ABSTRACT
Acute abdomen due to incarcerated umbilical hernia is a surgical emergency. Acute abdomen secondary to gynaecological conditions is not uncommon. However, acute abdomen due to incarceration of a gynaecological tumour in an umbilical hernia is rare. A 25-year-old nullipara was admitted to the accident and emergency unit with a history of recurrent lower abdominal pain and abdominal swelling for 4 weeks. Pain worsened within the last 24 h necessitating presentation. Examination revealed a low-grade pyrexia, tachypnoea, an umbilical swelling with generalised abdominal tenderness, and a pelvic mass more in the right iliac fossa. Bedside abdomino-pelvic ultrasound scan confirmed bilateral adnexal masses with features suggestive of mature teratoma. A diagnosis of acute abdomen secondary to ovarian tumour accident was made. An emergency exploratory laparotomy revealed a huge right ovarian tumour incarcerated in an umbilical hernia. She had bilateral ovarian cystectomy and herniorrhaphy. Gynaecological tumours presenting as incarcerated or strangulated hernias are extremely rare but can be a cause of acute abdomen in women.
ABSTRACT
Fibro-epithelial polyps (FEPs), also referred to as acrochordons or skin tags, are benign tumours that generally occur in women of reproductive age. They are uncommonly found in the vulva and vary in clinical appearances from small papillomatous growths to large pedunculated tumours. Typically, they are less than 5 cm. The wide range of morphological appearances of these tumours, especially when they are large, can be misinterpreted as malignant. This case involved a 30-year old multipara, 14-month post-partum who presented with a huge, irregular, firm, pedunculated mass on the right labium majus. The mass had patchy areas of skin ulceration and measured 25 cm × 15 cm × 10 cm on a 4-cm × 2-cm long stalk. It started as a 3-cm long finger-like projection with globular distal end that progressively increased in size over 7-month period. There were no swellings in other body parts. She had excisional biopsy of the mass which weighed 588 grams with histological diagnosis of inflamed FEP and had no recurrence at follow-up. This case illustrates an uncommon presentation of the second largest FEP of the vulva reported, which could be misinterpreted as malignant. Clinical, and pathological expertise with complete surgical excision are paramount for effective management to exclude atypia or malignancy and prevent recurrence.
ABSTRACT
Ovarian endometrioma is quite common among women of reproductive age but rarely exceed 6 cm in diameter. Ovarian endometrioma exceeding 10 cm in dimension, often referred to as giant endometrioma, is rare and can pose a diagnostic dilemma to clinicians. We present a 33-year-old single nullipara referred to our facility with a 3-year history of recurrent abdominal pain, abdominal swelling, and difficulty in breathing. The challenges in making diagnosis of a huge ovarian endometrioma are highlighted and the literature on huge ovarian endometrioma reviewed.
ABSTRACT
Gynaecological malignancies frequently metastasize to contiguous structures, internal organs and bones. Cutaneous metastasis as a primary or recurrent presentation of these malignancies is rare and only a few cases have been reported in the literature. A twenty year (1991-2010) retrospective search for umbilical metastasis from gynaecological malignancies in our departmental case records showed only four cases. Four post-menopausal females presented with painful cutaneous umbilical (Sister Joseph's) nodules. The clinical examinations of all four patients revealed well delineated nodules of varying sizes and degrees of ulceration. Other findings were matted axillary and inguinal lymph node enlargement, intra-abdominal and pelvic masses, vaginal discharge and vaginal bleeding. Incisional tissue biopsies from the nodules were processed in paraffin wax and stained with haematoxylin and eosin. Histology of the sections showed pigmented skin overlying metastatic malignant tumours consistent with adenocarcinoma from the endometrium and ovary in three cases, and squamous cell carcinoma, large cell keratinizing from the cervix uteri in the fourth case. Gynaecological cancers have a global spread and varied geographic distribution. Cervical cancer is the commonest in our setting and patients often present to hospital with advanced stage disease. Ovarian and endometrial cancers are infrequent and their diagnosis may be delayed by non- specificity of presenting clinical symptoms from other benign tumours at these sites. Although umbilical metastasis is commonly associated with gastro-intestinal malignancies, its presence may be the first harbinger of occult gynaecologic cancer.
