Cervical pregnancy. A report of a case and literature review

The cervical pregnancy is a rare clinical illness among the ectopic pregnancies; the diagnosis at the moment is made by means of ultrasonography, which shows an empty uterus and a gestation in cervical channel. At the moment the preservative treatment can be made with methotrexate, without determining of precise way the factors of fault for this handling, leaving the single surgical treatment in emergency situations, avoiding the uncontrollable haemorrhage. This paper reports the case of a patient with a cervical pregnancy of nine weeks, live, with initial determination of corionic gonadotrophin hormone of 68,919 mUl/mL; reason why it is decided to interrupt the gestation being applied two doses of methotrexate; first IV of 85 mg and second with intraamniotic application. The evolution of the gestation was towards the involution and absorption of the gestational coat, the sub-unit concentrations corionic gonadotrophin hormone beta presented decrement, until undetectable, with good clinical and functional results. The gestational coat was reduced, the embryo lost beat and the gonadotrophin were in decrement until zero, with clinical evolution with stained solely haematic, without haematological and functional repercussions. Criteria of fault of the preservative treatment with methotrexate are not defined, although due the peculiarity of this illness, it is not possible to make a more extensive study, but by the reproductive benefit in young patients, it would be adapted to take it in to account like option instead of the hysterectomy.     

Laparoscopic management of ovarian pregnancy. A case report

Operative laparoscopy has been reported to be a useful alternative to laparotomy for the treatment of tubal pregnancy. Ovarian pregnancy is a rare form of ectopic gestation that can be treated with operative laparoscopy. The most serious problem in treating ovarian pregnancy is making an accurate diagnosis; pathologic documentation is the only way to confirm the diagnosis. Postoperative follow-up should include evaluation of the patient for bleeding or infection and serial monitoring of quantitative beta-human chorionic gonadotropin levels to confirm the complete removal of placental tissue.     

Conservative management of decidualized ovarian endometriotic cyst during pregnancy mimicking malignancy: case report and a review of the literature

We report here the case of a 30-year-old woman with a decidualized ovarian endometriotic cyst (DOEC) during pregnancy mimicking malignancy occurring after fertility-preserving surgery for ovarian carcinoma arising from an endometriotic cyst. Intracystic excrescences appeared in the left ovarian endometriotic cyst at five weeks and three days of gestation. The serum CA-125 level rose to 676.7 U/ml (normal, 0-35). Based on these findings, ovarian carcinoma arising from the left ovarian cyst was strongly suspected. Frequent sonographic examinations revealed that the sizes and quality of the intracystic excrescences remained essentially unchanged. The cyst was evaluated for DOEC during pregnancy. The patient eventually delivered a male infant by normal vaginal delivery. After the delivery, the intracystic excrescences in the left ovarian endometriotic cyst disappeared. Close observation may be a reasonable alternative to antepartum surgery in patients with a DOEC during pregnancy.     

Repeated pregnancy with concomitant presence of ovarian teratoma: A case report and literature review

Objective

Benign mature teratoma during pregnancy is common, mostly discovered incidentally by antenatal sonography. However, repeated pregnancy coincident with ovarian mature teratoma is rarely reported. The cases of teratoma with rapid growing characteristics are even more unique.

Partial molar pregnancy. A case report and literature review

We report the case of a 17 year old patient with partial molar pregnancy and coexistent live fetus of 13 gestational weeks diagnosed by ultrasound, which required the termination of pregnancy for maternal decompensation.     

Primary ruptured ovarian pregnancy in a spontaneous conception cycle: a case report and review of the literature

Ovarian pregnancy is an uncommon presentation of ectopic gestation, where the gestational sac is implanted within the ovary. Usually, it ends with rupture, which occurs before the end of the first trimester. Its presentation often is difficult to distinguish from that of tubal ectopic pregnancy and hemorrhagic ovarian cyst. We describe a case of primary ovarian pregnancy in a 31-year-old patient who presented to the emergency room with symptoms and signs of peritonism and positive urine hCG test. The gestation sac was demonstrated in the right ovary by transvaginal sonography. MSD (mean sac diameter) was 15 mm corresponding to the sixth gestational week. Free fluid was found in the Douglas pouch. Culdocentesis was positive for hemoperitoneum. Henceforth, emergency laparotomy and wedge resection of the ovary was perfomed. Aetiological, clinical and therapeutical aspects of this rare extrauterine pregnancy are described. Also, the problems of its differential diagnosis are discussed.     

Bilateral tubal pregnancy: a case report and review of the literature.

We describe a patient whose secondary infertility was treated with clomifen. She developed a bilateral tubal pregnancy which was confirmed histologically. A short review of the pertinent literature is also presented.     

Acrofacial dysostosis syndromes: a relevant prenatal dilemma. A case report and brief literature review.

The acrofacial dysostosis (AFD) syndromes are an heterogeneous group of disorders with undefined classification and inheritance. We report the sonographic and clinical features of an AFD fetus with predominantly pre-axial forms. We made a prenatal diagnosis of Nager syndrome but postnatal examination showed post-axial defects previously undetectable by ultrasound.     

Idiopathic myelofibrosis in pregnancy: a case report and review of the literature.

Idiopathic myelofibrosis is a rare myeloproliferative disorder characterized by excessive accumulation of connective tissue in the bone marrow in association with anemia, splenomegaly, and extramedullary hematopoiesis. The cause of this disease is unknown, and the prognosis is generally poor. To our knowledge, this is the first case report of a patient with idiopathic myelofibrosis who carried a term pregnancy. In spite of the increased perinatal risks, a favorable outcome was possible with close antepartum surveillance.     

Insulinoma in pregnancy: a case report and review of the literature

Insulinomas are rare tumors with an incidence of approximately four cases per million person-years. Nineteen cases of insulinoma during pregnancy have been reported. Hypoglycemic symptoms usually appear during the first trimester. A 28-year-old primigravida was admitted at 6 weeks of gestation after referral for uncontrolled seizures. Her previous seizure work-up included a normal EEG and a normal magnetic resonance imaging of the brain. Elevated fasting insulin and C-peptide levels accompanied severe hypoglycemia. The patient was managed with glucose monitoring, frequent small meals, and rare doses of glucagon. Postpartum testing was consistent with insulinoma, and magnetic resonance imaging indicated a mass in the tail of the pancreas. During surgical exploration with intraoperative ultrasound, two insulinomas were removed from the tail of the pancreas. The hypoglycemic episodes resolved and the fasting glucose levels normalized. Insulinomas are rare in pregnancy and can be difficult to diagnose. Symptoms may resolve during the second and third trimesters, possibly due to changes in glucose metabolism associated with pregnancy. Misdiagnosis has been fatal. Careful management during pregnancy and aggressive treatment after delivery are essential. TARGET AUDIENCE: Obstetricians and Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to describe the pathophysiology of an insulinoma, to list the potential tests used to make the diagnosis of insulinoma, and to outline potential treatment options for a patient with an insulinoma.     

双侧输卵管同时妊娠1例及文献复习

目的:探讨临床罕见病例——双侧输卵管妊娠的诊断及治疗方法。方法:通过病例报道和相关文献复习,对双侧输卵管妊娠的病因、诊断及治疗作一分析。结果:双侧输卵管妊娠发生率较低,容易漏诊,对患者造成不良影响甚大,早期诊断和治疗尤为重要。结论:辅助生殖技术(ART)为不孕症患者带来福音的同时,在一定程度上增加了异位妊娠(EP)的发生率,尤其是某些特殊类型的EP。对于可疑患者,超声和手术应仔细探查双侧附件的情况,以便早期发现和治疗。     

Luteoma of pregnancy: report of a case and review of the literature.

A case of a unilateral, non-virilizing pregnancy luteoma in a 28 year old Caucasian female resulted in good health more than six years after removal of the lesion. Theories on the histogenesis of the lesion are briefly recounted and the literature is reviewed. This case appears to be number 62 in the world literature.     

Primary ovarian carcinosarcoma: a case report and review of the literature

Primary ovarian carcinosarcoma is characterized by an admixture of malignant epithelial and stromal elements. This neoplasm is extremely rare with fewer than 400 cases reported in the English literature. Its histogenesis, clinical features and optimal treatment remain unclear because of the rarity of primary ovarian carcinosarcoma. This study focuses on the clinical, pathological, immunohistochemical features and survival of a 73-year-old patient with primary ovarian carcinocarcoma. The patient was treated with surgery followed by combined chemotherapy with carboplatin and taxol and assigned to FIGO Stage IIIc. She died from the disease 17 months after surgery. In conclusion, ovarian carcinosarcoma is a very aggressive tumor, especially when it is diagnosed at advanced stage.     

Immature teratoma in pregnancy: a case report and literature review

BACKGROUND: The management of a Stage I immature teratoma during pregnancy with a review of the literature is reported. CASE REPORT: A growing adnexal mass was removed at 12 weeks of gestation. Although the frozen section was negative, because of intraoperative clinical suspicion, a right salpingo-oophorectomy and surgical staging were performed. Histological examination revealed a Stage Ia, grade 1 immature ovarian teratoma. Appropriate surgical staging enabled avoidance of chemotherapy despite the unexpected histological diagnosis. The pregnancy was terminated because of fetal distress, with cesarean section at 34 weeks of gestation. At that time the peritoneal cavity was inspected and biopsies were taken as in second-look laparotomy. Two years after the first operation the patient remains disease free. CONCLUSION: For adnexal masses removed during pregnancy frozen section is useful but when there is clinical suspicion surgical staging must be performed.     

Cushing's syndrome in pregnancy: a case report and literature review

The thirty-third instance of pregnancy and Cushing's syndrome is presented and the literature is reviewed. There is a poor fetal prognosis without definitive treatment of Cushing's syndrome during pregnancy. Maternal complications are common with adrenal adenomas, 44% developing pulmonary edema and 100% developing hypertension. Prompt diagnosis and early treatment are necessary.