Introduction: Adenomyosis is a benign gynecological condition that predominantly affects women in the late reproductive age. It is a real challenge in healthcare with prevalence ranging from 5 to 70%. It is characterized by uterine enlargement caused by ectopic rests of the endometrium within the myometrium. It is mainly associated with abnormal menstrual bleeding and severe dysmenorrhea. But now it can be done by advanced imaging modalities like transvaginal ultrasound (USG) and magnetic resonance imaging (MRI). Materials and methods: A prospective longitudinal study was conducted from November 1, 2018 to January 31, 2020 on subjects with complaints of abnormal uterine bleeding and or with dysmenorrhea in the department of obstetrics and gynecology (OBG) of a tertiary care hospital and medical institution. Various medical and surgical treatments were offered on merit depending on age group and clinical symptomatology. The subjects were followed up for a minimum period of six months thereafter. Results: It was found that out of the patients who had visual analog scale (VAS) score less than 7, 22.58% had adenomyosis with normal uterus while 12.90% had bulky uterus with adenomyosis on ultrasound. Of the patients who had VAS score more than or equal to 7, 9.68% had adenomyosis with normal uterus while 54.84% had bulky uterus with adenomyosis. MRI supplemented the ultrasound findings and was found useful in the confirmation of adenomyosis. Conclusion: The clinical diagnosis of adenomyosis has been called enigmatic largely because there are no pathognomonic symptoms of this disease. Ultrasound and MRI are found to be highly useful in supplementing the correct diagnosis of adenomyosis.
BackgroundSubsets of GCA have extensive vascular involvement, termed Large Vessel GCA (LV-GCA), seen in 12%–37% depending on imaging used. These patients have higher relapse rates and are more often refractory to glucocorticoids (GC), requiring steroid-sparing treatment to minimise GC toxicity and vascular complications. Diagnosis is reliant upon imaging, given the relative inaccessibility of tissue for histological analysis beyond temporal artery biopsy (TAB). If axillary and subclavian arteries are often affected, vascular ultrasound could be an effective screening tool.ObjectivesTo determine disease distribution in the Southend Large Vessel Vasculitis (LVV) cohort, particularly levels of axillary and subclavian involvement.MethodsThe cohort has sixty-five patients (2010–2017), from which sixty 18F-FDG-PET/CT scans were performed. They were retrospectively examined by two nuclear radiologists. Vascular involvement was determined by consensus opinion at six territories (thoracic-aorta, abdominal-aorta, subclavian, axillary, carotid, vertebral, and iliac and femoral). Six negative scans were excluded from analysis, with LVV confirmed from other evidence (ultrasound, computed tomography). Of these, four were on concurrent GC (7–12 mg prednisolone), raising the possibility of “false negatives”. Nineteen scans were positive despite GC (1–60 mg prednisolone). Higher doses tended to be of short duration, being unable to postpone due to clinical necessity, but exceeded the 3 day limit at which FDG signal starts to attenuate.Abstract AB0663 – Figure 1Disease distribution via 18F-FDG-PET/CTResults14.8% (n=8) had isolated supra-aortic disease, 14.8% (n=8) had isolated aortic disease, and 29.6% (n=16) had involvement in both (Fig 1). 72.2% of scans had involvement at either or both of the axillary and subclavian territories. Femoral and iliac involvement alone was seen in 1.9% (n=1), and in addition to aortic involvement in 7.4% (n=4). In this latter group, it was limited to the abdominal aorta in half, and included 1 case of Retroperitoneal Fibrosis. 31.5% (n=17) had involvement in all 3 regions. 24.1% (n=13) had no supra-aortic involvement.ConclusionsThis cohort demonstrates LVV has a predilection for aortic and supra-aortic regions. High axillary and subclavian involvement supports the use of vascular ultrasound as an effective imaging tool. Further imaging would still be warranted if suspicion remained high despite negative ultrasound, or to assess for vascular complications and alternate pathology. 18F-FDG-PET/CT is not without limitations. Atherosclerosis and vascular remodelling display increased FDG uptake, so requires cautious interpretation. Further research on GC influence is also needed. As such it has a role in monitoring flaring or non-responsive patients, rather than routine interval scanning. For the latter, ultrasound may be an alternative, especially if there is previously documented intimal-medial thickening at ultrasound accessible sites.References[1] Dejaco C, Brouwer E, Mason JC, Buttgereit F, Matteson...
Endometriosis is the presence of endometrial tissue outside the uterus. Endometriosis affects 10-15% of all women in reproductive age group and 70% of the women with chronic pelvic pain. The risk of malignant transformation in an endometrioma has been reported to be low, though there is an increased risk for certain gynecological as well as non-gynecological carcinomas with endometriosis. We present a case diagnosed as having endometrioma transforming into a malignant tumor in a young female. We intend to emphasize that all the clinicians should make their patients aware of the malignant potential of endometriosis and a strict follow up of all cases being treated conservatively should be a must.
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