Endometrial Cast Expulsion: A Rare Cause of Pelvic Pain Case Report and Review of the Literature

Parkes, Presley; Trainor, Jennifer L.; Raval, Mehul V.; Dhar, Cherie Priya

doi:10.1016/j.jadohealth.2020.08.035

Cited by 6 publications

(6 citation statements)

References 8 publications

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“…Keywords: Adolescent, Menorrhagia, Contraception, Progestogens, Progesterone, Anxiety, Anovulation, Decidualization rarely endometrial/decidual cast [1,2]. An endometrial cast is the expulsion of the near entirety of the endometrial lining of the uterine cavity, often maintaining the shape of the uterus [3]. It is also known as membranous dysmenorrhoea due to the gross appearance of the tissue passed and the pain often associated with its passage.…”

Section: Discussionmentioning

confidence: 99%

Unusual Case of Vaginal Bleeding in A Teenager Caused by Endometrial Cast: Case Report and Literature Review

J.S,

T.O

2024

AGWH

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Introduction Endometrial cast, a rare occurrence in gynaecology, is the expulsion of the near entirety of the endometrial lining of the uterine cavity, often maintaining the shape of the uterus. Also known as membranous dysmenorrhoea and largely associated with use of a progesterone-containing contraceptive; some cases following oral contraceptive pills (OCP) use in adolescence for the management of heavy menstrual bleeding (HMB), have been reported. Case Report A 16-year-old nulliparous girl presented with a sudden passage of tissue per vagina (PV) following a short duration of PV bleeding and short-lasting crampy abdominal pain, after a 3-month regular use of Rigevidon® (a combined oral contraceptive pill (OCP) containing ethinylestradiol and levonorgestrel): a contraceptive choice. Noted was a previously normal menstrual cycle following menarche at age 12 with an unremarkable past medical history, a negative urine pregnancy test and an empty uterus on ultrasound scan. Histological examination of the 14cm-long flat fleshy mass with an intrauterine outline confirmed an endometrial or decidual cast. Discussion Cast formation, with different underlying mechanisms – inadequate estrogen opposition effect on endometrium from dysfunctional oestrogen-progesterone imbalance +/- dysfunctional progesterone-mediated cellular Tissue inhibitors to- and matrix metallopeptidases (TIMP/MMP) – has been associated with HMB, ectopic gestations, miscarriages and secondary postpartum haemorrhage. Our case had no preceding significant risk factors and inadequate sonographic-evidence- a common occurrence in literature. This led to diagnostic and management challenges, increasing anxiety and treatment morbidity. Management in young women should be expectant +/- hormonal treatment. Reassurance with individualised progestogens type and dose will aid contraceptive-compliance. Conclusion While endometrial/decidual cast is not associated with a deleterious health effect, it can be distressing to patients and a diagnostic challenge to clinicians, unfamiliar with it. More research into underpinning pathways and disease associations is needed.

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Section: Discussionmentioning

confidence: 99%

Unusual Case of Vaginal Bleeding in A Teenager Caused by Endometrial Cast: Case Report and Literature Review

J.S,

T.O

2024

AGWH

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“…Membranous dysmenorrhea is a rare entity with an acute onset clinical picture characterized by severe hypogastric pain and transvaginal bleeding [ 4 , 5 ]. The definitive diagnosis is made by histopathological examination of the expectorated tissue, which shows an endometrium with abundant pre-decidualized stroma, with elongated cells infiltrated by polymorphonuclear cells and glands lined by cuboidal cells without atypia [ 1 , 2 ].…”

Section: Discussionmentioning

confidence: 99%

Unusual Manifestation of Membranous Dysmenorrhea: Case Report

Luna-López,

Zatarain-Mendívil,

Peña-Borrego

et al. 2023

Am J Case Rep

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Patient: Female, 43-year-old Final Diagnosis: Unusual clinical course Symptoms: Severe pain in the lower abdomen, radiating to the genital area with transvaginal bleeding Clinical Procedure: Speculum examination Specialty: Obstetrics and Gynecology • Pathology Objective: Unusual clinical course Background: In the 18 th century, Morgagni described membranous dysmenorrhea as the sudden and complete detachment of the decidua during menstruation. This causes intense and painful contractions of the myometrium, aggravated by the expulsion of tissues produced by the decidualization of the endometrium. It is a rare pathology associated with oral contraceptives, ectopic pregnancies, abortions, and natural cycles, with consequent thickening and endometrial decidualization with molding of the tissue of the uterine cavity of membranous appearance. The definitive diagnosis is made by histopathological examination. Case Report: A 43-year-old female patient came for urgent consultation for an acute picture of severe pain in the lower abdomen, radiating to the genital area with transvaginal bleeding of 2 h of evolution. She had no significant past medical history. A transvaginal ultrasound was performed and showed an unchanged endometrial cavity. A vaginal examination revealed a foreign body of soft consistency; therefore, a speculum examination was performed, which showed tissue of endometrial origin located in the cervical canal of a reddish spongy texture. The tissue was removed, thus improving the symptomatology, and was sent to the pathological anatomy service for histopathologic diagnosis. Conclusions: Membranous dysmenorrhea is a rare gynecologic disorder with only a few documented cases. According to other case reports, our patient’s case, at age 43 years, was an atypical presentation. The clinical features and association with this pathology allowed the diagnosis and its confirmation by histopathological examination.

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“…Although the progesterone and progesterone containing agents induce decidualization and cycle stability , the mystery of membranous dysmenorrhea still remains unclear [15].Only thirteen cases were found to suffer from pain, a type of secondary dysmenorrhea, which occurs from the passage of tissues through the non-dilated cervix [16]. Physiologic and supraphysiologic doses of progestin causes an exaggerated response of the immature uterus resulting in excessive endometrial growth and cast formation [4][5][6][7][8][9][10][11][12][13][14]. An immature uterus differs from a mature uterus by immature uterine natural killer (uNK) cells.…”

Section: Discussionmentioning

confidence: 99%

“…uNK cells matures with each cycle to form effective spiral artery and placental vasculature development during pregnancy. Increased progesterone on uNK cells may lead to an ineffective spiral artery development and makes adolescents more sensitive to form an endometrial cast [5]. Depomedroxyprogesterone acetate has been reported in the decidual cast development and was cited in 50% of reported adolescent cases.…”

Section: Discussionmentioning

confidence: 99%

Hysteroscopic management of infected and partially discharged desidual cast in an adolescent: A case report and review of the literature in adolescents

Telli,

Arda

2023

Aegean J Obstet Gynecol

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Objective: Decidual cast in other words membranous dysmenorrhea is a rare entity. Hereby, we report the first infected case caused by drospirenon containing contraceptive use and managed successfully by hysteroscopy. Case presentation: A13 year-old girl started on drospirenon containing contraceptive theraphy since her menarche resulted in menorrhagia and anemia that requires transfusion. On follow up, she developed a partially discharged infected mass revealed to be a decidual cast on pathological review. Discussion: Membranous dysmenorrhea occurs more frequently in the adolescent and young adult population. All cases in this review were on hormonal theraphy except one occured spontaneously. Cast formation of the immature uterus after menarche is an exaggerated response to dose-independent increased progestin levels. Conclusion: We conclude that diagnosis of decidual cast/membranous dysmenorrhea should be kept in mind for colicky pain with bleeding of adolescents under hormonal contraceptive therapy and partially discharged cases may be managed successfully by hysteroscopy.

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Endometrial Cast Expulsion: A Rare Cause of Pelvic Pain Case Report and Review of the Literature

Cited by 6 publications

References 8 publications

Unusual Case of Vaginal Bleeding in A Teenager Caused by Endometrial Cast: Case Report and Literature Review

Unusual Case of Vaginal Bleeding in A Teenager Caused by Endometrial Cast: Case Report and Literature Review

Unusual Manifestation of Membranous Dysmenorrhea: Case Report

Hysteroscopic management of infected and partially discharged desidual cast in an adolescent: A case report and review of the literature in adolescents

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