Fungal corneal ulcer

• Disease Description (Causes and Symptoms)

  • Definition: A benign lesion (polyp) in which part of the endometrium proliferates excessively in a localized area and protrudes into the uterine cavity. It is usually solitary, but occurs as multiple polyps in about 20% of cases, and is commonly found in the uterine fundus (base).
  • Causes/Pathophysiology: Localized excessive proliferation of the endometrial glands and stroma, associated with estrogen stimulation and sometimes showing monoclonal (neoplastic) proliferation. Increasing age, tamoxifen use, and hormonal changes are related factors.
  • Main symptoms: Asymptomatic cases are common. When symptoms occur, they may include abnormal vaginal bleeding (intermittent spotting, including postmenopausal bleeding), heavy menstrual bleeding (menorrhagia), dysmenorrhea, and increased vaginal discharge. It is often not detected through a pelvic examination or cervical cytology (Pap test).
  • Risk of malignant transformation: Rare overall, reported to be less than 5% depending on the study. The possibility of malignant transformation increases in postmenopausal women, with large polyps, and when abnormal histological findings are present.

• Treatment Methods

  • Observation (Conservative Management)
    • Follow-up observation may be possible when the patient is asymptomatic and the size and symptoms do not change.
    • After menopause or when symptoms are present, biopsy and removal should be considered.
  • Procedures/Surgery
    • Hysteroscopic polypectomy: The standard treatment. The polyp can be removed under direct visualization, and a biopsy can be performed. The recurrence rate is low, and the condition of the endometrium can be directly observed.
    • Endometrial curettage (D&C): Although it was frequently performed in the past, it has lower sensitivity for lesion removal and diagnosis than hysteroscopy.
    • Hysterectomy: Considered when polyps are multiple, bleeding is severe, preservation is difficult because of other uterine diseases (e.g., uterine fibroids), or malignancy is suspected or confirmed.
  • Medication Therapy
    • Hormonal treatment for symptom relief (progestins, oral contraceptives, GnRH agonists, etc.) may help temporarily control bleeding but cannot completely remove the polyp itself.
  • Precautions
    • Biopsy (pathological examination after removal) is recommended in cases of postmenopausal bleeding.
    • If pregnancy is desired, polyp removal may help improve pregnancy and pregnancy-related clinical outcomes.

• Outpatient Visit Checkpoints (Including Example Questions)

  • Items/Records to Prepare
    • List of medications currently being taken (hormonal medications, anticoagulants, tamoxifen, etc.)
    • Previous gynecological examination results (pelvic ultrasound, hysteroscopy findings, endometrial curettage/biopsy results)
    • Menstrual history: bleeding pattern, duration, intervals, menopausal status, and timing of any recent abnormal bleeding
    • Possibility of pregnancy (if a pregnancy test is needed)
    • Underlying conditions (obesity, diabetes, and other hormone-related diseases)
  • Information to Tell the Doctor First During the Outpatient Visit
    • Recent changes in the bleeding pattern
    • Whether hormonal medications or anticancer drugs (e.g., tamoxifen) are being taken
    • Pregnancy plans or a history of infertility
  • Example Questions (Questions the Patient Can Ask the Doctor First)
    • "Would it be helpful if I summarized my recent bleeding pattern?"
    • "May I show you the ultrasound/biopsy results I received previously?"

• Examples of General Questions to Ask the Doctor

  • "How likely is this condition to be malignant (cancer)? Are additional tests (a biopsy) needed?"
  • "Which treatment option—observation or hysteroscopic removal—is appropriate for me?"
  • "What are the side effects of treatment, and how long is the recovery period?"

• Examples of Condition-Specific Questions

  • "I have postmenopausal bleeding. If an endometrial polyp is found, does it always need to be removed?"
  • "What is the recurrence rate after removing an endometrial polyp by hysteroscopy, and are there any additional measures to reduce recurrence?"

Additional Notes (Brief)

• For diagnosis, suspected findings are first identified through uterine ultrasound (especially transvaginal ultrasound), and ultrasound after saline (physiological saline) infusion (SIS, saline infusion sonography) increases the detection rate. Definitive diagnosis is made by directly observing the polyp with hysteroscopy and performing a biopsy.
• Complications: Bleeding, infection, procedure-related uterine perforation, intrauterine adhesions, and, rarely, malignant transformation.
• Prevention: There is no clear method of prevention, but monitoring risk factors (such as tamoxifen use) and early evaluation of abnormal bleeding are recommended.