To date, only 12 cases of mature cystic teratoma with sigmoid colon perforation have been reported in the literature.We report a rare case of mature cystic teratoma accompanied by sigmoid colon perforation treated using laparoscopicassisted surgery. A 25-year-old woman (gravida 2 para 0) was admitted to our hospital for evaluation of a 2-week history of fever. Magnetic resonance imaging revealed a large cyst filled with fat, as well as free air in the pelvis. Laboratory investigations showed evidence of significant inflammation. Therefore, we suspected mature cystic teratoma concomitant with bowel perforation.Colonoscopy confirmed a sigmoid colon perforation, and we performed laparoscopic-assisted surgery.Histopathological evaluation confirmed diagnosis of a mature cystic teratoma without malignant transformation.Malignancy should be considered in the differential diagnosis, and an appropriate operative procedure should be selected in patients with ovarian cysts concomitant with bowel perforation.

Endometriotic cysts often develop in the ovaries, while endometriotic nodules commonly develop in extra-ovarian sites. Herein, we report a rare case of an endometriotic cyst occurring in the mesosalpinx, and immunohistological reviews of its the pathogenesis. Magnetic resonance imaging of a 36-year-old multiparous female patient detected a 6 cm-large cyst in the right adnexal region. Likewise, a cystic tumor in the right mesosalpinx distant to the right fallopian tube and ovary, was detected via laparoscopy. On pathological examination, the inner surface of the cyst was lined with cuboidal epithelium and showed hemosiderin deposition and, thus, was diagnosed as an endometriotic cyst.Immunohistologically, it was positive for CD10 and vimentin, further supporting the diagnosis of endometriotic cyst. It was also positive for estrogen and progesterone receptors, indicative of a Müllerian-type epithelial character, and parts with positivity and negativity for the mesothelial marker calretinin were found. The calretinin-negative transition was considered to be due to a metaplastic process from peritoneal mesothelium to Müllerian-type epithelium. In conclusion, the coelomic metaplasia theory is possibly involved in the pathogenesis of endometriotic cysts located in the mesosalpinx.Detailed macroscopic findings via laparoscopy were also helpful in reaching this conclusion.

Gynecological leiomyomas most frequently occur in the uterus and rarely in the vaginal wall. We report a case of vaginal leiomyoma in a 35-year-old woman who presented with significant genital bleeding as a rare presentation of this tumor. Physical examination showed a bleeding mass (10 mm) at the posterior vaginal vault. Gauze compression was applied for 3 days to control bleeding. Transvaginal ultrasonography and contrast-enhanced magnetic resonance imaging revealed a tumor protruding into the pouch of Douglas, which led to a high index of clinical suspicion for a mesenchymal tumor or Schnitzler metastasis from a gastrointestinal malignant tumor. Although a vaginal biopsy could not definitively diagnose the lesion, a malignant tumor could not be excluded, and we performed laparoscopic total tumor resection.Histopathological examination revealed a leiomyoma. She has shown no recurrence over 9 months since the surgery.Massive bleeding secondary to a vaginal leiomyoma as observed in this patient is extremely rare, and preoperative diagnosis is challenging. Laparoscopic resection with vaginal assistance may be useful in patients in whom the vaginal approach alone is ineffective.