Angiomatoid Spitz nevus is a variant of melanocytic nevus with prominent vasculature. Due to its pathologic features, angiomatoid Spitz nevus in the vaginal wall is extremely rare. A 42-year-old woman presented to the hospital with abnormal vaginal bleeding. Vaginal examination revealed a 2×2-cm well-demarcated tumor on the posterior wall of the vagina. The mass was successfully removed by complete excision and was diagnosed as angiomatoid Spitz nevus on pathologic examination. We present the first reported case of vaginal angiomatoid Spitz nevus, which caused vaginal bleeding. Although angiomatoid Spitz nevus has many histopathological similarities with malignant melanoma, precise histopathological diagnosis is important for preventing overtreatment.
Adult ; Diagnosis ; Female ; Gynecological Examination ; Humans ; Medical Overuse ; Melanoma ; Nevus, Epithelioid and Spindle Cell ; Nevus, Pigmented ; Uterine Hemorrhage ; Vagina

In 2017, 10 topics were selected as major clinical research advances in gynecologic oncology. For cervical cancer, efficacy and safety analysis results of a 9-valent human papillomavirus (HPV) vaccine and long-term impact of reduced dose of quadrivalent vaccine were updated. Brief introduction of KEYNOTE trials of pembrolizumab, a monoclonal antibody that blocks the interaction between programmed death (PD)-1 and its ligands, PD-L1 and PD-L2, followed. Tailored surveillance programs for gynecologic cancer related with Lynch syndrome and update on sentinel lymph node mapping were reviewed for uterine corpus cancer. For ovarian cancer, 5 topics were selected including poly(ADP-ribose) polymerases inhibitors and immunotherapy. The other potential practice changers covered in this review were lymphadenectomy in advanced disease, secondary cytoreductive surgery in recurrent disease, weekly dose-dense regimen for first-line chemotherapy, incorporation of bevacizumab maintenance in platinum-sensitive recurrent disease, and effect of platinum-free interval prolongation. Conflicting opinions of academic societies on periodic pelvic examination were introduced in conjunction with relevant literature review. For the field of radiation oncology, results of 2 big trials, The Postoperative Radiation Therapy in Endometrial Carcinoma-3 and Gynecologic Oncology Group-258, for endometrial cancer and recent advance in high-dose-rate brachytherapy for cervical cancer were reported. Topics for breast cancer covered adjuvant capecitabine after preoperative chemotherapy, adjuvant pertuzumab and trastuzumab in early human epidermal growth factor receptor 2-positive disease, olaparib for metastatic cancer in patients with a germline BRCA mutation, 20-year risks of recurrence after stopping endocrine therapy at 5 years, and contemporary hormonal contraception and the risk of breast cancer.
Bevacizumab ; Brachytherapy ; Breast Neoplasms ; Capecitabine ; Chemotherapy, Adjuvant ; Colorectal Neoplasms, Hereditary Nonpolyposis ; Contraception ; Drug Therapy ; Endometrial Neoplasms ; Female ; Gynecological Examination ; Humans ; Immunotherapy ; Ligands ; Lymph Node Excision ; Lymph Nodes ; Molecular Targeted Therapy ; Ovarian Neoplasms ; Poly(ADP-ribose) Polymerase Inhibitors ; Poly(ADP-ribose) Polymerases ; Radiation Oncology ; Receptor, Epidermal Growth Factor ; Recurrence ; Trastuzumab ; Uterine Cervical Neoplasms

Malignant melanoma of the genital tract is a rare disease that is usually diagnosed by chance. When a definite diagnosis is delayed, the prognosis is very poor without standardized treatment. Herein, we describe a 40-year-old patient who presented with a history of bloody vaginal discharge for 7 months. Gynecological examination showed an exophytic, hard and pigmented cervical mass involving the upper vagina. The patient was diagnosed with cervical melanoma after a punch biopsy and underwent a radical hysterectomy, upper vaginectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy. After surgeries, the patient underwent 2-cycles of adjuvant immunotherapy with pembrolizumab, but died within 8 months. In this report, treatment with pembrolizumab after radical surgery was not effective for this patient who had a primary cervical melanoma that metastasized to bone and lung tissue. We do not know why pembrolizumab was ineffective for this patient, but there are several possible explanations; further research is needed.
Adult ; Antibodies, Monoclonal, Humanized ; Biopsy ; Cervix Uteri* ; Diagnosis ; Female ; Gynecological Examination ; Humans ; Hysterectomy ; Immunotherapy ; Lung ; Lymph Node Excision ; Melanoma* ; Prognosis ; Rare Diseases ; Uterine Cervical Neoplasms ; Vagina ; Vaginal Discharge

Dermoid cysts or mature cystic teratoma are the most common type of ovarian germ cell tumor. It may be complicated by torsion, rupture, chemical peritonitis and malignant change but is rarely complicated by infection. We present a case of an ovarian dermoid cyst with super-infection caused by Schistosoma haematobium (S. haematobium). We present here a case of incidental finding of S. haematobium eggs in an infected cystic teratoma of the ovary because of the rare occurrence of this lesion. A 45-year-old Moroccan woman admitted to the gynecological department because of abdominal pain and fever. Gynecological examination, ultrasonography, and abdominopelvic computed tomography scan revealed an ovarian mass thought to be a dermoid cyst. The pathological evaluation suggested infected ovarian dermoid cyst with the presence of adult worm in the tumor, contains same eggs of S. haematobium. Super-infection of an ovarian dermoid cyst is a rare event, and the association with S. haematobium is extremely rare in the literature.
Abdominal Pain ; Adult ; Dermoid Cyst* ; Eggs ; Female ; Fever ; Gynecological Examination ; Humans ; Incidental Findings ; Middle Aged ; Neoplasms, Germ Cell and Embryonal ; Ovary ; Ovum ; Peritonitis ; Rupture ; Schistosoma haematobium ; Teratoma ; Ultrasonography

OBJECTIVE: To evaluate the effect of tamoxifen on female reproductive organs in women with breast cancer. METHODS: We retrospectively reviewed the medical records of 309 women with breast cancer who were currently receiving tamoxifen and undergoing regular gynecological examination. RESULTS: We evaluated 92 pre- and 217 postmenopausal women. The prevalence of endometrial thickening was 12% in the pre- and 10.6% in the postmenopausal group. An endometrial biopsy was performed in 43 women and confirmed endometrial cancer in 1, endometrial polyps in 14, and endometrial hyperplasia in 4 women. Transvaginal ultrasonography showed 25 cases of newly developed ovarian cysts. Most ovarian cysts had disappeared during follow-up. CONCLUSION: Tamoxifen use in women with breast cancer causes few complications and is considered safe for female reproductive organs in case of regular gynecological examination.
Biopsy ; Breast Neoplasms* ; Breast* ; Endometrial Hyperplasia ; Endometrial Neoplasms ; Endometrium* ; Female ; Follow-Up Studies ; Gynecological Examination ; Humans ; Medical Records ; Ovarian Cysts* ; Ovary ; Polyps ; Prevalence ; Retrospective Studies ; Tamoxifen* ; Ultrasonography

OBJECTIVE: Human papillomavirus (HPV) testing is widely incorporated into cervical cancer screening strategies. Current screening requires pelvic examination for cervical sampling, which may compromise participation. The acceptance could be raised by introducing testing on vaginal swabs. We explored the interchangeability of vaginal swabs and cervical smears for HPV testing, by means of a prospective study conducted in female sex workers (FSWs). Besides, we report on the occurrence of 32 different HPV genotypes in FSW with low-grade squamous intraepithelial lesion (LSIL) or high-grade squamous intraepithelial lesion (HSIL). METHODS: Paired physician-collected vaginal swabs and cervical smears from 303 FSW were tested for HPV using the Abbott RealTime High-Risk HPV assay. Cervical cytology was examined on cervical smears. In case of HSIL/LSIL cytological classification (n=52), both samples were genotyped using INNO-LiPa HPV Genotyping Extra II. RESULTS: The overall prevalence of high-risk (HR)-HPV was 51%. In FSW with HSIL/LSIL cervical cytology, the sensitivity and specificity of vaginal samples for the detection of HR-HPV was 100% and 70% and for probable HR-HPV 100% and 91%. The mean number of genotypes identified in vaginal samples (mean=3.5; 95% confidence interval [CI]=2.8–4.2) was significantly higher than in cervical smear samples (mean=2.6; 95% CI=2.1–3.0) (p=0.001). The most frequently encountered HR-HPV genotypes were HPV16, 31, 51, and 52. CONCLUSION: As our study shows that vaginal swabs are equivalent to cervical smears for the detection of (probable) HR-HPV, vaginal swabs can be used for HPV testing in cervical cancer screening strategies. Given the acceptance of vaginal sampling, this finding offers an opportunity to boost screening coverage.
Chlamydia trachomatis ; Classification ; DNA ; Female ; Genotype ; Gynecological Examination ; Humans ; Mass Screening ; Mycoplasma genitalium ; Neisseria gonorrhoeae ; Papillomaviridae ; Prevalence ; Prospective Studies ; Sensitivity and Specificity ; Sex Workers ; Sexually Transmitted Diseases ; Squamous Intraepithelial Lesions of the Cervix ; Trichomonas vaginalis ; Uterine Cervical Neoplasms ; Vaginal Smears

Pelvic organ prolapse (POP) is bulging of one or more of the pelvic organs into the vagina and triggered by multiple causes. It is a very common disorder, especially among older women. POP is characterized by protrusion of the presentation part visible by the naked eye, and problems with urination or bowel movements. POP can be diagnosed based on the onset of symptoms and a pelvic exam, and management options include medical and surgical treatment. Although medical treatment cannot correct the abnormal herniation of the pelvic structures, this can help alleviate symptoms. One of the disadvantages of surgical interventions is recurrence, and advances in surgical techniques have decreased recurrence rates of POP. Therefore, author will explain the gynecology and urology approach and treatment.
Cystocele ; Female ; Gynecological Examination ; Gynecology ; Humans ; Pelvic Organ Prolapse ; Rectocele ; Recurrence ; Urination ; Urology ; Vagina

BACKGROUND: Bacterial vaginosis (BV) is a very common gynecologic infection associated with a vast number of complications both in gynecologic and obstetric patients. One of the major concerns in its treatment is a high recurrence rate which was multifactorial and the choice of the suitable antimicrobial is important to decrease the treatment failure.

METHODS: All gynecologic patients aged 18 years old and above in a tertiary hospital diagnosed with bacterial vaginosis according to Amsel's criteria. A total of 80 patients were randomly assigned into two groups; one group to receive oral Probiotics (Protexin) while the other group to receive Metronidazole. The patients will be followed up accordingly on Days 1, 3, 7 and 30 and will be graded according to Amsel's criteria. The primary endpoint of the study is the treatment of bacterial vaginosis based on the mentioned criteria. (Anukam, 2006)

RESULTS: The results showed that there was a significant improvement in the character of the vaginal discharge based on the Amsels criteria on Day 1 of treatment for the Metronidazole group (0/40; 100%, p value <0.001) and Day 3 for Oral Lactobacillus arms. (7/40; 20%, p value 0.01). The Metronidazole arm showed a significant improvement in the fishy odor on vaginal examination with addition of 10% KOH on day 1 (0/40; 100%, p value <0.001) and Day 3 for oral Lactobacilus (0/40; 100%, p value 1.00). Then vaginal pH was noted to be more acidic in the Metronidazole compared to the Protexin arm on Day 1 of treatment (0/40; 0% and 40/40; 100% p value

CONCLUSION: The Metronidazole remains to be the standard treatment for Bacterial vaginosis. There was also faster recovery and clinical improvement in the character of the vaginal discharge, amount and smell based on the Amsel's criteria as early as Day 1 of follow-up; however, there was a small number of population with poor compliance resulting to higher recurrence rate which was evident on the 30 th day of follow-up. The oral lactobacillus rhamnosus showed advantage over Metronidazole due to lower recurrence rate of BV as noted on Day 30 of follow up.

Human ; Female ; Aged ; Middle Aged ; Adult ; Pregnancy ; Vaginosis, Bacterial ; Lactobacillus Rhamnosus ; Metronidazole ; Lactobacillus ; Probiotics ; Anti-infective Agents ; Gynecological Examination ; Odorants ; Smell ; Vaginal Discharge

Autoamputated ovary with mature cystic teratoma (MCT) is a rarely reported gynecologic entity with an unknown prevalence. A 34-year-old woman referred to our clinic for presumed left ovarian tumor. Pelvic examination, ultrasonography and computed tomography scan revealed a 5-cm, cystic ovarian mass with calcification and fat component, and tumor markers were as follows, cancer antigen (CA) 125; 10.4 U/mL, CA19-9; 2 U/mL. Laparoscopy was performed. The mass was identified in the left adnexal region without any ligamentous or direct connection with the pelvic organs. The right ovary was normal. However, the left ovary and the tube could not be identified in its proper anatomical location. The mass was successfully removed with sharp and blunt dissection. A review of histopathologic study revealed a MCT. The patient became pregnant within seven months and gave birth to a healthy baby by cesarean section. We present a rare case of an autoamputated ovary with MCT.
Adult ; Amputation ; Biomarkers, Tumor ; Cesarean Section ; Dermoid Cyst ; Female ; Gynecological Examination ; Humans ; Laparoscopy ; Ligaments ; Ovarian Neoplasms ; Ovary* ; Parturition ; Pregnancy ; Prevalence ; Teratoma* ; Ultrasonography

Herlyn-Werner-Wunderlich syndrome is a rare congenital anomaly of the urogenital tract, which is characterized by the triad of uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis. It usually presents at puberty with pelvic pain, dysmenorrhea, and a vaginal or pelvic mass. Although rare, it may present with purulent vaginal discharge due to secondary infection of the obstructed hemivagina, making diagnosis difficult. A careful pelvic examination to identify the cervix and vagina is the key to the diagnosis of Müllerian duct anomalies and magnetic resonance imaging can provide additional useful information. The optimal treatment is full excision and marsupialization of the obstructing vaginal septum so that both uteri can drain through the patent vagina. The authors report a case of a 22-year-old female with an unusual presentation of Herlyn-Werner-Wunderlich syndrome complicated by pyocolpos, which was successfully managed by vaginal septum resection and drainage of pus.
Adolescent ; Cervix Uteri ; Coinfection ; Diagnosis ; Drainage ; Dysmenorrhea ; Female ; Gynecological Examination ; Humans ; Magnetic Resonance Imaging ; Pelvic Pain ; Puberty ; Suppuration ; Uterus ; Vagina ; Vaginal Discharge ; Young Adult