Case Reports in Obstetrics and Gynecology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . 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. 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.