Ginekologia polska最新文献

Background: The pre- and intra-operative diagnoses of malignant uterine vascular perivascular epithelioid cell tumors (PEComas) can be challenging, for which the literature is limited. Some cases have been shown to have TSC gene mutations or rearrangements of the MiT factor family, resulting in variable responses to mTOR inhibitors. We report a case of a TFE-positive malignant PEComa of the uterus with pulmonary metastases that responded favorably to the mTOR inhibitor, everolimus.

Case presentation: A 52-year-old female underwent a total hysterectomy 5 years ago for suspected sub-serosal or broad ligament fibroids. The intraoperative pathologic diagnosis was leiomyosarcoma of the uterus and the postoperative diagnosis was malignant PEComa of the uterus. The patient declined genetic testing and further treatment. In December 2020 the patient presented with a pelvic mass and underwent open abdominal mass resection and pelvic adhesiolysis. The pathologic findings confirmed recurrent malignant PEComa of the uterus. The pulmonary lesions gradually progressed during the follow-up period, so treatment with everolimus was initiated. Close follow-up evaluation for nearly 3 years showed disease remission without recurrence or progression.

Conclusion: The patient described herein had a TFE-positive uterine malignant PEComa with lung metastasis and responded well to the mTOR inhibitor, everolimus. Close follow-up in the last 3 years showed remission without recurrence or progression.

Background: Adenomyosis is a uterine disorder commonly associated with painful menstrual cycles, abnormal uterine bleeding, and dyspareunia, which can significantly impact fertility, pregnancy outcomes and overall quality of life. Recent literature reports suggest that adenomyosis is increasingly being identified in adolescents, particularly in those presenting with severe dysmenorrhea and heavy menstrual bleeding. In this review we evaluate the frequency of adenomyosis diagnosis on imaging studies in relation to the occurrence of dysmenorrhea, pelvic pain and heavy menstrual bleeding (HMB).

Methods: A thorough literature search was performed using PubMed, EMBASE and SCOPUS databases. It was confined to articles published from 1 January 2019, to 1 August 2024 and included only those available in English. Due to the very limited number of publications on this topic, an age range of 12-25 years was selected as the inclusion criteria. For articles that met the inclusion criteria, information regarding diagnosis on imaging and relation to the occurrence of symptoms was extracted.

Results: Five full-text articles were reviewed. Studies including adolescents and young women from 12-25 years of age who presented with HMB, pelvic pain, dysmenorrhea and an imaging-based diagnosis of adenomyosis. The prevalence of adenomyosis in this population ranged from 25 to 45%. It is crucial to consider adenomyosis in the differential diagnosis of adolescent girls presenting with dysmenorrhea, heavy menstrual bleeding, and pelvic pain. Dysmenorrhea was the most frequently reported symptom (from 81 to 100%) associated with imaging features of adenomyosis.

Objectives: to explore the opinions of pregnant and postpartum women on the services provided via remotely conducted consultation and to assess the sense of security of patients under the care conducted remotely my midwives and gynecologists.

Material and methods: An anonymous, self-administered survey questionnaire was completed by 86 women who had at least one telephone consultation with a gynecologist or midwife during pregnancy or after birth. The questionnaire was spread via social media between February 1 and August 1, 2022.

Results: More than half of the surveyed group (51.2%) had 1-3 consultations performed remotely during pregnancy and 53.5% after birth. Phone call only was the most popular form of remote consultations performed during pregnancy (69.8%) and after birth (43.0%). Simple app was used in 10.5% consultations during pregnancy and 4.7% after birth. The predominant reason of the remotely conducted consultation during pregnancy and after birth was the need of getting the prescription or consultation of blood/urine test results (61.6%). Although phone-made medical consultations were a convenience and time-saver for most women, the preferred form of visit is to meet the caregiver in person.

Conclusions: Special times, such pandemic was, requires a different, individual approach, and perhaps thanks to these experiences we will be able to behave wiser in future states of public health emergency. Teleconsultations were an acceptable form of medical consultation to discuss the results, effects of treatment or to write a referral or prescription.

Objectives: We aimed to study the values of ultrasound elastography (UE) and progesterone receptor (PR) proteins for the diagnosis and prognostic evaluation of uterine fibroid (UF).

Material and methods: A total of 200 UF patients treated from January 2020 to June 2023 were selected as a UF group, and another 100 healthy women as a healthy group. Routine ultrasound parameters uterine artery pulsatility index (PI), resistance index (RI), and UE parameter strain ratio (SR) were obtained. The relative protein expressions of PRA and PRB in the peripheral blood were detected by Western blotting. The differences in these parameters and relative protein expressions of PRA and PRB were compared. The UF patients were divided into a cure group (n = 159) and a recurrence group (n = 41) according to their prognosis.

Results: The protein expressions of PRA and PRB in the UF group were higher than those in the healthy group (p < 0.05). In the recurrence group, PI and RI were lower, while SR and the protein expressions of PRA and PRB were higher than those in the cure group (p < 0.05). Age at menarche < 13 years old, intramural fibroid, PI, RI, SR, PRA, and PRB were risk factors for recurrence in UF patients (p < 0.05). The efficiency of combination of ultrasound and UE parameters, PRA and PRB for the diagnosis and prognostic evaluation of UF was significantly higher than that of any single indicator ( p < 0.05).

Conclusions: Ultrasound and UE parameters combined with PR proteins have high efficiency for the diagnosis and prognostic evaluation of UF.

Objectives: Though laparoscopic surgery is effective for the treatment of deep endometriosis (DE), postoperative management remains controversial. Dienogest therapy after surgery may improve spontaneous pregnancy rates and decrease the severity of dysmenorrhea in infertile patients with DE. To determine the efficacy of postsurgical therapy with dienogest for improving fertility and reducing the intensity of dysmenorrhea in infertile patients with DE.

Material and methods: This open label, randomized controlled trial was conducted involving 88 women aged 21-38 years with infertility who underwent surgery for DE. Three patients were lost to follow-up. After surgery, eligible patients were randomly divided into two groups. Forty-four patients who received dienogest for three months following surgery were enrolled in group 1. The remaining 41 patients comprised group 2 and did not receive any postsurgical treatment over the same period. The primary outcome measure was the pregnancy rate calculated nine months after surgery, while the mean intensity of dysmenorrhea was measured before and nine months after surgery.

Results: The pregnancy rate in group 1 was significantly higher than in group 2 (47.7% vs 22%, p = 0.013) nine months following surgical intervention. Patients in group 1 exhibited a more statistically significant reduction in the mean score of dysmenorrhea intensity compared to group 2, from 8.7 to 2.8 vs 8.76 to 5.63, respectively (p < 0.001).

Conclusions: The use of dienogest as an add-on therapy for treating DE may show significantly higher effectiveness compared to surgical intervention alone for improving fertility and reducing the severity of dysmenorrhea.