Journal of Obstetrics and Gynaecology of Eastern and Central Africa

Phyllodes tumor, cardiovascular and chronic renal disease in a young lady on hormone replacement therapy: A case report

2024-11-25T11:24:12+00:00

Background: Hormonal replacement therapy (HRT) has been associated with an
increased risk of developing breast cancer. The level of risk varies with different types of
HRT and the duration of use. Phyllodes tumor accounts for less than 1% of all breast
neoplasms and is associated with Li-Fraumeni syndrome.
Case presentation: A 37-year-old nulliparous woman presented with a left breast lump.
Histological examination revealed a spindle cell neoplasm consistent with a malignant
phyllodes tumor. She was diagnosed at age of 12 with ovarian dysgerminoma, had
subtotal hysterectomy and right oophorectomy, radiotherapy and chemotherapy. She
has been on HRT with conjugated equine estrogens for 13 years and tibolone for the
last 5 years. Following the diagnosis of phyllodes tumor, a mastectomy was performed,
and HRT was changed to vaginal estrogen gel.
Conclusion: Hormonal replacement therapy may pose a risk for certain types of breast
cancer, especially with prolonged use of combined therapy. Patients who develop
cancers early in life, as well as those on HRT, require close follow-up and adequate
patient education with an emphasis on self-breast examination. Sensitization of
healthcare providers and patients on the value of genetic screening would facilitate
early identification of such patients and follow-up at high-risk clinics.

Type 2 cesarean section scar pregnancy managed by hysteroscopic resection and methotrexate: A case report

2025-07-01T03:14:03+00:00

Background: Diagnosis and management of cesarean scar ectopic pregnancy (CSP) remain challenging. We describe ultrasound diagnosis followed by hysteroscopic resection and methotrexate administration.

Case presentation: A 42-year-old woman, para 2+1, presented with 8 weeks of amenorrhea and vaginal bleeding. She had two previous cesarean deliveries. Initial ultrasound suggested an incomplete miscarriage and beta human chorionic gonadotropin (β-HCG) was 46,129 mIU/ml. After failed medical management, repeat ultrasound diagnosed CSP. Hysteroscopic resection was performed, and she received methotrexate, resulting ß-HCG resolution.

Conclusion: Though rare, CSP should be entertained in any woman presenting with vaginal bleeding with a history of cesarean delivery. Hysteroscopic resection with methotrexate provides good fertility-preserving modality for management.

Keywords: cesarean scar ectopic pregnancy; hysteroscopic resection; methotrexate

Obstructive Hemivagina with Ipsilateral Renal Agenesis in a 16-year-old Diabetic African Girl: a case report

2025-07-01T03:14:13+00:00

Background: The obstructed hemivagina with ipsilateral renal agenesis (OHVIRA) syndrome is a type of Müllerian duct anomaly (MDA) resulting from abnormal development of Müllerian ducts. Its features typically become apparent at puberty when girls present with menstrual abnormalities. The varied presentation of MDAs presents diagnostic and management challenges.

Case presentation: A 16-year-old diabetic African girl presented to Savannah Healthcare with cyclical lower abdominal pain and foul-smelling per vagina discharge. Magnetic resonance imaging (MRI) showed complete duplication of the uterus, cervix, and vagina (uterine didelphys) with an obstructed left hemivagina with hematocolpos. The septum obstructing the hemivagina was resected with drainage of the hematocolpos. A follow-up abdominal renal ultrasound showed the absence of the left kidney.

Conclusion: Careful clinical examination and MRI are essential for diagnosing OHVIRA syndrome. Prompt surgical intervention improves outcomes.