1/266. Vaginal stenosis following allogeneic bone marrow transplantation for acute myeloid leukaemia. We report the unusual complication of vaginal stenosis occurring after allogeneic bone marrow transplantation (BMT) for leukaemia. This was in all likelihood a manifestation of chronic graft-versus-host disease (cGVHD), although the patient has no other stigmata of this and suffered little acute graft-versus-host disease (aGVHD) after BMT. Other risk factors for vaginal stenosis were considered and appear to be absent in this patient, although the total body irradiation used as part of her conditioning therapy may play a role. We suggest that vaginal stenosis may be under-reported, since female patients suffer a number of gynaecological complications after BMT, and that regular questioning and examination may aid in making an earlier diagnosis, allowing speedier instigation of therapy and thus improving quality of life. ( info) |
2/266. hematometra and extended vaginal haematoma after laser conization. A case report. A very rare case of haematometra and extended vaginal haematoma in a 53-year-old woman after laser conization is reported. The patient presented with amenorrhea and complete urinary retention. The possible pathogenesis of this complication is discussed. ultrasonography, combined with physical examination were very helpful in determining the diagnosis. Cervical dilation and protection of surrounding tissues from thermal damage is recommended during laser conization to avoid similar complications. ( info) |
3/266. Ultrasonic features of Gartner's duct cyst. Gartner's duct cysts will usually be incidental findings during pelvic sonography. Of developmental origin, they may present anywhere along the lateral aspect of the female genital tract. When the cysts are of parovarian origin, they will mimic other fluid-filled adnexal masses, and no specific diagnosis can be made. When alongside the vagina or cervix, however, their ultrasonographic appearance is probably characteristic. ( info) |
4/266. Primary non-Hodgkin's lymphoma and malakoplakia of the vagina: a case report. The vagina is a rare site for both primary non-Hodgkin's lymphoma and malakoplakia. We report a case of concurrent diffuse large B-cell lymphoma and malakoplakia of the vagina in a 67-year-old woman presenting with a vaginal discharge and a vaginal mass. The patient had two biopsy specimens reported as showing malakoplakia only, followed by a third biopsy specimen 10 months later which was diagnosed as diffuse large B-cell lymphoma. review of the first two biopsy specimens showed areas of histiocytes with Michaelis-Gutman bodies merging with areas of cells with slightly larger nuclei and more amphophilic cytoplasm. immunohistochemistry for the B-cell marker L-26 (CD20) and polymerase chain reaction analysis of the immunoglobulin heavy chain gene were helpful in retrospectively distinguishing the population of diffuse large B-cell lymphoma from the areas of malakoplakia. The third biopsy specimen showed sheets of large atypical lymphoid cells characteristic of a large cell lymphoma. Malakoplakia has been described in association with a variety of cancers, and this is only the second report of malakoplakia associated with non-Hodgkin's lymphoma. Considering the rarity of these two entities in the vagina, it is unlikely that the association in this case is coincidental, raising the possibilities of an unusual reaction to the presence of lymphoma or a common pathogenesis such as underlying chronic inflammation. Epstein-Barr virus dna was detected in the second biopsy specimen, suggesting a possible role in the pathogenesis of this lymphoma. ( info) |
5/266. Vaginal evisceration. Intestinal evisceration through the vagina is exceptionally rare. We report the cases of two patients presenting with this unusual clinical condition. Predisposing factors and management of vaginal evisceration are discussed. ( info) |
6/266. Cervical/vaginal endometriosis with atypia: A cytohistopathologic study. Neoplastic or atypical glandular epithelial cells of uncertain significance were reported in the preoperative smears from 10 women with cervical or vaginal endometriosis. Subsequent conization and vaginal biopsy revealed endometriotic tissue with variable epithelial atypia, but no evidence of in situ or invasive carcinoma. review of the smears revealed appearances similar to those seen in "high cervical sampling" or in smears from patients with tubal metaplasia. The presence of large cohesive cell sheets with retained cell polarity and well-defined cytoplasmic edges, of endometrial cell "whorls" and tubular structures, and of endometrial-like stromal cells coupled with the absence of three-dimensional cell clusters, peripheral cell-sheet crowding, "cell feathering," and pseudostratified cell strips are features helpful in the distinction between cervical/vaginal endometriosis and adenocarcinoma. Diagn. Cytopathol. 1999;21:188-193. ( info) |
7/266. Nefazodone-induced clitoral priapism. A case is presented of painful priapism of the clitoris lasting 3 days, with a strong temporal association with the administration of nefazodone hydrochloride. priapism has been described as a rare side-effect of drugs with high alpha1-adrenergic blocking potential. However, the alpha1-adrenergic blocking potential of nefazodone is moderate. Drug-induced clitoral priapism has been described for citalopram, bromocriptine, fluoxetine and trazodone combined with fluoxetine. To our knowledge, this is the first report in the literature about priapism of the clitoris associated with nefazodone. ( info) |
| A gonadotropin-releasing hormone agonist, leuprolide acetate, was administered every 4 weeks for treatment of rectovaginal endometriosis. Degrees of apoptosis (percentage of in situ deoxyribonucleic acid 3'-end-labeled cells) and cell proliferative activity (percentage of cells with immunostaining for proliferating cell protein Ki-67) were examined in endometriotic glands of biopsy specimens taken before and during gonadotropin-releasing hormone agonist therapy. gonadotropin-releasing hormone agonist induced apoptosis and suppressed cell proliferative activity in endometriotic glands. ( info) |
9/266. Vaginal outflow tract obstruction by graft-versus-host reaction. We describe a 25-year-old patient suffering from vaginal outflow obstruction which presented as secondary amenorrhea during hormone replacement therapy. The patient had undergone bone marrow transplantation for acute myelocytic leukemia, which caused ovarian failure. Oral mucositis associated with a chronic GVH reaction also occurred. For 3 years she was treated with HRT and had regular menses which gradually ceased and were associated with dyspareunia and abdominal cramps. Abdominal US examination demonstrated hematocolpus. Sonography guided adhesiolysis of a dense vaginal obstruction allowed free drainage with histologic confirmation of a graft-versus-host reaction. The possibility of vaginal stricture or obstruction should be considered in all patients after BMT who suffer from graft-versus-host disease. ( info) |
| A rectovaginal fistula after delivery is a rare complication, and its management can become difficult if infection occurs. In two such cases, we administered hyperbaric oxygenation (HBO) treatment against complicated infections, and we obtained a good outcome in each case. ( info) |