Pulse granuloma presenting as a complex pelvic cyst.

Pulse granuloma, a benign granulomatous lesion, develops due to foreign body reactions to food particles. This rare entity occurs occasionally in the abdominal cavity. However, it has never been reported as a pelvic mass or a recurrent case. A 37-year-old woman with a medical history of pelvic granulomatous lesions treated in Thailand, was admitted for abdominal pain. Imaging study revealed a pelvic complex cyst and disseminated nodules. Ovarian cancer or tuberculous peritonitis was suspected. The appearance at laparotomy was an inflammatory mass encased in adhesions; therefore, only biopsy was performed. The pathology diagnosis was pulse granuloma. The pathology report from Thailand was obtained only after her discharge, suggesting that the previous granulomatous lesion contained vegetable matter. This report demonstrates that pulse granuloma can present as a pelvic mass and may relapse. For complex cystic lesions with solid components in the pelvis, pulse granuloma should be considered as a differential diagnosis.

Useful technique for submucous myomectomy under direct transcervical resectoscope observation.

The transcervical resectoscope (TCR) is used for resecting a submucous myoma (SMM). Safe grasping of an SMM with forceps and its complete resection under transabdominal ultrasound (TAUS) guidance is not always easy. SMMs are slippery, making them difficult to grasp. The SMM moves right to left and anterior to posterior when the surgeon tries to grasp it with placental forceps. Surgeons could use small Martin forceps (65% smaller) to grasp SMMs safely and tightly under direct TCR (transcervical resectoscope) observation. We present a case in which this operative procedure was used to remove an SMM with Figure and Video. The benefits of this procedure are enormous and could be immeasurably important to hysteroscopists and gynecologists.