Disseminated Peritoneal Leiomyomatosis With Unusual Lung Mesenchymal Malignant Transformation.

Disseminated peritoneal leiomyomatosis (DPL) is a benign metastasis of leiomyoma mimicking metastasis of malignancy. It usually affects premenopausal women. Malignant transformation is a rare clinical scenario of DPL. However, its etiology is unknown with unusual growth patterns, either of which makes the diagnosis difficult. It was postulated that the pathophysiology of DPL is metaplasia of mesothelial cells under the effect of hormonal stimulation. Hence, we reported the case of a 62-year-old woman with a history of left breast cancer, who presented with DPL and metastasis to the lung with malignant transformation after two years of starting prophylactic tamoxifen therapy. The influence of tamoxifen use on the development of DPL is not fully understood; this is a rare case that highlights a possible association between tamoxifen and the malignancy transformation of DPL. Hence, it may help raise awareness among clinicians dealing with women using tamoxifen or other hormonal therapy, and the risk of DPL development with potential malignant transformation in such patients.

Sickle Cell Trait and Adverse Pregnancy Outcomes: Is There a Link?

Objective The objective is to assess the overall prevalence of maternal and neonatal pregnancy-related complications, and to compare their frequency among women with sickle cell trait (SCT) and those with normal hemoglobin patterns to examine the association between SCT and maternal and neonatal outcomes. Methods A retrospective cross-sectional case-control study was conducted by reviewing medical data from the labor room registry book and electronic database. All pregnant ladies delivered in Salmaneya medical complex from January 1 to December 31, 2019 were included. Patients were divided into two groups based on the presence or absence of SCT. Adverse maternal and neonatal outcomes were compared between the two groups.  Results Out of the 5,067 pregnant women reviewed, 934 (18.4%) were included (460 (49.3%) with SCT and 474 (50.7%) with healthy controls). Overall, maternal, and neonatal complications were noted in 40.8% (n=381) and 16.3% (n=152), respectively. In univariate analysis, patients with SCT were significantly more likely to underwent cesarean sections compared to healthy women, 28.7% (n=132) vs. 21.7% (n=103), respectively (P=0.044) and to have more intrauterine fetal death (3% [n=14] vs. 0.2% [n=1], respectively (P<0.0001). No significant differences were found between the two groups in terms of the occurrence of the pregnancy-related hypertensive disorder, gestational diabetes, small for gestational age, and preterm delivery.  Conclusion The result of this large, retrospective cross-sectional, case-control study shows that pregnant women with SCT were associated with an increase in intrauterine fetal death in comparison with pregnant women with normal hemoglobin. There were no differences found in pregnancy-related hypertensive disorder, gestational diabetes, small for gestational age, and preterm delivery. This result will emphasize the requirement of additional studies to scrutinize these findings and to determine whether there may be a benefit of a unique antenatal surveillance guideline for such patients.