Case Reports in Women's Health最新文献

Gastrointestinal stromal tumors (GISTs) are neoplasms of neural cells in the gastrointestinal tract; they typically develop in older adults, with less than 10% of cases presenting among patients under the age of 40. This report describes the clinical course and management of a 28-year-old woman with a history of irritable bowel syndrome (IBS) who presented with acute upper abdominal pain. Surgical pathology confirmed a diagnosis of metastatic GIST. The patient underwent imatinib therapy and subsequent surgical tumor debulking. Postoperatively, she presented with acute appendicitis, for which she eventually required appendectomy, and she became pregnant approximately 1 year after the initial diagnosis. This case highlights several treatment challenges that may be encountered in young patients presenting with GIST.

Sclerosing stromal tumors are a rare type of ovarian tumor in the category of sex cord stromal tumors, which arise from the ovarian connective tissue. This report concerns a case of a sclerosing stromal tumor in a 19-year-old nulliparous woman who presented with the chief complaints of menstrual irregularities and dyspareunia. Preoperative imaging revealed a complex right adnexal mass with blood flow and without associated ascites. Tumor markers were all normal except lactate dehydrogenase, which was elevated. The elevated lactate dehydrogenase, in combination with patient age and menstrual irregularities, initially misdirected the clinicians toward suspicion for dysgerminoma or other malignant germ cell tumor of the ovary. Clinicians should beware of excluding the diagnosis of sex cord stromal tumor on the differential in a young person with an adnexal mass and elevated lactate dehydrogenase.

This article presents a case of spontaneous conception and live birth in a 40-year-old woman who had undergone gonadotoxic chemotherapy and allogenic stem cell transplant for relapsed acute myelogenous leukemia complicated by treatment-refractory graft-versus-host disease. The patient's follicle stimulating hormone level was 44.4 mIU/mL at age 38 and then decreased to 4.1 mIU/mL at age 41, suggesting ovarian recovery. Her graft-versus-host disease subjectively improved during pregnancy. She ultimately delivered a healthy neonate. This case demonstrates the potential for ovarian recovery after stem allogenic cell transplant in a patient of advanced reproductive age and provides insight into the limited knowledge about graft-versus-host disease in pregnancy. As survival after stem cell transplant continues to improve, understanding the downstream consequences of the treatment, including for fertility and pregnancy, is of growing importance.

The corona mortis is a variant vascular anastomosis that crosses behind the superior pubic ramus connecting the external and internal iliac vessels. Its location with respect to key landmarks in the retropubic space varies. This case demonstrates a life-threatening hemorrhage following an anterior vaginal wall suspension due to needle passer injury of the corona mortis successfully managed with endovascular embolization. Surgeons operating in the retropubic space need to be cognizant of this vascular variant and potential for significant bleeding when injured. Prompt vascular control either endovascularly or with open exploration is critical in preventing patient mortality.

Bladder stones are rare in women. This report presents the case of a woman with a massive bladder stone and incarcerated procidentia. The 75-year-old woman presented to the outpatient clinic with procidentia and recurrent urinary tract infections. Preoperative imaging led to the diagnosis of cystolithiasis. After multidisciplinary counseling the patient underwent a vaginal hysterectomy with bilateral oophorectomy and transvaginal vesicolithotomy. A bladder biopsy was performed to rule out any malignancy. After three days, the patient was discharged with a Foley catheter; 15 days later, the bladder catheter was removed. She had an uncomplicated postoperative course. The presence of cystolithiasis and pelvic organ prolapse remains a challenge both in diagnosis and in treatment. The literature lacks solid evidence on the optimal management of these cases. Although there are no recommendations or consensus for their treatment, it seems that the one-step vaginal approach is preferable to the abdominal route.

Mature cystic teratomas (MCTs) arise from totipotent cells. While the ovaries are the most common sites, extragonadal teratomas are very rare. This case report describes the clinical details of a 20-year-old woman who was found to have a large pelvi-abdominal mass on clinical and imaging studies and elevated levels of CA-125. Because of the uncertainties of the origin of the mass, a multidisciplinary team suggested exploratory laparotomy with a mesenteric cyst as a differential diagnosis. Laparotomy showed both ovaries to be normal and revealed a large omental MCT, which was excised. Histopathology confirmed the diagnosis.

Uterine arteriovenous malformations (AVMs) are rare conditions that cause life-threatening bleeding. Endovascular treatment or total hysterectomy is performed to safely treat most AVMs. This case report describes a 54-year-old female patient with a large uterine AVM, uterine bleeding, and cardiac overload that was difficult to manage but successfully treated. Total hysterectomy poses a high risk of hemorrhage due to significant uterine and internal iliac vein dilation; thus, embolization of feeding arteries was performed with N-butyl cyanoacrylate. However, a postembolization computed tomography scan detected paradoxical embolization of the liver, kidneys, and spleen. Therefore, supracervical hysterectomy was performed with preoperative coil embolization and intraoperative balloon occlusion of the feeding arteries. In this case, supracervical, not total, hysterectomy needed to be performed as the shunts were determined to be in the uterine corpus.