Two women presented with history of vaginal bleeding and abnormal transvaginal ultrasound findings. Saline infusion sonohysterography was done for preoperative evaluation and this imaging study revealed centrally located uterine mass with internal cystic portion. Our initial impression was submucosal myoma with cystic degeneration and hysteroscopic removal of the mass was performed. During the procedure, dark brownish cystic fluid was drained. The excised submucosal mass was pathologically diagnosed as adenomyosis and clinically as submucosal adenomyotic cyst. Submucosal adenomyotic cyst should be part of the differential diagnosis of submucosal uterine masses with cystic portion. We report two cases of submucosal adenomyotic cyst successfully treated with hysteroscopic resection and brief review on this topic.
Adenomyosis ; Diagnosis, Differential ; Female ; Humans ; Myoma ; Uterine Hemorrhage

PURPOSE: We attempted to evaluate the usefulness of Doppler sonography in the diagnosis of uterine vascular abnormality caused by previous D&E, and to report that transarterial embolization is an exceelent treatment modality. MATERIALS & METHODS: We analyzed gray-scale US, color/duplex Doppler US and angiographic findings inseven patients with radiologically proven uterine vascular abnormality. Two of the seven cases were pseudoaneurysms and five of the seven cases were AVMs. In one of the AVMs, two small pseudoaneurysms were combined. In all cases, transarterial embolizations using 3mm coil or/and gelfoam particles were performed. Follow-up US studies, including color Doppler US, were performed. RESULTS: On color/duplex Doppler sonography, two cases of pseudoaneurysm showed blood pools with turbulent arterial flow, and five cases of AVM showed asymmetrically increased vascularity, with variable high velocities composed of the pulsatie arterial flow, with ahigh diastoic component. On angiography, the former showed pseudoaneurysmal sacs, and the latter densely opacified vascular tangles. No more abnormal uterine bleeding was shown, following transarterial embolization in all cases. CONCLUSION: Color/duplex Doppler sonography was valuable in the diagnosis or treatment of abnormal uterine bleeding caused by uterine vascular abnormality such as acquired AVM or pseudoaneurysm.
Aneurysm, False ; Angiography ; Diagnosis* ; Gelatin Sponge, Absorbable ; Humans ; Uterine Artery ; Uterine Hemorrhage*

The incidence of uterine arteriovenous malformation (AVM) is rare. However, it is clinically significant in that it can cause life-threatening vaginal bleeding. We report a case of a large uterine AVM with positive serum beta-human chorionic gonadotropin. A presumptive diagnosis was made; a uterine AVM accompanied by, early pregnancy or retained product of conception. Because this uterine AVM was extensive, transcatheter arterial embolization of both uterine arteries and extra-uterine feeding arteries was performed. Three months after undergoing transcatheter arterial embolization, complete resolution of the uterine AVM was confirmed without major complication.
Arteries* ; Arteriovenous Malformations* ; Chorion* ; Chorionic Gonadotropin* ; Diagnosis ; Fertilization ; Incidence ; Pregnancy ; Uterine Artery* ; Uterine Hemorrhage

The invasive cervical cancer associated with pregnancy is rare case, but the most common cancer among the malignancy associated with pregnancy. The diagnosis and the symptoms are not different from the non-pregnancy case, but vaginal bleeding which is the main symptom of cervical cancer is often misconceived for usual complication of pregnancy, and could delay the diagnosis. Pregnancy provides ideal times for cervical cancer screening, since pelvic examination could be easily performed. So all pregnant patients should have a cytology at the initial antenatal visit. The treatment is not significantly different from the non-pregnancy, but when we determine the treatment plan, the start time of treatment is most important point and it was affected by the gestational age at diagnosis and strong desire of the patients. We report 3 cases of invasive cervical cancer associated with pregnancy since 1998, and we delayed the treatment until postpartum in 2 cases.
Diagnosis ; Gestational Age ; Gynecological Examination ; Humans ; Mass Screening ; Postpartum Period ; Pregnancy* ; Uterine Cervical Neoplasms* ; Uterine Hemorrhage

The diagnosis of abruptio placentae is frequently difficult despite advanced diagnostic tool because of symptomatic diversity, so additional diannostic parameter would be useful. Maternal serum CA 125, which is derived from decidua, shows an increase by the tenth weeks and then decreases, remaining low level until delivery.However, within 1 hour after term delivery, CA 125 level shows a second increase, probably because of decidual disruption. Serum CA 125 level was measured in 45 patients between 29 and 41 weeks gestation who were seen with vaginal bleeding and in 30 control patients of same gestational age.Mean(+/-SD) CA levels were higher(p < 0.05) among patients with abruptio placentae(61.2+/-52.9U/ml) than among those with bleeding due to placenta previa(17.4+/-8.5U/ml) or control patients(20.3+/-21.3U/ml).Mean(+/-SD) serum CA 125 level in 17 control patients within 6 hours postpartum(81.7+/-102.6U/ml) were higher than those among patients with palcenta previa or normal pregnancy(p < 0.05).Sensitivity and specificity of maternal serum level of CA 125 for diagnosis of abruptio placentae were 73% and 92% on cut off level of 30U/ml, respectively.
Abruptio Placentae* ; Decidua ; Diagnosis* ; Female ; Hemorrhage ; Humans ; Placenta ; Pregnancy ; Sensitivity and Specificity ; Uterine Hemorrhage

The diagnosis of abruptio placentae is frequently difficult despite advanced diagnostic tool because of symptomatic diversity, so additional diannostic parameter would be useful. Maternal serum CA 125, which is derived from decidua, shows an increase by the tenth weeks and then decreases, remaining low level until delivery.However, within 1 hour after term delivery, CA 125 level shows a second increase, probably because of decidual disruption. Serum CA 125 level was measured in 45 patients between 29 and 41 weeks gestation who were seen with vaginal bleeding and in 30 control patients of same gestational age.Mean(+/-SD) CA levels were higher(p < 0.05) among patients with abruptio placentae(61.2+/-52.9U/ml) than among those with bleeding due to placenta previa(17.4+/-8.5U/ml) or control patients(20.3+/-21.3U/ml).Mean(+/-SD) serum CA 125 level in 17 control patients within 6 hours postpartum(81.7+/-102.6U/ml) were higher than those among patients with palcenta previa or normal pregnancy(p < 0.05).Sensitivity and specificity of maternal serum level of CA 125 for diagnosis of abruptio placentae were 73% and 92% on cut off level of 30U/ml, respectively.
Abruptio Placentae* ; Decidua ; Diagnosis* ; Female ; Hemorrhage ; Humans ; Placenta ; Pregnancy ; Sensitivity and Specificity ; Uterine Hemorrhage

Uterine arteriovenous vascular malformation (UAVM) is a disease that causes excessive bleeding. The symptoms do not subside without proper treatment and this can lead to life-threatening situations. The correct diagnosis of UAVM can be complicated if the patient's uterus did not completely discharge everything during abortion (in broader terms, retaining remnants of the products of conception). In this case, Doppler ultrasonography and computed tomography angiography with 3-dimensional rendering were used to analyze the cause of bleeding and provide proper treatment of this patient. Then, uterine artery embolization, dilatation, and curettage were performed safely and successfully. The patient no longer had symptoms of vaginal spotting during the planned follow up care. UAVM is uncommon; however, if reproductive-age women show repeated abnormal vaginal bleeding after dilatation and curettage, a diagnosis of UAVM must be considered based on the medical history and examination.
Angiography ; Arteriovenous Malformations ; Curettage ; Diagnosis ; Dilatation and Curettage ; Dilatation ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Metrorrhagia ; Ultrasonography ; Ultrasonography, Doppler ; Uterine Artery ; Uterine Artery Embolization ; Uterine Hemorrhage ; Uterus ; Vascular Malformations

Interstitial pregnancy is an ectopic pregnancy which is located in the intramural portion of the tube covered by myometrium. Rupture usually results in catastrophic hemorrhage, since there is an anastomosis of uterine artery and tuboovarian vessels. Therefore, the early diagnosis is important to decrease maternal morbidity. However, the diagnosis using the conventional 2-dimensional transvaginal sonography has some difficulties in differentiation from corneal pregnancy. In this case, we diagnosed an interstitial pregnancy using the 3-dimensional sonography in a woman with amenorrhea for 7 weeks and 1 days, which was resected through laparoscopic operation. The 3-dimensional sonography has a potential role to define the location of pregnancy implanted on the outer site of uterine fundus.
Amenorrhea ; Animals ; Diagnosis* ; Early Diagnosis ; Female ; Hemorrhage ; Humans ; Mice ; Myometrium ; Pregnancy* ; Pregnancy, Ectopic ; Rupture ; Uterine Artery

Interstitial pregnancy is an ectopic pregnancy which is located in the intramural portion of the tube covered by myometrium. Rupture usually results in catastrophic hemorrhage, since there is an anastomosis of uterine artery and tuboovarian vessels. Therefore, the early diagnosis is important to decrease maternal morbidity. However, the diagnosis using the conventional 2-dimensional transvaginal sonography has some difficulties in differentiation from corneal pregnancy. In this case, we diagnosed an interstitial pregnancy using the 3-dimensional sonography in a woman with amenorrhea for 7 weeks and 1 days, which was resected through laparoscopic operation. The 3-dimensional sonography has a potential role to define the location of pregnancy implanted on the outer site of uterine fundus.
Amenorrhea ; Animals ; Diagnosis* ; Early Diagnosis ; Female ; Hemorrhage ; Humans ; Mice ; Myometrium ; Pregnancy* ; Pregnancy, Ectopic ; Rupture ; Uterine Artery

To investigate the clinical characteristics of abnormal uterine bleeding (AUB) in nonpregnant hepatic cirrhosis patients and to assess the treatment and curative effects of AUB. A retrospective analysis was conducted on 72 nonpregant AUB patients treated in Ditan Hospital from October 2008 to October 2009. Data were assessed with SPSS 10.0 and the constituent ratio was examined by chi-square tests. 58 out of the 72 nonpregnant AUB patients were climacteric patients (80.56%). Approximately 42.5% and 68.8% (x2=7.189, P = 0.027) of the AUB patients were diagnosed with compensated and decompensated liver cirrhosis, respectively, which presents a statistical significance. Among the 18 cases of AUB with hypermenorrhea, 12 were with compensated cirrhosis and 6 with decompensated cirrhosis, which makes a statistical significance with a chi-square result of 7.189, P = 0.027. 41 out of the 52 cases with diagnostic curettage (75.00%) were observed with pathological changes in endomembrane. During the three months to one year follow-up,10 of 67 patients showed effective expectant treatment and 16 cases with hysterectomia complained no postoperative complications. A high frequency of AUB was observed in nonpregnant cirrhosis patients. The main bleeding pattern of the nonpregnant AUB patients with cirrhosis is hypermenorrhea.
Female ; Humans ; Liver Cirrhosis ; complications ; diagnosis ; therapy ; Middle Aged ; Retrospective Studies ; Uterine Hemorrhage ; complications ; diagnosis ; therapy