Pub Date : 2024-10-30DOI: 10.1016/j.crwh.2024.e00660
Kiley Hunkler , David Boedeker , Yovanni Casablanca , Micah Hill
Pyometra is rare and refers to purulent material in the uterine cavity, which can lead to uterine perforation. A hysterectomy is the historic treatment for perforated pyometra due to the condition's high morbidity and mortality. A 33-year-old woman with uterine factor infertility underwent an abdominal myomectomy that was complicated by post-operative, perforated pyometra. She received conservative treatment with surgical debridement and broad-spectrum antibiotics. Following her recovery and subsequent infertility treatments, she had a term live birth through in vitro fertilization. The case highlights the value of uterine-sparing treatment in carefully selected patients with post-operative, perforated pyometra, in order to preserve fertility.
{"title":"Live birth after uterine-sparing treatment of pyometra following abdominal myomectomy: A case report","authors":"Kiley Hunkler , David Boedeker , Yovanni Casablanca , Micah Hill","doi":"10.1016/j.crwh.2024.e00660","DOIUrl":"10.1016/j.crwh.2024.e00660","url":null,"abstract":"<div><div>Pyometra is rare and refers to purulent material in the uterine cavity, which can lead to uterine perforation. A hysterectomy is the historic treatment for perforated pyometra due to the condition's high morbidity and mortality. A 33-year-old woman with uterine factor infertility underwent an abdominal myomectomy that was complicated by post-operative, perforated pyometra. She received conservative treatment with surgical debridement and broad-spectrum antibiotics. Following her recovery and subsequent infertility treatments, she had a term live birth through <em>in vitro</em> fertilization. The case highlights the value of uterine-sparing treatment in carefully selected patients with post-operative, perforated pyometra, in order to preserve fertility.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"44 ","pages":"Article e00660"},"PeriodicalIF":0.7,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142572929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-23DOI: 10.1016/j.crwh.2024.e00658
Zahra Azeem, Jyoti Sharma, Robert Johnson, Natalia Price, Miquel Zilvetti Yabar, Donna Ghosh
Benign multicystic peritoneal mesothelioma (BMPM) is a rare peritoneal tumour. Treatment involves complete surgical resection, although recurrence rates are high. Notably, there are 7 documented cases of BMPM coexisting with endometriosis on histology and in the case reported here it was associated with deep infiltrating endometriosis. Examination of the 26-year-old nulliparous woman with deep dyspareunia, dyschezia and occasional rectal bleeding revealed restricted uterine mobility and a rectovaginal nodule.
Magnetic resonance imaging (MRI) showed multiple clear cystic structures in the pelvis of unknown aetiology. Following discussion by a multidisciplinary team, a diagnostic laparoscopy was performed. Intraoperatively, bilateral endometriomas were identified, along with multiple fluid-filled cystic structures in the pelvis and on the anterior abdominal wall. An adhesiolysis and drainage of endometriomas was performed and the cystic structures were sent for histology.
Histopathology confirmed BMPM, positive for AE1/3 and calretinin. The patient was referred to a mesothelioma malignancy institute and advised to undergo definitive surgery by the local endometriosis team. A joint surgical procedure with a colorectal team involved laparoscopic excision of peritoneal cysts, cystectomy for bilateral endometriomas, and excision of deep infiltrating endometriosis with bowel shaving. Histopathology revealed benign mesothelial cysts with foci of endometriosis.
The patient had an uncomplicated recovery and is planned for long-term follow-up with the mesothelioma malignancy institute due to the high recurrence rate (up to 50 %). This case report suggests a definitive role of this two-stage procedure in patients with this diagnostic complexity and emphasises the role of multidisciplinary management.
{"title":"Excision of benign multicystic peritoneal mesothelioma and deep infiltrating endometriosis with bowel involvement – A case report","authors":"Zahra Azeem, Jyoti Sharma, Robert Johnson, Natalia Price, Miquel Zilvetti Yabar, Donna Ghosh","doi":"10.1016/j.crwh.2024.e00658","DOIUrl":"10.1016/j.crwh.2024.e00658","url":null,"abstract":"<div><div>Benign multicystic peritoneal mesothelioma (BMPM) is a rare peritoneal tumour. Treatment involves complete surgical resection, although recurrence rates are high. Notably, there are 7 documented cases of BMPM coexisting with endometriosis on histology and in the case reported here it was associated with deep infiltrating endometriosis. Examination of the 26-year-old nulliparous woman with deep dyspareunia, dyschezia and occasional rectal bleeding revealed restricted uterine mobility and a rectovaginal nodule.</div><div>Magnetic resonance imaging (MRI) showed multiple clear cystic structures in the pelvis of unknown aetiology. Following discussion by a multidisciplinary team, a diagnostic laparoscopy was performed. Intraoperatively, bilateral endometriomas were identified, along with multiple fluid-filled cystic structures in the pelvis and on the anterior abdominal wall. An adhesiolysis and drainage of endometriomas was performed and the cystic structures were sent for histology.</div><div>Histopathology confirmed BMPM, positive for AE1/3 and calretinin. The patient was referred to a mesothelioma malignancy institute and advised to undergo definitive surgery by the local endometriosis team. A joint surgical procedure with a colorectal team involved laparoscopic excision of peritoneal cysts, cystectomy for bilateral endometriomas, and excision of deep infiltrating endometriosis with bowel shaving. Histopathology revealed benign mesothelial cysts with foci of endometriosis.</div><div>The patient had an uncomplicated recovery and is planned for long-term follow-up with the mesothelioma malignancy institute due to the high recurrence rate (up to 50 %). This case report suggests a definitive role of this two-stage procedure in patients with this diagnostic complexity and emphasises the role of multidisciplinary management.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"44 ","pages":"Article e00658"},"PeriodicalIF":0.7,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Partial cystectomy is often performed to treat bladder endometriosis. However, there are no reports of bladder rupture more than 10 years after cystectomy. A 55-year-old woman with a history of laparoscopic bilateral salpingo-oophorectomy and partial cystectomy for bladder endometriosis at the age of 44 years presented with worsening dysuria, decreased urine output, and malaise for over a week. Blood tests revealed elevated creatinine and BUN levels indicating renal failure. Transvaginal ultrasonography and computed tomography revealed large amounts of peritoneal fluid. Abdominocentesis was performed, and peritoneal fluid analysis confirmed the presence of urinary ascites, which was indicative of bladder rupture. Retrograde cystography revealed contrast leakage into the bladder wall. Therefore, a diagnosis was made of with bladder rupture and pseudo-renal failure. If abdominal pain and peritoneal fluid are present after bladder endometriosis surgery, bladder rupture should be considered in the differential diagnosis even after a long postoperative period.
{"title":"Bladder rupture 11 years after partial cystectomy for bladder endometriosis: A case report and review of literature","authors":"Haruna Tokuyama , Yosuke Tarumi , Saiko Yamauchi , Hiroyuki Okimura , Hisashi Kataoka , Tetsuya Kokabu , Kaori Yoriki , Fumitake Ito , Izumi Kusuki , Taisuke Mori","doi":"10.1016/j.crwh.2024.e00657","DOIUrl":"10.1016/j.crwh.2024.e00657","url":null,"abstract":"<div><div>Partial cystectomy is often performed to treat bladder endometriosis. However, there are no reports of bladder rupture more than 10 years after cystectomy. A 55-year-old woman with a history of laparoscopic bilateral salpingo-oophorectomy and partial cystectomy for bladder endometriosis at the age of 44 years presented with worsening dysuria, decreased urine output, and malaise for over a week. Blood tests revealed elevated creatinine and BUN levels indicating renal failure. Transvaginal ultrasonography and computed tomography revealed large amounts of peritoneal fluid. Abdominocentesis was performed, and peritoneal fluid analysis confirmed the presence of urinary ascites, which was indicative of bladder rupture. Retrograde cystography revealed contrast leakage into the bladder wall. Therefore, a diagnosis was made of with bladder rupture and pseudo-renal failure. If abdominal pain and peritoneal fluid are present after bladder endometriosis surgery, bladder rupture should be considered in the differential diagnosis even after a long postoperative period.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"44 ","pages":"Article e00657"},"PeriodicalIF":0.7,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The uterine myometrium is the rarest location for an ectopic pregnancy. Such an intramural or intramyometrial ectopic pregnancy presents a diagnostic and therapeutic challenge. If undiagnosed, it can lead to life-threatening uterine rupture, which may warrant a hysterectomy, leaving the patient with irreversible infertility. Different treatment modalities have been proposed for the management of this condition. We report a rare case of intramural ectopic pregnancy diagnosed in a 30-year-old woman. It initially manifested as moderate vaginal bleeding at an estimated gestational age (EGA) of 8 weeks 6 days, associated with mild lower abdominal pain. The patient was managed by laparoscopic conservative resection of the ectopic mass.
{"title":"Intramural pregnancy managed by conservative laparoscopic resection: A case report","authors":"Abdel Naser M.I. Aburayyan , Oday M.B. Zuhour , Barah K.S. Alsalameh , Maya Sabboh , Afnan W.M. Jobran","doi":"10.1016/j.crwh.2024.e00653","DOIUrl":"10.1016/j.crwh.2024.e00653","url":null,"abstract":"<div><div>The uterine myometrium is the rarest location for an ectopic pregnancy. Such an intramural or intramyometrial ectopic pregnancy presents a diagnostic and therapeutic challenge. If undiagnosed, it can lead to life-threatening uterine rupture, which may warrant a hysterectomy, leaving the patient with irreversible infertility. Different treatment modalities have been proposed for the management of this condition. We report a rare case of intramural ectopic pregnancy diagnosed in a 30-year-old woman. It initially manifested as moderate vaginal bleeding at an estimated gestational age (EGA) of 8 weeks 6 days, associated with mild lower abdominal pain. The patient was managed by laparoscopic conservative resection of the ectopic mass.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"44 ","pages":"Article e00653"},"PeriodicalIF":0.7,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This case report describes the successful management of a 16-year-old primigravida of Black African descent who had undergone Mainz-II ureterosigmoidostomy during infancy. Mainz-II ureterosigmoidostomy as a urinary diversion presents unique management challenges, particularly in pregnant patients. The patient presented to the antenatal clinic after a spontaneously achieved pregnancy; she had normal findings on obstetric and renal ultrasound scans throughout her pregnancy. At 38 weeks of gestation, an elective caesarean section was performed; the absence of the urinary bladder and the intact condition of the Mainz-II pouch were confirmed. A healthy biological male infant weighing 2.3 kg was delivered. Postoperatively, the patient experienced a mild superficial surgical site infection but otherwise had an uneventful recovery. This case underscores the importance of comprehensive prenatal care and meticulous surgical planning in managing pregnancies in patients with complex urinary diversions, and demonstrates that favorable maternal and neonatal outcomes can be achieved with appropriate medical oversight.
本病例报告描述了一名 16 岁的黑非洲裔初产妇在婴儿期接受美因茨 II 型输尿管乙状结肠造口术后的成功治疗。美因茨-II 型输尿管乙状结肠造口术作为一种尿路转流术，给治疗带来了独特的挑战，尤其是对怀孕患者而言。患者在自然怀孕后到产前门诊就诊，整个孕期的产科和肾脏超声扫描结果均正常。妊娠 38 周时，她接受了选择性剖腹产手术；手术证实了膀胱缺失和美因茨 II 袋完好无损。产下一名健康的亲生男婴，体重 2.3 千克。术后，患者出现了轻微的手术部位感染，但恢复顺利。本病例强调了全面的产前护理和细致的手术计划对处理复杂尿路改道患者妊娠的重要性，并证明了在适当的医疗监督下，可以获得良好的孕产妇和新生儿预后。
{"title":"Successful pregnancy and delivery in a patient with a Mainz-II pouch urinary diversion: Case report and literature review","authors":"Wisdom Klutse Azanu , Afia Tabua Sakyi , Aishah Fadila Adamu , Frank Obeng","doi":"10.1016/j.crwh.2024.e00656","DOIUrl":"10.1016/j.crwh.2024.e00656","url":null,"abstract":"<div><div>This case report describes the successful management of a 16-year-old primigravida of Black African descent who had undergone Mainz-II ureterosigmoidostomy during infancy. Mainz-II ureterosigmoidostomy as a urinary diversion presents unique management challenges, particularly in pregnant patients. The patient presented to the antenatal clinic after a spontaneously achieved pregnancy; she had normal findings on obstetric and renal ultrasound scans throughout her pregnancy. At 38 weeks of gestation, an elective caesarean section was performed; the absence of the urinary bladder and the intact condition of the Mainz-II pouch were confirmed. A healthy biological male infant weighing 2.3 kg was delivered. Postoperatively, the patient experienced a mild superficial surgical site infection but otherwise had an uneventful recovery. This case underscores the importance of comprehensive prenatal care and meticulous surgical planning in managing pregnancies in patients with complex urinary diversions, and demonstrates that favorable maternal and neonatal outcomes can be achieved with appropriate medical oversight.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"44 ","pages":"Article e00656"},"PeriodicalIF":0.7,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-09DOI: 10.1016/j.crwh.2024.e00655
Saeed Baradwan , Hassan M. Latifah , Haneen Al-Maghrabi , Abdulmonem M. Almutawa
Vulvar leiomyomas are rare benign tumors originating from smooth muscle cells of the vulvar tissue. This report concerns a 31-year-old woman who presented with a painless vulvar mass measuring 5 × 4 cm. The mass was clinically diagnosed as a Bartholin cyst due to its non-tender and soft nature, and as a result the patient underwent wide local excision of the vulvar mass. Histopathology confirmed it to be benign vulvar leiomyoma. This case emphasizes the importance of thorough clinical evaluation and accurate histopathological examination in identifying vulvar masses. This report underscores the diagnostic difficulties associated with rare vulvar lesions and stresses the necessity of a comprehensive approach to their evaluation and treatment.
{"title":"Vulvar leiomyoma mimicking Bartholin's gland cyst: A case report","authors":"Saeed Baradwan , Hassan M. Latifah , Haneen Al-Maghrabi , Abdulmonem M. Almutawa","doi":"10.1016/j.crwh.2024.e00655","DOIUrl":"10.1016/j.crwh.2024.e00655","url":null,"abstract":"<div><div>Vulvar leiomyomas are rare benign tumors originating from smooth muscle cells of the vulvar tissue. This report concerns a 31-year-old woman who presented with a painless vulvar mass measuring 5 × 4 cm. The mass was clinically diagnosed as a Bartholin cyst due to its non-tender and soft nature, and as a result the patient underwent wide local excision of the vulvar mass. Histopathology confirmed it to be benign vulvar leiomyoma. This case emphasizes the importance of thorough clinical evaluation and accurate histopathological examination in identifying vulvar masses. This report underscores the diagnostic difficulties associated with rare vulvar lesions and stresses the necessity of a comprehensive approach to their evaluation and treatment.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"44 ","pages":"Article e00655"},"PeriodicalIF":0.7,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Due to advancements in medical care and reconstructive surgery, more patients with bladder exstrophy are reaching reproductive age and considering pregnancy. Complications are more common during pregnancy in this patient population, given medical comorbidities and prior surgical intervention. In the case of cesarean delivery, careful planning is necessary to prevent inadvertent injury to the bladder or bowel segments. This report concerns a patient with a history of infant closure of bladder exstrophy, followed by two bladder augmentations and a catheterizable channel who presented for care at 9 weeks of gestation. Magnetic resonance imaging (MRI) at 36 weeks of gestation was used to delineate the anatomy in planning for cesarean delivery. The patient underwent a successful cesarean delivery at 38 weeks 1 day of gestation. Patients with prior urologic reconstruction can undergo safe cesarean delivery if proper surgical planning is performed. Multidisciplinary care and prenatal MRI are valuable tools for avoiding surgical complications.
{"title":"Optimizing cesarean delivery in a patient with exstrophy-epispadias via prenatal MRI and surgical planning: A case report","authors":"Jamie Michael , Hebron Kelecha , Diana Bowen , Amber Watters","doi":"10.1016/j.crwh.2024.e00654","DOIUrl":"10.1016/j.crwh.2024.e00654","url":null,"abstract":"<div><div>Due to advancements in medical care and reconstructive surgery, more patients with bladder exstrophy are reaching reproductive age and considering pregnancy. Complications are more common during pregnancy in this patient population, given medical comorbidities and prior surgical intervention. In the case of cesarean delivery, careful planning is necessary to prevent inadvertent injury to the bladder or bowel segments. This report concerns a patient with a history of infant closure of bladder exstrophy, followed by two bladder augmentations and a catheterizable channel who presented for care at 9 weeks of gestation. Magnetic resonance imaging (MRI) at 36 weeks of gestation was used to delineate the anatomy in planning for cesarean delivery. The patient underwent a successful cesarean delivery at 38 weeks 1 day of gestation. Patients with prior urologic reconstruction can undergo safe cesarean delivery if proper surgical planning is performed. Multidisciplinary care and prenatal MRI are valuable tools for avoiding surgical complications.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"44 ","pages":"Article e00654"},"PeriodicalIF":0.7,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-09DOI: 10.1016/j.crwh.2024.e00652
Daniël P.C. van der Spek , Caroline D. van der Marel , Cecile C. de Vos , Frank J.P.M. Huygen , Maaike Dirckx
Neurostimulation, for example dorsal root ganglion stimulation (DRGS), is increasingly used for managing chronic pain, including among women of reproductive age. We present the case of a 33-year-old patient with complex regional pain syndrome (CRPS) implanted with DRGS who subsequently became pregnant twice. Both pregnancies resulted in the delivery of healthy newborns via caesarean section under successful spinal anaesthesia, with no (device) complications. This case highlights the special considerations for managing pregnant patients with neurostimulation implants, including the differences between DRGS implants and other neurostimulators in the context of neuraxial anaesthesia and the continued use of neurostimulation during pregnancy.
{"title":"Successful spinal anaesthesia for caesarean section in a patient with a dorsal root ganglion stimulation implant: A case report","authors":"Daniël P.C. van der Spek , Caroline D. van der Marel , Cecile C. de Vos , Frank J.P.M. Huygen , Maaike Dirckx","doi":"10.1016/j.crwh.2024.e00652","DOIUrl":"10.1016/j.crwh.2024.e00652","url":null,"abstract":"<div><div>Neurostimulation, for example dorsal root ganglion stimulation (DRGS), is increasingly used for managing chronic pain, including among women of reproductive age. We present the case of a 33-year-old patient with complex regional pain syndrome (CRPS) implanted with DRGS who subsequently became pregnant twice. Both pregnancies resulted in the delivery of healthy newborns via caesarean section under successful spinal anaesthesia, with no (device) complications. This case highlights the special considerations for managing pregnant patients with neurostimulation implants, including the differences between DRGS implants and other neurostimulators in the context of neuraxial anaesthesia and the continued use of neurostimulation during pregnancy.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"44 ","pages":"Article e00652"},"PeriodicalIF":0.7,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12DOI: 10.1016/j.crwh.2024.e00650
Eun Min Lee , Ju Hee Kim , Uiree Jo , Yoon Jung Cho
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.
{"title":"Uterine lymphangioleiomyomatosis in a premenopausal woman with tuberous sclerosis: A case report","authors":"Eun Min Lee , Ju Hee Kim , Uiree Jo , Yoon Jung Cho","doi":"10.1016/j.crwh.2024.e00650","DOIUrl":"10.1016/j.crwh.2024.e00650","url":null,"abstract":"<div><p>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.</p></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"43 ","pages":"Article e00650"},"PeriodicalIF":0.7,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2214911224000717/pdfft?md5=bbc3a8fa7a9064618c85eaecccb07dee&pid=1-s2.0-S2214911224000717-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142233009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-05DOI: 10.1016/j.crwh.2024.e00649
Christine Herforth, Philippe E. Zimmern
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.
Macroplastique® 是一种尿道周围膨大剂，用于治疗女性压力性尿失禁。它由悬浮在聚乙烯吡咯烷酮载体中的聚二甲基硅氧烷大颗粒组成，便于注射。本病例报告中的患者曾在注射 Macroplastique® 的部位进行 PET 扫描，结果发现 18F-FDG 反应性增高。这种嗜性可能是由于局部炎症反应引起的，并不代表隐性恶性肿瘤。当曾接受过膨体治疗的妇女出现这种正电子发射计算机断层扫描(PET)阳性区域时，有必要进行审慎的临床判断，因为这是一种偶然的良性发现，不需要进一步的侵入性治疗。
{"title":"Macroplastique® for stress urinary incontinence lights up as a PET-avid urethral lesion: A case report","authors":"Christine Herforth, Philippe E. Zimmern","doi":"10.1016/j.crwh.2024.e00649","DOIUrl":"10.1016/j.crwh.2024.e00649","url":null,"abstract":"<div><p>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.</p></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"43 ","pages":"Article e00649"},"PeriodicalIF":0.7,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2214911224000705/pdfft?md5=dae6611b2f06d0d86cf9673075ebeaf9&pid=1-s2.0-S2214911224000705-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142228759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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