Cutaneous endometriosis is one of the rare gynecological conditions. Endometriosis is defined as the presence of endometrial glands and stroma outside the endometrial cavity. It commonly occurs in pelvic sites, such as the ovaries, cul-de-sac, bowel, or pelvic peritoneum. Endometriosis at the incisional scar is difficult to diagnose because of nonspecific symptoms. Usually, patients complain of pain at the site of the incision during menstruation. The main causes in most of the reported cases are obstetrical and gynecological surgeries. Endometrial tissues may be directly implanted in the scar during operation and, under hormonal stimulation, proliferate and form scar endometriosis. Diagnosis is usually made following histopathology. A wide excision is recommended to prevent recurrence. We report a case of a 33-year-old woman presenting with a brownish mass on the lateral aspect of the Pfannenstiel incision from a previous cesarean section scar. The symptoms appeared two years after her operation. The patient had cyclical pain and brownish discharge from the lesion during menstruation. Excision of the skin lesion with underlying subcutaneous tissue showed multiple, minute, firm hemorrhagic foci. Histopathology was performed and revealed a benign endometrial gland and stroma in the tissues, confirming the diagnosis of scar endometriosis. Cutaneous endometriosis is an uncommon gynecological condition and difficult to diagnose because of the nonspecific symptoms. Usually, it is confused with other dermatological and surgical diseases and delays the diagnosis and management. Surgical scar endometriosis following obstetric and gynecological procedures is more frequent recently due to an increase in the number of caesarian sections worldwide. Health care providers should suspect cutaneous endometriosis in any women with pain and a lump in the incisional scar after pelvic surgery.

Vulvar neoplasms represent four percent of all gynecological cancers. While most cases of vulvar neoplasms are benign, two percent of patients present with malignant disease. We present the case of a 37-year-old premenopausal female who presented to an outside institution with a lump in her left vulva, which had progressively enlarged to the size of an egg. A wide local excision of the left vulva was performed, and the pathology revealed a high-grade sarcoma, not otherwise specified (NOS), with negative margins. Imaging showed enlarged bilateral external iliac lymph nodes, likely metastatic. After discussion at a multidisciplinary gynecology oncology tumor board, she was treated with gemcitabine/docetaxel chemotherapy, followed by a left inguinal lymph node dissection and a left radical vulvectomy after being referred to our centre. The final pathology at that time showed a residual sarcoma of 3.5 mm in the left vulva with no lympho-vascular invasion (LVI) and negative margins, with the closest, laterally, at 2 mm. A total of three lymph nodes were negative. She received additional chemotherapy postoperatively. Approximately one year later, she returned to her gynecologist with a 1 cm mass on the left vulva. She underwent a left hemi-vulvectomy and lymph node dissection, and pathology confirmed the presence of a high-grade sarcoma with close margins. She received adjuvant radiotherapy. Three months later, she presented with persistent cough and pneumonia. Imaging revealed a 10 cm lung mass, which was believed to be metastasis from the vulva. This was confirmed with biopsy and was completely resected.Any mass in the Bartholin gland area should be investigated carefully. Poorly differentiated vulvar leiomyosarcoma in the Bartholin gland can recur locally but may also lead to distant metastasis. Despite surgical and systemic treatment, as well as adjuvant radiation, the tumor recurred. Due to the rarity of this condition, there are no clear recommendations for treatment of this disease. To our knowledge, this is the first report of vulvar leiomyosarcoma of the Bartholin gland with metastasis to the lung.

Placenta accreta is abnormal placental attachment to the myometrium, and the incidence rate has risen with the increased use of Cesarean sections. First-trimester placenta accreta is a rare, potentially life-threatening condition due to the severe hemorrhage it may cause, necessitating a hysterectomy. We present a case of a 38-year-old woman with a history of two Cesarean section deliveries who developed severe bleeding during curetting due to undiagnosed placenta accreta. Unilateral uterine and ovarian arterial ligations were performed to reduce expected bleeding along with a local resection of the placental implantation site that was invading the old scar. This procedure was effective with fewer complications than traditional procedures and preserved the patient’s fertility.