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23 pages, 11500 KiB

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Ovarian Germ Cell Tumors: Pictorial Essay

by Nicolae Gică, Gheorghe Peltecu, Raluca Chirculescu, Corina Gică, Mihai Ciprian Stoicea, Andreea Nicoleta Serbanica and Anca Maria Panaitescu

Diagnostics 2022, 12(9), 2050; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12092050 - 24 Aug 2022

Cited by 5 | Viewed by 3970

Abstract

Ovarian germ cell tumors of the ovary represent a histologically heterogenous group of tumors with a high incidence at reproductive age. Patients with this pathology are very often young women with amenorrhea. The aim of this article is to present a pictorial essay [...] Read more.

Ovarian germ cell tumors of the ovary represent a histologically heterogenous group of tumors with a high incidence at reproductive age. Patients with this pathology are very often young women with amenorrhea. The aim of this article is to present a pictorial essay of this rare pathology and to promote a national tumor registry and protocol. The treatment is individualized according to age, and fertility-sparing surgery is the actual standard of surgical treatment for young patients in early stage of the disease. Full article

(This article belongs to the Special Issue Interesting Images in Obstetrics and Gynecology)

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8 pages, 10348 KiB

Open AccessInteresting Images

Ruptured Recurrent Interstitial Ectopic Pregnancy Successfully Managed by Laparoscopy

by Claudiu Octavian Ungureanu, Floris Cristian Stanculea, Niculae Iordache, Teodor Florin Georgescu, Octav Ginghina, Raul Mihailov, Ileana Adela Vacaroiu and Dragos Eugen Georgescu

Diagnostics 2024, 14(5), 506; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics14050506 - 27 Feb 2024

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Abstract

Ectopic pregnancies are a frequently encountered cause of first-trimester metrorrhagia. They occur when an embryo is implanted and grows outside the normal uterine space. Uncommonly, the embryo can be implanted in the intramural portion of the uterine tube, a condition referred to as [...] Read more.

Ectopic pregnancies are a frequently encountered cause of first-trimester metrorrhagia. They occur when an embryo is implanted and grows outside the normal uterine space. Uncommonly, the embryo can be implanted in the intramural portion of the uterine tube, a condition referred to as interstitial localization. This specific type of ectopic pregnancy may have an unpredictable course, potentially leading to severe uterine rupture and catastrophic bleeding if not promptly diagnosed and managed. We present a rare case of a multiparous 36-year-old female patient who underwent pelvic ultrasonography in the emergency department for intense pelvic pain associated with hypotension and moderate anemia. A history of right salpingectomy for a ruptured tubal ectopic pregnancy 10 years previously was noted. High beta-HCG levels were also detected. A pelvic ultrasound allowed us to suspect a ruptured ectopic interstitial pregnancy at 8 weeks of amenorrhea. An association with hemoperitoneum was suspected, and an emergency laparoscopy was performed. The condition was confirmed intraoperatively, and the patient underwent a right corneal wedge resection with suture of the uterine myometrium. The postoperative course was uneventful, and the patient was discharged on the fourth day postoperatively. Interstitial ectopic pregnancy is a rare yet extremely perilous situation. Timely ultrasound-based diagnosis is crucial as it can enable conservative management with Methotrexate. Delayed diagnosis can lead to uterine rupture with consecutive surgery based on a transection of the pregnancy and cornual uterine resection. Full article

(This article belongs to the Special Issue Interesting Images in Obstetrics and Gynecology)

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4 pages, 767 KiB

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Umbilical Cord Wraps around a Newborn’s Legs like Ankle Shackles

by Kun-Long Huang, Ching-Chang Tsai, Hsin-Hsin Cheng, Yun-Ju Lai, Pei-Fang Lee and Te-Yao Hsu

Diagnostics 2024, 14(4), 444; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics14040444 - 17 Feb 2024

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Abstract

A 36-year-old woman, gravida 3, para 1 (previous cesarean section), with one medical abortion, and no history of systemic diseases presented an unremarkable medical history during prenatal visits. The final prenatal ultrasound at 38 weeks of gestation showed a vertex presentation, a weight [...] Read more.

A 36-year-old woman, gravida 3, para 1 (previous cesarean section), with one medical abortion, and no history of systemic diseases presented an unremarkable medical history during prenatal visits. The final prenatal ultrasound at 38 weeks of gestation showed a vertex presentation, a weight of 2600 g, a normal amniotic fluid level, and the placenta located on the posterior wall of the uterus. Fetal cardiotocography conducted before delivery reported a reactive heart rate without decelerations. The Doppler wave analysis of the fetal umbilical artery was normal (the ratio of peak-systolic flow velocity to the end-diastolic flow velocity was 2.5) without the absence or reversal of end-diastolic velocity. The total score of the fetal biophysical profile by ultrasound was 8. The night before the scheduled cesarean section, she experienced heightened anxiety and was unable to sleep, noting “crazy” fetal movements throughout the night. During the cesarean section, it was discovered that the umbilical cord was wrapped around the newborn’s legs, resembling ankle shackles. The fetal weight was 2740 g, and Apgar scores were 9 at the first minute and 10 at the fifth minute. The motility of the neonatal legs was normal without cyanosis or neurological adverse outcomes. Full article

(This article belongs to the Special Issue Interesting Images in Obstetrics and Gynecology)

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6 pages, 2172 KiB

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Prenatal Detection of Rapid Progressive Changes in Massive Lymphangioma from Flank to the Lower Extremity

by Saipin Pongsatha, Phudit Jatavan, Panisa Hantrakun and Theera Tongsong

Diagnostics 2023, 13(13), 2130; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics13132130 - 21 Jun 2023

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Abstract

Lymphangioma is a congenital anomaly in which abnormal lymphatic drainages localize to form a benign mass, but it has the tendency to grow in size and the potential to infiltrate surrounding structures, causing devastating effects and leading to severe morbidity. The most common [...] Read more.

Lymphangioma is a congenital anomaly in which abnormal lymphatic drainages localize to form a benign mass, but it has the tendency to grow in size and the potential to infiltrate surrounding structures, causing devastating effects and leading to severe morbidity. The most common site of lymphangioma is the neck region (cystic hygroma colli), whereas lymphangioma in the lower limbs is very rare, accounting for only 2% of cases. Accordingly, the prenatal diagnosis of lymphangioma of the lower limbs has been scarcely reported. This study describes two cases of lymphangioma of the lower limbs, focusing on unique sonographic features and the natural course of rapidly progressive changes, which is different from nuchal lymphangioma. Based on previous isolated case reports together with our two cases, lymphangioma of the lower limbs usually develops in the second trimester, tends to have rapidly progressive changes, and is unlikely to be associated with aneuploidy and structural anomalies. Diagnoses can be made by using sonographic findings pertaining to the subcutaneous complex and multi-septate anechoic cystic lesions in the lower limbs, the latter of which can infiltrate visceral structures. Prenatal detection can be helpful in laying the groundwork for providing counseling to the parents and the planning of management strategies, i.e., opting to terminate the pregnancy, revising delivery plans, and looking towards the postnatal management of the infant. Full article

(This article belongs to the Special Issue Interesting Images in Obstetrics and Gynecology)

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2 pages, 378 KiB

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Placenta Previa et Percreta: A Potentially Life-Threatening Condition

by Cornelia Bachmann, Harald Abele and Markus Hoopmann

Diagnostics 2023, 13(3), 539; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics13030539 - 01 Feb 2023

Cited by 1 | Viewed by 5125

Abstract

Placenta percreta occurs in about 5% of placenta accreta spectrum (PAS) and causes high maternal and fetal peripartum morbidity/mortality. A 34-year-old multiparous 4G2P (1xcesarean section (CS)) was admitted to hospital at the 34th week of gestation. Transvaginal ultrasound revealed a placenta previa totalis [...] Read more.

Placenta percreta occurs in about 5% of placenta accreta spectrum (PAS) and causes high maternal and fetal peripartum morbidity/mortality. A 34-year-old multiparous 4G2P (1xcesarean section (CS)) was admitted to hospital at the 34th week of gestation. Transvaginal ultrasound revealed a placenta previa totalis et percreta with a small tissue layer towards the bladder. Ultrasound was crucial for further planning. An interdisciplinary setting was established based on this life-threatening diagnosis. Due to the onset of labor one day later, a CS was performed. Intraoperatively, the suspicion was confirmed of a placenta previa et percreta with CS scar infiltration. Due to the life-threatening bleeding risk, simultaneous subtotal hysterectomy was needed. The diagnosis was confirmed histologically. The higher the number of previous CS, the higher the PASrate. Placenta percreta is the most severe form of this, characterized by placental invasion through the entirety of the myometrium and possibly into extrauterine tissues. This case demonstrates the great importance of prenatal diagnosis with the realization of dimensions of this very rare finding, especially with an increasing CS rate and other associated complications. Due to the close interdisciplinary cooperation of the prenatal diagnosticians, obstetricians, and anesthesiologists with optimal care in a specialized center, the otherwise high morbidity/mortality can be minimized. Full article

(This article belongs to the Special Issue Interesting Images in Obstetrics and Gynecology)

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7 pages, 1641 KiB

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Popcorn Appearance of Severely Calcified Uterine Leiomyoma: Image-Pathological Correlation

by Charuwan Tantipalakorn, Surapan Khunamornpong, Sirinart Sirilert and Theera Tongsong

Diagnostics 2023, 13(1), 154; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics13010154 - 02 Jan 2023

Cited by 2 | Viewed by 4534

Abstract

Calcified subserous leiomyoma is a rare benign tumor commonly seen in the postmenopausal age group. Cases with severely calcified degeneration all over the mass are extremely rare. It causes diagnostic confusion with the solid calcified adnexal mass and the large bladder calculi in [...] Read more.

Calcified subserous leiomyoma is a rare benign tumor commonly seen in the postmenopausal age group. Cases with severely calcified degeneration all over the mass are extremely rare. It causes diagnostic confusion with the solid calcified adnexal mass and the large bladder calculi in the pelvis. We hereby present a case of heavily calcified subserous uterine leiomyoma in a 66-year-old postmenopausal woman. An X-ray of the abdomen and pelvis and CT scan showed a pelvic mass with scattered popcorn appearance in the pelvis, representing severely calcified discrete spots all over the mass. Sonographically, different from typical uterine leiomyomas which exhibit recurrent refractory shadowing patterns, our case showed heavy homogeneous acoustic shadow obscuring all structures beneath the mass surface, resulting in a suboptimal ultrasound examination. Accordingly, CT scans, which are usually not a primary tool for the diagnosis of uterine leiomyomas, are helpful to characterize the mass and identify their organ of origin. The case presented here was treated with a hysterectomy with bilateral oophorectomy and was post-operatively confirmed for severely calcified subserous leiomyomas. Full article

(This article belongs to the Special Issue Interesting Images in Obstetrics and Gynecology)

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4 pages, 6255 KiB

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A Rare Case of Collision Tumours of the Ovary: An Ovarian Serous Cystadenoma Coexisting with Fibrothecoma

by Michele Mongelli, Erica Silvestris, Vera Loizzi, Gennaro Cormio, Gerardo Cazzato and Francesca Arezzo

Diagnostics 2022, 12(11), 2840; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12112840 - 17 Nov 2022

Cited by 3 | Viewed by 4258

Abstract

The incidence of epithelial tumours of the ovary ranges from 9–17 per 100,000 and is the highest in high-income countries, with the exception of the Japan. The coexistence of neoplastic Müllerian epithelial and sex cord-stromal elements within a single tumour is extremely rare. [...] Read more.

The incidence of epithelial tumours of the ovary ranges from 9–17 per 100,000 and is the highest in high-income countries, with the exception of the Japan. The coexistence of neoplastic Müllerian epithelial and sex cord-stromal elements within a single tumour is extremely rare. We describe the case of a 74-year-old woman with a voluminous left adnexal formation. Pre-operative assessment with ultrasound evaluation made a suspicious diagnosis of benignity of the lesion. Bilateral salpingo-ovariectomy was performed. Intraoperative frozen section analysis results in the diagnosis of fibrothecoma in the context of serous cystadenoma. The diagnosis is confirmed by histological examination. Some authors suggest labelling this phenomenon as collision tumours. Full article

(This article belongs to the Special Issue Interesting Images in Obstetrics and Gynecology)

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7 pages, 1617 KiB

Open AccessCase Report

Herlyn-Werner-Wunderlich Syndrome: Case Report and Review of the Literature

by Anca Maria Panaitescu, Gheorghe Peltecu and Nicolae Gică

Diagnostics 2022, 12(10), 2466; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12102466 - 12 Oct 2022

Cited by 1 | Viewed by 4833

Abstract

Herlyn-Werner-Wunderlich (HWW) syndrome is a very rare congenital malformation of the urogenital tract involving both the müllerian and the wolffian ducts, and it consists of the association of didelphys uterus, ipsilateral obstructed hemivagina, and ipsilateral kidney agenesis. Its etiology is related to the [...] Read more.

Herlyn-Werner-Wunderlich (HWW) syndrome is a very rare congenital malformation of the urogenital tract involving both the müllerian and the wolffian ducts, and it consists of the association of didelphys uterus, ipsilateral obstructed hemivagina, and ipsilateral kidney agenesis. Its etiology is related to the abnormal development of two embryonic structures—mesonephros and paramesonephros—although its precise mechanism is not known, but theories involving signaling molecules and gene expression are studied for potential explanations. Because of its rarity, there is limited literature on this subject. We present a case diagnosed in our department and elaborate on management. In HWW syndrome, symptoms appear after menarche and include pelvic pain, with progressive intensity due to the developing of hematocolpos. Menstruation may be present or absent depending on the type of anomaly. The use of magnetic resonance imaging (MRI) is the most recommended method of investigation since, in most cases, at this age, sexual life has not started yet and transvaginal ultrasound cannot be used. Surgical treatment in our case consisted of an exploratory laparoscopy followed by a vaginal surgical approach to resect the vaginal septum of the obstructed hemivagina. Full article

(This article belongs to the Special Issue Interesting Images in Obstetrics and Gynecology)

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5 pages, 1080 KiB

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An Unruptured True Aneurysm of the Uterine Artery during Pregnancy

by Charuwan Tantipalakorn, Suchaya Luewan, Sirinart Sirilert and Theera Tongsong

Diagnostics 2022, 12(10), 2459; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12102459 - 11 Oct 2022

Cited by 1 | Viewed by 1601

Abstract

The antenatal diagnosis of an unruptured true aneurysm of the uterine artery is extremely rare and has never been reported, whereas pseudoaneurysms associated with previous trauma or cesarean section have been reported several times. True aneurysms occur when the artery or vessel weakens [...] Read more.

The antenatal diagnosis of an unruptured true aneurysm of the uterine artery is extremely rare and has never been reported, whereas pseudoaneurysms associated with previous trauma or cesarean section have been reported several times. True aneurysms occur when the artery or vessel weakens and bulges, sometimes forming a blood-filled sac. Nearly all cases of pelvic true aneurysms involved ovarian arteries which ruptured during the peripartum period. The case presented here is unique in terms of being an unruptured true aneurysm of the uterine artery with a first diagnosis during pregnancy at 32 weeks of gestation and the spontaneous development of thrombosis in the aneurysm in late pregnancy, documented at 37 weeks of gestation. The diagnosis of a true aneurysm of the uterine artery was based on, (1) a demonstration of the cystic mass located in proximity to the lower segment of the uterus with ultrasound characteristics of arterial flow in the mass, and (2) the occurrence in a woman who had no history of trauma or surgery in the pelvis. The finding during cesarean section confirmed the prenatal sonographic finding. The pregnancy ended with successful outcomes. Full article

(This article belongs to the Special Issue Interesting Images in Obstetrics and Gynecology)

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4 pages, 1290 KiB

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Fetal Atrial Septal Aneurysm: Follow-Up from Second to Third Trimester

by Roxana Gireadă, Alexandra Ursache, Roxana Matasariu and Răzvan Socolov

Diagnostics 2022, 12(6), 1469; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12061469 - 15 Jun 2022

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Abstract

Atrial septal aneurysm (ASA) is a rarely reported fetal finding. Its definition is variable, but the diagnosis is usually made when the foramen ovale flap extends at least halfway across the left atrium. It is considered a transient, self-limiting condition, but on occasion, [...] Read more.

Atrial septal aneurysm (ASA) is a rarely reported fetal finding. Its definition is variable, but the diagnosis is usually made when the foramen ovale flap extends at least halfway across the left atrium. It is considered a transient, self-limiting condition, but on occasion, it can be complicated by fetal arrhythmia or left ventricular (LV) inflow obstruction—if longstanding, this can lead to left heart hypoplasia. We present two cases of ASA diagnosed at the second trimester scan, one of which was subsequently complicated by LV inflow obstruction and prenatal suspicion of hypoplastic aortic arch. This report is a good illustration of how structure follows function: a small LV preload can lead to a decreased LV output, which in turn will end up in a hypoplastic LV and outflow tract—all this is reversible after birth, due to the physiological circulatory modifications that occur in the newborn. Full article

(This article belongs to the Special Issue Interesting Images in Obstetrics and Gynecology)

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