Uterine tumor resembling ovarian sex cord-stromal tumor (UTROSCT) is a rare uterine neoplasm characterized by sex cord-like differentiation. Although typically indolent and confined to the uterus, UTROSCT can occasionally exhibit atypical clinical and pathological behavior, complicating preoperative diagnosis. A 52-year-old postmenopausal woman (G3P3A0) with no significant medical history presented with a painless umbilical swelling persisting for eight months. Physical and radiological assessment revealed a paraumbilical hernia and she was scheduled for elective laparoscopic repair. Intraoperatively, a large amount of viscous gelatinous material was unexpectedly discovered in the peritoneal cavity, with no visible peritoneal or visceral mass. Peritoneal biopsies and cytology suggested a low-grade neoplasm of uncertain origin, initially raising suspicion of pseudomyxoma peritonei (PMP). Computed tomography showed a large soft-tissue lesion occupying the lower abdomen and pelvic cavity, extending to the umbilicus and supplied by a branch of the uterine artery. Multidisciplinary tumor board discussion favored a uterine source, and cytoreductive surgery with total hysterectomy and peritonectomy was performed. A 40 cm encapsulated gelatinous uterine mass weighing 6.3 kg was excised. Histopathology and immunohistochemistry confirmed UTROSCT with positivity for sex cord markers and hormone receptors. Margins were negative and there was no lymphovascular invasion. The postoperative course was uneventful. The patient received adjuvant tamoxifen therapy and remained disease-free during 48 months of follow-up. This case illustrates an exceedingly rare presentation of UTROSCT, with much large tumor size than previously reported.
Sertoli-Leydig cell tumors are rare ovarian sex cord-stromal tumors that usually arise in young women and are often hormonally active. Intraperitoneal dissemination and relapse are uncommon, and recurrence patterns in postmenopausal women are poorly characterized. This report describes a 55-year-old postmenopausal woman with a poorly differentiated, estrogen receptor-negative, non-functional Sertoli-Leydig cell tumor. Despite adjuvant platinum-based chemotherapy, she relapsed within one year. Over eight years her disease followed a pattern of recurrent intraperitoneal dissemination, managed with multiple cytoreductive procedures, including three with heated intraperitoneal chemotherapy. Somatic molecular profiling identified a DICER1 mutation without a germline alteration. Systemic therapies, including platinum-based chemotherapy and immune checkpoint inhibition, produced only transient disease control, and repeated surgery, rather than systemic therapy, was the mainstay of management. The case illustrates an aggressive, somatic DICER1-mutated tumor arising outside the usual age range, and suggests that such tumors can behave aggressively in older women, in whom systemic therapy has limited efficacy and management is necessarily multidisciplinary.
Women with pre-existing cardiomyopathy experience high maternal and fetal complication rates when undergoing pregnancy. Different cardiomyopathy phenotypes and genetics can influence the presentation during pregnancy and help inform risk profile and management.This case series demonstrates the differing course of pregnancy in dilated, hypertrophic and arrhythmogenic cardiomyopathy. The main complications managed were arrhythmia, rising left ventricular outflow tract obstruction and heart failure. The cases highlight important pre-conception considerations, the use of biomarkers, and pharmacological and device management during pregnancy, delivery and post-partum.It is important to recognise that cardiomyopathies represent a heterogeneous group of conditions with differing phenotypes which need individualised specialist care during pregnancy. Risk stratification and management by an expert multidisciplinary team are recommended to support these women to attain good maternal and fetal outcomes.
Chronic myeloid leukemia (CML) during pregnancy is a rare clinical condition that poses significant therapeutic challenges, as maternal disease control must be balanced against fetal safety. Evidence-based management guidelines remain limited, particularly in settings with restricted access to pregnancy-compatible therapies. This report presents two cases of pregnant patients with chronic-phase CML who conceived without adequate hematologic control due to irregular tyrosine kinase inhibitor therapy and lack of access to interferon-alpha. The first case involved a woman at 33 weeks of gestation requiring an urgent preterm cesarean delivery for nonreassuring fetal status, complicated by significant postoperative hemoperitoneum, while her neonate required a prolonged stay in an intensive care unit. The second case concerned a patient at 25 weeks of gestation who was successfully managed with cytoreductive therapy using cytarabine, achieving hematologic stabilization and term delivery, though complicated by immediate postpartum hemorrhage. In both cases, treatment was guided by multidisciplinary decision-making and local availability of treatments. These cases demonstrate that CML during pregnancy carries a high risk of adverse maternal and perinatal outcomes when preconception counseling is absent, disease control is suboptimal, and access to recommended first-line therapies is unavailable. The clinical experience emphasizes the importance of individualized multidisciplinary care, robust family-planning counseling, and equitable access to safe, effective therapies to optimize outcomes for both mother and fetus.
Uterine artery embolization is a minimally invasive, uterus-preserving treatment for symptomatic uterine leiomyomas that is generally considered safe; delayed infectious complications are uncommon and may be difficult to distinguish from postembolization syndrome.This report presents a case of delayed pyometra associated with a necrotizing leiomyoma following uterine artery embolization. A 41-year-old multiparous woman with a history of two cesarean deliveries underwent bilateral uterine artery embolization for a symptomatic large FIGO type 2 submucosal leiomyoma after declining surgical treatment. Although her symptoms initially improved, she presented three months later with high fever and severe pelvic pain despite only mildly elevated inflammatory laboratory findings. Imaging demonstrated a necrotic leiomyoma with pyometra, and endometrial culture yielded Streptococcus agalactiae. Despite uterine drainage and culture-directed antimicrobial therapy, persistent symptoms ultimately required total laparoscopic hysterectomy. Histopathological examination confirmed extensive coagulative necrosis of the leiomyoma with acute inflammatory infiltration.This case highlights that delayed infectious complications may occur several months after uterine artery embolization for large submucosal leiomyomas and may mimic postembolization syndrome despite relatively mild inflammatory laboratory abnormalities. Careful long-term follow-up and prompt evaluation are essential for timely diagnosis and appropriate management.
A septate uterus is a congenital uterine anomaly associated with adverse reproductive outcomes, including miscarriage, preterm birth, and fetal malpresentation. This report presents the case of a successful early-term pregnancy in a 23-year-old woman (gravida 2, para 0) with a previously diagnosed partial uterine septum. Diagnosis was established using three-dimensional transvaginal ultrasound and confirmed by magnetic resonance imaging. The patient elected to have expectant management and underwent routine prenatal care with maternal-fetal medicine surveillance. Pregnancy progressed without major complications. The fetus remained confined to the right uterine horn and in persistent frank breech presentation. At 37 weeks and 2 days of gestation, cesarean delivery was performed following premature rupture of membranes. A live female neonate weighing 2.64 kg was delivered without immediate complications. This case demonstrates that successful pregnancy and live birth are possible in the setting of an unresected partial uterine septum and highlights the importance of individualized counseling, prenatal surveillance, and delivery planning in patients with congenital uterine anomalies.
Pelvic stress fractures in the early postpartum period are rare and may occur even in women with normal bone mineral density. This report describes the case of a 39-year-old woman (gravida 2, para 2) who developed bilateral sacral stress fractures and a left pubic ramus fracture three weeks after elective repeat cesarean delivery of a macrosomic infant. Bone mineral density and trabecular bone score were normal. She was managed conservatively with gradual clinical improvement. During recovery, she developed right forefoot pain consistent with metatarsophalangeal capsulitis and probable Morton's neuroma, likely secondary to altered gait mechanics. Postpartum pelvic stress fractures should be considered in women presenting with severe pelvic or low back pain after delivery, even in the absence of osteoporosis. Conservative management leads to favorable outcomes, although altered biomechanics during recovery may predispose to secondary overuse injuries.
Fallopian tube carcinoma is frequently detected at an advanced stage, and its imaging findings and tumor marker profiles are often indistinguishable from those of ovarian or peritoneal carcinoma. Nontuberculous mycobacteria (NTM) are environmental acid-fast bacilli with increasing clinical significance in both immunocompromised and immunocompetent individuals. Infection of gynecologic organs is extremely rare. This report describes a case of fallopian tube NTM infection caused by Mycobacterium abscessus that mimicked fallopian tube carcinoma. An 87-year-old woman underwent fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) during routine surveillance, which revealed focal FDG uptake in the right adnexal region. Serum CA125 was elevated, and magnetic resonance imaging demonstrated findings suspicious for fallopian tube carcinoma. Primary debulking surgery was performed. Intraoperative frozen-section examination of the right adnexa revealed necrotizing granulomas without evidence of malignancy, raising suspicion of mycobacterial infection. Fresh specimens were submitted for microbiological evaluation. Culture identified Mycobacterium abscessus, establishing the diagnosis of fallopian tube NTM infection. The patient was asymptomatic and had no abscess formation. Complete surgical resection was achieved, and no antimicrobial therapy was administered. The patient remained recurrence-free at 1-year follow-up. This case highlights the difficulty of differentiating infectious granulomatous disease from malignancy based on imaging findings alone. Intraoperative frozen-section examination played a crucial role in prompting microbiological investigation and establishing the correct diagnosis.
Heterotopic pregnancy involving cesarean scar implantation is rare and difficult to manage when continuation of a viable intrauterine pregnancy is desired. Evidence is particularly limited for cases occurring after surgical repair for cesarean scar disorder. A 40-year-old woman with three previous cesarean deliveries underwent laparoscopic repair for symptomatic cesarean scar disorder before assisted reproductive technology. After transfer of two blastocysts, transvaginal ultrasonography showed a viable intrauterine pregnancy together with a cesarean scar pregnancy of the in-the-niche type with minimal overlying residual myometrium. Because the patient wished to continue the intrauterine pregnancy, selective treatment of the scar gestation was performed. Ultrasound-guided local potassium chloride injection led to gradual regression of the cesarean scar pregnancy without significant bleeding or procedure-related complications. The intrauterine pregnancy continued under close surveillance, and an elective repeat cesarean delivery at 37 weeks resulted in the birth of a healthy neonate. Histopathology of residual tissue at the repaired scar was compatible with a placental remnant. Selective local potassium chloride injection may be considered a fertility-preserving option for heterotopic cesarean scar pregnancy after surgical repair for cesarean scar disorder in carefully selected patients. Early diagnosis, careful counseling, and management in a tertiary care setting are essential.
Uterine leiomyomas are a common benign neoplasm of the female reproductive tract. They are often asymptomatic and can be present during pregnancy without complication. When leiomyomas outgrow their blood supply, the tissue undergoes degeneration. This process is most often seen in pregnancy. A rare complication of this process is spontaneous rupture, which is a surgical emergency often resulting in intra-abdominal leakage, bleeding, and peritonitis. This report describes the case of a 36-year-old White woman (G1P0) at 35 weeks of gestation with a known enlarging anterior fundal leiomyoma with degeneration who presented with worsening abdominal pain and contractions in the setting of gestational diabetes mellitus. Imaging and clinical findings were concerning for rupture of a degenerating fibroid with intra-abdominal fluid leakage. This event resulted in threatened preterm labor. She underwent low transverse cesarean section, resulting in delivery of a viable neonate. Intraoperative findings included a broad-based fundal leiomyoma with a 1.5 cm defect and drainage of degenerative contents. Six months postpartum, the patient had persistent fibroid degeneration requiring robotic-assisted laparoscopic myomectomy. This case highlights the rare but serious complications of leiomyoma rupture in pregnancy and underscores the importance of close monitoring and appropriate surgical intervention for patients with degenerating leiomyomas.
Congenital portosystemic shunts are rare vascular anomalies of the fetal venous system caused by abnormal connections between the portal and systemic circulation. Although prenatal diagnosis is challenging, it is essential for appropriate counseling and management. A 34-year-old pregnant woman was referred at 26 weeks of gestation with suspected early-onset fetal growth restriction. Ultrasonography revealed severe fetal growth restriction, with all biometric parameters below the 1st percentile, while Doppler findings remained normal. Targeted evaluation demonstrated an abnormal vascular connection between the left portal vein and the left hepatic vein, consistent with an intrahepatic portosystemic shunt, without additional structural anomalies. The pregnancy was closely monitored, and a female infant weighing 1410 g was delivered at 37 weeks of gestation. The neonatal course was uneventful except for low birth weight. Intrahepatic portosystemic shunts should be considered in the differential diagnosis of unexplained early-onset fetal growth restriction, even when conventional Doppler findings are normal.
The cyst of the canal of Nuck is a rare developmental disorder of the female inguinal region. It arises from the failure of the obliteration of the peritoneal fold accompanying the round ligament through the inguinal canal. Although predominantly encountered in the pediatric population, its occurrence in women of reproductive age presents a significant diagnostic challenge, given the overlap with more common inguinal pathologies. This report describes the case of a 33-year-old nulliparous woman who presented with a six-month history of progressive left inguinal swelling. Pelvic magnetic resonance imaging (MRI) identified a left canal of Nuck cyst alongside a constellation of synchronous pelvic pathology, including a serous borderline tumour of the right ovary, a left ovarian cyst, endometriotic deposits on the bladder peritoneum and an anterior uterine wall fibroid. The patient underwent a combined single-stage surgical approach comprising bilateral cystectomy, myomectomy and repair of the inguinal ring defect. This case is notable for the coexistence of a canal of Nuck cyst with multiple independently significant gynaecological diagnoses in a young nulliparous woman. It underscores the importance of a thorough pelvic evaluation when an inguinal swelling is identified, as well as the diagnostic utility of multimodal imaging, given the broad differential diagnosis. This report also highlights the need to consider fertility-sparing surgical approaches in nulliparous women of reproductive age presenting with complex concurrent pelvic pathology.
Granulomatosis with polyangiitis (GPA) is a rare ANCA-associated vasculitis. De novo presentation during pregnancy is exceptionally rare and may mimic severe infection, delaying diagnosis. This report concerns a case of new-onset GPA in a 26-year-old primigravid woman presenting in the second trimester with progressive refractory sinonasal disease initially treated as severe bacterial sinusitis. Despite repeated antimicrobial therapy and multiple ENT interventions, her condition deteriorated with development of hemoptysis and cavitating pulmonary lesions. Histopathology demonstrated necrotizing granulomatous inflammation, and further evaluation revealed ANCA positivity with anti-PR3 antibodies, confirming GPA at approximately 22 weeks of gestation. Management was complicated by rapidly progressive multisystem disease, concern for evolving renal involvement, opportunistic pulmonary infection with Pneumocystis jirovecii, and the limited availability of pregnancy-compatible immunosuppressive therapy before fetal viability. Disease control was achieved with corticosteroids, intravenous immunoglobulin, azathioprine, and multidisciplinary reassessment, while rituximab was deferred until the postpartum period. Pregnancy was continued to 35 + 5 weeks of gestation, resulting in delivery of a live female neonate appropriate for gestational age. At 2-year follow-up, maternal remission was sustained and the child remained clinically well. This case highlights the diagnostic challenges of de novo GPA during pregnancy and demonstrates that favorable maternal and neonatal outcomes remain possible with timely multidisciplinary management.
Serous tubal intraepithelial lesion (STIL) is an uncommon precursor lesion in the spectrum of tubal serous neoplasia, characterised by atypical epithelial proliferation, aberrant p53 expression and a low proliferative index. Chronic inflammatory conditions such as tuberculosis may contribute to carcinogenesis through persistent epithelial injury. This report describes the case of a 29-year-old woman with previously treated tubercular endometritis who presented with persistent pelvic pain and bilateral pyosalpinx. Diagnostic laparoscopy revealed grossly enlarged fallopian tubes with torsion and purulent intraluminal contents, necessitating bilateral salpingectomy. Histopathological examination demonstrated chronic granulomatous salpingitis with focal epithelial atypia. Immunohistochemistry showed diffuse abnormal p53 overexpression (80%) and a low Ki-67 proliferation index (<10%), consistent with STIL. Marked cytological atypia and high proliferative activity were absent, favouring STIL over serous tubal intraepithelial carcinoma. This case highlights a rare association between chronic tuberculous inflammation and early tubal neoplastic transformation. It emphasises the importance of meticulous histopathological and immunohistochemical evaluation of salpingectomy specimens.
Cesarean scar ectopic pregnancy (CSEP) is a rare but increasingly recognized complication of prior cesarean delivery that carries significant risk of maternal morbidity. This report concerns the case of a 31-year-old patient who presented at 14 weeks of gestation for surgical abortion and was found intraoperatively to have a CSEP. Despite successful evacuation, she developed severe hemorrhage requiring uterine artery embolization and blood product transfusion. Medical records from the patient's previous encounter at another facility indicated that the CSEP had been interpreted there as an intrauterine pregnancy, leading her to travel out of state for legal abortion care. This case underscores the importance of maintaining suspicion for CSEP in patients with prior cesarean delivery and highlights the role of timely recognition, multidisciplinary management, and the complex impact of restricted abortion access on patient safety.
Giant condyloma acuminatum (Buschke-Löwenstein tumor; BLT) is a rare HPV-associated disease characterized by progressive proliferation, high recurrence rates (60-70%), and potential for malignant transformation to squamous cell carcinoma. Although histologically benign, aggressive local behavior and involvement of functionally critical anatomical structures present substantial therapeutic challenges. This report describes the successful function-preserving surgical management of extensive treatment-refractory BLT. A 69-year-old woman with a history of malignant lymphoma and diabetes mellitus developed vulvar condyloma that was resistant to sequential imiquimod therapy, cryotherapy, and laser ablation. The lesion progressively enlarged to 15 × 9.5 × 2.5 cm, encompassing the entire vulva and perianal area. Clinical examination and imaging confirmed the absence of urethral and rectal mucosal invasion. Preoperative imiquimod was administered to the urethral meatus, vaginal introitus, and perianal area for 4 weeks to control microscopic disease at functionally critical sites. Surgical resection prioritized function preservation: ≥1 cm margin at the periphery, while mucosal boundaries were approached closely at critical sites. Residual rough mucosal areas underwent bipolar cauterization. Primary closure was achieved without the need for flap reconstruction. Mild postoperative wound dehiscence without infection resolved with conservative management, permitting secondary healing. Five months postoperatively, complete epithelialization was achieved with no recurrence, preserved urinary and bowel function, and the absence of vaginal symptoms. This case demonstrates that combining preoperative imiquimod, function-prioritizing surgical margins, local ablation, and tolerance of secondary healing can achieve oncologic control while maintaining quality of life in extensive BLT. Long-term surveillance remains essential.
Appendiceal endometriosis is a rare form of extragenital endometriosis that can mimic acute appendicitis. This reports presents the case of a 19-year-old woman with no significant medical history who presented with right-sided abdominal pain, nausea, and lightheadedness. Physical examination revealed right lower quadrant tenderness and a positive Rovsing sign. Laboratory studies showed no leukocytosis, and her modified Alvarado score was 4. Computed tomography of the abdomen and pelvis demonstrated mild fluid and inflammatory changes near the base of the cecum extending toward the right adnexa, raising concern for acute appendicitis versus a ruptured ovarian cyst. Pelvic ultrasound identified a complex cystic structure in the right ovary with adjacent free fluid, while appendicitis could not be excluded. Due to persistent symptoms and diagnostic uncertainty, laparoscopic appendectomy was performed. Intraoperative findings included hemoperitoneum, endometriotic lesions, and possible rupture of a right ovarian follicle. Histopathological examination revealed appendiceal serosal endometriosis. This case underscores the diagnostic challenge of appendiceal endometriosis and the importance of considering gynecologic etiologies in young women presenting with right lower quadrant pain.
