Case Reports in Obstetrics and Gynecology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Coincidence of Incomplete Pentalogy of Cantrell and Meningomyelocele in a Dizygotic Twin Pregnancy Tue, 01 Sep 2015 13:17:24 +0000 Pentalogy of Cantrell is an extremely rare and lethal syndrome. Ectopia cordis is frequently found in fetuses with POC but not required for incomplete forms. Likewise, meningomyelocele is a relatively uncommon neural tube defect affecting central nervous system and associated with neurological problems. Herein, we presented a woman with dizygotic twin pregnancy having coincidence of incomplete POC and MMC in each individual fetus, which has never been reported previously. Hakan Timur, Aytekin Tokmak, Hatice Bayram, Esra Şükran Çakar, and Nuri Danışman Copyright © 2015 Hakan Timur et al. All rights reserved. Fetomaternal Hemorrhage following Placement of an Intrauterine Pressure Catheter: Report of a New Association Mon, 31 Aug 2015 12:38:40 +0000 Fetomaternal hemorrhage (FMH) can be associated with significant perinatal mortality. Our review of the literature did not identify any cases of FMH following placement of an intrauterine pressure catheter (IUPC). In our case, an IUPC was inserted in a patient undergoing induction of labor at term. Fetal bradycardia ensued shortly after placement, warranting an emergent cesarean delivery. Severe neonatal anemia was identified, and evaluation of maternal blood was consistent with massive FMH. This is the first reported association between FMH and IUPC placement. If this relationship is validated in future reports, appropriate changes in clinical practice may be warranted. Fadi G. Mirza, Harshwardhan M. Thaker, Wendy L. Flejter, and Mary E. D’Alton Copyright © 2015 Fadi G. Mirza et al. All rights reserved. Response to Plasmapheresis Measured by Angiogenic Factors in a Woman with Antiphospholipid Syndrome in Pregnancy Thu, 27 Aug 2015 13:41:44 +0000 An imbalance of angiogenic and antiangiogenic placental factors such as endoglin and soluble fms-like tyrosine kinase 1 has been implicated in the pathophysiology of preeclampsia. Extraction of these substances by plasmapheresis might be a therapeutical approach in cases of severe early-onset preeclampsia. Case Report. A 21-year-old primigravida with antiphospholipid syndrome developed early-onset preeclampsia at 18 weeks’ gestation. She was treated successfully with plasmapheresis in order to prolong pregnancy. Endoglin and sflt-1-levels were measured by ELISA before and after treatment. Endoglin levels decreased significantly after treatment (p < 0.05) and showed a significant decrease throughout pregnancy. A rerise of endoglin and sflt-1 preceded placental abruption 4 weeks before onset of incident. Conclusion. Due to the limited long-term therapeutical possibilities for pregnancies complicated by PE, plasmapheresis seems to be a therapeutical option. This consideration refers especially to pregnancies with early-onset preeclampsia, in which, after first conventional treatment of PE, prolongation of pregnancy should be above all. Karoline Mayer-Pickel, Sabine Horn, Uwe Lang, and Mila Cervar-Zivkovic Copyright © 2015 Karoline Mayer-Pickel et al. All rights reserved. Spontaneous Expulsion of Intramural Fibroid Six Weeks after Emergency Caesarean Section Wed, 26 Aug 2015 08:35:49 +0000 We present a thirty-six-year-old woman with a high risk pregnancy, complicated by multiple congenital anomalies, severe hyperemesis, a pulmonary embolus, and a large intramural fibroid. This fibroid grew in size during the pregnancy. At 34 + 5 weeks, there were reduced fetal movements and a pathological CTG. A live infant was delivered by an emergency cesarean section. Five weeks postpartum, she presented with abdominal pain, offensive vaginal discharge, and fevers. She was given antibiotics and ferrous sulphate. An abdominal ultrasound showed an 11 × 12 × 9 cm fibroid with a coarse degenerative appearance. Clinically, she showed signs of sepsis; a CT scan and laparotomy performed under general anesthetic did not find any collections as a source of sepsis. When stable, she was discharged. She re-presented two days later with a large mass (necrotic fibroid) in her vagina. This is the first case of spontaneous expulsion of fibroid six weeks after caesarean section. Presentation of pain and fever after the delivery may be due to red degeneration of the fibroid, caused by diminished blood supply, ischaemia, and necrosis. This case highlights the importance of considering fibroids as a cause for abdominal pain during and after pregnancy, even up to 6 weeks after delivery. Balvinder Sagoo, Ka Ying Bonnie Ng, G. Ghaleb, and Heather Brown Copyright © 2015 Balvinder Sagoo et al. All rights reserved. Uterus Wrapping: A Novel Concept in the Management of Uterine Atony during Cesarean Delivery Wed, 26 Aug 2015 08:04:08 +0000 Uterine atony during cesarean delivery is a serious cause of maternal morbidity and mortality. Management strategies include medical treatment with uterotonic agents, manual compression of the uterus, and interventional or surgical procedures. A novel technique to compress the uterus by wrapping it with an elastic bandage and its outcome in 3 cases of uterine atony during cesarean section are presented. Our novel method of intermittent wrapping of the uterus during cesarean delivery seems to be a successful additional approach in the management of uterine atony during cesarean delivery and may be an alternative treatment option to other compressing procedures in order to avoid high blood loss and last but not least postpartum hysterectomy. N. Kimmich, W. Engel, M. Kreft, and R. Zimmermann Copyright © 2015 N. Kimmich et al. All rights reserved. Silent Spontaneous Uterine Rupture at 36 Weeks of Gestation Wed, 19 Aug 2015 10:59:24 +0000 Introduction. Silent spontaneous rupture of the uterus before term, with extrusion of an intact amniotic sac and delivery of a healthy neonate, with no maternal or neonatal morbidity or mortality is very rare. Very few cases have been reported in literature. Case Presentation. We report a case of silent spontaneous uterine rupture, found during a scheduled repeat cesarean section at 36 weeks of gestation. Patient had history of two prior classical cesarean sections. She underwent cesarean section, with delivery of a healthy male infant. She had a good postoperative recovery and was discharged on postoperative day 3. Conclusion. Silent spontaneous rupture of the uterus before term with extrusion of an intact amniotic sac is rare. A high index of suspicion and good imaging during pregnancy are important in making this diagnosis. J. Y. Woo, L. Tate, S. Roth, and A. C. Eke Copyright © 2015 J. Y. Woo et al. All rights reserved. Pheochromocytoma Presenting as Partial HELLP Syndrome Sun, 16 Aug 2015 12:22:32 +0000 Diagnosis of pheochromocytoma in partial HELLP syndrome is extremely rare. We report a case of a 25-year-old multigravida woman at 30 weeks of gestation who presented with clinical features consistent with partial HELLP syndrome. Her symptoms were not controlled by pharmacologic therapy, and the patient underwent urgent cesarean section. The patient gave birth to a viable baby, but she sustained an episode of ventricular fibrillation intraoperatively that did not result in any long-term sequelae. The patient’s symptoms persisted postoperatively and work-up for secondary etiologies of hypertension demonstrated a right adrenal pheochromocytoma. Following resection, the patient’s signs and symptoms resolved, and her lab tests normalized. Yazan Daaboul, Serge Korjian, Lamis Khalil, and Rita Nemr Copyright © 2015 Yazan Daaboul et al. All rights reserved. Vitamin K Deficiency Embryopathy from Hyperemesis Gravidarum Wed, 12 Aug 2015 11:44:00 +0000 A 21-year-old primigravida had a pregnancy complicated by hyperemesis gravidarum (HG) beginning at 7-week gestation. Despite medical therapy, she lost 18% of her prepregnancy weight. Early ultrasound at 14 weeks demonstrated a flattened facial profile with nasal hypoplasia (Binder phenotype) consistent with vitamin K deficiency from HG. She had a percutaneous endoscopic gastrojejunostomy tube placed for enteral feeding at 15-week gestation. At repeated anatomy ultrasound at 21-week gestation, delivery, and postnatal pediatric genetics exam, nasal hypoplasia was consistent with vitamin K deficiency embryopathy from HG. Nausea and vomiting of pregnancy is a common condition. HG, the most severe form, has many maternal and fetal effects. Evaluation of vitamin K status could potentially prevent this rare and disfiguring embryopathy. Andrew S. Lane, Jennifer L. Stallworth, Kacey Y. Eichelberger, and Kenneth F. Trofatter Copyright © 2015 Andrew S. Lane et al. All rights reserved. Acute Renal Failure due to Obstructive Uropathy Secondary to Ureteral Endometriosis Sun, 09 Aug 2015 09:47:09 +0000 Ureteral involvement by endometriosis is a rare and often silent disease but capable of producing significant morbidity and leading to hydronephrosis and to renal failure. Surgery is the treatment of choice to remove endometriotic lesions and relieve ureteral obstruction if the kidney is still functional or a nephrectomy is performed if there is a complete loss of renal function. We report a case of acute renal failure induced ureteral endometriosis managed with laparoscopic unilateral nephrectomy and endometrioma cystectomy. Differential diagnosis is important to confirm diagnosis for patients with ureteral obstruction presenting nonspecific symptoms. Jeong In Choi, Jee Geun Yoo, Sa Jin Kim, Hae Nam Lee, and Min Jeong Kim Copyright © 2015 Jeong In Choi et al. All rights reserved. Pyomyoma as a Rare Source of Postpartum Sepsis Sun, 09 Aug 2015 09:08:29 +0000 Pyomyoma, also known as suppurative leiomyoma, is a rare clinical complication that occurs when a leiomyoma undergoes infarction and subsequent infection. A high index of suspicion is required to make the diagnosis and can be guided by a classic triad of symptoms that includes abdominal pain, sepsis without an obvious source, and a history of leiomyoma. In the vast majority of these cases, total abdominal hysterectomy is required to avoid severe morbidity and potential mortality. We present an unusual case of a postpartum pyomyoma that was successfully treated without the need for hysterectomy. With strong clinical suspicion, early diagnosis, and appropriate management, some affected patients may preserve fertility. A. DeMaio and M. Doyle Copyright © 2015 A. DeMaio and M. Doyle. All rights reserved. Multicystic Benign Mesothelioma Complicating Pregnancy Sun, 09 Aug 2015 08:32:57 +0000 Multicystic benign mesothelioma (MBM) is a rare peritoneal pathology typically affecting women in reproductive age. Though MBM is considered benign, these lesions are prone to recurrence and their growth could be modulated by the presence of oestrogen receptors. Acute presentation of MBM is still very rare in pregnancy and management options are not established. We describe a case of MBM presenting in early pregnancy with acute pain. This was successfully treated with surgical resection. Pregnancy continued uneventfully to term and no evidence of recurrent MBM was found at Caesarean section. V. A. Tamhankar Copyright © 2015 V. A. Tamhankar. All rights reserved. A Fatal and Extremely Rare Obstetric Complication: Neglected Shoulder Presentation at Term Pregnancy Wed, 05 Aug 2015 16:58:20 +0000 Stillbirth is still an important problem for parents and healthcare providers worldwide. Nowadays, the neglected shoulder presentation is usually observed in developing countries and is associated with increased risk of fetomaternal morbidity and mortality. In recent years, there were limited reports about obstetric management of this serious complication in the literature. In this case report, we aimed at describing the neglected shoulder presentation at term pregnancy that caused fetal death and discussing management options for this rare obstetric complication during labor. Orkun Cetin, Halise Yolli, Numan Cim, Recep Yıldızhan, and Hanım Guler Sahin Copyright © 2015 Orkun Cetin et al. All rights reserved. The First Case Report in Italy of Di George Syndrome Detected by Noninvasive Prenatal Testing Wed, 05 Aug 2015 16:41:51 +0000 Panorama Plus (Natera), a single-nucleotide polymorphism- (SNP-) based approach that relies on the identification of maternal and fetal allele distributions, allows the detection of common aneuploidies and also incorporates a panel of 5 microdeletions including Di George syndrome. We report here the first case of Di George syndrome detected by NIPT in Italy; blood was drawn at 12 weeks’ gestation. The patient had an amniocentesis to confirm the diagnosis by MLPA (multiplex ligation-dependent probe amplification) and an ultrasound aimed to detect the features associated with the syndrome. A right aortic arch and suspect of thymus atrophy were detected, but not other severe malformations typical of the disease. The patient terminated the pregnancy at 17 weeks. NIPT allowed an early screening of Di George syndrome. As the patient was at low risk, it is likely that an ultrasound would have missed the condition. Giuseppina Rapacchia, Cristina Lapucci, Maria Carla Pittalis, Aly Youssef, and Antonio Farina Copyright © 2015 Giuseppina Rapacchia et al. All rights reserved. Prenatal Diagnosis of Rare Familial Unbalanced Translocation of Chromosomes 7 and 12 Thu, 30 Jul 2015 11:30:43 +0000 Case Details. We report rare familial unbalanced translocation of chromosomes 7 and 12, which was diagnosed prenatally at 20+3 weeks of gestation. Woman’s partner had been tested in the past and was found to be a carrier of a balanced translocation; his karyotype showed a balanced reciprocal translocation of 46, XY, t(7;12)(q34;q24,32). Partner’s brother had an unbalanced form of the translocation with severe learning disability. The diagnosis of the anomaly was based on two- and three-dimensional ultrasound and microarray analysis. Ultrasonography findings included fetal microcephaly and alobar holoprosencephaly, dysmorphic face (flat occiput, absent nasal bone, microphthalmia, hypotelorism, and single nostril), and hyperechogenic bowel. Genome-wide array analysis and cytogenetic results from the amniotic fluid showed unbalanced translocation in chromosomes 7 and 12 with deletion of an approximately 16.5 Mb and a duplication of 6.1 Mb, respectively, Arr 7q34q36.3(142,668,576-159,161,648)x1,12q24.32q24.33(127,708,720-133,777,560)x3, karyotype (der (7) t(7;12) (q34;q24)pat). This unbalanced translocation was due to the segregation of the father’s balanced translocation. In this particular case, the recurrence of an unbalanced translocation in the subsequent pregnancies is estimated to be 20%. Understanding the individuals’ phenotype in association with the gain and loss of copy number is important and can further provide us with information on that particular region of the named chromosomes. Berrin Tezcan and Foteini Emmanouella Bredaki Copyright © 2015 Berrin Tezcan and Foteini Emmanouella Bredaki. All rights reserved. Successful Pregnancies after the Treatment of a Thymic Carcinoid Wed, 29 Jul 2015 16:13:50 +0000 The present report describes the case of a woman diagnosed with an adrenocorticotropic hormone- (ACTH-) secreting thymic carcinoid associated with Cushing’s syndrome. Treatment consisted of tumour resection and 131-I-meta-iodobenzylguanidine (MIBG) therapy. In spite of her iatrogenic menopausal state she twice became pregnant and delivered two healthy babies but developed recurrences during both pregnancies. The last recurrence presented as a primary breast cancer. Despite poor prognosis our patient survived for eleven years. To our knowledge this is the first report of successful pregnancy and delivery in a patient with a thymic carcinoid. Wiebren A. A. Tjalma Copyright © 2015 Wiebren A. A. Tjalma. All rights reserved. Antenatal Diagnosis of a Rare Neural Tube Defect: Sincipital Encephalocele Wed, 29 Jul 2015 08:55:26 +0000 Context. Fetal sincipital encephalocele is one of the most serious congenital neural tube defects with a high risk of mortality and neonatal morbidity. Prenatal diagnosis of this malformation is important in fetal medicine. Case Report. We report a case of prenatal diagnosis of sincipital encephalocele using ultrasound and MRI imaging. The diagnosis was done at 25 weeks of gestation by identifying an anterior cephalic protrusion through a defect in the skull. Conclusion. Through this case, we discuss the differential diagnosis, management, and prognosis of such lesions. Mehdi Kehila, Sana Ghades, Hassine Saber Abouda, Aida Masmoudi, and Mohamed Badis Chanoufi Copyright © 2015 Mehdi Kehila et al. All rights reserved. Use of Cetuximab in Combination with Cisplatin and Adjuvant Pelvic Radiation for Stage IIIB Vulvar Carcinoma Wed, 29 Jul 2015 07:57:44 +0000 Vulvar cancer is a rare carcinoma constituting only 4% of gynecologic malignancies and 0.6% of female cancers. Most chemotherapy regimens have been created from extrapolation from anal and cervical cancer research. Advanced stages have the worst prognosis and oftentimes invasive surgical procedures are needed to cure disease with high recurrence rates. Case. A 50 yo G2P2 presented for a 2 cm mass in her right labia. The patient underwent a partial radical vulvectomy and bilateral superficial and deep inguinal lymph node dissection. Bilateral inguinal lymph nodes were positive for residual disease. The patient underwent whole pelvic radiation with cisplatin as a radiosensitizer. The primary tumor was epidermal growth factor receptor (EGFR) positive and cetuximab, a monoclonal antibody to EGFR, was added. The patient underwent seven cycles of chemotherapy including cisplatin and cetuximab with adjuvant radiation therapy to the pelvis. She currently is without evidence of disease recurrence since completing treatment 4 years ago. Conclusion. One previous case report showed short-term palliative success of five months for recurrent, metastatic vulvar cancer. This case suggests that cetuximab could possibly be used in initial management of patients with advanced stages of vulvar cancer to improve prognosis. Jennifer Bergstrom, Michael Bidus, Edward Miles, and Jay Allard Copyright © 2015 Jennifer Bergstrom et al. All rights reserved. Pregnancy in a Previously Conjoined Thoracopagus Twin with a Crisscross Heart Mon, 27 Jul 2015 08:40:43 +0000 Background. Crisscross heart (CCH) is a complex, rare, congenital, rotational, cardiac abnormality that accounts for <0.1% of congenital heart defects (CHD). CCH is characterized by the crossing of the inflow streams of the two ventricles due to an abnormal twisting of the heart. A case of maternal CCH has not been previously reported. Case. We report a case of a primigravida with a CCH, who was separated at birth from her thoracopagus conjoined twin. Pregnancy was managed by congenital cardiology, maternal-fetal medicine, anesthesiology, and obstetrics. She underwent a 39-week vaginal delivery without maternal or neonatal complication. Conclusion. A successful term pregnancy outcome was achieved in a patient with CCH using a multidisciplinary approach to address her cardiac condition. Bassam H. Rimawi, Iris Krishna, Anurag Sahu, and Martina L. Badell Copyright © 2015 Bassam H. Rimawi et al. All rights reserved. Successful Pregnancy in a Couple with Severe Male Factor Infertility after Selection of Sperm with Cytoplasmic Droplets Sun, 26 Jul 2015 10:35:40 +0000 We present live births resulting from two separate IVF cycles in a couple in which ICSI was performed with sperm specifically selected for presence of small cytoplasmic droplets. These cycles followed previous cycles using standard sperm selection methods in which very poor embryo development and no pregnancies ensued. The male partner was diagnosed with severe male factor infertility including elevated DNA fragmentation. Jenna Bellish, David H. McCulloh, Khaliq Ahmad, and Peter G. McGovern Copyright © 2015 Jenna Bellish et al. All rights reserved. A Case of Giant Uterine Lipoleiomyoma Simulating Malignancy Wed, 22 Jul 2015 07:14:22 +0000 Introduction. Uterine leiomyoma is the most common benign pathology in women and lipoleiomyoma is an extremely rare and specific type of leiomyoma. Here, we report an unusual case of giant pedunculated subserous lipoleiomyoma misdiagnosed preoperatively as leiomyosarcoma. Case. A 45-year-old woman admitted to our gynecology outpatient clinic for complaints of abdominal distention, tiredness, and pelvic pain for the last 6 months. Sonography and abdominal magnetic resonance imaging (MRI) showed a giant semisolid mass that filled whole abdominal cavity from pelvis to subdiaphragmatic area. A primary diagnosis of uterine sarcoma or ovarian malignancy was made. On operation, total abdominal hysterectomy with a pedunculated mass of size 30 × 23 × 12 cm and weighing 5.4 kg and bilateral salpingo-oophorectomy were performed. The histopathology revealed a lipoleiomyoma with extensive cystic and fatty degeneration without any malignancy. Discussion. The diagnosis of leiomyoma is done usually with pelvic ultrasound but sometimes it is difficult to reach a correct diagnosis especially in cases of giant and pedunculated lipoleiomyoma that included fatty tissue which may mimick malignancy. Conclusion. Subserous pedunculated giant lipoleiomyoma should be kept in mind in the differential diagnosis of leiomyosarcoma or ovarian malignancy. Erbil Karaman, Numan Çim, Gülay Bulut, Gülhan Elçi, Esra Andıç, Mustafa Tekin, and Ali Kolusarı Copyright © 2015 Erbil Karaman et al. All rights reserved. Balloon Cell Urethral Melanoma: Differential Diagnosis and Management Tue, 14 Jul 2015 09:58:17 +0000 Introduction. Primary malignant melanoma of the urethra is a rare tumour (0.2% of all melanomas) that most commonly affects the meatus and distal urethra and is three times more common in women than men. Case. A 76-year-old lady presented with vaginal pain and discharge. On examination, a 4 cm mass was noted in the vagina and biopsy confirmed melanoma of a balloon type. Preoperative CT showed no distant metastases and an MRI scan of the pelvis demonstrated no associated lymphadenopathy. She underwent anterior exenterative surgery and vaginectomy also. Histology confirmed a urethral nodular malignant melanoma. Discussion. First-line treatment of melanoma is often surgical. Adjuvant treatment including chemotherapy, radiotherapy, or immunotherapy has also been reported. Even with aggressive management, malignant melanoma of the urogenital tract generally has a poor prognosis. Recurrence rates are high and the mean period between diagnosis and recurrence is 12.5 months. A 5-year survival rate of less than 20% has been reported in balloon cell melanomas along with nearly 20% developing local recurrence. Conclusion. To the best of our knowledge, this case is the first report of balloon cell melanoma arising in the urethra. The presentation and surgical management has been described and a literature review provided. M. McComiskey, C. Iavazzo, M. Datta, R. Slade, B. Winter-Roach, G. Lambe, V. K. Sangar, and M. Smith Copyright © 2015 M. McComiskey et al. All rights reserved. Uterine Intravenous Leiomyomatosis with Cardiac Extension: Radiologic Assessment with Surgical and Pathologic Correlation Sun, 05 Jul 2015 09:17:57 +0000 We present the computed tomography (CT) and magnetic resonance (MR) imaging findings of a 71-year-old woman with a cardiac extension of intravenous leiomyoma (IVL) that arose from the uterus, extended to the inferior vena cava (IVC), and reached the right ventricle through the right ovarian vein. Radiologic-pathologic correlation showed that the intravascular cord-like mass originating from the IVC and extending to the right ventricle was composed of degenerated smooth muscle cells with a number of large vessels that were regarded as arteries; moreover, the arteries within the cord-like mass appeared to be looping internally. Given the disappearance of the right ovarian venous wall around the IVL pathologically, extracting the tumor from the ovarian vein during an operation is considered to be impossible retrospectively. Also it was difficult to identify even the intravenous extension of the uterine leiomyoma histopathologically. Therefore, contrast-enhanced CT, in particular arterial phase imaging, provided important information that revealed the mass, range, and path of the lesion, ensuring that an appropriate operative plan could be drawn up and the tumor completely excised. Go Nakai, Kazuya Maeda, Kazuhiro Yamamoto, Takashi Yamada, Yoshinobu Hirose, Yoshito Terai, Masahide Ohmichi, Takahiro Katsumata, and Yoshifumi Narumi Copyright © 2015 Go Nakai et al. 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.