Yolk Sac Tumor of the Ovary in Mosaic 46XX Turner Syndrome.

Introduction: Correlation of Turner syndrome (TS) with germ cell malignancy is acknowledge in TS patient with Y chromosome material but not otherwise. This case report wishes to highlight yolk sac tumor occurrence in patients with TS 46XX karyotype mosaicism. Case Report: A 23-year-old nulligravid woman was admitted with abdominal mass and vaginal bleeding. She had primary amenorrhea and had already been diagnosed with TS. Her karyotype was 46XX with 5% X mosaicism. Ultrasonography revealed a solid mass measuring 14.05 x 10.99 cm based on the International Ovarian Tumor Analysis (IOTA) simple rule, M1 and M2. During surgery, a solid mass originates from her left ovary measuring 20 x 15 x 15 cm with adhesion to omentum, ileum, and caecum was found. Pathology examination reveals it's an endodermal sinus tumors (EST). Discussion: TS with Y cells are closely linked with germ cell malignancy but not otherwise. It's still unclear what causes the malignancy in such cases. Conclusion: The present report illustrates a rare case of EST occurred in a TS patient with 46XX mosaicism.

Mayer-Rokitansky-Kuster-Hauser syndrome complicated with giant mucinous cystadenoma and inguinal herniation: case report.

INTRODUCTION: Coexistence of Mayer-Rokitansky-Kuster-Hauster syndrome (MRKH) with other conditions is rare, especially when MRKH was found in a young woman presenting with ovarian malignancy. This case report wishes to highlight MRKH complicated with giant mucinous cystadenoma and bilateral inguinal hernia. CASE REPORT: A 22-year-old nulligravid woman was admitted with primary amenorrhea and abdominal mass. Abdominal examination revealed a cystic mass 25 × 25 × 20 cm in size and a vagina 1 cm in length. Pelvic magnetic resonance imaging (MRI) showed a giant multiloculated left ovarian mass amidst the absence of uterus. During the surgery, the giant multiloculated cystic mass was identified as mucinous cystadenoma on frozen section. Bilateral medial inguinal hernia was also identified. DISCUSSION: MRKH coexisting with other disease is rare but considering other structures arising from paramesonephric duct (PMD) may exist, allows the possibility of other structural anomalies. CONCLUSIONS: The present report illustrates a rare case of MRKH syndrome with giant ovarian cystadenoma and inguinal hernia.

Dilemmas in pregnancies with pulmonary hypertension: Case report from a low-resource setting.

Little awareness persists of how pregnancy worsens cardiac diseases. We wish to highlight the challenges in managing pulmonary hypertension (PH) in pregnancy, within low socioeconomic environments. A 31-year-old G3P1A1 of 5 months gestation presented with worsening dyspnea and extremital edema. She had a history of heart disease with no cardiologist follow-up. She was diagnosed with type I/II PH at 4 months gestation. Her ultrasound revealed intrauterine fetal death (IUFD). She was referred for pregnancy termination. At presentation, she was tachypneic with SaO2 at 68%. After labor, she was transferred to a cardiac intensive care unit with SaO2 at 60%. Bedside echocardiography revealed a high probability of PH (pulmonary artery systolic pressure value: 109 mmHg). Unfortunately, she deteriorated and passed away a day later. Cardiac diseases in pregnancy contribute significantly to maternal mortality in Indonesia and other low socioeconomic countries. Traditional views on pregnancy and family and human rights advocate pregnancy as one of the rights, pregnancy complicated with cardiac diseases is detrimental and potentially lethal. Disparities in healthcare practices and low socioeconomic environments also contribute to such outcomes. Lack of awareness and improperly held beliefs on conception and family have led women to conceive amidst severe underlying cardiac diseases with dire outcomes.

Management of Labor in Pregnancy Complicated with Previous Tuberculosis with Giant Lung Bullae and Intrauterine Growth Restriction: A Case Report.

BACKGROUND Tuberculosis (TB) is the leading infectious cause of mortality in developing countries. In pregnancy, TB may cause complications including intrauterine growth restriction (IUGR) and vertical transmission of TB. Recurrent TB infection can cause permanent damage to lung tissue, and formation lung bullae can occur. Giant lung bullae may be harmless in normal conditions, but cause concern if the patient is pregnant. CASE REPORT A 22-year-old G1P0A0 woman at 9 months of pregnancy came to our institution due to labor pain. She also presented with active TB from 1 month before admission. Chest X-ray findings suggestive of tuberculosis and giant bullae were found. She was diagnosed with active 1st phase of labor with active TB and giant lung bullae. The Cardiothoracic Surgery Department was on standby during labor to take countermeasures if bullae rupture occurred. The 2nd stage of labor was shortened with vacuum extraction. After delivery, the patient was shifted to an isolation room and started on antitubercular drugs. CONCLUSIONS Tuberculosis in pregnancy leads to many adverse outcomes, both in maternal and fetal. Prolong TB infection also causes lung scaring, which leads to formation of bullae. Possible causes of rupture of bullae during pregnancy are Valsalva maneuver during labor, increased alveolar ventilation, and positive­pressure ventilation during general anesthesia. Normal vaginal delivery would increase the need for Valsalva maneuver, and vacuum extraction is advised to shorten the 2nd stage of labor to minimize the need of Valsalva maneuver and avoid increased intrapulmonal pressure.