Hong-Hui Shi

Clinical characteristics and prognostic features of intravenous leiomyomatosis with inferior vena cava or intracardiac extension

OBJECTIVEnThe aim of this study was to explore the clinical characteristics and prognostic features of intravenous leiomyomatosis (IVL) with inferior vena cava extension (IVCE) or intracardiac extension (ICE).nnnMETHODSnA retrospective analysis was conducted of the clinical data of 38 patients with pathologically diagnosed IVL with IVCE or ICE.nnnRESULTSnThe mean age of the patients was 44.05xa0± 6.31 years. Twenty-two patients (57.9%) had a history of uterine leiomyoma. Nine patients (23.7%) had a history of IVL without IVCE or ICE. The most common symptoms were chest tightness (seven patients), lower limb swelling (five patients), palpitation (four patients), dizziness (two patients), and abdominal distention (two patients). Preoperative diagnoses were achieved in 28 patients (73.7%); 23 patients (60.5%) underwent one-stage surgery, whereas 15 (39.5%) underwent two-stage surgery. Eighteen patients (72%) received postoperative antiestrogen hormone therapy. Regular follow-up was available in 30 patients, with a median follow-up time of 12.0 months; 15 patients (50.0%) showed evidence of recurrence. Factors such as postoperative antiestrogen hormone therapy (9/20 compared with 6/10; Pxa0= .601), duration of postoperative hormonal therapy (10/15 in >6 months compared with 5/15 in ≤6 months; Pxa0= .862), and heart involvement (10/22 compared with 5/8; Pxa0= .669) were not significantly associated with recurrence.nnnCONCLUSIONSnIVL with IVCE or ICE is a rare disease with nonspecific manifestations. Surgery is the primary treatment. The postoperative recurrence rate is high, and postoperative antiestrogen hormone therapy is not significantly correlated with recurrence.

Reliability and validity of a Chinese version of the Modified Body Image Scale in patients with symptomatic pelvic organ prolapse

To validate a Chinese version of the Modified Body Image Scale (MBIS) among patients with symptomatic pelvic organ prolapse.

Predictive factors of ovarian carcinoma for women with ovarian endometrioma aged 45 years and older in China

BackgroundTo explore the risk factors of endometriosis-associated ovarian cancer (EAOC) in women with ovarian endometriosis (OEM) aged 45xa0years and above in China.MethodsThis study reviewed the medical records of 1038 women in total who were aged 45xa0years and above, surgical-pathologically diagnosed with ovarian endometriosis, and were treated at Peking Union Medical College Hospital between December 1996 and December 2016. Histology evaluation was used to determine whether the ovarian endometriosis specimen was with (nxa0=xa030) or without (nxa0=xa01008) ovarian cancer.Results2.9% (30/1038) of women with the surgical-pathological diagnosis of ovarian endometriosis were found to have EAOC. Those patients with EAOC were prone to be in the postmenopausal status at the time of the diagnosis (OR 5.50, 95%CI 2.54–11.90, Pxa0<xa0.001) and larger size of tumor (≥8xa0cm, OR 7.19, 95% CI 3.34–15.50, Pxa0<xa0.001), and higher prevalence of coexisting with endometrial disorders (OR 4.11, 95%CI 1.73–9.73, Pxa0=xa0.003). This study showed that patients of an older age when diagnosed with OEM, were at a higher risk of developing EAOC, respectively measuring of 1.7% (13/751) at 45–49xa0years, 5.6% (12/215) at 50–54xa0years, and 10.0%(5/50) at 55–59xa0years (Pxa0<xa00.001).ConclusionsThis study showed that for women aged 45xa0years and above who were diagnosed with OEM, the independent risk factors of EAOC were menopausal status, tumor size of 8xa0cm or greater in diameter, and coexisting endometrial disorders. Therefore, intensive follow-ups or active interventions should be considered for them.

Clinical Manifestations of Adenomyosis Patients with or without Coexisting Endometriosis

To the Editor: Uterine adenomyosis (AM) is caused by the ectopic growth of endometrial glands and stroma in the myometrium of the uterus, accompanied by hyperplasia and hypertrophy of the surrounding smooth muscle cells, leading to a diffuse enlargement of the uterus. Although AM is a common benign gynecological disease, it may cause severe dysmenorrhea, menorrhagia, enlarged uterus, and infertility, which have negative impacts on patients’ health and quality of life. Thus far, there is a lack of high‐quality data to give clinicians a comprehensive understanding of AM with regard to its clinical manifestations and pathological characteristics. This report presented clinical and pathological features of AM with or without coexisting endometriosis (EM) to assist clinicians and patients to make early diagnosis and intervention for such a disease in the future. We hoped that the above features would improve patients’ fertility and their quality of life.

Risk Factors for Recurrence of Ovarian Endometriosis in Chinese Patients Aged 45 and Over

Background: When considering the issue of recurrence, perimenopausal women may have more dilemma during management comparing with young women, for example, whether to retain the uterus and ovary during surgery, whether it is necessary to add adjuvant medicine treatment after operation, and there is no evidence for reference about using of gonadotropin-releasing hormone agonist. This study aimed to study the risk factors for the recurrence of ovarian endometriosis (EM) in patients aged 45 and over. Methods: This is a retrospective nested case-control study. We reviewed the medical records of patients aged over 45 years who underwent surgical treatments for ovarian EM from 1994 to 2014, in Peking Union Medical College Hospital of Chinese Academy of Medical Sciences. By following up to January 2016, 45 patients were found to have relapses and regarded as the recurrence group. The patients with no recurrence during the same follow-up period were randomly selected by the ratio of 1:4 as the nonrecurrence group (180 patients in total). Stratified Cox regression was used to analyze the risk factors of the recurrence. Results: Univariate analysis showed that there was a significant difference in the postoperative treatment (the percentage of patients who received postoperative treatment in non-recurrence group and recurrence group, 23.9% vs. 40.0%, &khgr;2 = 4.729, P = 0.030) and ovarian preservation (the percentage of patients who received surgery of ovarian preservation in non-recurrence group and recurrence group, 25.0 % vs. 44.4%, &khgr;2 = 19.462, P < 0.001) between the nonrecurrence group and the recurrence group. There was no correlation between recurrence and the following factors including patients age, menarche age, gravidity, parity, CA125 level, ovarian lesions, menopausal status, combined benign gynecological conditions (such as myoma and adenomyoma) and endometrial abnormalities, and surgical approach or surgical staging (all P > 0.05). Multivariate analysis indicated that whether to retain the ovary was the only independent risk factor of recurrence for patients aged 45 years and over with ovarian EM (odds ratio: 5.594, 95% confidence interval: 1.919–16.310, P = 0.002). Conclusion: Ovarian preservation might be the only independent risk factor of recurrence for patients aged 45 years and over with ovarian EM.

Medium-term outcomes after combined trachelectomy and uterosacral ligament suspension among young women with severe uterine prolapse.

To evaluate anatomic and sexual outcomes among young women with severe pelvic organ prolapse undergoing combined trachelectomy and laparoscopic high uterosacral ligament suspension (LHUS).