A 49-year-old woman, Gravida 8 Para 8 (8007), came in due to vomiting and enlarging abdominal mass. Initial diagnosis was partial gut obstruction and acute kidney injury probably secondary to adenomyosis versus colonic pathology. Ultrasound showed adenomyosis but computed tomography scan showed a uterine mass with possible tumor rupture and mass effects. Emergency hysterectomy was done and showed an ill-defined endometrial mass with multiple areas of rupture. It was diagnosed with malignant but final histopathology revealed extensive adenomyosis with acute inflammation and necrosis with no malignancy identified. Unusual symptoms such as uterine rupture and mass effects can accompany adenomyosis, alongside typical signs like pain and bleeding. Ultrasound aided the diagnosis, although it missed uterine rupture, highlighting its limitations. Magnetic resonance imaging could have been useful. Ultimately, histopathology is the gold standard for diagnosing adenomyosis.
Adenomyosis ; Necrosis

Context: Vulvar cancers are rare gynecologic tumors. Ultrasound can characterize primary tumors and guide the biopsy of suspicious nodes. Currently, there are no studies on the sonologic features of different vulvar cancer types. Aims: The aim is to determine the sonologic features of different vulvar malignancies. To compare the accuracy of ultrasound in identifying lymph node status. Settings and Design: This is a retrospective descriptive study. Subjects and Methods: Patient records, ultrasound images, and reports of vulvar cancer with long‑ and short‑axis (L/S) ratio of inguinal nodes were reviewed from the year 2010 to 2019. Statistical Analysis Used: The accuracy of ultrasound to detect lymph nodes and the correlation of L/S ratio to histopathology were done. Results: The study included 49 patients. The most common histopathologies were squamous cell carcinoma (SCCA), vulvar melanoma (VM), and adenocarcinoma (ADCA). Most tumors were > 4 cm, unifocal, and lateral in location. SCCA, verrucous carcinoma, VM, ADCA, adenosquamous carcinoma (ASCA), eccrine carcinoma (ECCA), and carcinosarcoma (CS) were irregular heterogeneous masses. Leiomyosarcoma (LMS) and proximal‑type epithelioid sarcoma (PES) were regular, heterogeneous masses. Paget’s disease of the vulva (PDV) was hypoechogenic with regular borders. Vascularities were absent in PDV and LMS, minimal in ECCA, moderate in ASCA and PES, moderate to abundant in CS, and variable in VM. The accuracy of ultrasound in detecting lymph nodes was 78%; the accuracy of the L/S ratio was 75%. Tumor border and FIGO stage showed significant association with histopathologic type. Conclusions Sonologic features and accuracy of ultrasound in predicting lymph node status help prognostication in vulvar cancer. Nodal morphometric studies are recommended for future researches.
Vulvar Neoplasms