Case Reports in Obstetrics and Gynecology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Drug Resistant Fetal Arrhythmia in Obstetric Cholestasis Tue, 03 Mar 2015 07:09:40 +0000 Obstetric cholestasis (OC) is a pregnancy specific liver disease characterized by increased levels of bile acid (BA) and pruritus. Raised maternal BA levels could be associated with intrauterine death, fetal distress, and preterm labor and also alter the rate and rhythm of cardiomyocyte contraction and may cause fetal arrhythmic events. We report a case of drug resistant fetal supraventricular tachycardia and concomitant OC. Conclusion. If there are maternal OC and concomitant fetal arrhythmia, possibility of the resistance to antiarrhythmic treatment should be kept in mind. Nahide Altug, Ayse Kirbas, Korkut Daglar, Ebru Biberoglu, Dilek Uygur, and Nuri Danisman Copyright © 2015 Nahide Altug et al. All rights reserved. Tracheal Agenesis: A Challenging Prenatal Diagnosis—Contribution of Fetal MRI Mon, 02 Mar 2015 12:48:41 +0000 Tracheal agenesis is a rare congenital anomaly. The prevalence is less than 1 : 50 000 with a male to female ratio of 2 : 1. This anomaly may be isolated but, in 93% of cases, it is part of polymalformative syndrome. The most evocative diagnosis situation is the ultrasonographic congenital high airway obstruction syndrome. Dilated airways, enlarged lungs with flattened diaphragm, fetal ascites and severe nonimmune hydrops can be observed. In the absence of a congenital high airway obstruction syndrome, the antenatal diagnosis of tracheal agenesis is difficult. Tracheal agenesis should be suspected in the presence of an unexplained polyhydramnios associated with congenital malformations. The fetal airway exploration should then be systematically performed by fetal thoracic magnetic resonance imaging. A case of Floyd’s type II tracheal agenesis, detected during the postnatal period, is reported here. The retrospective reexamination of fetal magnetic resonance images showed that the antenatal diagnosis would have been easy if a systematical examination of upper airways had been performed. Prenatal diagnosis of tracheal agenesis is possible with fetal MRI but the really challenge is to think about this pathology. Charline Bertholdt, Estelle Perdriolle-Galet, Pascale Bach-Segura, and Olivier Morel Copyright © 2015 Charline Bertholdt et al. All rights reserved. Drug-Induced Thrombocytopenia following a Transvaginal Oocyte Retrieval for In Vitro Fertilization Wed, 25 Feb 2015 11:35:31 +0000 Drug-induced immune thrombocytopenia has been associated with hundreds of medications and can lead to devastating consequences for the patient. We present a case of a healthy 33-year-old female undergoing in vitro fertilization who developed a severe drug-induced thrombocytopenia, petechiae, and a large hemoperitoneum after receiving Cefazolin antibiotic prophylaxis for a transvaginal oocyte retrieval. The patient was admitted to the intensive care unit for resuscitation with blood products. The presence of drug-dependent platelet antibodies to Cefazolin was confirmed serologically. Ioanna A. Comstock, Michelle Longmire, Richard H. Aster, and Amin A. Milki Copyright © 2015 Ioanna A. Comstock et al. All rights reserved. Intrasplenic Arterial Aneurysms during Pregnancy Tue, 24 Feb 2015 09:08:17 +0000 Splenic artery aneurysms account for about 60% of all visceral aneurysms. Pregnancy is a risk factor for splenic artery aneurysms rupture with high maternal mortality and fetal loss. Intrasplenic arterial aneurysms are extremely rare and have not been reported to be associated with pregnancy. This report presents a 34-year-old woman during the second trimester, admitted with severe left upper quadrant and left shoulder pain. She had two uncomplicated intrasplenic aneurysms. Splenectomy was done. She delivered a full term healthy girl. This is the first report of acute abdomen during pregnancy caused by intrasplenic artery aneurysms with maternal and fetal survival. Mahmoud M. S. Abu-khalaf, Sokiyna M. Al-Ameer, Moath M. Smadi, Ayman Qatawneh, Osama A. Smara, and Azmy T. Hadidy Copyright © 2015 Mahmoud M. S. Abu-khalaf et al. All rights reserved. A Case of Cardiac Metastasis from Uterine Cervical Carcinoma Tue, 24 Feb 2015 06:30:04 +0000 Cases of cardiac metastasis from uterine cervical carcinoma are rare. While they are occasionally found on autopsy, antemortem recognition is extremely rare. We confirmed a case of cardiac metastasis from cervical carcinoma antemortem, because we observed a decrease in platelet count during the course of treatment. The patient was a 27-year-old woman diagnosed with stage Ib1 uterine cervical carcinoma. Radical hysterectomy with pelvic lymphadenectomy was performed. Para-aortic lymph node metastasis was detected on positron emission tomography/computed tomography (PET-CT). Adjuvant chemotherapy was started, and most of the metastatic lesions disappeared. Pelvic lymph node recurrence was suspected on PET-CT during continued chemotherapy; therefore, treatment was shifted to radiation therapy. Tumor shrinkage was recognized, and the initial therapy was completed. A noticeable decrease in platelet count was recognized seven months after treatment. Multidetector CT was performed, and an intracardiac tumor was detected. The patient did not desire any further treatment. She died three weeks after the intracardiac tumor was confirmed. Few previous autopsy studies have reported cardiac metastasis from cervical carcinoma. Thus, it is necessary to consider the possibility of cardiac metastasis for patients diagnosed with terminal cervical carcinoma. Kazuhiro Okamoto, Tomoyuki Kusumoto, Noriko Seki, Keiichiro Nakamura, and Yuji Hiramatsu Copyright © 2015 Kazuhiro Okamoto et al. All rights reserved. An Unexpected Presentation of Haemoperitoneum in a Pregnant Woman Mon, 23 Feb 2015 11:54:30 +0000 In the majority of tertiary centres the Emergency Room or Assessment Unit is the gateway to the rest of the hospital. It is the location where critical decisions are formulated depending on whether a patient’s condition is serious enough to warrant admission and, at times, emergency surgery. On occasion this decision can be straightforward based solely on the patient’s presentation, observations, and basic investigations. This case highlights that although the decision and initial management may be apparent, often the diagnosis can be unexpected and that the diagnostic challenge is often outside the scope of a brief Emergency Room assessment. Corpus luteal cyst rupture is a common phenomenon but often not the cause of significant morbidity as it was in this case, especially in the absence of any associated risk factors. Kaushalya Arulpragasam, Andrea Atkinson, and Mathias Epee-Bekima Copyright © 2015 Kaushalya Arulpragasam et al. All rights reserved. Diagnosis of Pentalogy of Cantrell in the First Trimester Using Transvaginal Sonography and Color Doppler Mon, 23 Feb 2015 11:11:15 +0000 We report the prenatal diagnosis of Cantrell syndrome in the first trimester. During a routine transabdominal ultrasonographic examination, a midline supraumbilical abdominal wall defect including herniated liver and ectopia cordis with a large omphalocele containing the intestines and cystic hygroma was incidentally identified at the 12th week of gestation. A transvaginal sonography examination revealed a severe lumbosacral scoliosis in addition to the inability to visualize the abdominal aorta which was indicative of a severe intracardiac defect. The parents opted for pregnancy to be terminated. In this case report, we discuss the complementary role of transvaginal sonography and Doppler imaging in the diagnosis of Cantrell syndrome in early pregnancy. Ayşe Figen Türkçapar, Ayla Sargın Oruc, Aysegül Öksüzoglu, and Nuri Danışman Copyright © 2015 Ayşe Figen Türkçapar et al. All rights reserved. Serous Tubal Intraepithelial Carcinoma: An Incidental Finding at the Time of Prophylactic Bilateral Salpingo-Oophorectomy Mon, 23 Feb 2015 09:28:43 +0000 Background. Serous tubal intraepithelial carcinoma (STIC) is a precursor lesion for high-grade pelvic serous carcinoma. The incidence of STIC is estimated to occur in 0.6% to 6% of women who are BRCA positive or have a strong family history of breast or ovarian cancer. Case. A 56-year-old woman underwent robotic-assisted sacrocolpopexy, rectocele repair, and concurrent bilateral salpingo-oophorectomy for recurrent stage 3 pelvic organ prolapse and reported family history of ovarian cancer. Histopathologic examination of her left fallopian tube revealed STIC. Conclusion. We report this rare occurrence of STIC in a patient undergoing surgery primarily for pelvic organ prolapse and having a family history of ovarian cancer. Possible management options include observation with annual physical exam and CA-125, surgical staging, or empiric chemotherapy. However, due to the lack of consensus regarding management options, referral to a gynecologic oncologist is recommended. Monique Hiersoux Vaughan, Susan C. Modesitt, Yunchuan Mo, and Elisa R. Trowbridge Copyright © 2015 Monique Hiersoux Vaughan et al. All rights reserved. Prenatal Diagnosis of Concurrent Achondroplasia and Klinefelter Syndrome Wed, 18 Feb 2015 06:40:02 +0000 Achondroplasia is the most frequent nonlethal skeletal dysplasia, with a prevalence of 1 : 5000 to 1 : 40,000 live births, and it is caused by a fibroblast growth factor receptor alteration. The combination of achondroplasia and Klinefelter syndrome is extremely rare and just four reports have been published in the literature, which were all diagnosed postnatally. We report the fifth case described of this uncommon association and its prenatal diagnosis. In cases of prenatal diagnosis of achondroplasia with additional suspicious morphological abnormalities, an invasive test such as amniocentesis must be carried out to assess the karyotype normality. Esther Perez-Carbajo, Ignacio Zapardiel, Luis Sanfrutos-Llorente, Sara Cruz-Melguizo, Cristina Martinez-Payo, and Enrique Iglesias-Goy Copyright © 2015 Esther Perez-Carbajo et al. All rights reserved. A Rare Case of Primary Amenorrhea with Two Etiologies, Hypothalamic Amenorrhea, Transverse Vaginal Septum, and No Hematocolpos Mon, 16 Feb 2015 11:30:40 +0000 We reported a rare case of hypothalamic amenorrhea and transverse vaginal septum. A 28-year-old woman presented with primary amenorrhea and no complaint of abdominal pain. Laparoscopy revealed a small rudimentary uterus with streak ovaries and a vaginal pouch. The patient with diagnosis of Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome was subjected to a vaginoplasty in another fertility center. In our institute, after two courses of estrogen and progesterone, sonography revealed hematocolpos, while, under anesthesia, transverse vaginal septum was resected. Hysteroscopy revealed normal uterine cavity. She became pregnant 5 months postoperatively with controlled ovarian stimulation (COS) in conjunction with intrauterine insemination, and she has two healthy babies now. This case highlights the importance of careful evaluation of all primary amenorrheas. Clinicians should be aware of presence of more than one etiology which causes atypical presentations and accomplishes a systematic strategy for the evaluation of amenorrhea potential to avoid long-term side effects of a misdiagnosis. Firouzeh Ghaffari, Fatemeh Keikha, and Arezoo Arabipoor Copyright © 2015 Firouzeh Ghaffari et al. All rights reserved. A Case of Phosphoglyceride Crystal Deposition Disease in the Pelvic Soft Tissues Recurring after Initial Surgery Wed, 11 Feb 2015 12:35:58 +0000 Phosphoglyceride crystal deposition disease (PGDD) is a rare disease entity that is characterized by phosphoglyceride crystal deposition that stimulates the formation of masses in soft tissue scars or bones. We report a case of PGDD in the pelvic soft tissues that recurred after initial surgical treatment. A 50-year-old woman was referred to our hospital for the evaluation of pelvic masses that were observed on an abdominal ultrasound. Magnetic resonance imaging (MRI) revealed masses in the pelvic region, with the largest being 10 cm in diameter. The masses were diagnosed as ovarian malignant tumors, and an exploratory laparotomy was performed. Operative findings revealed them to be foreign body granulomas, and the patient was diagnosed with PGDD. The patient had a history of cesarean delivery at the age of 24 years. PGDD is extremely rare, but it should be considered in the differential diagnosis of abdominal masses in patients with a history of abdominal surgery. Yuki Yamada, Kazuhiro Nishioka, Hirotaka Kajihara, Taketoshi Noguchi, Katsuhiko Naruse, and Kiyoshige Horie Copyright © 2015 Yuki Yamada et al. All rights reserved. Abdominal Tumor in a 14-Year-Old Adolescent: Imperforate Hymen, Resulting in Hematocolpos—A Case Report and Review of the Literature Sun, 08 Feb 2015 14:14:50 +0000 Background. Abdominal masses in female adolescents are uncommon. A rare cause of this condition is hematocolpos due to imperforate hymen. Case. We present a case of an unusually massive asymptomatic abdominal bulk in a 14-year-old female patient, who sought for medical advice after unusual abdominal pain lasting for few weeks. The patient was otherwise asymptomatic, apart from an unusual dramatic expansion of her abdominal wall during the last month. We describe the surgical management and the follow-up of the patient. Summary and Conclusion. Clinicians should keep in mind that an imperforate hymen can cause abdominal growth due to hematocolpos and include it in the differential diagnosis of such a clinical entity in female adolescents. 2D ultrasound is usually efficient for the confirmation of the diagnosis of hematocolpos, but 3D ultrasound is more accurate. Wide excision should be undertaken, as an initial approach, to avoid recurrence. George Marios Makris, Doris Macchiella, Dennis Vaidakis, Charalampos Chrelias, Marco Johannes Battista, and Charalampos Siristatidis Copyright © 2015 George Marios Makris et al. All rights reserved. Extremely Rare Case of Vulvar Myxoid Epithelioid Sarcoma Sun, 08 Feb 2015 13:24:46 +0000 Epithelioid sarcoma is a distinct sarcoma type with specific morphology and immunophenotype. An epithelioid sarcoma of the vulva is an extremely rare and aggressive tumor and most commonly occurs on the labia majora in women of reproductive age. Only few cases have been reported, especially with the presence of focal myxoid changes. Early diagnosis is difficult because of its benign appearance as a painless subcutaneous nodule. Optimal treatment is not well established due to its rarity. We report a successfully approached case of vulvar epithelioid sarcoma that occurred in a 34-year-old female patient, treated with wide local excision, and review of the current medical literature. Joana Lima Rego, Georgia Fontes Cintra, Ana Karina Junqueira Netto, Lucas Faria Abrahão-Machado, and Audrey Tsunoda Copyright © 2015 Joana Lima Rego et al. All rights reserved. Significantly Elevated Serum Lipase in Pregnancy with Nausea and Vomiting: Acute Pancreatitis or Hyperemesis Gravidarum? Mon, 02 Feb 2015 09:35:41 +0000 Hyperemesis gravidarum is a severe manifestation of nausea and vomiting of pregnancy and it is associated with weight loss and metabolic abnormalities. It is known that abnormal laboratory values, including mildly elevated serum lipase level, could be associated with hyperemesis gravidarum. However, in this case report details of two women with hyperemesis gravidarum but with significantly elevated serum lipase levels were discussed. These patients presented with severe nausea and vomiting but without abdominal pain. They were found to have severely elevated lipase levels over 1,000 units/liter. In the absence of other findings of pancreatitis, they were treated with conservative measures for hyperemesis gravidarum, with eventual resolution to normal lipase levels. Although significantly elevated lipase level in pregnant patients with nausea and vomiting is a concern for acute pancreatitis, these two cases of significantly elevated serum lipase without other clinical findings of pancreatitis led to this report that serum lipase could be quite elevated in hyperemesis gravidarum and that it might not be an accurate biochemical marker for acute pancreatitis. Imaging studies are thus necessary to establish the diagnosis of acute pancreatitis. Amanda Johnson, Bethany Cluskey, Nina Hooshvar, Daphne Tice, Courtney Devin, Elaine Kao, Suhalia Nawabi, Steven Jones, Lihua Zhang, and Chi Dola Copyright © 2015 Amanda Johnson et al. All rights reserved. Uterine Myxoid Leiomyosarcoma with Tumor Embolism Extending into the Right Atrium Mon, 02 Feb 2015 06:40:39 +0000 Uterine myxoid leiomyosarcoma (MLMS) is an extremely rare variant of uterine leiomyosarcoma; only 56 cases were reported from 1982 to 2013. Uterine MLMS is characterized by a myxoid appearance and highly malignant behavior. We herein report a case involving a 65-year-old woman with uterine MLMS with a large tumor embolism that reached the right atrium. A total abdominal hysterectomy, bilateral salpingooophorectomy, and tumor embolism resection with the use of a heart-lung machine were performed. Epirubicin-ifosfamide chemotherapy in the adjuvant setting led to reductions in both the tumor emboli and peritoneal dissemination. The patient retained a good quality of life for 10 months after the initial surgery. She then developed progressive disease despite treatment with pazopanib. She died of her disease 14 months after the initial surgery. Although complete surgical resection of the tumor is desirable, tumor reduction surgery followed by adjuvant chemotherapy might help to retain a good quality of life. This is the first reported case of a primary uterine MLMS with tumor emboli. Hiromi Imai, Hiroshi Yagi, Kaoru Okugawa, Hironori Kenjo, Tatsuhiro Ohgami, Yoshiaki Kawano, Eisuke Kaneki, Akimasa Ichinoe, Kazuo Asanoma, Hideaki Yahata, Kenzo Sonoda, Hiroaki Kobayashi, Tsunehisa Kaku, and Kiyoko Kato Copyright © 2015 Hiromi Imai et al. All rights reserved. Müllerian Cyst of the Vagina Masquerading as a Cystocele Sat, 31 Jan 2015 07:16:06 +0000 Müllerian cysts are usually small, ranging from 0.1 to 2 cm in diameter. Rarely, they may be enlarged and mistaken for other structures, such as a cystocele or urethral diverticulum. We report on a female with symptomatic vaginal wall prolapse, diagnosed as a vaginal Müllerian cyst, which was originally misdiagnosed as a cystocele. The mass was soft and could be compressed manually without difficulty. Perineal ultrasonography and cystoscopy revealed no relationship between the cyst and the lower urinary tract, suggesting independence of the lesion. We performed surgical treatment with complete excision of the mass via a vaginal approach under spinal anaesthesia. The pathology result confirmed a benign Müllerian cyst lined with mucinous and squamous epithelium. When evaluating an anterior vaginal cyst, assessment of the lesion via history taking and pelvic examination is important to confirm both lesion size and location. Perineal ultrasonography performed with an empty bladder is useful to differentiate such vaginal cysts and to define their communication, if any, with adjacent organs. Emrah Töz, Muzaffer Sancı, Süheyla Cumurcu, and Aykut Özcan Copyright © 2015 Emrah Töz et al. All rights reserved. Pregnancy after Uterine Artery Embolization: A Case Report in a Woman with Leiomyomata Thu, 29 Jan 2015 15:38:11 +0000 Background. Several pregnancies have been reported after embolization of uterine artery. This procedure is an accepted nonsurgical treatment for symptomatic uterine fibroids but its safety in women desiring future childbearing is not well established. Case Report. We present a 40-year-old woman with leiomyomata who became pregnant after previously undergone uterine artery embolization for three times. The placenta was previa and the fetus was in transverse position. She had a cesarean delivery of an appropriately grown fetus at 37 weeks, which was followed by uterine atony requiring hysterectomy. Conclusion. Although pregnancy-related outcomes remain understudied, the available reports evidence that pregnancies after uterine artery embolization may be at significantly increased risk for postpartum hemorrhage, cesarean delivery, abnormal placentation, and malpresentation. In patients who are undergoing this type of treatment and contemplating pregnancy, the possibility of adverse complications should be taken in consideration and women should be appropriately advised. Helena Isabel Lopes, Maria Isabel Sá, and Rosa Maria Rodrigues Copyright © 2015 Helena Isabel Lopes et al. All rights reserved. A New Case of Prenatally Diagnosed Pentasomy X: Review of the Literature Thu, 29 Jan 2015 13:19:24 +0000 Pentasomy X is a rare chromosomal abnormality probably due to a nondisjunction during the meiosis. Only four cases prenatally diagnosed were described until now. Our case is the fifth one prenatally diagnosed at 20 weeks of gestational age in a 39-years-old woman. She underwent invasive prenatal diagnosis for her advanced maternal age without any other known risk factor. Amniocentesis performed at 17 weeks showed a female 49, XXXXX karyotype. The ultrasonographic examination revealed nonspecific signs of a mild early fetal growth retardation and no significant increased nuchal fold. The fetal autopsy and the X-ray excluded major malformations. Prenatal diagnosis is often difficult due to the lack of indicative ultrasonographic findings and the rarity of described cases. The influence of the mother’s age on the occurrence of penta-X syndrome has not been determined. Considering the lack of correlation between advanced maternal age and increased risk for pentasomy X, as well as the absence of typical echographic signs, evaluation of the inclusion of a noninvasive prenatal test (NIPT) that expands clinical coverage to include the X and Y chromosomes in routine prenatal diagnosis should be considered as well as three-dimensional ultrasound to detect any helpful indicative prognostic signs. Linda Maria Azzurra Pirollo, Leila Baghernajad Salehi, Simona Sarta, Marco Cassone, Maria Vittoria Capogna, Emilio Piccione, Giuseppe Novelli, and Adalgisa Pietropolli Copyright © 2015 Linda Maria Azzurra Pirollo et al. All rights reserved. Diffusion-Weighted MRI and FDG-PET in Diagnosis of Endometrial Stromal Nodule Wed, 28 Jan 2015 11:14:36 +0000 Preoperative differentiation of benign endometrial stromal nodule (ESN) from malignant low-grade endometrial sarcoma (LGESS) is challenging, because it requires histological evaluation of the tumor-myometrium interface, which is difficult to obtain in conventional endometrial curettage. A 72-year-old postmenopausal woman presented with 5-year history of persistent vaginal bleeding. Histological examination of the endometrial curettage specimen revealed hyperplasia of apparently normal endometrial stromal cells. T2-weighted magnetic resonance imaging (T2W-MRI) showed polypoid tumor occupying the entire uterine cavity. The tumor exhibited high signal intensity in diffusion-weighted MRI (DW-MRI) and intense accumulation of 18F-fluorodeoxyglucose (FDG) in positron emission tomography (PET). Intense FDG accumulation was also observed in the left internal iliac region. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy were performed under the diagnosis of LGESS with lymph node metastasis. However, postoperative histological examination proved that the tumor was ESN without lymph node metastasis. Since mitotic figure is no longer included in the diagnostic criteria of ESN or LGESS, ESN could exhibit high cellularity and high proliferative activity as observed in this case. Therefore, DW-MRI or FDG-PET is not useful in the differentiation of ESN from LGESS. Shunsuke Maruyama, Yukiyasu Sato, Yumiko Satake, Hiroko Mise, and Tomoko Kim Copyright © 2015 Shunsuke Maruyama et al. All rights reserved. Delayed Interval Delivery following Early Loss of the Leading Twin Thu, 22 Jan 2015 08:33:46 +0000 This was a case of a nulliparous woman with reduced chance of conception following unilateral salpingectomy and years of infertility. She eventually conceived following ovulation induction resulting in twin pregnancy. She had miscarriage that led to loss of one of the twins at 17 weeks of gestational age. The pregnancy was however continued for 116 days following meticulous management with eventual delivery of a live female baby with good outcome. P. C. Udealor, I. V. Ezeome, F. C. Emegoakor, D. O. Okeke, and P. C. N. Okere Copyright © 2015 P. C. Udealor et al. All rights reserved. Intrapartum Intrauterine Fetal Demise with Normal Umbilical Cord Blood Gas Values at Birth Mon, 19 Jan 2015 09:42:35 +0000 A case is presented in which a fetus was delivered by cesarean section for failure to progress and a “nonreassuring heart rate tracing” in which the Apgar scores were unexpectedly 0 at 1, 5, and 10 minutes. Resuscitation was unsuccessful after 30 minutes. The venous cord gas was normal and the arterial blood gas was not consistent with intrapartum asphyxia. At the time of surgery, the placenta appeared grossly normal. The autopsy was entirely normal. This case raises questions about our understanding of intrauterine fetal demise and suggests an approach to future research. Michael D. Benson Copyright © 2015 Michael D. Benson. All rights reserved. Primary Vaginal Myeloid Sarcoma: A Rare Case Report and Review of the Literature Sun, 18 Jan 2015 13:34:12 +0000 Myeloid sarcoma (chloroma, granulocytic sarcoma, or extramedullary myeloid tumour) is an extramedullary mass forming neoplasm composed of myeloid precursor cells. It is usually associated with myeloproliferative disorders but very rarely may precede the onset of leukemia. Here, we are presenting a rare case of primary vaginal myeloid sarcoma in a geriatric female patient without initial presentation of acute myeloid leukemia (AML). A 68-year-old female patient with ECOG Performance Score of 1 presented with pervaginal bleeding for 20 days. On colposcopic examination, she was found to have mass in the anterior fornix of vagina. A punch biopsy specimen revealed chloromatous infiltration of the vagina. LCA (leukocyte common antigen), MPO (myeloperoxidase), and c-kit were strongly positive on IHC (immunohistochemistry). The patient’s routine blood investigations were normal including peripheral smear, lactose dehydrogenase, uric acid, 2D echocardiography, conventional cytogenetics, bone marrow aspiration, and biopsy. The patient was given 4 cycles of decitabine (Decitex, manufactured by Sun Pharmaceutical Industries Limited, India), 20 mg/m2 for 5 days at an interval of 28 days. There was a partial response to decitabine according to RECIST criteria. As decitabine therapy was well tolerated, we are continuing in the same way until disease progression without any complications. The patient is undergoing regular follow-up at our centre. Gaurang Modi, Irappa Madabhavi, Harsha Panchal, Apurva Patel, Asha Anand, Sonia Parikh, Pritam Jain, Swaroop Revannasiddaiah, and Malay Sarkar Copyright © 2015 Gaurang Modi et al. All rights reserved. Mature Cystic Teratoma of the Fallopian Tube in a Postmenopausal Woman: A Case Report and Review of the Literature Thu, 15 Jan 2015 12:01:33 +0000 Background. Mature cystic teratomas of the fallopian tube are extremely rare and only 54 cases have been reported in the literature. In this paper, we report a mature cystic teratoma of the fallopian tube in a postmenopausal woman and we report the review of literature of tubal cystic teratomas. Case. A 62-year-old, gravida 4 postmenopausal woman presented with pain in the right lower abdominal region for a long time. An 88 × 72 × 95 mm heterogeneous mass which contained calcifications and lipoid components was detected in the right adnexal region by transvaginal ultrasonogram (TV-USG). Serum tumour markers, namely, CA125, CA15-3, and CA19-9, were within normal range. A laparotomy revealed a 9 × 10 cm cystic mass within the fimbrial region in the right fallopian tube, and right salpingoopherectomy was performed consequently. Microscopic examination revealed squamous epithelium with sebaceous glands and hair follicles, and pseudostratified ciliated respiratory epithelium with cartilage and mucous glands. Because the frozen section resulted in a benign dermoid cyst, no further operative procedure was performed. The postoperative follow-up was uneventful and the patient was discharged on the second postoperative day. Conclusion. In cases of undetermined pelvic or abdominal masses, a teratoma of the fallopian tube should be considered. Mustafa Erkan Sari, Ozhan Ozdemir, Pinar Kadirogullari, Funda Arpaci Ertugrul, and Cemal Resat Atalay Copyright © 2015 Mustafa Erkan Sari et al. All rights reserved. The Treatment of Giant Periurethral Condyloma in Pregnancy Using an Ultrasonic Thermal Scalpel: A Case Report and New Single Session Treatment Option Mon, 12 Jan 2015 12:20:28 +0000 Multiple large polypoid lesions with exophytic appearance occurring in anal and perineal region as a result of human papilloma virus (HPV) infection are referred to as giant condyloma acuminatum (GCA). The conventional treatment of these lesions involves the use of surgical excision, laser, electrocautery, and/or application of trichloroacetic acid. A 28-year-old primigravid patient at 22 weeks of pregnancy presented to the hospital complaining of vaginal bleeding and palpable mass in the vulva. The physical examination revealed a 60 × 35 mm broad-based, fragile, and patchy hemorrhagic polypoid lesion originating 1 cm below the clitoris and completely occupying urethral orifice and partially occluding vaginal vestibule. The patient underwent excision of GCA in the midtrimester using an ultrasonic thermal scalpel (Harmonic Scalpel) without any additional treatment and subsequently delivered a single live healthy baby. The excision of GCA occurring during pregnancy using Harmonic Scalpel can be regarded as a new successful method. Prospective, randomized, and controlled studies are warranted in order to provide clear evidence of the efficiency and safety of HS in the treatment of GCA. Ali Yavuzcan, Mete Çağlar, Hakan Turan, Ali Tekin, Seren Topuz, Gizem Yavuzcan, Serdar Dilbaz, Yusuf Üstün, Cihangir Aliağaoğlu, and Selahattin Kumru Copyright © 2015 Ali Yavuzcan et al. All rights reserved. Endometrial Stromal Sarcoma Arising in Colorectal Endometriosis: A Case Report and Review of the Literature Mon, 12 Jan 2015 06:19:24 +0000 Extrauterine endometrial stromal sarcoma (ESS) arising in endometriosis is extremely rare, particularly in the colorectum. It should always be included in the differential diagnosis of primary tumors originating from gastrointestinal tract in females, given that preoperative endoscopical biopsy may reveal no specific changes. We reported a case of ESS arising in colorectal endometriosis and reviewed the previous 7 cases reported in the English literature. Our patient, who was unavailable for tumor resection and refused further adjuvant therapy, played a role in representing the natural history of low-grade extragenital ESS. This case was the only death from ESS arising in colorectal endometriosis. Qiao Wang, Xia Zhao, and Ping Han Copyright © 2015 Qiao Wang et al. All rights reserved. Meckel’s Diverticulitis as a Cause of an Acute Abdomen in the Second Trimester of Pregnancy: Laparoscopic Management Sun, 11 Jan 2015 07:58:47 +0000 Introduction. Meckel’s diverticulitis is an extremely rare cause of an acute abdomen in pregnancy. Its clinical presentation tends to be rather unusual and therefore commonly delaying diagnosis. The surgical method of exploration can be either by laparoscopy or through an open incision. Case Report. We report a case of a 34-year-old, P1 with previous Caesarean section, who presented at 20 weeks with worsening right-sided abdominal pain, distention, and peritonism. Ultrasound scan showed an area of a possibly thickened loop of bowel inconsistent with an appendicitis. The findings at laparoscopy were purulent fluid in the pelvis, a congested appendix, and inflamed Meckel’s diverticulum. An appendectomy and excision of the diverticulum was performed using stapler technique. Discussion. Meckel’s diverticulitis in pregnancy can have nonspecific presentation and poses difficulties for preoperative diagnosis. Delay in diagnosis and management poses significant maternal and fetal risks. The use of laparoscopy if the gestational age and uterine size permit its use allows a thorough exploration of the abdominal cavity and management of rarer and unexpected pathology. Laparoscopic management of acute abdomen in the midtrimester of pregnancy has been found to be safe and effective. Ivilina Pandeva, Sumit Kumar, Atif Alvi, and Hema Nosib Copyright © 2015 Ivilina Pandeva et al. All rights reserved. Dilemma in Timing of Delivery in a Patient with an Acute Myocardial Infarction Thu, 08 Jan 2015 13:04:25 +0000 Introduction. Acute myocardial infarction (AMI) in a pregnant woman is rare. When occurring, AMI is a major cause of maternal and neonatal death. By presenting the following case we describe the dilemma concerning the timing of delivery. Case. A 36-year-old, multiparous women, at 35 6/7 weeks of gestation, suffered from an AMI due to an acute blockage of the left anterior descending artery (LAD). This was treated by angiographic thrombosuction and biodegradable stent placement. Within 5 hours after this procedure, a cesarean section (CS) was performed because of a nonreassuring fetal condition. A healthy son with an Apgar score of 9/10 was born. The patient’s postoperative course was complicated by a big wound hematoma, a hemoglobin drop, and heart failure. Discussion. In case of AMI during pregnancy, the cardiological management has absolute priority. The obstetrical management is not outlined. In a nonreassuring fetal condition, delivery is indicated after stabilization of the mother. However, delivery after recent AMI and angiography will bring new risks of cardiologic stress and bleeding complications. The limited literature available tends to an expectant obstetrical management, but this case emphasizes the difficulty of waiting in suspected fetal distress. Laura M. Héman, Ingrid E. C. Devies, and Frans J. M. E. Roumen Copyright © 2015 Laura M. Héman et al. All rights reserved. Nonpneumatic Antishock Garment Combined with Bakri Balloon as a Nonoperative “Uterine Sandwich” for Temporization of Massive Postpartum Hemorrhage from Disseminated Intravascular Coagulation Thu, 08 Jan 2015 09:14:58 +0000 Disseminated intravascular coagulation (DIC) is an uncommon but potentially catastrophic complication of postpartum hemorrhage. We describe two cases of massive postpartum hemorrhage complicated by DIC that were successfully temporized with combined use of the Bakri balloon and nonpneumatic antishock garment (NASG) during massive transfusion. In the first case, a healthy, term gravida underwent emergent cesarean for fetal bradycardia during labor induction. 10 minutes after completion of surgery, brisk vaginal hemorrhage of nonclotting blood from fulminant DIC resulted in maternal shock. A Bakri balloon and NASG were placed during massive transfusion, resulting in rapid maternal stabilization. In the second case, a healthy, term gravida suffered an amniotic fluid embolism during labor requiring emergent cesarean delivery and complicated by cardiac arrest with successful resuscitation. Postoperative rapid uterine bleeding from DIC was treated with a Bakri balloon and NASG, stabilizing the patient during massive transfusion. Neither patient required further surgical procedures. NASG combined with Bakri balloon may serve as a valuable nonoperative treatment or temporization option in cases of massive postpartum hemorrhage complicated by coagulopathy such as these. Further study of the utility of NASG in high-resource settings is warranted. Andrea Jelks, Monica Berletti, Liliana Hamlett, and Michele Hugin Copyright © 2015 Andrea Jelks et al. All rights reserved. Severe Acute Pancreatitis in Pregnancy Mon, 05 Jan 2015 10:09:15 +0000 This is a case of a pregnant lady at 8 weeks of gestation, who presented with acute abdomen. She was initially diagnosed with ruptured ectopic pregnancy and ruptured corpus luteal cyst as the differential diagnosis. However she then, was finally diagnosed as acute hemorrhagic pancreatitis with spontaneous complete miscarriage. This is followed by review of literature on this topic. Acute pancreatitis in pregnancy is not uncommon. The emphasis on high index of suspicion of acute pancreatitis in women who presented with acute abdomen in pregnancy is highlighted. Early diagnosis and good supportive care by multidisciplinary team are crucial to ensure good maternal and fetal outcomes. Bahiyah Abdullah, Thanikasalam Kathiresan Pillai, Lim Huay Cheen, and Ray Joshua Ryan Copyright © 2015 Bahiyah Abdullah et al. All rights reserved. Cholangiocarcinoma Presenting as Uterine Metastasis Wed, 31 Dec 2014 06:27:39 +0000 Metastases to the female genital tract are rare, with metastatic disease restricted to the uterus being even less frequent. The primary tumor is most often intragenital rather than extragenital. The diagnosis is usually made after occurrence of gynecological symptoms. We describe the case of a 26-year-old female, in whom a curettage for menorrhagia revealed a uterine malignancy, at first thought to be a carcinosarcoma. Biochemistry only showed iron deficiency anemia. Imaging showed discrepant results with liver lesions, suspect of neoplastic or inflammatory disease. She underwent an abdominal hysterectomy and, peroperatively, a frozen section of a mass in the liver hilus demonstrated a cholangiocarcinoma. The diagnosis of a uterine metastasized cholangiocarcinoma was made. We emphasize the fact that uterine metastases have to be excluded in every woman with abnormal uterine bleeding and a personal history of malignancy. However, our case also indicates that gynecological metastatic disease may be the first presentation of an extragenital primary neoplasm. W. Dendas, L. Cappelle, J. Verguts, and G. Orye Copyright © 2014 W. Dendas et al. All rights reserved.