{"paper_id":"61a1eb24-782b-4b83-9e3a-06423dd9d804","body_text":"Endometrial vascular dystrophy is rare under hysteroscopy. Hamou \n 1 \n  described endometrial vascular dystrophy as abnormal vessels that are very tortuous,\ndilated, and sometimes thrombosed. The authors reported two types of vascular dystrophy. The\nfirst was a uniformly distributed spiral-like vessel, and the second was a mesh of branching\ncapillaries. In the literature, only 11 cases have been reported, 2 – 4  and the pathogenesis is unknown. Here, we describe a case of endometrial\nvascular dystrophy with endometrial polyps.\n\nThe case of a 38-year-old patient with two pregnancies and one vaginal birth is presented.\nThe patient experienced minimal vaginal bleeding after menstruation without obvious cause\nfor 3 months, lasting from 3 to 7 days. She had regular menstruation with a cycle of 28 to\n30 days and a period of 5 to 7 days. There was no history of unusual diseases, and no\nhistory of surgery, or alcohol or drug abuse. There was also no genetic history. Speculum\nexamination revealed a small amount of vaginal blood, smooth cervix, and a uterus of normal\nsize. Sex hormone measurements were as follows: testosterone (T): 0.71 nmol/L, prolactin\n(PRL): 20.3 µg/L, progesterone (P): 41.75 nmol/L, estradiol (E2): 349.48 pmol/L,\nfollicle-stimulating hormone (FSH): 4.51 IU/L, and luteinizing hormone (LH): 3.21 IU/mL. No\nabnormalities were found in routine blood examinations, or testing for coagulation function,\nand liver and kidney function. Ultrasonography revealed that the local endometrial echo was\nuniform. Hysteroscopy and curettage were performed on the 19th day of menstruation (Video),\nwhich revealed that the uterine cavity was filled with small, curved blood vessels ( Figure 1 ), the bottom of the cavity was\nobvious, and polyps were visible ( Figure\n2 ). Curettage was performed, and no lesions were found in the uterine cavity after\nre-examination. Pathological findings ( Figure 3 ) indicated secretory endometrium and endometrial polyps. The diagnosis\nwas endometrial vascular dystrophy with endometrial polyps. The patient was then treated\nwith a combined oral contraceptive (COC) for 6 months, and no abnormal uterine bleeding was\nobserved.\nHysteroscopic image in a 38-year-old patient with vaginal bleeding showing that the\nuterine cavity is filled with small curved blood vessels.\nHysteroscopic image in a 38-year-old patient with vaginal bleeding. The area in the\ndashed box contains endometrial polyps.\nPathological section from a 38-year-old patient with vaginal bleeding showing no\nblood-filled glands (hematoxylin and eosin (HE) ×100).\nApproval for the study protocol was unnecessary because our institutional review board does\nnot require approval for case reports. We obtained written informed consent for the\ntreatment of the patient. All patient details were de-identified for the case report, and\nthe report was written in accordance with the CARE guidelines. \n 5\n\nHysteroscopically, the uniform distribution of curved blood vessels is not difficult to\nidentify. Paoletti et al. \n 2 \n  reported two cases, one in which the entire endometrial lining was covered by\nreddish, tortuous vessels arranged in parallel. In another case, the uterine fundus\ncontained several reddish tortuous vessels arranged in parallel that merged with endometrial\npolyps. The pathological examination of the endometrium demonstrated secretory endometrium.\nSopelana et al. \n 4 \n  observed eight cases of endometrial vascular dystrophy, four of which were linked to\nthe presence of an endometrial polyp. The authors used several stains to demonstrate the\npresence of red cells in the lumen of the glands. The authors felt that the structures were\nnot blood vessels but glands in the secretory phase. Nevertheless, the authors could not\nexplain how red cells entered the lumen of the gland. In our case, no blood-filled glands\nwere found in any of the pathological sections ( Figure 3 ). Lata et al. \n 3 \n  reported one case of endometrial vascular dystrophy and concluded that this benign\ncondition does not require intervention. The case we reported, with a diagnosis of\nendometrial vascular dystrophy with endometrial polyps, was the twelfth case reported to\ndate and the sixth with endometrial polyps. Pathology revealed only secretory endometrium.\nWhether endometrial vascular dystrophy is related to progesterone and endometrial polyps\nrequires further study.\n\nEndometrial vascular dystrophy is very rare but is easily identifiable under hysteroscopy.\nPrevious reports indicate that this condition is a benign lesion of the endometrial vessels.\nThe etiology and underlying mechanism of endometrial vascular dystrophy are still unclear,\nand more cases and studies are needed.\n\nClick here for additional data file.\nResearch Data for Hysteroscopic presentation of endometrial vascular dystrophy: a case\nreport by SuZhen Jiang and HongXia Gong in Journal of International Medical Research","source_license":"CC0","license_restricted":false}