Dilemma in diagnosing ovarian ectopic pregnancy

To study different presentation of ovarian ectopic pregnancy and its management. All the 4 patients of ovarian ectopic pregnancy presented in our hospital in the month of April 2019 were analysed. We reported 4 cases with a pre-operative provisional diagnosis of ruptured ectopic pregnancy and intra-operative diagnosis of? ovarian ectopic pregnancy, however histopathological examination confirmed the diagnosis of ovarian ectopic pregnancy in only 2 of the cases while the other 2 were ruptured corpus luteal cyst. Wedge resection was performed in all 4 patients. Ovarian ectopic pregnancy is rare and can be missed radiologically and intra-operatively. Establishing early diagnosis is a challenge to the clinician, it commonly mimics tubal ectopic or ruptured corpus luteal cyst. Provisional diagnosis can be made intra-operatively when a hemorrhage mass is seen near the ovary with a normal fallopian tube but can be confirmed by histopathological examination. The chief goal of the treatment remains life-saving intervention by early diagnosis to reduce maternal mortality and morbidity.

Cesarean scar ectopic with ruptured corpus luteal cyst: a rare case report

Incidence of caesarean scar pregnancy (CSP) is increasing because of a rising number of caesarean sections. Prompt diagnosis of the condition is required to reduce associated morbidity. A high index of suspicion is required for women with a suggestive history of CSP. Ultrasound scan is the diagnostic tool of choice. Management options include medical, surgical and interventional radiology. Appropriate patient selection is important for optimal results. Major haemorrhage and hysterectomy are the main risks associated with CSP. Therefore, adequate counselling and availability of surgical expertise and blood transfusion should be part of a comprehensive management strategy. We are reporting a rare case of G3P2L1 with previous two lower caesarean deliveries diagnosed with caesarean scar ectopic based on clinical and ultrasound finding came with acute pain in abdomen with haemodynamically unstable with intraoperative finding s/o unruptured c scar pregnancy along with ruptured corpus luteal cyst leading to severe intra-abdominal bleeding. C-scar ectopic and corpus luteal cyst confirmed on histopathology.

Extramedullary hematopoiesis in ovary: a rare presentation of CML

Extramedullary hematopoiesis (EMH) is a rare phenomenon, and represents infiltration and proliferation of myeloid, erythroid, and megakaryocytic cells in non-bone marrow sites. Extramedullary hematopoiesis (EMH) is normal during fetal life, but after birth, the presence of EMH is considered to be abnormal.  EMH has been associated with CML (chronic myeloid leukaemia). Lymph node is the most common site of involvement, other sites being the abdomen (liver, spleen) and thorax (bone, mediastinum) but very rarely in the gynecological tract. Here authors report a case of a 20-year young female, a known case of CML who presented with abdominal pain with hemoperitonium, with negative urine pregnancy test. Initially hemorrhagic corpus luteal cyst was thought to be the cause of hemoperitonium and patient was taken for surgery wherein histopathology confirmed the diagnosis of extra medullary hematopoiesis of ovary. Women with CML when presents with hemoperitoneum, extramedullary hematopoiesis should be a differential diagnosis apart from rupture ectopic and other causes of spontaneous hemoperitoneum.  Patient was started on imatinib after diagnosis and is doing well.

The relative frequency and histopathological pattern of ovarian masses - 11 year study at tertiary care centre.

Background: Ovarian tumours are one of the major cause of gynaecological problems in females and present marked variation in their histological types. Relative frequency of these lesions is different for Western and Asian countries. Aims & Objective: This study was designed to find out frequency of various histological patterns of ovarian tumours in patients attending Pathology department of a teaching institute in Gujarat. Material and Methods: A retrospective – series study was conducted on 337 cases of ovarian masses, reported from January 2002 to December 2012. Results: Mean age of the subjects was 33.6 years, ranging from 8 to 70 years. In a total 337 cases of ovarian masses, 197 (58.46%) were non-neoplastic and 140 (41.54%) were neoplastic. Among neoplastic lesions, 77.14% (108/140) were benign, 3.57% (5/140) were borderline and 19.29% (27/140) were malignant. The commonest non-neoplastic lesion was luteal cyst (59/197) followed by simple serous cyst (56/197). The commonest malignant tumour was serous cystadenocarcinoma (11/27) followed by mucinous cystadenocarcinoma (5/27). The commonest borderline tumour was borderline serous tumour (4/5). Conclusion: Non-neoplastic lesions were more common than neoplastic lesions. Among neoplastic lesions benign tumours were common. The commonest benign tumour was serous cystadenoma and malignant was serous cystadenocarcinoma. The commonest non-neoplastic lesion was luteal cyst. Among histological types of ovarian tumours, surface epithelial tumours dominated the other types.

Laparoscopic ovarian ligament plication in pregnancy / Plicatura laparoscópica del ligamento ovárico en el embarazo

This 32-year old patient presented at seven weeks gestation with severe left-sided lower abdominal pain. This was against the background of a previous history of left salpingectomy from a ruptured ectopic gestation seven years previously. Transvaginal sonographic evaluation revealed a viable seven week intrauterine embryo, a 2 cm left corpus luteum cyst and Doppler studies revealed reduced internal flow. This led the way for a conservative approach via laparoscopy of untwisting the pedicle to restore blood flow. In this case, the ovarian ligament was shorted using 1/0 vicryl and the pregnancy went to term.

Esta paciente de 32 años se presentó en la séptima semana de gestación con un severo dolor abdominal en el lado inferior izquierdo. Esto ocuría teniendo la paciente por antecedente una historia previa de salpingectomía izquierda a partir de la ruptura de un embarazo ectópico siete años antes. La evaluación sonográfica transvaginal reveló un embrión intrauterino viable de siete semanas, un quiste del 2 cm en el cuerpo lúteo izquierdo, y los estudios de Doppler revelaron un flujo interno reducido. Esto abrió el camino para un abordaje conservador vía laparoscopia encaminada a deshacer la torsión del pedículo y restablecer así el flujo sanguíneo. En este caso, el ligamento ovárico fue acortado usando vicryl 1/0, y el embarazo continuó a término.

A case of Hyperstimulated Corpus luteal cyst torsion in Pregnancy after In vitro Fertilization / 대한산부인과학회잡지

Ovarian torsion is the fifth most common condition in gynecologic surgical emergencies, with an incidence of 2.7% occuring mainly in women of reproductive age. It is an uncommon but well recognized complication of ovarian stimulation, especially when ovarian hyperstimulation syndrome occurs. Patients with ovarian torsion normally present with an acute abdomen, necessitating an exploratory laparotomy, with removal of the organ when necrosis is evident. Ultrasound may suggest the diagnosis of adnexal torsion. If the ovarian tumor is a luteal cyst, it is also standard to administer progesterone after surgical treatment, although how efficient this treatment is in preventing miscarriage is questionable. A documented case of adnexal torsion associated with in vitro fertilization is hyperstimulated enlarged corpus luteal cyst. Emergency left salpingo-oophorectomy was done and have concluded a successful pregnancy after exogenous progesterone support. We report a case of enlarged corpus luteal cyst torsion in early pregnancy with a brief review of literatures.

A Case of Autonomous Ovarian Cyst with Severe Vaginal Bleeding / 대한소아내분비학회지

Small ovarian cysts(<0.7 cm in diameter) are common in prepubertal children. Occasionally larger cysts occur in young girls with isosexual incomplete precocious puberty in the absence of LH and FSH elevation. The mechanism of production of these autonomous functioning cysts is unknown. A 3 year 6 month-old girl was referred to our department of pediatrics because of severe vaginal bleeding. On examination, she was tall and had breast enlargement of Tanner stage II. On hormonal study, FSH(0.38mIU/ml) was suppressed and estradiol(62.2pg/ml) was markedly elevated, and GnRH stimulation failed to evoke an increase in gonadotropin. Bone age was advanced. Pelvic ultrasonography showed both huge ovarian cysts. Brain MRI showed no abnormalities. We underwent both ovarian cystectomy and histological examination showed follicular cyst in left ovary and luteal cyst in right ovary. After ovarian cystectomy vaginal bleeding stopped and hormonal abnormalities were normalized. We report a case of autonomous ovarian cysts presenting severe vaginal bleeding treated with ovarian cystectomy.