A bizarre highly vascular tumor with alarming presentation: a diagnostic dilemma

An exceedingly rare, highly vascular tumor with atypical and alarming presentation posed diagnostic and management challenges. A 29 years old lady, complained of abdominal and pelvic pain, nausea, vomiting and repeated spells of fainting attacks following the jumping episode (2-3 times). Emergency admission and investigations at United States of America (USA) revealed a large, complex, highly vascular, irregular mass displaying finger like projections, filling the lower abdomen, pelvis and large amount of intra peritoneal bleed. A provisional diagnosis of arteriovenous malformation (AVM), arteriovenous fistula (AVF), and rupture/leak was made. Uterine artery angiography (UAA), preoperative embolization and possibility of hysterectomy as a life saving measure were suggested, to which the couple declined and got discharged. To save uterus and fertility they presented to us for second opinion and further management. Angiography, magnetic resonance imaging (MRI) and preoperative uterine artery embolization were done followed by exploratory laparotomy which revealed hemoperitoneum and a large weird looking vascular tumor (a veil of sea weeds/dark purple nodules of various sizes resembling cotyledons of placenta). Intra-operative tissue analysis (frozen section) suggested benign pathology. Mass was removed completely and fertility sparing surgery was undertaken. Histopathological diagnosis was cotyledonoid dissecting leiomyoma (CDL). No recurrence/metastasis has been observed on follow up of 5 years

A unique variant of spontaneous ovarian hyperstimulation syndrome: case report

Spontaneous ovarian hyperstimulation syndrome (SOHSS) is extremely rare in naturally conceived pregnancies and is potentially a life-threatening condition. Objective of present study was to highlight the development of new and atypical findings associated with SOHSS in a woman who conceived naturally with singleton pregnancy while taking inositols and metformin. A 35 years old lady was under pressure to conceive, so she presented to us for fertility consultation and further management. Being a case of polycystic ovary syndrome (PCOS) with irregular periods, hyperandrogenism and dyslipidemia with raised blood sugar level, she was started on inositols and metformin to aid fertility and to improve endocrine and metabolic parameters. To evaluate the status of ovaries and endometrium, ultrasound (US) was done which revealed moderate amount of free fluid in pelvis, thickened endometrium and mild enlargement of ovaries with unusually small and atypical follicles. Pregnancy test and beta-human chorionic gonadotropin (βHCG) confirmed pregnancy. She was asymptomatic and was managed conservatively. Pregnancy progressed and at term, a healthy male baby was delivered. Awareness and suspicion of SOHSS in a PCOS case aided early diagnosis and timely management. Intake of type of pharmacological and non-pharmacological agents to be monitored for their impact on fertility, ovarian enlargement, severity of ovarian hyperstimulation syndrome (OHSS), clinical presentation, laboratory profile and outcome of pregnancy