Tuberous sclerosis complex and gynaecological complications: navigating diagnostic and surgical challenges

Tuberous sclerosis complex (TSC) is a rare genetic disorder characterised by benign tumours in multiple organs, with potential complications in the reproductive system. The author reports a case of a nulliparous woman in her mid-30s with a history of TSC and prior radical nephrectomy for renal angiomyolipoma. She presented with a history of heavy menstrual bleeding, dysmenorrhoea and lower abdominal pain. Imaging studies were suggestive of a large ruptured haemorrhagic ovarian cyst with the presence of blood in the uterine cavity. Laparoscopy-guided biopsy was performed by a gastrointestinal surgeon due to extensive adhesions. Intraoperative findings included a friable mass adherent to the pouch of Douglas and dense ovarian adhesions. Postoperative recovery was uneventful, and the patient was put on hormonal therapy. This case highlights the complex interplay of TSC-related pathology with gynaecological emergencies, emphasising the role of multidisciplinary management.