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      Endometrial polyp filled with gestational tissues remained undiscovered in an infertile woman for years: a case report

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          Abstract

          Recurrent pregnancy loss (RPL) is a common disease, which presents as two, three or more failed pregnancies. It is attributed to many risk factors, yet half of the cases are idiopathic. In this report, we present a case of a 44-year-old woman with a complaint of secondary infertility for 10 years and a history of three spontaneous abortions. Blood tests and images showed no abnormalities, except for hysteroscopy which showed a polyp-like mass. Pathology revealed an endometrial stroma showing severe decidualization with a lot of gestational villi showing fibrosis and hyaline degeneration, features of old gestational product death, with no glands crowding or cellular atypia. In this case, the conception products were not preceded with a miscarriage and did not cause any symptoms indicating its existing. The asymptomatic endometrial polyp filled with fibrotic gestational villi without a prior miscarriage is an unprecedented case in the medical literature.

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          Uterine polyps, adenomyosis, leiomyomas, and endometrial receptivity

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            Recurrent pregnancy loss and vitamin D: A review of the literature.

            Recurrent pregnancy loss (RPL) affects approximately 1%-2% of reproductive women. Auto- and cellular immune responses seem to be associated with RPL. Vitamin D (VD) has been shown to play a role in the modulation of the immune system. Effects of VD deficiency (VDD) in pregnancy have been associated with preeclampsia, gestational diabetes, fetal growth restriction, preterm labor, and sporadic spontaneous abortion (SA). We systematically reviewed articles that studied women with 2 or more SA and its association with VD. Eleven studies were included. Studies reported a high prevalence of VD insufficiency (VDI) or VDD in women with RPL and suggested that this could be associated with immunological dysregulation and consequently with RPL. Immunological benefits were reported in the peripheral blood of women with RPL after VD exposure. Thus, it is possible to speculate a beneficial role for VD supplementation in RPL. It seems that there are not differences in the vitamin D receptor (VDR) and CYP27B1 expression in endometrium of women with RPL but, in villous and decidual tissues, RPL women seem to have a decreased expression of VDR and, perhaps, a decreased expression of CYP27B1. Further randomized controlled studies are required to investigate the association between VDD or VDI and RPL.
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              Endometrial polyps affect uterine receptivity.

              This case-control study evaluated the effect of hysteroscopically identified endometrial polyps on endometrium by means of HOXA10 and HOXA11, known molecular markers of endometrial receptivity. Uteri with endometrial polyps demonstrated a marked decrease in HOXA10 and HOXA11 messenger RNA levels, which may impair implantation. These findings suggest a molecular mechanism to support the clinical findings of diminished pregnancy rates in women with endometrial polyps. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Oxf Med Case Reports
                Oxf Med Case Reports
                omcr
                Oxford Medical Case Reports
                Oxford University Press
                2053-8855
                June 2020
                13 June 2020
                13 June 2020
                : 2020
                : 6
                : omaa038
                Affiliations
                [1 ] Faculty of Medicine, University of Hama , Hama, Syria
                [2 ] Department of Pathology, Faculty of Medicine, Damascus University , Damascus, Syria
                Author notes
                Correspondence address. Faculty of Medicine, University of Hama, 0500 Hama, Syria. Tel: 00963933479486; E-mail: najah.dhemesh@ 123456gmail.com
                Author information
                http://orcid.org/0000-0001-9888-5764
                http://orcid.org/0000-0002-7368-5464
                http://orcid.org/0000-0002-4355-8448
                Article
                omaa038
                10.1093/omcr/omaa038
                7293139
                32551129
                8518429f-544f-4264-8686-24283dccd1d1
                © The Author(s) 2020. Published by Oxford University Press.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                : 14 April 2020
                : 29 April 2020
                : 3 May 2020
                Page count
                Pages: 3
                Categories
                AcademicSubjects/MED00010
                omcrep/1400
                Case Report

                endometrial polyp,gestational tissue,infertility,recurrent pregnancy loss,obstetrics

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