{"paper_id":"dddea6dc-1fe2-4785-b9ec-210c96abbb02","body_text":"Journal of Medical Case Reports and Case Series ISSN: 2692-9880 \nCitation: Kaushik S, Acharya S (2021) A rare case of cervical endometriosis presenting with profuse vaginal bleeding during an embryo transfer cycle: A case report. J Med Case Rep \nCase Series 2(19): \nhttps://doi.org/10.38207/JMCRCS/2021/0219263 \n \n \nCase Report Volume 2 Issue 19 \nA rare case of cervical endometriosis presenting with profuse vaginal bleeding during an embryo \ntransfer cycle: A case report. \nSomya Kaushik1, Santanu Acharya2* \n1Clinical Fellow, Department of Obstetrics & gynaecology, NHS Ayrshire & Arran, UK. \n2Ayrshire Fertility Unit, University Hospital Crosshouse, Honorary Clinical Associate Professor, University of Glasgow, UK; ORCID id: \nhttps://orcid.org/0000-0003-4251-9655 \n*Corresponding Author: Santanu Acharya, Ayrshire Fertility Unit, University Hospital Crosshouse, Honorary Clinical Associate Professor, \nUniversity of Glasgow; ORCID id: https://orcid.org/0000-0003-4251-9655 \nReceived date: 16 December 2021; Accepted date: 27 December 2021; Published date: 06 January 2022 \nCitation: Kaushik S, Acharya S (2021) A rare case of cervical endometriosis presenting with profuse vaginal bleeding during an embryo transfer \ncycle: A case report. J Med Case Rep Case Series 2(19): https://doi.org/10.38207/JMCRCS/2021/0219263 \nCopyright: © 2021 Santanu Acharya. This is an open-access article distributed under the terms of the Creative Commons Attribution License, \nwhich permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. \n \n \nCase presentation \nA 40-year-old woman was referred for assisted conception. During \nembryo transfer, the procedure had to be abandoned due to excessive \nbleeding from the cervix. Her cervix appeared abnormal, and she \nwas referred urgently to colposcopy. Her previous cervical s mears \nwere up to date and normal. Colposcopy revealed a slightly inflamed \ncervix with an ectropion. Within this area, was a raised nodular \ngrowth that appeared  suspicious and bled profusely on contact. \nBiopsy confirmed histological features of cervical endometriosis \nwith no features suggestive of dysplasia or malignancy. She was \nreferred back to the gynaecology for further investigation in light of  \n \nthis new diagnosis and to review her in the context of any potential \nconsequences for her fertility treatment. \nA detailed history revealed a chronic symptom of prolonged bleeding \nthroughout the month with the variable flow for which she was on \ncombined oral pills for 18 years. She had been experiencing chronic \npelvic pain and dyschezia. \nDiagnostic laparoscopy was undertaken and was suggestive of \nendometriotic spots on the right ovary and the utero -vesical fold \nwhich were treated by diathermy. Hysteroscopic view of the \nendometrial cavity was normal. \n \nDiscussion \nEndometriosis is a very common condition affecting women of \nreproductive age. Although endometriosis is most commonly noted \nin the  pelvis, extra-pelvic locations are also demonstrated in some \ncases. The presentation of cervical endometriosis is variable. It is \nusually asymptomatic and diagnosed retrospectively in \nhistopathological reports but can also present as post -coital bleeding \nor abnormal smears. Almost all the previous documented cases were \nmisdiagnosed with cervical myoma, cysts, polyps, melanoma, or \ncervical cancer; only to receive the diagnosis of endometriosis once \nthe tissue had been biopsied.  \nSome authors consider cervical endometriosis as a leading cause of \nrecurrent minimal metrorrhagia [1]. In one of a large series only  \n12.5 % of cases of cervical endometriosis, complained of irregular \nbleeding [2]. In another case series, 20 % of women presented with \nmetrorrhagia [3]. One of the cited cases in literature was pr esented \nwith severe vaginal haemorrhage, who ultimately required uterine \nartery embolization to control the haemorrhage. A considerable \nnumber of patients reported in the literature only had abnormal \nsmear results and were diagnosed after histopathological evaluation. \nOther findings are glandular abnormalities like cervicitis, \nendocervical gland  dysplasia, adenocarcinoma in situ, squamous \ncarcinoma in situ, atypical squamous metaplasia involving glands \nand tubal metaplasia, especially in th e superficial cervical \nendometriosis. Cervical endometriosis being a source of atypical \nglandular cells should be kept  in mind [4-7]. In our case, there was \nno abnormality noted in the cervical smears.  \n \nVarious theories had been proposed to explain the origin of \nendometriosis. Theories such as Sampson’s menstrual reflex and  \nimplantation theory can be used to explain cervical endometriosis in \ncases with previous cervical trauma caused by the procedures such \nas LLETZ or curettage or biopsy [8]. In our patient, there was no \nhistory of the aforementioned procedures ruling out any cervical \ntrauma and hence  the most likely theory for her developing \nAbstract \nCervical endometriosis is seen very rarely, much lesser than even the extra pelvic sites like an abdominal wall or vaginal wall. Limited awareness \nof the condition may account for its rarity. This report aims to remind gynaecologists of the possibility of cervical endomet riosis by reviewing \nthe case of a woman who presented with profuse vaginal bleeding during embryo transfer in an assisted conception cycle. \n\nJournal of Medical Case Reports and Case Series ISSN: 2692-9880 \nCitation: Kaushik S, Acharya S (2021) A rare case of cervical endometriosis presenting with profuse vaginal bleeding during an embryo transfer cycle: A case report. J Med Case Rep \nCase Series 2(19): \nhttps://doi.org/10.38207/JMCRCS/2021/0219263 \n \n \ncervical endometriosis could be explained by the abnormal intrinsic \nproperties of eutopic  endometrium, embryonic remnants and \nmetaplastic origination [9]. \n \nAsymptomatic cases may not always require treatment but \nsymptomatic cases presenting with post -coital bleeding and inter - \nmenstrual bleeding can be treated with the LLE TZ procedure, \nelectrocoagulation, cryosurgery or CO2 laser vaporization [10]. \nAlso, treatment can be necessary as many will present with \nassociated pathologies like adenomyosis, fibroid, ovarian cyst or  \n \n \npelvic endometriosis. In our case, a diagnostic laparoscopy was \nperformed to evaluate the extent of the disease before proceeding \nwith fertility treatment. In order to prevent a further recurrence, \npatients can be prescribed hormonal management in order to delay \nmenstrual bleeding for several  weeks, to allow the cervix to heal. \nOur patient was keen on her fertility treatment and therefore refused \nto wait for her next IVF cycle. \nLearning points \n· Cervical endometriosis can be encountered in different clinical \npresentations and should be considered in the differential diagnosis of \nabnormal vaginal bleeding. \n \n· Colposcopy, cervical biopsy and fine -needle aspiration cytology \n(FNAC) are important investigations for superficial cervical \nendometriosis. \n \nReferences \n1. Gardner HL, Kaufmann RH. Benign diseases of the vulva and \nvagina. St Louis, Mo: CV Mosby; 1969. pp. 98–104. \n2. Veiga-Ferreira MM, Leiman G, Dunbar F, Margolius KA (1987) \nCervical endometriosis: facilitated diagnosis by fine needle  \naspiration cytologic testing. Am J Obstet Gynecol. 4(pt 1): 849– \n856. \n3. Phadnis SV, Doshi JS, Ogunnaike O, Coady A, Padwick M, et  \nal. (2005) Cervical endometriosis: a diagnostic and management  \ndilemma. Arch Gynecol Obstet. 272(4): 289–93. \n4. Symonds DA, Reed TP, Didolkar SM, Graham RR (1997) AGUS \nin cervical endometriosis. J Reprod Med. 42(1): 39-43. \n5. Kim TJ, Kim HS, Park CT, Park IS, Hong SR, et al. (1999)  \nClinical evaluation of follow -up methods and results of atypical  \nglandular cells of undetermined significance (AGUS) detected on \ncervicovaginal Pap smear. Gynecol Oncol. 73(2): 292-8. \n \n \n6. Lundeen SJ, Horwitz CA, Larson CJ, Stanley MW (2002)  \nAbnormal cervicovaginal smears due to endometriosis: a  \ncontinuing problem. Diagn Cytopathol. 26(1): 35-40. \n7. Szyfelbein WM, Baker PM, Bell DA (2004) Superficial  \nendometriosis of the cervix: A source of abnormal glandular cells \non cervicovaginal smears. Diagn Cytopathol. 30(2): 88-91. \n8. Sampson JA (1940) The development of the implantation theory  \nfor the origin of peritoneal endometriosis. Am J Obstet Gynecol.  \n40(4): 549-557. \n9. Hoang NM, Smadja A, Orcel L (1987) Endometriosis of the  \nuterine cervix. A hypothesis on its histogenesis. J Gynecol Obstet \nBiol Reprod. 16(5): 587-93. \n10. Wozniak J, Szczepanska M, Opala T, Pisarska -Krawczyk M,  \nWilczak M, et al. (1995) Point CO 2 laser vaporisation in  \ntreatment  of  superficial  endometriosis  of   the   uterine    \ncervix. Ginekol Pol. 66(1): 19–23","source_license":"CC0","license_restricted":false}