Paraovarian Cyst Torsion in a Patient with Rubinstein-Taybi Syndrome: A Case Report

The "Double Ovary" Sign: A Unique Sonographic Observation in Isolated Fallopian Tube Torsion

Isolated fallopian tube torsion (IFTT) is a rare subset of adnexal torsion. Timely diagnosis of IFTT is essential for preservation of the fallopian tube. However, a pre-operative diagnosis is challenging due to nonspecific symptoms and findings on physical exam. In addition, ultrasound (US) is typically the initial imaging modality in this setting and adnexal torsion may not be considered when normal ovaries are seen. In this small case series, we introduce the "double ovary" sign, a unique observation on US characterized by two adjacent structures: the ovary and the twisted fallopian tube giving rise to an ovary-like, cystic structure. We present three cases in which IFTT was diagnosed preoperatively.

Pueperal Paratubal Cyst Torsion and Secondary Fallopian Tube Torsion Without Ovarian Involvement: A Case Report

Paratubal cyst torsion accompanied by secondary isolated fallopian tube torsion without involvement of the ipsilateral ovary is rare. A similar case occurring in the postpartum period has not been reported to date in the English literature. Our case report concerns a pregnant multiparous woman in the 40th gestational week, without regular antenatal care attendance, who was urgently admitted to the maternity ward with pushing labour pains and gave birth with vaginal delivery. A few hours later, puerperant complained of worsening severe lower abdominal pain, accompanied by nausea, dizziness and vomiting, unresponsive to analgesic medication. Based on the clinical and ultrasound findings, the diagnosis of an ovarian cyst torsion was established, and it was decided to treat the patient with surgery and in particular with laparotomy. Intraoperatively, in the left parametrium, the presence of an ovoid mass with a brownish-red hue and a smooth outer surface was detected, along which the ipsilateral fallopian tube ran, without the involvement of the ovary. Histological examination of the surgical specimen confirmed the diagnosis of isolated fallopian tubal torsion with paratubal cyst. The postoperative course was uneventful. In this paper, based on modern data, a brief literature review of this rare nosological entity is attempted, regarding the diagnostic and therapeutic approach, the immediate application of which can ensure the best prognosis.

Rubinstein-Taybi Syndrome: A Model of Epigenetic Disorder

The Rubinstein-Taybi syndrome (RSTS) is a rare congenital developmental disorder characterized by a typical facial dysmorphism, distal limb abnormalities, intellectual disability, and many additional phenotypical features. It occurs at between 1/100,000 and 1/125,000 births. Two genes are currently known to cause RSTS, CREBBP and EP300, mutated in around 55% and 8% of clinically diagnosed cases, respectively. To date, 500 pathogenic variants have been reported for the CREBBP gene and 118 for EP300. These two genes encode paralogs acting as lysine acetyltransferase involved in transcriptional regulation and chromatin remodeling with a key role in neuronal plasticity and cognition. Because of the clinical heterogeneity of this syndrome ranging from the typical clinical diagnosis to features overlapping with other Mendelian disorders of the epigenetic machinery, phenotype/genotype correlations remain difficult to establish. In this context, the deciphering of the patho-physiological process underlying these diseases and the definition of a specific episignature will likely improve the diagnostic efficiency but also open novel therapeutic perspectives. This review summarizes the current clinical and molecular knowledge and highlights the epigenetic regulation of RSTS as a model of chromatinopathy.