A case of cutaneous endometriosis developed on an abdominal scar.

BACKGROUND: Endometriosis is characterized by the presence of an ectopic endometrial tissue. It affects between 1% and 5% of women in reproductive age. Its main clinical symptoms are dysmenorrhoea and infertility. Among women having had abdominal surgery for any gynecological reason, the prevalence of endometriosis is between 15% and 50%. CASE REPORT: We report the case of a 15 year-old patient who underwent surgery twice : once for appendicitis two years before and once for acute salpingitis and tubo-ovarian abscesses one year before. Laparotomy was performed by Pfannenstiel incision. The post operative course was uneventful. The patient reported the gradual emergence of two bluish nodes on the abdominal scar. These nodules became painful and turgid during the menstrual period. She also reported the issue of blood from the abdominal scar during menstruation. The abdominal examination, performed during the menstrual period, showed a scar of good quality and two regular shiny and bluish cutaneous nodules measuring 1 cm in size. These elements were firm and painless. An endometriosis node on the scar of laparotomy was suspected. Surgery was performed in order to remove both nodules. At surgery the depth of nodules reached the top of the abdominal fascia of the major rights. The content of these nodules was chocolate brown. The histo-pathological examination confirmed that these nodules contained ectopic endometrial tissue. CONCLUSION: The etiopathogeny of endometriosis is still a subject of debate. This case illustrates the possibility of occurrence of endometriosis on abdominal scars after laparotomy: an unusual location.

Incidence, clinical analysis, and management of ovarian fibromas and fibrothecomas.

OBJECTIVE: The objective of the study was to identify the incidence, diagnosis, and therapeutic and histological particularities of ovarian fibromas and fibrothecomas. STUDY DESIGN: This was a retrospective study of 24 patients who underwent surgical treatment for ovarian fibromas and fibrothecomas between January 1994 and December 2006. Clinical, ultrasonographic, tumor marker, therapeutic, and histologic data were analyzed. RESULTS: The mean age of patients was 49 years. Thirteen patients were menopausal. Ultrasonographic findings were ovarian echogenic tumor in 6 cases, hypoechogenic tumor in 12 cases, mixed tumor in 6 cases, and anechogenic tumor in 1 case. Cancer antigen-125 level measured in 21 cases was abnormal in 3 cases. Twenty-one patients underwent laparotomy. Three patients underwent laparoscopy; however, 1 was converted to laparotomy because of a suspected tumor. Histological findings were 16 fibromas and 9 fibrothecomas. CONCLUSION: Ovarian fibromas and fibrothecomas are uncommon, accounting for 3.3% of ovarian tumors. These lesions often occur in perimenopausal and menopausal patients. Clinical, ultrasonographic, and tumor marker data remain the best preoperative approach currently available for ovarian tumors. However, the diagnosis remains histological.

Fetal intracranial haemorrhage and periventricular leukomalacia after second-trimester intrauterine fetal death in monochorionic twins.

BACKGROUND: Intrauterine fetal death of one twin in a monochorionic pregnancy may be associated with adverse neurologic sequelae in the surviving co-twin. OBJECTIVE: The aim of this report is to try, through a review of literature, to predict the risk of cerebral impairment in the survivor co-twin and to assess the feasability of neurosonography and magnetic resonance imaging in the prenatal diagnosis of brain damage. CASE REPORT: We report a case of monochorionic twins complicated by a fetal death at approximately 23 weeks' gestation with pathologically confirmed leukomalacia in the surviving twin. A detailed sonographic evaluation of the intracranial anatomy of the surviving twin was performed. Fetal magnetic resonance imaging was offered as well. The patient opted for termination. Evacuation was performed at 24 weeks, and pathologic evaluation revealed severe cerebral infarction with haemorrhage. CONCLUSION: However difficult, a multidisciplinary prenatal counselling should be performed in order to study the prognosis and to try to prevent cerebral palsy in the surviving co-twin.