Caesarean myomectomy in a case of bad obstetric history and multiple fibroids: a case report

Uterine myomas are being observed in pregnancy more frequently now than in the past, because many women are delaying child bearing till their late thirties, which is the time for the greatest risk of the myoma growth. Traditionally, obstetricians are trained to avoid myomectomies during caesarean sections as severe haemorrhages can occur, which may often necessitate hysterectomies. Pedunculated fibroids which can be easily removed are an exception. A 38-year-old, elderly female, G3 A2, 37 weeks pregnancy with bad obstetric history and multiple fibroids was admitted in Apollo Hospitals, Ahmedabad. She underwent high risk caesarean section followed by myomectomy. Four large and one small fibroid were removed. One posterior wall intramural fibroid 6×5 cm was lower down, hence not removed. Histopathological examination showed leiomyomata with degenerative changes, infarct and calcification. She didn’t have any intraoperative haemorrhage or any postpartum complications. On follow up after 6 weeks, patient was healthy, had no complaints. Caesarean scar was healthy. Ultrasound scan showed normal uterus with one posterior wall intramural fibroid 3×3 cm. With the advent of better anaesthesia, easy availability of blood and blood components, caesarean myomectomy is a safe surgical procedure when performed by experienced obstetrician in carefully selected patients. Intraoperative assessment of fibroids is important in decision making for caesarean myomectomy.

Androgenic alopecia in post-menopausal female: a clinical presentation

Androgenic alopecia is a patterned hair loss occurring due to systemic androgens and genetic factors. It is the most common cause of hair loss in both genders. The appearance of this condition is the cause of significant stress and psychological problems, making appropriate management important. A 68-year-old postmenopausal female presented with complaints of increased hair loss from scalp, excessive hair growth at undesired sites and hirsutism not corrected with medications. On thorough investigations, CT scan whole abdomen and endocrinological workup, a clinical diagnosis of alopecia and hirsutism due to hyperandrogenemia secondary to ovarian tumor made. Abdominal hysterectomy with B/L salpingo-oophorectomy was done. Histopathological examination revealed an encapsulated tumor in right ovary-sex cord stromal tumor consistent with Leydig cell tumor in right ovary, no evidence of malignancy. Left ovary was normal. Patient showed significant regression of clinical signs and symptoms on follow up after 1 month. All women with severe hirsutism or androgenic alopecia needs further work up to locate the source of androgen over production.