4 research outputs found
Spontaneous de novo vaginal adenosis resembling Bartholin’s cyst: A case report
No full textBackground: Vaginal adenosis is a rare benign condition with a small percentage of patients at risk of vaginal adenocarcinoma.
Case: A 34 year old woman presented with paravaginal swelling resembling Bartholin’s cyst. Vaginal examination revealed a cystic, fluctuant and non-tender mass on the right lateral vaginal wall measuring 6 by 5 cm. The cervix, uterus, adnexa and Pouch of Douglas (POD) were normal. She had paravaginal cyst excision and histology showed stratified cuboidal epithelial cells with proliferation of numerous glands of small caliber within its wall that are separated by scanty stroma and consistent with vaginal adenosis. No other lesion was found on the genital tract.
Conclusion: Excision and histology is required in suspicious cases of paravaginal cyst to rule out vaginal adenosis, a potential precursor of vaginal adenocarcinoma. Counseling and follow up will help detect early occurrence of adenocarcinoma
Cervical leiomyosarcoma in a teenage girl: A rare form of uterine leiomyosarcoma
No full textالملخص: الساركوما التي تنشأ من عنق الرحم نادرة وتتراوح نسبة انتشارها ما بين 0.20% و0.55%. طالبة في مدرسة ثانوية تبلغ من العمر 15 عاما، لم يسبق لها الحمل، تعرضت لصدمة مع تاريخ مرضي مدته عام واحد من نتوء مهبلي غير مؤلم، ونزيف مهبلي، وإفرازات مهبلية كريهة الرائحة، وتكتلات دموية في بعض الأحيان، وتعب، ونوبات إغماء، وفقدان الوزن. تم إنعاشها بالسوائل الوريدية ونقل الدم. كشف الفحص العام عن وجود كتلة في البطن بحجم 16 أسبوعا. كشف الفحص المهبلي عن وجود كتلة لحمية كبيرة متحركة بحجم 14 سم × 10 سم مع إفرازات ورائحة كريهة. كانت قابلة للتفتيت من الخارج وتنزف بشكل نشط عند التلامس، ومناطق نخر أنسجة، مع وذمة. كان من الصعب فحص ملحقات الرحم بسبب الألم. أظهر الفحص تحت التخدير أن الكتلة كانت متصلة بعنق الرحم ولم تكن ملتصقة بالمهبل أو الفرج. أظهر تقرير علم الانسجة لعينات الخزعة ميزات تتفق مع الساركومة العضلية الملساء لعنق الرحم. تم تأكيد الساركومة العضلية الملساء العنقية عن طريق اختبار الكيمياء النسيجية المناعية وتم استئصال الرحم الكلي واستئصال البوق والمبيض الثنائي كعلاج نهائي. بدأت المريضة في العلاج بالهرمونات البديلة بعد الجراحة. كانت حالة ما بعد الجراحة مستقرة ولم يكن هناك تكرار للورم لأكثر من عامين من المتابعة. يعد تشخيص ووضع علاجات جراحية لمرضى الساركومة العضلية الملساء من التحديات الصعبة في بيئة منخفضة الموارد، بسبب عدم توفر تغطية صحية شاملة. يعطي النهج متعدد التخصصات مع التشخيص المبكر والاستئصال الجراحي الكامل للورم فرصة أكبر للبقاء على قيد الحياة والحفاظ على جودة الحياة. Abstract: Sarcomas arising from the cervix are rare, and the reported prevalence is 0.20–0.55%. A 15-year-old Para 0+0 secondary school student presented to the emergency department in shock with a 1-year history of painless vaginal protrusion, vaginal bleeding, foul-smelling vaginal discharge, occasional passage of blood clots, fatigue, fainting episodes, and weight loss. She was resuscitated with intravenous fluids and blood transfusions. General examination revealed a young girl with a 16-week sized abdominal mass. Vaginal examination revealed a large mobile fleshy mass 14 cm by 10 cm with an offensive discharge and odour. It was externally friable, bled actively on contact, had areas of tissue necrosis, and was oedematous. It was difficult to determine the adnexa structures because of tenderness. Examination under anaesthesia showed that the mass was continuous with the cervix and was not attached to the vagina or vulva. The histology report of the biopsied specimens showed features consistent with cervical leiomyosarcoma (LMS). Cervical LMS was confirmed by immunohistochemistry and a total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed as definitive treatment. Postoperative hormone replacement therapy was initiated. The patient's postoperative condition was stable and there was no tumour recurrence for >2 years on follow-up. Making a diagnosis and instituting surgical and adjuvant treatments for LMS in a low-resource setting are challenging. This is due to lack of access to universal healthcare coverage. A multidisciplinary approach with early diagnosis and complete surgical resection of the tumour provides the most favourable possibility of an improved survival and quality of life
Snake bite in third trimester of pregnancy with systemic envenomation and delivery of a live baby in a low resource setting: A case report
No full textBackground: Snake bite in the third trimester of pregnancy with late presentation, systemic envenomation; disseminated intravascular coagulopathy and delivery of a live neonate is uncommon in a low resource setting.
Case: We present a 22 year old unbooked Gravida 3 Para 1+1 1alive lentiviral positive woman at 32 weeks gestation with snake bite, leg swelling, vaginal bleeding and labour pains. At presentation, there were anemia, tachycardia, hypotension; a gravid uterus with a single fetus in longitudinal lie, cephalic presentation, regular fetal heart rate and cervical dilatation of 3 cm. Preterm labour with antepartum hemorrhage due to venomous snake bite was diagnosed. Multidisciplinary management instituted led to the survival of both mother and baby.
Conclusion: In resource constrained setting, disseminated intravascular coagulopathy arising from systemic envenomation due to snake bite in pregnancy could be challenging. Obstetric outcome depends on the degree of envenomation, gestational age at presentation, timing, duration and quality of treatment
Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial.
No full textBACKGROUND: Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. METHODS: In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. FINDINGS: Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65-1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52-0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88-1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. INTERPRETATION: Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. FUNDING: London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation
