BACKGROUND Microwave endometrial ablation(MEA)is a minimally invasive treatment method for heavy menstrual bleeding.However,additional treatment is often required after recurrence of uterine myomas treated with MEA.Ad...BACKGROUND Microwave endometrial ablation(MEA)is a minimally invasive treatment method for heavy menstrual bleeding.However,additional treatment is often required after recurrence of uterine myomas treated with MEA.Additionally,because this treatment ablates the endometrium,it is not indicated for patients planning to become pregnant.To overcome these issues,we devised a method for ultrasound-guided microwave ablation of uterine myoma feeder vessels.We report three patients successfully treated for heavy menstrual bleeding,secondary to uterine myoma,using our novel method.CASE SUMMARY All patients had a favorable postoperative course,were discharged within 4 h,and experienced no complications.Further,no postoperative recurrence of heavy menstrual bleeding was noted.Our method also reduced the myoma’s maximum diameter.CONCLUSION This method does not ablate the endometrium,suggesting its potential appli-cation in patients planning to become pregnant.展开更多
Giant myomas, defined as those > 9 cm, are uncommon. Due to the difficulties caused by its enormous size, the usual surgical treatment is a simple total hysterectomy. The surgery may be performed by either laparosc...Giant myomas, defined as those > 9 cm, are uncommon. Due to the difficulties caused by its enormous size, the usual surgical treatment is a simple total hysterectomy. The surgery may be performed by either laparoscopy or laparotomy. However, the case presents a 45-year-old woman who was diagnosed with a giant myoma of 23 cm. The patient is asymptomatic and does not accept the indication of a simple total hysterectomy because of her fear to lose her femininity and a feeling of mutilation and unfulfilled genesic desire. A personalized procedure was performed: myomectomy by laparotomy with subsequent uterine reconstruction. The case is described to focus the interest on giant uterine myomas, taking into account the limited availability of literature on the topic, and to highlight the reconstruction after myomectomy.展开更多
BACKGROUND Levonorgestrel-releasing intrauterine systems(LNG-IUSs)gradually release levonorgestrel into the uterus and is effective against hypermenorrhoea and dysmenorrhea.Complications associated with the insertion ...BACKGROUND Levonorgestrel-releasing intrauterine systems(LNG-IUSs)gradually release levonorgestrel into the uterus and is effective against hypermenorrhoea and dysmenorrhea.Complications associated with the insertion include expulsion,displacement,and uterine perforation.Ultrasonic identification of copper intrauterine devices(IUDs)is possible due to echogenicity from the copper coils.However,the barium sulfate coatings of LNG-IUSs do not always provide hyperechoic images.Both barium sulfate and copper are radiopaque and clearly identifiable on X-ray.Thus,X-ray imaging is required to locate LNG-IUSs.CASE SUMMARY A 46-year-old woman with hypermenorrhoea due to submucosal myomas was treated with LNG-IUS at another hospital.Three LNG-IUS insertions had apparently been followed by spontaneous expulsion,although objective confirmation using imaging was not performed.The patient was referred to our institution for surgery.At the first visit,there appeared to be no device in the uterus,and none was observed on transvaginal ultrasound.However,two LNGIUSs were observed in the pelvis on abdominal plain X-rays prior to surgery.Hysteroscopic myomectomy was performed,and the two LNG-IUSs were found to have perforated the myometrium.The devices were safely removed during surgery,and the submucosal myomas were also removed.The perforated section of the myometrium was minimal+ADs-therefore,a repair operation was not required.CONCLUSION Plain abdominal X-rays facilitate the determination of whether an LNG-IUS is in the uterine cavity.Therefore,it is important to confirm a device’s location,regardless of whether spontaneous expulsion is suspected,prior to inserting another device.展开更多
BACKGROUND Hysteromyoma is not a rare tumor among pregnant women.During pregnancy,the symptoms caused by hysteromyoma can be improved through conservative treatment in most cases.However,in order to ensure the safety ...BACKGROUND Hysteromyoma is not a rare tumor among pregnant women.During pregnancy,the symptoms caused by hysteromyoma can be improved through conservative treatment in most cases.However,in order to ensure the safety of mothers and children,surgeries are necessary in some special cases.CASE SUMMARY We report a case of pregnancy complicated with hysteromyoma red degeneration.The patient had peritonitis after sudden abdominal pain during the 20th week of pregnancy.Laparoscopic exploration suggested rupture and bleeding of hysteromyoma,which were improved after drainage and an anti-inflammatory treatment.A cesarean section was performed after full term.This case shows the complications of rupture after red degeneration of hysteromyoma during pregnancy.CONCLUSION We should be alert to rupture of hysteromyoma during pregnancy,and active laparoscopic exploration is essential to improve the prognosis of such patients.展开更多
Uterine inversion is rare. It is classically described as a complication of the delivery period. Non-puerperal uterine inversion is exceptional and usually results from a tumor implanted on fundus of the uterus. We re...Uterine inversion is rare. It is classically described as a complication of the delivery period. Non-puerperal uterine inversion is exceptional and usually results from a tumor implanted on fundus of the uterus. We report two cases of non-puerperal uterine inversion caused by fundal submucosal myoma. Its diagnosis can be difficult and a high index of clinical suspicion is required to make a prompt diagnosis. The delayed diagnosis observed in our cases, caused uterine necrosis, which was managed by hysterectomy. The patients’ post-operative course was uneventful.展开更多
BACKGROUND Uterine myoma is the most common benign tumor among women and is often accompanied by anemia.Here,we report the case of a patient with a very large leiomyoma but with a hemoglobin level as high as 197 g/L.A...BACKGROUND Uterine myoma is the most common benign tumor among women and is often accompanied by anemia.Here,we report the case of a patient with a very large leiomyoma but with a hemoglobin level as high as 197 g/L.After undergoing hysterectomy,all her hematological parameters returned to normal.Immunohistochemical staining of her myoma for erythropoietin showed strong positivity,which suggested that erythropoietin may be the cause of her erythrocytosis.A multidisciplinary team played a significant role in treating the disease.CASE SUMMARY A 47-year-old woman visited our department complaining that her abdomen had been continuously growing for the past 2 years.After careful examinations,she was suspected of having a very large leiomyoma.She was also diagnosed with erythrocytosis because her RBC count was 6.49×10^(12)/L,hemoglobin was 197 g/L.Following a multidisciplinary team consultation,bilateral ureteral stents were placed,and 800 m L blood was removed by phlebotomy.The patient then underwent hysterectomy and bilateral salpingectomy.She recovered well from the operation,and her hemoglobin level decreased sharply following the surgery.Low-molecular-weight heparin was administered daily to prevent postoperative thrombosis.She was discharged from the hospital on the fourth postoperative day.Two months later,all her hematological parameters returned to normal.Pathological analysis of the myoma revealed that it was a benign leiomyoma,with partial hyalinization,and strong positivity for erythropoietin in immunohistochemical staining suggested that erythropoietin may be responsible for the erythrocytosis.CONCLUSION Erythropoietin ectopically produced from the myoma was responsible for the erythrocytosis in this patient.A multidisciplinary team is strongly recommended.展开更多
Uterine fibroids are common in females of reproductive age and substantially affecting fertility and quality of life. Current management strategies mainly involve surgical interventions. For treatment, options availab...Uterine fibroids are common in females of reproductive age and substantially affecting fertility and quality of life. Current management strategies mainly involve surgical interventions. For treatment, options available are surgical and non-surgical, but the mode of management leans on several factors, such as severity of symptoms, patient’s age, myoma characteristics, desire to preserve uterus and fertility. Alternative approach to surgery for the treatment of symptomatic females with uterine myomas has been recognized. Ulipristal acetate (UPA) has been the first selective progesterone-receptor modulator (SPRM) approved for the pre-operative and long-term management of uterine fibroids. There are evidences promoting an important role for progesterone pathways in the pathophysiology of uterine fibroids which supports the use of ulipristal acetate. The availability of alternative choices to surgical intervention is very necessary especially for those willing to preserve uterus and fertility. One of the alternatives is with ulipristal acetate, which has been proven to treat fibroid symptoms effectively.展开更多
文摘BACKGROUND Microwave endometrial ablation(MEA)is a minimally invasive treatment method for heavy menstrual bleeding.However,additional treatment is often required after recurrence of uterine myomas treated with MEA.Additionally,because this treatment ablates the endometrium,it is not indicated for patients planning to become pregnant.To overcome these issues,we devised a method for ultrasound-guided microwave ablation of uterine myoma feeder vessels.We report three patients successfully treated for heavy menstrual bleeding,secondary to uterine myoma,using our novel method.CASE SUMMARY All patients had a favorable postoperative course,were discharged within 4 h,and experienced no complications.Further,no postoperative recurrence of heavy menstrual bleeding was noted.Our method also reduced the myoma’s maximum diameter.CONCLUSION This method does not ablate the endometrium,suggesting its potential appli-cation in patients planning to become pregnant.
文摘Giant myomas, defined as those > 9 cm, are uncommon. Due to the difficulties caused by its enormous size, the usual surgical treatment is a simple total hysterectomy. The surgery may be performed by either laparoscopy or laparotomy. However, the case presents a 45-year-old woman who was diagnosed with a giant myoma of 23 cm. The patient is asymptomatic and does not accept the indication of a simple total hysterectomy because of her fear to lose her femininity and a feeling of mutilation and unfulfilled genesic desire. A personalized procedure was performed: myomectomy by laparotomy with subsequent uterine reconstruction. The case is described to focus the interest on giant uterine myomas, taking into account the limited availability of literature on the topic, and to highlight the reconstruction after myomectomy.
文摘BACKGROUND Levonorgestrel-releasing intrauterine systems(LNG-IUSs)gradually release levonorgestrel into the uterus and is effective against hypermenorrhoea and dysmenorrhea.Complications associated with the insertion include expulsion,displacement,and uterine perforation.Ultrasonic identification of copper intrauterine devices(IUDs)is possible due to echogenicity from the copper coils.However,the barium sulfate coatings of LNG-IUSs do not always provide hyperechoic images.Both barium sulfate and copper are radiopaque and clearly identifiable on X-ray.Thus,X-ray imaging is required to locate LNG-IUSs.CASE SUMMARY A 46-year-old woman with hypermenorrhoea due to submucosal myomas was treated with LNG-IUS at another hospital.Three LNG-IUS insertions had apparently been followed by spontaneous expulsion,although objective confirmation using imaging was not performed.The patient was referred to our institution for surgery.At the first visit,there appeared to be no device in the uterus,and none was observed on transvaginal ultrasound.However,two LNGIUSs were observed in the pelvis on abdominal plain X-rays prior to surgery.Hysteroscopic myomectomy was performed,and the two LNG-IUSs were found to have perforated the myometrium.The devices were safely removed during surgery,and the submucosal myomas were also removed.The perforated section of the myometrium was minimal+ADs-therefore,a repair operation was not required.CONCLUSION Plain abdominal X-rays facilitate the determination of whether an LNG-IUS is in the uterine cavity.Therefore,it is important to confirm a device’s location,regardless of whether spontaneous expulsion is suspected,prior to inserting another device.
文摘BACKGROUND Hysteromyoma is not a rare tumor among pregnant women.During pregnancy,the symptoms caused by hysteromyoma can be improved through conservative treatment in most cases.However,in order to ensure the safety of mothers and children,surgeries are necessary in some special cases.CASE SUMMARY We report a case of pregnancy complicated with hysteromyoma red degeneration.The patient had peritonitis after sudden abdominal pain during the 20th week of pregnancy.Laparoscopic exploration suggested rupture and bleeding of hysteromyoma,which were improved after drainage and an anti-inflammatory treatment.A cesarean section was performed after full term.This case shows the complications of rupture after red degeneration of hysteromyoma during pregnancy.CONCLUSION We should be alert to rupture of hysteromyoma during pregnancy,and active laparoscopic exploration is essential to improve the prognosis of such patients.
文摘Uterine inversion is rare. It is classically described as a complication of the delivery period. Non-puerperal uterine inversion is exceptional and usually results from a tumor implanted on fundus of the uterus. We report two cases of non-puerperal uterine inversion caused by fundal submucosal myoma. Its diagnosis can be difficult and a high index of clinical suspicion is required to make a prompt diagnosis. The delayed diagnosis observed in our cases, caused uterine necrosis, which was managed by hysterectomy. The patients’ post-operative course was uneventful.
文摘BACKGROUND Uterine myoma is the most common benign tumor among women and is often accompanied by anemia.Here,we report the case of a patient with a very large leiomyoma but with a hemoglobin level as high as 197 g/L.After undergoing hysterectomy,all her hematological parameters returned to normal.Immunohistochemical staining of her myoma for erythropoietin showed strong positivity,which suggested that erythropoietin may be the cause of her erythrocytosis.A multidisciplinary team played a significant role in treating the disease.CASE SUMMARY A 47-year-old woman visited our department complaining that her abdomen had been continuously growing for the past 2 years.After careful examinations,she was suspected of having a very large leiomyoma.She was also diagnosed with erythrocytosis because her RBC count was 6.49×10^(12)/L,hemoglobin was 197 g/L.Following a multidisciplinary team consultation,bilateral ureteral stents were placed,and 800 m L blood was removed by phlebotomy.The patient then underwent hysterectomy and bilateral salpingectomy.She recovered well from the operation,and her hemoglobin level decreased sharply following the surgery.Low-molecular-weight heparin was administered daily to prevent postoperative thrombosis.She was discharged from the hospital on the fourth postoperative day.Two months later,all her hematological parameters returned to normal.Pathological analysis of the myoma revealed that it was a benign leiomyoma,with partial hyalinization,and strong positivity for erythropoietin in immunohistochemical staining suggested that erythropoietin may be responsible for the erythrocytosis.CONCLUSION Erythropoietin ectopically produced from the myoma was responsible for the erythrocytosis in this patient.A multidisciplinary team is strongly recommended.
文摘Uterine fibroids are common in females of reproductive age and substantially affecting fertility and quality of life. Current management strategies mainly involve surgical interventions. For treatment, options available are surgical and non-surgical, but the mode of management leans on several factors, such as severity of symptoms, patient’s age, myoma characteristics, desire to preserve uterus and fertility. Alternative approach to surgery for the treatment of symptomatic females with uterine myomas has been recognized. Ulipristal acetate (UPA) has been the first selective progesterone-receptor modulator (SPRM) approved for the pre-operative and long-term management of uterine fibroids. There are evidences promoting an important role for progesterone pathways in the pathophysiology of uterine fibroids which supports the use of ulipristal acetate. The availability of alternative choices to surgical intervention is very necessary especially for those willing to preserve uterus and fertility. One of the alternatives is with ulipristal acetate, which has been proven to treat fibroid symptoms effectively.
