Chronic pelvic pain (CPP) affects approximately 26% of women and significantly impacts quality of life. Common causes include dysmenorrhea and pelvic floor dysfunction. Transcutaneous electrical nerve stimulation (TENS) is widely used for pain relief to inhibit pain transmission and stimulate endogenous opioid release. The aim of this study is to evaluate the effectiveness of TENS in the rehabilitation of pelvic pain in women through randomised controlled trials (RCTs). A systematic search was conducted in PubMed and ClinicalTrials.gov databases using the terms "transcutaneous electrical nerve stimulation", "pelvic pain", and "pelvic floor", selecting RCTs published between 2020 and 2025. Inclusion criteria followed the PICO framework, targeting adult women with CPP and TENS as the intervention. Studies involving males, pregnancy, or without full texts were excluded. PRISMA guidelines were followed; study quality was assessed using the Cochrane risk of bias tool. Four RCTs met the inclusion criteria; they involved 281 participants. Three studies focused on primary dysmenorrhea (PD) and one on vestibulodynia. All studies reported a significant reduction in pain following TENS treatment, assessed by the visual analogue scale or numeric rating scale, with some studies also noting reduced analgesic consumption. However, improvements in secondary outcomes such as sexual function and pelvic floor muscle strength were inconsistent. Transcutaneous electrical nerve stimulation appears to be an effective, safe, and non-invasive modality for reducing pelvic pain in women, especially in cases of PD and vestibulodynia. Evidence remains limited by heterogeneity in study protocols and outcome measures. Further high-quality RCTs are needed for standardized protocols and broader rehabilitative outcomes, including functional and quality-of-life improvements.
Introduction:We aimed to investigate the prognostic significance of estrogen receptor status (ER)-low status in breast cancer (BC). Additionally, we compared the ER-low subgroup with ER-negative and ER-high BC according to clinical, histopathological and molecular factors. Material and methods:The analysis included medical records of BC patients treated at the National Institute of Oncology in Gliwice, Poland, between 2002 and 2018. Results:Of the 657 tumours, 14% were classified as ER-low, 52% as ER-high and 34% as ER-negative. Patients with ER-low tumours were more likely to present with T3-T4 disease compared with those with ER-high (19% vs. 12%, p = 0.089) and less frequently than ER-negative (19% vs. 29%, p = 0.092). Patients with ER-low tumours were less likely to be progesterone receptor status (PgR) negative (19% vs. 92%, p < 0.001) and G3 (22% vs. 49%, p < 0.001) compared with ER-negative. BRCA P/LP (pathogenic/likely pathogenic) variants were less frequent in ER-low than in ER-negative tumours (5% vs. 20%, p = 0.001). Overall survival (OS) was similar in both ER-high and ER-low groups (p = 0.333; 5-year OS: 93% vs. 92%, 7-year OS: 86% vs. 83%). Overall survival was non-significantly better for those with ER-low compared with ER-negative (p = 0.107). Conclusions:Estrogen receptor-low status appears to be associated with a higher T stage and PgR negativity compared with ER-high tumours, and with a lower grade and fewer BRCA P/LP variants compared with ER-negative tumours. A trend toward improved OS was observed in ER-low compared with ER-negative patients.
The global discourse surrounding menopause has undergone a seismic shift, transitioning from clinical silence to a hyper-visible cultural phenomenon. However, this "menopausal turn" has introduced a significant paradox: while visibility reduces stigma, it frequently replaces clinical nuance with market-driven, reductive narratives. This paper provides a comprehensive bio-psycho-social synthesis of the menopause transition, bridging the gap between emerging neurobiological evidence and contemporary public discourse. We examine the neuroendocrine basis of perimenopausal mood changes, illustrating how fluctuating ovarian steroids - specifically oestradiol and progesterone - modulate serotonergic, dopaminergic, and GABAergic systems to create a window of psychiatric vulnerability. Challenging the "oestrogen deficiency" monocausal model, we integrate epidemiological data from major longitudinal cohorts, such as the Study of Women's Health Across the Nation, to highlight the "domino effect" of vasomotor symptoms, sleep fragmentation, and pre-existing psychosocial stressors. A critical focus is placed on the diagnostic attribution bias prevalent across medical specialties. We argue that primary care and psychiatry often operate through divergent "disciplinary lenses," leading to the misattribution of symptoms and fragmented care pathways. Furthermore, we critique the commercialisation of the "wellness" industry, which often leverages "femvertising" to promote non-clinical solutions that mask complex neurobiological realities. Ultimately, this paper advocates for a nuanced, interdisciplinary framework. By reconciling physiological evidence with the lived sociocultural experience, healthcare providers can move beyond superficial public narratives to deliver individualized, evidence-based care that addresses the holistic mental and physical wellbeing of women navigating this profound midlife transition.
Introduction:The relationship between the triglyceride-glucose (TyG) index - a reliable surrogate marker of insulin resistance - and stress urinary incontinence (SUI) in women remains insufficiently explored. Material and methods:We analysed cross-sectional data from 9,184 women aged 20 years and older, obtained from the National Health and Nutrition Examination Survey cycles spanning from 2001 to 2023. Stress urinary incontinence was defined based on self-reported urine leakage during physical exertion. The triglyceride-glucose index was calculated as ln[fasting triglycerides (mg/dl) × fasting glucose (mg/dl)/2], and its derivatives were computed by multiplying TyG with body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR), respectively. Multivariable logistic regression models, adjusted for sociodemographic, behavioural, and clinical covariates, were employed to assess independent associations. Dose-response relationships were examined using tertile analyses, and nonlinear associations were explored with restricted cubic splines. Results:The overall prevalence of SUI was 41.77% (n = 3,836). In fully adjusted models, all TyG-related indices demonstrated significant, dose-dependent positive associations with SUI risk. Compared to the lowest tertile (T1), the highest tertile (T3) exhibited markedly increased odds of SUI: TyG (odds ratio (OR) = 1.46, 95% CI: 1.29-1.66), TyG-BMI (OR = 2.50, 95% CI: 2.21-2.82), TyG-WC (OR = 2.29, 95% CI: 2.02-2.59), and TyG-WHtR (OR = 2.39, 95% CI: 2.10-2.71), with all p-values < 0.001. Nonlinear relationships were statistically significant (p < 0.05). Conclusions:Elevated levels of TyG-derived indices, particularly TyG-BMI and TyG-WHtR, are independently associated with an increased prevalence of SUI among U.S. adult women.
Transitional cell carcinoma (TCC) of the endometrium is an extremely rare histologic subtype of endometrial carcinoma. While TCC is more frequently observed in the ovary, only a few cases have been documented in the cervix, fallopian tubes, adnexa, and endometrium. We describe the clinical presentation, diagnostic work-up, treatment, and histopathological features of a patient with pure high-grade endometrial TCC, followed by a focused review of previously published cases. A 70-year-old woman presented with an enlarging endometrial mass detected incidentally on imaging, despite two prior benign curettages. A total laparoscopic hysterectomy with bilateral salpingo-oophorectomy was performed. Histopathology revealed a pure high-grade TCC confined to the endometrium, without lymphovascular invasion or myometrial infiltration. The immunophenotype was CK7+, Vimentin+, CK HMW+, p16+, and CK20-, with a very high Ki-67 index (> 90%). Molecular classification (The Cancer Genome Atlas/ProMisE) could not be established due to unavailable p53 and mismatch repair testing. One-month follow-up showed no evidence of recurrence. Pure endometrial TCC is extremely rare. Although its morphology is high grade, early-stage disease without invasion may demonstrate favourable short-term outcomes. This case contributes a unique value because it shows a completely pure TCC pattern, absence of invasion, and early detection. Primary high-grade TCC of the endometrium represents a diagnostic and therapeutic challenge due to its rarity, aggressive histologic features, and lack of standardized treatment protocols. This unusual case underscores the importance of integrating histopathological and immunohistochemical findings for accurate diagnosis and guiding optimal patient management.
Introduction:Polycystic ovary syndrome (PCOS) is a multifactorial, endocrinological, and reproductive condition among women of reproductive age worldwide, with a global prevalence between 6-13%. Multiple studies from different ethnicities have associated more than a dozen candidate genes with PCOS, including the anti-Mullerian hormone gene (AMH). To date, there have been no comprehensive reports on the molecular studies of PCOS patients from Assam, India. Material and methods:The current study is a prospective, case-control, tri-centric, hospital-based study. We recruited 100 PCOS patients, diagnosed based on Rotterdam classification, and 50 controls. Relevant clinical data was recorded and tabulated. A candidate gene screening approach was employed to identify novel and reported sequence variations in the AMH gene. Results:A novel pathogenic sequence variation, c.698T>A (homozygous), p.Leu233Gln substitution, was observed in a 31-year-old married female patient with no positive family history, with oligomenorrhea and multiple cysts in both ovaries. The observed sequence change variant was absent in 50 controls and was conserved across species. In silico tools such as SIFT, Polyphen2, Align GVGD, MutationTaster and I-Mutant2.0 had predicted the L233Q mutation to alter the structure and function of AMH protein. Conclusions:This is the first study to report L233Q pathogenic missense mutation in the AMH gene in PCOS patient from India. Our finding adds to the spectrum of reported mutations in the AMH gene and provides further evidence on the importance of AMH in the aetiopathogenesis of PCOS and also might aid in developing novel diagnostic markers.
Introduction:Uterine smooth muscle tumours are primarily classified as benign leiomyomas or malignant leiomyosarcomas, with diagnosis based on cytologic atypia, mitotic activity, and tumour cell necrosis. Smooth muscle tumour of uncertain malignant potential (STUMP), a rare variant accounting for 2-5% of myomas, cannot be unequivocally classified as benign or malignant and most commonly affects women aged 45-55. The clinical presentation is similar to that of fibroids, and management is surgical, though standardized procedures are lacking due to the uncertain malignant potential. While prognosis is generally favourable, STUMP may recur, occasionally as leiomyosarcoma, highlighting the need for careful postoperative follow-up. Material and methods:This retrospective study included 12 patients with histopathologically confirmed STUMP treated between 2019 and 2024. Clinical data were analysed, and patients were followed until July 2025 to assess survival, recurrence, and outcomes. Results:Twelve patients with histopathologically confirmed STUMP were analysed, with a median age of 44.5 years and a median tumour size of 6.25 cm. Most patients presented with heavy menstrual bleeding (50%) or a pelvic mass (42%). Surgical treatment included hysterectomy in 50% of cases and myomectomy in 42%, performed via laparotomy, laparoscopy, or transvaginal approaches. After a median follow-up of 44 months, no recurrences were observed. Conclusions:Smooth muscle tumour of uncertain malignant potential remains a rare uterine neoplasm of uncertain malignant potential, requiring postoperative histopathological confirmation, individualized management, and long-term surveillance due to its risk of recurrence or metastasis.
Introduction:Postmenopausal bleeding (PMB) is a common clinical symptom, with endometrial cancer (EC) accounting for about 10% of cases. This study aimed to develop machine-learning models to predict EC in women with PMB, supporting risk stratification and optimizing diagnostic pathways. Material and methods:We retrospectively analysed 617 women who underwent hysteroscopy for PMB at the Meir Medical Center between 2014 and 2023. Demographic, clinical, laboratory, and imaging data were collected. Three supervised machine-learning algorithms - Random Forest, eXtreme Gradient Boosting (XGBoost), and Light Gradient Boosting Machine (LightGBM) - were trained and evaluated. Synthetic minority oversampling technique addressed class imbalance. Model performance was assessed using accuracy, precision, recall, F1 score, and area under the receiver operating characteristic curve. Results:Seventy-two women (11.7%) were diagnosed with EC. eXtreme Gradient Boosting achieved the highest sensitivity (80%) for detecting EC, despite moderate accuracy (65%). Random Forest and LightGBM showed higher accuracy (85% and 84%, respectively) but much lower sensitivity. The most influential predictors in the XGBoost model were tamoxifen use, hormone therapy, age, hypertension, gravidity, parity, endometrial thickness, diabetes, and duration of bleeding. Conclusions:eXtreme Gradient Boosting provided the best clinical performance by minimizing missed diagnoses. Machine-learning models may enhance decision-making by identifying women at high risk for EC who require further evaluation. Larger datasets and additional clinical features are needed to improve specificity and reduce false positives.
Chronic pelvic pain (CPP) of gynaecological origin encompasses a heterogeneous group of disorders, among which pelvic venous disorders (PeVD) and adenomyosis are recognised contributors. Concomitant PeVD and adenomyosis may potentiate symptom burden and complicate management strategies. A 45-year-old parous woman was referred with a protracted history of CPP manifesting as lower abdominal, lumbar and hip pain, exacerbated by prolonged orthostasis and coital activity. Menstrual symptoms comprised dysmenorrhoea and menorrhagia complicated by iron-deficiency anaemia. Prior conservative measures were ineffective and the patient declined definitive surgical intervention. Transvaginal ultrasonography demonstrated features consistent with both adenomyosis and pelvic venous congestion. After multidisciplinary discussion, the patient underwent endovascular treatment consisting of concurrent embolisation of the bilateral uterine arteries and ovarian veins, performed by an interventional radiologist. At six-month follow-up the patient reported complete resolution of abdominal, back and hip pain and of menstrual pain and menorrhagia; postcoital ache persisted but was markedly attenuated. Magnetic resonance imaging demonstrated a reduction in the radiological extent of adenomyosis and no evidence of pelvic venous reflux. To our knowledge, this is the first reported case of simultaneous embolisation of the uterine arteries and ovarian veins for CPP attributable to coexisting PeVD and adenomyosis. While these preliminary results are encouraging, the efficacy and safety of this combined endovascular approach warrant evaluation in appropriately designed prospective studies.
Uterine leiomyosarcoma (uLMS) is a rare, heterogeneous, and aggressive tumour, representing only 2-5% of all uterine neoplasms. It poses a significant diagnostic and therapeutic challenge due to symptom overlap with benign uterine conditions such as uterine fibroids. Risk factors of uLMS include advanced age, larger tumour size, submucosal localisation, prior malignancies, tamoxifen use, pelvic radiation, and higher body mass index. This review analyses 13 studies to better identify preoperative indicators of leiomyosarcoma and highlights the challenges in differentiating malignant tumours from benign fibroids. Early detection remains difficult because the clinical presentation often mimics more common benign conditions, leading to delays in diagnosis and treatment. Current diagnostic methods: clinical examination, ultrasound, magnetic resonance imaging (MRI), and histopathology, offer important clues such as tumour size, irregular margins, necrosis, and vascular patterns, but none offers definitive preoperative diagnosis. While advanced imaging techniques like dynamic MRI show promise in distinguishing uLMS from leiomyomas, these methods are not yet practical for routine use. Blood markers lack diagnostic reliability. Minimally invasive surgical procedures, such as laparoscopic power morcellation, carry risks of spreading occult malignancies and should only be performed in carefully selected patients. Therefore, comprehensive preoperative evaluations and improved diagnostic tools are critical to facilitate earlier detection and optimise treatment outcomes, particularly in high-risk populations. Increased awareness among healthcare providers and patients is essential for improving prognosis and reducing the incidence of late-stage presentations.
Introduction:Coronary heart disease (CHD) is a condition resulting from a disproportion between the oxygen supply to the heart muscle and its actual demand for it. One of the risk factors for CHD is menopause. Women are more likely than men to experience non-specific symptoms of this disease, which contributes to inadequate diagnosis and delayed interventional treatment, resulting in a poorer prognosis. The aim of the research was to determine the level of women's knowledge among perimenopausal women about CHD and to confront this knowledge with health behaviour undertaken by respondents. Material and methods:The data were collected using a diagnostic survey method and research tools included an original questionnaire and standardized health behaviour inventory. The study was carried out on 262 respondents, by CAWI method. Results:Most respondents demonstrated limited general knowledge about CHD, but showed good awareness of gender-specific differences and the role of hormones and hormone replacement therapy. Knowledge levels were not significantly associated with demographic factors. Health-promoting behaviours were generally moderate and not correlated with awareness of CHD risk factors. Conclusions:There is a great necessity to educate women, especially in the menopausal period, about modifiable CHD risk factors and to undertake appropriate health behaviours.
Introduction:Urinary bladder endometriosis (BE) is a rare but significant condition, which may co-occur with vesicouterine pouch endometriosis (EVUP). Our study examined the outcomes of laparoscopic surgeries for BE and EVUP. Material and methods:Twenty-nine patients who underwent the laparoscopic treatment in our centre in 2017-2023 were included. The patients were divided into EVUP and BE groups. The data was taken by analysing detailed patients' history/histories, which was/were taken at admission, follow-up was made 6 months after the surgery and in January 2024. Moreover, the patients filled in questionnaires regarding their pre- and postoperative symptoms using NRS scale. Results:Patients with BE (n = 10) presented with symptoms of the following median intensity before vs. after surgery: dysmenorrhoea (5.5 IQR 0-10 vs. 0 IQR 0-2; p = 0.028), intermenstrual/intramenstrual pain (1 IQR 0-10 vs. 0 IQR 0-2; p = 0.043), dysuria (9 IQR 2-10 vs. 0 IQR 0-2; p = 0.005), dyschezia (0 IQR 0-9 vs. 0 IQR 0-0), and dyspareunia (0 IQR 0-8 vs. 0 IQR 0-2). Patients with EVUP (n = 8) presented with the following symptoms: dysmenorrhoea (8 IQR 4-10 vs. 0.5 IQR 0-6; p = 0.012), intermenstrual/intramenstrual pain (5 IQR 3-8 vs. 0 IQR 0-3; p = 0.012), dysuria (0 IQR 0-6 vs. 0 IQR 0-0), dyschezia (1.5 IQR 0-10 vs. 0 IQR 0-8), and dyspareunia (0.5 IQR 0-10 vs. 0 IQR 0-5). Conclusions:Despite similar lesion locations, BE and EVUP symptoms differed significantly. Nevertheless, laparoscopic surgery was an effective treatment for both conditions.
Introduction:One of the most common urogynecological diseases in women in menopause is urinary incontinence, which reduces the quality of life of patients, causing psycho-emotional discomfort, social maladjustment and hygienic inconvenience. Material and methods:265 working women aged 47-65 years were examined and were divided into 2 groups. Group I included 145 women who suffered from urinary incontinence, the Group II (control group)consisted of 120 women who did not complain of urinary disorders or could note rare episodes of stress urinary incontinence. All patients underwent clinical, laboratory and instrumental examinations according to the requirements of modern clinical protocols. Results:The most probable trigger factors for urinary incontinence in the patients of Group I were carbohydrate metabolism disorders (84.14%), a history of complicated vaginal births (71.72%), a sedentary lifestyle (38.62%) and excess body weight (37.93%). In the overwhelming majority of the patients of Group I (88.28%) suffering from urinary incontinence, their daily volume of fluid intake did not meet the World Health Organization normative recommendations. According to the questionnaire, 59.31% of the patients of Group I consciously reduced fluid intake during the working day. Conclusions:An unbalanced fluid intake schedule plays an important role in urinary incontinence in women and can be considered as a risk-stratification factor for this pathology.
Introduction:Although the C-reactive protein-triglyceride-glucose index (CTI) is associated with various adverse outcomes, its relationship with mortality in postmenopausal women remains unclear. Material and methods:We analysed data on 5,582 postmenopausal women from the National Health and Nutrition Examination Survey 2001-2010, with mortality follow-up continuing until the end of 2019. C-reactive protein-triglyceride-glucose index was calculated as 0.412 × ln [C-reactive protein (mg/l)] + ln [triglycerides (mg/dl) × fasting plasma glucose (mg/dl))/2]. The Cox proportional hazards model assessed the risk of mortality across CTI levels. We assessed potential nonlinearity with spline analyses and conducted sensitivity analyses. Results:The mean age of participants was 65.1 ±11.2 years and a mean CTI of 4.2 ±0.6 recorded at baseline. Over a median follow-up of 141 months (~ 11.8 years), 1,846 (33.1%) deaths occurred, including 582 (10.4%) cardiovascular disease (CVD) deaths. An association was observed between increasing CTI values and greater mortality risk in this population. Non-linear analysis identified a CTI threshold at 4.16. Below this value, no significant association with all-cause mortality was found (hazard ratio - HR 0.87, 95% CI: 0.74-1.03); above it, each 1-unit CTI increase raised all-cause mortality risk by 68% (HR 1.68, 95% CI: 1.47-1.92; p < 0.01). Tertile comparisons showed that the highest group/tertile group had significantly increased risks for all-cause (adjusted HR 1.34, 95% CI: 1.19-1.51) and cardiovascular mortality (HR 1.43, 95% CI: 1.16-1.76) compared to the middle tertile. A similar trend was observed for CVD mortality. These associations remained consistent in sensitivity analyses. Conclusions:Elevated CTI remains independently associated with an increased risk of both all-cause and CVD mortality in postmenopausal women.
Introduction:Asherman Syndrome is a refractory gynecological disorder resulting from injury to the endometrium due to various causes. The treatment of choice is hysteroscopic adhesiolysis; however, recurrence rates remain high. Stem cell therapy has emerged as a promising approach for regenerating damaged endometrium in refractory cases. So, this study aims to assess the efficacy of mesenchymal stem cell therapy in refractory Asherman syndrome unresponsive to conventional treatment. Material and methods:The study involved the literature searched in PubMed, Embase and Google Scholar databases from inception to June 2024. We included pre- and postintervention studies. We excluded case reports, conference abstracts, articles without full texts and studies with animal trials. Women with primary or secondary infertility of the reproductive age group (aged 20-50 years) with AS (Grade I-IV) not responding to standard treatment (hysteroscopic adhesiolysis and hormonal therapy) were included. Primary outcome included pregnancy outcome and change in the endometrial thickness whereas secondary outcome included improvement in menstrual pattern. Results:We identified 382 studies from our constructive search strategy. Finally, 12 studies with 137 women met the inclusion criteria. Stem cell therapy has been associated with an increase in endometrial thickness; the standardised mean difference was 2.09 (95% CI: 1.4-2.7). It has also been shown to improve pregnancy rate with risk ratio (RR) of 9.35 (95% CI: 4.2-24.9) and live birth rate (RR - 5.870, 95% CI: 2.071-16.633). All the patients reported improvement in menstrual function. Conclusions:Stem cell therapy is safe and effective in improving endometrial thickness, menstrual function and pregnancy rate in women with refractory AS. However, given the limitations of our study, further studies with a large sample size are needed to validate the findings.
Introduction:Menopause is a universal stage in women's lives, accompanied by major physiological and psychological changes. In many low- and middle-income countries, including Vietnam, evidence on healthcare workers' knowledge and attitudes towards menopause remains limited, despite their dual role as both providers and recipients of care. This study assessed knowledge, attitudes, and practices regarding perimenopause and menopause among female health workers. Material and methods:A descriptive cross-sectional survey was conducted among 403 female health workers aged 40-60 years at Hung Vuong Hospital, Ho Chi Minh City, from March to June 2024. Data were collected using a 45-item questionnaire adapted from validated international tools and translated into Vietnamese. Descriptive statistics summarised participant characteristics. Associations between variables were analysed using the χ2/Fisher's exact test, and significant factors were entered into Poisson regression with robust variance to estimate prevalence ratios (PR) with 95% CI. Results:Most respondents demonstrated good knowledge (73.5%) and positive attitudes (65.3%), while 39.7% reported good practices. Higher education was significantly associated with better knowledge (p < 0.05). Participants with good knowledge were more likely to have positive attitudes (PR 3.55, 95% CI: 1.28-9.8, p = 0.015), and those with good practices were more likely to express positive attitudes (PR 1.55, 95% CI: 1.18-2.04, p = 0.002). Knowledge was also strongly correlated with practice (p < 0.001). Conclusions:Knowledge showed a strong positive association with both attitude and practice. Workplace-based education is needed to enhance awareness and promote healthier behaviours among female health workers.
Introduction:Breast-conserving surgery (BCS) is the standard treatment for early breast cancer, offering comparable oncological effectiveness to mastectomy with better aesthetic outcomes. Achieving negative surgical margins is essential, as positive margins increase the risk of recurrence and reoperation, which place a burden on both patients and the healthcare system.This retrospective study evaluated the effectiveness of intraoperative margin assessment in BCS, focusing on its impact on reducing reoperation rates and analysing financial and organisational benefits. Material and methods:Between 2016 and 2023, 549 patients underwent BCS with intraoperative margin assessment using frozen section analysis. Positive surgical margins were identified in 70 patients (12.8%). Through intraoperative re-excisions, negative margins were ultimately achieved in 55 cases, avoiding mastectomy or later reoperation. Only four patients (0.7%) required reoperation after the initial procedure. Results:Avoiding reoperation generated significant cost savings. The average cost of one reoperation was estimated at PLN 12,829 (approximately EUR 3,013) in centres without comprehensive oncological care and PLN 17,855 (approximately EUR 4,194) in centres with comprehensive oncological care. The total savings for avoided procedures amounted to PLN 898,045 (about EUR 210,918) and PLN 1,249,857 (about EUR 293,545), respectively. Conclusions:Intraoperative margin assessment during BCS is an effective strategy that minimises the need for repeated procedures, improves patient outcomes, and provides measurable economic benefits at the healthcare system level. Wider implementation of this method may help optimise surgical resources while enhancing the quality of care.
Adenosarcomas constitute approximately 1% of all malignancies affecting the female reproductive system. Their most common locations are the uterine corpus and ovaries. Cervical adenosarcomas are rare and poorly described in the literature. Therefore, there are still no treatment guidelines for such cases, and the proper scope of the surgical procedure has become questionable. The most popular options include total abdominal hysterectomy and/or bilateral salpingo-oophorectomy (BSO). Generally, the prognosis is relatively good, among other things, because it is detected in the earlier International Federation of Gynaecology and Obstetrics stage than other locations, with a 5-year overall survival rate of 63-84%. Here, the present paper describes the case of a 44-year-old female with adenosarcoma located in the cervix. The patient experienced abnormal vaginal bleeding occurring 7-10 days before proper menstruation and pelvic pain. Interestingly, despite a normal routine Pap smear test, the cervical mass was revealed in transvaginal ultrasonography. A subsequent biopsy of the lesion confirmed the presence of low-grade adenosarcoma. A radical hysterectomy (RH) with BSO and pelvic lymph node sampling was performed. The patient reports resolution of all symptoms. Our case study highlights the effectiveness of RH as the mainstay treatment for cervical adenosarcomas. Furthermore, we discuss these tumours' pathology and imaging features, as well as other therapeutic options. The present study has an exceptional value for practicing gynaecologists and oncologists.
The aim of the study was to review publications on the early, most accurate diagnosis of pathological changes in the endometrium, which occur during and after tamoxifen (TAM) therapy for breast cancer (BC). Accurate diagnosis of potential endometrial lesions is essential to make correct decisions regarding the necessity of adjuvant therapy with TAM. MEDLINE (http://www.ncbi.nlm.nih.gov/pubmed), EMBASE (http://www.embase.com) and Scopus (http://www.scopus.com) databases were searched using the following MeSH terms in titles and abstracts: ("tamoxifen endometrial hyperplasia" OR "tamoxifen endometrial pathology" OR "endometrial pathology tamoxifen"). No language restriction was used in the literature search. The search was limited to studies in humans. The results of an ultrasound investigation of the endometrium in asymptomatic BC patients receiving TAM should be interpreted with caution. An overdiagnosis of endometrial abnormalities, and the consequent unnecessary invasive diagnostic procedures could discourage some patients from continuing the adjuvant treatment with TAM, putting them at increased risk of recurrent BC. There is no evidence that patients receiving adjuvant TAM therapy could benefit from a screening program based on the ultrasound examination alone. Asymptomatic BC patients on adjuvant TAM-treatment should not be submitted routinely to ultrasound examination or biopsy, but encouraged to report any abnormal vaginal bleeding promptly.
