ABSTRACT
BACKGROUND: A rare complication of mature cystic teratoma of the ovary is malignant transformation, mostly being squamous cell carcinoma (SCC). Due to small case series, there are no established standard surgical and postoperative procedures. CASE: A 41-year-old pregnant woman presented with a right ovarian tumour. At 14 weeks of gestation, laparotomy with oophorectomy was performed. Histology revealed a pT1a poorly differentiated SCC with lymphovascular invasion. She delivered a healthy infant at 39 weeks of gestation. Nine weeks after delivery, she underwent complete surgical resection and was staged pT1a, pN0 (0/40) pMx, G0. No further treatment was given and 37 months later she is still free of disease. CONCLUSION: For this rare entity complete surgical resection seems to be a safe treatment.
Subject(s)
Dermoid Cyst/pathology , Neoplasms, Squamous Cell/pathology , Ovarian Cysts/pathology , Ovarian Neoplasms/pathology , Pregnancy Complications, Neoplastic/pathology , Adult , Cell Transformation, Neoplastic , Dermoid Cyst/surgery , Female , Humans , Neoplasm Staging , Neoplasms, Squamous Cell/surgery , Ovarian Cysts/surgery , Ovarian Neoplasms/surgery , Ovariectomy , Pregnancy , Pregnancy Complications, Neoplastic/surgery , Pregnancy Trimester, FirstABSTRACT
We report the case of a 39-year-old woman who became pregnant despite a levonorgestrel-releasing intrauterine system (LNG-IUS), which was inserted 40 months before the pregnancy was detected. When a Caesarean section was performed, the LNG-IUS was found within the omentum majus. It has been reported, that displaced LNG-IUS can cause amenorrhea and high plasma levels of LNG in affected women, probably due to the higher resorptive capacity of the peritoneum, recommending a removal of the displaced LNG-IUS. Our case report demonstrates that a dislocated LNG-IUS does not necessary has the ability to suppress ovulation and therefore pregnancy. Therefore, every gynaecologist should be aware of a pregnancy despite a dislocated LNG-IUS.
Subject(s)
Foreign-Body Migration , Intrauterine Devices, Medicated , Levonorgestrel , Pregnancy, Unplanned , Adult , Cesarean Section , Contraceptive Agents, Female , Female , Humans , Incidental Findings , Infant, Newborn , Omentum , Pregnancy , Pregnancy OutcomeABSTRACT
PROBLEM: The common 677C>T mutation of the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene is less prevalent in mothers of spontaneously conceived dichorionic twins than in those with singleton pregnancies. (Hasbargen U, Lohse P, Thaler CJ: Hum Reprod 2000; 15:2659-2662). As polyovulation is a pre-requisite for dichorionic pregnancies, we investigated whether the T allele is associated with reduced ovarian responsiveness to follicle-stimulating hormone (FSH). MATERIALS AND METHODS: We studied 105 infertility patients undergoing a total of 269 A.R.T cycles stimulated with recombinant (r)-FSH. The MTHFR 677C>T genotype was analyzed by digestion of polymerase chain reaction-amplified DNA fragments. RESULTS: Homozygous 677C patients older than 35, required significantly (P <0.02) less r-FSH and produced significantly more oocytes (P < 0.04) and higher maximal serum estradiol concentrations (P < 0.002) than heterozygous or homozygous carriers of the 677T allele. CONCLUSION: Our results suggest that, in patients of advanced reproductive age, the MTHFR 677C>T mutation affects ovarian responsiveness.
