ADVANCES IN OBSTETRICS AND GYNECOLOGY

The frequency of conjoined twins has been estimated to be 1 in 50,000 gestations, but as more than 60% of the conjoined twin cases succumb in utero or are stillborn, the true incidence is around 1 in 200,000 live births. Female conjoined twins predominate over male conjoined twins with a ratio of 3:1. We present a case of “Cephalopagus”, which was diagnosed by realtime 3-dimensional ultrasound imaging at 14 weeks of gestation. The patient was a 28-year-old primiparous G0P0 woman with no history of excessive alcohol consumption, viral infection, drug ingestion, or exposure to radiation during pregnancy. Realtime 3-dimensional and color doppler ultrasound revealed fused heads, faces and chests and two separate lower bodies. The fetuses were of approximately equal size, and their combined weight was 60 g and their heights were both 11.5 cm. They were conjoined along the midline of upper bodies to the umbilicus, which was single. All upper and lower limbs were normally developed. We diagnosed the conjoined twins as “Cephalopagus” at 14 weeks of gestation. With the clear realtime 3-dimensional presentation of the anomaly, the family decided to have the pregnancy terminated. Early prenatal diagnosis of conjoined twins allows better counseling of the parents regarding the management options, including continuation of pregnancy with post-natal surgery and termination of pregnancy. [Adv Obstet Gynecol, 61 (1) : 1-6, 2009 (H21.2)]

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Uterine smooth muscle tumors are one of the most common types of gynecologic neoplasm. We report a case of a rare and benign uterine smooth muscle tumor with an unusual growth pattern, preoperatively diagnosed as a malignant ovarian neoplasm. A 57-year-old woman, with gravidity 2 and parity 2, presented with a pelvic mass that was detected during a screening examination for liver transplantation. On pelvic examination, a soft mass without elasticity was palpable in the pelvic cavity. Pelvic magnetic resonance imaging showed massive ascites and a multinodular mass, 20cm in size, with enhanced solid areas. The patient underwent laparotomy, which revealed that the mass was exophytic with a multinodular or multilobulated appearance and extended from the right uterine fundus into the right broad ligament. Supravaginal hysterectomy and bilateral salpingo-oophorectomy with tumor resection were performed. Frozen section of the mass revealed that it was a smooth muscle neoplasm, probably a leiomyoma. Histopathological analysis revealed many micronodules of benign smooth muscle cells, separated by fibrous connective tissue. No intramural or intravascular involvement was evident. Based on these findings, this tumor was diagnosed as a cotyledonoid dissecting leiomyoma. Preoperatively, these benign tumors have often been confused with malignant tumors, such as uterine sarcomas, due to their bizarre and sarcomatous gross appearance. Therefore, attention to the elasticity of the mass during pelvic examination and awareness of gynecologists regarding this rare tumor are important for accurate diagnosis. Furthermore, this type of lesion should be subjected to intraoperative frozen section analysis to avoid unnecessary treatment. [Adv Obstet Gynecol, 61 (1) : 7-12, 2009 (H21.2)]

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