Browsing by Author "Stojnic, J. (13613250800)"

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.

Purpose of investigation: To determine whether in vitro fertilization/intracytoplasmatic sperm injection (IVF/ICSI) singleton pregnancies are at increased risk for maternal and fetal complications than spontaneous singleton conceptions. Materials and Methods: The pregnancy outcome of 634 singleton pregnancies after IVF/ICSI delivered at the Clinic for Gynecology and Obstetrics during the period January 2006 to January 2010 were compared to 634 matched singleton controls, matched one by one by age, parity, education, and body mass index (BMI). Differences in pregnancy outcomes between the groups were assessed using Student's t-test with Yates correction for continuous variables and Chi-squared test for categorical variables. Results: The mean gestational age at delivery of the IVF group was 38.13 ± 1.72 weeks, slightly shorter than spontaneously conceived singletons at 38.65 ± 1.79 weeks. The diagnosis of gestational diabetes mellitus (GDM) was frequently made in the IVF group (11.82% vs 8.35%, t = 2.052, p < 0.05). Total preterm delivery rate of IVF pregnancies was 9.30%, significantly higher than the controls 5.85% (t = 2.33, p < 0.05), especially at the 30-32 weeks gestation period. The predominant mode of delivery after IVF pregnancy was cesarean section (80.75% vs 31.38% at spontaneously conceived, t = 17.71, p < 0.001), while vaginal route was the choice for naturally originated pregnancies 68.6% vs 19.24% (p < 0.01). No differences were found in the average birth weights, LBW, VLBW, SGA, and LGA regarding the pregnancy origin. Perinatal mortality rates were comparable among singletons with different pregnancy origin. Conclusions: Singletons from IVF/ICSI pregnancies have poorer perinatal outcome associated with higher rates of cesarean sections, preterm birth and prematurity, fetal malpresentation (breech presentation), and the occurrence of maternal GDM in pregnancy.

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.

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.