Humans ; Female ; Hysteroscopy/methods* ; Endometrial Neoplasms/therapy* ; Fertility Preservation/methods* ; Consensus ; China ; Endometrium/surgery* ; Hysterectomy

Retained products of conception (RPOC) represent a common pregnancy-related condition that may lead to complications such as abnormal uterine bleeding, infection, secondary arteriovenous fistula, intrauterine adhesions, and infertility. Currently, the main clinical treatments for RPOC include surgical intervention, medical therapy, and expectant management, sometimes supplemented by high-intensity focused ultrasound or uterine artery embolization when necessary. However, no standardized treatment guidelines exist. Medical and expectant management may help some patients avoid or reduce the need for surgery, though these approaches often involve a prolonged disease course. While surgery yields rapid results, patients with large lesions may require multiple procedures, increasing the risk of endometrial damage and intrauterine adhesions. There is still a lack of robust evidence-based guidance for selecting the optimal or individualized treatment approach. This review explores recent advances in the management of RPOC, with an emphasis on strategies that effectively preserve the endometrium, safeguard fertility, and support more precise, minimally invasive, and efficient personalized treatment.
Humans ; Female ; Pregnancy ; Placenta, Retained/surgery* ; Uterine Artery Embolization/methods* ; Tissue Adhesions ; Endometrium ; High-Intensity Focused Ultrasound Ablation

OBJECTIVES: Transcervical resection of adhesions (TCRA) under hysteroscopy is the mainstay treatment for intrauterine adhesions (IUA), but its effectiveness varies depending on the surgical approach. This study aims to investigate the impact of different surgical techniques on endometrial repair and pregnancy outcomes in patients with secondary infertility and moderate-to-severe IUA. METHODS: A retrospective analysis was conducted on 225 patients who underwent TCRA followed by in vitro fertilization and embryo transfer between January 2021 and December 2022. Patients were grouped based on the surgical method: A cold knife group (n=127) and an electrosurgical group (n=98). Adhesions were separated using either cold knife or electrosurgical instruments. Postoperative visualization of uterine angle and tubal ostia, endometrial restoration, vascular endothelial growth factor (VEGF) expression in adhesion tissues, and clinical pregnancy outcomes were compared. Univariate and multivariate Logistic regression analyses were performed to identify factors influencing pregnancy outcomes. A LightGBM model was constructed to predict pregnancy outcomes. RESULTS: Compared with the electrosurgical group, patients in the cold knife group had significantly greater postoperative endometrial thickness [(8.86±0.53) mm vs (8.10±0.87) mm, P<0.05], higher live birth rates (64.57% vs 30.61%, P<0.05), and lower VEGF expression (1.31±0.09 vs 1.53±0.16, P<0.05). Logistic regression analyses identified age, number of visible tubal ostia postoperatively, and surgical method as significant factors affecting pregnancy outcomes (P<0.05). The LightGBM model based on surgical method had an area under the curve (AUC) of 0.882 (0.838-0.926), with internal validation AUC of 0.817 (0.790-0.840). CONCLUSIONS Cold knife surgery promotes faster recovery of the endometrial microenvironment and earlier improvement of fertility in patients with secondary infertility and IUA Surgical method is a key factor influencing pregnancy outcomes, and the LightGBM model based on surgical approach shows good predictive performance for pregnancy outcomes in patients with moderate-to-severe IUA.
Humans ; Female ; Pregnancy ; Tissue Adhesions/surgery* ; Retrospective Studies ; Adult ; Pregnancy Outcome ; Uterine Diseases/surgery* ; Hysteroscopy/methods* ; Infertility, Female/etiology* ; Electrosurgery/methods* ; Fertilization in Vitro ; Endometrium/surgery* ; Embryo Transfer ; Vascular Endothelial Growth Factor A/metabolism*

Corded and hyalinized endometrioid carcinoma (CHEC) is a morphologic variant of endo-metrioid adenocarcinoma. The tumor exhibits a biphasic appearance with areas of traditional low-grade adenocarcinoma merging directly with areas of diffuse growth composed of epithelioid or spindled tumor cells forming cords, small clusters, or dispersed single cells. It is crucial to distinguish CHEC from its morphological mimics, such as malignant mixed mullerian tumor (MMMT), because CHECs are usually low stage, and are associated with a good post-hysterectomy prognosis in most cases while the latter portends a poor prognosis. The patient reported in this article was a 54-year-old woman who presented with postmenopausal vaginal bleeding for 2 months. The ultrasound image showed a thickened uneven echo endometrium of approximately 12.2 mm and a detectable blood flow signal. Magnetic resonance imaging revealed an abnormal endometrial signal, considered endometrial carcinoma (Stage Ⅰ B). On hysterectomy specimen, there was an exophytic mass in the uterine cavity with myometrium infiltrating. Microscopically, most component of the tumor was well to moderately differentiated endometrioid carcinoma. Some oval and spindle stromal cells proliferated on the superficial surface of the tumor with a bundle or sheet like growth pattern. In the endometrial curettage specimen, the proliferation of these stromal cells was more obvious, and some of the surrounding stroma was hyalinized and chondromyxoid, which made the stromal cells form a cord-like arrangement. Immunostains were done and both the endometrioid carcinoma and the proliferating stroma cells showed loss of expression of DNA mismatch repair protein MLH1/PMS2 and wild-type p53 protein. Molecular testing demonstrated that this patient had a microsatellite unstable (MSI) endometrial carcinoma. The patient was followed up for 6 months, and there was no recurrence. We diagnosed this case as CHEC, a variant of endometrioid carcinoma, although this case did not show specific β-catenin nuclear expression that was reported in previous researches. The striking low-grade biphasic appearance without TP53 mutation confirmed by immunohistochemistry and molecular testing supported the diagnosis of CHEC. This special morphology, which is usually distributed in the superficial part of the tumor, may result in differences between curettage and surgical specimens. Recent studies have documented an aggressive clinical course in a significant proportion of cases. More cases are needed to establish the clinical behaviors, pathologic features, and molecular profiles of CHECs. Recognition of the relevant characteristics is the prerequisite for pathologists to make correct diagnoses and acquire comprehensive interpretation.
Female ; Humans ; Middle Aged ; Carcinoma, Endometrioid/surgery* ; Endometrial Neoplasms/pathology* ; Endometrium/metabolism* ; Adenocarcinoma/pathology* ; Stromal Cells/pathology*

Cervical stenosis is a challenging condition that often recurs despite intervention. Multiple therapeutic options have been described, but a clearly effective and reliable treatment method has yet to be identified. Patients with recurrent stenosis are at risk of developing severe complications such as chronic pelvic pain and infertility. We describe a case of congenital cervical stenosis with secondary haematometra in which repeated cervical dilatation, hysteroscopic canalisation and administration of medications to retard endometrial development were unsuccessful in relieving the obstruction and preventing re-accumulation of menstrual blood. Total hysterectomy was eventually mandated by spontaneous rupture of the haematometra.
Adult ; Constriction, Pathologic ; complications ; diagnosis ; Endometrium ; pathology ; Female ; Hematometra ; complications ; diagnostic imaging ; surgery ; Humans ; Infertility ; Pelvic Pain ; Recurrence ; Risk ; Rupture, Spontaneous ; complications ; Tomography, X-Ray Computed ; Uterine Cervical Diseases ; complications ; diagnosis ; Uterine Diseases ; complications ; diagnosis ; Uterine Hemorrhage ; complications ; diagnosis ; Uterine Rupture ; diagnostic imaging ; etiology ; surgery

OBJECTIVETo investigate the usefulness of high-field MR diffusion-weighted imaging (DWI) in the diagnosis of endometrial carcinoma.

METHODSThirty-five female patients with pathologically proven endometrial carcinoma, 10 patients with pathologically proven endometrial dysplasia and 41 normal volunteers were enrolled into this study. MR images were obtained at a 3.0 T MR scanner (GE, SIGNA EXCITE HD 3.0T) and an 8-element phased-array torsopa coil was used to receive MR signal. The conventional pulse sequences included axial SE T1WI, FSE T2WI and fat saturated FSE T2WI, sagittal FSE T2WI, and coronal fat saturated FSE T2WI. Axial DWI was performed in all patients using a SE-EPI sequence with a 1000 s/mm(2) b value. The apparent diffusion coefficients (ADC) of carcinoma, dysplasia and normal mucosa were measured among the patients.

RESULTSCompared with myometrium, all the endometrial carcinoma, dysplasia and normal endometrium had a markedly high signal intensity on DWI. The ADC of endometrial carcinoma, dysplasia and normal endometrium was (1.08 +/- 0.23) x 10(-3)mm(2)/s, (1.29 +/- 0.21) x 10(-3) mm(2)/s and (1.41 +/- 0.21) x 10(-3) mm(2)/s, respectively. There were statistically significant differences between the carcinoma and normal endometrium (t = -6.416, P = 0.000), and between the carcinoma and dysplasia (t = -2.590, P = 0.013). However, no significant difference in ADC was found between highly-differentiated and moderately-differentiated adenocarcinomas.

CONCLUSIONHigh-field MR diffusion-weighted imaging (DWI) is highly sensitive in detecting endometrial lesions. It can be used to differentiate the endometrial carcinoma from either dysplasia or normal endometrium, but is difficult to differentiate highly-differentiated adenocarcinoma from moderately-differentiated one.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Endometrioid ; diagnosis ; surgery ; Cystadenocarcinoma, Serous ; diagnosis ; surgery ; Diagnosis, Differential ; Diffusion Magnetic Resonance Imaging ; methods ; Ectodermal Dysplasia ; diagnosis ; Endometrial Neoplasms ; diagnosis ; surgery ; Endometrium ; Female ; Humans ; Middle Aged ; Myometrium

OBJECTIVETo investigate the effect and mechanism of E-leng Capsule (ELC) in preventing and treating post-operation recurrence of ovarian endometriotic cysts (OEC).

METHODSA total of 60 patients enrolled were the inpatients, who underwent cystectomy of OEC in the Gynecological Department of Guangdong Provincial Hospital of Traditional Chinese Medicine from 2002 to 2004. They were randomly assigned to two groups, the treatment group and the control group. Patients in the treatment group were administered with ELC before operation and after operation (starting from the 7th day post-operation), each for 3 months, while patients in the control group were untreated before operation and administered with Danazol from the 7th day post-operation for 3 months. Specimens of eutopic and ectopic endometrium in all patients of both groups were taken during the operation for detecting expressions of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) mRNA by polymerase chain reaction (PCR), and the incidence of post-operation recurrence was observed 12 months later.

RESULTSThe 12-month follow-up showed that recurrence presented in 1 patient in the treatment group (3.3%), and 6 in the control group (20.0%), showing significant difference between them (P<0.05). The expressions of TIMP-1 mRNA in eutopic and ectopic endometrium were 0.85 +/- 0.36 and 0.76 +/- 0.57 in the treatment group, and 0.71 +/- 0.33 and 0.56 +/- 0.39 in the control group, while the expressions of MMP-9 mRNA were 0.36 +/- 0.40 and 0.35 +/- 0.35 vs 0.36 +/- 0.33 and 0.72 +/- 0.59, respectively. The expression of endometrial TIMP-1 mRNA, either eutopic or ectopic, was significantly higher, and the expression of ectopic endometrial MMP-9 mRNA was lower in the treatment group than that in the control group (P<0.01).

CONCLUSIONELC can reduce the invasive ability of endometrium tissue probably by regulating the balance of MMP/TIMP, namely, increase the expression of eutopic and ectopic endometrial TIMP-1 and decrease the expression of ectopic endometrial MMP-9, and thus to achieve its preventive and therapeutic effect on recurrence of OEC.

Adult ; Capsules ; pharmacology ; therapeutic use ; Endometriosis ; complications ; drug therapy ; prevention & control ; surgery ; Endometrium ; drug effects ; metabolism ; Female ; Gene Expression Regulation ; drug effects ; Humans ; Matrix Metalloproteinase 9 ; genetics ; Ovarian Cysts ; complications ; drug therapy ; prevention & control ; surgery ; Postoperative Complications ; drug therapy ; metabolism ; prevention & control ; Secondary Prevention ; Time Factors ; Tissue Inhibitor of Metalloproteinase-1 ; genetics ; Young Adult

BACKGROUNDMicrowave endometrial ablation (MEA) is a new form of minimal invasive surgical procedure for menorrhagia. It has been widely adopted clinically in many countries. In this study, we compare the outcome of MEA and total hysterectomy for menorrhagia.

METHODSSixty patients with menorrhagia were divided into MEA group or total hysterectomy (control) group (30 in each). The intra operative blood loss, operating time, either preserving the uterus or not, and length of recovery time in the two groups were compared. The independent samples t test was used to analyse our data in the study.

RESULTSIn comparing the MEA group and the control group, the effective rates were 96% (29/30) and 100% (30/30, chi(2) = 0, P = 1.0). The operating time was (4.0 +/- 1.1) minutes and (68.3 +/- 1.9) minutes (t = -160.42, P = 0.00). The mean blood loss was 0 ml and 50 ml, respectively.

CONCLUSIONSThe curative effect of MEA is similar to that of total hysterectomy. When considering preservation of the uterus and postoperative recovery, MEA is obviously superior to total hysterectomy.

Adult ; Blood Loss, Surgical ; Catheter Ablation ; methods ; Endometrium ; surgery ; Female ; Humans ; Hysterectomy ; Menorrhagia ; surgery ; Microwaves ; therapeutic use ; Middle Aged ; Pain, Postoperative ; drug therapy ; Time Factors

OBJECTIVETo investigate the clinicopathological features of intermediate trophoblastic non-tumor lesions, and to evaluate the position of immunohistochemistry in differential diagnoses.

METHODSClinical presentation and morphological study of 15 cases of exaggerated placental site (EPS) and 4 cases of placental site nodule or plaque (PSNP) were reviewed. Immunohistochemical stains for hCG, hPL, inhibin-alpha, PLAP, CK18 and Ki-67 were performed.

RESULTSThe age of patients ranged from 25 to 40 years with an average of 31.5 years for EPS and 26 to 39 years with an average of 34.3 years for PSNP. Microscopically, EPS was characterized by cords and small sheets of implantation site intermediate trophoblasts infiltrating the endometrium, myometrium and arterial walls. The general histological structures of the endometrium and myometrium were preserved. PSNP was characterized by multiple circumscribed nodular lesions consisting of so-called chorionic-type intermediate trophoblasts and hyaline-like matrix present in the endometrium. Immunohistochemical stainings for hPL and CK18 were positive in the 15 EPS cases. Immunoreactivity for CK18, Inhibin-alpha and PLAP was detected in 4 PSNP cases. The Ki-67 labeling index in 15 EPS cases was low (< or = 5%), while Ki-67 index in 4 PSNP cases was close to 0.

CONCLUSIONSThe clinical presentation and pathological features of EPS and PSNP differ from those of trophoblastic tumors (placental site trophoblastic tumor, epithelioid trophoblastic tumor and choriocarcinoma). Immunochemical staining is of great value in their differential diagnoses.

Adult ; Diagnosis, Differential ; Endometrium ; pathology ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; methods ; Inhibins ; metabolism ; Keratins ; metabolism ; Myometrium ; pathology ; Placenta ; metabolism ; pathology ; Placenta Diseases ; metabolism ; pathology ; surgery ; Placental Lactogen ; metabolism ; Pregnancy ; Trophoblastic Neoplasms ; pathology ; Trophoblastic Tumor, Placental Site ; pathology ; Trophoblasts ; pathology ; Uterine Neoplasms ; pathology

To determine how endometrium alone would contribute to maintaining the circulating levels of Insulin-like growth factor binding protein-1 in vivo, serum immunoreactive IGFBP-1 levels were measured in 19 patients undergoing endometrial ablation using gynecologic resectoscopy. After endometrial ablation there was a significant decrease in the mean levels of circulating IGFBP-1, which was not correlated with the menstrual cycle. This result indicates that the endometrium is one of the sources of the circulating IGFBP-1.
Adult ; Endometrium/surgery* ; Endoscopes ; Female ; Human ; Insulin-Like Growth-Factor Binding Protein 1/blood* ; Menstruation ; Middle Age