RESUMO
Transvaginal ultrasound (TVUS) is the initial investigation of choice for postmenopausal bleeding (PMB), followed by diagnostic hysteroscopy and endometrial sampling if abnormalities are detected. Saline contrast sonohysterography (SCSH) - injection of saline through the cervix into the uterine cavity prior to TVUS - allowed increased diagnostic accuracy in women with PMB in several small, heterogeneous studies. The objectives of the current study were to evaluate the diagnostic accuracy of SCSH in women with PMB, comparing findings with surgical and pathological reports, highlight the necessity of SCSH in guiding clinical decision-making, and establish if there is an increase/decrease in the number of hysteroscopies performed for PMB and, hence, the adherence of clinicians to imaging referral guidelines. The search strategy included formulating search terms identifying all synonyms of SCSH and postmenopause. The databases searched were MEDLINE, Embase, and the Cochrane Library. Only studies comparing SCSH to an alternative method were selected. The studies were screened and data analysis performed using content analysis. Data reduction was performed through systematic coding and the generation of themes We identified 18 studies, comprising 974 women, using SCSH to evaluate the endometrial cavity in women with PMB; most support SCSH improving diagnostic accuracy through delineating intracavitary structures. In effect, SCSH could be a first-line investigative modality to assess the uterine cavity once a larger, well-designed study has been conducted to clarify its specificity, sensitivity, and positive predictive value (PPV). Owing to its relatively non-invasive nature and potentially high diagnostic accuracy, SCSH could allow for more accurate decisions regarding the need for further investigation and subsequent management. Tweetable abstract "Saline contrast sonohysterography improves the diagnostic accuracy of the endometrium in postmenopausal bleeding."
RESUMO
We present the case of a pregnant patient who was found to have a primary retroperitoneal mucinous tumour (PMRT). An abdominal mass measuring 11.5 × 9.8 × 8.8cm, initially thought to be of ovarian origin, was found incidentally on ultrasound in a 36-year-old patient at 20 weeks' gestation. Tumour markers were normal. She underwent an elective Caesarean section at 34 weeks, but the uterus, fallopian tubes and ovaries were normal. The mass was found to be retroperitoneal. A clinical decision was made to avoid further surgical exploration at the time. Following further surgical planning, the patient underwent open resection of the retroperitoneal mass, 6 weeks after her Caesarean section. Histology confirmed a moderately differentiated adenocarcinoma suggestive of a primary retroperitoneal mucinous adenocarcinoma. A literature review following this identified five case reports of PMRT in pregnancy in the last decade. In all cases, the patients underwent tumour resection without adverse pregnancy outcomes. While our patient had an uncomplicated pregnancy, she developed a 2cm lesion suggestive of disease recurrence 15 months post-operatively. A plan was made for surgical resection. PMRT are rare, but can occur in pregnant patients and patients of childbearing age. Tumour resection should be carried out, but where there is no concrete evidence of tumour invasion, the uterus and ovaries should be spared to avoid infertility and menopause. We would recommend early tumour resection, given its potentially aggressive nature.