Large pelvic mass arising from the cervical stump: A case report

BACKGROUND A large cervical cyst with a cervical high-grade squamous intraepithelial lesion arising from the cervical stump is rare.After supracervical hysterectomy,there is a risk of various lesions occurring in the cervical stump.We review the types and characteristics of cervical stump lesions and compare total hysterectomy with subtotal hysterectomy.Gynecologists should choose the most suitable surgical method based on both the patient’s condition and wishes.If the cervix is retained,patients require a close follow-up.CASE SUMMARY A 57-year-old woman was admitted to the Gynecology Department for a large pelvic mass.Her chief complaint was abdominal distention for two months.She had undergone subtotal supracervical hysterectomy for leiomyoma 14 years prior.Abdominal ultrasonography detected a 9.1 cm×8.5 cm×8.4 cm anechoic mass with silvery fluid in the pelvic cavity and high-risk human papilloma virus 53(HPV53)was positive.The admission diagnosis we first considered was a pelvic mass mimicking carcinoma of the cervical stump.We performed a laparotomy and a rapid frozen biopsy was suggestive of a fibrous cyst wall coated with a high squamous intraepithelial lesion.The pelvic mass was removed,and a bilateral adnexectomy was implemented.Final pathology confirmed that the pelvic mass was a large inflammatory cyst with a cervical high-grade squamous intraepithelial lesion.After successful intervention,the patient was discharged one week after surgery and there was no recurrence of the vaginal stump at 43 mo.CONCLUSION When addressing benign uterine diseases,gynecologists should pay adequate attention to retaining the cervix.If the cervix is retained,patients require a close follow-up.

The Application of HE4 in Diagnosis of Gynecological Pelvic Malignant Tumor

OBJECTIVE To investigate the value of human epididymis geneproduct 4 (HE4) in differential diagnosis of gynecological pelvictumors.METHODS The level of serum HE4 in 132 women wasdetermined. These women were divided into three groups, i.e.,46 women with good health being classified as the normal control(NC) group, and based on clinicopathological results, the other 86with pelvic masses being classified into groups of benign (n = 56)and malignant lesions (n = 30), respectively.RESULTS The range of serum HE4 in the NC group was(23.5～46.0) pmol/L, with an average value of (34.1 ± 5.6) pmol/L;the range of serum HE4 in the benign lesion group was (30.1～58.9)pmol/L, with an average value of (39.1 ± 7.2) pmol/L; the range ofserum HE4 in the group of malignancy was (31.2～1430.0) pmol/L,and the average value was (248.7 ± 364.5) pmol/L. The level ofHE4 in the malignant lesion group was significantly higher thanthat in the other 2 groups, with a statistical difference, P < 0.001.The diagnostic index reached maximum (0.847) when the serumHE4 was at 51.6 pmol/L, and the sensitivity and specificity of HE4were 86.7% and 98.0%, respectively. The area under the receiver-operator characteristic curve (ROC) was 0.935 (95% CI 0.832～1.037,P = 0.000). The consistency checking Kappa value of HE4 in thediagnosis of pelvic malignant tumors was 0.867, P = 0.000.CONCLUSION The determination of serum HE4 is a goodindicator in differential diagnosis of benign and malignant ovariantumors.

A Pelvic Free-Floating “Intraperitoneal Mice” Mimicking Seminal Vesicle Malignancy: A Case Report

Peritoneal loose bodies or “peritoneal mice” are rare well circumscribed benign masses composed of free-floating organized fat necrosis. They are usually asymptomatic and found as “incidentalomas” during Imaging. Their pathogenesis is not well known. We report a rare case of giant intraperitoneal mice which was clinically misdiagnosed as left seminal vesicle malignancy. A review of the literature is also presented.

Accidental discovery of appendiceal carcinoma during gynecological surgery:A case report

BACKGROUND Malignant tumors of the appendix are extremely rare,constituting about 1%of all gastrointestinal tumors.Generally,pathology identifies these tumors during or after appendectomy because they are difficult to detect at the preoperative stage.This case report aims to introduce the definitive diagnosis and treatment of mucinous adenocarcinoma of the appendix.CASE SUMMARY A 49-year-old female patient came to our hospital with right lower abdominal pain,nausea,and vomiting for three days.There was no change in the menstrual cycle.Gynecological ultrasound showed a cystic,solid mass in the right adnexa.Abdominal enhanced computed tomography showed a thick appendix.Cancer was found on exploration of the appendix during gynecological surgery.The right colon was removed.After surgery,the patient received chemotherapy and is recovering well.CONCLUSION Appendiceal carcinoma is frequently found during or after surgery,and both preoperative examination and early evaluation of clinical manifestations are extremely important.

Primary Presentation of Ovarian Cancer with Bladder Outlet Obstruction/Chronic Urinary Retention in a 12-Year Old Female

Urinary retention in women is rare and is more frequently described as case reports or small case series. The female/male ratio is 1:13 with about 3 cases per 100,000 women every year We report a case of a 12-year old female student. She presented with progressive weight loss, worsening lower urinary tract symptoms with distended lower abdomen of 10 weeks duration. Physical examination revealed a mobile tender firm pelvic mass, 18 centimeters (cm) × 16 cm in size. Laboratory and imaging studies showed obstructive nephropathy and uropathy respectively. She was worked up and had uneventful exploratory laparotomy with right salpingo-oophorectomy, urinary bladder diverticulectomy and pelvic lymphadenectomy. Histopathology of the pelvic mass showed ovarian dysgerminoma with lymph node metastasis. She responded very well to chemotherapy and resumed her school activities. Bladder outlet obstruction is relatively rare in females and in the index patient, ovarian dysgerminoma is the cause leading to obstructive nephropathy and uropathy.