Jovan Bila

Bilateral ampulary pregnancy after clomifen citrate and intrauterine insemination--a unique case report.

Abstract We report a case with bilateral tubal ampullary pregnancy after Clomifen Citrate medication. The first conception in the right tube was after intrauterine insemination or intercourse performed before insemination, while the second one was achieved 10 d after insemination, during the intercourse, in the left tube. This life-threatening and routinely unexpected finding must always have in mind all doctors dealing with patients in emergency care, especially those receiving fertility enhancing drugs. According to the literature data available, this is the first and unique such case in the literature.

Diagnostic value of serum tumor markers for adnexal masses

ObjectiveThe study aim was to investigate the diagnostic value of measuring preoperative serum tumor markers in patients with adnexal masses.MethodsThe study included all (358) consecutive patients treated for adnexal tumors at the Clinic of Obstetrics and Gynecology, Clinical Center of Serbia during 12 months. Tumor-marker levels (Ca 125, CEA, HE 4, Ca 19.9 and Ca 15.3) obtained from all women on admission were compared with histopathological findings in cases in which tumors were removed.ResultsWomen with malignant tumors had the highest levels of Ca 125, CEA and HE 4 (p<0.01). Mucinous adenocarcinoma produced the highest amounts of Ca 19.9 and CEA. Ca 15.3 was the highest in women with endometrioid carcinoma. There were no significant differences in the levels of all serum tumor markers between women with benign and borderline tumors (p>0.05). Malignant forms of tumors were well indicated by Ca 125, HE 4 and Ca 15.3 levels. The combination of Ca 125 and HE 4 resulted in the highest sensitivity, specificity, and positive or negative predictive value (91.04%, 87.6%, 67.9%, 77.2%, respectively).ConclusionsBlood levels of tumor markers can be effective? predictors of the nature of adnexal masses. For the most precise evaluation, a combination of serum tumor markers should be used.

Pelvic Leiomyosarcoma obstructing vaginal opening - case report

We present a 42-year-old female admitted for a 4 month history of increasing pelvic discomfort and pain. Clinical examination revealed a large tumor obstructing the vagina. Tumor markers (CA 125, CEA, AFP and CA 19-9), white blood cells and biochemical tests were all within the normal limits. Pelvic ultrasound and magnetic resonance imaging scan confirmed the presence of a large retroperitoneal/pelvic mass. The tumor was surgically excised and pathohistologically diagnosed as a well differentiated leiomyosarcoma, staged IB. Six years after surgery the patient is well and disease free.

Fallopian tube torsion caused by extremely large Morgagni hydatid: A very rare cause of acute abdomen in a virgin adolescent

Torsion of the fallopian tube is rare and generally isolated and unilateral. We report a case of acute abdominal pain in an adolescent virgin female caused by a complete torsion that resulted in an infarction of the left fallopian tube. On surgery, extremely large hydatid of Morgagni was found, that caused torsion of the fallopian tube threefold.CaseAn 18-year-old virgin presented with severe abdominal pain in the left lower quadrant accompanied by vomiting for three hours. Abdominal examination revealed tenderness and guarding in the left lower abdominal part while on rectal examination there was a palpable mass in the left adnexal region, but no mass or tenderness in the cul-de-sac. Blood (CBC, ESR, CA -125, and serum β-human chorionic gonadotrophin) and urine tests were all within a normal range. Ultrasound scan showed a left adnexal unilocular cyst approximately 10 cm in diameter with no solid areas or ascites. At laparotomy performed due to acute abdomen, the left fallopian tube was twisted threefold, distended and turned into a black colored cyst. The left salpingectomy was performed, electrosurgically, using Ligashure®. Microscopic examination showed a hemorrhagic and necrotic tube and fimbrial cyst lined with flat cuboidal epithelium indicating origin from the hydatid of Morgagni. The postoperative course was uneventful, and she was discharged on the 3rd postoperative day.ConclusionLarge Morgagni hydatid is an extremely rare cause of tubal torsion that is usually detected at surgery. Surgical treatment should not be delayed, although a majority of adolescent females loose function of the twisted oviduct at the time of surgery.

Predictors of IVF/ICSI success following treatment of endometriosis as the cause of primary infertility

OBJECTIVES Treatment of endometriosis prior to IVF/ICSI could be followed by the significant reduction of ovarian reserve. The aim is to identify potential markers of the IVF/ICSI outcome in patients with endometriosis associated infertility and to evaluate their clinical significance. MATERIAL AND METHODS The prospective cohort study included 73 patients with primary infertility caused by endometriosis that were subjected to 77 IVF/ICSI cycles. Patients were classified into two groups. In the first group some type of treatment had previously been applied, and in the second group patients were immediately subjected to the IVF/ICSI procedures. RESULTS When pregnancy was achieved, there were significantly more patients under 35 years of age, more patients with primary infertility duration up to 3 years, and more patients with endometriosis that was previously treated (77.4%) (p < 0.039). In the cases of the successful outcome Endometriosis Fertility Index > 7, lower basal FSH and FSH/LH ratio were found, as well as significantly higher basal E2, basal P4 and AMH. Significantly lower doses of gonadotropins were needed in cases of the successful outcome, and long protocol with agonists was more frequently used. Multivariate logistic regres-sion analysis showed that previous therapy of endometriosis, P4 ≥ 0.7 ng/mL, AMH ≥ 0.9 ng/mL, A class of embryos, and the use of long protocol with agonists were predictors of the successful IVF/ICSI outcome. CONCLUSIONS Therapy for endometriosis, AMH and P4 levels appeared to be predictors for the successful IVF/ICSI outcome and the use of long protocol with agonists could be advised in these cycles.

Diagnostic value of serum tumor markers evaluation for adnexal masses

ObjectiveThe study aim was to investigate the diagnostic value of preoperative serum tumor markers in patients with adnexal masses.MethodsStudy included all (358) consecutive patients treated for adnexal tumors at the Clinic of Ob/Gyn, Clinical Center of Serbia in 12 months. Tumor marker levels (Ca 125, CEA, HE 4, Ca 19.9, and Ca 15.3), taken from all women on admission, were compared with postoperative histopathological findings of extracted tumors. Results. Women with malignant tumors had the highest levels of Ca 125, CEA, and HE 4 (p<0.01). Mucinous adenocarcinoma produced the highest amounts of Ca 19.9 and CEA. Ca 15.3 was the highest in women with endometrioid carcinoma. There were no significant differences in the levels of all examined tumor markers (p>0.05) between women with benign and borderline tumors. Ca 125, HE 4, and Ca 15.3 can discriminate the malignant from other tumor types well. The highest sensitivity, specificity, positive and negative predictive values (91.04%, 87.6%, 67.9%, 77.2%, respectively) were achieved for the combination of Ca 125 and HE 4.ConclusionsBlood levels of examined tumor markers can be good predictors of the adnexal masses nature. For the most precise evaluation the combination of serum tumor markers should be used.