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Background: Mature cystic teratomas, also known as dermoid cysts, are the most prevalent form of ovarian germ cell tumors. While they typically manifest in women of reproductive age, they can also occur in pediatric patients. These tumors are generally benign and comprise a diverse array of tissue types. However, large lesions, particularly those exceeding 10 cm in diameter, are infrequent and can present diagnostic and therapeutic challenges. Notably, elevated tumor markers, such as cancer antigen 19-9 (CA 19-9), are not commonly associated with mature cystic teratomas, rendering this case particularly unusual. Case presentation: The clinical case involved an 8-year-old female patient who presented with an exceptionally large ovarian teratoma, measuring 13 × 12 cm. While the prepubertal presentation of such tumors is not uncommon, the remarkable size of the lesion was an extraordinary occurrence. Preoperative evaluation revealed markedly elevated levels of CA 19-9, a tumor marker, at 297 U/mL-an atypical finding for mature cystic teratomas. Imaging studies identified a complex cystic adnexal mass, indicative of a teratoma. Consequently, a laparotomy was performed, revealing an intact, benign lesion that was successfully resected via cystectomy, with preservation of the ovary. Histopathological examination confirmed the diagnosis of a mature cystic teratoma, without any evidence of malignant transformation. Notably, following the surgical intervention, the elevated CA 19-9 levels normalized, suggesting a potential association between the teratoma and the abnormal tumor marker levels. Discussion: This report delineates the surgical management and clinical course of an exceptionally large ovarian teratoma in a pediatric patient with abnormal preoperative tumor markers. Despite atypical features, the excellent prognosis following fertility-sparing resection underscores the significance of conservative treatment in young females. Conclusion: This case highlights the occurrence of a large mature cystic teratoma with elevated CA-19-9 in a pediatric patient with no complications such as torsion, rupture, or malignancy. The elevation in CA-19-9 likely relates directly to the teratoma itself. A conservative, fertility-sparing surgical approach proved effective, emphasizing the importance of careful preoperative evaluation and management in similar cases.
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BACKGROUND: Pregnancy loss occurring before 20 weeks gestation is referred to as miscarriage. Various clinical presentations of miscarriage include threatened, inevitable, incomplete, complete, septic, and missed miscarriage. Early-stage threatened miscarriage may manifest with symptoms such as abdominal discomfort and vaginal bleeding. Threatened miscarriage is clinically defined as the manifestation of positive fetal heart sounds in pregnancies occurring before the 20th week of gestation, concomitant with vaginal bleeding and a closed cervix. OBJECTIVES: The primary aim of this study was to evaluate the association between serum C-reactive protein (CRP) levels and fetal ultrasound findings in the prediction of threatened miscarriage during the first trimester of pregnancy. METHODS: In this prospective case-control study, a total of 100 pregnant women at 7-13 weeks of gestation were enrolled. All participants initially presented with a singleton embryo displaying cardiac activity on ultrasound. The study cohort was divided into two groups: Group 1 consisted of 50 women with uncomplicated pregnancies, while Group 2 comprised 50 women experiencing symptoms indicative of threatened miscarriage. RESULTS: Notably, within Group 2, patients who eventually experienced miscarriage exhibited significantly elevated serum high-sensitivity CRP levels in comparison to those who maintained their pregnancies. CONCLUSIONS: Threatened miscarriage cases demonstrated a substantial increase in serum high-sensitivity CRP levels compared to the control group. Furthermore, CRP levels exhibited a correlation with the risk of miscarriage, suggesting their potential utility in conjunction with ultrasound parameters for prognosticating threatened miscarriage during the first trimester.
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Introduction: The aim was to assess the hemostatic impact of B-Lynch sutures following an open myomectomy for efficacy. Material and methods: In this prospective clinical research, performed in Alazhar university hospitals (Al-Hussain, Damietta, Assiut) and Minia University Maternity Hospital, 250 women scheduled for open myomectomy between January 2021 and January 2023 had multiple fibroid uteri with uterine sizes corresponding to 12-22 weeks. There were two groups of women. Group I (125) underwent standard open myomectomy surgery, whereas Group II (125) underwent normal open laparotomy surgery followed by B-Lynch sutures. Certain inclusion and exclusion criteria were applied to every patient. We recorded vital data, length of the procedure, complications (bleeding during the procedure, bleeding from multiple bites, bladder injury, fever, wound infection), complete blood count before and after surgery, need for blood transfusion, postoperative vital data, time until ambulation, passing flatus, and ability to eat and drink, as well as the amount of blood lost during and after the procedure. Results: There was no statistically significant difference between the two groups in age, parity, weight, number of fibroids, or uterine size as measured by ultrasonography. Between groups I and II, there was a significant difference in the average intraoperative blood loss (Group I lost 562.6 ml, whereas Group II lost 411.3 ml) as well as the mean blood loss following surgery (205 ±82 ml in Group I and 117 ±41 ml in Group II). No significant difference was observed in the mean length of hospital stay between groups I and II (2 ±0.3 days and 2 ±0.6 days, respectively). Conclusions: Using a B-Lynch suture can help minimize blood loss during and after an open myomectomy. Therefore, if the uterus is large and has a lot of fibroids, it is recommended to be done frequently.