Uterine torsion is a rare life-threatening event that happens at any age or any gestational age. By defi nition, it consists of a rotation of more than 45 degrees around the long axis of the uterus. The reported cases have variable presentations. The uterine torsion can happen without any sequelae either for the fetus or the mother. However, fetal and maternal mortalities were also reported in such a case We hereby, report the case of a 29-year-old female patient, with previous four Normal Vaginal Deliveries, pregnant with twins, presenting at 36 weeks gestation with an irreducible uterine torsion at the third trimester of her pregnancy complicated by maternal and fetal deaths. We concluded that the prognosis is improved as long as the management is done rapidly. More data is needed to know about the genetic predilection and the characteristics of imaging workup for a rapid preoperative diagnosis of this condition.
Xanthogranuloma is a benign disorder that is considered to be a very rare event when it happens in the female reproductive organs. It can mimic adnexal tumors clinically and radiologically. The vulva, the vagina, the cervix or the endometrium can be involved. It is a process during which the tissues are infiltrated by lipid-laden histiocytes mixed with lymphocytes, plasma cells and polymorphonuclear leucocytes. In this article, we are reporting a rare case of an adult xanthogranulomatous inflammation of the uterine cervix with a detailed clinical, pathologic, radiologic and follow up data. A 46-year-old lady presented with vaginal bleeding, dysmenorrhea and pelvic heaviness. She underwent a diagnostic dilation and curetting at a peripheral hospital due to increased endometrial thickness on ultrasound. Then, she was misdiagnosed with a diffused large B cell lymphoma (Non-Hodgkin Lymphoma) and was treated with two cycles of chemotherapy. At our department, abdominopelvic ultrasound and CT scan showed a 10 x 9.4 cm round cervical mass associated with hydronephrosis. A cervical biopsy was also taken turned back with a pseudotumoral xanthogranulomatous cervicitis. Consequently, a hysterectomy with bilateral salpingo oophorectomy was decided and performed taking into consideration the possibility of a coexistent associated malignancy of the reproductive organs. In contrast with juvenile xanthogranuloma, we could not have expected from our case of adult xanthogranuloma to regress. Finally, more studies and reported cases are needed in order to assess the adequate management and utility of radiotherapy/chemotherapy in such cases of Xanthogranulomatous inflammation of the female genital tract.
Leiomyoma is a benign tumour composed mainly of smooth muscle cells. It contains varying amount of fibrous connective tissues. Parasitic leiomyoma is a rare manifestation of uterine leiomyoma defined as a pedunculated subserosal fibroid that undergoes torsion and detaches from the uterus. We are reporting a case of parasitic leiomyoma in a 55 Y/O female patient that had already given her consent for the case to be published. She presented with increased abdominal girth since 6 months and body weight and consulting for possible bariatric surgery 1 month prior to presentation. Ultrasonography revealed a large heterogeneous mass starting from the pelvic region to the middle and upper abdomen of more than 37 cm compatible with an adnexal mass. On abdominopelvic MRI: presence of an enlarged heterogeneous mass that seems taking its origin from the right ovary, an exploratory laparotomy was performed. Identification and complete excision of a huge mass of cystic and solid component adherent to the uterus and the mesentery of the small bowel. Histopathologically mass was confirmed as a hyelanized leiomyoma with a focal necrobiosis with no signs of malignity. Parasitic leiomyomas are rare tumors. Imaging modalities help in diagnosis but not always. The definitive treatment is surgical excision, presenting this case due to its rarity and diagnostic difficulties posed.
Giant fibroadenomas are exceptional in pregnancy and in most of cases, diameter doesn't reach more than 15 cm. However, our case is a rare one that reached 18 cm in a 23-year-old female referred post-partum for evaluation of a huge left breast mass. On the other hand, there is a persistent debate regarding the best modality of the surgical approach to giant tumors; most of the experts recommend the enulceation of the tumor after delivery while others argue that extirpation during pregnancy is the best since we have to exclude malignancy. In our patient, the whole tumor was excised at the postpartum period and the pathology did not show any sign of malignancy. Even if our case does not clearly reveal the long term result of the postpartum excision of a giant fibroadenoma, the short term result we have had after this approach was satisfying. Further studies are important to be published in order to confirm pros and cons of the postpartum approach.
Parasitic Leiomyoma (PL) is considered a rare variant of uterine fibroids occurring outside the uterus. We hereby report a challenging case of parasitic leiomyoma that is considered rare in the literature with all its particularities. A 62 YO lady is known to have a history of diabetes, right breast carcinoma, appendectomy and normal vaginal deliveries presenting with a two-year history of back and abdominal pain with recent urinary symptoms. Therefore, an abdominopelvic Ct scan and MRI were done showing uterine fibroids compressing the bladder. The patient underwent an exploratory laparotomy. A palpable intravesical mass was identified. Transurethral cystoscopic resection was performed. Pathology results confirmed the leiomyomatous nature of the mass. Postoperatively, the surgery was complicated with a wound dehiscence and a hematoma formation on the left lateral wall of the bladder that was treated conservatively with a good follow-up outcome.
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