Cases reported "Vaginal Diseases"

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1/24. 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.
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2/24. Micro-hydrovaginoscopy in examining children.

    BACKGROUND: The gynecologic evaluation of children is challenging and requires mastery of special examination techniques. TECHNIQUE: small-diameter endoscopic trocar sleeves and endoscopes (2 or 3 mm) were used in conjunction with hydrodistention with normal saline, to view atraumatically the entire vagina and cervix. EXPERIENCE: During the past 3 years we have used micro-hydrovaginoscopy (2-mm trocar sleeve and endoscope, with hydrodistention) for vaginal examination of young girls and in selected cases of young adolescents and virginal adults in whom traditional speculum examination proved difficult or impossible. This technique was effective for (1) confirming diagnosis of cribriform hymen and facilitated hymenotomy; (2) diagnosis of vaginal discharge unresponsive to medical treatment caused by an intravaginal foreign body (color crayon), which was removed under direct endoscopic view; (3) suspected mullerian agenesis and persistent vaginal discharge confirming absence of the cervix and ruling out foreign body in the urogenital portion of the vagina; and (4) a vulvar straddle injury and urinary retention in which vaginal laceration and hematoma were excluded.CONCLUSION: Micro-hydrovaginoscopy is simple, minimally invasive, and effective for vaginal examination in prepubertal girls. It permits precise and complete diagnosis, directs and assists treatment, and has potential for well- tolerated office use in cooperative patients.
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3/24. Acute peritonitis due to introital stenosis and perforation of a bowel neovagina in a transsexual.

    BACKGROUND: Stenosis of the neovagina is a late postoperative complication of male-to-female sex reassignment surgery when patients do not have frequent sexual intercourse or do not perform vaginal dilation. CASE: A 39-year-old male-to-female transsexual who had sex reassignment surgery, in which a segment of sigmoid colon was used for neovagina construction, developed total introital stenosis and subsequent peritonitis caused by bowel perforation of the colon conduit. CONCLUSION: To avoid stenosis of the neovagina, an inflatable silicon vaginal stent should be used all day for 30 days, then for 3 months overnight or until sexual function is regular.
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keywords = operative
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4/24. Diagnostic and therapeutic problems in a case of prenatally detected fetal hydrocolpos.

    We report on a female fetus with prenatally suspected hydrometrocolpos. Postnatal evaluation additionally revealed ambiguous genitalia, anorectal atresia, vertebral segmentation anomalies and congenital intestinal aganglionosis. colostomy was performed, but postoperative recovery was complicated by pulmonary hypertension and renal failure, resulting in death at day 18. Postmortem examination furthermore revealed a small ventricular septal defect, as well as rectovaginal and urethrovaginal fistulae, causing massive dilatation of the septated vagina (hydrocolpos). The possibility of an overlapping VACTERL and MURCS association is discussed.
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keywords = operative
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5/24. Treatment of vaginal agglutination associated with chronic graft-versus-host disease.

    OBJECTIVE: To describe the presentation and clinical course of two patients after development of vaginal agglutination associated with chronic graft-versus-host disease. DESIGN: Case report. SETTING: Tertiary referral center for pelvic reconstructive surgery. PATIENT(S): Two patients with the diagnosis of chronic graft-versus-host disease who later developed vaginal agglutination requiring treatment. INTERVENTION(S): Surgical lysis of vaginal adhesions and postoperative use of vaginal dilators. MAIN OUTCOME MEASURE(S): Successful treatment of vaginal adhesions. RESULT(S): Both patients underwent successful surgical lysis of vaginal adhesions and maintained vaginal patency with postoperative use of vaginal dilators. CONCLUSION(S): Prompt diagnosis of vaginal agglutination in patients with chronic graft-versus-host disease and appropriate surgical correction of this complication rather than prophylaxis is the correct treatment course.
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ranking = 2
keywords = operative
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6/24. Pelvic Castleman disease presenting as vaginal occlusion.

    BACKGROUND: Castleman disease is a lymphoreticular disorder, which may be clinically silent. However, systemic manifestations can occur, which include generalized adenopathy and life-threatening bronchiolitis obliterans. CASE: A woman presented with vaginal mucosal lesions recalcitrant to initial treatment efforts. Progression of the disease required hospitalization for pulmonary involvement. Castleman disease was diagnosed after extensive multidisciplinary evaluation and excision of a pelvic mass. The patient's symptoms dramatically improved postoperatively. CONCLUSION: Castleman disease should be included in the differential diagnosis in patients with paraneoplastic symptoms and a pelvic mass.
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ranking = 1
keywords = operative
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7/24. Aggressive angiomyxoma of the vulva and vagina. A common problem: misdiagnosis.

    Aggressive angiomyxoma (AA) is a rare myofibroblastic tumor, usually affecting young women. Two patients, one with a vaginal and the other with a vulvar mass underwent surgical intervention with different preoperative diagnoses; the former as vaginal cyst and the latter as vulvar hernia. Unfortunately, the pathological evaluation of the specimens revealed aggressive angiomyxoma. Misdiagnosis of this tumor is a common problem.
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8/24. Suburethral vaginal erosion and pyogenic granuloma formation: an unusual complication of intravaginal slingplasty (IVS).

    We report an unusual case of suburethral vaginal erosion and pyogenic granuloma formation 14 months after intravaginal slingplasty (IVS). A 64-year-old woman underwent IVS for recurrent stress incontinence 12 years after Burch colposuspension. Following seemingly uncomplicated surgery and recovery, she developed a recurrent urinary tract infection which was treated with antibiotics. When she presented with vaginal pain and postmenopausal bleeding approximately 14 months postoperatively, she was found to have suburethral vaginal erosion of the tape and a pyogenic granuloma. The exposed tape was removed, the granuloma excised, and the overlying vaginal skin was then closed. She then made an uneventful recovery.
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ranking = 1
keywords = operative
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9/24. A rare case of extrauterine adenosarcoma arising in endometriosis of the rectovaginal septum.

    OBJECTIVE: To present a rare case of endometrial stromal sarcoma arising in endometriosis of the rectovaginal septum. DESIGN: Case report. SETTING: Academic tertiary referral center for endometriosis treatment. PATIENT(S): A 50-year-old woman with a history of endometriosis presented with catamenial rectal pain and deep dyspareunia. Imaging findings suggested new endometriotic lesions in the rectovaginal space. INTERVENTION(S): Total hysterectomy, salpingo-oophorectomy, and excision of the lesion in the rectovaginal septum were performed. Although extemporary pathology confirmed endometriosis, the final histologic diagnosis was extrauterine adenosarcoma in the rectovaginal septum. Two years later, recurrence of the malignancy occurred and was treated by resecting the new perirectal mass. Subsequent radiotherapy and chemotherapy were administered. MAIN OUTCOME MEASURE(S): Imaging findings at follow-up evaluation. RESULT(S): The patient was in good health for 2 years after the initial surgery, when she developed a new lesion at the site of the previous resection. The histologic appearance of the lesion was consistent with recurrence of the tumor. After postoperative therapy, the patient is now without evidence of disease. CONCLUSION(S): Malignant transformation of endometriosis should be considered in the differential diagnosis of a new pelvic lesion in a patient with a history of endometriosis.
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ranking = 1
keywords = operative
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10/24. Vaginal wall erosion after transobturator tape procedure.

    Transobturator Prolene tape insertion represents a new method of operative treatment for stress urinary incontinence. The first results show that it is a simple and effective procedure accompanied by a minimum number of complications. Since February 2004, 30 Monarc procedures were done at our department and no intraoperative complications were observed. However, two cases (6.7%) of vaginal wall erosion due to the Prolene tape were noted 6 weeks after surgery. In a subsequent surgical procedure, the periurethral portion of the tape was removed and a new Prolene tape was placed through the retropubic space. Three months after secondary surgery both patients were continent, with no sign of erosion. The transobturator approach was introduced to minimize the risk of complications. However, the greater prevalence of vaginal wall erosion after this procedure found in our series demands a scrupulous search for this complication and for the mechanisms leading to its occurrence.
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ranking = 2
keywords = operative
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