Case Reports in Obstetrics and Gynecology最新文献

Background: Deep vaginal wall hematoma is a common vaginal delivery complication. Exploring effective treatments is key to improving clinical management and patient outcomes.

Case: A patient with deep vaginal wall hematoma (admitted in November 2024) underwent hematoma removal, followed by "T"-shaped drainage tube combined with vaginal packing gauze. The treatment achieved remarkable hemostasis; the patient recovered rapidly with well-healed perineal wounds, shorter hospital stays, and low pain scores.

Conclusions: Early detection and timely treatment of vaginal wall hematoma, combined with "T"-shaped drainage tube drainage, avoid open abdominal hemostasis and related damage. This method is safe, effective, and worthy of clinical application.

Objective: Uterine leiomyoma represents one of the most common pathologies affecting women of reproductive age, often presenting with lower abdominal pain and abnormal bleeding. Benign metastasising leiomyomatosis (BML) is a rare tumour originating from uterine leiomyomas, with the lungs being a common extrauterine location. The aetiopathogenesis remains unclear, and no standardised treatment protocols exist due to the rarity of the disease.

Case report: We present a case of a patient who developed pulmonary BML 7 years after hysterectomy for uterine leiomyoma. Despite initial hormonal therapy and various interventions, the patient's condition progressively worsened, leading to pulmonary hypertension, cardiac decompensation and ultimately death. Despite consultations with oncologists and treatment with aromatase inhibitors and doxorubicin, the disease proved refractory to treatment.

Conclusion: BML remains a challenging condition to manage due to its low incidence and lack of standardised treatment protocols. Multidisciplinary approaches are essential, and further research is needed to establish better treatment guidelines.

Introduction: Total abdominal hysterectomy (TAH), commonly referred to as extrafascial hysterectomy, is widely used in standard gynecological practice. However, hysterectomy performed in cervical leiomyoma presents greater challenges and pitfalls that require a modified approach. This case report wishes to highlight the importance of anatomical identification and the application of the intrafascial approach of hysterectomy.

Case report: A 57-year-old multiparous woman was admitted with a significant abdominal mass. During the physical examination, a large globular firm mass, corresponding to approximately 24 weeks of pregnancy, was identified. Ultrasonography revealed a cervical fibroid, and subsequent biopsy confirmed this diagnosis. We decided to perform intrafascial hysterectomy. Intraoperatively, the cervical fibroid was found 20 × 16 cm in size, whereas the uterus measured 14 × 14 cm. Pathological examination confirmed the presence of leiomyoma and endocervicosis of the cervix.

Discussion: Cervical fibroids present considerable challenges during surgical procedures due to alterations in uterine anatomy, which can affect the ureter's danger zone. The application of the intrafascial technique in hysterectomy is essential for minimizing the risk to the ureters and for preserving the cervical ring.

Introduction: Interstitial ectopic pregnancy is a rare and potentially life-threatening condition that occurs when a fertilized ovum implants in the interstitial (intramural) portion of the fallopian tube within the myometrium. It accounts for 2%-4% of all ectopic pregnancies and poses significant risks due to the potential for rupture and severe hemorrhage.

Case presentation: We report the case of a 34-year-old woman, gravida 5 para 3 + 1, living 4, who presented with right iliac fossa pain at 5 weeks of gestation. Ultrasonography and elevated β-hCG levels revealed a suspicious interstitial ectopic pregnancy. Initial treatment with systemic methotrexate was administered; however, due to plateauing β-hCG levels, a second dose of methotrexate was given via direct injection into the ectopic site. Follow-up monitoring demonstrated a significant reduction in β-hCG levels, resulting in the successful resolution of the ectopic pregnancy.

Conclusion: This case highlights the successful treatment of interstitial ectopic pregnancy with local methotrexate injection, emphasizing the importance of early diagnosis and timely intervention. Future studies with larger sample sizes and standardized treatment criteria are recommended.

Background and aims: Cystic adenomyoma is a rare focal cystic variant of adenomyosis, and giant lesions are particularly uncommon. Malignant transformation has been reported in endometriosis-related disease, but the molecular features of cystic adenomyoma, especially in adults, remain unclear. We are aimed at describing a premenopausal patient with two giant cystic adenomyomas, including the largest lesion reported to date, and to explore a possible pathogenic mechanism using immunohistochemistry.

Methods: A 47-year-old nulliparous premenopausal woman presented with progressive abdominal distension and urinary symptoms. Imaging showed two large hemorrhagic cystic masses adjacent to a mildly enlarged fibroid uterus, and ovarian endometriotic cysts were suspected preoperatively. The patient underwent hysterectomy with bilateral salpingo-oophorectomy. Gross, histologic, and immunohistochemical examinations were performed on the uterus and cystic lesions. Clinical follow-up was obtained for 10 months.

Results: Surgery revealed two cystic adenomyomas measuring 30 and 10 cm, contiguous with the uterus but separate from both ovaries. The thick cyst walls were composed of smooth muscle bundles, and the inner surfaces were lined by a single layer of endometrial-type epithelium; multiple foci of conventional adenomyosis were also present. In the cystic adenomyomas, glands were HNF-1β+, pAKT+, estrogen receptor+, PTEN-, PIK3CA-, and ARID1A- with a p53 wild-type pattern. Eutopic endometrial glands were HNF-1β+, PIK3CA+, pAKT+, ARID1A+, and p53+, with mixed PTEN-positive and -negative glands. The postoperative course was uneventful, and no recurrence was observed at 10 months.

Conclusion: This case represents the largest cystic adenomyoma reported to date and the first adult case characterized in detail by immunohistochemistry. Differential PTEN and ARID1A expression between eutopic endometrium and cystic adenomyomas supports a model in which PTEN-deficient endometrial clones invade the myometrium to form adenomyosis, with additional ARID1A loss and pAKT activation driving cystic enlargement without malignant transformation.

Dropped gallstones are a known complication of laparoscopic cholecystectomy, occurring in up to 40% of cases. While often considered benign, they can lead to complications like abscess formation and peritoneal adhesions. In cancer patients, dropped gallstones may mimic disease recurrence, leading to unnecessary diagnostic procedures and patient distress. We report the case of a 63-year-old woman with a history of leiomyosarcoma, previously treated with surgical resection. She subsequently underwent laparoscopic cholecystectomy for acute cholecystitis. Ten months later, she presented with nonspecific upper abdominal symptoms, and imaging indicated peritoneal nodularity suspicious for malignancy. A CT-guided biopsy was inconclusive, prompting diagnostic laparoscopy revealing multiple dropped gallstones with granulomatous inflammation but no evidence of malignancy. The patient remained symptoms free after retrieval, with no further radiological abnormalities on follow-up imaging. This case highlights the diagnostic challenges posed by dropped gallstones, particularly in oncology patients where they can be mistaken for peritoneal metastases. Surgeons should be meticulous to retrieve all gallstones during laparoscopic cholecystectomy, and radiologists should include dropped gallstones in the differential diagnosis of new intra-abdominal lesions in postsurgical patients. Awareness of this phenomenon can prevent unnecessary interventions and patient anxiety.

Leiomyoma are benign tumors of smooth muscle origin. Uterine leiomyoma are extremely common; leiomyoma in extraperitoneal spaces, however, are not. There have been several documented cases of leiomyoma in retroperitoneal spaces, though the majority of them have been in the posterior retroperitoneum. Here, we report a patient presenting with a large, firm suprapubic mass, initially thought to be a fundal uterine fibroid. On surgical excision, it was found to be the extremely rare finding of a benign leiomyoma in the anterior retroperitoneum or space of Retzius.

Vaginal cuff dehiscence (VCD) with bowel evisceration is a rare but serious post-operative complication following hysterectomy, particularly associated with minimally invasive surgical approaches. It carries significant morbidity and requires prompt diagnosis and surgical intervention. We report the case of a 43-year-old woman who presented with post-coital acute lower abdominal pain and evisceration of bowel through the vagina 3 months after undergoing a total laparoscopic hysterectomy for heavy menstrual bleeding. On examination, large loops of small bowel were noted to be eviscerated through the vaginal canal, with pieces of tissue paper adhered to the eviscerated bowel. Emergent surgical exploration was performed, revealing a dehisced vaginal cuff with underlying viable bowel. The bowel was reduced, the vaginal cuff was repaired transvaginally, and an exploratory laparoscopy was performed with the remaining adherent tissue paper being left on the bowel. The patient recovered without complication and was discharged after a 3-day hospital stay. VCD with evisceration is a rare complication that requires high clinical suspicion, particularly in posthysterectomy patients presenting with pelvic pain, vaginal bleeding or protrusion. Timely surgical management is essential to avoid bowel ischaemia and other complications. Awareness of risk factors and careful surgical technique during cuff closure at the time of hysterectomy may help prevent this potentially life-threatening condition. This case also highlights the unique and novel occurrence of tissue paper being left intra-abdominally at the time of surgery in support of potential conservative management in these instances.

Introduction: Primary vulvar cancer is uncommon, accounting for only 3%-5% of all gynecological malignancies. Metastases to the vulva are even rarer, and those originating from breast cancer are exceptional, with fewer than 20 cases reported in the literature.

Case presentation: We report the first case observed at our institution. A 38-year-old woman had been treated for breast cancer. Ten years after completing treatment, she presented with an analgesic-resistant headache, cervical swelling, and vulvar discomfort. Updated staging revealed hepatic, pulmonary, pleural, and bone metastases. Biopsy of the vulvar lesion confirmed metastasis of an infiltrating ductal breast carcinoma. The patient underwent chemotherapy, with disease progression despite treatment. She is currently receiving palliative chemotherapy.

Conclusion: Early detection of unusual metastatic sites and appropriate management require careful monitoring of women with breast cancer. Pelvic and gynecological examinations should be included in the follow-up of breast cancer patients to detect vulvar or vaginal metastases.

Background and aims: Periventricular nodular heterotopia is an unusual disorder caused by a neuronal migration disorder.

Methods: A case report and narrative review of the literature were carried out.

Results: This pathology involves multiple systemic manifestations, mainly neurological (seizures) and cardiovascular (valve insufficiency). Only 186 periventricular nodular heterotopia patients have been described in the literature. The present case report is one of the scarce cases diagnosed prenatally by ultrasound. Postnatal genetic test revealed the newborn was heterozygous for the FLNA gene variant mutation, associated with an X-linked dominant inheritance pattern with ventricular heterotopia.

Conclusion: This study underlines that comprehensive prenatal diagnosis helps with paternal counseling, newborn management, and preconception counseling.