Cooijmans Tessel, Koks Carolien, Bongers Marlies
Obstetrics and Gynaecology, Máxima MC, Veldhoven, The Netherlands
Obstetrics and Gynaecology, Máxima MC, Veldhoven, The Netherlands.
BMJ Case Rep. 2025 Apr 24;18(4):e254401. doi: 10.1136/bcr-2022-254401.
A woman in her 40s presented with complaints of watery discharge (sloughing).These symptoms developed three months after treatment of her Fédération Internationale de Gynécologie et d'Obstétrique (FIGO) type 2 fibroid with the transcervical use of intrauterine ultrasound-guided radiofrequency ablation, the Sonata system (Gynesonics). Previous symptoms of heavy menstrual bleeding significantly decreased three months after transcervical ablation. In spite of this, the patient presented with complaints of sloughing. Examination by transvaginal ultrasound revealed an intracavitary fibroid. Additional hysteroscopy identified a FIGO type 0 fibroid with a necrotic aspect. Eventually, the intracavitary fibroid was removed by hysteroscopic myomectomy, and complaints of sloughing vanished completely. The necrotic fibroid tissue was confirmed by the pathologist.Intrauterine expulsion of a (submucosal) fibroid after treatment with the Sonata system should be discussed with patients during pre-treatment counselling as a possible consequence of this treatment. Thus, patients can recognise symptoms of intrauterine expulsion of the ablated fibroid in a timely manner.
一名40多岁的女性因水样分泌物（脱屑）前来就诊。这些症状在她使用宫腔内超声引导射频消融术（Sonata系统，Gynesonics）治疗国际妇产科联盟（FIGO）2型肌瘤三个月后出现。经宫颈消融三个月后，之前月经过多的症状明显减轻。尽管如此，患者仍有脱屑的主诉。经阴道超声检查发现宫腔内有肌瘤。进一步的宫腔镜检查发现一个有坏死外观的FIGO 0型肌瘤。最终，通过宫腔镜肌瘤切除术切除了宫腔内的肌瘤，脱屑的主诉完全消失。病理学家证实了坏死的肌瘤组织。在治疗前咨询中，应与患者讨论使用Sonata系统治疗后（黏膜下）肌瘤排出宫腔的可能性，以便患者能够及时识别消融肌瘤排出宫腔的症状。
