Imaging Manifestations of Accessory Cavitated Uterine Mass—A Rare Mullerian Anomaly

Context Accessory cavitated uterine mass (ACUM) is an uncommon and under-recognized entity with distinct imaging characteristics and causing significant patient distress. Differentiating it from its other clinical and radiological differentials is therefore extremely important and prevents delay in surgical management which is the treatment of choice. Aims The aim of the study is to describe the MRI appearance of the surgically and pathologically proven ACUM cases from our institution in the last 2 years. Settings and Design This is a retrospective study in a tertiary care hospital in South India. Methods and Material We reviewed the clinical presentations and imaging findings of seven surgically proven cases of ACUM qualifying the proposed diagnostic criteria. Results All patients presented with chronic pelvic pain, dysmenorrhea, and prolonged post-menstrual pain. MRI in all seven cases showed an intramural, noncommunicating, and cavitating lesion near the uterine cornua with internal contents similar to that of endometrioma. Although the cavity was lined by endometrium in all the cases (proven in pathology), it was well appreciable on MRI in only five cases. The rest of the uterine myometrium and main endometrial cavity were normal with no features of adenomyosis. Conclusion MRI is a reliable diagnostic tool for accurate diagnosis of ACUM, and more importantly, in distinguishing it from other causes of chronic pelvic pain like adenomyosis and endometriosis and other imaging differentials like adenomyoma, noncommunicating uterine horn, and degenerating leiomyoma.

Ectopic pregnancy managed medically at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia

Background: Ectopic pregnancy, a pregnancy in which the embryo implants outside the endometrial cavity, is an important cause of maternal mortality, especially in developing countries. It can be managed medically using methotrexate. In Ethiopia, limited evidence exists regarding the treatment outcome of this approach.Methods: This retrospective study was conducted based on medical records of ectopic pregnancies managed medically using methotrexate. The data of women who had unruptured ectopic pregnancy and who were managed medically in the study period at St. Paul’s Hospital Millennium Medical College were included. Data were extracted from patients’ medical records and analysed using SPSS software.Results: During the 5-year period 2015 to 2019, 81 women with unruptured ectopic pregnancy were managed medically using methotrexate with 93.8% (n=76) success. Methotrexate was administered intramuscularly to all patients in either single dose or multiple doses. Five out of the 81 patients underwent surgical intervention for either ectopic rupture or persistent ectopic mass. There were no fatal complications.Conclusion: Methotrexate is a successful and safe alternative to surgical management of unruptured ectopic pregnancy in our settings. It should be given a trial in patients who meet the selection criteria in a setting ready for emergency surgical intervention and blood transfusions.

O-025 Value of hysteroscopy

text The 3 main characters in any ART are the uterus, the endometrium, and the embryo. With the rutinary use of 2D US and especially 3D US in infertile patients we are able to assess most of the uterine anomalies and intrauterine pathologies. Until recently, the assessment of the endometrial cavity with hysteroscopy was reserved only for cases of IVF failure, as a complementary evaluation to ensure that nothing was missed during the ultrasound scan. We also need to remember how hysteroscopy was performed in the past and, unfortunately, in some cases even today. In the old days, to assess the endometrial cavity, it was required to take the patient to the operating room and under general anesthesia, dilate the cervix to then introduce a large diameter hysteroscope only for diagnostic purposes. The prevalent working model in ART today is in close collaboration between Fertility specialists, Ultrasound and Hysteroscopy units in order to improve patient’s outcome. In our center, a diagnostic hysteroscopy is performed as part of the diagnostic workup of the infertility patient. It is performed in office setting and without anesthesia, by the staff of the reproduction and infertility unit. When we look at hysteroscopy as an in-office procedure and no longer as a procedure performed in operating room, we appreciate that it is something that all infertility patients can benefit from. The right question to ask now would be “Is there a benefit in performing a hysteroscopy to all our patients?”. Ultrasound is not perfect, especially when evaluating the endometrium. The gold standard and the only modality that we have to assess the endometrium with direct visualization is hysteroscopy. Chronic endometritis, adhesions and adenomyosis are only a few examples of what can be assessed by direct vision of the endometrial cavity. The advantages of a simple, inexpensive, office procedure such as hysteroscopy outweigh any other consideration against it. During my talk all these points will be presented helping to understand why hysteroscopy is becoming an indispensable tool in every assisted fertility unit.

Primar Urinary Bladder Endometriosis: Laparoscopic Approach towards Therapeutic Mapping

Endometriosis of genital tract consists a controversial entity arising from current bibliography. Many conducted studies suggested a variety of pathophysiologic mechanisms in order to establish proper diagnosis and treatment. In many cases development of endometrial tissue outside endometrial cavity, can lead to depiction of physical symptomatology with unexpected clinical route. Besides, dysmenorrhea, dyspareunia and decrease of fertility capability, endometriosis can infiltrate many intraperitoneal organs such as urine bladder, rectum, or even mesenterium and lungs. Primary bladder endometriosis represents a very rare entity among female reproductive patients. Ultimate scope remains fertility preservation and increase of patient’s quality of life. Aim of our study reflects assiduous diagnosis and depiction of proper therapeutic strategy

Endometrial Serous Carcinoma Arising from Adenomyosis: A Clinico-Pathological Insight

Objective: Endometrial cancer (EC) is the most commonly diagnosed malignancy and has the secondhighest mortality rate among gynecological cancers. Adenomyosis is well-known for abnormal uterine bleeding and is a widely reported entity; however, an EC arising from the adenomyosis is a rare event; even rarer is the occurrence of serous endometrial carcinoma. Case report: A 60-year post-menopausal female presented with post-menopausal bleeding. Subsequently, she underwent a hysterectomy, which showed atrophic and cystic endometrium with extensive adenomyosis and atypical endometrial glands, which are diffusely P53 positive with intervening negative benign and focally positive dysplastic endometrial glands. A final diagnosis of serous endometrial carcinoma arising from adenomyosis was rendered. In a table format, previously reported serous endometrial carcinoma Arising cases from adenomyosis using PubMed search had been described. Conclusion: Serous endometrial carcinoma arising from adenomyosis (<20 cases reported) and has a slightly more dismal prognosis than those deriving from the endometrial cavity. Hence, this case report highlights the occurrence, rarity, and importance of such an entity.

Ultrasound Imaging of Abdominal Wall Endometriosis: A Pictorial Review

Endometriosis is a debilitating disease characterized by endometrial glands and stroma outside the endometrial cavity. Abdominal wall endometriosis (AWE) indicates the presence of ectopic endometrium between the peritoneum and the skin, including subcutaneous adipose tissue and muscle layers, often following obstetric and gynecological surgical procedures. AWE is a not infrequent gynecological surgical complication, due to the increasing number of cesarean sections worldwide. In this pictorial review, we discuss the importance of medical history and physical examination, including the main ultrasound features in the diagnosis of AWE.

Laparoscopic excision of accessory cavitated uterine mass and its vaginal retrieval in toto

Accessory cavitated uterine mass (ACUM), a rare cause of dysmenorrhoea, has to be diagnosed with essential criteria and is to be treated with appropriate surgery. Hereby, presenting the surgical approach by laparoscopy and vaginal retrieval of the specimen in toto as a perfect tool. We report a rare case study of ACUM, a mullerian anomaly in a 27 years old female with severe dysmenorrhoea with secondary infertility, evaluated and diagnosed as ACUM. Preoperative diagnosis and surgical plane evaluation are made by ultrasound and magnetic resonance imaging. Hysteroscopic examination of the cavity was normal and laparoscopic excision of an ill-defined mass in the anterior and right lateral wall of 3×2 cm followed by retrieval of the specimen through a pouch of Douglas. Myometrial defect sutured. Cut section showed chocolate coloured fluid in the endometrial cavity and the same confirmed by histopathology. This is the first case report doing vaginal retrieval of ACUM in toto.