ABSTRACT
Mature cystic teratoma is the most common type of ovarian germ cell tumor. Malignant transformation is a rare complication in 1-3% of cases, especially in post-menopausal women. The most common type of malignant transformation by histology is squamous cell carcinoma, followed by adenocarcinoma, carcinoid tumor, melanoma, and sarcoma. Diagnostic difficulties exist due to non-specific findings. No clinical, radiological, or biological signs are specific to malignant transformation. Most patients are diagnosed in advanced stages and have poorer outcomes. Staging of the disease is an important prognostic factor, with early diagnosis and treatment being critical for improved survival. Here, we report a rare case of mature cystic teratoma presented as torsion, postoperatively diagnosed as mature cystic teratoma with borderline mucinous cystadenoma and focal intra-epithelial malignant transformation.
ABSTRACT
Patients with muscular dystrophies, especially those pauci-symptomatic presenting for surgery pose a complex problem for the anesthesiologist in preparing, optimizing and performing anesthesia. A myriad of complications including cardiac, respiratory, rhabdomyolysis, hyperkalemia, increased sensitivity to muscle relaxants etc., influence the anesthetic technique and recovery. Preoperative identification and appropriate choice of anesthesia technique can prevent most of the adverse events during anesthesia. We present a case of facioscapulohumeral dystrophy (FSHD) presenting for emergency appendectomy. Preoperative investigations and lung function were adequate. The patient underwent general anesthesia with propofol, cisatarcurium, and remifentanil and was maintained on total IV anesthesia for the duration of surgery. Continuous neuromuscular monitoring was carried out at two sites and the patient responded normally to intubating dose of cisatracurium and subsequent top-up doses, showing no increased sensitivity or need for dose reduction. The patient was hemodynamically stable with propofol and remifentanil infusions, with inhalational agents purposefully avoided. The patient was reversed with anticholinesterase and good train-of-four (TOF) ratio (>90%) was ensured before being shifted to recovery. The patient had a further uneventful course in the hospital.
