The aim of our study was to access office hysteroscopy results in postmenopausal patients with thickened endometrium. A retrospective descriptive study was carried out on 245 postmenopausal patients submitted to office hysteroscopy after sonographic diagnosis of thickened endometrium in 20 consecutive months. Women were evaluated for age, hormonal therapy, hysteroscopic findings, procedure duration, complications and associated pain, and histological diagnosis. Patients with and without uterine bleeding were considered separately. Symptomatic patients were older and had longer procedure duration. The most frequent hysteroscopic finding was endometrial polyp in both groups. Pain was subjectively assessed in a numeric scale from 0 to 10 and median value was 4. There were no complications reported. Global neoplasia rate was 2.9% for asymptomatic patients and 16.4% for symptomatic ones (p<0.05). Thickened endometrium with postmenopausal metrorrhagia gave patients a significantly higher risk for neoplasia and hyperplasia.

The aim of our study was to access office hysteroscopy results in postmenopausal patients with thickened endometrium. A retrospective descriptive study was carried out on 245 postmenopausal patients submitted to office hysteroscopy after sonographic diagnosis of thickened endometrium in 20 consecutive months. Women were evaluated for age, hormonal therapy, hysteroscopic findings, procedure duration, complications and associated pain, and histological diagnosis. Patients with and without uterine bleeding were considered separately. Symptomatic patients were older and had longer procedure duration. The most frequent hysteroscopic finding was endometrial polyp in both groups. Pain was subjectively assessed in a numeric scale from 0 to 10 and median value was 4. There were no complications reported. Global neoplasia rate was 2.9% for asymptomatic patients and 16.4% for symptomatic ones (p<0.05). Thickened endometrium with postmenopausal metrorrhagia gave patients a significantly higher risk for neoplasia and hyperplasia.

A 64-year old woman presenting with symptoms of abdominal pressure and bloody discharge was found to have a pelvic mass above the vaginal apex on ultrasound scan. She had undergone hysterectomy and bilateral salpingo-oophorectomy and pelvic lymphadenectomy, 13 years previously, for cervical adenocarcinoma with early invasion. There were no lymph node metastases, and at that time all other staging procedures showed normal findings. Now, both transvaginal and transabdominal ultrasound showed a 6 cm nonhomogenous solid and richly vascularized pelvic mass immediately affecting the bladder wall, but it was not possible to determine whether the tumor originated from or infiltrated the bladder. She had another large tumor of similar structure in the right iliac fossa as well as severe hydronephrosis of the right kidney. The suspected diagnosis was that of a recurrence of the cervical carcinoma or a tumor of the urinary bladder. A CT scan confirmed the findings of the pelvic masses, one engulfing the right ureter and the other engulfing the external iliac vessels, but did not add valuable information regarding tumor origin, except to exclude invasion of the bladder. Again the suspected diagnosis was a recurrence or the possibility of a lymphogenic tumor. She underwent surgery, which included dissection of the tumor from the bladder with partial resection of the bladder, resection of the affected segment of the ureter, reconstruction of the bladder and direct reimplantation of the ureter into the bladder. Histopathology supplemented by immunohistochemistry concluded with the diagnosis of an atypically proliferating endometrioid papillary cystadenoma (borderline tumor) with extensive mucinous metaplasia that originated from cystic endometriosis. OP13.03A diagnosis with a concealing outfit S. Muhammad, S. Devarajan, K. Hayes Obstetrics & Gynaecology, St Georges Hospital, University of London, London, United Kingdom36 years old parous patient had presented at the acute gynaecology unit with intermenstrual bleeding. She had one Caesarean in the past followed by normal vaginal delivery. When she was scanned initially, a mass was seen anterior to lower anterior uterine wall measuring 23 × 15 × 35 mm over her previous Caesarean scar. A diagnosis of haematoma communicating with endometrial cavity and an impression of anterior wall defect post Caesarean section was made. She then had laparoscopy and hysteroscopy. The findings were multiple adhesions and a haematoma tracking from the anterior abdominal wall to the superior edge of bladder peritoneum. Haematoma was not drained in view of its close proximity to the bladder. Patient was managed conservatively with hormonal treatment. As patient continued to bleed, hysterectomy was performed as per patient's request since the symptoms were affecting her quality of life. Post hysterectomy, histological diagnosis of placental site nodule was made. Placental site nodule is thought to represent incomplete involution of implantation site within the endometrium. Most often reported in women...

Alkaptonuria is a rare autosomal recessive metabolic disease caused by homogentisic acid oxidase enzyme deficiency. High homogentisic acid levels will eventually result in black deposits in skin, sclerae, connective tissues (ochronosis) and urine (alkaptonuria). It can lead to early degeneration of joints. The diagnosis is often delayed because of its low prevalence and non-specific early symptoms. We describe a clinical presentation of ochronotic arthropathy, on a complex patient, who developed a septic arthritis of the knee. The patient was under immunosuppressive therapy, due to a previous colon adenocarcinoma and received a knee corticosteroid infiltration, two weeks before the onset of pain. It was performed joint lavage and arthrolysis by arthrotomy. During the procedure, we found a dark pigmentation on bone. Urine tests were positive for alkaptonuria. The patient completed an antibiotic cycle and rehabilitation, with satisfying improvement in knee's range of motion. At four years follow-up the patient can walk without crutches, presents minor knee pain. High level of suspicion and awareness is needed to diagnose ochronosis. The joint destruction in a complex patient must be carefully analysed. We've chosen a non-aggressive therapeutic management, but according to the literature, other therapeutic strategies could have also been chosen, like joint arthroplasty. We've declined this option because the patient is still doing antineoplastic treatment.

Poster abstracts observer supports that ovarian volume measurements in this population may have some imprecision. This observation should question the value of this method for clinical decisions. P11.12 A case of an unusual presentation of the ovarian hyperstimulation syndrome