Mayer-Rokitansky-Kuster-Hauser syndrome, the second most common cause of primary amenorrhea, is a congenital anomaly caused by defective Mullerian duct development. It is the absence of uterus, cervix and upper two thirds of the vagina that results in primary amenorrhea. This is a case of a 42-year-old, nulligravid with primary amenorrhea complaining of acute abdominal pain. She has no co-morbidities or previous surgeries. Examination revealed an absent cervix and a left adnexal mass. Ultrasonography revealed an atrophic uterus with no endometrial stripe and cervix, with possible ovarian tumor versus myoma. Impression was mullerian agenesis with pelvoabdominal mass in torsion. She then underwent total abdominal hysterectomy with bilateral salpingectomy and adhesiolysis. Intraoperatively, there were two hemiuteri connected by a fibromuscular stalk. Left hemiuterus was dextrorotated, adherent to the sigmoid mesentery and peritoneum. Histopathology confirmed absence of endometrial cavity but with adenomyosis in bilateral uterine buds. Chromosomal analysis confirmed 46, XX karyotype.
Adenomyosis

Objective: To determine the prevalence of the causes of abnormal uterine bleeding based on the FIGO (PALM-COEIN) Classification, among patients admitted at a tertiary hospital in Las Pinas City Methods: A cross sectional (retrospective) study was done. Patients aged 15-50 years old who were admitted due to abnormal uterine bleeding from January 2017 to December 2019 were included. Patients with AUB due to pregnancy, vaginitis, bleeding before menarche, and bleeding after menopause were excluded from the study. Patient’s data as to age, obstetrical score, co-morbidity, bleeding patterns were tabulated. Results: A total of 455 subjects were included in the study. Results showed that the most common causes of abnormal uterine bleeding among admitted patients in Perpetual Help Medical Center Las Piñas from January 2017 – December 2019 were due to structural causes (91%). Most prevalent was bleeding due to polyps (50.5%), followed by adenomyosis (18.8%), leiomyoma (16.04%), and malignancy (6.2%). Prevalence of non-structural causes of bleeding was 0.4% for coagulopathy, 3.3% due to ovulatory dysfunction, 4.6% due to endometrial dysfunction, and 0.2% for AUB-N. Conclusion Based on this 3-year retrospective study, structural causes are the most common causes of AUB, comprising about 91% of all patients admitted for AUB. The most common structural causes are AUB-P (50.5%), followed by AUB-A, AUB-L and AUB-M. Prompt recognition of the causes of AUB is very important, to prevent complications such as severe anemia and shock. Proper treatment, be it surgical or medical, also depends on the exact cause of AUB.
Polyps ; Adenomyosis

A 49-year-old woman, Gravida 8 Para 8 (8007), came in due to vomiting and enlarging abdominal mass. Initial diagnosis was partial gut obstruction and acute kidney injury probably secondary to adenomyosis versus colonic pathology. Ultrasound showed adenomyosis but computed tomography scan showed a uterine mass with possible tumor rupture and mass effects. Emergency hysterectomy was done and showed an ill-defined endometrial mass with multiple areas of rupture. It was diagnosed with malignant but final histopathology revealed extensive adenomyosis with acute inflammation and necrosis with no malignancy identified. Unusual symptoms such as uterine rupture and mass effects can accompany adenomyosis, alongside typical signs like pain and bleeding. Ultrasound aided the diagnosis, although it missed uterine rupture, highlighting its limitations. Magnetic resonance imaging could have been useful. Ultimately, histopathology is the gold standard for diagnosing adenomyosis.
Adenomyosis ; Necrosis

No abstract available.
Adenomyosis* ; Humans ; Uterus*

No abstract available.
Adenomyosis* ; Humans ; Uterus*

We experienced 3 cases of early stage tubal cancer incidentally recognized during the operation and diagnosed pathologically after surgery of the tubo-ovarian abscess, the symptomatic adenomyosis, the myoma with adnexal cyst patients, so we report our cases with a review of the literature.
Abscess ; Adenomyosis ; Humans ; Myoma

OBJECTIVES: To understand the importance of the serum level of Ca-125 among pelvic mass, we performed a study. METHOD: From January to December 1998, we performed the study. Before hysterectomy, we performed a blood sampling to know the serum level of Ca-125, After hysterectomy, we weighed the uterus and measured the thickness of endometrium and other histologic characteristics. RESULTS: We performed my research to 80 peoples. The relation between uterine weight and the serum level of Ca-125 is little, if ever(R2=0.0007), and the relation between the thickness of endometrium and the serum level of Ca-125 is also little, if ever(R2=0.0353). The relation between leiomyoma, the cycle of endometrium and the serum level of Ca-125 were also little, but there was a close relationship between adenomyosis and the serum level of Ca-125. CONCLUSION: There was little relationship between uterine weight and the serum level of Ca-125.
Adenomyosis ; Endometrium ; Female ; Humans ; Hysterectomy* ; Leiomyoma ; Uterus

OBJECTIVE: To understand the pathogenesis of adenomyosis through the immunohistochemical staining with bcl-2 and matrix metalloproteinase-9 (MMP-9) antibody. METHODS: We selected 45 cases of adenomyosis among the uterine specimens that were extirpated surgically due to benign gynecologic problem. Immunohistochemical staining to the myometrial tissue was performed using anti-bcl-2 and anti-MMP-9 antibodies. Staining was qualitatively assessed in terms of extent and intensity. RESULTS: There were 32 cases of proliferative phase and 13 cases of secretory phase depending on the date of endometrium. Anti-bcl-2 stained 81.3% (26/32) compared with anti-MMP-9 stained 6.3% (2/32) in the glandular tissue of the proliferative phase (p<.001). In the secretory phase, anti-bcl-2 92.3% (12/13) and anti- MMP-9 7.7% (1/13) respectively (p<.001). In the stromal tissue of the proliferative phase, anti-bcl-2 stained 62.5% (20/32) compared with anti- MMP-9 stained 6.3% (2/32) (p<.001). In the secetory phase, anti-bcl-2 84.6% (11/13) and anti-MMP-9 15.4% (2/13) (p<.001). CONCLUSION: The adenomyosis may be developed from simple invagination and cellular proliferation of endometrial tissue, not caused by myometrial infiltration of endometrial tissue.
Adenomyosis* ; Antibodies ; Cell Proliferation ; Endometrium ; Female ; Matrix Metalloproteinase 9

OBJECTIVE: To compare the clinical results between laparoscopically assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH), and to realize the merits and demerits of both operations, so we know which pelviscopic hysterectomy operation is better method at the present time. METHODS: 30 of LAVH cases and 30 of TLH cases were performed from 12 December 2002 to 25 February 2004 at department of OB and GY, Dankook University Hospital. We analyzed the results with regard to patient's characteristics, indication of hysterectomy, size of uterus, operation time, blood loss, duration of hospitalization and complications. RESULTS: LAVH operations, and TLH operations were performed by same operator respectively. There were no significant differences in patient's characteristics (age, height, weight) between the two groups. The main preoperative indication was myoma uteri in both groups, followed by CINIII in LAVH groups and adenomyosis in TLH groups. The majority of uterine size on operation field was adult fist size in both groups. The mean operation time was 86.3 +/- 19.5 min for LAVH group and 153.3 +/- 44.4 min for TLH group, the operation time is significantly longer in TLH group (P-value<0.05). The blood loss was not significantly different between the two groups (265 +/- 92.9 mL for LAVH, 268 +/- 119.2 mL for TLH, P-value>0.05). The duration of hospitalization was not significantly different between the two groups (6.1 +/- 0.4 days for LAVH, 6.2 +/- 0.8 days for TLH, P-value>0.05). There is no complication in LAVH group, 3 complications in TLH group. CONCLUSION: LAVH has no significant differences in patient's characteristics, indication of operation, size of uterus, blood loss and duration of hospitalization, compared with TLH, but it has the merits of short operation time and less complication. In this study we consider that LAVH operation method stands at advantage over TLH.
Adenomyosis ; Adult ; Female ; Hospitalization ; Humans ; Hysterectomy* ; Hysterectomy, Vaginal* ; Myoma ; Uterus

PURPOSE: To determine the detection rate of MRI in the diagnosis of adenomyosis and ascertain the accuracy of MRI in assessing the extent and depth of the myometrial invasion. MATERIALS AND METHODS: By retrospective analysis of MR images of the pelvis in 65 pathologically proven cases of uterine adenomyosis, we investigated the detection rate and differences of in the detection rate when this was based on (a) the extent, and (b) the depth of myometrial invasion. The condition was classified as diffuse or focal according to the extent of invasion, and mild, moderate, or severe according to its depth. RESULTS: Pathologically, there were 35 cases of focal adenomyosis (53.8%), and 30 of diffuse adenomyosis (46.2%). Among patients with the focal variety of this condition, 12 cases were mild, 14 were mild, 14 were moderate, and nine were severe, while among those with the diffuse variety, two were mild, ten were moderate and 18 were severe. A total of 48 cases (73.8%) were detected on MR images; the detection rate of focal adenomyosis was 60.0% (21/35) and that of diffuse adenomyosis was 90.0% (27/30). The detection rates of mild, moderate, and severe adenomyosis were 42.9%(6/14), 79.2%(19/24), and 85.2% (23/27), respectively. Among the 48 cases detected on MR images, the pathologic and MR findings were consistent with regard to both the extent and depth of myometrial invasion in 26(54.2%). For diffuse adenomyosis, the consistency rate was higher than for the focal variety (81.5%, 22/27; compared with 19%, 4/21). The extent of myometrial invasion was correctly evaluated in 32 cases (66.7%); the consistency rate for the diffuse form was higher than for the focal form [96.3% (26/27), compared with 28.6% (6/21)]. In 42 cases (87.5%), the depth of invasion was correctly evaluated, though differences in this depth were not significant. CONCLUSION: MR imaging was a useful imaging modality in the diagnosis of uterine adenomyosis. With regard to the extant of mymetrial invasion, the detection rate was higher among cases of the diffuse form than of the focal form, and with regard to depth, the rate was higher among moderate and severe cases than among mild ones. These findings may be useful for preoperative diagnosis based on clinical symptoms, and provide important yardstick for decisions as to whether hysterectony should be replaced by an alternative therapy.
Adenomyosis* ; Diagnosis ; Humans ; Magnetic Resonance Imaging* ; Pelvis ; Retrospective Studies ; Uterus