Case Reports in Obstetrics and Gynecology最新文献

Müllerian duct anomalies and uterine leiomyomas represent distinctive facets of female reproductive health. While uterine leiomyomas are prevalent reproductive pathologies, the coexistence of Müllerian anomalies and leiomyomas is relatively uncommon. This case study examines the complex medical and surgical management of a woman who initially presented with chronic abdominal pain and swelling. Following evaluation, the patient received a diagnosis of an uncommon co-occurrence of congenital uterus didelphys and leiomyomas. Notably, during the surgical procedure, a rectovesical peritoneal band was identified. This case study seeks to broaden the scientific understanding of these subsets of women, offering insights into the complexities arising from a common diagnosis overlaying a rare condition.

Fetal limb anomaly presentation varies greatly. It can present as amelia (complete absence of skeletal part of one or more limb), meromelia (partial absence of skeletal part of one or more limb), phocomelia (only rudimentary limb formed), and minor limb disorders like polydactyly. The complete absence of the four fetal limbs is extremely rare. Incidence of tetra-amelia is not well known, but it is mentioned to be 1-4 in 100,000 births in different literature. Etiopathogenesis of fetal tetra-amelia remains speculative. Tetra-amelia occurs either as tetra-amelia syndrome (when other organ systems are affected too) or isolated tetra-amelia. Tetra-amelia syndrome is more common than isolated tetra-amelia. It occurs secondary to genetic aberration or is sporadic. Genetic inheritance of tetra-amelia may present as autosomal dominance, autosomal recessive, or X-linked recessive. The protein coded on WTN 3 on chromosome 17q21 is important for fetal limb and other organ system formation. Mutation associated with the WTN 3 gene is a known cause for fetal limb malformation. Maternal diabetes, amniotic band syndrome, TORCH (toxoplasmosis, rubella cytomegalovirus, herpes simplex, and HIV) infection, alcohol consumption, and intrauterine exposure to some drugs like thalidomide, glucocorticoids, and sedatives are risk factors for limb malformation. Tetra-amelia can be diagnosed as early as the first trimester of pregnancy. Ultrasound imaging is a gold standard investigation to detect tetra-amelia. Tetra-amelia syndrome is associated with high mortality and morbidity than isolated tetra-amelia. In this case report, we present an extremely rare case, isolated tetra-amelia, born to G3P2 (Gravida 3, Para 2) mother at 36 weeks of gestation. It was diagnosed late in pregnancy at 34 weeks. The fetal organs (kidney, lung, abdominal wall, heart, vertebrae, and brain) were evaluated with ultrasound and were found healthy. She gave birth by cesarean section at 36 weeks of gestation for other obstetric indication. Isolated tetra-amelia is an extremely rare case. Early antenatal ultrasound fetal evaluation should be promoted. Early detection of tetra-amelia helps to provide parental counselling and option of management timely. Parental counselling should involve how to care for the neonate with tetra-amelia. Community awareness creation is important to decrease social stigma against babies with tetra-amelia. In such rare cases, it is important to alert public health researchers for possible further epidemiological study.

Placenta accreta spectrum (PAS) presents a significant risk of maternal morbidity and mortality, in large part due to the potential for massive hemorrhage at time of delivery. Recently, multiple gestations have been shown to be an independent risk factor for PAS, especially in the setting of other major risk factors. Importantly, antenatal detection of PAS in twin pregnancies has been shown to be suboptimal when compared to singleton pregnancies. Here, we present a case of postpartum hemorrhage and unplanned cesarean hysterectomy due to an undiagnosed placenta increta, which originated from the placenta of a demised twin in the second trimester. This case underscores the importance of thorough prenatal monitoring and evaluation for PAS, especially in multifetal gestations with additional risk factors. It also highlights the need for heightened awareness among healthcare providers to mitigate risks associated with PAS in twin pregnancies. Early detection and multidisciplinary collaboration are crucial in optimizing outcomes for both mothers and infants in such complex obstetric scenarios.

Endometriosis is a common gynecological condition in women of reproductive age and has variable symptomology such as pelvic pain, menorrhagia, dysmenorrhea, dyspareunia, and infertility. Endometriomas are a form of endometriosis and are characterized by cystic masses most commonly found on the ovaries. This case discusses the management of a rare occurrence of a 25-cm endometrioma in a patient without a prior diagnosis of endometriosis, who presented to the emergency room in an acute hypertensive emergency. It is believed that the large cyst caused a mass effect against renal vasculature precipitating renovascular hypertension that required immediate intervention. This case was approached with minimally invasive surgical removal of the cyst and lysis of adhesions without postoperative complications.

Adenomatoid tumors are rare benign neoplasms arising from mesothelial cells, commonly found in the female genital system, particularly the uterus and fallopian tubes. The giant cystic variant of adenomatoid tumor is exceptionally rare and can cause massive growth mimicking malignant gynecological conditions. Histology and immunohistochemistry play a crucial role in confirming the diagnosis, with markers such as calretinin, D2-40, CK7, BAP1, ER, and WT1 proving useful. A 51-year-old female with a history of breast cancer presented with pelvic pressure and vague pain. Imaging revealed an enlarged uterus with multiple heterogeneously enhancing masses and a predominantly cystic mass arising from the fundus, all believed to be leiomyomas. Surgical exploration and subsequent pathologic examination identified the cystic tumor as cystic adenomatoid tumor coexisting with leiomyomas, adenomyosis, and abdominal endometriosis. Diagnosing cystic adenomatoid tumor presents challenges, especially in patients with complex gynecologic histories. Cystic adenomatoid tumors typically have a favorable prognosis following surgical intervention. This case demonstrates one of the few reports of a giant cystic adenomatoid tumor (11.5 cm) and highlights diagnostic mimics. As these tumors are typically small and often seen only microscopically, the large size can confuse the pathologist who may be unaware of this feature leading to a misdiagnosis.

In this case, a 66-year-old female patient presented with the chief complaint of abdominal distention. Computed tomography and magnetic resonance imaging revealed no enlarged ovaries or obvious primary lesions; however, massive ascites and peritoneal disseminated nodules were observed. Ascites cytology revealed adenocarcinoma and immunohistochemical findings suggested serous carcinoma. The patient then underwent tumor reduction surgery after preoperative chemotherapy for suspected Stage IIIC primary peritoneal carcinoma. Postoperative histopathology revealed carcinoma consisting mainly of high-grade serous carcinoma (HGSC) and sarcoma. In addition, serous intraepithelial carcinoma (STIC) of the fallopian tube was observed in the fimbriae of the left fallopian tube. Recently, it has been noted in the literature that most cases of peritoneal carcinoma are metastases or dissemination of carcinoma originating from the fimbriae of the fallopian tube. This is a rare case of peritoneal carcinosarcoma with STIC, and its report leads to a better understanding of the disease's features and possible therapeutic approaches.

Background: Anti-NMDA receptor (A-NMDAR) encephalitis is an autoimmune condition often associated with ovarian teratoma. Surgical removal of the teratoma is generally curative, and recurrence is uncommon. Case: A 14-year-old female presented with psychiatric symptoms and was ultimately diagnosed with A-NMDAR encephalitis during a prolonged hospitalization. She was found to have bilateral ovarian teratomas, underwent laparoscopic bilateral ovarian cystectomy, and returned to neurologic baseline within 2 months. One year later, the patient was re-presented with similar symptoms and was diagnosed with recurrent A-NMDAR encephalitis. Initial imaging was negative for ovarian teratomas. After another prolonged hospitalization, repeat imaging ultimately demonstrated a suspected left ovarian teratoma. A left salpingo-oophorectomy was performed, and the patient's condition again fully recovered. Conclusion: This case of A-NMDAR encephalitis presented with many atypical features including neuropsychiatric presenting symptoms, bilateral teratomas, and severe recurrence of disease. While imaging is the recommended modality for investigation of etiology, no teratoma was identified on the second presentation, leading to an ethical and clinical conundrum in this adolescent patient. More research is needed to investigate other diagnostic methods for A-NMDAR encephalitis without distinct teratoma on imaging in female patients.

Introduction: Cesarean scar ectopic pregnancy (CSEP) is a rare gynecological disorder that occurs at a rate of approximately 0.05% of pregnancies and less than 0.2% of cesarean scars. The ultimate goal in the management of CSEP cases is to remove pregnancy and reduce morbidity while preserving fertility. This case report highlights the successful application of a conservative laparoscopic approach in managing a 14-week viable CSEP. Case Presentation: A 35-year-old multiparous woman (G8P5A2L5) with five previous cesarean sections and five normal healthy children presented to the clinic with a viable CSEP of 14 weeks of gestation as revealed by abdominal and transvaginal ultrasound examination. The decision for a conservative laparoscopic approach was made in light of the patient's desire to preserve fertility. Intervention and outcome: The laparoscopic procedure included the following steps: extensive dissection of adhesions between the bladder and the uterus; identification of the ectopic pregnancy at the level of the lower segment; extraction of the product of conception in an endobag; and suturing of the lower segment defect. The successful execution of these steps resulted in the removal of the ectopic pregnancy while addressing associated structural concerns. This approach allowed for mitigating morbidity and, importantly, preserving the patient's fertility. Conclusion: This case highlights the importance of a conservative laparoscopic approach for CSEP in the second trimester. Imaging techniques play a pivotal role in accurate diagnosis, with minimally invasive technologies offering effective solutions. Individualized, patient-centered approaches are necessary to prioritize clinical outcomes and patient preferences.

Background: Metastatic vulvar choriocarcinoma, a rare ectopic gestational trophoblastic neoplasia (GTN), often presents a diagnostic challenge due to its mimicry of other conditions, particularly in resource-limited settings. Its primary symptom is abnormal vaginal bleeding without a clear cause. Consequently, diagnosing and managing it poses difficulties for many low-resource health facilities, as evidenced by the current case. Case Presentation: We present the case of a 25-year-old, P2+2+2L2, who had a large painless, bleeding vulva mass for nearly 5 months. This followed a spontaneous abortion the month prior. The mass gradually increased in size and was accompanied by fever, pus discharge, and weight loss. Despite being treated at multiple health facilities for a vulvar abscess, there was no improvement. A diagnosis was finally made at a tertiary facility where elevated quantitative serum beta-human chorionic gonadotropin (hCG) (β-hCG) was noted. Due to uncontrollable vulva bleeding, she was referred to another tertiary facility for emergency radiotherapy. Following stabilization, chemotherapy was administered using the EMA-CO protocol. Conclusion: The report highlights the difficulty in diagnosing vulvar choriocarcinoma, underscoring the importance of a high index of suspicion. Clinical tests such as serum (β-hCG) and imaging studies are crucial for diagnosis. In resource-limited settings, a simple strip-based urine pregnancy test with serial dilutions can be sufficient for diagnosing and managing vulvar choriocarcinoma.

The incidence of unilateral tubal twin pregnancy is 1/20,000-1/250,000 with about 100 reported cases. Four of the six cases that were medically managed were successful. A 24-year-old female presented to the emergency department (ED) with vaginal bleeding and abdominal cramping. She was hemodynamically stable without signs of an acute abdomen. Laboratory evaluation revealed she was pregnant with a serum beta-human chorionic gonadotropin (b-hCG) of 798 mIU/mL. Transvaginal ultrasound (TVUS) revealed a single left tubal pregnancy with a yolk sac. The patient elected medical management with body surface area (BSA)-based intramuscular (IM) methotrexate (MTX). On Day 4, the patient returned to the ED; her b-hCG was 727 mIU/mL. TVUS revealed twin left tubal pregnancies with yolk sacs and fetal poles without cardiac activity. The patient elected to continue medical management with a second dose of BSA-based IM MTX. On Day 6, the patient returned to the ED with abdominal and rectal pain. She was hemodynamically stable without signs of an acute abdomen. Her b-hCG was 533 mIU/mL. TVUS showed persistent twin left tubal pregnancies-one at 5 weeks gestational age and the other at 6 weeks gestational age-without evidence of rupture. The patient continued serial b-hCGs. Thirty-one days after the first dose of MTX, her b-hCG was < 1 mIU/mL. TVUS showed resolution of tubal pregnancies. The patient consented to the publication of this case report. This case documents the successful treatment of spontaneous, unilateral tubal twin pregnancies with two-step dosing of IM MTX.