Ovarian Fibroma Presents As Uterine Leiomyoma in a 61-Year-Old Female: A Case Study.

Uterine leiomyoma should be considered when a female patient reports symptoms of abdominal pressure and abnormal vaginal bleeding. However, the symptoms of a uterine leiomyoma are vast and overlap with other possible diseases that are difficult to distinguish even with imaging studies. This is why it is important for physicians and healthcare providers to keep an open mind and have a broad differential diagnosis.  In this case study, we present a 61-year-old postmenopausal female patient who presented to the emergency department with complaints of pelvic and abdominal pain, as well as vomiting and diarrhea. She was admitted for observation. A complete blood count (CBC), comprehensive metabolic panel (CMP), and urinalysis revealed no abnormalities; a pelvic ultrasound and CT scan reported possible adnexal torsion. The patient remained stable and the pain had subsided when she was seen the next morning by her gynecologist (GYN) who discharged her to follow-up in the office. Subsequent examinations that aided in the diagnosis included, but were not limited to pelvic and transvaginal ultrasounds, an abdominal and pelvic CT, and a pelvic MRI. In this case, the MRI revealed an 11-cm mass that could represent a torsioned pedunculated necrotic fibroid originating from the uterus. Radiology recommended surgical removal. Upon removal and review of the pathology of the mass, it was revealed to be a torsioned, partially necrotic fibroma that had originated from the ovary and not from the uterus, as imaging had originally suggested.

Seromucinous Cystadenoma Presenting as Endometriosis Complications in a 57-Year-Old Female: A Case Report.

Endometriosis should be considered when a female patient reports symptoms of severe pain/tenderness in the pelvic area associated with a frequent need for urination, bloating, vomiting, or nausea. Clinical suspicion is increased if the patient has a history of endometriosis. However, many patients with endometriosis can be asymptomatic, which is why physicians and providers must keep an open mind and have a broad differential. Examinations that aid in the diagnosis of endometriosis include but are not limited to a pelvic examination, an ultrasound, magnetic resonance imaging (MRI), and an exploratory laparoscopy. In this case study, we present a 57-year-old postmenopausal female patient who presented to her obstetrics and gynecology (OBGYN) physician with hot flashes and an abnormal ultrasound revealing an ovarian cyst. Seventeen years prior, at the age of 40, the patient was found to have endometriosis and endometrial polyps and underwent a left oophorectomy. Due to the patient's history, symptoms, and current scans, it was assumed that the present cyst was a complication of endometriosis. Ultimately, the cyst, right ovarian cyst wall, right fallopian tube, and uterine fibroids were surgically removed and sent to pathology. Upon further review of the patient's pathology reports, it was found that the cyst removed was a seromucinous cyst with focal borderline features.

Fallopian Tube Originating Ovarian Cancer in a 53-Year-Old Postmenopausal Female With Hereditary Breast Cancer (BRCA) Genes: A Case Study.

Ovarian cancer is the second most common gynecologic malignancy, but it is the deadliest of the gynecologic cancers. Out of 21,410 new cases of ovarian cancer in the United States in 2021, more than half were fatal. In this case study, a 53-year-old sexually active postmenopausal patient with a family history of breast cancer presented to her gynecologist for an annual exam. Given the patient's family history and breast cancer mutations, malignancy was a concern that had to be addressed. Elective bilateral salpingo-oophorectomy of the patient revealed ovarian serous carcinoma originating from the fallopian tubes. Historically, fallopian tube carcinoma was presumed to be rare, though many high-grade serous carcinomas previously classified as advanced ovarian carcinomas are now believed to have actually originated from the fallopian tubes. This case study adds to the body of evidence that many high-grade carcinomas have fallopian tube origins. This emerging perspective of ovarian cancer's origin provides healthcare workers and the scientific community a more complete picture of the etiologies and dissemination pattern of ovarian cancer. We hope this study will help physicians have a more extensive knowledge base of such a disease when looking for risk factors and taking care of their patients.

Panhypopituitarism Presents As Amenorrhea Secondary to Post Traumatic Stress Disorder in a 33-Year-Old Patient: A Case Report.

Hormonal derangements should be suspected whenever a patient experiences amenorrhea with no abnormal physical exam findings. Clinical suspicion is increased if she also reports psychological trauma that could affect her nervous system and, by association, her hormones since the pituitary gland is present in the brain. Additional exams that aid in the diagnosis of amenorrhea include a variety of blood panels and imaging scans. Panhypopituitarism is a disorder in which there is a deficiency of all pituitary hormones that include but are not limited to the thyroid-stimulating hormone (FSH), luteinizing hormone (LH), and follicle-stimulating hormone (FSH). Diagnosis is usually made by baseline blood sampling of these hormones. Secondary to panhypopituitarism, amenorrhea can be disguised as other neurogenic problems. In this case study, we present a 33-year-old female patient who presented to the clinic with amenorrhea and a traumatic past social history. Upon further workup of the patient, it was determined that the patient had panhypopituitarism that had to be managed with medications indefinitely. This case study is of the utmost interest because it highlights how panhypopituitarism, being such a rare condition, can easily be mistaken as amenorrhea secondary to psychological issues and how integral it is for a physician to keep an open mind when evaluating such patients.

Ovarian Serous Cystadenoma Presents As Bladder Issues in 23-Year-Old Female: A Case Report.

Pelvic organ problem(s) should be suspected when a female patient experiences difficulty emptying her bladder (urinary retention), abdominal distention, and bloating. Clinical suspicion is increased if she also reports any sexual activity while not using barrier contraception or is inconsistent with the use of barrier contraception as this can increase the likelihood of a sexually transmitted disease which can ultimately mimic the same symptoms. Exams that aid in the diagnosis of bladder issues include bladder ultrasound, urine analysis, and cystoscopy. Ovarian serous cystadenomas are common benign epithelial neoplasms that can range in size from 1-30 cm, and can also mimic symptoms/signs associated with bladder issues. In this case study, we present a 23-year-old female patient that presented to the clinic with signs and symptoms of bladder issues including difficulty voiding and abdominal distention. Upon further workup of the patient, it was evident that the patient had a large cyst of the right ovary that was surgically removed. A pathologic exam revealed that it was a benign serous cystadenoma that measured an impressive 28 cms in diameter.

Hydatidiform Mole Presents As Pregnancy in a 48-Year-Old Perimenopausal Female: A Case Study.

Pregnancy should be suspected whenever a woman in her childbearing years misses a menstrual period. Clinical suspicion is increased if she also reports any sexual activity while not using contraception or is inconsistent in her use of contraception. Laboratory findings that aid in the diagnosis of pregnancy include the detection of human chorionic gonadotropin (hCG) in blood or urine. Hydatidiform mole (HM) is part of a group of diseases classified under gestational trophoblastic disease (GTD), which originate in the placenta and have the potential to locally invade the uterus and metastasize. Although molar pregnancies are designated as benign, they have the potential to develop into a malignancy. In this case study, we present a 48-year-old peri-menopausal female patient, with a 1+ year history of irregular menses, who presented to the clinic with signs and symptoms of pregnancy, unprotected sexual activity, and a positive at-home pregnancy test. Upon further workup of the patient, it was diagnosed that the patient had a hydatidiform molar pregnancy. It is interesting to note that benign gestational trophoblastic diseases generally occur in younger women, of "reproductive age" (generally in their twenties to early thirties), and is extremely rare in peri- and post-menopausal women.

Melanoma in the Vulva of a 71-Year-Old Patient: A Case Report.

Mucosal melanomas (MM) are a rare type of melanomas commonly found in the vulvovaginal, anorectal, and respiratory tract. In this case report, a 71-year-old female presented to her OB/GYN clinic with dark raised mass on her right labial region adjacent to the perineum. Past medical and surgical history of note included third-degree uterine prolapse, senile vaginitis, fibrocystic changes of the breasts bilaterally, hypothyroidism, hypertension, as well as a past hysterectomy and anterior colporrhaphy. Upon further workup, the 2.7 x 1.8 x 2 cm polyploid mass was biopsied and was found to be consistent with malignant melanoma. The patient then underwent a wide local excision confirming that the lesion was a nodular vulvar melanoma with superficial ulcerations and lymphovascular invasion of the vulvar region. Post-wide local incisions were found to be healed well after the procedure and the patient was referred to a gynecological oncologist for continuous monitoring. The purpose of this case report is to bring awareness of melanomas arising in atypical regions. While MMs are rare in comparison to cutaneous melanomas (CM), the prognosis can be poor if not caught early.