Diffuse leiomyomatosis of the uterus

The clinical and pathological features of four cases of the rare entity diffuse leiomyomatosis of the uterus are described. The patients, who ranged in age from 28 to 35 years, presented with a six month to ten year history of abnormal uterine bleeding, dysmenorrhoea and an enlarged uterus. Hysterectomy in each case revealed a symmetrically enlarged uterus containing numerous small ill-defined leiomyomatous nodules. On microscopic examination the nodules were composed of compact fascicles and interweaving bundles of plump uniform benign smooth muscle cells. The nodules blended with each other and merged imperceptibly with the surrounding less cellular normal myometrium. The four patients are alive and well without further treatment. The follow-up period ranged from six months to twelve years.     

Synchronous occurrence of multiple malignant neoplasms in the uterus (adenocarcinoma of the endometrium, large B-cell lymphoma of the cervix)

Multiple primary malignancies of the uterus are extremely rare. We report a case of endometrial adenocarcinoma and cervical large B-cell lymphoma occurring simultaneously in a 64-year-old woman with uterine bleeding. Adenopathy, hepatosplenomegaly or bone marrow infiltration were not found. Both malignant neoplasms mentioned above were diagnosed incidentally on the specimen (total hysterectomy with bilateral salpingo-oophorectomy) removed for uterine leiomyomas.     

True uterine diverticulum. A partial müllerian duct duplication?

True uterine diverticulum is an exceedingly rare entity. We report only the second case, to our knowledge, of a nulliparous uterus containing a diverticulum communicating with the endometrial cavity. True uterine diverticula probably arise from a localized duplication of the distal Müllerian duct on one side. They may be confused pathologically with uterine sacculations of pregnancy, but tend to have thicker walls. Associated conditions include "ectopic" pregnancy in the diverticulum, dysmenorrhea, and abnormal uterine bleeding.     

Cotyledonoid leiomyoma of uterus: a case report

The diagnosis of uterine smooth muscle tumors is usually not difficult. Occasionally, benign tumors with an unusual growth pattern may cause some diagnostic confusion for pathologists who had not experienced such a tumor before. A fifty-one year old female patient had admitted to our gynecology outpatient clinics with abnormal uterine bleeding (menorrhagia) and undergone a surgery with a diagnosis of pelvic mass. A neoplasm consisting of spindle cell nodules with prominent hydropic degeneration was observed at pathological examination. Tumor cells were positive for vimentin, desmin and smooth muscle actin at immunohistochemical evaluation. Cotyledonoid leiomyomas are rare benign smooth muscle tumors of uterus which are recently defined in the literature. In this article we report a case of cotyledonoid leiomyoma of uterus with an exophytic growth pattern in the serosa and did not contain an intramural dissecting component.     

Non-Hodgkin's lymphomas involving the uterus: a clinicopathologic analysis of 26 cases.

Non-Hodgkin's lymphomas (NHL) involving the uterus may be either low-stage neoplasms that probably arise in the uterus (primary) or systemic neoplasms with secondary involvement. In this study, 26 NHL involving the uterus are reported. Ten cases were stage I(E) or II(E) and are presumed to be primary. The mean age of patients at presentation was 55 years (range, 35 to 67 years), and abnormal uterine bleeding was the most frequent complaint (six patients). Nine of 10 tumors involved the cervix. Histologically, eight were diffuse large B-cell lymphoma (DLBCL); one was follicle center lymphoma, follicular, grade 1; and one was marginal zone B-cell lymphoma. At 5 years of clinical follow-up, five of six patients were alive after treatment. In 12 cases, uterine involvement was part of a systemic disease at diagnosis, either stage III(E) or IV. The mean patient age at the time that uterine involvement was detected was 58 years (range, 22 to 75 years); 6 of 12 had abnormal uterine bleeding. Six tumors involved both cervix and corpus, four corpus, and two cervix. Six were DLBCL; two were small lymphocytic lymphoma; three were follicle center lymphoma, follicular, grade 1 (two cases) or grade 2 (one case); and one was precursor T-cell lymphoblastic lymphoma. At 5 years of clinical follow-up, two of seven patients were alive after treatment. Four DLBCL arose in patients with incomplete clinical information; therefore, stage is unknown. We conclude that low-stage (presumably primary) uterine NHL are most commonly DLBCL, predominantly arise in the cervix, and cause abnormal uterine bleeding. High-stage NHL are a heterogeneous group of B-cell neoplasms that can involve the cervix or the corpus.     

Pure lipoma of the uterus: a rare case report

Pure fatty tumors of the uterus are exceedingly rare. The more common lipomatous tumor is lipoleiomyoma with varying amounts of two components. Most are post-operative chance findings following hysterectomy for leiomyoma. Computed Tomography and Magnetic Resonance Imaging can assist in pre-operative diagnosis. A 60 year old post-menopausal woman presented with a mass per abdomen. Ultrasound revealed fibroid uterus with lipomatous areas. The hysterectomy specimen showed a pure intramural lipoma of the uterus. As clinical symptoms and signs of uterine lipoma are indistinguishable from uterine leiomyoma, various imaging techniques can aid in pre-operative diagnosis. The diagnosis of pure lipoma of the uterus should only be made when any smooth muscle if present is confined to the periphery of the tumor.     

B超观察剖腹产术后子宫复旧的临床价值

目的探讨B超观察剖宫产术后子宫及其切口愈合的临床应用价值。方法289例剖宫产术后9 d行腹部B超检查,观察子宫大小、形态及内部结构。结果术后9 d宫腔线清晰者210例（72.66%）,宫腔内液性暗区及强回声光点及光斑者79例（27.33%）。根据子宫切口处声像图特点将术后子宫切口愈合情况分为A类：切口轻度隆起267例（92.33%）;B类：切口明显隆起18例（6.27%）;C类：切口形成局限性包块突于膀胱与子宫肌壁之间3例（1.03%）;D类：切口肌壁间血肿形成1例（0.4%）。结论B超在剖宫产术后观察子宫复旧及切口愈合情况能有效地指导临床医师有的放矢进行治疗,对防治剖宫产术后出血等并发症有指导意义。     

MRI常规序列及3D-SPACE序列在先天性子宫发育异常中的临床应用价值

目的探讨MRI常规序列及3D-SPACE序列在先天性子宫发育异常分型诊断中的临床应用价值。方法回顾性分析30例先天性子宫发育异常患者的MRI和临床资料,参照美国生殖学会的标准进行先天性子宫发育异常的分型诊断。结果30例先天性子宫发育异常的患者中纵隔子宫19例（完全性纵隔子宫11例,不完全性纵隔子宫8例）,双子宫3例,单角子宫2例,残角子宫1例,双角子宫2例,弓形子宫3例,并经临床或手术证实,准确率达100％。结论MRI常规序列及3D-SPACE序列可对先天性子宫发育异常的类型作出准确的诊断,是先天性子宫发育异常的最佳无创性影像检查方法。     

Sarcoidosis of the uterus

The present case of sarcoidosis of the uterus and the previously reported cases are reviewed. Uterine sarcoidosis is usually detected during the investigation of abnormal uterine bleeding in patients with prior evidence of sarcoidosis in another site. However, in several of the reviewed cases, either the uterus was the site of the initial diagnosis of sarcoidosis or its involvement was detected soon afterward. When hysterectomies were performed on patients with endometrial involvement, the myometrium was usually found to contain nonnecrotizing epithelioid granulomas. By contrast, uterine tuberculosis usually spares the myometrium. The differential diagnosis between uterine sarcoidosis and uterine tuberculosis is discussed.     

Endometrial stromal sarcoma with endometrioid adenocarcinoma of the uterus: a case report

Endometrial stromal sarcoma (ESS) is a rare malignant neoplasm of the uterus. We report the first case of undifferentiated ESS (UES) coexistent with grade 1 endometrioid adenocarcinoma in a 73-year-old female who presented with irregular vaginal bleeding for 4 days after menopause 20 years. Imaging examination including Magnetic Resonance Imaging (MRI) demonstrated multi-node reflection in uterine cavity without metastatic lesions, and the endometrium essentially normal. Grossly, a grey-red breakable polypoid tumor of 4.5 × 3.0 ×2.0 cm was recognized in the posterior uterine wall with surrounding slight rough endometrium. Microscopically, the tumor was composed of a larger component of undifferentiated stromal sarcoma that was distinct from a smaller endometrioid adenocarcinoma. The separate components of the tumor could be supported in immunohistochemical studies. There was no sign of recurrence for postoperative 6 months.     

影响剖宫产术后瘢痕子宫足月分娩结局的相关因素分析

目的 探讨剖宫产术后瘢痕子宫足月分娩方式的选择及影响分娩结局的因素。方法 选取我院在2015年4月~2017年3月收治的100例剖宫产后瘢痕子宫足月妊娠患者为观察组,包括阴道分娩者49例（A组）,再次剖宫产者51例（B组）。另挑选同期非瘢痕子宫足月分娩的产妇（110例）为对照组。对比A组与B组临床效果及影响瘢痕子宫妊娠结局的因素。结果 A组出血量明显少于B组,且A组新生儿Apgar评分比B组高,数据对比差异具有统计学意义（P＜0.05）。观察组与对照组先兆子宫破裂、社会因素方面差异具有统计学意义（P＜0.05）。结论 剖宫产后影响瘢痕子宫妊娠结局的因素的因素比较多,如先兆子宫破裂,必须对这些危险因素给予恰当的控制,方可达到改善分娩结局的目的。     

Papillary serous carcinoma of the broad ligament: a rare case report

Primary broad ligament carcinomas unassociated with either uterine or ovarian disease are extremely rare. This case report deals with such a rare occurrence of primary broad ligament carcinoma of the serous papillary type with foci of transitional differentiation in a 40 yr old woman with a clinical diagnosis of multiple fibroids of uterus. The highlight of this case is that besides being a rare tumor occurring in an unusual site such as the broad ligament the papillary serous carcinoma reported here also has a unique feature of transitional cell differentiation.     

Fine-needle aspiration cytology of primary granulosa cell tumor of the adrenal gland: a case report

Extraovarian granulosa cell tumors are extremely rare. We report on a primary granulosa cell tumor of the adrenal gland. A 69-yr-old African-American female presented with a 1-yr history of irregular uterine bleeding and a palpable right abdominal mass. CT scan showed a 9.0-cm suprarenal mass as well as an enlarged uterus. CT-guided fine-needle aspiration (FNA) cytology of the adrenal mass was interpreted as a malignant neoplasm. She underwent exploratory laparotomy, right nephrectomy, and hysterectomy with bilateral salpingo-oophorectomy. The gross, histologic, and immunohistochemical findings of the adrenal mass were characteristic of a granulosa cell tumor. The uterus contained multiple leiomyomas. The endometrium showed simple hyperplasia. Both fallopian tubes and ovaries showed no pathologic abnormality. There was no evidence of tumor elsewhere. Although rare, extraovarian granulosa cell tumor should be considered in the differential diagnosis of adrenal tumors in women showing the FNA features described herein, especially when there is evidence of excessive estrogen production. Diagn. Cytopathol. 2000;22:107-109.     

Torsion of the pregnant uterus

A 31-year-old woman, with a history of previous cesarean section and right oophorectomy, was admitted for a repeat cesarean section. After the commencement of surgery uterine torsion was diagnosed because of the anterior position of the remaining left ovary and tube, the absence of normal uterovesical peritoneum, and extremely engorged vessels in the lower uterine surface. Posterior classical hysterotomy was performed and a healthy female baby was delivered. Following delivery of the baby and suturing the incision site of the uterus, the contracted uterus was detorted and put back in the pelvic cavity. Extreme uterine torsion of 180 degrees at term is a rare obstetric event. This paper presents a case of uterine torsion at full term pregnancy in which the delivery and repositioning of the uterus was successful.     

超声和宫腔镜检查在219例绝经后子宫出血中的诊断价值

目的探讨宫腔镜及B超检查在绝经后子宫出血病因中的诊断价值。方法对我院2001年8月至2011年8月219例绝经后子宫出血妇女的临床资料及宫腔镜检查的病理结果进行回顾性分析。结果以病理诊断为基础,宫腔镜诊断子宫内膜增生症、子宫内膜炎、子宫粘膜下肌瘤、子宫内膜息肉、子宫内膜癌与病理诊断的符合率分别为60.8%（48/79）、91.9%（34/37）、90.9%（20/22）、93.1%（27/29）、80.0%（20/25）,超声检查的符合率分别为48.1%（38/79）、35.1%（13/37）、59.1%（13/22）、65.5%（19/29）、44.0%（11/25）。宫腔镜诊断与病理诊断的符合率为78.1%（171/219）,明显高于超声诊断与病理诊断的符合率48.9%（107/219）（χ2=40.334,P=0.01）。结论绝经后子宫出血的患者最佳诊断方法是,先做超声检查了解子宫及盆腔情况,再宫腔镜检查后行分段诊刮术做组织病理学检查确诊。     

Fetal parts embolization during termination of pregnancy: report of a case

A 19-year-old woman underwent termination of pregnancy by dilatation and evacuation at 19 weeks of gestation. She subsequently developed persistent massive hemorrhage, with laboratory evidence of a consumption coagulopathy. Attempts to control bleeding were unsuccessful, and the patient underwent a hysterectomy. Pathologic evaluation of the uterus revealed embolization of fetal tissues and placental fragments in the uterine and parametrial veins. This is the first reported case of such a finding, and its importance in relation to the patient's clinical presentation is discussed.     

Pure Basaloid Squamous Cell Carcinoma of the Uterine Cervix: A Case Report

Basaloid squamous cell carcinoma of the uterine cervix is an extremely rare malignancy of the female genital tract with a poorer clinical outcome than squamous cell carcinoma of the uterine cervix. We report a case of pure basaloid squamous cell carcinoma of the uterine cervix. A 70-yr-old woman with vaginal bleeding was referred to our institute. A basaloid squamous cell carcinoma of the uterine cervix, of International Federation of Gynecology and Obstetrics (FIGO) stage Ib1, was diagnosed by a loop electrosurgical excision procedure cone biopsy. A radical hysterectomy was performed, along with bilateral salpingo-oophorectomy, pelvic lymph node dissection, and para-aortic lymph node sampling. Pathologic findings were consistent with a basaloid squamous cell carcinoma confined to the cervix without an extracervical tumor. No further treatment was administered and there was no clinical evidence of recurrence during the 12 months of follow-up. Follow-up for the patient is ongoing. Although basaloid squamous cell carcinoma of the uterine cervix is thought to behave aggressively, accumulation of data on these rare tumors is necessary to determine whether their behavior differs significantly from that of conventional cervical squamous cell carcinoma of similar clinical stage. These data would be useful for defining the best diagnosis and treatment for these rare tumors.     

Emotional aspects of menstrual dysfunction

Psychological factors are the most common cause of menstrual dysfunction. Emotionally-induced disturbance at the hypothalamic level can lead to irregular cycles, dysfunctional uterine bleeding, or amenorrhea. Mild disturbances are usually associated with an ample amount of endometrial lining, and a period of withdrawal bleeding can usually be produced with progesterone. Where there is a deficiency of estrogen and consequently insufficient endometrial lining for withdrawal bleeding, organic pituitary and/or hypothalamic disease must be excluded. The psyche can also influence the uterus and ovary directly.     

Coexisting epithelioid trophoblastic tumor and placental site trophoblastic tumor of the uterus following a term pregnancy: report of a case and review of literature

Gestational trophoblastic neoplasms are a group of fetal trophoblastic tumors including choriocarcinomas, epithelioid trophoblastic tumors (ETTs), and placental site trophoblastic tumors (PSTTs). Mixed gestational trophoblastic neoplasms are extremely rare. The existence of mixed gestational trophoblastic neoplasms that were composed of choriocarcinoma and/or PSTT and/or ETT was also reported. Herein, we present a case of uterine mixed gestational trophoblastic neoplasm which is ETT admixed with PSTT, and reviewed 9 cases of mixed gestational trophoblastic neoplasms reported in English literature available. The most common combination was a choriocarcinoma admixed with an ETT and/or PSTT. Mixed gestational trophoblastic neoplasms present in women of reproductive age and rare in postmenopausal, Abnormal vaginal bleeding is the most common presenting symptom, serum β-HCG levels are elevated, mostly below 2500 mIU/ml, the tumor was limited to uterus in 7 cases, the rest of 3 with pulmonary metastases at the time of diagnosis. Mixed gestational trophoblastic neoplasms have more similar clinical features with intermediate trophoblastic tumors (ITTs). Total hysterectomy with lymph node dissection is recommended treatment for mixed gestational trophoblastic neoplasms, and chemotherapy should be used in patients with metastatic disease and with nonmetastatic disease who have adverse prognostic factors.     

Laparoscopic surgery of unicornuate uterus with rudimentary uterine horn

This report describes a new procedure for laparoscopic treatment of non-communicating rudimentary uterine horn when attached to the contralateral unicornuate uterus by a band of tissue. A retrograde dissection with primary bipolar coagulation and section of the band of tissue enables primary occlusion of the main blood supply. In our opinion, this new approach may prevent bleeding during laparoscopic dissection of the rudimentary horn and may avoid myometrial injury of the resting unicornuate uterus.