Primary High-grade Serous Carcinoma of the Fallopian Tube as an Incidental Intraoperative Finding: A Case Report

: Primary carcinoma of the fallopian tube is a rare, but fatal gynecologic cancer. The preoperative diagnosis of this carcinoma is challenging due to the absence of specific symptoms and signs, and in most patients, it is an intraoperative finding. A 55-year-old patient (G3Ab1P2) was referred to the urogynecology clinic of our hospital with the chief complaints of heavy, prolonged menstrual bleeding and a persistently abnormal yellow discharge, which could not be distinguished by the patient from urinary leaks. After a complete diagnostic work-up, the patient was identified as a candidate for hysterectomy due to abnormal vaginal bleeding resistant to megestrol acetate, family history of malignancy, and abnormal vaginal discharge. Laparotomy revealed unusual left fallopian tube features (large, bulky, and vegetative), suggesting malignancy. The intraoperative frozen-section analysis of the left fallopian tube and the ovarian specimens indicated the mass as a high-grade serous carcinoma of the fallopian tube. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, and partial omentectomy were performed for the patient. The definitive histopathological diagnosis was high-grade serous carcinoma of the left fallopian tube (stage 2b) with omental involvement, without any evidence of lymphovascular invasion. High-grade serous carcinoma of the fallopian tube is likely to have non-specific symptoms, causing a significant delay in diagnosis and treatment, which negatively affects the prognosis and survival of these patients.

Management of a patient diagnosed with ovarian cancer during pregnancy

Insufficient diagnosis of ovarian tumors during pregnancy and decreased oncological alertness constitute huge problems that can subsequently have an unfavorable outcome for both the pregnant woman and the fetus. The difficulties of diagnosing and treating ovarian cancer during pregnancy were demonstrated on the following clinical case example. In pregnant patient A. at 19-20 weeks of pregnancy, a lesion was found in the area of the right appendages (100.9 55.4 93.4 mm, V = 273 cm3), with many tissue partitions and parietal tissue inclusions. The growth of the neoplasm was noted (CA-125 884 U / ml) and the pain syndrome occurred in the patient at 23-24 weeks of pregnancy. Magnetic resonance imaging revealed a solid-cystic neoplasm of the right ovary (cystadenoma?) and surgery was performed in November 2019. Based on the results of histological examination, a high-grade serous ovarian cancer was diagnosed without signs of microsatellite instability MSI-H/dMMR (in the right ovary, in the biopsy of the left fallopian tube). The patient. received two cycles of polychemotherapy (TC scheme). The treatment was tolerated satisfactorily (CA-125 287.3 U / ml). At a gestational age of 34 6/7 weeks (January 2020), a simultaneous operation was performed, including a lower midline laparotomy, a lower uterine segment caesarean section, extirpation of the uterus with appendages, and an omentectomy. A boy was born (weight 2280 g, height 44 cm) with the Apgar score of 7/7 points, with no complications noticed in the postpartum period. Postoperative histological examination showed metastasis of carcinoma in the left ovary with signs of therapeutic pathomorphosis. The treatment was completed in March 2020 after six cycles of polychemotherapy.

A CASE REPORT OF SUCCESSFUL PREGNANCY OUTCOME IN UNICORNUATE UTERUS WITH KYPHOSCOLIOSIS

Unicornuate uterus belongs to class U4 or Hemi-uterus classication according to the European society of human reproduction and embryology (ESHRE). The incidence of Hemi-uterus is 1-2 %. It is associated with fetal survival of 40%. Kyphoscoliosis is an abnormal curvature of the spine in both coronal and sagittal planes. Prevalence varies from 0.3% to 15.3%. We present a case of 27 years, unbooked primigravida with 34 weeks gestation with leaking per vagina and pain abdomen with breech presentation. She had short stature and kyphoscoliosis. During caesarean section she was found to have unicornuate uterus with absent left fallopian tube and ovary.

Isolated torsion of a fallopian tube: an uncommon cause of abdominal pain in an 11-year-old

This report describes a rare case of isolated fallopian tube torsion (IFTT) in a premenarchal 11-year-old girl. The patient presented with subacute abdominal pain, associated with nausea and vomiting. Sonographic findings revealed left tube enlargement with free intraperitoneal fluid. Doppler mapping was not unequivocal. During exploratory laparoscopy, a large pelvic necrotic mass was found to be a twisted left fallopian tube. After detorsion, salpingectomy was performed and the patient recovered promptly, showing no complications 3 months post operation. IFTT should be considered as a differential diagnosis of lower abdominal pain in adolescent girls with normal-appearing ovaries on ultrasound. Conservative management for fertility preservation is the ideal approach. Therefore, avoiding delay in laparoscopy is crucial.

Laparoscopic evaluation of pelvic organ in case of subfertility

Background: Globally subfertility affects 10-15% of couple. All these people need proper evaluation and treatment. Now a days laparoscopy considered as a gold standard procedure for evaluation of pelvic organ. The aim of this study was to find out the different causes of female factor infertility with the help of laparoscopy.Methods: This retrospective study was conducted in infertility clinic of BIRDEM hospital, Dhaka, Bangladesh during the period of May, 2007 to October 2007. The study group comprised 100 cases of infertile patients.Results: In this study, among 100 patients 68% had primary and 32% had secondary infertility. In laparoscopy majority (55.0%) had normal ovary, 20.0% had cystic change with thick capsule in right ovary and 22% had in left ovary, 7.0% had endometriosis, 8.0% had adhesion, 10.0% had simple cyst in right ovary and 8% had in left ovary and rest could not be visualized. 79.4% right and 77.9% left fallopian tube patent in primary subfertility cases and 56.3% right and 59.4% left tube normal in secondary subfertility cases. Both fallopian tube patent in 62%, unilateral block 21% and bilateral block in 17% cases in this study peritoneum was normal in 78% cases, 8% cases there was endometriosis and 14% cases there was adhesion of fallopian tube with the ovary, adhesion of uterus with intestine and also with bladder.Conclusions: Laparoscopy is an important tool for diagnosing anatomical and pathological abnormalities of pelvic organ which has a major role in subfertility management.

Levonorgestrel intrauterine system embedded within tubal ectopic pregnancy: a case report

Background The presence of the levonorgestrel-releasing intrauterine system embedded within an ectopic pregnancy is a rare occurrence. Tubal migration of an intrauterine device is not well understood and has not been extensively studied in literature. Case presentation A 34-year-old African woman, para 1, gravida 2, presented with symptoms of ruptured ectopic pregnancy. She underwent a laparoscopy where a ruptured left ectopic pregnancy was found with a levonorgestrel-releasing intrauterine system inserted 2 years prior embedded within the tube. A left salpingectomy was performed with removal of the levonorgestrel-releasing intrauterine system. The patient recovered well and proceeded to have an intrauterine pregnancy 3 months later. Conclusion Migration of the levonorgestrel-releasing intrauterine system into the fallopian tube is a rare occurrence that is not well understood. In the case presented, levonorgestrel-releasing intrauterine system was found embedded within the fimbrial end of the left fallopian tube, which had a ruptured ectopic pregnancy. Surgical treatment with laparoscopy is recommended for intraabdominal intrauterine device to prevent complications.

Possibilities of early ultrasound diagnosis of placenta accreta

A case of ultrasound diagnosis of placenta accreta during early (8 weeks) and screening ultrasound examination at 12 weeks 4 days in a pregnant woman with a burdened obstetric history is presented. At 38 weeks, a planned caesarean section was performed, followed by hysterectomy and removal of the right ovary and left fallopian tube. A live girl was born, 3520 g / 54 cm, Apgar score 8/9. The course of the postoperative period in the woman was adequate to the severity of the operation. The child is now healthy. The diagnosis of true placenta percreta was confirmed intraoperatively and by the results of histological examination.

An incidental finding of a unicornuate uterus with non-communicating rudimentary horn in a 30-year-old female with recurrent abortion

Unicornuate uterus is a form of uterine anomalies which arise from failure of development and fusion of the Mullerian ducts, and accounts for about 2.4-13% of all Mullerian anomalies. This is a 30-year-old housewife referred for hysterosalpingography (HSG) on account of secondary infertility. The patient also had history of recurrent abortion in the first trimester. The HSG showed an ellipsoidal or Banana shaped uterus in the left lateral pelvic cavity with prominent left fallopian tube that showed peri-fimbrial spillage of contrast medium with non-demonstration of a communicating rudimentary horn. She also had a pelvic ultrasound that showed an empty uterus with a right hypoechoic solid area most likely the right rudimentary horn. We report the radiologic features of Unicornuate uterus due to its rare nature and peculiar presentation

Primary High-grade Serous Carcinoma of Fallopian Tube, an Incidental Intraoperative Finding: A Case Report

Background: Primary carcinoma of fallopian tube is a rare but deadly gynecologic cancer, In addition, its preoperative diagnosis is strict due to the lack of specific symptoms and signs and in most patients, it is an intraoperative finding.Case presentation: A 55-year-old patient, G3Ab1P2 referred to urogynecology clinic of our hospital with chief complaint about heavy, prolonged menstrual bleeding and a permanently abnormal yellow discharge that could not be distinguished from its urinary or vaginal source.After complete diagnostic work-up, the patient became a candidate for hysterectomy due to the drug (Megestrol Acetate) -resistant abnormal vaginal bleeding, her abnormal vaginal bleeding, positive family history of malignancy, and abnormal vaginal discharge.Laparotomy revealed unusual left fallopian tube feature (Large, bulky, and vegetative feature), suspected to malignancy. Intraoperative frozen-section analysis of the left fallopian tube and ovary specimens detected the mass as a high-grade serous carcinoma of fallopian tube. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, and partial omentectomy were performed. The definitive histopathological diagnosis was high-grade serous carcinoma of the left fallopian tube stage 2b with omental involvement without any evidence of lymph-vascular invasion.Conclusions: High-grade serous carcinoma of fallopian tube is likely to present nonspecific symptoms, which may cause considerable delay in diagnosis and treatment. This consequently, affects the prognosis and survival of the patient.

Isolated Fallopian Tubal Torsion Complicated by a Large Hydrosalpinx in a Perimenopausal Woman

Adnexal torsion frequently causes acute pelvic pain in women. Ovarian tumour torsion is common; twisting and torsion of a fallopian tube are rare. This report presents a rare case of fallopian tubal torsion requiring the management of a large hydrosalpinx with laparoscopic surgery. A 48-year-old woman reported with acute abdominal pain and lower abdomen tenderness. Transvaginal ultrasonography and Magnetic Resonance Imaging (MRI) showed a cystic mass on the anterior uterine surface. Emergency surgery was performed for a suspected torsion of the left ovarian cyst. In the abdominal cavity, the left fallopian tube was enlarged (neonatal head size), dark purple coloured, and exhibited a 180° torsion; the left ovary was normal. Laparoscopic left salpingectomy was performed and the postoperative course was uneventful. Surgical pathology revealed hydrosalpinx with torsion. As diagnosing isolated fallopian tube torsion before surgery is difficult, laparoscopic surgery is useful in diagnosing and treating isolated tubal torsion.