Twelve-year experience of office-setting removal of lost intrauterine devices in place for more than 10 years.

Objective: We investigated the effectiveness of removing lost intrauterine devices (IUDs) that had been in place for over 10 years, using Lin's biopsy grasper in an office setting. Methods:This single-centre, retrospective study conducted between March 2006 and June 2018 included 49 women who had had an IUD in place for contraception for more than 10 years and who underwent removal of the lost IUD using Lin's biopsy grasper under transabdominal sonography without use of a tenaculum, anaesthesia and analgesia, after dilation of the cervical os and hysteroscopy. Results: The women's median age was 52 years (range 34-80 years) and the median duration of insertion was 17 years (range 10-43 years). Forty-eight (98%) women had their lost IUD removed using Lin's biopsy grasper. Among the removed IUDs, there were eight FD-1 IUDs with a string, 13 FD-1 IUDs without a string, 13 Chinese IUDs, seven Ota ring IUDs, three KS ring IUDs, two Saf-T-Coil IUDs, two Lippe loop IUDs and one Wing IUD. All women tolerated the procedure and there were no major operative complications. Conclusions: Lin's biopsy grasper was effective in removing IUDs that had been in place for a long time.

Intravenous low-grade endometrial stromal sarcoma with intracardiac extension: A CASE OF inaccurate tumor location on contrast-enhanced computed tomography.

We herein report a case of low-grade endometrial stromal sarcoma with intracardiac extension in a 58-year-old woman with a uterine tumor with intravascular involvement. The tumor was suspected preoperatively to be an endometrial stromal sarcoma by magnetic resonance imaging. The extent of intravascular involvement was determined to be below the level of the renal veins on preoperative contrast-enhanced computed tomography (CT). However, perioperative echography revealed that the tumor extended to the right atrium. An emergency cardiotomy with extracorporeal circulation was required. The risk of tumor embolism was reduced through transection of the inferior vena cava, but the tumor was difficult to remove completely. Postoperative hormonal therapy reduced the size of the residual tumor and no recurrence was detected for 1 year. The preoperative contrast-enhanced CT was unable to detect the free-floating intravascular tumor. This case illustrates a limitation of CT and indicates that accurate determination of the tumor extent for planning a surgical strategy in similar cases should be performed using multiple imaging methods.