Case Reports in Obstetrics and Gynecology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . 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. The Challenge of Prenatal Diagnostic Work-Up of Maternally Inherited X-Linked Opitz G/BBB: Case Report and Literature Review Mon, 04 May 2015 13:54:18 +0000 Background. Prenatal diagnosis of Optiz G/BBB syndrome (OS) is challenging because the characteristic clinical features, such as facial and genitourinary anomalies, may be subtle at sonography and rather unspecific. Furthermore, molecular testing of the disease gene is not routinely performed, unless a specific diagnosis is suggested. Method. Both familial and ultrasound data were used to achieve the diagnosis of X-linked OS (XLOS), which was confirmed by molecular testing of MID1 gene (Xp22.3) at birth. Results. Sequencing of MID1 gene disclosed the nucleotide change c.1285 +1 G>T, previously associated with XLOS. Conclusions. This case illustrates current challenges of the prenatal diagnostic work-up of XLOS and exemplifies how clinical investigation, including family history, and accurate US foetal investigations can lead to the correct diagnosis. Marialuigia Spinelli, Carmine Sica, Bruno Dallapiccola, Antonio Novelli, Letizia Di Meglio, and Pasquale Martinelli Copyright © 2015 Marialuigia Spinelli et al. All rights reserved. Vulvar Metastasis from Bladder Cancer Mon, 27 Apr 2015 09:13:02 +0000 Vulvar metastasis of urothelial carcinoma of the bladder is a very rare entity; few cases are reported in the English literature. In this paper, we describe the clinical and pathological characteristics, evolution, and treatment of a patient with vulvar metastasis of urothelial carcinoma of the bladder followed by a brief review of the reported cases in the literature. Fouad Aoun, Elie El Rassy, Hampig Raphael Kourie, Eric Hawaux, and Roland van Velthoven Copyright © 2015 Fouad Aoun et al. All rights reserved. Uterine Necrosis Associated with Fusobacterium necrophorum Infection Mon, 27 Apr 2015 07:49:07 +0000 Fusobacterium necrophorum is infrequently implicated as a pathogenic organism. When pathogenic, the typical clinical presentation is that of pharyngitis, cervical adenopathy, and unilateral thrombophlebitis of the internal jugular vein. Infections caused by Fusobacterium necrophorum within the fields of obstetrics and gynecology have been infrequently reported. We describe a 19-year-old woman who underwent a cesarean delivery complicated by sepsis and purulent uterine necrosis secondary to Fusobacterium necrophorum infection. T. Widelock, R. Elkattah, S. Gibbs, Z. Mashak, S. Mohling, and S. DePasquale Copyright © 2015 T. Widelock et al. All rights reserved. A Case of Ultrasound Diagnosis of Fetal Hiatal Hernia in Late Third Trimester of Pregnancy Thu, 23 Apr 2015 05:54:11 +0000 Congenital hiatal hernia is a condition characterized by herniation of the abdominal organs, most commonly the stomach, through a physiological but overlax esophageal hiatus into the thoracic cavity. Prenatal diagnosis of this anomaly is unusual and only eight cases have been reported in the literature. In this paper we describe a case of congenital hiatal hernia that was suspected at ultrasound at 39 weeks’ gestation, on the basis of a cystic mass in the posterior mediastinum, juxtaposed to the vertebral body. Postnatal upper gastrointestinal tract series confirmed the prenatal diagnosis. Postnatal management was planned with no urgency. Hiatal hernia is not commonly considered in the differential diagnosis of fetal cystic chest anomalies. This rare case documents the importance of prenatal diagnosis of this anomaly for prenatal counseling and postnatal management. Stefania Di Francesco, Mariano Matteo Lanna, Marcello Napolitano, Luciano Maestri, Stefano Faiola, Mariangela Rustico, and Enrico Ferrazzi Copyright © 2015 Stefania Di Francesco et al. All rights reserved. Decidualized Ovarian Mass Mimicking Malignancy Wed, 15 Apr 2015 13:13:11 +0000 Deciduosis classically occurs in the context of known endometriosis in the pelvis, most commonly in the ovaries, but also in the peritoneum. However, ovarian deciduosis outside the context of endometriosis is rare and makes diagnosis difficult, especially as the sonographic appearance suggests a malignant process. We report a case of decidualized ovarian mass in a patient without prior history of endometriosis that mimicked an ovarian malignancy. MRI may be a useful imaging modality to monitor these lesions and guide management. Consultation with a multidisciplinary team accustomed to such conditions will help to tailor the management to each individual. Lufee Wong, Vola Botolahy, Thibault Carteret, Marion Marty, and Jean-Luc Brun Copyright © 2015 Lufee Wong et al. All rights reserved. Conservative Treatment of Ewing’s Sarcoma of the Uterus in Young Women Wed, 15 Apr 2015 12:58:33 +0000 Ewing sarcoma-primitive neuroectodermal tumors (ES/PNETs) constitute a family of neoplasms characterized by a continuum of neuroectodermal differentiations. ES/PNET of the uterus is rare. There are 48 cases of ES/PNET of the uterus published in the literature as far as we know. We describe a case of Ewing sarcoma of the uterus occurring in a 17-year-old woman presenting with a two-month history of pelvic pain. After surgical excision and microscopic, immunohistochemical, and electron microscopy examination, the diagnosis of Ewing sarcoma of the uterus was suggested. This report will discuss the diagnosis and surgical and clinical management of Ewing uterine sarcoma in young women, according to the available literature. In spite of the rarity of ES/PNETs, they should be taken into account in the differential diagnosis of uterine neoplasms in young women. Giuseppe Loverro, Leonardo Resta, Edoardo Di Naro, Anna Maria Caringella, Salvatore Andrea Mastrolia, Mario Vicino, Massimo Tartagni, and Luca Maria Schonauer Copyright © 2015 Giuseppe Loverro et al. All rights reserved. Successful Reduction of Acute Puerperal Uterine Inversion with the Use of a Bakri Postpartum Balloon Sun, 12 Apr 2015 14:27:59 +0000 Uterine inversion is a state wherein the endometrial surface is inverted. Although this condition may be observed in nonpregnant women, it most commonly develops at the time of delivery. In the present case, a 37-year-old woman without any remarkable history developed acute puerperal uterine inversion after the successful induction of labor. Following the delivery, she complained twice of severe lower abdominal pain; subsequently, hemorrhage was noted at the site of partial detachment of the placenta. These findings led to a diagnosis of placenta accreta, and the patient developed a state of shock. A Bakri postpartum balloon was inserted into the uterine cavity under ultrasonographic guidance and was filled with physiological saline for treatment of this condition. With this procedure, the uterine inversion was completely reduced and the hemorrhage was stopped. Moreover, no reinversion was observed in the postoperative period. These findings suggest that a Bakri postpartum balloon can be used to noninvasively reduce uterine inversion and prevent its recurrence. Akinori Ida, Koichi Ito, Yoko Kubota, Maiko Nosaka, Hiroshi Kato, and Yoshiyuki Tsuji Copyright © 2015 Akinori Ida et al. All rights reserved. Giant Vulvar Epidermoid Cyst in an Adolescent Girl Thu, 09 Apr 2015 14:05:41 +0000 Introduction. Vulvar cyst in adolescent girls is very uncommon. Epidermoid cyst can be seen in many sites including face, trunk, and extremities but its occurrence in vulva is uncommon. This is the first case of epidermoid cyst of vulva reported in an adolescent girl. Case. A 17-year-old, adolescent girl admitted to our gynecology outpatient clinic with a complaint of painful and palpable mass in her vulva. On examination, a giant mass located in left vulva and labia majora with 11 cm in diameter was seen. The magnetic resonance imaging (MRI) showed a well-defined cystic mass without contrast enhancement. The surgery was advised to the patient and the pathologic examination of mass revealed vulvar epidermoid cyst. Discussion. Vulvar cysts generally grow slowly and the main etiologies are vulvar trauma and surgical interventions including episiotomy and female circumcision in some culture. The exact treatment is total surgical excision and pathologic examination. MRI is an important imaging modality for detection of extension to deep perineal tissue and localization of mass in vulva especially in giant ones. Conclusion. Although vulvar mass in adolescents is rare, the epidermoid cyst with benign origin should be kept in mind. Erbil Karaman, Numan Çim, Zülküf Akdemir, Erkan Elçi, and Hüseyin Akdeniz Copyright © 2015 Erbil Karaman et al. All rights reserved. Comment on “Intrapartum Intrauterine Fetal Demise with Normal Umbilical Cord Blood Gas Values at Birth” Thu, 09 Apr 2015 10:05:18 +0000 Jeffrey J. Pomerance Copyright © 2015 Jeffrey J. Pomerance. All rights reserved. Tubocutaneous Fistula Tue, 07 Apr 2015 13:08:21 +0000 Introduction. Tubocutaneous fistula is a very rare condition; most cases described in the literature are secondary to endometriosis, tuberculosis, and complications of child birth and gynecological operations. Case Presentation. We report a case of 40-year-old woman who presented with tubocutaneous fistula secondary to pelvic inflammatory disease which was diagnosed in the setting of persistent discharging wound in the right groin. Conclusion. Tubocutaneous fistula is a rare condition. Salpingectomy and resection of fistulous tract is the treatment of choice as is treating the underlying cause. Early diagnosis and treatment of these patients are essential for avoiding long term complications. Krishnaveni Nayini and Clive Gie Copyright © 2015 Krishnaveni Nayini and Clive Gie. All rights reserved. Triplet Delivery following Unilateral Twin Salpingocyesis Thu, 02 Apr 2015 11:10:56 +0000 We present the case of a 36-year-old woman with primary infertility of six-year duration who had IVF/ICSI on account of male factor infertility. Transvaginal scanning done on the 30th day following embryo transfer revealed an empty uterine cavity with two gestational sacs containing active fetal echoes in the right adnexum. Patient reluctantly had right salpingectomy via open laparatomy. The patient had repeat embryo transfer eleven months afterwards that culminated in the delivery of living twins with a fetal papyraceous. Johnson O. Komolafe, Rasaq A. Akindele, Adeniyi O. Fasanu, Callistus A. Akinleye, Taiwo O. Akinbile, Monisayo O. Komolafe, and Muyiwa O. Oguntunde Copyright © 2015 Johnson O. Komolafe et al. All rights reserved. Widespread Recurrence 7 Years after Radical Abdominal Trachelectomy for Early Cervical Adenocarcinoma Mon, 30 Mar 2015 12:10:28 +0000 Cervical cancer is the third most common female cancer worldwide and the use of routine screening resulted in earlier stage and younger age at diagnosis. Fertility preservation via radical trachelectomy comes up as an option in such patients. Recent literature reviews confirm the safety of this operation with excellent oncologic outcomes in appropriately chosen patients. However, recurrent disease is likely and a strict follow-up is recommended to detect recurrences at an early stage following radical trachelectomy. In this report, a case who underwent radical trachelectomy and developed widespread recurrences 7 years after initial surgery possibly due to the lack of oncologic follow-up is discussed. M. Coskun Salman, Nejat Ozgul, and Kunter Yuce Copyright © 2015 M. Coskun Salman et al. All rights reserved. Primary Hyperparathyroidism in Pregnancy: A Two-Case Report and Literature Review Sun, 29 Mar 2015 08:05:27 +0000 Primary hyperparathyroidism (PHPT) in pregnant women is an uncommon disease. It could be easily misdiagnosed because of physiologic changes during pregnancy; in some cases, patients could remain asymptomatic maintaining elevated calcium serum levels, and this situation represents a threat to the health of both mother and fetus. We present two cases of PHPT during pregnancy and their evolution after surgical treatment in the second trimester; there were no observed complications during pregnancy or delivery in our patients. Early diagnosis and medical/surgical treatment in PHPT are necessary for avoiding maternal and fetal complications which could not be predicted based on duration or severity of hypercalcemia. An appropriate management of PHPT during pregnancy is necessary for preserving the health of both the woman and the fetus. A. D. Herrera-Martínez, R. Bahamondes-Opazo, R. Palomares-Ortega, C. Muñoz-Jiménez, M. A. Gálvez-Moreno, and J. M. Quesada Gómez Copyright © 2015 A. D. Herrera-Martínez et al. All rights reserved. Paraurethral Leiomyoma in a Postmenopausal Woman: First European Case Tue, 24 Mar 2015 06:12:17 +0000 Leiomyomas are benign tumors extending from smooth muscle cells and only few cases of paraurethral leiomyomas have been described in the literature. They are often seen in the reproductive age and around 50% of the cases are asymptomatic. We describe a 59-year-old woman with a solid mobile tumor below the symphysis revealed at a gynecological examination. Transvaginal ultrasound and MRI confirmed the tumor and excision of the paraurethral tumor was carried out. The histological examination showed a benign paraurethral leiomyoma. The postoperative period was characterized by urethral pain as well as vaginal leakage of urine. Susy Shim, Camilla Skovvang Borg, Huda Galib Majeed, and Peter Humaidan Copyright © 2015 Susy Shim et al. All rights reserved. An Ovarian Pregnancy in a Patient with a History of Bilateral Salpingectomies: A Rare Case Tue, 17 Mar 2015 08:28:26 +0000 Background. 1 in 200 ectopic pregnancies are true ovarian pregnancies that fulfill the Spiegelberg criteria. Despite being rare, multiple case reports and series have been reported. Few cases have been published in which the event was preceded by salpingectomy. Case. The patient is a 32-year-old female who presented to the emergency room with abdominal pain. She was found to be pregnant, despite a history of two previous ectopic pregnancies treated with salpingectomies. Sonography confirmed a left adnexal mass and free fluid. Surgery revealed a ruptured ovarian pregnancy which was also confirmed by pathology. Conclusion. This is a case of an ovarian pregnancy in a patient with two previous salpingectomies. It underscores the importance of searching for an ectopic pregnancy in patients with abdominal pain after fertility impairing surgery. Sadia Khandaker, Pranav Chitkara, Eric Cochran, and Jed Cutler Copyright © 2015 Sadia Khandaker et al. All rights reserved. Uterine Balloon Tamponade in Combination with Topical Administration of Tranexamic Acid for Management of Postpartum Hemorrhage Thu, 12 Mar 2015 09:38:46 +0000 While uterine balloon tamponade is an effective modality for control of postpartum hemorrhage, the reported success rates have ranged from the level of 60% to the level of 80%. In unsuccessful cases, more invasive interventions are needed, including hysterectomy as a last resort. We developed a modified tamponade method and applied it to two cases of refractory postpartum hemorrhage after vaginal delivery. The first case was accompanied by uterine myoma and low-lying placenta. After an induced delivery, the patient had excessive hemorrhage due to uterine atony. Despite oxytocin infusion and bimanual uterine compression, the total blood loss was estimated at 2,800 mL or more. The second case was diagnosed as placental abruption complicated by fetal death and severe disseminated intravascular coagulation, subsequently. A profuse hemorrhage continued despite administration of uterotonics, fluid, and blood transfusion. The total blood loss was more than 5,000 mL. In each case, an intrauterine balloon catheter was wrapped in gauze impregnated with tranexamic acid, inserted into the uterus, and inflated sufficiently with sterile water. In this way, mechanical compression by a balloon and a topical antifibrinolytic agent were combined together. This method brought complete hemostasis and no further treatments were needed. Both the women left hospital in stable condition. Masato Kinugasa, Hanako Tamai, Mayu Miyake, and Takashi Shimizu Copyright © 2015 Masato Kinugasa et al. All rights reserved. Successful Conservative Management of a Dislocated IUD Thu, 12 Mar 2015 07:56:14 +0000 Background. Intrauterine contraceptive devices (IUDs) are widely utilized all over the world owing to their low cost and high efficacy. Uterine perforation is a rare complication that may occur at IUD insertion resulting in extrauterine location of the IUD. Traditionally, surgical removal of dislocated IUDs has been recommended. Case. A 68-year-old patient who had an IUD (Lippes loop) inserted 32 years ago and whose routine examination incidentally revealed a dislocated IUD in the abdominal cavity. The patient remained asymptomatic during three years of follow-up and the IUD was left in place. Conclusion. Asymptomatic patients, whose vaginal examinations and ultrasonography or X-ray results reveal a dislocated IUD, may benefit from conservative management. Hasan Ali Inal, Zeynep Ozturk Inal, and Ender Alkan Copyright © 2015 Hasan Ali Inal et al. All rights reserved. Dealing with Pheochromocytoma during the First Trimester of Pregnancy Sun, 08 Mar 2015 14:09:39 +0000 Purpose. Pheochromocytoma in association with pregnancy is a very rare, without specific symptoms, life-threatening condition, increasing both maternal and fetal mortality up to 50%. The present paper illustrates the case of a pregnant woman, diagnosed with pheochromocytoma, aiming to demonstrate and discuss the difficulties that arouse during the diagnosis and the problems concerning the treatment. Patient. A 34-year-old woman, in the 9th week of pregnancy, complained for headache, sweating, and a feeling of heavy weight on the right renal area. A tumor of 10 cm diameter at the site of the right adrenal was found. Twenty-four-hour urine catecholamine and VMA excretion levels were well raised. Results. Multidisciplinary approach treated the patient conservatively. Surgical resection of the tumor was performed after the 14th week of pregnancy at the completion of organogenesis. Neither postoperative complications occurred nor hypertension relapse was recorded. The fetus was delivered without complications at the 36th week. Conclusions. There are no consensus and guidelines for treating pheochromocytoma during pregnancy, especially when it is diagnosed in the first trimester. The week of pregnancy and a multidisciplinary approach will determine whether the pregnancy should be continued or not, as well as the time and the approach of surgical treatment. Konstantinos Kiroplastis, Apostolos Kambaroudis, Apostolos Andronikou, Andromachi Reklou, Dimitris Kokkonis, Panagiotis Petras, Apostolos Mamopoulos, Eudokia Anagnostara, and Charalampos Spyridis Copyright © 2015 Konstantinos Kiroplastis et al. All rights reserved. Round Ligament of Uterus Leiomyoma: An Unusual Cause of Dyspareunia Thu, 05 Mar 2015 11:56:12 +0000 Round ligament of uterus leiomyoma is a rare, benign tumor of the vulva. Its incidence is not known exactly, and the mean age ranges from 13 to 70. Although clinical properties of benign and malignant diseases in the vulvar area are frequently similar, early diagnosis and treatment are essential. Local excision is recommended as definitive therapy. We present an 28-year-old female without any birth with a mass in anterior vaginal wall diagnosed as vulvar leiomyoma. In conclusion, a brief review of relevant literature emphasizes that leiomyomas are quite rare outside of the uterus but they might occur in any tissue or organ containing smooth muscle, spontaneously or parasitically after the spreading effect of an accident or surgical trauma. Clinicians should be alert especially for the diagnosis in a tissue with smooth muscle content. Ozer Birge, Deniz Arslan, Erdinc Kinali, and Berk Bulut Copyright © 2015 Ozer Birge et al. All rights reserved.