Steroid cell tumor not otherwise specified is a subtype of steroid ovary tumors. These are a rare subgroup of ovarian sex cord-stromal tumors. We present a case of a young woman submitted to laparoscopic cystectomy with ovarian steroid cell tumor as histological finding. This represents the second case where laparoscopic cystectomy is performed in this type of tumor. Up to 36 months after surgery, the woman remains under surveillance, without recurrence of the tumor, and attempts to conceive. This case suggests that steroid cell tumors can be asymptomatic, and gynecologists must think about preserving fertility in women of reproductive age.

Patr&#xed;cia Alves

In&#xea;s S&#xe1;

Miguel Brito

C&#xe1;tia Carnide

Osvaldo Moutinho

An Early Diagnosis of an Ovarian Steroid Cell Tumor Not Otherwise Specified in a Woman

Ureteral injury is an uncommon but potentially morbid complication following any open or endoscopic pelvic procedure. Gynecologic surgeries alone make up 50 percent of nonurologic ureteral injuries leading to prolonged hospital stays, secondary interventions, and potential loss of renal function. The use of AmnioFix &#xae; a processed dehydrated, immunologically privileged cellular amniotic membrane allograft has been well established in urologic and gynecologic procedures. These allografts contain human extracellular matrix components, growth factors, and cytokines that mediate inflammation and facilitate would healing. We report the first application of AmnioFix on a denuded ureter during a case of robotic-assisted excision of endometriosis. We include a literature review and discussion on the management outcomes of iatrogenic injury to the ureters.

Osamah Hasan

Grant S. Johnson

James J. Siegert

Francisco Garcini

Thai T. Nguyen

Novel Role of Dehydrated Human Amnion/Chorion Membrane in Healing of Denuded Ureter in Robot-Assisted Excision of Endometriosis

The simultaneous or sequential development of autoimmune hemolytic anemia (AIHA) and idiopathic thrombocytopenic purpura (ITP) is known as Evans syndrome. We experienced a case of Evans syndrome that developed AIHA during pregnancy and ITP long after delivery. The patient was a 35-year-old pregnant woman (gravida 2, para 1). A routine blood test at 28 weeks of gestation revealed moderate macrocytic anemia. Her haptoglobin level was markedly low, and a direct antiglobulin test (DAT) was positive. Based on these results, AIHA was considered. A healthy female newborn with bodyweight 3575 g was vaginally delivered uneventfully. After delivery, the DAT remained positive, but anemia did not develop. At 203 days after delivery, ITP was detected. Because AIHA and ITP developed sequentially, she was diagnosed with Evans syndrome. When AIHA occurs during pregnancy, long-term follow-up is needed because ITP can develop sequentially.

Haruka Suzuki

Koji Yamanoi

Jumpei Ogura

Takahiro Hirayama

Koji Yasumoto

Shimpei Shitanaka

Yoshihide Inayama

Mie Sakai

Tsutomu Ohara

Koh Suginami

A Case of Pregnancy Complicated with Evans Syndrome with Sequential Development of Autoimmune Warm Antibody Hemolytic Anemia and Idiopathic Thrombocytopenic Purpura

Congenital ATIII deficiency is one of the congenital thrombophilia diseases that can cause severe venous thromboembolism (VTE) in pregnant patients. A 30-year-old female, 4 gravida and 2 para, came to the emergency department with a complaint of oedema and pain in the left lower leg at 11 weeks of gestation. An inferior vena cava thrombus and pulmonary embolism were found. Because VTE was very severe, artificial abortion was performed, and VTE disappeared rapidly. She maintained oral administration of edoxaban (NOAC) and got pregnant naturally fifty-five weeks later after the abortion. Anticoagulation therapy was changed from NOAC to ATIII formulation and unfractionated heparin at 5 weeks of gestation. The course of pregnancy was good, and a healthy female newborn of 2310&#x2009;g was delivered vaginally at 37 weeks 6 days of gestation. In puerperium, anticoagulation therapy was changed to warfarin. Currently one and one-half years had passed after delivery and no major adverse events or thrombosis has occurred. This case indicates that severe VTE can develop even in multipara pregnancy and that those who take NOAC may be able to continue pregnancy when they get pregnant.

A Case of Pregnancy Complicated with ATIII Deficiency in a Patient Who Developed Severe Venous Thromboembolism in Her Fourth Pregnancy and Had a Favourable Outcome in Her Subsequent Pregnancy with Careful Management of Anticoagulation Therapy including Edoxaban

Overactive bladder (OAB) is urgency, with or without urgency incontinence. For OAB, an injection of onabotulinumtoxin A (BOTOX&#xae;) can be a low-risk outpatient procedure. We present a patient on a novel anticoagulant that experienced excessive bleeding after this procedure. This 80-year-old G2P2002 Caucasian female had a history of urge urinary incontinence. She presented for intravesicular onabotulinumtoxin A injection (150 units) after recent initiation of rivaroxaban (Xarelto&#xae;) for her atrial fibrillation. Several hours after an uncomplicated procedure, she presented with anuria and pain after gross hematuria earlier in the day. Her pain was immediately alleviated with bladder irrigation. She was discharged home and remained asymptomatic. With the popularity of the novel anticoagulants, new guidance on management of these medications during procedures is limited. When managing a patient on a novel anticoagulant before any procedure, even a low risk procedure, several factors should be considered to determine if the medication should be held, bridged, or continued. In sum, each patient on anticoagulation undergoing any procedure should be assessed individually for thrombotic risk, bleeding risk, and the procedural risk to best avoid postprocedural hemorrhage.

Allison Eubanks

Katherine Dengler

Daniel Gruber

Intravesicular Onabotulinumtoxin A Hemorrhage on Rivaroxaban

About this journal

Case Reports in Obstetrics and Gynecology publishes case reports and case series related to obstetrics, maternal-fetal medicine, gynecology, gynecologic oncology, uro-gynecology, reproductive medicine, infertility, and reproductive endocrinology.

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Case Reports in Obstetrics and Gynecology - Table of contents 2019

Case Reports in Obstetrics and Gynecology | Hindawi

title

Case Reports in Obstetrics and Gynecology publishes case reports and case series related to obstetrics, maternal-fetal medicine, gynecology, gynecologic oncology, uro-gynecology, reproductive medicine, infertility, and reproductive endocrinology.

description

Case Reports in Obstetrics and Gynecology

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Case Reports in Obstetrics and Gynecology