Management of congenital cervical atresia with vaginal aplasia: A case report and review of the literature.

INTRODUCTION: Vaginal agenesis is a rare congenital condition, with an incidence of 1 in 4500 female births. CASE REPORT: We present a clinical case of vaginal aplasia with cervical atresia in a 31-year-old woman with primary amenorrhea. We aim to report the diagnostic process and provide a comprehensive outline of different possible treatments. DISCUSSION: The most common etiology of these agenesis cases is Mayer-Rokitansky-Küster-Hauser syndrome associated with uterine aplasia. However, vaginal aplasia can occur in 9 % of cases where the uterus is present. During embryogenesis, the Müllerian ducts give rise to the fallopian tubes, uterus, and upper two-thirds of the vagina, while the lower portion of the vagina develops from the urogenital sinus. Vaginal aplasia arises from a failure in the development of the terminal portion of the paramesonephric ducts. Abdominal pain, especially periodic pain, is the most common symptom, followed by primary amenorrhea. MRI is considered the gold standard for the diagnosis and precise description of female genital tract anomalies. CONCLUSION: Total hysterectomy remains a preferred option for cases of complete vaginal atresia to mitigate the risk of cervical or vaginal stenosis, adhesions, and pelvic inflammation resulting from poor menstrual blood drainage.

Mesenteric cystic lymphangioma misdiagnosed as ovarian cyst in a 63-year-old female: A case report and review of literature.

INTRODUCTION: Cystic lymphangioma is rare benign tumor that results from a lymphatic system malformation. The mesenteric location is even more uncommon. CASE REPORT: We report the case of a menopausal 63-year-old woman who presented with a persistent painful well-defined mass of the pelvis. On ultrasound and computed tomography, the mass appeared as thick-walled unilocular homogenous cyst in favor of an ovarian cystadenoma. During laparotomy, the misdiagnosis was confirmed as the tumor was found to be embedded in the mesentery of the ileum. Subsequent histopathological examination confirmed the benign cystic lymphangioma diagnosis. DISCUSSION: Mesenteric cystic lymphangioma is rare peritoneal tumor of the adult. Clinically, it often masquerades as other abdominopelvic masses like ovarian cysts. Differential diagnosis is often challenging because of the overlapping clinical abdominal presentation and radiological features. Histopathological is the gold standard in diagnosing mesenteric cystic lymphangioma. Surgery is the mainstay treatment, and the recurrence rate is low if negative surgical margins are achieved. CONCLUSION: Mesenteric cystic lymphangioma often mimics more frequent and potentially malignant lesions. It is essential for surgeons to remain vigilant for the possibility of this diagnosis when evaluating abdominopelvic cystic masses.

A Sertoli-Leydig ovarian tumor presenting as ovarian torsion: A case report.

Torsion occurs as a complication in 10% of cases of ovarian tumors. It predominantly occurs in benign ones, while malignant tumors are less prone to torsion. Sertoli-Leydig cell tumors are highly unusual sex cord-stromal tumors of the ovary, accounting for less than 0.2% of all ovarian cancers. A 39-year-old patient presented to the emergency department with a Sertoli-Leydig cell tumor diagnosed due to ovarian torsion. The clinical presentation was characterized by abdominal pain. Ultrasound indicated signs of torsion, and torsion of the right ovary was subsequently confirmed during laparotomy. A salpingo-oophorectomy was performed, and histological examination revealed a moderately differentiated Sertoli-Leydig cell tumor. Sertoli-Leydig cell tumors often present with hormone-related or non-hormonal symptoms. Surgery plays a crucial role in both diagnosis and treatment. Postoperative treatment is not necessary for well-differentiated Sertoli-Leydig cell tumors in stage IA-IB. However, patients with grade 2-3 disease, advanced stage, or heterologous elements may consider adjuvant treatment. As these tumors are rare, this case contributes to the documentation of Sertoli-Leydig cell tumors, with a case diagnosed due to ovarian torsion. The case highlights the importance of establishing international registries of Sertoli-Leydig cell tumor cases for standardized management.

Uterine smooth muscle tumors of uncertain malignant potential (STUMP): A case report.

INTRODUCTION: Uterine smooth muscle tumors of uncertain malignant potential (STUMP) are extremely rare, defined as a uterine smooth muscle tumors that cannot be diagnosed as benign or malignant and does not satisfy all the criteria for leiomyosarcoma or leiomyoma. CASE REPRESENTATION: A 48-year-old woman who presented with a history of heavy menstrual bleeding and pelvic pain. Physical examination revealed an enlarged uterus. Ultrasonography showed lobular and enlarged uterus containing multiples leiomyomas. A subtotal hysterectomy was performed. A Pathological analysis revealed a uterine mass diagnosed as a smooth muscle tumor of uncertain malignant. DISCUSSION: Uterine STUMPs are rare and are commonly diagnosed by histopathological evaluation following myomectomy or hysterectomy. The most common clinical manifestations of uterine STUMP are the same as leiomyomas. Prognosis for the patient is unclear and there is a risk of recurrence with the tumors. However, considering their potential risk of recurrence and metastasis, it is advisable to maintain six-monthly controls for 5 years and then annual controls for 5 years more. CONCLUSION: Due to the rarity of uterine STUMP, there are no specific guidelines for their treatment and control. The scientific literature needs to be constantly updated in order to identify masses suspected of malignancy before surgery and improve patient management and follow-up.

Parietal endometriosis: An uncommon cause of c-section scar pain - A case report.

INTRODUCTION: Parietal endometriosis is the most common form of extra-pelvic endometriosis. It develops on the surgical scar of c-section or hysterectomy. It is one of the causes of scar pain. CASE PRESENTATION: A 26 years old patient presents with recurring pain and swelling of a Pfannenstiel scar 6 years after a caesarean section. Physical examination revealed a firm tender subcutaneous nodule that appeared at MRI as a heterogenous parietal mass infiltrating the rectus abdominis muscles. The patient underwent a wide excision of the nodule. DISCUSSION: Parietal endometriosis can be the cause of debilitating scar pain even in patients with no history of deep endometriosis. It presents as firm parietal nodule that can become large and infiltrative if left untreated. Diagnosis is purely histological. Surgery remains the treatment of choice and requires a wide excision. CONCLUSION: Parietal endometriosis, potentially more common due to rising number of caesarean sections, should be considered with persistent scar pain. Surgery is the preferred treatment, offering a conclusive diagnosis.