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

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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CHRONIC UTERINE INVERSION ASSOCIATED WITH FIBROID - A CASE REPORT

SRMS Journal of Medical Science ◽

10.21761/jms.v1i2.7358 ◽

2016 ◽

Vol 1 (2) ◽

Author(s):

J. K. Goel ◽

Shanti Sah ◽

Shashi Bala Arya ◽

Ruchica Goel ◽

Nandini Agarwal

Keyword(s):

Case Report ◽

Coming Out ◽

Uterine Prolapse ◽

Uterine Fibroids ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Lower Abdomen ◽

Uterine Inversion ◽

History Of ◽

Fibroid Polyp

Introduction: Uterine inversion is a condition in which the uterus turns inside out with prolapse of fundus through the cervix into or outside vagina. Chronic inversion cases are rare. We present a rare case of chronic uterine inversion associated with uterine fibroids. Case Report: A 42 year old female, P3 L3 , was admitted with complains of menorrhagia and pain 3 3 lower abdomen for 1 month. Speculum examination revealed a fleshy polyp filling whole of vagina. Upon per vaginal examination size of mass could not be assessed and cervical lips could not be felt. So, a provisional diagnosis of fibroid polyp was made. Per-operatively inversion of tube and ovaries along with a sessile submucosal fundal fibroid polyp of size 10 x 8 cm was found. A revised diagnosis of chronic uterine inversion with sessile fibroid polyp was made. Patient then underwent Total Abdominal Hysterectomy with bilateral Salpingooophrectomy. Conclusion: Chronic inversion should be kept as a differential diagnosis in a patient with history of irregular bleeding associated with dragging pain of lower abdomen and feeling of a mass coming out of introitus. Pre operatively it should be differentiated from fibroid polyp, uterine prolapse and prolapsed hypertrophied ulcerated cervix.

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A Case of Giant Fibroid Uterus

Bangladesh Journal of Obstetrics & Gynaecology ◽

10.3329/bjog.v27i1.29911 ◽

2016 ◽

Vol 27 (1) ◽

pp. 27-30

Author(s):

Irin Parveen Alam ◽

Rafat Newaz

Keyword(s):

Uterine Leiomyoma ◽

Uterine Fibroids ◽

Total Abdominal Hysterectomy ◽

Muscle Layer ◽

Abdominal Hysterectomy ◽

Severe Anaemia ◽

History Of ◽

High Frequency Ultrasonography ◽

Benign Tumours ◽

One Year

Fibroids are muscular tumours, the most common benign tumours in females and typically found during the middle and later reproductive years. It originate from the smooth muscle layer of the uterus. Another medical term is leiomyoma or just myoma. It can be as small as an apple seed or as big as a melon. In unusual cases they can become very large. With the advent of high frequency ultrasonography and magnetic resonance imaging it is now possible to diagnose such cases at an early stage1. Asymptomatic uterine fibroids often left untreated. Giant fibroids are the fibroids weighing 11.4kg2,3 or more. Such a fibroid may appear as a solitary tumor or as a conglomerate mass of uterine fibroids presenting as a single uterine tumor4. Giant uterine fibroid are very rare neoplasm and represents a great diagnosis and therapeutic challange. This article illustrates a case of 34 years old woman presented with a four year history of slowly increasing abdominal size with rapid increase in the last one year associated with shortness of breath and severe anaemia by a painless lump. Total abdominal hysterectomy was performed; histologically the specimen was 9.5 kg benign uterine leiomyoma. The patients postoperative evaluation was uneventful and she went back abroad in two months time following operation.Bangladesh J Obstet Gynaecol, 2012; Vol. 27(1) : 27-30

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Degenerated fibroid - a diagnostic challenge

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20164677 ◽

2016 ◽

Vol 6 (1) ◽

pp. 292

Author(s):

Sonal Bhuyar ◽

Bhavana Sontakke ◽

Pooja Mukund Rajbhara

Keyword(s):

Ovarian Tumor ◽

Unusual Case ◽

Uterine Fibroids ◽

Total Abdominal Hysterectomy ◽

Large Mass ◽

Abdominal Hysterectomy ◽

Diagnostic Challenge ◽

Malignant Ovarian Tumor ◽

History Of ◽

Leiomyoma Of The Uterus

Leiomyoma of the uterus is the most common type of tumor affecting the female pelvis and arises from uterine smooth muscle. The size of leiomyoma varies from microscopic to giant; giant myoma is exceedingly rare. We report an unusual case of a large, cystic, uterine leiomyoma mimicking a primary malignant ovarian tumor on sonography and CT. A 39 year old infertile nulliparous woman presented with a history of lump in abdomen since 2 years and 6 months of amenorrhea. Sonography and CT examination showed a large mass that filled the abdomen. A preoperative diagnosis of a primary malignant ovarian tumor was made. The patient underwent laparotomy with total abdominal hysterectomy preserving tubes and ovaries. The histology revealed a leiomyoma with extensive hyaline degeneration. The current established management of uterine fibroids may include expectant, surgical, or medical management or uterine artery embolization or a combination of these treatments. A surgical approach is preferred for management of giant leiomyomas. Leiomyomas should be considered in the differential diagnosis of a multilocular and predominantly cystic adnexal mass.

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Abdominal skin metastasis in endometrial cancer

Majalah Obstetri & Ginekologi ◽

10.20473/mog.v27i22019.84-89 ◽

2019 ◽

Vol 27 (2) ◽

pp. 84

Author(s):

Eccita Rahestyningtyas ◽

Pungky Mulawardhana ◽

Tomy Lesmana

Keyword(s):

Endometrial Cancer ◽

Uterine Fibroids ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Low Grade ◽

Endometrioid Adenocarcinoma ◽

Comprehensive Management ◽

High Risk Factors ◽

History Of ◽

Anatomical Pathology

Objectives: Surgical wound metastases in stage 1 endometrial cancer are possible, with a variety of different pathophysiological possibilities. Comprehensive management is needed to keep the patient on the possibility of a good prognosis.Cases Report: During January 2015 – January 2018 at dr. Soetomo Hospital, there were 2 cases of metastatic endometrial cancer in the laparotomy wounds by which the condition is very rare. Case 1, The patient was diagnosed with endometrial carcinoma following the results of curettage. Anatomical pathology examination was done and obtained grade 2 endometrioid adenocarcinoma. In Case 2, the patient underwent Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy in 2013 at Mojokerto General Hospital, indicating Uterine Fibroids and Ovarian Cysts. The results of anatomical pathology examination were unknown. On April 2017, the patient complained abdominal swelling since 3 months ago.Conclusion: In January 2015 - January 2018, 2 cases of metastatic endometrial cancer was found in a former laparotomy operation where this condition is very rare in endometrial cancer cases with low grade ,so that follow-up, monitoring and more vigilance are required in patients with low-grade endometrial Ca who have finished undergoing a surgery and chemotherapy. Rapture or mass resection, followed by external radiation, may be performed in patients with recurrence in the laparotomy wound area or in patients with high risk factors for endometrial cancer such as a history of estrogen use, tamoxifen, nullipara, obesity, diabetes mellitus, and family history of endometrial cancer. Currently, there is no fixed procedure (guideline) in RS. Dr. Soetomo to overcome recurrences especially in the scars of cancer surgery.

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Abnormal Contour Huge Uterine Fibroids

Medicine Today ◽

10.3329/medtoday.v27i2.30047 ◽

2016 ◽

Vol 27 (2) ◽

pp. 49-50

Author(s):

Parveen Ahmed ◽

GM Farid ◽

Tanveen Ishague ◽

Ayesha Siddiqua

Keyword(s):

Genital Tract ◽

Benign Tumor ◽

Female Genital Tract ◽

Uterine Fibroids ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Pelvic Ultrasound ◽

Benign Leiomyoma ◽

History Of ◽

Female Genital

Uterine fibroids represent the most common large solid benign tumor of the female genital tract. This 35 years old lady, mother of one child represented to our clinic with a history of progressive abdominal swelling that had rapidly increased in the last two years. There were associated abdominal pain, easy fatigability, heavy menstrual loss and prolong secondary subfertility of about ten years. On examination abdomen was enlarged and the mass measuring about 25cm from xiphisternum, firm, irregular and fairly mobile. Pelvic ultrasound scan revealed features of huge multiple uterine fibroids and the size of the largest one was about 20x25cm,moderate bilateral hydro-nephrosis. Intraoperative findings were moderate pelvic adhesions, huge multiple fibroids and the largest measuring about 18x20cm. Total abdominal hysterectomy with preservation of both ovaries were done. Histopathological report confirmed benign leiomyoma with no evidence of malignancy.Medicine Today 2015 Vol.27(2): 49-50

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TREACHEROUS OVARIAN TUMOURS

The Professional Medical Journal ◽

10.29309/tpmj/2009.16.03.2884 ◽

2009 ◽

Vol 16 (03) ◽

pp. 463-465

Author(s):

FARHAT RASHID ◽

NAZIA AMJAD

Keyword(s):

Ct Scan ◽

Endometrial Hyperplasia ◽

Abdominal Mass ◽

Uterine Fibroids ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Ovarian Tumours ◽

History Of ◽

Peritoneal Washings ◽

Mucinous Cyst

A 47 years old P7 AO presented with history of gradually increasing abdominal mass and menorrhagia for the last six months.Pelvic ultrasound showed enlarged uterus with multiple fibroids of varying sizes with bilateral, large ovarian tumours with solid elements andhypoehoic thick fluid with septations. CT scan also confirmed same findings. Staging Laparotomy was performed which confirmed the findingsof ultrasound and CT scan. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was done along with peritoneal washings forcytology. Histopathology showed uterine fibroids, simple endometrial hyperplasia and Bilateral Mucinous cyst Adenomas of ovary with noevidence of malignancy.

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Large cervical fibroid: a rare case report

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20193577 ◽

2019 ◽

Vol 8 (8) ◽

pp. 3414

Author(s):

Sunanda N.

Keyword(s):

Uterine Fibroids ◽

Total Abdominal Hysterectomy ◽

Large Mass ◽

Abdominal Hysterectomy ◽

Reproductive Age ◽

Pelvic Tumors ◽

Rare Case Report ◽

Tender Mass ◽

Restricted Mobility ◽

Reproductive Age Group

Although leiomyomas are the most common pelvic tumors presenting in the reproductive age group, cervical fibroids are rare accounting for 2% of all uterine fibroids. We report a case of 40 year old lady presenting with a firm, non-tender mass of 22-24 weeks size pregnant uterus with restricted mobility. Laparotomy showed a large mass arising from the anterior lip of cervix, with a small uterus pushed posteriorly. Enucleation followed by total abdominal hysterectomy was done. Large cervical fibroids are rare, presenting with surgical difficulties. Careful dissection by expert hands is needed in the management of such cases.

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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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CLINICAL PROFILE AND MANAGEMENT OPTION OF FIBROID UTERUS PATIENTS OF OBSTETRICS AND GYNAECOLOGY DEPARTMENT OF DMCH, LAHERIASARAI, BIHAR

10.36106/ijsr/0137418 ◽

2020 ◽

pp. 1-2

Author(s):

Sangeeta Singh ◽

Renu Jha ◽

Seema Seema ◽

Debarshi Jana

Keyword(s):

Uterine Fibroids ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Management Options ◽

Fibroid Uterus ◽

Number Of Patients ◽

Study Results ◽

The Mean ◽

Benign Tumours ◽

Symptomatic Uterine Fibroid

Background: Fibroids are the most common benign tumours of smooth muscle cells of uterus in females and typically found during the middle and later reproductive years. As fibroid is an estrogen and progesterone dependent tumour, it gradually decreases in size during starting of menopause. The objective of this presented study was to determine management options among fibroid uterus patients. Methods: 50 number of patients were included in this study those who’s age of 20-55, with symptomatic uterine fibroid and undergone hysterectomy or myomectomy. Postmenopausal, Pregnancy and Asymptomatic fibroid were excluded from this study. Results: The study showed that 52 percent of patient having fibroid uterus were belonged to 31-40 years of age. The mean age was 41.2±6.07. The majority 74% of patients in this study presented with menstrual abnormalities, 40% presented with abdominal lump. Dysmenorrhoea was 26%, 6% patient had primary subfertility and 14% secondary subfertility. Total Abdominal Hysterectomy (TAH) with unilateral salpingo- oophorectomy done in 10% cases, TAH with bilateral salpino-oophorectomy in 22% cases, non descent vaginal hysterectomy in 6% cases, myomectomy done in 20% cases and polypectomy was done in 2% cases. Conclusion: Uterine fibroids are very common in women and frequently in late reproductive and perimenopausal years. It is also a common gynecological problem in our country, which frequently disturbs the lives of woman. Women now have choice of therapies for the treatment of fibroids.

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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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