Case Reports in Women's Health最新文献

Lymphangioleiomyomatosis is a rare disease characterized by abnormal smooth muscle cell growth. It primarily occurs in the lungs but can also rarely occur in other organs, in which case it is classified as extrapulmonary lymphangioleiomyomatosis. It often accompanies tuberous sclerosis complex. This report concerns a case of uterine lymphangioleiomyomatosis with spontaneous uterine rupture in a young woman with tuberous sclerosis complex. A 27-year-old nulligravida patient presented to the emergency room with vaginal bleeding. She had a history of clinical diagnosis of tuberous sclerosis complex and pulmonary lymphangioleiomyomatosis. Initially, abdominopelvic computed tomography and magnetic resonance imaging suggested a hemorrhagic necrosis and rupture of degenerated uterine myoma. She underwent emergency exploratory laparotomy. The right side of her normal-sized uterus were ruptured without any specific mass. Active bleeding and hematoma from the ruptured uterus and partially ruptured right ovary were noted. The procedure included total hysterectomy and right salpingo-oophorectomy. Pathological analysis confirmed lymphangioleiomyomatosis in the uterine serosa and myometrium. Lymphangioleiomyomatosis mainly occurs in women of reproductive age and worsens with estrogen. Early diagnosis and careful follow-up are necessary due to the risk of worsening gynecological symptoms or even uterine rupture during pregnancy. This case enhances our understanding of extrapulmonary lymphangioleiomyomatosis and highlights the importance of comprehensive evaluation in complex clinical scenarios.

Macroplastique® is a periurethral bulking agent used for the treatment of female stress urinary incontinence. It is composed of polydimethylsiloxane macroparticles suspended in a polyvinylpyrolidone carrier to allow injection. The patient in this case report had increased 18F-FDG avidity on PET scan at the site of prior Macroplastique® injection. This avidity was likely due to a local inflammatory response and did not represent an occult malignancy. Keen clinical judgement is necessary when this PET-avid area is demonstrated in women with prior bulking therapy as this is an incidental benign finding that does not require further invasive management.

Herlyn-Werner-Wunderlich (HWW) syndrome is a rare congenital condition characterized by renal agenesis, uterine didelphys, and obstructed hemivagina. This report presents the case of a 19-year-old woman who reported lower abdominal pain and offensive vaginal discharge. Imaging revealed a didelphys uterus, two vaginas, two cervixes, hematocolpos, and an absent right kidney. Surgical intervention involved draining the hematocolpos and excising the uterine septum. After surgery, the patient successfully conceived and had a full-term pregnancy, delivering via cesarean section without complications. This case highlights the importance of early diagnosis and surgical management in preventing complications such as endometriosis and infertility. Prompt recognition and treatment are crucial for preserving fertility in patients with HWW syndrome.

Lymphangiomas are rare benign neoplasms traditionally thought to result from congenital lymphatic channel malformations, though they may also be associated with other conditions. Retroperitoneal lymphangiomas account for 1% of all lymphangiomas, and fewer than 200 cases have been reported. A 42-year-old woman was admitted with symptoms of abdominal pain and distension. A computerized tomography (CT) scan showed an abdomino-pelvic mass and a giant uterine myoma. The patient underwent explorative laparotomy and the whole cyst mass was removed along with the uterine myoma. Cystic lymphangiomas are often misdiagnosed because of the vague symptoms and the absence of obvious etiology. A provisional diagnosis can be made with CT but histological examination confirms the diagnosis. Cystic lymphangioma should be included in the differential diagnosis of an ovarian cystic mass. Complete resection can be curative.

Infections after obstetric and gynecologic surgery are commonly caused by enterobacteria, commensal vaginal bacteria, or indigenous skin bacteria (primarily Staphylococcus aureus and Streptococcus). Mycoplasma hominis (M. hominis) rarely causes postoperative infection in the field of obstetrics and gynecology and its treatment is generally delayed. This report describes a case report of peritonitis caused by M. hominis after laparoscopic total hysterectomy. A 44-year-old patient (gravida 1, para 1) presented with heavy menstrual bleeding and severe anemia. She was diagnosed as having multiple uterine fibroids and bilateral endometriomas and underwent laparoscopic surgery. She subsequently developed postoperative peritonitis due to M. hominis. This microorganism was identified in the postoperative cultures of the vaginal discharge and the transvaginal drainage fluid by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. The patient was treated successfully with the appropriate antimicrobial agents. It is important to consider M. hominis infection when gynecological postoperative infection persists despite treatment with beta-lactam antibiotics, and no causative organisms are identified by Gram staining.

Insulin autoimmune syndrome or Hirata's disease is a rare condition characterized by hypoglycemia associated with endogenous autoimmune hyperinsulinism. This report concerns the case of a 28-year-old Latin American woman with Graves' disease who developed insulin autoimmune syndrome and then subsequently became pregnant. She displayed symptoms related to severe hypoglycemia due to hyperinsulinemia, elevated C-peptide, and anti-insulin antibodies. Prior to pregnancy she was treated with corticosteroids and had ablative treatment with iodine-131. During follow-up of both conditions, the patient became pregnant, and clinically and biochemically hyperthyroid, for which total thyroidectomy was performed during the second trimester of pregnancy. Anti-insulin antibodies, blood glucose, and C-peptide remained normal throughout pregnancy. At 40 weeks of gestation she gave birth to a healthy female newborn with normal blood glucose values. Molecular genetic analysis determined the following genotypes: HLA-DRB1*03:01 / HLA-DRB1*04:01 in the mother; and HLA-DRB1*04:01 / HLA-DRB1*08:02 in the daughter. Because some HLA-DRB1*04 alleles are associated with susceptibility to insulin autoimmune syndrome induced by environmental factors, the patient was advised regarding the future use of drugs with a sulfhydryl group and possible triggering factors for insulin autoimmune syndrome. At 6-month follow-up the daughter presented normal growth and development, as well as normal plasma glucose values, and this remained the case at five-year follow-up.

The synchronous occurrence of primary endometrioid endometrial adenocarcinoma and primary squamous cell carcinoma of the cervix is exceedingly rare. Ovarian and endometrial cancers represent the most frequently observed forms of synchronous gynaecological malignancies. In contrast, in less than 1 % of cases, endometrial cancer coexists with primary cervical cancer. Considering the unique characteristics of each primary malignancy, the management of synchronous tumours of the female genital tract poses significant challenges and requires a multidisciplinary, tailored approach to treatment.

This report concerns the case of a 63-year-old woman who underwent radical hysterectomy, bilateral salpingo-oophorectomy and bilateral pelvic lymph node dissection following a histological diagnosis of a poorly differentiated squamous cell carcinoma on cervical biopsy. Histological assessment of the surgical specimen also confirmed a primary grade I endometrioid endometrial adenocarcinoma confined to the endometrium and grade 3 squamous cell cancer of the cervix. The patient was successfully treated with adjuvant vaginal brachytherapy after primary surgery.

Synchronous endometrial adenocarcinoma and squamous cell carcinoma of the cervix is rare and associated with a poor prognosis. Fewer than ten cases could be found in the medical literature. This report raises awareness and adds to the study of an unusual synchronous cancer of the female genital tract and contributes evidence to advance the development of standardized treatment protocols.

Listeria monocytogenes (Lm) is a Gram-positive bacterium causing listeriosis, a rare but severe foodborne infection, particularly impactful during pregnancy. Maternal-fetal transmission can lead to adverse fetal outcomes, yet symptoms in mothers may be nonspecific, delaying intervention. Despite the severity, the mechanisms of vertical transmission remain unclear. This report describes a case of rapid Lm diagnosis in a preterm newborn using cord blood and placental swabs. A 31-week pregnant woman presented with abdominal pain, diarrhea, and reduced fetal movements after consuming raw sushi. Laboratory findings indicated infection, and she vaginally delivered a live infant with placental and fetal abscesses. Cultures confirmed Lm, with swift diagnosis aided by molecular syndromic testing. The neonate received appropriate antibiotics and was asymptomatic by the end of treatment. This case underscores the need for the rapid diagnosis of maternal-fetal listeriosis, as it poses significant risks during pregnancy, including preterm birth and neonatal complications. Current diagnostic methods often delay treatment. This report emphasizes the use of innovative molecular techniques for early diagnosis, which is crucial in managing neonatal infections, especially in preterm newborns.

Branch retinal artery occlusion is a rare cause of sudden vision loss. New-onset visual disturbances are considered a severe feature of preeclampsia and an indication for delivery regardless of gestational age. This report describes the management of a primigravida at 31 weeks of gestation, with multiple comorbidities, who presented with preeclampsia and a new dark spot in her vision. After extensive workup, her branch retinal artery occlusion was not attributable to her preexisting comorbidities nor an undiagnosed thrombophilia. Multidisciplinary collaboration and close observation enabled delay of delivery until 34 weeks of gestation without detriment and substantially mitigated the risks of preterm birth. Her visual defect was stable and permanent. This seems to be the first case in the literature to describe branch retinal artery occlusion diagnosed simultaneously with preeclampsia in the third trimester. Branch retinal artery occlusion may not be a severe feature of preeclampsia requiring delivery.