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Case Reports in Obstetrics and Gynecology

Ronja Fierz, Gian-Piero Ghisu, Daniel Fink
Squamous cell carcinoma (SCC) of the neovagina after genital reconstruction surgery is a rare occurrence with only very few cases published up to the present. We report a case of a 43-year-old transgender woman who developed neovaginal SCC 23 years after vaginoplasty. The patient tested positive for high-risk human papillomavirus (HPV). At the time of diagnosis, radiological investigations revealed already existing lymph node and osseous metastases. The treatment consisted of various cycles of chemotherapy and radiation therapy...
2019: Case Reports in Obstetrics and Gynecology
Osamah Hasan, Grant S Johnson, James J Siegert, Francisco Garcini, Thai T Nguyen
Ureteral injury is an uncommon but potentially morbid complication following any open or endoscopic pelvic procedure. Gynecologic surgeries alone make up 50 percent of nonurologic ureteral injuries leading to prolonged hospital stays, secondary interventions, and potential loss of renal function. The use of AmnioFix ® a processed dehydrated, immunologically privileged cellular amniotic membrane allograft has been well established in urologic and gynecologic procedures. These allografts contain human extracellular matrix components, growth factors, and cytokines that mediate inflammation and facilitate would healing...
2019: Case Reports in Obstetrics and Gynecology
Haruka Suzuki, Koji Yamanoi, Jumpei Ogura, Takahiro Hirayama, Koji Yasumoto, Shimpei Shitanaka, Yoshihide Inayama, Mie Sakai, Tsutomu Ohara, Koh Suginami
The simultaneous or sequential development of autoimmune hemolytic anemia (AIHA) and idiopathic thrombocytopenic purpura (ITP) is known as Evans syndrome. We experienced a case of Evans syndrome that developed AIHA during pregnancy and ITP long after delivery. The patient was a 35-year-old pregnant woman (gravida 2, para 1). A routine blood test at 28 weeks of gestation revealed moderate macrocytic anemia. Her haptoglobin level was markedly low, and a direct antiglobulin test (DAT) was positive. Based on these results, AIHA was considered...
2019: Case Reports in Obstetrics and Gynecology
Allison Eubanks, Katherine Dengler, Daniel Gruber
Overactive bladder (OAB) is urgency, with or without urgency incontinence. For OAB, an injection of onabotulinumtoxin A (BOTOX®) can be a low-risk outpatient procedure. We present a patient on a novel anticoagulant that experienced excessive bleeding after this procedure. This 80-year-old G2P2002 Caucasian female had a history of urge urinary incontinence. She presented for intravesicular onabotulinumtoxin A injection (150 units) after recent initiation of rivaroxaban (Xarelto®) for her atrial fibrillation...
2019: Case Reports in Obstetrics and Gynecology
Mie Sakai, Jumpei Ogura, Koji Yamanoi, Takahiro Hirayama, Tsutomu Ohara, Haruka Suzuki, Yoshihide Inayama, Koji Yasumoto, Koh Suginami
Congenital ATIII deficiency is one of the congenital thrombophilia diseases that can cause severe venous thromboembolism (VTE) in pregnant patients. A 30-year-old female, 4 gravida and 2 para, came to the emergency department with a complaint of oedema and pain in the left lower leg at 11 weeks of gestation. An inferior vena cava thrombus and pulmonary embolism were found. Because VTE was very severe, artificial abortion was performed, and VTE disappeared rapidly. She maintained oral administration of edoxaban (NOAC) and got pregnant naturally fifty-five weeks later after the abortion...
2019: Case Reports in Obstetrics and Gynecology
Lindsay Hasegawa, Patricia Nascu, John McNaught
Ovarian pregnancy is a rare subtype of ectopic pregnancy with an increased incidence after assisted conception. We present a 31-year-old gestational carrier who presented with suprapubic and pelvic pain at 6 weeks and 2 days' gestation. An ultrasound scan demonstrated an empty uterus and a complex mass in the left adnexa. Operative laparoscopy was performed and an ovarian pregnancy was found and treated. We believe this to be the first report of ovarian pregnancy after IVF in a gestational carrier. Appropriate counselling of surrogate mothers is of utmost importance as the risk of ectopic pregnancy is increased by using assisted reproduction technology...
2018: Case Reports in Obstetrics and Gynecology
Jade Edwards, Hamza Katali
Fibroids are a condition commonly seen as part of routine gynaecological practice and generally present with menorrhagia, infertility, or pressure symptoms depending on their exact location. We report the case of a postmenopausal 57-year-old lady presenting with left-sided pain and frequency with a complex 15 cm mass mid pelvis and an adjacent additional 7 cm cyst but a risk of malignancy index suggesting benign pathology. She underwent total abdominal hysterectomy (TAH) and right-sided salpingo-oophrectomy (RSO) on recommendation of the multidisciplinary team (MDT) and histology confirmed leiomyomatosis peritonealis disseminata...
2018: Case Reports in Obstetrics and Gynecology
Mon-Lai Cheung, Shadi Rezai, Janelle M Jackman, Neil D Patel, Basem Z Bernaba, Omid Hakimian, Dilfuza Nuritdinova, Catherine L Turley, Ray Mercado, Takeko Takeshige, Sudha M Reddy, Paul N Fuller, Cassandra E Henderson
Background: Throughout the world, intrauterine contraceptive devices (IUDs) are a frequently used, reversible, popular contraceptive method. They are usually placed without major complications. Uterine perforation is a rarely observed complication. Migration of the IUD to the pelvic/abdominal cavity or adjacent structures can occur after perforation. We present 3 cases of uterine perforation, possibly due to scarred myometrium associated with a cesarean delivery. We describe 3 perforations with IUDs lodged in the bladder serosa, the posterior cul-de-sac, and tissue adjacent to the cardinal ligament and external iliac artery...
2018: Case Reports in Obstetrics and Gynecology
Wondimagegnehu Sisay Woldeyes
Conjoined twin is a rare complication of monozygotic twins resulting from incomplete splitting of an embryo into two separate twins or early secondary fusion of two originally separated embryos. When diagnosed at early gestation, one can get adequate time to counsel the family on whether to continue with the pregnancy and proper intervention can be planned. On the other hand, undiagnosed cases may be first recognized in labor after they have caused labor-related complications. In the present case report, an undiagnosed case of a conjoined twin has presented in labor followed by delivery of one baby with the retention of the second baby...
2018: Case Reports in Obstetrics and Gynecology
Hiroto Hirashima, Masahiro Iwamoto, Tadashi Ozawa, Shigeyoshi Kijima, Shigeki Matsubara, Akihide Ohkuchi
Posterior reversible encephalopathy syndrome with stroke is very rare in puerperal women. A 36-year-old nulliparous woman with both rheumatoid arthritis and recurrent pregnancy loss, probably due to a high titer of anti-phospholipid IgM antibody, was referred at 10 weeks of gestation. Low-dose aspirin at 100 mg/day and heparin calcium subcutaneous injection at 10,000 units/day were started before pregnancy and stopped at 35+6 and 40+2 weeks, respectively. She transabdominally delivered a male infant weighing 3,344 g at 40+5 weeks...
2018: Case Reports in Obstetrics and Gynecology
Felicity Harl, Cassandra Niemi, Lori Mankowski Gettle, Paul Weisman, Stephen Rose
A 68-year-old woman presented with a three-week history of confusion and anomic aphasia. Imaging of her head demonstrated a single large left frontal mass. Pathology revealed metastatic adenocarcinoma of Müllerian origin. Subsequent surgery revealed a small primary site in a fallopian tube, high left para-aortic lymphadenopathy, and no disseminated intraperitoneal disease. This case was remarkable in that CNS metastasis was her presenting symptom and was restricted to a solitary brain lesion, and other disease sites were limited to retroperitoneal lymphadenopathy and a small fallopian tube primary...
2018: Case Reports in Obstetrics and Gynecology
Kaori Yamada, Yoshitsugu Chigusa, Motoo Nomura, Katsuyuki Sakanaka, Mitsuhiro Nakamura, Shinsuke Yano, Shigeru Tsunoda, Eiji Kondoh, Masaki Mandai
Esophageal cancer rarely coincides with pregnancy, and only five cases have been reported thus far. The management of esophageal cancer during pregnancy is extremely challenging due to its aggressive nature. We herein report a case of recurrent esophageal cancer in pregnancy. A 41-year-old multigravida with a history of esophageal squamous cell cancer treated with esophagectomy and perioperative chemotherapy was diagnosed with local recurrent carcinoma of the residual esophagus at 16 weeks of gestation. The patient strongly desired to continue the pregnancy, and concurrent chemoradiation therapy (CRT) consisting of 50...
2018: Case Reports in Obstetrics and Gynecology
Takako Sugiura, Yuka Sato, Naoyuki Nakanami, Kiyomi Tsukimori
Sirenomelia is a rare congenital malformation characterized by varying degrees of fusion of the lower extremities. It is commonly associated with severe urogenital and gastrointestinal malformations; however, the association of sirenomelia with anencephaly and rachischisis totalis is extremely rare. To our knowledge, the prenatal sonographic images of this association have not been previously published. Here, we present prenatal sonographic images of this association, detected during the 17th week of gestation through combined two-dimensional, four-dimensional, and color Doppler ultrasound...
2018: Case Reports in Obstetrics and Gynecology
Nuntasiri Eamudomkarn, Yuwadee Itarat, Pilaiwan Kleebkaow, Chumnan Kietpeerakool
High-grade endometrial stromal sarcoma (HG-ESS) is a rare clinical entity, particularly among young women, and only few cases have been reported in the literature. Herein, we describe the case of a 21-year-old woman who presented with a four-month history of excessive bleeding per vagina. Endometrial curettage and cervical biopsy revealed a malignant round cell tumor suggestive of metastatic sarcoma of uterine origin. Computed tomography of the abdominopelvic region showed an enlarged uterus with diffused thickening throughout the entire endometrial cavity...
2018: Case Reports in Obstetrics and Gynecology
Neveta S V Sutherland, Hemashree Rajesh
The management of retained products of conception (RPOC) may be medical or surgical. Surgical options include blind curettage, ultrasound guided curettage, or curettage under direct vision via hysteroscopy. The definitive management of patients presenting with retained products of conception will depend on several factors: severity of bleeding, presence of hemodynamic instability or infection, and patient preference. Optimal management of retained products of conception should result in complete evacuation of the uterine cavity while minimizing endometrial trauma...
2018: Case Reports in Obstetrics and Gynecology
Michelle Nguyen, Maria Raquel Kronen, Alex Nhan, Antonio Liu
Background: Spontaneous epidural hematoma (SEH) is a rare finding in pregnancy, especially since most pregnant women do not have risk factors for developing SEH. The presence of epidural anesthesia can delay the diagnosis of SEH in pregnant patients. Immediate surgical decompression is the current standard of care for treating SEH. Case Presentation: We present the case of a 37-year-old pregnant woman with preeclampsia with severe features who developed neurological deficits that were initially attributed to her epidural anesthesia...
2018: Case Reports in Obstetrics and Gynecology
Tetsuya Okaneya, Kiyoshi Onishi, Michio Saze, Kei Iwakura, Hiroko Sakuma
Clitoral hypertrophy is caused by disorders of sex development and it is observed from birth in most cases. We encountered a patient in whom normal morphology at birth may have acquired deformity and hypertrophy. The patient was a 10-year-old girl with a chief complaint of pudendal deformity. The clitoral hood was enlarged and the clitoris size was 8 x 5 mm on the first examination. Various tests were performed. Sex chromosome or hormonal abnormalities and tumorous lesions were not detected, and the ovaries, uterus, and vagina were normal, indicating that disorders of mullerian development were negative...
2018: Case Reports in Obstetrics and Gynecology
Anis Haddad, Olfa Zoukar, Houda Mhabrich, Awatef Hajjeji, Raja Faleh
In recent years, the incidence of placenta accreta and associated complications has increased significantly. The authors report the case of a pregnant woman in the 5th month of pregnancy for premature rupture of the membranes. The placenta was inserted low. The evolution was marked spontaneous work followed by the expulsion of the fetus. The delivery of the placenta was haemorrhagic and incomplete. Ultrasonic testing showed a placental fragment integrated in the thickness of the myometrium. Conservative treatment with methotrexate was published a few days later and MRI showed that the anterior uterine sac was filled with blood clots associated with pelvic effusion...
2018: Case Reports in Obstetrics and Gynecology
Maria Inês Raposo, Catarina Meireles, Mariana Cardoso, Mariana Ormonde, Cristina Ramalho, Mónica Pires, Mariana Afonso, Almerinda Petiz
Benign Metastasizing Leiomyoma (BML) is a rare condition with few cases reported in the literature. It is usually incidentally diagnosed several years after a primary gynecological surgery for uterine leiomyoma. Differential diagnosis of BML is complex requiring an extensive work-up and exclusion of malignancy. Here, we report two cases of BML based on similarity of histopathological, immunohistochemical, and genetic patterns between lung nodules and uterine leiomyoma previously resected, evidencing the variability of clinical and radiological features of BML...
2018: Case Reports in Obstetrics and Gynecology
Evangelos N Symeonidis, Elias Sdralis, Asterios Symeonidis, Christos Georgiadis, Vasileios Kalyvas, Apostolos Malioris, Michail Papathanasiou
Vesicouterine fistula (VUF) represents a rare urogenital complication. It is considered to be the least common type of urogenital fistulas. Iatrogenic reasons have been shown to be the most prominent cause, with lower segment caesarean section accounting for approximately two-thirds of the cases. The highest incidence concerns young females of reproductive age. VUF can present with clinical symptoms varying from cyclic hematuria, amenorrhea, and vaginal leakage of urine to secondary infertility and first-trimester abortion...
2018: Case Reports in Obstetrics and Gynecology
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