Case Reports in Obstetrics and Gynecology The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Metastasis of Pregnancy-Associated Breast Cancer (Suspected to Be Hereditary Breast and Ovarian Cancer) to the Brain, Diagnosed at 18 Weeks’ Gestation: A Case Report and Review of the Literature Thu, 11 Feb 2016 09:30:05 +0000 We report a case of pregnancy-associated breast cancer with metastasis to the brain, likely resulting from hereditary breast and ovarian cancer (HBOC). A 35-year-old woman (gravida 2, para 0-1-0-1) underwent a right mastectomy and right axillary dissection after a cesarean section at 30 years of age; her mother died at 47 years of age due to breast cancer. Histopathological examination indicated an invasive ductal carcinoma with triple-negative cancer (cancer stage 2B [pT3N0M0]). The patient refused adjuvant therapy because of the risk of infertility. After 4 years, she became pregnant naturally. At 18 weeks’ gestation, she experienced aphasia and dyslexia due to brain metastasis. The pregnancy was terminated at 21 weeks’ gestation after thorough counseling. Her family history, young-onset disease, and histopathological findings suggested HBOC. She declined genetic testing for BRCA1/2, though genetic counseling was provided. In cases of pregnancy-related breast cancer, consideration must be given to whether the pregnancy should be continued and to posttreatment fertility. HBOC should also be considered. Genetic counseling should be provided and the patient should be checked for the BRCA mutation, as it is meaningful for the future of any potential children. Genetic counseling should be provided even if the cancer is advanced or recurrent. Tomohiro Okuda, Sakura Yamamoto, Seiki Matsuo, Hisashi Kataoka, and Jo Kitawaki Copyright © 2016 Tomohiro Okuda et al. All rights reserved. A Case of Recurrent Rudimentary Horn Ectopic Pregnancies Managed by Methotrexate Therapy and Laparoscopic Excision of the Rudimentary Horn Sun, 07 Feb 2016 15:51:03 +0000 This report presents a case of a 31-year-old woman successfully treated medically for a noncommunicating rudimentary horn ectopic pregnancy who presented with a second, successive rudimentary horn pregnancy. Patient underwent laparoscopic excision of right rudimentary horn and right salpingectomy after failed methotrexate therapy. Given the potential for rupture and recurrence, serious efforts should be made to excise a uterine rudimentary horn. Gaby N. Moawad and Elias D. Abi Khalil Copyright © 2016 Gaby N. Moawad and Elias D. Abi Khalil. All rights reserved. Minilaparotomy Hysterectomy as a Suitable Choice of Hysterectomy for Large Myoma Uteri: Literature Review Wed, 27 Jan 2016 06:10:59 +0000 The objective of this paper is to propose minilaparotomy hysterectomy as the suitable choice for large uterus on the basis of our experienced case of performed minilaparotomy hysterectomy to 4,500 g myoma uteri and review published cases about this clinical condition. We presented a 44-year-old woman (gravida 0, virgin) who consulted our hospital because of the chief complaints of abnormal genital bleeding and hypermenorrhea. Transabdominal ultrasonography revealed that abdominal solid tumor reached over the navel. Her tumor was an indication of surgery; to do minilaparotomy hysterectomy with laparoscope was decided because her informed consent was obtained. A 6 cm transverse incision (Maylard incision) was made to the skin above the pubic hairline. At the end of surgery, the length of abdominal wound was 8.5 cm, operating time was 128 min, weight of resected myoma uteri was 4,500 g, and intraoperative blood loss was 895 mL. Blood transfusion was not done; postsurgical course was not a problem without anemia. We propose that a large uterine case in which it is difficult to perform vaginal or laparoscopic hysterectomy should be considered in order to select minilaparotomy hysterectomy up to around 5 kg weight of uterus, and the length of skin incision in minilaparotomy hysterectomy is necessarily <9 cm particularly in large uterus. Kenichiro Sato and Yasuyoshi Fukushima Copyright © 2016 Kenichiro Sato and Yasuyoshi Fukushima. All rights reserved. Spontaneous Uterine Rupture in a Preterm Pregnancy following Myomectomy Tue, 26 Jan 2016 12:57:15 +0000 A 44-year-old nulliparous woman was transferred to a tertiary obstetric hospital for investigation of acute onset abdominal pain. She was at gestation of 32 weeks and 2 days with a history of previous laparoscopic fundal myomectomy. An initial bedside ultrasound demonstrated oligohydramnios. Following an episode of increased pain early the following morning, a formal ultrasound diagnosed a uterine rupture with the fetal arm extending through a uterine rent. An uncomplicated classical caesarean section was performed and the neonate was delivered in good condition but with a bruised and oedematous right arm. The neonate was transferred to the Special Care Nursery for neonatal care. The patient had an uncomplicated postoperative course and was discharged home three days following delivery. This is an unusual presentation of uterine rupture following myomectomy where the fetal arm had protruded through the uterine wall. Claire Sutton, Prue Standen, Jade Acton, and Christopher Griffin Copyright © 2016 Claire Sutton et al. All rights reserved. A Rare Clinical Presentation of Giant Bilateral Labial Fibroepithelial Stromal Polyps in Patient with Psoriasis Disease Tue, 26 Jan 2016 08:40:31 +0000 Fibroepithelial polyps (FEPs) are rarely seen lesions of the lower female genital tract with polypoid proliferations of stroma. These tumors usually present in the vulvovaginal region of the reproductive aged women. In this presentation, we report a case of a psoriatic woman who developed unusual multiple polypoid lesions approximately 15 cm in size arising from both left and right labia minora and unique connection of FEPs with psoriasis disease. Ayse Filiz Avsar, Elcin Islek, Melahat Yildirim, and Hilal Ahsen Copyright © 2016 Ayse Filiz Avsar et al. All rights reserved. Essure Surgical Removal and Subsequent Resolution of Chronic Pelvic Pain: A Case Report and Review of the Literature Sun, 24 Jan 2016 07:16:46 +0000 Background. Hysteroscopic tubal sterilization (Essure) is a minimally invasive option for permanent contraception with high reported rates of patient satisfaction. A small percentage of these women subsequently choose to have the tubal inserts removed due to regret or perceived side effects such as late-onset pelvic pain secondary to placement of the Essure device. Case. A twenty-nine-year-old woman G4P4014 presented with a two-year complaint of chronic pelvic pain and dyspareunia after the hysteroscopic placement of an Essure device for sterilization. On reviewing the images of the HSG, it was noted that although tubal occlusion was confirmed, the left Essure coil appeared curved on itself in an elliptical fashion and did not seem to follow the expected anatomic trajectory of the fallopian tube. The patient reported resolution of chronic pelvic pain following laparoscopic removal of Essure device. Conclusion. A misplaced Essure device should be considered in the differential diagnosis of chronic pelvic pain in women who had difficult placement of the device. In addition to demonstrating tubal occlusion, careful examination of the configuration of the Essure microinserts on HSG examination provides valuable information in patients with pelvic pain after Essure placement. Isamarie Lora Alcantara, Shadi Rezai, Catherine Kirby, Annika Chadee, Cassandra E. Henderson, and Malvina Elmadjian Copyright © 2016 Isamarie Lora Alcantara et al. All rights reserved. Prenatal Ultrasound Diagnosis of a Cyst of the Oral Cavity: An Unusual Case of Thyroglossal Duct Cyst Located on the Tongue Base Thu, 21 Jan 2016 10:58:00 +0000 We describe a case of a lingual thyroglossal duct cyst diagnosed prenatally by ultrasound at 26 weeks of gestation. The follow-up ultrasound scans revealed no changes in the cyst measurement. Surgical treatment was performed without any complication 72 hours after delivery with good results. E. Rodríguez Tárrega, S. Fuster Rojas, R. Gómez Portero, S. Roig Boronat, G. Pérez Martínez, J. Zamora Prado, and A. Perales Marín Copyright © 2016 E. Rodríguez Tárrega et al. All rights reserved. Rare Case of Methemoglobinemia Complicating Pregnancy Mon, 04 Jan 2016 09:59:15 +0000 A patient at 38 weeks of gestation when taken for emergency cesarean section had her oxygen saturation of 66 to 70% (by saturation probe on monitor) in operation theatre. She was otherwise asymptomatic but her oxygen saturation was persistently low on the monitors. Her arterial blood gas analysis showed all parameters to be normal. Her electrocardiography was normal. Her surgery was imperative but due to her reduced oxygen saturation she became a high-risk case. In presence of senior consultants of anesthesia and gynecology and under high-risk consent she had an uneventful cesarean delivery. Physician and cardiologist opinions were sought thereafter. The outcomes and the results of our efforts to find the etiology of her reduced saturation on monitors despite being clinically asymptomatic lead to the disclosure of this rare hemoglobinopathy. Mother and baby had uneventful course after delivery and were discharged well. S. Verma, P. Sachdeva, and G. Gandhi Copyright © 2016 S. Verma et al. All rights reserved. Case with a Nonreassuring Fetal Status Induced by Massive Hematemesis due to Mallory-Weiss Tear That Required Emergency Cesarean Section at 38 Weeks’ Gestation Thu, 31 Dec 2015 06:04:30 +0000 We describe a rare case of Mallory-Weiss tear with massive hematemesis at 38 weeks’ gestation. A 35-year-old woman presented with epigastralgia followed by massive hematemesis. An emergency endoscopy indicated active pulsatile bleeding at the esophagocardial junction. Although an emergency endoscopic hemostasis was successful, late decelerations without acceleration on cardiotocogram were observed. Therefore, the patient underwent emergency cesarean section, along with blood transfusion, following the endoscopic hemostasis. The hemoglobin level just before the operation was 5.1 g/dL. We suspected that massive hematemesis induced maternal acute anemia and hypovolemia, which resulted in a nonreassuring fetal status. Hence, urgent endoscopic hemostasis, adequate blood transfusion, and emergency cesarean section were needed. Mallory-Weiss tear during the third trimester may have a possibility of massive hematemesis and urgent blood transfusion, emergency endoscopic hemostasis, and emergency cesarean section may be needed. Takashi Suzuki, Maiko Wagata, Hiroko Konno, Takahiro Ito, Yuichi Torii, and Takeshi Murakoshi Copyright © 2015 Takashi Suzuki et al. All rights reserved. A Case of Idiopathic Acute Pancreatitis in the First Trimester of Pregnancy Wed, 30 Dec 2015 08:53:39 +0000 Acute pancreatitis is rare in pregnancy, with an estimated incidence of approximately 1 in 1000 to 1 in 10,000 pregnancies. Acute pancreatitis in pregnancy usually occurs in the third trimester. Here, we report a case of acute pancreatitis in the first trimester. A 36-year-old primigravida at 11 weeks of gestation complained of severe lower abdominal pain. The pain gradually worsened and migrated toward the epigastric region. She had no history of chronic alcoholism. Blood investigations showed elevated level of C-reactive protein (9.58 mg/dL), pancreatic amylase (170 IU/L), and lipase (332 IU/L). There was no gallstone and no abnormality in the pancreatic and biliary ducts on ultrasonography. Antinuclear antibody and IgG4 were negative and no evidence of hyperlipidemia or diabetes was found. There was also no evidence of viral infection. On the third day of hospitalization, she was diagnosed with severe acute pancreatitis on magnetic resonance imaging. Medical interventions were initiated with nafamostat mesilate and ulinastatin, and parenteral nutrition was administered through a central venous catheter. On the eighth day of hospitalization, her condition gradually improved with a decreased level of pancreatic amylase and the pain subsided. After conservative management, she did not have any recurrence during her pregnancy. Tomomi Hara, Haruhiko Kanasaki, Aki Oride, Tomoko Ishihara, and Satoru Kyo Copyright © 2015 Tomomi Hara et al. All rights reserved. Placenta Accreta in a Woman with Escherichia coli Chorioamnionitis with Intact Membranes Sun, 27 Dec 2015 11:39:24 +0000 Background. Escherichia coli (E. coli) associated intrauterine infections with intact membranes are extremely rare. Case. A 30-year-old multiparous female presented at 26 weeks’ gestation with clinical signs of chorioamnionitis but physical examination suggested intact membranes. Her dietary history was concerned with Listeriosis. An amniocentesis was performed. Shortly thereafter, the mother developed septic shock and an urgent Cesarean delivery was performed. The patient required a peripartum hysterectomy for placenta accreta. Amniotic fluid cultures grew E. coli. Emma M. Montelongo, Nathan R. Blue, and Richard H. Lee Copyright © 2015 Emma M. Montelongo et al. All rights reserved. Fetal Bowel Dilatation: A Sonographic Sign of Uncertain Prognosis Thu, 24 Dec 2015 14:13:18 +0000 Fetal bowel dilatation is an indirect sonographic sign of mechanical or functional bowel obstruction. The etiology of fetal bowel dilatation is a difficult prenatal diagnosis since ultrasound has limited accuracy for bowel evaluation. The authors describe a case of fetal bowel dilatation diagnosed in the third trimester. Patrícia Silva, Filipa Reis, Paulo Alves, Luís Farinha, Manuel Sousa Gomes, and Pilar Câmara Copyright © 2015 Patrícia Silva et al. All rights reserved. Ectopic Pregnancy in Uncommon Implantation Sites: Intramural Pregnancy and Rudimentary Horn Pregnancy Thu, 24 Dec 2015 08:08:02 +0000 Ectopic pregnancy is commonly located in the fallopian tube. Nevertheless, two unusual types of ectopic pregnancy, intramural pregnancy and rudimentary horn pregnancy, seriously threaten maternal life. The diagnosis and treatment of these unusual implantation sites present a clinical challenge. In this study, we illustrated the two unusual types of ectopic pregnancy and summarized the current data regarding diagnosis and optimal treatment from our experience. Yi Wang, Fan Yu, and Li-Qin Zeng Copyright © 2015 Yi Wang et al. All rights reserved. Etiology of Ascites and Pleural Effusion Associated with Ovarian Tumors: Literature Review and Case Reports of Three Ovarian Tumors Presenting with Massive Ascites, but without Peritoneal Dissemination Thu, 17 Dec 2015 09:48:11 +0000 Borderline ovarian tumors are benign but relatively large tumors that are often initially mistaken as ovarian cancers. We report three cases of stage I borderline ovarian tumors having massive ascites that we (preoperatively) suspected of being advanced ovarian cancer. The three patients (35, 47, and 73 years old) reported feeling fullness of the abdomen before consulting their gynecologist. By CT scan, they were diagnosed with a pelvic tumor accompanied by massive ascites, the diameters of which were 11, 20, and 11 cm, respectively. Postsurgical pathology showed all were stage I borderline ovarian tumors without dissemination; two were mucinous and one was serous. The amount of ascites was 6,300, 2,600, and 3,600 mL, respectively, and was serous in all. Cytodiagnosis of the ascites found that one was positive for tumor cells and two were negative. After resection of the mass, the ascites disappeared in all three cases. No pleural effusion was present at any time. The literature is reviewed concerning ascites and pleural effusions linked to ovarian tumors, and a supposition is forwarded of why pleural effusion presents sporadically in these cases. Ai Miyoshi, Takashi Miyatake, Takeya Hara, Asuka Tanaka, Naoko Komura, Shinnosuke Komiya, Serika Kanao, Masumi Takeda, Mayuko Mimura, Masaaki Nagamatsu, and Takeshi Yokoi Copyright © 2015 Ai Miyoshi et al. All rights reserved. Management of Membranous Glomerulonephritis in Pregnancy: A Multidisciplinary Challenge Thu, 17 Dec 2015 05:45:28 +0000 We present a case of 28-year-old female, who had a past obstetrical history complicated by uncontrolled blood pressure, early onset preeclampsia, and a fetal demise at 29 weeks. Her blood pressure normalized after each pregnancy, and no diagnosis of renal disease was ever established. In her most recent pregnancy, she remained normotensive and initially presented with normal blood urea nitrogen and creatinine levels. However, after the early first trimester, she developed nephrotic range proteinuria, hypoalbuminemia, and peripheral edema. After delivery of the baby, all clinical symptoms rapidly resolved and laboratory values normalized. We review the clinical course, diagnosis, and management of new onset nephrotic syndrome in pregnancy. Sherifat Ope-Adenuga, Michael Moretti, and Nisha Lakhi Copyright © 2015 Sherifat Ope-Adenuga et al. All rights reserved. Iatrogenic Lower Extremity Subcutaneous Emphysema after Prolonged Robotic-Assisted Hysterectomy Wed, 16 Dec 2015 11:16:15 +0000 Subcutaneous emphysema is a known complication of carbon dioxide insufflation, an essential component of laparoscopy. The literature contains reports of hypercarbia, pneumothorax, or pneumomediastinum. However, isolated lower extremity subcutaneous emphysema remains a seldom-reported complication. We report a case of unilateral lower extremity subcutaneous emphysema following robotic-assisted hysterectomy, bilateral salpingooophorectomy, staging, and anterior/posterior colporrhaphy for carcinosarcoma and vaginal prolapse. On postoperative day 1, the patient developed tender crepitus and bruising of her right ankle. Radiography confirmed presence of subcutaneous air. Vital signs and laboratory findings were unremarkable. Her symptoms spontaneously improved over time, and she was discharged in good condition on day 2. In stable patients with postoperative extremity swelling or pain with crepitus on exam, the diagnosis of iatrogenic subcutaneous emphysema must be considered. Monica Hagan Vetter, Chelsea Mutscheller, and Joel Cardenas-Goicoechea Copyright © 2015 Monica Hagan Vetter et al. All rights reserved. Ovarian Vein Thrombosis as a Complication of Laparoscopic Surgery Mon, 14 Dec 2015 12:53:28 +0000 Ovarian vein thrombosis (OVT) is an extremely rare but life-threatening complication of the postpartum period. It has never been reported as a complication of laparoscopic surgery. We report a case of right ovarian vein thrombosis that occurred in the postoperative period after patient underwent laparoscopic salpingectomy for a right side ectopic pregnancy. She presented with 1-week history of abdominal pain and fever. A complete workup for fever was performed and was found negative. Computed tomography of the abdomen and pelvis revealed right ovarian vein thrombosis. The patient was treated with anticoagulant therapy and responded well. Anu Gupta, Natasha Gupta, Josef Blankstein, and Richard Trester Copyright © 2015 Anu Gupta et al. All rights reserved. Hypokalemia-Induced Rhabdomyolysis as a result of Distal Renal Tubular Acidosis in a Pregnant Woman: A Case Report and Literature Review Mon, 14 Dec 2015 06:41:02 +0000 Rhabdomyolysis in pregnancy is a rare occurrence. The manifestation of distal renal tubular acidosis (RTA) for the first time during adulthood is uncommon. According to a review of the literature, pregnancy may predispose individuals to rhabdomyolysis due to hypokalemia. A reduction in interstitial potassium ions could decrease muscular blood flow and lead to muscle injury. This report describes the case of a pregnant woman with rhabdomyolysis induced by hypokalemia resulting from distal RTA. The patient subsequently delivered a healthy newborn. Manasawee Srisuttayasathien Copyright © 2015 Manasawee Srisuttayasathien. All rights reserved. Leiomyosarcoma of the Vagina: An Exceedingly Rare Diagnosis Wed, 09 Dec 2015 08:33:15 +0000 Background. Primary leiomyosarcoma of the vagina is an exceedingly rare diagnosis. Current estimates are that this tumor could at most represent a mere 0.062% of malignant neoplasms in the female genital tract, although in actuality it is likely far less common. Case Presentation. A 70-year-old female gravida 3 para 2 with new onset palpable vaginal mass and pink vaginal discharge is diagnosed with primary leiomyosarcoma of the vagina. Chemotherapy is complicated by acute Lyme disease, and the patient requires a robotic-assisted total hysterectomy with bilateral salpingo-oophorectomy and partial vaginectomy. The patient remains without recurrence 18 months after surgery. Conclusion. Vaginal leiomyosarcoma is exceedingly rare with an aggressive course, high recurrence, and undetermined ideal treatment regimen. Its diagnosis can be delayed and its presentation varied. Information on this rare tumor type is predominantly through rare case reports with collective consensus on management lacking. The gynecologic oncologist must exercise prudence in individualizing treatment regimens for this rare yet aggressive malignancy. Nathan A. Keller and Heidi Godoy Copyright © 2015 Nathan A. Keller and Heidi Godoy. All rights reserved. Fetal Midgut Volvulus with a Cystic Appearance, Accompanying a Sinus Rhythm and an Increased Peak Systolic Velocity without Anemia Tue, 08 Dec 2015 08:15:23 +0000 A midgut volvulus rarely occurs in a fetus; however, when it does, it requires an immediate diagnosis and surgery. Thirty-week pregnant was referred to our clinic with a diagnosis of a fetal abdominal cystic mass and preterm labor. The initial ultrasound examination revealed a female fetus with a 55 × 50 mm cystic mass in the lower abdomen, which was preliminarily diagnosed as an ovarian cyst. There was a sinusoidal rhythm on cardiography. The middle cerebral artery peak systolic velocity was 60.4 cm/sec, compatible with 1.49 MoMs that suggested fetal anemia on Doppler examination. Uterine contractions were observed with tocography and maternal hydration was administered for tocolytic treatment. Despite hydration, uterine contractions continued and the infant was delivered. A newborn ultrasonographic evaluation revealed a 6 cm abdominal cyst, and plain abdominal radiographs revealed distended loops of the small bowel on the left side. Emergency surgery was performed. A midgut volvulus leading to dilatation and necrosis of the small bowel without anatomical causes was observed during laparotomy. The necrotic bowel loop was resected and an end-to-end anastomosis was performed. The newborn died due to multiorgan failure. Obstetricians should be familiar with the appropriate diagnosis and management of a fetal volvulus. Metin Kaba, Aysegul Oksuzoglu, Gokcen Kaba, Hakan Timur, Eren Akbaba, and Kadriye Turgut Copyright © 2015 Metin Kaba et al. All rights reserved. Metastatic Colorectal Cancer Resembling Severe Preeclampsia in Pregnancy Mon, 07 Dec 2015 13:33:41 +0000 Although colorectal cancer (CRC) is the third most common cancer in women, it is a rare malignancy in pregnancy. Symptoms of CRC such as fatigue, malaise, nausea, vomiting, rectal bleeding, anemia, altered bowel habits, and abdominal mass are often considered typical symptoms of pregnancy. Many cases of CRC are diagnosed in advanced stages due to missed warning signs of CRC, which may be misinterpreted as normal symptoms related to pregnancy. This report reviews 2 cases of CRC diagnosed within a 4-month interval at our institution. Both cases were initially thought to be atypical presentations of preeclampsia. Prenatal history, hospital course, and postpartum course were reviewed for both patients. CRC is often diagnosed at advanced stages in pregnancy. Common physiological symptoms of pregnancy should be scrutinized carefully and worked up appropriately, especially if symptoms remain persistent or increase in intensity or severity. Raminder Kaur Khangura, Charanpreet Kaur Khangura, Anagha Desai, Gregory Goyert, and Roopina Sangha Copyright © 2015 Raminder Kaur Khangura et al. All rights reserved. Conservative Management of Cesarean Scar Ectopic Pregnancy with Fetal Heart Activity and a Very High β-hCG Sun, 06 Dec 2015 12:02:22 +0000 Cesarean scar ectopic pregnancy (CSP) is a rare type of ectopic pregnancy that is growing in incidence. The diagnosis of most CSP occurs when patients present in unstable conditions requiring surgical management and leading sometimes to hysterectomy. It has been shown that medical management is a safe option for early diagnosed hemodynamically stable CSP. However, no cases of CSP with β-hCG higher than 62,000 IU/L, conservatively treated, have been reported. We report the case of a 29-year-old patient who presented for her first prenatal visit at 13-week gestation and was diagnosed with CSP with present fetal heart tones and a quantitative β-hCG of 144,337 IU/L. She was treated with bilateral uterine artery embolization and systemic methotrexate. Her β-hCG significantly decreased and became undetectable within 10 weeks. We propose that patients with CSP with very high β-hCG and fetal heart activity can be offered conservative or fertility preserving management. Rodney McLaren, Sandra McCalla, and Mohamad Irani Copyright © 2015 Rodney McLaren et al. All rights reserved. Humerus Diaphysis Fracture in a Newborn during Vaginal Breech Delivery Thu, 03 Dec 2015 12:45:41 +0000 While most obstetricians are familiar with fracture of the clavicle in newborns during birth, an unlucky minority of obstetricians has encountered long-bone fractures in newborns as well. This complication is traumatic not only for the neonate, but also for the family and the obstetrician; it is also difficult to explain. Fortunately, the long-term prognosis for fracture of the long bones is excellent. Both vaginal and cesarean breech deliveries and maneuvers can be responsible for birth traumas, including long-bone fractures. This case report presents a newborn with breech presentation delivered vaginally that resulted in humerus diaphysis fracture. Baris Kaya, Korkut Daglar, Ayse Kirbas, and Abdullah Tüten Copyright © 2015 Baris Kaya et al. All rights reserved. Gestational Gigantomastia Complicating Pregnancy: A Case Report and Review of the Literature Wed, 02 Dec 2015 14:27:02 +0000 Background. Gestational gigantomastia is a rare disorder without clear etiology or well-established risk factors. Several pathogenic mechanisms contributing to the disease process have been proposed, all of which can lead to a similar phenotype of breast hypertrophy. Case. A 28-year-old Guinean woman presented at 37 weeks of gestation with bilateral gigantomastia, mastalgia, peau d’orange, and back pain. Prolactin levels were 103.3 μg/L (with a normal reference value for prolactin in pregnancy being 36–372 μg/L). The patient was treated with bromocriptine (2.5 mg twice daily), scheduled for a repeat cesarean, and referred to surgery for bilateral mammoplasty. Conclusion. Gestational gigantomastia is a rare disorder, characterized by enlargement and hypertrophy of breast tissue. Our patient presented with no endocrine or hematological abnormalities, adding to a review of the literature for differential diagnoses, workup, and management of cases of gestational gigantomastia with normal hormone levels. Shadi Rezai, Jenna T. Nakagawa, John Tedesco, Annika Chadee, Sri Gottimukkala, Ray Mercado, and Cassandra E. Henderson Copyright © 2015 Shadi Rezai et al. All rights reserved. Serous Ovarian Carcinoma Recurring as Malignant Mixed Mullerian Tumor Wed, 02 Dec 2015 14:24:49 +0000 Only five cases of recurrence of malignant mixed Mullerian tumor (carcinosarcoma) from the ovarian carcinoma have been published in the literature to our knowledge. A 64-year-old woman first underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy because of pelvic mass. Histological diagnosis was serous papillary carcinoma of the left ovary. After six courses of chemotherapy, CA125 level returned to normal range. However, she had persistent multiple mediastinal and para-aortic lymphadenopathies in spite of additional six courses of chemotherapy. Then she underwent the second operation about 2 years after primary surgery. Multiple excisional biopsies were taken from subcutaneous tissue, over the bowels and the left external iliac artery. The histopathological diagnosis which was confirmed by immunohistochemical study was malignant mixed Mullerian tumor for all metastatic foci. A rare case of ovarian serous papillary carcinoma recurring as malignant mixed Mullerian tumor is reported. Demir Hale, Demiroz Ahu Senem, Aydin Ovgu, Erenel Hakan, Ilvan Sennur, Calay Zerrin, and Demirkiran Fuat Copyright © 2015 Demir Hale et al. All rights reserved. Clinical Features of Miller-Fisher Syndrome in Pregnancy Tue, 01 Dec 2015 09:16:47 +0000 Miller-Fisher syndrome (MFS) is recognized as a variant of Guillain-Barré syndrome (GBS). MFS is a rare disorder that is characterized by the acute onset of ophthalmoplegia, ataxia, and areflexia/hyporeflexia. MFS has a higher incidence in Asia, where the incidence is estimated to be 18%–26% of GBS compared with 3%–5% in the West. The differential diagnosis of MFS includes Wernicke’s encephalopathy (WE) which is characterized by a clinical triad (nystagmus and ophthalmoplegia, mental status changes, and ataxia), myasthenia gravis, and brainstem stroke. The association between MFS and pregnancy has not been reported previously. Here, we describe the clinical features of a pregnant woman in early pregnancy with MFS. This case highlights the fact that it is necessary to establish an accurate diagnosis based on the details from the patient’s history on appropriate complementary testing in a pregnant patient with MFS. Masanori Ono, Hideki Sato, Mayu Shirahashi, Noriko Tomioka, Julia Maeda, Keiko Watanabe, Tomoko Amagata, Toshiyuki Ikeda, Kazumi Yakubo, and Tatsuro Fukuiya Copyright © 2015 Masanori Ono et al. All rights reserved. Respiratory Arrest in an Obese Pregnant Woman with Hyperemesis Gravidarum Sun, 29 Nov 2015 14:00:12 +0000 A pregnant, non-Japanese-speaking Peruvian, and, thus, with communication difficulty, suffered hyperemesis gravidarum and had respiratory arrest, requiring cardiopulmonary resuscitation. The obese pregnant woman (prepregnancy weight: 107 kg) had vomited and lost 15 kg in bodyweight over appropriately 2 weeks prior to the arrest but had not complained due to communication difficulty, which, together with her obesity, prevented a Japanese obstetrician from noticing her severe condition. 1,000 mL of low potassium fluid plus thiamine was administered. She became unable to stand, suggesting lower-extremity-proximal-muscle weakness, and then respiratory arrest occurred. Hypopotassemia (2.3 mEq/L), pulseless electrical activity, and muscle weakness suggested the presence of severe potassium deficiency, which may have caused respiratory muscle paralysis, leading to the respiratory arrest. Hypercapnea was severer than expected for compensatory hypoventilation, indicating the presence of concomitant severe hypoventilation, which may also have contributed to respiratory arrest. She recovered with electrolyte and volume replacement. Respiratory arrest can occur with hyperemesis gravidarum, and obesity and communication difficulties can prevent the early detection of severe conditions. Ayumi Iwashita, Yosuke Baba, Rie Usui, Akihide Ohkuchi, Shigeaki Muto, and Shigeki Matsubara Copyright © 2015 Ayumi Iwashita et al. All rights reserved. Transvaginal Resection of a Bladder Leiomyoma Misdiagnosed with a Vaginal Mass: A Case Report and Literature Review Thu, 26 Nov 2015 12:55:45 +0000 Bladder leiomyoma is a rare benign tumor and it could be easily misdiagnosed with many other pelvic diseases, especially obstetrical and gynecological diseases; abdominal, laparoscopic, and transurethral resection of bladder leiomyoma have been reported. Herein, we present a case of bladder leiomyoma misdiagnosed with a vaginal mass preoperatively; the mass was isolated, enucleated from the bladder neck, and removed transvaginally; to the best of our knowledge, this is the first case of intramural leiomyoma of bladder neck that has been enucleated transvaginally only without cystotomy. Fu-Fen Yin, Ning Wang, You-Lin Wang, Xiao-Ning Bi, Xiao-Hui Xu, and Yan-Kui Wang Copyright © 2015 Fu-Fen Yin et al. All rights reserved. Tumor-To-Tumor Metastasis of Poorly Differentiated Gastric Carcinoma to Uterine Lipoleiomyoma Wed, 25 Nov 2015 13:08:20 +0000 The rare phenomenon of tumor-to-tumor metastasis was first described in 1930. The donor neoplasm is most frequently lung or breast carcinoma, whereas intracranial meningiomas are reportedly the commonest recipient neoplasm. Here we report a case of metastasis from a primary gastric cancer to a uterine lipoleiomyoma. A 65-year-old woman presented with locally advanced gastric cancer with computed tomography (CT) evidence of peritoneal dissemination and a 9 cm pelvic mass. She underwent 16 courses of TS-1/cisplatin chemotherapy, which achieved significant tumor reduction. However, repeat CT and magnetic resonance imaging revealed a 9 cm diameter pelvic mass adjacent to the uterus. The mass was heterogeneously hyperintense on T1- and T2-weighted images with some low signal spots on fat-suppressed T1-weighted images, suggesting a benign ovarian tumor such as a mature cystic teratoma. After 3 months, pelvic CT revealed a 10 cm multilocular cystic mass that exhibited heterogeneous enhancement after intravenous contrast administration. A diagnostic laparotomy revealed a subserosal uterine tumor extending into the right broad ligament; total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed. The uterine tumor showed histological features of lipoleiomyoma infiltrated by well- to moderately differentiated carcinoma cells that were similar to those of the gastric biopsy, supporting a diagnosis of metastatic gastric adenocarcinoma. Ryo Kiyokoba, Hiroshi Yagi, Hideaki Yahata, Yoshiaki Kawano, Eisuke Kaneki, Kaoru Okugawa, Kenzo Sonoda, and Kiyoko Kato Copyright © 2015 Ryo Kiyokoba et al. All rights reserved. Primary Endometrial Adenocarcinoma with Signet-Ring Cells: A Rarely Observed Case and Review of the Literature Mon, 23 Nov 2015 11:07:48 +0000 An extremely rare case of a “primary endometrial adenocarcinoma with signet-ring cells” is presented in this study with microscopical images of the characteristic coexistence of the tumour and intermediate precancerous areas containing signet-ring cells. Aslı Kahraman Akkalp, Eser Sefik Ozyurek, Umit Seza Tetikkurt, Senay Yalcin, Yazgi Koy, and Abdullah Taner Usta Copyright © 2015 Aslı Kahraman Akkalp et al. All rights reserved.