Chocolate Endometrial Cyst: A Case Report

Introduction: Chocolate cysts are noncancerous, fluid-filled cysts that typically form deep within the ovaries. They get their name from their brown, tar-like appearance, looking something like melted chocolate. They're also called ovarian endometriomas [1]. Case Presentation: The authors report an unusual case of chocolate endometrial cyst. During history collection it found that patient develop a severe pain at midnight, after all the investigation the ultrasonography they diagnosed probe tenderness in RIF. Significant free fluid in abdominal cavity. Well circumscribed mix echoic mass lesion seen in hypogastric region more in right paraumbilical region with eccentrically placed small tubular structure visualized. Mass lesion of size 110mm×110mm. USG guided tapping done, the ascitic fluid smears shows fresh RBC’s and other blood cells entrapped in fibrin clot. Background is haemorrhagic and malignant cells are absent. Abdominal surgery was done and chocolate cyst was removed and sent to histopathology for further investigations. Conclusion: In this study, author mainly focus on expert surgical management and excellent nursing care which leads to fast recovery of patient. After conversation with patient her response was positive and after nursing management and treatment she was discharged without any postoperative complications and satisfaction of recovery.

Added value of contrast-enhanced ultrasound (CEUS) in the diagnosis of primary retroperitoneal serous adenocarcinoma: a case report

Background Primary retroperitoneal serous adenocarcinoma (PRSA) is a rare malignant disease. Given the rarity of the disease, the imaging features of PRSA are unclear. Contrast-enhanced ultrasound (CEUS) also plays an important role in the evaluation of the differential diagnosis of retroperitoneal lesions. Case presentation We report the case of a 62-year-old woman of with increased CA125 levels for 1 year who was referred to our hospital. After conducting contrast-enhanced computed tomography and magnetic resonance imaging, the mass was misdiagnosed as a chocolate cyst. After transvaginal ultrasound (TUS) combined with CEUS, cystadenocarcinoma was considered as the initial diagnosis. Pathology results confirmed PRSA as the final diagnosis. Conclusions CEUS features of PRSA are reported for the first time based on this case, potentially aiding in the differential diagnosis of this rare entity before surgery.

A Rare Case of Combined Endometrioid Adenocarcinoma Arising from Uterine Adenomyosis and Clear Cell Carcinoma Arising from Parametrial Deep Endometriosis

Background: Simultaneously malignant transformation from both uterine adenomyoma and deep endometriotic lesions is very rare. Case presentation: We present a case of a 44-year-old nulliparous woman begun with abdominal pain and intestinal obstruction. Past medical history showed laparoscopic ovarian endometriotic cyst excision. Ultrasound indicated adenomyoma and a parametrial hypoechoic nodule with abundant blood flow signals and unclear boundaries. Deep invasive endometriosis was considered preoperatively. The patient underwent laparoscopic subextensive hysterectomy and bilateral adnexa resection. Chocolate cyst-like lesion was observed in the parametiral lesion. Postoperative pathological examinations suggested endometrioid adenocarcinoma arising from eutopic endometrium and adenomyoma. Left parametrial lesions suggested poorly differentiated endometrioid adenocarcinoma combined with clear cell carcinoma. CD10+ endometrial stromal cells was observed surrounding tumor cell masses. The patient underwent subsequent transabdominal tumor cell reduction surgery and chemotherapy.Conclusion: Combined with surgical founding and pathological characters of the left parametrial adenocarcinoma, it was more likely to be carcinomatous changes of the original deep endometriosis.

USE OF UTTAR BASTI IN SECONDARY INFERTILITY WITH CHOCOLATE CYST – A CASE STUDY

Women are worshipped as Goddess due to their ability of bringing new life on earth. During reproductive period of women’s life there are varieties of ovarian cysts formation which leads to menstrual disturbance which might further lead to infertility. In recent years there is gradual rise in detection of ovarian cysts due to advance diagnostics. There is prevalence of 17 to 44% of ovarian cysts formation during reproductive phase. In this article, a case report regarding a patient of age 30 years having previous H/O bilateral choco-late cyst with both tubes thick with endometriosis and laparoscopic findings s/o impatiens tubes. For which patient had undergone laparoscopic aspiration. She was again diagnosed with recurrence of chocolate cyst by ultrasonography for that she came to my OPD for treatment. In Ayurveda it is stated that Shuddha yoni, Ambu, Beej and Kshetra are needed for Garbhadharan. Treatment plan was Shodhana, Uttar Basti with lekhandravyas and Shamanachikitsa. After 3 months of treatment regimen ultrasonography and hyster-osalpingography were repeated and reports revealed that previous mentioned left ovarian com-plex/haemorrhagic cyst is not seen, and tubes are patent. Hence, case study confirms that we can treat chocolate cyst with the help of Uttar Basti and Shamanachikitsa which acts as Lekhan and normalizes Vat-adosha and Raktadosha.

FINDING A SIMPLIFIED CLINICAL SCORE FOR DIAGNOSIS AND TREATMENT OF ENDOMETRIOSIS WITHOUT CHOCOLATE CYST

Introduction: This study has been proposed to evaluate the feasibility of trans-vaginal and trans-abdominal ultrasound in screening of endometriosis. Methods: This was a retrospective observational study in which women with clinical symptoms, features and family history of endometriosis were included. Women with diagnosed endometriosis on treatment, with chocolate cystor adenomyosis were excluded. The ultrasound features in patients with suspected endometriosis were correlated with the laparoscopy findings and a new scoring system has been introduced to facilitate the management of the disease. Results: 2080 patients were examined clinically either by per-vaginal or by per-rectal examination (in adolescents, unmarried patients) and the findings were noted and ultrasound was performed. 489 of these women had undergone laparoscopy. Combined clinical score of 1-3 is associated with USG score 1. The visualisation shows that combined clinical score of 7-9 is associated with laparoscopy score 4 and combined clinical score of 1-3 is associated with laparoscopy score 2.Combined clinical score 10-12 is highly differentiated statistically. Conclusion: Clinical symptoms, signs along with USG findings have been seen to be quite helpful to screen endometriotic cases and thereby they should be followed up closely to detect its presence. In extremely doubtful cases laparoscopy should be performed for detection of the foresaid disease. It is very important to note that the clinical score and USG score corresponds to a large extent to laparoscopy score as mentioned in the results. Keywords: endometriosis, trans-vaginal, trans-abdominal, ultrasonography, clinical, score, laparoscopy List of abbreviations USG – Ultrasonography MRI –Magnetic Resonance Imaging POD- Pouch of Douglas VAS- Visual Analogue Scale TVS- Trans-vaginal ultrasonography TRUS- Trans-rectal ultrasonography USL- utero-sacral ligament

Extrapelvic endometrioma presenting as acute incarcerated right inguinal hernia in a postpartum patient

A 33-year-old postpartum patient, who had an uncomplicated repeat caesarean section 4 weeks prior, presented with a 2-day history of acute right lower quadrant, incisional and groin pain. She was found to have a palpable tender lump in the right groin. A CT scan with contrast identified fluid along the anterior abdominal wall of the right lower quadrant (inguinal region) measuring about 1.7 cm, a preliminary diagnosis of an incarcerated inguinal hernia was made and the patient underwent immediate surgery. The hernia sac was dissected free and had chocolate cyst that was confirmed to be endometrioma on histopathology. The hernia defect was repaired. Postoperative, the patient did well and was discharged home. We emphasise to consider this differential diagnosis of extrapelvic inguinal endometrioma in reproductive-aged women with or without history of endometriosis especially in a post-caesarean patient who has atypical presentations.

A Case Report on Chylolymphaticus Variety of Mesenteric Cyst

Mesenteric cyst is rare with a variable clinical presentation. The clinical presentation is not characteristic and the preoperative imaging although suggestive but not diagnostic. In most cases, the diagnosis is confirmed following surgical exploration. We report a case of chylolymphaticus variety of mesenteric cyst in18-year-old girl, who was presented to us with diffuse abdominal pain and lump in the lower abdomen for 14 days. Ultrasonography (USG) of the abdomen revealed large cystic lesion(12x10.8x11.4cm, volume77cc) in the abdominal cavity containing dense echogenic debris within, with no obvious flow in the wall-suggestive of twisted chocolate cyst. Exploration of the abdomen revealed a solitary cyst containing milky fluid about 55 cm distal to dudenojejunal flexure and twisted cyanosed coils of intestine. Histopathology of the excised cyst was consistent with chylolymphaticus cyst (Mesenteric cyst) J Bangladesh Coll Phys Surg 2019; 37(2): 83-85