A severe case of ovarian hyperstimulation syndrome with pulmonary thromboembolism

Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic, life-threatening complication of ovarian stimulation. Renal and hepatic dysfunction, thrombosis, pulmonary edema, cerebral infarcts and adult respiratory distress syndrome are the leading causes of morbidity and mortality seen in severe cases. Here we report a case of OHSS with pulmonary thromboembolic event. Although the pathogenesis of thromboembolic events occurring during OHSS is not clear, it is probable that rising levels of estradiol may trigger hypercoagulability. Thromboembolic events seen with oral contraceptives and hormone replacement therapy support this hypothesis. © Internet Scientific Publications, LLC

Successful obturator nerve repairing: Intraoperative sural nerve graft harvesting in endometrium cancer patient

Introduction Intraoperative injury of obturator nerve is a rare complication of gynecologic surgeries, it has been reported especially in patients with endometriosis and genitourinary malignancies. Gynecologic patients undergoing open lymphadenectomy are at increased risk of obturator nerve injury. PRESENTATION OF CASE A 60-year-old woman with FIGO stage II Grade II endometrial adenocarcinoma underwent bilateral pelvic paraaortic lymphadenectomy. During right obturator lymph node dissection, the right obturator nerve was inadvertently transected with Harmonic scalpel sealing system. The graft was used to anastomose epyneurium of distal segment of obturator nerve to its counterpart in the proximal segment with 10-0 prolen suture. DISCUSSION In case of iatrogenic nerve transection, microsurgical end to end tension-free coaptation is advocated. In case of the obturator nerve is fixed and because of the thermal injury end to end alignment can not be achieved, nerve grafting is necessary. CONCLUSION According to our knowledge, successful immediate grafting of iatrogenically damaged obturator nerve during pelvic lymphadenectomy in our patient is the third report of such a case, but also it has a unique feature of being the first obturator nerve repairing case after dissected with tissue sealing system which causes large sealed area that does not make it possible to make end-to-end anastomosis without nerve harvesting. © 2014 Elsevier Ltd. All rights reserved

Endothelial nitric oxide synthase expression in gestational trophoblastic diseases

Objective: Nitric oxide is thought to play a role in the regulation of trophoblast activity. The aim of this study was to compare endothelial nitric oxide synthase expression in tissue samples taken from gestational trophoblastic diseases and placentas of normal pregnancies. Methods: The expression of endothelial nitric oxide synthase was tested in formalin-fixed, paraffin-embedded tissues from specimens including 8 first trimester placentas, 3 partial hydatidiform moles, 20 complete hydatidiform moles, 2 invasive moles, and 5 choriocarcinomas. The expression of antibody was scored by a semiquantitative scale to define staining intensity. Results: The first trimester placentas showed moderate expression in the villous. Gestational trophoblastic diseases displayed strong to very strong endothelial nitric oxide synthase expression in the syncytiotrophoblast, villous, and proliferating mononuclear trophoblasts. Conclusions: Endothelial nitric oxide synthase expression seems to have a strong correlation with proliferation of trophoblastic cells, in gestational trophoblastic diseases and in normal pregnancy. Copyright © 2010 by IGCS and ESGO

Herlyn-Werner-Wunderlich syndrome (uterus didelphys, blind hemivagina and ipsilateral renal agenesis) - a case report [Herlyn-Werner-Wunderlich sendromu (uterus didelphys, kör hemivajen ve ipsilateral renal agenezi) - vaka sunumu]

Uterovaginal duplication with obstructed hemivagina and ipsilateral renal agenesis is referred to as the Herlyn-Werner-Wunderlich (HWW) syndrome. A 17 year old woman presented with right pelvic pain and dysmenorrhea, present since menarche at 13 and worsening over the past year. Ultrasound examination revealed a right pelvic mass (5×5 cm), double endometrial echoes, and hematocolpos. A right pelvic mass, agenesis of the right kidney, double uterus, and blind hemivagina with hematocolpos were detected by magnetic resonance imaging and intravenous pyelography. A right tubo-ovarian abscess with dense adhesions and a double uterus were observed on diagnostic laparoscopy. Adhesiolysis was carried out and purulent material irrigated. After a course of antibiotics, a vaginal septum resection was performed and the pyocolpos drained. She remained symptom free after four months of follow-up. Prompt and accurate diagnosis and treatment of this syndrome can significantly improve the lives of sufferers and prevent future omplications

Ovarian cancer during pregnancy

The frequency of cancer during pregnancy is approximately 1 per 1000 live births. This rate may increase as more women postpone childbirth until later in life, when cancer becomes more frequent. Pregnancy affectsmanagement of the cancer, and the cancer affects the management of pregnancy. The most common malignancies, in order of frequency, are breast cancer, leukaemia and lymphomas as a group, melanoma, gynaecologic cancers, and bone tumours. Ovarian tumours are found in about 1 in 1000 pregnancies and 3-6% of these are malignant. Thus, ovarian cancer occurs in approximately 1 in 12,500-25,000 pregnancies. Here, we report a case of ovarian mucinous carcinoma that was diagnosed at 22 weeks of gestation. After conservative surgery, she was given three cycles of carboplatin chemotherapy. She delivered at 33 weeks of gestation and after undergoing surgery she was given six cycles of paclitaxel and carboplatin chemotherapy. The patient is now being followed by the oncology department with no evidence of disease

Primary pulmonary sarcoma metastasising to the skin during pregnancy

Lung cancer during pregnancy is a rare situation which is being increasingly reported during the past two decades due to a rising trend of cigarette smoking among young women and the tendency to delay pregnancy to a later age in life. We describe the case of a 32-year-old woman with primary pulmonary sarcoma, diagnosed at 31st week of pregnancy. X-ray chest and thoracic magnetic resonance imaging revealed a 9 × 6 cm mass in the left mediastinum, with tracheal shift, and pleural effusion. Biopsy performed during broncoscopy, was reported as mesenchymal tumour. She delivered a baby by Caesarean section at the 32nd week of gestation due to the development of superior vena cava syndrome. A skin biopsy taken 3 weeks later from the nodular lesion at the periumblical region was reported as a tumour metastasis. She received radiotherapy for 10 days, but died in the intensive care unit. Malignancies, even those as uncommon as a pulmonary sarcoma, should be considered in the differential diagnosis of pleural effusion during pregnancy

Recurrent partial hydatidiform mole

Hydatidiform moles are abnormal conceptions characterised by atypical hyperplastic trophoblasts and hydropic villi. Their incidence is approximately 1 in 1000 pregnancies. The recurrence risk of hydatidiform mole is approximately 1 in 60 in a subsequent pregnancy and 1 in 6.5 in the third pregnancy. In cases with recurrence, the majority of moles are of the same type as that in the preceding pregnancy. Here, we describe the case of a recurrent partial hydatidiform mole after an initial healthy pregnancy. Both pregnancies were evacuated by suction curettage, and the patient was followed by serial monitoring of ß-human chorionic gonadotropin levels. Recurrent molar pregnancy is not an indication for chemotherapy, and subsequent pregnancies do not have an increased risk for other obstetric complications

Comparison of serum androgens and endometrial thickness in obese and non-obese postmenopausal women [Obez ve obez olmayan postmenopozal hastalarda serum androjen seviyeleri ve endometrial kalınlıgn karşılaştınlması]

Objective: In this study, we investigated whether serum androgen levels and endometrial thickness differed in obese and non-obese women. Material and Methods: Thirtytwo non-obese (BMI 5 mm had significant pathology. Conclusion: These results suggest that obesity may be a risk factor for endometrial carcinoma and other pathologies in post-menopausal women through an action on androgen concentrations

Idiopathic ileoileal invagination two days after cesarean section

Postoperative enteroenteric invagination is rare. The only previously reported case post-cesarean was secondary to colonic adenocarcinoma. A 27-year-old woman with preeclampsia delivered a baby by cesarean section. On the second postoperative day, she had abdominal pain, nausea, vomiting, constipation, and distention. An abdominal x-ray showed air-fluid levels, while free fluid (ascites) was detected by ultrasonography. A computed tomography scan did not show the typical invagination picture. Her condition did not improve after 72 h of conservative treatment, and diagnostic laparotomy was performed. A 10 x 3-cm ileoileal invagination 80 cm proximal to the ileocecal valve was found and manually reduced. The patient was discharged on the fifth postoperative day, and her six-month follow-up was normal. © 2011 Japan Society of Obstetrics and Gynecology

Comparison of the histopathological diagnoses of preoperative dilatation and curettage and hysterectomy specimens

Aim: A biopsy is often taken as part of the preoperative workup, regardless of the indication for hysterectomy. Some authors believe that dilatation and curettage is a poor diagnostic procedure for intrauterine pathologies, but dilatation and curettage has been the method of choice for obtaining an endometrial sample. The aim of this study was to investigate the concordance between endometrial histopathological diagnoses from preoperative dilatation and curettage and hysterectomy specimens. The differences between premenopausal and postmenopausal women were also investigated. Methods: Histopathological results for dilatation and curettage specimens from 645 women (401 premenopausal and 244 postmenopausal) who underwent a hysterectomy between 2003 and 2009 were analyzed retrospectively. Results: High sensitivity (87.8%), specificity (100%), positive (100%) and negative (98.7%) predictive values, and accuracy (98.8%) were observed for all malignant endometrial pathologies obtained at dilatation and curettage. In postmenopausal women, eight malignancies were missed when the preoperative diagnosis from the dilatation and curettage sample indicated inadequate tissue or premalignant lesions. For premenopausal women, we found only two missed malignancies. The accuracywas 99.5% and 96.8% for malignant pathologies diagnosed from curettage material for pre- and postmenopausal women, respectively. Conclusions: Dilatation and curettage remains the 'gold standard' for diagnosing endometrial pathologies, especially malignancies. © 2011 Japan Society of Obstetrics and Gynecology