ABSTRACT
Introduction: Struma ovarii is a rare ovarian teratoma characterised by the unusual presence of thyroid tissue. Even though usually benign, malignant transformation is sometimes detected. We report such a case of malignant struma ovarii in a 29-year-old nulliparous woman who was managed systematically with fertility preservation and followed up to have a successful delivery. Patient Intervention: The patient was diagnosed to have bilateral complex ovarian cyst when evaluated for pain abdomen. She underwent bilateral ovarian cystectomy with frozen section biopsy as initial management. On diagnosing as malignant epithelial ovarian tumour in frozen, definitive treatment was planned after final histopathology report and fertility preservation. Her histopathology showed stage 3 malignant struma ovarii. Multidisciplinary team was convened. After further detailed evaluation, she had embryo freezing by controlled ovarian stimulation with antagonist protocol. Two good quality embryos were vitrified on day 2 post-intra-cytoplasmic sperm insemination (ICSI). She underwent staging laparotomy that included uterus conserving surgery with bilateral oophorectomy, omentectomy, peritonectomy, appendicectomy with total thyroidectomy and iodine ablation. After 1 year of follow-up, embryo transfer was done which resulted in a successful delivery. This is, to our knowledge, the first case of fertility preservation after stimulation with gonadotropins in a case of malignant struma ovarii. Conclusion: Poor ovarian reserve due to bilateral ovarian cystectomy, time constraint as she had to undergo a definitive surgery and residual complex ovarian cystic lesions made this a challenging case.
ABSTRACT
Krukenberg tumour is a rare ovarian metastatic carcinoma arising from a primary malignancy elsewhere, classically the gastrointestinal tract and breast. They are bilateral solid ovarian tumour which most commonly occurs between 40-60 years, and its occurrence in the second decade of life is extremely rare. In this short commentary, we present an unusual case of Krukenberg tumour in a 16-year old in which diagnosis was made intraoperatively and managed systematically, thus emphasising the need to suspect Krukenberg in all age groups.
ABSTRACT
Genital tuberculosis is usually diagnosed in young women being assessed for infertility. After menopause it usually presents with symptoms resembling endometrial malignancy, such as postmenopausal bleeding, persistent vaginal discharge and pyometra. The diagnosis is made by detection of acid-fast bacilli on microscopy or bacteriological culture and/or presence of epithelioid granuloma on biopsy. Anti-tubercular therapy involves the use of rifampicin, isoniazid, pyrazinamide and ethambutol. Surgery is indicated if a pelvic mass and recurrence of pain or bleeding persist after 9 months of treatment. Three cases of genital tuberculosis in postmenopausal women with different clinical presentations are reported. The first woman presented with ascites and weight loss. The second had postmenopausal bleeding with a pipelle biopsy suggestive of endometrial intraepithelial neoplasia. The third presented with weight loss and a palpable abdominal mass. Pelvic malignancy was initially suspected but a diagnosis of tuberculosis was made following pre-operative endometrial biopsy, bacteriological culture and intra-operative frozen section. All three women responded to anti-tubercular therapy.
