Deniz ŞİMŞEK, Ali AKDEMİR, Gülruh EMİROĞLU BÜBERAL, Özgür Deniz TURAN, Ahmet Mete ERGENOĞLU

Rare Reason for Vaginal Bleeding and Dysmenorrhea in A Young Woman: Endometriosis in A Cervical Polyp

Abnormal vaginal bleeding in adolescent and young women is not a rare event and can be attributed mainly to anovulatory cycles, pregnancy-related bleeding, and endocrinological disorders in this age group. Cervical polyps commonly occur during the reproductive years, especially after the age of 40. Here we present a rare reason for vaginal bleeding and dysmenorrhea in a 20-year-old woman caused by endometriosis in a cervical polyp. Twenty-year-old patient admitted to Ege University Faculty of Medicine Gynecologic clinic due to vaginal bleeding and prolapsed lesion which was seen from introitus of the vagina. She had mental retardation and seizures since infancy. Her first menstrual bleeding occurred at the age of 14 and she had regular menstrual cycles. Gynecologic speculoscopy and bimanual examination could not be performed because the patient was sexually inactive and she did not accept the bimanual vaginal examination. Magnetic resonance imaging was performed. Multiple cervical polyps and genito-urinary system malformation were reported. Vaginoscopy with hysteroscope was performed and cervical polyp in 5 cm length was detected. Polypectomy was performed with operative hysteroscope without complication. No damage was occurred to hymen. Pathologic result was determined endometriosis in cervical polyp. Cervical polyp in young women is rare and endometriosis in cervical polyp is detected only in a few cases in literature. It is a reason of abnormal vaginal bleeding and dysmenorrhea. Vaginal masses that prolapse from the cervix should be examined precisely. Malignancies of the cervix, vagina and uterus should be kept in mind in patients with malformations and anomalies. We aimed to present this rare case and to show the feasibility of vaginoscopy with operative hysteroscope in sexually inactive patients. Pre-operative evaluations should be patient specific and care should be taken to avoid complications.

Genç Bir Kadında Vajinal Kanama ve Dismenorenin Nadir Bir Sebebi: Servikal Polipte Endometriozis

Adölesanlarda ve genç kadınlarda anormal vajinal kanama nadir olmayan bir durumdur. Bu yaş grubunda en sık sebepler anovulatuvar sikluslar, gebelikle ilişkili kanamalar ve endokrinolojik bozukluklardır. Servikal polipler genellikle reprodüktif çağda, özellikle 40 yaş sonrasında saptanmaktadır. Yirmi yaşındaki bir kadında saptanan vajinal kanamanın ve dismenorenin nadir bir sebebi olan servikal polipte endometrizis olgusunun sunumu amaçlanmıştır. Yirmi yaşında hasta, Ege Üniversitesi Tıp Fakültesi, Jinekoloji Kliniği'ne vajinal kanama ve vajen introitusundan gözlenebilen sarkmış bir lezyon yakınması ile başvurdu. Hastanın doğumda başlayan mental retardasyon ve epilepsisi mevcuttu. İlk menstruasyon kanaması 14 yaşında gerçekleşmiş ve düzenli sikluslara sahipti. Hastaya spekulum ve jinekolojik bimanuel muayene hastanın cinsel inaktif olması ve vajinal muayeneyi kabul etmemesi nedeniyle yapılamadı. Hasta manyetik rezonans görüntüleme ile değerlendirildi ve multipl servikal polipler ve genitoüriner sistem malformasyonu saptandı. Histeroskop ile vajinoskopi gerçekleştirildi ve 5 cm uzunluğunda servikal polip saptandı. Operatif histeroskop kullanılarak polipektomi gerçekleştirildi. Komplikasyon ve himende yaralanma gerçekleşmedi. Patolojik inceleme sonucu servikal polipte endometriozis olarak raporlandı. Genç kadınlarda servikal polip nadir olmakla beraber servikal polipte endometriozis literatürde sadece birkaç olgu sunumunda belirtilmiştir. Anormal vajinal kanama ve dismenoreye sebep olur. Serviksten prolabe olan vajinal lezyonlar dikkatlice incelenmelidir. Malformasyon ve anomalisi olan hastalarda serviks, vajina ve uterusun maligniteleri akılda tutulmalıdır. Bu nadir olguyu sunmak ve seksüel olarak inaktif kadınlarda operatif histeroskop kullanılarak vaginoskopinin uygulanılabilirliğinin değerlendirilmesi amaçlanmıştır. Pre-operatif değerlendirme her hastaya özgü olmalı ve komplikasyonlardan kaçınmak için dikkatli olunmalıdır.

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