Vaginal Endometriosis Research Articles

Clear Cell Carcinoma Arising in Vaginal Endometriosis in a Patient 33 Years after Total Hysterectomy and Bilateral Salpingo-oophorectomy: A Case Report

Abstract Introduction/Objective Endometriosis, a common gynecological disorder characterized by ectopic endometrial tissue, is associated with an increased risk of extraovarian malignancies. Vaginal endometriosis is a rare condition, and the occurrence of vaginal malignancies arising from endometriosis is anticipated to be exceedingly rare. Here, we present a rare case of clear cell carcinoma arising in vaginal endometriosis, occurring three decades post-total hysterectomy and bilateral salpingo-oophorectomy. Methods/Case Report A 71-year-old female presented with abnormal Cologuard results, leading to a colonoscopy revealing a mass in the recto-sigmoid colon. She had undergone total hysterectomy and bilateral salpingo- oophorectomy for leiomyoma and endometriosis 33 years prior. Histopathological examination revealed clear cell carcinoma arising in vaginal endometriosis, with tumor extension through the colon wall to the colonic mucosal surface (Figure 1). Notably, the vaginal mucosal surface was negative for tumor. Immunohistochemistry staining demonstrated positivity for Pax8, CK7, AE1/3, racemase, and p16, while negtive for ER, PR, CDX2, CK20, CAIX, SatB2, RCC, WTI, Napsin, and calretinin (Figure 2). The staining for p53 was patchy (wild type, not mutated). Cancer-type relevant biomarkers reveal BRAF mutation (p.D594G), ARID1A mutation (p.M1564fs), PD-L1 mutation (Positive, CPS:80), and PIK3CA mutation (p.H1047L). The histologic and immunohistochemistry findings are consistent with clear cell carcinoma arising in a long-standing area of endometriosis (previous surgery in 1990). Results (if a Case Study enter NA) NA Conclusion Clear cell adenocarcinoma arising from endometriosis is exceptionally rare. Pathologists must consider the possibility of tumors arising from endometriosis when evaluating bowel or mesenteric neoplasms, even decades post-total hysterectomy and bilateral salpingo-oophorectomy. Immunohistochemistry plays a crucial role in the differential diagnosis between carcinoma arising from endometriosis and primary colonic carcinoma. Additionally, Sampson’s criteria are valuable for diagnosing malignant transformations in endometriosis. The identification of specific cancer-type relevant biomarkers, such as BRAF, ARID1A, PD-L1, and PIK3CA mutations, provides additional insights into the molecular characteristics of the tumor, which may have implications for prognosis and treatment selection.

Primary endometrioid adenocarcinoma arising on vaginal endometriosis: a case report and review of the literature

Primary endometrioid adenocarcinoma arising on vaginal endometriosis: a case report and review of the literature

Low-grade extrauterine endometrial stromal sarcoma arising from vaginal endometriosis: a case report and literature review.

Extrauterine endometrial stromal sarcoma arising from malignant transformation of the vagina is an extremely rare condition. The diagnosis is often difficult as the symptomatology and pathological features overlap with that of pelvic endometriosis. A 38 years old female presented with complaints of dyspareunia, dysmenorrhea, and painful defecation along with blood-stained vaginal discharge for a year. Examination revealed the presence of multiple brownish irregular nodules in posterior vaginal fornix and fixed tender nodules which on biopsy revealed florid vaginal endometriosis. She improved symptomatically on medical therapy. After 18 months of diagnosis, she presented again with a necrotic growth in posterior fornix, which on repeat biopsy revealed a low-grade endometrial stromal sarcoma. Laparotomy revealed a 7×5 cm mass in the pouch of Douglas, infiltrating the posterior vaginal wall and rectum. A complete cytoreductive surgery with retrograde hysterectomy, excision of posterior vaginal wall and rectosigmoid resection was done. The patient is disease-free at a follow-up of 65 months.

RESECTION OF DEEP INFILTRATING VAGINAL ENDOMETRIOSIS

To present principles and techniques for safe and efficient excision of deep infiltrating vaginal endometriosis after hysterectomy.

Feasibility and safety of transvaginal specimen extraction in deep endometriosis colorectal resectional surgery and analysis of risk factors for postoperative complications

The aim of the present study was to demonstrate that transvaginal specimen extraction is a feasible and safe approach in colorectal resection for deep endometriosis (DE) and to assess the risk factors for postoperative complications. This retrospective cohort study included all the consecutive patients undergoing segmental bowel resection for symptomatic endometriosis at "La Paz" University Hospital (Madrid, Spain) and at "Hospital General Universitario de Valencia" (Valencia, Spain) from January 2014 to December to 2017. Patients were grouped according to specimen extraction approach into those who had transvaginal extraction (Group I) and those who had suprapubic extraction (Group II). Clinic-demographical, surgical and post-surgical data were recorded. Intra- and postoperative complications were classified according to Clavien-Dindo criteria. Postoperative data were compared between groups. Risk factors associated with surgery were investigated. Out of 99 female patients included (average age 36.91 ± 5.36years), 23 patients (23.2%) had transvaginal and 76 (76.8%) had suprapubic specimen extraction. The groups were comparable regarding operative time, nodule size, level of anastomosis, hospital stay and intraoperative complications. We observed no statistically significant differences in postoperative complications and rectovaginal fistula rate between the groups. Binary logistic regression analyses determined that vaginal endometriosis is an independent risk factor for postoperative complications (OR: 2.63, 95% CI [1.10-6.48], p = 0.03). Transvaginal specimen extraction is a safe and feasible technique in DE colorectal surgery and should be taken into consideration whenever vaginal endometriosis exists. Nevertheless, vaginal endometriosis can be an independent risk factor for postoperative complications in DE surgery.

A Locally Advanced Endometrioid Adenocarcinoma Arising from Vaginal Endometriosis: Management and Review of the Literature

Endometrioid adenocarcinoma associated with endometriosis at extrauterine or extraovarian localization is a rare entity. Often presenting with local spread without nodal and distant metastasis, this entity has no specific staging system nor treatment guidelines. In the case of nodal and distant spread, the treatment decision requires personalization. In this article, we present the diagnosis and surgical and systemic treatment of a 56-year-old woman diagnosed with an endometriosis-associated advanced endometrioid adenocarcinoma of the vagina with nodal involvement. Following an extensive review of the scarce data reported to guide the treatment choices in this rare setting, we proposed a multidisciplinary treatment with laparoscopic surgical cytoreduction, four cycles of adjuvant chemotherapy with carboplatin and paclitaxel, and radiotherapy with brachytherapy. Due to an anaphylactic reaction on the first administration, paclitaxel was replaced with nab-paclitaxel. Despite many negative prognostic factors, the patient is free from relapse after 48 months. We report the case of a locally advanced endometrioid adenocarcinoma associated with endometriosis of the vagina, with pelvic nodal spread, and the relevant literature review of similar cases.

Systematic evaluation of endometriosis by transvaginal ultrasound can accurately replace diagnostic laparoscopy, mainly for deep and ovarian endometriosis.

What is the sensitivity and the specificity of preoperative transvaginal ultrasound with bowel preparation (TVUS-BP) compared to diagnostic laparoscopy (DL) for the identification of ovarian and deep sites of endometriosis? DL was able to detect retrocervical, ovarian, and bladder endometriosis with similar sensitivity and specificity as TVUS-BP, whereas for vaginal and rectosigmoid endometriosis, DL had lower sensitivity and specificity than TVUS-BP. TVUS-BP is a non-invasive examination with good accuracy for diagnosing ovarian and deep endometriosis. DL is expensive and can lead to surgical complications. This prospective study included a total of 120 consecutive patients who underwent surgery for suspected endometriosis with preoperative imaging (TVUS-BP), including a video of the laparoscopic procedure, between March 2017 and September 2019. Two radiologists performed preoperative TVUS-BP using the same protocol for diagnosing endometriosis. Two surgeons, who were blinded to the results of the preoperative imaging and clinical data, reviewed the surgical videos from the entry of the abdominal cavity until the surgeon finalized a complete and systematic review prior to beginning any dissection (considered as a DL). A data sheet was used by surgeons and radiologists to record the sites and size of disease involvement, the American Society for Reproductive Medicine (ASRM) stage, and the Enzian score. The surgical visualization of endometriosis lesions that were confirmed by histological analysis was the gold standard. DL was able to detect retrocervical, ovarian, and bladder endometriosis with similar sensitivity and specificity as TVUS-BP. DL was not able to detect vaginal endometriosis (sensitivity and specificity 0%): this is compared to a sensitivity and specificity of 85.7% and 99.1%, respectively with the utilization of a preoperative TVUS-BP. In addition, DL was notably poor at detecting rectosigmoid endometriosis, with a sensitivity of 3.7-5.6%, and this compares to 96.3% sensitivity with utilization of a preoperative TVUS (P < 0.001). For the ASRM stage, TVUS-BP results were highly correlated with the degree of endometriosis and pouch of Douglas (POD) obliteration (weighted Kappa of 0.867 and 0.985, respectively). For the Enzian score, there was a substantial correlation between TVUSP-BP and DL for compartment A (weighted Kappa = 0.827), compartment B (weighted Kappa = 0.670), and compartment C (weighted kappa = 0.814). The number of participants included may be a limitation in this study and, as the evaluators were blinded to the physical exam, the DL accuracy could be underestimated. As biopsies of pelvic organs were obtained only if there was a suspicion of endometriosis, the gold standard was not always applicable. This aspect could underestimate the prevalence of lesions and overestimate the sensitivity and the specificity of both the TVUS-BP and the DL. Preoperative TVUS-BP was accurate in identifying all sites of ovarian and deep endometriosis that were evaluated. It had significantly higher sensitivity than DL in detecting rectosigmoid endometriosis and predicting intraoperative ASRM staging and the Enzian score. These results suggest that TVUS-BP can replace DL for the diagnosis and treatment planning for patients with ovarian and deep endometriosis. The authors declare no source of funding or conflicts of interest. N/A.

71. Case Report: Vaginal Endometriosis After Treatment of an Imperforate Hymen

<h3>Background</h3> Obstructive anomalies at any level of the reproductive tract increase the risk of endometriosis. While endometriosis may improve after relieving the obstruction, persistent endometriosis has been reported. While not common, vaginal endometriosis may occur in adolescents. A case of vaginal endometriosis in an adolescent with history of imperforate hymen is presented. <h3>Case</h3> A 14-year-old, never sexually active, female presented to a tertiary pediatric and adolescent gynecology clinic with secondary amenorrhea. She reported one episode of vaginal bleeding 4 months prior to presentation and had noted a "bulge" at her introitus for 1 year prior to the bleeding episode. She sought gynecologic care for the secondary amenorrhea and was diagnosed with an imperforate hymen and hematocolpos (Figure 1). She underwent a hymenectomy – notable for 800mL of menstrual blood, a dilated single cervix, and normal appearing vaginal mucosa. Her post-operative course was uncomplicated. She had monthly menses without dysmenorrhea. Three months after the hymenectomy she complained of painless intermenstrual vaginal bleeding that occurred after bowel movements. She had a history of constipation. An external genital exam and bimanual exam were unremarkable. A speculum exam was significant for diffuse red friable lesions on the vaginal mucosa and cervix which appeared similar to endometriosis (Figure 2). Her hymenectomy site was well healed. Constipation treatment was initiated. She underwent an exam under anesthesia and biopsy of the vaginal lesions. Pathology confirmed endometriosis. Progestin only pills (POPs) were started for hormonal suppression. Resolution of the vaginal bleeding with bowel movements occurred, however she initially struggled with pill compliance and breakthrough bleeding with POPs. At her most recent visit, she was doing well with minimal breakthrough bleeding, no bleeding after bowel movements, and no dysmenorrhea. She continues to treat her constipation. <h3>Comments</h3> The risk of endometriosis with obstructive outflow tract anomalies is well known, however, painless vaginal bleeding is not the typical presentation of adolescent endometriosis. While providers must consider other etiologies of vaginal bleeding in the adolescent, endometriosis should be included in the differential – particularly in women with a history of an outflow tract obstruction. Medical management using hormonal suppression to reduce the risk of endometriosis proliferation is recommended for adolescents with endometriosis – thereby achieving the overall goals of therapy: minimizing pain symptoms and maximizing quality of life and future fertility.

Endometriosis presenting as vaginal polyps: outpatient vaginoscopic treatment

To demonstrate an outpatient vaginoscopic technique for treating multiple vaginal polyps. Demonstration of surgical technique using slides, pictures, and video. Private hospital. Thirty-two-year-old nulligravid woman presenting to the gynecology clinic with one episode of intermenstrual bleeding, regular menstrual cycles with normal flow, and no history of dysmenorrhoea or dyspareunia. The genital local examination was normal, and speculum examination showed multiple vaginal lesions like polyps in the proximal posterior two-thirds and right lateral vaginal walls. Her transvaginal ultrasound read a normal uterus with a right ovarian simple cyst. The surgeon performed an outpatient operative vaginoscopy using a 5-mm continuous flow office hysteroscope with a 2.9-mm rod lens optical system and a 5F working channel. Distension of the vagina was achieved with a normal saline solution, and an intrauterine pressure of 50 to 60 mm Hg was maintained by an irrigation and aspiration electronic pump. An inspection of the vaginal walls, fornices, and the external cervical os (Fig. 1) revealed 10 vaginal lesions like polyps in the proximal two-thirds of the posterior and right lateral vaginal wall. The vaginal lesions (Fig. 2) varied in size from 0.5 cm to 4 cm. An excisional biopsy was performed and the sample sent for histopathologic evaluation. The vaginal lesions <2 cm in length were excised by cutting the base with scissors or using a bipolar vaporization electrode, which was connected to an electrocautery unit by a bipolar high-frequency cord. Vaginal lesions >2 cm were excised with the TruClear 5C Hysteroscopic Tissue Removal System (HTRS) with a zero-degree scope using the 2.9-mm incisor with a 5-mm cutting window at one end attached to a reusable handpiece with two connectors-one to the motor unit and second to the suction bottle with a collection bag. The overall diameter of TruClear 5C is 5.7 mm, and the optic size is 0.8 mm. The same irrigation pump is compatible with HTRS, and the pressure was increased to 150 mm Hg to maintain vaginal distension. Three factors influenced our decision to use the HTRS intraoperatively: the number and size of the vaginal lesions and the surgical time in the outpatient setting. A mechanical system that works on the principle of excising and aspirating tissue, the HTRS incisor has a rotatory action with the excising window placed against the most distal part of the vaginal lesions. The cutting action is controlled via a foot pedal attached to a motor control with 800 rotations per minute. The handpiece remains stationary while the polyp is excised and aspirated through the window into the collection bag. Minimal bleeding occurred and stopped spontaneously. The institutional ethics committee exempted this case report from review, and we obtained informed written consent from the patient. All vaginal lesions excised in an outpatient setting via vaginoscopy technique without anesthesia. The operative time with the Bettocchi hysteroscope was 14 minutes, and HTRS was 6 minutes. The patient did not complain of pain but did describe minimal discomfort, rated on the visual analog scale as 2 (where ≥5 is severe pain). She was discharged 1 hour later. The histopathology was reported as vaginal endometriosis (ectopic presentation of endometriosis is rare, accounting for 0.02% of cases). After surgery, she was started on cyclical oral contraceptive pills (OCP) in the combination of 30 mg of ethinyl estradiol + 2 mg of dienogest because she desired to delay pregnancy by 1 year. She remained asymptomatic for 6 months. These contraceptive hormones are available in the form of oral pills, vaginal rings, and transdermal patches, and a physician can provide OCP continuously or cyclically. Continuous OCP is more efficacious for control of dysmenorrhoea, but cyclical OCP is preferred because it is affordable, tolerable, effective, produces no unpredictable bleeding, and slows the progression of the disease. (A cohort study found the contraceptive vaginal ring to be more effective for symptom-control in rectovaginal endometriosis with higher patient satisfaction than the transdermal patch; vaginal rings or transdermal patches are not available in some countries.) CONCLUSION(S): Vaginoscopy allows a more in-depth visualization of the vagina with complete inspection and removal of all polyps. Vaginoscopy is feasible in the outpatient setting and allows a comfortable, ergonomic position for the surgeon. Vaginoscopy or no-touch technique avoids the use of a speculum or tenaculum and results in minimal pain during the outpatient procedure.

Value of 3D MRI and Vaginal Opacification for the Diagnosis of Vaginal Endometriosis.

Objective: The aim of the study was to evaluate three-dimensional (3D) T2 MRI before and after vaginal opacification (VO) by gel (3DT2VO) and the additional value of 3DT1 with fat-suppression (3DT1FS) MRI in the diagnosis of vaginal endometriosis.Methods: In this study conducted from 2010 to 2013, 51 patients scheduled for surgical treatment of endometriosis underwent MRI 1 day before surgery. Three readers (novice, intermediate, expert) were asked to retrospectively diagnose vaginal endometriosis independently and blindly using four different readings (i.e., 3DT2, 3DT2VO, 3DT2 with 3DT1FS, 3DT2VO with 3DT1FS). Vaginal endometriosis diagnosis was positive on observation of a thickening of vaginal walls on 3DT2 with or without high-signal-intensity spots on 3DT2 and/or 3DT1FS. The reference standard was surgery and histology. Descriptive analysis, Chi-square test, and ROC curves were used for statistical analysis.Results: For all readers, the combination of 3DT2 and 3DT1FS significantly improved the diagnosis of vaginal endometriosis compared with 3DT2 (p = 0.002, p = 0.02, and p = 0.003). 3DT2VO significantly improved diagnosis for the intermediate reader (p = 0.01). High-signal-intensity spots on 3DT1FS had a sensitivity of 50–63.6%, specificity of 86.2–96.6%, and high positive likelihood ratios (14.5-Inf).Conclusion: 3DT2 in association with 3DT1FS appears to be the best 3D MRI protocol for the diagnosis of vaginal endometriosis, whatever the level of experience of readers. The additional value of 3DT2VO is variable among the readers.

Carbon dioxide (CO2) laser ablation of symptomatic vaginal endometriosis: a pilot study.

Deep dyspareunia affects almost half of the women with endometriosis and is associated with vaginal endometriotic lesions. Our pilot study's objective is to assess the feasibility and effectiveness of CO2-laser ablation under colposcopic guidance for the treatment of symptomatic vaginal endometriosis. A non-comparative pilot study has been performed. Only women with histologically proven vaginal endometriosis, who declared the presence of moderate or severe deep dyspareunia, resistant to at least 6months of conventional hormonal treatment, were deemed eligible for the study. All treatments were performed in an outpatient setting with a colposcopic-guided, hand-directed CO2-laser. Variation in pain symptoms was measured with a 0- to 10-point numerical rating scale (NRS), in sexual functioning with the Female Sexual Function Index (FSFI), in psychological status with the Hospital Anxiety and Depression Scale (HADS), and in quality of life with the Short Form-12 questionnaire (SF-12). Satisfaction with treatment was evaluated according to a five-category scale (very satisfied, satisfied, neither satisfied nor dissatisfied, dissatisfied, very dissatisfied). Nineteen women were enrolled. No complications occurred. At 12-month follow-up, significant improvements were observed in deep dyspareunia and dyschezia scores, in FSFI, HADS, and in the physical component summary scores of SF-12, whereas the mental component score of SF-12 did not vary substantially. Most women (84%) were satisfied with the treatment received. CO2-laser ablation for vaginal endometriosis could represent a valuable alternative option for women with symptomatic lesions, both in terms of amelioration of pain symptoms and improvement in quality of life and sexual function.

Roadmap to Safe Vaginal Cuff Revision for Endometriosis

Video Objective This video describes a systematic stepwise approach for vaginal cuff revision associated with vaginal cuff endometriosis and rectovaginal disease. Setting 39 year-old presented with persistent cyclic vaginal bleeding, pelvic pain and deep dyspareunia following laparoscopic hysterectomy. She was noted to have a 2 cm vaginal cuff nodule with posterior cul de sac obliteration. The patient failed medical management and desired surgical management. Interventions Laparoscopic vaginal cuff revision was performed using a systematic approach with bilateral ureterolysis, excision of uterosacral ligament fibrosis, opening the rectovaginal space, shaving of rectal endometriosis and resection of the vaginal cuff nodule. Conclusion This stepwise approach for vaginal cuff revision in patients with symptomatic rectovaginal endometriosis provides a roadmap for the effective and safe excision of vaginal cuff nodules, while minimizing the risks of injury to the bladder, the ureters, the rectum and the risk of vaginal cuff dehiscence, persistent dyspareunia and recurrent endometriosis.

A New Perspective on the Problem of Concomitant Endometriosis and Genital Malformations: Surgical and Embryogenetic Aspects

Study Objective To optimize the results of surgical treatment and rehabilitation of patients with genital tract malformations combined with external genital endometriosis. Design Prospective study. Level II. Setting Department of Operative Gynecology, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Healthcare of Russian Federation. Patients or Participants 453 patients with utero-vaginal malformations underwent surgery from 2013 to 2018. Based on the presence of endometriotic foci, two groups of patients were created: group 1 included 240 patients with uterine and vaginal malformations and external genital endometriosis; group 2 included 213 patients with uterine and vaginal malformations without concomitant endometriosis. Interventions All patients underwent surgical treatments using laparocopic and hysteroscopic approaches for correction of congenital malformations and endometriosis excision. Measurements and Main Results The indications for surgical treatment of patients with utero-vaginal anomalies included primary infertility in 41.5%, secondary infertility in 18.6%, recurrent miscarriages in 26.2%, dysmenorrhea in 45.4%, menorrhagia in 23.2%, pain syndrome in 17.2%, and dyspareunia in 8.1% cases. External genital endometriosis was diagnosed in 53.0% of these patients. We revealed no significant difference in the incidence of endometriosis in patients with utero-vaginal anomalies with or without the obstruction to the menstrual flow. Conclusion Implantation theory cannot explain the development of endometriosis in all patients with utero-vaginal malformations. Therefore, all pathogenetic theories must be considered in the investigation of possible mechanisms of endometriosis development in patients with genital tract malformations.

Diagnosis and management of vaginal endometriosis involvement in postmenopausal woman. A case report

Diagnosis and management of vaginal endometriosis involvement in postmenopausal woman. A case report

Vaginal Endometriosis: An Enigma for Clinicians

Endometriosis is the presence of ectopic endometrial tissue that responds to hormonal stimulation. Although it occurs most often in pelvis, several unusual sites have been reported like skin, umbilicus, vagina, etc. The pivotal case here is a 19-year-old lady who presented with a vaginal polypoidal growth mimicking carcinoma vagina. She gave a history of irregular vaginal bleeding since 3 years and something protruding through the vagina periodically before and during menstrual period. It was accompanied by moderate-to-severe dysmenorrhea and persistent pain in right iliac fossa. MRI was suggestive of B/L Adnexal masses with focal soft tissue lesion involving Right posterolateral fornix. On EUA, patient had a 3 × 4 cm polypoidal tongue-like vascular growth arising from right posterolateral fornix which was totally excised using diathermy. The histological exam of the tissue showed features of endometriosis. The patient was managed by monthly i/m injections of Depot preparation of GnRH analogs for 6 months. The patient now is absolutely symptom free. EUA and excision followed by proper medical management allayed the anxiety of patient and her parents.

Diagnosis and Management of Vaginal Endometriosis Involvement in Postmenopausal Woman. A Case report

Diagnosis and Management of Vaginal Endometriosis Involvement in Postmenopausal Woman. A Case report

СОФІЯ ПАРФАНОВИЧ – УКРАЇНСЬКИЙ ЛІКАР ТА ПРОСВІТНИК (до 120-РІЧЧЯ З ДНЯ народження)

The life and work of Sofia Parfanovych (1898-1968), one of the prominent ascetics of Ukrainian medicine, first female Ukrainian student of medical faculty of Lviv University, active public figure and writer is described. Together with Sofia Okunevska they belong to the first female doctors in Western Ukraine that woke Ukrainian womenfolk to education, struggle for gender equality and social progress. Sofia Parfanovych finished her study at Lviv University in 1926 and got the diploma of a doctor. She began her professional career as obstetrician and gynecologist at General hospital in Lviv, then started private medical practice and work on a voluntary basis at “Narodna lichnytsya”. In 1929 doctor Parfanovych became the head of anti-alcohol section of Ukrainian Hygiene Society as well as the chief of anti-alcohol and anti-nicotine society “Vidrodzhennya”. The members of these societies worked actively publishing about half a million educational postcards, posters and magazines. The slogan printed on each paper motivated for a healthy lifestyle, eradication of bad habits such as smoking and alcohol drinking. It was one of the ways of hygienic education of population. As a scientist Sofia Parfanovych wrote a plenty of articles dedicated to the diagnostics and treatment of pleural empyema in children, mycosis as a women’s disease, vaginal endometriosis, protein therapy of certain women’s diseases, trichomonas infection, the relation between youth’s villainy and mental retardation and acute alcoholism. Moreover, doctor Parfanovych published works for hygienic education of families. The most famous of them are: “Women’s hygiene”, “Proper nutrition”, “Husband and wife”. At the end of 1939 Sofia Parfanovych became the director of paramedic and obstetric school in Lviv. Two years later she wrote a dissertation “Metastases of malignant tumors of ovaries to the central nervous system” and became a docent at Lviv Medical University. In 1944 due to the strained situation in Ukraine associated with the World War II the family of Sofia Parfanovych and her husband Pylyp Volchuk together with his son emigrated to Austria, firstly to Wienna and later to the small Austrian city of Telfs. A year later they continued travelling and settled in Bayern, Germany. Unfortunately, in 1946 Pylyp Volchuk after years of fighting against stomach cancer died. In 1949 Sofia Parfanovych emigrated to the USA where seven years later affirmed her doctor’s diploma and got the permission for a private medical practice. Due to the disease of retinal detachment of the left eye doctor Parfanovych stopped her work at the hospital and dedicated herself to the literary work. In December 1968 Sofia Parfanovych died and was buried at Mount Olivet Cemetery in Detroit. The life of a doctor and enlightener Sofia Parfanovych demonstrates the sacrifice and mercy, professionalism and patriotism, love to the people and Ukraine. All this contributed to the development of the Ukrainian culture and nation.

M&amp;#252;llerian Adenosarcoma of the Vaginal Stump: A Case Report and Literature Review

Mullerian adenosarcomas are rare mixed tumors with low malignant potential, and occur mainly in the uterus. Primary adenosarcomas arising in vaginal endometriosis are even more rarely reported. We report a very rare case with Mullerian adenosarcoma arising from vaginal endometriosis. A 43-year-old nulliparous woman has a history of endometriosis. Due to two parallel fistulas in cervix, severe endometriosis and adenosarcoma, she has undergone radical and multiple surgeries. After the surgery, persistent vaginal vault masses were noticed, and eight resections of the polyps at vaginal stump were performed. For the first six resections, all the pathological examinations showed endometriosis. And the last two resections demonstrated vaginal adenosarcoma. Transition between Mullerian adenosarcoma and endometriosis was gradual. Finally, adenosarcoma associated with endometriosis was diagnosed from recurrent vaginal masses. To our knowledge, this report is the sixth case that primary adenosarcomas arising in vaginal endometriosis. But chemo-therapy and radiation therapy were not taken and the patient remained in a good condition throughout the 9-year follow-up period. In addition, we present a review of the literature. The diagnosis and treatment of the tumor are also discussed.

Postcoital bleeding in a case of recto-vaginal endometriosis

Introduction: Rectovaginal Endometriosis (RVE) is a severe form of endometriosis, less frequent than peritoneal or ovarian endometriosis. Recto-vaginal endometriosis has multiple diagnostic and management options with long-term outcomes varying according to the management strategy used. Case: A 40 years old woman complained of postcoital bleeding. Detailed history revealed that she suffered from persistent dysmenorrhea, dyschasia and constipation. Vaginal speculum examination revealed a large fleshy polypoidal mass in the posterior vaginal fornix, which was excised and biopsied. Histo-pathological examination revealed vaginal endometriosis. Four months later the mass recurred, in spite of, receiving hormonal treatment. Ultrasound and MRI revealed multiple uterine fibroids, with heterogenous lesion located in the rectovaginal area, and CA-125 was 80 u/ml. exploratory laparotomy was done after proper bowel preparation. Total abdominal hysterectomy with excision of the upper vaginal portion and a part of the anterior aspect of the recto-sigmoid was resected due to the invasion of its musculosa, short of the mucosa, with primary repair. Histo-pathological examination showed advanced endometriosis including the vaginal fornix and the rectal wall. The patient received two doses of Leuprolide Acetate 11.25 mg as an adjuvant treatment. Conclusion: All women with postcoital bleeding or pelvic pain should have a detailed history taken from them and thorough examination including speculum examination and visualization of posterior vaginal fornix to detect vaginal endometriosis. The primary line of management for recto-vaginal endometriosis is surgery, as hormonal therapy is less effective in such cases, which might be explained by difference in origin from the peritoneal disease.

Vaginal Cuff Endometriosis with Endometrial Hyperplasia: A Rare Cause of Post-Hysterectomy Vaginal Bleeding

Abstract Background: In patients who undergo hysterectomy for endometriosis, there is the possibility for recurrence. This article, however, reports a rare instance of vaginal cuff endometriosis in...