Benign peritoneal cystic mesothelioma is a rare benign tumor occurring in women of reproductive age. Acute presentation is even very rare and options of management are not established. A case of a 25-year-old woman with multiple episodes of hypogastric pain and dysmenorrheal is presented. Transvaginal US showed a cystic mass involving left flank to pelvis. The uterus and adnexae were congestive at laparoscopy. Both ovaries, Douglas sac and omentum had grape-like thin-walled cystic clusters. The patient was treated with total omentectomy and complete surgical resection of cysts. Histological analysis of the mass confirmed the diagnosis of benign peritoneal cystic mesothelioma.

Pelvic fractures, either traumatic or atraumatic, are relatively rare and should be considered in the differential diagnosis of low back pain in women. Pelvic stress fractures related to pregnancy are even rarer and poorly understood phenomena that pose diagnostic and therapeutic challenges. These fractures are caused by insufficiency or fatigue. Those that result from bone insufficiency occur when normal stress is placed upon bone with decreased mineralization and elastic resistance. Those caused by fatigue occur when abnormal forces are applied to normal bone. Pregnancy and lactation are risk factors for pelvic stress fracture. Most cases occur postpartum and few cases during the third trimester. Pelvic fracture should be considered in pregnant women with severe back pain of insidious onset before or after delivery, usually in the absence of trauma. Plain films of the pelvis are often ...

Pubic symphysis diastasis is rare in normal vaginal delivery. Etiology is not clear but it is associated with multiparity, macrosomia, physiological joint loosening and excessive force on the pubic area. Symptoms include pain around the pubic symphysis, hips, groin, lower abdomen and inner thighs, as well as tenderness over the area. Imaging shows distance between pubic bones. Management varies from case to case and outcomes are scarcely known. Delayed diagnosis has health implications for the woman in the short and long term. We report a case of postpartum pubic symphysis diastasis. An 18-year-old woman presented lacerating pain in the pubic area in the second day of the postpartum period, after a pregnancy of normal evolution and a spontaneous vaginal delivery, with a term live newborn and no apparent complications. On physical examination, we found moderate pain in the pubic region, w...

El hígado graso agudo del embarazo es una condición rara que ocurre más comúnmente en el tercer trimestre. Produce disfunción hepática severa asociada a alteración renal y tiempos de coagulación alargados. Se vincula a complicaciones hepáticas y extrahepáticas que pueden causar morbimortalidad materno-fetal significativa y el tratamiento definitivo es la interrupción inmediata del embarazo. Se presenta un caso de hígado graso agudo del embarazo en paciente de primigesta de 40 años, quien presentó epigastralgia de aparición súbita, junto con letargia, náuseas y vómitos. Los exámenes de laboratorio mostraron alteración de las pruebas de funcionalismo hepático y retal, junto con hipoglucemia, realizándose el diagnóstico de hígado graso agudo del embarazo. La paciente fue tratada para corregir las alteraciones metabólicas y se practicó cesárea, presentando mejoría...

Twin reversed arterial perfusion sequence is a complication of monochorionic twin pregnancies in which one twin that exhibits lethal anomalies, including acardia, is perfused by the other ‘pump’ twin via anastomoses between placental arteries. This results in growth and characteristic anomalies of the acardiac twin, and possible heart failure of the pump twin. The exact pathophysiological mechanisms that lead to this devastating phenomenon are not well known. It occurs in about 1% of monochorionic pregnancies and in one out of 35 000 pregnancies. Mortality is usually due to anemia and cardiac complications which can lead to cardiac failure, appear early during pregnancy and cause the death of the pump twin. We report a case of twin reversed arterial perfusion in a 28-year-old patient with 12 weeks monochorionic-diamniotic pregnancy that was referred for absent cardiac activity in one...

Hyperreactio luteinalis is a rare entity of pregnancy characterized by bilateral and functional enlargement of the ovaries that present thin-walled cysts. Several hypotheses suggest it is caused by increased concentrations or ovarian sensitivity to chorionic gonadotropin. Many cases do not present symptoms or complications during pregnancy, and diagnosis is done accidentally by routine ultrasound. This rare benign condition is usually self-limited and resolves spontaneously following delivery. However, some have to be differentiated from malignant ovarian tumors by histological examination. Surgery is indicated when there are complications such as ovarian torsion or peritonitis due to hemorrhage or rupture. We present a case of hyperreactio luteinalis during the third trimester of pregnancy.

Idiopathic granulomatous mastitis is a rare, benign chronic disease. Its etiology is not clear; however, the disease has been associated with breastfeeding, use of oral contraceptives, and an autoimmune component. The characteristic presentation is an inflammatory reaction with non-caseating granulomas. Histological features include signs of chronic granulomatous inflammation with giant cells, leukocytes, epithelioid cells, and macrophages, as well as microabscesses. In the differential diagnosis, all causes of granulomatous changes should be excluded. Due to its low frequency, the treatment is difficult to standardize and optimize. We present the case of a 36-year-old woman with a painful nodule in the right breast. Clinical presentation and imaging raised suspicion of carcinoma. Histopathology revealed acute and chronic inflammation, infiltration of macrophages and giant perivascular h...

Ovarian cystic teratomas are mainly composed of a cyst enterily or partly lined by epithelium resembling keratinized epidermis with sebaceous and sweat glands. The presence of floating balls or globules inside an ovarian cystic teratoma is an unusual finding. We report a 40-yearold with a history of pelvic pain for 6 months. The ultrasonographic evaluation showed an ovarian cyst of 26 x 16 centimeters with multiple mobile, spherical echogenic structures floating in the cystic mass. Right oophorosalpingectomy was performed by laparotomy. Histopathology diagnosis was mature cystic teratoma. The appearance of intracystic floating globules is rarely seen but it is pathognomonic for mature cystic teratoma.

Paraganglioma is an extra-adrenal neuroendocrine neoplasia derived from neural crest precursors that arise in association with autonomic ganglia. Also called extraadrenal pheochromocytomas, these tumors are defined by their anatomical site and whether they are hormonally functional. Paragangliomas are rare neoplasms of the female genital tract and may be located in the ovaries, uterus or cervix. Those that appear in the vulvovaginal region are extremely rare. Clinical manifestations depend on unregulated catecholamine secretion and location. Diagnosis is based on morphological and immunohistochemical findings. Surgical resection is the primary treatment for this tumor as it does not respond to chemotherapy and radiotherapy. Due to its low frequency and nonspecific symptomatology, diagnosis may be difficult. We present a case of primary vulvovaginal paraganglioma.

Sebaceous carcinoma is a rare malignant tumor of the skin that usually appears in the head and neck region. Its clinical course is aggressive and local recurrences - distant metastases are common. Some cases of sebaceous carcinoma of the female genital tract have been reported. Although sebaceous glands are prominent in the vulva, sebaceous carcinomas rarely occur in this location. Little is known about the behavior and prognosis of this type of cancer. We present a case of a 69-year-old patient with a history of a 3 x 2-centimeter tumor for 9 months in the left labium majus. She had no medical or family history of malignant neoplasms. Increases in size was observed during this period, but otherwise, she was asymptomatic. Lesion was completely excised. The tumor was composed of lobes of tumor cells with sebaceous differentiation. Histopathological report revealed vulvar sebaceous carcino...

Müllerianosis is an embryonal disease of the müllerian or paramesonephric ducts, consists in the mixture of two or more types of tissues and results in the formation of adenomyosis, endometriosis, endosalpingiosis, and endocervicosis. It most often affects the urinary bladder in women of childbearing age. Müllerianosis of the cervix is a very rare benign condition, with few reported cases. The exact pathogenesis remains a matter of debate. There are several theories on its etiology; the main two are the implantation and metaplastic theories. Symptoms range from absent to pelvic pain and dysmenorrhea. It generally appears as a cystic tumor with glands of different sizes lined by endometrial, endocervical, or tubal epithelium. This lesion could be confused with other benign, premalignant, or even malignant lesions, and histopathological confirmation is necessary. Because it is a benign ...

Ovarian steroid cell tumors are classified into stromal luteoma, Leydig cell tumor and steroid cell tumor not otherwise specified, according to their embryonal origin. Ovarian steroid cell tumor not otherwise specified is a rare benign tumor, but with malignant potential; it accounts for less than 0.1% of all ovarian tumors. They should be considered as a cause of virilization in adult women due to testosterone production. Only a female fetus is at risk of virilization. Like other ovarian stromal tumors, the tumors must be treated surgically. Surgery is indicated in cases of solid unilateral ovarian enlargement, due to a 50% chance of malignancy. In pregnancy, ovarian steroid cell tumors not otherwise specified are exceptionally rare and should be differentiated from luteoma of pregnancy and other malignant ovarian neoplasms. More frequently they may be complicated by rupture and/or tors...

Placental chorioangiomas are benign vascular tumors and are the most common placental tumors, with a prevalence of 1%. It rarely surpasses 4 - 5 centimeters in length and, when it happens, is referred to as giant chorioangioma. Pregnancies with giant chorioangiomas are associated with maternal and fetal complications, such as severe microangiopathic haemolytic anemia, preterm labor, polyhidramnios, intrauterine growth restriction, thrombocytopenia and hydrops. A case of giant chorioangioma diagnosed at 22 weeks is presented. Despite close follow-up, delivery occurred at 30 weeks of pregnancy due to polyhidramnios and premature rupture of membranes. Both mother and newborn recovered without complications.

Postpartum hemorrhage can be a life-threatening condition. Successful approaches have been described using uterine compression sutures to control postpartum hemorrhage, in some cases by a combination of techniques. Procedures to reduce blood loss consist of uterine massage, medical treatment, uterine tamponade and hysterectomy. The uterine compression suture, or B-Lynch technique, has been proposed to control postpartum hemorrhage in such cases of uterine atony, preserving fertility. Although report of complications of this procedure is scarce, the appearance of necrosis, pyometra, uterine rupture and, more recently, exaggerated and abnormal invasion of the placenta (placenta accreta) in a subsequent pregnancy has been described. It is necessary to inform patients on potential complications of the procedure and the need of postoperative follow-up to confirm their absence. We present a ca...

Postpartum hemorrhage is an important cause of maternal mortality. The rupture of a uterine artery pseudoaneurysm, a rare vascular lesion of unknown prevalence, produces secondary postpartum hemorrhage without an evident cause. If not properly diagnosed and treated, it can be life threatening. Etiology includes vascular trauma during cesarean section, vaginal delivery, curettage or hysterotomy. Its clinical presentation is varied and often associated with other more frequent gynecological and obstetric pathologies. Patients may present no symptoms, vaginal bleeding or even postpartum hemorrhage and hypovolemic shock. To prevent fatal bleeding, a rapid and accurate diagnosis must be made, based on non-invasive imaging studies. Angiographic embolization is a safe and effective method to control hemorrhage in hemodynamically stable patients and should be an option before resortin...

Paratubal cysts are simple cystic structures filled with serous fluid that are located along the Fallopian tube, usually arising from the broad ligament or mesosalpinx. It is important to always consider tube torsion as a differential diagnosis for female patients presenting with an acute abdomen, and to be aware of the need for quick diagnosis and surgical treatment in order to preserve the patient’s fertility, especially in younger patients of child-bearing age. We present the case of a 16 year-old female patient who complained of intense hypogastric pain together with vomits. During laparoscopy, a torted paratubal cyst was found in the right adnexa. Laparotomy was performed to remove the cyst and salpingectomy was carried out, since the right Fallopian tube was unsalvageable. Histological analysis showed that the mass was a paratubal cyst.

Catamenial pneumothorax is a rare and complex clinical condition that should be considered as a cause of spontaneous and recurrent pneumothorax that is often misdiagnosed. It is a pulmonary pathology commonly associated with menstruation since it occurs within 72 hours before or after the onset of menstrual bleeding. The etiology and the exact underlying mechanism have not been identified, but it could be a rare form of extra-pelvic endometriosis characterized by the presence of functional endometrial tissue in the pleura, pulmonary parenchyma, and respiratorytract. Diagnosis is a challenge, so it can result in recurrences. It should be suspected in young women of childbearing age. The first line of treatment is medical, while surgical treatment is necessary to avoid recurrence. A case of recurrent catamenial pneumothorax is presented.

Peritoneal tuberculosis is a common extrapulmonary site in females, mimicking an advanced ovarian malignancy. It is difficult to diagnose because it may produce massive ascites, and a gross peritoneal appearance similar to carcinomatosis. It requires confirmation by pathological studies and bacterial cultures, as there are not pathognomonic clinical, laboratory or radiologic findings. Early treatment usually is associated to good prognosis. A case of peritoneal tuberculosis with the classic triad (advanced-stage ovarian carcinoma-like ascites, abdominopelvic tumors and elevated serum CA-125 levels) is presented. Laparotomy showed abdominal and peritoneal nodules reported as granulomatous inflammation on biopsy. Patient started treatment and, on follow-up, symptoms and CA-125 levels normalized.

Placental mesenchymal dysplasia is a rare and benign placental abnormality. It is characterized by placentomegaly with multiple cystic lesions of the villous tree and vascular abnormalities along with increased maternal serum alpha-fetoprotein concentrations. It is an unknown clinical entity and can be confused with gestational trophoblastic disease due to the similar ultrasound findings in both entities; but the management and the perinatal outcome are different. It should be included in the differential diagnosis of ultrasound findings showing a normal-appearing fetus and a placenta with cystic lesions. However, placental mesenchymal dysplasia is associated with complications such as intrauterine growth restriction and intrauterine fetal death. Due to the high number of complications and associated pathologies, it is necessary to increase ultrasound evaluations to reduce fetal morbidit...

Ovarian teratomas are tumors derived from the three germinal layers. Gliomatosis peritonei is a rare condition characterized by glial tissue implants in peritoneum, commonly associated with immature ovarian teratoma, but not with mature teratomas. Definitive diagnosis is based on histopathological examination. Currently, there are no guidelines for its follow-up. Prognosis is favorable; however, implants may present fibrotic regression or exceptionally degenerate into glioblastoma. Treatment should be similar to that of metastatic ovarian carcinoma if immature glial tissue or other teratomatous components are found in peritoneum or omentum. Long-term follow-up is necessary in patients with residual peritoneal disease due to risk of recurrence and malignant transformation. We present a case of gliomatosis peritonei associated to mature ovarian teratoma.