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Purpose of Review: With a rising number of cesarean sections, the prevalence of uterine isthmoceles is increasing. We performed a rapid review to assess the most recent data on the diagnosis and management of uterine isthmoceles over the past 18 months to identify current trends and directions for continued research., Recent Findings: A comprehensive search was conducted in PubMed (NLM), Embase (Ovid), CINAHL (EBSCOhost) to find English written articles discussing the diagnosis or management of uterine isthmoceles published in the previous 18 months. Data extraction was performed on one hundred articles that met inclusion criteria., Summary: This rapid review highlights agreement regarding diagnostic methods, symptoms, and recommended treatment paths for patients with symptomatic uterine niches. However, the diversity in definitions hampers the capacity to formulate detailed conclusions regarding the features of uterine niches and their impact on women's health., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: To study the factors affecting the prognosis of patients with intrauterine adhesions (IUAs) after transcervical resection of adhesions (TCRA), analyze the reproductive outcome, and guide prognostic improvements., Design: Prospective study., Patients: Our study included 292 patients diagnosed with IUAs who underwent follow-up office hysteroscopy at Shenyang Women's and Children's Hospital between June 2018 and June 2022., Interventions: Patients were divided into case (52 patients whose hysteroscopy results indicated the presence of IUAs) and nocase (240 patients whose uterine cavity had returned to normal shape without obvious adhesion) groups on the basis of the results of a 2-month follow-up hysteroscopy following TCRA. Clinical data were collected and compared with various influencing factors, and the combined effect of these factors was assessed using multifactorial logistic regression analysis. A nomogram prediction model was constructed and internally validated on the basis of multifactorial analysis., Main Outcome Measures: Intrauterine re-adhesion was observed at a 2-month follow-up after TCRA., Results: Postoperative re-adhesion occurred in 52 of 292 patients with IUAs. Multifactorial binary logistic regression analysis showed that IUA barrier gel reapplication 5 days after TCRA was a protective factor. In contrast, the preoperative American Fertility Society scores demonstrated that severe IUAs and chronic endometritis were risk factors. The results of the multifactorial analysis were used to build a nomogram model, and the area under the curve value of the nomogram model for predicting postoperative recurrence was 0.914 (95% confidence interval: 0.864-0.956). The bootstrap method was subsequently used to resample 1,000 times for internal validation. The results showed that the internal validation C-index was 0.9135, and the calibration and ideal curves were well-matched., Conclusion: The prognosis of patients with IUAs after TCRA is related to the severity of preoperative IUAs, presence of chronic endometritis, and IUA barrier gel reapplication 5 days after TCRA. Therefore, clinicians should monitor patients using targeted data to reduce recurrence risk after TCRA and improve the prognosis of patients with IUAs., Competing Interests: Declaration of Interests J.Z. has nothing to disclose. C.S. has nothing to disclose. J.S. has nothing to disclose. J.N. has nothing to disclose., (Copyright © 2024 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Intrauterine adhesions (IUA) are a challenging clinical problem in reproductive infertility. The most common causes are intrauterine surgery and abortions. We aimed to investigate whether early second-look office hysteroscopy can prevent IUA., Methods: A single-center, prospective, two-armed, randomized controlled trial was designed to explore the efficacy of early office hysteroscopy after first-trimester induced abortion (suction dilatation and curettage [D&C]) and to further analyze fertility outcomes. Women aged 20-45 years undergoing suction D&C and desiring to conceive were recruited. Between October 2019 and September 2022, 66 women were enrolled, of whom 33 were allocated to group A (early hysteroscopy intervention). The women in intervention group A were planned to receive 2 times of hysteroscopies (early and late). In group B, women only underwent late (6 months post suction D&C) hysteroscopy., Results: The primary outcome was the IUA rate assessed using office hysteroscopy 6 months after artificial abortion. Secondary outcomes included menstrual amount/durations and fertility outcomes. In intervention group A, 31 women underwent the first hysteroscopy examination, and 15 completed the second. In group B (late hysteroscopy intervention, 33 patients), 16 completed the hysteroscopic exam 6 months after an artificial abortion. Twenty-one women did not receive late hysteroscopy due to pregnancy. The IUA rate was 16.1% (5/31) at the first hysteroscopy in group A, and no IUA was detected during late hysteroscopy. Neither group showed statistically significant differences in the follow-up pregnancy and live birth rates., Conclusions: Early hysteroscopy following suction D&C can detect intrauterine lesions. IUA detected early by hysteroscopy can disappear on late examination and become insignificant for future pregnancies. Notably, the pregnancy outcomes showed a favorable trend in the early hysteroscopy group, but there were no statistically significant differences., Trial Registration: ClinicalTrials.gov , ID: NCT04166500. Registered on 2019-11-10. https://clinicaltrials.gov/ct2/show/NCT04166500 ., (© 2024. The Author(s).)

Hysteroscopy has truly revolutionized the field of diagnostic and operative gynecology. It is presently regarded as the gold standard method for both the diagnosis and treatment of intrauterine diseases and it has fundamentally altered the way gynecologists treat patients with such conditions. These pathologies can now be diagnosed and treated in an outpatient setting, thanks to technological advancements and instrument downsizing. Two hundred years of development and notable innovation are now reflected in the present hysteroscopic practice. This review attempts to trace the boundaries-pushing history of hysteroscopy by highlighting the advancements in technology and the therapeutic and diagnostic benefits offered by this groundbreaking approach., (© 2024. The Author(s).)

This case report describes the presentation, diagnosis, and surgical management of a rare vesical ectopic pregnancy in a 36-year-old woman with a history of multiple cesarean sections. The patient presented with symptoms of suprapubic pain, fever, and amenorrhea. An initial ultrasound indicated retained products of conception, leading to a preliminary diagnosis of septic miscarriage. However, subsequent rescanning revealed an empty uterus and a non-viable fetus within the bladder, connected to the uterine cavity. Cystoscopy confirmed the presence of fetal parts inside the bladder. Finally, a laparotomy was performed and the fetus was removed from the bladder with repair of the underlying uterovesical fistula. An uneventful postoperative period ensued. The literature review revealed only four previously reported cases with similar overall presentations. This case highlights the importance of considering vesical ectopic pregnancies in patients with a history of cesarean sections and unusual symptoms, as prompt surgical intervention is crucial for ensuring successful management of the condition., (© 2023 International Federation of Gynecology and Obstetrics.)

Objective: To develop a multimodal learning application system that integrates electronic medical records (EMR) and hysteroscopic images for reproductive outcome prediction and risk stratification of patients with intrauterine adhesions (IUAs) resulting from endometrial injuries., Materials and Methods: EMR and 5014 revisited hysteroscopic images of 753 post hysteroscopic adhesiolysis patients from the multicenter IUA database we established were randomly allocated to training, validation, and test datasets. The respective datasets were used for model development, tuning, and testing of the multimodal learning application. MobilenetV3 was employed for image feature extraction, and XGBoost for EMR and image feature ensemble learning. The performance of the application was compared against the single-modal approaches (EMR or hysteroscopic images), DeepSurv and ElasticNet models, along with the clinical scoring systems. The primary outcome was the 1-year conception prediction accuracy, and the secondary outcome was the assisted reproductive technology (ART) benefit ratio after risk stratification., Results: The multimodal learning system exhibited superior performance in predicting conception within 1-year, achieving areas under the curves of 0.967 (95% CI: 0.950-0.985), 0.936 (95% CI: 0.883-0.989), and 0.965 (95% CI: 0.935-0.994) in the training, validation, and test datasets, respectively, surpassing single-modal approaches, other models and clinical scoring systems (all P<0.05). The application of the model operated seamlessly on the hysteroscopic platform, with an average analysis time of 3.7±0.8 s per patient. By employing the application's conception probability-based risk stratification, mid-high-risk patients demonstrated a significant ART benefit (odds ratio=6, 95% CI: 1.27-27.8, P=0.02), while low-risk patients exhibited good natural conception potential, with no significant increase in conception rates from ART treatment (P=1)., Conclusions: The multimodal learning system using hysteroscopic images and EMR demonstrates promise in accurately predicting the natural conception of patients with IUAs and providing effective postoperative stratification, potentially contributing to ART triage after IUA procedures., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: We describe a rare case of uterine mesothelial cysts mimicking ovarian cysts in a primipara patient with a history of Cesarean section., Case Report: A 39-year-old female patient with history of Cesarean section presented with dysmenorrhea. Sonography revealed that a hypoechoic and anechoic multicystic complex, which was located on the right side of the pelvic cavity, had infiltrated the adjacent posterior wall of the uterus, and it was preoperatively misdiagnosed as ovarian cysts with suspected endometrioma. Laparoscopic surgery revealed multiple cystic lesions filled with clear yellow fluid on the posterior uterine wall instead of the adnexa. Laparoscopic uterine cystectomy was performed, and the patient's recovery was uneventful. Pathohistological and immunohistochemical examinations confirmed the diagnosis of uterine mesothelial cysts., Conclusion: Uterine mesothelial cysts should be considered in the differential diagnosis of pelvic lesions. Increasing the awareness of this rare disease can contribute to improved evaluation, decision-making, and disease management., (Copyright © 2024. Published by Elsevier B.V.)

A pregnant female domestic longhair cat ~8 mo of age was referred to the Western College of Veterinary Medicine (Saskatoon, Saskatchewan) for a diagnostic evaluation of severe anemia (PCV: 10.8%) after a 2-day period of lethargy. A CBC, serum biochemistry profile, FeLV/FIV testing, and abdominal radiographs were completed and did not determine a cause for the anemia. Abdominal ultrasonography identified 1 viable and 6 nonviable and fetuses, anechoic fluid in the uterus, and a mild volume of peritoneal effusion. A whole-blood transfusion and C-section with ovariohysterectomy were performed even though a definitive presurgical diagnosis for the anemia had not yet been established. Exploratory surgery revealed a left uterine horn torsion with a necrotic base, severe congestion, and 7 nonviable fetuses. Following surgery, the queen made a full clinical recovery. Key clinical message: Uterine torsion can be easily overlooked as a cause of severe anemia due to the relative infrequency of this condition in cats and the low sensitivity of ultrasonography to provide a definitive presurgical diagnosis. Client communication must emphasize the need for a prompt surgical intervention to establish the diagnosis and to save the cat, despite poor rates of neonatal survival. Once the animal is stabilized after surgery, further diagnostic tests and procedures are indicated if the cause of anemia has not yet been identified., (Copyright and/or publishing rights held by the Canadian Veterinary Medical Association.)

Objective: To evaluate independent factors that affect the chance of live birth (LB) after hysteroscopic adhesiolysis in patients with intrauterine adhesions., Design: Retrospective cohort study., Setting: Hysteroscopic center of Fuxing Hospital in Beijing, China., Patient(s): Patients diagnosed with Asherman syndrome between June 2020, and February 2022., Intervention(s): Hysteroscopic adhesiolysis is followed by a second look hysteroscopy to assess the outcome and follow-up for a year., Main Outcome Measure(s): Live birth rate (LBR) without the use of assisted reproductive technologies at 12-month follow-up., Result(s): Of the 544 women included in the cohort, the pregnancy rate at the end of 1 year of follow-up was 47.6% (95% confidence interval [CI] 45.5%-49.7%), and the LBR was 41.0% (95% CI 38.9%-43.1%). Stepwise multiple logistic regression analysis identified three independent predictors of LB in decreasing order of significance: increase in menstrual flow after surgery (odds ratio [OR] 3.69, 95% CI 1.77-8.21), postoperative endometrial thickness in the midluteal phase (OR 1.53, 95% CI 1.31-1.80), and the severity of recurred adhesion at second-look hysteroscopy (OR 0.62, 95% CI 0.50-0.76). Among subjects with good independent prognostic factors, namely, increased menstrual flow after surgery, postoperative endometrial thickness in the midluteal phase >6 mm, and no or minimal recurrence of adhesions at second-look hysteroscopy, the LBR was 69.0% (95% CI 65.4%-72.6%). On the other hand, in women (n = 26) without any of the three good prognostic factors, none had a successful LB (0)., Conclusion(s): Overall, the LBR after treatment for Asherman syndrome was 41.0%. The prognosis is dependent on three outcome measures after surgery, namely, improvement in menstrual flow, postoperative endometrial thickness, and the minimal degree of recurrent adhesions at second-look hysteroscopy., Competing Interests: Declaration of interests Y.H. has nothing to disclose. X.H. has nothing to disclose. R.H. has nothing to disclose. R.X. has nothing to disclose. E.X. has nothing to disclose. T.C.L. has nothing to disclose., (Copyright © 2024. Published by Elsevier Inc.)

Background: Uterine necrosis is a rare condition and is considered a life-threatening complication. However, cases of uterine necrosis were rarely reported, particularly those caused by infection. In terms of treatment, no minimally invasive treatment for uterine necrosis has been reported, and total hysterectomy is mostly considered as the treatment option., Objective: The article specifically focuses on minimally invasive treatments and provides a summary of recent cases of uterine necrosis., Case Presentation: We report the case of a 28-year-old patient gravid 1, para 0 underwent a cesarean section after unsuccessful induction due to fetal death. She presented with recurrent fever and vaginal discharge. The blood inflammation markers were elevated, and a CT scan revealed irregular lumps with low signal intensity in the uterine cavity. The gynecological examination revealed the presence of gray and white soft tissue, approximately 5 cm in length, exuding from the cervix. The secretions were found to contain Fusobacterium necrophorum, Escherichia coli, and Proteus upon culturing. Given the patient's sepsis and uterine necrosis caused by infection, laparoscopic exploration uncovered white pus and necrotic tissue openings in the anterior wall of the uterus. The necrotic tissue was removed during the operation, and the uterus was repaired. Postoperative pathological findings revealed complete degeneration and necrosis of fusiform cell-like tissue. Severe uterine necrosis caused by a multi-drug resistant bacterial infection was considered after the operation. She was treated with antibiotics for three weeks and was discharged after the infection was brought under control. The patient expressed satisfaction with the treatment plan, which preserved her uterus, maintained reproductive function, and minimized the extent of surgery., Conclusion: Based on the literature review of uterine necrosis, we found that it presents a potential risk of death, emphasizing the importance of managing the progression of the condition. Most treatment options involve a total hysterectomy. A partial hysterectomy reduces the extent of the operation, preserves fertility function, and can also yield positive outcomes in the treatment of uterine necrosis, serving as a complement to the overall treatment of this condition., (© 2024. The Author(s).)

Competing Interests: None declared.

Aim: Aim of the study to summarize the current information on diagnostic and treatment options for uterovesical fistula as a consequence of iatrogenic complication. Methods: Literature review of available information on surgical treatment options for uterovesical fistula resulting from previous caesarean section and comparison with our own experience in the developing world. Conclusion: Uterovesical fistula is an abnormal communication between the bladder and uterus. The cause of this pathology in most cases is an iatrogenic complication, most commonly arising after a caesarean section. The incidence of this pathology varies significantly geographically. In developed countries, these fistulas are rather rare. On the other hand, in developing countries, uterovesical fistulas are more common with a significant impact on the subsequent life of the patient due to generally inaccessible health care.

Objective: To describe the feasibility of hysteroscopy-assisted suction curettage for early pregnancy loss and to investigate whether it reduces the rates of retained products of conception (RPOC) and intrauterine adhesions (IUA)., Design: Prospective single-arm cohort study., Setting: University-affiliated Department of Obstetrics and Gynecology., Patients: Women admitted for surgical evacuation of early pregnancy loss were invited to participate in the study., Intervention: Vaginal misoprostol was administered for cervical ripening preoperatively. Under general anesthesia, a diagnostic hysteroscopy was performed to identify the pregnancy's implantation wall, followed by ultrasound-guided suction and curettage directed to the implantation wall, and then diagnostic hysteroscopy to verify complete uterine cavity emptying. Postoperative IUA were evaluated by follow-up office hysteroscopy., Main Outcome Measure: Identification of the pregnancy's implantation wall on hysteroscopy, and intra-, and postoperative complications associated with the procedure. The evaluation of postoperative IUA was limited due to the COVID-19 pandemic-related restrictions on elective procedures., Results: Forty patients were included in the study group. Their mean age was 34.0 ± 6.6 years, and their mean gestational age was 8.9 ± 1.6 weeks. The implantation wall was clearly visualized on hysteroscopy in 33 out of 40 cases (82.5%). The mean operative time was 17.2 ± 8.8 min, and no intraoperative complications occurred. Suspected RPOC were diagnosed intraoperatively by hysteroscopy and removed in 4 cases, and the histologic examination confirmed the presence of RPOC in three of them. Follow-up office hysteroscopy was performed in nine women: mild IUA was diagnosed in one case and a normal cavity was confirmed in eight cases. A new pregnancy was reported at the time of follow-up in 15 cases, while 12 women declined to attend the follow-up hysteroscopy and four were lost to follow-up., Conclusions: Hysteroscopy-assisted suction curettage for early pregnancy loss is a safe, short, and inexpensive procedure, which allows the identification of the pregnancy's wall in most cases and may reduce the rates of RPOC., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Hydrometrocolpos is a rare finding in newborns. It can be an isolated finding or may be associated with syndromes. Antenatal diagnosis is possible. It is due to the accumulation of secretion in the uterus, distending it and resulting in abdominal swelling. In case of suspected syndromes, an attempt should be made to look for other organ involvement and genetic diagnosis. We here report a term neonate with hydrometrocolpos, which was antenatally diagnosed and was managed conservatively., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose of Review: The goal of this review is to provide a comprehensive overview of hydrometrocolpos, covering disease etiology, pathophysiology, clinical presentation, and diagnostic and management techniques, and known outcomes., Recent Findings: This narrative review presents the literature on hydrometrocolpos in the pediatric population from the past 5 years. We highlight the 69 reported cases of hydrometrocolpos and classify them based on type of obstruction or associated anomaly, discuss new diagnostic algorithms based on imaging, and present novel and underutilized surgical techniques for definitive management. Hydrometrocolpos, a condition characterized by retained fluid causing a distended vagina and uterus in the setting of a distal vaginal outflow obstruction, has a wide range of presentation severity based on the type of obstruction. Whether hydrometrocolpos is due to an isolated condition like imperforate hymen, a complex abnormality like cloacal malformation, or a part of a large congenital syndrome, the mainstay of treatment is decompression of the dilated vagina and surgical correction of the outflow obstruction. Imaging-based diagnostic algorithms and new treatment techniques reported in the literature, as well as longitudinal and patient-reported outcome research, can improve the lives of children affected by this condition., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: To compare pathology results after office-based blind endometrial biopsy and pathology results from hysteroscopy in women presenting with abnormal uterine bleeding (AUB)., Methods: A retrospective cohort study of biologic women presenting with AUB at a tertiary care referral care center. Patients were included if they underwent evaluation with blind endometrial biopsy performed in the office followed by hysteroscopy within one year. Hysteroscopic findings and pathology were correlated with index endometrial biopsy findings., Results: 689 patients met inclusion criteria. The mean age and BMI were 49 (±10) years and 31 (±8) kg/m 2 . The median duration of bleeding leading up to presentation was of 3.5 (1.5-9) months. Of the patients who had operative hysteroscopic pathology demonstrating endometrial polyp, 30.6 % (81) had a polyp detected on office endometrial biopsy. Of the patients who had hysteroscopic pathology demonstrating intracavitary fibroids, 0 % (0) were detected on endometrial biopsy. Of the patients who had hyperplasia without atypia on hysteroscopy, 28.6 % (4) were detected or suspected on endometrial biopsy. Of the patients who had hyperplasia with atypia on hysteroscopy, 5.9 % (1) were detected or suspected on endometrial biopsy. There were 12 cases of confirmed or suspected malignancy on hysteroscopy, of which 8.3 % (1) were detected on endometrial biopsy., Conclusion: Concordance between focal findings on office hysteroscopy and endometrial biopsy is low. Endometrial biopsy when malignancy is suspected has been shown to be of benefit, but in the setting of suspected benign focal pathology, blind assessment of the endometrial cavity for definitive diagnosis should be abandoned. In women with symptomatic uterine bleeding, hysteroscopic visualization is associated with increased sensitivity in identifying intrauterine pathology., Competing Interests: Declaration of Competing Interest Dr. Ferrando receives authorship royalties from UpToDate and Elsevier; Dr. Bradley receives authorship royalties from UpToDate, Wolters Kluwer, and Elsevier., (Copyright © 2023. Published by Elsevier Masson SAS.)

Objective: To study the comparison between hysteroscopic morcellation (HM) of retained products of conception (RPOC) with ultrasound (US)-guided electric vacuum aspiration in terms of intrauterine adhesion (IUA) formation, efficacy, and complications., Design: A randomized controlled, nonblinded trial., Setting: Three teaching hospitals and one university hospital from April 2015 to June 2022., Patients: A total of 133 women with RPOC on US, ranging from 1-4 cm, were randomized to receive either HM or electric vacuum aspiration., Intervention: Hysteroscopic morcellation was performed with the TruClear System (Medtronic, Minneapolis, MN, USA). Electric vacuum aspiration was performed using an 8- or 10-mm flexible plastic Karman cannula under US guidance. Women allocated to vacuum aspiration underwent the procedure as soon as possible., Main Outcome Measures: In the HM group, an office diagnostic hysteroscopy was planned a minimum of 6 weeks after the end of pregnancy, followed by retained product of conception removal at least 8 weeks after the end of the pregnancy. Postoperatively, an office second-look hysteroscopy was scheduled to assess the primary outcome of IUAs., Results: Postoperative IUAs were seen in 14.3% (9/63) of patients in the HM group and 20.6% (13/64) of patients in the vacuum aspiration group (-6% [-19.1% to 7.1%]). Significantly more RPOC were removed completely by HM compared with vacuum aspiration (95.2% vs. 82.5% (-14% [-24.9% to -3.1%]), and additional operative hysteroscopy was less frequently necessary in the HM group (12.5%) compared with the vacuum aspiration group (31.3%) (-20.1% [-34.3% to -6%]). The median operating time was shorter for vacuum aspiration compared with HM (5.80 minutes vs. 7.15 minutes). No differences were observed between HM and vacuum aspiration for the occurrence of intraoperative or postoperative complications (5.5% vs. 5.0% and 2.7% vs. 1.3%, respectively)., Conclusion: In our randomized controlled trial, no significant differences were found in the occurrence of IUAs and complications. However, the RPOC were more often completely removed by HM than vacuum aspiration, and the HM group required fewer additional hysteroscopic treatments., Clinical Trial Registration Number: NTR4923 (https://trialsearch.who.int/Trial2.aspx?TrialID=NTR4923). Date of registration: November 23, 2014, date of initial participant enrollment: January 1, 2015., Competing Interests: Declaration of interests L.P.W. has nothing to disclose. T.W.H. (the Ghent University Hospital) has received compensation from Medtronic for a lecture on RPOC. C.M.R. has nothing to disclose. L.W.P. has nothing to disclose. S.W. has nothing to disclose. B.C.S. has received compensation from Medtronic on an hourly basis for lectures on HM and donated all the compensation to a foundation that promotes research in obstetrics and gynecology. H.A.v.V. has received compensation from Medtronic on an hourly basis for lectures on HM and donated all the compensation to a foundation that promotes research in obstetrics and gynecology., (Copyright © 2023 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the utility of office hysteroscopy in diagnosing and treating retained products of conception in patients with infertility who experience early pregnancy loss (EPL) after in vitro fertilization (IVF)., Methods: We evaluated a retrospective cohort of 597 pregnancies that ended in EPL in patients aged 18-45 years who conceived through fresh or frozen embryo transfer at an academic fertility practice between January 2016 and December 2021. All patients underwent office hysteroscopy after expectant, medical, or surgical management of the EPL. The primary outcome was presence of retained products of conception at the time of office hysteroscopy. Secondary outcomes included incidence of vaginal bleeding, presence of intrauterine adhesions, treatment for retained products of conception, and duration of time from EPL diagnosis to resolution. Log-binomial regression and Poisson regression were performed, adjusting for potential confounders including oocyte age, patient age, body mass index, prior EPL count, number of prior dilation and curettage procedures, leiomyomas, uterine anomalies, and vaginal bleeding., Results: Of the 597 EPLs included, 129 patients (21.6%) had retained products of conception diagnosed at the time of office hysteroscopy. The majority of individuals with EPL were managed surgically (n=427, 71.5%), in lieu of expectant management (n=140, 23.5%) or medical management (n=30, 5.0%). The presence of retained products of conception was significantly associated with vaginal bleeding (relative risk [RR] 1.72, 95% CI 1.34-2.21). Of the 41 patients with normal pelvic ultrasonogram results before office hysteroscopy, 10 (24.4%) had retained products of conception detected at the time of office hysteroscopy. When stratified by EPL management method, retained products of conception were significantly more likely to be present in individuals with EPL who were managed medically (adjusted RR 2.66, 95% CI 1.90-3.73) when compared with those managed surgically. Intrauterine adhesions were significantly less likely to be detected in individuals with EPL who underwent expectant management when compared with those managed surgically (RR 0.14, 95% CI 0.04-0.44). Of the 127 individuals with EPL who were diagnosed with retained products of conception at the time of office hysteroscopy, 30 (23.6%) had retained products of conception dislodged during the office hysteroscopy, 34 (26.8%) chose expectant or medical management, and 63 (49.6%) chose surgical management. The mean number of days from EPL diagnosis to resolution of pregnancy was significantly higher in patients who elected for expectant management (31 days; RR 1.18, 95% CI 1.02-1.37) or medical management (41 days; RR 1.54, 95% CI 1.25-1.90) when compared with surgical management (27 days)., Conclusion: In patients with EPL after IVF, office hysteroscopy detected retained products of conception in 24.4% of those with normal pelvic ultrasonogram results. Due to the efficacy of office hysteroscopy in diagnosing and treating retained products of conception, these data support considering office hysteroscopy as an adjunct to ultrasonography in patients with infertility who experience EPL after IVF., Competing Interests: Financial Disclosure Andrea Lanes reports receiving payment from BORN Ontario. Elizabeth S. Ginsburg receives royalties from UpToDate, stipends from Elsevier and ASRM, and is a medical consultant for Hall Matson Esq., Teledoc, and CRICO. Serene S. Srouji receives royalties from UpToDate and served on the medical advisory board for Ferring. The other authors did not report any potential conflicts of interest., (Copyright © 2023 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

The occurrence of uterine torsion is rare, as the uterus is supported in place by the uterine ligaments. When occurring during pregnancy, it is associated with increased perinatal mortality and maternal morbidity. We report a case of uterine torsion in a 36-week pregnant woman with a history of one previous caesarean section who presented with acute abdominal pain and signs of fetal distress. A 180 degree uterine torsion was recognised during emergency caesarean section with detorsion done prior to delivery and the baby was delivered in good condition. This case highlights the importance of prompt recognition and decision-making in managing this rare obstetric emergency to achieve a successful maternal and foetal outcome., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Adenomyosis is a benign uterine disease that pathologically shows endometrial glands and stroma in the myometrium. There are multiple lines of evidence that adenomyosis is associated with abnormal bleeding, painful menstruation, chronic pelvic pain, infertility, and spontaneous pregnancy loss. Pathologists have researched adenomyosis by studying tissue specimens from its first report more than 150 years ago, and differing viewpoints on its pathological alterations have been advanced. However, the gold standard histopathological definition of adenomyosis remains controversial to date. The diagnostic accuracy of adenomyosis has steadily increased due to the continual identification of unique molecular markers. This article provides a brief description of the pathological aspects of adenomyosis and discusses adenomyosis categorization based on histology. The clinical findings of uncommon adenomyosis are also presented to offer a thorough and detailed pathological profile. Furthermore, we describe the histological alterations in adenomyosis after medicinal therapy., (©The Author(s) 2023. Open Access. This article is licensed under a Creative Commons CC-BY International License.)

Asherman syndrome is characterized by a triad of symptoms including pain, menstrual abnormalities, and infertility and is a result of intrauterine scar tissue after instrumentation of a gravid uterus. Saline sonohysterogram is typically the most sensitive diagnostic tool; however, hysteroscopy is the criterion standard for diagnosis. Treatment includes hysteroscopic-guided lysis of adhesion, with restoration of the anatomy of the uterine cavity. Several modalities are used in an attempt to reduce the reformation of scar tissue after surgery; however, there is no consensus on the ideal method. Stem cells and platelet-rich plasma are being explored as means of regenerative therapy for the endometrium, but data remain limited. At present, most individuals can have restoration of menstrual function; however, lower pregnancy rates and obstetric complications are not uncommon. These complications are worse for patients with a higher grade of disease. Efforts are needed in standardizing classification, reducing uterine instrumentation of the gravid uterus, and referring patients to health care professionals with clinical expertise in this area., Competing Interests: Financial Disclosure The author did not report any potential conflicts of interest., (Copyright © 2023 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Rationale: Endometrial vascular dystrophy refers to abnormal vessels that are very tortuous, dilated, and sometimes thrombosed. Endometrial vascular dystrophy is rare under hysteroscopy., Patient: All three patients had a history of abnormal uterine bleeding. The duration of vaginal bleeding ranged from 1 month to 2 years. There was no history of unusual diseases, alcohol or drug abuse, or genetic history., Diagnoses: Endometrial vascular dystrophy., Intervention: Three patients underwent hysteroscopy and curettage under intravenous general anesthesia. Pathological examination showed secretory endometrium, with one case coexisting with endometrial polyps., Outcomes: No recurrence was found during postoperative follow-up at 12 months., Lessons: Endometrial vascular dystrophy is a rare hysteroscopy phenomenon shown in the secretory endometrium. We believe that it was a capillary loop with different manifestations., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: To examine whether the early diagnosis of uterine incarceration before 20 weeks of gestation improves maternal-perinatal prognoses., Methods: A systematic review of all of the cases published in the past 30 years that met the inclusion and exclusion criteria was performed and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. A comparative analysis of diagnoses before and after 20 weeks of gestation was performed., Results: Eighty-nine studies with a total of 146 cases of uterine incarceration during pregnancy were included. For cases of incarceration diagnosed before 20 weeks of gestation, a higher proportion of clinical symptoms was observed; however, a lower proportion of complications, such as premature delivery, need for cesarean section, and poor perinatal outcomes, were observed (P < 0.05). The proportion of spontaneous resolution and minimally invasive techniques for the treatment of incarceration was significantly higher among patients diagnosed with this pathology before 20 weeks (P < 0.05)., Conclusion: The literature indicates that uterine incarceration is a rare complication during pregnancy with better maternal-perinatal results if diagnosed earlier than 20 weeks., (© 2022 International Federation of Gynecology and Obstetrics.)

Objective: To explore the similarities and differences of China Society of Gynecology Endoscopy (CSGE) and American Fertility Society (AFS) intrauterine adhesion (IUA) scoring criteria on IUA grading and their predictive value of reproductive prognosis. Methods: From January 2016 to January 2019, a total of 1 249 patients were diagnosed with IUA by hysteroscopy at Beijing Obstetrics and Gynecology Hospital. Totally, 378 patients with complete clinical data were enrolled, and the results diagnosed by CSGT and AFS scoring criteria were compared and analyzed.And follow-up for 2 years, the pregnancy rate and live birth rate were statistical analysis. Results: (1) The grade of IUA according to AFS and CSGE scoring criteria was less consistent ( κ =0.295, P <0.001). Compared with AFS, the proportion of severe IUA cases diagnosed by CSGE was significantly lower [45.8% (173/378) vs 15.1% (57/378); RR =0.22, 95% CI : 0.15-0.30, P <0.01); the proportions of both mild and moderate IUA cases were significantly higher ( RR =4.16, 95% CI : 2.38-7.14; RR =2.38, 95% CI : 1.75-3.23; both P <0.01). (2) The pregnancy rates of mild, moderate and severe IUA diagnosed according to CSGE were 11/13, 64.5% (147/228), 31.8% (7/22), live birth rates were 11/13, 54.8% (125/228) and 22.7% (5/22), respectively; there were statistically significant differences between the groups (all P <0.01). The pregnancy rates of mild, moderate and severe IUA diagnosed based on AFS were 3/3, 66.9% (97/145) and 56.5% (65/115), respectively, with no statistically significant difference between the groups ( P >0.05). (3) IUA grades based on both CSGE and AFS criteria were significantly negatively correlated with pregnancy rates and live birth rates (CSGE: r =-0.210, r =-0.226; AFS: r =-0.130, r =-0.147; all P <0.05). Univariate logistic regression analysis showed that CSGE had higher OR for both pregnancy rates and live birth rates compared to AFS (3.889 vs 1.657, 3.983 vs 1.554, respectrvely). Conclusions: Compared with AFS, the IUA grade based on CSGE is better related with reproductive prognosis, suggesting that the CSGE standard might be more objective and comprehensive and has better predictive value for reproductive prognosis, thus avoiding overdiagnosis and overtreatment.

Uterine torsion is defined as a rotation of uterus around its axis by more than 45° in its longitudinal length. Uterine torsion is very rare, it is reported that a physician encounters it only 1 time in a lifetime. Our case describes uterine torsion in a twin pregnancy, in a completely asymptomatic patient, where the dia-gnosis was made only peroperatively.

Background: Incarceration of the gravid uterus is an infrequent obstetric complication that can cause severe complications., Case: A 37-year-old woman, G3P2002, at 14 weeks of gestation presented with vomiting, back pain, and urinary retention. She was noted to be in acute renal failure, with a creatinine level of 9.24 mg/dL, and results of her physical examination were concerning for uterine incarceration. Passive maneuvers and manual pressure failed to resolve the incarceration. Under spinal anesthesia, a Bakri balloon was inflated in the posterior vagina, elevating the fundus and relieving the incarcerated uterus., Conclusion: An intravaginal balloon may aid in the alleviation of uterine incarceration., (Copyright © 2022 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

This study aimed to clarify the appropriate management of gravid uterus incarceration through a retrospective analysis of 10 women with an incarcerated gravid uterus who delivered at our hospital between 2000 and 2019. The incidence of an incarcerated gravid uterus was one in 2000 cases. Nine cases were diagnosed during pregnancy (15-30 gestational weeks) and one during caesarean section (performed at 37 gestational weeks on suspicion of placenta previa). Two women underwent manual reduction at 19 and 20 gestational weeks, respectively; the procedure failed in one case, and intrauterine foetal death occurred after the procedure. Among the remaining eight cases, spontaneous reduction was observed in three women at 31, 33 and 34 gestational weeks, respectively. The prevalence of incarcerated gravid uteri may be higher than that previously reported, cases may more likely recover spontaneously, and spontaneous reduction could occur in the third trimester.Impact Statement What is already known on this subject? Gravid uterine incarceration is a rare condition that occurs in one in 3000-10,000 cases. In addition, previous reports have suggested that manual reduction should not be attempted after the 20th week of gestation. What do the results of this study add? In the current study, the incidence of an incarcerated gravid uterus was one in 2000 cases, higher than that mentioned in previous reports. In addition, spontaneous reductions occurred in three of eight cases in which manual reductions were not performed at 31, 33 and 34 gestational weeks. What are the implications of these findings for clinical practice and/or further research? The prevalence of an incarcerated gravid uterus and the rate of spontaneous reduction might be higher than those reported in previous studies, and spontaneous reduction could occur in later gestational weeks than that previously reported. Further prospective multicentre studies are necessary to establish new evidence for the management of gravid uterine incarceration.

Purpose: To summarize the clinical characteristics and surgical option of Robert's uterus., Methods: We reported a rare case of Robert's uterus with severe uterine adhesion with successive laparoscopic and hysteroscopic surgery. To our knowledge, such a case has not been reported previously. We also performed a systematic literature review from the PubMed, Embase, and Cochrane databases., Results: Our patient with Robert's uterus with severe uterine adhesions was successfully treated with hysteroscopic septal resection and hysteroscopic adhesiolysis, and the intractable dysmenorrhea disappeared after the hysteroscopic septal resection. In our study, we analyzed the selected 22 reported cases, 10/22 cases (45.5%) were diagnosed before age 20; 20/22 cases (90.91%) experienced dysmenorrhea, 19/22 cases (86.36%) were with hematometra. 5/22 cases (22.73%) underwent re-operation or a third surgery before diagnosis and management., Conclusion: Robert's uterus, a rare congenital abnormality of Mullerian duct development, consists of an oblique septum and non-communicating asymmetrical uterine hemi-cavity. The main symptoms are the presence of hematometra and severe dysmenorrhea. Septal resection is the main surgical procedure; however, the rarity and difficulty obtaining a pre-operative diagnosis lead to a high rate of misdiagnosis and second surgery., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Failure to obtain an office-based endometrial biopsy for abnormal uterine bleeding is not uncommon. Although operating room-based procedures are traditionally considered the gold standard assessment tool in these circumstances, outpatient hysteroscopy is a less invasive, more cost-effective, and safer alternative. However, there is no contemporary Canadian literature on the effectiveness of an outpatient approach for this specific population., Objective: We aim to evaluate the effectiveness and outcomes of outpatient hysteroscopy for uterine cavity evaluation for patients who have failed an in-office endometrial biopsy attempt., Methods: We conducted a retrospective cohort study of all patients referred to an academic outpatient hysteroscopy unit between January 2015 and January 2018, who underwent an outpatient hysteroscopy following failed endometrial biopsy. Data were collected from electronic medical records., Results: Of the 407 consecutive patients who underwent an outpatient hysteroscopic procedure, 68 met inclusion criteria. Postmenopausal bleeding was the most common indication for initial biopsy, and most failures were attributed to cervical stenosis. Outpatient hysteroscopies were successfully completed in 96% of cases (n = 65/68). Failure resulted from either anxiety and discomfort (n = 2), or severe intrauterine adhesions (n = 1). Overall, 10% of patients subsequently required an operating room-based hysteroscopy, either to complete a myomectomy or polypectomy, or to allow general anesthesia. Outpatient hysteroscopy identified endometrial hyperplasia and cancer in 4.5% and 3% of patients, respectively., Conclusion: Outpatient hysteroscopy following unsuccessful office endometrial biopsy attempts appears to be a feasible, safe, and cost-effective investigation strategy that may prevent the need for an operating room-based procedure in 90% of cases., (© 2022 Japan Society of Obstetrics and Gynecology.)

Background: Abnormal uterine bleeding is a common cause of hospital admission in perimenopausal women. It can be the first sign of many diseases such as endometrial cancer and endometrial hyperplasia. Endometrial sampling is valuable in early diagnosis and treatment. Although hysterectomy is the gold standard in the diagnosis of endometrial pathology, it is not considered an acceptable method for diagnosis. With the principle of "see and treat, hysteroscopy seems to be the most successful method., Methods: After obtaining the necessary ethics committee approval, we obtained liquid-based cytology samples of our perimenopausal patients who frequently applied to our outpatient clinic with abnormal uterine bleeding. To conduct endometrial sampling of our patients, we used pipelle aspiration method in our 75-disease group and direct hysteroscopic sampling method in our other 75 disease group. We then compared the pre- and postoperative pathology results., Results: There was no statistically significant difference between preoperative and postoperative pathological results in both pipelle and hysteroscopic sampling groups., Conclusions: Evaluation of endometrial pathologies by hysteroscopic method and pipelle method has high sensitivity and specificity. Gynecologists may determine the method preference according to the status of the health system together with their patients.

Hysteroscopy has evolved from the traditional art of examining the uterine cavity for diagnostic purposes to an invaluable modality to concomitantly diagnose and (see and) treat a multitude of intrauterine pathologies, especially in the field and clinics specialising in female reproduction. This article reviews the literature on the most common cervical, endometrial, uterine and tubal pathologies such as chronic endometritis, endometrial polyps, adenomyosis, endometriosis, endometrial atrophy, adhesions, endometrial hyperplasia, cancer, and uterine malformations. The aim is to determine the efficiency of hysteroscopy compared with other available techniques as a diagnostic and treatment tool and its association with the success of in vitro fertilisation procedures. Although hysteroscopy requires an experienced operator for optimal results and is still an invasive procedure, it has the unique advantage of combining great diagnostic and treatment opportunities before and after ART procedures. In conclusion, hysteroscopy should be recommended as a first-line procedure in all cases with female infertility, and a special effort should be made for its implementation in the development of new high-tech procedures for identification and treatment infertility-associated conditions.

Purpose: Uterine torsion (UT) in pregnancy is a rare condition in obstetric practice. It is defined as a rotation of the uterus of more than 45° around its long axis. Presentations are varied and, most of the time, this condition is recognized at laparotomy or cesarean section (CS). The aim of this study is to summarize the latest evidence about UT in pregnancy., Methods: A systematic research of the literature was conducted fetching all papers published from March 2006 to June 2020. We collected data regarding clinical features, treatment, and feto-maternal outcomes. Finally, we reported data of a case of UT associated with intrauterine growth restriction (IUGR) diagnosed and treated at our institution., Results: According to our search strategy, 38 articles were included. In 66% of the cases, acute symptomatology was present at the onset, most frequently abdominal pain was reported. In one-third of the cases, UT was diagnosed during CS without clinical suspicion. Only in two cases, including our case, IUGR was reported. Most (66%) of the cases presented a 180° torsion. In the majority of the cases, a CS was performed also with a deliberate or accidental posterior hysterotomy. One and six cases of maternal and fetal death were, respectively, reported., Conclusion: UT is an infrequent obstetric condition but should be considered in case of abdominal pain, vomiting, or shock presentation during pregnancy. It could lead to a reduction in uterine blood flow contributing to poor placental perfusion, even though more evidence is needed to clarify this link., (© 2021 Japan Society of Obstetrics and Gynecology.)

Objective: The purpose of present report is an effective clinical approach to incarcerated uterus by the trimester of pregnancy, in this case and 54 cases reported previously., Case Report: A woman at 18 + 5 weeks of gestation was referred with abdominal pain and urinary dysfunction. In pelvic examination, the cervix was not seen and huge myoma was located at retroverted anterior uterine wall and the elongated cervix was pulled up above the bladder in ultrasonography. The uterine incarceration was confirmed by magnetic resonance imaging. The manual reduction of uterus was attempted with knee-chest-position repeatedly. However, this was unsuccessful because large fibroid was impacted and immovable. Therefore, laparotomy was conducted for repositioning of uterus. Pregnancy was maintained without any complication and a 4250 g healthy female infant was delivered by cesarean section., Conclusion: By analyzing of several cases, useful diagnostic modalities and effective management should be approached according to trimester of pregnancy., Competing Interests: Declaration of competing interest The authors have no conflicts of interest relevant to this article., (Copyright © 2021. Published by Elsevier B.V.)

Background: Little is known about the long-term reproductive effects of pelvic infection when a levonorgestrel-releasing intrauterine device (LNG-IUD) is in situ. Society guidelines do not recommend removing an LNG-IUD during pelvic infection., Case: A 37-year-old woman presented with primary infertility, and the only contributing factor was intrauterine adhesions in the shape of an IUD. She was known to previously have an LNG-IUD and was treated for asymptomatic chlamydia infection while the IUD was in place. After lysis of adhesions, she successfully conceived spontaneously., Conclusion: Data on long-term reproductive effects of pelvic infection with an LNG-IUD in situ are not available, and there may be consequences affecting the intrauterine milieu requiring further studies and potential counseling., Competing Interests: Financial Disclosure Dr. Wright is a product consultant for Caldera Medical, Cooper Surgical, Hologic, Karl Storz, and Uvision360. The other authors did not report any potential conflicts of interest., (Copyright © 2021 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: This study aimed to assess the feasibility and efficacy of office hysteroscopy to diagnose and treat the specific uterine pathologies frequently diagnosed and thought to be associated with female infertility., Material and Methods: Using office hysteroscopy, we examined the uterine cavity in women with primary or secondary infertility and evaluated the reproductive outcomes of those affected by one or more pathologies, including cervico-isthmic adhesions, intrauterine polyps and intrauterine adhesions. Additional patient characteristics considered were age and parity, uterine pathology, pain during hysteroscopy, and outcomes including spontaneous pregnancies achieved and time between treatment and pregnancy., Results: Reproductive outcomes of 200 patients affected by one or more uterine pathologies were evaluated. Cervico-isthmic adhesions were the most frequent findings in older women, with nearly 80% of them achieving pregnancy sooner than the others in our study. Spontaneous pregnancy rates following office hysteroscopy were 76%, 53% and 22% in women with cervico-isthmic adhesions, polyps (< 5 mm) and intrauterine adhesions, respectively., Conclusions: Office hysteroscopy is a feasible and highly effective diagnostic and therapeutic procedure for cervico-isthmic and intrauterine adhesions, as well as for small polyps, allowing the resolution of female infertility related to these pathologies, without trauma and with only minimal discomfort.

Surgical innovations in hysteroscopic surgery have radically changed the way of treating intrauterine pathologies, throughout the advent of the 'see-and-treat' philosophy, which transferred the advantages of inpatient surgery to the office setting. However, in-office operative hysteroscopy was mainly limited to minor pathology as a supplement to its diagnosis, whereas commonly larger abnormalities were left to be treated in the operating room. Nowadays, pre-surgical assessment of uterine pathology is based on modern ultrasound evaluation and the evolving role of in-office hysteroscopy as a well-planned treatment modality for larger lesions and more complex procedures. Office operative hysteroscopy has been accepted as a feasible, cost-effective, practical way to treat almost any intrauterine disease. Despite the growing role of other imaging tools in the proper evaluation of benign uterine diseases, especially extended beyond to direct hysteroscopic visualization, diagnostic hysteroscopy remains a valuable tool of direct endometrial sampling and may be used as the first line in the diagnosis of endometrial cancer and hyperplasia. Our aim is to describe the most recent innovations and future perspectives in the field of outpatient operative hysteroscopy: mini-resectoscopes, intrauterine morcellators, tissue retrieval systems, diode laser, new miniaturized mechanical instruments, endometrial ablation devices and portable and entry-level hysteroscopes.

In zoos, rock hyrax ( Procavia capensis ) are commonly maintained in groups and population control is necessary. Here we report on hydrometra prevalence in a group of rock hyraxes. Prevalence of hydrometra in this small group (4/8) far exceeds reproductive pathology prevalence previously reported for this species under managed care. Affected females were nulliparous, but had not been contracepted; instead they were maintained as a single-sex group. The first case presented as sudden death and three additional cases were diagnosed antemortem via ultrasound. Two of these underwent ovariohysterectomy to treat the severe hydrometra. The last case was a mild hydrometra and during follow-up exam was found to have spontaneously resolved. Detailed information regarding clinical presentation, diagnostics and surgical techniques are provided.

The paper aims to understand the expression of nerve growth factor receptor (TrkA) in the ectopic and entopic endometrium of patients with adenomyosis and dysmenorrhea and, at the same time, explore and analyze the combination of hysteroscopy and ultrasound imaging based on multioperator algorithms. The clinical treatment value of color Doppler ultrasound in the diagnosis and treatment of endometrial polyps. The immunohistochemical avidin-peroxidase staining method (SP method) was used to detect 20 cases of ectopic endometrium and entopic endometrium in patients with dysmenorrhea of adenomyosis (study group) and 22 cases of uterine fibroids in the control group. The expression of nerve growth factor receptor in the endometrium of patients with dysmenorrhea and comparative analysis. At the same time, all patients were examined by transvaginal color Doppler ultrasound and hysteroscopy. The scores of endometrial polyps, diagnostic efficiency of the methods, and receiver operating characteristic curve analysis of various diagnostic methods were observed and recorded in the 2 groups. There was no significant difference in the expression of TrkA in the ectopic endometrium and the entopic endometrium in the study group (P > 0.05), but the expression intensity of TrkA in the 2 groups was significantly higher than that in the control group (P = 0.05). In the diagnosis of endometrial polyps, the area of receiver operating characteristic curve in the parallel combined diagnosis of ultrasound and hysteroscopy is significantly larger than that under the combined diagnosis of series. TrkA is widely expressed in the ectopic and entopic endometrium of patients with adenomyosis and dysmenorrhea and may play an important role in the onset of adenomyosis and dysmenorrhea. Hysteroscopy combined with color Doppler ultrasound can effectively improve the diagnostic accuracy of patients with endometrial polyps., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background/aim: We present a case of uterine dedifferentiated mesonephric-like adenocarcinoma (MLA)., Case Report: A 54-year-old woman underwent total hysterectomy for a uterine mass under the impression of a uterine sarcoma. Histologically, MLA exhibited various growth patterns including tubular and glandular architecture. Undifferentiated carcinoma (UC) displayed discohesive tumor cells without any obvious architecture. Immunohistochemically, UC was positive for epithelial markers in very few scattered tumor cells. MLA exhibited the wild-type p53 expression pattern, whereas UC showed a uniform and strong p53 immunoreactivity. Targeted sequencing analysis revealed an identical Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation in both components. A pathogenic missense tumor protein 53 (TP53) mutation was detected in UC, but not in MLA., Conclusion: The mutant p53 expression pattern exclusively detected in UC was concordant with the presence of missense TP53 mutation. Our observations suggested that TP53 mutation is associated with the possible transformation from MLA to UC., (Copyright © 2021 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)