1
|
Verta S, Brambs CE, Christmann C. Cystic Adenomyoma in Pregnancy: A Case Report. Int J Womens Health 2024; 16:421-432. [PMID: 38469356 PMCID: PMC10926917 DOI: 10.2147/ijwh.s450701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/29/2024] [Indexed: 03/13/2024] Open
Abstract
Cystic adenomyomas (CA) are rare. They primarily affect adolescents and young women in their fertile years. Therefore, fertility and pregnancy outcome are of pivotal relevance in this patient collective. Apart from the guidelines of the European Society of Human Reproduction and Embryology (ESHRE) on the management of endometriosis in general, there are no specific treatment recommendations for CA and, as far as our research shows, no data illustrating the behavior of a CA over the course of pregnancy. Thus, we report the case of a 32-year-old 1-gravida, 1-para, preconceptionally diagnosed with a CA by ultrasound. After thoroughly discussing further treatment options, the decision was made to opt for a more conservative approach and not perform surgery before attempting a next pregnancy. The patient conceived spontaneously and sonographic monitoring of the CA throughout pregnancy showed complete regression of the cystic component during the second trimester. A healthy baby was delivered at term by an uncomplicated elective cesarean section. Following a review of the literature and taking into account the course of our case, we propose the feasibility of a conservative, non-surgical approach in women with a CA and the desire to conceive.
Collapse
Affiliation(s)
- Stephanie Verta
- Department of Obstetrics and Gynecology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Christine E Brambs
- Department of Obstetrics and Gynecology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Corina Christmann
- Department of Obstetrics and Gynecology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| |
Collapse
|
2
|
Liang Y, Mei L, Ning Q, Zhang J, Fei J, Dong J. A Case of Rectal Endometriosis Misdiagnosed as Rectal Malignancy on Three Colonoscopies and Biopsies Sharing a Combined Literature Review. Int J Womens Health 2024; 16:163-174. [PMID: 38292299 PMCID: PMC10826710 DOI: 10.2147/ijwh.s445280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/11/2024] [Indexed: 02/01/2024] Open
Abstract
Background Endometriosis involves the intestine, and its clinical manifestations are nonspecific and lack of etiological manifestations. The diagnosis is difficult, which often leads to misdiagnosis. We report a case of endometriosis which was misdiagnosed as intestinal malignant tumor after colonoscopy and three biopsies. Case Presentation We reported a 42-year-old woman who went to see a doctor because of anal distension. She was examined by three gastrointestinal endoscopists at different levels in different hospitals and underwent biopsy at the same time. Combined with clinical manifestations, imaging examination, endoscopic examination and pathological examination, she was misdiagnosed as intestinal malignant tumor, and partial intestinal resection was performed according to the surgical principle of malignant tumor. Conclusion Although there are advanced gastrointestinal endoscopy and imaging techniques, intestinal endometriosis is still easy to be misdiagnosed. As our case report shows, after three colonoscopy and biopsy, it is still misdiagnosed as intestinal malignant tumor. Further research is needed to improve the ability of preoperative diagnosis, which deserves the attention of gastroenterologists and obstetricians and gynecologists.
Collapse
Affiliation(s)
- Yufei Liang
- Department of Gynaecology and Obstetrics, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
| | - Lina Mei
- Department of Digestive, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
| | - Qipeng Ning
- Department of Digestive, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
| | - Jiao Zhang
- Department of Digestive, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
| | - Jingying Fei
- Department of Ultrasound, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
| | - Jie Dong
- Department of Gynaecology and Obstetrics, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
| |
Collapse
|
3
|
Franco PN, García-Baizán A, Aymerich M, Maino C, Frade-Santos S, Ippolito D, Otero-García M. Gynaecological Causes of Acute Pelvic Pain: Common and Not-So-Common Imaging Findings. Life (Basel) 2023; 13:2025. [PMID: 37895407 PMCID: PMC10608316 DOI: 10.3390/life13102025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
In female patients, acute pelvic pain can be caused by gynaecological, gastrointestinal, and urinary tract pathologies. Due to the variety of diagnostic possibilities, the correct assessment of these patients may be challenging. The most frequent gynaecological causes of acute pelvic pain in non-pregnant women are pelvic inflammatory disease, ruptured ovarian cysts, ovarian torsion, and degeneration or torsion of uterine leiomyomas. On the other hand, spontaneous abortion, ectopic pregnancy, and placental disorders are the most frequent gynaecological entities to cause acute pelvic pain in pregnant patients. Ultrasound (US) is usually the first-line diagnostic technique because of its sensitivity across most common aetiologies and its lack of radiation exposure. Computed tomography (CT) may be performed if ultrasound findings are equivocal or if a gynaecologic disease is not initially suspected. Magnetic resonance imaging (MRI) is an extremely useful second-line technique for further characterisation after US or CT. This pictorial review aims to review the spectrum of gynaecological entities that may manifest as acute pelvic pain in the emergency department and to describe the imaging findings of these gynaecological conditions obtained with different imaging techniques.
Collapse
Affiliation(s)
- Paolo Niccolò Franco
- Department of Radiology, Hospital Universitario de Vigo, Carretera Clara Campoamor 341, 36312 Vigo, Spain; (A.G.-B.); (S.F.-S.); (M.O.-G.)
- Department of Diagnostic Radiology, IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy; (C.M.); (D.I.)
| | - Alejandra García-Baizán
- Department of Radiology, Hospital Universitario de Vigo, Carretera Clara Campoamor 341, 36312 Vigo, Spain; (A.G.-B.); (S.F.-S.); (M.O.-G.)
- Diagnostic Imaging Research Group, Radiology Department, Galicia Sur Health Research Institute (IIS Galicia Sur), Galician Health Service (SERGAS)-University of Vigo (UVIGO), 36213 Vigo, Spain;
| | - María Aymerich
- Diagnostic Imaging Research Group, Radiology Department, Galicia Sur Health Research Institute (IIS Galicia Sur), Galician Health Service (SERGAS)-University of Vigo (UVIGO), 36213 Vigo, Spain;
| | - Cesare Maino
- Department of Diagnostic Radiology, IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy; (C.M.); (D.I.)
| | - Sofia Frade-Santos
- Department of Radiology, Hospital Universitario de Vigo, Carretera Clara Campoamor 341, 36312 Vigo, Spain; (A.G.-B.); (S.F.-S.); (M.O.-G.)
- Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), Rua Prof. Lima Basto, 1099-023 Lisbon, Portugal
| | - Davide Ippolito
- Department of Diagnostic Radiology, IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, Italy; (C.M.); (D.I.)
- School of Medicine, University of Milano Bicocca, Via Cadore 33, 20090 Monza, Italy
| | - Milagros Otero-García
- Department of Radiology, Hospital Universitario de Vigo, Carretera Clara Campoamor 341, 36312 Vigo, Spain; (A.G.-B.); (S.F.-S.); (M.O.-G.)
- Diagnostic Imaging Research Group, Radiology Department, Galicia Sur Health Research Institute (IIS Galicia Sur), Galician Health Service (SERGAS)-University of Vigo (UVIGO), 36213 Vigo, Spain;
| |
Collapse
|
4
|
Olinger K, Maheshwari E, Shenoy-Bhangle AS, Adejolu M, McGettigan M, Mathew H, Lee KS, Nicola R. Mimics of cancer in pregnancy. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 48:1752-1773. [PMID: 36577923 DOI: 10.1007/s00261-022-03783-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/30/2022]
Abstract
Pregnancy is a remarkable time of pronounced growth and development of the fetus. Benign pathologies outside of the uterus, including those containing hormonally responsive tissue which undergo physiologic changes and other incidentally identified lesions, may mimic malignancy on clinical evaluation and imaging. A detailed history and physical exam, ultrasound and non-contrast magnetic resonance imaging features and comparison with prior imaging if available may help to narrow the list of potential differential diagnoses. Follow-up imaging in the postpartum period is often vital to confirm benignity and, in some cases, sampling to confirm the diagnosis is necessary. This review will cover the clinical, pathological and multimodality imaging features of numerous potential mimickers of cancer in the setting of pregnancy organized by organ systems. The goal is to better equip abdominal radiologists to accurately identify benign disease and help guide further imaging or follow-up recommendations to avoid unnecessarily aggressive intervention and improve patient care.
Collapse
Affiliation(s)
- Kristen Olinger
- Division of Abdominal Radiology, Department of Radiology, University of North Carolina at Chapel Hill, 2021 Old Clinic Building, Chapel Hill, NC, 27599, USA.
| | - Ekta Maheshwari
- Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15143, USA
| | - Anuradha S Shenoy-Bhangle
- Division of Abdominal Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02214, USA
| | - Margaret Adejolu
- Department of Radiology, The Royal Marsden Hospital, London, England, UK
| | | | | | - Karen S Lee
- Division of Abdominal Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Refky Nicola
- Division of Abdominal Imaging, Department of Radiology, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| |
Collapse
|