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Gynaecology Case Reports 205
Figure 1. (a) Preoperative photographs of the patient. (b) Photographs of the patient on postoperative 10th day. (c) Intraoperative photograph of the myoma. (d) Giant myoma with uterus. Stanko CM, Severson MA 2nd, Molpus KL. 2001. Deep venous thrombosis associated with large leiomyomata uteri. A case report. Journal of Reproductive Medicine 46:405–407. Toru S, Murata T, Ohara M et al. 2013. Paradoxical cerebral embolism with patent foramen ovale and deep venous thrombosis caused by a massive myoma uteri. Clinical Neurology and Neurosurgery 115:760–761. Wu CJ, Huang KH, Liu JY. 2011. Ovarian vein thrombosis associated with compression by a uterine myoma. European Journal of Obstetrics, Gynecology, and Reproductive Biology 159:485–487.
Rapid recurrence of a corpus luteum cyst after laparoscopic surgery in a young woman with a levonorgestrel releasing coil A. Daniilidis1, K. Chatzistamatiou1, T. Dagklis2, C. Chatziparadisi1, Z. Oikonomou1 & M. Tzafettas1 12nd and 23rd University Clinic of Obstetrics and Gynecology,
Hippokrateio General Hospital, Aristotle University of Thessaloniki, Greece DOI: 10.3109/01443615.2014.935716
Correspondence: K. Chatzistamatiou, 2nd Department of Obstetrics and Gynecology, Hippokrateio Hospital of Thessaloniki, 49 Konstantinoupoleos st, 54642 Thessaloniki, Greece. E-mail: [email protected]
Introduction Under certain circumstances, the development of the corpus luteum may be abnormal and result in the formulation of a cystic mass, a corpus luteum cyst, which may have various clinical complications (Barbuscia et al. 2010). The corpus luteum cyst may be ruptured or twisted causing acute abdominal pain, or the excess of hormone production from the cystic corpus luteum may lead to abnormal uterine bleeding. However, it is usually asymptomatic and resolves spontaneously. Cystic corpus luteum is a functional ovarian cyst for which there is still some debate on the use of surgical methods for their treatment (Muzii and Panici 2001). We present a case of a laparoscopically removed symptomatic corpus luteum cyst of 8 ⫻ 8 cm, followed by the formation of a similar sized luteal cyst 1 month postoperatively, in a woman of reproductive age with a levonorgestrel releasing intrauterine coil for the past 2 years. The recurrent cyst was asymptomatic and was treated with a simple course of the combined contraceptive pill, while the coil was removed. The recurrence of a corpus luteum cyst is common but in our case, this recurrence occurred quite rapidly, at approximately 1 month after the initial excision.
206
Gynaecology Case Reports
J Obstet Gynaecol Downloaded from informahealthcare.com by Nyu Medical Center on 06/21/15 For personal use only.
Case report A 32-year-old parous woman presented with acute lower pelvic pain. The onset was sudden, the pain was steady and radiating to the back. She had a levonorgestrel-releasing coil (Mirena® Bayer HealthCare Pharmaceuticals) inserted for contraception 2 years previously. A pregnancy test was negative. Transvaginal ultrasound examination revealed a cyst measuring 8 cm in diameter on the right ovary. The sonographic appearance was that of a cyst with a thin wall, smooth surface and hyperechogenic content. Doppler showed high-velocity, low-impedance peripheral vascularisation of the ovary. Initial diagnosis was torsion of a corpus luteum cyst. She was operated on laparoscopically and a pedunculated benign ovarian cystic mass, originating from the right ovary, was recognised (Figure 1). The procedure was aspiration of the cystic fluid, and removal of the pathological tissue by coagulation and cutting at the level of the pedicle, leaving the rest of the ovary intact. Intact removal of the cyst prior to aspiration could not be performed due to technical issues. Her postoperative course was uneventful. The pathology report was that of a corpus luteum cyst. At 30 days postoperatively, and 5 days after menstruation, she presented, with no abnormal clinical signs or symptoms. A pelvic examination suspected an enlarged right adnexa. An ultrasound examination was performed and it revealed a cystic mass on the right ovary measuring 8 cm, similar to the one extracted. Conservative management was decided upon. She received combined oral contraceptives (COP) (oestradiol valerate/dienogest – Qlaira®) and was re-examined 1 month later. Transvaginal ultrasound evaluation did not reveal any pathology. She was advised to continue with COP and the coil was removed.
Discussion Corpus luteum may have an abnormal development and instead of degeneration, it might persist or even form a cystic mass known as a corpus luteum cyst or luteal cyst. The excess of progesterone production may result in abnormal uterine bleeding (Barbuscia et al. 2010) or the cyst might even be ruptured or twisted causing internal haemorrhage and acute abdominal pain. In our case, the patient presented with symptoms of ovarian torsion. Sonographic appearance varies and the content of these cysts may appear as hyperechogenic or as a greatly enlarged fine trabecular (‘jelly-like’) echostructure, due to the presence of fibrin strands, and mimic other causes of gynaecological pathology, such as ectopic pregnancy, tubo-ovarian abscesses, endometriomas, fibroids and neoplasms (Swire et al. 2004). Treatment of a corpus luteum cyst depends on its clinical complications. They usually disappear spontaneously or decrease in volume after the subsequent menstrual flow or within 5 weeks from diagnosis. In our case, because of the acute symptomatology and due to the large size of the cyst, it was decided that surgical laparoscopic treatment should be applied. There was a rapid recurrence of the cyst
within 1 month. The recurrence, the lack of any acute symptoms and the pathology report from the laparoscopy, suggested conservative treatment for the second cyst. The cyst regressed after the administration of only one course of oral contraceptives, which is quite usual in everyday practice in Greece, although the mechanism is not clear. In these cases, the use of COP is mostly empirical and not evidencebased. Although there was no evidence that the coil was the causal factor for the recurrence of the cyst, it was removed upon the patient’s request. It is well known that, after insertion of the coil, plasma levels of levonorgestrel stabilise at 100–200 pg/ml after a few weeks, which is thought to be a significantly low concentration to be considered aversively effective for ovarian function (Jensen 2005). A levonorgestrel coil could lead to a cystic formation of ⬎ 3 cm in diameter, at 6–12 months after insertion, for 17.5–21.5% of women, respectively (Varma et al. 2006). The vast majority of them are asymptomatic and a high rate (94%) of spontaneous resolution of the cysts is exhibited within 6 months (Varma et al. 2006). In the reported case herein, the formation of the cyst, the first as well as the recurrent, could not be undoubtedly attributed to the levonorgestrel-releasing coil. Benign cysts in reproductive age sometimes can be difficult to manage and treatment requires consideration of the woman’s age, parity and clinical presentation. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
References Barbuscia M, DE Luca M, Ilaqua A et al. 2010. [Etiopathogenetic and clinical considerations of corpus luteum cysts]. Giornale di Chirurgia 31:103–107. Jensen JT. 2005. Contraceptive and therapeutic effects of the levonorgestrel intrauterine system: an overview. Obstetrical and Gynecological Survey 60: 604–612. Muzii L, Panici PB. 2001. Surgery for functional cysts: is it unnecessary? Journal of the American Association of Gynecologic Laparoscopists 8:616–618. Swire MN, Castro-Aragon I, Levine D. 2004. Various sonographic appearances of the hemorrhagic corpus luteum cyst. Ultrasound Quarterly 20:45–58. Varma R, Sinha D, Gupta JK. 2006. Non-contraceptive uses of levonorgestrelreleasing hormone system (LNG-IUS) – a systematic enquiry and overview. European Journal of Obstetrics, Gynecology, and Reproductive Biology 125:9–28.
Sudden sensorineural hearing loss after laparoscopic cystectomy under general anaesthesia N. Aydin1, Y. Aydin2 & S. Uludag2 1Kanuni Sultan Suleyman Training and Research Hospital and 2Istanbul University, Istanbul, Turkey
DOI: 10.3109/01443615.2014.935722 Correspondence: Y. Aydin, Atakent mah, Soyakolimpiakent sit, D 12 Blok No: 53. Postal Code:34303, Halkali, Istanbul, Turkey. E-mail: [email protected]
Introduction
Figure 1. Rapid recurrence of a corpus luteum cyst after laparoscopic surgery in a young woman with a levonorgestrel releasing coil.
Few cases of hearing loss following non-otological surgical procedures have been reported, and the majority of these cases have been associated with cardiopulmonary surgery (Walsted et al. 2000). Hearing loss after other types of surgery, especially laparoscopic surgery performed under general anaesthesia, is extremely rare (Warltier et al. 2003). This report describes one such case. Screening to detect perioperatory hearing alterations is not consistently performed. Surgical procedures can simulate such alterations, which may go unnoticed because of their subclinical nature if audiometry is not performed. Hearing loss in association with epidural anaesthesia and lumbar puncture has been reported frequently (Schaffartzik et al. 2000). Its occurrence in association with local
Gynaecology Case Reports 205
Figure 1. (a) Preoperative photographs of the patient. (b) Photographs of the patient on postoperative 10th day. (c) Intraoperative photograph of the myoma. (d) Giant myoma with uterus. Stanko CM, Severson MA 2nd, Molpus KL. 2001. Deep venous thrombosis associated with large leiomyomata uteri. A case report. Journal of Reproductive Medicine 46:405–407. Toru S, Murata T, Ohara M et al. 2013. Paradoxical cerebral embolism with patent foramen ovale and deep venous thrombosis caused by a massive myoma uteri. Clinical Neurology and Neurosurgery 115:760–761. Wu CJ, Huang KH, Liu JY. 2011. Ovarian vein thrombosis associated with compression by a uterine myoma. European Journal of Obstetrics, Gynecology, and Reproductive Biology 159:485–487.
Rapid recurrence of a corpus luteum cyst after laparoscopic surgery in a young woman with a levonorgestrel releasing coil A. Daniilidis1, K. Chatzistamatiou1, T. Dagklis2, C. Chatziparadisi1, Z. Oikonomou1 & M. Tzafettas1 12nd and 23rd University Clinic of Obstetrics and Gynecology,
Hippokrateio General Hospital, Aristotle University of Thessaloniki, Greece DOI: 10.3109/01443615.2014.935716
Correspondence: K. Chatzistamatiou, 2nd Department of Obstetrics and Gynecology, Hippokrateio Hospital of Thessaloniki, 49 Konstantinoupoleos st, 54642 Thessaloniki, Greece. E-mail: [email protected]
Introduction Under certain circumstances, the development of the corpus luteum may be abnormal and result in the formulation of a cystic mass, a corpus luteum cyst, which may have various clinical complications (Barbuscia et al. 2010). The corpus luteum cyst may be ruptured or twisted causing acute abdominal pain, or the excess of hormone production from the cystic corpus luteum may lead to abnormal uterine bleeding. However, it is usually asymptomatic and resolves spontaneously. Cystic corpus luteum is a functional ovarian cyst for which there is still some debate on the use of surgical methods for their treatment (Muzii and Panici 2001). We present a case of a laparoscopically removed symptomatic corpus luteum cyst of 8 ⫻ 8 cm, followed by the formation of a similar sized luteal cyst 1 month postoperatively, in a woman of reproductive age with a levonorgestrel releasing intrauterine coil for the past 2 years. The recurrent cyst was asymptomatic and was treated with a simple course of the combined contraceptive pill, while the coil was removed. The recurrence of a corpus luteum cyst is common but in our case, this recurrence occurred quite rapidly, at approximately 1 month after the initial excision.
206
Gynaecology Case Reports
J Obstet Gynaecol Downloaded from informahealthcare.com by Nyu Medical Center on 06/21/15 For personal use only.
Case report A 32-year-old parous woman presented with acute lower pelvic pain. The onset was sudden, the pain was steady and radiating to the back. She had a levonorgestrel-releasing coil (Mirena® Bayer HealthCare Pharmaceuticals) inserted for contraception 2 years previously. A pregnancy test was negative. Transvaginal ultrasound examination revealed a cyst measuring 8 cm in diameter on the right ovary. The sonographic appearance was that of a cyst with a thin wall, smooth surface and hyperechogenic content. Doppler showed high-velocity, low-impedance peripheral vascularisation of the ovary. Initial diagnosis was torsion of a corpus luteum cyst. She was operated on laparoscopically and a pedunculated benign ovarian cystic mass, originating from the right ovary, was recognised (Figure 1). The procedure was aspiration of the cystic fluid, and removal of the pathological tissue by coagulation and cutting at the level of the pedicle, leaving the rest of the ovary intact. Intact removal of the cyst prior to aspiration could not be performed due to technical issues. Her postoperative course was uneventful. The pathology report was that of a corpus luteum cyst. At 30 days postoperatively, and 5 days after menstruation, she presented, with no abnormal clinical signs or symptoms. A pelvic examination suspected an enlarged right adnexa. An ultrasound examination was performed and it revealed a cystic mass on the right ovary measuring 8 cm, similar to the one extracted. Conservative management was decided upon. She received combined oral contraceptives (COP) (oestradiol valerate/dienogest – Qlaira®) and was re-examined 1 month later. Transvaginal ultrasound evaluation did not reveal any pathology. She was advised to continue with COP and the coil was removed.
Discussion Corpus luteum may have an abnormal development and instead of degeneration, it might persist or even form a cystic mass known as a corpus luteum cyst or luteal cyst. The excess of progesterone production may result in abnormal uterine bleeding (Barbuscia et al. 2010) or the cyst might even be ruptured or twisted causing internal haemorrhage and acute abdominal pain. In our case, the patient presented with symptoms of ovarian torsion. Sonographic appearance varies and the content of these cysts may appear as hyperechogenic or as a greatly enlarged fine trabecular (‘jelly-like’) echostructure, due to the presence of fibrin strands, and mimic other causes of gynaecological pathology, such as ectopic pregnancy, tubo-ovarian abscesses, endometriomas, fibroids and neoplasms (Swire et al. 2004). Treatment of a corpus luteum cyst depends on its clinical complications. They usually disappear spontaneously or decrease in volume after the subsequent menstrual flow or within 5 weeks from diagnosis. In our case, because of the acute symptomatology and due to the large size of the cyst, it was decided that surgical laparoscopic treatment should be applied. There was a rapid recurrence of the cyst
within 1 month. The recurrence, the lack of any acute symptoms and the pathology report from the laparoscopy, suggested conservative treatment for the second cyst. The cyst regressed after the administration of only one course of oral contraceptives, which is quite usual in everyday practice in Greece, although the mechanism is not clear. In these cases, the use of COP is mostly empirical and not evidencebased. Although there was no evidence that the coil was the causal factor for the recurrence of the cyst, it was removed upon the patient’s request. It is well known that, after insertion of the coil, plasma levels of levonorgestrel stabilise at 100–200 pg/ml after a few weeks, which is thought to be a significantly low concentration to be considered aversively effective for ovarian function (Jensen 2005). A levonorgestrel coil could lead to a cystic formation of ⬎ 3 cm in diameter, at 6–12 months after insertion, for 17.5–21.5% of women, respectively (Varma et al. 2006). The vast majority of them are asymptomatic and a high rate (94%) of spontaneous resolution of the cysts is exhibited within 6 months (Varma et al. 2006). In the reported case herein, the formation of the cyst, the first as well as the recurrent, could not be undoubtedly attributed to the levonorgestrel-releasing coil. Benign cysts in reproductive age sometimes can be difficult to manage and treatment requires consideration of the woman’s age, parity and clinical presentation. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
References Barbuscia M, DE Luca M, Ilaqua A et al. 2010. [Etiopathogenetic and clinical considerations of corpus luteum cysts]. Giornale di Chirurgia 31:103–107. Jensen JT. 2005. Contraceptive and therapeutic effects of the levonorgestrel intrauterine system: an overview. Obstetrical and Gynecological Survey 60: 604–612. Muzii L, Panici PB. 2001. Surgery for functional cysts: is it unnecessary? Journal of the American Association of Gynecologic Laparoscopists 8:616–618. Swire MN, Castro-Aragon I, Levine D. 2004. Various sonographic appearances of the hemorrhagic corpus luteum cyst. Ultrasound Quarterly 20:45–58. Varma R, Sinha D, Gupta JK. 2006. Non-contraceptive uses of levonorgestrelreleasing hormone system (LNG-IUS) – a systematic enquiry and overview. European Journal of Obstetrics, Gynecology, and Reproductive Biology 125:9–28.
Sudden sensorineural hearing loss after laparoscopic cystectomy under general anaesthesia N. Aydin1, Y. Aydin2 & S. Uludag2 1Kanuni Sultan Suleyman Training and Research Hospital and 2Istanbul University, Istanbul, Turkey
DOI: 10.3109/01443615.2014.935722 Correspondence: Y. Aydin, Atakent mah, Soyakolimpiakent sit, D 12 Blok No: 53. Postal Code:34303, Halkali, Istanbul, Turkey. E-mail: [email protected]
Introduction
Figure 1. Rapid recurrence of a corpus luteum cyst after laparoscopic surgery in a young woman with a levonorgestrel releasing coil.
Few cases of hearing loss following non-otological surgical procedures have been reported, and the majority of these cases have been associated with cardiopulmonary surgery (Walsted et al. 2000). Hearing loss after other types of surgery, especially laparoscopic surgery performed under general anaesthesia, is extremely rare (Warltier et al. 2003). This report describes one such case. Screening to detect perioperatory hearing alterations is not consistently performed. Surgical procedures can simulate such alterations, which may go unnoticed because of their subclinical nature if audiometry is not performed. Hearing loss in association with epidural anaesthesia and lumbar puncture has been reported frequently (Schaffartzik et al. 2000). Its occurrence in association with local
