Ectopic production of HCG by a benign ovarian mature cystic teratoma simulating an extra-uterine pregnancy: a case report.

UNLABELLED: Physicians should consider a benign mature cystic teratoma in their differential diagnosis of a patient with an elevated serum human chorionic gonadotropin concentration. BACKGROUND: Following tubal ligation, a woman with amenorrhea and elevated serum human chorionic gonadotropin (HCG) concentrations may be experiencing either an ectopic or an intrauterine pregnancy. Other sources of HCG production can include ovarian germ cell tumors or gestational trophoblastic disease such as a complete or partial molar pregnancy. A rare source of HCG production is a benign mature ovarian teratoma. CASE: A 31-year old Gravida 2 para 2 presented with a positive home pregnancy test three years after she had experienced a Pomeroy tubal ligation. Her serum HCG was 57,914 mlU/mL but a transvaginal ultrasound did not find an intrauterine pregnancy. Laparoscopy was performed due to a suspicion of an ectopic pregnancy and an 11-cm benign mature cystic teratoma (dermoid cyst) within the right ovary was removed. An ectopic pregnancy was not visualized. Post-operatively, her serum HCG levels decreased and were negative within four weeks. CONCLUSION: Mature ovarian cystic teratomas have rarely been reported to secrete HCG. They can be an infrequent source of HCG production and may lead to emergency surgery to treat a suspected extra-uterine pregnancy.

Carotid and vertebral arterial fibromuscular dysplasia masquerading as severe preeclampsia: a case report.

BACKGROUND: Fibromuscular dysplasia is a non-atherosclerotic noninflammatory vascular disease that can affect any vascular bed. Dysplasia of the intima, media, or adventitia layer of the affected arteries causes stenosis and hypertension. Pregnant or post-partum patients may present with hypertension and be mistakenly diagnosed with preeclampsia. CASE: A 26 year old Gravida 1 Para 1 female 20 days post partum from a spontaneous vaginal delivery was transported from an outlying facility due to severely elevated blood pressure and transient left arm numbness and left sided facial droop. Upon arrival the patient was begun on intravenous magnesium sulfate and labetalol for a presumptive diagnosis of severe post partum preeclampsia. Her blood pressure and symptoms responded promptly. Due to her neurologic symptoms a magnetic resonance angiogram was ordered revealing 90% stenosis of her bilateral carotid and vertebral arteries. CONCLUSION: Severe hypertension and minimal neurologic symptoms may be the presenting symptoms for fibromuscular dysplasia. Cranial imaging is warranted in any pregnant or post partum patient who presents with these symptoms to allow appropriate treatment.

Alpha II Antiplasmin Deficiency Complicating Pregnancy: A Case Report.

Background. Alpha II antiplasmin is a protein involved in the inhibition of fibrinolysis. A deficiency in this protein leads to increased hemorrhage. It is inherited in an autosomal recessive fashion. Case. 30-year-old Gravida 1, Para 0, presented for prenatal care with her first and subsequently her second pregnancy. Her medical history was significant for a known deficiency in alpha II antiplasmin. Her first and second pregnancies were complicated by nonobstetrical hemorrhage requiring transfusions and severe preeclampsia requiring preterm deliveries. Conclusion. Alpha II antiplasmin deficiency resulted in multiple episodes of nonobstetrical hemorrhages requiring transfusion and ultimately preterm deliveries due to severe preeclampsia. Both infants and mother had a good outcome. The presence of this disorder may require a multidisciplinary team approach involving obstetricians, pediatricians, and hematologists. Precis. Alpha II antiplasmin deficiency is a rare autosomal recessive disorder leading to increased fibrinolysis and hemorrhage. We present a case report of a pregnancy complicated by this disorder.

Intracranial subdural hematoma after spinal anesthesia in a parturient.

BACKGROUND: : An intracranial subdural hematoma is a rare and potentially fatal complication of spinal anesthesia. CASE: : A gravida 2, para 1 underwent a repeat cesarean for transverse fetal lie. Four hours postoperatively she developed a severe headache with acute nausea and vomiting. Computed tomography scan revealed a 6-mm right subdural hematoma and midline shift of ventricles. She underwent a right frontal craniotomy with evacuation of the hematoma and eventually had a complete recovery. CONCLUSION: : Headache and atypical neurologic signs presenting after spinal anesthesia should prompt rapid evaluation for intracranial hemorrhage.

A retroperitoneal femoral nerve schwannoma as a cause of chronic pelvic pain.

This is a case report of pelvic pain caused by a large retroperitoneal femoral nerve schwannoma. A 31-year-old woman, gravida 2 para 2, was referred for surgical treatment of her chronic right lower quadrant pain. Laparoscopy revealed normal pelvic anatomy and a 7- x 5-cm mass overlying the right psoas muscle and involving the right femoral nerve. A combination of laparoscopic and laparotomy dissection allowed complete excision of the mass. Pathological analysis of the mass revealed a benign schwannoma of the femoral nerve sheath. Transient right femoral neuropathy complicated her postoperative course. Nongynecologic causes of pelvic pain are common and may include neurologically derived causes. Retroperitoneal schwannomas are uncommon and occur in about 0.5% of schwannomas. Complete surgical excision is recommended and results in an excellent cure rate.