Search Results (21)

Background: The total vaginal hysterectomy (TVH) technique has been performed for many gynecological surgeries but is less used than total abdominal hysterectomy (TAH). The purpose of this study was to analyze the outcomes in patients who underwent either TVH or TAH for enlarged diffuse uterine adenomyosis (ADS). Methods: In this retrospective study, 160 hysterectomies with bilateral adnexectomy were scheduled for premenopausal women with diffuse ADS between 2020 and 2024 at a tertiary care center in Romania. The diagnosis was established based on clinical symptomatology, color Doppler transvaginal ultrasound, transabdominal ultrasonography and magnetic resonance imaging with histopathological confirmation of diffuse uterine ADS post-operatively from the hysterectomy specimen. All surgical procedures were performed by the same surgeon. The patients were divided into two groups: the TVH group (n = 80) and the TAH group (n = 80). Patient characteristics, including age, uterine weight, body mass index (BMI), parity, operative time, intraoperative blood loss, length of hospital stay, medical history, surgical history, intra- and postoperative complications, and the presence of adhesions, were evaluated. Results: No differences were observed between the two groups with regard to uterine weight, BMI, or parity. However, the TVH group was associated with significantly younger age, shorter operative time, lower intraoperative blood loss, and a reduced length of hospital stay (p < 0.001). Additionally, both medical and surgical histories were more frequently observed in the TAH group than in the TVH group. However, intra- (i.e., 3.75%) and postoperative complications (i.e., 13.75% vs. 3.75%) were slightly more frequent in the TAH group, as well as adhesions (i.e., 17.50% vs. 8.75%). Uterine hemisection, tactical myomectomy, or morcellation were frequently employed in the TVH group, being required in 77.5% of cases. Conclusions: In our cohort of patients with enlarged diffuse uterine ADS, TVH was associated with younger age, shorter operative time, reduced intraoperative blood loss, and a shorter length hospital stay compared with TAH, without an observed increase in perioperative complications. These results support the use of TVH as a feasible surgical approach for selected enlarged diffuse uterine ADS. Full article

Background/Objectives: Acromegaly is a systemic connective tissue disease driven by chronic growth hormone (GH) and insulin-like growth factor-1 (IGF-1) excess; yet, the female reproductive tract—especially the extracellular matrix (ECM)-rich cervix—has been poorly studied. We aimed to compare uterine and cervical morphology in women with acromegaly versus healthy controls and a gynecologic disease comparator, testing the hypothesis of selective cervical hypertrophy. Methods: We performed a retrospective case–control study of reproductive-age women who underwent pelvic ultrasound: acromegaly (n = 33), healthy controls (n = 45), and adenomyosis without acromegaly (n = 44). Uterine body measurements were obtained by TAUS/TVUS; cervical biometry was performed transvaginally in all cases. Volumes were estimated using the ellipsoid formula, and a uterus-to-cervix (U:C) volume ratio was calculated. Group differences were analyzed with Mann–Whitney tests and Bonferroni correction. Results: A total of 122 women were included. Uterine body length, width, AP size, and volume did not differ between acromegaly and either comparison group (all p-values non-significant). In contrast, cervical length, width, AP thickness, and volume were significantly higher in acromegaly than in healthy controls, with a corresponding reduction in the U:C volume ratio, indicating disproportionate cervical enlargement. Compared with adenomyosis, women with acromegaly again showed larger cervical width, AP thickness, and volume, together with altered U:C indices, whereas cervical length did not differ, suggesting a pattern not explained by nonspecific pelvic pathology. Conclusions: Women with acromegaly demonstrate a distinct uterine phenotype characterized by selective cervical hypertrophy with preserved uterine corpus size—an ECM-centric “acromegalic uteropathy.” This noninvasive morphometric signature may have diagnostic and procedural relevance and warrants confirmation in prospective studies. Full article

Background and Objectives: Total vaginal hysterectomy (TVH) has been performed quite often for a uterus with prolapse, although less used than total abdominal hysterectomy (TAH). The purpose of this study was to compare the perioperative outcomes of patients who underwent either TVH or TAH for a uterus with a weight between 250 and 300 g and uterine prolapse (UP). Materials and Methods: In this retrospective study, 180 hysterectomies were planned for women with UP between 2020 and 2024 in a tertiary center in Romania. Patients were diagnosed based on clinical symptomatology and transabdominal ultrasound. All hysterectomies were performed by the same surgeon and were divided into two groups: TVH group (n = 90) and TAH group (n = 90). Patients’ characteristics like age, uterine weight, body mass index (BMI), parity, operative time, intra-operative blood loss, hospital stay, medical history, surgical history, intra- and post-operative complications, and adhesions were evaluated. Results: No significant differences were found between groups in terms of mean age, uterine weight, BMI, or parity. TVH was associated with significantly shorter operative time, lower intra-operative blood loss, and reduced hospital stay compared to TAH (p < 0.001). Both medical and surgical histories were more common in the TAH group compared with the TVH group. However, post-operative complications were slightly more frequent in the TAH group (9.99% vs. 3.33%), as were adhesions (33.33% vs. 13.33%). Uterine hemisection, tactical myomectomy, or morcellation were used in most cases to obtain a reduction in uterine size for the TVH group (81.11%). Conclusions: Our results showed that shorter operating time, lower intra-operative blood loss, and reduced hospital stay support the use of TVH in the case of an enlarged uterus with UP. The present study showed that all patients requiring hysterectomy for such conditions can be offered TVH, which could represent a better therapy option. Full article

Uterine leiomyomas are a heterogenous group of benign mesenchymal tumours. While diagnosis is usually achieved through clinical assessment and pelvic ultrasound (PU), atypical subtypes are not as easily recognisable and can be mistaken for malignant tumours such as leiomyosarcoma or ovarian carcinoma. We describe the case of a 41-year-old patient who presented with increasing bulk symptoms, urinary frequency and growth of a hydropic leiomyoma (HLM) of the left lateral and posterior uterine wall that had been known for 10 years, confirmed with previous biopsy. The tumour filled the entire pelvic cavity in PU and was increasingly difficult to delineate; therefore an abdominal hysterectomy without oophorectomy was performed. Gross tissue examination showed an irregularly enlarged, asymmetric uterus with an intrauterine subserosal mass and an extrauterine papillary tumour arising from the right and posterior uterine wall. The tumour measured 20 × 17 × 10 cm in size. Numerous smooth muscle nodules were observed within the uterus and extending into the extrauterine component in a continuous transition, exhibiting a benign, bland appearance. The nodules were separated by abundant edematous connective tissue with increased vascularization. Histopathological analysis revealed low mitotic activity with no evidence of nuclear atypia, pleomorphism, or necrosis. Immunohistochemical staining confirmed the diagnosis of a benign smooth muscle tumour. Our findings confirm a rare, benign smooth muscle neoplasm with both intrauterine and extrauterine involvement, and add to the existing literature regarding presentation, diagnostic and therapeutic challenges associated with HLM. Full article

Uterine adenosarcoma with sarcomatous overgrowth (ASSO) is an exceptionally rare and aggressive subtype of uterine sarcomas, characterized by high mitotic activity, deep myometrial invasion, and an elevated risk of recurrence and metastasis. We report the case of a 79-year-old institutionalized woman with a history of hypertension, type 2 diabetes, chronic hepatitis B, and mild Alzheimer’s disease. During routine hepatic ultrasound surveillance, an incidental 26 mm endometrial lesion was detected. Initial diagnostic hysteroscopy revealed a benign endometrial polyp. However, due to the patient’s institutionalization and absence of gynecologic symptoms, no specialized follow-up was conducted. Four years later, she presented with profuse postmenopausal bleeding. Imaging revealed a markedly enlarged uterus with a 12–13 cm heterogeneous endometrial mass containing cystic and hemorrhagic areas, demonstrating diffusion restriction and significant contrast enhancement on MRI, with no radiologically suspicious lymphadenopathy. Hysteroscopy demonstrated a giant polyp with a broad implantation base; histology suggested sarcomatous transformation. Definitive diagnosis after total hysterectomy with bilateral salpingo-oophorectomy confirmed high-grade ASSO with homologous sarcomatoid overgrowth, consistent with endometrial stromal sarcoma. This case illustrates the progressive malignant transformation of an initially benign-appearing lesion in a patient with significant comorbidities and limited follow-up. It underscores the importance of clinical vigilance, regular monitoring, and interdisciplinary coordination in the evaluation of uterine enlargement in asymptomatic postmenopausal women. Full article

Background and Objectives: Gestational hydronephrosis (GH) is a physiological condition commonly observed during pregnancy, resulting from hormonal effects and mechanical compression of the ureters by the enlarging uterus. Although often asymptomatic, GH can cause urinary stasis, recurrent infections, and renal function impairment in symptomatic cases. The optimal management of such cases remains controversial, especially regarding the role of ureteral stent placement. This study aimed to compare clinical outcomes—including renal function, inflammatory markers, and obstetric parameters—in pregnant women with symptomatic GH who underwent ureteral stent placement versus those managed conservatively. Materials and Methods: We conducted a retrospective cohort study at Düzce University Hospital between 2020 and 2024, including 40 pregnant women diagnosed with symptomatic GH. The patients were divided into the following two groups: those who received a ureteral stent (n = 20) and those who were managed with conservative treatment (n = 20). Conservative management included hydration therapy, acetaminophen-based analgesia, and close clinical monitoring. The parameters assessed included serum creatinine, estimated glomerular filtration rate (GFR), inflammatory markers (C-reactive protein, erythrocyte sedimentation rate, and white blood cell count), urinary findings, obstetric outcomes, and postpartum complications. Statistical significance was set at p < 0.05. Results: Gestational age at diagnosis was significantly higher in the stent group (29.1 ± 3.2 weeks) than in the non-stent group (27.1 ± 3.5 weeks; p = 0.045), possibly reflecting increased mechanical compression in later pregnancy. Renal function parameters (serum creatinine and GFR), inflammatory markers (CRP, ESR, and WBC count), and obstetric outcomes (birth weight, Apgar scores) showed no significant differences between groups (p > 0.05). Interestingly, gestational diabetes mellitus (GDM) was more prevalent in the non-stent group (20% vs. 5%; p = 0.042), although no significant differences were found in fasting glucose levels. Conclusions: Ureteral stent placement in symptomatic GH does not appear to significantly improve renal function or obstetric outcomes. However, it may provide symptom relief in select patients with persistent or severe discomfort. Given the limitations of retrospective data and a small sample size, further prospective studies with larger cohorts and quality-of-life assessments are warranted to optimize management strategies and enhance patient-centered care. Full article

The reproductive cycle in domestic dogs involves prolonged phases of hormonal activity, making the endometrial tissue vulnerable to degenerative changes. One common result of these changes is cystic endometrial hyperplasia (CEH), which often leads to pyometra. Another, though rarer, condition is pseudo-placentational endometrial hyperplasia (PEH), characterized by abnormal proliferation of the endometrial glands and stroma, forming placental-like structures without the presence of pregnancy. Case presentation: An 8-year-old female Golden Retriever, healthy and intact, was presented for a routine ultrasound examination to confirm pregnancy after natural breeding 25 days earlier. Two previous pregnancies of this bitch have resulted in small but live litters. The ultrasound examination revealed multiple bilateral thickenings of the uterine horns, with ampullary-shaped enlargements measuring approximately 2.5 × 3.0 cm 25 days after breeding. The endometrium was conspicuously thickened, hypoechogenic, and either homogeneous or with scattered hyperechoic markings and faint striations. The mucosal surface ranged from regular to slightly irregular, and a small amount of hyperechoic condensed fluid was present in the lumen of the horns. No embryos were observed. Based on these findings, two primary diagnoses were considered: PEH or embryonic resorption sites, with a possible segmental uterine inflammation. A diagnosis suggestive of PEH was established through histopathological examination of the uterus after ovariohysterectomy, supported by consistent ultrasound findings that showed no progression or changes over time. Full article

This case report includes the clinical utility of ultrasonography, intrauterine endoscopy (hysteroscopy), and computed tomography (CT) in the preoperative evaluation of hydrometra in a pet goat, which did not completely heal with medical therapy using prostaglandin F2α. Ultrasonography revealed an anechoic liquid within the uterine lumen on a percutaneous scan. CT identified an enlarged uterus and right ovary with a cystic follicle-like structure. Hysteroscopy revealed an accumulation of clear fluids within the uterine lumen and a corrugated, thickened endometrial structure. Plasma estradiol-17β (E2) concentrations were found to be higher (41.9 pg/mL) than normal levels, whereas plasma progesterone (P4) concentrations were at normal levels (0.55 ng/mL) during the follicular phase. Histopathological examination of the endometrium removed by biopsy revealed accelerated mucosal secretion with hyperplasia. Ovariohysterectomy was performed 14 days after the initial diagnosis. Immediately before surgery, plasma E2 and P4 levels were 23.4 pg/mL and 18.34 ng/mL, respectively. Histopathological examination of the surgically removed endometrium revealed cystic endometrial hyperplasia in the uterus and follicular cysts in the ovary. Based on these results, the patient was histologically diagnosed with hydrometra, including cystic endometrial hyperplasia, possibly induced by follicular cysts in the ovary. Ultrasonography and intrauterine endoscopy enabled clear visualization of the secreted mucosa within the uterine lumen, whereas CT enabled an effective visualization of an ovary with a cystic follicle structure. Preoperative observations based not only on ultrasonography but also on evaluations, particularly combined with CT and endoscopy, are useful in diagnosing hydrometra and determining the need for ovariohysterectomy in goats. Full article

The clinical outcomes of laparoscopic-assisted ovariohysterectomy for the treatment of hydrometra or pyometra in small-sized dogs have not been reported. This study aimed to retrospectively investigate the clinical outcomes of two-port laparoscopic-assisted ovariohysterectomy in small-sized dogs weighing < 6 kg with mild to moderate hydrometra or pyometra. Laparoscopic ports were placed at the umbilicus on the midline, as well as at the midpoint between the umbilicus and pelvic brim. While the uterine horn was externally retracted, the cervical region was ligated and transected. A total of 77 dogs were included, with a median age of 8.8 years (range: 10 months to 16.1 years) and a median weight of 3 (range: 1.26–6.0) kg. Clinical signs included lethargy, anorexia, polydipsia, and polyuria; 51 dogs (66%) were asymptomatic, with an enlarged uterus incidentally detected during health checkups. Histopathological analysis revealed hydrometra and pyometra in 51 and 26 dogs, respectively. The median operative time was 32 (range: 15–83) minutes, and the median hospital stay was 0 (range: 0–3) days. No intraoperative complications occurred, although 18 dogs experienced anorexia postoperatively, and 3 showed signs of incision site infection. All sutures were removed 7–10 days postoperatively, and all dogs were clinically healthy at the two-week follow-up. The findings indicate that two-port laparoscopic-assisted ovariohysterectomy is a safe and effective treatment option for managing mild to moderate hydrometra and pyometra in small-sized dogs. Full article

Background/Objectives: Hysterectomy (HE) is the most common surgical procedure in gynecology worldwide. The guidelines of most countries unanimously recommend vaginal hysterectomy (VH) as the access of first choice. However, there are significant international differences in the implementation of this recommendation. Methods: In the consistent implementation of the national guidelines, the aim of this prospective observational cohort study was to evaluate how many hysterectomies can be performed vaginally under real-world conditions for benign indications excluding genital prolapse and extensive endometriosis. For this purpose, the requirements of the guidelines were implemented for all HE cases. All HEs were performed by a single, experienced surgeon. The aim was not to go to the limits of the method, but to develop a reproducible benchmark with the lowest possible complication rate. Results: From 2011 to 2020, 230 hysterectomies were performed for benign indications. A VH was performed in 146 cases (63.5%), and a laparoscopic hysterectomy (LH) in 75 cases (32.6%). An abdominal hysterectomy (AH) was only required in nine cases (3.9%). The decision for LH was made in half of the cases due to the assumed presence of endometriosis or a significantly enlarged uterus. The median duration of VH was 32 min (range 16–118 min), and the uterine weights were 15–540 g. The rate of postoperative complications of VH was 3.4%. Conclusions: In line with international guidelines, VH is possible in over 60% of cases with a short surgical time and a low complication rate. LH procedures are useful in the presence of assumed additional pathology in 35%. AH is reserved for huge uteri. A reduction in AH below 10% is possible. The global target could be a rate of 60–30–10% for VH, LH, and AH. Full article

Uterine tumor resembling ovarian sex-cord tumor (UTROSCT) is a rare form of uterine mesenchymal neoplasm. Although UTROSCT generally exhibits benign behavior with a favorable prognosis, this neoplasm is nevertheless classified as being of uncertain malignant potential, given its low rate of recurrence and the fact that it rarely produces metastases (e.g., in the lymph nodes, epiploic appendix, omentum, small bowel, subcutaneous tissue, lungs). Its histogenesis is also uncertain. Typically, UTROSCT occurs in peri-menopausal or menopausal women, but it can sometimes be observed in young women. Usually, this neoplasm can be found in the uterine corpus as a nodular intramural lesion, while it is less frequently submucosal, subserosal, or polypoid/intracavitary. UTROSCT can cause abnormal bleeding, pelvic pain, enlarged uterus, and mass sensation, but sometimes it is found purely by chance. This neoplasm can be considered polyphenotypic on morphological, immunohistochemical, and genetic analyses. Generally, upon microscopic examination, UTROSCT shows a predominant pattern of the cords, nests, and trabeculae typical of sex-cord tumors of the ovary, while immunohistochemically it is characterized by a coexpression of epithelial, smooth muscle, and sex-cord markers. The aim of this review is to report clinical and pathological data and genetic alterations to establish their impact on the prognosis and management of patients affected by this rare entity. Full article

Parturition is the final and essential step for mammalian reproduction. While the uterus is quiescent during pregnancy, fundamental changes arise in the myometrial contractility, inducing fetal expulsion. Extracellular matrix (ECM) remodeling is fundamental for these events. The gelatinases subgroup of matrix metalloproteinases (MMPs), MMP2 and MMP9, participate in uterine ECM remodeling throughout pregnancy and parturition. However, their loss-of-function effect is unknown. Here, we determined the result of eliminating Mmp2 and/or Mmp9 on parturition in vivo, using single- and double-knockout (dKO) mice. The dystocia rates were measured in each genotype, and uterine tissue was collected from nulliparous synchronized females at the ages of 2, 4, 9 and 12 months. Very high percentages of dystocia (40–55%) were found in the Mmp2^−/− and dKO females, contrary to the Mmp9^−/− and wild-type females. The histological analysis of the uterus and cervix revealed that Mmp2^−/− tissues undergo marked structural alterations, including highly enlarged myometrial, endometrial and luminal cavity. Increased collagen deposition was also demonstrated, suggesting a mechanism of extensive fibrosis in the Mmp2^−/− myometrium, which may result in dystocia. Overall, this study describes a new role for MMP2 in myometrium remodeling during mammalian parturition process, highlighting a novel cause for dystocia due to a loss in MMP2 activity in the uterine tissue. Full article

Widely viewed as an enigmatic disease, adenomyosis is a common gynecological disease with bewildering pathogenesis and pathophysiology. One defining hallmark of adenomyotic lesions is cyclic bleeding as in eutopic endometrium, yet bleeding is a quintessential trademark of tissue injury, which is invariably followed by tissue repair. Consequently, adenomyotic lesions resemble wounds. Following each bleeding episode, adenomyotic lesions undergo tissue repair, and, as such, platelets are the first responder that heralds the subsequent tissue repair. This repeated tissue injury and repair (ReTIAR) would elicit several key molecular events crucial for lesional progression, eventually leading to lesional fibrosis. Platelets interact with adenomyotic cells and actively participate in these events, promoting the lesional progression and fibrogenesis. Lesional fibrosis may also be propagated into their neighboring endometrial–myometrial interface and then to eutopic endometrium, impairing endometrial repair and causing heavy menstrual bleeding. Moreover, lesional progression may result in hyperinnervation and an enlarged uterus. In this review, the role of platelets in the pathogenesis, progression, and pathophysiology is reviewed, along with the therapeutic implication. In addition, I shall demonstrate how the notion of ReTIAR provides a much needed framework to tether to and piece together many seemingly unrelated findings and how it helps to make useful predictions. Full article

A nine-year-old intact female sable antelope (Hippotragus niger) with a six-week history of gradual loss of body condition was found dead by the owner and presented for autopsy. Macroscopic examination revealed an enlarged spleen and liver with the hepatic and splenic parenchyma showing extensive infiltration with firm, white to cream-coloured nodules. The uterus showed a few small, firm, well-demarcated, white-to-cream-coloured nodules in the uterine body. Similar nodules were present in the mediastinum, parietal pleura, heart, and marrow cavity of the femur. Histological analysis of the uterus revealed densely cellular neoplastic proliferations, forming nests, tubules, and acini within an abundant fibrovascular stroma. The samples from the other tissues revealed neoplastic cells with a similar appearance to those seen in the uterus, also forming nests and acini in a fibrovascular stroma. Importantly, multiple neoplastic cells were also seen in the peribronchiolar lymphatic vessels. The neoplastic cells in the uterine sections showed positive immunohistochemical labelling for cytokeratin, as did the neoplastic cells in the sections of liver and parietal pleura, confirming they were of epithelial origin. In addition, transmission electron microscopy of the uterus and liver showed neoplastic cells arranged in groups surrounded by basement membranes and interspersed with collagen fibres. Junctions were present between the cells, and junctional complexes could be seen at some cell surfaces. This confirmed that the neoplastic cells seen in the liver sample were the same as those seen in the uterine sample and were of epithelial origin. Thus, a diagnosis was made of uterine adenocarcinoma with widespread metastasis. This is the first report of uterine adenocarcinoma in a sable antelope. Full article

An 8.5-year-old intact female lion (Panthera leo) with a history of vomiting, lethargy, and anorexia was referred to our institution. On physical examination, the lion weighed 180 kg and had a rectal temperature of 40 °C. Blood analysis showed mild neutrophilic leukocytosis, and abdominal ultrasonography revealed an enlarged uterus with echogenic fluid. Based on the clinical signs and hematologic and ultrasonographic findings, the lion was tentatively diagnosed with pyometra. Ovariohysterectomy was performed using the lateral flank approach to avoid complications that can occur with ventral celiotomy. Surgery was performed successfully despite unexpected rupture of the uterus which had occurred before the surgery. The lion recovered uneventfully and continued to do well at the 1 year follow up after surgery. To the best of our knowledge, this is the first reported case of ovariohysterectomy with the lateral flank approach in a lion with pyometra. Our report suggests that ovariohysterectomy with the lateral flank approach could be considered as an alternative method for pyometra in wild big cats with risk of complications at the surgical site. Full article