Samara Sabur is a junior medical doctor, training in obstetrics and gynecology at the Northern Beaches Hospital in Sydney, Australia. She is currently completing a Master of Public Health through the University of Sydney and is an associate lecturer at the School of Medicine in University of Western Sydney. She has previously presented research at the European Congress of Obstetrics and Gynecology as well as the Australasian Gynecological and Endoscopy Society annual scientific meeting.
Intravascular leiyomyomatosis (IVL) is a rare smooth muscle cell tumour that is histologically benign with metastatic behaviour. The tumour arises from the uterus and grows within the venous system, extending to the inferior vena cava, right-sided cardiac chambers and pulmonary vessels. IVL can be fatal, resulting in thromboembolic events, congestive heart failure and intra-pulmonary leiyomyomatosis. There is also a risk of recurrence if the tumour is not completely resected.1 rn rnPresentation usually occurs after the disease has advanced with symptoms of haemodynamic instability, dyspnoea, palpitations, chest or abdominal pain.2 Typically, diagnosis is based on macroscopic description of worm-like tumour projections in the veins and/or microscopic evidence of intraluminal leiyomyomas.3 rn rnWe report a case of a 44-year-old woman who underwent a total abdominal hysterectomy and bilateral salpingectomy for simple hyperplasia, diagnosed from uterine curettage performed for menorrhagia. Intraoperatively, increased vascularity and aberrant vessels were noted on the serosal surface. The macroscopic pathology examination was normal, however, the histopathology demonstrated smooth muscle tumours in 2 vessels, consistent with IVL. The patient underwent computed tomography imaging of the chest and abdomen to rule out metastases and is scheduled for yearly follow-up due to the risk of recurrence. rn rnThis case highlights a rare but important diagnosis that gynecologists should be suspicious of when abnormal vascularity is seen on the uterus, especially due to the high risk of morbidity and recurrence with IVL. We review the literature and discuss management options for optimal outcomes of this disease.rn
Samara Sabur is a junior medical doctor, training in obstetrics and gynecology at the Northern Beaches Hospital in Sydney, Australia. She is currently completing a Master of Public Health through the University of Sydney and is an associate lecturer at the School of Medicine in University of Western Sydney. She has previously presented research at the European Congress of Obstetrics and Gynecology as well as the Australasian Gynecological & Endoscopy Society annual scientific meeting.
The placental site nodule (PSN) and its neoplastic counterpart epitheloid trophoblastic tumour (ETT) are forms of non-molar gestational trophoblastic disease that are thought to arise from incomplete involution of the placenta, particularly in women with previous uterine surgery e.g. caesarean section (CS) or curettage.1 Presentation is varied and non-specific including abnormal uterine bleeding (AUB), amenorrhoea, infertility and incidental finding through abnormal cervical smear cytology.2 rn rnAs symptoms usually occur long after the last pregnancy, average latent phase 3-years2, placental pathology is not usually considered. However, it is extremely important for clinicians to distinguish these lesions due to emerging evidence that PSNs may have potential to develop malignant transformation to ETTs.3-5 rn rnWe report 2 cases of PSN illustrating an interesting spectrum of pathological diagnoses with differing natural histories and management. rn rnCase 1: - 29-year-old, G2P2: 2 vaginal deliveries - AUB 4-years after last delivery, non-responsive to medical management - ultrasound normal - hysteroscopy normal, endometrial curettage: PSN - Endometrial ablation performed due to ongoing AUB - endometrial biopsy pre-ablation: normal rn rnCase 2: - 39-year-old, G3P2: suction curettage for miscarriage, 2 CS - Pelvic pain 6-months after first CS - ultrasound: possible retained products of conception - hysteroscopy: scant material, curetting: PSN - symptoms resolved - AUB 1 year following second CS - ultrasound normal - hysteroscopy normal, endometrial curettage: PSN, differential diagnosis ETT. - Gyne-oncology review: hysterectomy performed. rn rnThese cases demonstrate the highly variable presentations of PSN. Diagnosis should alert practitioners to arrange ongoing follow-up, given the potential to develop ETT. rn