Case Reports in Obstetrics and Gynecology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Gestational Weight Gain and Peripartum Cardiomyopathy in a Twin Pregnancy Sun, 28 Jun 2015 11:46:44 +0000 Preeclamptic twin pregnancy with larger gestational weight gain (GWG) is suggested to have a higher risk of peripartum cardiomyopathy (PPCM). This was true in a 5-year experience at a single center. A primiparous woman with twins and prepregnancy weight of 51.0 kg exhibited hypertension at gestational week (GW) 32−6/7 and GWG of 18.3 kg (6.0 kg and 2.9 kg during the last four weeks and one week of gestation, resp.) concomitant with generalized edema, gave birth at GW 34−4/7, developed proteinuria, cough, and dyspnea postpartum, and was diagnosed with preeclampsia and PPCM showing left ventricular ejection fraction of 34% and plasma BNP level of 1530 pg/mL. This was the only case of PPCM among 101 (12 with preeclampsia) and 3266 women with twin and singleton pregnancies, respectively. Thus, PPCM occurred significantly more often in women with preeclamptic twin pregnancies than in women with singleton pregnancies (8.3% [1/12] versus 0.0% [0/3266], ). This patient showed the greatest weight gain of 6.0 kg during the last four weeks of gestation and the greatest weight loss of 19.2 kg during one month postpartum among 90 women with twin deliveries at GW ≥ 32. Hiroko Matsumiya, Naotaka Saito, Hisanori Minakami, and Soromon Kataoka Copyright © 2015 Hiroko Matsumiya et al. All rights reserved. Endometrial Stromal Nodule: A Rarity and a Pathological Challenge Sun, 28 Jun 2015 11:31:39 +0000 Endometrial stromal tumors are rare, and endometrial stromal nodule is the least common. In the region of Middle Jutland, Denmark, only two cases are reported since 1995. The nodules are benign; nevertheless, hysterectomy is the treatment of choice. Tumor margins are required for diagnosis and essential to differentiate it from an invasive stromal sarcoma whose prognosis is very different. We report a rare case of a 38-year-old woman, with presurgical diagnosis of a uterine tumor/polyp. She presented with nausea and changes in bleeding pattern and initially had a transcervical polyp resection performed. Histopathological examination showed the presence of an endometrial stromal tumor with unclear margins, and an invasive malignant endometrial sarcoma could not be excluded. Pathological examination revealed an endometrial stromal nodule with invasion, not exceeding three mm. Endometrial stromal tumors are interesting due to their rare existence and difficulties in establishing a histological diagnosis. Although endometrial stromal nodules are benign entities, they must be differentiated from the other invasive malignant stromal tumors, which may change the final prognosis. No preoperative diagnostic tools are at hand, and benign as well as malignant tumors are treated with hysterectomy. Camilla Skovvang Borg, Peter Humaidan, Hanne Noer, and Huda Galib Majeed Copyright © 2015 Camilla Skovvang Borg et al. All rights reserved. Pregnancy and Vaginal Delivery after Sacrohysteropexy Tue, 23 Jun 2015 12:10:02 +0000 Pregnancy and birth after a Pelvic Organ Prolapse (POP) surgery is a rare condition and less is known about the method for delivery. A 31-year-old women with gravida 3 para 3 underwent abdominal sacrohysteropexy and transobturatuar tape (TOT) procedures for stage III prolapse who delivered via vaginal birth and showed no relapse. Sacrohysteropexy is a good option for women with POP who desire fertility with a long term follow-up period. Deniz Balsak, Ahmet Eser, Onur Erol, Derya Deniz Altıntaş, and Şerif Aksin Copyright © 2015 Deniz Balsak et al. All rights reserved. Myxoid Epithelial Leiomyoma of the Vulva: A Case Report and Literature Review Mon, 22 Jun 2015 08:33:16 +0000 Leiomyoma of vulva is rare, and usually misdiagnosed clinically as Bartholin cyst. It usually presents spindle-shaped tumor cells, but some rare cases consisted mainly of atypical epithelioid tumor cells. We report here a case of 30-year-old woman consulting with a vulvar mass of 7 cm in the Bartholin glands area. The lesion was surgically excised with its capsule completely. Pathological examination and immunochemistry showed characteristic of epithelioid leiomyoma with myxoid stroma with both estrogen receptor (ER) and progesterone receptor (PR) staining negative, which was really rare as only 2 cases of vulvar leiomyoma with both ER and PR were reported before. Ting Zhao, Xishi Liu, and Yuan Lu Copyright © 2015 Ting Zhao et al. All rights reserved. Ovarian and Renal Vein Thrombosis: A Rare Cause of Fever Outer the Postpartum Period Mon, 22 Jun 2015 06:29:07 +0000 Although there is no other underlying disease, women can sometimes experience rare and serious diseases such as ovarian vein thrombosis (OVT) and renal vein thrombosis (RVT) after giving birth. The widespread development of thrombosis is treated for the first time in this study. Stasis, coagulation factor abnormalities, and intimal damage to the venous thrombosis risk can increase during pregnancy. It was mentioned that it diagnoses an abnormality in the hypercoagulability half of women with OVT. Despite the hypercoagulant abnormality observed in pregnant women, it was very unusual that the renal vein thrombosis led to this complication. It can lead to severe complication of OVT which can even cause death. It was the first time that the renal vein and ovarian vein thrombosis were observed in the postpartum period, and there was no coagulation abnormality. It is known that the thrombus in the postpartum period can be observed with the fever of unknown origin. The problematic, but rarely observed, postpartum disease such as ovarian venous thrombosis (OVT) is generally observed in the right ovarian vein. In this disease, avoiding the resulting laparotomy heparin and intravenous antibiotics is best solution for the patient. If it is to be noted a fever for unknown reasons, that it be thrombosis. Turhan Togan, Hale Turan, Egemen Cifci, and Ceylan Çiftci Copyright © 2015 Turhan Togan et al. All rights reserved. An Infected Urachal Cyst in an Adult Woman Thu, 18 Jun 2015 07:26:07 +0000 The urachus is an embryologic remnant which degenerates after the birth. Defective obliteration of the urachus leads to urachal abnormalities. An infected urachal cyst is one of the urachal abnormalities and this pathology is rare in adult women. We report a case of 33-year-old woman with pelvic pain and dysuria who was diagnosed with infected urachal cyst. Infected urachal cyst is a rare pathology in adult women and this pathology should be considered in the differential diagnosis of acute abdomen. Serdar Kaya, Besim Haluk Bacanakgıl, Zeynep Soyman, Roya Kerımova, Semiha Battal Havare, and Başak Kaya Copyright © 2015 Serdar Kaya et al. All rights reserved. A Case of Spontaneous Tumor Lysis Syndrome in a Patient with Ovarian Cancer Tue, 16 Jun 2015 09:08:53 +0000 Tumor lysis syndrome (TLS) is a potentially life-threating complication of tumors or chemotherapy treatment. TLS commonly occurs in hematological malignancies, but it is very rare in patients with a solid tumor. In cases of solid tumors, TLS usually occurs spontaneously and after the initiation of anticancer therapy, and it has a high mortality rate. We present the novel case of a 62-year-old woman with an ovarian tumor who spontaneously developed TLS. Surgical reduction of the tumor mass vastly improved her condition. She showed no sign of tumor recurrence 8 months after treatment. As TLS is life-threatening, successful treatments must be seriously considered. Kazuhiro Okamoto, Toshifumi Kinoshita, Miyuki Shimizu, Isoji Okura, Akinori Kawada, Koichi Mizobuchi, and Midori Ando Copyright © 2015 Kazuhiro Okamoto et al. All rights reserved. Incidental Chylous Ascites at the Time of Cesarean Section Mon, 15 Jun 2015 12:14:35 +0000 Chylous ascites has multiple etiologies including malignancies, liver cirrhosis, intraperitoneal infections, and trauma. It is rarely reported in pregnancy. We report a case of chylous ascites noted at the time of cesarean section performed at 35 weeks of gestation on a patient with preeclampsia and suspected placental abruption. The diagnosis and treatment of chylous ascites as well as the pregnancy outcome are presented. A literature review of chylous ascites in pregnancy is discussed as well. Kida A. Thompson and Antoun Al Khabbaz Copyright © 2015 Kida A. Thompson and Antoun Al Khabbaz. All rights reserved. Postpartum Pyomyoma, a Rare Complication of Sepsis Associated with Chorioamnionitis and Massive Postpartum Haemorrhage Treated with an Intrauterine Balloon Sun, 14 Jun 2015 08:57:45 +0000 We report the successful treatment of a postpartum pyomyoma, a rare but serious complication of uterine leiomyomata in a 28-year-old primigravida. The patient was treated for an Escherichia Coli (E. Coli) urinary tract infection (UTI) at 16 weeks of gestation. She had asymptomatic short cervical length on ultrasound scan at 20 weeks that was managed conservatively due to the presence of further UTI and received antibiotics. She was known to have a left sided intramural leiomyoma. She presented with abdominal pain and vaginal bleeding at 23+1 weeks of gestation and the next day she had spontaneous vaginal delivery and collapsed with E. Coli septic shock, massive postpartum haemorrhage, and disseminated intravascular coagulation and was successfully treated with oxytocic drugs, a Rusch intrauterine balloon, and intravenous antibiotics. Eleven days postnatally she re-presented with systemic sepsis and was treated for retained products of conception. Sepsis persisted and investigations showed a postpartum pyomyoma that was initially managed with intravenous antibiotics to avoid surgery. Ultimately she required laparotomy, drainage of pyomyoma, and myomectomy. Postoperative recovery was good and the patient had a successful pregnancy two years later. Mandeep Kaler, Ruth Gailer, Joseph Iskaros, and Anna L. David Copyright © 2015 Mandeep Kaler et al. All rights reserved. Estimating the Radiation Dose to the Fetus in Prophylactic Internal Iliac Artery Balloon Occlusion: Three Cases Tue, 09 Jun 2015 08:00:08 +0000 Background. Although radiation exposure is of great concern to expecting patients, little information is available on the fetal radiation dose associated with prophylactic internal iliac artery balloon occlusion (IIABO). Here we estimated the fetal radiation dose associated with prophylactic IIABO in Caesarean section (CS). Cases. We report our experience with the IIABO procedure in three consecutive patients with suspected placenta previa/accreta. Fetal radiation dose measurements were conducted prior to each CS by using an anthropomorphic phantom. Based on the simulated value, we calculated the fetal radiation dose as the absorbed dose. We found that the fetal radiation doses ranged from 12.88 to 31.6 mGy. The fetal radiation dose during the prophylactic IIABOs did not exceed 50 mGy. Conclusion. The IIABO procedure could result in a very small increase in the risk of harmful effects to the fetus. Kentaro Kai, Tomohiro Hamada, Akitoshi Yuge, Hiro Kiyosue, Yoshihiro Nishida, Kaei Nasu, and Hisashi Narahara Copyright © 2015 Kentaro Kai et al. All rights reserved. Ureteral Injury with Delayed Massive Hematuria after Transvaginal Ultrasound-Guided Oocyte Retrieval Thu, 04 Jun 2015 13:21:05 +0000 We report a case of ureteral injury with delayed hematuria after transvaginal oocyte retrieval. A 28-year-old infertile patient with a history of previous laparoscopic resection of endometriotic nodes of both sacrouterine ligaments presented with abdominal pain one day after oocyte retrieval. Four days after oocyte retrieval, she presented with massive hematuria that reappeared 6 days after oocyte retrieval. Monopolar coagulation with wire electrode and insertion of a double-J-stent was performed during operative cystoscopy. The patient recovered completely after transfusion and had no signs of renal impairment after ureteric stent removal. This is the first report of ureteral injury after oocyte retrieval presenting itself with delayed massive hematuria and no signs of renal dysfunction or urinary leakage into retroperitoneal space. Tanja Burnik Papler, Eda Vrtačnik Bokal, Vesna Šalamun, Dejan Galič, Tomaž Smrkolj, and Nina Jančar Copyright © 2015 Tanja Burnik Papler et al. All rights reserved. Management of Second Trimester Fetal Demise in a Noncommunicating Uterine Horn Wed, 03 Jun 2015 08:54:14 +0000 Müllerian anomalies are uncommon but when present they can increase the risk of obstetrical complications. Anomalies such as bicornuate and unicornuate uterus can also increase the surgical risks of pregnancy termination. The diagnostic approach and surgical management must be individualized for each patient so that the termination procedure is safe and preserves fertility. We present a case of a patient with a 17-week pregnancy with fetal demise in a noncommunicating right uterine horn. Laparotomy and hysterotomy were required for evacuation of the fetus. The use of appropriate imaging studies to diagnose suspected uterine anomalies and a flexible and individualized operative strategy are essential for reducing complications associated with the termination of abnormal or unintended pregnancies in women with Müllerian anomalies. R. Tyler Hillman, Homer G. Chin, and Sheila K. Mody Copyright © 2015 R. Tyler Hillman et al. All rights reserved. A Case of Chronic Abdominal Neuropathic Pain and Burning after Female Genital Cutting Tue, 02 Jun 2015 11:53:17 +0000 Introduction. Female genital cutting is prevalent in the Middle Eastern and African countries. This ritual entails not only immediate complications such as infection, pain, and haemorrhage, but also chronic ones including dysmenorrhea and dyspareunia. However, there is limited data on neuropathic pain secondary to female genital mutilation when searching the literature. Case. This case discusses a 38-year-old female with a history of infibulation who presented with a chronic burning abdominal and anterior vulvar pain including the related investigations and treatment. Discussion. This case brings to light the additional delayed complication of this ritual: sensory neuropathy. Our goal is to educate health professionals to be aware of these complications and to appropriately investigate and treat them in order to find a solution to relieve the patients’ symptoms. Vicky Hadid and Michael Haim Dahan Copyright © 2015 Vicky Hadid and Michael Haim Dahan. All rights reserved. Bilateral Maternal Pelvic Kidneys Presenting as a Tumor Previa: Sonographic Diagnosis and Obstetric Management Tue, 02 Jun 2015 07:14:47 +0000 Renal ectopia occurs when the kidney fails to ascend normally to the retroperitoneal renal fossa. Bilateral cases have also been reported but are very rare. Pregnancy and labor with maternal renal ectopia provides a unique challenge to the obstetricians attempting to prevent damage to the kidneys during labor and allow safe delivery. We describe a case of congenital bilateral pelvic kidneys assessed and diagnosed by 3D sonography as “tumor previa” and managed accordingly. Eran Weiner, Karina Haratz, Maya Ram, and Zvi Leibovitz Copyright © 2015 Eran Weiner et al. All rights reserved. Extensive Thrombosis of the Inferior Vena Cava and Left Renal Vein in a Neonate Mon, 01 Jun 2015 06:55:17 +0000 Antenatal renal vein thrombosis is a rarely described diagnostic finding, with variable consequences on kidney function. We present the case of an affected fetus, born at 35-week gestation, with intrauterine oligohydramnios and two small kidneys. A renal ultrasound carried out after birth confirmed the presence of prenatal abnormalities. Renal vein thrombosis was not diagnosed at the time. The baby died 20 days later of kidney failure, metabolic acidosis, and polypnea with severe hypotrophy. Autopsy revealed atrophied kidneys and adrenal glands. The vena cava had thrombosis occupying most of its length. The right renal vein was normal, while the left renal vein was threadlike and not permeable. Histologically, there was necrosis of the left adrenal gland with asymmetrical bilateral renal impairment and signs of ischemic and hemorrhagic lesions. A review of thrombophilia was carried out and a heterozygous mutation in Factor V was found in both the mother and the child. Moez Kdous, Oussema Khlifi, Marwene Brahem, Mohamed Khrouf, Sarah Amari, Monia Ferchiou, and Fethi Zhioua Copyright © 2015 Moez Kdous et al. All rights reserved. Xanthogranulomatous Salpingooophoritis: The Youngest Documented Case Report Sun, 31 May 2015 13:37:02 +0000 Background. Xanthogranulomatous inflammation is an uncommon affection of the female genital tract. The youngest case reported of xanthogranulomatous salpingooophoritis in literature was by Shilpa et al. in 2013 in an eighteen-year-old female. Case Report. We report a case of 2-year-old female child with right-sided xanthogranulomatous salpingooophoritis presented as mass in abdomen. This is a case report of the youngest documented case of xanthogranulomatous salpingooophoritis in literature. As per abdominal examination, there was generalized distention of abdomen and a mass was palpable which was arising out of pelvis more on the right side. The ultrasonography (USG) abdomen and pelvis revealed a thick-walled mass measuring 9.2 cm × 6.0 cm × 7.6 cm in pelvis. We did right salpingooophorectomy of the patient. On histopathology, the diagnosis of xanthogranulomatous salpingooophoritis was confirmed. Conclusion. Clinical presentation, radiological appearance, and gross features of xanthogranulomatous lesions of ovary can mimic neoplastic lesions and lead to misdiagnosis. Though, it is very rare in pediatric age group, xanthogranulomatous salpingooophoritis as one of the differential diagnoses should be kept in mind while dealing with tuboovarian masses in this age group. Harshawardhan Tanwar, Avinash Joshi, Vinayak Wagaskar, Siddharth Kini, and Manoj Bachhav Copyright © 2015 Harshawardhan Tanwar et al. All rights reserved. Gonococcal Chorioamnionitis with Antepartum Fetal Death In Utero Sun, 31 May 2015 12:52:51 +0000 We report the case of a patient who developed gonococcal chorioamnionitis resulting in stillbirth at 28 + 4 weeks of pregancy. As this infection is rare and potentially serious, questions remain regarding occurrence and screening for Neisseria gonorrhoeae infection. B. Coutanceau, J. Boujenah, and C. Poncelet Copyright © 2015 B. Coutanceau et al. All rights reserved. Carnitine Deficiency and Pregnancy Thu, 28 May 2015 11:30:40 +0000 We present two cases of carnitine deficiency in pregnancy. In our first case, systematic screening revealed L-carnitine deficiency in the first born of an asymptomatic mother. In the course of her second pregnancy, maternal carnitine levels showed a deficiency as well. In a second case, a mother known with carnitine deficiency under supplementation was followed throughout her pregnancy. Both pregnancies had an uneventful outcome. Because carnitine deficiency can have serious complications, supplementation with carnitine is advised. This supplementation should be continued throughout pregnancy according to plasma concentrations. Anouk de Bruyn, Yves Jacquemyn, Kristof Kinget, and François Eyskens Copyright © 2015 Anouk de Bruyn et al. All rights reserved. Primary T-Cell Non-Hodgkin Lymphoma of the Vagina Tue, 26 May 2015 09:05:26 +0000 The primary vaginal T-cell non-Hodgkin lymphoma is a rare form of lymphoma. Most of the previously published cases were about B-cell non-Hodgkin lymphomas. We present the case of a vaginal mass in an 82-year-old patient presenting vaginal bleeding. The results of the immunohistological studies of the mass revealed the presence of a cytotoxic T-cell non-Hodgkin lymphoma, which is the least common subtype. J. L. Herraiz, A. Llueca, Y. Maazouzi, D. Piquer, A. Palmeiro, and E. Calpe Copyright © 2015 J. L. Herraiz et al. All rights reserved. Metastatic Uterine Leiomyosarcoma Involving Bilateral Ovarian Stroma without Capsular Involvement Implies a Local Route of Hematogenous Dissemination Sun, 24 May 2015 09:52:24 +0000 Uterine sarcomas spread via lymphatic and hematogenous dissemination, direct extension, or transtubal transport. Distant metastasis often involves the lungs. Ovarian metastasis is uncommon. Here we present an unusual case of a large, high-grade uLMS with metastatic disease internal to both ovaries without capsular involvement or other abdominal diseases, and discovered in a patient with distant metastases to the lungs, suggesting likely hematogenous dissemination of uLMS to the ovaries in this case. Knowledge of usual uLMS metastases may influence surgical management in select cases. Monica Dandapani, Brandon-Luke L. Seagle, Amer Abdullah, Bryce Hatfield, Robert Samuelson, and Shohreh Shahabi Copyright © 2015 Monica Dandapani et al. All rights reserved. Xanthogranulomatous Pyelonephritis Associated with Hepatic Dysfunction in Pregnancy Thu, 21 May 2015 08:41:32 +0000 Xanthogranulomatous pyelonephritis is a rare disease characterised by the replacement of normal renal parenchyma by foamy macrophages. The only treatment for this type of pyelonephritis is of a surgical nature with partial or total nephrectomy. The occurrence of xanthogranulomatous pyelonephritis during pregnancy is a rare event (with only 6 cases described in the literature). We report a case of xanthogranulomatous pyelonephritis in a 32-week pregnant woman associated with hepatic dysfunction. L. Ferreira, C. Oliveira, C. Cruz, and A. Pacheco Copyright © 2015 L. Ferreira et al. All rights reserved. Warfarin-Associated Diaphragmatic Hernia: An Unusual Diagnosis Wed, 20 May 2015 12:26:08 +0000 Fetal warfarin syndrome is a consequence of maternal intake of warfarin during pregnancy and comprises a wide range of manifestations, including some typical facial dysmorphologic features. The authors report a case of prenatal ultrasonographic diagnosis of warfarin embryopathy in an obese woman on unsupervised warfarin prophylaxis at the 16th week of gestation. The fetus presented with facial dysmorphism, pectus excavatum, diaphragmatic hernia, and pulmonary hypoplasia. To the best of our knowledge, this is the second reported case of warfarin-associated diaphragmatic hernia. Cristina Vilhena, Cátia Gameiro, Cláudia Tomás, Antónia Santos, and Raquel Ilgenfritz Copyright © 2015 Cristina Vilhena et al. All rights reserved. Prenatal Three-Dimensional Ultrasound Detection of Adducted Thumbs in X-Linked Hydrocephaly: Two Case Reports with Molecular Genetic Studies Wed, 20 May 2015 11:44:50 +0000 X-linked hydrocephaly is a rare sex-linked genetic recessive condition occurring in 1/30,000 deliveries. Adduction of thumbs and mental retardation are additional associated clinical findings. We describe two cases of X-linked hydrocephaly with associated adducted thumbs that were diagnosed prenatally with the combined use of three-dimensional (3D) ultrasound and fetal blood sampling for cytogenetic and molecular analyses. This report suggests that 3D ultrasound can facilitate the identification of adducted thumbs in fetuses affected by X-linked hydrocephaly and supports evaluation of the fetal hands as an integral part of the ultrasound anatomical assessment in male fetuses with hydrocephaly secondary to aqueductal stenosis. Edgardo Corral, Andres Barrios, Monica Isnard, Pascale Saugier-Veber, Sophie M. Fortier, Sarah Durrin, and Waldo Sepulveda Copyright © 2015 Edgardo Corral et al. All rights reserved. Primary Fallopian Tube Clear Cell Adenocarcinoma in Pregnancy: Case Presentation and Review of the Literature Tue, 19 May 2015 13:59:22 +0000 Primary fallopian tube cancer in pregnancy is rare and is even more so for the clear cell variant. Our case is the third case of primary fallopian tube cancer in pregnancy and the first case of clear cell adenocarcinoma of the fallopian tube in pregnancy. The patient presented with increasing pelvic pain starting in the second trimester. Serial ultrasound evaluations were performed and revealed a rapidly growing complex adnexal mass adjacent to the uterus. Her pregnancy was further complicated by spontaneous preterm labor and she delivered prematurely per vaginam at 31 weeks. She underwent an urgent laparotomy in the immediate postpartum period for acute aggravation of her right pelvic pain and fever. The diagnosis of tubal clear cell adenocarcinoma was subsequently made on histopathology examination. Mohammed Malak and Stephanie Klam Copyright © 2015 Mohammed Malak and Stephanie Klam. All rights reserved. Gestational Choriocarcinoma Presenting with Lacrimal Gland Metastasis: A First Reported Case Thu, 14 May 2015 12:54:32 +0000 Background. Gestational choriocarcinoma (GC) is a recognized clinicopathological subtype of gestational trophoblastic neoplasia that usually metastasizes hematogenously to highly vascular organs like the lung, liver, and brain. However, orbital metastasis to the choroid and lacrimal gland is a rare occurrence. Case Presentation. A 21-year-old female presented with headache and left orbital swelling one year after resection of a complete hydatidiform mole followed by adjuvant methotrexate chemotherapy. A metastatic imaging screening revealed multiple metastases in the lungs, brain, and adrenal gland, in addition to the choroid and lacrimal gland. Based on her modified WHO risk factors scoring she was started on chemotherapy and whole brain radiotherapy, which resulted in a complete response. At two-year follow-up, serum b-HCG level was with normal limits; imaging surveillance was uneventful. Conclusion. We present the first case of lacrimal gland metastasis in a young girl from GC relapse. Naushad A. B. Ahamed, Khalid Sait, Nisreen Anfnan, Khader Farwan, S. H. M. Nizamuddin, and Saleh S. Baeesa Copyright © 2015 Naushad A. B. Ahamed et al. All rights reserved. Ovarian Seromucinous Borderline Tumor and Clear Cell Carcinoma: An Unusual Combination Wed, 13 May 2015 12:00:08 +0000 Ovarian seromucinous borderline tumors (SMBTs) are rare. They architecturally resemble serous borderline tumors but are much more frequently associated with endometriosis. The coexistence of other tumors with seromucinous tumors is also extremely rare. Here, we report an unusual combination of bilateral ovarian SMBT and clear cell carcinoma associated with polypoid endometriosis of the colon, in a 62-year-old woman. There was no transitional lesion between the two tumors. Immunohistochemistry showed different staining patterns in tumor components. Seromucinous tumor cells were positive for estrogen receptor (ER) and progesterone receptor (PgR) but negative for Napsin A, p504S, and HNF1B. Clear cell tumor cells were positive for Napsin A and p504S and focally positive for HNF1B but negative for ER and PgR. Loss of ARID1A expression was not observed in SMBTs, clear cell tumors, or endometriosis. These findings suggest that these tumors arose from separate endometriosis foci and collided within the same ovary. To the best of our knowledge, this is the first case of this unusual combination of ovarian seromucinous tumor and clear cell carcinoma to be reported in the English literature. Eriko Nakamura, Yuichiro Sato, Sayaka Moriguchi, Atsushi Yamashita, Takashi Higo, and Yujiro Asada Copyright © 2015 Eriko Nakamura et al. All rights reserved. Pancreatic and Colonic Abscess Formation Secondary to HELLP Syndrome Tue, 12 May 2015 06:26:29 +0000 Preeclampsia and the variant HELLP syndrome are systemic conditions associated with vascular changes resulting in vasoconstriction. Most commonly, patients present with elevated blood pressure and proteinuria, with a background of complaints such as headache, scotoma, and right upper quadrant pain. The systemic vascular changes experienced can target any organ system, oftentimes with more than one organ system being involved. We present the case of a patient admitted with HELLP syndrome who subsequently developed multisystem organ dysfunction, including placental abruption, disseminated intravascular coagulopathy, acute renal failure, colitis, abdominal ascites, pancreatitis, and the development of pancreatic and colonic abscesses. James M. O’Brien, Nicole Pursell, and Fred Fumia Copyright © 2015 James M. O’Brien et al. All rights reserved. Management of Recurrent Stricture Formation after Transverse Vaginal Septum Excision Mon, 11 May 2015 11:20:13 +0000 Background. A transverse vaginal septum (TVS) is a rare obstructing anomaly, caused due to improper fusion of Müllerian ducts and urogenital sinus during embryogenesis. Case. A 15-year-old girl presented with primary amenorrhea. She had multiple congenital anomalies. Initial examination and imaging investigation revealed the presence of a unicornuate uterus and a TVS. The TVS was excised; however the patient was unable to perform vaginal dilation postoperatively leading to recurrent stricture formation. She underwent multiple surgeries for excision of the stricture. The patient was eventually evaluated every day in the clinic until she was able to demonstrate successful vaginal dilatation in the presence of a clinician. Summary and Conclusion. Properly guided regular and intensive vaginal dilation after TVS excision may decrease the need of reoperations due to recurrent stricture formation. Ridhima Gupta, Joseph D. Bozzay, David L. Williams, Robert T. DePond, and Pickens A. Gantt Copyright © 2015 Ridhima Gupta et al. All rights reserved. Mucoepidermoid Carcinoma of Uterine Cervix: A Distinct Pathological and Clinical Entity Sun, 10 May 2015 09:30:16 +0000 Mucoepidermoid carcinoma of uterine cervix is a rare tumor that has some individual features. Defining risk factors after surgery shape the postoperative treatment modality on cervical cancer patients. Although there is not a well-known strategy for the postoperative follow-up of mucoepidermoid carcinoma, the aggressive behaviour of this tumor makes the gynecological oncologists choose liberal therapies on these patients. Ilker Selcuk, Bulent Ozdal, Mengu Turker, Alp Usubutun, Tayfun Gungor, and Mehmet Mutlu Meydanli Copyright © 2015 Ilker Selcuk et al. All rights reserved. Rectal Cancer Diagnosed after Cesarean Section in Which High Microsatellite Instability Indicated the Presence of Lynch Syndrome Thu, 07 May 2015 09:52:57 +0000 We report a case of rectal cancer with microsatellite instability (MSI) that probably resulted from Lynch syndrome and that was diagnosed after Cesarean section. The patient was a 28-year-old woman (gravid 1, para 1) without a significant medical history. At 35 gestational weeks, vaginal ultrasonography revealed a 5 cm tumor behind the uterine cervix, which was diagnosed as a uterine myoma. The tumor gradually increased in size and blocked the birth canal, resulting in the patient undergoing an emergency Cesarean section. Postoperatively, the tumor was diagnosed as rectal cancer with MSI. After concurrent chemoradiation therapy, a lower anterior resection was performed. The patient’s family history revealed she met the criteria of the revised Bethesda guidelines for testing the colorectal tumor for MSI. Testing revealed that the tumor did indeed show high MSI and, combined with the family history, suggested this could be a case of Lynch syndrome. Our findings emphasize the importance of considering the possibility of Lynch syndrome in pregnant women with colorectal cancer, particularly those with a family history of this condition. We suggest that the presence of Lynch syndrome should also be considered for any young woman with endometrial, ovarian, or colorectal cancer. Tomohiro Okuda, Hiroshi Ishii, Sadao Yamashita, Sakura Ijichi, Seiki Matsuo, Hiroyuki Okimura, and Jo Kitawaki Copyright © 2015 Tomohiro Okuda et al. All rights reserved.