Clinical outcomes in women with endometrial polyps underwent conservative management.

OBJECTIVE: To evaluate the regression rate of endometrial polyps (EPs) in a cohort of asymmetric women after conservative follow-up. MATERIALS AND METHODS: In this retrospective cohort study, a total of 1006 women with asymptomatic EPs were treated with expectant management or hormonal drugs between June 1999 and May 2018. Four hundred forty-eight women (44.5%) were administered with hormonal medications and 558 women were managed expectantly (55.5%). Office hysteroscopy was performed to confirm the diagnosis and regression of EPs. Hormonal administration included oral contraceptives, progestin and cyclic estrogen/progestin regimen according to physicians' preferences. Clinical characteristics, including the patient's age, body mass index, parity, and type of conservative management were collected. RESULTS: The mean observation time was 14.1 ± 18.5 months (range, 1-162 months). The overall regression rate of EPs in this cohort was 33.5%, 24.6% occurred after medication and 8.9% after expectant management. Patient age (<50 years) (p < 0.001), follow-up period (p = 0.005) and hormonal drugs used (p < 0.001) were significantly associated with EP regression. Twenty-four (7.1%) of the 337 EP regression patients later developed recurrent disease. Follow-up period (p < 0.001) and hormonal drugs used (p = 0.032) were closely related to polyp recurrence after initial regression. Nevertheless, multivariate logistic regression analysis revealed that hormonal drugs used was significantly associated with the regression (p < 0.001) and recurrence (p = 0.016) of EPs. CONCLUSION: Women aged 50 or less are more suitable for conservative treatment for EPs. Hormonal drugs used could increase the incidence of EP regression.

An incidental diagnosis of endometrial cancer in a young and underweight female with isolated symptom of amenorrhea.

OBJECTIVE: We demonstrate a young woman with the incidental diagnosis of endometrial cancer, although all common risk factors of endometrial cancer were absent and endometrial lining in ultrasound was smooth either. CASE REPORT: A 23-year-old female was referral from local clinic for frequent lower abdominal pain, enlarged right adnexal cystic tumor and suspected adnexal torsion. A special symptom of annual menses (menses around every year) was also complained. The onset of the amenorrhea was 6 years ago just after a laparoscopic salpingostomy for right pyosalpinx. Her body mass index (BMI) was 16.8 kg/m2. Laboratory examination documented the level of prolactin, thyroid function, gonadotropins, estradiol and free testosterone were all within normal range. Pelvic ultrasound revealed the smooth endometrial lining with 1.2 cm in thickness. Laparoscopic surgery was arranged for the adnexal torsion. Besides, a diagnostic hysteroscopic was simultaneously planned for a further endometrial survey and endometrial sampling. Apart from a large functional cyst noted in right adnexa, the hysteroscopy disclosed diffuse polypoid endometrial lesions with neovascularity. The pathology showed atypical hyperplasia with focal endometrioid carcinoma. Postoperative magnetic resonance image revealed no residual tumor and FIGO IA status. Fertility preservation treatment with Mirena insertion was performed. CONCLUSION: Generally, the clues to detect endometrial neoplasm in a young female include family or genetic predisposition, menstrual patterns of abnormal spotting, obesity, risk of polycystic ovary syndrome and/or bizarre images of endometrial lining. However, the above conditions are all absent in the presenting case except the symptom of amenorrhea, in which the chronic anovulatory status may overstimulate the endometrium from the unopposed estrogen and potentially lead to the malignant transformation. Endometrial tissue assessment would be crucial for any young woman suspected to have prolonged exposure (≥6-12 months) of unopposed estrogenic stimulation. Endometrial tissue sampling in premenopausal group with amenorrhea for more than 6-12 months could not be ignored even for the young patient without common risk factors of endometrial cancer.

A feasibility analysis of the ArcBlate MR-guided high-intensity focused ultrasound system for the ablation of uterine fibroids.

PURPOSE: Uterine fibroids are benign gynecologic tumors and commonly occur in women by the age of 50. Women with symptomatic uterine fibroids generally receive surgical intervention, while they do not favor the invasive therapies. To evaluate the feasibility and safety of a novel magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) modality, ArcBlate, in the treatment of uterine fibroids. METHODS: Nine patients with uterine fibroids and one patient with adenomyosis were treated with ArcBlate MRgHIFU. Tumor size and quality of life were evaluated postoperatively at 1 and 3 months by magnetic resonance imaging (MRI) and the 36-Item Short Form Survey (SF-36), respectively. RESULTS: All patients completed the ArcBlate MRgHIFU procedure and there were no treatment-related adverse effects either during the procedure or during the 3 months of follow-up. Despite limiting the ablation volume to under 50% of the treated fibroid volume as a safety precaution, tumor volumes were markedly reduced in four patients by 15.78-58.87% at 3-month post-treatment. Moreover, SF-36 scale scores had improved at 3 months from baseline by 2-8 points in six patients, indicating relief of symptoms and improved quality of life. CONCLUSION: This study evidence demonstrates the safety and feasibility of ArcBlate MRgHIFU and suggests its potential for treating uterine fibroids.