Case Reports in Women's Health最新文献

英文中文

Corded and hyalinized endometrioid carcinoma: A case report 绳状及透明化子宫内膜样癌1例

IF 0.6 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2025-12-13 DOI: 10.1016/j.crwh.2025.e00774

Kathleen Waeldner , Chinenye Gloria Anaedobe , Mary I. Whitehead , Steven Sieber , Linus Chuang , Leslie Andriani

Corded and hyalinized endometrioid carcinoma (CHEC) is a rare histologic variant of endometrioid adenocarcinoma first described in 2005. Due to its biphasic appearance, comprising traditional low-grade endometrioid carcinoma and corded/spindled cells within a hyalinized stroma, CHEC may be misdiagnosed as more aggressive malignancies, including uterine carcinosarcoma. Here is presented the case of an 84-year-old woman who was initially diagnosed with uterine carcinosarcoma but was ultimately found to have FIGO Grade 2 Stage IA2 endometrioid adenocarcinoma with CHEC features following multi-institutional pathologic review. Histopathologic and molecular characterization, including wild-type p53 staining, nuclear β-catenin expression, and a CTNNB1 exon 3 mutation, facilitated the amended diagnosis. Given the updated diagnosis, adjuvant treatment was de-escalated to vaginal brachytherapy alone, sparing the patient unnecessary systemic chemotherapy. This case underscores the critical role of molecular and immunohistochemical analysis in differentiating CHEC from more aggressive endometrial cancers, thus preventing overtreatment. Increased awareness and documentation of CHEC are essential to refining diagnostic criteria, informing prognosis, and optimizing patient management. Future studies are needed to further characterize the molecular landscape and clinical behavior of this rare entity.

绳状和透明化子宫内膜样癌（CHEC）是一种罕见的子宫内膜样腺癌的组织学变异，于2005年首次报道。由于其双期表现，包括传统的低级别子宫内膜样癌和透明化间质内的绳状/梭形细胞，CHEC可能被误诊为更具侵袭性的恶性肿瘤，包括子宫癌肉瘤。本文报告一位84岁的女性，她最初被诊断为子宫癌肉瘤，但在多机构病理检查后最终发现为FIGO 2级IA2期子宫内膜样腺癌，伴有CHEC特征。组织病理学和分子特征，包括野生型p53染色，核β-catenin表达和CTNNB1外显子3突变，有助于修改诊断。鉴于最新的诊断，辅助治疗降级为阴道近距离治疗，省去了患者不必要的全身化疗。该病例强调了分子和免疫组织化学分析在鉴别CHEC和侵袭性子宫内膜癌中的关键作用，从而防止过度治疗。提高对CHEC的认识和记录对于完善诊断标准、告知预后和优化患者管理至关重要。未来的研究需要进一步表征这种罕见实体的分子景观和临床行为。

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引用次数: 0

Maternal-fetal complications of non-immune fetal hydrops – mirror syndrome and hypereactio luteinalis with ovarian torsion: A case report 非免疫性胎儿镜囊积液综合征和黄体亢进伴卵巢扭转的母胎并发症1例

IF 0.6 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2025-12-12 DOI: 10.1016/j.crwh.2025.e00775

Helena C. Bartels, Greg Ryan, Edgar Jaeggi, Homero Flores-Mendoza

Mirror syndrome, previously referred to as Ballantyne's syndrome, is a rare obstetric disorder characterized by maternal edema in association with fetal hydrops and placental edema. This report concerns the case of a 35-year-old multiparous woman who developed mirror syndrome secondary to fetal supraventricular tachycardia complicated by hydrops and intrauterine fetal demise. Her pregnancy was further complicated by hypereactio luteinalis with ovarian torsion requiring surgical detorsion. The case highlights the challenges of managing maternal and fetal hydrps, and its rare association with hypereactio luteinalis.

镜像综合征，以前被称为Ballantyne综合征，是一种罕见的产科疾病，其特征是母体水肿与胎儿水肿和胎盘水肿相关。本报告涉及的情况下，35岁的多胎妇女谁发展镜像综合征继发于胎儿室上性心动过速并发积水和宫内胎儿死亡。她的妊娠进一步复杂化黄体亢进和卵巢扭转需要手术扭转。该病例强调了管理母体和胎儿水肿的挑战，以及与黄体亢进的罕见关联。

引用次数: 0

Recurrent endometrial carcinoma with immune-mediated thrombocytopenia following durvalumab: A case report 杜伐单抗后复发性子宫内膜癌伴免疫介导的血小板减少：1例报告

IF 0.6 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2025-12-02 DOI: 10.1016/j.crwh.2025.e00773

Ami Sakakibara , Shimpei Nagai , Terumi Shirane , Tomomi Sakai , Yoko Fujioka , Makiko Hino , Yoshihisa Hattori , Takashi Kurahashi

The use of immune checkpoint inhibitors (ICIs) has expanded the therapeutic landscape for advanced or recurrent endometrial carcinoma. Durvalumab—a programmed death-ligand 1 (PD-L1) inhibitor—demonstrated clinical benefit in the 2023 DUO-E trial when combined with carboplatin and paclitaxel. Immune thrombocytopenia (ITP) is an uncommon but potentially life-threatening immune-related adverse event (irAE). A 73-year-old woman with recurrent endometrial carcinoma developed severe ITP after three cycles of paclitaxel, carboplatin, and durvalumab. Fourteen days after cycle 3 she presented with pyelonephritis, bacteremia, and acute disseminated intravascular coagulation (DIC). Despite infection control, her platelet count declined to 1 × 10³/μL, with epistaxis, hematuria, and melena. Suspecting ITP as an irAE, intravenous immunoglobulin (IVIG 10 g/day × 5 days) and high-dose intravenous prednisolone (1 mg/kg/day) were administered. Platelet counts improved gradually to 85 × 10³/μL by hospital day 32, and she was discharged on a steroid taper. This appears to be the first Japanese report of durvalumab-associated ITP in endometrial carcinoma. Clinicians should maintain a high index of suspicion for ITP when unexpected thrombocytopenia or bleeding occurs during durvalumab therapy and initiate prompt treatment.

免疫检查点抑制剂（ICIs）的使用扩大了晚期或复发性子宫内膜癌的治疗前景。duvalumab是一种程序性死亡配体1 （PD-L1）抑制剂，在2023年的DUO-E试验中与卡铂和紫杉醇联合使用时显示出临床益处。免疫性血小板减少症（ITP）是一种罕见但可能危及生命的免疫相关不良事件（irAE）。一名患有复发性子宫内膜癌的73岁女性在紫杉醇、卡铂和杜伐单抗治疗三个周期后出现了严重的ITP。第3周期后14天，患者出现肾盂肾炎、菌血症和急性弥散性血管内凝血（DIC）。感染控制后，患者血小板计数降至1 × 103/μL，并发鼻出血、血尿、黑黑。怀疑ITP为irAE，静脉注射免疫球蛋白（IVIG 10 g/天× 5天）和大剂量静脉注射强的松龙（1 mg/kg/天）。住院第32天，患者血小板计数逐渐改善至85 × 103/μL，给予类固醇减量治疗出院。这似乎是日本关于子宫内膜癌中durvalumab相关ITP的第一篇报道。当杜伐单抗治疗期间发生意外的血小板减少或出血时，临床医生应保持对ITP的高度怀疑，并立即开始治疗。

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引用次数: 0

Advances in detection and treatment of maternal sepsis 产妇败血症的检测与治疗进展

IF 0.6 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2025-12-01 DOI: 10.1016/j.crwh.2025.e00751

Michael J. Fassett

引用次数: 0

Challenges in managing cervical cancer in pregnancy: Three case reports 妊娠期宫颈癌管理的挑战：三例报告

IF 0.6 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2025-12-01 DOI: 10.1016/j.crwh.2025.e00765

Katie Crabb , Janet Okwesa , Jason K.W. Yap , Fong Lien Kwong

Cervical cancer in pregnancy is a rare but increasingly recognised condition, affecting approximately 0.1–12.0 per 10,000 pregnancies annually. Symptoms such as vaginal bleeding, discharge, dyspareunia, and pelvic pain may overlap with normal pregnancy-related changes, often leading to delayed diagnosis. Speculum and bimanual examination is essential in pregnant women presenting with vaginal bleeding. Urgent colposcopy referral (for example, in the UK through the two-week wait pathway) is essential. Management strategies depend on cancer stage, gestational age, and patient preferences. Options include pregnancy termination with immediate treatment or consideration of neoadjuvant chemotherapy during pregnancy in women who wish to postpone definitive therapies until after delivery. Pelvic lymphadenectomy for staging is considered safe prior to 22 weeks of gestation. Neoadjuvant chemotherapy is contraindicated in the first trimester but may be administered safely later in pregnancy. Serial magnetic resonance imaging is valuable for monitoring tumour progression and informing treatment plans. This case series highlights the clinical and ethical complexities in managing cervical cancer in pregnancy and underscores the importance of specialist, multidisciplinary, and individualised care. Further research is necessary to develop standardised, evidence-based guidelines for this challenging clinical scenario.

妊娠期宫颈癌是一种罕见的疾病，但越来越多的人认识到，每年每10,000例妊娠中约有0.1-12.0例发生宫颈癌。阴道出血、分泌物、性交困难和盆腔疼痛等症状可能与正常妊娠相关的变化重叠，常常导致诊断延误。有阴道出血的孕妇必须进行镜检和双手检查。紧急阴道镜检查转诊（例如，在英国通过两周的等待途径）是必不可少的。治疗策略取决于癌症分期、胎龄和患者偏好。选择包括终止妊娠立即治疗或考虑在怀孕期间新辅助化疗的妇女谁希望推迟最终治疗，直到分娩后。在妊娠22周之前，盆腔淋巴结切除术被认为是安全的。新辅助化疗在妊娠早期是禁忌症，但在妊娠后期可以安全使用。连续磁共振成像是有价值的监测肿瘤进展和通知治疗计划。本病例系列突出了临床和伦理复杂性管理宫颈癌在妊娠和强调专科，多学科和个性化护理的重要性。有必要进行进一步研究，为这一具有挑战性的临床情况制定标准化的循证指南。

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引用次数: 0

Gestational trophoblastic disease-induced thyroid storm: A case report 妊娠滋养层病致甲状腺风暴1例

IF 0.6 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2025-12-01 DOI: 10.1016/j.crwh.2025.e00771

Abera Wondie Gizaw , Suleiman Ayalew Belay , Abilo Tadesse , Yohannes Kenaw Babu , Girma Damtew Adisu , Yilkal Yehuala , Segenet Bizuneh Mengistu

Gestational trophoblastic disease describes tumors caused by abnormal proliferation of trophoblastic tissue. A rare but potentially fatal complication is thyroid storm, which results from excessive thyroid hormone secretion stimulated by high levels of beta-human chorionic gonadotropin.

A 28-year-old woman (gravida 4, para 1, with two prior miscarriages) presented with vaginal bleeding, abdominal pain, vomiting, palpitations, dyspnea, and an enlarging neck swelling. Examination revealed hypertension, tachycardia, hypoxia, an enlarged thyroid gland, pulmonary crackles, elevated jugular venous pressure, and a holosystolic murmur. The uterus was consistent with a 20-week gestation and was actively bleeding. The patient was confused and agitated without focal neurological deficits. Laboratory evaluation showed anemia, abnormal liver function, suppressed thyroid-stimulating hormone, and markedly elevated beta-human chorionic gonadotropin. Imaging demonstrated the classic “snowstorm” appearance of a molar pregnancy, which was confirmed by histopathology. The Burch-Wartofsky score supported the diagnosis of thyroid storm. She received anti-thyroid treatment and underwent uterine evacuation. Nine weeks after discharge, her hormone levels had normalized and serum beta-human chorionic gonadotropin was undetectable.

妊娠滋养层疾病是指由滋养层组织异常增生引起的肿瘤。甲状腺风暴是一种罕见但可能致命的并发症，它是由高水平的人绒毛膜促性腺激素刺激甲状腺激素分泌过多引起的。28岁女性（妊娠4期，第1段，既往有两次流产）表现为阴道出血、腹痛、呕吐、心悸、呼吸困难和颈部肿大。检查发现高血压、心动过速、缺氧、甲状腺肿大、肺脆裂、颈静脉压升高和全收缩期杂音。子宫符合妊娠20周，且出血频繁。患者神志不清，躁动不安，无局灶性神经功能缺损。实验室检查显示贫血，肝功能异常，促甲状腺激素抑制，β -人绒毛膜促性腺激素明显升高。影像学表现为磨牙妊娠的典型“暴风雪”外观，经组织病理学证实。Burch-Wartofsky评分支持甲状腺风暴的诊断。她接受了抗甲状腺治疗，并进行了子宫清除术。出院后9周，患者激素水平恢复正常，血清β -人绒毛膜促性腺激素未检出。

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引用次数: 0

Acute cardiovascular complications of pregnancy 妊娠期急性心血管并发症

IF 0.6 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2025-12-01 DOI: 10.1016/j.crwh.2025.e00748

Jana Karam , Chrisandra Shufelt

引用次数: 0

Vaginal polypoid endometriosis in a woman in her 30s with advanced pelvic endometriosis: A case report and literature review 30岁晚期盆腔子宫内膜异位症伴阴道息肉样子宫内膜异位症1例报告并文献复习

IF 0.6 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2025-12-01 DOI: 10.1016/j.crwh.2025.e00768

Vishal Bahall, Lance De Barry

Polypoid endometriosis is a remarkably rare variant of endometriosis that may clinically and morphologically mimic benign or malignant neoplasms. Vaginal involvement is particularly uncommon and can pose diagnostic challenges due to its atypical presentation. Recognition of this clinical entity is crucial, especially in women with advanced pelvic endometriosis and a history of abnormal vaginal bleeding.

This report concerns the case of a 36-year-old woman with a known history of stage IV endometriosis who presented with intermenstrual bleeding, postcoital bleeding, secondary infertility and chronic abdominal pain. Clinical assessment revealed a left-sided mass arising from pelvis and multiple polypoid masses that was just visible posterior to cervix. Pelvic ultrasonography revealed bilateral endometriomas and an endometrial polyp. She was scheduled for laparoscopic cystectomy, hysteroscopic polypectomy and removal of polypoid vaginal polyp. Excisional biopsy of the lesion demonstrated endometrial glands and stroma within fibrotic tissue consistent with vaginal polypoid endometriosis.

This case adds to the limited body of literature describing polypoid endometriosis of the vagina. It underscores the importance of careful, individualized decision-making for treatment, particularly for young women desirous of fertility preservation.

息肉样子宫内膜异位症是一种非常罕见的子宫内膜异位症，在临床上和形态学上可能与良性或恶性肿瘤相似。阴道受累是特别罕见的，可构成诊断挑战，由于其非典型的表现。认识到这一临床实体是至关重要的，特别是对晚期盆腔子宫内膜异位症和有异常阴道出血史的妇女。本文报告了一名36岁的女性，她有IV期子宫内膜异位症的病史，表现为经间出血、性交后出血、继发性不孕和慢性腹痛。临床评估显示左侧肿块起源于骨盆，宫颈后方可见多发息肉样肿块。盆腔超声检查显示双侧子宫内膜瘤和子宫内膜息肉。她被安排行腹腔镜膀胱切除术，宫腔镜息肉切除术和切除息肉样阴道息肉。病变的切除活检显示纤维化组织内的子宫内膜腺和间质与阴道息肉样子宫内膜异位症一致。本病例增加了有限的文献描述阴道息肉样子宫内膜异位症。它强调了谨慎、个性化的治疗决策的重要性，特别是对希望保留生育能力的年轻妇女。

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引用次数: 0

Idiopathic ovarian vein thrombosis in a nonpregnant premenopausal woman in her 40s: A case report 40多岁未怀孕绝经前妇女的特发性卵巢静脉血栓：1例报告

IF 0.6 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2025-12-01 DOI: 10.1016/j.crwh.2025.e00769

Ibrahim Hersi, Lubabah Al-Ani, Mehtab Shah, Mohamed Elmezaien, Rehmani Jawad, Olumide Ofinran

Ovarian vein thrombosis (OVT) is a rare and often underdiagnosed condition, most frequently associated with pregnancy, infection, malignancy, or recent surgery. Idiopathic OVT (i.e. that occurring in the absence of identifiable risk factors) is exceedingly uncommon and can easily be overlooked due to its non-specific presentation. This article reports the case of a 40-year-old multiparous woman who presented with a 6-day history of severe left-sided lower abdominal pain associated with fever and nausea. Clinical examination demonstrated left iliac fossa tenderness without palpable adnexal masses. Contrast-enhanced computed tomography (CT) showed a bulky left ovary and left ovarian vein, initially reported as suggestive of left adnexal torsion. Given the presumed diagnosis, diagnostic laparoscopy was undertaken and revealed a thrombosed left ovarian ligament without torsion, leading to left partial salpingectomy. Postoperatively, the final CT report concluded that the appearances were highly suggestive of left ovarian vein thrombosis. The patient was commenced on anticoagulation following haematology consultation. This case demonstrates that OVT may arise in the absence of known risk factors and highlights the diagnostic challenges when it mimics more common acute pelvic pathologies. Careful radiological review, multidisciplinary involvement, and a high index of suspicion are essential to avoid unnecessary surgical intervention and ensure timely anticoagulation in stable patients.

卵巢静脉血栓形成（OVT）是一种罕见且常被误诊的疾病，最常与妊娠、感染、恶性肿瘤或近期手术有关。特发性OVT（即在没有可识别的危险因素的情况下发生）非常罕见，由于其非特异性表现，很容易被忽视。这篇文章报告的情况下，一个40岁的多胎妇女谁提出了6天的历史严重的左下腹疼痛，并伴有发烧和恶心。临床检查显示左侧髂窝压痛，未见附件肿块。增强计算机断层扫描（CT）显示左侧卵巢和左侧卵巢静脉肿大，最初报告提示左侧附件扭转。鉴于假定的诊断，进行了诊断性腹腔镜检查，发现左卵巢韧带血栓形成，无扭转，导致左侧部分输卵管切除术。术后，最终的CT报告得出结论，表现高度提示左卵巢静脉血栓形成。患者在血液学会诊后开始抗凝治疗。本病例表明，OVT可能在没有已知危险因素的情况下发生，并强调了当它模仿更常见的急性盆腔病变时的诊断挑战。仔细的放射学检查、多学科参与和高度怀疑是避免不必要的手术干预和确保稳定患者及时抗凝的必要条件。

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引用次数: 0

Maternal collapse in pregnancy: evolving aetiology and healthcare system response 妊娠期产妇崩溃：不断演变的病因和卫生保健系统反应

IF 0.6 Q4 OBSTETRICS & GYNECOLOGY

Case Reports in Women's Health

Pub Date : 2025-12-01 DOI: 10.1016/j.crwh.2025.e00750

Danny Tucker , Melissa Freestun

引用次数: 0

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