Saubhagya Kumar Jena

Bilateral Simultaneous Tubal Ectopic Pregnancy: A Case Report, Review of Literature and a Proposed Management Algorithm

Bilateral simultaneous Tubal Ectopic Pregnancy (BTP) is the rarest form of ectopic pregnancy. The incidence is higher in women undergoing assisted reproductive techniques or ovulation induction. The clinical presentation is unpredictable and there are no unique features to distinguish it from unilateral ectopic pregnancy. BTP continues to be a clinicians dilemma as pre-operative diagnosis is difficult and is commonly made during surgery. Treatment options are varied depending on site of ectopic pregnancy, extent of tubal damage and requirement of future fertility. We report a case of BTP which was diagnosed during surgery and propose an algorithm for management of such patients.

Uterine Fibroid (Leiomyoma) with Acute Urinary Retention: A Case Series.

Uterine leiomyomas are an extremely rare cause of acute urinary retention in women. The delay in diagnosing uterine leiomyomas presenting with acute urinary retention further complicates the management. The rarity of the condition makes it difficult to plan either prospective or retrospective trials. Hence, most of the evidence comes from case reports or series. We report a case series of acute urinary retention in women with uterine leiomyomas and discuss the pathophysiology, diagnosis and management options.

Ovarian Pregnancy: Uncommon Mode of Presentation

Ovarian pregnancy is very rare, and its incidence is 1 in 3000 live births. In this condition, common risk factors for ectopic pregnancy not usually found. It usually occurs in fertile women and more commonly with in-situ intrauterine device (IUD). Preoperative diagnosis is always not possible although the patient commonly presents with abdomen-pelvic pain, per vaginal bleeding and hypovolemic shock. High degree of suspicion with estimation of serum beta HCG, transvaginal ultrasonography by an experienced sonologist and laparoscopy is required for confirming the diagnosis. Though, the usual treatment is surgery, it can be managed by medical methods only in hemodynamically stable patients. In this case report, we describe the unusual mode of clinical presentation in an elderly woman with ovarian pregnancy.

Lipoleiomyoma of the left broad ligament with dermoid cyst in ipsilateral ovary and synchronous multiple benign lesions of female genital tract: An unusual association

Lipoleiomyoma of the uterus is a rare variant of leiomyoma, and lipoleiomyoma of the broad ligament is still rarer, with only a handful of cases being reported. The present case was a perimenopausal woman who presented with a huge lower abdominal mass. Ultrasonography and computed tomography showed a heterogeneous solid mass in the left adnexa. The histopathological findings confirmed the nature of the lesions as a benign lipoleiomyoma with dermoid cyst of the left ovary and its other associated benign lesions, were the interesting features seen in this case which were not suspected clinically and radiologically.

Bilateral ovarian serous cystadenocarcinoma metastasizing to cervix: a rare case report

Occurrence of cervical metastasis from ovarian tumor is very unusual and rare, the reverse i.e. ovarian metastasis from cervical tumor is rather more common. In the same way metastasis from ovarian cancer to vagina and/or vulva also very rarely detected. Most common mode of metastasis in secondary cervical involvement is usually, direct spread of endometrial carcinoma to the cervix. But hematogenous spread of tumor emboli leading to cervical metastasis has been detected in cases of ovarian malignancy and cancer of stomach, gall bladder, pancreas, breast and lung. Cervical metastasis in the above malignancies always indicates the advanced stage of tumor and multiorgan involvement, indirectly stating poor prognosis.

Giant endometrioma of the ovary: a case report

Endometriosis is a common gynaecological condition, affecting between 6%-10% of women in the reproductive age group. Ovarian endometrioma is seen in approximately 17%-44% of women with endometriosis. While the ovaries remain the commonest site of endometriosis, the size of ovarian endometriomas is typically not large, usually ranging from 1-6 cm. Huge ovarian endometriomas are extremely rare, with only a few case reports being described. We report a case of giant ovarian endometrioma in a 38-year-old multiparous woman, and discuss the challenges in diagnosis and management.

Spontaneous Fingertip Endometriosis: A Rare Case Report.

Here is a young unmarried girl of 18 y with bleeding from right index finger tip below nail bed, during menstruation for the last 3 months. She had attained menarche at the age of 13 y. She had regular menstrual cycles, where duration of flow was 4 to 5 days. There was no history of any comorbid illness or surgical intervention in the past. General examination revealed no abnormalities except mild pallor. Abdomen was soft, non-tender, with no palpable mass or free fluid. Per rectal examination was done and was normal. Examination of respiratory, cardiovascular and central nervous system was normal. On examination of the right index finger, there was a lesion with reddish discoloration of size 1 cm2 with slight swelling and tenderness just below the nail bed [Table/Fig-1]. There was a bleeding point within the lesion from where there was continuous oozing of blood during periods. USG of abdomen and pelvis showed no abnormality. MRI and diagnostic laparoscopy could not be done due to financial constraints. Biopsy of the bleeding site was done. Histological features revealed endometrial glands and stroma suggestive of endometriosis [Table/Fig-2]. Complete surgical excision was done with relief of the presenting symptoms thereafter. This is a very rare site of extra pelvic endometriosis reported till date. [Table/Fig-1]: Spontaneous bleeding from fingertip during menstruation [Table/Fig-2]: Histology of finger tip tissue showing features of endometriosis Extrapelvic endometriosis accounts up to 15% of all cases of endometriosis [1]. The most common sites in extrapelvic endometriosis include sites of previous surgical scars like cesarean scars, hysterectomy scars, episiotomy wounds and laparoscopic port sites. The other sites include bowel, omentum, urinary system, lungs, pleura, nasal mucosa, lymph nodes, umbilicus and undersurface of diaphragm. Nerve involvement of conus medullaris and sciatic nerve and muscle involvement of gluteal, adductors and rectus abdominis are rare sites that have been described in the literature previously [2,3]. This case is one of such rare spontaneous extrapelvic endometriosis described till date. The pathogenesis is probably due to vascular or lymphatic dissemination of endometrial cells [4]. The diagnosis and management of extrapelvic endometriosis pose a real big challenge to clinicians. The cyclical nature of symptoms is sometimes the only clue to reach the diagnosis. As up to 50% of these affected women may have concomitant pelvic endometriosis, further pre-operative diagnostic investigation is advisable. The gold standard for definitive diagnosis is laparoscopy and biopsy, but MRI can be recommended as the best non-invasive investigation. These tests could not be performed in our case due to financial constraints. Surgical excision only, brought complete relief of symptoms in this case.

Bilateral Serous Psammocarcinoma of Ovary: Rare Variant Low Grade Serous Carcinoma

Serous psammocarcinoma is a rare variant of serous carcinoma arising from either ovary or peritoneum, characterized by massive psammoma body formation, low grade cytologic features, and invasiveness. Its clinical behavior is similar to serous borderline tumors with relatively favorable prognosis. We report herein a case of a 60-year-old postmenopausal woman who presented with abdominal distension. Contrast enhanced computed tomography (CECT) revealed calcified pelvic masses with ascites. Elevated serum CA-125 (970 U/mL) suggested malignant ovarian neoplasm. Patient underwent exploratory laparotomy with primary debulking surgery. Histopathology showed bilateral serous psammocarcinoma of ovary with invasive implants on omentum. Adjuvant chemotherapy was advised in view of advanced stage disease, although its benefits are poorly defined due to rarity of the tumor. However, patient opted out of it and is now on follow-up.