Laparoscopic excision of a benign peritoneal cystic mesothelioma

Benign cystic peritoneal mesothelioma is a rare tumor and most commonly occurs in women in the reproductive age group. It is very rare in women of postmenopausal age. We present a rare case of a postmenopausal woman with benign peritoneal cystic mesothelioma removed at laparoscopy.     

Symptomatic endosalpingosis in a postmenopausal woman

The presence of ectopic fallopian tube epithelium (endosalpingosis) in postmenopausal women is rare and usually asymptomatic. A case is presented of symptomatic endosalpingosis in a postmenopausal woman who had none of the previously described predisposing factors.     

Primary ovarian leiomyosarcoma: a case report

Primary ovarian leiomyosarcomas are extremely rare tumors that comprise less than 0.1% of all ovarian malignancies. We present a case of 62-year-old postmenopausal woman with a slightly enlarged right ovary and a Color Doppler sonography resistance index (RI) measuring 0.54. The patient, after being managed with surgery alone, is alive after 14 months without any evidence of disease. This is an unusual case in that primary ovarian leiomyosarcoma was diagnosed in the setting of a slightly enlarged irregular postmenopausal ovary with a concomitant intermediate RI value on color flow Doppler evaluation. A high index of suspicion may help prevent delay in the diagnosis of this rare neoplasm.     

Primary malignant melanoma of the vagina. Poor response to radical surgery and adjuvant therapy

Primary malignant melanoma of the vagina is an extremely rare condition usually found in postmenopausal women. It has a poor prognosis associated with a high rate of recurrences and rare long-term survivorship. We describe a case and review the literature emphasizing the importance of prognostic factors and elective treatment.     

Severe virilization in a postmenopausal woman: a case report

Severe postmenopausal virilization is a rare event in clinical practice. To evaluate ovarian or adrenal hyperandrogenism endocrine tests and imaging are useful diagnostic tools. We report a case of a postmenopausal woman with hirsutism and androgenetic alopecia. A malignant cause for the present disorder could be excluded by imaging. Selective venous sampling was administered with increased testosterone level of the right adrenal vein. Right adrenalectomy and right oophorctomy was recommended.     

Cavernous hemangioma of the uterus (a case report)

Cavernous hemangioma of the uterus is an extremely rare lesion. We report a postmenopausal patient with abnormal uterine bleeding due to hemangioma and simple endometrial hyperplasia.     

Embryonal rhabdomyosarcoma of the uterus in a postmenopausal woman. Case report and review of the literature

BACKGROUND: Embryonal rhabdomyosarcoma is a rare sarcoma which characteristically occurs in non genitourinary sites in children. CASE: We present a case of uterine embryonal rhabdomyosarcoma in a postmenopausal patient who presented with increasing abdominal girth, early satiety, weight loss, and pelvic pain. CONCLUSION: Embryonal rhabdomyosarcoma does not commonly originate from the uterine corpus, and it is rarely seen in postmenopausal patients. A review of the literature confirms the unique nature of this case.     

Mucinous adenocarcinoma arising from one retroperitoneal mature cystic teratoma in a postmenopausal woman

Malignant degeneration of a retroperitoneal mature cystic teratoma to adenocarcinoma at postmenopausal age is extremely rare. A 72-year-old woman with mucinous adenocarcinoma arising from a retroperitoneal mature cystic teratoma is presented.     

Hysteroscopy and three-dimensional ultrasonography in uterine diverticulum diagnosis: a case report

The authors describe a case report of a uterine diverticulum in a postmenopausal woman with abnormal uterine bleeding, confirmed by 3-dimensional ultrasonography and hysteroscopy. They comment on the clinical significance of this rare lesion.     

Postmenopausal hyperthecosis: functional dysregulation of androgenesis in climacteric ovary

BACKGROUND: Hyperandrogenism of ovarian origin is rare in postmenopausal women. However, there is evidence that the ovaries of postmenopausal women are active endocrine glands, secreting mainly androgens.CASE: A postmenopausal woman sought treatment for progressive hirsutism. Endocrine evaluation revealed androgen excess. Transvaginal ultrasound revealed enlarged ovaries. Hysterectomy and bilateral oophorectomy were recommended. However, surgery had to be withheld for 6 months while the patient recovered from an acute myocardial infarction. In the interim, the patient’s hyperandrogenemia was successfully treated with monthly injections of the gonadotropin-releasing hormone agonist (GnRH), leuprolide acetate.CONCLUSION: This report illustrates the potential for postmenopausal ovaries to become active androgen-secreting endocrine organs. It also demonstrates the efficacy of pharmacologic intervention for postmenopausal ovarian hyperthecosis when the patient is a poor surgical candidate.     

Small bowel and omentum evisceration after abdominal hysterectomy

Intestinal evisceration through the vagina is rare, and transvaginal evisceration after transabdominal surgery is even more rare. Vaginal evisceration is a very rare complication of abdominal hysterectomy, but when this occurs, it is a surgical emergency. Prompt attention is required to prevent further morbidity and potential mortality. The most common organ to eviscerate is the distal ileum, with only two cases of prolapsed omentum having been reported. We present an unusual case of a postmenopausal woman who presented with a vaginal evisceration of the small bowel and omentum after abdominal hysterectomy.     

Transvaginal evisceration after radical abdominal hysterectomy

BACKGROUND: Intestinal evisceration through the vagina is rare and transvaginal evisceration after transabdominal surgery is far more rare. CASE: We present an unusual case of a postmenopausal woman who presented with transvaginal evisceration of the small bowel after radical abdominal hysterectomy and pelvic lymphadenectomy. CONCLUSION: This was a rare case of terminal ileal evisceration through a ruptured vaginal cuff after radical hysterectomy and bilateral pelvic lymphadenectomy. We performed a delayed closure of the vaginal defect through the vagina after manual reduction of the eviscerated small bowel, and the outcome was satisfactory.     

Pseudo-Meigs syndrome and elevated CA125 associated with struma ovarii

BACKGROUND: Struma ovarii is a rare form of ovarian neoplasm composed entirely and predominantly of thyroid tissue. The association of pseudo-Meigs syndrome, elevation of CA125 and hyperthyroidism to struma ovarii is a rare condition. CASE: We report an unusual presentation of a postmenopausal woman with benign struma ovarii associated with pseudo-Meigs syndrome, hypertiroidism, and elevated CA125 serum level, and a large complex right pelvic mass thereby mimicking an ovarian cancer. CONCLUSIONS: Struma ovarii is a rare cause of ascites, hydrothorax, elevated CA125, and hyperthyroidism. This rare condition should be considered in the differential diagnosis in patients with ascites and pleural effusions but with negative cytology.     

Transvaginal color Doppler sonography and CA-125 elevation in a patient with ovarian thecoma and ascites.

A postmenopausal patient presented with a pelvic mass and ascites. The CA-125 level was 329 U/ml, and transvaginal color Doppler sonography of the tumor vasculature suggested malignancy. At laparotomy, a luteinized thecoma and cytologically benign ascites were found. On rare occasions ovarian thecoma may be associated with ascites without hydrothorax. Preoperative evaluation of the patient with ascites and a pelvic mass may suggest malignancy, but histologic confirmation is necessary to exclude this rare association.     

Epithelioid leiomyosarcoma of the ovary

INTRODUCTION: Leiomyosarcoma of the ovary is a rare lesion usually seen in postmenopausal women. Epithelioid leiomyosarcoma of the ovary is exceptionally rare, with only one previously reported case. CASE: A 42-year-old nulliparous woman undergoing ovulation induction presented with a left adnexal mass. An exploratory laparotomy was performed. Frozen section diagnosis was read as fibrothecoma, and an oophorectomy was performed. The final diagnosis was epithelioid leiomyosarcoma of the ovary. Subsequently, a staging procedure including hysterectomy was performed with no residual disease. DISCUSSION: This is an unusual case for several reasons. Most leiomyosarcomas of the ovary have occurred in postmenopausal women and were of advanced stage at diagnosis. Our case had an epithelioid histology, occurred in a premenopausal woman, and was confined to the ovary. The fact that the patient was undergoing ovulation induction at the time of diagnosis raises the question of the risk of developing ovarian neoplasms with these medications.     

Endometriosis of the liver containing mullerian adenosarcoma: case report

We present a case of a liver endometrioma in a postmenopausal woman. After failed management with leuprolide acetate, the mass was resected and contained focal areas of mullerian adenosarcoma. This is a rare case of mullerian adenosarcoma that appeared to arise within an endometrioma of the liver.     

Primary choriocarcinoma of the uterine cervix in a postmenopausal patient: a case report

BACKGROUND: Primary cervical choriocarcinoma seen in a postmenopausal patient is a very rare entity. CASE: Primary choriocarcinoma of the uterine cervix was diagnosed in a 54-year-old woman. She had admitted to our clinic with vaginal bleeding and had been postmenopausal for 1 year at the time of diagnosis. A cervical tumoral mass was seen in her pelvic examination and cervical biopsy revealed squamous cell carcinoma of the cervix. Pelvic examination under anesthesia was done and patient was accepted as FIGO Stage IIA. Type III hysterectomy with bilateral salphingoopherectomy and bilateral pelvic-paraaortic lymph node dissection was carried out. Postoperative pathological evaluation of the surgical specimen showed that case was a primary choriocarcinoma of the cervix. CONCLUSION: This is one of the few reported cases of cervical choriocarcinoma in a postmenopausal patient. The most appropriate theory for the development of this tumor is metaplastic differentiation of the tumor from another histologic type.     

Hormontherapie bei gynäkologischen, nichtmalignen Erkrankungen

About one third of all postmenopausal women need hormone replacement therapy (HRT) and hypoestrogenism affects most organ systems. The therapeutic benefit of HRT is well proven and in postmenopausal women with endometriosis and/or uterine myoma represents a special challenge. Both benign diseases are estrogen-dependent and can be negatively influenced by HRT. Cases of endometriosis/uterine myoma in postmenopausal women are rare but can severely influence the quality of life of those women affected. A HRT is still feasible as long as the advantages and disadvantages are taken into account but should be reserved for patients with severe hypoestrogenism. In cases of active endometriosis and symptomatic myoma surgical therapy should be preferentially performed. As estrogen replacement can be associated with a higher risk of recurrence or malignant transformation, combined preparations should be chosen instead of estrogen monotherapy. Although there is no firm evidence tibolone and aromatase inhibitors appear to be the optimal choice.     

Postmenopausal uterine inversion associated with endometrial polyps

BACKGROUND: Postmenopausal uterine inversion is an extremely rare gynecologic complication. We report a case of uterine inversion associated with endometrial polyps alone. CASE: A postmenopausal nullipara with a history of recurrent postmenopausal bleeding was evaluated for persistent vaginal bleeding. Benign endometrial polyps were found, and the patient's symptoms improved after a therapeutic dilation and curettage. She had acute onset of profuse vaginal bleeding 3 months later and a mass protruded from the cervix. A laparotomy revealed an inverted uterus that was resolved by the Haultain technique and was followed by total abdominal hysterectomy. CONCLUSION: Nonpuerperal uterine inversion associated with endometrial polyps was successfully treated surgically.     

Postmenopausal hormone therapy and cardiovascular disease in perspective

The totality of data indicate that the window of opportunity for reducing mortality and coronary heart disease is initiation of hormone therapy (HT) within 6 years of menopause and/or by 60 years of age and continued for 6 years or more. Additionally, the risks of HT are rare (<1/1000) especially in younger postmenopausal women and comparable with other primary prevention therapies. In fact, as randomized controlled trial results accumulate, the more they look like the consistent observational data. These studies showed that young postmenopausal women with menopausal symptoms who use HT for long periods of time have lower rates of mortality and coronary heart disease than comparable postmenopausal women who do not use HT.