Treatment of pregnant patient with disseminated intravascular coagulation (DIC) due to placental abruption--a case report.

A primigravid woman at 29th gestational week with placental abruption causing fetal death, that underwent instant cesarean section, developed a disseminated intravascular coagulation (DIC), revealed by hemoperitoneum and hematoma of the abdominal wall. After re-laparotomy and transfusion of blood, fresh plasma, and platelets, the patient was discharged from hospital on the 14th postoperative day completely recovered. To conclude, conservative surgical approach for DIC treatment is possible and safe. Novel antifibrinolitic drugs are recommended for obstetrical patients with DIC to enable a healthy subsequent pregnancy.

Pregnancy associated with melanoma and fetal anomalies: a case report and review of literature.

The estimated incidence of melanoma complicating pregnancy has ranged from 0.1 to 2.8 per 1,000 pregnancies. Here the Authors present a case of a 40-year-old pregnant woman, who was admitted to the Clinic of Obstetrics and Gynaecology in 26 weeks of gestation, with diagnosis of melanoma and suspected with fetal anomaly, as possible bowel obstruction, and polyhydraminos. The melanoma was asported with a wide local excision under local anesthesia. Histological evaluation revealed melanoma Stage Ib (Clark IV, Breslow thickness 1.2 mm, pT2a). Lymph node sonography of neck, axilla, inguinum, abdomen, and pelvis as well as chest radiography did not demonstrate any evidence of metastatic disease. After vaginal delivery at 37 weeks of gestation, the female preterm hypotrophic newborn was transferred to the Institute for Neonatology and underwent resection of duodenojejunal atresia with tapering duodenoplasty and duodenojejunal termino-terminal anastomoses due to intestinal obstruction. No evidence of the melanoma was found in the placenta. Two years later the child was healthy and the mother was disease-free.

Spindle-cell epithelioma of the vagina diagnosed during pregnancy--a case report.

Spindle-cell epithelioma or "mixed tumor" of the vagina is an unusual and intriguing vaginal tumor consisting of both epithelial and mesenchymal components. A case of spindle-cell epithelioma of the vagina diagnosed at delivery of a 31-year-old primiparous woman is described. The excision of the mass was performed immediately after the delivery, which was uneventful. The patient was regularly followed up and no evidence of local recurrence or dissemination was found 40 months after surgery. The presentation and the diagnosis of this kind of tumor in pregnancy, and its effect on the pregnancy and delivery are still largely unknown. Since it is unlikely that any institution will have a large number of patients with this rare disease, case reports add further information to this entity. As the number of cases studied is small, close follow-up is recommended although there has been no report in the literature of metastasis so far.

Primary melanoma of the vagina: a case report and review of literature.

Summary Primary melanoma of the vagina is a rare and very aggressive tumor with an incidence of only 0.46 per one million women per year and less than 250 cases reported in the literature. Here the authors present a case of a 60-year-old woman, gravida 5, para 5, post-menopausal by 28 years, admitted to the Clinic for Obstetrics and Gynecology, with recurrent vaginal bleeding for the last year and with the complaint of a palpable tumor near the vaginal introitus. The preoperative biopsy revealed melanoma. CT scan did not prove she had distant metastasis. The patient was treated surgically, with wide local excision of four x five cm measured lesion and safety margins of two cm. Bilateral inguinal lymphadenectomy was performed. Follow-up five months after initial diagnosis, revealed no evidence of local recurrency or distant metastasis.

Multiorgan thrombotic disorder in a young patient with primary antiphospholipid syndrome (APS) and ovarian tumor.

Catastrophic antiphospholipid syndrome (CAPS) is a life-threatening condition with high mortality rate besides aggressive multimodal treatment. Underlying triggers of "thrombotic and cytokine storm" include pregnancy, inflammation, trauma, surgery, and infection. The authors present a case of a young female patient with primary antiphospholipid syndrome (APS) who was admitted to the hospital due to abdominal pain caused by ovarian tumor with elevated tumor markers. After the prophylactic anticoagulants and antibiotic treatment, surgery was performed. Suddenly after treatment, her clinical status deteriorated and she died regardless of intensive immunosupresive and anticoagulant therapy attempts. This condition requires all clinical awareness, timely diagnosis, and therapeutical approach, including a better understanding of the pathophysiology that leads to CAPS.

Perinatal outcome of singleton pregnancies following in vitro fertilization.

PURPOSE OF INVESTIGATION: To determine whether in vitro fertilization/intracytoplasmatic sperm injection (IVF/ICSI) singleton pregnancies are at increased risk for maternal and fetal complications than spontaneous singleton conceptions. MATERIALS AND METHODS: The pregnancy outcome of 634 singleton pregnancies after IVF/ICSI delivered at the Clinic for Gynecology and Obstetrics during the period January 2006 to January 2010 were compared to 634 matched singleton controls, matched one by one by age, parity, education, and body mass index (BMI). Differences in pregnancy outcomes between the groups were assessed using Student's t-test with Yates correction for continuous variables and Chi-squared test for categorical variables. RESULTS: The mean gestational age at delivery of the IVF group was 38.13 +/- 1.72 weeks, slightly shorter than spontaneously conceived singletons at 38.65 +/- 1.79 weeks. The diagnosis of gestational diabetes mellitus (GDM) was frequently made in the IVF group (11.82% vs 8.35%, t = 2.052, p < 0.05). Total preterm delivery rate of IVF pregnancies was 9.30%, significantly higher than the controls 5.85% (t = 2.33, p < 0.05), especially at the 30-32 weeks gestation period. The predominant mode of delivery after IVF pregnancy was cesarean section (80.75% vs 31.38% at spontaneously conceived, t = 17.71, p < 0.001), while vaginal route was the choice for naturally originated pregnancies 68.6% vs 19.24% (p < 0.01). No differences were found in the average birth weights, LBW, VLBW, SGA, and LGA regarding the pregnancy origin. Perinatal mortality rates were comparable among singletons with different pregnancy origin. CONCLUSIONS: Singletons from IVF/ICSI pregnancies have poorer perinatal outcome associated with higher rates of cesarean sections, preterm birth and prematurity, fetal malpresentation (breech presentation), and the occurrence of maternal GDM in pregnancy.

Malignant fibrous histiocytoma of the ovary: a case report.

Malignant fibrous histiocytoma (MFH) is the most common soft-tissue sarcoma of late adult life occurring predominantly in the extremities and the retroperitoneum. MFH of the ovary is very rare, with only six cases previously reported. A 67-year-old woman with a right pelvic tumor highly suspicious of ovarian carcinoma was submitted to exploratory laparotomy. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, total omentectomy, pelvic and paraaortic lymphadenectomy with right hemicolectomy along with permanent cutaneous ileostomy were performed. Since a storiform-pleomorphic type of MHF was diagnosed from histopathological and immunohistochemical findings, chemotherapy was proposed as the postoperative treatment. Despite extensive surgery with negative surgical margins, the patient had recurrence of the tumor within four months, and was submitted to secondary surgery. A combination of chemo- and radiotherapy was performed postoperatively, but the patient developed respiratory problems and died one year later from the primary diagnosis.

Krukenberg tumor of gastric origin in pregnancy with dismal outcome.

Krukenberg tumors are mostly found as metastatic signet-ring cell adenomucinous carcinomas in young, premenopausal women. They are bilateral in 80% of the cases, and thus can be expected in pregnancy. A 31-year-old female was diagnosed by explorative laparotomy at 27 weeks of gestation with a Krukenberg tumor due to bilateral adnexal masses and a large amount of ascites. At surgery cesarean section with total abdominal hysterectomy, bilateral salpingo-oophorectomy, total omentectomy and pelvic lymphadenectomy was performed. The neonate died 24 hours later due to prematurity and respiratory distress syndrome. The primary site of the cancer was detected metachronously two months after surgery and postoperative chemotherapy, as stomach adenomucinous carcinoma. In spite of surgery and postoperative multiagent chemotherapy, the patient died six months from the diagnosis of Krukenberg.

Radical abdominal trachelectomy in managing early cervical invasion.

The purpose of the study was to determine if radical abdominal trachelectomy with pelvic lymphadenectomy could be a method for treatment of early cervical cancer to preserve fertility. We examined 12 patients who were surgically treated from 2002 to 2006. The diagnostic method to determine cervical cancer was histologic examination by cone or biopsy. The histologic condition was well differented planocellular carcinoma. Two of the patients had Stage Ia1, seven had Ia2, and three had Ib1. We performed radical abdominal trachelectomy with pelvic lymphadenectomy. Resection edges were pathohistologically analyzed extemporaneously, as well as selective lymph nodes. According to the extempore analysis we determined if radical trachelectomy should be done. In one patient resection edges were positive, so she underwent radical hysterectomy. Postoperatively we found a positive lymph node in one patient, so radiation therapy was continued. In the two-year follow-up period we did not find any signs of residual cancer. We concluded that radical trachelectomy with pelvic lymphadenectomy could be an appropriate method for treatment of early-stage cervical cancer.

Renal cell carcinoma in pregnancy: a case report.

Renal cell carcinoma is seen most frequently after childbearing years, but occasionally is diagnosed in pregnancy. The pregnancy demands special considerations in terms of the diagnostic evaluation and management. A case of a patient with renal cell carcinoma diagnosed in the first trimester of pregnancy, which suddenly enlarged at the end of the second trimester, is presented. She underwent radical nephrectomy after delivery. Since the mother's welfare is the primary concern, surgical management should not be delayed.

[Radical treachelectomy in treatment of early stages of cervical cancer].

The aim of the study was to determine if radical trachelectomy with pelvic lymphonodectomy could be a method for treatment of early cervical cancer to preserve fertility. We examined 12 patients who were operatively treated from 1996. to 2006. year. Diagnostic method for cervical cancer was histologic examination, cone or biopsy. Histologic condition was planocelular carcinoma well differented. Two of the patients had Ia1 stage, seven had Ia2, and three of them had Ib1. We performed abdominal radical trachelectomy with pelvic lymphonodectomy. Resectional edges were patohistologically analyzed ex tempore, as well as lymphonodi, selectively. According to ex tempore analysis we determined if the radical trachelectomy should be done. In one patient resectional edges were positive, so she underwent radical hysterectomy. Postoperatively we found a positive lymphonodus in one patient, so we continued radiation therapy. In two-year follow-up period we did not find any sign of residual cancer. We concluded that radical trachelectomy with pelvic lymphonodectomy could be appropriate method for treatment of early stage cervical cancer.

Treatment for infertility and risk of invasive epithelial ovarian cancer--a case report.

A 30-year-old women was admitted to the Institute of Gynecology and Obstetrics, Clinical Center of Serbia in April 2004 with the following diagnosis: adnexal mass soon after in vitro fertilization. Her history revealed salpingo-oophorectomy for mucinous cystadenofibroma of the left ovary eight years before and cystectomy of the right ovary three years before. At admission, the most remarkable findings were high temperature and elevated white blood cells with erythrocyte sedimentation rate. After the antibiotic treatment, laparatomy was performed and a multilocular right adnexal tumor was found. The right salpingo-oophorectomy was performed and pathological diagnosis was mucinous ovarian adenocarcinoma. Two weeks later, radical surgery was carried out and chemotherapy was applied. There is an urgent need for clear interpretation of the link between ovarian stimulation and ovarian cancer. An association between ovarian stimulation treatment and ovarian cancer has still not been completely proven.