Anterior perineal hernia - A case report of a rare complication after pelvic exenteration.

INTRODUCTION AND IMPORTANCE: Perineal hernias are protrusions of intra-abdominal contents resulting from weakness of the pelvic floor muscles. They are an uncommon complication after ultraradical pelvic surgeries, with no established gold standard for surgical treatment. This case describes a rare anterior perineal hernia that developed after radical surgery for bladder carcinoma. CASE PRESENTATION: A 77-year-old Caucasian woman presented with a painful 10 cm bulge in the perineal region. The hernial sac involved the entire left labia majora and developed 4 years after radical surgery for bladder carcinoma. She had been misdiagnosed twice in the past with vaginal prolapse, leading to two unsuccessful vaginoplasty procedures due to recurrence. She underwent hernia repair with perineal approach and polypropylene mesh placement. The postoperative period was uncomplicated, and the patient was discharged after five days, with histology showing no malignancy. CLINICAL DISCUSSION: Perineal hernias are protrusions of intra- or extraperitoneal contents into the perineum due to a defect in the pelvic musculature. Various surgical modalities exist for perineal hernia repair, which adhere to the fundamental principles of hernia surgery: sac mobilization, precise incision, sac debridement and excision, and defect repair. Here, we successfully applied the perineal approach in a complicated case of a misdiagnosed perineal hernia after radical surgery. CONCLUSION: The perineal approach for hernia repair, involving an implantation of a polypropylene mesh and tissue flap was successfully applied, confirming its main place in the surgical treatment of perineal hernias. During the two-year follow-up no postoperative complications or recurrence hernia were registered.

Robot-Assisted Hysterectomy for Primary Choriocarcinoma of the Cervix - A Novel Approach.

The incidence of ectopic choriocarcinoma with primary localization in the uterine cervix is extremely low, with less than hundred cases reported in the English language literature to date. We present a case of primary cervical choriocarcinoma in a 41-year-old woman, originally suspected for cancer of the cervix. After histological investigation, the decision was made for primary surgical treatment due to extensive hemorrhage, finished family planning, and the localization of the tumor. Currently, after six months of follow-up, the patient is disease-free without evidence of recurrence or metastasis. Our case demonstrates an innovative use of the robot-assisted technique, the feasibility and the efficacy of this approach for primary treatment of ectopic choriocarcinoma.

Uterine tumor resembling ovarian sex-cord tumor - a rare gynecological neoplasm.

Uterine tumor resembling ovarian sex-cord tumor is a rare group of uterine neoplasms with unknown histogenesis and differentiation towards ovarian sex-cord elements. They are benign in nature with low malignancy potential. Diagnosis is based on immunohistochemistry and morphological features, and the distinction from other more malignant differentials is paramount to correctly individualizing treatment.