Gestational Trophoblastic Neoplasia (GTN) is a rare disease originating from pregnancy events that have varied incidences and clinical manifestations based on regional variation. We are reporting a case of a 36-year-old woman with Invasive mole from Central India who presented with abnormal uterine bleeding with severe anemia. She had three full-term vaginal deliveries and 2 spontaneous abortions, the last conception being an abortion around 7 years back. MRI pelvis demonstrated a hypervascular uterine mass suggestive of an Invasive Mole, supported by increased serum β-hCG levels of 31.8 IU/ml. There was no evidence of any metastases on adjunct radiological investigations. After a thorough counselling, the enlarged vascular uterine mass was managed by uterine artery embolization (UAE) followed by simple hysterectomy. Histopathology report confirmed the diagnosis of invasive mole with villi lying in the fibrinous blood clot sheath of the syncytial, and cytotrophoblasts were seen invading the myometrium foci. The patient being in the low risk FIGO scoring, calculated was 5, chemotherapy was not deemed necessary for the patient. Serial post operative β-hCG along with ultrasound pelvis and chest radiogram surveillance showed favourable results with no evidence of metastases even on 6 months follow up. Being a very rare condition, a high index of suspicion with prompt timely management ensures optimum care.
Uterine torsion is a rare, life-threatening and unexpected obstetric emergency. It is almost always diagnosed at caesarean section. Its ill-defined clinical presentation may pose a diagnostic dilemma. Here the authors present a case of 32-year-old, Primigravida, 36 weeks pregnancy with acute abdomen and intrauterine foetal demise. Clinical features resembled Abruptio Placentae. The diagnosis of uterine torsion (180°) was established on laparotomy where the left ovarian ligament was seen on the right side anteriorly. A posterior hysterotomy was done to extract the baby which was followed by detorsion of the uterus. The postoperative period was uneventful.
Adenomyosis is a benign gynaecological condition in multiparous women during their middle age commonly presenting as pelvic pain and menorrhagia. We report a case of a 27-year-old nulligravida of Asian origin from the Indian subcontinent who presented with a huge adenomyotic uterus with mild splenomegaly, and portal cavernoma having gross ascites that developed life-threatening peritonitis and septicaemia. Endometrial aspiration done showed no atypia or malignancy and upper gastrointestinal tract endoscopy done showed no dilated varices. With increasing abdominal distension, she developed tachycardia, tachypnoea, septicaemia and oliguria. Exploratory laparotomy done revealed purulent loculi, omentum and bowel adhesion around the uterus. Adnexa was not distinctly identifiable. Hysterectomy with left salpingo-oopherectomy was performed. She required ventilatory support and intensive unit care postoperatively. Histopathology examination showed adenomyosis with suppuration, right ovary endometriotic cyst and left ovary non-specific inflammation. The patient was discharged in stable condition on day 21. Adenomyosis may rarely occur in young nulligravida women as life-threatening manifestations with purulent peritonitis and septicaemia. Early exploration is crucial for diagnosis and recovery.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.