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Sato A, Usui H, Nakamura N, Katayama E, Shozu M, Koga K. Removal of an Intrauterine Polypoid Lesion Resolved Chemotherapy-resistant Gestational Trophoblastic Neoplasia: A Case Report. CANCER DIAGNOSIS & PROGNOSIS 2024; 4:193-197. [PMID: 38434909 PMCID: PMC10905286 DOI: 10.21873/cdp.10307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/12/2024] [Indexed: 03/05/2024]
Abstract
Background/Aim Single-agent chemotherapy typically has curative outcomes in patients with low-risk gestational trophoblastic neoplasia (GTN). Although surgical intervention is a potential alternative, its efficacy in these patients remains unclear. This report describes a case in which surgical excision of a uterine polypoid lesion resolved chemotherapy-resistant low-risk GTN. Case Report A 43-year-old patient received pulse actinomycin D treatment for post-molar low-risk GTN without extrauterine metastasis. However, the patient showed resistance to the chemotherapy regimen. There was no initial evidence of protrusion of GTN into the uterine cavity; however, a polypoid lesion grew into the uterine cavity during therapy. This growth was successfully excised via a transvaginal approach using forceps with minimal blood loss. There was a postoperative decrease in human chorionic gonadotropin levels, which ultimately reached the predetermined threshold without the need for changing the therapeutic protocol. Conclusion Surgical resection should be considered a viable therapeutic strategy for uterine polypoid growth in chemotherapy-resistant low-risk GTN.
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Affiliation(s)
- Asuka Sato
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba University, Chiba, Japan
| | - Hirokazu Usui
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba University, Chiba, Japan
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Natsuko Nakamura
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba University, Chiba, Japan
| | - Eri Katayama
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba University, Chiba, Japan
| | - Makio Shozu
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba University, Chiba, Japan
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Evolution and Reproductive Medicine, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Kaori Koga
- Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba University, Chiba, Japan
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
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Spielvogel R. A hypervascular placental polyp after complete abortion: a case report. BMC Womens Health 2023; 23:534. [PMID: 37817177 PMCID: PMC10566062 DOI: 10.1186/s12905-023-02672-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/22/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Placental polyps are rare complications of delivery or abortion. They are thought to complicate less than 0.25% of all pregnancies, although the actual incidence is unknown. While they typically occur within four weeks of delivery or abortion, they can have a variable presentation, which can lead to a delay in care. CASE PRESENTATION A 35-year-old G4P2012 patient presented at 9 weeks gestation for a medication abortion. Post-abortion ultrasound after one week confirmed the abortion was complete and her bleeding ceased. The patient then presented two months later with the new onset of worrisome bleeding. She was found on ultrasound to have a new hypervascular polypoidal mass in the endometrial cavity. She then underwent an in-office dilation and curettage with an electric vacuum aspirator, which was curative. A follow up ultrasound three months later demonstrated no recurrence. CONCLUSIONS Placental polyps are a rare complication following pregnancy and should be included in the differential when a patient presents with bleeding and a new mass in the endometrial cavity on ultrasound following a delivery or abortion, even when frankly retained products of conception had been ruled out at time of abortion.
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Affiliation(s)
- Ryan Spielvogel
- Department of Family Medicine, Sutter Medical Group, 1201 Alhambra Blvd. Ste 300, Sacramento, CA, 95816, USA.
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Chawla S, Sharma R. Retained Products of Conception (RPOC): Diagnosis, Complication & Management. J Obstet Gynaecol India 2023; 73:374-380. [PMID: 37916054 PMCID: PMC10616057 DOI: 10.1007/s13224-023-01873-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/03/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction Retained products of conception (RPOC) generally result after first half of pregnancy termination and also may occur after vaginal or cesarean delivery. It frequently presents with irregular or continuous vaginal bleeding, lower abdominal and pelvic pain, and discharge per vaginum due to infection; it can also cause late complications like formation of intrauterine adhesions and subfertility. The diagnosis of the RPOC along with the symptoms is generally supported by ultrasonography with or without colour Doppler. The patient also undergoes uterine vasculature assessment to diagnose arteriovenous malformation (AVM). The management of RPOC has been conventionally done with blind dilation and suction curettage (D and C); however, expectant management, uterine artery embolization, and hysteroscopic resection of RPOC are safe and efficient alternatives. Materials and methods In this review, we analyse the current available evidence regarding the clinical presentation, diagnosis and treatment of RPOC comparing the sensitivity, specificity, outcomes, pros and cons of various methods. Conclusion RPOC is a common complication associated with early and late complications. The judicious use of antibiotics along with interventional radiology and hysteroscopy forms the backbone for the treatment of this condition.
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Damiani GR, Dellino M, Cascardi E, Xuamin H, Di Gennaro D, Vimercati A, Vitagliano A, Malvasi A, loizzi V, Paniga C, Lanteri L, Alfonso R, Cicinelli E, Pellegrino A. Uterine venous malformations in the puerperium: 2 Atypical cases and literature review. Eur J Obstet Gynecol Reprod Biol X 2023; 19:100220. [PMID: 37636521 PMCID: PMC10450833 DOI: 10.1016/j.eurox.2023.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/29/2023] [Indexed: 08/29/2023] Open
Abstract
Uterine arteriovenous malformations (AVMs) is a rare but high-risk cause of uterine bleeding. The clinical management of this condition is challenging, as the ultrasound picture can sometimes be unambiguously interpreted. Moreover, in the puerperium in which acquired AVMs are most frequently formed, it is necessary to discuss the correct management in a multidisciplinary and personalized manner. We present two cases of AVMs developing in the puerperium, both with a vaginal delivery and spontaneous and complete secondment. The symptom of onset was an episode of bright red blood loss in the puerperium, on the 14th and 21st postpartum days, respectively. Transvaginal ultrasound showed a hypervascularized lesion in the myometrium with turbulent vascular flow, confirmed by transabdominal ultrasound and angiography. To date, there are no guidelines on the management of MAVs. In our cases we opted for a conservative approach, in order to preserve the fertility of the patient. These experiences reported have the purpose of enriching a literature still sparse on the subject and in the future to be able to represent a fulcrum for official recommendations.
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Affiliation(s)
- Gianluca Raffaello Damiani
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Miriam Dellino
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Eliano Cascardi
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy
- Pathology Unit, FPO-IRCCS Candiolo Cancer Institute, 10060 Candiolo, Italy
| | - He Xuamin
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
- San Raffaele Hospital, Milan,Italy
| | - Daniele Di Gennaro
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Antonella Vimercati
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Amerigo Vitagliano
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Antonio Malvasi
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Vera loizzi
- Department of Interdisciplinary Medicine (DIM), University of Bari "Aldo Moro", 70124 Bari, Italy
- Oncology Unit IRCSS Istituto Tumori "Giovanni Paolo II", 70124 Bari, Italy
| | - Cristiana Paniga
- University of Milan-Biccocca,Department of Medicine and Surgery, Milan, Italy
| | - Laura Lanteri
- University of Milan-Biccocca,Department of Medicine and Surgery, Milan, Italy
| | - Raffaello Alfonso
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Ettore Cicinelli
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Antonio Pellegrino
- Department of Obstetrics and Gynecology, ASTT LECCO, Alessandro Manzoni Hospital, Dell'Eremo Street 11, Lecco, Italy
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Goda M, Suzuki T, Adachi H. Placental polyp with arteriovenous malformation treated with a gonadotoropin-releasing hormone antagonist. BMJ Case Rep 2021; 14:14/9/e244664. [PMID: 34497058 PMCID: PMC8438750 DOI: 10.1136/bcr-2021-244664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 35-year-old woman (gravida 1, para 0) underwent termination of pregnancy (ToP) at 12 weeks of gestation. One month after ToP, she experienced significant vaginal bleeding and the mass with blood flow was identified on imaging. The presence of a placental polyp with arteriovenous malformation (AVM) was suspected on transvaginal sonography and MRI. Since the bleeding had ceased when she visited our hospital, we decided to treat the placental polyp with AVM with gonadotropin-releasing hormone (GnRH) antagonist therapy instead of surgery. Two months after GnRH antagonist treatment, the mass and blood flow in the uterus disappeared. Menstruation resumed 1 month after the completion of treatment. In our case, we were able to successfully treat placental polyps with AVM using GnRH antagonist therapy.
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Affiliation(s)
- Mayuko Goda
- Obstetrics and gynaecology, Seirei Hamamatsu Hospital, Hamamatsu, Shizuoka, Japan
| | - Takashi Suzuki
- Obstetrics and gynaecology, Seirei Hamamatsu Hospital, Hamamatsu, Shizuoka, Japan
| | - Hiroshi Adachi
- Obstetrics and gynaecology, Seirei Hamamatsu Hospital, Hamamatsu, Shizuoka, Japan
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Di Serio M, Capozzi VA, Berretta R, Marcato C, Dall'Asta A, Frusca T. Conservative treatment for hypervascularised placental polyp with secondary haemoperitoneum: a case report. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021157. [PMID: 33944840 PMCID: PMC8142775 DOI: 10.23750/abm.v92is1.9559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We describe the first case to our knowledge of Hypervascularised placental polyp (HPP) presenting with acute pelvic pain and hemoperitoneum. CASE REPORT A 33 years-old woman with a history of medical abortion three months earlier came to our attention complaining acute pelvic pain and vaginal bleeding. Transvaginal (TV) and transabdominal (TA) ultrasound (US) demonstrated a highly vascular intrauterine lesion and intra-abdominal free fluid consistent with a diagnosis of haemoperitoneum. Emergency laparoscopy yielded no intra-abdominal bleeding and was followed by bilateral selective embolization of the uterine arteries due to persistent vaginal bleeding. Hysteroscopy and pathology findings were consistent with a final diagnosis of HPP. CONCLUSION HPP may occur months or years after pregnancy or abortion and the clinical picture of abnormal vaginal bleeding associated with acute abdominal pain and haemoperitoneum should warrant to consider HPP among the differential diagnosis. Clinical and imaging findings need to be considered when planning the conservative management of HPP. Our experience suggests that uterine artery embolization is a safe and effective for the conservative treatment of highly vascularized HPP.
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Affiliation(s)
- Maurizio Di Serio
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma.
| | - Vito Andrea Capozzi
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma.
| | - Roberto Berretta
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma.
| | - Carla Marcato
- Department of Radiology, University Hospital of Parma.
| | - Andrea Dall'Asta
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology University of Parma.
| | - Tiziana Frusca
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology University of Parma.
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Wen C, Huang L, Jiang H. Diagnosis of Interventional Transvaginal Maternal Diseases Based on Color Doppler Ultrasound. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:5517785. [PMID: 33868617 PMCID: PMC8032514 DOI: 10.1155/2021/5517785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/15/2021] [Accepted: 03/22/2021] [Indexed: 11/18/2022]
Abstract
In recent years, with the development of color Doppler ultrasound technology in obstetrics, this noninvasive, direct, convenient, and sensitive inspection method has become one of the best methods to observe the fetal circulation in the uterus. This paper discusses the clinical value of using transvaginal color Doppler ultrasound in the differential diagnosis of ovarian corpus luteum disease and ectopic pregnancy disease. This paper selects 100 cases of ectopic pregnancy and 100 cases of pregnant corpus luteum as the experimental research objects. Clinical analysis of transvaginal color Doppler ultrasonography was performed on all patients. In the process of measuring the patient's ectopic pregnancy, the size of the patient's adnexal mass is mainly measured, and the blood flow spectrum is measured. The clinical choice of transvaginal color Doppler ultrasound method to distinguish ectopic pregnancy disease and corpus luteum pregnancy disease can play a significant value. It can be effectively diagnosed according to the type of disease, then effective methods can be studied for clinical treatment, the quality of life of patients with the two diseases can be significantly improved, and the clinical application value of color Doppler ultrasound can be improved.
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Affiliation(s)
- Canliang Wen
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong 510623, China
| | - Lan Huang
- Department of Ultrasound, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong 510623, China
| | - Hongye Jiang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
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Alhussami R, Noorwali F, Ibrahim G. A Rare Medical Dilemma: Presentation and Management of Placental Polyp. Cureus 2020; 12:e12259. [PMID: 33391961 PMCID: PMC7767836 DOI: 10.7759/cureus.12259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Placental polyp is one of the rare diseases that affect women after parturition or abortion. In this series of case reports, we aim to demonstrate the presentation, imaging findings, and management of these cases of placental polyps, which were presented to our institution. These cases vary in age and clinical findings. Our objective is to shed light on this disease, which could be initially disregarded. Also, we analyze the screening modalities that may aid in reaching the appropriate diagnosis, and possible treatment options.
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Affiliation(s)
- Raghad Alhussami
- Obstetrics and Gynecology, King Abdulaziz Medical City - Jeddah, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Fatma Noorwali
- Obstetrics and Gynaecology, King Abdulaziz Medical City - Jeddah, Jeddah, SAU
| | - Ghadah Ibrahim
- Obstetrics and Gynaecology, King Abdulaziz Medical City - Jeddah, Jeddah, SAU
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Nieto-Calvache AJ, Campos-García CI, Granados-Sánchez AM, Benavides-Calvache JP, Suso-Palau JP, Palacios-Jaraquemada JM, Escobar-Vidarte MF. Surgical Resection with Uterine Preservation in Uterine Arteriovenous Fistula: A Case Report and Literature Review. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2018.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Albaro Jose Nieto-Calvache
- Abnormally Invasive Placenta Clinic, Maternity and Children's Department, Fundación Valle de Lili, Cali, Colombia
- Highly Complex Obstetrics Unit, Maternity and Children's Department, Fundación Valle de Lili, Cali, Colombia
- Clinical Postgraduate Program, Health Science Faculty, Universidad Icesi, Cali, Colombia
| | - Clara Ivette Campos-García
- Abnormally Invasive Placenta Clinic, Maternity and Children's Department, Fundación Valle de Lili, Cali, Colombia
- Department of Pathology, Fundación Valle de Lili, Cali, Colombia
| | - Ana Maria Granados-Sánchez
- Abnormally Invasive Placenta Clinic, Maternity and Children's Department, Fundación Valle de Lili, Cali, Colombia
- Department of Radiology, Fundación Valle de Lili, Cali, Colombia
| | - Juan Pablo Benavides-Calvache
- Abnormally Invasive Placenta Clinic, Maternity and Children's Department, Fundación Valle de Lili, Cali, Colombia
- Highly Complex Obstetrics Unit, Maternity and Children's Department, Fundación Valle de Lili, Cali, Colombia
| | - Juan Pablo Suso-Palau
- Clinical Postgraduate Program, Health Science Faculty, Universidad Icesi, Cali, Colombia
| | | | - Maria Fernanda Escobar-Vidarte
- Abnormally Invasive Placenta Clinic, Maternity and Children's Department, Fundación Valle de Lili, Cali, Colombia
- Highly Complex Obstetrics Unit, Maternity and Children's Department, Fundación Valle de Lili, Cali, Colombia
- Clinical Postgraduate Program, Health Science Faculty, Universidad Icesi, Cali, Colombia
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