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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.

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.

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.

Rational: Ovarian sertoli-leydig cell tumor (OSLCT) is extremely rare. We reported a OSLCT case in whom postmenopausal vaginal bleeding was the first symptom. Patient concerns: The patient came to our hospital due to postmenopausal vaginal bleeding. Diagnoses: Serum tumor markers and color Doppler ultrasound for her pelvic cavity were negative. The patient was finally diagnosed with left OSLCT by pathology. It was difficult to make a definite diagnosis before operation, the diagnosis of OSLCT required postoperative pathology in the patients. Interventions: the patient underwent laparoscopic hysterectomy+bilateral adnexectomy+lysis of pelvic adhesions. Outcomes: Postoperative laboratory examinations were normal. The patient was discharged from our hospital on the seventh day after operation and came to our hospital for follow-up check in April 2020. Physical and laboratory examinations were normal. Lessons: OSLCT can show different endocrine abnormalities, which are related to the various types of tumor tissues. Missed diagnosis and misdiagnosis are likely to occur in the patients who only have elevated serum testosterone. For the menopausal women with elevated serum testosterone, ovarian tumor shoule be highly suspected after excluding adrenal gland-related diseases.

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.

SUMMARY Steroid cell tumors are tumors that account for less than 0.1% of all ovarian malignant tumors and cause increase in secretion of androgen or estrogen. Steroid cell tumors usually occur in the post-menopausal period. This article reports four steroid cell tumor cases who underwent surgery for overian mass during post-menopausal period, who were diagnosed with steroid cell tumor after histopathological examination and displayed different clinical manifestations. No signs of increased hormonal activity in two of these cases were observed. On the other hand, the other two cases applied with complaints of menopausal vaginal bleeding, which led to the consideration of increased estrogenic activity in these two cases. Case 1 The case, who was 77 years of age in her postmenopausal period, applied to our hospital with the complaint of urinary incontinence. The routine laboratory findings of the patient, who had no feature in her history, were within normal limits. No findings of virilization were observed during the physical examination of the patient. During the gynaecological examination, a mass of approximately 6 cm was detected in the right adnexal area. The transvaginal ultrasonography (TVUSG) revealed an endometrial thickness of 9 mm, and an approximately 72mm-sized solid-cystic mass, surrounded with free liquid in the right ovary area. The preoperative Case 2 In the TVUSG performed during the routine follow- up examinations at the menopause clinic of the 52 year-old case, who did not have active complaints, a 66 X 35 mm mass with the possibility of dermoid cyst was detected in the right ovary. There was no feature in the patient's physical examination, her history and family history. The gynaecological examination, during which an approximately 6 cm mass was palpated in the right adnexial area, revealed a CA 125 value of 9.07 IU/ml. With the preliminary diagnosis of pelvic mass, laparoscopic right salpingo-ooforectomy was performed. The intraoperative pathological examination reported "malignancy was not observed". The paraffin block indicated a right ovarian steroid cell tumor; the largest diameter of the capsule was 8 cm and the capsule had a ruptured appearance; there was 1 mitosis /10 HPF, focal light atypia and focal hemorrhage but there was no presence of necrosis. Based on these findings, it was decided that the potential for malignancy was low. Adjuvant treatment during the postoperative period was not considered. The patient did not come to the follow-up examinations after the operation. Figure 2: The postoperative paraffin block section of case 1. Case 3 The 64-year-old case who was in her postmenopausal period applied to our hospital with vaginal bleeding complaints. The routine laboratory findings of the patient, who had no feature in her history and family history, were within normal limits. In the physical examination of the case, virilization and increased hormonal activity findings were not observed. It was thought that postmenopausal vaginal bleeding could be associated with hyperestrogenic environment. A 10 cm-diameter mobile mass, the borders of which could not be clearly differentiated from the uterus and right ovary and filled up the Douglas space, was detected during the gynaecological examination. The TVUSG

OBJECTIVE: In our study, we compared the results of the hysterescopy and dilatation and currettage (D&C) of the postmenopausal patients with uterin bleeding and endometrial thickness. Institution: Medical Faculty of Ege University, Department of Obstetrics and Gynecology, IZMIR. MATERIAL-METHODS: In our propective study, hysterescopy was performed to136 postmenopausal patients who applied to our clinic with symptoms of the uterin bleeding and endometrial thickness. After hysterescopy, D&C was performed to all patients. If the intracavitary pathology could not be removed with D&C, hysterescopy was performed again and intracavitary pathology was removed with hysterescopy. The accurate results of the endometrial sampling were determined with hystopathologic evaluation and these results are compared with hysterecopy. RESULTS: The hysterescopy revealed normal cavity in 74 patients (54%) and intracavitary pathology (polyp, hyperplasia, malignancy, endometrittis) in 62 (%46) patients. 72 (%97) of 74 patients with normal cavity (atrophic endometrium, functional endometirum) on hysterescopy were confirmed by hystopathologic evaluation. The histopathologic results of the remaning 2 patients were endometrial hyperplasia and endometrittis. 43 (%69) of 62 patients with intracavitary pathology on hysterescopy were confirmed by hystopathologic evaluation. The sensitivity, specificity, positive and negative predictive values for detection of intracavitary pathology by hysterescopy were 95.9%, 82%, 75.8%, 97.2%, respectively. These values for detection of polyps and hyperplasia by hysterescopy were 100%, 94.4%, 81.8%, 100% and 93.3%, 89.2%, 51.8%, 99%, respectively. CONCLUSION: The determined rate of the intracavitary pathology using the hysterescopy was high, espaciallly for polyps. Sometimes, the diagnosis of the hyperplasia and malignancy could be overlooked with hysterescopy. Therefore, D&C must be performed not to overlooked the focal malignancy patients.