A case of an ovarian tumour pre-operatively thought to be malignant, which was per-operatively diagnosed as benign and later confirmed as a mucinous cystadenoma.
Ob-Gyn Department, BIRDEM-2 General Hospital, Shegunbagicha, Dhaka, Bangladesh
This document provides an overview of endometrial carcinoma, including its epidemiology, risk and protective factors, classification, clinical presentation, diagnosis, staging, treatment, prognosis, and prevention. Endometrial carcinoma is the most common gynecological cancer and occurs most often in postmenopausal women. Risk factors include older age, early menarche, late menopause, nulliparity, obesity, and unopposed estrogen exposure. Treatment involves surgery, with additional chemotherapy, radiation, or hormonal therapy depending on the stage and grade of cancer. Prognosis depends on histologic grade and stage, with 5-year survival rates ranging from 83% for stage I to 27% for stage IV disease.
The document discusses adenomyosis, a benign condition where endometrial tissue grows within the uterine wall. It defines adenomyosis and describes associated symptoms like pelvic pain and abnormal bleeding. Diagnosis can only be confirmed by pathology after hysterectomy, though other imaging methods like ultrasound and MRI can provide clues. TVUS shows heterogeneous myometrial texture while MRI may detect increased thickness or consistency changes in the myometrium.
This document summarizes a medical case involving a 52-year-old female patient presenting with a lower abdominal mass. She reported a 5 month history of the mass along with weight loss and pain over the past 3 months. Physical examination revealed a large abdominal mass. Imaging studies including ultrasound and CT scan showed a large solid-cystic pelvic mass likely originating from the left ovary. Based on findings and elevated CA-125 level, the impression was of a likely malignant ovarian tumor. The recommended management was surgical staging and tumor debulking followed by chemotherapy.
Staging laparotomy is a surgical procedure used to accurately stage cancers like ovarian carcinoma by examining the abdominal region. It provides more detailed information about metastasis than non-invasive techniques. A significant percentage of early-stage cancers are found to be more advanced after staging laparotomy. The surgeon explores the abdominal cavity systematically, taking biopsies of suspicious areas to determine if the cancer has spread from the ovaries. Staging laparotomy is important for planning the most effective treatment and understanding a patient's prognosis, as improper staging can lead to undertreatment and reduced survival.
A 42-year-old teacher presented with menorrhagia for 6 months with lethargy and palpitations. On examination, she was pale with a pulse of 108 bpm. Investigations showed Hb levels decreasing from 8.1 to 7.8 g/dL. Ultrasound found an endometrial thickness of 6 mm without masses. She was diagnosed with dysfunctional uterine bleeding (DUB) and admitted for further management including IV fluids and iron supplements. DUB is abnormal bleeding due to hormonal imbalances that can cause heavy periods, and is diagnosed after excluding other causes. It is typically treated with hormonal therapy.
This document provides an overview of endometrial carcinoma, including its epidemiology, risk and protective factors, classification, clinical presentation, diagnosis, staging, treatment, prognosis, and prevention. Endometrial carcinoma is the most common gynecological cancer and occurs most often in postmenopausal women. Risk factors include older age, early menarche, late menopause, nulliparity, obesity, and unopposed estrogen exposure. Treatment involves surgery, with additional chemotherapy, radiation, or hormonal therapy depending on the stage and grade of cancer. Prognosis depends on histologic grade and stage, with 5-year survival rates ranging from 83% for stage I to 27% for stage IV disease.
The document discusses adenomyosis, a benign condition where endometrial tissue grows within the uterine wall. It defines adenomyosis and describes associated symptoms like pelvic pain and abnormal bleeding. Diagnosis can only be confirmed by pathology after hysterectomy, though other imaging methods like ultrasound and MRI can provide clues. TVUS shows heterogeneous myometrial texture while MRI may detect increased thickness or consistency changes in the myometrium.
This document summarizes a medical case involving a 52-year-old female patient presenting with a lower abdominal mass. She reported a 5 month history of the mass along with weight loss and pain over the past 3 months. Physical examination revealed a large abdominal mass. Imaging studies including ultrasound and CT scan showed a large solid-cystic pelvic mass likely originating from the left ovary. Based on findings and elevated CA-125 level, the impression was of a likely malignant ovarian tumor. The recommended management was surgical staging and tumor debulking followed by chemotherapy.
Staging laparotomy is a surgical procedure used to accurately stage cancers like ovarian carcinoma by examining the abdominal region. It provides more detailed information about metastasis than non-invasive techniques. A significant percentage of early-stage cancers are found to be more advanced after staging laparotomy. The surgeon explores the abdominal cavity systematically, taking biopsies of suspicious areas to determine if the cancer has spread from the ovaries. Staging laparotomy is important for planning the most effective treatment and understanding a patient's prognosis, as improper staging can lead to undertreatment and reduced survival.
A 42-year-old teacher presented with menorrhagia for 6 months with lethargy and palpitations. On examination, she was pale with a pulse of 108 bpm. Investigations showed Hb levels decreasing from 8.1 to 7.8 g/dL. Ultrasound found an endometrial thickness of 6 mm without masses. She was diagnosed with dysfunctional uterine bleeding (DUB) and admitted for further management including IV fluids and iron supplements. DUB is abnormal bleeding due to hormonal imbalances that can cause heavy periods, and is diagnosed after excluding other causes. It is typically treated with hormonal therapy.
Uterine fibroid - Case scenarios and DiscussionHaynes Raja
This presentation is prepared to meet out the undergraduate medical student needs especially to understand the practical aspects of uterine fibroid and to rapidly revise some important viva questions.
Dedicated to my Great Teachers in the Dept. of Obstetrics & Gynaecology Dr. Lavanya Kumari and Dr. Sangeereni, Inspiring Friends Dr. Paulin Benedict, Dr. Jeyakumar Meyyappan and Dr. Hannah Jane and our REVELLIONZ 08’ batch.
This document discusses the diagnosis and management of adnexal masses. It provides information on the normal size and variation of ovaries and lifetime risk of ovarian neoplasms. Differential diagnoses of adnexal masses are outlined based on patient age. Diagnostic evaluation includes physical exam, ultrasound, CT or MRI if needed. Common ovarian tumors at different life stages are described. Functional cysts, endometriomas, benign and borderline tumors are discussed. Complications, clinical presentation, imaging and tumor markers are summarized. Guidelines for management of asymptomatic cysts and indications for surgery are provided.
4 cases of pelvic mass are discussed .Adnexal mass invilves masses arisinf from ovary,fallopian tube,uterus,bowel and some miscellenious masses.USG is used to detect its size and the origin.Histopathological findings are diagnostic.
(I) The document discusses various types of ovarian tumours including functional cysts, inflammatory cysts, and benign and malignant neoplastic tumours.
(II) Functional cysts include follicular cysts, corpus luteal cysts, and theca lutein cysts which are usually asymptomatic and resolve on their own. Inflammatory cysts include tubo-ovarian abscesses.
(III) Benign neoplastic tumours discussed are serous cystadenoma, mucinous cystadenoma, dermoid cyst, fibroma, thecoma, and Brenner's tumour. Malignant transformations are possible in some tumour types.
This document provides information from Dr. Kirtan Vyas about fetal growth restriction (FGR). It discusses the challenges in identifying and managing FGR. Key points include:
1) Timely identification of FGR is difficult but crucial for proper management and a favorable neonatal outcome, as it is the second leading cause of perinatal mortality after prematurity.
2) FGR remains extensively studied but still confusing and controversial to researchers.
3) The major concern with FGR is not the small size of the fetus but the possibility of life-threatening fetal compromise.
4) Screening approaches, management recommendations, and postnatal care for babies with FGR are discussed.
Ovarian torsion refers to the rotation of an ovary, cutting off its blood supply. It most commonly affects women ages 20-39 and can occur at any age. Risk factors include ovarian tumors, pregnancy, assisted reproduction, and abnormally large or positioned ovaries. The twisting of the ovary leads to venous congestion and ischemia over time. Patients experience sudden, severe, unilateral abdominal pain that may radiate to the back. Ultrasound and surgery are used to diagnose and treat the condition by detorsion of the ovary within 8 hours to restore blood flow before tissue necrosis occurs. Delayed diagnosis can lead to loss of ovarian function or infection.
Basic ultrasound in O&G can be used to confirm and date pregnancies, screen for abnormalities, and evaluate problems in early pregnancy. Key applications include using scans from 4-5 weeks to detect a gestational sac and fetal pole, measuring the crown-rump length from 6-12 weeks to date the pregnancy, screening for issues like ectopic pregnancy or miscarriage, and assessing fetal growth and anatomy later in pregnancy. Ultrasound is also used for gynecological conditions like fibroids, cysts and infertility workups.
MANAGEMENT OF VAULT PROLAPSE BY DR SHASHWAT JANIDR SHASHWAT JANI
This document discusses the management of vault prolapse, which is the descent of the vaginal cuff after a hysterectomy. It defines vault prolapse and lists risk factors. Conservative management includes pessaries but surgery is often needed. Surgical options include vaginal approaches like sacrospinous ligament fixation or abdominal approaches like sacral colpopexy. The document compares techniques and factors to consider in surgical planning like prolapse severity and patient factors. Prevention techniques like culdoplasty at time of hysterectomy are also discussed.
Dr. Gitanjali presented a case of a 36-year-old primigravida woman at 38 weeks and 2 days of pregnancy who presented with raised blood pressure of 200/150 mmHg. She was diagnosed with chronic hypertension, superimposed preeclampsia, anemia, fetal growth restriction, and hypothyroidism. Despite treatment with antihypertensive medications, her blood pressure remained elevated. She underwent an emergency cesarean section under spinal anesthesia and delivered a baby. Her case highlights the importance of monitoring and managing the multiple complications that can arise in hypertensive disorders of pregnancy.
This document discusses placenta accreta syndrome, including risk factors, diagnostic methods, and management strategies. It begins with an overview of placenta accreta classifications. Ultrasound and MRI are important diagnostic tools, with ultrasound being the primary method. Risk factors include prior c-sections, placenta previa, and uterine surgeries. Early diagnosis allows for elective c-section and interventions like arterial embolization to reduce bleeding. Hysterectomy is often needed to control hemorrhage but conservative approaches aim to preserve the uterus. Proper multidisciplinary care and prevention of delays in management can improve outcomes for this serious condition.
Acute fatty liver of pregnancy is a rare but potentially lethal condition that affects 1 in 7,000 to 20,000 pregnancies. It commonly presents after 30 weeks of pregnancy with nausea, vomiting, abdominal pain and jaundice. Liver function tests show elevated enzymes and hypoglycemia is present in 70% of cases. Prompt delivery improves outcomes for both mother and baby, with supportive care including treatment of coagulopathy and hypoglycemia before delivery. Recurrence is possible in subsequent pregnancies if the mother has an underlying fatty acid oxidation disorder.
Puberty menorrhagia Dr Sharda Jain , Dr Jyoti Agarwal Lifecare Centre
Puberty menorrhagia refers to heavy menstrual bleeding lasting longer than 7 days or exceeding 80 ml of blood loss during puberty. Common causes include dysfunctional uterine bleeding due to immature hypothalamic-pituitary-ovarian axis, bleeding disorders, polycystic ovary syndrome, and complications of pregnancy. Evaluation involves detailed history, physical exam, ultrasound, blood counts, pregnancy test, and tests for underlying causes as needed. Treatment is usually medical, focusing on controlling bleeding through hemostatic agents like tranexamic acid or desmopressin, correcting anemia, and treating any underlying disorders found. Surgery is rarely needed.
This document provides information on intrapartum fetal monitoring techniques including fetal heart rate monitoring, indications for continuous electronic fetal monitoring, interpretation of fetal heart rate patterns, and management of non-reassuring fetal status. It discusses techniques like intermittent auscultation, electronic fetal monitoring, fetal scalp pH testing, pulse oximetry, and lactate testing. The goal of intrapartum monitoring is timely identification and rescue of fetuses at risk for neonatal morbidity from hypoxic insult during labor and delivery.
Fibroids are benign tumors that can develop in the uterus and complicate pregnancy. During pregnancy, fibroids may cause issues like miscarriage, preterm labor, malpresentation, obstructed labor, and postpartum hemorrhage. While most fibroids do not increase significantly in size during pregnancy, some may enlarge due to increased vascularity, edema, and growth of fibrous tissue. Red degeneration of fibroids, where the tumor tissue begins to break down, can cause severe abdominal pain and may be diagnosed by ultrasound or MRI. Conservative management with pain medications is typically used to treat red degeneration. Cesarean delivery is considered for pregnancies with fibroids located in positions that could obstruct labor.
Uterine prolapse (also called descensus or procidentia) means the uterus has descended from its normal position in the pelvis farther down into the vagina.Cervicopexy is fertility conserving surgical management of prolapse.
Recurrent pregnancy loss is a significant redroductive medical problem, influencing 2%–5% of couples. ... Throughout the years, proof based medications, for example, surgical correction of uterine abnormalities or asprin and heparin for antiphospholipid syndrome have improved the results for couples with repetitive pregnancy loss.
Journal Club presented at Dept. of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Delhi. Aspirin versus Placebo in Pregnancies at high risk for preterm preeclampsia
Adherent placenta occurs when there is a defect in the decidua basalis, Resulting in an abnormal invasion of the placenta directly into the substance of the uterus
PUBERTY MENORRHAGIA & BLEEDING DISORDERS Made Easy Dr Sharda Jain Lifecare Centre
This document discusses evaluation and treatment of puberty menorrhagia and bleeding disorders. It begins with classifications of abnormal uterine bleeding and an overview of common causes of puberty menorrhagia such as dysfunctional uterine bleeding and bleeding disorders. Evaluation involves a detailed history, physical exam, ultrasound, and lab tests to rule out other causes before screening for bleeding disorders. Common bleeding disorders seen in puberty menorrhagia are von Willebrand disease, platelet function defects, and coagulation factor deficiencies. Treatment depends on the underlying cause but may include combined oral contraceptives, antifibrinolytic agents, plasma concentrates, and managing anemia.
This document discusses a case of a 17-year-old girl who presented with acute lower abdominal pain. On examination, a 10cm mass was detected in her right lower abdomen. Laboratory tests showed no abnormalities. Transvaginal ultrasound revealed a large multilocular solid mass in the right ovary. Color Doppler showed signs of borderline tumor with torsion. She underwent emergency laparoscopy and right salpingo-oophorectomy. Histopathology confirmed torsion of a serous borderline ovarian tumor. The document then provides further details on the common presentations, differential diagnosis, investigations, risk factors, staging, management and prognosis of ovarian masses and cancers.
Spontaneous rupture of endometriotic cyst in 3rd trimester of pregnancyApollo Hospitals
Endometriosis is a well established cause of female infertility and may be associated with early pregnancy losses. Association of endometriosis with pregnancy is rare. Ruptured endometriotic cyst presenting as acute abdomen in pregnancy is even a rarer presentation.
We present hereby a rare and interesting case, presented in our hospital, of Spontaneous rupture of endometiotic Cyst in 3rd trimester of pregnancy and its subsequent management.
Uterine fibroid - Case scenarios and DiscussionHaynes Raja
This presentation is prepared to meet out the undergraduate medical student needs especially to understand the practical aspects of uterine fibroid and to rapidly revise some important viva questions.
Dedicated to my Great Teachers in the Dept. of Obstetrics & Gynaecology Dr. Lavanya Kumari and Dr. Sangeereni, Inspiring Friends Dr. Paulin Benedict, Dr. Jeyakumar Meyyappan and Dr. Hannah Jane and our REVELLIONZ 08’ batch.
This document discusses the diagnosis and management of adnexal masses. It provides information on the normal size and variation of ovaries and lifetime risk of ovarian neoplasms. Differential diagnoses of adnexal masses are outlined based on patient age. Diagnostic evaluation includes physical exam, ultrasound, CT or MRI if needed. Common ovarian tumors at different life stages are described. Functional cysts, endometriomas, benign and borderline tumors are discussed. Complications, clinical presentation, imaging and tumor markers are summarized. Guidelines for management of asymptomatic cysts and indications for surgery are provided.
4 cases of pelvic mass are discussed .Adnexal mass invilves masses arisinf from ovary,fallopian tube,uterus,bowel and some miscellenious masses.USG is used to detect its size and the origin.Histopathological findings are diagnostic.
(I) The document discusses various types of ovarian tumours including functional cysts, inflammatory cysts, and benign and malignant neoplastic tumours.
(II) Functional cysts include follicular cysts, corpus luteal cysts, and theca lutein cysts which are usually asymptomatic and resolve on their own. Inflammatory cysts include tubo-ovarian abscesses.
(III) Benign neoplastic tumours discussed are serous cystadenoma, mucinous cystadenoma, dermoid cyst, fibroma, thecoma, and Brenner's tumour. Malignant transformations are possible in some tumour types.
This document provides information from Dr. Kirtan Vyas about fetal growth restriction (FGR). It discusses the challenges in identifying and managing FGR. Key points include:
1) Timely identification of FGR is difficult but crucial for proper management and a favorable neonatal outcome, as it is the second leading cause of perinatal mortality after prematurity.
2) FGR remains extensively studied but still confusing and controversial to researchers.
3) The major concern with FGR is not the small size of the fetus but the possibility of life-threatening fetal compromise.
4) Screening approaches, management recommendations, and postnatal care for babies with FGR are discussed.
Ovarian torsion refers to the rotation of an ovary, cutting off its blood supply. It most commonly affects women ages 20-39 and can occur at any age. Risk factors include ovarian tumors, pregnancy, assisted reproduction, and abnormally large or positioned ovaries. The twisting of the ovary leads to venous congestion and ischemia over time. Patients experience sudden, severe, unilateral abdominal pain that may radiate to the back. Ultrasound and surgery are used to diagnose and treat the condition by detorsion of the ovary within 8 hours to restore blood flow before tissue necrosis occurs. Delayed diagnosis can lead to loss of ovarian function or infection.
Basic ultrasound in O&G can be used to confirm and date pregnancies, screen for abnormalities, and evaluate problems in early pregnancy. Key applications include using scans from 4-5 weeks to detect a gestational sac and fetal pole, measuring the crown-rump length from 6-12 weeks to date the pregnancy, screening for issues like ectopic pregnancy or miscarriage, and assessing fetal growth and anatomy later in pregnancy. Ultrasound is also used for gynecological conditions like fibroids, cysts and infertility workups.
MANAGEMENT OF VAULT PROLAPSE BY DR SHASHWAT JANIDR SHASHWAT JANI
This document discusses the management of vault prolapse, which is the descent of the vaginal cuff after a hysterectomy. It defines vault prolapse and lists risk factors. Conservative management includes pessaries but surgery is often needed. Surgical options include vaginal approaches like sacrospinous ligament fixation or abdominal approaches like sacral colpopexy. The document compares techniques and factors to consider in surgical planning like prolapse severity and patient factors. Prevention techniques like culdoplasty at time of hysterectomy are also discussed.
Dr. Gitanjali presented a case of a 36-year-old primigravida woman at 38 weeks and 2 days of pregnancy who presented with raised blood pressure of 200/150 mmHg. She was diagnosed with chronic hypertension, superimposed preeclampsia, anemia, fetal growth restriction, and hypothyroidism. Despite treatment with antihypertensive medications, her blood pressure remained elevated. She underwent an emergency cesarean section under spinal anesthesia and delivered a baby. Her case highlights the importance of monitoring and managing the multiple complications that can arise in hypertensive disorders of pregnancy.
This document discusses placenta accreta syndrome, including risk factors, diagnostic methods, and management strategies. It begins with an overview of placenta accreta classifications. Ultrasound and MRI are important diagnostic tools, with ultrasound being the primary method. Risk factors include prior c-sections, placenta previa, and uterine surgeries. Early diagnosis allows for elective c-section and interventions like arterial embolization to reduce bleeding. Hysterectomy is often needed to control hemorrhage but conservative approaches aim to preserve the uterus. Proper multidisciplinary care and prevention of delays in management can improve outcomes for this serious condition.
Acute fatty liver of pregnancy is a rare but potentially lethal condition that affects 1 in 7,000 to 20,000 pregnancies. It commonly presents after 30 weeks of pregnancy with nausea, vomiting, abdominal pain and jaundice. Liver function tests show elevated enzymes and hypoglycemia is present in 70% of cases. Prompt delivery improves outcomes for both mother and baby, with supportive care including treatment of coagulopathy and hypoglycemia before delivery. Recurrence is possible in subsequent pregnancies if the mother has an underlying fatty acid oxidation disorder.
Puberty menorrhagia Dr Sharda Jain , Dr Jyoti Agarwal Lifecare Centre
Puberty menorrhagia refers to heavy menstrual bleeding lasting longer than 7 days or exceeding 80 ml of blood loss during puberty. Common causes include dysfunctional uterine bleeding due to immature hypothalamic-pituitary-ovarian axis, bleeding disorders, polycystic ovary syndrome, and complications of pregnancy. Evaluation involves detailed history, physical exam, ultrasound, blood counts, pregnancy test, and tests for underlying causes as needed. Treatment is usually medical, focusing on controlling bleeding through hemostatic agents like tranexamic acid or desmopressin, correcting anemia, and treating any underlying disorders found. Surgery is rarely needed.
This document provides information on intrapartum fetal monitoring techniques including fetal heart rate monitoring, indications for continuous electronic fetal monitoring, interpretation of fetal heart rate patterns, and management of non-reassuring fetal status. It discusses techniques like intermittent auscultation, electronic fetal monitoring, fetal scalp pH testing, pulse oximetry, and lactate testing. The goal of intrapartum monitoring is timely identification and rescue of fetuses at risk for neonatal morbidity from hypoxic insult during labor and delivery.
Fibroids are benign tumors that can develop in the uterus and complicate pregnancy. During pregnancy, fibroids may cause issues like miscarriage, preterm labor, malpresentation, obstructed labor, and postpartum hemorrhage. While most fibroids do not increase significantly in size during pregnancy, some may enlarge due to increased vascularity, edema, and growth of fibrous tissue. Red degeneration of fibroids, where the tumor tissue begins to break down, can cause severe abdominal pain and may be diagnosed by ultrasound or MRI. Conservative management with pain medications is typically used to treat red degeneration. Cesarean delivery is considered for pregnancies with fibroids located in positions that could obstruct labor.
Uterine prolapse (also called descensus or procidentia) means the uterus has descended from its normal position in the pelvis farther down into the vagina.Cervicopexy is fertility conserving surgical management of prolapse.
Recurrent pregnancy loss is a significant redroductive medical problem, influencing 2%–5% of couples. ... Throughout the years, proof based medications, for example, surgical correction of uterine abnormalities or asprin and heparin for antiphospholipid syndrome have improved the results for couples with repetitive pregnancy loss.
Journal Club presented at Dept. of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Delhi. Aspirin versus Placebo in Pregnancies at high risk for preterm preeclampsia
Adherent placenta occurs when there is a defect in the decidua basalis, Resulting in an abnormal invasion of the placenta directly into the substance of the uterus
PUBERTY MENORRHAGIA & BLEEDING DISORDERS Made Easy Dr Sharda Jain Lifecare Centre
This document discusses evaluation and treatment of puberty menorrhagia and bleeding disorders. It begins with classifications of abnormal uterine bleeding and an overview of common causes of puberty menorrhagia such as dysfunctional uterine bleeding and bleeding disorders. Evaluation involves a detailed history, physical exam, ultrasound, and lab tests to rule out other causes before screening for bleeding disorders. Common bleeding disorders seen in puberty menorrhagia are von Willebrand disease, platelet function defects, and coagulation factor deficiencies. Treatment depends on the underlying cause but may include combined oral contraceptives, antifibrinolytic agents, plasma concentrates, and managing anemia.
This document discusses a case of a 17-year-old girl who presented with acute lower abdominal pain. On examination, a 10cm mass was detected in her right lower abdomen. Laboratory tests showed no abnormalities. Transvaginal ultrasound revealed a large multilocular solid mass in the right ovary. Color Doppler showed signs of borderline tumor with torsion. She underwent emergency laparoscopy and right salpingo-oophorectomy. Histopathology confirmed torsion of a serous borderline ovarian tumor. The document then provides further details on the common presentations, differential diagnosis, investigations, risk factors, staging, management and prognosis of ovarian masses and cancers.
Spontaneous rupture of endometriotic cyst in 3rd trimester of pregnancyApollo Hospitals
Endometriosis is a well established cause of female infertility and may be associated with early pregnancy losses. Association of endometriosis with pregnancy is rare. Ruptured endometriotic cyst presenting as acute abdomen in pregnancy is even a rarer presentation.
We present hereby a rare and interesting case, presented in our hospital, of Spontaneous rupture of endometiotic Cyst in 3rd trimester of pregnancy and its subsequent management.
This case report describes a 70-year-old woman presenting with a third-degree uterine prolapse and non-healing vaginal ulcer. Biopsies revealed squamous cell carcinoma of the vagina. She received 25 cycles of external beam radiation therapy and 5 cycles of intracavitary radiation therapy. This led to a reduction of the prolapse and shrinkage of the cancer. The patient's symptoms improved. Radiation therapy is concluded to be a suitable treatment for vaginal cancer in patients with uterine prolapse who are not candidates for surgery.
A 58-year-old female presented with a left breast lump. Mammography and biopsy revealed ductal carcinoma in situ. She underwent wide excision of the lump. Routine blood tests and imaging exams like ultrasound and echocardiogram were normal. Histopathology of the excised lump confirmed focal ductal carcinoma in situ. She tolerated the surgery well and was discharged with drain in situ and medications.
- A 65-year-old male presented with a left iliac fossa mass and changes in bowel habits. CT and examination revealed a large sigmoid colon and rectal mass. He underwent exploratory laparotomy and Hartmann's procedure with resection of the mass and nodes. Pathology found a clear cell carcinoma.
- Follow up CT found no evidence of recurrence but a stationary small renal mass. Options for the renal mass include radical nephrectomy or modifying the incision for access. Restoring bowel continuity may be considered with possible loop ileostomy protection.
- Renal cell carcinoma is known for its varied presentations and unpredictable behavior, sometimes presenting as unusual metastases that require individualized management even for solitary or
This document contains a patient case report for Januka Katuwal, a 32-year-old female presenting with cessation of menstruation for over a month, abdominal pain for 8 hours, and vomiting for 8 hours. Her examination and investigations revealed a ruptured ectopic pregnancy in her right fallopian tube, which was then managed via an emergency laparotomy and right salpingectomy with left tubal ligation. The document also provides definitions, classifications, risk factors, clinical approaches, diagnostic methods, and management options for ectopic pregnancies.
1. A 53-year-old woman presented with abdominal pain and loose stools for 7-8 months. Imaging showed a large pelvic mass and liver metastases.
2. She underwent staging laparotomy where a 18x12cm mass was removed from her left ovary. Histopathology revealed a neuroendocrine carcinoma.
3. She was diagnosed with Stage IIIB neuroendocrine carcinoma of the ovary based on the FIGO staging system, with the tumor involving one or both ovaries with peritoneal implants outside the pelvis.
A Bleeding Abdominal Tumor(Pseudopappilary Pancreatic Tumor)Nasir Mahmood
A 27-year old female presented with abdominal pain and vomiting. Physical examination revealed a large abdominal mass. Imaging showed a large heterogeneous mass in the abdomen. The patient underwent surgery where a large solid and cystic mass involving the pancreas and surrounding structures was removed. Histopathology of the mass found it to be a solid pseudopapillary neoplasm of the pancreas, a rare low-grade malignant tumor that predominantly affects young women. The patient recovered well after surgery.
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: August C...Sean M. Fox
Dr. Kelsey Lena is an Emergency Medicine Resident and Drs. Michael Avery and Joshua Davis are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s topics include:
• Splenic Rupture
• Obstructive jaundice
• Ovarian Torsion
A 14-year-old boy presented with a neck swelling. Physical exam revealed a mobile, fluid-filled lump below the hyoid bone that moved on swallowing. Ultrasound was determined to be the single most appropriate investigation, as it is the first-line imaging to distinguish fluid-filled cysts and visualize the mass and surrounding tissues. Ultrasound can confirm the diagnosis of a thyroglossal cyst in most cases without the need for biopsy or other invasive tests.
Background: A 51-year-old woman had left lower abdomen pain for 18 hours with nausea and vomiting. Prior CT scans suggested pelvic neoplasms. Our hospital's emergency CT showed an enlarged uterus with cystic shadows, right adnexal cysts, and stomach fluid. Physical examination revealed left lower abdomen discomfort. A gynaecological examination revealed a painful, firm pelvic mass of 151210 cm. Further diagnosis is underway. Method: The patient underwent emergency exploratory laparotomy, discovering a twisted, swollen left ovary with a 540° rotation, classified as a benign cyst. It was found that the patient had congenital upper vaginal atresia and bilateral initial uteri. Pain was reduced after surgery, thanks to symptomatic treatment. An abnormal karyotype of 46, XX,1qh+ was found during genetic testing. Result: Fallopian tubes, uterus, and vagina develop from the embryonic accessory mesonephric duct. MRKH syndrome is caused by bilateral accessory mesonephric duct dysplasia and disappearance of the uterus or vagina. MRKH has three types, with Type 1 lacking uterus or vagina. Due to ovarian cyst torsion, this Type 1 MRKH with double initial uterus and upper vaginal atresia needed left adnexa resection. Genetic testing showed a typical female karyotype. MRKH's complex aetiology incorporates chromosomal abnormalities, emphasizing early cytogenetic evaluation for personalized treatment and fertility assistance. Conclusion: Early cytogenetic testing for MRKH syndrome patients is crucial for determining the underlying cause and guiding personalized treatment plans to restore reproductive function and improve quality of life.
Key-words: Double primordial uterus; MRKH syndrome; Upper vaginal atresia; Torsion of left ovarian cyst pedicle
This document presents a case report of a 60-year-old woman in Papua New Guinea who presented with a massive abdominal distension caused by a giant ovarian mucinous cystadenoma measuring 30x30x25cm and weighing 25kg. Mucinous cystadenomas are benign ovarian tumors that typically affect middle-aged women. Surgical removal of the entire left ovary and tube was performed due to the large size of the tumor and involvement of the entire left ovary. Histological examination found the tumor to be a benign mucinous cystadenoma with intestinal-like epithelium. The patient had an uneventful recovery and was scheduled for follow up appointments to monitor for any recurrence of the tumor.
This document discusses the case of a 31-year-old woman, G3P2, who presented at 12 weeks and 1 day post-amnenorrhea with a suspected molar pregnancy. Ultrasound findings showed multiple cysts in the uterine cavity with no fetal echo, and her hCG level was 7513 IU/ml. She was diagnosed with a leaking ectopic pregnancy and underwent a laparoscopic left salpingectomy. Intraoperatively, 700cc of hemoperitoneum was found along with a left tubal ectopic pregnancy, while the right fallopian tube and ovaries were normal. The patient was discharged well with advice on contraception.
Case Report:Massive Ovarian Cyst in a Adolescent GirlTana Kiak
For benign tumours adhesion prevention strategies should be used. Surgical intervention should as much as possible be directed towards preservation of ovarian tissue. There is scarcity of published literature on this subject.
We need bigger studies to address the issue of how much fertility preservation is safely possible.Irrespective of indication for surgery, it is always preferable to attempt conservative, fertility sparing surgery in adolescents.
case presentation Dr. Neveen Nabeeh >>> 14 Annunal Meeting of Nephrology Dep...Ahmed Albeyaly
A 35-year-old female presented with a painful rash, fever, decreased urine output, and weakness for one month. Examination found purpuric lesions and splenomegaly. Labs showed kidney injury, low platelets, and cryoglobulins. A skin biopsy found leukocytoclastic vasculitis. She was diagnosed with mixed cryoglobulinemia and kidney involvement. She received treatments including plasmapheresis, steroids, cyclophosphamide, and antivirals.
Austin Journal of Clinical Case Reports is an open access scholarly journal. The goal of this journal is to provide a platform for scientists and academicians all over the world to promote, share, and discuss various new issues and developments by publishing case reports in all aspects of Clinical Medicine. Case Reports is an open access journals. The goal of this journal is to provide a platform for scientists and academicians all over the world to promote, share, and discuss various new issues and developments by publishing case reports in all aspects of Clinical Medicine.
The aim of this open access journal is to offer service for scientists and academicians to promote, share, and discuss various new issues and developments by publishing clinical case reports in all aspects.
Austin Journal of case repots are a reflective analysis of one, two, or three clinical cases. All clinical case reports submitted must have been approved by an ethics committee or institutional review board.
Austin Journal of Clinical Case Reports is an open access scholarly journal. The goal of this journal is to provide a platform for scientists and academicians all over the world to promote, share, and discuss various new issues and developments by publishing case reports in all aspects of Clinical Medicine. Case Reports is an open access journals. The goal of this journal is to provide a platform for scientists and academicians all over the world to promote, share, and discuss various new issues and developments by publishing case reports in all aspects of Clinical Medicine.
International Journal of Pharmaceutical Science Invention (IJPSI) inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
This document discusses benign diseases of the uterus, including the anatomy and histological variation of the endometrium and myometrium. Specific conditions covered include endometrial polyps, various types of endometrial hyperplasia (simple, complex, with or without atypia), endometritis, congenital uterine anomalies, leiomyomas (fibroids), adenomyosis, and dysfunctional uterine bleeding (DUB). Diagnostic methods and treatment approaches are described for each condition. Medical therapies include hormonal treatments, while surgical options include hysteroscopic resection, myomectomy, and hysterectomy depending on the diagnosis and patient's desire for future fertility.
The document discusses abnormal uterine bleeding, including definitions of normal and abnormal bleeding, common etiologies and classifications using the PALM-COEIN system. Evaluation and treatment options are presented, including initial medical management, surgical procedures for structural causes or refractory symptoms, and considerations for chronic treatment.
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4. History of present illness
According to the patient’s statement, she was
reasonably well 2 months back. Then she noticed a
feeling of heaviness in her lower abdomen, which
was progressively increasing.
She also complained of lower abdominal pain, which
was localized to the right side, sudden, mild, dull pain
with no radiation, without any exacerbating factor.
5. For these reasons, she was advised MRI of abdomen
which showed “Huge complex (2000 mL) right
ovarian cyst occupying abdomino-pelvic cavity,
without any adhesion with surrounding structures or
any ascites”.
She is non-diabetic, normotensive and non-
asthmatic.
6. Menstrual history Obstetric history
Menarche at: 13 years
MP: 5-6 days
MC: 30-40 days
Menstrual flow: Scanty
Dysmenorrhea: Absent
LMP: 1st April 2019
She is unmarried
7. Past history
Past surgical: No abdominal surgery
Past medical: Nothing significant
Personal history
Nothing significant
Family history
Father is hypertensive; Mother is diabetic
Socio-economic history
Middle class
8. General examination
Height: 149 cm
Weight: 61 kg
BMI: 27.4
Nutrition: Average
Anemia: Absent
Jaundice: Absent
Cyanosis: Absent
Edema: Absent
Dehydration: Absent
Clubbing: Absent
Leukonychia: Absent
Koilonychia: Absent
Neck veins: Not engorged
Lymph nodes: Not palpable
Thyroid: Not enlarged
Skin: Normal
Vitals:
Temperature: 98.6 ℉
Pulse: 80/min
Respiratory rate: 16 breaths/min
Blood pressure: 130/90 mmHg
10. Abdominal examination
Inspection: Abdomen was enlarged. Umbilicus
inverted.
Palpation: A mass was found which was situated in
the midline, size around 6X6 cm, firm in consistency,
mobile in all direction.
Percussion: Dull in center; Flanks were tympanic.
11. Per vaginal and Per speculum examination
Not done as she is unmarried
12. Salient features
Ms. X, a 27 year old non-diabetic, normotensive, non-asthmatic
student, got admitted with the complaints of feeling of
heaviness in her abdomen for 2 months which was
progressively increasing.
She also complained of right sided lower abdominal pain for 2
days which was dull, sudden, mild with no radiation and no
exacerbating factor.
On General examination, no abnormalities were detected.
Systemic examination also revealed no abnormalities.
18. Date Investigation Results
22/3/2019 USG of Whole abdomen Slightly bulky uterus. Big semi-solid
mass with thick internal septations in
pelvic cavity, more on right, attached
to right ovary (ovarian cyst).
30/3/2019 MRI of Lower Abdomen Huge complex (2000 mL) right
ovarian cyst (20X15X12 cm)
occupying abdomino-pelvic cavity
(suggestive of malignant ovarian
tumour) without adhesion to
surrounding structures or any ascites.
21. OT Note (7/4/2019)
With all aseptic precaution under G/A, abdomen was
opened by low midline incision. There was a large thick-
walled ovarian cyst extending upto xiphisternum.
The tumour was free and mobile in all directions and looked
benign. After taking precaution not to contaminate the
peritoneal cavity, a stab incision was given and the content
was sucked out which was mucinous (1600 mL).
22. OT Note (Continued)
A specimen was sent for frozen section and report showed no
evidence of malignancy. So, right sided salpingo-
oophorectomy was done.
Omentum was free and healthy looking.
Uterus contained a small fibroid on the anterior wall near
fundus.
Left fallopian tube and ovary were healthy-looking.
There was no ascites.
Abdomen was closed in layers after ensuring all points of
hemostasis and after counting all mops and instruments.
29. Post-operative order
Please keep the patient NPO till further order
Inf. 5% DA (1L) + 5% DNS (1L) IV @ 25 drps/min
Inj. Ceftriaxone 1gm IV stat and OD
Inj. Metronidazole 500mg IV stat and TDS
Inj. Esomeprazole 40mg IV stat and BD
Inj. Ondansetron 8mg IV stat and TDS
Inj. Pethidine IM stat and 8 hourly after checking BP
Supp. Diclofenac Na 1 stick P/R stat and BD
Monitor vitals routinely
Maintain I/O chart
Continue catheterization for 24 hours
30. Frozen Section on 7/4/2019
Impression: No malignant cells seen
Histopathology report on 10/4/2019
Gross: Specimen received fresh for Frozen section consists of 20X18X9
cystic ovary. On opening the cyst wall shows multiple loci filled with slimy
material. Embedded two blocks for Frozen section and later on four blocks
for paraffin embedded section.
Microscopic: Section shows ovarian tissue. It reveals a multilocular cyst.
The wall is composed of fibrocollagenous tissue. The loculi are lined by
single layer of mucin containing columnae epithelial cells. The wall exhibits
congested blood vessels. No malignancy is seen.
Diagnosis: Right ovarian cyst- Mucinous cystadenoma
31. Test Results
Quantity Sufficient
Colour Straw
Appearance Clear
Sediment Nil
Sp. Gravity Not done
pH, Albumin, Sugar Nil
Pus cell 1-2/HPF
Epithelial cell 3-4/HPF
RBC Nil
Casts and Crystals NIl
Urine R/E on 9/4/2019
Hb% on 9/4/2019 11.0 g/dL
33. Mucinous cystadenoma
These account for up to 20% of all ovarian tumours.
In approximately 10% of cases the tumour is bilateral.
They may attain a very large size and may be multilocular.
The growing point of the cyst is marked by a mass of small
locules and some of the large locules may result from a
breakdown of partitions.
The outer wall varies in thickness and is white, grey or silvery -
blue in colour.
Adhesions to adjacent tissues are not present unless there have
been degenerative changes in the wall.
36. The cysts are lined by tall columnar cells and these
secrete a mucus material—a glycoprotein with a high
content of neutral polysaccharides.
The appearance of the epithelium is remarkably like that
of the glands of the cervix or of the intestine.
The fluid content is thick in consistency and glairy, and is
colourless, yellow, green or brown depending on the
presence of blood pigments derived from previous
intracystic haemorrhages.
37. Take Home Message
Even though the mucinous cysadenoma is a benign
tumour, it can lead to a rare complication when it
ruptures and spills into the peritoneum, known as
Pseudomyxoma peritonei.
When this happens, the epithelial cells of the tumour
spread as a film over the visceral and parietal peritoneum
and from these sites they secrete semisolid mucin into
the abdominal cavity and this causes distension, aching,
pain and vomiting.
So it is advisable to diagnose mucinous cyst adenoma
carefully and treat surgically as soon as possible.