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Highlights : Noteworthy Gynecology Cases

Mrs. R 23 years / Female

A1 – Patient referred from private hospital, near Sulur with c/o secondary Infertility. 1 -? Missed Abortion around 6 -7 weeks. Medical abortion was given.

On Evaluation, the Patient was obese (BMI – 28) and Hormonal analysis showed mild LH overactivity ultrasound of the pelvis showed multiple immature follicles in both ovaries. (PCO pattern) and uterus was diadelphic with two well-developed uterine horns.

The patient underwent good lifestyle modification and reduced weight by around 5% of her body weight and hence with minimal stimulation, she got pregnant and implantation occurred on the Left Horn of the uterus.

All forms of uterine support in the form of progesterone were given and she crossed the second trimester successfully.

Mullerian Anomalies

Mrs. M 26years / Female

  • The patient came with complaints of delay in fertility after 3 years of marriage.
  • All Fertility evaluations were carried out, including the follicular study which showed mild ovulatory dysfunction, and the Hormonal study including TFT was normal & Seminal Analysis was also normal.
  • Throughout the whole doing, HSG there was some vaginal tissue obstructing more on the Left side which divides the vaginal cavity into two.
  • On deep examination, there is also a thin pathway/vagina which leads to the Left side of the uterine cavity.
  • During HSG, only the Right tube was visualized, and the Left adnexa was not seen.

MRI Findings

  • MRI pelvis is planned and the report is enclosed.
  • MRI showed Bicorporeal septate uterus with a septum extending up to the vagina.
  • ESHRE/ESGI classification of female genital tract anomaly – U3c CIVI. Uterine fibroid.
  • Hence, corrective surgery with the removal of the septum is planned. Meanwhile, the patient got conceived, and interestingly Implantation occurred, on the left horn of the uterus. Now, she has crossed the I Trimester successfully.

Struma Ovarii

Mrs. P 45years / Female

  • The patient came for a master health checkup with chronic left-side lower abdominal pain lasting for more than 5 months.
  • A patient has severe dysmenorrhea for 1 year and galactorrhea for 6 months.
  • Gravida Index P2L2 | Regular cycles | Normal flow.
  • On evaluation, an ultrasound abdomen showed a left-sided multiobulated ovarian cystic lesion with calcifications measuring (6 x 6 x 4cms) with mild tenderness on the LIF area.
  • The uterus was adenomyosis with an indistinct functional zone and an MRI confirmed the findings.
  • The uterus is anteverted and anteflexed. The junctional zone measures 15mm and is indistinct.
  • Endometrial thickness measures 6mm. Dimension of the Uterus = 9.5 x 4.6 x 6.3cm. No focal endometrial/myometrial lesions.
  • Multilocular cystic lesion of left ovary evident measuring.
  • 6.0 (TRA) x 6.0(CO) x 4.4(AP) cm. One tiny locule reveals hemorrhagic areas.
  • Punctate calcific focus noted as well.
  • No intralesional fat. No evidence of solid components/ papillary projections/mural nodules.

MRI Findings

  • LDH was elevated markedly SR- CA – 125 was normal.
  • Hence TAH with BSO planned to avoid spillage of contents.
  • Intraoperatively, the left ovarian mass was multilobulated with a smooth surface.
  • The uterus is bulky and the right ovary is cystic.
  • Biopsy came as STRUMA OVARII
  • Struma (ovary) ovarii typically presents as a lobulated multicystic lesion with solid components.
  • High attenuation areas and calcification in the solid components are common findings.
  • It is a variant of teratoma with either entire or predominant thyroid tissue.
  • It may be associated with stromal carcinoids.
  • It commonly occurs in reproductive women.