ABSTRACT
BACKGROUND: Uterine arteriovenous malformation(AVM) refers to the abnormal direct traffic between uterine arteries and veins, which can be characterized by the imaging examination, showing increased uterine vascularity and arteriovenous shunting. However, similar imaging manifestations can also be seen in a variety of conditions including retained production of conception, gestational trophoblastic disease, placental polyp, and vascular neoplasm. CASE PRESENTATION: Here we present a case of a 42-year-old woman who was suspected of suffering uterine AVM indicated by Doppler sonography and magnetic resonance imaging but was finally diagnosed with a persistent ectopic pregnancy located on the right uterine corner by pathology after laparoscopy. She recovered well after surgery. CONCLUSION: Uterine AVM is a rare and serious condition. In general, it presents special radiological manifestations. However, when complicated with other diseases it can also be distorting. Standardized diagnosis and management are important.
Subject(s)
Arteriovenous Malformations , Pregnancy, Cornual , Uterine Artery , Uterus , Adult , Female , Humans , Pregnancy , Arteriovenous Malformations/diagnostic imaging , Arteriovenous Malformations/surgery , Placenta/pathology , Pregnancy, Cornual/pathology , Uterine Artery/diagnostic imaging , Uterine Artery/pathology , Uterus/diagnostic imaging , Arteriovenous Shunt, SurgicalABSTRACT
OBJECTIVE: To concisely review what is known about cornual ectopic pregnancies and to provide a step-by-step demonstration of the resection of a large cornual ectopic pregnancy, highlighting various laparoscopic techniques. DESIGN: A video review of cornual ectopic pregnancy and a laparoscopic approach for treatment featuring a patient case at 9 weeks gestation. SETTING: Tertiary care facility. PATIENTS: A 31-year-old G2P1001 at 9 weeks 0 days by transvaginal ultrasound and with a beta human chorionic gonadotropin of 13,099 presented to the emergency department for vaginal bleeding and cramping left lower quadrant pain. She was hemodynamically stable. Her ultrasound was suspicious for a cornual ectopic pregnancy, which was confirmed by magnetic resonance imaging. INTERVENTIONS: The patient was taken to the operating room for resection, given the size of the pregnancy, concern for intraoperative blood loss, concern for persistent pregnancy, and concern that patient would not be able to reliably follow up for multiple appointments. Patient underwent laparoscopic resection of a large cornual ectopic pregnancy. Included is a short review of laparoscopic suturing techniques. MAIN OUTCOME MEASURES: Pathology, decline in beta hCG, and post-operative course. RESULTS: The patient's pathology was confirmatory for cornual ectopic pregnancy. Her beta human chorionic gonadotropin decreased as expected, and she had a normal post-operative course. CONCLUSIONS: Laparoscopic cornual resection is a safe and effective method for management of large cornual ectopic pregnancy, and fertility outcomes are similar to patients after salpingectomy for non-interstitial ectopic pregnancy.
Subject(s)
Laparoscopy/methods , Pregnancy, Cornual/surgery , Pregnancy, Ectopic/surgery , Adult , Blood Loss, Surgical , Female , Humans , Pregnancy , Pregnancy Trimester, First , Pregnancy, Cornual/pathology , Pregnancy, Ectopic/pathology , Salpingectomy/methods , Treatment OutcomeABSTRACT
OBJECTIVES: To evaluate the presentation, assessment, treatment, and pregnancy outcomes of 22 women with a rudimentary uterine horn. METHODS: We reviewed the data regarding the outcomes of patients with a rudimentary horn pregnancy (RHP) who were managed at Peking Union Medical College Hospital over the last 30 years. Twenty-two pregnant patients with a rudimentary horn have been treated at our institute over the last 30 years. All patients with RHP were divided into two groups: Type A (n = 4), a rudimentary horn with a cavity that communicated with the uterus; and Type B (n = 7), a rudimentary horn with a cavity that did not communicate with the uterus. We classified all 22 patients into communicating group or noncommunicating group according to the anatomical connection of the rudimentary horn to the contralateral hemiuterus. RESULTS: The mean gestational age of Type A patients (23.5 weeks) was significantly higher (P = 0.046) than that of Type B patients (10 weeks). The rudimentary uterine horn carried 4 of 5 (80%) pregnancies in the communicating group. Three case of rudimentary horn pregnancies ruptured before a gestational age of 12 weeks, and one abortion occurred after a gestational age of 12 weeks. In the noncommunicating group, 7 of 17 (41.2%) cases were RHPs, and 3 ruptured after a gestational age of 12 weeks. CONCLUSIONS: The diagnosis and management of the rudimentary uterine horn continues to be challenging. Medical and radiological personnel must maintain a high degree of alertness to prevent the morbidity associated with this condition. In particular, patients with RHP (Type A), who have a higher chance being misdiagnosed before 12 gestational weeks, have a higher risk of potential complications. If pregnancy in the rudimentary horn is diagnosed, excision of the pregnant horn is recommended, regardless of the type of unicornuate uterus.
Subject(s)
Pregnancy, Cornual/therapy , Urogenital Abnormalities/complications , Uterus/abnormalities , Abortion, Spontaneous/etiology , Adult , China , Female , Gestational Age , Humans , Infant, Newborn , Pregnancy , Pregnancy Outcome , Pregnancy, Cornual/classification , Pregnancy, Cornual/pathology , Prenatal Diagnosis/methods , Retrospective Studies , Urogenital Abnormalities/pathology , Urogenital Abnormalities/therapy , Uterine Rupture/etiology , Uterus/pathology , Young AdultSubject(s)
Laparoscopy , Ovarian Cysts/diagnosis , Pregnancy, Cornual/diagnosis , Urogenital Abnormalities/diagnosis , Uterus/abnormalities , Adult , Dyspareunia/etiology , Female , Humans , Ovarian Cysts/complications , Pelvic Pain/etiology , Pregnancy , Pregnancy, Cornual/pathology , Urogenital Abnormalities/complications , Urogenital Abnormalities/pathology , Uterus/pathologyABSTRACT
BACKGROUND: Choriocarcinoma associated with cornual pregnancy is extremely rare. To our knowledge, only three other cases have been reported in the literature. CASE: A 38-year-old woman was found to have a left cornual ectopic pregnancy on ultrasound after presenting with abdominal pain, irregular vaginal bleeding, and a positive pregnancy test. Laparoscopy confirmed the diagnosis and she underwent total abdominal hysterectomy. Three weeks later, she presented with vaginal bleeding. A solid ulcerating lesion was found arising from the vaginal wall and biopsy revealed metastatic gestational choriocarcinoma. CONCLUSION: Careful histopathological examination of the surgical specimen and diligent monitoring of ß-human chorionic gonadotropin to zero is crucial to prevent potentially missing this very malignant, but highly curable disease. Early systemic metastases are common and presentation can include bleeding from vaginal metastases.
Subject(s)
Choriocarcinoma/secondary , Pregnancy, Cornual/pathology , Uterine Neoplasms/etiology , Uterus/pathology , Vaginal Neoplasms/secondary , Adult , Female , Humans , Pregnancy , Uterine Neoplasms/pathologyABSTRACT
El embarazo cornual es una patología poco frecuente pero con una elevada mortalidad si no se diagnostica precozmente. La ecografía vaginal permite un diagnóstico precoz y la realización de un tratamiento conservador con metotrexato, reduciendo la morbimortalidad materna. Presentamos un caso de una gestante diagnosticada de embarazo cornual derecho no accidentado que fue tratada con metotrexato multidosis con éxito
Cornual pregnancy is a rare condition but has high mortality unless diagnosed early. Early diagnosis with transvaginal ultrasound allows conservative treatment with methotrexate, thus reducing maternal morbidity and mortality. We report a case of an unruptured right cornual pregnancy successfully treated with multidose systemic methotrexate
