HYSTEROSCOPY CASE PRESENTATION

HISTORY:

This patient is a 50 year old GoPo female whose last period was four years ago. She was being followed by a gynecologist for pelvic pain and recently had an ultrasound showing a thickened endometrium. It was recommended that she have a D & C. She sought a second opinion prior to having the procedure.

She has a diagnosis of mild to moderate osteoporosis involving only the hip.

PHYSICAL EXAM:

There were no abnormal findings with the exception of very atrophic vaginal mucosa and introitus. The uterus was normal size and the adnexa were not appreciated secondary to her postmenopausal status.

RADIOLOGIC EXAMINATION:

An initial transvaginal ultrasound was performed which revealed a markedly thickened endometrial cavity with there being no distinct border between the endometrium and myometrium.

A somohysterogram was performed to more specifically define intrauterine anatomy, which revealed an asymmetric cavity again with this markedly thickened area.

Because of the asymmetric nature of this lesion, a decision was made to perform an operative hysteroscopy with resection of what was felt to be most likely a polyp.

INITIAL SURGERY:

Under general anesthesia and using a continuous flow

Because of the asymmetric nature of this lesion, a decision was made to perform an operative hysteroscopy with resection of what was felt to be most likely a polyp.

PAST MEDICAL HISTORY:

She has a past history of multiple meningiomas and is on an experimental protocol consisting of RU486 for suppression of the tumors and Dilantin for seizure control. She was not on estrogen replacement therapy because it was the feeling of the investigators perscribing the RU486 that estrogen use may stimulate growth of these tumors.

The pathology came back as probable benign cystic hyperplasia or endometrial polyp with multiple cystic components to it.

SECOND SURGICAL PROCEDURE:

Because of concern over possible further changes to this lesion over time and that the patient needed to continue her RU486 to control the growth of her meningiomas, the patient elected to undergo laparoscopic assisted vaginal hysterectomy.

At the time of the procedure the body of the uterus was extremely soft and spongy. The uterus was opened after removal revealing a transmural process with cystic changes but of a benign nature.

DISCUSSION:

There have been no reports of women who have been treated with extended therapy with RU486. However as the possible approval of its use by the FDA becomes more likely and with individuals considering usage in women with endometriosis, the long term use of this drug may become more common. More data needs to be gathered about its use in women who have intact ovarian function to see if a situation of unopposed estrogen is created by this usage.

She was not on estrogen replacement therapy because it was the feeling of the investigators perscribing the RU486 that estrogen use may stimulate growth of these tumors.

The pathology came back as probable benign cystic hyperplasia or endometrial polyp with multiple cystic components to it.