Granulosa cell tumor presenting with ovarian torsion and de novo borderline mucinous ovarian tumor in the contralateral ovary.

The authors report a case of 25-year-old women with a rare acute presentation of granulosa cell tumor (GCT) as an ovarian torsion. Right salpingoo-ooferectomy was performed. The pathological diagnosis was GCT One month after the surgery there was a three-cm ovarian cyst in the contralateral ovary and the tumor size increased to six cm in diameter in the following month. Serum inhibin-B levels progressively increased. Cystectomy was performed to contralateral ovary as frozen-section examination indicated mucinous tumor. Final histopathological examination revealed borderline mucinous tumor. Regarding her request, the patient was reoperated again and unilateral oophorectomy and hysterectomy were performed. Clinicians must be aware of the possibility of an underlying malignancy associated with adnexal torsion even in young patients. Frozen section will be helpful in order to avoid incomplete surgeries. Cyst rapidly growing in the ovary in young women should raise the suspicion of a de novo malignancy.

The value of transvaginal sonography in detecting endometrial pathologies in postmenopausal women with or without bleeding.

AIM: The aim of this study was to estimate the incidence of endometrial pathologies and compare the findings in postmenopausal women with or without bleeding who had endometrial thickness ≥5 mm. METHODS: Between January 2010 and December 2012 medical records of postmenopausal patients who underwent endometrial biopsy were reviewed retrospectively. 91 patients who presented with postmenopausal bleeding (Group A) with an endometrial thickness equal to or greater than 5 mm and 44 patients with an incidental finding of increased endometrial thickness (≥5 mm) on ultrasound without bleeding (Group B) were included in the study. RESULTS: The mean endometrial thickness of patients in group A (9.3±4.6) was significantly lower than women in group B (11±4.6). Seven (7.7%) cases of endometrial hyperplasia and 6 (6.6%) cases of endometrial carcinoma were detected in women with bleeding, 2 (4.5%) cases of endometrial hyperplasia and no cases of endometrial carcinoma were diagnosed in group B women. The prevalence of endometrial carcinoma associated with endometrial thickness in group A women whereas we cannot see this relation in group B women. The mean endometrial thickness was highest in women with the histopathologic diagnosis of polyps in this group. CONCLUSION: In postmenopausal women with bleeding, the risk of endometrial carcinoma increases with increasing endometrial thickness; however, the use of endometrial thickness as a screening test for endometrial carcinoma may not be effective in women without bleeding. 6.5 mm cut-off seems to be acceptable thickness for polyp detection in postmenopausal women with bleeding.

Iatrogenic bladder injuries during caesarean delivery: a case control study.

This study determined the rate, risk factors, management and outcome of bladder injury during caesarean section and suggests ways to improve the quality of care and reduce maternal morbidity and mortality. During the study period, there were 76 bladder injuries in 56,799 caesarean deliveries for an overall incidence of 0.13%. Women with a bladder injury were more likely to have had a prior caesarean delivery, as compared with the control group (72.4% vs 34.2%; p < 0.001). Cases were also more likely than controls to have had prior pelvic surgery. The presence of adhesions during the procedure was greater in the bladder injury group than the controls. In conclusion, our study suggests that a previous caesarean delivery is the most common risk factor for bladder injury during caesarean delivery. Moreover, the presence of labour, station of the presenting fetal part deeper than or equal to +1, and a large baby were independent risks for a bladder injury during caesarean delivery. Women requesting primary caesarean deliveries should be counselled about the potential for significant surgical complications in repeat caesarean deliveries when discussing the indications for a primary elective caesarean delivery.

Peripartum hysterectomy in Turkey: a case-control study.

This was a retrospective review of all cases of peripartum obstetric hysterectomy performed at the Istanbul Bakirkoy Women and Children's Teaching Hospital in the period between January 2001 and September 2008. We included any women who required emergency hysterectomy to control major postpartum haemorrhage after delivery. During the study period, there were 91 cases of peripartum hysterectomy. Two controls per case were randomly selected from the remaining births by using the random table. The incidence of emergency peripartum hysterectomy was 0.67 in 1,000 deliveries. The main indication for emergency hysterectomy was uterine atony in 52 cases (57.1%). The most independent risk factors for emergency hysterectomy were multiparity (odds ratios (OR) 17.3, 95% confidence interval (95% CI) 8.7-34.6); caesarean delivery in index delivery (OR 6.7, 95% CI 3.8-11.9) and caesarean section for placental abruption (OR 3.8, 95% CI 0.4-33.4). Our study suggests that multiparity, primary or repeat caesarean deliveries for placental abruption are independently associated risks for peripartum hysterectomy and uterine atony is the still most common indication for peripartum hysterectomy in Turkey.