The development of leiomyomas on the grounds of an aplastic/hypoplastic uterus in patients with Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) has been rarely described. We report the first case of development of multiple leiomyomas in a patient with MRKHS complicated with pulmonary valve stenosis, and we present a narrative review of the existing literature. A 44-year-old patient with MRKHS attended our clinic because of pelvic pain, which was attributed to a pelvic mass found on ultrasound. Magnetic resonance imaging revealed a multinodular mass, indicating either ovarian pathology or the presence of leiomyomas. Exploratory laparotomy was performed, and multiple solid masses on the grounds of two rudimentary uterine buds were observed. Histological analysis revealed multiple leiomyomas arising from parametrial or paratubal tissue. We searched medical databases for articles relevant to leiomyomas and MRKHS. We present a review of the current literature and summarize the clinical manifestation, diagnosis, management, and histopathological findings of all the cases described. We underline that it is important for gynecologists to be aware of this rare clinical entity, and symptomatic leiomyomas cannot be excluded in patients with MRKHS.
Adult ; Diagnosis ; Humans ; Laparotomy ; Leiomyoma ; Magnetic Resonance Imaging ; Pathology ; Pelvic Pain ; Pulmonary Valve Stenosis ; Ultrasonography ; Uterus

PURPOSE: To evaluate the relibility of transrectal ultrasonography (TRUS) to define adult female genital organ and to diagnose and stage the cervical carcinomas. METHODS AND MATERIALS: After analysis of normal ultrasonographic anatomy of female pelvis in ten healthy women, I performed TRUS in thirty patients of uterine cervical carcinomas by rotating the 5 MHz electronic linear array transducer(SL2, Siemens, Erlangen, Germany) along the reference sagittal plane in the middle of uterine cervix & vagina. The results of TRUS were analyzed and compared to FIGO, surgical pathology, CT and MRT, ect. RESULTS: TRUS allowed good visualization of the uterus, uterine cervix, parametrium, vagina, anterior rectal wall, walls of the urinary bladder, and uterine cervical carcinomas. The accuracy of staging with TRUS was 83%, compared with the accuracy of 67% for clinical staging according to the criteria of the International Federation of Gynecotogy and Obstetrics(FIGO). For extent of parametrial involvement, the sensitivity of TRUS was 93%, with the specificity of 86% and the diagnostic accuracy of 89%. The same reliability parameters for clinical evaluation were 71%, 79%, and 75% respectively. CONCLUSION: Above findings suggest that low-cost TRUS could be usefully applied to pretreatment evaluation of patients with uterine cervical carcinoma.
Adult ; Cervix Uteri ; Diagnosis* ; Female ; Genitalia ; Humans ; Pathology, Surgical ; Pelvis ; Sensitivity and Specificity ; Ultrasonography* ; Urinary Bladder ; Uterus ; Vagina

OBJECTIVE: To determine the accuracy of two dismensional sonography and color doppler in diagnosing placenta previa accreta in patients with previous cesarean section. METHODS: Forty-one patients with previous cesarean sections were confirmed to have partial or total placenta previa in the current pregnancy and were given ultrasound examinations after the 28th week of gestation. Specific ultrasound features of the placenta and its interphase with the uterus and the bladder for placenta accreta were checked by two-dimensional ultrasonography and color Doppler. All the patients were traced until delivery. The golden standard in diagnosis was the intraoperative finding and the pathologic exam. RESULTS: Twenty-two patients had ultrasonographic evidence of placenta previa, 20 of which were later confirmed placenta previa accreta intraoperatively. Nineteen patients had no ultrasound evidence of placenta previa, and 1 of which was later confirmed placenta previa accreta. The sensitivity and specificity of antenatal ultrasound diagnosis of placenta previa accreta were 95.24% and 94.74% respectively. The most prominent feature to suggest placenta accreta in twodismensional sonography was the presence of multiple lakes that represented dilated vessels extending from the placenta through the myometrium. The most prominent color Doppler feature was the presence of interphase hypervascularity with abnormal vessels linking the placenta to the bladder, and the rate was 95.24%. CONCLUSION Placenta previa accreta can be diagnosed made with a thorough two dimensional ultrasonographic and color Doppler examination in patients with previous cesarean scar and placenta previa.
Adult ; Cesarean Section ; Cicatrix ; complications ; Female ; Humans ; Placenta Accreta ; diagnostic imaging ; Placenta Previa ; diagnostic imaging ; Pregnancy ; Ultrasonography ; methods ; Ultrasonography, Doppler, Color ; Uterus ; pathology ; Young Adult

PURPOSE: Venous air embolism (VAE) is characterized by the entrainment of air or exogenous gases from broken venous vasculature into the central venous system. No study exists regarding the effect of patient positioning on the incidence of VAE during abdominal myomectomy. The purpose of this study was to assess the incidence and grade of VAE during abdominal myomectomy in the supine position in comparison to those in the head-up tilt position using transesophageal echocardiography. MATERIALS AND METHODS: In this study, 84 female patients of American Society of Anesthesiologist physical status I or II who were scheduled for myomectomy under general anesthesia were included. Patients were randomly divided into two groups: supine group and head-up tilt group. Transesophageal echocardiography images were videotaped throughout the surgery. The tapes were then reviewed for VAE grading. RESULTS: In the supine group, 10% of the patients showed no VAE. Moreover, 10% of the patients were classified as grade I VAE, while 50% were categorized as grade II, 22.5% as grade III, and 7.5% as grade IV. In the head-up tilt group, no VAE was detected in 43.2% of the patients. In addition, 18.2% of the patients were classified as grade I VAE, 31.8% as grade II, and 6.8% as grade III; no patients showed grade IV. VAE grade in the head-up tilt group was significantly lower than that in the supine group (p<0.001). CONCLUSION: The incidence and grade of VAE in the head-up tilt group were significantly lower than those in the supine group during abdominal myomectomy.
Abdomen/pathology ; Adult ; Echocardiography, Transesophageal ; Embolism, Air/epidemiology/*etiology ; Female ; Humans ; Incidence ; Middle Aged ; Myoma/pathology/*surgery ; *Posture ; Supine Position ; Uterine Myomectomy/adverse effects/*methods ; Uterus/pathology/ultrasonography ; Veins/*ultrasonography

We would like to report a case of leiomyoma of the ovaries in a dog. Leiomyoma is commonly seen in the vagina in dogs. However, it is a very rare neoplasm in the ovaries. As there have only been a few reported cases, this report provides valuable information on veterinary medicine and pathology. Masses found in the ovaries need to be differentiated from other ovarian tumors. Therefore, we describe the gross, histopathological, and immunohistochemical features of a case of ovarian leiomyoma in a 10-year-old female Yorkshire Terrier dog. The mass on the right of the uterus was found accidentally by pelvic ultrasonography. Laparatomy revealed a large multi-nodulated ovarian mass. Grossly, cut surfaces of the mass showed multiple firm whitish nodules in the cortex and bloody loose connective tissue in the medulla. Histopathologically, the cortex of the mass was composed of spindle cells forming interlacing fascicles. The cells had elongated, blunt-ended nuclei and eosinophilic cytoplasm as detected by hematoxylin and eosin staining. Immunohistochemical stained sections were immunoreactive for alpha-smooth muscle actin and desmin but negative for vimentin and S-100. Therefore, differential diagnosis confirmed leiomyoma based on morphology and positive staining for alpha-smooth muscle actin and desmin.
Actins ; Animals ; Child ; Connective Tissue ; Cytoplasm ; Desmin ; Diagnosis, Differential ; Dogs* ; Eosine Yellowish-(YS) ; Eosinophils ; Female ; Hematoxylin ; Humans ; Leiomyoma* ; Ovary* ; Pathology ; Ultrasonography ; Uterus ; Vagina ; Veterinary Medicine ; Vimentin

This is the first case report of a patient with a large serous cystadenoma accompanied by a juvenile granulosa cell tumor that was discovered in the remaining ovarian tissue. A 25-year-old female was presented with constipation and amenorrhea. Ultrasonography revealed a large cystic mass in the left ovary with a normal uterus. The remaining ovarian tissue seemed normal at first look after cystectomy, but showed abnormal consistency on palpation. The remaining ovarian tissue was removed and granulosa cell tumor was confirmed by pathologic examination. The patient has been followed up for 30 months without evidence of recurrence. We would like to emphasize the importance of inspection, and palpation of remaining ovarian tissue during operation to avoid risks of remaining ovarian pathology.
Adult ; Amenorrhea ; Constipation ; Cystadenoma, Serous* ; Cystectomy ; Female ; Granulosa Cell Tumor* ; Granulosa Cells* ; Humans ; Ovarian Neoplasms ; Ovary* ; Palpation ; Pathology ; Recurrence ; Ultrasonography ; Uterus

Endometriosis is a condition where uterine mucosal tissue is located outside of the uterus, which may be pelvic or extrapelvic. The term endometrioma is used when extrapelvic endometriosis appears as a discrete mass. A 34-year-old female, with an abdominal mass along the scar site of a cesarean section, was transferred from her local hospital following the diagnosis of a foreign body granuloma or infected lipoma. The patient had history of two cesarean sections, 5 and 7.5 years previously. The abdominal mass was associated with abdominal pain, which increased in severity during her menstrual cycle. The ultrasonography showed a solid irregular, ill defined mass, with heterogeneous echogenicity. The cytological findings showed epithelial and stromal cells. A mass excision was performed under local anesthesia. The final pathology results confirmed an endometrioma in the abdominal wall, and the microscopic findings indicated benign endometrial glands, with surrounding spindled endometrial cells in the soft tissue of the abdominal wall. The treatment of choice is wide local excision of endometrial tissue, with a clear margin. An endometrioma in the abdominal scar, following a cesarean section, is a rare event, but may be more frequent than estimated from the literature. This case was reported with a brief review of the literature.
Abdominal Pain ; Abdominal Wall ; Adult ; Anesthesia, Local ; Cesarean Section ; Cicatrix* ; Diagnosis ; Endometriosis* ; Female ; Granuloma, Foreign-Body ; Humans ; Lipoma ; Menstrual Cycle ; Mucous Membrane ; Pathology ; Pregnancy ; Stromal Cells ; Ultrasonography ; Uterus

A 56-year-old female was referred to our hospital due to a mass measuring 5 cm in size in the left pelvic cavity, which was found incidentally during a health examination by ultrasonography. Exploratory laparotomy was performed and the mass was located at the left retroperitoneal parametrium without invasion of the uterus and ovary. The pathology report confirmed squamous cell carcinoma. Even after further studies, we did not find any other primary lesion. Human papillomavirus (HPV) DNA chip test (HPV 9G DNA Membrane Kit, Biometrixtechnology Inc.) showed that the surgical specimen was positive for HPV 18. She received adjuvant chemotherapy and would receive radiation therapy for the possibility of occult gynecologic cancer. Retroperitoneal squamous cell carcinoma of unknown primary is extremely rare and little is known about it. It is reported that HPV may be associated with the disease. Hence, the result of HPV test could have an impact on finding a suspicious primary lesion and treatment modality in this case.
Carcinoma, Squamous Cell* ; Chemotherapy, Adjuvant ; DNA ; Female ; Human papillomavirus 18 ; Humans ; Laparotomy ; Membranes ; Middle Aged ; Oligonucleotide Array Sequence Analysis ; Ovary ; Pathology ; Retroperitoneal Neoplasms ; Ultrasonography ; Uterus

We describe a case of recurrent uterine rupture at the site of a previous rupture. Our patient had a history of right interstitial pregnancy with spontaneous uterine fundal rupture at 18 weeks of pregnancy. During her subsequent pregnancy, she was monitored closely by a senior consultant obstetrician. The patient presented at 34 weeks with right hypochondriac pain. She was clinically stable and fetal monitoring showed no signs of fetal distress. Ultrasonography revealed protrusion of the intact amniotic membranes in the abdominal cavity at the uterine fundus. Uterine rupture is a rare but hazardous obstetric complication. High levels of caution should be exercised in patients with a history of prior uterine rupture, as they may present with atypical symptoms. Ultrasonography could provide valuable information in such cases where there is an elevated risk of uterine rupture at the previous rupture site.
Abdominal Pain ; Adult ; Amnion ; diagnostic imaging ; pathology ; Female ; Humans ; Infant, Newborn ; Laparotomy ; Magnetic Resonance Imaging ; Pregnancy ; Pregnancy Complications ; diagnostic imaging ; Pregnancy Outcome ; Recurrence ; Ultrasonography ; Uterine Rupture ; diagnostic imaging ; Uterus ; diagnostic imaging ; pathology

A 32-year-old multiparous woman (gravida 2, para 2) with a history of previous cesarean section had acute abdominal pain and collapsed at 21 weeks of gestation. Exploratory laparotomy was performed because of the patient's worsening condition; ultrasound examination results were suggestive of massive hemoperitoneum, and fetus in vertex presentation with bradycardia. Uterine rupture between the left lower segment and borderline of the cervix in the anterior wall with active bleeding was confirmed. An uncomplicated classical cesarean section was performed, but the fetus was stillborn due to preterm birth. Hysterectomy was performed after the cesarean section. The patient was admitted to intensive care units for 3 days and was discharged in 12 days following delivery. Placenta percreta at the anterior lower segment of the uterus was confirmed in the pathology report.
Abdominal Pain ; Adult ; Bradycardia ; Cervix Uteri ; Cesarean Section ; Female ; Fetus ; Hemoperitoneum ; Hemorrhage ; Humans ; Hysterectomy ; Intensive Care Units ; Laparotomy ; Pathology ; Placenta Accreta* ; Placenta* ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnancy* ; Premature Birth ; Ultrasonography ; Uterine Rupture* ; Uterus