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Background: Granulosa cell tumors (GCT) of the ovary are extremely infrequent tumors accounting for about 3% of the entire ovarian malignancies with a very high rate of recurrence. Due to its ability to secrete estrogen unopposed, it can give rise to endometrial cancer thus leading to the coexistence of the two tumors on rare occasions. Case presentation: We present here, the case of a 58-year-old post-menopausal Nigerian woman with GCT coexisting with endometrial carcinoma. She presented with abdominal pain, weakness, and post-menopausal vaginal bleeding. Examination revealed an irregular 30-week size abdominopelvic mass while an abdominopelvic ultrasonography showed a right ovarian mass and multiple uterine fibroids. However, the diagnosis of GCT coexisting with endometrial carcinoma was histologically confirmed. She has been clinically stable for ten months post-surgical intervention and completion of adjuvant chemotherapy (Cisplatin [75mg/m2] and Docetaxel [75mg/m2]). Conclusion: Although rare, GCT can exist synchronously with endometrial carcinoma. This should form an important differential diagnosis in a post-menopausal woman with bleeding par vaginum as this is its most important clinical presentation. Total abdominal hysterectomy with bilateral adnexectomy should be done in older patients with GCT. Additionally, adjuvant chemotherapy may be of tremendous benefit to diagnosed patients.

Aims: This study aims to assess the clinicopathological features, treatment, recurrence pattern, survival, and prognostic factors in patients with endometrial carcinoma (EC). Materials and Methods: This was a retrospective study of 64 patients with EC who were diagnosed and treated at our institute from January 2010 to December 2013 and were followed till December end 2019. Survival analysis was done using Kaplan–Meier estimates and significance between curves by using the log-rank test. Results: The mean age of diagnosis was 60 years. The most common complaint was vaginal bleeding (75%). More than half of the patients (52.6%) had high body mass index (BMI). The majority of patients underwent surgery (90.7%) and had the early-stage disease (Stage I in 82.9%). During a median follow-up of 79 months (range: 4–100 months), 18.8% of patients experienced recurrence and vaginal vault (33.3%) was the most common site for recurrence. The 5-year disease-free survival was 83% and the 5-year overall survival was 84.7%. Elderly age, high BMI, advanced disease stage, more than 50% of myometrial invasion, nonendometrioid histology, Grade II and Grade III tumors, lymphovascular space invasion, and lymph node involvement adversely affected long-term survival. Conclusion: EC is mainly a disease of postmenopausal women, and most of them are diagnosed at an early stage and have good survival outcomes.

Mucosal melanomas are rare, accounting for only 1.4% of all melanomas. Only 18% of mucosal melanomas are vulvovaginal in origin, making it exceedingly rare. Mucosal melanomas typically carry a worse prognosis than those arising from cutaneous sites with a higher risk of recurrence and disseminated disease. We report a rare case of vaginal melanoma presenting as postmenopausal bleeding and discuss management of this disease.

Abstract Background Mantle cell lymphoma is one of several subtypes of non-Hodgkin lymphoma. Cervical relapse of non-Hodgkin lymphoma is a very rare condition that has a variable and nonspecific presentation and may resemble other neoplastic or inflammatory conditions. Case presentation Our patient was a 58-year-old Caucasian woman who experienced relapse of mantle cell lymphoma with cervical localization. She complained of postmenopausal vaginal bleeding, bladder pressure, and rapid growth of a cervical lesion. An irregular tumor mass of the cervix was visualized during gynecological examination, with findings highly suggestive of locally advanced cervical cancer. Surprisingly, the biopsies showed an extra nodal relapse of mantle cell lymphoma in the cervix. The rarity of this presentation and the scarcity of clinical studies make this type of recurrence very aggressive and difficult to treat. Conclusions Obtaining a definitive histological diagnosis by biopsy or surgical resection and starting appropriate therapy are essential for recovery and treatment of these patients, even if the prognosis is poor.

Abstract Background Post-menopause vaginal haemorrhage is typically related to gynaecological malignancies. Bleeding from vaginal varices rarely occurs, especially in nonpregnant women. Moreover, nonpregnancy-related causes of vaginal varicosities include portal hypertension, especially that caused by liver cirrhosis, pelvic congestion syndrome and Klippel-Trenaunay syndrome or Parkes-Weber syndrome. Here, we report an unusual cause of nonpregnancy-associated vaginal variceal bleeding. Case presentation A 55-year-old postmenopausal woman presented in our outpatient department with complaints of recurrent bloody vaginal discharge. A group of varicose veins and several haemorrhagic spots were found on her vaginal wall during a vaginal speculum examination. Genital cancers were excluded by colposcopy and transvaginal ultrasonography; furthermore, a pelvic arteriovenous fistula was not found on a pelvic computed tomography (CT) scan. However, congenital varicosities and deep arteriovenous shunts were observed in her left leg on arterial angiography. Moreover, vaginal bleeding was improved after resolution of the underlying deep arteriovenous shunts in her left leg. Therefore, congenital arteriovenous shunts and elevated inferior vena cava pressure might be responsible for her recurrent vaginal varicose bleeding. Conclusion Haemorrhage due to vaginal varices is easily detected with a vaginal speculum examination. However, diagnosis and treatment of the original disease are important after bleeding is controlled.

Postmenopausal bleeding (PMB) is a relevant aspect for health-care providers in clinical practice: the first objective is to rule out potential gynecological cancer. The purpose of this narrative review is to evaluate the role of office hysteroscopy in the management of PMB. Office hysteroscopy is a minimally invasive procedure allowing direct visualization of uterine pathology without the need for general anesthesia and the use of an operating room, generating cost savings and greater compliance among patients. Here, we focus on major intrauterine diseases (polyps, submucosal myomas, endometrial hyperplasia, and cancer) as causes of PMB. Office hysteroscopy appears to be safe and feasible, and could allow accurate diagnosis of intrauterine pathologies, especially that with a focal growth pattern, otherwise misdiagnosed with blinded procedures. However, studies focusing exclusively on postmenopausal women are still few, so further research, especially randomized controlled trials, is needed. [ABSTRACT FROM AUTHOR]

Purpose: This aim of this study is to determine the risk of endometrial cancer in symptomatic postmenopausal women, when endometrial thickness on transvaginal ultrasonography is equal to or greater than 10 mm, and subsequent office-based endometrial sampling histology is negative.Methods: This is a prospective cross-sectional study, performed in a gynaecological oncology centre in the United Kingdom between February 2008 and July 2012. All postmenopausal women presenting with vaginal bleeding were investigated using transvaginal ultrasonography. Women with endometrial thickness measurements equal to or greater than 10 mm and negative office-based endometrial biopsy underwent hysteroscopy and endometrial biopsies.Results: Over a 52-month period, 4148 women were investigated for postmenopausal vaginal bleeding. 588 (14.2%) women were found to have endometrial thickness measurements of equal to or greater than 10 mm on transvaginal ultrasonography. 170 (28.9%) cases of endometrial cancer were diagnosed in this group: 149 (87.6%) of the cancer cases were diagnosed in the outpatient setting with a Pipelle® endometrial sampler, whilst 21 (12.4%) had a negative Pipelle® sample and were diagnosed with hysteroscopy. The group diagnosed with hysteroscopy had lower BMI (32.7 kg/m2 versus 39.7 kg/m2, p < 0.001) whilst the group diagnosed with Pipelle was more likely to have a history of hypertension and diabetes mellitus (p = 0.019 for both). The sensitivity of Pipelle was 87.65%.Conclusion: For women presenting with postmenopausal bleeding and where the endometrial thickness is equal to or greater than 10 mm and Pipelle sampling is negative, hysteroscopic evaluation with directed biopsy is strongly recommended. [ABSTRACT FROM AUTHOR]

BACKGROUND: Human leech infestation is a disease of the poor who live in rural areas and use water contaminated with leeches. Like any other body orifices, vagina can also be infested by leech when females use contaminated water for bathing and/or douching. Although this condition is very rare in postmenopausal women, it causes morbidities and mortalities. CASE DETAILS: A 70 year old Para X (all alive) abortion I mother, postmenopausal for the last 20 years, presented with vaginal bleeding of 3 weeks duration to Gimbie Adventist Hospital, Western Ethiopia. On examination, she had deranged vital signs and there was a dark moving worm attached to the cervical os. She was admitted with the diagnosis of hypovolumic shock and severe anemia secondary to postmenopausal vaginal bleeding. After the patient was stabilized with intravenous crystalloids, the leech was removed from the vagina. She was then transfused with two units of whole blood and discharged with good condition on the 3rd post procedure day with ferrous sulphate. CONCLUSION: Vaginal leech infestation in postmenopausal woman can cause hypovolumic shock and severe anemia. Therefore, in order to decrease morbidities from failure or delay in making the diagnosis, health care providers should consider the possibility of vaginal leech infestation in postmenopausal woman from rural areas and those who use river water for drinking, bathing and/or douching and presented with vaginal bleeding. In addition, the importance of using clean water and improving access to safe water should be emphasized. [ABSTRACT FROM AUTHOR]

Objective: To evaluate feasibility of office hysteroscopy in postmenopausal women and correlation between transvaginal ultrasound (TV-US) and hysteroscopy., Methods: Postmenopausal women addressed at office hysteroscopy for postmenopausal bleeding or increase endometrial thickness were included. A 3.5-mm rigid hysteroscope was used without cervical dilatation or local anaesthesia. Speculum was never used. Data concerning women's symptoms and TV-US findings were collected., Results: Four-hundred-seventy postmenopausal women referred for office hysteroscopy were included in this descriptive study. Three-hundred-fifty women (74.5%) experienced abnormal uterine bleeding. The success rate of office hysteroscopy was 76.4% and was significantly higher in cases of postmenopausal bleeding (80.9%) than in women without postmenopausal bleeding (63.3%) (p=0.01). Three-hundred-sixteen women had both a successful hysteroscopy and TV-US. The correlation between hysteroscopy and TV-US was 68.5% for the diagnosis of increased endometrial thickness, polyps and submucosal myoma (Kappa=0.28). The rate of endometrial cancer for women with postmenopausal bleeding was 12.6% (n=44) while it was 1.7% (n=2) for asymptomatic women. Two (4.3%) out of these 46 women with endometrial cancer had normal hysteroscopy, while 7 (15.2%) had a normal TV-US (including endometrial thickness below 5mm). Among the 54 women without bleeding and with a thickened endometrium, one (1.8%) had endometrial cancer., Conclusion: Office hysteroscopy is successful without anaesthesia for 76.4% of postmenopausal women. The correlation between TV-US and hysteroscopy is low, and we recommend to practice both sonography and hysteroscopy in women with postmenopausal bleeding., (Copyright © 2018. Published by Elsevier Masson SAS.)