Browsing by Author "Kadija, S. (21739901200)"

Introduction: The authors present an interesting case of large ovarian carcinoma challenging for diagnosis (with lymphonodal and umbilical subcutaneous metastases, but without infiltrating intestines and therefore causing few symptoms). Case Report: A 63-year-old patient, almost completely asymptomatic, presented with large bilateral adnexal masses. ROMA index was elevated. Abdominal and pelvic MRI scan showed presence of 20-cm mixed-consistency tumors of both ovaries and lymphedema in periumbilical subcutis. Only two parailiacal lymph nodes were enlarged. Patient had total hysterectomy with bilateral adnexectomy, selective lymphadenectomy, and excision of subcutaneous tumor. The right tumor formed the incarceration of the intestines, without infiltrating the intestinal wall. Histopathological analysis diagnosed ovarian serous papillary adenocarcinoma with metastases in lymph nodes and umbilical region subcutis. Conclusion: This report highlights that, although very rare, one of the first ovarian carcinoma manifestations can be its subcutaneous/cutaneous metastases. Additionally, lack of clear symptoms can exist in even at the advanced stage. © 2018 S.O.G. CANADA Inc. All rights reserved.

Spindle-cell epithelioma or "mixed tumor" of the vagina is an unusual and intriguing vaginal tumor consisting of both epithelial and mesenchymal components. A case of spindle-cell epithelioma of the vagina diagnosed at delivery of a 31-year-old primiparous woman is described. The excision of the mass was performed immediately after the delivery, which was uneventful. The patient was regularly followed up and no evidence of local recurrence or dissemination was found 40 months after surgery. The presentation and the diagnosis of this kind of tumor in pregnancy, and its effect on the pregnancy and delivery are still largely unknown. Since it is unlikely that any institution will have a large number of patients with this rare disease, case reports add further information to this entity. As the number of cases studied is small, close follow-up is recommended although there has been no report in the literature of metastasis so far.

Background: Cervical ectopic pregnancy is a potentially life-threatening condition due to the unexpected occurrence of uncontrollable bleeding from the cervix. Case Report: A 39-year-old secundigravida was admitted with amenorrhea of 12 weeks and four days due to suspected cervical pregnancy, without bleeding. The ultrasonography revealed a gestational sac at the anterior wall of the isthmic-cervical part with a single viable fetus, with crown-rump length (CRL) of 59 mm and regular heart rate. The serum β-human chorionic gonadotropin (β-hCG) level on admission was 143.416 mIU/1. Two possible therapeutic options were considered, (1) systemic methotrexate treatment and (2) uterine artery embolization with gelatine sponge. The first was rejected due to gestational age, viable fetus, high β-hCG level, and CRL, and the later was rejected by the vascular surgeons due to lack of experience. The curettage was performed. After the evacuation, prostin was administered into cervix accompanied with tamponade. On the next day β-hCG level was 44.342 mIU/1 and the following day ultrasonography revealed the oval non-homogenous formation in the cervical cavity (blood clots or residual trophoblastic tissue); β-hCG level was 36.501 mIU/1. The reintervention was performed on the fifth day after the curettage and 200 ml of coagulated blood was aspirated; β-hCG level was 16.432 mIU/1. Since the isthmic-cervical part was slightly dilated (23 mm) seven days after the curettage, systemic methotrexate treatment (100 mg intramuscular) was initiated. Serum β-hCG level on the second and fourth day after methotrexate were 12.553 mIU/1 and 8.900 mIU/1, respectively. The second dose of 100 mg of methotrexate was administered intramuscular seven days after the first dose. Three days after, β-hCG level was 2.329 U/l and ultrasound scan revealed normal isthmic-cervical finding. Conclusion: The present case report showed efficient fertility sparing conservative treatment, dilatation and curettage, of 13 week cervical pregnancy followed by systemic methotrexate.

A primigravid woman at 29th gestational week with placental abruption causing fetal death, that underwent instant cesarean section, developed a disseminated intravascular coagulation (DIC), revealed by hemoperitoneum and hematoma of the abdominal wall. After re-laparotomy and transfusion of blood, fresh plasma, and platelets, the patient was discharged from hospital on the 14th postoperative day completely recovered. To conclude, conservative surgical approach for DIC treatment is possible and safe. Novel antifibrinolitic drugs are recommended for obstetrical patients with DIC to enable a healthy subsequent pregnancy.

A uterine tumor resembling an ovarian sex cord tumor (UTROSCT) shows a poly phenotypic immunophenotype with coexpression of epithelial, myoid, and sex cord markers, as well as hormone receptors. The authors present a case of a 59-year-old multiparous woman admitted to the Institute of Gynecology and Obstetrics Clinical Centre of Serbia in January 2010 due to prolonged vaginal bleeding and abdominal discomfort. The vaginal ultrasound showed an enlarged uterus size of 100 x 74 x 81 mm, with extended cavity with an unhomogenic content and myomas sized 54 x 69 mm located in fundus with secondary changes. She underwent abdominal hysterectomy with adnexectomy. Microscopic examination revealed submucosal uterine tumor with variabile histological organization that had anastomotic trabeculae with solid cellular grupations. Rare mitotic figures (2/10 HPF) were found. Additional imunohistochemistry showed immunophenotype: the sex cord areas were positive for vimentin(++), aSMA(++), AE1/AE3(+), PR(+), and ER(+). The poly phenotypic immunophenotype can be useful in differential diagnosis from other neoplasms but also suggests an origin of UTROSCT from uncommitted stem cell enabling for multidirectional differentiation.

Introduction: Metastatic renal cell carcinoma is often found in distant organs, including lung, bone, brain,and liver. Metastases to the vagina are extremely rare. Case Report: The authors present a case of renal cell carcinoma metastasis to the anterior vaginal wall four months after nephrectomy in a 56-year-old patient. The vaginal lesions were excised. After two years the patient had no signs of recurrence or the disease progression. Conclusion: Vaginal metastases should be considered in differential diagnosis of female renal cell carcinoma patients presenting with vaginal bleeding of mass.