Prise en charge des kystes ovariens

A CT-based radiomics nomogram for differentiating ovarian cystadenomas and endometriotic cysts

AIM

To construct and validate a computed tomography (CT)-based radiomics nomogram integrating radiomics signature and clinical factors to distinguish ovarian cystadenomas and endometriotic cysts.

MATERIALS AND METHODS

A total of 287 patients with ovarian cystadenomas (n=196) or endometriotic cysts (n=91) were divided randomly into a training cohort (n=200) and a validation cohort (n=87). Radiomics features based on the portal venous phase of CT images were extracted by PyRadiomics. The least absolute shrinkage and selection operation regression was applied to select the significant features and develop the radiomics signature. A radiomics score (rad-score) was calculated. The clinical model was built by the significant clinical factors. Multivariate logistic regression analysis was employed to construct the radiomics nomogram based on significant clinical factors and rad-score. The diagnostic performances of the radiomics nomogram, radiomics signature, and clinical model were evaluated and compared in the training and validation cohorts. Diagnostic confusion matrices of these models were calculated for the validation cohort and compared with those of the radiologists.

RESULTS

Seventeen radiomics features from CT images were used to build the radiomics signature. The radiomics nomogram incorporating cancer antigen 125 (CA-125) level and rad-score showed the best performance in both the training and validation cohorts with AUCs of 0.925 (95% confidence interval [CI]: 0.885-0.965), and 0.942 (95% CI: 0.891-0.993), respectively. The accuracy of radiomics nomogram in the confusion matrix outperformed the radiologists.

CONCLUSIONS

The radiomics nomogram performed well for differentiating ovarian cystadenomas and endometriotic cysts, and may help in clinical decision-making process.

Ovarian cystic tumor composed of brenner tumor and stroma ovarii

Introduction

Brenner's tumors are transitional cell ovarian tumors composed of mature cells similar to urothelial cells forming nests within a fibromatous stroma.

Case report

In this observation we report the case of a brenner's tumor diagnosed in a 63 year old female patient. The positive diagnosis was difficult to retain.

Discussion

Brenner tumors are rare fibroepithelial ovarian tumors, representing 1 to 2 % of all ovarian tumors. They are almost always benign.

Conclusion

The treatment is essentially surgical and the indication of chemotherapy remains debatable.

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Brenner's tumors are transitional cell ovarian tumors composed of mature cells similar to urothelial.

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Brenner tumors are rare fibroepithelial ovarian.

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it is usually an echogenic mass, with an echogenicity close to the myometrium.

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The treatment of ovarian cysts is primarily surgical and the indication of chemotherapy remains debatable.

Perception and awareness of patients regarding ovarian cysts in Peshawar, Pakistan: a qualitative approach

AIM OF THE STUDY

Women health is one of the key issues in developing countries including Pakistan. To improve the women's quality of life, awareness about health is necessary. The objective of this study is to evaluate the patient's perception regarding ovarian cyst and the awareness of the patients about the symptoms and health management in ovarian cyst.

MATERIAL AND METHODS

A qualitative approach was used to conduct this study. An interview guide was prepared for the data collection. The interview guide had 29 questions which were asked from the patients. The duration of each interview was about 15-20 minutes and conducted in native language (Urdu) which was then translated to English language for the purpose of documentation. Snowball technique was adopted and the sample size was estimated from the point of saturation.

RESULTS

All the interviews were conducted in the Gynecology ward of Hayatabad Medical Complex (HMC), Peshawar, Pakistan. Results were thematically analyzed. Thematic content analysis yielded 5 major themes: 1) Irregular menstrual cycle, 2) nausea and vomiting, 3) difficulty in emptying urinary bladder completely, 4) emergency due to severe pain, and 5) Physical works.

CONCLUSIONS

There is a need of time that patients should be counseled at the time of discharge of the patient from the hospital. This is the right of the patient that they know about their disease and benefits of the successful treatment outcomes. Compliance can only be achieved through the counseling of the patients, resulting good quality of life and less economic burden over the patients.

[Results of gynecologic laparoscopy in the Central University Hospital (CHU) of Dakar: prospective series of 128 cases]

OBJECTIVES

To analyze the results of, and to evaluate, gynaecologic laparoscopy in Dakar Teaching Hospital.

METHODS

This exploratory and descriptive study deals with a continuous series of 128 gynaecologic laparoscopies carried out between January 1, 2006, and December 31, 2009. In each operative case, sociodemographic and clinical parameters,operative data, and outcomes were studied.

RESULTS

Laparoscopies represented 14.37% of the programmed operative activities. The average age of the patients was 32 years,and the average parity was 1.2. The interventions were most frequently undertaken because of infertility (78.9%). A history of pelvic infections was found in 39.8% of the cases. The most frequent pathologies were tubal anomalies (70% of infertility cases) followed by ovarian cysts (10.1%) and endometriosis. The operative interventions included adhesiolysis in 35.1% of cases,and tubal surgery in 30.4%. A conversion, necessary in 7% of cases, was necessitated by the extent of adhesions (3 cases),the treatment of an associated pathology (4 cases), or a technical difficulty (2 cases).The main complications were vascular wounds and uterine perforations. The average operating times for diagnostic and operative laparoscopies were 56 minutes and 107 minutes,respectively. Outcomes were simple in 91.8% of cases. During the immediate postoperative period, a death occurred due to an acute pneumopathy. The average length of hospital stay was 3 days. We observed a pregnancy rate of 4.6%. Assisted reproduction was indicated in 28.7% of infertility cases.

CONCLUSION

Given its many advantages, diagnostic and operative laparoscopy must be integrated and developed by gynaecology departments in developing countries. This necessity is emphasized by the prevalence of tubal infertility of infectious origins, which, if diagnosed and treated early by laparoscopy,could have a better prognosis.

Efficacy of laparoscopic stripping for ovarian cysts: histological and clinical findings

AIM

The aim of our study was to evaluate the efficacy of the laparoscopic stripping technique on benign ovarian masses with respect to healthy ovarian tissue.

MATERIAL AND METHODS

Seventy-six patients between 14 and 40 years of age were enrolled after receiving a diagnosis of mono-lateral ovarian cyst and underwent laparoscopic surgery for cyst excision with the stripping technique. Histological observations of these specimens were then performed and graded on a semiquantitative scale.

RESULTS

The 76 samples included 36 endometriotic cysts, 18 dermoid cysts, 12 serous cysts, and 10 mucinous cysts. Only 26 of the endometriomas showed histological evidence of healthy ovarian tissue that, however, differed morphologically from normal ovarian tissue.

CONCLUSION

The laparoscopic stripping technique used for the excision of different ovarian cysts is a practice that safeguards the organ.