Ureteric Endometriosis: 3 Case Reports and a Review of the Literature

Endometriosis involving the ureter is a relatively rare phenomenon but at least 121 cases have been reported previously. The 3 cases presented in this report emphasize some important facets of this condition: the lack of symptoms leading to late diagnosis, the presence of severe renal damage with very localized pelvic disease, how an incomplete initial operation may lead to further major difficulties, and the failure of medical therapy to halt its progress. The potentially lethal nature of ureteric endometriosis is stressed, and the different treatment modalities for patients of different ages and parity discussed. Surgical management, either conservative or radical, is suggested as the modality of choice, and where conservative operation is undertaken very careful continuing observation of renal function is a necessity.     

Diagnosis and Surgical Treatment of Uterine Isthmus Atresia: A Case Report and Review of the Literature

Uterine isthmus atresia is a rare Müllerian duct anomaly occasionally diagnosed in adolescents with primary amenorrhea and cyclic abdominal pain. A case is presented of a 14-year-old female with monthly cyclic lower abdominal pain of a 2-year duration. Magnetic resonance imaging and 3-dimensional ultrasound showed separation of a 10-mm fibrotic tissue between the cervical canal and the endometrial cavity. In an attempt to preserve reproductive ability, an end-to-end anastomosis was laparoscopically performed between the cervical canal and uterine cavity. A platinol stent (WallFlex Biliary RX; Boston Scientific, Boston, MA) was placed by hysteroscopy to avoid stenosis after surgery. Laparoscopic end-to-end anastomosis is proposed to treat congenital uterine isthmus atresia.     

Hymen Sparing Surgery for Imperforate Hymen: Case Reports and Review of Literature

BackgroundImperforate hymen, with an incidence between 0.1% and 0.05%, is the most common obstructive congenital abnormality of the female genital tract. 'Standard' surgical treatment of imperforate hymen involves hymenectomy after a cruciate, plus, or X-shaped hymenotomy incision.CasesTwo cases with imperforate hymen treated with a simple vertical incision are presented. A few oblique sutures were used to prevent refusion. Postoperative follow up was uneventful.Summary and ConclusionThe importance of the integrity of hymen changes in different cultures and religious groups. Option of a hymen sparing procedure is readily preferred by most of these patients and families. Also preservation of hymenal tissue, hence the perception of 'integrity' of female genitalia, might be an alternative treatment option.     

Malignant Struma Ovarii: Two Case Reports and a Review of the Literature

Struma ovarii consists of thyroid tissue derived from germ cells in a mature teratoma. Malignant transformation is very rare, with clinically evident metastatic disease reported in approximately 20 cases. The rarity of this disease renders evaluation of treatment modalities difficult. There is evidence that these tumors behave like their thyroid counterparts, and cytoreductive surgery followed by ablation with radioactive iodine has been advocated. We report the diagnosis and treatment of 2 patients with metastatic malignant struma ovarii treated with a combination of surgery and radiation therapy.     

Uterine Artery Pseudoaneurysm after Cesarean Section: Case Report and Literature Review

Uterine artery pseudoaneurysm (UAP) occurs rarely and can develop after various gynecologic or obstetric procedures. The delayed diagnosis of this disease often results in life-threatening hemorrhage. Herein is described a case of UAP after cesarean section. The patient visited our emergency outpatient department 99 days after cesarean section because of abnormal uterine bleeding, which was diagnosed as UAP using color Doppler ultrasonography and contrast medium–enhanced computed tomography. Selective transcatheter arterial embolization was performed to resolve the lesion without complications. We also conducted a review to identify the demographic etiology of UAP. A PubMed search yielded 57 cases reported in the English literature. The most frequent cause of UAP was cesarean section, which accounted for 47.4% of all cases. The mean interval between the incident and the symptoms was approximately 2 weeks, regardless of cause. At analysis of 17 cases diagnosed within a day, it became evident that the definitive diagnosis was made at angiography (41.2%), computed tomography (29.4%), or color Doppler ultrasonography (29.4%). Almost all cases (94.1%) were conservatively treated with transcatheter uterine artery embolization. Consideration of UAP in the differential diagnosis is crucial for proper treatment before rupture and to preserve fertility.     

巨大宫颈纳氏腺囊肿一例

宫颈纳氏腺囊肿为妇科常见的良性疾病,多为分娩、炎症、人工流产等因素对宫颈的损伤所致。此病为直径在数毫米至4厘米的较小的宫颈囊肿,可为单发或多发,患者多无自觉症状,较大者罕见,性生活可有不适。临床对于宫颈巨大纳氏腺囊肿的术前识别至关重要,与宫颈恶性疾病相鉴别可避免扩大手术范围,提高患者的术后生存质量。巨大宫颈纳氏腺囊肿与阴道苗勒管囊肿、宫颈恶性腺瘤术前易混淆,超声检查不具有绝对性诊断价值。巨大宫颈纳氏腺囊肿病因不清,报告1例合并完全性纵隔子宫且妊娠至足月分娩病例,巨大宫颈纳氏腺囊肿的发生与子宫先天性畸形之间是否有关仍有待研究。     

卵巢非特异性类固醇细胞瘤2例分析及文献复习

目的：探讨卵巢非特异性类固醇细胞瘤的临床、病理学特点,以及诊断和治疗方法。方法：回顾性分析复旦大学附属妇产科医院2000—2010年间收治的2例卵巢非特异性类固醇细胞瘤患者的临床资料,并进行文献复习。结果：良、恶性卵巢非特异性类固醇细胞瘤各1例。2例患者均表现为闭经、男性化等特征,术中及病理所见均与已报道特点一致。良性患者经保守治疗后各项生化指标恢复正常,随访至今状况良好;而恶性患者虽经手术和化疗,10个月后仍死于肿瘤复发。结论：卵巢非特异性类固醇细胞瘤是罕见的卵巢肿瘤,治疗以手术为主,部分患者为恶性,可行化疗,但预后较差。     

Ureteric Injury at Burch Colposuspension 4 Case Reports and Literature Review

Summary: The Burch colposuspension operation is an accepted and effective technique for the correction of genuine stress incontinence. It is, however, associated with a number of well-recognized complications. Ureteric injury at the time of colposuspension is a potentially severe, if uncommon, complication of this procedure with legal ramifications for the surgeon as well as health risks for the patient. To date, only 19 cases have been described in the literature. This paper highlights 4 cases of this injury occurring amongst the patients of 1 urogynaecologist (2) and gives an incidence for its occurrence as well as discussing the aetiology and management of this complication.     

Twin-Reversed Arterial Perfusion (TRAP) Sequence: Case Reports and Review of Literature

Summary: The twin reversed-arterial-perfusion (TRAP) sequence found in monozygotic twins is a consequence of primary or secondary cardiac development disruption and direct arterioarterial and venovenous placental anastomoses. Associated findings include the presence of a single umbilical artery (66%) and chromosomal abnormalities in the acardiac twin (33%). Morphological abnormalities in the acardiac twin are consistent with perfusion of tissues supplied by the common iliac and lower branches of the aorta with deoxygenated blood. The pump or donor twin may develop cardiac failure because of the anomalous perfusion circuit. Polyhydramnios is significantly associated with the presence of renal tissue in the acardiac twin. An acardiac pump twin weight ratio (>50%) is associated with the development of polyhydramnios and preterm labour. Identified high-risk factors for poor obstetrical outcome include: acardiac anceps, polyhydramnios, acardiac twin with ears, and pump twin cardiac failure. Management options include elective termination, observation (serial cardiotocography (CTG), ultrasonography and echocardiography) and selective nonsurgical interventions (indomethacin, digitalis, tocolysis). Additionally, surgical interventions (hysterotomy with selective delivery of the acardiac twin or ligation of the acardiac twin's umbilical cord), and ultrasound-guided embolization of the acardiac twin's umbilical artery with absolute alcohol, platinum coils, or thrombogenic coils have been reported. The most appropriate interventions for the varous clinical presentations of this disorder are as yet undetermined, and conservative nonintervention is often appropriate. Long-term follow-up data on surviving pump twins are lacking. It is anticipated that centres with active study protocols for these conditions will best serve patient care and clinical research needs.     

Laparoscopic Uterine Anastomosis for Traumatic Separation of the Cervix From the Uterine Corpus Caused by Closed Pelvic Fracture: Case Report and Literature Review

Primary amenorrhea caused by separation of the cervix from the uterine body resulting from pelvic trauma is exceptionally rare. This case report describes the diagnosis and successful laparoscopic approximation of traumatic separation of the cervix from the uterine corpus. A 16-year-old girl who was involved in a car accident at age 2 years had primary amenorrhea and cyclic abdominal pain. A closed pelvic fracture was managed nonsurgically, with an uneventful recovery. Since age 13 years, the patient has been experiencing cyclic abdominal pain. Ultrasonography suggested a 5-cm left adnexal mass. Diagnostic laparoscopy revealed complete separation of the uterine corpus from the cervix, and an endometrioma in the left ovary. The uterine corpus was approximated to the cervix with circumferentially placed sutures under direct laparoscopic guidance. The endometrioma was resected concomitantly. Normal cyclic menstruation resumed 2 months postoperatively, without cyclic abdominal pain. This case report demonstrates successful laparoscopic approximation of traumatic separation of the uterine corpus from the cervix, manifested as primary amenorrhea.     

绝经后子宫内膜腺肉瘤致子宫内翻一例并文献复习

绝经后慢性子宫内翻是一种罕见病,报告1例老年女性因子宫内膜腺肉瘤导致子宫内翻,继发感染、尿潴留及静脉血栓栓塞的病例。患者因绝经后阴道出血就诊,期间发现肿物自阴道逐步脱出,经专科查体及影像学检查,考虑是继发于宫底肿物的慢性完全性子宫内翻。病程中患者先后出现感染、尿潴留及左下肢全程静脉血栓栓塞。经多学科会诊,最终于椎管内麻醉下行经腹会阴联合子宫及双附件切除术,术后病理示子宫内膜腺肉瘤,临床拟诊ⅠA期,患者拒绝再分期手术及辅助治疗,术后随访2年无新发肿物。针对该类罕见疾病,结合超声及盆腔磁共振成像典型征象可尽早明确诊断,其治疗需针对原发肿瘤、继发于内翻子宫的并发症及患者自身合并症,制定个体化的围手术期管理方案。     

肥胖影响子宫内膜蜕膜化机制的研究进展

子宫内膜蜕膜化是胚胎植入、胎盘形成以及维持妊娠的必要条件,蜕膜化受损与多种不良妊娠结局有关。目前肥胖人群显著增多,对健康有不同程度的损害,肥胖女性子宫内膜间质细胞中蜕膜化标志物催乳素和胰岛素样生长因子结合蛋白1的mRNA表达明显降低,且肥胖对蜕膜化过程中涉及的孕激素相关蛋白、胰岛素受体底物2、信号转导与转录激活因子3、Wnt蛋白等相关因子及蜕膜免疫细胞均有影响,认为肥胖与蜕膜化受损具有密切的关系。研究肥胖与子宫内膜蜕膜化受损的相关性,有助于进一步了解子宫内膜蜕膜化受损的发病机制,对预防蜕膜化受损、改善不良妊娠结局具有重要意义。深入开展此方面的研究可能为肥胖型反复妊娠丢失患者的诊治提供新思路。     

Large Uterine Cervical Adenomyoma Excised by Vaginal Approach: Case Report,Images, and Literature Review

Uterine adenomyoma is often overlooked, and cervical adenomyoma is extremely rare. Previous reports suggest that a uterine adenomyoma usually occurs in the uterine corpus but rarely in the uterine cervix. Approximately 20 reports of cervical adenomyoma have been published to date. However, cervical adenomyoma has been rarely investigated using magnetic resonance imaging. We encountered a large multicystic tumor in the uterine cervix of a 26-year-old woman that was difficult to diagnose preoperatively. On the basis of cytology, biopsy, and imaging findings, the cervical multicystic tumor measured approximately 13.0 cm. The patient underwent vaginal adenomyomectomy, and the tumor was completely resected. A histologic diagnosis of cervical adenomyoma was made because of proliferation of endocervical glands and the presence of rounded smooth muscle stroma. Awareness of this tumor in the uterine cervix is important for accurate diagnosis and treatment. Herein we present a rare case of a large cervical adenomyoma, with imaging studies, an image of the operation, histologic findings, and a literature review.     

Denial of Pregnancy: A Review and Case Reports

ABSTRACT: This paper describes the characteristics of women who deny awareness of their pregnancies, the underlying causes and conflicts, and specific interventions required to address these issues. Case reports illustrate this complication of pregnancy. The absence of many physical symptoms of pregnancy, inexperience, general inattentiveness to bodily cues, intense psychological conflicts about the pregnancy, and external stresses can contribute to the denial in otherwise well-adjusted women. Assessment should include the possible contribution of painful reactivation of memories concerning childhood or adult trauma and the effect of dissociative states on the development of denial of pregnancy. Psychotherapy is recommended to resolve these conflicts, and to prevent future pregnancy denials and child abuse or neglect. Denial of pregnancy is easier to understand in women with psychosis or serious cognitive impairment than in those without such disorders. The underlying illness requires treatment by a psychiatrist. Psychological conflicts also exist in psychotic women, such as the intense wish to have a baby while fearing loss of the infant to child-protection services. Acknowledging the conflict and supporting the mother despite her puzzling behavior is an important task for health caregivers.     

Meigs’ Syndrome with Elevated Serum CA 125 Levels: Two Case Reports and Review of the Literature

Two cases of Meigs’ syndrome in association with elevated serum CA 125 levels are reported. The significance of Meigs’ syndrome lies in the fact that neither ascites nor pleural effusion is necessarily an ominous sign in women with a pelvic tumor. Although there is a strong correlation between ovarian malignancy and elevated serum CA 125 levels, several benign conditions have been found to cause a rise in CA 125 levels. It is important to remember that a pelvic neoplasm in a woman presenting with hydrothorax, ascites, and elevated CA 125 levels might be benign and that this condition can rapidly be resolved with surgical removal. Neither ultrasound examination nor computed tomography can reliably offer a preoperative diagnosis.