Pelvic splenosis mimicking a suspicious adnexal mass

2021 ◽  
Vol 14 (7) ◽  
pp. e243505
Author(s):  
Clarisse Peter ◽  
Jean-Christophe Tille ◽  
Diomidis Botsikas ◽  
Patrick Petignat
Keyword(s):  
Adnexal Mass ◽  
Transvaginal Ultrasound ◽  
Gynecologic Oncology ◽  
Broad Ligament ◽  
Pelvic Mass ◽  
Splenic Tissue ◽  
Oncology Unit ◽  
Patient’S History ◽  
Car Accident ◽  
Work Up

A 58-year-old asymptomatic woman was referred to our gynecologic oncology unit for the management of a left adnexal mass found during a routine gynecologic examination. Her personal history included an emergency splenectomy at the age of 4 years old, following traumatic splenic laceration after a car accident. The patient’s work-up (including transvaginal ultrasound and MRI) confirmed a pelvic solid mass, which was reported as suspicious for malignancy and classified as Ovarian-Adnexal Reporting & Data System-MRI 5. An exploratory laparoscopy was performed, showing a reddish blue lesion located at the left broad ligament. Histologic analysis showed the presence of splenic tissue and normal adnexa. The postoperative follow-up was uneventful.Pelvic splenosis is a challenging diagnosis rarely made preoperatively due to concern for malignancy. In the presence of a pelvic mass, the collection of a detailed patient’s history, including information about previous splenic rupture, might raise suspicion for pelvic splenosis.

scholarly journals Multiple recurrence of granulosa cell tumor of the ovary: A case report and literature review

2016 ◽  
Author(s):  
Varkha Chandra ◽  
Sandhya Jain ◽  
Neerja Goel ◽  
Bindia Gupta ◽  
Shalini Rajaram
Keyword(s):  
Case Report ◽  
Granulosa Cell ◽  
Adnexal Mass ◽  
Malignant Tumors ◽  
Abdominal Mass ◽  
Pelvic Mass ◽  
Granulosa Cell Tumor ◽  
Cell Tumor ◽  
Surgical Staging ◽  
Granulosa Cell Tumors

Introduction: Granulosa cell tumors comprise approximately 5% of all ovarian malignancy and account for 70% of malignant sex cord stromal tumors. Granulosa cell tumors have been diagnosed from infancy, the peak incidence being perimenopausal age. The potential of malignancy of these tumors is low, recurrences are often late and found in 10-33% of cases. Case Report: A 32-year-old P1L1 presented with large abdominal mass for which she underwent staging laparotomy with debulking surgery. She was a known case of granulosa cell tumor in the past and had undergone three laparotomies, along with chemotherapy. At the age of 13 yrs, she was diagnosed with a stage IA granulosa cell tumor (GCT) of the ovary first time. She underwent surgical staging and removal of left sided adnexal mass, after which she was asymptomatic for 7 years. In 2003 she again presented with lump abdomen for which she underwent resection of adnexal mass, histopathology was consistent with recurrent GCT. After second surgery she also received two cycles of chemotherapy. Despite adjuvant chemotherapy, patient presented again after three years in 2006 with adnexal mass and was found to have a third recurrence. At that time, she received 6 cycles of chemotherapy and the mass regressed. Meanwhile she got married and had one child. After four year in 2010 she again presented with lump abdomen and she underwent surgical staging, total abdominal hysterectomy with right salphingo ophorectomy along with removal of mass. After five year in 2015 she again presented with lump abdomen; there was a large pelvic mass which was removed and patient referred for chemotherapy. Discussion: GCTS which a rare malignant tumors of ovary tend to be associated with late recurrences. Although most recurrences occurs within 10 years after initial diagnosis, there are occasional reports of recurrences after10 years. We experienced the rare case of a patient who relapsed multiple times over 20 years, despite surgical and targeted treatment. Conclusion: The long history of granulosa cell tumor highlights the importance of extended follow up of the patient.

scholarly journals Parasitic hypereosinophilia in childhood: a diagnostic challenge

2018 ◽  
Vol 10 (1) ◽  
pp. 2018034
Author(s):  
Roberto Antonucci ◽  
Nadia Vacca ◽  
Giulia Boz ◽  
Cristian Locci ◽  
Rosanna Mannazzu ◽  
...  
Keyword(s):  
Eosinophil Count ◽  
Hypereosinophilic Syndrome ◽  
Igg Antibodies ◽  
Diagnostic Challenge ◽  
Etiological Diagnosis ◽  
Maximum Value ◽  
History Of ◽  
Diagnostic Work ◽  
Patient’S History ◽  
Work Up

Severe hypereosinophilia (HE) in children is rare, and its etiological diagnosis is challenging. We describe a case of a 30-month-old boy, living in a rural area, who was admitted to our Clinic with a 7-day history of fever and severe hypereosinophilia. A comprehensive diagnostic work-up could not identify the cause of this condition. On day 6, the rapidly increasing eosinophil count (maximum value of 56,000/mm3), the risk of developing hypereosinophilic syndrome, and the patient’s history prompted us to undertake an empiric treatment with albendazole.The eosinophil count progressively decreased following treatment. On day 13, clinical condition and hematological data were satisfactory, therefore the treatment was discontinued and the patient was discharged. Three months later, anti-nematode IgG antibodies were detected in patient serum, thus establishing the etiological diagnosis. In conclusion, an empiric anthelmintic treatment seems to be justified when parasitic hypereosinophilia is strongly suspected, and other causes have been excluded.

scholarly journals Spinal Brucellosis: A Case Report and Review of the Literature

2021 ◽  
Vol 11 (3) ◽  
Author(s):  
James M Rizkalla ◽  
Khalid Alhreish ◽  
Ishaq Y Syed
Keyword(s):  
Case Report ◽  
Signs And Symptoms ◽  
Radiographic Findings ◽  
Common Location ◽  
Uncommon Case ◽  
Spine Surgeon ◽  
Patient’S History ◽  
Hispanic Male ◽  
Work Up ◽  
Rare Diagnosis

Introduction: The most common location of infection of brucellosis is the musculoskeletal system. It is estimated that the spine is involved in 2–54% of brucellosis infections, with the lumbar spine most commonly affected. We report an uncommon case of brucellar spondylodiscitis, in addition to the pathology, common presentation, and management of spinal brucellosis through additional literature review. Case Report: A 65-year-old Hispanic male presented to an orthopedic spine surgeon with signs and symptoms concerning for metastatic disease to the spine. Investigation revealed that the patient had the rare diagnosis of brucellar spondylodiscitis. This only became apparent after detailed questioning of the patient’s history revealed his employment within a Mexican meat slaughterhouse and a regular consumer of unpasteurized Mexican cheeses. Conclusion: Although uncommon, brucellosis spondylodiscitis should remain as a differential diagnosis in any patient who presents with back pain and fever. Detailed history taking and thorough physical examination remain vital in the work-up of brucellar spondylodiscitis. Understanding the pathology, radiographic findings, and necessary work-up are essential to properly treat this infection. Keywords: Spine, Brucella, spinal brucellosis, infection, spondylodiscitis, discitis, abscess.

scholarly journals Broad Ligament Fibroid Mimicking as Ovarian Tumor on Ultrasonography and Computed Tomography Scan

2013 ◽  
Vol 3 ◽  
pp. 8 ◽  
Author(s):  
Dayananda Kumar Rajanna ◽  
Vaibhav Pandey ◽  
Sujit Janardhan ◽  
Sujatha N Datti
Keyword(s):  
Adnexal Mass ◽  
Histopathological Examination ◽  
Broad Ligament ◽  
Ovarian Neoplasm ◽  
Cystic Degeneration ◽  
Resonance Imaging ◽  
Computed Tomography Scan ◽  
Computed Tomographic ◽  
Contrast Enhanced ◽  
Tomography Scan

Giant fibroids are known to arise from the uterus, and very rarely from the broad ligament. Large fibroids often undergo hyaline, cystic, and at times, red degeneration. In the present case, cystic degeneration with intervening septations in an adnexal mass raised the suspicion of ovarian neoplasm as the ovaries were not seen as separate from the lesion. The ultrasonographic and contrast-enhanced computed tomographic findings of this case were characteristic of ovarian neoplasm. The differential diagnosis included rare possibility of giant fibroid with cystic degeneration. The diagnosis was confirmed on histopathological examination. The patient underwent excision of the broad ligament fibroid, hysterectomy, and bilateral salpingo-oophorectomy. Magnetic resonance imaging has a role in the diagnosis of such lesions.

scholarly journals Adnexal mass: a clinicopathological study at a tertiary care centre in Assam, India

2019 ◽  
Vol 8 (4) ◽  
pp. 1457
Author(s):  
Mukut Jyoti Das ◽  
Pranay Phukan
Keyword(s):  
Clinical Examination ◽  
Adnexal Mass ◽  
Histopathological Examination ◽  
Color Doppler ◽  
Tertiary Care ◽  
Broad Ligament ◽  
Reproductive Age ◽  
Transvaginal Sonography ◽  
Age Group ◽  
Adnexal Masses

Background: An adnexal mass may be found in females of all ages with significantly variable prevalence, but more common among women of reproductive age. Adnexal masses pose a special dilemma to the attending gynaecologist because the diagnosis is often difficult and differential diagnosis is vast. Clinical examination is the first step in evaluation of patients with adnexal mass. Pelvic masses which are undetected or overlooked on physical examination can be identified by Ultrasonography. The aims and objectives of the study were to: to find out different types of adnexal pathology clinically, correlation of clinical finding with histopathology, correlation of ultrasonography finding with histopathology.Methods: The present study was carried in the Department of Obstetrics and Gynecology, Assam medical college and hospital, Dibrugarh from 1st July 2017 to 30th June 2018. This study was a hospital based observational study which included 145 patients of adnexal mass attending the GOPD who required admission and operative intervention. All cases underwent an abdominal ultrasound examination with color Doppler. Transvaginal sonography was done wherever feasible. Following surgery, specimens were sent for histopathological examination and the reports were correlated with pre-operative clinical and ultrasonography findings.Results: The most common site of origin of adnexal mass was ovary (92.41%) followed by fallopian tube (6.20%) and broad ligament (1.39%). Majority (79.31%) were non neoplastic or benign adnexal masses. All cases of adnexal malignancy were of ovarian origin. The sensitivity and specificity of clinical examination for diagnosis and discriminating benign and malignant ovarian neoplasms were 70% and 86.6% and that of ultrasonography was 86.67% and 96.65% respectively.Conclusions: Adnexal mass in reproductive age group were mostly non neoplastic and benign, whereas malignancy was mostly seen in peri and post-menopausal age group. Ultrasonography is a useful adjunct to clinical examination for diagnosis and proper management of patients with adnexal mass in low resource setup.

scholarly journals Broad Ligament Pregnancy: Lessons Learnt

2014 ◽  
Vol 6 (3) ◽  
pp. 178-179
Author(s):  
Rukshana LNU ◽  
Preet Agarwal ◽  
Usha Viswanath ◽  
MS Natarajan
Keyword(s):  
South Asian ◽  
Transvaginal Ultrasound ◽  
Broad Ligament ◽  
Termination Of Pregnancy ◽  
Abdominal Pregnancy ◽  
Pregnancy Induced Hypertension ◽  
Previous Cesarean Section ◽  
Lessons Learnt ◽  
Induced Hypertension ◽  
Previous Cesarean

ABSTRACT Abdominal pregnancy is a rare obstetric condition seen by the obstetricians. Its diagnosis is usually difficult and management is a matter of debate. A 39-year-old multigravida with 20 weeks gestation complicated by pregnancy-induced hypertension, diabetes mellitus and anemia with previous cesarean section was admitted. She was not aware of her pregnancy earlier and she desired termination of pregnancy. But, termination of pregnancy failed inspite of using all possible methods of inducing labor. Diagnosis of abdominal pregnancy was made on by transvaginal ultrasound and proceeded with laparotomy. Left broad ligament pregnancy was found and the sac with fetus extracted. However, due to uncontrollable bleeding from broad ligament during placenta separation and hysterectomy was proceeded in this lady. We present our experience with the diagnosis and management of this rare case. How to cite this article Agarwal P, Viswanath U, Rukshana, Natarajan MS. Broad Ligament Pregnancy: Lessons Learnt. J South Asian Feder Obst Gynae 2014;6(3):178-179.

scholarly journals Heavy menstrual bleeding: work-up and management

Hematology ◽  
2016 ◽  
Vol 2016 (1) ◽  
pp. 236-242 ◽  
Author(s):  
Andra H. James
Keyword(s):  
Treatment Strategy ◽  
Bleeding Disorder ◽  
Heavy Menstrual Bleeding ◽  
Menstrual Bleeding ◽  
Laboratory Assessment ◽  
Life Saving ◽  
Ovulatory Dysfunction ◽  
History Of ◽  
Patient’S History ◽  
Work Up

Abstract Heavy menstrual bleeding (HMB), which is the preferred term for menorrhagia, affects ∼90% of women with an underlying bleeding disorder and ∼70% of women on anticoagulation. HMB can be predicted on the basis of clots of ≥1 inch diameter, low ferritin, and “flooding” (a change of pad or tampon more frequently than hourly). The goal of the work-up is to determine whether there is a uterine/endometrial cause, a disorder of ovulation, or a disorder of coagulation. HMB manifest by flooding and/or prolonged menses, or HMB accompanied by a personal or family history of bleeding is very suggestive of a bleeding disorder and should prompt a referral to a hematologist. The evaluation will include the patient’s history, pelvic examination, and/or pelvic imaging, and a laboratory assessment for anemia, ovulatory dysfunction, underlying bleeding disorder, and in the case of the patient on anticoagulation, assessment for over anticoagulation. The goal of treatment is to reduce HMB. Not only will the treatment strategy depend on whether there is ovulatory dysfunction, uterine pathology, or an abnormality of coagulation, the treatment strategy will also depend on the age of the patient and her desire for immediate or long-term fertility. Hemostatic therapy for HMB may serve as an alternative to hormonal or surgical therapy, and may even be life-saving when used to correct an abnormality of coagulation.

Laparoscopically Assisted Schauta Operation: Learning Experience at the Gynecologic Oncology Unit, Buenos Aires University Hospital

1999 ◽  
Vol 75 (3) ◽  
pp. 361-365 ◽  
Author(s):  
Juan Sardi ◽  
Javier Vidaurreta ◽  
Adriana Bermúdez ◽  
Guillermo di Paola
Keyword(s):  
Buenos Aires ◽  
Learning Experience ◽  
Gynecologic Oncology ◽  
University Hospital ◽  
Oncology Unit

scholarly journals Adenomyosis in Infertile Women : A Review

2016 ◽  
Vol 30 (2) ◽  
pp. 105-108
Author(s):  
Shakeela Ishrat ◽  
Parveen Fatima
Keyword(s):  
Magnetic Resonance Imaging ◽  
Transvaginal Ultrasound ◽  
Endometrial Receptivity ◽  
Early Age ◽  
Resonance Imaging ◽  
Infertile Women ◽  
Non Invasive ◽  
Future Pregnancy ◽  
And Function ◽  
Work Up

Adenomyosis is found during infertility work up in many women who delay pregnancy till their late thirties and in some women in their early age. Dysregulation of myometrial architecture and function and altered endometrial receptivity are among the possible mechanisms by which adenomyosis causes infertility. Adenomyosis and endometriosis may have similar pathogenesis as they have frequent association in women. Adenomyosis can be reliably diagnosed in symptomatic infertile women by non invasive means such as transvaginal ultrasound and magnetic resonance imaging as well as hysterosalpingography, hysteroscopy and laparoscopy. Early diagnosis by non-invasive means followed by surgical (adenomyomectomy) or non-surgical (MRgFUS) treatment of focal adenomyosis have promising effect on future pregnancy whereas diffuse severe adenomyosis have poor prognosis.Bangladesh J Obstet Gynaecol, 2015; Vol. 30(2) : 105-108

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