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M103 A VERY RARE CASE OF BENIGN VULVAL PATHOLOGY: INVERTED FOLLICULAR KERATOSIS OF THE VULVAR SKIN
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
M102 PRESACRAL MASS; A DIAGNOSTIC DILEMMA N. Aslam1 , P.A. Moran1 . 1 Worcester Royal Hospital, Worcester, West Midlands, United Kingdom Objectives: To highlight the significance of unusual differential diagnosis of presacral mass and to inform the clinicians that all suspicious masses are not melignant. Materials: A presacral mass can present a diagnostic dilemma for the gynecologist and surgeons. Differential diagnoses include congenital causes such as teratoma or chordoma, neurological causes such as neurilemoma or neurofibroma or other malignancies such as lymphoma or sarcoma. Diagnosis usually requires imaging such as CT and MRI and tissue biopsy. Methods: We present an unusual case of a presacral mass being pelvic kidney. 68 years old with a very large stage 4 procidentia associated with cystocele and rectocele underwent laparotomy for subtotal abdominal hysterectomy and bilateral salpingo-oophorectomy with sacrocervicopexy combined with pelvic floor repair. She had previous midline laparotomy and previous peritonitis as child. Bowel and omental adhesions were dissected on right side and it showed a very unusual and enlarged retroperitoneal mass 6–7 cm in diameter sitting just to the right of the sacral promontory. It was agreed with surgeons that this was probably a lymph node and surgeons proceeded to do a wedge biopsy of the lymph node for histology. Given the findings, hysterectomy with pelvic floor repair was done instead of sacrocervicopexy. Results: Quite surprisingly histology demonstrated this to be a renal cortex and indeed on further CT imaging post operatively this patient had a right pelvic kidney overlying the sacral promontory area. She made an excellent recovery. Renal pelvic ectopia has been estimated to occur in 1 of 2100 to 3000 autopsies. Most ectopic kidneys are clinically asymptomatic and they are no more susceptible to disease than the normally positioned kidney, except for the development of hydronephrosis or urinary calculus formation. Conclusions: This case showed that all masses in presacral area are not malignant and highlights the significance of careful assessment with multidisciplinary input keeping in mind the rare unusual presentation of pelvic kidney. Biopsy could have been avoided if this diagnosis was considered. M103 A VERY RARE CASE OF BENIGN VULVAL PATHOLOGY: INVERTED FOLLICULAR KERATOSIS OF THE VULVAR SKIN M. Siddiqa2 , S. El-Tuhamy1 . 1 Antrim Area Hospital, Antrim, Northern Ireland, United Kingdom; 2 Ulster Hospital, Belfast, Northern Ireland, United Kingdom Background: Inverted follicular keratosis of the vulvar skin is extremely rare condition and can be confused with squamous cell carcinoma. Inverted follicular keratosis usually occurs on the face. There is at least one case report in the literature of occurrence on the vulval hair bearing skin. Case report: A seventy-three years old lady presented with a vulval lump of six weeks duration that had gradually increased in size. There were no associated symptoms. On examination lump was found on the left labia majora approximately six millimetres in size. It was non tender and showed a central crater. A punch biopsy of the lesion was performed in the clinic. Histology showed an intradermal squamo-proliferative lesion continuous with infundibular part of the hair follicle with a minor peripheral component of basaloid squamous proliferation. Most of the lesion was composed of squamous eddies and occasional small horn cysts. The epithelial proliferation incorporated a minor stromal component, variably myxiod and hyaline. Around the lesion there was a zone of chronic inflammatory infiltration with scattered foreign body type giant cells. A
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differential of well differentiated squamous cell carcinoma was excluded. Conclusions: Inverted follicular keratosis of the vulvar skin is a rare condition and should be kept in mind in the differential diagnosis of vulval skin pathology. Reference(s) Roth, Lawrence M. M.D.; Look, Katherine Y. M.D. Inverted Follicular Keratosis of the Vulvar Skin: A Lesion That Can Be Confused with Squamous Cell Carcinoma. International Journal of Gynecological Pathology. 19(4):369–373, October 2000. Murphy GF. Dermatopathology. Philadelphia: W.B. Saunders; 1995:189– 190.
M104 THE CHILDREN – ADOLESCENTS GYNECOLOGIST ROLE IN THE PREVENTION OF NON-TRANSMISSIBLE CHRONIC DISEASES S. Pebe1 , V. Sivo1 . 1 Ginecologia, Hospital Interzonal de Ezeiza Dr. A. Eurnekian, Ezeiza, Buenos Aires, Argentina Objectives: The non-trasmissible chronic diseases (NCD) are the first cause of death in Argentina and the world (60%). The cardiovascular disease (CVD), diabetes, respiratory diseases and cancer are the main problems that affect humans. In Europe a woman dies every 6 minutes, in the United States once every minute for CVD. Born with low weight is a risk for CVD and metabolic sindrome. Compare the risk factors for cardiovascular disease in adolescents with low birth weight and normal weight. To estimate insulin resistance. Materials: Of 354 women adolescents who were assisted 01/01/11 to 31/12/11 in the office of Children and Adolescents Gynecologist Ezeiza Hospital-Argentina, 50 (14%) were excluded from this study because they were pregnant as well as carriers of previous pathologies. Consecutive random sample of 126 adolescent girls in two independent samples: Birth weight <2500 gr and >2500 gr to 3999 gr. Methods: A prospective, observational, cross-sectional comparison. Variables: age, BMI (weight and height), HDL-chol, HOMA (glucose, insulin), cholesterol, triglycerides, blood pressure (BP), birth weight. Cutoff values: ATP III (Adult Treatment Panel III). Scale: nominal. Statistical analysis: arithmetic mean, percentage, rank, Chi 2, RR and IC. Alpha 0.05. Results: The average age was 16.2 (range: 10 to 19 years). Adolescents with low birth weight (group 1) was 19.04% and normal birth weight (group2) of 80.96%. BMI >24.9 in the G1 was 41.66% and 17.64% G2. The HDL-col <50 was 83.33% and 49.01% in G1 and 2 respectively. Triglycerides >150 in G1 was 25% and G2 of 3.92%. BP >130/80 on the G1 was 8.33% and 1.96% for G2. The p value for BMI, triglycerides and HOMA (0.019; 0.0006;0.003 respectively). Insulin resistance (HOMA >2.5) in G1 33.33%, in G2 9.80%. We found 3% of hypertension and 45.5% of smokers. Conclusions: Risk factors for cardiovascular disease in adolescents girls with low birth weight were higher in this group compared with those born with normal weight, were significant. There were no significant differences in total cholesterol and blood pressure. Adolescent girls with low birth weight showed higher insulin resistance than those of normal weight. Early intervention in childhood and adolescence to prevent risk factors for this disease is a valid tool. The gynecologist is the primary care of the adolescent female. M105 VON WILLEBRAND’S DISEASE AND MANAGEMENT OF MENORRHAGIA J. Mamo2 , N. Mamo1 , D. Azzopardi Micallef2 , C. Vella2 , A. Micallef Fava2 . 1 University of Malta Medical School, Qawra, Malta; 2 Mater Dei Hospital, Msida, Malta Objectives: Clotting disorders are rare in women complaining of heavy menstrual flow, Women and adolescents with clotting
M102 PRESACRAL MASS; A DIAGNOSTIC DILEMMA N. Aslam1 , P.A. Moran1 . 1 Worcester Royal Hospital, Worcester, West Midlands, United Kingdom Objectives: To highlight the significance of unusual differential diagnosis of presacral mass and to inform the clinicians that all suspicious masses are not melignant. Materials: A presacral mass can present a diagnostic dilemma for the gynecologist and surgeons. Differential diagnoses include congenital causes such as teratoma or chordoma, neurological causes such as neurilemoma or neurofibroma or other malignancies such as lymphoma or sarcoma. Diagnosis usually requires imaging such as CT and MRI and tissue biopsy. Methods: We present an unusual case of a presacral mass being pelvic kidney. 68 years old with a very large stage 4 procidentia associated with cystocele and rectocele underwent laparotomy for subtotal abdominal hysterectomy and bilateral salpingo-oophorectomy with sacrocervicopexy combined with pelvic floor repair. She had previous midline laparotomy and previous peritonitis as child. Bowel and omental adhesions were dissected on right side and it showed a very unusual and enlarged retroperitoneal mass 6–7 cm in diameter sitting just to the right of the sacral promontory. It was agreed with surgeons that this was probably a lymph node and surgeons proceeded to do a wedge biopsy of the lymph node for histology. Given the findings, hysterectomy with pelvic floor repair was done instead of sacrocervicopexy. Results: Quite surprisingly histology demonstrated this to be a renal cortex and indeed on further CT imaging post operatively this patient had a right pelvic kidney overlying the sacral promontory area. She made an excellent recovery. Renal pelvic ectopia has been estimated to occur in 1 of 2100 to 3000 autopsies. Most ectopic kidneys are clinically asymptomatic and they are no more susceptible to disease than the normally positioned kidney, except for the development of hydronephrosis or urinary calculus formation. Conclusions: This case showed that all masses in presacral area are not malignant and highlights the significance of careful assessment with multidisciplinary input keeping in mind the rare unusual presentation of pelvic kidney. Biopsy could have been avoided if this diagnosis was considered. M103 A VERY RARE CASE OF BENIGN VULVAL PATHOLOGY: INVERTED FOLLICULAR KERATOSIS OF THE VULVAR SKIN M. Siddiqa2 , S. El-Tuhamy1 . 1 Antrim Area Hospital, Antrim, Northern Ireland, United Kingdom; 2 Ulster Hospital, Belfast, Northern Ireland, United Kingdom Background: Inverted follicular keratosis of the vulvar skin is extremely rare condition and can be confused with squamous cell carcinoma. Inverted follicular keratosis usually occurs on the face. There is at least one case report in the literature of occurrence on the vulval hair bearing skin. Case report: A seventy-three years old lady presented with a vulval lump of six weeks duration that had gradually increased in size. There were no associated symptoms. On examination lump was found on the left labia majora approximately six millimetres in size. It was non tender and showed a central crater. A punch biopsy of the lesion was performed in the clinic. Histology showed an intradermal squamo-proliferative lesion continuous with infundibular part of the hair follicle with a minor peripheral component of basaloid squamous proliferation. Most of the lesion was composed of squamous eddies and occasional small horn cysts. The epithelial proliferation incorporated a minor stromal component, variably myxiod and hyaline. Around the lesion there was a zone of chronic inflammatory infiltration with scattered foreign body type giant cells. A
S565
differential of well differentiated squamous cell carcinoma was excluded. Conclusions: Inverted follicular keratosis of the vulvar skin is a rare condition and should be kept in mind in the differential diagnosis of vulval skin pathology. Reference(s) Roth, Lawrence M. M.D.; Look, Katherine Y. M.D. Inverted Follicular Keratosis of the Vulvar Skin: A Lesion That Can Be Confused with Squamous Cell Carcinoma. International Journal of Gynecological Pathology. 19(4):369–373, October 2000. Murphy GF. Dermatopathology. Philadelphia: W.B. Saunders; 1995:189– 190.
M104 THE CHILDREN – ADOLESCENTS GYNECOLOGIST ROLE IN THE PREVENTION OF NON-TRANSMISSIBLE CHRONIC DISEASES S. Pebe1 , V. Sivo1 . 1 Ginecologia, Hospital Interzonal de Ezeiza Dr. A. Eurnekian, Ezeiza, Buenos Aires, Argentina Objectives: The non-trasmissible chronic diseases (NCD) are the first cause of death in Argentina and the world (60%). The cardiovascular disease (CVD), diabetes, respiratory diseases and cancer are the main problems that affect humans. In Europe a woman dies every 6 minutes, in the United States once every minute for CVD. Born with low weight is a risk for CVD and metabolic sindrome. Compare the risk factors for cardiovascular disease in adolescents with low birth weight and normal weight. To estimate insulin resistance. Materials: Of 354 women adolescents who were assisted 01/01/11 to 31/12/11 in the office of Children and Adolescents Gynecologist Ezeiza Hospital-Argentina, 50 (14%) were excluded from this study because they were pregnant as well as carriers of previous pathologies. Consecutive random sample of 126 adolescent girls in two independent samples: Birth weight <2500 gr and >2500 gr to 3999 gr. Methods: A prospective, observational, cross-sectional comparison. Variables: age, BMI (weight and height), HDL-chol, HOMA (glucose, insulin), cholesterol, triglycerides, blood pressure (BP), birth weight. Cutoff values: ATP III (Adult Treatment Panel III). Scale: nominal. Statistical analysis: arithmetic mean, percentage, rank, Chi 2, RR and IC. Alpha 0.05. Results: The average age was 16.2 (range: 10 to 19 years). Adolescents with low birth weight (group 1) was 19.04% and normal birth weight (group2) of 80.96%. BMI >24.9 in the G1 was 41.66% and 17.64% G2. The HDL-col <50 was 83.33% and 49.01% in G1 and 2 respectively. Triglycerides >150 in G1 was 25% and G2 of 3.92%. BP >130/80 on the G1 was 8.33% and 1.96% for G2. The p value for BMI, triglycerides and HOMA (0.019; 0.0006;0.003 respectively). Insulin resistance (HOMA >2.5) in G1 33.33%, in G2 9.80%. We found 3% of hypertension and 45.5% of smokers. Conclusions: Risk factors for cardiovascular disease in adolescents girls with low birth weight were higher in this group compared with those born with normal weight, were significant. There were no significant differences in total cholesterol and blood pressure. Adolescent girls with low birth weight showed higher insulin resistance than those of normal weight. Early intervention in childhood and adolescence to prevent risk factors for this disease is a valid tool. The gynecologist is the primary care of the adolescent female. M105 VON WILLEBRAND’S DISEASE AND MANAGEMENT OF MENORRHAGIA J. Mamo2 , N. Mamo1 , D. Azzopardi Micallef2 , C. Vella2 , A. Micallef Fava2 . 1 University of Malta Medical School, Qawra, Malta; 2 Mater Dei Hospital, Msida, Malta Objectives: Clotting disorders are rare in women complaining of heavy menstrual flow, Women and adolescents with clotting