Endometrial polyps are benign disorganized growth of endometrial glands and stroma in the uterine cavity. They are associated with subfertility, abnormal uterine bleeding, and tamoxifen use. While most polyps are smaller than 2 cm in size, rare giant polyps can cause concerns over malignancy. We report a case of a 15 cm giant endometrial polyp in a 58-year-old woman with a history of tamoxifen use who presented with an uncommon complaint of constipation. Additionally, a literature review of giant endometrial polyp cases is presented. This case represents the largest reported endometrial polyp to date.

Endometrial osseous metaplasia (EOM) is a rare condition characterized by abnormal bone formation in the endometrium. This acts as a foreign body in the uterus. The commonest clinical presentation is secondary infertility. Transvaginal ultrasonography is the mainstay of first-line diagnosis. Hysteroscopy confirms the diagnosis and aids in complete removal. Diagnosis of this condition is crucial as post-treatment fertility outcomes are good. This case highlights the importance of three-dimensional ultrasonography before infertility treatment and after hysteroscopic removal of osseous metaplasia to look for reactive endometrial polyps which may interfere with the embryo implantation and spontaneous conception altering the post-surgical fertility outcome.

BACKGROUND: The procedure for microwave endometrial ablation (MEA) follows established MEA practice guidelines but requires hysteroscopic observation of the uterine lumen before and after MEA. When a luminal uterine lesion is recognized, its removal requires preoperative dilation of the cervix because the outer diameter of a conventional rigid hysteroscope is 8.7 mm. Recently, a fully disposable rigid hysteroscope (LiNA OperaScopeTM) with a narrow diameter (4.4 mm) and forceps capable of extracting endometrial lesions has become available.
METHODS: Here, we report a case of heavy menstrual bleeding (HMB) complicated by endometrial polyps where MEA was performed after removing endometrial polyps using the LiNA OperaScopeTM device. A 48-year-old woman with three prior pregnancies and three deliveries was referred to our hospital for further examination and treatment after being diagnosed with HMB 2 years earlier. The patient underwent MEA following endometrial polypectomy using LiNA OperaScopeTM. After MEA, endometrial cauterization was again examined using the LiNA OperaScopeTM, and the procedure was completed. No preoperative cervical dilation was performed. The patient\'s clinical course was favorable, and she was discharged 3 h after surgery. One month after surgery, menstruation resumed, and both HMB and dysmenorrhea improved markedly from 10 preoperatively to 1 postoperatively, as assessed subjectively using the visual analog scale. The patient\'s postoperative course was uneventful with no complications.
CONCLUSIONS: LiNA OperaScopeTM can be a minimally invasive treatment for MEA of HMB with uterine lumen lesions.

Von Willebrand disease (VWD) is a bleeding disorder caused by a congenital quantitative reduction, deficiency, or qualitative abnormality of the von Willebrand factor (VWF). Here, we report a case of delayed postoperative bleeding in an infertile woman with endometrial polyps complicated by VWD. The patient was a 39-year-old infertile woman with type 2A VWD. At 38 years of age, she was referred to our hospital for infertility and heavy menstrual bleeding. Hysteroscopy revealed a 15-mm polyp lesion in the uterus. The patient was scheduled for transcervical resection (TCR) of the endometrial polyp. Gonadotropin-releasing hormone agonists were preoperatively administered to prevent menstruation. The VWF-containing concentrate was administered for 3 days according to guidelines. The patient was discharged on postoperative day 3 after confirming the absence of uterine bleeding. Uterine bleeding began on postoperative day 6. The patient was readmitted on postoperative day 7 and treated with VWF-containing concentrate for 5 days, after which hemostasis was confirmed. TCR surgery for endometrial lesions is classified as a minor surgery, and guidelines recommend short-term VWF-containing concentrate replacement. However, it should be kept in mind that only short-term VWF-containing concentrate replacement may cause rebleeding postoperatively.

Uterine inversion is a rare disease that is particularly uncommon among non-puerperal women. Herein we reported the only case of uterine inversion known to us that was caused by the endometrial thickening and changes in the polypoid lesion in early puberty. The patient was admitted to our hospital because of massive vaginal bleeding, abdominal pain, and a protruding mass from the vagina. We obtained the patient history by collecting the results of various examinations (including magnetic resonance imaging and color Doppler ultrasound), accurate diagnosis was performed, and a reasonable treatment protocol was developed. She was subjected to laparoscopic uterine-sparing surgery to preserve her fertility. Uterine inversion is a rare disease, and early diagnosis and selection of appropriate treatment options are essential for patients with fertility requirements.

BACKGROUND: Non-puerperal uterine inversion is a rare condition with diagnostic and surgical challenges. Clinically, the inverted uterus appears as a mass protruding from the vagina and is often misdiagnosed as a malignant tumor and surgically removed.
METHODS: An 11-year-old girl was admitted to the emergency room due to spontaneous vaginal mass protrusion. The pudendum examination showed an irregular and dark red neoplasm protruding from the vagina. The final diagnosis was non-puerperal uterine inversion with an endometrial polyp.
CONCLUSIONS: MRI is the key to the diagnosis of uterine inversion. Our review confirmed that the 11-year-old girl was the youngest in the world to suffer from non-puerperal uterine inversion.

Recurrent pregnancy loss (RPL) is a common disease, which presents as two, three or more failed pregnancies. It is attributed to many risk factors, yet half of the cases are idiopathic. In this report, we present a case of a 44-year-old woman with a complaint of secondary infertility for 10 years and a history of three spontaneous abortions. Blood tests and images showed no abnormalities, except for hysteroscopy which showed a polyp-like mass. Pathology revealed an endometrial stroma showing severe decidualization with a lot of gestational villi showing fibrosis and hyaline degeneration, features of old gestational product death, with no glands crowding or cellular atypia. In this case, the conception products were not preceded with a miscarriage and did not cause any symptoms indicating its existing. The asymptomatic endometrial polyp filled with fibrotic gestational villi without a prior miscarriage is an unprecedented case in the medical literature.

This article reports the pathologic features and malignant biological behavior of a perivascular epithelioid cell neoplasm (PEComa) with the clinical manifestation being endometrial polyps. The case was cured with curettage in a local hospital one year ago. The postoperative diagnosis was \"endometrial polyps\". This time, due to \"irregular bleeding\", we carried out another curettage in our hospital. After the operation, 3 pieces of polyps were inspected with diameters of 0.3 cm, 0.5 cm and 0.6 cm, respectively. The tumor consisted of epithelioid cells with alveolar and nesting pattern and showed a diffuse strong expression of HMB45, Melan-A and TFE3. The patient then underwent a hysterectomy and the \"polyps\" were sent for pathological examination. The result showed that tumor cells infiltrated the deep muscle layer, close to the outer membrane, suggesting a malignant biologic behavior. TFE3-related PEComa is different from general PEComa. This neoplasm and Melanotic Xp11 renal carcinoma have similar clinicopathologic features, histology, immunity and molecular phenotypes, belonging to the same type of tumor. It has been suggested in the literature naming this neoplasm as \'Xp11 neoplasm with melanocytic differentiation\' or \'melanotic Xp11 neoplasm\'. Our case has expanded our understanding of PEComa characteristics and increased data for TFE3 translocation-related PEComa, reminding us to avoid misdiagnosis when PEComa manifests as small polyps.

Endometrial polyps are a common cause of abnormal vaginal bleeding and infertility, which can be identified with different imaging methods. A lack of distention of the endometrial cavity is not a common presentation of endometrial polyps and is associated with endometrial carcinoma. In this article, we present a case of a 30-year-old patient with previous history of infertility and abnormal vaginal bleeding. During a hysterosalpingography (HSG), we were not able to distend the endometrial cavity. Therefore, we performed a transvaginal ultrasound (TVUS) and a pelvic magnetic resonance study, which showed an obstructive endometrial polyp adjacent to the internal cervical os. This structure was successfully removed through hysteroscopy by the gynecology department.

Endometrial stromal sarcoma (ESS) is a rare malignant tumor of the uterus. We report an uncommon case of ESS composed of both low-grade ESS and high-grade ESS arising from an endometrial polyp. On the findings of magnetic resonance imaging and contrast computed tomography, a patient was suspected of having uterine malignant tumor. She underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy. Macroscopically, the tumor was a polypoid lesion in the uterine cavity. The tumor was an endometrial polyp with ESS components. ESS was composed of low-grade ESS and high-grade ESS. By immunohistochemistry, both an endometrial polyp and low-grade ESS showed a positivity for CD10, estrogen receptor (ER), and progesterone receptor (PR). However, high-grade ESS showed only a focal and weak CD10 positivity with no immunostaining for ER and PR. A focal or diffuse positivity for α-smooth muscle actin and desmin was noted in both low-grade and high-grade ESS. The positive rates of Ki-67 and p53 in high-grade ESS were elevated up to over 95%. She was diagnosed as having ESS in a stage IA. After surgery, she received no further treatment. She has been without recurrence for 4 years since an initial surgery. In conclusion, immunohistochemical analyses are useful for make an accurate diagnosis of ESS showing a transition from low-grade ESS to high-grade ESS in addition to the conventional method.