A Rare Uterine Malformation: Asymmetric Septate Uterus

Study Objective

To demonstrate a step by step surgical hysteroscopy technique in a patient with asymmetric uterine septum and transverse uterine septum that was not previously described in the literature.

Prenatal Identification of a Tetraploid Fetus with fish

The first prenatal diagnosis of a tetraploid fetus via fluorescent in situ hybridization (FISH) technology is reported. FISH analysis of uncultured amniotic fluid cells utilizing probes for chromosomes 13, 21, 18, X, and Y revealed that greater than 65% of hybridized nuclei had four signals. Standard cytogenetic analysis revealed a 92, XXXX karyotype     

Vesicouterine Fistula and Fetus in Bladder: A Case Report

BackgroundVesicouterine fistulas are the rarest of all urogenital fistulas, with most cases occurring after cesarean section.CaseA 38-year-old woman in rural Zimbabwe presented at 20 weeks gestation with a suspected fetus in the urinary bladder by transabdominal ultrasonography. This finding was confirmed intraoperatively together with a vesicouterine fistula. Cesarean section 20 years earlier was the only risk factor. Diagnosis was delayed for lack of access to appropriate imaging and a tertiary facility.ConclusionA vesicouterine fistula is a rare presentation in the context of an advanced health care system. To our knowledge, this is the fourth case report of a fetus in the bladder secondary to vesicouterine fistula. Patient morbidity in this case possibly could have been avoided with earlier diagnosis and access to care.     

Uterine Arteriovenous Malformation - A Rare Cause of Uterine Haemorrhage

Summary: Uterine arteriovenous malformation (AVM) is a rare cause of massive uterine bleeding, with 70 cases reported in the English literature. Although uterine AVM is a rare cause of menorrhagia or postmenopausal bleeding, it is important to consider in the assessment of a patient with abnormal (especially heavy) uterine bleeding because accurate diagnosis can allow appropriate treatment to be planned and avoid hysterectomy in women who wish to retain their reproductive capacity. Until relatively recently this condition was difficult to diagnose and management almost always required hysterectomy. Special investigations (hysteroscopy, Doppler flow ultrasound and pelvic angiography) are important for diagnosis and assessment. Transcatheter embolization has replaced hysterectomy as the treatment of choice in women who wish to retain their fertility. Curettage may precipitate life-threatening haemorrhage and is therefore contraindicated when uterine AVM is suspected.     

Lymphatic Vaginal Fistula after Wertheim-Taussig Hysterectomy: A Case Report

Significant vaginal discharge of clear fluid after Wertheim-Taussig hysterectomy with bilateral salpingo-oophorectomy is most often due to urinary fistula. Rarely, the same symptom may be caused by lymphatic fistula, which has not been reported previously. The differentiation between lymph and urine is simple. If this rare complication is not suspected, patients may undergo unnecessary invasive diagnostic procedures of the urinary tract.     

孤立性轻度侧脑室增宽胎儿的产前诊断及预后分析

目的:研究孤立性轻度侧脑室增宽(i MVM)胎儿与染色体异常、先天性宫内感染及不良妊娠结局的关系。方法:回顾性分析我院2009年1月至2013年12月i MVM胎儿143例的产前诊断情况及妊娠结局。结果:143例i MVM胎儿中共有48例(33.57%)同意产前诊断,行胎儿染色体核型及TORCH-Ig M检查,发现1例(2.08%)染色体异常,为47,XX,+21;2例(4.17%)胎儿分别合并巨细胞病毒和弓形体感染。89例(62.24%)有追踪随访结果,其中1例21-三体终止妊娠,3例孕妇主动选择终止妊娠,2例分别合并继发性耳聋和语言发育障碍,其余83例(93.26%)在出生后0~4年内智力及生长发育正常;在i MVM的胎儿中男女比例为2.07∶1。结论:排除i MVM胎儿的染色体异常及先天性宫内感染后,此类胎儿的预后良好,而且男胎发病率远远高于女胎。     

Intrapartum Detection of a Maerosomie Fetus: Clinieal Versus 8 Sonographic Models

Summary: The purpose of this study was to determine whether clinical or sonographic models have 1) the highest accuracy in differentiating newborns with birth-weights ≥ 4,000 g (macrosomia) versus ≤ 3,999 g, and 2) among macrosomics which method of predicting birth-weight has the lowest percentage error. Prospectively, 602 consecutive parturients at term had a clinical estimate of birth-weight followed by sonographic measurement of fetal parts. The sonographic prediction of birth-weight was derived using 8 different models that utilize either 1 measurement or a combination of 2 to 4 parameters. The incidence of macrosomia was 11.1% (67 of 602). Analysis of ROC curves indicated that clinical predictions (w = 0.85) were significantly better than 4 of the 8 sonographic models. The mean standardized absolute error among maerosomie newborns is significantly lower when predictions are derived clinically (99 ± 70 g/kg) than using 1 or 2 fetal parts. Sonographic assessment of birth-weight is not significantly more accurate in the detection of a maerosomie fetus than clinical predictions.     

Congenital Venous Lymphatic Malformation as an Unusual Source of Premenarchal Vaginal Bleeding

Background

Premenarchal vaginal bleeding can present a diagnostic challenge and has not been previously reported in association with congenital venous lymphatic malformation.

A Rare Case of Cardiac Rhabdomyomas in a Dizygotic Twin Pair

Cardiac rhabdomyoma (CR) is the cardiac tumour most commonly diagnosed in utero. Eighty percent of CRs are associated with tuberous sclerosis (TS). TS is a rare multi-system disease, with autosomal dominant genetic transmission. If the parents of an affected child do not have features of TS, then either one parent is mosaic for the TS gene mutation or the affected child is the result of a de novo germline mutation. We present a case of a dizygotic twin pregnancy complicated by CRs in both fetuses at 24 weeks. Twin A died in utero at 28 weeks. Preterm labour and delivery of twin B occurred at 33 weeks. Twin B had multiple small CRs and a large apical CR. At six weeks after delivery, the CRs had disappeared or reduced in size. Regression in the third trimester or postnatally is the natural course of CRs. Molecular testing for TS identified two variants in the TSC2 gene. The parents were clinically unaffected; however, the father was subsequently found on an MRI of the head to have cortical tubers, and he was found to carry the pathogenic TSC2 mutation. Since dizygotic twin pregnancy is akin to two consecutive pregnancies, the etiology in our case is due to one parent having subclinical TS. To the best of our knowledge, this is the first such case to be reported.     

Harlequin Ichthyosis: A Rare Case of Congenital Ichthyosis

The Journal of Obstetrics and Gynecology of India -     

A Rare Case of Vulvar Superficial Angiomyxoma in a Pediatric Patient

BackgroundSuperficial angiomyxoma (SAM) is a rare, benign cutaneous tumor. Originally described as a component of Carney complex, it is now recognized as a sporadic condition.CaseA 7-year-old girl was referred for management of a 2.5-cm mass arising from the right labia majora. Key pathologic features included lobules of spindle-shaped cells in a myxoid matrix and prominent neutrophilic infiltrate. The cells were positive for CD34 and negative for desmin, progesterone receptor, and estrogen receptor staining.Summary and ConclusionThis case is that of the youngest described patient with vulvar SAM. Patients should be carefully examined for manifestations of Carney complex to avoid potentially life-threatening complications. It is critical to distinguish SAM from aggressive angiomyxoma. The patient was referred to genetics and will be followed for local recurrence.     

First Case Report of Adnexal Fetus in Fetu

BackgroundThere is an ambiguous and controversial line between fetiform teratoma and fetus in fetu (FIF) as differential diagnoses of a fetiform mass. Classically, the presence of vertebral column often with a relatively proper arrangement of other organs around the central axis favor the diagnosis of FIF over teratoma.CaseBased on previously proposed criteria and the presence of vertebral organization in the radiological and histopathological assessment of the fetiform mass, we present an extremely rare case of adnexal FIF in a 10-year-old girl presenting with acute abdominal pain.Summary and ConclusionWhether FIF and fetiform teratoma are one entity or two, clinical discrimination for the choice of treatment seems to be unnecessary and the patient should be clinically followed for the probable malignant potential.     

A Rare Case of a Giant Vulval Fibroepithelial Stromal Polyp

BackgroundA fibroepithelial stromal polyp is an uncommon benign pathology of the female genital tract. Rarely, these benign tumors present as a giant lesion and are clinically difficulty to distinguish from other pathologies.CaseA 19-year-old female presented with a vulval fibroepithelial stromal polyp measuring ～8 × 8 × 3 cm that extended from the right labia majora. Present for 2 years, the lesion caused mild discomfort and aesthetic dissatisfaction due to its size but otherwise had no associated symptoms. It was diagnosed using a combination of imaging techniques including ultrasound and magnetic resonance imaging and histological analysis. It was removed surgically and has had no recurrence.Summary and ConclusionThe consideration of both benign and malignant pathologies is paramount when differentiating vulval masses. Thorough clinical reasoning and appropriate use of imaging modalities and histological analysis are essential.