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Bhat CS, Reddy NS, Vembu R, Pandurangi M. Dual extrauterine ectopic pregnancy: double management. BMJ Case Rep 2021; 14:e244417. [PMID: 34764105 PMCID: PMC8587342 DOI: 10.1136/bcr-2021-244417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2021] [Indexed: 11/04/2022] Open
Abstract
A 30-year-old nulliparous woman was referred with suspected left ovarian ectopic pregnancy. She had undergone laparoscopic left salpingectomy for ruptured tubal ectopic pregnancy 3 weeks earlier, following treatment with medications for ovulation induction. Sonological examination revealed a left ovarian ectopic pregnancy corresponding to 8 0/7 weeks with cardiac activity. She underwent ultrasound-guided intrasac therapy with intrasac instillation of 3 mEq of potassium chloride followed by 50 mg of methotrexate. She was followed with weekly measurements of serum beta human Chorionic Gonadotropin (hCG) which returned to baseline after 65 days of the intrasac therapy. This case not only highlights the need for continued follow-up of the serum beta hCG after definitive management of an ectopic pregnancy in cases with multiple ovulations, but also the option of medical management in cases of advanced ovarian ectopic pregnancy. It also accentuates the necessity for adequate counselling to avoid conception in a multiple ovulation cycle.
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Affiliation(s)
- Chandana S Bhat
- Department of Reproductive Medicine and Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - N Sanjeeva Reddy
- Department of Reproductive Medicine and Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Radha Vembu
- Department of Reproductive Medicine and Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Monna Pandurangi
- Department of Reproductive Medicine and Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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2
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Fessehaye A, Gudu W, Gashawbeza B. A rare presentation of chronic ovarian ectopic pregnancy: A case report. Int J Gynaecol Obstet 2021; 154:183-185. [PMID: 33779984 DOI: 10.1002/ijgo.13689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/06/2021] [Accepted: 03/26/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Abraham Fessehaye
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Wondimu Gudu
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Biruck Gashawbeza
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Istrate-Ofiţeru AM, Ruican D, Niculescu M, Nagy RD, Roşu GC, Petrescu AM, Drăguşin RC, Iovan L, Zorilă GL, Iliescu DG. Ovarian ectopic pregnancy: the role of complex morphopathological assay. Review and case presentation. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2020; 61:985-997. [PMID: 34171048 PMCID: PMC8343605 DOI: 10.47162/rjme.61.4.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 05/27/2021] [Indexed: 11/25/2022]
Abstract
Ovarian ectopic pregnancy (OEP) represents the rarest type of ectopic pregnancy, accounting for 1-3% of this pathology. The diagnosis of this pathology is challenging due to the non-specific clinical aspects and the ultrasound examination hampered by the lack of visible gestational sac in the presence of hematocele and hemoperitoneum. The purpose of the extended histopathological (HP) examination was to identify particular aspects of the OEP trophoblast and to highlight potential local ovarian modifications which can determine pregnancy fixation at this level. The patient presented local favorable conditions for intraovarian nidation, conditions confirmed by the HP classical examination and by the immunohistochemical evaluation. We identified, using classical Hematoxylin-Eosin, Masson's trichrome and Periodic Acid-Schiff (PAS)-Hematoxylin, necrotic hemorrhage, accentuated vascular thrombosis and high density lymphoplasmocytary infiltrate. These modifications increased local adhesivity and cell destruction through hypoperfusion. Anti-cluster of differentiation antibodies (CD34, CD38, tryptase) revealed the low number of intravillous vessels and the high number of macrophages and mastocytes involved in the local inflammatory process heighten. We identified the presence of trophoblast tissue in the ovarian structure using anti-cytokeratin AE1∕AE3 (CK AE1∕AE3)/anti-cytokeratin 7 (CK7) antibodies. The anti-alpha-smooth muscle actin (α-SMA) and anti-vimentin (VIM) antibodies displayed the density of myofibroblasts and intravillous stromal cells and with the aid of anti-progesterone receptor (PR) antibody, we identified the corpus luteum hormonal response in the OEP. The placental villosities present a blocked multiplication process at the anti-apoptotic B-cell lymphoma 2 (BCL2) protein, confirmed by the Ki67 cell proliferation and tumor protein 63 (p63) immunomarkers. Anti-neuron specific enolase (NSE), anti-calretinin and anti-inhibin A antibodies showed the particular aspects of the granulosa and internal theca cells, which may be involved in oocyte release blockage, intraluteal and extraluteal fecundation of the OEP.
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Affiliation(s)
- Anca-Maria Istrate-Ofiţeru
- Department of Histology, University of Medicine and Pharmacy of Craiova, Romania
- Research Center for Microscopic Morphology and Immunology, University of Medicine and Pharmacy of Craiova, Romania
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, Romania
| | - Dan Ruican
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, Romania
- PhD Student, Doctoral School, University of Medicine and Pharmacy of Craiova, Romania
| | - Mihaela Niculescu
- Department of Anatomy, University of Medicine and Pharmacy of Craiova, Romania
| | - Rodica Daniela Nagy
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, Romania
- PhD Student, Doctoral School, University of Medicine and Pharmacy of Craiova, Romania
| | - Gabriela-Camelia Roşu
- Department of Histology, University of Medicine and Pharmacy of Craiova, Romania
- Research Center for Microscopic Morphology and Immunology, University of Medicine and Pharmacy of Craiova, Romania
| | - Ana-Maria Petrescu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, Romania
| | - Roxana Cristina Drăguşin
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, Romania
| | - Larisa Iovan
- Department of Histology, University of Medicine and Pharmacy of Craiova, Romania
- Research Center for Microscopic Morphology and Immunology, University of Medicine and Pharmacy of Craiova, Romania
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, Romania
- PhD Student, Doctoral School, University of Medicine and Pharmacy of Craiova, Romania
| | - George Lucian Zorilă
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, Romania
| | - Dominic Gabriel Iliescu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, Romania
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Jain S, Jeet S, Jain N, Dahiya K, Dahiya P. Primary Ovarian Pregnancy: Early Diagnosis Still a Myth. J Gynecol Surg 2015. [DOI: 10.1089/gyn.2014.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shaveta Jain
- Department of Obstetrics and Gynaecology, Pt. B.D Sharma, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Simran Jeet
- Department of Obstetrics and Gynaecology, Pt. B.D Sharma, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Nitin Jain
- Department of Radiology, Pt. B.D Sharma, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Krishna Dahiya
- Department of Obstetrics and Gynaecology, Pt. B.D Sharma, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Pushpa Dahiya
- Department of Obstetrics and Gynaecology, Pt. B.D Sharma, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
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Samal S, Gupta S, Mahapatro A. Laparoscopic Management of Primary Ovarian Pregnancy. J Gynecol Surg 2015. [DOI: 10.1089/gyn.2014.0051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sunita Samal
- Department of Obstetrics and Gynecology, Mahatma Ghandi Medical College and Research Institute, Puducherry, India
| | - Shweta Gupta
- Department of Obstetrics and Gynecology, Mahatma Ghandi Medical College and Research Institute, Puducherry, India
| | - Akshaya Mahapatro
- Department of Obstetrics and Gynecology, Mahatma Ghandi Medical College and Research Institute, Puducherry, India
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Gupta N, Gupta A, Onyema G, Pantofel Y, Ying SC, Garon JE, Lampley C, Blankstein J. Accurate preoperative diagnosis of ovarian pregnancy with transvaginal scan. Case Rep Obstet Gynecol 2012; 2012:934571. [PMID: 23091755 PMCID: PMC3472540 DOI: 10.1155/2012/934571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 09/15/2012] [Indexed: 11/26/2022] Open
Abstract
Ovarian pregnancy is a rare variant of ectopic pregnancy, and an accurate preoperative diagnosis is very challenging. Dr. Saint Monnissey described the first reported case of ovarian pregnancy in 17th century. Transvaginal ultrasonography is a valuable tool in identifying an ovarian pregnancy from other types of ectopic pregnancies. Management with laparoscopy or laparotomy is required in all cases, and in almost all cases, ovary can be preserved since implantation is usually superficial (Koo et al.; 2011). A single case of an ovarian pregnancy, consistent with Spiegelberg's criteria is presented here. This case history demonstrates the use of ultrasonography (USG) and surgery in the diagnosis and treatment, respectively, of the ovarian pregnancy. As we step into an era where in vitro fertilization rate is on its hike, one should be aware that incidence of ovarian pregnancy is also increasing, necessitating a high index of suspicion.
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Affiliation(s)
- Natasha Gupta
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, 1500 S California Avenue, Chicago, IL 60608, USA
| | - Anu Gupta
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, 1500 S California Avenue, Chicago, IL 60608, USA
| | - Godwin Onyema
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, 1500 S California Avenue, Chicago, IL 60608, USA
| | - Yelena Pantofel
- Department of Ultrasound, Mount Sinai Hospital, 1500 S California Avenue, Chicago, IL 60608, USA
| | - Shan-Ching Ying
- Department of Pathology, Mount Sinai Hospital, 1500 S California Avenue, Chicago, IL 60608, USA
| | - Jack E. Garon
- Department of Pathology, Mount Sinai Hospital, 1500 S California Avenue, Chicago, IL 60608, USA
| | - Charles Lampley
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, 1500 S California Avenue, Chicago, IL 60608, USA
| | - Josef Blankstein
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, 1500 S California Avenue, Chicago, IL 60608, USA
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Eskandar O. Conservative laparoscopic management of a case of ruptured ovarian ectopic pregnancy by using a Harmonic scalpel. J OBSTET GYNAECOL 2010; 30:67-9. [PMID: 20121515 DOI: 10.3109/01443610903295912] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- O Eskandar
- Department of Obstetrics and Gynaecology, North Devon Hospital, Barnstaple, Devon EX31 4JB, UK.
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