Cases reported "Abdominal Pain"

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1/21. A case of primary transitional cell carcinoma of the fallopian tube.

    The primary carcinoma of the fallopian tube is the rarest of all gynecologic malignancies and histologically most of them are adenocarcinomas. Primary transitional cell carcinomas are extremely rare in the fallopian tube. A 63-year-old postmenopausal woman presenting with lower abdominal pain was found to have a left adnexal mass. Exploratory laparotomy revealed a mass arising from the fallopian tube with the histologic features of transitional cell carcinoma. light and electron microscopic studies supported the notion of transitional cell carcinoma. The tumor was extended to the muscle layer and confined to the left fallopian tube without metastasis. The patient received 3 courses of systemic cisplatin-based chemotherapy and has been well with no evidence of recurrence until August, 1998.
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2/21. rectus abdominis endometrioma.

    A 31-year-old woman presented with complaints of increasingly severe right lower quadrant discomfort that had occurred for several days each month over the course of the previous 6 months. A tender mass of the abdominal wall was palpated on physical examination, and subsequent ultrasonography and magnetic resonance imaging disclosed a discrete mass of the body of the right rectus abdominis muscle which was confirmed as endometrial tissue on biopsy. rectus abdominis endometrioma is a relatively rare cause of abdominal pain which may mimic an acute abdomen. Clinical clues to the diagnosis include previous uterine or gynecological surgery/invasive procedure (with preservation of ovarian function), cyclical nature of the discomfort, and the presence of a palpable mass with or without associated skin color changes.
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3/21. Primary non Hodgkin's lymphoma of the vagina.

    The genital tract as a primary site of malignant lymphoma in women is extremely rare. This report concerns a 64 year old patient with a primary vaginal non-Hodgkin lymphoma (large cell B lineage according to the REAL classification--centroblastic type according to the Kiel classification--"G" according Working Formulation) with an unusual clinical presentation--pelvic discomfort accompanied by frequent ureteral-like colic. Due to gynecological onset symptoms and the rarity of this extranodal primary site misinterpretation of a primary vaginal lymphoma as a benign inflammatory disease or endometriosis may occur. We emphasize the importance of their recognition and also the differential diagnosis of cervical lymphoma from other neoplastic and non-neoplastic lesions.
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4/21. Intra-abdominal desmoplastic small round cell tumor in a 68-year-old female.

    BACKGROUND: desmoplastic small round cell tumor (DSRCT) of the peritoneum typically occurs in young adults. The mean age of females with DSRCT is 20 years. We describe a DSRCT with an unusual age of presentation mimicking a metastatic ovarian neoplasm. CASE: A 68-year-old para 4 female presented with abdominal enlargement. Laparatomy showed multiple tumor nodules attached to the peritoneal surface. The tumor was debulked. The histological findings were characteristic for DSRCT. Adjuvantly the patient received cytotoxic chemotherapy but died of recurrent disease 3 months after initial diagnosis. CONCLUSION: DSRCT should be added to the differential diagnosis of unusual gynecologic malignancies in elderly as well as younger females. Identification of DSRCT is important because it can be confused with primary ovarian neoplasms.
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5/21. hemoperitoneum in patients receiving hemodialysis.

    Acute abdominal pain in chronic hemodialysis patients has well-known causes, including acute pancreatitis, mesenteric arterial insufficiency, or complicated duodenal ulcer. Others, such as hemoperitoneum, are far less common. Although hemoperitoneum occurs in patients receiving peritoneal dialysis, dialysis is seldom if ever the direct cause of the bleeding. hemoperitoneum is often related to menses or ovulation, particularly to ovarian cyst rupture; therefore, it is more common in young women. In most cases, no specific treatment is required. hemoperitoneum is rarely considered as the cause of acute abdominal pain in chronic hemodialysis patients. In this report of hemoperitoneum confirmed by emergency laparotomy in 3 women, bleeding was not related to gynecologic origin. All of the women were younger than age 50 and undergoing long-term hemodialysis. All patients had a history of acute abdominal pain associated with shock. The cause of bleeding was always an organ lesion: hepatic amyloidosis with suspected portal hypertension or sclerosing peritonitis and acute hemorrhagic pancreatitis. Coagulation abnormalities and the use of anticoagulants during hemodialysis sessions may have been aggravating factors in all three patients. hemoperitoneum is difficult to diagnose, particularly in the minor forms, and consequently its incidence may be underestimated. Therefore, it should be considered whenever a chronic hemodialysis patient presents with persistent acute abdominal pain.
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6/21. Transvaginal ultrasonographic identification of appendicitis in a setting of chronic pelvic pain and endometriosis.

    Our patient had a history of chronic endometriosis and pelvic pain and complained of recent onset of right-sided abdominal pain, nausea, and vomiting. Transvaginal ultrasonography revealed a thick-walled mass superior and medial to the right ovary, which was thought to be an inflamed appendix. The woman was not pregnant, and the structure appeared to be anatomically separate from the uterus. Subsequent laparoscopy confirmed the diagnosis of acute appendicitis; uncomplicated laparoscopic appendectomy followed. In the setting of chronic endometriosis, other nongynecologic sources of acute pelvic pain must be considered. Surgical intervention is appropriate whenever clinical suspicion for an acute abdomen is high, and the a priori diagnosis of endometriosis should not result in operative delay.
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7/21. Lymphatic filariasis of the ovary and mesosalpinx.

    We report 2 cases of filariasis, one in the ovary and the other in the mesosalpinx. In the first case, the patient underwent panhystrectomy and in the second case, right ovarian cystectomy with right salpingectomy were performed under general anaesthesia. Histopathology showed adult filarial worms in the dilated lymphatics of the right ovary, in the first case and in the mesosalpinx, in the second case. Both patients presented with complaints related to gynecological problems and not filariasis. Reports of filariasis in the literature and possible treatments and prevention strategies are also discussed.
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keywords = gynecologic
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8/21. Severe abdominal pain associated with allergic reaction to nafamostat mesilate in a chronic hemodialysis patient.

    A 33-year-old woman was referred from an outside dialysis clinic to our hospital because of severe abdominal pain during hemodialysis. She had been on chronic hemodialysis for the past 11 years due to chronic glomerulonephritis. Nafamostat mesilate was used as an anticoagulant for hemodialysis, because it was during her menstrual period with hypermenorrhea. On admission, she had no abdominal pain or gynecological abnormalities. On the second day, she had similar abdominal pain during hemodialysis with nafamostat mesilate in our dialysis unit. The abdominal pain disappeared within 60 minutes after discontinuing the hemodialysis. We re-started dialysis using heparin instead of nafamostat mesilate and she had no symptoms. The titer of total immunoglobulin e was high. The drug lymphocyte stimulation test was positive for nafamostat mesilate and antigen specific immunoglobulin e to nafamostat mesilate was highly positive in her blood. Although an allergic reaction to nafamostat mesilate is a rare complication, it should be one of the differential diagnoses of abdominal pain occurring during hemodialysis.
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keywords = gynecologic
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9/21. Hydatid cyst of the uterus.

    BACKGROUND: Hydatidosis is a common zoonosis that affects a large number of humans and animals, especially in poorly developed countries. The infesting parasite has four forms named echinococcus granulosis, E. multilocularis, E. vogeli and E. oligarthrus (very rare in humans). The most frequently involved organs are liver followed by the lung. The involvement of the genital tract is rare and the occurrence in the uterus is an extreme rarity. We report a case of hydatid cyst in the uterus. CASE: A 70-year-old female with a history of hydatid cysts of the liver, was admitted to hospital after complaining of low abdominal pains. On physical and gynecological examinations, no pathological finding was detected. However, the uterus was significantly large for a postmenopausal patient. Transvaginal sonography (TS) revealed a cystic mass in the uterus with a size of 7 x 6 cm. After further examinations a subtotal hysterectomy was performed. Microscopic examination showed scolices of echinococcus granulosis. CONCLUSION: Hydatid cysts in the genital tract are rare and the occurrence in the uterus is an extreme rarity. Differentiation between hydatid cyst and malignant disease of the related organ is difficult. To avoid misdiagnosis, a careful examination of pelvic masses should be carried out in endemic areas for detection of hydatid cysts.
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keywords = gynecologic
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10/21. Two episodes of hemoperitoneum from luteal cysts rupture in a patient with congenital factor x deficiency.

    The clinical manifestation of two episodes of hemoperitoneum from ruptured corpus luteum cysts, during the luteal phase of the cycle in a young patient with the rare congenital factor x deficiency, is reported for the first time in literature. The correct diagnosis of the underlying disorder, the gynecological management and the regular follow-up can minimize the risks of this potentially life-threatening hematological disorder.
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