Hysteroscopy in pregnancy-related conditions: descriptive analysis in 273 patients.

STUDY OBJECTIVE: To describe the feasibility of office hysteroscopy in patients with pregnancy-related problems such as retained trophoblastic tissue, persistent molar tissue, pregnancy with in situ intrauterine device (IUD), isthmocele, embryoscopy, and osseous metaplasia. DESIGN: Retrospective cohort chart review of use of hysteroscopy in 273 patients with pregnancy-related conditions (Canadian Task Force classification II-2). SETTING: University tertiary-care hospital. PATIENTS: Office hysteroscopy with the indication of pregnancy-related conditions such as retained trophoblastic tissue, pregnancy with IUD, molar pregnancy, cesarean scar defects, and fetal death were studied. The study included 273 patients: 185 with retained trophoblastic tissue, 14 with persistent molar tissue, 7 with an in situ IUD, 22 with symptomatic isthmocele, 41 with embryoscopy, and 4 with osseous metaplasia. INTERVENTION: Diagnostic and operative office hysteroscopy. MEASUREMENTS AND MAIN RESULTS: Variables studied included resolution of abnormal uterine bleeding in patients with persistent trophoblastic tissue, normalization of ß-human chorionic gonadotropin levels in patients with persistent molar tissue, continuation of pregnancy after retrieval of lost IUDs, resolution of postmenstrual bleeding in patients with symptomatic isthmocele, rate of uncontaminated embryonic tissue after embryoscopic biopsy, and successful extraction of bony tissue in patients with osseous metaplasia. Office hysteroscopy enabled resolution of most cases of retained trophoblastic tissue (91.8%) and all 14 cases of persistent molar tissue. 7 IUDs were extracted from pregnant patients. Fifteen isthmoceles resolved with office hysteroscopy, and 7 were resected in the operating room. A normal karyotype was obtained in 37 embryoscopies (90.2%). Four osseous metaplasia cases resolved with either office hysteroscopy (75%) or resectoscopy in the operating room (25%). CONCLUSION: Office hysteroscopy is a safe and minimally invasive treatment for pregnancy-related conditions, with good clinical and functional results.

Hysteroscopic dynamic assessment of the endometrium in patients treated with long-term tamoxifen.

STUDY OBJECTIVE: To describe the evolutive endometrial hysteroscopic patterns in patients undergoing long-term tamoxifen treatment. DESIGN: Prospective analysis. Analysis of variance test with post hoc Bonferroni test and homogeneity test of percentages were used for hypothesis contrast between the groups. DESIGN CLASSIFICATION: Canadian task force II-2. SETTING: Four Spanish tertiary care hospitals. PATIENTS: A total of 278 patients with breast cancer diagnosed between 2002 and 2004, which completed 5-years adjuvant therapy with tamoxifen. INTERVENTIONS: Ultrasonography and hysteroscopic explorations were performed before starting the treatment and then at yearly intervals during the 5 years of adjuvant treatment. MEASUREMENTS AND MAIN RESULTS: Hysteroscopic endometrial changes were significant throughout the years of treatment. Tamoxifen-exposed endometria present five different patterns: atrophic, cystic, hypervascularized, endometrial polyp, and suspicious of malignancy. Endometrial carcinoma appeared in four patients (1.5%) that bled during the follow-up. CONCLUSION: Tamoxifen produces five different endometrial patterns that evolve dynamically throughout the 5 years of treatment.

True osseous metaplasia of the endometrium: the bone is not from a fetus.

OBJECTIVE: To identify the origin of calcified tissue in endometrial ossification. DESIGN: DNA analyses from the ossified tissue and from the woman were studied to compare both genotypes. SETTING: University and general hospitals. PATIENT(S): A 27-year-old infertile woman diagnosed of osseous metaplasia of the endometrium. INTERVENTION(S): Hysteroscopic resection of the endometrial osseous metaplasia for DNA analysis. MAIN OUTCOME MEASURE(S): DNA comparison between the patient and the osseous tissue extracted from the uterus. RESULT(S): All markers produced the same allele length for both blood and endometrial biopsy (including bones), thus confirming the same genetic origin. CONCLUSION(S): Endometrial ossification is derived from the patient, resulting in a true osseous metaplasia.