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Uterine leiomyomas, or fibroids, are the most common benign tumours of the female genital tract. Although uterine fibroids are commonly associated with menorrhagia, dysmenorrhea, symptomatic anaemia, urinary or bowel symptoms and infertility, intra-abdominal haemorrhage is an exceedingly rare complication. Often, the diagnosis is poorly recognizable based on the patient's clinical presentation and alternative diagnoses such as ruptured ectopic pregnancy, ruptured ovarian cyst or perforated viscus are frequently considered. Herein, we describe a case of a 50-year-old perimenopausal woman who presented with acute, lower abdominal pain, evolving anaemia, hypovolaemic shock and haemoperitoneum with no discernable source. Emergency exploratory laparotomy confirmed the source of massive haemoperitoneum arising from a ruptured blood vessel supplying a large subserosal uterine leiomyoma and the patient subsequently underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Given the paucity of publications on this clinical entity, the aim of this report is to highlight a rare complication of uterine leiomyomas, its pathophysiological spectrum and its relevance to emergency physicians, general surgeons and gynaecologists.
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Spontaneous hepatic rupture in pregnancy (SHRP) is a rare but often fatal condition associated with pre-eclampsia or HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome. SHRP is linked to significant maternal and perinatal morbidity and mortality, and maternal complications can extend past the initial intraoperative period. This case report describes the challenging perioperative course of a 35-year-old woman with SHRP. She underwent five laparotomies during a prolonged and complicated course in the intensive care unit. Despite these challenges, maternal and fetal outcomes were good. This case report serves to highlight key perioperative multidisciplinary issues in the care of these patients.
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Thoracic endometriosis is an exceedingly rare condition characterized by the presence of endometriotic deposits on the diaphragm, lungs or pleural space. Patients may present with massive hemothorax, pneumothorax, hemoptysis or pulmonary nodules. It is a complex condition that often proves to be a diagnostic challenge, resulting in under-diagnosis, delays in treatment and significant morbidity in women of reproductive age. We report a case of endometriosis causing massive pleural effusion and ascites, with a left adnexal fibroid mass mimicking Meigs' syndrome in a nulliparous woman in her late 30s. The patient was successfully managed with hormonal therapy following fertility-sparing surgical treatment. This case highlights the diagnostic and therapeutic challenges associated with thoracic endometriosis because of its close resemblance to more sinister gynecological conditions. Hormonal therapy is the long-term treatment of choice in patients with thoracic endometriosis to reduce the risk of symptom recurrence and preserve fertility.
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Leiomyomas are the most common benign tumours of the female genital tract, and almost always arise from the uterine myometrium. Although extrauterine leiomyomas are rare, they usually develop in sites such as the ovary, broad ligament, round ligament, cervix or abdominal wall. The broad ligament is the most common site of extrauterine leiomyoma involvement, and this unique clinical entity may prove to be a diagnostic or therapeutic challenge, particularly in patients with advanced endometriosis and distorted pelvic anatomy. Herein, we report the case of a large true broad ligament leiomyoma that was discovered during a total laparoscopic hysterectomy and bilateral salpingo-oophorectomy in a 47-year-old patient with stage IV endometriosis and a congenital left kidney and left ureter. This case highlights a rare occurrence of a true broad ligament leiomyoma, the challenges associated with preoperative diagnosis, and the laparoscopic approach to its management.
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Background: Clear cell carcinoma arising from the malignant transformation of endometriosis is a rare but aggressive cancer often diagnosed in perimenopausal women. Malignant transformation constitutes a rare complication of endometriosis, with only a few cases reported in the medical literature. Clear cell carcinoma and endometrioid carcinoma are the two most common histological subtypes associated with malignant endometriosis. Case Presentation: A 61-year-old Afro-Trinidadian woman underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy for a degenerated uterine leiomyoma. Histopathology demonstrated an isolated finding of clear cell carcinoma occurring within an endometriotic cyst on the uterine serosa. Subsequent surgical staging demonstrated early-stage disease associated with a high-risk histological subtype and the patient was referred for adjuvant chemoradiotherapy. Conclusion: This case highlights the clinical manifestations and treatment modalities employed for an early-stage high-risk subtype of endometriosis-associated cancer. In light of the few publications on this clinical entity, we hope to raise awareness of this unique complication of endometriosis and contribute evidence to the development of standardized treatment protocols.
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BACKGROUND: Poorly differentiated diffuse-type gastric adenocarcinoma often presents at an advanced stage. While gastric cancer typically metastasizes to the liver, lung and bone, metastasis to the uterine cervix is extremely rare. To our knowledge, less than forty cases have been described in the medical literature. CASE PRESENTATION: We report a case of a 47-year-old woman who presented to us with symptomatic uterine leiomyomas and subsequently underwent a successful total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. The diagnosis of metastatic cancer involving the cervix was established incidentally on histopathology, which demonstrated atypical signet ring cells in the lymphovascular spaces of the cervix. Further investigations for a primary malignancy revealed a poorly differentiated diffuse-type gastric adenocarcinoma. CONCLUSION: Gastric cancer involving the uterine cervix is rare and associated with a poor prognosis. When presented with isolated cervical metastases, the gastrointestinal tract should be considered as a possible primary source. Due to the limited publications on this clinical entity, we expect to raise awareness and study this unique manifestation of gastric cancer by presenting our case.
Assuntos
Adenocarcinoma , Neoplasias Gástricas , Neoplasias do Colo do Útero , Adenocarcinoma/patologia , Colo do Útero/patologia , Feminino , Humanos , Histerectomia , Pessoa de Meia-Idade , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgiaRESUMO
Embryonal rhabdomyosarcoma (RMS) of the uterine cervix is an exceedingly rare mesenchymal tumor that accounts for less than 1% of all cervical cancers. This highly malignant tumor primarily affects adolescents and young adults. Due to the paucity of publications on this clinical entity, there are no clearly established treatment protocols. However, a multimodal approach to treatment that involves surgical intervention combined with adjuvant chemoradiotherapy appears to improve patient outcomes. Herein, we report a case of embryonal rhabdomyosarcoma of the uterine cervix in a 24-year-old female, who presented with an exophytic cervical mass and vaginal bleeding. Histopathology and immunohistochemistry confirmed embryonal rhabdomyosarcoma of the uterine cervix with extension into the lower uterine segment. This patient was successfully managed with a combination of neoadjuvant chemoradiotherapy, a total abdominal hysterectomy with bilateral salpingo-oophorectomy, and adjuvant chemoradiotherapy.
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BACKGROUND: Malignant transformation of abdominal wall endometriosis is extremely rare. Clear cell carcinoma and endometrioid carcinoma are the two most prevalent histological subtypes of malignant endometriosis. To date, approximately, thirty cases of clear cell carcinoma arising from abdominal wall endometriosis have been described worldwide. CASE PRESENTATION: We report two cases of clear cell carcinoma developing postoperatively in the anterior abdominal wall in women with a history of extensive endometriosis. Histopathology of the resected abdominal wall tumor demonstrated benign endometriosis contiguous with features of clear cell carcinoma. These histological features satisfied Sampson's criteria which are required for diagnosing malignant endometriosis. Both patients were successfully managed with platinum-based adjuvant chemotherapy following cytoreductive surgery. CONCLUSION: Clear cell carcinoma arising from the abdominal wall endometriosis is a rare, highly aggressive cancer with a propensity to recur or metastasize. Due to the limited publications on this clinical entity, there are no clearly established protocols regarding adjuvant treatment, and an evaluation of prognostic factors is lacking. Clinicians must have a high index of suspicion for malignant endometriosis of the abdominal wall, particularly in patients with an abdominal wall mass, prior abdominal surgery, and long-standing endometriosis. By presenting our case, we expect to raise awareness and study of this rare endometriosis-related neoplasm.