Matija Prka

The detection of stage I ovarian cancer by three-dimensional sonography and power Doppler

OBJECTIVE The objective was to determine the diagnostic accuracy of three-dimensional (3D) sonography and 3D power Doppler imaging, used together with standard 2D transvaginal grayscale and color/power Doppler modalities, for preoperative sonographic assessment of suspected ovarian lesions. METHODS Five-year retrospective analysis was performed by our experts on ultrasonography and surgery on the reports from 43 referred patients with suspected stage I ovarian cancer. All patients were evaluated during the week prior to surgery at our department. Preoperative sonographic assessment included careful examination of ovarian volume, morphology, and vascularity by four complementary sonographic methods. Scoring systems combining morphological and Doppler parameters were adopted for 2D and 3D sonographic examinations. Final diagnosis was confirmed by a histopathologist. RESULTS Out of the 43 stage I ovarian cancers, 42 cases were successfully detected preoperatively by four complementary sonographic methods. Only 30 (69.8%) and 37 (86.1%) cases of stage I ovarian cancer were detected by 2D grayscale and combined 2D grayscale and color Doppler sonography, respectively. Morphological analysis obtained by 3D sonography alone detected 32 of 43 ovarian malignancies, reaching a diagnostic rate of 74.4%. Qualitative analysis of tumor vascularity architecture by 3D power Doppler significantly improved the sonographic management process and successfully detected 41 cases of stage I ovarian cancer (95.4%). When morphological features obtained by 3D sonography were added to 3D power Doppler findings, we achieved an even higher diagnostic accuracy of 97.7%. We found a statistically significant difference (P </= 0.01) in diagnostic rates of 3D power Doppler, and especially the combined use of 3D sonography and 3D power Doppler in comparison to those obtained with transvaginal 2D grayscale (P </= 0.002 and P </= 0.001, respectively) or 3D sonography (P </= 0.006 and P </= 0.002, respectively). CONCLUSIONS In comparison to transvaginal 2D grayscale or 3D sonography, 3D power Doppler and especially the combined use of 3D sonography and power Doppler imaging significantly improve diagnostic accuracy in preoperative sonographic assessment of suspected ovarian lesions.

Unusual case of OHVIRA syndrome with a single uterus, unrecognized before labor and followed by an intrapartal rupture of obstructed hemivagina

PurposeThe acronym for obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) was created to describe patients with an obstructed hemivagina and ipsilateral renal anomaly and enables inclusion of other uterine anomalies except uterus didelphys. The main goal of this article is to present a rare case of OHVIRA syndrome with intrapartal rupture of obstructed hemivagina.MethodsWe present an unusual case of OHVIRA syndrome with single uterus, uterine septum (previously resected by hysteroscopy) and renal agenesis, unrecognized before labor and followed by an intrapartal rupture of obstructed hemivagina.Results and conclusionVarious symptoms, included in OHVIRA acronym, are a result of different morphologic variants included in this syndrome. Most likely, in our case, the absence of communication between the cervical canal/patent vagina and the obstructed hemivagina prevented formation of mucocolpos or hematocolpos. This rare clinical variant made our MRI diagnosis of obstructed hemivagina, as well of the entire OHVIRA syndrome, ineffective. We did not find OHVIRA cases in the literature with a single septate uterus and single cervix, associated with obstructed hemivagina diagnosed during and after labor and presented with intrapartal rupture of hemivagina. Because of lack of guidelines, the final decision about management of the labor in such rare cases of OHVIRA syndrome is difficult.

Ruptured ovarian metastatic malignant melanoma caused acute abdomen

Ovarian metastatic malignant melanoma is a rare form of disseminated malignant melanoma. We present a rare case of acute abdomen due to rupture of ovarian metastatic malignant melanoma seven years after removal of a primary cutaneous malignant melanoma lesion, followed by reexcision of the cicatrix and axillary dissection (Clark III, Breslow IV), one year after osteoplastic parietal craniotomy for removal of recidiv metastatic lesions, and excision of the cutaneous malignant melanoma lesion on the upper leg were performed. During laparotomy because of acute abdomen, 4 L of free liquid (blood and ascites) were evacuated. The right adnexal mass was loose tumor, size 110x75 mm, with rupture on the posterior wall and hemorrhage. Unilateral adnexectomy was performed. Pathohystologic evaluation revealed tumor cells with eosinophilic, clear cytoplasm, intracytoplasmatic melanotic pigment and a great number of mitosis.Immunohistochemical results supported positivity for protein S-100, whereas results for cytoceratin 7, cytoceratin 20, pancytoceratin, epithelial membrane antigen and HMB-45 were negative. Three months after the surgery the patient died due to disseminated cerebral melanoma. An adnexal mass and the history of previous MM should be suspected to be ovarian metastatic malignant melanoma and the patient should be seen by gynecologist at least for active treatment.

Giant vulvar pendulated lypoma in patients with endometrial adenocarcinoma and inoperated giant ventral hernia

A case is presented of a operated giant pedunculated vulvar lipoma weighing 14 kg in a patient with concomitant inoperable giant ventral postoperative hernia, complete diastasis of the anterior abdominal wall musculature and endometrial adenocarcinoma.

Invasive malplacentation of lower uterine segment in first trimester patient with obstetric shock development

We present a case of invasive malplacenta-tion of the lower uterine segment found in a first trimester, 38-year old woman following curettage for missed abortion. Uncontrolled hemorrhage and obstetric hemorrhagic shock developed, resulting in abdominal hysterectomy, with resuscitation. The pa-tient made a full recovery.

Preservational procedure of cervical pregnancy.

because it would be difficult to insert a needle into the tubal cavity, aspirate the hydrosalpinx, and infuse the sclerosing agent. Major complications of sclerotherapy reported by others, all uncommon, are hemorrhage from the vaginal wall, the oviduct, or other pelvic vessels; trauma related to pelvic structures such as bowel or ureters; and pelvic infection and adhesion. In our study, we assessed complications by both patient self-report and clinician assessment, and only mild abdominal cramping was reported. Na et al also found no suspected intraperitoneal adhesion after sclerotherapy. It should be mentioned that all the patients in our previous 2010 study were enrolled in this study for recruiting more subjects to further evaluate the efficacy, safety, and recurrence of hydrosalpinx sclerotherapy. -