Posterior Fourchette Fissure Resolution After Injection of Autologous Adipose-Derived Regenerative Cells.

BACKGROUND: Posterior fourchette fissures can recur and become chronic despite multiple medical and surgical treatments. We report the case of a recurrent posterior fourchette fissure that resolved after subdermal injection with adipose-derived regenerative cells. CASE: A 44-year-old primiparous patient experienced severe dyspareunia for 10 years as a result of a recurrent posterior fourchette fissure that began after a vaginal delivery with episiotomy. She was treated unsuccessfully with topical antibiotics, estrogen, and steroids and ultimately with a perineoplasty at the age of 42 years. Adipose-derived regenerative cells were extracted enzymatically from her adipose tissue and injected subdermally and submucosally beneath the fissure and surrounding area. The fissure completely resolved within 3 months after treatment and has not recurred after more than 1 year of follow-up. CONCLUSION: Subdermal injection of autologous adipose-derived regenerative cells may be a treatment option for treatment of recurrent fourchette fissures that do not respond to standard medical and surgical therapies.

Risk of malignancy index validity assessment in premenopausal and postmenopausal women with adnexal tumors.

OBJECTIVE: The aim of this study was to investigate the validity of the risk of malignancy index (RMI) in premenopausal and postmenopausal patients with adnexal masses. MATERIALS AND METHODS: The study involved all women treated for adnexal tumors throughout an 18-month period in the Clinic for Gynecology and Obstetrics, Clinical Center of Serbia (Belgrade, Serbia). On admission, detailed anamnestic and laboratory data were obtained and an expert ultrasound scan was performed. The RMI was calculated for all patients and the obtained data were related to histopathological findings of the tumors. For statistical analysis, we used descriptive and analytical statistics methods and an SPSS computer program. RESULTS: From a total number of 540 women, 85 women had malignant tumors; 20 women, borderline tumors; and 435 women, benign adnexal tumors. The RMI was reliable in 84.6% of all patients; in 77% of premenopausal patients, and in 81.1% of postmenopausal patients. The sensitivity of the RMI in the overall population was 83.81%; the specificity was 77.24%; the positive predictive value (PPV) was 47.06%, and the negative predictive value (NPV) was 95.18%. In premenopausal women, the RMI sensitivity was 83.87%; specificity, 80.31%; PPV, 28.89%; and NPV, 98.12%. In postmenopausal women the RMI sensitivity was 83.78%; specificity, 68.18%; PPV, 63.92%; and NPV, 74.71%. CONCLUSION: The RMI was a reliable factor for differentiating benign from malignant adnexal masses in premenopausal and postmenopausal patients.

A rare case of benign omentum teratoma.

INTRODUCTION: Mature teratomas (benign cystic teratomas or dermoid cysts) are among the most common ovarian tumours; however, teratomas of the omentum and mesentery are extremely rare. Teratoma in the intraperitoneal cavity is uncommon and atypical, and it is even more uncommon in adulthood. CASE OUTLINE: An 82-year-old female was admitted to our department with clinical signs of abdominal tumour. The ultrasound scan and preoperative laboratory tests were done. Explorative laparotomy revealed tumour with torsion on its pedicle at the greater omentum. After removal of the mass and the incision a tooth and hair were found, characteristics of teratoma. CONCLUSION: The excision was very effective and also definitive treatment for this case. The patient recovered well and was discharged 3 days later. The patient probably carried the tumour all her life asymptomatically until admission.