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Ghuman N, Atagu N, Sachdev R, Covarrubias O, Gregg L, Brookmeyer C, Johnson P, Gomez E. 'That's just the Ovary!' and other cases of mistaken identity on CT of the female pelvis. Curr Probl Diagn Radiol 2024; 53:422-435. [PMID: 38365459 DOI: 10.1067/j.cpradiol.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/16/2024] [Indexed: 02/18/2024]
Abstract
CT is often the first imaging test in female patients with lower abdominal and pelvic pain because of the wide availability of CT and differential diagnoses that span both gynecologic and gastrointestinal disease. Pathology within the female pelvis may be difficult to diagnose on CT owing to suboptimal delineation of anatomy in comparison to MRI and ultrasound. These challenges are confounded by overlapping imaging features of a wide range of gynecologic entities and can lead to diagnostic dilemmas. High value CT interpretation will direct the clinician to the best next diagnostic step as ultrasound and MRI provide superior soft tissue delineation. Other imaging modalities, laboratory investigations, or tissue sampling may be necessary to definitively characterize indeterminate lesions. In this review, we illustrate various cases of mistaken identity on CT of the female pelvis involving the ovaries, uterus, and peritoneal cavity while highlighting clinical pearls that may aid the radiologist in arriving at the correct diagnosis and avoiding potential pitfalls.
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Affiliation(s)
- Naveen Ghuman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Norman Atagu
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Rahul Sachdev
- St.Agnes Medical Center, Department of Internal Medicine, Fresno, CA, USA
| | - Oscar Covarrubias
- Medical Student, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lydia Gregg
- Johns Hopkins Department of Art as Applied to Medicine and Division of Interventional Neuroradiology, Baltimore, MD, USA
| | - Claire Brookmeyer
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pamela Johnson
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erin Gomez
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Viganò S, Smedile A, Cazzella C, Marra P, Bonaffini PA, Sironi S. Abnormal Uterine Bleeding: A Pictorial Review on Differential Diagnosis and Not-So-Common Cases of Interventional Radiology Management. Diagnostics (Basel) 2024; 14:798. [PMID: 38667444 PMCID: PMC11049404 DOI: 10.3390/diagnostics14080798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/05/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
Abnormal uterine bleeding (AUB) poses a multifaceted challenge in women's health, necessitating an integrated approach that addresses its diverse etiologies and clinical presentations. The International Federation of Gynecology and Obstetrics PALM-COEIN classification system provides a systematic approach to the diagnosis of AUB in non-pregnant women, based on clinical and imaging-based categorization of causes into structural (Polyps, Adenomyosis, Leiomyomas and Malignancy; PALM), and non-structural causes (Coagulopathies, Ovulatory disorders, primary Endometrial disorders, Iatrogenic and Not otherwise classified; COEIN). On the other hand, placental disorders, uterine rupture, ectopic pregnancy and retained products of conceptions are the main causes of uterine bleeding during pregnancy and in the peripartum period. Ultrasound is usually the first-line imaging technique for the differential diagnosis of causes of AUB. Computed Tomography may be useful if ultrasound findings are unclear, especially in emergency settings. Magnetic resonance imaging, when indicated, is an excellent second-line diagnostic tool for a better non-invasive characterization of the underlying cause of AUB. This pictorial review aims to illustrate the main causes of AUB from the point of view of diagnostic imaging and to show not-so-common cases that can be treated by means of interventional radiology.
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Affiliation(s)
- Sara Viganò
- Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (A.S.); (C.C.); (P.M.); (P.A.B.); (S.S.)
| | - Antonella Smedile
- Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (A.S.); (C.C.); (P.M.); (P.A.B.); (S.S.)
| | - Caterina Cazzella
- Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (A.S.); (C.C.); (P.M.); (P.A.B.); (S.S.)
| | - Paolo Marra
- Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (A.S.); (C.C.); (P.M.); (P.A.B.); (S.S.)
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milano, Italy
| | - Pietro Andrea Bonaffini
- Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (A.S.); (C.C.); (P.M.); (P.A.B.); (S.S.)
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milano, Italy
| | - Sandro Sironi
- Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (A.S.); (C.C.); (P.M.); (P.A.B.); (S.S.)
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milano, Italy
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Guruvare S, Hebbar S, Bai L, Jaiprakash P, Reddy D, Hc D. Accuracy of 3-D Surface Rendering of 2-D Ultrasound Images of the Uterus Using a Novel Software in Mapping Uterine Fibroids. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:128-133. [PMID: 37821244 DOI: 10.1016/j.ultrasmedbio.2023.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/07/2023] [Accepted: 09/20/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE Three-dimensional surface rendering of 2-D ultrasound images of the uterus in mapping uterine fibroids is a fast-evolving imaging technique that holds great potential for gynecology. The purpose of this study was to assess the accuracy of 3-D surface rendering of 2-D ultrasound images of the uterus using a new Fibroid Mapping Reviewer Application (FMRA) software for mapping uterine fibroids as compared with the pathological evaluation of uterine fibroids in pre-menopausal women undergoing hysterectomy. METHODS We enrolled women aged 35-55 y scheduled for hysterectomy for symptomatic fibroids at a tertiary care hospital from 2019 to 2021. Per pre-set guidelines, we recorded 2-D images and videos of the uterus with fibroids during the transvaginal ultrasound. The recordings were transferred through USB, loaded in the FMRA software and post-processed to generate a 3-D rendered uterus model. An experienced pathologist assessed and documented the gross examination details per a set protocol. We compared the pre-specified dimensions related to the size (L1, L2) and location (X, Y) of fibroids between the 3-D model and the pathologist's assessment of the hysterectomy specimen. RESULTS A total of 25 fibroids in 25 women, the single largest per woman, were considered for analysis. The two methods had good correlation with respect to size (for L1, R² = 0.9723, and for L2, R² = 0.9784) and location (for X, R² = 0.9618, and for Y, R² = 0.9753). Inter-observer analysis revealed that measurements from two sonologists were reproducible (Cronbach's α = 0.9 for the L1, L2 and L3 dimensions of fibroids from the 3-D model). CONCLUSION The FMRA is a novel tool for mapping fibroids. With its proven accuracy, it will be helpful in planning surgeries and during guided procedures for managing uterine fibroids.
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Affiliation(s)
- Shyamala Guruvare
- Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India.
| | - Shripad Hebbar
- Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Lakshmi Bai
- Nesa Medtech Private Limited, Bhavani Colony, Banashankari 3rd Stage, Banashankari, Bengaluru, Karnataka, India
| | - Padmapriya Jaiprakash
- Department of Pathology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Deepa Reddy
- Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Deepa Hc
- Department of Pathology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
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Gao M, Bhosale P, Devine C, Palmquist S, Javadi S. US, MRI, CT Performance and Interpretation of Uterine Masses. Semin Ultrasound CT MR 2023; 44:541-559. [PMID: 37821051 DOI: 10.1053/j.sult.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Uterine masses are commonly encountered as incidental findings during cross-sectional imaging or when individuals present with symptoms such as pain and bleeding. The World Health Organization categorizes tumors of the uterine corpus into 5 distinct groups: endometrial epithelial tumors and their precursors, tumor-like growths, mesenchymal uterine tumors, tumors with a combination of epithelial and mesenchymal elements, and various other types of tumors. The primary imaging method for assessing uterine abnormalities is transvaginal ultrasound. However, magnetic resonance imaging (MRI) can be employed to enhance the visualization of soft tissues, enabling a more detailed characterization of uterine masses. This article aims to outline the imaging features of both benign and malignant uterine masses using ultrasound, MRI, and computed tomography.
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Affiliation(s)
- Mamie Gao
- University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Priya Bhosale
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Sanaz Javadi
- University of Texas MD Anderson Cancer Center, Houston, TX
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A pictorial review of ultrasonography of the FIGO classification for uterine leiomyomas. Abdom Radiol (NY) 2022; 47:341-351. [PMID: 34581926 DOI: 10.1007/s00261-021-03283-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 01/08/2023]
Abstract
Uterine leiomyomas are the most common gynecological and pelvic neoplasm, reported in up to 80 percent of women by age 50. While the majority are asymptomatic, uterine leiomyomas, depending on size, number, and location can result in bulk symptoms, abnormal uterine bleeding (AUB), infertility or recurrent pregnancy loss. Ultrasonography (USG) remains first-line for the diagnosis of leiomyomas and is the most appropriate imaging modality for the initial assessment of abnormal uterine bleeding. In an effort to standardize nomenclature and identify causes of AUB, the International Federation of Gynecology and Obstetrics (FIGO) developed a classification system based on the acronym PALM-COEIN (polyp; adenomyosis; leiomyoma; malignancy and hyperplasia; coagulopathy; ovulatory dysfunction; endometrial; iatrogenic; and not yet classified). For the L category of leiomyoma, when present, a secondary and tertiary subclassification system is described distinguishing submucosal masses from others and categorizing the relationship of the mass to the endometrium and serosa. With advancements in newer minimally to non-invasive techniques developed for the management of leiomyomas, uniform characterization, mapping, and classification of leiomyomas is necessary to decide the optimal therapeutic approach. While this classification system has recently been reviewed on MR, to our knowledge, it has not been reviewed on ultrasound in the radiology literature. We hereby present a pictorial review of USG images of all the FIGO categories of leiomyomas to provide a standard guide for radiology reporting.
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Balcacer P, Jaramillo-Cardoso A, Gupta S, Mortele K, Johnson SC. The "Speckle Sign" in the Diagnosis of Posterior Compartment Endometriosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2181-2188. [PMID: 33417291 DOI: 10.1002/jum.15611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/11/2020] [Accepted: 12/17/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To determine usefulness of the "speckle sign" in the diagnosis of deep invasive endometriosis. MATERIALS AND METHODS This HIPAA-compliant, institutional review board-approved retrospective study with informed consent waived included 25 women (mean age 20-69 years) with histopathologically confirmed posterior cul-de-sac endometriosis between 2013 and 2018. Transvaginal ultrasound exams of these patients were reviewed by 2 expert radiologists searching for the "speckle sign," defined as irregular obliteration of the posterior cul-de-sac and bright (hyperechoic) internal echoes. The frequency of additional findings such as "kissing ovaries," endometriomas in the adnexa, bowel tethering in the posterior pelvic compartment, retroflexed uterus, adenomyosis, and pelvic free fluid were also analyzed. Data regarding clinical features, histopathologic findings and management were collected through a review of the medical record. RESULTS Reader one identified posterior compartment endometriosis in 20/25 patients, and reader two in 22/25 patients, with 96% agreement. Adnexal endometriomas were found in 21/25 patients for both readers (k = 0.70) and were bilateral in 23% of patients. The ovaries were adherent to each other in the midline ("kissing ovaries") in 50% of patients; the bowel was tethered anteriorly in 20%; the presence of adenomyosis was seen in about 27%, and a retroflexed uterus was seen in 24% of patients. CONCLUSIONS The speckle sign could be helpful in making the diagnosis of posterior compartment endometriosis, and the sign is often found in conjunction with other imaging features of endometriosis.
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Affiliation(s)
- Patricia Balcacer
- Department of Diagnostic Radiology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Adrian Jaramillo-Cardoso
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sonia Gupta
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Samuel C Johnson
- Department of Diagnostic Radiology, Wayne State University School of Medicine, Detroit, MI, USA
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Jagannathan JP, Steiner A, Bay C, Eisenhauer E, Muto MG, George S, Fennessy FM. Differentiating leiomyosarcoma from leiomyoma: in support of an MR imaging predictive scoring system. Abdom Radiol (NY) 2021; 46:4927-4935. [PMID: 34075468 DOI: 10.1007/s00261-021-03132-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/08/2021] [Accepted: 05/19/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to determine the Magnetic Resonance (MR) imaging features that best differentiate leiomyosarcoma (LMS) from leiomyoma, and to explore a scoring system to preoperatively identify those at highest risk of having LMS. METHODS Our Institutional Review Board approved this retrospective HIPAA-compliant study with a waiver for written informed consent. Institutional Research Patient Data Registry identified patients with histopathologically-proven LMS (n = 19) or leiomyoma (n = 25) and a pelvic MRI within six months prior to surgery. Qualitative differentiating MRI features were selected based on prior publications and clinical experience. Patient and MRI characteristics for leiomyomas versus LMS were compared using Wilcoxon rank-sum tests or Fisher's exact tests and using a basic classification tree. Hypothesis testing was two-tailed, with a p value < 0.001 used to determine inclusion of variables into an MR imaging predictive (MRP) score. Diagnostic performance [sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV)] of the MRP in diagnosis of LMS used all possible scores as cutoffs. RESULTS Seven out of 15 MRI features were found to have an association with LMS. The final MRP scores ranged from 0 to 7: a score of 0-3 was associated with 100% NPV for LMS, and a MRP score of 6-7 with 100% PPV for LMS. CONCLUSION Seven qualitative MR imaging features, extracted from a standard MR imaging protocol, allow differentiation of LMS from leiomyoma. An exploratory risk stratification MRP score can be used to determine the likelihood of LMS being present.
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Affiliation(s)
- Jyothi P Jagannathan
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Aida Steiner
- Department of Radiology, Turku University Hospital, University of Turku, Kiinamyllynkatu 4-8, 20521, Turku, Finland
| | - Camden Bay
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Department of Medicine/Biostatistics, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Eric Eisenhauer
- Department of Gynecologic Oncology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02214, USA
| | - Michael G Muto
- Division of Surgical Oncology, Harvard Medical School, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Suzanne George
- Department of Medical Oncology, Harvard Medical School, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Fiona M Fennessy
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
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Pisano S, Giustiniani M, Francis L, Gonzalez D, Margarit L, Sheldon IM, Paolino D, Fresta M, Conlan RS, Healey GD. Liquid crystal delivery of ciprofloxacin to treat infections of the female reproductive tract. Biomed Microdevices 2019; 21:36. [PMID: 30923927 PMCID: PMC6439215 DOI: 10.1007/s10544-019-0385-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Infections of the female reproductive tract are a major cause of morbidity and mortality in humans, requiring significant investment to sustain treatment and representing a major challenge to health. The increasing prevalence of bacterial resistance, and an almost complete absence of new antibiotic therapies for the past five decades, mean there is a desperate need for novel approaches to the treatment of bacterial infections. Within the present study, we demonstrate the effective ex vivo treatment of bacterial infection of the female reproductive tract using a controlled-release, liquid crystal-based platform. Liquid crystal encapsulation of ciprofloxacin significantly enhanced its bactericidal efficacy and reduced cell toxicity. Liquid crystal structures are low-cost, simple to manufacture and provide a sustained-release profile of encapsulated ciprofloxacin. Treatment of Escherichia coli infected reproductive tract epithelial cells and whole organ cultures with liquid crystal encapsulated ciprofloxacin proved to be an effective strategy for reducing bacterial load and reproductive tract inflammatory responses to infection. These data suggest that such an approach could provide an efficacious treatment modality for enhancing the effectiveness of current antibiotic therapies.
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Affiliation(s)
- Simone Pisano
- Institute of Life Science, Swansea University Medical School, Swansea University, Swansea, SA2 8PP, UK
| | - Matteo Giustiniani
- Department of Clinical and Experimental Medicine, University of Catanzaro "Magna Graecia", Viale "S. Venuta", 88100, Catanzaro, Italy
- Inter-Regional Research Center for Food Safety & Health, University of Catanzaro "Magna Græcia", Viale "S. Venuta", 88100, Catanzaro, Italy
| | - Lewis Francis
- Institute of Life Science, Swansea University Medical School, Swansea University, Swansea, SA2 8PP, UK
| | - Deyarina Gonzalez
- Institute of Life Science, Swansea University Medical School, Swansea University, Swansea, SA2 8PP, UK
| | - Lavinia Margarit
- Institute of Life Science, Swansea University Medical School, Swansea University, Swansea, SA2 8PP, UK
- Obstetrics & Gynecology Department Princess of Wales Hospital, Abertawe Bro Morannwg University Health Board, Coity Road, Bridgend, CF31 1RQ, UK
| | - I Martin Sheldon
- Institute of Life Science, Swansea University Medical School, Swansea University, Swansea, SA2 8PP, UK
| | - Donatella Paolino
- Department of Clinical and Experimental Medicine, University of Catanzaro "Magna Graecia", Viale "S. Venuta", 88100, Catanzaro, Italy
- Inter-Regional Research Center for Food Safety & Health, University of Catanzaro "Magna Græcia", Viale "S. Venuta", 88100, Catanzaro, Italy
| | - Massimo Fresta
- Department of Clinical and Experimental Medicine, University of Catanzaro "Magna Graecia", Viale "S. Venuta", 88100, Catanzaro, Italy
- Inter-Regional Research Center for Food Safety & Health, University of Catanzaro "Magna Græcia", Viale "S. Venuta", 88100, Catanzaro, Italy
| | - R Steven Conlan
- Institute of Life Science, Swansea University Medical School, Swansea University, Swansea, SA2 8PP, UK
| | - Gareth D Healey
- Institute of Life Science, Swansea University Medical School, Swansea University, Swansea, SA2 8PP, UK.
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Kim TH, Kim JW, Kim SY, Kim SH, Cho JY. What MRI features suspect malignant pure mesenchymal uterine tumors rather than uterine leiomyoma with cystic degeneration? J Gynecol Oncol 2018; 29:e26. [PMID: 29400019 PMCID: PMC5920213 DOI: 10.3802/jgo.2018.29.e26] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 12/09/2017] [Accepted: 12/26/2017] [Indexed: 12/15/2022] Open
Abstract
Objective To retrospectively assess conventional magnetic resonance imaging (MRI) features that differentiate malignant pure mesenchymal uterine tumors (MPMUT); endometrial stromal sarcoma (ESS) and leiomyosarcoma (LMS) from uterine leiomyoma with cystic degeneration (ULCD). Methods We retrospectively reviewed magnetic resonance (MR) images of 30 patients with ULCD, 18 with ESS, and 15 with LMS, to assess tumor location, margin, T2 signal intensity (SI), speckled appearance, and peripheral band using univariate and multivariate analyses. Results ULCD more frequently showed subserosal location (53.3%), well-defined margin (96.7%), and speckled appearance (90.0%) compared with ESS (0%, 33.3%, and 33.3%, respectively) or LMS (20.0%, 33.3%, and 60.0%, respectively). In quantitative T2 SI comparisons, the T2 SI ratio of the main solid tumor portion to gluteus maximus muscle differed significantly among the three groups, with ULCD showing a lower SI ratio (0.62) compared with ESS (2.44) and LMS (1.13). On multivariate analysis, an ill-defined margin (odds ratio [OR]=44.885; p=0.003) and high T2 SI (OR=4.396; p=0.046) were the significant MR differentiators. Conclusion An ill-defined tumor margin and high T2 SI ratio of the main solid tumor-to-gluteus maximus muscle were useful MRI features in the differentiation of MPMUT from ULCD.
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Affiliation(s)
- Tae Hyung Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Weon Kim
- Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Youn Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hyup Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Yeon Cho
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
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Czuczwar P, Stepniak A, Szkodziak P, Korolczuk A, Paszkowski T, Wozniak S. Unusual location of a plexiform neurofibroma in the fallopian tube: A case report. J Obstet Gynaecol Res 2016; 42:1618-1622. [PMID: 27641440 DOI: 10.1111/jog.13116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/09/2016] [Accepted: 06/18/2016] [Indexed: 11/27/2022]
Abstract
It is rare for neurofibromatosis to occur in the female genital tract. We report a case of a plexiform neurofibroma in the left fallopian tube in a 50-year-old postmenopausal woman. The initial diagnosis was a pedunculated leiomyoma or a fallopian tube tumor. Laparotomy was performed and a solid mass approximately 90 x 60 x 40 mm in size was found in the left fallopian tube. Total abdominal hysterectomy and bilateral salpingo-oophorectomy with an appendectomy, lymphadenectomy and omentectomy was performed. The histopathological diagnosis was plexiform neurofibroma. Although neurofibromatosis may involve various gynecological structures, to the best of our knowledge, localized plexiform neurofibroma in the fallopian tube has not previously been reported. The presented case is the first report of clinical, ultrasound and histopathological findings in a fallopian tube neurofibroma. Neurofibroma is a neoplasm that should be taken into consideration when diagnosing pelvic masses.
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Affiliation(s)
- Piotr Czuczwar
- 3rd Department of Gynecology, Medical University, Lublin, Poland.
| | - Anna Stepniak
- 3rd Department of Gynecology, Medical University, Lublin, Poland
| | - Piotr Szkodziak
- 3rd Department of Gynecology, Medical University, Lublin, Poland
| | | | | | - Slawomir Wozniak
- 3rd Department of Gynecology, Medical University, Lublin, Poland
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Abdel Latif M, Shady M, Nabil H, Mesbah Y. Trans-vaginal sono-elastography in the differentiation of endometrial hyperplasia and endometrial carcinoma. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Reif PA. Uterine Leiomyosarcoma Mimicking Benign Submucosal Leiomyoma. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2016. [DOI: 10.1177/8756479307309414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Uterine leiomyosarcoma is a rare, aggressive tumor of the smooth muscle with a typical intramural location. Patients present with abnormal uterine bleeding and an enlarged pelvic mass with clinical signs and symptoms that are virtually indistinguishable from benign leiomyoma. Sonographically, leiomyosarcoma presents as a large solitary tumor that closely resembles a benign leiomyoma that may be undergoing degenerative changes. Because of the infiltrative nature of leiomyosarcoma, invasion into the myometrium may be demonstrated. Leiomyosarcoma has a poor prognosis due to local pelvic recurrences and spread to distant sites. This case report demonstrates a fast-growing submucosal leiomyosarcoma with characteristic sonographic echo enhancement and infiltration into the myometrium.
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Wongwaisayawan S, Kaewlai R, Dattwyler M, Abujudeh HH, Singh AK. Magnetic Resonance of Pelvic and Gastrointestinal Emergencies. Magn Reson Imaging Clin N Am 2016; 24:419-31. [DOI: 10.1016/j.mric.2015.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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14
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Effects of low dose estrogen therapy on the vaginal microbiomes of women with atrophic vaginitis. Sci Rep 2016; 6:24380. [PMID: 27103314 PMCID: PMC4840317 DOI: 10.1038/srep24380] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 03/22/2016] [Indexed: 12/30/2022] Open
Abstract
Atrophic vaginitis (AV) is common in postmenopausal women, but its causes are not well understood. The symptoms, which include vaginal itching, burning, dryness, irritation, and dyspareunia, can usually be alleviated by low doses of estrogen given orally or locally. Regrettably, the composition of vaginal bacterial communities in women with AV have not been fully characterized and little is known as to how these communities change over time in response to hormonal therapy. In the present intervention study we determined the response of vaginal bacterial communities in postmenopausal women with AV to low-dose estrogen therapy. The changes in community composition in response to hormonal therapy were rapid and typified by significant increases in the relative abundance of Lactobacillus spp. that were mirrored by a decreased relative abundance of Gardnerella. These changes were paralleled by a significant four-fold increase in serum estradiol levels and decreased vaginal pH, as well as nearly a two-fold increase in the Vaginal Maturation Index (VMI). The results suggest that after menopause a vaginal microbiota dominated by species of Lactobacillus may have a beneficial role in the maintenance of health and these findings that could lead to new strategies to protect postmenopausal women from AV.
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Chaudhari UK, Imran M, Manjramkar DD, Metkari SM, Sable NP, Gavhane DS, Katkam RR, Sachdeva G, Thakur MH, Kholkute SD. Use of ultrasound imaging for the diagnosis of abnormal uterine bleeding in the bonnet macaque ( Macaca radiata). Lab Anim 2016; 51:65-74. [PMID: 26946119 DOI: 10.1177/0023677216637304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ultrasound is a powerful, low-cost, non-invasive medical tool used by laboratory animal veterinarians for diagnostic imaging. Sonohysterography and transvaginal ultrasound are frequently used to assess uterine anomalies in women presenting with abnormal uterine bleeding (AUB). In the present study, we have evaluated the abdominal ultrasound of bonnet monkeys ( n = 8) showing spontaneous ovulatory ( n = 5) and anovulatory ( n = 3) AUB. The ovulatory ( n = 5) macaques showed cyclic AUB for 7-8 days. The anovulatory ( n = 3) macaques had irregular AUB with menstrual cycles of 40-45 days. The B-mode abdominal, colour Doppler and 3D ultrasound scans were performed during the proliferative phase of the menstrual cycle. Ultrasound examination revealed endometrial polyps in five macaques and endometrial hyperplasia in three animals. The width and length of endometrial polyps was around 0.5-1 cm (average 0.51 ± 0.23 cm × 0.96 ± 0.16 cm) with significant increase in endometrial thickness ( P < 0.0002). 3D ultrasound also showed a homogeneous mass in the uterine cavity and colour Doppler ultrasound showed increased vascularity in the endometrial polyps. Endometrial hyperplasia characteristically appeared as a thickened echogenic endometrium ( P < 0.0002). This study demonstrates the use of non-invasive ultrasound techniques in the diagnosis of AUB in macaques.
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Affiliation(s)
- Uddhav K Chaudhari
- 1 Department of Primate Biology, National Institute for Research in Reproductive Health (NIRRH), Indian Council of Medical Research (ICMR), Parel, Mumbai, India
| | - M Imran
- 1 Department of Primate Biology, National Institute for Research in Reproductive Health (NIRRH), Indian Council of Medical Research (ICMR), Parel, Mumbai, India
| | | | | | - Nilesh P Sable
- 3 Department of Radiodiagnosis, Tata Memorial Hospital (TMH), Parel, Mumbai, India
| | | | - Rajendra R Katkam
- 1 Department of Primate Biology, National Institute for Research in Reproductive Health (NIRRH), Indian Council of Medical Research (ICMR), Parel, Mumbai, India
| | - Geetanjali Sachdeva
- 1 Department of Primate Biology, National Institute for Research in Reproductive Health (NIRRH), Indian Council of Medical Research (ICMR), Parel, Mumbai, India
| | - Meenakshi H Thakur
- 3 Department of Radiodiagnosis, Tata Memorial Hospital (TMH), Parel, Mumbai, India
| | - Sanjeeva D Kholkute
- 1 Department of Primate Biology, National Institute for Research in Reproductive Health (NIRRH), Indian Council of Medical Research (ICMR), Parel, Mumbai, India
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The challenge of preoperative identification of uterine myomas: Is ultrasound trustworthy? A prospective cohort study. Arch Gynecol Obstet 2015; 293:1235-41. [DOI: 10.1007/s00404-015-3937-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 10/21/2015] [Indexed: 11/25/2022]
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Mutai JK, Vinayak S, Stones W, Hacking N, Mariara C. Uterine fibroid embolization for symptomatic fibroids: study at a teaching hospital in kenya. J Clin Imaging Sci 2015; 5:18. [PMID: 25883858 PMCID: PMC4392566 DOI: 10.4103/2156-7514.154351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 02/24/2015] [Indexed: 11/25/2022] Open
Abstract
Objective: Characterization of magnetic (MRI) features in women undergoing uterine fibroid embolization (UFE) and identification of clinical correlates in an African population. Materials and Methods: Patients with symptomatic fibroids who are selected to undergo UFE at the hospital formed the study population. The baseline MRI features, baseline symptom score, short-term imaging outcome, and mid-term symptom scores were analyzed for interval changes. Assessment of potential associations between short-term imaging features and mid-term symptom scores was also done. Results: UFE resulted in statistically significant reduction (P < 0.001) of dominant fibroid, uterine volumes, and reduction of symptom severity scores, which were 43.7%, 40.1%, and 37.8%, respectively. Also, 59% of respondents had more than 10 fibroids. The predominant location of the dominant fibroid was intramural. No statistically significant association was found between clinical and radiological outcome. Conclusion: The response of uterine fibroids to embolization in the African population is not different from the findings reported in other studies from the west. The presence of multiple and large fibroids in this study is consistent with the case mix described in other studies of African-American populations. Patient counseling should emphasize the independence of volume reduction and symptom improvement. Though volume changes are of relevance for the radiologist in understanding the evolution of the condition and identifying potential technical treatment failures, it should not be the main basis of evaluation of treatment success.
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Affiliation(s)
- John Kiprop Mutai
- Department of Radiology, Aga Khan University Hospital, Nairobi, Kenya
| | - Sudhir Vinayak
- Department of Radiology, Aga Khan University Hospital, Nairobi, Kenya
| | - William Stones
- Department of Obstetrics and Gynaecology, University of Malawi, Blantyre, Malawi
| | - Nigel Hacking
- Department of Interventional Radiology, University Hospital Southampton NHS Foundation Trust (UHS), UK
| | - Charles Mariara
- Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Nairobi, Kenya
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Abstract
The perception that certain body cavities and spaces that are heavily inhabited by micro-organisms should be regarded as 'external' to the body function is no longer valid. Extensive research during recent years has demonstrated the importance of those microbes to normal physiology, which means that the human body and those tiny organisms are actually symbiotic. The major point of interaction between the human body and the microbiome is the gut. There are also gender-specific aspects for this symbiosis: bacterial vaginosis has serious implications for female morbidity, including reports of pelvic inflammatory disease, adverse pregnancy outcomes, increased susceptibility to sexually transmitted infections and infertility. Re-establishing a normal flora might be beneficial and therefore the use of probiotics and re-colonization by 'healthy' bacteria have become very popular. Probiotics may serve as an adjunct for treating recurrences of urogenital infections and vaginal atrophy. Some animal studies have pointed at potential beneficial effects of Lactobacilli species on bone health.
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Affiliation(s)
- A Pines
- a Sackler School of Medicine, Tel-Aviv University , Tel-Aviv , Israel
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Badawy ME, Elkholi DGEY, Sherif MF, Hefedah MAE. Magnetic resonance imaging of uterovaginal lesions associated with female infertility. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2015. [DOI: 10.1016/j.mefs.2014.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Derrouis S, Egger JF, Wespi Y, Kinkel K. Masse pelvienne chez une femme à 21 semaines d’aménorrhée. IMAGERIE DE LA FEMME 2014. [DOI: 10.1016/j.femme.2013.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Burich R, DeGregorio M. Current treatment options for vulvovaginal atrophy. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.11.3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Fonseca-Moutinho JA, Barbosa LS, Torres DG, Nunes SM. Abnormal uterine bleeding as a presenting symptom is related to multiple uterine leiomyoma: an ultrasound-based study. Int J Womens Health 2013; 5:689-94. [PMID: 24194648 PMCID: PMC3814927 DOI: 10.2147/ijwh.s50786] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the prevalence of uterine leiomyomas, diagnosed by ultrasound, in a private health care setting located in the central eastern region of Portugal, and to explore the demographic and clinical factors related to diagnosis and symptomatology. Patients and methods The files of 624 patients attending a private clinic in Covilhã, Portugal, from January 2 to December 31, 2010 were retrieved for evaluation. Pelvic ultrasound record, age, weight, height, age at menarche, number of pregnancies and deliveries, marital status, menstrual cycles characteristic, and contraceptive method at consultation were included in the analysis. Results Uterine leiomyoma (UL) was diagnosed by ultrasonography in 161 (25.8%) patients. A single UL was diagnosed in 80 (49.7%) patients. In 79 (49.1%) patients, the largest leiomyoma had a dimension <20 mm. Prevalence of UL was age dependent: at 11.0% for women 20–39 years old; 45.4% for those aged 40–59 years; and 19.5% for women 60 years or older. Metrorrhagia was the most distressing presenting symptom. When menorrhagia was the presenting symptom, the probability of having an ultrasound diagnosis of UL was 73.3%. Metrorrhagia or menorrhagia, as presenting symptom, was significantly related to the ultrasound diagnosis of multiple ULs. Conclusion UL was especially prevalent in women aged between 40 and 59 years. Patients with multiple ULs had significantly more abnormal uterine bleeding. In patients with menorrhagia or metrorrhagia, special attention should be taken in searching for the presence of multiple ULs during ultrasound.
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Affiliation(s)
- José Alberto Fonseca-Moutinho
- Faculty of Health Sciences, School of Medicine, Beira Interior University, Covilhã, Portugal ; Child and Women Department, Cova da Beira Academic Medical Center, Covilhã, Portugal
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Value of magnetic resonance imaging in diagnosis of adenomyosis and myomas of the uterus. J Minim Invasive Gynecol 2013; 19:620-6. [PMID: 22935303 DOI: 10.1016/j.jmig.2012.06.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Revised: 06/14/2012] [Accepted: 06/21/2012] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To estimate the diagnostic performance of magnetic resonance imaging (MRI) in detection of myomas and adenomyosis of the uterus. DESIGN Prospective cohort observational study (Canadian Task Force classification II-2). SETTING Department of obstetrics and gynecology, tertiary academic hospital. PATIENTS One hundred fifty-three consecutive women with an enlarged uterus accompanied by gynecologic symptoms and/or with an asymptomatic pelvic mass. INTERVENTION Total abdominal hysterectomy. All patients underwent MRI before the operation. MEASUREMENTS AND MAIN RESULTS The sensitivity, specificity, positive, and negative predictive value of MRI for the diagnosis of uterine pathology was calculated using histologic findings as the standard criterion for final diagnosis. Receiver operating characteristics curves were constructed to describe the diagnostic performance of MRI. In the diagnosis of myomas, MRI demonstrated sensitivity of 94.1%, specificity of 68.7%, PPV of 95.7%, and NPV of 61.1%. In the diagnosis of adenomyosis, MRI demonstrated sensitivity of 46.1%, specificity of 99.1%, PPV of 92.3%, and NPV of 88.5%. The area under the curve (AUC) for the diagnostic performance of MRI in the detection of myomas and adenomyosis was 0.81 and 0.73, respectively. Uterine sarcoma was diagnosed in 5 patients; in these cases, MRI demonstrated sensitivity of 60.0%, specificity of 99.2%, PPV of 75.0%, and NPV of 98.4%. The AUC for MRI in the diagnosis of uterine sarcomas was 0.80. CONCLUSIONS MRI exhibits a high AUC for the diagnosis of both adenomyosis and myomas. The PPV of MRI in the diagnosis of adenomyosis and myomas of the uterus is high as well. MRI seems to be a useful technique in everyday clinical practice in the diagnostic approach of these common conditions, enabling clinicians to select the most appropriate management.
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Takeda A, Imoto S, Mori M, Nakamura H. Successful pregnancy outcome after laparoscopic-assisted excision of a bizarre leiomyoma: a case report. J Med Case Rep 2011; 5:344. [PMID: 21812974 PMCID: PMC3199851 DOI: 10.1186/1752-1947-5-344] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 08/03/2011] [Indexed: 11/19/2022] Open
Abstract
Introduction Bizarre leiomyoma is a rare leiomyoma variant that requires a precise histopathological evaluation. Especially when diagnosed in a younger woman, this tumor leads to challenging treatment issues involving fertility preservation. Owing to the low incidence of bizarre leiomyoma, there is insufficient evidence to support myomectomy alone as an appropriate management option. Also, the impact of bizarre leiomyoma on fertility is not well known. Case presentation A 30-year-old Japanese woman who had never given birth was referred to us because of a uterine tumor with an unusual diagnostic image and was treated by a gasless laparoscopic-assisted excision with a wound retractor. Owing to an unclear margin between her uterine tumor and myometrium, a concomitant excision of adjacent myometrial tissue was required to achieve the maximum resection of her tumor. The histopathological diagnosis was bizarre leiomyoma. Seven months later, she conceived spontaneously and her pregnancy course was uneventful. At 37 weeks of gestation, an elective cesarean section was performed. Although a slight omental adhesion was noted at the postexcisional scar, her uterine wall structure was well preserved and a recurrence of bizarre leiomyoma was not noted. Conclusions A laparoscopic-assisted excision of bizarre leiomyoma is a feasible and minimally invasive conservative measure for a woman who wishes to preserve fertility.
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Affiliation(s)
- Akihiro Takeda
- Department of Obstetrics & Gynecology, Gifu Prefectural Tajimi Hospital, Maebata-cho 5-161, Tajimi, Gifu, 507-8522, Japan.
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Abstract
Uterine fibroids, also known as leiomyomas, are the commonest uterine neoplasms. Although benign, they can be associated with significant morbidity and are the commonest indication for hysterectomy. They are often discovered incidentally when performing imaging for other reasons. Usually first identified with USG, they can be further characterized with MRI. They are usually easily recognizable, but degenerate fibroids can have unusual appearances. In this article, we describe the appearances of typical and atypical uterine fibroids, unusual fibroid variants and fibroid mimics on different imaging modalities. Knowledge of the different appearances of fibroids on imaging is important as it enables prompt diagnosis and thereby guides treatment.
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Affiliation(s)
- Sue Wilde
- Department of Radiology, Norfolk & Norwich University Hospital, Colney Lane, Norwich, Norfolk, NR4 7UY, United Kingdom
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Miomas y función sexual. Estudio prospectivo de un año. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2011. [DOI: 10.1016/j.gine.2010.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Nogueira RC, Costa AMM, Silva IDCG, Carvalho CV, Maganhin C, Baracat EC, Soares JM. Influence of the CYP17 polymorphism on vasomotor symptoms in postmenopausal women: a pilot study. Climacteric 2011; 14:537-43. [DOI: 10.3109/13697137.2010.548668] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kuzbari O, Hou J, Rotenberg O, Shahabi S. Management of Large Intramural Isthmic-Cervical Leiomyomas: Two Case Reports and Review of Literature. J Gynecol Surg 2010. [DOI: 10.1089/gyn.2009.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Oumar Kuzbari
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY
| | - June Hou
- Department of Obstetrics and Gynecology and Women's Health, Division of Gynecologic Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Ohad Rotenberg
- Department of Obstetrics and Gynecology and Women's Health, Division of Gynecologic Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Shohreh Shahabi
- Department of Obstetrics and Gynecology and Women's Health, Division of Gynecologic Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
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Farage MA, Miller KW, Sobel JD. Dynamics of the Vaginal Ecosystem—Hormonal Influences. ACTA ACUST UNITED AC 2010. [DOI: 10.4137/idrt.s3903] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The vagina is a dynamic and finely tuned ecosystem in which homeostasis depends on mutually beneficial interactions between a human female and her resident microorganisms, an ecosystem that can be thrown off balance by a wide variety of both intrinsic and extrinsic factors. Although a functional equilibrium provides stability to the ecosystem considered crucial to maintaining vaginal health, “normal flora” is a concept currently being redefined. New methodologies enable molecular analyses of the vaginal microbiota which have widened the definition of “normal” from a single specific microbiological profile to a range of functional microbial equilibria dependent upon pertinent host and microbial factors. One of the strongest influences on the vaginal microbiota is the hormonal changes that define the reproductive phases of a woman's life. The vaginal environment is particularly responsive to estrogen, a hormone that creates distinctive changes in the vaginal microbiota. This review summarizes the components of a healthy vaginal ecosystem during the reproductive years, including the characteristics of a healthy equilibrium and factors that can disturb a functional balance. It also summarizes what is known about the vaginal microbiota in childhood and after menopause. Healthful ecosystems at any stage of a female's reproductive life will be characterized by a microbiota that both maintains physiological function and though changeable, adapts to normal perturbation without succumbing to disease.
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Affiliation(s)
- Miranda A. Farage
- The Procter and Gamble Company, Winton Hill Business Center, Cincinnati, OH USA
| | - Kenneth W. Miller
- The Procter and Gamble Company, Winton Hill Business Center, Cincinnati, OH USA
| | - Jack D. Sobel
- Wayne State University, Infectious Diseases, Detroit, MI USA
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Padua MAF, Fonseca AM, Deguti MM, Bagnoli VR, Farias AQ, Maciel GAR, Soares JM, Carilho FJ, Baracat EC. Hormone therapy in Brazilian postmenopausal women with chronic hepatitis C: a pilot study. Climacteric 2010; 13:179-86. [DOI: 10.3109/13697130902952577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Ami O, Lamazou F, Mabille M, Levaillant JM, Deffieux X, Frydman R, Musset D. Real-time transvaginal elastosonography of uterine fibroids. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 34:486-488. [PMID: 19790094 DOI: 10.1002/uog.7358] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- O Ami
- Services de Gynécologie-Obstétrique et Médecine de la Reproduction, Université Paris-Sud, France.
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Abstract
Menometrorrhagia is a frequent cause of medical consulting. After a clinical examination showing the uterine origin of bleeding and that excludes a cervical or vulvo-vaginal origin, transvaginal sonography (TVS) represents the first-line technique examination. TVS allows to identify endometrial diseases (atrophy, polyps or diffuse hyperplasia), endometrial carcinoma, myometrial disorders (adenomyosis, leiomyoma or vascular abnormalities), and adnexal disorders. Color Doppler sonography and hysterosonography are useful complementary tools for ultrasound performance improvement. MR imaging should be performed if TVS is not contributive or is highly recommended for staging of uterine cancers. All these techniques provide useful information for optimal planning treatment.
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Affiliation(s)
- M Bazot
- Hôpital Tenon, service de radiologie, 4, rue de la Chine, 75970 Paris cedex 20, France.
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Levens ED, Wesley R, Premkumar A, Blocker W, Nieman LK. Magnetic resonance imaging and transvaginal ultrasound for determining fibroid burden: implications for research and clinical care. Am J Obstet Gynecol 2009; 200:537.e1-7. [PMID: 19268886 DOI: 10.1016/j.ajog.2008.12.037] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Revised: 10/08/2008] [Accepted: 12/22/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To compare magnetic resonance and ultrasound imaging for uterine fibroid measurement. STUDY DESIGN Eighteen women undergoing hysterectomy for symptomatic fibroids underwent preoperative pelvic ultrasound and magnetic resonance imaging. Resected fibroids were correlated with the images. Weighted kappa agreement statistics and Spearman correlations for patient characteristics were calculated. RESULTS Magnetic resonance imaging identified 121 of 151 pathologically confirmed fibroids, yielding 91% positive predictive value (95% confidence interval [CI], 85-95) and 80% sensitivity (95% CI, 73-86). Positive predictive value and sensitivity for ultrasound were 97% (95% CI, 89-100) and 40% (95% CI, 32-48), respectively. Mean diameter-equivalent discrepancies between imaging and pathologic measurements were 0.51 +/- 0.68 cm for magnetic resonance imaging and 0.76 +/- 0.88 cm for ultrasound. kappa statistics comparing imaging to pathology showed better agreement for magnetic resonance than ultrasound (kappa = 0.60 vs 0.36). The number of fibroids detected by magnetic resonance imaging predicted measurement errors (r = 0.76; P = .0002). CONCLUSION Superior sensitivity and minimal measurement discrepancies suggest magnetic resonance imaging may be preferentially used for fibroid assessment in clinical research.
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Khademi S, Westphalen AC, Webb EM, Joe BN, Badiee S, Hawkins RA, Coakley FV. Frequency and etiology of solitary hot spots in the pelvis at whole-body positron emission tomography/computed tomography imaging. Clin Imaging 2009; 33:44-8. [PMID: 19135929 DOI: 10.1016/j.clinimag.2008.06.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Accepted: 06/13/2008] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine the frequency and etiology of a single hypermetabolic focus within the pelvis with no other areas of increased 18-fluorodeoxyglucose (FDG) uptake in the reminder of the whole body in an oncological population. METHOD AND MATERIALS We retrospectively examined the first 700 whole-body PET/CT scans performed at our institution for baseline staging or follow-up of cancer and identified all patients with a solitary focus of increased FDG uptake in the pelvis. All available medical records and imaging findings in these patients were reviewed in order to determine the etiology of increased FDG uptake. RESULTS Eight (1.1%) of the 700 patients had a solitary hot spot in the pelvis at positron emission tomography (PET)/computed tomography (CT) imaging, consisting of seven of 380 women and one of 320 men. In the seven women, increased FDG uptake was due to physiological endometrial uptake (n=2), leiomyoma (n=1), corpus luteum cyst (n=1), physiological ovarian uptake (n=1), urinary leak (n=1), and nonspecific colitis (n=1). In the man, uptake was due to recurrent rectosigmoid adenocarcinoma. None of the 700 patients was found to have metastatic disease in the pelvis. CONCLUSION Isolated pelvic hot spots at PET/CT imaging in an oncological population are not common and usually benign; physiological endometrial or ovarian uptake is the single commonest cause.
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Affiliation(s)
- Sara Khademi
- Department of Radiology, University of California San Francisco, San Francisco, CA 94143-0628, USA
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Maubon A, Pouquet M, Piver P, Mazet N, Viala-Trentini M, Rouanet J. Imagerie de l’infertilité féminine. ACTA ACUST UNITED AC 2008; 89:172-83. [DOI: 10.1016/s0221-0363(08)70391-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Al-Mahrizi S, Tulandi T. Treatment of uterine fibroids for abnormal uterine bleeding: myomectomy and uterine artery embolization. Best Pract Res Clin Obstet Gynaecol 2007; 21:995-1005. [PMID: 17478123 DOI: 10.1016/j.bpobgyn.2007.03.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Uterine myoma is a common benign tumour in women and most cases do not require treatment. Excessive uterine bleeding is usually due to a submucous myoma or an intramural myoma that is encroaching into the uterine cavity. After eliminating endometrial malignancy, perimenopausal women could be managed expectantly or with gonadotrophin-releasing hormone agonist until menopause. Hysteroscopic myomectomy is highly effective in controlling menorrhagia that is related to submucous myoma. Concomitant endometrial ablation improves menorrhagia; however, the subsequent hysterectomy rate remains the same. For those with an intramural myoma, abdominal myomectomy results in good bleeding control. It could also be done by laparoscopic approach; however, the surgeon should have expertise in laparoscopic suturing and the uterine incision should be properly sutured. In women who have completed their family, hysterectomy remains the most effective treatment for excessive uterine bleeding. Compared with uterine artery embolization (UAE), it is associated with better improvement in pelvic pain. Nevertheless, UAE is a good alternative to hysterectomy.
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Affiliation(s)
- Sharifa Al-Mahrizi
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
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