Differential Diagnosis In Young Women Research Articles

Abstract 11578: A Case of Spontaneous Coronary Artery Dissection Masking as Acute Myopericarditis

Introduction: Chest pain is a common reason for emergency room visits. Acute coronary syndrome (ACS) remains a high mortality etiology of chest pain. Spontaneous coronary artery dissection (SCAD) is a rare cause of ACS in the general population, but a relatively common cause of ACS in young women. Case: Patient is a 29-year-old female with history of anxiety and fibroids that presented with chest pain. She described the chest pain as sharp, substernal, non-radiating that lasted for 10 minutes after eating dinner. The pain improved with leaning forward and resolved when lying on her stomach. She had a second episode of chest pain after 2 hours with similar characteristics which lasted 10 minutes. She was 4 months post-partum. She reported having a sore throat 4 days prior to the presentation. Troponin peaked at 0.173. ECG showed diffuse ST-elevation and PR depression in V3-V6 I II III aVF. TTE showed LVEF 65% and no wall motion abnormalities. CTA coronary showed 50-60% narrowing of mid LAD. Cardiac MR showed mild hypokinesis of mid-anteroseptal wall with associated subendocardial to midmyocardial delayed enhancement with focal elevations in myocardial native T1 and T2, and LVEF 53%. Coronary catheterization showed 50-60% stenosis in the mid-LAD distal to the first diagonal artery, there was no improvement in the stenosis after administration of intra-coronary nitroglycerin, there were no septals noted to arise from this area, consistent with diagnosis of SCAD (figure 1). Diagnosis: On initial evaluation, the etiology of her chest pain appeared to be myopericarditis. However, using CTA coronary, cardiac MR and coronary catheterization findings, the pain was more consistent with type 1 NSTEMI in the setting of SCAD. Patient was started on IV heparin, metoprolol tartrate, and aspirin. Conclusions: SCAD is a life-threating and often missed etiology of ACS. It requires a high index of suspicion and should be in the differential diagnosis in young women presenting with chest pain.

Solid pseudopapillary tumor of the pancreas: clinical-pathological features and management of 13 cases.

Background and aimSolid pseudopapillary tumor (SPT) of the pancreas is a rare pathological condition, representing less than 3% of all exocrine pancreatic tumors. SPT usually occurs in young females, without notable symptoms, with a low malignant potential and excellent prognosis.MethodWe conducted a retrospective study during the period January 2005 – January 2015. SPT patients admitted in our institution were reviewed by describing demographic data, clinico-pathologic and radiological features, therapeutic management and prognosis records.ResultsThirteen patients with SPT were identified (10 females), with a median age of 30 years. The main clinical presentation was abdominal pain (92.3%). The tumor was mostly located in the body or tail of the pancreas (77%), and the mean size was 8.2 cm. Regarding the surgical approach there were 5 distal pancreatectomies with splenectomy, 3 body and tail pancreatectomies, 2 body and tail pancreatectomies with splenectomy, 2 pancreato-duodenectomy, 1 partial enucleation and of all only 2 partial resections. Postoperative hematoxylin- eosin staining and immunohistochemistry confirmed the diagnosis in all cases. None of the patients had lymph nodes metastases. Only one local invasion. There was one case of death due to postoperative complications. Four cases followed adjuvant systemic chemotherapy. The mean follow-up was 18 months, without evidence of recurrence during this period.ConclusionSPT should always be considered in the differential diagnosis in young women with a pancreatic tumor. Complete surgical excision is the treatment of choice, and is usually curative. The decision to administer systemic therapy must be individualized. Malignant behavior and late recurrences mandates long-term follow-up for patients with SPT.

Clear Cell Adenocarcinoma of the Uterine Cervix

We report an extremely rare case of a patient with clear cell carcinoma of the cervix who had no history of in utero diethylstilbestrol (DES) exposure. Although clear cell adenocarcinoma is an uncommon tumor, it must be considered in the differential diagnosis in young women and children who have cervico-vaginal lesions even without in utero DES exposure history. We present the case of 2 girls, a 14-year-old and a 16-year-old, who were admitted to hospital because of intermittent vaginal bleeding and the presence of a cervical mass diagnosed as clear cell cervix carcinoma. Neither of them had a history of exposure to DES.

Management of rectosigmoid obstruction due to severe bowel endometriosis

Bowel obstruction is a rare complication of intestinal endometriosis. The aim of this work was to evaluate outcomes after colorectal resection for bowel obstruction due to endometriosis. Of 720 patients who underwent colorectal resection for bowel endometriosis, 12 (1.7 %) presented with bowel obstruction. Preoperative work-up, management, perioperative and long-term outcomes were analyzed. All lesions were localized in the rectosigmoid tract. All patients underwent colorectal resection, which was carried out laparoscopically in 4 (33 %). Rate of low or ultra-low colorectal anastomoses was 83 %. Four patients (33 %) required blood transfusions. Two patients developed rectovaginal fistulas. After a median follow-up of 38 months, there were no cases of disease recurrence and dyschezia improved in 75 % of patients. Bowel endometriosis should be considered in the differential diagnosis of young women with bowel obstruction. Despite challenging operations, colorectal resections are associated with good outcomes.

Desmoplastic small round cell tumor of the ovary: A rare but devastating disease in young women

•Desmoplastic small round cell tumor of the ovary is a rare clinical entity with poor prognosis.•Accurate diagnosis utilizes a combination of histological, immunohistological, and cytogenetic findings.•This disease should be kept on the differential diagnosis in young women with widespread disease on presentation.

Spontaneous Coronary Artery Dissection in a Young Woman without Risk Factors

BackgroundSpontaneous coronary artery dissection is a very rare event and is more common in women than in men. Pregnancy and the early puerperium stage have been recognized as predisposing factors for this condition. Case ReportA 33-year-old woman presented to the Emergency Department (ED) with chest pain; the patient's electrocardiogram (ECG) showed an ST-segment elevation similar to that observed in ST-segment elevation myocardial infarction (STEMI). She experienced a ventricular fibrillation cardiac arrest when she was in the hospital and received resuscitation, after which she regained consciousness and showed spontaneous circulation. She underwent cardiac catheterization under the impression of spontaneous coronary artery dissection, and conservative therapy was chosen. ConclusionIn this report, we have underlined the importance of considering coronary artery dissection in the differential diagnosis of young women who present to the ED with chest pain, an ECG with ST-segment elevation, and very few cardiac risk factors.

Severe endometriosis may be considered in the differential diagnosis in young women presenting massive hemorrhagic ascites

Endometriosis, the presence of endometrial tissue outside the uterine cavity, affects 10% of women in reproductive age and has immunological aspects conferring the disease an indubitable inflammatory trace [1]. Patients may present dysmenorrhea, chronic pelvic pain, dyspareunia, and infertility but rarely develops massive hemorrhagic ascites. One of the components of peritoneal fluid in normal menstrual cycles is an ovarian exudate. The increase in vascular permeability along with some other factors as extremely high estrogen concentrations, and the presence of angiogenic factors, prostaglandins, histamines, and cytokines, may play an important role in the appearance of massive ascites. Inflammation increase the volume of exudation and, consequently, of the peritoneal fluid [2]. In the USA, cirrhosis represents 81% of the causes of ascites followed by cancer (10%), heart failure (3%), tuberculosis (2%), dialysis (1%), pancreatic disease (1%), and other causes (2%). Ovarian tumors, ovarian hyperstimulation syndrome, pelvic or peritoneal tuberculosis, and Meigs syndrome also can cause ascites. The correct and successful treatment depends on a precise diagnosis of its cause [3]. Most gynecologists are unaware that endometriosis can be related to massive ascites, leading to a misdiagnosis, especially when the symptoms includes loss of weight. To improve the knowledge of this kind of clinical case, we describe a patient that presented hemorrhagic ascites due to endometriosis [2, 4].

Uropatía obstructiva secundaria a endometriosis vesicoureteral: características clínico-radiológicas y anatomopatológicas

To report the case of a 37 year-old woman suffering from endometriosis of the urinary tract, that presented with lumbar and pelvic pain associated to cyclic recurrent haematuria. Following history, physical examination, abdomino-pelvic ultrasound (USS), CT scan and cystoscopy with biopsies, surgical treatment was indicated Imaging (USS-CT ) revealed a protrusion of the left bladder hemi-trigone with a nodular, irregular thickening and ipsilateral grade II-III/IV uretero-hydronefrosis. Cistoscopy confirmed a swollen and oedematous lesion in left hemi-trigone that seemed extrinsic in origin. With the clinical diagnosis of a possible neoplasia of gynaecological origin, the patient underwent surgical treatment consisting in radical hysterectomy with bilateral oophorectomy, partial cystectomy and left ureteroneocystostomy. The frequency of endometriosis in the urinary tract is relatively low and therefore, endometriosis presenting with ureteral obstruction (uretero-hydronephrosis) has been rarely reported in the literature and should be part of the differential diagnosis in young women, especially if symptoms are cyclic. The treatment is surgery and the final diagnosis by pathology report.

Desmoplastic small round cell tumour: Obstetric and gynecological presentations

Background. Desmoplastic small round cell tumour (DSRCT) is a rare sarcoma primarily affecting young men. We report two cases in young women mimicking gynaecological malignancy. Cases. A 23-year-old woman underwent caesarean section for obstructed labour. At surgery, multiple tumour deposits were found throughout abdomen and pelvis. Histology and PCR confirmed DSRCT. Despite chemotherapy, the patient relapsed and died 27 months after diagnosis. A 29-year-old woman presented with abdominal distension and elevated Ca125. Imaging demonstrated widespread tumour within abdomen and pelvis. Histology confirmed DSRCT. Although attaining a complete response to chemotherapy, she relapsed within 2 months and died 11 months after diagnosis. Conclusion. DSRCT should be considered in the differential diagnosis of young women presenting with abdominal distension and multiple masses on imaging.

Importance of accurate preoperative diagnosis in the management of aggressive angiomyxoma: report of three cases and review of the literature

Aggressive angiomyxoma is a benign but locally aggressive tumor that occurs mostly in young women. Because excision is often incomplete, the risk of local recurrence is high. This report describes differences in presentation and the importance of accurate preoperative diagnosis of this rare neoplasm. We describe three cases with different presentations. Two were initially misdiagnosed, and local recurrence necessitated reoperation. Accurate diagnosis in the third case was followed by complete excision, with no recurrence. Aggressive angiomyxoma should be considered in the differential diagnosis of young women who present with a well-defined mass in the pelvic tissue. Accurate preoperative diagnosis should alert the surgeon to the need for wide excision, which is essential for prevention of local recurrence.

Torsion of bilateral paramesonephric cysts in young girls

Torsion of bilateral paramesonephric cysts in young girls

Benign Metastasizing Leiomyoma

The cases of 2 patients with benign metastasizing leiomyofibroma are reviewed. Although extremely rare both in our experience and in the literature, benign metastasizing leiomyofibroma is an important differential diagnosis in young women seen with multiple lung nodules. Our patients underwent staged thoracotomies for diagnosis and treatment, and have experienced no evidence of recurrence over a six-year period.