Angular ectopic pregnancy presenting as rupture of lateral wall of the uterus: late presentation in gestation week 20

The differential diagnosis of acute abdominal pain in pregnancy is broad and can be complicated by atypical manifestations that are due to the anatomic distortions and physiologic changes of pregnancy. Due to the lack of clinical understanding, angular pregnancy does not appear to be recognized as a clinical entity and many cases are likely to go undiagnosed. This is a case report of a 34-year-old woman who was referred to the obstetrics emergency department with sudden abdominal pain and in a state of hypovolemic shock. She had 20 weeks amenorrhea with a positive blood pregnancy test. She underwent laparatomy with internal hemorrhage diagnosis. During the emergency laparotomy, the authors were surprised to encounter the conceptus of 20 weeks angular pregnancy extruded through the left lateral angulation of uterine cavity. The placenta and amnion were removed and the uterine was repaired. Angular pregnancy is rare, but it should be fully understood since its clinical management, outcomes, and maternal mortality are different

Fertility sparing surgery in gestational trophoblastic neoplasia: a report of 4 cases

Background: Gestational trophoblastic neoplasia [GTN] is a curable disease that involves the development of malignant tumor in the woman after a normal or molar pregnancy. The position of surgery in GTN is not properly specified and is changing due to new chemotherapy protocols. However, the role of surgery is highlighted in chemotherapy-resistant GTN. Other indications of surgery in trophoblastic diseases are drug toxicity and uterine perforation. Based on the fact that most women in certain age tend to preserve fertility, this study reported 4 cases of successful treatment after fertility sparing surgery

Case: A hospital-based case-report study was carried out to investigate the role of surgery in 4 patients with GTN. In this study, acute complications, such as intraabdominal bleeding and liver dysfunction due to chemotherapy occurred in some patients. Surgery was performed and all cases underwent localized tumor removal while preserving the uterus. No hysterectomy surgery was performed

Conclusion: Surgery is supposed in specific cases of GTN, who desire preserving fertility

Leiomyosarcoma with unusual macroscopic features: a case report

Uterine sarcoma is a rare tumor of mesodermal origin, accounting for 2-6% of uterine malignancies. Leiomyosarcoma [LMS] has been reported in only 1% of all uterine malignancies and is regarded as the most common primary uterine sarcoma. Herein, we present a case of LMS with unusual macroscopic features. The patient was a 61- years-old woman with LMS, which consisted of a large cystic mass [88×136 mm], containing six liters of brownish fluid on the right side of the pelvis and abdomen. The fundus of the uterus was ruptured by the solid part of the tumor. For treatment, total hysterectomy, salpingo-oophorectomy and the optimal resection of tumor were carried out. Overall, the distinctive biological behavior and poor overall survival of uterine sarcoma challenge the post-operative management of this tumor. According to the one-year follow-up, the patient was disease-free. Unfortunately, no further data is available beyond this period

Sentinel node mapping in vulvar cancers: report of two cases and literature review

Vulvar cancer is a rare gynecological malignancy with mainly lymphatic spread. Sentinel node mapping plays an important role in the management of this gynecological malignancy. In the current study, we reported our experience in sentinel node mapping of vulvar cancer and review the literature accordingly. Since the introduction of sentinel node mapping to the surgical oncology community of our university in 2004, we had two operable vulvar cancer patients who were candidate for sentinel node mapping for inguinal lymph node staging. In the current study, we reported these two cases in details and a brief review of literature on sentinel node mapping in vulvar cancer was done. We specifically discussed the overall accuracy, importance of blue dye injection, learning curve effect, frozen section, excisional biopsy and location of the tumors. Overall sentinel node mapping is a safe and effective method for inguinal lymph node staging in vulvar cancers. In order to perform sentinel node mapping efficiently, paying attention to the details is of utmost importance

value of lateral lymphoscintigraphy images of the pelvis for gynecological cancers: are they necessary?

In the current study we evaluated the incremental value of lateral pelvic lymphoscintigraphy imaging of endometrial or cervical cancer patients who underwent sentinel node mapping. Operable endometrial and cervical cancer patients without clinical or paraclinical evidence of lymph node involvement were included in the study. The day before surgery the patients were sent to the nuclear medicine department for injection of the radiotracer. All patients received two intra-cervical injection of 1 mCi/0.2 cc radiotracer in the 6 and 12 hour locations. 18-24 hours after the radiotracer, lymphoscintigraphy imaging in anterior/posterior and lateral views was done. After induction of anesthesia, 2 mL Methylene blue in two aliquots was injected intra-cervically in the same location as the radiotracers. During operation, any hot and/or blue node was harvested as sentinel nodes. Overall 40 patients were included in the study [30 endometrial and 10 cervical cancers]. Sentinel node visualization was achieved in 30 patients. These sentinel nodes were all visualized on the ANT/POST views. Only in 7 patients sentinel nodes could be visualized on the lateral views. Intra-operative sentinel node detection rate was 38 out of 40 [95%]. Radiotracer detection rate was 37/40 [92.5%] and blue dye detection rate was 17/40 [42.5%]. Anterior/Posterior pelvic lymphoscintigraphy imaging is sufficient for imaging in cervical and endometrial cancer patients undergoing sentinel node mapping. Lateral views can be omitted due to limited valued of these projections

Vulvar carcinoma in pregnant women aged less than 40 years: case report

Invasive squamous cell carcinoma of the vulva is primarily a disease of postmenopausal women and thus is rarely associated with pregnancy. We have reported on a young woman under 40 years old with vulvar carcinoma, which occurred during the pregnancy but optimal treatment was delayed to the postpartum period. This 37-year-old woman was diagnosed with 3x3 cm vulvar lesion, 2 weeks after cesarean section, subsequent biopsy revealed squamous cell carcinoma. She had a history of an ulcer on her left labia minor at the third month of the pregnancy. She was treated by a modified radical vulvectomy and bilateral groin lymphadenectomy. She did not receive any additional treatments. Now after two years, she has had no recurrence of the disease. This case emphasizes on the need to consider malignancy as a differential diagnosis in vulvar lesions of pregnant young women

Peripheral primitive neuroectodermal tumor of the pelvis

The primitive neuroectodermal tumor [PNET] belongs to a group of highly malignant tumors and is composed of small round cells of a neuroectodermal origin. Categorized in the same tumor family as Ewing sarcoma, the PNET is most likely to occur in bones and soft tissues. However, a small number of PNET cases arising in the pelvis have been reported as well. We present three cases of pelvic PNET: two cases in the ovary and one case in the broad ligament. The PNET often exhibits aggressive clinical behavior with worse outcomes than other small round cell tumors. The significant prognostic factors of the PNET include site of tumor, volume of neoplasm, and presence of metastasis. The treatment protocol is multimodal and includes local surgical treatment followed by chemotherapy. We herein describe three PNET cases as a rare entity in the pelvis. Pelvic PNETs should be included in the differential diagnosis of pelvic masses

Surgeon's errors in the managment of patients with Cervical Cancer

Generally, in patients with cervical cancer, careful preliminary evaluation is necessary for avoiding improper surgical procedures and making effective clinical decisions for treatment. The aim of this study was to determine surgeon errors, which necessitate a combination of surgery and radiotherapy for cervical cancer patients. In this retrospective study, medical records of all cervical cancer patients, undergoing hysterectomy at tumor clinics of Ghaem and Omid Hospitals, were collected from 1988 to 2008. In total, the medical records of 93 subjects with postoperative radiotherapy were examined. All records were assessed in terms of surgeons' errors, patients' follow-up after radiotherapy, rate of disease recurrence, and mortality rate. In addition, survival factors were recordedandassessed, and cumulative 3- and 5-year disease-free survival [DFS] rates as well as overall survival [OS] rate were determined by Kaplan-Meiertest. The overall rate of surgeons' errors was 41%. The most common surgical error was improper surgical care due to surgeon's lack of knowledge about the cervical cancer treatment. The 3-year DFS rates were 86% and 64% in cases without surgeon's error and those affected by surgeon's error, respectively. In addition, the 5-year DFS rate was 53% in the non-affected group and 47% in cases affected by surgeon's error [P=0.05]. Pre-treatment evaluation as well as proper treatment is necessary for the prevention of adverse effects, caused by inappropriate surgical interventions. It is suggested that more time and attention be allocated to the improvement of surgical outcomes

Ovarian dermoid cyst

Mature teratoma is the most common germ cell tumor [and the most common tumor] of the ovary, composing more than 20% of all ovarian neoplasms. Super infection of dermoid ovarian cyst is very rare. A 72 years-old woman admitted to the gynecological outpatient clinic because of lower abdominal pain and fever. Gynecological examination and ultrasonography revealed a heterogeneous cystic mass in the right ovary. Abdominopelvic CT scan revealed a right ovarian mass [15 x 15cm] thought to be a dermoid cyst. Right adnexectomy was performed. The pathological evaluation suggested infected benign ovarian dermoid. Infection of a mature teratoma is a relatively uncommon event. However, based on our case and others, superinfection with abscess formation should be considered in the differential diagnosis whenever a patient with a documented pelvic mass and fever

Metastatic renal cell carcinoma; vaginal bleeding as a presentation

Approximately 30% of patients with renal cell carcinoma present with metastatic disease at the time of diagnosis. Metastasis of renal cell carcinoma to the vagina is rare. A 61 year old female presented with a vaginal lesion which was excised and diagnosed as metastatic clear cell carcinoma. A workup further is done Radiological studies revealed a left renal mass; A subsequent nephrectomy confirmed renal cell carcinoma. Renal cell carcinoma must be in the differential diagnosis of a vaginal clear cell neoplasm in a postmenopausal woman

Elevated plasma total homocysteine in preeclampsia

To investigate the possible association between hyperhomocysteinemia and preeclampsia. A case-control study was carried out in the Departments of Obstetrics and Gynecology of the Ghaem Hospitals in Mashhad University of Medical Sciences, Mashhad, Iran from May 2004 to August 2006 and included 75 preeclamptic patients, 37 women with mild preeclampsia, and 38 women with severe preeclampsia, in addition we included 40 controls without pregnancy complications. Plasma total homocysteine was determined in all subjects by enzyme linked immunosorbent assay. The 3 groups were similar in age and body. Patients with severe preeclampsia had significantly higher mean plasma levels 13.8 +/- 7mg/l than normal pregnant women 8.8 +/- 2.8mg/l and mild pre-eclamptic women 10.4 +/- 2.3mg/l p < 0.05. Women who developed severe preeclampsia have higher plasma homocysteine levels than women who remain normotensive throughout pregnancy

Vulvar carcinoma in pregnancy: a case report

Carcinoma of the vulva has commonly been recognized as a disease of postmenopausal women, but some cases have been reported in young women during pregnancy. Medical records were reviewed for a patient with vulvar carcinoma diagnosed in pregnancy. Using Medline and cross references, pertinent articles were sought and reviewed. A 28-year-old Afghan woman in her sixth pregnancy presented with a vulvar lesion. Subsequent biopsy revealed squamous cell carcinoma. The patient was treated with local excision. She had a cesarean section in her 36[th] week of pregnancy. She underwent modified radical vulvectomy with bilateral groin dissection four weeks after cesarean. Because of a grossly positive groin lymph node, she also underwent radiation therapy. She is alive without invasive cancer 7 months after diagnosis.This case demonstrates the need to biopsy all suspicious vulvar lesions, even in young and pregnant women