Dysgerminomas are the most common type of malignant germ cell tumor. It primarily occurs in women under age thirty. Five percent of cases occur in phenotypic females with dysgenetic gonads.?

This paper presents a phenotypically female patient with hypogastric mass and primary amenorrhea. Eight months prior, patient underwent left salpingo- oophorectomy. Physical examination showed? absent secondary sexual characteristics along with normal external female genitalia. Intra-operative findings at that time confirmed the presence of a uterus along with absent right ovary. Hormonal studies revealed increased gonadotropin levels, decreased estrogen and female testosterone levels. Serum LDH was elevated. Karyotyping revealed XY chromosome. Pure gonadal dysgenesis is characterized by abnormal testicular determination. The syndrome, as described by the Swyer in 1955, presents the complete form of "pure" gonadal dysgenesis. This involves the association of the female phenotype, female internal genitalia, normal or tall statue and sexual infantilism with primary amenorrhea. These patients have streak gonads that do not secrete testosterone or Mullerian inhibiting factor, and therefore Mullerian derivatives develop.

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Human ; Female ; Young Adult ; Dysgerminoma ; Amenorrhea ; Anti-mullerian Hormone ; Sexual Infantilism ; Gonadal Dysgenesis ; Turner Syndrome ; Chromosomes

Lymphoma is the fourth most frequent malignancy diagnosed during pregnancy,occurring in approximately 1:6000 deliveries. In managing pregnant patients with Hodgkin's lymphoma, there are dilemmas to timely diagnosis and treatment, considering many of the diagnostic procedures and treatment options for the mother's condition may be harmful to the developing fetus. A 27-year-old G3P1 (1011) pregnant patient with a four-month history of anterior mediastinal mass, non-productive cough and low-grade afternoon fever, was initially treated as a case of community-acquired pneumonia. The patient was later admitted at our institution due to the persistence of symptoms, accompanied by dyspnea and chest pain. Biopsy done at 29 4/7 weeks age of gestational showed Hodgkins disease, lymphocyte depleted type (responsive to chemotherapy). At 31-32 weeks age of gestation, the patient started to experience dyspnea with intermittent low-grade fever. Chemotherapy consisting of doxorubicin 25mg/m2, bleomycin 10u/m2, vinblastine 6mg/m2 and dacarbazine 375mg/m2 was started. Radiotheraphy was deferred until after delivery. She underwent spontaneous vaginal delivery and delivered a live baby girl small for gestational age, with no congenital malformations. It is imperative that in pregnant patients presenting with anterior mediastinal masses, accompanied by systematic symptoms, timely histopathologic diagnosis through incision or excision biopsies should be obtained. Treatment options for these patients would differ based on the histology and stage of the disease and also the age of gestation of the pregnancy.

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Human ; Female ; Adult ; Hodgkin Disease ; Vinblastine ; Dacarbazine ; Cough ; Lymphoma ; Bleomycin ; Biopsy ; Doxorubicin ; Chest Pain ; Dyspnea ; Pneumonia ; Lymphocytes ; Fetus

With the advent of B-mode transvaginal sonography, new opportunities are presented to better define ovarian lesions. Since its development in 1966, the transvaginal ultrasound continues to be an essential component in the diagnostic work-up of adnexal masses. This study reviewed the histopathological diagnoses of 387 patients who underwent surgery for removal of a benign ovarian cyst at our institution and compared it with the results of the patient's pre-operative ultrasound examinations done at the ultrasound section. After statistical analysis, this study showed that the B-mode transvaginal ultrasound is accurate in diagnosing the majority of benign ovarian cysts. Although it is more sensitive and specific for some types of benign ovarian cysts over others, it continues to be an important tool in the initial work-up of an ovarian cyst.

Human ; Female ; Ovarian Cysts ; Adnexal Diseases ; Ultrasonography ; Physical Examination

The correct diagnosis and management of patients with uterine inversion will always remain as a challenge to any obstetrician. Two cases of puerperal uterine inversion managed differently are presented. In the first patient, there was delay in the diagnosis of uterine inversion and patient had to undergo hysterectomy. In contrast, there was early recognition of uterine inversion in the second patient prompting immediate manual repositioning.

Human ; Female ; Young Adult ; Adolescent ; Uterine Inversion ; Hysterectomy ; Obstetric Labor Complications

Vaginal vault prolapse occurs in 0.2% to 1.0% of menopausal women with prior hysterectomy. Even rarer is the development of concurrent rectal prolapse seen in 0.03% to 0.1% of cases. This paper aimed to 1) present a rare case of concurrent prolapses of the vaginal vault and rectum in an 87-year old grandmultipara, 2) evaluate factors predisposing to vault prolapse and rectal prolapse and their manifestations, 3) introduce the new quantitative staging system of pelvic organ prolapse by the International Continence Society, 4) discuss the options of management, and 5) emphasize the need for multidisciplinary management approach. An 87-year old grandmultipara presented with two distinct prolapsing masses at the introitus and anus. Implicated factors such as prior hysterectomy, advanced age, multiple vaginal deliveries, menopausal state and history of heavy lifting were identified. Diagnosis was made clinically. The vaginal vault prolapse was categorized quantitatively according to the Pelvic Organ Prolapse Quantification System wherein she was diagnosed to be at stage IV C. Based on such stage, treatment options, both conservative and surgical, were discussed. She underwent perineal surgery for both lesions. Effective therapy for concurrent prolapses of vaginal vault and rectum requires in-depth knowledge of pelvic anatomy and physiology, a thorough physical examination, adequate preoperative planning and prudent selection of surgical procedures that will achieve the most anatomically complete repair that will prevent recurrence.

Human ; Female ; Aged 80 And Over ; Rectal Prolapse ; Anal Canal ; Rectum ; Lifting ; Pelvic Organ Prolapse ; Vagina ; Hysterectomy ; Physical Examination

OBJECTIVE: This is a prospective case control study which aimed to determine the correlation of ovarian volume measurements with endometrial tissue diagnosis such as benign, premalignant and malignant conditions in women with postmenopausal bleeding.

METHODS: Thirty four postmenopausal women with bleeding underwent transvaginal ultrasound for ovarian volume measurements prior to dilatation and curettage. The presence of benign (Group I), premalignant and malignant endometrial. conditions (Group II) were correlated with ovarian volume.

RESULTS: Mean endometrial stripe thickness for group I (N= 19; 1.16ml+/- SD 0.88ml) was not significantly different from group II (N = 15; 1.58ml +/- SD 0.53ml). Mean ovarian volume among patients with premalignant and malignant histology (5.70ml +/- SD 1.91ml) was significantly higher than those with benign histology (2.04ml +/- SD?1.10ml) (P = 0.023). Linear regression analysis showed an association between ovarian volume and premalignant and malignant endometrial conditions (P=0.000). Using the mean ovarian volume cut-off of 5.8ml for postmenopausal women with bleeding, the sensitivity, specificity, positive predictive value and negative predictive value for premalignant and malignant endometrial conditions were 100%, 67.87%,40% and 100%,respectively.

CONCLUSION: Large ovaries among postmenopausal women may represent a marker of risk for endometrial cancer and may be used as an adjunct to endometrial thickness in ruling endometrial malignancy.

Human ; Female ; Aged ; Middle Aged ; Adult ; Postmenopause ; Ovary ; Dilatation And Curettage ; Uterine Hemorrhage ; Endometrial Neoplasms ; Uterine Diseases

Endometriosis is a benign condition in which endometrial glands and stroma are present outside the uterine cavity. The most common sites are the ovaries. Abdominal wall implantation, although uncommon, typically occurs in areas of previous surgical scars, usually involving the subcutaneous tissue. Endometriosis arising in the rectus abdominis muscle is rare. A case of extra pelvic endometriosis, spontaneously arising within the rectus abdominis muscle, in the absence of a previous surgical scar, is presented here.

Human ; Female ; Middle Aged ; Rectus Abdominis ; Endometriosis ; Abdominal Wall ; Cicatrix ; Subcutaneous Tissue ; Ovary ; Endometrium ; Subcutaneous Fat ; Uterus ; Vulva

Intrauterine insemination (IUI) together with controlled ovarian hyperstimulation (COH) has been increasingly used for the treatment of variety of subfertile indications, both male and female or even combined. The overall success rate of IUI ranges from 4% to 66%. The wide variance of success of the procedure is likely to be influenced by a number of factors. The pregnancy rate in the local setting has never been determined. This cross-sectional study reviewed all available clinical records of patients undergoing fertility work-up who had sperm processing in a hospital-based andrology unit and who underwent intrauterine insemination in either the hospital-based facility or a private clinic from January to December, 2004. Objective: It aimed to determine the pregnancy rate following IUI and assess the intrinsic and extrinsic variables affecting its success and describe the IUI's pregnancy outcome. The intrinsic factors include patient's age (male and female), number of subfertility years, previous reproductive history specifically involving the different factors (male, cervical, uterine, ovarian, tubal, peritoneal). Extrinsic factors include treatment effect and timing of IUI (medicine administered, monitoring of number and size of follicles, endometrial thickness, total motile count inseminated, number of inseminations) and preference for facility (hospital-based clinic or private clinics). Results: For the period of one year, there were a total of 1051 cycles of IUI, 305 in the hospital-based facility and 746 in private clinics. Due to limitation of accessible data, only 424 cycles were studied. However, out of the 424 cycles data retrieved, only 365 showed IUI outcomes. The overall pregnancy rate following IUI was 2.47%. In this study, it seems that only the wives' age (younger) and years of subfertility (2.9 years), were found to be associated with pregnancy rates. The median female age was 35.4 years (range 23.4-48.2), and median male age was 36.5 years (range: 25.0 - 54.4) with a median duration of subfertility of 6.0 years (range: 0.3 -18.0). Conclusion: There is no sufficient evidence to conclude that the other factors studied under treatment, different parameters and topography are associated with rates of pregnancy following IUI.

Human ; Male ; Female ; Adult ; Reproductive History ; Spouses ; Infertility ; Uterus ; Fallopian Tubes ; Insemination ; Fertility ; Spermatozoa

OBJECTIVE: This prospective study was conducted to determine the correlation between preoperative serum CA 125 levels and the presence of surgicopathologic prognostic factors in endometrial cancer. Subsequently, the study also aimed to determine the CA 125 cutoff value which best predicted the prognostic factors to which it had a significant correlation.
METHODS: Patients diagnosed with endometrial cancer at a tertiary gynecologic oncology unit from October 2006 until July 2008 who were eligible for primary surgical treatment were included in this analysis. Blood was extracted for serum CA 125 determination using a chemiluminescent enzyme immunoassay (CLEIA) prior to surgery. All patients underwent exploratory laparotomy, peritoneal fluid cytlogy, extrafascial or radical hysterectomy with bilateral salpingooophorectomy, bilateral pelvic lymph node dissection and para-aortic lymph node sampling. All specimens were examined for tumor differentation, lymphovascular space invasion, depth of myometrial invasion, cervical, adnexal, and vaginal involvement pelvic and para-aortic lymph node metastases, and peritonneal fluid cytology. Statistical analysis was performed using the Pearson r correlation test to evaluate the correlation of preoperative serum CA 125 with the different surgicopathologic prognostic factors mentioned. A receiver operating characteristics curve (ROC) was used to determine the optimal cutoff value of preoperative CA 125. Sensitivity, specificity, accuracy and likehood ratios were calculated.
RESULTS: A total of 90 patients with endemetrioid type endometrial adenocarcinoma underwent co,plete surgical staging from October 2006 until July 2008. Of the different surgicopathologic prognostic factors, pre-operative serum CA 125 was demonstrated to be significantly correlated with deep myometrial invasion (correlation coefficient 0.24, p=0.02), adnexal metastasis (correlation coefficient 0.26, p=0.01), pelvic lymph node involvement (correlation coefficient 0.31, p=0.01) and para-aortic lymph node involvement (correlation coefficient 0.43, p 0.01. The test likewise significantly correlated with the presence of extrauterine disease with a coefficient of 0.26 (p=0.01). A cutoff value of 55 U/ml has been calculated to predict extrauterine spread with a sensitivity of 53.85% , specificity of 84.38%, and accuracy of 75.56%. Using this cutoff, the odds of the positive test is 3.44, and the odds of negative test is 0.54.
CONCLUSION: Pre-operative serum CA 125 has a statistically significant correlation with the presence of deep myometrial invasion, adnexal metastasis, pelvic and para-aortic lymph node involvement, and extrauterine disease at a determined cutoff value of 55U/mL. It is recommended that serum CA 125 determination be adopted as an integral part of the routine pre-operative work-up of patients with endometrial cancer.

Human ; Ascitic Fluid ; Laparotomy ; Prognosis ; Endometrial Neoplasms ; Lymph Node Excision ; Lymphatic Metastasis ; Lymph Nodes ; Hysterectomy ; Immunoenzyme Techniques ; Adenocarcinoma

Uterine inversion is a condition in which the uterus turns inside out with the fundus prolapsing to or through the cervix. Uterine inversion is classified into puerperal or nonpuerperal. Non-puerperal uterine inversion is a rare entity with no accurate estimate regarding its incidence available to date. A case of 25 year-old primipara with a one year history of abnormal uterine bleeding is presented. Her only pregnancy was 5 years prior to admission. She delivered a term baby girl of unrecalled birth weight vaginally, with no reported intrapartal or postpartum complications. Internal examination revealed a palpable mass within the middle third of the vagina measuring 4.0cm x 4.0cm x 4.0cm, doughy, with a smooth, spongy surface, seemingly prolapsed out of a smooth dilated cervix. The uterine corpus was not appreciated on bimanual examination. The patient was diagnosed to have uterine inversion and underwent conservative surgical reduction of the uterus initially with a vaginal approach using the Kustner technique which was later converted to an abdominal repair via the Haultain procedure. Non puerperal uterine inversion can be diagnosed and successfully managed in a lowresource environment, but may require the utilization of elements from several standard techniques before reduction is accomplished.

Human ; Female ; Adult ; Uterine Inversion ; Birth Weight ; Vagina ; Term Birth ; Parity ; Postpartum Period ; Uterine Hemorrhage