Leiomyomas are common benign uterine smooth muscle tumours. Rarer subsets may demonstrate aggressive extrauterine growth which mimic metastatic disease. We discuss the case of a female patient in her 40s, with a long-standing atrophic right kidney, presenting with a 17 cm uterine mass demonstrating bilateral para-aortic and pelvic sidewall spread. Although biopsies favoured the diagnosis of a benign tumour, a leiomyosarcoma could not be excluded. The surgical complexity of the case was compounded by a tumour residing close to the only functioning kidney and engulfment of the inferior mesenteric artery. The surgical procedures indicated were a radical hysterectomy, the laterally extended endopelvic resection procedure to achieve clear margins in the pelvic sidewall and a left hemicolectomy. In the absence of formal guidelines, we present this challenging case to provide clarity into the histological assessment and surgical management of rare leiomyomas, as well as an overview of the current literature.

Uterine carcinosarcomas are aggressive gynaecological cancers comprising less than 5% of uterine malignancies. We present the case of a woman in her 70s with a complicated history of advanced anal carcinoma treated with pelvic radiotherapy and multiple laparotomies, who was referred to gynae-oncology following MRI surveillance imaging showing evidence of endometrial carcinoma and para-aortic lymphadenopathy. Successful surgical excision required multidisciplinary teamwork between gynae-oncology, colorectal and urology surgeons. The patient underwent midline laparotomy, with adhesiolysis, ileum resection and side to side anastomosis, posterior exenteration, left kidney mobilisation and suspension, para-aortic lymph node debulking and left ureteric stent insertion. Significant challenge was posed by the extensive adhesions from previous laparotomies and the debulking of the para-aortic lymph nodes around the renal vessels. This case demonstrates the importance of a multidisciplinary approach in complex pelvic surgery and the vitality of good communication between colleagues in achieving effective patient care.

Introduction: Swyer's syndrome is a distinct type of pure gonadal dysgenesis characterized by a 46 XY karyotype in female phenotypic patients. It shows an abnormality in testicular differentiation. Objective: To present cases of Swyer syndrome.Material and methods: We present the clinical, sonographic, endocrine findings, genetic analyses and treatment in two cases of phenotypic females with XY karyotype and gonadal dysgenesis.Results: All patients presented with primary amenorrhea. All patients had female-type external genitalia. Secondary sexual characters were developed in all cases. FSH levels were high. Chromosome analyses revealed a 46, XY male karyotype with no detectable mosaicism. The surgical findings were steak gonads, one of them with bilateral gonadoblastoma. Intervention(s): Bilateral gonadectomy followed by hormone replacement therapy. Conclusion:We aimed to underline the necessity of considering 46, XY complete pure gonadal dysgenesis in the differential diagnosis in every adolescent female patient with delayed puberty and the importance of early gonadectomy in order to avoid the risk for gonadal tumor development.

Objective To describe the diagnosis and management of uterine artery pseudoaneurysm after caesarian section. Design Case report. Setting Department of Obstetrics and Gynaecology. Patient A 25-year-old woman developed uterine artery pseudoaneurysm after caesarean section. Intervention Uterine artery pseudoaneurysm after caesarian section was diagnosed on ultrasonography, computerised tomographic angiography and treated by bilateral internal iliac artery ligation. Main Outcome Measure Uterine conservation. Result Fertility preservation was achieved in the woman. Conclusion(s) Diagnosis and management of uterine artery pseudoaneurysm after caesarian section are important to prevent life-threatening haemorrhage caused by pseudoaneurysmal rupture. Keywords Uterine artery pseudoaneurysm, Caesarian section, Secondary postpartum, haemorrhage, Ultrasonography, Computerised tomographic angiography, Internal iliac artery ligation.

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