scholarly journals Office Hysteroscopy as a Valid Tool for Diagnosis of Genital Tract Lesions in Females with Intact Hymen

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Hui-Yu Huang ◽  
Yi-Ting Huang ◽  
Kai-Yun Wu ◽  
Yu-Ying Su ◽  
Cindy Hsuan Weng ◽  
...  
Keyword(s):  
Genital Tract ◽  
Endometrial Hyperplasia ◽  
Outpatient Setting ◽  
Chang Gung Memorial Hospital ◽  
Postmenopausal Bleeding ◽  
Office Hysteroscopy ◽  
Endometrial Thickening ◽  
History Of ◽  
Diagnostic Hysteroscopy ◽  
Endometrial Pathology

Background. To evaluate the feasibility and applicability of using office hysteroscopy in women with intact hymen. Methods. We recruited 836 patients with intact hymen with different indications who underwent diagnostic hysteroscopy without anesthesia in an outpatient setting from 2007 to 2016 at Chang Gung Memorial Hospital at Linkou. Results. Patients’ mean age was 35 ± 10.6 years (range 3–69 years). Most patients (86.4%) with postmenopausal bleeding had intrauterine lesions, and they were especially at high risk (50%) for endometrial hyperplasia or malignancy. Five hundred thirty (63.3%) patients had histologic findings confirming concordance between hysteroscopic and histologic findings. Submucosal myoma had the highest concordance (96.3%), whereas endometrial hyperplasia had the lowest concordance (50%). Forty-eight patients (5.7%) had endometrial hyperplasia, and 35 patients (4.2%) had endometrial malignancy. Two patients who were thought to have nonspecific endometrial thickening actually had endometrial pathology. Conclusions. Hysteroscopy through vaginoscopic approach is feasible and well-tolerated in the patients with intact hymen. This outpatient procedure provides accurate evaluation of lesions of the genital tract and should be considered in patients without a history of intercourse.

scholarly journals Concordance between the Hysteroscopic Diagnosis of Endometrial Hyperplasia and Histopathological Examination

Diagnostics ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. 142 ◽  
Author(s):  
De Franciscis ◽  
Riemma ◽  
Schiattarella ◽  
Cobellis ◽  
Guadagno ◽  
...  
Keyword(s):  
Endometrial Hyperplasia ◽  
Histopathological Examination ◽  
Abnormal Uterine Bleeding ◽  
University Hospital ◽  
Clinical Indication ◽  
Histopathological Diagnosis ◽  
Office Hysteroscopy ◽  
Predictive Values ◽  
Endometrial Thickening ◽  
Post Menopause

The goal of this paper is to assess the concordance between the clinical diagnosis of Endometrial Hyperplasia (EH), suspected by senior gynecologists throughout outpatient office hysteroscopy, and the results from histopathological examination, in order to evaluate hysteroscopic accuracy for EH. A prospective cohort study was done at a Tertiary University Hospital. From January to December 2018, we enrolled women with the following criteria: abnormal uterine bleeding in post-menopause and endometrial thickening in pre-or post-menopause. Patients underwent office hysteroscopy with a 5 mm continuous-flow hysteroscope, and endometrial biopsies were taken using miniaturized instruments. Senior operators had to foresee histopathological diagnosis using a questionnaire. Histopathological examination was conducted to confirm the diagnosis. This study was approved by the local ethical and registered in the ClinicalTrials.gov registry (ID no. NCT03917147). In 424 cases, 283 clinical diagnoses of EH were determined by senior surgeons. A histopathological diagnosis was then confirmed in 165 cases (58.3%; p = 0.0001). Furthermore, 14 endometrial carcinoma and atypical hyperplasia were found. The sensitivity, positive predictive value, and negative predictive values for EH were, respectively, 90.4, 58.4, and 86.6%. Subdivided by clinical indication, the sensitivity was higher in patients with post-menopause endometrial thickening. The diagnostic accuracy of office hysteroscopy in the diagnosis and prediction of endometrial hyperplasia was high. Senior operators could foresee EHs in more than half the cases.

Recurrent Postmenopausal Bleeding: Just Endometrial Disease or Ovarian Sex Cord Stromal Tumor? A Case Report and Literature Review

2021 ◽  
Author(s):  
Jiao Wang ◽  
Qing Yang ◽  
Ningning Zhang ◽  
Dandan Wang
Keyword(s):  
Endometrial Hyperplasia ◽  
Elderly Women ◽  
Estrogenic Activity ◽  
Sex Hormone ◽  
Recurrent Bleeding ◽  
Postmenopausal Bleeding ◽  
Psychological Burden ◽  
Estrogen Level ◽  
Endometrial Thickening ◽  
Abnormal Vaginal Bleeding

Abstract Background: Postmenopausal bleeding (PMB) is a common gynecologic complaint among elderly women, and endometrial hyperplasia is a common cause of this bleeding. Ovarian fibromas are the most common ovarian sex cord stromal tumors (SCST). They arise from non-functioning stroma, rarely show estrogenic activity, and stimulate endometrial hyperplasia, leading to abnormal vaginal bleeding. Case presentation: We report herein the case of a 64-year-old Chinese woman who presented with recurrent PMB. A sex-hormone test revealed her estrogen level was significantly higher than normal, and other causes of hyperestrogenism had been excluded. In the past 7 years, the patient had undergone four curettage-and-hysteroscopy procedures due to recurrent PMB and endometrial hyperplasia. Finally, the culprit behind the rise in estrogen – an ovarian cellular fibroma with estrogenic activity – was found in the fifth operation.Conclusions: Ovarian cellular fibromas occur insidiously, and some may have endocrine functions. For postmenopausal patients with recurrent PMB and endometrial thickening indicated by ultrasonography, it is recommended they undergo sex-hormone testing while waiting for results regarding the pathology of the endometrium. If the estrogen level remains elevated, even if the imaging does not indicate an ovarian tumor, the clinician should consider the possibility of an ovarian SCST and follow the patient closely. Once the tumor is found, no matter the size, it should be removed as soon as possible to avoid endometrial lesions caused by long-term estrogen stimulation. More studies are needed to confirm whether preventive total hysterectomy with bilateral salpingo-oophorectomy should be recommended for postmenopausal women with recurrent bleeding whose estrogen levels are higher than normal, even when the auxiliary examination does not indicate ovarian mass. It is possible this could avoid the physical and psychological burden caused by repeated curettage.

Relationship between Transvaginal Ultrasound Endometrial Volume, Body Mass Index and Endometrial Pathology in Women with Postmenopausal Bleeding

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed Salah El Sokkary ◽  
Mahmoud Mohamed Ghaleb ◽  
Rowyna Hany Mohamed El Helw
Keyword(s):  
Statistical Analysis ◽  
Endometrial Carcinoma ◽  
Diagnostic Performance ◽  
Endometrial Hyperplasia ◽  
Transvaginal Ultrasound ◽  
Postmenopausal Bleeding ◽  
Diagnostic Characteristics ◽  
Endometrial Volume ◽  
One Year ◽  
Endometrial Pathology

Abstract Background Menopause is recognized to have occurred after one year of amenorrhea, for which there is no other obvious pathological or physiological cause. Perimenopause should include the period immediately prior to the menopause (when the endocrinological, biological and clinical features of approaching menopause commence) and the first one year after menopause. Objectives The aim of the study is classification of patients into those with benign endometrial pathology and those with endometrial hyperplasia or carcinoma using endometrial volume and BMI. Patients and Methods This observational cross sectional study was conducted at the Department of Obstetrics and Gynecology in Ain Shams University Hospital from March 2019 till January 2020. The population of this study was 100 menopausal women with postmenopausal bleeding ≥12 months and endometrial thickness by TVUS ≥5 mm. Results According to histopathology of endometrial carcinoma, statistical analysis of our data revealed that age, menopausal duration and BMI were significantly highest. Parity was significantly lowest. Endometrial volume was significantly highest in carcinoma (7.9±2.9 cc). Age, menopausal duration, parity and endometrial volume had significant moderate diagnostic performance in predicting endometrial carcinoma but BMI had significantly low. Age ≥ 62.0, menopausal duration ≥ 11.0 and parity ≤3.0 had low diagnostic characteristics in diagnosis of endometrial carcinoma but endometrial volume ≥ 6.0 had high sensitivity but low other diagnostic characteristics in the diagnosis of endometrial carcinoma. According to histopathology of endometrial hyperplasia, statistical analysis of our data revealed that age, menopausal duration, BMI, parity and endometrial volume had no significant diagnostic performance in the diagnosis of endometrial hyperplasia. Conclusion In our study, analysis of data revealed that the using of transvaginal measurement of endometrial volume is the best predictor of endometrial cancer with a positive correlation with BMI.

scholarly journals Hysteroscopy: an effective tool in post-menopausal bleeding

2018 ◽  
Vol 8 (1) ◽  
pp. 159
Author(s):  
K. K. Junnare ◽  
G. J. Desai ◽  
G. S. Shekhawat
Keyword(s):  
Vaginal Bleeding ◽  
Endometrial Hyperplasia ◽  
Endometrial Thickness ◽  
Transvaginal Sonography ◽  
Postmenopausal Bleeding ◽  
Diagnostic Modalities ◽  
Post Menopausal ◽  
Histopathology Examination ◽  
Endometrial Pathology ◽  
Vaginal Ultrasonography

Background: Postmenopausal bleeding is a condition where endometrial carcinoma is to be ruled out. Traditionally, D and C is the preferred method for diagnosis in such condition. Other diagnostic modalities like trans vaginal ultrasonography (TVS) and hysteroscopy are being used for diagnosis in the cases of PMB. The objective of this study is to evaluate the efficacy and accuracy of TVS and hysteroscopy in women with postmenopausal bleeding (PMB).Methods: One hundred postmenopausal women with vaginal bleeding underwent TVS and hysteroscopy. Endometrial tissue was obtained by curettage and sent for histopathology examination. The results of TVS and Hysteroscopy were compared against HP report.Results: Hysteroscopy was successful in 98 patients. Endometrial histopathology revealed proliferative, secretory and atrophic endometrium in 26, 7 and 23 patients respectively. Polyp was diagnosed in 13 patients. Endometrial hyperplasia was detected in 11 patients and endometrial malignancy in 14 patients. All patients with endometrial hyperplasia and malignancy had ET (endometrial thickness) more than 4 mm, except one patient with endometrial malignancy who had 4 mm ET. The sensitivity and specificity of TVS for suspecting endometrial pathology at ET 4mm were 93% and 69.6%, respectively. Hysteroscopy had sensitivity of 95.2%, specificity of 92.8%, with diagnostic accuracy of 93.8%.Conclusions: Hysteroscopy was found to be the more sensitive and specific than Transvaginal sonography for diagnosing endometrial pathologies. Hysteroscopy is safe and effective for detecting endometrial pathologies in patients with PMB.

scholarly journals Radio Histological Treatment of Endometrial Hyperplasia: A Case Report

2020 ◽  
Vol 4 (2) ◽  
pp. 55-58
Author(s):  
Priscila F. Berganza ◽  
◽  
Maria D. Molina ◽  
María A. P. Dahinten ◽  
Mariela S. Ramos ◽  
...  
Keyword(s):  
Endometrial Hyperplasia ◽  
Pathological Condition ◽  
Transvaginal Ultrasound ◽  
Optimal Management ◽  
Endometrial Thickening ◽  
Endometrial Cavity ◽  
History Of ◽  
Plastic Changes ◽  
Endometrial Carcinomas ◽  
Essential Problem

Endometrial hyperplasia is defined as the pathological condition caused by hyper plastic changes at the level of the glandular and stromal structures of the endometrium that are part of the lining of the endometrial cavity. Atypical endometrial hyperplasia can cause an essential problem because it is considered a precursor of endometrial cancer. The early diagnosis of precancerous endometrial lesions and the exclusion of pre-existing endometrial carcinomas are necessary for patients’ optimal management. The following is a case of a 50-year-old Guatemalan patient with a three-day history of vaginal bleeding. The transvaginal ultrasound reports endometrial thickening suggestive of endometrial hyperplasia. The diagnosis was confirmed with histology. The treatment offered was surgery without indicating any medication.

Etiological structure and diagnosis of abnormal uterine bleeding

GYNECOLOGY ◽  
2018 ◽  
Vol 20 (2) ◽  
pp. 14-17
Author(s):  
G E Chernukha ◽  
I A Ivanov ◽  
Z N Efendieva ◽  
M R Dumanovskaya ◽  
A V Asaturova
Keyword(s):  
Diagnostic Accuracy ◽  
Endometrial Hyperplasia ◽  
Ultrasound Examination ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Histological Diagnosis ◽  
Reproductive Age ◽  
Endometrial Polyps ◽  
Chronic Endometritis ◽  
Endometrial Pathology

Abnormal uterine bleeding (AUB) is one of the most common indications for hysteroscopy. Most of the AUB cases occur due to endometrial or myometrium pathology. Among it, endometrial polyps (EP) and chronic endometritis (CE) prevalent in reproductive age, while endometrial hyperplasia (EH) and EP dominate in perimenopause. It was determined that EP and CE are characterized with menorrhagia and metrorrhagia approximately equally, whereas EH reveals AUB with oligomenorrhoea. Verification of exact endometrial pathology by ultrasound examination is hindered, that results in deviations of ultrasound and histological diagnosis. The usage of ultrasound data and AUB’s characteristics may improve the diagnostic accuracy on preadmission period.

Relation between Human Epididymis Protein 4 and Endometrial Pathology in Women with Postmenopausal Bleeding

2020 ◽  
Vol 11 (1) ◽  
pp. 937
Author(s):  
Ahmed L. Aboul Nasr ◽  
Ghada A. Abdel Moety ◽  
Mostafa S. Salem ◽  
Marwa M. Elsharkawy ◽  
Nada Kamal ◽  
...  
Keyword(s):  
Postmenopausal Bleeding ◽  
Human Epididymis Protein 4 ◽  
Human Epididymis ◽  
Endometrial Pathology

scholarly journals Prediction of Endometrial Hyperplasia and Cancer among Premenopausal Women with Abnormal Uterine Bleeding

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Luca Giannella ◽  
Lillo Bruno Cerami ◽  
Tiziano Setti ◽  
Ezio Bergamini ◽  
Fausto Boselli
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Prediction Model ◽  
Endometrial Hyperplasia ◽  
Premenopausal Women ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Stepwise Logistic Regression ◽  
Simultaneous Presence ◽  
Endometrial Pathology

Objective. To create a prediction model including clinical variables for the prediction of premalignant/malignant endometrial pathology in premenopausal women with abnormal uterine bleeding (AUB). Methods. This is an observational retrospective study including 240 premenopausal women with AUB referred to diagnostic hysteroscopy. Based on the presence of endometrial hyperplasia (EH) or cancer (EC), the women were divided into cases (EH/EC) and controls (no EH/EC). Univariate, stepwise logistic regression and ROC curve analysis were performed. Results. 12 women had EH/EC (5%). Stepwise logistic regression analysis showed that EH/EC associated significantly with BMI ≥ 30 (OR=7.70, 95% CI 1.90 to 31.17), diabetes (OR=9.71, 95% CI 1.63 to 57.81), and a thickened endometrium (OR=1.20, 95% CI 1.08 to 1.34, criterion > 11 mm). The AUC was 0.854 (95% confidence intervals 0.803 to 0.896, p<0.0001). Considering the pretest probability for EH/EC of 5%, the prediction model with a positive likelihood ratio of 8.14 showed a posttest probability of 30%. The simultaneous presence of two or three risk factors was significantly more common in women with EH/EC than controls (50% vs. 6.6 and 25% vs. 0%, respectively, p<0.0001). Conclusion. When premenopausal vaginal bleeding occurs in diabetic obese women with ET > 11 mm, the percentage of premalignant/malignant endometrial pathology increases by 25%. It is likely that the simultaneous presence of several risk factors is necessary to significantly increase the probability of endometrial pathology.

Asymptomatic shedding of herpes simplex virus from the genital tract: uncertainty and its consequences for patient management

1996 ◽  
Vol 7 (4) ◽  
pp. 229-232 ◽  
Author(s):  
S E Barton ◽  
P E Munday ◽  
R J Patel
Keyword(s):  
Herpes Simplex Virus ◽  
Herpes Simplex ◽  
Genital Herpes ◽  
Genital Tract ◽  
Patient Management ◽  
Sexual Transmission ◽  
Supportive Counselling ◽  
History Of ◽  
Simplex Virus ◽  
The Relationship

A frequent component of the management of patients with genital herpes concerns the possibility of asymptomatic shedding and potential sexual transmission of the virus. Approaches intended to provide supportive counselling and reassurance of patients about these issues need now to be modified in the light of increasing data of the frequency of asymptomatic detection of virus and the effects of antiviral therapy on this phenomenon. Further studies to delineate the relationship between asymptomatic detection of HSV in the genital tract and the mechanism of sexual transmission of this virus need to be conducted before clinicians instigate antiviral suppressive treatment primarily to prevent sexual transmission of HSV. However, it is important that the new data and our greater understanding of the natural history of genital herpes is translated into accurate and comprehensible information for our patients.

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