Endodermal sinus tumor of vagina posing a diagnostic challenge and managed by chemotherapy and novel posterior sagittal surgical approach: lessons learned.

Vaginal germ cell tumor (GCT) is a rare gynecological malignancy with no more than 100 reported cases in the international medical literature. It is an unusual, but an important, cause of premenarchal vaginal bleeding in a child. This article describes a 2-year-old child with vaginal GCT, initially misdiagnosed as rhabdomyosarcoma (on imprint smear cytology) and then as clear cell adenocarcinoma. The authors highlight the salient differentiating clinical, radiological and histological features to prevent misdiagnosis in future. The report emphasizes the need for increased awareness and screening for vaginal GCT by estimation of serum α-fetoprotein levels, in all patients with premenarchal vaginal bleeds, to prevent inadvertent operative interventions.

Uterine Artery Pseudoaneurysm after Cervical Cerclage: A Rare Case and Its Management Through Uterine Artery Embolization.

Background: Uterine arterial pseudoaneurysm (UAP) is a rare cause of vaginal bleeding. Usually, UAP follows cesarean section, uterine curettage, vaginal delivery, or cervical conization and must be considered in the differential diagnosis. Here we report a very unusual case of UAP causing intra-abdominal and vaginal bleeding after cervical cerclage and its successful management through the endovascular route. Case Presentation: This 30-year-old P2L1A2 woman presented with vaginal bleeding after 7 days following hysterotomy for termination of pregnancy. At 16 weeks of her index pregnancy, she underwent cervical cerclage for cervical insufficiency, followed by an emergency hysterotomy at 20 weeks for profuse vaginal bleeding after failed medical management. On ultrasound and contrast-enhanced computed tomography (CECT), uterine dehiscence and a cervical pseudoaneurysm were detected. Dehiscence was repaired surgically, and pseudoaneurysm was successfully managed by uterine artery embolization. Conclusion: UAP is an uncommon cause of vaginal bleeding; however, it should be considered in the differential diagnosis of a woman with unusual vaginal bleeding, particularly in the postpartum or postoperative setting like cesarean section, uterine curettage, cervical conization, or cerclage. Endovascular uterine artery embolization is a minimally invasive, effective, preferred, and safe method for managing UAP.

A Case of Dulaglutide-Induced Vaginal Bleed.

Type 2 diabetes mellitus (T2DM) is a growing challenge across the globe. The disease process is amendable to lifestyle modifications in the early stages. If those changes fail to correct endocrine dysfunction, medical therapy is initiated. Initially, therapy for type 2 diabetes consisted of biguanides and sulfonylureas. With modern medicine, we have developed dipeptidyl peptidase-4 inhibitors, sodium-glucose cotransporter-2 inhibitors, and glucagon-like peptide 1 (GLP-1) receptor agonists. Dulaglutide is a GLP-1 receptor agonist that is sold under the brand name Trulicity. The most common side effect associated with Dulaglutide is gastrointestinal discomfort. We present a case of severe vaginal bleeding due to a rare side effect of Dulaglutide. A 44-year-old perimenopausal female with a past medical history of type 2 diabetes mellitus presented to the clinic after experiencing significant vaginal bleeding. The patient was unable to tolerate Metformin and Semaglutide in the past. The abnormal vaginal hemorrhage started one week after receiving the second dose of Dulaglutide. Her hemoglobin concentration fell significantly. Dulaglutide was immediately discontinued, and her vaginal bleeding stopped. This case documents the necessity of post-market surveillance to oversee the safety of recently approved medications by the Food and Drug Administration (FDA). Rare side effects can emerge in the general population that were not seen during clinical trials. Physicians should consider the possibility of adverse medication reactions when determining whether to start a new medication or a conventional one.