Mullerian Adenosarcoma of the Endometrium in a 19-Year-Old Girl: Case Report and a Literature Review

Mullerian adenosarcoma of the endometrium in adolescent girls is extremely rare, with only fifteen cases under 20 years old having been reported to date. We describe here a new case of adolescent Mullerian adenosarcoma and provide an updated review of the previous literature on such rare tumors. Our 19-year-old case presented with a six-month history of prolonged menstruation. She had not yet had any sexual relationship. On gross examination, a fragile mass was seen in her vagina that bled easily. A 4.0×2.0 cm mass was visualized with Magnetic Resonance Imaging (MRI). The tumor seemed to slightly invade the myometrium of the uterine corpus. Transvaginal ultrasound sonography confirmed the presence of a 4.0 cm mass located in the cervix and vagina. The tumor biopsy was diagnosed as a Mullerian adenosarcoma of the endometrium. We performed a Total Abdominal Hysterectomy (TAH) and Bilateral Salpingectomy (BS). The post-surgical specimen was diagnosed as a pT1aNXM0 Mullerian adenosarcoma of the endometrium. The patient did not require adjuvant chemotherapy. She has been monitored every 3 months and has been without recurrence now for 28 months.

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Mullerian Adenosarcoma of the Endometrium in a 19-Year-Old Girl: Case Report and a Literature Review

10.26420/austincritcarecaserep/2021.1022 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Miyoshi A ◽

◽

Ueda Y ◽

Sato K ◽

Kimura T ◽

...

Keyword(s):

Adolescent Girls ◽

Transvaginal Ultrasound ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Tumor Biopsy ◽

Surgical Specimen ◽

Ultrasound Sonography ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

Gross Examination

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Leiomyoma as a cause of urinary retention

Urogynaecologia ◽

10.4081/uij.2013.e4 ◽

2013 ◽

Vol 27 (1) ◽

pp. 4

Author(s):

Kemal Sarsmaz ◽

Asli Goker ◽

Naci Kemal Kuscu

Keyword(s):

Urinary Retention ◽

Pelvic Mass ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Uterine Wall ◽

Reproductive Age ◽

Mri Findings ◽

Pelvic Masses ◽

History Of ◽

Magnetic Resonance Imaging Mri

Urinary retention is uncommon in reproductive age women. The frequent causes for obstructive retention are pelvic masses and a history of surgery. We report a case of intermittent urinary retention caused by a leiomyoma. A 47-year old patient with voiding difficulties for the past four months was referred to the gynecology outpatient clinic. She had urinary retention and had been catheterized several times for bladder emptying. She had been evaluated by the urology clinic and a cystoscopy was performed with normal findings. Magnetic resonance imaging (MRI) revealed a pelvic mass at the anterior uterine wall with a diameter of 10 cm. Her physical examination confirmed the MRI findings. Total abdominal hysterectomy was performed with a complete resolution of the patient’s complaints. Women with urinary retention should be consultated with a gynecologist in order to rule out pelvic masses.

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A Case of Adenosarcoma of the Uterus

Case Reports in Obstetrics and Gynecology ◽

10.1155/2014/342187 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4

Author(s):

Shigeki Taga ◽

Mari Sawada ◽

Aya Nagai ◽

Dan Yamamoto ◽

Ryoji Hayase

Keyword(s):

Histopathological Examination ◽

Uterine Cavity ◽

Total Abdominal Hysterectomy ◽

Final Diagnosis ◽

Abdominal Hysterectomy ◽

Pelvic Lymphadenectomy ◽

Postoperative Treatment ◽

Case Presentation ◽

Magnetic Resonance Imaging Mri ◽

Gross Examination

Adenosarcoma is a rare tumor which consists of benign glandular epithelium and malignant mesenchymal component. Here we report a case of adenosarcoma of the uterine corpus.Case Presentation. A 59-year-old woman presented with vaginal bleeding and visited a local clinic. She had a uterine tumor pointed out and was referred to our hospital. Ultrasound scans revealed a large heterogeneous mass occupying the whole uterine cavity. Cytological test of endometrium was performed but the result was negative. A fractional endometrial curettage revealed no malignancy. Magnetic resonance imaging (MRI) revealed a heterogeneous solid tumor of 77 × 76 mm. Total abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy was performed. On gross examination, the tumor was arising from the uterine body and occupied the whole uterine cavity. Histopathological examination revealed phyllodes-like architecture on low magnification　and　periglandular cuffing of tumor cells. The lesion was confined to the uterus. Histopathological final diagnosis was adenosarcoma. Her postoperative course was uneventful and she was discharged without postoperative treatment and remains alive without disease 6 months after the surgery.

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Clear cell carcinoma of Mullerian origin in the urinary bladder: A rare entity

Journal of Clinical Urology ◽

10.1177/2051415820987668 ◽

2021 ◽

pp. 205141582098766

Author(s):

Harshit Garg ◽

Brusabhanu Nayak ◽

Tripti Nakra ◽

Prabhjot Singh ◽

Seema Kaushal

Keyword(s):

Urinary Bladder ◽

Cell Carcinoma ◽

Clear Cell ◽

Clear Cell Carcinoma ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Rare Entity ◽

Level Of Evidence ◽

History Of ◽

Carcinoma Of The Bladder

Mullerian neoplasms of the urinary system are rare but complex tumor-like lesions. The identification of the Mullerian neoplasm is crucial for patient management owing to its etiology, natural history, and prognosis. We present a case of a 42-year-old female with a history of three lower segment cesarean sections presenting with complaints of dysmenorrhea and suprapubic pain with no history of hematuria or any urinary symptoms. Magnetic resonance imaging revealed a 2 cm×2 cm exophytic lesion suspicious of being either a bladder lesion or an endometrial lesion infiltrating the urinary bladder. Cystoscopy and transurethral biopsy of this suspicious bladder tumor revealed a malignant tumor with papillary and tubulocystic architecture. Based on the overall histomorphological and immunohistochemical features, a diagnosis of clear cell carcinoma of Mullerian origin was made, and the patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy and partial cystectomy. The patient was kept on regular surveillance and showed no signs of recurrence at the one-year follow-up. Clear cell carcinoma of the bladder of Mullerian origin is a rare entity and is established on histopathology. Prompt diagnosis and a multidisciplinary approach are indispensable for management. Level of evidence: Level 4.

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Uterus-sparing myomectomy for idiopathic uterine pyomyoma in a young woman: A case report

Aegean Journal of Obstetrics and Gynecology ◽

10.46328/aejog.v2i2.43 ◽

2020 ◽

Vol 2 (2) ◽

pp. 19-22

Author(s):

Ugur Sen ◽

Tuğba Karadeniz ◽

Emrah Beyan

Keyword(s):

Risk Factor ◽

Uterine Fibroids ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Proper Treatment ◽

Imaging Findings ◽

Cervical Stenosis ◽

Mortality And Morbidity ◽

Risk Of Mortality ◽

History Of

Pyomyoma, or suppurative leiomyoma, is a rare but serious complication of uterine fibroids. The mechanism of pyomyoma is an infection caused by microorganisms coming from ascending or hematogenously on the ground of necrosis following ischemia and infarction. It can be seen during the course of pregnancy or after abortion and birth. It can also develop after uterine instrumentation or due to cervical stenosis. Patients often present with pain and fever. It should be considered in cases had no other etiology of fever and had a history of uterine fibroids. Diagnosis and treatment are often delayed due to non-specific presentation and imaging findings. This delay increases the risk of mortality and morbidity such as fertility loss. In the vast majority of these cases, total abdominal hysterectomy is required. The case we presented is a premenopausal and sexually inactive woman without any history of pregnancy or uterine instrumentation or immunocompromised. This patient is the 5th case of pyomyoma without risk factor and the 3rd case that was successfully treated with myomectomy. Knowing the proper treatment of pyomyoma will be beneficial to prevent potential mortality and morbidity.

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Vesico-Vaginal Fistula Repair Through Abdominal Approach

KYAMC Journal ◽

10.3329/kyamcj.v11i3.49869 ◽

2020 ◽

Vol 11 (3) ◽

pp. 129-132

Author(s):

Hafiz Al Asad ◽

Asif Yazdani ◽

Zulfia Zinat Chowdhury ◽

Muhammad Faruk Hussain ◽

AKM Shahadat Hossaion ◽

...

Keyword(s):

Wound Infection ◽

Operative Time ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Pelvic Surgery ◽

Vaginal Fistula ◽

Abdominal Approach ◽

History Of ◽

Vesico Vaginal Fistula

Background: Vesico-Vaginal Fistula (VVF) is a major cause for concern in many developing countries with significant morbidity. Among the different techniques abdominal approach of VVF repair is important one. Objective: To find out the outcome of VVF repair by abdominal approach. Materials and Methods: It is a prospective study. Twenty-three patients with VVF were operated with abdominal approach from the period of January 2016 to January 2019. Age of patients, co-morbidities, cause, size and location of VVF were evaluated. Then abdominal approach of VVF repair was done. Operative time and need of blood transfusion were encountered. Post operative (POD) urine leakage, wound infection or other complications were enlisted. Patients were discharged with keeping urethral catheter for 14 days. Follow up was done after 1 and 3 month and in each follow up history and physical examination was done. All collected data were evaluated. Results: Mean age of the patient was 40 years. Among the 23 patients 12 (52%) patients had history of total abdominal hysterectomy, 9 had history of caesarian section and 2 cases had history of pelvic surgery. VVF repair was done at least 12 weeks after its occurrence. Operative time ranged from 90 minutes to 150 minutes. In the immediate POD no obvious complications were noted except one patient developed wound infection on 7th POD. Follow-up done as per schedule and no recurrence of VVF noted. Conclusion: VVF repair through abdominal approach is a feasible, safe and effective technique if performed meticulously. KYAMC Journal Vol. 11, No.-3, October 2020, Page 129-132

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Subacute uterine inversion following an induced abortion in a teenage girl: a case report

BMC Women s Health ◽

10.1186/s12905-020-01089-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Asiphas Owaraganise ◽

Leevan Tibaijuka ◽

Joseph Ngonzi

Keyword(s):

Rare Complication ◽

Hypovolemic Shock ◽

Lower Abdominal Pain ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Unsafe Abortion ◽

Axillary Temperature ◽

Uterine Inversion ◽

History Of ◽

Failed Surgery

Abstract Background Subacute uterine inversion is a very rare complication of mid-trimester termination of pregnancy that should be considered in a situation where unsafe abortion occurs. Case presentation We present a case of subacute uterine inversion complicated by hypovolemic shock following an unsafe abortion in a 17-year-old nulliparous unmarried girl. She presented with a history of collapse, mass protruding per vagina that followed Valsalva, and persistent lower abdominal pain but not vaginal bleeding. This followed her second attempt to secretly induce an abortion at 18 weeks amenorrhea. On examination, she was agitated, severely pale, cold on palpation, with an axillary temperature of 35.8 °C, a tachycardia of 143 beats per minute and unrecordable low blood pressure. The abdomen was soft and non-tender with no palpable masses; the uterine fundus was absent at its expected periumbilical position and cupping was felt instead. A fleshy mass with gangrenous patches protruding in the introitus was palpated with no cervical lip felt around it. We made a clinical diagnosis of subacute uterine inversion complicated with hypovolemic shock and initiated urgent resuscitation with crystalloid and blood transfusion. Non-operative reversal of the inversion failed. Surgery was done to correct the inversion followed by total abdominal hysterectomy due to uterine gangrene. Conclusion Our case highlights an unusual presentation of subacute uterine inversion following unsafe abortion. This case was managed successfully but resulted in significant and permanent morbidity.

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A Case Report of Primary Ovarian Mucinous Adenocarcinoma treated at Dr. Akbar Niazi Teaching Hospital, Bara Kahu, Islamabad

Journal of Rawalpindi Medical College ◽

10.37939/jrmc.v24i4.1348 ◽

2020 ◽

Vol 24 (4) ◽

pp. 430-433

Author(s):

Jahan Ara Saeed

Keyword(s):

Abdominal Distension ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Uneventful Recovery ◽

Ovarian Mass ◽

Resonance Imaging ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index ◽

History Of ◽

Stage 1

Introduction: This is a case of a patient who had a history of grossly increasing abdominal distension for 6 months. The patient had no symptoms except pressure symptoms with a regular menstrual cycle. She initially was investigated as a case of abdominal distension and indigestion. With increasing size, the discomfort was the main symptom. She attended our Gynaecology Outpatient department and was diagnosed as a case of Large Ovarian mass. The first investigation performed was Pelvic ultrasound and Tumour markers and a Risk of malignancy index were calculated. Her Magnetic resonance imaging with contrast showed a large well encapsulated ovarian mass with no ascites and no metastasis. After getting all the investigations and discussion with the patient a Staging Laparotomy with Total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed, The ureters were stented before laparotomy to avoid damage to the ureters during surgery. She was diagnosed as Stage 1-A at the time of surgery and had an uneventful recovery. Her histopathology report showed a unilateral Mucinous cystadenocarcinoma with negative peritoneal wash and omentum histopathology.

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Case 1 − A case of gynecological PEComa

Cancer Breaking News ◽

10.19156/cbn.2017.0037 ◽

2017 ◽

Vol 5 (1) ◽

pp. 31-34

Author(s):

Caterina Fontanella ◽

Maria Luisa Carcangiu ◽

Domenica Lorusso ◽

Bruno Vincenti

Keyword(s):

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Epithelioid Cell ◽

Perivascular Epithelioid Cell ◽

Primary Surgery ◽

Dilation And Curettage ◽

Formalin Fixed Paraffin ◽

Expert Pathologist ◽

Formalin Fixed Paraffin Embedded ◽

Magnetic Resonance Imaging Mri

Perivascular epithelioid cell tumors (PEComas) are a heterogeneous group of rare mesenchymal neoplasms composed of epithelioid cells which express melanocytic and myogenic markers, such as HMB-45, desmin and actin. In March 2013, we visited a postmenopausal 51-year-old woman with a suspected diagnosis of uterine PEComa diagnosed by a dilation and curettage of the lining of the uterus. After the histological revision of the formalin-fixed paraffin-embedded (FFPE) material by our expert pathologist, we confirmed the diagnosis and referred the patient for complete primary surgery. On November 2013, the patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy with no macroscopically detectable residual cancer. However, in January 2014, due to voiding dysfunction and inconstant vaginal bleeding, the patient underwent magnetic resonance imaging (MRI) which documented multiple irregular lesions in the pelvis suspected as recurrent PEComa. Considering the early relapse of PEComa after optimal primary surgery, we suggested a systemic treatment with the combination of gemcitabine and docetaxel. For logistic reasons, the patients started the chemotherapy in her district hospital. After two cycles of chemotherapy the patient died due to treatment-related complications.

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Mullerian Adenosarcoma of the Uterus with Sarcomatous Overgrowth

Clinical Medicine Insights Case Reports ◽

10.4137/ccrep.s5082 ◽

2010 ◽

Vol 3 ◽

pp. CCRep.S5082 ◽

Cited By ~ 2

Author(s):

Reecha Singh ◽

S. Shameema ◽

Koothan Vijaya ◽

Pradeep Kumar

Keyword(s):

Histopathological Examination ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Polypoid Mass ◽

Histologic Diagnosis ◽

Surgical Specimen ◽

Stromal Component ◽

Poorly Differentiated ◽

Post Menopausal ◽

Formalin Fixed

Background and objectives Mullerian adenosarcoma is an uncommon variant of mixed mesodermal tumour of the uterus. This is a case report of a 65 year old post-menopausal lady who presented with complaints of passing tissue fragments per vaginum for 2 days followed by spotting. On examination, a polypoid mass protruding through the cervix was seen which was biopsied. Following a preliminary histologic diagnosis of poorly differentiated sarcoma on the biopsy; the patient underwent total abdominal hysterectomy with bilateral salpingo-oopherectomy. Method The surgical specimen was formalin fixed and paraffin embedded. Haematoxylin and eosin stained sections were studied. Result and conclusion Histopathological examination of the polypoid mass revealed a tumour comprising of an admixture of benign endometrial glandular component with overgrowth of sarcomatous stromal component and heterologous elements. This may pose a problem in diagnosis due to its rarity, and hence its distinctive morphological features merit attention as described here. In view of the rarity of this tumor, it is mandatory to do extensive histologic sampling to identify areas of sarcomatous overgrowth before arriving at a diagnosis of mullerian adenosarcoma as the clinical course and management vary.

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