Medline ® Abstracts for References 2-5

INTRODUCTION: Inversion of the uterus associated with a uterine sarcoma is extremely rare with only 17 cases reported since 1887, so that its clinical presentation and appearance at laparotomy may be confusing.

CASE: A 26-year-old woman presented with a vaginal mass and bleeding. At laparotomy, her uterus appeared depressed or concave. The final diagnosis of uterine sarcoma and inversion was unique in her age group.

CONCLUSIONS: Uterine sarcoma with inversion can occur in the premenopausal age group. It presents as a vaginal mass with bleeding. As a clue to the diagnosis, the uterus per se may not be palpable or it may appear concave on physical exam or at laparotomy.

BACKGROUND: We report a case of nonpuerperal uterine inversion associated with an immature teratoma of the uterus.

CASE: An adolescent nullipara with prolonged vaginal bleeding, severe abdominal pain, symptomatic anemia, and a presumed diagnosis of retained products of conception was found to have a large mass in the vagina. Uterine inversion was diagnosed and corrected using the Haultain procedure. The inversion catalyst was found to be an immature teratoma of the uterus.

CONCLUSION: Reproductive age women with the rare finding of nonpuerperal uterine inversion are likely to have a malignancy. However, uterine-sparing surgery to correct the inversion should be attempted in young women until final pathology is known.

Non-puerperal uterine inversion due to uterine sarcomas represents a very rare event with no reliable estimate of frequency in the literature. Clinically, the diagnosis of inversion may be difficult, as far as imaging procedures are concerned, although ultrasonography may prove to be useful. However, some characteristics such as the indentation of the fundic area and a depressed longitudinal groove extending from the uterus to the center of the inverted portion are difficult to recognize. Moreover, there is no specific computed tomography feature accurate enough to aid in the differential diagnosis. Here, we report a case of uterine inversion due to Müllerian uterine adenosarcoma whose preoperative workup and diagnosis took advantage of the application of magnetic resonance imaging.

Non-puerperal uterine inversion is an extremely rare event, and the diagnosis is made during vaginal examination or exploratory laparotomy. We report a case of complete uterine inversion which was diagnosed on abdominal ultrasound examination in a 50-year-old nulliparous virgin who was admitted to the hospital because of profuse vaginal bleeding, lower abdominal pain and anuria. The confirmatory diagnosis of complete uterine inversion secondary to a fundal fibroid was made at exploratory laparotomy. Total abdominal hysterectomy was performed, and the pathological examination confirmed its benign nature. Ultrasound evaluation is useful in the diagnosis of non-puerperal uterine inversion.