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Placental site trophoblastic tumor is a very rare neoplasm and is a subtype of gestational trophoblastic neoplasm. Owing to its rarity and varied clinical manifestations, it can lead to a diagnostic dilemma. We report a very rare case of PSTT presenting as massive hemoperitoneum caused by rupture of secondary arteriovenous malformation. MR angiogram revealed the presence of arteriovenous malformation and the diagnosis of the neoplasm was confirmed on histopathology and immunohistochemistry. Hysterectomy was done and the patient was managed successfully. Keywords: Placental site trophoblastic tumor, Arteriovenous malformation, Hemoperitoneum, Embolisation, Immunohistochemistry

Introduction: Paraovarian cyst arise from either mesothelium or from paramesonephric remnant. These present as either adneal mass or as an incidental finding. Diagnosis is usually established on ultrasound and it is important to differentiate these from ovarian cyst. Material and Methods: The present study is a retrospective analysis of 32 women with a confirmed diagnosis of paraovarian cyst after surgery. The clinical profile, symptoms and radiological findings of these patients were noted from the hospital records. A correlation was made with the surgical findings and the final histopathological diagnosis. Results: Only 2 patients were postmenopausal and one case was diagnosed during pregnancy. Ultrasound accurately diagnosed paraovarian cyst in 87.5% patients. 78% paraovarian cysts were found to be simple and none had any malignant change. We reported a higher incidence of cystic adenomatoid tumor in these paraovarian cysts. Conclusion: In our study, most paraovarian cysts occur in reproductive age group and present as an adnexal mass. Ultrasound is the diagnostic modality and a paraovarian cyst needs to be differentiated from ovarian cyst. Most of them were simple cysts on histopathology.

Objective: To study a case series of genital malignancies coexisting with genital tuberculosis. Materials and Methods: A series of three cases with known genital malignancies were found to have coexisting genital tuberculosis on subsequent workup. Results: First case was a 45 years old lady who underwent staging laparotomy for ovarian cancer. On histopathology examination, there was coexisting tuberculosis with papillary serous carcinoma. Second case was 53 years old postmenopausal lady who underwent extrafascial hysterectomy along with pelvic lymph node dissection. Histopathology showed tubercular changes along with endometrial malignancy. Third patient was a 50 years old postmenopausal lady with stage IIA carcinoma of cervix. She underwent radical hysterectomy and histopathology revealed tubercular changes in pelvic lymph nodes. All patients were given antitubercular therapy for 9 months in postoperative period along with adjuvant therapy. Conclusion: Although diagnosed as an incidental finding in the case series, genital tuberculosis may present in patients with malignancies as a result of immunosupression.

Pyomyoma is a very rare complication of uterine fibroid, but is associated with high morbidity and mortality. We report a case of pyomyoma in a young lady caused by an ascending infection. She presented with chronic fever. CT scan showed the presence of gas inside the pyomyoma. An exploratory laparotomy was performed followed by drainage of pus. She responded well to the treatment. Although rare, pyomyoma should be suspected in patients with leiomyoma, unexplained fever, abdominal pain and no other apparent source of infection.

We present a rare case of vaginal leiomyoma presenting as prolapsed vaginal mass in a 45 years old woman. The leiomyoma was found to arise from the right lateral vaginal fornix with a vascular stalk. MRI showed homogenous hypointense signals on T1W1 and iso to hyperintense signals on T2W1 images with moderate heterogenous enhancement on post contrast images. It was enucleated via vaginal route and the histopathological examination confirmed the diagnosis of vaginal leiomyoma.