Extragonadal omental teratoma: a case report

Mature cystic teratomas or dermoid cysts are among the most common ovarian tumors; however teratomas of extragonadal origin are extremely rare. The most common extragonadal site of these teratomas is the omentum. It is generally accepted that teratomas arise from germ cells that originate in the mature gonads. Of the three proposed etiologies of omental teratoma, auto-amputation and subsequent re-implantation of gonadal teratoma is the most likely preceding event

A review of literature reveals that only 31 cases of teratoma of the greater omentum have been published to date and three cases reported wherein omental teratoma and dermoid of the ovary were coexisting. We report a rare case of an omental teratoma in a 26-year woman who underwent ovarian cystectomy for dermoid cyst. This is the fourth case of an omental mature teratoma with coexisting ovarian dermoid cyst

Extragonadal omental teratoma: a case report

Mature cystic teratomas or dermoid cysts are among the most common ovarian tumors; however teratomas of extragonadal origin are extremely rare. The most common extragonadal site of these teratomas is the omentum. It is generally accepted that teratomas arise from germ cells that originate in the mature gonads. Of the three proposed etiologies of omental teratoma, auto-amputation and subsequent re-implantation of gonadal teratoma is the most likely preceding event. A review of literature reveals that only 31 cases of teratoma of the greater omentum have been published to date and three cases reported wherein omental teratoma and dermoid of the ovary were coexisting. We report a rare case of an omental teratoma in a 26-year woman who underwent ovarian cystectomy for dermoid cyst. This is the fourth case of an omental mature teratoma with coexisting ovarian dermoid cyst

Uterine clear cell adenocarcinoma with adenomyosis: a case report with review of literature

Corpus cancer is the most frequently occurring female genital cancer. Clear cell carcinoma is a rare form of endometrial cancer accounting for 1-1.5% of all endometrial carcinomas and is often associated with an aggressive clinical behaviour and poor clinical outcome. The molecular pathways involved in development of clear cell carcinoma are still unclear with the present presumption that it arises from atrophic endometrium. Patients with clear cell carcinoma often experience relapse in pelvis, in para-aortic nodes and at distant sites. Total abdominal hysterectomy and bilateral salphingo-oopharectomy with comprehensive surgical staging is the standard surgical treatment of patients with clear cell carcinoma of endometrium, whereas pelvic irradiation, para-aortic irradiation, whole abdominal irradiation and chemotherapy have been widely employed as post operative therapy. This is a case report of a rare case of clear cell carcinoma of endometrium with adenomyosis. A 65 years menopausal lady presented with bleeding per vagina for the past 6 months. She was married and nulliparous. She was a hypertensive patient on irregular treatment. Physical examination was unremarkable. She was evaluated for her post menopausal bleeding. She had an unsatisfactory colposcopy. MRI showed a large polypoidal endometrial mass lesion with an impression of neoplastic endometrial growth. With a provisional diagnosis of endometrial polyp/ carcinoma endometrium she was planned for total abdominal hysterectomy and bilateral salphing-oopharectomy surgery. Following a difficult surgery for a suspected uterine malignancy she had a good post operative recovery. Histopathological report revealed a high grade endometrial clear cell carcinoma with focal papillary serous differentiation with adenomyosis and leiomyoma. In view of high grade invasive carcinoma of endometrium she was referred to a radiotherapy unit for post operative radiotherapy. This case was analyzed with review of other reported case. Review re-emphasised the need of accurate histopathological diagnosis in addition to clinical staging especially in rare variants of endometrial carcinomas like clear cell carcinoma and squamous carcinoma in optimizing the treatment. However the importance of myometrial invasion cannot be overlooked especially when adenomyosis co-exists with adenocarcinoma. It is important to have a clear distinction between a true myometrial invasion by adenocarcinoma and involment of adenomyotic foci by malignant cells without myometrail invasion in determining the staging and prognosis. In view of non-availability of commonly accepted guidelines for the management of patients with clear cell carcinoma of endometrium, and adequate molecular, characterization of clear cell carcinoma is strongly warranted in order to identify new biological prognostic variables of the disease and to develop novel molecular targeted therapies

Cervical ectopic pregnancy - a review

Cervical ectopic pregnancy is the implantation of a pregnancy in the endocervical canal and is a rare entity. Cervical pregnancy is the least common variant of ectopic pregnancy with a reported incidence of < 1% and 1;18000 live births. Diagnosis and management of cervical ectopic pregnancy is a challenging obstetrical entity both for the obstetrician and the radiologist. Diagnostic dilemma still exist because of close resemblance of clinical presentation between cervical ectopic pregnancy and incomplete abortion. Unexpected diagnosis of cervical ectopic pregnancy following dilatation and curettage for a presumed incomplete abortion was not uncommon. Uncontrolled hemorrhage warranted emergency hysterectomy in majority of cases. Advances in sonological techniques have made the diagnosis easy. Dramatic change has been witnessed over the past two decades in this regard. Fertility sparing treatment options are the ray of hope especially for nulliparous women with cervical ectopic pregnancy. Here is a case report of 24 year old nulliparous presented to emergency room with lower abdominal cramping, burning micturition, bleeding per vagina and vomiting of two days' duration. Her last menstrual period was six weeks back. Pelvic examination revealed eight weeks pregnancy with enlarged cervix and bloody mucous discharge from the cervix with unremarkable adnexa. She was found to be positive for pregnancy test. Clinical and biochemical marker [b HCG] suggested ectopic pregnancy with a possibility of cervical ectopic pregnancy following ultrasound examination. As the patient was keen on immediate symptomatic cure she was managed surgically followed by a good postoperative recovery. Misdiagnosis and mismanagement of cervical ectopic pregnancy carry high maternal mortality and morbidity. Literature was reviewed in view of the enigma surrounding the diagnosis and management of cervical ectopic pregnancy. The review revealed the need of appropriate diagnosis and that fertility sparing treatment options [medical methods] are gaining momentum and are found to be effective. High index of clinical suspicion by the obstetrician, aided with high resolution transvaginal scan, should help in making an early appropriate diagnosis. Timely correct diagnosis and intervention with right therapeutic option should prevent high maternal morbidity and mortality associated with cervical ectopic pregnancy