Unexpectedly large myoepithelioma-like tumor of the vulvar region with two local recurrences: A rare case report and review of the literature.

Myoepithelioma-like tumors of the vulvar region (MELTVR) are rare. Only a limited number of MELTVRs are reported in the literature, and various aspects of this lesion still need to be clarified. In this study, we reported a case of MELTVR in a 46-year-old female. The uniqueness of the present case was its large size (12 cm) compared to the MELTVRs reported in earlier studies, the presence of two separate but attached lesions (one in labia majora and one in the mons pubis), and two recurrences within ten years after wide local excision. The second recurrence was managed with wide excision, and the patient remained disease-free during the two-year follow-up. This case highlights the local aggressiveness of MELTVR and the necessity of resection with an adequate margin. It also urges more awareness regarding the differential diagnosis of MELTVR with other lesions of the vulva, particularly when located in the labia majora and mons pubis.

Treatment of Immature Teratoma Associated with Ovarian Endometrioma: A Case Report.

Background: Mature teratoma is a benign neoplasm, mostly composed of well-differentiated derivations of almost two or three germ cell layers, while immature teratoma is a malignant neoplasm composed of immature neural and embryonic tissue. Immature teratoma in the context of ovarian endometrioma has not been reported yet. Case Presentation: A 34-year-old woman with primary infertility is reported in this study who suffered from immature teratoma associated with ovarian endometrioma. After several rounds of fertility treatment, the patient was referred for severe abdominal pain and underwent emergency surgery for the rupture of ovarian endometrioma. To preserve the ovary, the cyst was not resected in areas attached to the ovary. Some months later, the patient noticed a progressive abdominal enlargement. The sonographic evaluation revealed multiple solid-cystic lobulated masses on the abdominal wall and throughout the pelvic cavity. The histologic diagnosis was consistent with immature teratoma. The patient was treated with high-dose neoadjuvant chemotherapy and fertility-sparing surgery (FSS). The histologic evaluation of the extracted masses revealed teratoma maturation. Conclusion: This study reveals the importance of complete removal of endometrioma and highlights the role of neoadjuvant chemotherapy in fertility-sparing surgery and potentiating teratoma maturation.

Second recurrence of aggressive vulvar angiomyxoma: a case report.

Aggressive angiomyxoma is a rare benign tumor with diverse clinical and radiologic presentations, making its differential diagnosis challenging. Here we report the second recurrence of an aggressive angiomyxoma of the vulva in a 33-year-old woman who presented with pain and swelling. Clinical examination revealed a well-circumscribed large palpable mass extending from the inferior part of the right labia major into the right side of the gluteus. A second recurrence of aggressive angiomyxoma was suspected based on the patient's history, clinical examination, and magnetic resonance imaging report, and the patient underwent surgical resection with a negative margin. Histological evaluation of the extracted lesion confirmed the diagnosis of aggressive angiomyxoma. At the 1-year follow-up, the patient was recurrence-free. The present report urges more awareness regarding the aggressiveness of angiomyxoma of the vulva. Closer attention should be given to margin-free removal of such tumors, and patients should be routinely followed up for at least 2 years postoperatively for early diagnosis of recurrence, thereby reducing the risk of morbidity.

The Effect of Uterine Contractions on Fertility Outcomes in Frozen Embryo Transfer Cycles: A Cohort Study.

Background: The relationship between uterine peristalsis before embryo transfer and the success of assisted reproductive techniques (ARTs) has not been properly investigated. In this study, the effect of uterine contractions on embryo implantation in frozen embryo transfer (FET) cycles was investigated to determine whether the frequency of uterine contractions can be used as a quantitative marker to assess endometrial receptivity. Methods: In this cohort study of 68 eligible FET candidates, one hour before embryo transfer (ET), frequency of uterine contractions was assessed with transvaginal ultrasonography. Patients were followed up for 20 weeks. The association between FET outcomes including clinical pregnancy, abortion, and ectopic pregnancy with uterine contractions was evaluated. Binary logistic regression was conducted to test the association between clinical pregnancy outcomes in different groups. The p<0.05 were considered statistically significant. Results: Of 68 patients, 25 (36.8%) experienced clinical pregnancy. Multiple logistic regression for omitted confounders (age, BMI, duration, type and cause of infertility) revealed that patients with uterine peristaltic wave frequency less than 2≤ wave/min had higher chance of successful pregnancy compared to those with ≥4 wave/min (odds ratio: 10.8; 95% confidence interval: 1.5-79.4, p=0.019). The Pearson's correlation showed a statistically significant relationship between the frequency of uterine contraction and endometrial thickness (r= 0.42, p=0.002). Conclusion: Patients with uterine peristalsis of <4.0 wave/min before embryo transfer had a higher chance of successful implantation and pregnancy compared with those with higher contraction frequencies. It seems that measuring uterine contraction frequency before embryo transfer might help to predict pregnancy outcomes.