Accessory Cavitated Uterine Mass Masquerading as Endometriotic Cyst, in a Multiparous Woman with Refractory Dysmenorrhea.
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ABSTRACT:
SUBMITTER: Kaur J
PROVIDER: S-EPMC9701281 | biostudies-literature | 2022 Dec
REPOSITORIES: biostudies-literature
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Accessory Cavitated Uterine Mass Masquerading as Endometriotic Cyst, in a Multiparous Woman with Refractory Dysmenorrhea.
Kaur Japleen J Rani Shikha S Gill Ravneet Kaur RK Bhagat Nisha N Sharma Sushmita S
Journal of obstetrics and gynaecology of India 20220828 Suppl 2
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Project description:ObjectiveWe report a case of an accessory cavitated uterine mass (ACUM) in a patient with infertility and chronic pelvic pain. In addition, we summarize the literature to better characterize ACUM diagnosis and management.DesignA comprehensive literature search using the PubMed database was performed through April 2023. Historical ACUM diagnostic criteria were applied as inclusion criteria. Descriptive statistics and statistical evaluation were reported.ResultsA 31-year-old nulligravid woman presented with chronic pelvic pain, dysmenorrhea, primary infertility, and history of endometriosis. Three-dimensional ultrasonography identified an ACUM and laparoscopic excision provided complete resolution of symptoms. Subsequently, she conceived without assistance twice with uncomplicated vaginal deliveries. A total of 154 articles were identified, 34 papers met inclusion criteria and were individually reviewed, consisting of 70 reported cases. The most common presenting complaints were dysmenorrhea (81.4%), chronic pelvic/abdominal pain (54.1%), and refractory pain (34.3%). Diagnostic imaging included magnetic resonance imaging (62.9%) and transvaginal ultrasound (55.7%). Management included resection via laparoscopy (75.7%) or laparotomy (18.6%), or hysterectomy (5.7%). Of cases with reported outcomes, 90.7% had complete relief of symptoms after surgery.ConclusionACUM often presents with dysmenorrhea, chronic pelvic pain, or abdominal pain and is identifiable on magnetic resonance imaging as a hyperenhancing mass. Three-dimensional transvaginal ultrasound can also accurately identify ACUM. A total of 90.7% of patients had complete relief of symptoms after intervention. It is important to identify ACUM early to relieve pain and reduce unnecessary interventions. Like our patient, other reports have demonstrated concomitant infertility and endometriosis. However, further investigation is needed to explore the association between infertility and ACUM.
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Project description:IntroductionDentigerous cysts (DCs) involving the orbit are extremely rare. The authors report a unique case of stand-alone orbital DC associated with ectopic canine tooth masquerading as a lacrimal sac diverticulitis with superadded preseptal cellulitis.Case presentationA 21-year-old lady presented with left inferomedial swelling, associated with pain and redness of 1-week-duration. A lacrimal sac diverticulitis with preseptal cellulitis was suspected and imaging was requested in view of progression. Computed tomography scan of orbit revealed a well-defined heterogenous mass, with associated hyperdense lesion within the mass, prompting a possibility of a foreign body granuloma. Surgical exploration and excision confirmed the diagnosis of an ectopic canine tooth with associated DC along with excessive adhesion of the cyst to the lacrimal sac wall. Maxillary sinus did not show any abnormality. Lacrimal irrigation was patent with no recurrence noted at 6-month follow-up.ConclusionThis report highlights the presentation of DC with associated ectopic canine tooth as an isolated orbital mass, initially manifesting as preseptal cellulitis with lacrimal sac diverticulitis. Recurrent episodes of infection can lead to synechiae formation, rendering adjacent lacrimal sac more prone to injury. Cyst excision with meticulous dissection yields good outcome.
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Project description:Intrapulmonary teratoma (IPT) is a rare mediastinal teratoma. IPT arise because of abnormal migration of pluripotent stem cells along the developing lung bud. Patients present with chest pain, hemoptysis, and trichoptysis. These tumors have the potential to rupture into adjacent pleura, pericardium, or tracheobronchial tree. The differential diagnosis includes hydatid cyst, fungal ball, lung abscess, and lung parenchymal tumor. We report a case of IPT, which was initially diagnosed as hydatid cyst of the lung due to positive hydatid serology and correlating radiological features. The role of cross-reaction of hydatid antigens with sera of cancer patients needs to be evaluated. Surgical resection of the tumor is advised to avoid complications.
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Project description:A retrorectal epidermoid cyst is an uncommon congenital lesion that arises from the remnants of the embryonic tissues. This type of cyst is difficult to diagnose before surgery. In this study, we report a rare case of a giant retrorectal epidermoid cyst in a 30-year-old woman. Initially, the condition was diagnosed as a perianal abscess and treated with incision and drainage. Since the abscess recurred, a pelvic magnetic resonance imaging was ordered, which revealed an 8.2?cm perianal cyst with appearance not compatible with an abscess. Postsurgical histologic analysis confirmed a retrorectal epidermoid cyst. Postoperative course was uneventful, and the woman was discharged on postoperative day 3. She was doing well at 4 months of follow-up. This report suggests that retrorectal cysts should be considered in cases of recurrent perianal swellings/abscesses.
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Project description:IntroductionPubic disjunction syndrome has been identified as responsible for pain during pregnancy and post partum; it is favored by twins and traumatic events such as extraction maneuvers.Case reportA 38-year-old woman, 5G/5P, with no pathological history, who presented 2 days postpartum with no notion of instrumental extraction, with severe pelvic symphysis pain with functional impotence. Examination revealed elective pain on palpation of the pubic symphysis without radiation. X-ray of the pelvis showed a 15-mm enlargement of the symphysis. CT scan of the pelvis showed a 17-mm disjunction of the pubic symphysis. The patient received analgesic treatment with pelvic bandage and anticoagulant therapy with good clinical response.DiscussionPeripartum pubic disjunction is a rare entity whose etiologies are still poorly understood, although multiparity, fetal macrosomia, extraction maneuvers, and joint pathologies have been incriminated. Symptomatology includes pubic symphysis pain. Conventional radiology shows an abnormal space at the inter-symphysial joint greater than 10 mm. Medical treatment with pelvic bandage, rest, physical therapy and physiotherapy allows a favorable evolution, otherwise infiltrations containing a local anesthetic and corticosteroids. Surgery is indicated if the diastasis is greater than 4 cm.ConclusionSymphyseal disjunction is evoked in front of any pelvic pain in peripartum, the diagnosis is made at the radiology of the pelvis with intersymphysis space higher than 10 mm. The treatment is medical associating an analgesia or a local infiltration, a rest and a physiotherapy. Pelvic bandaging and surgical treatment are reserved for complicated forms.
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Project description:To identify the miRNAs which play a role in the development of endometriosis, we explored differentially expressed miRNAs between ECSCs (N=8) and normal endometrial stromal cells (NESCs, n=8) using miRNA microarray. The expression profiles in ECSCs and NESCs were obtained, then the miRNAs were filtered by signal intensity (20.0<, at least one out of 16 samples have values within range) and flags (at least 70% of cases have good flags). The differentially expressed miRNAs in ECSCs compared with NESCs were identified using volcano plot (Fold change >= 2.0, Mann-Whiteny U test p<0.05). The primary culture of ECSCs and NESCs (controls) were utilized. Total RNA was extracted from them, and miRNA microarray analysis was performed. The miRNAs differentially expressed between ECSCs and NESCs were identified, and aberrantly expressed miRNAs in ECSCs were defined as the endometriosis related miRNAs.
2013-02-06 | E-GEOD-40186 | biostudies-arrayexpress
Project description:Retroperitoneal cystic mass is a rare surgical condition that is often misdiagnosed preoperatively. Here, we report a case of a 56-year-old woman who presented with abdominal swelling for a 1-year duration, which was associated with lower abdominal pain for 6 months. Her abdominal radiograph showed a huge radiopaque lesion, and contrast-enhanced computed tomography scan of the abdomen reported it as a left ovarian serous cystadenoma causing local mass effect to the left ureter leading to mild left hydronephrosis. She underwent exploratory laparotomy and noted there was a huge retroperitoneal cystic mass. The histopathological assessment finding was consistent with a benign retroperitoneal cyst. This case report aims to share the rare case of primary retroperitoneal lesions, which can cause a diagnostic challenge preoperatively to all clinicians despite advanced achievement in medical imaging.
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Project description:To identify the miRNAs which play a role in the development of endometriosis, we explored differentially expressed miRNAs between ECSCs (N=8) and normal endometrial stromal cells (NESCs, n=8) using miRNA microarray. The expression profiles in ECSCs and NESCs were obtained, then the miRNAs were filtered by signal intensity (20.0<, at least one out of 16 samples have values within range) and flags (at least 70% of cases have good flags). The differentially expressed miRNAs in ECSCs compared with NESCs were identified using volcano plot (Fold change >= 2.0, Mann-Whiteny U test p<0.05).
2013-02-06 | GSE40186 | GEO
Project description:Increasing imaging data point to a link between deep endometriotic nodules (DENs) and uterine adenomyosis (AD). The study aimed to investigate this link at the histological level and detect potential features shared by the two diseases. We collected formalin-fixed paraffin-embedded tissue (endometrium and lesions) from women with DENs of the rectovaginal septum (n = 13), AD (n = 14), and control subjects (n = 14). Immunohistochemical analyses of CD41 and CD68 were conducted to explore the roles of platelets and macrophages, respectively. Picrosirius red staining was carried out to gather evidence of fibrosis. Vascular endothelial growth factor (VEGF) was assessed, and total numbers of CD31-positive vessels were calculated to investigate the mechanism governing angiogenesis. Double immunohistochemistry for CD31 and alpha smooth muscle actin (αSMA) was performed to discern stable vessels. Platelet aggregation was significantly decreased in both types of lesions compared to their corresponding eutopic endometrium and healthy controls. Macrophage numbers were higher in both lesions than in their corresponding endometrium and healthy subjects. Significantly higher rates of collagen accumulation were detected in DENs and AD lesions compared to their corresponding eutopic and healthy endometrium. VEGF expression was downregulated in the stromal compartment of AD lesions compared to the healthy endometrium. The total number of vessels per area was significantly higher in DENs and AD lesions than in the healthy endometrium. Rates of αSMA-surrounded vessels were decreased in DENs and AD lesions compared to their corresponding eutopic and healthy endometrium. We report common pathogenic mechanisms between DENs and AD, namely excessive macrophage accumulation, fibrosis, and irregular angiogenesis. Our results further support the notion of DENs and AD being linked at the histological level.
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Project description:Case presentationA seven-year-old male presented to the pediatric emergency department with one day of abdominal pain. His physical exam was significant for rebound, guarding, and tenderness in the right lower quadrant, and his labs demonstrated a leukocytosis. Both a point-of-care ultrasound and radiology-performed ultrasound were concerning for acute appendicitis with a periappendiceal abscess, but on emergent laparoscopy the patient was found to have an infected urachal cyst.DiscussionInfected urachal remnants are a rare but important cause of pediatric abdominal pain. In this case, inflammation surrounding the patient's midline urachal cyst triggered a serositis that involved the appendix and pulled the cyst to the right. This created a clinical and radiologic presentation similar to appendicitis. This atypical presentation of an already rare anomaly highlights the importance of maintaining a broad differential during the work-up of pediatric abdominal pain.
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