Cornual Pregnancy: Results of a Single-Center Retrospective Experience and Systematic Review on Reproductive Outcomes.

Background and Objectives: Cornual pregnancies (CPs) are rare forms of ectopic pregnancy. When abortion does not occur, it can be a life-threatening condition for the mother and can also impair future fertility. We present our experience in the diagnosis and management of CPs. A systematic review was also conducted to investigate the reproductive outcomes after treatment. Materials and Methods: Between January 2010 and December 2022, we performed a retrospective, cross-sectional, single-center, and descriptive data collection and analysis (ClinicalTrial ID: NCT06165770). The search for suitable articles published in English was carried out using the following databases (PROSPERO ID: CRD42023484909): MEDLINE, EMBASE, Global Health, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Cochrane Methodology Register), Health Technology Assessment Database, Web of Science, and search register such as ClinicalTrial. Only studies describing the impact of CP treatment on fertility were selected. Results: Two studies were included in the systematic review. Seventeen patients suffering from CPs were selected. In our series, a pelvic ultrasound allowed for the diagnosis of a cornual localization in 35.30% of cases. Thirteen women (76.47%) underwent immediate surgical management. The laparoscopic approach was the most used (76.92%), with a laparotomic conversion rate of 30%. Four patients (23.52%) received medical treatment with methotrexate. After treatment, two patients managed to achieve pregnancy. Conclusions: CP is a rare form of ectopic pregnancy that can quickly become life-threatening for the mother. Ultrasound does not lead to a precise diagnosis in all cases. In the absence of complications and emergencies, laparoscopy is an approach that could be considered valid. For selected asymptomatic patients, medical treatment may be a valid alternative. The data from the studies included in the systematic review, although demonstrating a superiority of medical treatment in terms of future pregnancies, are heterogeneous and do not allow us to reach a definitive conclusion.

Diagnostic and therapeutic challenges of a rare large ovarian strumal carcinoid in pregnancy, about a case report.

INTRODUCTION: Ovarian strumal carcinoid is a rare type of germ cell tumor. It usually affects perimenopausal and postmenopausal women. Very few cases of stromal carcinoid have been reported in the literature in women of childbearing age, particularly during pregnancy. The clinical presentation of the tumor, and in particular its non-specific clinical and radiological appearance and rarity, explain the difficulties in diagnosis and management. PRESENTATION OF CASE: Herein, we describe a rare case of a 36-year-old patient who was followed-up in our outpatient clinic for organic cyst of the ovary. The ultrasound revealed a multilocular regular cystic mass with a modestly thickened wall and fine septations. The MRI indicated a right ovarian cyst with solid tissue. The levels of tumor markers were normal. The patient was lost to follow-up and did not return until six months later. She was admitted in our Department with acute ovarian torsion and underwent emergency surgery at 17 weeks' gestation. A laparoscopic cystectomy of the right ovary was provisionally performed. Pathology revealed an ovarian strumal carcinoid tumor. DISCUSSION: Patients with ovarian stromal carcinoid have an excellent prognosis. Ovarian strumal carcinoid 's primary therapy method is operation. The majority of original ovarian carcinoid tumors progress slowly, and practically all thyroid carcinoid tumors are clinical stage I with a positive prognosis. CONCLUSION: In the absence of standardized treatment, the association of carcinoid strumal tumor with pregnancy, underlines the need for early diagnosis and appropriate multidisciplinary management, taking into account both the maternal and fetal prognosis.

A non-pregnant woman with elevated beta-HCG: A rare case of ovarian seminoma.

INTRODUCTION: Ovarian seminoma is a rare germ cell tumor that typically affects young women. Early diagnosis of malignant tumors, although difficult due to mild symptoms, is crucial for a better prognosis. Here we report the case of a 15-year-old female patient with a large malignant ovarian dysgerminoma to provide a comprehensive overview of the diagnosis and management of this pathology and to help practitioners make an early diagnosis. CASE PRESENTATION: A 15-year-old patient with no significant past medical history presented to the Obstetrics and Gynecology emergency D in Tunisia with subacute abdominal pain, fever, and unexplained weight loss. Diagnostic evaluation revealed a large, solid ovarian mass with elevated CA-125 levels, and the patient subsequently underwent right adnexectomy with peritoneal cytology. Histopathological analysis confirmed the diagnosis of dysgerminoma with peritoneal involvement, resulting in a FIGO IC and TNM T1C classification, and the patient received fertility-sparing polychemotherapy with satisfactory progression. DISCUSSION: Ovarian seminoma mainly affects young women and can be associated with a variety of risk factors. Clinical signs are variable and can be difficult to detect at an early stage. Imaging techniques can help with diagnosis. Tumor markers may be elevated, but histological confirmation is needed. Treatment usually consists of a combination of surgery and chemotherapy, with good long-term survival rates. CONCLUSION: Seminomas are rare tumors and early detection is crucial for a better prognosis. This requires close attention to risk factors and regular gynecological examinations from an early age in patients with these risk factors.

Secondary postpartum hemorrhage due to uterine scar dehiscence, a case report.

INTRODUCTION: Secondary postpartum hemorrhage is rare. The most common cause is retained placenta. Having a uterine scar dehiscence as an etiology is unusual. Complete dehiscence of the uterine scar is even rarer. This rare but serious cause of post-partum haemorrhage can be potentially life threatening due to severe hemorrhage if not managed in adequate time. PRESENTATION OF CASE: We present the case of a 35-year-old patient, gravida 2 para 2. She had undergone two caesarean sections in our department and, after the last one in March 2021, she presented twice to our emergency department with relatively abundant metrorrhagia, but neither the clinical nor the radiological examinations revealed any abnormalities. At 43 days postpartum, she presented to the emergency with severe bleeding per vaginum. The bleeding was profuse, causing hemodynamic instability and severe acute anaemia. An explorative laparotomy was necessary to diagnose the etiology and manage the treatment. Surgical exploration revealed a lateral uterine rupture in the broad ligament and complete dislocation of the caesarean scar. An urgent hysterectomy was performed. DISCUSSION: Partial or complete dehiscence of the hysterorrhoea is a rare cause of secondary postpartum hemorrhage after caesarean section. When hysterorrhaphy dehiscence does occur, the origin of the bleeding is likely to be related to erosion of the vessels at the incision angles. CONCLUSION: The diagnosis of partial or complete dehiscence of the uterine scar may be misleading in the absence of specific clinical or radiological signs. This condition must therefore be considered and suspected in cases of secondary postpartum hemorrhage.

The pentalogy of Cantrell: A rare and challenging prenatal diagnosis.

INTRODUCTION: The sternum, pericardium, diaphragm, abdominal wall, and heart are all affected by the unusual congenital condition known as Cantrell pentalogy. It is a rare congenital disorder that requires multidisciplinary care. Early diagnosis and appropriate management are crucial for improving outcomes in affected individuals. To illustrate the difficulties and complexity of Cantrell pentalogy, we provide two cases. PRESENTATION OF CASE: In case 1, a routine antenatal scan at 12 weeks' gestation revealed thoracoabdominal ectopia cordis in a 29-year-old woman. The pregnancy was terminated medically due to the severity of the anomalies and the poor prognosis. A 32-year-old patient in case 2 had a diaphragmatic hernia, thoracoabdominal ectopia cordis and midline abdominal wall abnormalities. After counselling, a medical termination was chosen. The ultra-sonographic features were confirmed by autopsy results in 2 cases. DISCUSSION: Early diagnosis is feasible in the first trimester if ectopia cordis and omphalocele exist. Additionally, development in ultrasound technology provides us with better visualization and early diagnosis. With patients who have fully developed Cantrell syndrome and those who also have accompanying anomalies, the prognosis is often poor, with short survival and quality of life. CONCLUSIONS: Cantrell pentalogy is a rather uncommon congenital condition. Early detection is possible in the first trimester. The severity of the illness varies greatly, and treatment is determined by the precise abnormalities present. Early diagnosis necessitates adequate initial training as well as ongoing in-service training for sonographers. Early detection and treatment are critical for improving outcomes in affected persons.

Ovarian fibrosarcoma: Diagnostic challenges and treatment options, a case report.

INTRODUCTION: Ovarian fibrosarcoma is a rare cancer. In the literature, there have been very few occurrences of fibrosarcoma with ascites. The presence of ascites complicates the diagnosis further, and is associated with a poor prognosis and has been linked to chemoresistance and metastasis. We present this case of an ovarian fibrosarcoma with ascites to provide a comprehensive overview of the clinical presentation, diagnostic evaluation and management of this pathology, which remains a challenge given the rarity of this entity. PRESENTATION OF CASE: We report the case of a 60-year-old woman who was referred to our unit, because of abdominal bloating, sporadic pelvic pain and abdominal distension. Ultrasound showed a heterogeneous mass over the right adnexa with ascites. Serum tumour markers were within normal limits. During surgery, a total abdominal hysterectomy plus bilateral adnexectomy was performed. The final histopathological findings showed a well-differentiated fibrosarcoma. The patient was followed up regularly and no recurrence was seen 2 years after surgery. DISCUSSION: Ovarian fibrosarcomas are uncommon cancers with no known risk factors. Diagnosis can be difficult, especially in the presence of ascites, and other diagnostic options should be considered. Pathological and immunohistochemistry investigations are required for a clear diagnosis. Early metastases and resistance to adjuvant chemotherapy characterize the prognosis of ovarian fibrosarcoma with ascites. CONCLUSIONS: Ovarian fibrosarcoma with ascites is a rare and challenging ovarian disease, highlighting the need for postoperative pathology to make a clear diagnosis, complete cytoreductive surgery and individual consideration of adjuvant radiochemotherapy should be included in the management.