Search Results (3)

Appendiceal intussusception is a rare condition characterized by the invagination of the appendix into the base of the cecum. In some cases, this condition can lead to obstruction, ischemia, and perforation. It is more common in elderly patients, particularly women, and is often associated with the presence of a lesion, benign or malignant, acting as a “lead point.” This case report details the emergency management of a 54-year-old female patient with severe abdominal pain, nausea, and vomiting. The physical examination was unremarkable, as were the laboratory tests. However, ultrasound revealed a small amount of fluid in the pelvis, leading to further investigation with a CT scan which showed appendiceal intussusception with significant wall edema, fluid in the surrounding fatty tissue, and reactive lymph nodes. The patient then underwent an operation that confirmed an intussuscepted appendix showing signs of ischemia. Histopathology showed the presence of an endometrioma acting as the “lead point”. This case report showcases the crucial role of diagnostic imaging, which is superior to clinical examination and laboratory tests when diagnosing these patients. Diagnostic imaging, coupled with careful differential diagnosis, is vital to distinguishing benign conditions from malignancy and ensuring timely and appropriate intervention. Early diagnosis and surgical intervention are essential to prevent life-threatening complications such as gangrene and perforation and exclude malignancy in adult patients. Full article

Abdominal wall endometriosis (AWE) is a clinical disorder with unknown pathogenesis with an incidence between 0.03% and 1% in women affected by cutaneous/scar endometriosis. We investigated the pathological, molecular cytogenetic and cell proliferation features of a primary AWE developed in rectus abdominis muscle in a patient without co-existing pelvic endometriosis. An investigational model of cultured stromal cells was additionally established. Histologically, the lesion revealed areas of endometrial-like glands surrounded by a thick stromal layer in addition to numerous disseminated foci composed exclusively of stromal cells. Beyond the strong expression of Estrogen (ER) and Progesterone receptors (PRs), consistent immunolabeling for several mesenchymal stromal/stem cell antigens and oncoproteins was revealed in both the endometrioma as well as in the cultured stromal cells. The Fluorescence in situ hybridization (FISH) analysis of the endometrioma demonstrated a structural alteration of the c-MYC protooncogene, with a mean of three gene copies in 3% to 5% of both glandular and stromal cells. The FISH assay applied on the cultured cells showed c-MYC gene amplification, with an average number of more than six gene copies in 18% to 25% of the cellular nuclei. Altogether, these results markedly highlight the pathological and molecular features of idiopathic AWE essential for histo-pathogenetic categorization. Full article

Accurate diagnosis of Müllerian duct anomalies (MDA) remains a clinical challenge even by direct surgical inspection. Although obstetrical complications are more frequent in women with MDA, some subtypes allow normal reproduction, further delaying the diagnosis. Unicornuate uterus with a rudimentary non-communicating functioning horn is a rare form of MDA, susceptible to many gynecologic and obstetric complications such as miscarriages, premature birth, hematosalpinx, endometriosis, and chronic pelvic pain. We present an entire case pictorial assay including preoperative imaging as well as the surgical correction of the uterine anomaly and the associated complication of an occult unicornuate right uterus with rudimentary non-communicating functioning left horn (Class U4aC0V0/ European Society of Human Reproduction and Embryology/European Society of Gastrointestinal Endoscopy Classification) and its natural evolution following a previous incomplete surgical treatment. The patient had an emergency left adnexectomy for hematosalpinx and ovarian endometrioma at her local county hospital. After five years, the patient presented with severe dysmenorrhea and abdominal endometriosis due to blocked retrograde menstruation from a rudimentary, non-communicating functioning horn. Surgical treatment with the resection of the rudimentary uterine horn, together with the abdominal wall endometriosis lesions, was carried out with good outcomes. Full article