Submucosal cystic adenomyosis: a report of five cases and review of the literature.

AIM: To investigate the clinical characteristics, diagnosis, and clinical treatment of submucosal cystic adenomyosis. METHODS: The clinical data of five cases of patients with submucosal cystic adenomyosis in our hospital from January 2020 to June 2023 were retrospectively analyzed. RESULTS: The average age of the patients was 37.8 ± 4.5 years old, three of them experienced prolonged menstruation and heavy menstrual bleeding. All patients had a history of abnormal uterine bleeding and mild to moderate dysmenorrhea, with a VAS score of 2.8 ± 1.6. The average Carbohydrate antigen 125 (CA125) value was 29.9 ± 23.6U/ml. Two out of the five patients (40%) had CA125 values above the upper limit of normal. The nodules had a diameter of 3.2 ± 1.3 cm and a cavity size of 1.3 ± 0.7 cm. Color ultrasound revealed hypo or iso or anechoic echoic cysts, and blood flow signals were detected. The magnetic resonance imaging (MRI) findings varied among each patient. All the patients underwent hysteroscopy and resection of uterine cavity-occupying lesions, and no recurrence was observed. CONCLUSIONS: The clinical features of submucosal cystic adenomyosis include abnormal uterine bleeding and menstrual changes, and the degree of dysmenorrhea is generally not severe. The diagnostic utility of CA125 in submucosal cystic adenomyosis may be limited. The three-dimensional ultrasound and MRI are valuable preoperative examination methods currently. Hysteroscopy can not only diagnose submucosal cystic adenomyosis, but also treat it, and preserve the fertility function of the patient.

Analysis of factors affecting pregnancy rate after laparoscopic surgery for infertility associated with endometriosis.

OBJECTIVE: To analyze the factors that might influence the pregnancy rate in patients with infertility related to endometriosis (EMs) after undergoing laparoscopic surgery, providing guidance for our clinical diagnostic and therapeutic decision-making. METHODS: A retrospective analysis was conducted on clinical records and 1-year postoperative pregnancy outcomes of 335 patients diagnosed with endometriosis-related infertility via laparoscopic surgery, admitted to our department from January 2018 to December 2020. RESULTS: The overall pregnancy rate for patients with endometriosis (EMs) related infertility 1-year post-surgery was 57.3 %, with the highest pregnancy rate observed between 3 to 6 months after surgery. Factors such as Body Mass Index (BMI) (P = 0.515), presence of dysmenorrhea (P = 0.515), previous pelvic surgery (P = 0.247), type of EMs pathology (P = 0.893), and preoperative result of serum carbohydrate antigen 125 (CA125)（P = 0.615）had no statistically significant effect on postoperative pregnancy rates. The duration of infertility (P = 0.029), coexistence of adenomyosis (P = 0.042), surgery duration (P = 0.015), intraoperative blood loss (P = 0.050), preoperative result of serum anti-Müllerian hormone (AMH) (P = 0.002) and age greater than 35 (P = 0.000) significantly impacted postoperative pregnancy rates. The post-surgery pregnancy rate in patients with mild (Stage I-II) EMs was notably higher than those with moderate to severe (Stage III-IV) EMs (P = 0.009). Age (P = 0.002), EMs stage (P = 0.018), intraoperative blood loss (P = 0.010) and adenomyosis (P = 0.022) were the factors that affected the postoperative live birth rate. CONCLUSION: For patients with EMs-related infertility undergoing laparoscopic surgery, factors such as age > 35 years, infertility duration > 3 years, concurrent adenomyosis, severe EMs, surgery duration ≥ 2 h, intraoperative blood loss ≥ 50 ml, and low AMH before surgery are detrimental for the pregnancy rate within the first postoperative year. However, BMI, dysmenorrhea, past history of pelvic surgery, EMs pathology types (ovarian, peritoneal, deep infiltrating),and preoperative result of serum CA125 barely show any statistical difference in their effect on postoperative pregnancy rates. In terms of postoperative live birth rate, age > 35 years, severe EMs, intraoperative blood loss ≥ 50 ml, and adenomyosis were adverse factors.

Prepubertal Vaginal Bleeding: An Inpatient Series from a Single Center in Fujian China.

STUDY OBJECTIVE: This study characterizes the etiology, clinical features and outcomes of prepubescent vaginal bleeding and summarizes our experience. DESIGN: The data of patients who were hospitalized with vaginal discharge or bleeding treated from January 2012 to December 2018 were retrospectively reviewed. SETTING: A provincial Grade III Level A Maternity and Children's Hospital. PARTICIPANTS: Prepubertal patients with vaginal discharge or bleeding. MAIN OUTCOME MEASURES: Patient age, bleeding duration, etiology, treatment and prognosis were recorded. Physical examinations and color Doppler ultrasonography were also performed. RESULTS: There were 158 patients aged from 1 month to 10 years (mean age 5.2 years). Bleeding duration ranged from 1 to 98 days, with an average of 13.3 days. Sixty patients were diagnosed with vaginal foreign bodies, 34 with vulvovaginitis, 34 with vulvar trauma, 13 with ovarian granulosa cell tumors, 8 with urethral mucosa prolapse, 5 with vaginal yolk sac tumors and 1 each with pituitary tumor, hypothyroidism, McCune-Albright syndrome, and short-term intake of a large number of strawberries. All the children were treated according to their different disease etiologies. CONCLUSION: Prepubertal vaginal bleeding is caused by a variety of different conditions. In our study, the most common causes were vaginal foreign bodies, vulvovaginitis, trauma, vaginal malignant tumors and urethral mucosa prolapse. Careful medical histories and targeted examinations are needed. Vaginoscopy could be considered. Considering the different causes, different treatments should be administered to achieve a good prognosis.

Utilization of preoperative ultrasound-guided fine needle aspiration cytology for the evaluation of axillary lymph nodes status in patients with early stage breast cancer / 中华内分泌外科杂志

Objective To study the utilization of preoperative ultrasound-guided fine needle aspiration cytology (FNAC) for the evaluation of axillary lymph nodes metastasis in patients with early stage breast cancer.Methods All 58 early stage breast cancer patients (cT1-2N0M0) whose ultrasound examination showed suspicious signs in axillary lymph node underwent ultrasound-guided fine needle aspiration.The cytopathological results were compared with the histopathological results.The sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accuracy of ultrasound-guided fine needle aspiration for the axillary lymph node metastasis were analyzed.Results The sensitivity of ultrasound-guided fine needle aspiration was 84.1％,specificity 100.0％,positive predictive value 100.0％,negative predictive value 66.7％ and the diagnostic accuracy of ultrasound guided fine needle aspiration was 87.9％.Conclusions Preoperative axillary ultrasound-guided fine needle is a useful step in the process of axillary staging.The results provids valuable preferences for the option of axillary procedure in breast cancer

Prognostic significance of lymphatic density and mircovessel vessel density in breast invasive ductal carcinoma / 中华内分泌外科杂志

Objective To investigate tumor lymphatic and mircovascular densities as prognostic markers in 69 cases of invasive breast cancer treated with partial or total mastectomy and lymph node dissection.Methods 69 cases of untreated primary unilateral invasive ductal breast carcinomas were selected.All cases were immunostained with D2-40 and CD31.Positively stained microvessels were counted in densely vascular/lymphatic foci (hot spots).The relationship between lymphatic vessel density (LVD),microvessel density(MVD) and prognosis was analyzed.Results The mean ± SD peritumoral lymphatic vessel density (P-LVD) was significantly higher than intratumoral LVD(I-LVD) (P ＜ 0.01).There was a positive correlation of D2-40 LVD(peritumoral) counts with lymph node metastasis (P =0.003) and clinical stage (P =0.026),and CD31 microvessel density was found significantly associated with clinical stage(P =0.038).No significant association was found between above variants with I-LVD (P ＞ 0.05).Univariate analysis showed that survival time was impaired by higher MVD and higher peritumoral LVD(P =0.007,P =0.008,P =0.014,P =0.024,log-rank test),but not I-LVD.Multivariate survival analysis showed that MVD,peritumoral LVD,TNM stage and lymph node metastasis were independent prognostic factors for overall survival.Conclusions Peritumoral LVD and MVD were significantly correlated with survival status of patients with breast cancer.This is the first attempt to predict prognosis of breast cancer patients by quantifying the peritumoral LVD and MVD.

Pathological changes of CT scan on thermochemotherapy during and after human glioma operation / 中国基层医药

Objective To explore the pathological changes by CT scan on localized thermochemotherapy dur- ing and after the operation of human gliomas.Methods Retrospective analysis was given to the CT scan of 37 pa- tients receiving thermochemotherapy during and after the operation,and the relation of the tumorous cells and mi- crovessels and CT density by EM were analyzed.Changes of tumorous cells and microvessels after localized ther- mochemotherapy on C_6 gliomas in rat were analyzed.Results When the tumor was low dense on CT pattern,less cellular number with increasing the amount of fluid between the cells was demonstrated pathologically.On EM,a lower cellular electron density was observed.The amount of fluid in cytoplasm was increased,the cytoplasm was porous,swelling denaturation was chiefly seen in organelle.If the tumor had mixed density on CT,cellular number was more,the amount of fluid was less.On EM,cellular electron density increased correspondingly,the fluid in cyto- plasm decreased,organdie was aggregated.After thermochemotherapy,the tumor reduced,liquefied,and vanished by CT scan.It could be observed that the tumorous cell become smaller,concentrated and cataclased,finally formed apoprotic bodies and separated from the cell in C_6 gliomas in EM.The tumorous vessels was less,smaller and thinker. Some vessels only could see the base membrane and no endothelioid cells.Conclusion The remaining tumors is van- ished by CT scan.The mechanisms of tumors disappearance proposes to explain that thermochemotherapy can dam- age C_6 glioma cells and microvessels,decrease microvessels density and induce tumor ceils apoptosis.That inhibits tu- morous angiogenesis and proliferation.