Abdominal Wall Endometriosis at the Cesarean Section Scar.

Abdominal wall endometriosis is atypical localization of the extra-pelvic endometriosis with non-specific symptoms and is difficult for diagnosis. Cesarean scar endometriosis (CSE) is the most common type of abdominal wall endometriosis, which usually develops after obstetric operations. We report a case of a 33-year-old woman who had two previous cesarean sections presented with a mass in the subcutaneous tissue of the abdominal wall, approximately 4 cm superior to the Pfannenstiel incision, 5 years after her second lower segment caesarean section. The classic clinical presentation, imaging findings on ultrasonography and computed tomography are analyzed. Treatment with local surgical excision of the mass is discussed. The diagnosis was confirmed with histopathological analysis of the surgical sample. When it comes to the limited painful lesion in the subcutaneous tissue at the cesarean scar, with a pain intensifying during menstruation, the physician should consider cesarean scar endometriosis in women of reproductive age with a history of cesarean section.

An Unusually Large Fibroepithelial Polyp of Uterine Cervix: Case Report and Review of Literature.

BACKGROUND: Fibroepithelial cervical polyps (FEPs) are benign growths protruding from the inner surface of the cervix. They are typically asymptomatic, but a very small minority can undergo malignant change. Giant cervical polyps with a size greater than 4 cm are rare entities with only 23 reported cases in the literature. Cervical polyps develop as a result of focal hyperplasia of the columnar epithelium of the endocervix. CASE PRESENTATION: We present the case of a giant fibroepithelial polyp measuring approximately 11 x 6 x 4 cm which was protruding from the anterior lip of the uterine cervix in a 51-year-old woman who clinically presented vaginal bleeding. She was nulligravida and doesn't have a child. The speculum examination revealed a soft, mobile, painless irregular cerebriform mass on the cervix, protruding through the vagina. The polyp was excised using a scalpel, and the pedicle was sutured using the Vicryl 1-0 under short-term intravenous anaesthesia. Histopathological examination revealed a polypoidal tumour mass composed of cellular fibrovascular stroma covered with stratified squamous epithelium. Three months after the initial surgery, there was no recurrence seen. CONCLUSION: Cervical giant polyps are rare entities and occur mostly in perimenopausal women. Transvaginal polypectomy, as performed for this patient followed by histopathological examination is an adequate procedure for these lesions.

Values and Correlations between C-Reactive Protein and Apolipoprotein B after Treatment with Methotrexate at Patients with Rheumatoid Arthritis.

BACKGROUND: Patients with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease (CVD). Lipid changes related to inflammation have been described in RA. Methotrexate (MTX) treatment is effective in controlling inflammation and decreasing the CRP (C-reactive protein) values. AIM: To examine the disease activity, CRP and Apo B values in the detection of new patients with active and untreated RA, and impact of MTX therapy on their levels after 6 months and one year of treatment, and the correlation between their values in this period. METHODS: 80 patients with active and newly discovered RA patients who meet the American Rheumatology Association (ARA) 1987 revised criteria were treated with disease-modifying anti-inflammatory drugs (DMARDs) according to the protocol for treatment. RESULTS: After a year of therapy RA patients achieved significant decrease in the DAS28 (disease activity score) (p < 0.01 and p < 0.001), and CRP values (p < 0.001). Levels of Apo B values at the 12 months were nonsignificantly higher compared to the results obtained at the beginning of the study (p < 0.001). After 6 and 12 months there was a weak nonsignificant negative correlation about the values of CRP and Apo B at baseline and after 12 months (r = -0.15 and r = -0.12 p > 0.05). CONCLUSION: Use of MTX therapy at RA patients had a reduced effect on disease activity and inflammation, but the nonsignificance effect on the values of Apo B lipoproteins.

Hospital-Based Study of Maternal, Perinatal and Neonatal Outcomes in Adolescent Pregnancy Compared to Adult Women Pregnancy.

BACKGROUND: Adolescent pregnancy, defined as a pregnancy in girls aged 10 to 19 years. Adolescent mothers are at high risk for maternal and neonatal complications. AIM: To compare maternal, perinatal and neonatal outcomes in adolescents and adult women aged 20-24 years. MATERIAL AND METHODS: This retrospective cohort study included all singleton pregnancies during a three-year period (January 2016-December 2018) who gave birth in a Clinical Hospital in Tetovo, Republic of Macedonia. After exclusion criteria, a total of 932 cases were reviewed and divided into two groups: one of the teenage mothers (< 19 years old) (115 women) and the other of adult mothers (20-24 years old) (817 women). RESULTS: Of the total number of 5643 births, 128 (2.27%) were from adolescent pregnancies. Of them, nulliparous adolescent women were 115 (2.04%). Adolescents compare to adult mothers had a higher rate of urinary tract infections (33% vs. 22%), increased rate of maternal anemia (26% vs. 15%), preterm birth, small for gestational age newborns (25.2% vs. 17.1%), lower high school attendance (0 vs. 21.9%) and inadequate prenatal care. Spontaneous labour was more common in adolescents (73% vs 63.5%), while Caesarean sections were less common than in women aged 20-24 years (25.2% vs 33.5%). The rate of other perinatal outcomes was not significantly different between the 2 groups. CONCLUSIONS: The results of the study showed that the frequencies of some maternal, perinatal and neonatal complications were considerably higher in adolescent mothers.

Giant Fibroepithelial Polyp of Vulva: A Case Report and Review of Literature.

Fibroepithelial stromal polyps of vulva are the type of mesenchymal lesion that typically occurs in women of reproductive period. They are common, usually small and hystologically benign. Larger lesions are rare and likely arise from proliferation of mesenchymal cells within the hormonally sensitive subepithelial stromal layer of the lower genital tract. We present a case of 16 year old female with a giant polypoid lesion of the vulva localized on the right labium. The mass measure was 18×12×3 cm. Total surgical resection of the lesion was performed. Histopathological examination reported a fibroepithelial stromal polyp of the vulva. The patient showed no evidence of recurrence four years after the resection. Fibroepithelial polyps of the vulvar region are benign lesions that have a wide range of morphologic appearances and may be misinterpreted as malignant. Total excision is the best treatment options and histopathological examination is strongly recommended to rule out a malignant neoplasm.

Primary Fallopian Tube Carcinoma: A Case Report and Literature Review.

BACKGROUND: Primary fallopian tube carcinoma (PFTC) is a rare tumour of the female genital tract with an incidence of 0.1-1.8% of all genital malignancies, and it is very difficult to diagnose preoperatively, because of its non-specific symptomatology. In most cases, it is an intraoperative finding or a histopathological diagnosis. It is a tumour that histologically and clinically resembles epithelial ovarian cancer. CASE PRESENTATION: We are reporting a case of a 62-year-old, postmenopausal women with primary fallopian tube carcinoma of the right fallopian tube in stage IA. The patient has lower abdominal pain, watery vaginal discharge and repeated episodes of bleeding from the vagina. The clinical and radiological findings suggested a right adnexal tumour with elevated CA-125 levels. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy and peritoneal washing were performed. Pathologic confirmation of primary serous cystadenocarcinoma of the right fallopian tube was made. Peritoneal washings were negative for malignancy. FIGO stage was considered as IA, and the patient received no courses of chemotherapy and postoperative radiation because she refused it. Ten months after initial surgery, the patient is alive and in good condition. CONCLUSION: Cytoreduction surgery followed by adequate cycles of chemotherapy is an important strategy to improve patients' prognosis.