Early Gestational Age Placenta Accreta Case Report: Can We Avoid Missed Diagnosis?

BACKGROUND Placenta accreta is an abnormal invasive placenta that can be life-threatening because of the risk of hemorrhage. Its incidence has increased due to high cesarean delivery rates. Early gestational age placenta accreta is difficult to diagnose and misdiagnosis can lead to inappropriate treatment. CASE REPORT Patient 1, a 34-year-old woman (para 2 abortus 1) with 2 previous cesarean deliveries, was referred to our department for vaginal bleeding and abdominal pain. She received 2 curettages for blighted ovum; then, ultrasound examination found uterus perforation and fluid in the Douglas cavity. Exploratory laparotomy confirmed uterine perforation, and a hysterectomy was performed. Histopathological examination revealed placenta accreta. Patient 2, a 35-year-old woman (para 3) with 3 previous cesarean deliveries, was treated at a previous hospital for vaginal bleeding and stomach enlargement. She received serial chemotherapy for gestational trophoblastic neoplasia. Ultrasound examination showed a nonhomogeneous opacity in the lower uterine corpus with color score 4. Total abdominal hysterectomy was performed, and histopathological examination revealed placenta accreta. Patient 3, a 32-year-old woman (para 2) with 2 previous cesarean deliveries, had irregular vaginal bleeding suspected as gestational trophoblastic neoplasia due to ultrasound examination and positive beta-human chorionic gonadotropin. Ultrasound and MRI examination showed enlargement with nonhomogeneous opacity, color score 4, and bridging vessels. Due to our previous experience, we suspected it was a placenta accreta and performed a hysterectomy. The histopathology result indicated placenta accreta. CONCLUSIONS The key point in diagnosing placenta accreta properly is to evaluate the morphometric changes based on the structure using imaging like ultrasound. Collection and analysis of these data enables precise diagnosis in early gestational age placenta accreta.

Deep (aggressive) angiomyxoma of the vagina misdiagnosed as Gartner cyst: A case report.

INTRODUCTION AND IMPORTANCE: Aggressive angiomyxoma is a rare soft tissue tumor. Aggressive angiomyxoma is a slow-growing vulvovaginal mesenchymal neoplasm with a marked tendency for local recurrence, but with a low tendency to metastasize. As it has a predilection for the pelvic and perineal regions, Aggressive angiomyxoma is often misdiagnosed. This case report documented rare case of misdiagnosed Aggressive Angiomyxoma as Gartner duct cyst. PRESENTATION OF CASE: This article report a case of 31 year old women who complained mass came out from vagina without any urinary symptom and trauma. Physical examination and ultrasound finding suggested that the mass was Gartner Duct cyst. Management in this case was excision of the vaginal cyst. Histopathology examination revealed Deep (aggressive) angiomyxoma. DISCUSSION: The rarity of Deep (Aggressive) Angiomyxoma makes the preoperative diagnosis fairly difficult. Aggressive angiomyxoma is often misdiagnosed as it may have similar clinical presentation to common lesions such as Bartholin cyst or prolapse vaginal wall, Gartner cyst or levator hernia. Aggressive Angiomyxoma should be considered as differential diagnosis in patient with vaginal cyst. CONCLUSION: Aggressive Angiomyxoma is rare condition. Preoperative diagnosis and management are challenging. Long term follow op and evaluation should be done due to high rate of recurrence.

Histopathology and ARID1A Expression in Endometriosis- Associated Ovarian Carcinoma (EAOC) Carcinogenesis Model with Endometrial Autoimplantation and DMBA Induction.

BACKGROUND: Ovarian carcinoma is one of the most deadly malignancies in the gynecologic field. The cause is not yet known, and the clinical symptoms are not specific. Endometrioid carcinoma and ovarian clear cell carcinoma can originate from endometriosis and are known as endometriosis-related ovarian carcinoma (EAOC). Development of EAOC experimental animal models is needed for basic research and clinical preparation of human tissue tests. This study aimed to determine the role of the ARID1A gene mutation in the carcinogenetic process of EAOC in experimental animal models induced with DMBA. METHODS: In this study, the EAOC experimental model was developed using the autoimplantation technique and DMBA induction. This study involved placebo surgery mice (sham), endometrial autoimplantation, and a combination of endometrial autoimplantation and DMBA induction, which were sacrificed at weeks 5, 10, and 20, respectively. Histopathological assessment and immunohistochemical ARID1A staining with an assessment of positive percentages were carried out on 200 cells. RESULTS: This study produced 1 (20%) atypical endometriosis and 1 (20%) clear cell carcinoma at implantation and after 10 weeks of DMBA induction, and 100% endometrioid carcinoma in the DMBA-induced group. ARID1A staining did not show any significant difference (p = 0.313) in all groups. CONCLUSION: The combination of endometrial autoimplantation techniques and DMBA induction in the ovary produced atypical endometriosis, clear cell carcinoma, and endometrioid carcinoma, where time is an important factor. There was no significant difference in ARID1A expression between the treatment and control groups.

Minimal apparent diffusion coefficient value of the solid component to differentiate borderline and malignant ovarian epithelial tumours: a preliminary report.

PURPOSE: Ovarian tumours are the second most common cause of death from gynaecological cancer. There are three types of ovarian cancer based on histopathological examination: benign, borderline, and malignant. However, it is difficult to distinguish the borderline and malignant tumours. Several studies used the apparent diffusion coefficient value to distinguish the ovarian tumour types, with various results. This preliminary report focused more on the use of the minimal ADC (mADC) value on the solid component, to differentiate borderline and malignant ovarian tumours. MATERIAL AND METHODS: In 21 cases of borderline ovarian tumours, of which 11 were regarded as malignant and 10 were regarded as borderline following histopathological examination, the mADC value was measured by two different radiologists by using free-hand technique. The intraclass correlation coefficient (ICC) was used to measure the reliability and agreement between the two radiologists. Receiver-operating characteristic (ROC) curves were then calculated to determine the optimum cut-off point. RESULTS: There were statistically significant (p = 0.001) of the mADC value between the borderline and malignant tumours. The intraclass correlation coefficient value showed excellent reliability and agreement between the examiners. The ROC curve showed the optimum cut-off point at 0.628 × 10-3 mm2/s (p = 0.001), which yielded 100% sensitivity and 80% specificity. CONCLUSIONS: The use of free-hand technique to measure the mADC value on the solid component can be valuable in differentiating borderline and malignant ovarian epithelial tumours. This result may assist clinicians in considering further treatment approaches.

Case report: Unpredictable nature of tubal cancer.

INTRODUCTION: Primary tubal cancer is very rare, most are diagnosed intra and post operatively. Histopathology is vital in determining the cancer origin. Here we present a case of fallopian tube cancer with clinical presentation mimicking endometrial origin. CASE DESCRIPTION: A 74-year old patient came with complaints of intermittent post-menopausal bleeding and pelvic pain. The patient had several investigations using Ultrasonography, Hysteroscopy-guided biopsy, and Magnetic Resonance Imaging. Pre-operative diagnosis was endometrial cancer based on histopathology of endometrial biopsy during hysteroscopy. Explorative laparotomy, total abdominal hysterectomy, bilateral salphingo-oophorectomy, pelvic and para-aortic lymph node dissection were then performed, and the tumor samples were sent to the histopathology laboratory. It was found that the post-operative diagnosis was in fact primary fallopian tube cancer stage IIB. CONCLUSION: For patients with gynecological malignancies, rare cases such as fallopian tube cancer should never be overlooked as a differential diagnosis.