Identification and treatment of primary cervical gestational trophoblastic neoplasia: a retrospective study of 13 patients and literature review

Background Primary cervical gestational trophoblastic neoplasias (GTNs) are extremely rare ectopic GTNs. Such lesions are difficult to diagnose clinically because of their rarity, with abnormal vaginal bleeding of a non-specific cause being the most common symptom. To that end, this retrospective study aimed to identify the clinical characteristics of cervical GTN and to explore diagnostic and therapeutic strategies. Results Thirteen patients diagnosed with primary cervical GTN at the Department of Gynecology, Peking Union Medical College Hospital, Beijing, China, between June 1, 1988 and May 31, 2020 were included in the study. All patients had irregular vaginal bleeding, including six who presented with massive bleeding. Seven patients (53.8%) were initially misdiagnosed with a cervical pregnancy. All patients received chemotherapy; 11 (84.6%) also underwent hysterectomy because of chemoresistant lesions or uncontrolled bleeding. All patients achieved complete remission; however, two women (15.4%) experienced a relapse during the median follow-up period of 35 months. A comprehensive review of English-language literature published between 1980 and 2020 identified 22 case reports encompassing 27 patients. The definitive diagnosis was achieved via pathology in 26 of them (96.3%), and hysterectomy was performed in 21 (77.8%). Conclusions Owing to its rarity and nonspecific symptoms, the diagnosis of primary cervical GTN is challenging and often relies on pathology. The combination of chemotherapy and hysterectomy is the main therapeutic strategy for this disease.

Malignant transformation of endometriosis on vaginal cuff after hysterectomy: a case report

Objective. Endometriotic tissue implants rarely transform to malignant tissue, especially in a patient with a hysterectomy and bilaterally salpingo-oophorectomy. However, several cases with cancer arising from endometriosis after hysterectomy were reported in the literature. Hormone replacement therapy only with estrogen is a crucial risk factor for malignant transformation of persistent endometriotic tissue. Case Report. The present case demonstrates an endometrioid adenocarcinoma arising from persistent endometriosis tissue in a patient who was performed hysterectomy with bilateral salpingectomy 3 years ago. The histopathologic specimens of the previous surgery did not include any malignant tissue. After 3 years, she applied to the hospital with abnormal vaginal bleeding, and her histopathologic examination result found an ulcerated mass at the upper one-third of the vagina that is compatible with endometrioid adenocarcinoma. Conclusion. It is crucial to keep in mind the endometriosis history of the patient, to be able to diagnose cancer arising from endometriosis while evaluating the patient with a hysterectomy.

Angiographic features and transarterial embolization of retained placenta with abnormal vaginal bleeding

Objectives To clarify characteristic angiographic features and clinical efficacy of selective transarterial embolization (TAE) of retained placenta with abnormal vaginal bleeding. Methods The study cohort comprised 22 patients (mean age, 33.5 years; range, 22–24 years) who underwent selective TAE for retained placenta with abnormal bleeding between January 2018 and December 2020 at our institution. Angiographic images were reviewed by two certified radiologists with consensus. Medical records were reviewed to evaluate the efficacy of TAE. Angiographic features of retained placenta, technical success (disappearance of abnormal findings on angiography), complications, clinical outcomes (hemostatic effects and recurrent bleeding) were evaluated. Results Pelvic angiography showed a dilated vascular channel mimicking arteriovenous fistulas or an aneurysm contiguous with dilated uterine arteries in the mid-arterial–capillary phase in 20 patients; it showed contrast brush in the remaining two patients. TAE technical success was achieved in all patients. No major complications were observed in any patients. Fifteen patients were followed up with expectant management after TAE; all but one patient showed no re-bleeding during the follow-up period (mean follow-up interval, 3.4 months; range, 1–17 months). One patient showed minor rebleeding, which resolved spontaneously. Seven patients underwent scheduled hysteroscopic resection within 1 week after TAE, and no excessive bleeding was observed during or after the surgical procedure in all seven patients. Conclusions The characteristic angiographic feature of retained placenta is “dilated vascular channel that mimic low flow AVM.” TAE is a safe and effective treatment to manage retained placenta with abnormal bleeding.

Frequency of Cervical Cancer in Women Attending Gynae OPD with Complaint of Abnormal Vaginal Bleeding

Aim: Frequency of cervical cancer in women of reproductive age presenting with abnormal vaginal bleeding. Methodology: Descriptive cross sectional study, done at Department of Obs &Gynae, JPMC, Karachi Duration of study: Six months from 01-11-2014 to 30-04-2015 Total 73 patients of age 18-45 years, having history of abnormal vaginal bleeding > 3 menstrual cycles were selected. Pregnant woman, abortion within last 6 months, age >45 years, fibroid/ tumors/ polyps, PID, gonorrhea, or Chlamydia patients were excluded. Chi-square was used as test of significance with a P value <0.05 taken as significant. Results: Mean ± SD age was 38.12 ± 4.33 years. Mean ± SD parity was 2.21 ± 1.67 children (Range: 0-5). Mean ± SD duration of presenting symptoms was 7.45 ± 2.81 months (Range 3-11). About one fifth of patients (i.e. 19.2%) were of age between 18-25 years. a vast majority (i-e; 43.8%) were in 26-35 years age category while remaining (36.99%) patients were of age between 36-45 years. 12.3% women had no children, 35.6% had 1-2 children, 28.8% had 3-4 children while remaining 23.3% women had 5 children. 12 out of 73 (16.4%) women had cervical cancer confirmed through biopsy and histopathology of cervical tissue. Age was significant (P value = 0.003) while parity & duration of presenting symptoms were non-significant (P values = 0.110 & 0.405 respectively). Conclusion: The study found that almost every 6th women with abnormal vaginal bleeding is suffering from cervical cancer. Younger age women and those having lesser parity are less prone to this condition. Keywords: Abnormal vaginal bleeding, Cervical cancer, Postcoital bleeding

INCIDENCE OF CERVICAL ADENOCARCINOMA: A RETROSPECTIVE CASE STUDY AT RIMS RANCHI

BACKGROUND:Cervical cancer remains one of the most common causes of death for women globally and ranks 4th of all cancers.Currently,every 2 minutes a life is lost to this disease.Endocervical adenocarcinomas are a heterogeneous group of neoplasms. Screening strategies designed for and effective in detecting squamous cell carcinoma precursors are less effective in detecting endocervical glandular precursor lesions.Because of this and possible other reasons,the real and relative incidence of endocervical adenocarcinoma has increased in recent years from 5% to up to 20-25%, particularly in patients 30yr of age or older.MATERIAL AND METHOD: It was a retrospective record based study, performed in the Department of pathology, RIMS Ranchi. Study population included all cases who were clinically suspected of any cervical pathology, with common clinical presentation of abnormal vaginal bleeding, intermenstrual heavy bleeding,postmenopausal bleeding,postcoital bleeding,whitish discharge per vagina,pain in lower abdomen, from January 2020- july 2021.RESULT:In our study incidence of SCC of cervix is 91.97% and second most common type is adenocarcinoma of cervix with incidence of 8.02%.Striking feature of adenocarcinoma of cervix is its preponderance in younger female as compared to SCC

Total Uterine Inversion After Normal Vaginal Delivery: A Case Report

Puerperal uterine inversion is a rare obstetric emergency that may cause maternal mortality. We describe a multiparous woman with total uterine inversion after a normal vaginal delivery. A 28-years-old, gravid 3, pregnant woman was admitted to the hospital in the first stage of labor. She had a past medical history of curettage due to abnormal vaginal bleeding following her second vaginal delivery and the present pregnancy proceeded without complications. After the delivery, due to the history of placental adhesion, umbilical cord traction was avoided and after 20 min, the patient was asked to push hard. During a Valsalva maneuver, the uterus and the placenta were suddenly expelled from the vagina. The placenta was completely adherent to the decidua and the patient displayed no signs of shock. Then manual repositioning of the uterus was performed by a closed fist and a subtotal abdominal hysterectomy was performed. Pathological examination revealed placenta accreta and the placenta was found completely adherent at the fundus. Uterine inversion usually occurs unexpectedly and is unpreventable in some cases. Assessment of the possible risk factors before delivery may help predict its occurrence. Therefore, in women with a positive history, special measures should be taken in the third stage of labor to manage the possibility of inversion.

Identification and Treatment of Primary Cervical Gestational Trophoblastic Neoplasia: a Retrospective Study of 13 Patients and Literature Review

Background: Primary cervical gestational trophoblastic neoplasias (GTNs) are extremely rare ectopic GTNs. Such lesions are difficult to diagnose clinically because of their rarity, with abnormal vaginal bleeding of a non-specific cause being the most common symptom. To that end, this retrospective study aimed to identify the clinical characteristics of cervical GTN and to explore diagnostic and therapeutic strategies.Results: Thirteen patients diagnosed with primary cervical GTN at the Department of Gynecology, Peking Union Medical College Hospital, Beijing, China, between June 1, 1988 and May 31, 2020 were included in the study. All patients had irregular vaginal bleeding, including six who presented with massive bleeding. Seven patients (53.8%) were initially misdiagnosed with a cervical pregnancy. All patients received chemotherapy; 11 (84.6%) also underwent hysterectomy because of chemoresistant lesions or uncontrolled bleeding. All patients achieved complete remission; however, two women (15.4%) experienced a relapse during the median follow-up period of 35 months. A comprehensive review of English-language literature published between 1980 and 2020 identified 22 case reports encompassing 27 patients. The definitive diagnosis was achieved via pathology in 26 of them (96.3%), and hysterectomy was performed in 21 (77.8%).Conclusions: Owing to its rarity and nonspecific symptoms, the diagnosis of primary cervical GTN is challenging and often relies on pathology. The combination of chemotherapy and hysterectomy is the main therapeutic strategy for this disease.

Angiographic Features and Transarterial Embolization of Retained Placenta With Abnormal Vaginal Bleeding

Objectives: To clarify characteristic angiographic features and clinical efficacy of selective transarterial embolization (TAE) of retained placenta with abnormal vaginal bleeding.Methods: The study cohort comprised 22 patients (mean age, 33.5 years; range, 22–24 years) who underwent selective TAE for retained placenta with abnormal bleeding between January 2018 and December 2020 at our institution. Angiographic images were reviewed by two certified radiologists with consensus. Medical records were reviewed to evaluate the efficacy of TAE. Angiographic features of retained placenta, technical success (disappearance of abnormal findings on angiography), complications, clinical outcomes (hemostatic effects and recurrent bleeding) were evaluated. Results: Pelvic angiography showed a dilated vascular channel mimicking arteriovenous fistulas or an aneurysm contiguous with dilated uterine arteries in the mid-arterial–capillary phase (tentatively named “serpiginous blood sinus”) in 20 patients; it showed contrast brush in the remaining two patients. TAE technical success was achieved in all patients. No major complications were observed in any patients. Fifteen patients were followed up with expectant management after TAE; all but one patient showed no re-bleeding during the follow-up period (mean follow-up interval, 3.4 months; range, 1–17 months). One patient showed minor rebleeding, which resolved spontaneously. Seven patients underwent scheduled hysteroscopic resection within 1 week after TAE, and no excessive bleeding was observed during or after the surgical procedure in all seven patients.Conclusions: The characteristic angiographic feature of retained placenta is “serpiginous blood sinus.” TAE is a safe and effective treatment to manage retained placenta with abnormal bleeding.

Determine the Frequency of Endometrial Hyperplasia in Female with Abnormal Vaginal Bleeding

Objective: To determine the frequency of endometrial hyperplasia in female with abnormal vaginal bleeding. Study Design: Cross-sectional Place and Duration of Study: Department of Obstetrics & Gynaecology, Allama Iqbal Memorial Teaching Hospital, Sialkot from 1st January 2021 to 31st March 2021. Methodology: One hundred and ten females with abnormal bleeding were presented in this study. Patients were aged between 40-65 years. Demographically details of age, weight, body mass index and socio economic status were recorded after taking written consent. Complete patients were undergone for transvaginal ultrasound. Frequency of endometrial hyperplasia was recorded. Results: Mean age of the females was 47.16±7.53 years with mean BMI 26.17±8.44 kg/m2. Mean weight of the patients were 59.16±17.66 kg. Most of the patients 65 (59.09%) were from urban area and majority of the patients 70 (63.64%) were illiterate. Sixty (54.5%) cases were from low socio-economic status and 50 (45.5%) had high socio-economic status. Endometrial hyperplasia was found in 25 (22.73%) patients, in which 18 (72%) had cystic hyperplasia, adenomatous hyperplasia found in 4 (16%) and 3 (12%) had atypical hyperplasia. Among 25 cases of hyperplasia, menorrhagia found in 15 (60%), polymenorrhea found in 8 (32%) and polymenorrhagia in 2 (8%). Medical treatment were given to 20 (80%) cases and surgical treatment were given to 5 (20%). Conclusion: The prevalence of endometrial hyperplasia was 22.73% among women with abnormal bleeding. It can be cure by early diagnosis and treatment. Keywords: Transvaginal ultrasound (TVS), Endometrial hyperplasia, Abnormal vaginal bleeding, Menorrhagia