A rare case of perineal endometriosis with anal sphincter involvement

Perineal endometriosis is a rare entity which can be explained by direct implantation of endometriotic cells over the fresh episiotomy wound and subsequent development of scar endometriosis. Perineal scar endometriosis incidence is reported to be 0.3% to 1%. 28 years old, P1L1, presented with pain and swelling near episiotomy site which is associated with menstruation. Examination during menstruation revealed swelling was tender, erythematous and slightly increased in size. Clinical diagnosis of scar endometriosis was made after clinical examination. Mass excised and sent for histopathological examination. Although diagnosis essentially remains clinical, preoperative evaluation with perineal ultrasound and MRI was performed. Wide local excision remains treatment of choice and follow up for recurrence is recommended. Histopathological examination is obligatory to exclude rare possibility of malignant changes

A case of atypical leiomyoma mimicking as endometrial cancer

Atypical leiomyoma or leiomyoma with bizarre nucleus is diagnosed on histopathological examination characterized by severe cytological atypia in the form of nuclear enlargement, multi nucleation, hyperchromasia, coarse chromatin and prominent nuclei. These tumours do not have typical features of necrosis or mitotic figures to characterize them as leiomyosarcoma. There are 2% risk of these tumours to convert to leiomyosarcoma. 50-year P3L3A1 postmenopausal for past 6 years presented to gynaecology outpatient department (GOPD) with complains of pain in lower abdomen for past 1 year. Patient was examined and investigated. On clinical examination there was no apparent finding. On radiological examination a well-defined hypoechoic lesion of 6.4×5.7 cm2 was found arising from uterus. Contrast enhanced computed tomography (CECT) abdomen showed heterogenous mass involving endometrium and myometrium likely neoplastic. Total abdominal hysterectomy with bilateral salpingoophrectomy was done. Histopathological examination (HPE) report revealed features of atypical leiomyoma. Patient is under follow up in GOPD