Recurrent Abnormal Uterine Bleeding Research Articles

Selecting the best surgical approach in various cases of prolapsed pedunculated submucosal fibroids: A case series

IntroductionThe pedunculated fibroid is classically managed through vaginal myomectomy. However, vaginal myomectomy cannot be safely and easily performed in all cases. We reviewed three cases of prolapsed pedunculated submucosal fibroids, each with a specific surgical difficulty. Presentation of casesThe first case had a prolapsed pedunculated uterine fibroid in pregnancy and underwent fibroid extirpation during an emergency cesarean section through the lower uterine segment incision. The second case was a nulliparous woman with recurrent abnormal uterine bleeding due to a giant prolapsed pedunculated uterine fibroid who underwent laparotomy fibroid extirpation through posterior colpotomy, preserving the uterus. The third case had a prolapsed pedunculated uterine fibroid in perimenopause with multiple fibroids and underwent fibroid stalk excision through an isthmic incision to facilitate a safe laparotomy hysterectomy procedure. DiscussionVaginal removal has become the standard surgical method for prolapsed pedunculated submucous fibroids. However, some possible consequences of vaginal myomectomy include severe stalk bleeding, infection, and uterus inversion induced by excessive traction. Therefore, specific approaches are needed in some circumstances. ConclusionCustomised surgical approaches provided safe and efficient access to the prolapsed pedunculated fibroid stalk during myomectomy or hysterectomy.

Патоморфологические маркеры рецидивирующей лейомиомы матки в репродуктивном возрасте

Aim. To determine the pathomorphological markers and clinical factors of recurrent uterine fibroids in reproductive age. Design. Prospective, non-randomized, longitudinal study. Materials and methods. The study included 75 patients, of whom 52 had uterine fibroids without recurrence (group I), 23 with relapse (group II). Indications for surgical treatment were: prolonged, heavy menstruation leading to anemia, pain syndrome, recurrent abnormal uterine bleeding, compression syndrome of adjacent organs. The study included patients with myomatous nodes of types 0–7 according to the FIGO (International Federation of Gynaecology and Obstetrics) classification. Results. During morphological examination, leiomyoma was macroscopically presented as a dense nodular formation with an uneven surface, whitish in color, and fibrous in appearance when cut. When comparing the size of the uterus (weeks of conditional pregnancy) in the comparison groups, it was revealed that in group I Me (Q1–Q2) was 13.00 (10.0–15.0), in group II - 13.0 (11.0–15.0) without statistically significant differences (p = 0.58). At the same time, in patients of group II with uterine sizes up to 10 weeks. – recurrence of uterine fibroids occurs in every fifth (21.7%), from 10 to 15 weeks. almost every second (60.9%) and more than 15 weeks. – every sixth (17.4%) (see diagram 1). As for the number of myomatous nodes, in group II, multiple uterine fibroids were detected in every second patient (60.9%). When comparing the growth rate of myomatous nodes in half (43.5%) of the examined women with relapse, their growth rate ranged from 6 months to 1 year, in every third (39.1%) — more than 1 year. Conclusion. According to our data, patients with recurrent uterine myoma have a number of clinical features compared to those with simple uterine myoma — younger age and duration of the disease. Recurrent uterine fibroids are characterized by rapid growth of myomatous nodes, large size and growth rate of nodes. Thus, understanding all of the mechanisms underlying leiomyoma through the integration of differential cellular/molecular characteristics may contribute to the discovery of tumor-specific biomarkers as well as the development of targeted therapeutic approaches that specifically target the affected pathways. Key words: uterine leyomioma, pathomorphology of uterine leyomioma, growth zones of leiomyoma.

Effectiveness of Hysteroscopic Morcellation of Endometrial Polyps Compared to Traditional Technique: A Comparison of Disease Recurrence

Study ObjectiveTo compare the outcomes between hysteroscopic morcellation of endometrial polyps and traditional techniques such as hysteroscopic resection with monopolar or bipolar radiofrequency energy, scissors and graspers or mechanical resection with polyp forceps.DesignRetrospective chart review.SettingAcademic tertiary referral center.Patients or Participants193 patients who underwent operative hysteroscopic polypectomy between January 2015 and May 2016.InterventionsHysteroscopic polypectomy with intrauterine morcellation, monopolar or bipolar radiofrequency energy, scissors and graspers or mechanical resection with polyp forceps with evaluation and/or treatment of recurrent abnormal uterine bleeding (AUB) after operative polypectomy.Measurements and Main ResultsThere were 9 patients who underwent hysteroscopic polypectomy with monopolar radiofrequency energy, 3 patients with bipolar radiofrequency energy, 91 patients with intrauterine morcellation, 67 patients with polyp forceps and 12 patients with scissors and graspers. The recurrence rate for AUB for monopolar was 1.89%, bipolar was 1.67%, intrauterine morcellation was 1.93%, polyp forceps was 1.84% and hysteroscopic scissors and/or graspers was 1.83%. Among the recurrences the average time until recurrence was 1162 days for monopolar, 207 days for bipolar, 749.5 days for intrauterine morcellation, 477.6 days for polyp forceps and 341.5 days for hysteroscopic scissors and graspers.ConclusionThere was no significant difference in terms of recurrence of AUB following the different modalities of operative hysteroscopy. Among the patients with recurrence in order of shortest time until recurrence: bipolar, hysteroscopic scissors and graspers, polyp forceps, intrauterine morcellation and monopolar.

Collision tumour of endometrial stromal sarcoma, uterine tumour resembling ovarian sex-cord tumour, and leiomyoma

Purpose of investigation: Endometrial stromal (ES) tumours may show different types of differentiation including smooth muscle and sex-cord like elements. A common problem is the differential diagnosis of ES tumour variants from other tumours that have smooth muscle or sex cord-like elements. We report a case of collision tumour that was composed of a low-grade endometrial stromal sarcoma (ESS) with sex-cord like differentiation, a uterine tumour resembling ovarian sex-cord tumour (UTROSCT), and a leiomyoma. Result: The patient was a 63-year-old multiparous woman who was referred to us with the complaint of recurrent abnormal uterine bleeding. Magnetic resonance imaging demonstrated a 3.4-cm-dia. solid tumour in her uterine cavity. We performed an abdominal total hysterectomy and a bilateral salpingo-oophorectomy. On gross and microscopic examination, the tumour consisted of a CD10-positive low-grade ESS, a CD10-negative UTROSCT, and a leiomyoma. Conclusion: ESS should be distinguished from UTROSCT and leiomyoma because of its malignant potential.

The Office Vaginoscopic Hysteroscopy in Management of Virginal Women with Recurrent Abnormal Uterine Bleeding

Introduction: Abnormal uterine bleeding (AUB) is the most common reason to visit gynecology outpatient clinic. Virginal women are a challenge for gynecologist in management of AUB. The office vaginoscopic hysteroscopy is an ideal selection. The usefulness and feasibility of no touch hysteroscopy in virginal women is rarely reported. Objectives: The feasibility of vaginoscopic hysteroscopy for management of virginal women with abnormal uterine bleeding AUB.

A Case Report on Recurrent Cotyledonoid Dissecting Leiomyoma

Cotyledonoid dissecting leiomyoma is an extremely rare variant of uterine leiomyomas. Although they are pathologically benign, they manifest as sarcomatoids because of their appearance. A 34-year-old single patient was admitted to the Obstetrics and Gynaecology outpatient clinic for recurrent abnormal uterine bleeding and inguinal pain. The patient underwent hysterectomy with a diagnosis of recurrent cotyledonoid dissecting leiomyoma. In this report, we discuss the aggressive clinical course of a patient with recurrent cotyledonoid dissecting leiomyoma resulting in hysterectomy, which has been reported in a limited number of studies in the literature.

The role of transvaginal power Doppler ultrasound in the differential diagnosis of benign intrauterine focal lesions

The purpose of this prospective study was to assess the role of power Doppler imaging in the differential diagnosis of benign intrauterine focal lesions such as endometrial polyps and submucous myomas using the characteristics of power Doppler flow mapping. A total of 480 premenopausal patients with abnormal uterine bleeding were evaluated by transvaginal ultrasonography (TVS) searching for intrauterine pathology. Sixty-four patients with a suspicious focal endometrial lesion received saline infusion sonography (SIS) after TVS. Fifty-eight patients with focal endometrial lesions underwent power Doppler ultrasound (PDUS). Three different vascular flow patterns were defined: Single vessel pattern, multiple vessel pattern, and circular flow pattern. Finally, hysteroscopic resection was performed in all cases, and Doppler flow characteristics were then compared with the final histopathological findings. Histopathological results were as follows: endometrial polyp: 40 (69 %), submucous myoma: 18 (31 %). Of the cases with endometrial polyps, 80 % demonstrated a single vessel pattern, 7.5 % a multiple vessel pattern, and 0 % a circular pattern. Vascularization was not observed in 12.5 % of patients with polyps. Of the cases with submucousal myomas, 72.2 % demonstrated a circular flow pattern, 27.8 % a multiple vessel pattern, and none of them showed a single vessel pattern. The sensitivity, specificity, and positive and negative predictive values of the single vessel pattern in diagnosing endometrial polyps were 80, 100, 100, and 69.2 %, respectively; and for the circular pattern in diagnosing submucous myoma, these were 72.2, 100, 100, and 88.9 %, respectively. Power Doppler blood flow mapping is a useful, practical, and noninvasive diagnostic method for the differential diagnosis of benign intrauterine focal lesions. Especially in cases of recurrent abnormal uterine bleeding, recurrent abortion, and infertility, PDUS can be preferred as a first-line diagnostic method.

Long-Term Outcomes After Intrauterine Morcellation vs Hysteroscopic Resection of Endometrial Polyps

Study ObjectiveTo compare the long-term outcomes of intrauterine morcellation (IUM) of endometrial polyps vs a traditional operative polypectomy technique, hysteroscopic resection (HSR), and to identify factors predictive of recurrent abnormal uterine bleeding (AUB) after operative polypectomy. DesignRetrospective cohort study (Canadian Task Force classification II-2). SettingMinimally invasive gynecologic surgery practice in a tertiary care center. PatientsWomen who underwent operative hysteroscopic polypectomy between January 1, 2004 and December 31, 2009. InterventionsIntrauterine morcellation or HSR with evaluation and/or treatment of recurrent AUB after operative polypectomy. Measurements and Main ResultsOf 311 patients (IUM group, 139; HSR group, 172), 167 (53.7%) had at least 1 gynecologic follow-up visit and 57 (18.4%) had recurrent AUB. Subsequent gynecologic clinic visit rates were similar between the 2 groups (HSR, 58.1%, vs IUM, 48.2%; p = .08). Recurrence of AUB within the first 4 years of follow-up was similar between the IUM and HSR groups (hazard ratio for HSR vs IUM, 1.12; 95% confidence interval, 0.64–1.98; p = .59). However, recurrence of endometrial polyps approached statistical significance (hazard ratio, 3.3; 95% confidence interval, 0.94–11.49; p = .06). Premenopausal status, history of hormone replacement therapy, multiparity, and polycystic ovarian syndrome were independently associated with AUB recurrence. There were no reports of inability to establish a histopathologic diagnosis among all pathology specimens evaluated. ConclusionCompared with HSR, intrauterine morcellation may be associated with lower recurrence of endometrial polyps. However, the incidence of recurrent AUB is independent of polypectomy method.

Three-year follow-up results of polypectomy with endometrial ablation in the management of endometrial polyps associated with tamoxifen in Chinese women

The aim of this study was to investigate the role of hysteroscopic polypectomy with endometrial ablation in the management of tamoxifen-associated endometrial polyps in postmenopausal women with a more than 3-year follow-up period. The medical records of 76 postmenopausal patients on tamoxifen who were performed hysteroscopic polypectomy with endometrial ablation were evaluated more than 3 years after the procedure with recurrence of polyps, recurrent abnormal uterine bleeding and surgical re-intervention. Average follow-up period was 74.91 ± 20.84 months. No patient underwent hysterectomy, 7 of 76 patients had a surgical re-intervention representing a total of 90.8% avoidance of additional surgery during the follow-up period, and 4 patients had a recurrent endometrial polyp representing the recurrence rate was 5.3%. 3 of 41 patients with postmenopausal bleeding had a recurrent abnormal uterine bleeding representing symptomatic relief rate is 92.7%. The treatment failed in 7 patients who requested surgical re-intervention: 4 patients requested a repeat polypectomy and ablation, 1 patient requested a repeat ablation and 2 patients requested a repeat hysteroscopy with uterine adhesion. No malignant endometrial pathological result was found. For postmenopausal patients suffering from endometrial polyps associated with tamoxifen, hysteroscopic polypectomy with endometrial ablation continues to be proven as a safe and effective minimally invasive treatment method. The high rate of surgical re-intervention avoidance, great symptomatic relief and low recurrence rate are very encouraging for this technology.