scholarly journals Atypical Endometrial Hyperplasia Arising in a Cesarean Section Scar: A Mechanism of Malignant Transformation

2019 ◽  
Vol 12 (1) ◽  
pp. 317-321
Author(s):  
Marta Monist ◽  
Dorota Lewkowicz ◽  
Maciej Jóźwik ◽  
Marek Gogacz ◽  
Michał Bogusiewicz ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Malignant Transformation ◽  
Endometrial Hyperplasia ◽  
Morbidly Obese ◽  
Cesarean Sections ◽  
Recurrent Pain ◽  
Palpable Mass ◽  
Scar Endometriosis ◽  
Abdominal Scar ◽  
Atypical Endometrial Hyperplasia

The incidence of scar endometriosis in Cesarean sections varies between 0.03 and 0.4%. However, the recently increased rate of Cesarean sections worldwide may be causing an increase in occurrence of scar endometriosis. This report presents anatomopathological evidence of an early-stage malignant transformation in endometriotic tissue from a post-Cesarean scar and briefly reviews possible underlying mechanisms. A 40-year-old woman with a body mass index of 42.7 was referred to the gynecological department with recurrent pain and presence of a palpable mass in her Cesarean section scar. She had undergone this procedure 7 years earlier and began experiencing discomfort and pain at the incision site 6 months postoperatively. Surgical treatment was instituted with complete removal of the lesion. Anatomopathological examination revealed endometriotic tissue intertwined with atypical endometrial hyperplasia and fibrosis. At 2 years’ follow-up, she was asymptomatic, both clinically and based on ultrasound examination. Endometriotic foci inoculated within an abdominal scar may undergo malignant transformation. Long-lasting abdominal scar endometriosis, in morbidly obese women, requires special attention from the physician.

scholarly journals Abdominal Wall Endometriosis: Clinical Presentation And Imaging Features with Emphasis on Sonography

2016 ◽  
Vol 29 (1) ◽  
pp. 3-8
Author(s):  
Quorrata Eynul Forhad ◽  
Ali Akbar Biswas ◽  
Sk Monirul Islam ◽  
Md Shah Alam
Keyword(s):  
Cesarean Section ◽  
Abdominal Wall ◽  
Power Doppler ◽  
Clinical Findings ◽  
Imaging Features ◽  
Palpable Mass ◽  
Scar Endometriosis ◽  
Abdominal Wall Endometriosis ◽  
Cystic Changes ◽  
Pathological Material

Objective(s): The purpose of our study was to evaluate clinical findings and sonographic features of abdominal wall endometriosis and also to report its CT and MRI appearance.Materials and methods: A retrospective study was performed from January 2008 - December 2012, yielding 12 surgically proven cases of abdominal wall endometriosis. All patients had undergone sonography including power Doppler examination. Additional CT was performed in one case and MRI in four. Pathological material was preoperatively obtained by sonographically guided puncture in six patients. The clinical data were analyzed and the imaging studies were reviewed by radiologist working in consensus.Results: All patients had a history of at least one prior cesarean section. All patients’ C/S was done in this institution and 1500 C/S were performed within a period of 5 years giving a frequency of 0.8% scar endometriosis after C/S. All presented with focal pain near the surgical scar, which was cyclic in three patients. Nine patients presented with a palpable mass near the scar. Sonography detected 11 lesions within the abdominal wall with a mean diameter 25mm and in one case sonography could not identify any lesion. All lesions were hypoechoic, vascular, and solid, with some cystic changes in one. MRI CT scan showed enhancement of the lesions. Finally histopathologically all were proved as endometriosis’.Conclusion: Abdominal wall endometriosis frequently presents with noncyclic symptoms. Imaging findings of a solid mass near a cesarean section scar strongly suggest its diagnosis.Bangladesh J Obstet Gynaecol, 2014; Vol. 29(1) : 3-8

Malignant transformation of atypical endometrial hyperplasia after progesterone therapy showing germ-cell tumor-like differentiation

2004 ◽  
Vol 54 (6) ◽  
pp. 451-456 ◽  
Author(s):  
Masanori Yasuda ◽  
Naruaki Matsui ◽  
Hiroshi Kajiwara ◽  
R. Yoshiyuki Osamura ◽  
Tsuyoshi Miyamoto ◽  
...  
Keyword(s):  
Germ Cell ◽  
Malignant Transformation ◽  
Germ Cell Tumor ◽  
Endometrial Hyperplasia ◽  
Cell Tumor ◽  
Atypical Endometrial Hyperplasia

scholarly journals Anesthetic management of obese and morbidly obese parturients

2021 ◽  
Vol 16 (4) ◽  
pp. 313-321
Author(s):  
Sang Tae Kim
Keyword(s):  
Cesarean Section ◽  
Pregnant Women ◽  
Spinal Anesthesia ◽  
Anesthetic Management ◽  
Operation Time ◽  
Rapid Onset ◽  
The Body ◽  
Morbidly Obese ◽  
Single Shot ◽  
Cesarean Sections

The prevalence of obese parturients is increasing worldwide. This review describes safe analgesic techniques for labor and anesthetic management during cesarean sections in obese parturients. The epidural analgesic technique is the best way to provide good pain relief during the labor phase and can be easily converted to a surgical anesthetic condition. However, the insertion of the epidural catheter in obese parturients is technically more difficult compared to that in non-obese parturients. The distance from the skin to the epidural space increases in proportion to the body mass index (BMI): 4.4 cm in mothers of normal weight and 7.5 cm in mothers with BMI 50 and above. Neuraxial blocks are the ideal anesthetic methods and gold standard techniques for cesarean section in pregnant women with obesity. Single-shot spinal anesthesia is the most common type of anesthesia used for cesarean sections. The advantage of single-shot spinal anesthesia is a dense-sufficient block of rapid onset. A combined spinal-epidural (CSE) anesthetic technique is also recommended as an attractive alternative method. In obese parturients, the operation time can be longer than expected, and therefore, the CSE technique provides the advantage of rapid onset and intense block for prolonged operation with postoperative pain control. The risk of postoperative complications is very high in obese parturients. Therefore, detailed communication of the parturient's medical condition and the details of surgery and anesthesia between the anesthesiologist and obstetrician is important prior to cesarean section in obese pregnant women.

scholarly journals Endometriosis cases that occurred at the incision site after cesarean section; Single-center experience

2020 ◽  
Vol 7 (8) ◽  
pp. 594-597
Author(s):  
Mehmet Patmano ◽  
Tufan Gümüş ◽  
Durmuş Ali Çetin ◽  
Gülçin Patmano ◽  
Leymune Parlak
Keyword(s):  
Cesarean Section ◽  
Surgical Excision ◽  
Scar Tissue ◽  
Gynecologic Surgery ◽  
Palpable Mass ◽  
Preliminary Diagnosis ◽  
Scar Endometriosis ◽  
Incision Site ◽  
History Of ◽  
The Mean

Objective: Endometriosis is the growth of functional endometrial gland and stroma outside the uterine cavity. Scar endometriosis is a very rare disease and is diagnosed by histopathologic examination. Endometriosis may be detected in the scar tissue after a previous gynecological operation. Scar endometriosis is a mass consisting of endometrial glands and stroma that may develop in the incision scar tissue or in the neighborhood after gynecologic procedures performed especially by cesarean section. We aimed to present the patients who had a history of gynecologic surgery, who presented with mass and/or pain complaints especially in the corner regions of the previous incision line, and underwent surgical excision and reported as endometriosis as a result of postoperative pathology. Materials and Methods: Patients who presented to the general surgery outpatient clinic between September 2018 and December 2019 with complaints of palpable mass, pain and swelling at the edge of the pfannenstiel incision were evaluated. The records of patients who underwent surgery with a preliminary diagnosis of endometriosis and reported as endometriosis as a result of pathology were reviewed retrospectively. Results: Surgical excision was performed in 14 patients with a preliminary diagnosis of endometriosis. The mean age of the patients was 29.5 (min: 18-max: 39 years). All patients had a history of cesarean section as a history of abdominal surgery. When the pathology results were examined, all the reports were endometriosis externa. In the pathology reports, the mean diameter of the lesion was 25x20x17mm (min: 10- max: 40). Result: Endometriosis should be considered in patients with a history of palpable mass and pain around the incision site in patients with a history of gynecologic surgery.

scholarly journals Clinical analysis of 12 cases of ovarian cystic mature teratoma with malignant transformation into squamous cell carcinoma

2021 ◽  
Vol 49 (2) ◽  
pp. 030006052098154
Author(s):  
Xiangyu Wang ◽  
Wenjing Li ◽  
Yan Kong ◽  
Xiangyu Liu ◽  
Zhumei Cui
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Malignant Transformation ◽  
Squamous Cell ◽  
Tumor Size ◽  
Treatment Guidelines ◽  
Mature Teratoma ◽  
Cystic Teratoma ◽  
Clinical Analysis ◽  
Palpable Mass

Objective This study aimed to examine the clinicopathological characteristics, treatment, and prognostic factors in 12 cases of malignant transformation of mature cystic teratoma of the ovary (MCTO). Methods We performed a retrospective study of 12 patients with malignant transformation of MCTO who were admitted to the Affiliated Hospital of Qingdao University from 2003 to 2019. We examined case records, clinical parameters, and biological assessments. Results The median age of the patients was 56.5 years and seven of them were postmenopausal. The average tumor size was 18.5 cm. All patients had pelvic masses at their first hospital visit. Nine of the patients had discomfort in the lower abdomen, two presented with a lower abdominal palpable mass, and three were complicated by fever. The median follow-up time was 73 months (12‒193 months). Ten patients survived with a disease-free status and two died. Conclusions There is a low incidence of malignant transformation of MCTO, and its most common histological type is squamous cell carcinoma. Age and tumor size are important factors in malignant transformation of teratomas. While there is a lack of treatment guidelines for malignant transformation of MCTO, early diagnosis and treatment may be beneficial for these patients.

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