. Surgical-pathologic results revealed intracavitary pathologies in 23 (30%) of 76 women who were said to have normal endometrium on hydrosonography. Among 121 women diagnosed of intracavitary pathologies on hydrosonography, 101 (81%) women were confirmed after histological evaluation of the surgical specimens. The sensitivity, specificity, positive predictive value, and negative predictive value of hydrosonography in the detection of intracavitary pathology were 81, 73, 83, and 70%, respectively. Sensitivity and negative predictive value were significantly higher with hydrosonography. There were five cases of endometrial malignancy in which one of the case of malignancy was on polyp and two cases of endometrial hyperplasia with atypia which were not stated on sonographic results.ConclusionHydrosonography is more accurate than transvaginal ultrasography in the detection of intracavitary pathologies in women with abnormal uterine bleeding.

Detection of testosterone and estrogen receptors in the postmenopausal endometrium

Objective: To detect the presence of testosterone and estrogen receptors in the stroma and glandular epithelium in the malignant and non-malignant endometrium. Methods: One hundred and forty-five consecutively-enrolled peri- or postmenopausal patients were submitted to diagnostic or operative hysteroscopy. These patients either had a history of abnormal uterine bleeding or they were asymptomatic with an endometrial echo greater than 4 mm. The presence of estrogen and testosterone receptors was determined in endometrial samples by immunohistochemistry, using monoclonal antibodies and a streptavidin–biotin peroxidase complex system with diamino benzidine as the chromogen. Results: Testosterone receptors were detected mainly in the stroma in the non-malignant endometrial lesions and in the atypical glandular epithelium in cases of estrogen-positive endometrial carcinomas. Conclusions: The presence of testosterone receptors in estrogen receptor positive endometrial carcinomas may be involved in the mechanism of cell proliferation in these tumors. The strong staining reaction for testosterone receptors in the endometrial glands can be considered one of the features of invasive malignancy.

An Ovarian Cholelithiasis

45-year-old woman had a history of abnormal uterine bleeding for 2 years. She was admitted to the hospital and underwent a hysterectomy and bilateral salpingo-oophorectomy. The specimen was received in pathology and consisted of a 280-g uterus with attached bilateral fallopian tubes and ovaries. Adherent to the right ovary was an encapsulated, multifaceted, black calculus (Figure 1). Closer examination revealed an apparent gallstone connected to the ovary by dense fibrous tissue (Figure 2). The patient had undergone a laparoscopic cholecystectomy 2 years prior to the hysterectomy. The gallbladder contained multiple hard, black, multifaceted gallstones, which were identical to the calculus adherent to the ovary. Gallstones implanting in the ovary are an unusual finding. Spillage and loss of gallstones into the peritoneal cavity

The accuracy of endometrial biopsy and saline sonohysterography in determining the etiology of abnormal uterine bleeding

Objective: To compare the results of endometrial biopsy and saline sonohysterography to that of D & C/hysteroscopy or definitive surgery in the evaluation of abnormal uterine bleeding. Methods: The study protocol was approved by the Human Investigation Committee. The patient population studied consisted of women presenting to outpatient services complaining of a history of abnormal uterine bleeding who had failed conservative medical management. The study consisted of two arms with a combined total of 120 patients. The prospective arm included 91 patients who underwent endometrial biopsy and saline sonohysterography as outpatients before being evaluated by a definitive surgical procedure such as D & C/hysteroscopy with or without thermal balloon ablation or hysterectomy. The retrospective group included 41 patients who before the initiation of this study had endometrial biopsies and saline sonohysterography performed with subsequent definitive surgical procedures. These charts were reviewed retrospectively and included in the results as a separate group. All saline sonohysterographies and procedures were performed under supervision of the attending staff. Results: The combination of endometrial biopsy and saline sonohysterography had a sensitivity and specificity of 96.2% and 65.7%, respectively. The positive predictive value of a saline sonohysterography study showing an endometrial polyp, submucous myoma, or irregular endometrial contour was 80.6%. A normal saline sonohysterography had a negative predictive value of 92.0%. Conclusions: Endometrial biopsy and saline sonohysterography are useful for the evaluation of abnormal uterine bleeding; however, it is important to recognize the limitations in the predictive value of this diagnostic modality.