Hysteroscopic Mx of endometrial smooth muscle metaplasia
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Published in the Journal of Minimally Invasive Gynecology, the authors present a case of a 34-year-old woman who presented with abnormal uterine bleeding (AUB-L)(5) and infertility. Pelvic ultrasound and sonohysterogram revealed a normal size uterus with multiple submucous fibroids protruding into the uterine cavity.

Hysteroscopy confirmed the presence of multiple (approximately 15) subcentimiter submucosal fibroids and 2 larger leiomyomas measuring 2 cm in diameter disseminated throughout the uterine cavity. No other abnormality was found in the couple infertility evaluation. Hysteroscopic myomectomies were performed using a continuous flow monopolar resectoscope of 27Fr with en bloc resection of the fibroids to minimize endometrial damage. Fragmentation of the myoma was only required to extract the two larger ones.

Although with a controversial indication, following custom practice, ethinyl estradiol was prescribed to prevent post-myomectomy intrauterine adhesion formation. A follow up hysteroscopy performed 60 days after the initial procedure showed a regular endometrial cavity without recurrence of myoma or presence of intrauterine adhesion.

The pathology reported leiomyomatous proliferation of the endometrial mucosa with areas of endometrial stromal smooth muscle metaplasia (nodular stromal metaplasia with leiomyomatous differentiation).

Differentiation from smooth muscle metaplasia and submucous leiomyomatosis is based on pathologic findings. The presence of smooth muscle tissue is limited to the endometrium and not invading the myometrium in endometrial smooth muscle metaplasia. Clinically, the patient improved with normalization of her menstrual pattern.

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Dr. S●●●●●v S●●●●●1
Dr. S●●●●●v S●●●●●1 Obstetrics and Gynaecology
I hope the fertility would now substantially improve but to be on the safer side I would like to investigate the male partner and plan pregnancy as early as possible instead of wasting more time in following the case any further.
Jan 19, 2019Like