1/72. Torsion of a functional ovarian cyst in a premenopausal patient receiving tamoxifen.We report a case of torsion of an ovarian follicular cyst that developed during treatment with tamoxifen for breast cancer. A 40-year-old Japanese woman was admitted complaining of acute lower abdominal pain. Eight months earlier, she had undergone a partial mastectomy and local irradiation for ductal carcinoma of her left breast, estrogen receptor-positive stage I (T(1a) N(1b) M(0)). The administration of tamoxifen, 20 mg/day, and doxifluridine, 600 mg/day, were started immediately postoperatively. Pelvic examination after admission revealed the left ovarian cyst and enlarged uterus. Transvaginal ultrasonography and computed tomography revealed a multilocular cystic mass in the pelvic cavity. The pathological diagnosis of the tumor after total hysterectomy and bilateral salpingo-oophorectomy was a typical follicular cyst with torsion and uterine leiomyoma. This ovarian cyst was believed to have developed during tamoxifen administration.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
2/72. hemoperitoneum from spontaneous bleeding of a uterine leiomyoma: a case report.Bleeding from uterine leiomyoma is a rare cause of hemoperitoneum. In most cases bleeding is a result of trauma or torsion. Spontaneous rupture of a superficial vein is extremely rare. Fewer than 100 cases have been reported. Our patient is a 44-year-old black woman who presented in the emergency room with acute onset of epigastric pain. Past medical and surgical history was not contributory except for a uterine "fibroid." In the emergency room, the patient's abdomen became diffusely tender. Her pregnancy test was negative, and the abdominal ultrasound showed fluid in the peritoneal cavity. The patient became hemodynamically unstable, and there was a significant drop of the hemoglobin/hematocrit. A surgical consultation was requested, and the patient underwent exploratory laparotomy. A subserosal uterine leiomyoma was found, with an actively bleeding vein on its dome. The leiomyoma was excised and 3 liters of blood and blood clots were evacuated from the peritoneal cavity. The patient was premenopausal and had a known leiomyoma. The clinical course was similar to that of previously reported cases. Although extremely rare, when there is no history of trauma, pregnancy, or other findings, spontaneous bleeding from uterine leiomyoma should be in the differential diagnosis. Emergent surgical intervention is recommended to establish the diagnosis and stop the hemorrhage.- - - - - - - - - - ranking = 2keywords = cavity (Clic here for more details about this article) |
3/72. Endometrial stromal sarcoma of the uterus: MR and US findings.We describe the MRI and US features of two patients with endometrial stromal sarcoma of the uterus. Both lesions appeared as voluminous polypoid masses within an expanded endometrial cavity on both US and MRI. They had mixed echo-texture and heterogenous signal intensity on both T1- and T2-weighted sequences. T2-weighted images were most helpful in detecting the endometrial nature of the disease and its relationships with surrounding myometrium.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
4/72. Intravenous leiomyomatosis extending into the right ventricular cavity: one-stage radical operation using cardiopulmonary bypass--a case report.The authors describe a 47-year-old woman with intravenous leiomyomatosis (IVL) extending into the right ventricular cavity. This rare entity is a neoplasm originating from smooth muscle of the uterus, with vermiform extensions into the inferior vena cava. The patient underwent a one-stage operation under simultaneous sternotomy and laparotomy, and radical excision of the tumor was successfully achieved with use of normothermic cardiopulmonary bypass. Although this tumor is histologically benign, it sometimes extends into the cardiac cavity and causes sudden death due to incarceration into the atrioventricular orifice. Moreover, recurrence or lung metastasis of IVL has been reported. The authors recommend a one stage-radical resection of the tumor or a two-staged operation within a short interval. In the literature, 24 surgical cases of the intravenous leiomyomatosis with intracardiac extension have been reported. The diagnosis and surgical treatment of this tumor are reviewed and discussed.- - - - - - - - - - ranking = 6keywords = cavity (Clic here for more details about this article) |
5/72. Ureteral complications after gasless laparoscopic hysterectomy.Laparoscopic hysterectomy is becoming a more common operation. Gasless laparoscopy initially seems to be a better technique, reducing CO2 complications and allowing the use of conventional instruments rather than more expensive laparoscopic tools. We report our experience with 50 cases of laparoscopic hysterectomies, 5 of which were performed using a gasless technique. Of these five cases, there were two cases of ureteral stenosis. Ureteral injuries are common with hysterectomy, even in nonlaparoscopic procedures, and the literature is replete with recommendations to avoid this damage. In the gasless procedure, the ureters cannot be repositioned completely from the cervix after the hydrodissection. Extreme caution must be taken when applying bipolar or monopolar energy. The abdominal cavity shape does not allow complete avoidance of the ureters using the gasless technique. We have decided not to use a gasless technique with hysterectomy. We believe that the actual complication rate may be higher than reported, due to investigators' reluctance to report such complications. Our hope is that this report will encourage other investigators to help establish a more accurate rate of possible complications associated with this procedure.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
6/72. Cotyledonoid leiomyoma of the uterus: report of a case.A 46-year-old woman presented with a pelvic mass. At the time of operation a large, exophytic, multinodular tumor extended into the peritoneal cavity and right broad ligament from a pedunculated attachment to the uterus in the region of the right cornu. On external examination the lesion had the appearance of cotyledonoid dissecting leiomyoma. On microscopic examination bulbous processes were composed of benign smooth muscle arranged in interlacing fascicles or swirls; there was focal hydropic degeneration. Significant nuclear atypia, mitotic activity, and coagulative tumor necrosis were not encountered. No intravascular involvement was present. There was no demonstrable parent leiomyoma or intramural dissecting component, and thus the case differed from previously reported cases of both cotyledonoid dissecting leiomyoma and intramural dissecting leiomyoma. This tumor represents another variation in the group of benign uterine smooth muscle tumors with unusual growth patterns.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
7/72. Uterine fistula induced by hysteroscopic resection of an embolized migrated fibroid: a rare complication after embolization of uterine fibroids.OBJECTIVE: To describe a case in which hysteroscopic removal of a fibroid that had migrated through the uterine wall induced formation of a uterine fistula. DESIGN: After embolization of uterine fibroids, an investigative clinical, sonographic, and hysteroscopic protocol was followed. SETTING: Gynecologic clinic of a university hospital. PATIENT(S): A 38-year-old woman undergoing embolization of uterine arteries for uterine fibroids. INTERVENTION(S): angiography-guided transcatheter bilateral embolization of uterine arteries, with clinical, sonographic, and hysteroscopic follow-up. MAIN OUTCOME MEASURE(S): Patient morbidity and satisfactory intercourse. RESULT(S): Six months after embolization of the uterine arteries, the patient presented migration of the fibroid through the uterine wall. Hysteroscopic removal of the fibroid induced posthysteroscopic formation of a uterine fistula. CONCLUSION(S): After embolization of the uterine arteries, thorough follow-up examination of the uterine cavity is strictly recommended. diagnosis of a uterine wall perforation can identify an abnormal source of uterine bleeding, and patients should be counseled to avoid pregnancy until the lesion heals completely.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
8/72. hydrothorax: an unexpected complication after laparoscopic myomectomy.We report a case of hydrothorax as a complication of laparoscopic myomectomy in an otherwise healthy woman. The most likely cause of the patient's hydrothorax was irrigation fluid moving from the peritoneal cavity into the pleural space via defects in the diaphragm. Anaesthesists and surgeons should consider hydrothorax as a potential complication in any patient undergoing laparoscopy.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
9/72. Thoracoscopic resection of an esophageal stromal tumor through the left pleural cavity.We describe the technique for endoscopic removal of a stromal tumor of the lower third of the esophagus through the left thoracoscopic approach. The tumor resembled a leiomyoma and was classified as a borderline, potentially malignant lesion after thoracoscopic removal. The technique and clinical implications in such cases are discussed on the basis of current knowledge.- - - - - - - - - - ranking = 4keywords = cavity (Clic here for more details about this article) |
10/72. Giant uterine leiomyoma devascularized by embolization prior to surgical removal.A 49-year-old woman presented a tumor of pelvic origin filling almost the whole abdominal cavity. angiography confirmed that it arose from the uterus. Bilateral internal iliac artery embolization was performed prior to surgical removal. It was found to be a 25kg uterine leiomyoma.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
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