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Clinical Medical Reviews and Case Reports





DOI: 10.23937/2378-3656/1410101



Endometrioma Complicated by a Rare Bleeding Disorder Mimicking Ovarian Cancer

Mitchell Hoffman1*, Odette Daly2 and John Bomalaski3


1Professor of Obstetrics and Gynecology, University of Central Florida College of Medicine, Florida, USA
2Ob/Gyn Private practice in Melbourne, Florida, USA
3Health First Gynecologic Oncology, Florida, USA


*Corresponding author: Mitchell Hoffman, MD, Professor of Obstetrics and Gynecology, University of Central Florida College of Medicine, Health First Gynecologic Oncology, Florida, USA, Tel: 321-752-0944, E-mail: Mitchel.hoffman@health-first.org
Clin Med Rev Case Rep, CMRCR-3-101, (Volume 3, Issue 4), Case Report; ISSN: 2378-3656
Received: March 14, 2016 | Accepted: April 16, 2016 | Published: April 18, 2016
Citation: Hoffman M, Daly O, Bomalaski J (2016) Endometrioma Complicated by a Rare Bleeding Disorder Mimicking Ovarian Cancer. Clin Med Rev Case Rep 3:101. 10.23937/2378-3656/1410101
Copyright: © 2016 Hoffman M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.



Abstract

Background: Hemophilia A is exceedingly rare in females. Reported here is a case of hemoperitoneum secondary to an endometrioma, which mimicked ovarian cancer on imaging.

Case: A 39 year old with a known complex adnexal mass and a vague history of hemophilia presented with abdominal pain. Imaging was suspicious for ovarian cancer. The patient was discharged with a plan for elective surgery. She represented 2 days later with a massive hemoperitoneum and coagulopathy. Emergent laparotomy with salpingo-oophorectomy for an endometrioma resolved the problem. Subsequent review of records confirmed hemophilia A.

Conclusion: A rare bleeding disorder may be associated with hemoperitoneum in a woman with a hemorrhagic ovarian tumor. The rarity of the condition may lead to initial confusion regarding the correct diagnosis.


Teaching Points

• Although exceedingly rare, hemophilia A does occur in females.

• Hemophilia A in a female may be associated with significant hemorrhage from a hemorrhagic ovarian tumor.

• The diagnosis of ovarian hemorrhage in a patient with hemophilia A may initially be difficult to arrive at, in part due to the rarity of the condition.


Introduction

Hemophilia A is a congenital X-linked recessive bleeding disorder due to factor VIII deficiency. It is exceedingly rare in females. The association of the most common bleeding disorder (Von Willebrand Disease) and hemoperitoneum secondary to a hemorrhagic corpus luteum is well known [1]. Most women with Hemophilia A are asymptomatic but scattered moderate and severe cases have been described [2]. In addition, there have been isolated reports of bleeding disorders associated with endometriosis [3]. Described here is what we believe to be the first case of hemoperitoneum secondary to an endometrioma associated with Hemophilia A.


Case

A 39 year old woman who was followed for several months with a benign appearing complex adnexal mass presented to the emergency department with abdominal pain. She gave a vague history of hemophilia with "easy bleeding" and one uneventful vaginal delivery. The hemoglobin level was 8.8 g/dl. CT scan was interpreted as ascites and a complex 7 cm pelvic mass (Figure 1). The patient was transferred to Holmes Regional Medical Center, seen by gynecologic oncology and discharged home with a plan to be booked for elective surgery. Two days later the patient presented with pain, a dramatic increase in the amount of peritoneal fluid seen on imaging, and hemoglobin of 4.5 g/dl. INR on admission was 4.9, dropping to 1.1 after 1 unit of fresh frozen plasma, 1 unit of prothrombin complex concentrate and 3 units of blood. Emergency laparotomy revealed a hemoperitoneum of approximately 2500 cc and a right ovarian endometrioma, which was removed. Recovery was uncomplicated. Subsequent review of hematology records confirmed a diagnosis of Hemophilia A. Genetic testing has not been performed to date.


.
Figure 1: Computerized tomographic imaging was interpreted as ascites with a complex pelvic mass suspicious for ovarian cancer. View Figure 1



.




Discussion

The rarity of Hemophilia A in a female and the insidious presentation of this case led to concern for possible ovarian cancer. In retrospect, consideration should have been given to hemorrhage from a benign tumor, which may have prevented acute massive hemoperitoneum. In women with a bleeding disorder, a functioning ovary and apparent free peritoneal fluid, consideration should be given to hemoperitoneum.


Precise

A woman with hemophila A and suspicious imaging ultimately developed massive hemoperitoneum secondary to an endometrioma.


References
  1. (2013) Von Willebrand Disease in Women. ACOG Committee Opinion No, 580.

  2. Di Michelle DM, GibbC, Lefkowitz JM, Ni Q, Gerber LM (2014) Severe and moderate hemophilia A and B in US females. Hemophilia 20: e136-e143.

  3. Valizadeh N, Bromand F, Ayatollahi H (2013) Association between a bleeding tendency and endometriosis (presentation of two cases). J Applied Hematol 4: 118-120.

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