Genital Prolapse in Pregnant Woman as a Presentation of Aggressive Angiomyxoma: Case Report and Literature Review

Background: Aggressive angiomyxoma is a rare entity within mesenchymal cell neoplasms, especially in pregnant women. Its main characteristic is the ability to infiltrate neighboring structures and to recur. Case Presentation: We present the case of a pregnant woman who debuted with a genital prolapse in the second trimester of pregnancy. She was diagnosed with bilateral ovarian teratomas and a pelvic mass of which the diagnosis could not be established until delivery. The route of delivery used was cesarean section since the genital prolapse behaved as a previous tumor. After the puerperium, the patient was referred for consultation to complete the study of the mass. The extension study was carried out with a negative result. The patient underwent surgery for tumor exeresis. Hormonal treatment was not administered according to the patient’s preferences. Conclusions: Aggressive angiomyxoma is a benign neoplasm that should be considered in the differential diagnosis of pelvic tumors in women. In pregnant women, the vaginal route of delivery is not contraindicated as long as the tumor does not obstruct the birth canal. The definitive treatment is surgery, preferably performed in a second stage after delivery.

Giant Multilocular Prostatic Cystadenoma in a 14-Year-Old Male: A Case Report of a Pediatric Pelvic Mass

Giant multilocular prostatic cystadenoma (GMC) is an extremely rare, benign tumor seen in both adult and pediatric males. The neoplasm originates from prostatic tissue and is typically found within the rectovesical pouch, varying in both size and morphology. Microscopically, GMC contains both glandular and cystic prostatic tissue lined by cuboidal and columnar epithelium. Symptoms often arise once the pelvic mass begins to obstruct the surrounding structures and organs, although invasion into surrounding tissue is unlikely. Common symptoms include abdominal pain, urinary retention, and dysuria. The standard treatment for GMC is surgical removal of the mass with good outcomes and only 1 known case of recurrence. Here we present the case of a 14-year-old male with GMC—the youngest patient reported to date—who presented with abdominal pain, difficulty voiding, and hydroureteronephrosis.

Myasthenia gravis associated with a pelvic follicular lymphoma

An 81-year-old woman presented with neck weakness, dysarthria, dysphasia and left-sided ptosis. Myasthenia gravis (MG) was strongly suspected. Voltage gated calcium channel (VGCC) antibodies, associated with Lambert-Eaton myasthenic syndrome (LEMS), were negative. Acetylcholine receptor (AChR) antibody level was 536 nmol/L and diagnosis of MG was confirmed. Imaging revealed a pelvic mass and subsequent biopsy confirmed a pelvic follicular lymphoma. Our searches revealed this to be the first documented case of MG associated with a pelvic follicular lymphoma. She underwent radiotherapy to treat the lymphoma and received both pyridostigmine and immunosuppression to treat the MG. Her AChR antibody level decreased to 38 nmol/L and her MG symptoms resolved aside from head drop which is continuing to improve. Her lymphoma is now in remission. We have presented a case with a successful outcome, which highlights the importance of screening for lymphoma and thymoma in new presentations of MG.

Giant Fibrothecoma of the Ovary in a Young Patient a Case Report

Fibrothecomas are benign ovarian stromal tumors, they are rare tumors of gonadal stromal cell origin that represent 3-4% of all ovarian tumors. It commonly occurs in post-menopausal women. The clinical presentation is often nonspecific, whereas patients more frequently present with a pelvic mass, metrorrhagia, and pelvic pain. We present a 35-year-old patient, nulli-pregnant, with no personal or family pathological history, who attended a medical consultation for presenting progressive abdominal distention of 6 months of evolution in addition to abdominal pain in the last 2 months type colic which increased during her menstrual periods concomitantly alteration in your defecatory habits. Abdominal ultrasound was performed, finding a solid intrapelvic mass of approximately 14x10x10 cm in diameter of probable left ovarian origin, free fluid in the Douglas space, compression and displacement of intestinal loops and bladder. The patient underwent surgery and an exploratory laparotomy was performed, finding a pelvic tumor adhered to the tube and left ovary, in addition to ascites fluid in the abdominal cavity, complete resection of the tumor, ovary and left salpingue was performed.

Prostate Artery Embolization for Megaprostate Causing Urinary Retention, DVT and Macroscopic Haematuria Post Thrombolysis and Catheterisation: A Case Report

Background: Benign prostatic hyperplasia is the most common urological condition affecting quality of life in men. Its incidence increases proportionally with age and typically manifests with mixed lower urinary tract symptoms. Giant prostatic hyperplasia, the most extreme form of BPH, can present with more serious clinical consequences and presents a challenge to surgical management. Case presentation: We present the first reported case of provoked deep vein thrombosis and near fatal pulmonary embolus from a symptomatic megaprostate exerting pelvic mass effect on the external iliac vein, further complicated by haematuria post catheter-directed thrombolysis. Conclusion: This case highlights the success of prostate artery embolization and catheter-directed thrombolysis to treat potential sequelae of giant prostate hyperplasia.

One-stop clinic for patients with suspected ovarian cancer: results from a retrospective outcome study of the referral pathway

Background Women with abdominal pain and bloating frequently have their Ca-125 levels investigated for suspected ovarian cancer and this has led to a significant increase in referrals to the ovarian cancer service. We have conducted this study to help improve the efficiency in which these patients are investigated and to improve future pathways within the referral service. Methods This was a retrospective observational outcome study. Data were collected from electronic documents of patients’ referrals, assessments, and clinical correspondences over 48 months. The study was conducted in a secondary gynaecology cancer centre with direct referrals from primary care. The pelvic mass clinic was set up to include a consultation and an ultrasound scan with support available for patients if required. All patients included were referred directly from primary care for suspected ovarian cancer with Ca-125 result over a period of 2 years. Results 286 were referred from primary care according to the NICE guidelines of ‘2-week wait for ovarian cancer’. Only 223 patients who had a Ca-125 result reported at the time of their referral were included in the analysis. Out of the 223 patients, 126 patients were discharged with or without a repeat Ca-125 after the initial assessment. 18 patients were diagnosed with cancer following the referral, but only 12 of them had a primary ovarian malignancy. The malignancy rate in women under 50 years of age was 22% (4/18) and 78% (14/18) in women aged 50 or above. Conclusion One-stop focused gynaecology ultrasound clinics where clinicians may assess patients and perform ultrasound scans for suspected cancer, may be better for managing this patient population due to improved efficiencies in waiting times, same day diagnosis and a reduction in waiting times to first appointment. Secondly, the majority of the patients with Ca-125 of more than 35 U/mL, who were referred through this pathway, did not have cancer. This review queries the future value of using Ca-125 as the basis for referrals from primary care for suspected ovarian malignancy. Further studies are required to assess whether a higher Ca-125 cut off may be used as the basis of referrals for premenopausal women.

Mitotically active cellular fibroma of the ovary diagnosis and treatment

Mitotically active cellular fibroma (MACF) of the ovary is a relatively newly recognized histological disease entity which explains its scarce reporting in literature and unknown prognosis [1]. In this tumor type, high mitotic activity is noticed without severe atypia. These tumors are categorized as benign ovarian tumors with late recurrence, if any. However, we herein report an unusual case of an ovarian mitotically active atypical fibrous tumor case which presented as recurrence within six months of being operated thereby raising suspicion of an element of malignancy. On presentation, the patient suffered from abdominal pain and abdomino-pelvic mass. After imaging confirmed an ovarian neoplastic lesion patient underwent bilateral salpingo-oophorectomy and hysterectomy. Histopathology defined the lesion as “ovarian mitotically active atypical fibrous tumor”. Six months later, abdominal pain recurred for which imagining was done and confirmed a newly developed well defined irregular complex solid cystic mass causing intestinal obstruction giving an impression of a malignant neoplasm, probably ovarian carcinoma. However, histopathology for the new lesion remained the same as was for the previous mass, i.e. mitotically active ovarian fibroma, but with lung and mesenteric lymph nodes metastases. Patient couldn’t be operated on due to her co-morbid conditions, and the mass was vascular. She was given supportive care with consideration to start hormonal therapy and during this period died due to sepsis. This case highlights the importance of having a high suspicion of the possibility of malignancy when mitotically active cellular fibroma manifests as a recurrence of mass as this tumor may tend to have an uncertain malignant potential. Thereby, stressing the importance of long term follow up even after the primary tumor is surgically treated without any surgical difficulty or tumor rupture [2]. Such tumors need to be followed and reported more often to help understanding the way they behave and their management.