Background:Ovarian dermoid cysts are common benign neoplasms that typically manifest as a solitary lesion. Bilateral multifocal presentations, particularly in the context of polycystic ovarian syndrome (PCOS), are exceptionally rare and pose significant diagnostic challenges. Case Presentation:A 22-year-old nulligravid Caucasian woman with a history of PCOS presented with acute, severe lower abdominal pain accompanied by nausea and vomiting. Initial imaging revealed large bilateral ovarian masses with features consistent with dermoid cysts and clinical findings suggestive of a right ovarian torsion. Despite a prior computed tomography (CT) scan indicating bilateral ovarian cysts, the patient attributed her symptoms to PCOS-related changes, delaying timely evaluation. Intraoperative findings during an exploratory laparotomy confirmed the presence of more than five distinct dermoid teratomas on each ovary. Bilateral ovarian cystectomies were performed with careful preservation of ovarian stromal tissue, and histopathological analysis verified the diagnosis of mature cystic teratomas. Conclusion:This case underscores the critical need for early differentiation between PCOS-related cysts and ovarian dermoid cysts to avert complications such as ovarian torsion and to preserve fertility. It also highlights the essential role of clear and effective communication between healthcare providers and patients in ensuring timely diagnosis and intervention. Misinterpretation of clinical symptoms can lead to delayed presentation with potentially deleterious effects on future fertility. Teaching Point:A CT scan obtained during the patient's initial evaluation revealed ovarian teratomas; however, the patient mistakenly believed these masses represented her typical PCOS-associated cysts rather than pathology of a different etiology. This misconception delayed recognition of the severity of her condition and underscores the importance of clear physician-patient communication to ensure patients understand the significance of their diagnoses, particularly when fertility and overall well-being may be affected.
Cannabinoid hyperemesis syndrome (CHS) is a rare but increasingly recognized condition among chronic cannabis users, characterized by cyclic nausea, vomiting, and relief with hot bathing. During pregnancy, CHS may mimic hyperemesis gravidarum (HG), complicating diagnosis and management. We report the case of a 24-year-old pregnant patient who presented at 20 weeks' gestation with recurrent nausea, vomiting, and labile hypertension. Investigations ruled out preeclampsia and secondary causes of hypertension. She met DSM-5 criteria for cannabis use disorder, had a prior hospitalization for CHS, and had recently reduced her cannabis use, raising concern for withdrawal as a contributing factor to her presentation. Gabapentin was initiated off-label after an Addiction Medicine consultation, resulting in resolution of symptoms and normalization of blood pressure within 24 h. To our knowledge, this is the first reported use of gabapentin in a pregnant patient with a history of CHS and suspected cannabis withdrawal. This report highlights the importance of screening for cannabis use, recent reduction or cessation, and withdrawal symptoms in pregnant patients presenting with severe or refractory hyperemesis. In this case, short-term off-label gabapentin use led to rapid symptom resolution without apparent maternal or fetal complications, suggesting that it may be relatively safe in this population, although data remain limited.
Congenital pulmonary airway malformation (CPAM) is a rare developmental anomaly of the fetal lung characterized by abnormal branching morphogenesis, resulting in cystic and/or solid masses within the pulmonary parenchyma. These cysts can range in size and symptoms: from small and asymptomatic to large and clinically evident. CPAM is typically identified during prenatal ultrasonography as an abnormal lung mass, predominantly involving a single pulmonary lobe. We herein describe a case of a fetus diagnosed with CPAMs type 1 harboring a KRAS pathogenic variant.
Lower genital tract myofibroblastoma is a gynecologic rarity, with most of the published literature consisting of case reports. Differential diagnoses for lower genital tract soft tissue masses include cervical leiomyomas, nabothian cysts, and other rare tumors such as angiomyofibroblastoma. The pathogenesis is unclear; however, research aims to identify an association with hormones or infections. We report the case of a 32-year-old female who was found to have cervical myofibroblastoma after excision of a large cervical lesion. Based on an extensive literature review, this case will be the sixth reported case of cervical myofibroblastoma since 2017.
Aggressive angiomyxoma (AAM) is a rare, slow-growing, locally infiltrative mesenchymal tumor of the pelvis and perineum, most often affecting women. Its nonspecific presentation and tendency to mimic more common vaginal or periurethral masses frequently delay diagnosis. Early recognition is critical to guide appropriate surgical planning, optimize resection, and reduce recurrence risk. In this case, a 61-year-old woman with prior vaginal hysterectomy presented with symptoms of pelvic organ prolapse, urinary incontinence, and occasional bleeding. Examination revealed a 10 × 3-cm protruding anterior vaginal wall mass with a spongy texture. MRI demonstrated a well-defined tubular lesion in the left distal vaginal wall extending towards the vulva. Intraoperative evaluation, including cystourethroscopy, diagnostic laparoscopy, and general surgery consultation, ruled out bowel involvement. The mass was excised via vaginal approach with preservation of surrounding structures. Histopathology confirmed AAM. Margins could not be assessed due to specimen disruption. At 6-week follow-up, the patient was asymptomatic with well-healed incisions, and ongoing surveillance with gynecologic oncology was arranged. This case highlights the importance of including AAM in the differential diagnosis of anterior vaginal wall masses. Multidisciplinary collaboration and advanced imaging are essential for accurate diagnosis and surgical planning. Given the tumor's locally infiltrative nature and high recurrence rate, long-term follow-up is warranted. Awareness of this rare pathology can aid timely recognition and improve patient outcomes.
Background:Intrauterine devices (IUDs) are widely used as a highly effective method of contraception. Although rare, uterine perforation is a serious complication, occurring in approximately 1 per 1000 insertions. This case underscores the value of laparoscopy in enabling accurate diagnosis and immediate removal of an occult extrauterine IUD migration. In addition, fluoroscopy guidance improves localization accuracy, facilitates precise retrieval, and may help prevent laparotomy. Case Presentation:This case presents a 25-year-old woman presented with progressive abdominal pain 1 year after IUD insertion. Physical examination revealed no involuntary guarding and the IUD strings were not visible. Transvaginal ultrasonography showed no evidence of a myometrial defect. An abdominal x-ray with uterine marker demonstrated extrapelvic migration of the IUD. The patient subsequently underwent fluoroscopy-assisted laparoscopic retrieval. Intraoperative findings revealed a uterine scar and dense adhesions between the IUD and the omentum. Conclusion:Early clinical suspicion and a structured imaging approach are essential for the diagnosis of extrauterine IUD migration. When pelvic ultrasonography is inconclusive, abdominal radiography with uterine markers can improve localization. Fluoroscopic guidance improves intraoperative localization and facilitates safe minimally invasive retrieval of extrapelvic IUD migration while minimizing surgical morbidity.
Cervical insufficiency is a significant cause of recurrent midtrimester pregnancy loss. Although transabdominal cerclage (TAC) is an established option for selected patients with severe cervical insufficiency, its application and outcomes remain undocumented in West African clinical settings. This case report documents the first use of TAC in Ghana. Three Ghanaian women, aged 32-33, with severe cervical insufficiency and a cumulative history of eight prior midtrimester losses and multiple failed transvaginal cerclages, underwent open TAC using 5-mm Mersilene tape between 12 and 13 weeks of gestation at Oak Specialist Hospital in Kumasi, Ghana. All three reported pregnancies resulted in live births, yielding five neonates. Deliveries occurred at 38 weeks 4 days (singleton), 35 weeks 2 days (singleton) and 30 weeks 1 day (triplet gestation complicated by preeclampsia and peripartum cardiomyopathy). No major intraoperative or postoperative complications directly attributable to the surgery were observed. This case report demonstrates that TAC is a feasible intervention for severe cervical insufficiency in a Ghanaian specialist hospital setting. The preliminary outcomes are encouraging, but larger studies are needed to establish efficacy and generalizability across the West African region.
Background:Leiomyomas are common gynecological masses. However, atypical variants, such as those with myxoid degeneration, can mimic malignancies. This, in turn, might result in diagnostic challenges. Case Presentation:A 29-year-old female presented with chronic pelvic pain and backache. Imaging revealed a 10-cm adnexal mass with features suspicious of endometrioma or malignancy. Laparoscopic resection was performed. Histopathology confirmed a leiomyoma with myxoid degeneration. Discussion:Myxoid degeneration, a rare type of leiomyoma degeneration, can alter typical findings on imaging. It can also lead to uncertainties when it comes to diagnosis. This case highlights the importance of correlating imaging with histopathology to avoid unnecessary or radical surgeries. Conclusion:Atypical leiomyomas should be considered in the differential diagnosis of pelvic masses, despite their rarity. Accurate diagnosis and management can prevent overtreatment. It also ensures optimal patient outcomes.
Background:Takotsubo syndrome (TTS) is considered rare in premenopausal women and presents as a transient, nonischemic acute heart failure with relatively fast, spontaneous recovery of myocardial function. It is typically characterized by apical ballooning, or less commonly, akinesia of the midsegments of the left ventricle, commonly triggered by acute emotional stress and therefore also known as "broken-heart syndrome" and "stress-induced cardiomyopathy." Case:In this article, we present a case of a 26-year-old female patient pregnant with dichorionic-diamniotic twins, who developed TTS peripartum following emergency cesarean section due to premature membrane rupture at 33 weeks of gestation. On the first postoperative day, she suddenly developed dyspnea with desaturation to 80% oxygen on pulse oximetry. She became hypotensive and tachycardic. An electrocardiogram revealed T-wave inversion in aVL and ST-segment changes in leads V4-V6. An assay of cardiac enzymes was elevated. In order to exclude acute myocardial infarction and pulmonary thromboembolism, CT angiography of the lungs and coronary arteries was performed. Transthoracic echocardiography revealed akinesia of the midsegments of the left ventricle and a moderately reduced ejection fraction. After the introduction of cardioprotective therapy with bisoprolol 1.25 mg, her ECG normalized. She was normotensive, normocardic, and oxygen saturation on pulse oximetry was within the normal range.The echocardiogram on the 11th postpartum/postoperative day revealed partial spontaneous regression of segmental motion disorders and improvement of left ventricular ejection fraction. On the day of discharge, the patient was eupnoic with normal oxygen saturation without supplemental oxygen. She was normotensive and normocardic. The uterus was appropriately contracted, lochia normal, and the wound was healing normally. She was breastfeeding. She was prescribed with bisoprolol 1.25 mg once daily until follow-up heart ultrasound 6 months after the discharge. Conclusions:In a state that suggests cardiac emergency, TTS should be considered among other differential diagnoses, such as myocardial infarction, acute myocarditis, pulmonary embolism, and peripartal cardiomyopathy. It is very important to differentiate TTS from peripartal cardiomyopathy because of the differences in management and prognosis. The clinical awareness and holistic approach to differential diagnosis are crucial for management of acute heart failure after cesarean section.
This case report examines the association between autoimmune thyroid disease, more commonly known as Graves' disease, and endometriosis with a focus on the complication of an endometrioma rupture. The interplay between these two conditions is of clinical interest as increased levels of estrogen are caused by immune system dysregulation. Research has depicted a positive correlation between the concentration of thyroid hormones and the size of endometriomas and/or adhesions caused by endometriosis. We report a case of an endometrioma rupture in a 31-year-old woman with a history of autoimmune hyperthyroidism who presented with acute abdominal pain. We are aimed at enhancing the timeliness of diagnosis and treatment by raising awareness among healthcare providers about the importance of considering endometrioma rupture in the differential diagnosis for women of childbearing age who have a history of autoimmune hyperthyroidism or endometriosis.
Introduction:Müllerian cysts are benign embryologic lesions arising from remnants of the paramesonephric (Müllerian) ducts. They are commonly found in the vagina or cervix, whereas vulvar involvement is rare. Occurrence in the clitoral hood is exceptionally uncommon, and diagnostic differentiation from other vulvar cystic lesions is challenging. Case Presentation:A 43-year-old woman (P1A1) presented with a slowly enlarging mass in the clitoral hood over 13 years, which become mildly tender in the week prior to presentation. Physical examination showed a well-defined cystic mass (6 × 2 × 2 cm) without inflammation. Complete surgical excision was performed with preservation of clitoral neurovascular structures. Histopathology revealed a cyst lined by ciliated cuboidal to columnar epithelium, consistent with a Müllerian cyst. No malignancy was identified. Additional immunohistopathology studies were not performed due to the classic histomorphology. The patient recovered with no sensory disturbance or recurrence at the 2-week and 1-month follow-up visits. Discussion:Müllerian cysts of the clitoral hood are rare and may mimic other vulvar cystic lesions. Definitive diagnosis relies on histopathological identification of ciliated Müllerian-type epithelium. The prolonged indolent growth observed in this case supports the benign nature of the lesion, whereas the anatomical proximity to clitoral neurovascular structures highlights the importance of meticulous surgical excision to preserve sensory and sexual function. Conclusion:A Müllerian cyst of the clitoral hood is uncommon. Histopathological evaluation is essential for definitive diagnosis. Comprehensive surgical excision with careful neurovascular preservation yields excellent outcomes.
Introduction:Upper extremity deformation may come in isolation, such as polydactyly, or be associated with a syndrome involving other body parts. Cornelia de Lange syndrome (CDLS) is a syndrome encompassing many abnormalities with some variation and a spectrum of severity. This case report presents a case of a baby with suspected CDLS. Case Presentation:A 28-year-old woman, Gravida 3 Para 2, came to the polyclinic referred because of her small gestational age and a possibility of congenital abnormality. The ultrasound examination showed upper extremity malformation with hypoplasia of the left radius and ulna, right ulna, agenesis of the right ulna, intrauterine growth restriction, and polyhydramnios. An elective Caesarean section was performed at 37 weeks of gestational age due to two previous Caesarean sections. Baby girl was born at 1446 g, with a body length of 39 cm and an Apgar score of 6/8. The baby had some features of CDLS, such as thick eyebrows, a short nose, a concave nasal ridge, a long indistinct philtrum, and a distinct upper extremity malformation. Discussion:CDLS was characterized by prenatal growth retardation, microcephaly, craniofacial abnormalities, hand or foot malformation, and hirsutism in the face. Prenatally, CDLS has some distinctive features in ultrasound, such as fetal growth retardation, craniofacial abnormalities, and limb malformation. CDLS has a broad spectrum of clinical presentation; its prognosis may vary based on the abnormality and the symptoms caused.
Mature cystic teratoma of the fallopian tube is extremely rare, with no reports existing on infertility treatment following its surgical removal. We report a case of mature cystic teratoma identified within the right fallopian tube during laparoscopic surgery, with only the tumor resected while preserving the tube. Three-month postoperative hysterosalpingography showed preserved tubal patency, but contrast agent retention in the pelvic cavity was noted during the delayed phase, suggesting peritubal adhesions. Subsequent timed intercourse failed to result in pregnancy, leading to in vitro fertilization. Laparoscopy prior to embryo transfer confirmed hydrosalpinx, prompting right salpingectomy. Clinical pregnancy was achieved following frozen-thawed blastocyst transfer performed 2 months postoperatively. The pregnancy progressed well and resulted in delivery at term. Even when tubal preservation is chosen for mature cystic tubal teratoma, normal tubal function may not necessarily be maintained. Therefore, early postoperative hysterosalpingography and prompt laparoscopic evaluation with appropriate surgical intervention if abnormalities are detected are useful for improving subsequent infertility treatment outcomes.
Background and Aims:Secondary postpartum hemorrhage (SPPH) is defined as the hemorrhage occurring beyond 24 h and within the puerperium (6 weeks). The incidence of SPPH is 0.21%. Pseudoaneurysm of the uterine artery is a rare cause of SPPH following the caesarean or vaginal delivery and is reported to be developed as a complication of vascular trauma during caesarian section or after uterine curettage and pelvic surgery. Prompt diagnosis and early management should be done to avoid the complications. Methods:An informed written consent was taken from a patient for writing the case. A brief literature review was done for writing the case. Results:In our case, the patient had recurrent vaginal bleeding following LSCS where she was managed conservatively along with multiple blood transfusions. The final diagnosis was made on the 48th day postpartum. This highlights the necessity of considering further investigation to rule out the rare causes of SPPH like pseudoaneurysm and also emphasizes the role of TAE in the management of such cases. Conclusion:Early diagnosis and management of SPPH is crucial to reduce complications in patients. Pseudoaneurysm should be ruled out, though rare in patients presenting with recurrent vaginal bleeding in the postpartum period. Pseudoaneurysm can be effectively managed with the TAE considering its advantages.
Mature cystic teratomas arise from three germ lines: ectoderm, mesoderm, and endoderm. They have a certain malignant potential, which is a diagnostic and therapeutic challenge. They occur very often in young women, but there are a significant number of postmenopausal cases where the risk of malignancy is greater. Symptoms may be nonspecific, but in the event of complications, an acute condition may develop, threatening the patient's life. Treatment depends on the risk of malignancy, age, and presence of complications. We present a case of a postmenopausal woman with a large mature teratoma of the left ovary involving elements from all three germ lines. A laparotomy and hysterectomy with bilateral salpingo-oophorectomy were performed, considering the patient's age and risk of malignancy. Given the risk of complications and malignancy in patients with mature teratoma, early detection, correct diagnosis, and therapeutic management are crucial for a higher chance of a successful outcome.
Objective:We report a rare case of congenital cystic adenomatoid malformation (CCAM) diagnosed antenatally based on USG and postnatally based on babygram, CT scan, and chest x-ray. We follow up the baby up to 1 year of age. Method:This study is a retrospective case report describing the clinical presentation, diagnosis, and management of a single patient. Results:The patient is an outpatient clinic with a diagnosis of G2P1A0, gestational age 38-39 weeks with breech presentation, not in labor, and the fetus is suspected for CCAM. The patient was planned for termination with cesarean delivery. The patient was first diagnosed with CCAM based on antenatal USG examination: A cystic mass in the thorax region of the fetus measuring 1.5 cm was found. The baby was then born by CS in consideration of breech presentation. At birth, the baby had a good APGAR score of 7-8-9. The baby underwent a babygram at 2 days old, which showed a CPAM type III result; CT scan at 16 days old showed infected CPAM type I/CCAM. The baby has been observed for 1 year of life, and no signs of respiratory distress were found. The latest chest x-ray at 1 year of age showed left superior pulmonary cyst. Conclusion:CCAM can be diagnosed perinatally by ultrasound examination. Management of CCAM depends on the size of the lesion and whether significant respiratory distress is present in the newborn. In our case, the CCAM was established prenatally and postnatally; no signs of respiratory symptoms were found within 1 year of age.
Cervical clear cell adenocarcinoma is a rare malignancy in adolescents and young girls. Since the prescription of diethylstilbestrol (DES) was banned in 1971, only 11 cases have been reported in girls under 10 years in the literature. However, treatment with ovary preservation has not been reported. Here, we report an 8-year-old prepubertal girl without a history of exposure to DES who was diagnosed with cervical clear cell adenocarcinoma. Hysterectomy and unilateral oophorectomy were performed. The remaining ovary was transposed to the left iliac fossa to preserve ovarian function for the future. Additionally, ovarian cortical tissue from the removed ovary was cryopreserved. Chemotherapy, including paclitaxel and carboplatin, was started after surgery for four cycles via an implantable venous access port. Additionally, genetic analysis did not identify any known gene mutations in the tumour tissue.
Introduction:Ectopic pregnancy, affecting 1%-2% of pregnancies, is a major cause of first-trimester maternal morbidity and mortality, most commonly occurring in the fallopian tubes. Abdominal ectopic pregnancy is rare (< 1%) but highly dangerous, with risk of hemorrhage, infection, and misdiagnosis. Splenic implantation is exceptionally rare. Diagnosis relies on ultrasound, MRI, and beta-hCG levels, though symptoms are often nonspecific. Risk factors include tubal disease, infections, prior surgery, and assisted reproduction. Early diagnosis is critical, as maternal and perinatal mortality are high. Management is usually surgical, with laparoscopy preferred in stable early cases and laparotomy in more advanced or complicated presentations. Case Presentation:A 29-year-old gravida 2 para 1 at 5 + 4 weeks presented with mild vaginal bleeding and stable vital signs. Serum beta-hCG levels showed an abnormal rise followed by a plateau. Transvaginal ultrasound revealed no intrauterine pregnancy, suggesting a pregnancy of unknown location, with a suspicious right-sided adnexal finding. A second-level ultrasound identified a vascularized multilocular mass near the anterior uterine recess, raising concern for ectopic or abdominal pregnancy. Due to diagnostic uncertainty and plateauing beta-hCG, exploratory laparoscopy was performed. The pelvis appeared normal, but two vascularized formations were found on the prevesical peritoneum and excised. Postoperatively, beta-hCG levels declined significantly. Histological analysis confirmed first-trimester chorionic villi and trophoblast cells within splenic tissue, consistent with ectopic pregnancy implanted in splenosis. The patient recovered well and was discharged in stable condition with near-complete resolution of beta-hCG levels on follow-up. Discussion:Abdominal pregnancy is a rare, life-threatening ectopic pregnancy with a challenging diagnosis. In this case, inconclusive imaging and plateauing beta-hCG prompted laparoscopy, confirming prevesical implantation. Prior splenectomy may have contributed. Surgical removal led to resolution, highlighting the importance of systematic evaluation, clinical suspicion, and timely intervention in atypical ectopic pregnancies.
Introduction:Solitary fibrous tumors (SFTs) generated from uterine corpus are extremely rare and hard to distinguish from myomas, but their prognoses are wildly different. Doege-Potter syndrome (DPS) is a form of nonislet cell tumor hypoglycemia (NITCH) caused by a SFT. Vigilance is required when a pelvic mass is found concurrent with NITCH. Case Presentation:A 65-year-old female with huge pelvic masses generated from uterine corpus presented with mild symptoms of transient slow response, accompanied by memory loss once, and was found to have hypoglycemia. The pituitary glucocorticoid axis, pituitary sex hormone axis, and pituitary growth hormone axis functioned normally; insulin release was normal, but relatively low insulin levels indicated suppression of secretion. Abdominal total hysterectomy and bilateral salpingo-oophorectomy were performed, and pathology confirmed a benign SFT with DPS. Blood glucose levels after surgery are significantly elevated and more stable. This case fell into the intermediate-risk group, but the disease recurred. Cytoreduction surgery was performed 13 months after initial treatment without DPS. Discussion:Uterine corpus-generated SFTs are hard to distinguish preoperatively. However, complete tumor resection is a key prognostic factor because SFTs have a risk of long-term recurrence. DPS can be a differential diagnostic point, but there is no significant relation between tumor burden and recurrence.
Background Tubo-ovarian abscess is a serious complication of pelvic inflammatory disease that often requires surgical management. Diabetic ketoacidosis is a life-threatening metabolic emergency most seen in Type 1 diabetes but can rarely occur in Type 2 diabetes. The simultaneous occurrence of TOA and DKA is extremely rare, highlighting a clinically important association. Case Presentation We report a 37-year-old woman with poorly controlled Type 2 diabetes mellitus who presented with severe abdominal pain, fever, and metabolic decompensation diagnosed as DKA. On workup, CT scan revealed bilateral tubo-ovarian abscesses. She was admitted to the intensive care unit and managed appropriately. Persistent fever with elevated CRP prompted laparoscopic drainage of both abscesses, resulting in clinical improvement. Conclusion Bilateral tubo-ovarian abscess can precipitate diabetic ketoacidosis in women with Type 2 diabetes mellitus. Recognizing gynecologic sepsis as a potential precipitant is crucial for timely management.
