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Schwartz B, Weerasooriya N, Mercier R, Gould S, Saul D, Berman L. Factors Associated With Isolated Fallopian Tube Torsion in Pediatric Patients. J Pediatr Surg 2024:S0022-3468(24)00237-9. [PMID: 38649311 DOI: 10.1016/j.jpedsurg.2024.03.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 03/13/2024] [Accepted: 03/26/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Isolated fallopian tube torsion (IFTT) is a rare form of adnexal torsion that is more difficult to diagnose, which may lead to delays in treatment. Our objectives were to identify clinical and radiologic factors associated with surgically-confirmed IFTT and compare them with those of patients without torsion and with adnexal torsion (AT) in a large pediatric population. METHODS We conducted a retrospective chart review of all patients who underwent surgery for suspected adnexal torsion from 2016 to 2019. Torsion was determined intraoperatively, with IFFT defined as those with only tubal but no ovarian torsion and AT defined as those with ovarian torsion, with or without involvement of the ipsilateral fallopian tube. Clinical and radiologic variables were compared between patients with IFTT and those without torsion and with AT using descriptive statistics. A previously-described composite score to predict torsion based on the presence of vomiting and adnexal volume (VVCS) was calculated for each patient. RESULTS Of 291 patients who underwent surgery for suspected torsion, 168 had confirmed torsion: 33 (19.6%) IFTT and 135 (80.4%) AT. Patients with IFTT were more likely to be younger (12.8 vs. 14.2 years, P = 0.02), premenarchal (29.0% vs. 10.7%, P = 0.009), experience nausea (90.6% vs. 70.9%, P = 0.02) and vomiting (81.3% vs. 32.8%, P < 0.001), have a paratubal cyst on imaging (18.8% vs. 2.5%, P = 0.003), and have larger adnexal volume (143.3 vs. 64.9 ml, P < 0.001) than those without torsion. Higher BMI (26.6 vs. 22.9 kg/m2, P = 0.03), a paratubal cyst on imaging (18.8% vs. 1.5%, P < 0.001), presence of arterial (65.5% vs. 44.1%, P = 0.04) and venous Doppler flow (79.3% vs. 55.9%, P = 0.02), and radiologic impression indicating lack of torsion (37.9% vs. 16.8%, P = 0.04) were more common in IFTT than AT. The accuracy of the VVCS in predicting torsion for the IFFT group was 83.9%. CONCLUSIONS IFTT has a similar clinical presentation to AT but with a higher likelihood of a paratubal cyst and preserved Doppler flow on imaging. IFTT should be strongly considered in patients who present with pain, nausea, and vomiting and have an adnexal mass separate from the ovary on imaging, regardless of Doppler flow. LEVEL OF EVIDENCE Level II. TYPE OF STUDY Prognosis study.
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Affiliation(s)
- Beth Schwartz
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA; Division of Adolescent Medicine and Pediatric Gynecology, Nemours Children's Health, Wilmington, DE, USA.
| | - Nimali Weerasooriya
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rebecca Mercier
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sharon Gould
- Division of Radiology, Nemours Children's Health, Wilmington, DE, USA
| | - David Saul
- Division of Radiology, Nemours Children's Health, Wilmington, DE, USA
| | - Loren Berman
- Department of Surgery, Nemours Children's Health, Wilmington, DE, USA
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Marcinkowski K, Saul D, Gould S, Berman L, Schwartz BI. Application of a Composite Score to Predict Adnexal Torsion in Premenarchal and Menarchal Children and Adolescents. J Pediatr Surg 2024; 59:509-514. [PMID: 37875379 DOI: 10.1016/j.jpedsurg.2023.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/05/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023]
Abstract
STUDY OBJECTIVE The study objective was to apply a previously created composite score for the prediction of adnexal torsion in children and adolescents to a larger group of heterogeneous patients to test its validity and to refine this scoring system to more accurately predict adnexal torsion. METHODS This was a retrospective chart review at a tertiary care children's hospital and its affiliates. Participants were female patients 0-20 years of age who underwent surgery for suspected adnexal torsion from 2016 to 2019. Data were collected from outpatient, emergency department, and inpatient notes, radiographic data, and operative reports. The primary outcome was the accuracy and predictive value of the total composite score (TCS) to identify or exclude adnexal torsion. RESULTS Of the 291 patients with suspected adnexal torsion who went to the operating room during the study period, 168 (57.8 %) had confirmed adnexal torsion. The accuracy of the TCS, which included presence of vomiting, adnexal volume, and adnexal ratio, in predicting or excluding torsion was 83.6 % for all patients, 92.1 % for premenarchal patients, and 81.3 % for menarchal patients. A variation of the TCS that included only vomiting and adnexal volume had an accuracy of 85.8 %. CONCLUSIONS Our study demonstrates the accuracy and reproducibility of a previously published composite score to predict adnexal torsion in children and adolescents. It also further refines this score to a potentially more clinically useful tool. Future studies are needed to prospectively evaluate these composite scores and their implementation in clinical settings. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Katrina Marcinkowski
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - David Saul
- Department of Radiology, Nemours Children's Health, Wilmington, DE, USA
| | - Sharon Gould
- Department of Radiology, Nemours Children's Health, Wilmington, DE, USA
| | - Loren Berman
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA; Department of Surgery, Nemours Children's Health, Wilmington, DE, USA
| | - Beth I Schwartz
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA; Division of Adolescent Medicine and Pediatric Gynecology, Nemours Children's Health, Wilmington, DE, USA.
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Pietkiewicz P, Giedziun P, Idziak J, Todorovska V, Lewandowicz M, Lallas A. Diagnostic Accuracy of Hyperpigmented Microcircles in Dermatoscopy of Non-Facial Non-Acral Melanomas: A Pilot Retrospective Study using a Public Image Database. Dermatology 2023; 239:976-987. [PMID: 37666232 DOI: 10.1159/000533820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/22/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Grey perifollicular circles are a dermatoscopic clue to melanoma, especially in facial skin. So far, no other adnexal clues than follicular have been investigated in this diagnosis. OBJECTIVES The study aimed to analyse the prevalence of hyperpigmented periadnexal microcircles (HMs) in melanoma and its common simulators at non-facial non-acral sites, analyse the relation between the presence of HM, regression and hypopigmentation, and evaluate the diagnostic accuracy of this structure in melanoma. METHODS International Skin Imaging Collaboration (69,445 images) was searched in April 2020 for the pathology-confirmed dermatoscopic images with metadata including sex, age bin, and declared non-acral non-facial anatomic site. The final study sample (5,408 images, 1,326 of which were melanomas) was evaluated by expert dermatoscopist blinded to the diagnosis and labelled for the presence of ≥3 HM distributed centrally (cHM) or peripherally (pHM), hypopigmentation, and classic dermatoscopic regression structures. A subset of 40 images was labelled by 7 raters (2 residents, 5 experts) to assess interobserver agreement. We compared the presence of pHM with the presence of regression as well as performed a set of independent χ2 tests to evaluate the discriminatory power and its fragility. Performance of the models was assessed using measures of discrimination and calibration. RESULTS HM were significantly more prevalent in melanomas than in non-melanomas and nevi. Fair/good interobserver agreement for HM was reached for all the raters, and moderate/good for experts only (single rater/average, respectively). Regardless of regression/hypopigmentation status, pHM were significantly more common in melanoma than in non-melanomas or nevi and were observed significantly more often in melanomas on sun-damaged skin (upper extremity, posterior torso). No significant differences between the groups were found for cHM. pHM proved a high odds ratio in the tests as to the classical indicators such as classic dermatoscopic regression structures. CONCLUSION pHM could be considered a novel dermatoscopic clue to melanoma.
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Affiliation(s)
- Paweł Pietkiewicz
- General and Oncological Surgery Clinic I, Greater Poland Cancer Centre, Poznań, Poland
- Polish Dermatoscopy Group, Research Workgroup, Poznań, Poland
| | - Piotr Giedziun
- Polish Dermatoscopy Group, Research Workgroup, Poznań, Poland
- Faculty of Information and Communication Technology, Wrocław University of Science and Technology Centre for Scientific and Technical Knowledge and Information, Wrocław, Poland
| | - Jan Idziak
- Polish Dermatoscopy Group, Research Workgroup, Poznań, Poland
| | | | - Michał Lewandowicz
- Polish Dermatoscopy Group, Research Workgroup, Poznań, Poland
- Breast Cancer Unit, Department of Surgical Oncology, Regional Oncology Center, Łódź, Poland
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
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Schwartz BI, Mercier R, Gould S, Saul D, Loiselle C, Weerasooriya N, Marcinkowski K, Teeple EA, Berman L. Clinical and radiologic factors associated with adnexal torsion in premenarchal and menarchal children and adolescents. J Pediatr Surg 2023; 58:767-73. [PMID: 36008196 DOI: 10.1016/j.jpedsurg.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/15/2022] [Accepted: 08/08/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Adnexal torsion is a gynecologic emergency in children and adolescents but remains a challenging diagnosis, with no consistent clinical or radiologic diagnostic criteria. Our objective was to identify risk factors associated with adnexal torsion in premenarchal and menarchal patients with surgically confirmed torsion compared with those without torsion. METHODS We conducted a retrospective chart review of all patients who underwent surgery between January 2016 and December 2019 for possible adnexal torsion. Data on demographics, clinical characteristics, radiologic variables, and operative findings were compared using descriptive statistics. Independent predictors of torsion were then examined in multivariate logistic regression models. RESULTS Of the 291 patients who underwent surgery, 168 (57.7%) had torsion. Patients with torsion were younger than those without torsion (11.9 vs. 14.2 years, P < .01). Vomiting was significantly associated with torsion for all patients (P < .001). Large adnexal volume and absent arterial Doppler flow were associated with torsion for the total population and menarchal subgroup. A logistic regression model for the total population that controlled for age and menarchal status found that vomiting (adjusted odds ratio [aOR] 5.92, 95% confidence interval [CI] 2.87-12.22), highest adnexal volume category (aOR 4.92, 95% CI 2.25-10.75), and absent arterial Doppler flow (aOR 2.674, 95% CI 1.28-5.60) were associated with torsion. CONCLUSIONS Vomiting, enlarged adnexal volume, and absent arterial Doppler flow were associated with adnexal torsion. However, no single risk factor accurately diagnosed torsion, and multiple factors should be interpreted together. LEVEL OF EVIDENCE Study of Diagnostic Test, Level II.
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Messingschlager C, Ferrando CA, Chang OH. Intention matters: Success rate of bilateral salpingo-oophorectomy at the time of vaginal hysterectomy for pelvic organ prolapse. Eur J Obstet Gynecol Reprod Biol 2023; 283:54-58. [PMID: 36773471 DOI: 10.1016/j.ejogrb.2023.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/23/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The objective of this study was to determine the incidence of successful bilateral salpingo-oophorectomy at the time of vaginal hysterectomy for pelvic organ prolapse and to evaluate associated factors and success rate over time. STUDY DESIGN This was a retrospective chart review of all women who underwent vaginal hysterectomy for pelvic organ prolapse who were consented for bilateral salpingo-oophorectomy "if possible" and "including extraordinary measures" between 2014 and 2019 at a tertiary medical center. Baseline demographic data along with prolapse stage, operative findings, operative time, and complications were recorded. Univariate analysis using the Pearson's chi-square test, the student's t-test or Mann Whitney U test when appropriate and multivariable logistic regression was performed to determine predictors of successful vaginal bilateral salpingo-oophorectomy. RESULTS A total of 453 eligible patients were included. 420 patients (92.7 %) were consented for bilateral salpingo-oophorectomy "if possible" and 33 patients (7.3 %) were consented for "including extraordinary measures". The success rate of vaginal bilateral salpingo-oophorectomy in all patients was 57.9 % (n = 262). Of the patients consented for extraordinary measures, the success rate was 93.9 % (n = 31), compared to a success rate of 55 % (n = 231) in the "if possible" group. A concurrent posterior repair was found to have higher odds of successful bilateral salpingo-oophorectomy (adjOR 1.75 [95 % CI = 1.17-2.61]). Successful bilateral salpingo-oophorectomy extended operative time by 14 min (154 min vs 140 min, p < 0.001). Compared to patients in the unsuccessful group, the successful group had a higher proportion of the following indications: a family history of ovarian cancer, personal breast cancer history or patient request for definitive removal. CONCLUSION When the pre-operative intention to perform bilateral salpingo-oophorectomy at the time of vaginal hysterectomy for pelvic organ prolapse is high, the success rate is nearly 40% higher when compared to an opportunistic procedure. This suggests that success is closely linked to the surgeon's determination to complete this procedure vaginally.
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Affiliation(s)
- Cory Messingschlager
- Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Cecile A Ferrando
- Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Olivia H Chang
- Division of Female Urology, Pelvic Reconstructive Surgery & Voiding Dysfunction. Department of Urology, University of California Irvine, Irvine, CA, United States.
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Elsingergy MM, Oliver ER, Otero HJ, Back SJ. Added value of gadolinium-based contrast agents for magnetic resonance evaluation of adnexal torsion in girls. Abdom Radiol (NY) 2022; 47:3868-82. [PMID: 35978184 DOI: 10.1007/s00261-022-03642-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE Ultrasound is the first-line imaging modality to evaluate adnexa in girls with clinical suspicion of torsion. Patients with equivocal ultrasound findings can undergo MRI for better delineation of adnexal pathology. Here, we assess the utility of intravenous contrast in MRI evaluation of adnexal torsion in children. METHODS Two pediatric radiologists (R1, R2) retrospectively reviewed 198 pelvic MRI exams in 172 girls (median age 15 years). Each MRI was reviewed twice. The first review included pre-contrast images only. A second review, at least 1 month later, included both pre- and post-contrast images. Readers concluded if findings were suspicious for torsion or not. Readers' findings were compared to each other's and to surgical and MRI reports and clinical course. RESULTS 198 MRI exams yielded 354 evaluable ovaries. Surgical and pathological reports were available for 47 patients. 11 patients had adnexal torsion. Both readers accurately diagnosed acutely torsed ovaries during pre- and post-contrast reviews (n = 4). However, readers disagreed on torsed paraovarian cysts (n = 4) and chronically/intermittently torsed ovaries (n = 3). In 21 non-torsed ovaries that had lesions, one or both readers concluded that there were pre-contrast features of torsion. In this set with ovarian lesions, contrast helped readers to correctly conclude no torsion (R1 = 8, R2 = 6) more commonly than to incorrectly conclude torsion (1 each), improving post-contrast specificity for each reader. CONCLUSIONS Post-contrast sequences did not provide additional benefit in evaluating acutely torsed ovaries but helped in excluding torsion in patients with adnexal lesions. Therefore, contrast administration should be individualized, potentially reserved only for those with abnormal ultrasound or pre-contrast images.
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Jamshidi P, Levi J, Suarez MJ, Rivera R, Mahoney N, Eberhart CG, Rosenberg A, Rodriguez FJ. Clinicopathologic and Proteomic Analysis of Amyloidomas Involving the Ocular Surface and Adnexa. Am J Clin Pathol 2022; 157:620-627. [PMID: 34698334 PMCID: PMC8973273 DOI: 10.1093/ajcp/aqab161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/22/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Ocular amyloidoma is a rare disorder characterized by deposition of insoluble proteinaceous fibrils in the extracellular space of the ocular adnexa. This study details the clinicopathologic features and proteomic characteristics of periocular amyloid deposition. METHODS Specimens (1991-2020) were retrieved and reviewed. All available H&E slides and special stains were reviewed. Proteomic analysis was performed using immunohistochemistry (IHC) for IgG, IgG4, IgA, IgD, IgM, CD20, CD3, CD138, and κ/λ, as well as chromatography-electrospray tandem mass spectrometry on formalin-fixed, paraffin-embedded tissue. RESULTS There were 14 patients (7 men, 7 women). The depositions involved eyelid (n = 3), conjunctiva (n = 8), and orbit (n = 3). All patients were adults with a median age at diagnosis of 56 (range, 39-88) years. The deposits were predominantly λ light chain restricted (n = 6) and mixed light chains (n = 2), and one case was κ predominant. Two of the cases with a mixture of κ and λ light chains had an excess of transthyretin by mass spectrometry. Four of the cases did not have adequate material for proteomic subtyping. CONCLUSIONS Amyloidomas involving ocular adnexa contain a variety of amyloid-related and immunoglobulin-associated peptides. The λ light chain predominates as in other body sites, but mixed patterns and rarely κ light chain restriction may be encountered.
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Affiliation(s)
- Pouya Jamshidi
- Department of Pathology and Laboratory Medicine, Northshore University Health System, Evanston, IL, USA
| | | | - Maria Jose Suarez
- Department of Infectious Diseases, Maimonides Medical Center, Brooklyn, NY, USA
| | - Roxana Rivera
- Cincinnati Eye Institute, Cincinnati and Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA
| | - Nicholas Mahoney
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Charles G Eberhart
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Avi Rosenberg
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Fausto J Rodriguez
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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Joudi N, Adams Hillard PJ. Adnexal torsion in a pediatric population: Acute presentation with question of chronicity. Eur J Obstet Gynecol Reprod Biol 2021; 268:82-6. [PMID: 34883338 DOI: 10.1016/j.ejogrb.2021.11.435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 09/24/2021] [Accepted: 11/27/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To establish the frequency of torsion with multiple twists of the adnexa in girls 19 years old and younger surgically diagnosed with torsion. STUDY DESIGN A retrospective chart review using an institutional tool to review charts of female patients 19 years old or younger who presented with acute abdominal pain leading to a surgical diagnosis of adnexal torsion. RESULTS Of 141 pediatric patients with torsion, 61 (43%) had documentation of multiple twists, with 2 to 12 rotations present. 33% reported acute pain (<24 hrs) whereas most (67%) had pain > 24 h up to 4 weeks without abatement (23%) or experienced discrete episodes with pain resolution between episodes (44%). Even when vascular flow was demonstrated, multiple twists were frequently found (14/36 = 39%). When multiple twists were documented, more patients had an extirpative procedure due to a nonviable appearing ovary than when a single or unstated number of twists twist was found, although the results were not statistically significant (53.5% vs 42.9%, p = 0.098). CONCLUSIONS Forty-three percent of girls presenting with symptoms of torsion had multiple twists in the adnexa. Many had provided a history of previous similar episodes of pain and presentation to emergency departments, suggesting possible previous undiagnosed episodes of torsion. Earlier diagnosis may provide a better opportunity for ovarian conservation prior to a recurrent torsion. Further study may reveal whether multiple twists are more likely to result in a nonviable ovary and need for oophorectomy.
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Umasankar N, Howard SM, Tomlin KV. Adnexal Torsion Predictive Tool Maintains Applicability in a Heterogeneous Pediatric Population. J Pediatr Adolesc Gynecol 2021; 34:656-661. [PMID: 33989799 DOI: 10.1016/j.jpag.2021.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/14/2021] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE A previously published scoring system showed promise in identifying adnexal torsion in adolescents. However, published patients were homogeneously Caucasian/White. We sought to assess whether this scoring system was generalizable to a more diverse population that is predominantly African American and overweight. DESIGN Retrospective chart review. SETTING Tertiary academic hospital. PARTICIPANTS Female patients 0-21 years of age undergoing surgery for suspected ovarian torsion from 2010 to 2019. INTERVENTIONS Records were reviewed for patients, including laboratory studies, imaging, surgery, and pathology. Significance was determined for clinical and imaging findings, and retrospective composite scores were calculated for each participant as suggested by the scoring system. MAIN OUTCOME MEASURES Determination of whether the previously published composite score was predictive of pediatric adnexal torsion in our population. RESULTS A total of 57 cases of suspected torsion were included. Approximately 60% of patients were African American, 10% Hispanic, and 30% Caucasian/White. The average body mass index (BMI) across ethnicities was 29. Our findings significantly correlated with previously published predictors for all components. The presence of nausea/vomiting, leukocytosis, ovarian volume and ratio were found to be significant. The post hoc calculated composite score was applied to our cohort, and more than 90% of confirmed torsion would have been identified. CONCLUSION Our study suggests that a previously published composite score assessing torsion can successfully be used to predict torsion in a more diverse setting than the original study population, potentially accelerating surgical management of patients with the condition.
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Affiliation(s)
- Nivedita Umasankar
- University of South Carolina School of Medicine, Columbia, South Carolina; Prisma Health - Midlands, Columbia, South Carolina
| | - Shannon M Howard
- University of South Carolina School of Medicine, Columbia, South Carolina
| | - Kristl V Tomlin
- University of South Carolina School of Medicine, Columbia, South Carolina; Prisma Health - Midlands, Columbia, South Carolina.
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Li PC, Chen H, Ding DC. Shoulder pain after natural orifice transluminal endoscopic surgery decreased with abdominal compression and pulmonary recruitment maneuver: A retrospective study. Taiwan J Obstet Gynecol 2021; 60:878-81. [PMID: 34507665 DOI: 10.1016/j.tjog.2021.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The study aimed to assess the efficacy of abdominal compression and pulmonary recruitment maneuver (CPRM) after transvaginal natural orifice transluminal endoscopic surgery (vNOTES) to alleviate post-laparoscopic shoulder pain (PLSP). MATERIALS AND METHODS In this retrospective cross-sectional study conducted in a tertiary referral medical center, women who underwent vNOTES between January 2018 and May 2019 were classified into control group and CPRM group with CO2 force expelled. Data on the demographic characteristics, indications for surgery, and surgical history were collected. Postoperative pain was assessed 24 and 48 h postoperatively using the visual analog scale (VAS, 0-10). Chest radiography was used to determine the residual air volume 24 h after surgery. RESULTS Of 10 patients, 6 and 4 underwent vNOTES adnexal surgeries and vNOTES hysterectomy, respectively. The median volumes of residual pneumoperitoneum were 9.02 mL and 28.11 mL in the CPRM and control groups, respectively (p = 0.001). The intensity of PLSP in the CPRM and control groups were 0 ± 0 vs. 3.4 ± 3.4 and 0.4 ± 0.8 vs. 2.2 ± 2.2 24 and 48 h after surgery, respectively (p = 0.005 for 24 h and p = 0.04 for 48 h). CONCLUSION CPRM might facilitate decrease in residual gas volume and PLSP after vNOTES. CPRM might be considered using in vNOTES to decrease PLSP.
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Gulati S, Rathi V, Jain S, Bhatt S. Incidentalomas of the female genital tract on 64-slice MDCT: a clinico-radiological pictorial review. Abdom Radiol (NY) 2021; 46:4420-4431. [PMID: 33890122 DOI: 10.1007/s00261-021-03086-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/01/2021] [Accepted: 04/09/2021] [Indexed: 11/27/2022]
Abstract
Sonography is the imaging modality of choice for diagnosing diseases of the female genital tract due to its high resolution, easy availability, low cost and lack of radiation. CT is not advocated for the primary evaluation of the female pelvis. However, with the advent of Multidetector CT (MDCT), females of all ages undergo CT scan of the abdomen and pelvis for myriad non-gynaecological diseases, e.g. subacute intestinal obstruction, abdominal lump, abdominal tuberculosis, appendicitis, ureteric colic, pancreatitis, oncological staging, follow-up, etc. Incidental female genital tract disorders were seen on these scans that are a dilemma for both, the radiologists and the clinicians. The objective of this pictorial review is to characterise the incidentally detected lesions of the female genital tract observed on 64-slice MDCT by correlating with sonography, if necessary, and establishing a clinico-radiological diagnosis. Our aim is to emphasise that the radiologist may be the first person to recognise a gynaecologic disorder and hence can play a significant role in patient management.
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Affiliation(s)
- Shrea Gulati
- Department of Radio Diagnosis, University College of Medical Sciences, Delhi, India
| | - Vinita Rathi
- Department of Radio Diagnosis, University College of Medical Sciences & GTB Hospital, 89/2 Radhey Puri Extension-II, Delhi, 110051, India.
| | - Sandhya Jain
- Department of Obstetrics & Gynaecology, University College of Medical Sciences, Delhi, India
| | - Shuchi Bhatt
- Department of Radio Diagnosis, University College of Medical Sciences, Delhi, India
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Abstract
Adnexal masses in pregnancy are not commonly encountered. The majority of these masses are discovered incidentally during routine follow-up. However, some of these masses become symptomatic due to their size, location, and impingement of adjacent structures. Several diagnostic modalities can be utilized for the detection of adnexal masses with different sensitivity and specificity rates. The differential diagnosis of adnexal masses discovered during pregnancy is broad and includes both benign and malignant lesions. The management of such lesions has been a subject of debate for years with no consensus regarding the best management plan. Tumor size, site, and the trimester of mass detection are all crucial in management. In this account, we review adnexal masses discovered in pregnancy, the diagnostic modalities utilized for detecting these lesions, their differential diagnosis, and management strategies.
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Affiliation(s)
| | - Iyad AbouAl-Shaar
- School of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khaled J Zaza
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Abstract
Incidental adnexal masses and uterine findings occur with a high frequency on cross-sectional imaging examinations, particularly in postmenopausal women in whom imaging is performed for a different reason. These incidentalomas encompass a gamut of potential pelvic gynecologic disorders. Most are benign ovarian cysts; however, other less commonly encountered disorders and improperly positioned gynecologic devices may be seen. A knowledge of the management recommendations for such pelvic incidental findings is critical to avoid unnecessary imaging and surgical interventions, as well as to avoid failure in diagnosis and management of some of these conditions.
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Affiliation(s)
- Margarita V Revzin
- Department of Radiology and Biomedical Imaging, Abdominal Imaging and Emergency Radiology, Yale School of Medicine, 333 Cedar Street, PO Box 208042, Room TE-2, New Haven, CT 06520, USA.
| | - Anne Sailer
- Department of Radiology and Biomedical Imaging, Abdominal Imaging and Emergency Radiology, Yale School of Medicine, 333 Cedar Street, PO Box 208042, Room TE-2, New Haven, CT 06520, USA
| | - Mariam Moshiri
- Department of Radiology, University of Washington Medical Center, 1959 NE Pacific Street, Box 357115, Seattle, WA 98195, USA
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14
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Sherbaf FG, Tavallaei N, Ghanbarinasab Z, Hoseinyazdi M, Movahedipour M, Lotfi R, Dehghanian A. First Case Report of Adnexal Fetus in Fetu. J Pediatr Adolesc Gynecol 2020; 33:745-747. [PMID: 32889084 DOI: 10.1016/j.jpag.2020.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/15/2020] [Accepted: 07/20/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND There is an ambiguous and controversial line between fetiform teratoma and fetus in fetu (FIF) as differential diagnoses of a fetiform mass. Classically, the presence of vertebral column often with a relatively proper arrangement of other organs around the central axis favor the diagnosis of FIF over teratoma. CASE Based on previously proposed criteria and the presence of vertebral organization in the radiological and histopathological assessment of the fetiform mass, we present an extremely rare case of adnexal FIF in a 10-year-old girl presenting with acute abdominal pain. SUMMARY AND CONCLUSION Whether FIF and fetiform teratoma are one entity or two, clinical discrimination for the choice of treatment seems to be unnecessary and the patient should be clinically followed for the probable malignant potential.
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Affiliation(s)
- Farzaneh Ghazi Sherbaf
- Medical Imaging Research Center, Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nazfar Tavallaei
- Department of Gynecology, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Zahra Ghanbarinasab
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Meisam Hoseinyazdi
- Medical Imaging Research Center, Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Reza Lotfi
- Department of Radiology, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Amirreza Dehghanian
- Molecular Pathology and Cytogenetics Division, Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; Trauma Research Center, Shahid Rajaee (Emtiaz) Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
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15
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Ben Artsi E, Mckelvie PA, McNab AA. Histopathologic Findings in Idiopathic Orbital Myositis. Ophthalmology 2020; 128:609-616. [PMID: 32926913 DOI: 10.1016/j.ophtha.2020.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/17/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To report the histologic and clinical features of idiopathic orbital myositis (IOM) patients who underwent extraocular muscle (EOM) biopsy over 20 years, to provide the first methodical reference to the expected histopathologic findings, and to discuss the histopathologic differences from common differential diagnoses. DESIGN Cohort study. PARTICIPANTS All patients with a diagnosis of IOM who underwent EOM biopsy from 2000 through 2019 were included. Patients who had a different final diagnosis were excluded. METHODS Tissue samples of EOM and medical records of all participants were reviewed. MAIN OUTCOME MEASURES Histopathologic features of muscle biopsy, including tissue morphologic features and cellular composition. RESULTS Thirteen patients met both inclusion and exclusion criteria, and their tissue samples were revisited. Nine patients showed histopathologic findings that suggested a conclusive diagnosis of IOM, and the study focused on them. The average age at presentation was 49 years, and 66.7% of patients were women. The most commonly biopsied EOM was the medial rectus (44.4%). The most common indications for biopsy were nonresolving orbital disease with inadequate response to corticosteroids (44.4%) or a high suspicion of malignancy because of known pre-existing systemic malignancy or the presence of an atypical orbital mass in addition to enlarged muscles (44.4%). The histopathologic findings that suggested a diagnosis of IOM were splaying of muscle fibers by inflammatory infiltrates (n = 9) and mild fibrosis (n = 8) in the endomysium or replacing muscle fibers, with no granulomas or vasculitis. The inflammatory infiltrates identified were of chronic inflammatory cells, consisting of lymphocytes (n = 9), plasma cells (n = 6), and histiocytes (n = 6). Other less commonly identified cells were eosinophils (n = 4), polymorphonuclears (n = 1), and giant cells (n = 1). Muscle fiber degeneration or regeneration was evident in 5 patients. Four patients from the initial cohort showed inconclusive histologic findings on revision and were reassigned as suspected IOM. CONCLUSIONS The histopathologic features of involved muscles in IOM resemble those seen in idiopathic orbital inflammation and differ from those seen in common differential diagnoses. Extraocular muscle biopsy should be strongly considered whenever the presentation of orbital myositis is not typical or when significant underlying conditions are a possibility.
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Affiliation(s)
- Elad Ben Artsi
- Orbital Plastic and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.
| | - Penelope A Mckelvie
- Department of Anatomical Pathology, St. Vincent's Hospital, Fitzroy, Australia
| | - Alan A McNab
- Orbital Plastic and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
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16
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Wattar B, Rimmer M, Rogozinska E, Macmillian M, Khan KS, Al Wattar BH. Accuracy of imaging modalities for adnexal torsion: a systematic review and meta-analysis. BJOG 2020; 128:37-44. [PMID: 32570294 DOI: 10.1111/1471-0528.16371] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Adnexal torsion (AT), a serious gynaecological emergency, often presents with non-specific symptoms leading to delayed diagnosis. OBJECTIVE To compare the test accuracy of ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) to diagnose AT. SEARCH STRATEGY We searched EMBASE, MEDLINE and Cochrane CENTRAL until December 2019. SELECTION CRITERIA Studies reporting on the accuracy of any imaging modality (Index Test) in female patients (paediatric and adult) suspected of AT compared with surgical diagnosis and/or standard clinical/radiological follow-up period until resolution of symptoms (Reference Standard). DATA COLLECTION AND ANALYSIS We assessed study quality using QUADAS-2. We conducted test accuracy meta-analysis using a univariate model or a hierarchical model. MAIN RESULTS We screened 3836 citations, included 18 studies (1654 women, 665 cases), and included 15 in the meta-analyses. Ultrasound pooled sensitivity (n = 12, 1187 women) was 0.79 (95% CI 0.63-0.92) and specificity was 0.76 (95% CI 0.54-0.93), with negative and positive likelihood ratios of 0.29 (95% CI 0.13-0.66) and 4.35 (95% CI 2.03-9.32), respectively. Using Doppler with ultrasound (n = 7, 845 women) yielded similar sensitivity (0.80, 95% CI 0.67-0.93) and specificity (0.88, 95% CI 0.72-1.00). For MRI (n = 3, 99 women), the pooled sensitivity was 0.81 (95% CI 0.63-0.91) and specificity was 0.91 (95% CI 0.80-0.96). A meta-analysis for CT was not possible with two case-control studies and one cohort study (n = 3, 232 women). Its sensitivity range was 0.74-0.95 and specificity was 0.80-0.90. CONCLUSIONS Ultrasound has good performance as a first-line diagnostic test for suspected AT. Magnetic resonance imaging could offer improved specificity to investigate complex ovarian morphology, but more evidence is needed. TWEETABLE ABSTRACT To investigate adnexal torsion, ultrasound is a good first-line diagnostic test with a pooled sensitivity of 0.79 and specificity of 0.76.
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Affiliation(s)
- B Wattar
- West Suffolk NHS Foundation Trust, Bury St Edmunds, Suffolk, UK
| | - M Rimmer
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - E Rogozinska
- MRC Clinical Trials Unit, University College London, London, UK
| | - M Macmillian
- MRC Centre for Regenerative Medicine, The University of Edinburgh, Edinburgh, UK
| | - K S Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - B H Al Wattar
- Warwick Medical School, University of Warwick, Coventry, UK
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17
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Alam MS, Tongbram A, Krishnakumar S, Biswas J, Mukherjee B. Sensitivity and specificity of frozen section diagnosis in orbital and adnexal malignancies. Indian J Ophthalmol 2020; 67:1988-1992. [PMID: 31755434 PMCID: PMC6896554 DOI: 10.4103/ijo.ijo_2096_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: To analyze the diagnostic accuracy of frozen section in orbital and adnexal malignancies. Methods: A total of 55 cases between January 2006 and December 2011 for which intraoperative frozen section was performed for various orbital and adnexal lesions were included in the study. The frozen section diagnosis was compared with the permanent section diagnosis. Margin clearance was also compared between the two. Data were analysed using SPSS version 14. Odds ratio and cross-tabulation was used to perform the analysis. Results: The mean age at presentation was 51.46 ± 20 years. Eyelid was the most common site of involvement. Out of 55 cases, diagnosis was deferred in four cases (7.27%) on frozen section. Among 51 cases, 44 (86%) cases were concordant, whereas 7 (13%) cases were discordant. The sensitivity and specificity of frozen section compared to permanent section for diagnosis of malignancy was found to be 87.2% and 87.5%, respectively. The sensitivity and specificity of frozen section for diagnoses of basal cell carcinoma was found to be 100%, while it was 83.3% and 100% respectively for sebaceous gland carcinoma and 87.5% and 94.9% respectively for squamous cell carcinoma. Conclusion: Frozen section had high sensitivity and specificity when compared with permanent section for all three parameters studied. It is an important intraoperative tool that is increasingly being used in histopathological examination of ophthalmic lesions. However, it should not be used as a substitute for the permanent section and critical decisions based on it are best avoided.
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Affiliation(s)
- Md Shahid Alam
- Department of Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
| | - Andrea Tongbram
- Department of Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Subramanian Krishnakumar
- Department of Ocular Pathology, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Jyotirmay Biswas
- Department of Ocular Pathology, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Bipasha Mukherjee
- Department of Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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18
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Abstract
Background and Objectives Laparoendoscopic single site surgery (LESS), a minimally invasive procedure, is performed in many hospitals. Although its cosmetic superiority is widely touted, some authors have disputed this view. Here, we compare the surgical and long-term cosmetic outcomes of and patient satisfaction with postoperative wounds for LESS and over 2-port laparoscopy (OTPL), including 2-port laparoscopy (TPL) and standard laparoscopy (SL), after a 6-mo follow-up period. Methods A total of 125 patients who underwent adnexal surgery performed by the same surgeon at the same institution between March 2005 and May 2017 were included. The patients were divided into 2 groups: the LESS group and the OTPL group. The patients completed an evaluation using the Patient Scar Assessment Scale (PSAS, used to evaluate linear scars) and the Ultimate Question (UQ, used to determine overall patient satisfaction). We evaluated surgical scars using the Observer Scar Assessment Scale, which includes the Umbilical Scar Overall Shape Assessment Scale (USOSAS) and the Vancouver Scar Scale (VSS). Results There were no significant differences in the PSAS, UQ, USOSAS, and VSS results between the study groups. The USOSAS score was consistently correlated with VSS scores of 2, 3, and 4 and the total VSS score, indicating that the USOSAS score may be as effective as the VSS score. Conclusions Because the long-term patient satisfaction with and cosmetic wound outcomes of LESS were not significantly different from those achieved by OTPL, surgeons should consider performing LESS after weighing the pros and cons with regard to the patient's condition.
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Affiliation(s)
- Sang Wook Yi
- Division of Minimally Invasive Surgery and Gynecological Laparoendoscopy, Department of Obstetrics and Gynecology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Korea
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19
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Abstract
Pelvic pain is a common condition. Many underlying gynecologic and nongynecologic conditions can contribute to this symptom. Pelvic ultrasound using comprehensive 2-dimensional interactive imaging techniques as well as color Doppler and 3-dimensional imaging optimizes the detection of inciting etiologies.
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Affiliation(s)
- Bryann Bromley
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Diagnostic Ultrasound Associates, One Brookline Place, Suite 506, Brookline, MA 02445, USA
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20
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Abstract
Ovarian lesions are common and require a consistent approach to diagnosis and management for best patient outcomes. In the past 20 years, there has been an evolution in the approach to abnormal ovarian lesions, with increasing emphasis on reducing surgery for benign disease, standardizing terminology, assessing risk of malignancy through use of evidence-based scoring systems, and triaging suspicious abnormalities to dedicated oncology centers. This article provides an evidence-based review of how these changes in diagnosis and management of ultrasound-detected abnormal ovarian lesions have occurred. Current recommended practices are summarized. The current literature on transvaginal screening for ovarian cancer also is reviewed and summarized.
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21
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Abstract
There are many diagnostic methods to assist clinicians in assessing adnexal masses on ultrasound. After suggesting a standardized terminology and measurement technique to evaluate adnexal masses, the International Ovarian Tumor Analysis (IOTA) group has developed different strategies such as the Simple Rules and Assessment of Different Neoplasias in the adneXa (ADNEX) model, which have been shown to outperform other available methods. Besides differentiating between benign neoplasms and malignancies, the ADNEX model can also give the predicted risk for different subtypes of malignant adnexal masses, which is clinically very relevant for guiding patient management.
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Affiliation(s)
- Wouter Froyman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Dirk Timmerman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium.
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22
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Alotaibi L, Alsaif M, Alhumidi A, Turkmani M, Alsaif F. Steatocystoma Multiplex Suppurativa: A Case with Unusual Giant Cysts over the Scalp and Neck. Case Rep Dermatol 2019; 11:71-76. [PMID: 31011316 PMCID: PMC6465725 DOI: 10.1159/000498882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/08/2019] [Indexed: 11/19/2022] Open
Abstract
Steatocystoma multiplex (SM) is a rare hamartomatous malformation of the pilosebaceous duct junction. Most cases of SM are sporadic, although less common autosomal dominant inherited forms have been reported. Steatocystoma multiplex suppurativa (SMS) is a much rarer inflammatory variant of SM, associated with severe inflammatory lesions resembling those of hidradenitis suppurativa. We describe herein a 28-year-old male with SMS who presented with extensive giant cysts on his neck, face, and scalp.
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Affiliation(s)
- Lama Alotaibi
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Alsaif
- College of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ahmed Alhumidi
- Department of Pathology, King Saud University Medical City, Riyadh, Saudi Arabia
| | | | - Fahad Alsaif
- Department of Dermatology, King Saud University Medical City, Riyadh, Saudi Arabia
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23
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Huang C, Hong MK, Chu TY, Ding DC. A retrospective study of surgical treatment and outcome among women with adnexal torsion in eastern Taiwan from 2010 to 2015. PeerJ 2018; 6:e5995. [PMID: 30533300 PMCID: PMC6284449 DOI: 10.7717/peerj.5995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/24/2018] [Indexed: 12/22/2022] Open
Abstract
Background Adnexal torsion is a gynecologic emergency that requires surgical treatment. In this study, we reviewed the surgical outcomes of women with adnexal torsion in eastern Taiwan (Hualien county, area 4,629 km2, 330,000 residents). Methods This retrospective study included 42 women diagnosed with surgically-proven adnexal torsion from January 1, 2010, to September 31, 2015. We compared the symptoms, objective findings, and surgical outcomes of patients who underwent laparotomy or laparoscopy. Results The laparoscopy and laparotomy groups included 27 and 15 patients, respectively. The most common symptom and sign was abdominal pain, followed by nausea and vomiting. In all patients, an adnexal tumor was detected through ultrasound. The median and range of time from admission to surgery was 1.5 (1–11.5) and 1.0 (1–11) hours in the laparotomy and laparoscopy groups, respectively. Compared with those undergoing laparotomy, the smaller tumor size [7 (4.2–10) vs. 10 (7–17) cm] and shorter hospital stay [4 (2–8) vs. 6 (3–9) days] in patients undergoing laparoscopy were significantly noted, respectively (P < 0.01). No differences were observed in age, operative time, and blood loss between both groups. The surgeries performed were mostly detorsion with cystectomy and adnexectomy. The most common pathology was a simple ovarian cyst, followed by teratoma. Regarding the surgical types, older age is the only risk factor for radical surgery. Discussion Acute onset of abdominal pain with a presenting ovarian tumor is the most common feature of adnexal torsion. Laparoscopic surgical group showed a small tumor size and a short ER hospital stay than laparotomy. Older age is the risk factor for radical surgery.
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Affiliation(s)
- Ci Huang
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan, Taiwan
| | - Mun-Kun Hong
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan, Taiwan
| | - Tang-Yuan Chu
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Tawian, Taiwan
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24
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Sadowski EA, Rockall AG, Maturen KE, Robbins JB, Thomassin-Naggara I. Adnexal lesions: Imaging strategies for ultrasound and MR imaging. Diagn Interv Imaging 2019; 100:635-46. [PMID: 30177450 DOI: 10.1016/j.diii.2018.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/24/2022]
Abstract
Adnexal lesions are routinely encountered in general practice. Ultrasound is the first line of investigation in determining the benign or malignant potential of an adnexal lesion. In the cases of classic simple cysts, hemorrhagic cysts, endometriomas, dermoids and obviously malignant lesions, ultrasound may be sufficient for management recommendations. In cases where there is an isolated adnexal lesion, without peritoneal disease or serum CA-125 elevation, and in lesions considered indeterminate on ultrasound, MR imaging with incorporation of the ADNEx MR score can increase the specificity for the diagnosis of benignity or malignancy. This article will review the imaging evaluation of adnexal lesions and how to incorporate the ADNEx MR score to help guide clinical management.
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25
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Abstract
Hydrosalpinx in reproductive-age women without sexual experience is uncommon and may be asymptomatic. Hydrosalpinx-induced torsion of the adnexa is a rare situation and requires prompt and accurate management. This report describes a 21-year-old female without history of sexual intercourse presented with right lower abdominal pain. Ultrasonography revealed right ovary about 4.2 cm × 3.6 cm in size with a well-defined, round cystic mass measuring 6.3 cm × 4.1 cm without septations. Diagnostic laparoscopic surgery showed a darkish right ovary and round-shaped cystic right hydrosalpinx that twisted at the infundibulopelvic ligament. Laparoscopic detorsion and salpingostomy were performed successfully. This case is a rare gynecologic situation with hydrosalpinx induced adnexa torsion, making it a rare presentation. Early diagnosis is important for preventing ovarian gangrene. Laparoscopy is a useful tool for diagnosing and treating tubal and ovarian torsion. It brings good prognosis if detorsion was performed within 24 h.
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Affiliation(s)
- Pei-Chen Li
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan
| | - Bo-Cheng Chen
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan
| | - Bo-Han Yeh
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Sheng-Po Kao
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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26
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Schwartz BI, Huppert JS, Chen C, Huang B, Reed JL. Creation of a Composite Score to Predict Adnexal Torsion in Children and Adolescents. J Pediatr Adolesc Gynecol 2018; 31:132-137. [PMID: 28847757 DOI: 10.1016/j.jpag.2017.08.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/13/2017] [Accepted: 08/18/2017] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE To create a composite score to predict adnexal torsion in children and adolescents. DESIGN A prospective cross-sectional study. SETTING Emergency department of a tertiary care children's hospital. PARTICIPANTS Three hundred twenty-four female participants aged 6-21 years who presented to the emergency department with lower abdominal pain and underwent ultrasound or computed tomography imaging. INTERVENTIONS Collection of possible clinical and radiologic predictors of torsion. MAIN OUTCOME MEASURES The primary outcome was a composite score to predict adnexal torsion. We used χ2 analyses to identify possible risk factors. The classification and regression tree decision method was used to identify risk factor cutoff points. Independent risk factors were combined into a composite score. Receiver operating characteristic curve analyses were used to assessed score performance. RESULTS Of 324 participants with abdominal pain, 241 underwent imaging, and 6.6% (16 of 241) had torsion. Duration of pain, intermittent pain, nausea, and absence of arterial or venous flow were not associated with torsion. Vomiting (P = .05 in premenarchal subjects; P < .001 in menarchal subjects), adnexal volume (P = .008 in premenarchal subjects; P < .001 in menarchal subjects), and adnexal volume ratio (P = .04 in premenarchal subjects; P < .001 in menarchal subjects) were independent predictors of torsion. These predictors were incorporated into a composite score. No torsions were identified with a score of less than 2. There was an increasing risk of torsion for each 1-point score increase. CONCLUSION Independent predictors of torsion can reliably be combined into a composite score to identify children and adolescents at risk for adnexal torsion. This score might aid in improving triage and management of these challenging patients.
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Affiliation(s)
- Beth I Schwartz
- Division of Pediatric and Adolescent Gynecology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Jill S Huppert
- Division of Pediatric and Adolescent Gynecology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Chen Chen
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Bin Huang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jennifer L Reed
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Abstract
While pyoderma gangrenosum (PG) most commonly affects the skin it can also involve other organs. It rarely affects the eye, orbit, or adnexa. Its early recognition and proper management with prompt initiation of immunosuppressive therapy are essential for the preservation of the eye and, in turn, vision, in these cases. Here, we review the limited literature already published regarding ocular involvement in PG.
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Affiliation(s)
- Elizabeth McElnea
- a Ophthalmology Department Mater Misericordiae University Hospital , Dublin , Ireland
| | - Kirk Stephenson
- a Ophthalmology Department Mater Misericordiae University Hospital , Dublin , Ireland
| | - Tim Fulcher
- a Ophthalmology Department Mater Misericordiae University Hospital , Dublin , Ireland
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28
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Rushton JO, Thaller D, Krametter-Froetscher R. Ocular involvement of multicentric malignant B-cell lymphoma in a ewe. A case report. Tierarztl Prax Ausg G Grosstiere Nutztiere 2017; 45:182-186. [PMID: 28203686 DOI: 10.15653/tpg-160480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 10/05/2016] [Indexed: 11/22/2022]
Abstract
An 8.5-year-old, 98 kg female mountain sheep presented with bilateral exophthalmos with reduced retropulsion of the globes, impairing physiologic eyelid closure, sanguineous ocular discharge, as well as swelling of the eyelids and periocular skin. Bilateral vitreal hemorrhage hindering examination of the fundus was further noticed. Systemic signs included reduced general demeanour, presence of a firm mass in the left half of the mammary gland, multiple masses in the area of the vulva and a mass between the shoulder blades. Complete diagnostic work-up, i. e. complete blood count, blood chemistry and coagulation status, fine needle aspiration of periocular swellings and incisional biopsy of the vulvar masses revealed a diagnosis of malignant B-cell lymphoma. Due to the deterioration in general demeanour and rapid progression of exophthalmos, resulting in bilateral corneal ulceration, despite symptomatic medical treatment, the ewe was humanely euthanized. Gross necropsy and histopathology of select tissue samples confirmed the diagnosis of multicentric malignant B-cell lymphoma. To the authors' knowledge, this is the first report of multicentric malignant B-cell lymphoma involving the ocular adnexa in sheep.
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Affiliation(s)
- James O Rushton
- James O. Rushton, Rowe Referrals, The Eye Clinic, The Veterinary Hospital, Bradley House, Ferndene, Bristol, BS32 9DT, United Kingdom,
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Romanski PA, Melamed A, Elias KM, Stanic AK, Anchan RM. Association between peak estradiol levels and ovarian torsion among symptomatic patients receiving gonadotropin treatment. J Assist Reprod Genet 2017; 34:627-31. [PMID: 28299550 DOI: 10.1007/s10815-017-0901-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 03/03/2017] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Ovarian torsion is a surgical emergency that can be clinically challenging to diagnose. Patients who have received assisted reproductive technologies (ART) are a subset of women with an increased risk for torsion. As the ART population continues to increase, there is a need to delineate risk factors for the development of ovarian torsion in this unique population. A pilot study was performed to determine the proportion of patients with suspected ovarian torsion who have received ART and to identify possible diagnostic biomarkers for ovarian torsion among these patients. METHODS A single institution retrospective cohort study of patients taken to surgery for suspected ovarian torsion over a 5-year period. RESULTS During the study period, 171 patients were taken to surgery for suspected ovarian torsion. Patients receiving ART constituted 19 (11%) of these patients. Among the 19 fertility treatment patients, 16 had received treatment with gonadotropins, 10 of which had surgically confirmed ovarian torsion. These ten patients had higher preoperative peak estradiol levels (3122 versus 1875 pg/mL, p = 0.05) and a larger ovarian diameter (9.7 versus 7.6 cm, p = 0.05) than the six patients receiving gonadotropins found to not have ovarian torsion. CONCLUSIONS These results suggest infertility treatment using gonadotropins for ovarian hyperstimulation may be an independent risk factor for ovarian torsion as suggested by the disproportionate number of such individuals represented in the study population (9% of all patients, 84% of fertility patients). Additionally, among women taking gonadotropins, an association exists between peak estradiol levels, ovarian diameter, and risk for ovarian torsion.
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Jung SI, Park HS, Yim Y, Jeon HJ, Yu MH, Kim YJ, Jeong K. Added Value of Using a CT Coronal Reformation to Diagnose Adnexal Torsion. Korean J Radiol 2015; 16:835-45. [PMID: 26175583 PMCID: PMC4499548 DOI: 10.3348/kjr.2015.16.4.835] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 04/08/2015] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the increased value of using coronal reformation of a transverse computed tomography (CT) scan for detecting adnexal torsion. Materials and Methods This study included 106 woman suspected of having adnexal torsion who underwent CT with coronal reformations and subsequent surgical exploration. Two readers independently recorded the CT findings, such as the thickening of a fallopian tube, twisting of the adnexal pedicle, eccentric smooth wall thickening of the torsed adnexal mass, eccentric septal thickening of the torsed adnexal mass, eccentric poor enhancement of the torsed adnexal mass, uterine deviation to the twisted side, ascites or infiltration of pelvic fat, and the overall impression of adnexal torsion with a transverse scan alone or combined with coronal reformation and a transverse scan. The areas under the receiver operating characteristic curves (AUCs), sensitivity, specificity, and positive predictive value were used to compare diagnostic performance. Results Fifty-two patients were confirmed to have adnexal torsion. The addition of coronal reformations to the transverse scan improved AUCs for readers 1 and 2 from 0.74 and 0.75 to 0.92 and 0.87, respectively, for detecting adnexal torsion (p < 0.001 and p = 0.004, respectively). Sensitivity of CT for detecting twisting of the adnexal pedicle increased significantly for readers 1 and 2 from 0.27 and 0.29 with a transverse scan alone to 0.79 and 0.77 with a combined coronal reformation and a transverse scan, respectively (p < 0.001 and p < 0.001, respectively). Conclusion Use of a coronal reformation with transverse CT images improves detection of adnexal torsion.
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Affiliation(s)
- Sung Il Jung
- Department of Radiology, Konkuk University School of Medicine, Research Institute of Medical Science, Seoul 143-729, Korea
| | - Hee Sun Park
- Department of Radiology, Konkuk University School of Medicine, Research Institute of Medical Science, Seoul 143-729, Korea
| | - Younghee Yim
- Department of Radiology, Konkuk University School of Medicine, Research Institute of Medical Science, Seoul 143-729, Korea
| | - Hae Jeong Jeon
- Department of Radiology, Konkuk University School of Medicine, Research Institute of Medical Science, Seoul 143-729, Korea
| | - Mi Hye Yu
- Department of Radiology, Konkuk University School of Medicine, Research Institute of Medical Science, Seoul 143-729, Korea
| | - Young Jun Kim
- Department of Radiology, Konkuk University School of Medicine, Research Institute of Medical Science, Seoul 143-729, Korea
| | - Kyungah Jeong
- Department of Obstetrics and Gynecology, School of Medicine, Ewha Womans University, Seoul 158-710, Korea
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Abstract
Background: Laparoscopic surgery is often used to excise adnexal masses; however, the retrieval of specimens such as large cystic masses through conventional 5- or 10-mm ports is difficult and time-consuming. We compared outcomes between conventional laparoscopic surgery for adnexal masses and transumbilical specimen retrieval through a multichannel port during single- or 2-port laparoscopy. Methods: A total of 341 patients who underwent laparoscopic surgery for adnexal masses from November 2006 to December 2010 were included. The patients were divided into 2 groups: group I consisted of 249 patients who underwent conventional laparoscopy, and group II consisted of 92 patients who underwent single- or 2-port laparoscopy using a multichannel port. The clinical characteristics and operative outcomes of the 2 groups were compared. Results: The mean operation time was 51.8 ± 21.5 minutes in group I and 57.2 ± 23.9 minutes in group II. The mean specimen retrieval time was longer in group I (2.9 ± 4.0 minutes) than in group II (2.2 ± 1.8 minutes). Endoscopic bag rupture during specimen retrieval occurred in 11 patients in group I and in no patients in group II. Conclusions: The transumbilical retrieval of surgical specimens through a multichannel port with a wound retractor was safe and did not result in leakage of the cystic contents. This technique reduced the specimen retrieval time, especially for large masses. However, the mean operation time was not shortened with this procedure, because of the learning period and the time required to prepare the umbilical multichannel port.
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Affiliation(s)
- Sang Wook Yi
- Department of Obstetrics and Gynecology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Gangwon, Korea
| | - Da Hye Ju
- Department of Obstetrics and Gynecology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Gangwon, Korea
| | - Sang Soo Lee
- Department of Obstetrics and Gynecology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Gangwon, Korea
| | - Woo Seok Sohn
- Department of Obstetrics and Gynecology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Gangwon, Korea
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West AH, Yamada SD, MacMahon H, Acharya SS, Ali SM, He J, Lukas RV, Miller VA, Salgia R. Unique metastases of ALK mutated lung cancer activated to the adnexa of the uterus. ACTA ACUST UNITED AC 2014; 1:151-154. [PMID: 25541622 DOI: 10.5430/crcp.v1n2p151] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Anaplastic lymphoma kinase (ALK) fusion positive non-small cell lung cancer (NSCLC) is a relatively novel molecular subtype in lung cancer. ALK targeted therapies such as crizotinib increase survival benefit in this patient population. However, further understanding of the disease subtype including patterns of metastasis and pathways of treatment resistance are needed. We describe a 50 year-old-woman diagnosed with stage IV NSCLC, T2N3M1b, ALK fusion positive disease. Although her initial sites of metastasis included the liver and bone, her story is notable for crizotinib resistant growth of a metastatic lesion to her adnexa. This report brings to attention unique mechanisms of metastasis in ALK positive patients.
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Affiliation(s)
- Allison H West
- Department of Medicine, The University of Chicago, Chicago, IL, United States
| | - S Diane Yamada
- Department of Obstetrics/ Gynecology, The University of Chicago, Chicago, IL, United States
| | - Heber MacMahon
- Department of Radiology, The University of Chicago, Chicago, IL, United States
| | | | - Siraj M Ali
- Foundation Medicine, Cambridge, MA, United States
| | - Jie He
- Foundation Medicine, Cambridge, MA, United States
| | - Rimas V Lukas
- Department of Neurology, University of Chicago, Chicago, IL, United States
| | | | - Ravi Salgia
- Department of Medicine, The University of Chicago, Chicago, IL, United States
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Jung SI, Park HS, Kim YJ, Jeon HJ. Multidetector computed tomography for the assessment of adnexal mass: is unenhanced CT scan necessary? Korean J Radiol 2014; 15:72-9. [PMID: 24497795 PMCID: PMC3909865 DOI: 10.3348/kjr.2014.15.1.72] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 09/16/2013] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the diagnostic performance and radiation dose between contrast-enhanced CT (ECT) alone, and combined unenhanced and contrast-enhanced CT (UE + ECT) for the assessment of adnexal mass. MATERIALS AND METHODS This retrospective study was approved by the Institutional Review Board. A total of 146 consecutive patients (mean age, 41.1 years) who underwent preoperative unenhanced and contrast-enhanced multidetector CT of the pelvis and had adnexal masses found at surgery were included. Two readers independently evaluated the likelihood of adnexal malignancy on a 5-point scale on two different imaging datasets (ECT alone and UE + ECT). The area under the receiver operating characteristic curve (AUC) was used to evaluate diagnostic performance. Radiation dose to patients was calculated by the volume CT dose index (CTDIvol) and the dose length products (DLP) on each dataset. RESULTS Of the total 178 adnexal masses, 133 masses were benign and 45 masses were malignant. For both readers, there is no significant difference of AUC values between ECT alone and UE + ECT for the detection of adnexal malignancy (reader 1, 0.93 vs. 0.95; reader 2, 0.92 vs. 0.91) (p > 0.05). The mean CTDIvol (12.6 ± 2.2 mGy) and DLP (641.2 ± 137.2 mGy) of ECT alone was significantly lower than the mean CTDIvol (21.5 ± 2.7 mGy) and DLP (923.6 ± 158.8 mGy) of UE + ECT (p < 0.0001). CONCLUSION The use of unenhanced CT scan in addition to contrast-enhanced CT scan does not improve the detection of adnexal malignancy, but increases radiation exposure.
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Affiliation(s)
- Sung Il Jung
- Department of Radiology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 143-729, Korea
| | - Hee Sun Park
- Department of Radiology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 143-729, Korea
| | - Young Jun Kim
- Department of Radiology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 143-729, Korea
| | - Hae Jeong Jeon
- Department of Radiology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 143-729, Korea
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Arora D, Bhattacharyya TK, Kathpalia SK, Kochar S, Lele PR. Acute Abdomen in Gynaecological Practice. Med J Armed Forces India 2005; 61:66-70. [PMID: 27407707 PMCID: PMC4923373 DOI: 10.1016/s0377-1237(05)80124-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2004] [Accepted: 12/15/2004] [Indexed: 10/18/2022] Open
Abstract
Acute abdomen in pregnancy is due to consequence of pregnancy itself or is totally unrelated to pregnancy. During pregnancy, a woman is at an increased risk of acute abdomen due to various physiological changes. The article discusses the various conditions which can present as acute abdomen in women during pregnancy and in non-pregnant state. The clinician often has a difficult task in diagnosing and managing acute abdomen in pregnancy. Clinical evaluation is further confounded by various anatomical and physiological changes occurring in pregnancy. The growing gravid uterus too causes difficulty in detailed examination. The general reluctance to use conventional X-rays because of pregnancy should be set aside when faced with a seriously ill mother. A reluctance to operate during pregnancy adds unnecessary delay, which increases morbidity for both the mother and the fetus. Adnexal accidents should always be kept in mind in a woman with acute abdomen even if she is not pregnant. Such mistakes should be avoided as prompt diagnosis and appropriate therapy are crucial. A general approach to acute abdominal conditions in pregnancy is to manage these problems considering the risk to mother regardless of the pregnancy.
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Affiliation(s)
- Devendra Arora
- Reader, Department of Obstetrics and Gynaecology, Armed Forces Medical College, Pune - 411040
| | - T K Bhattacharyya
- Professor & Head, Department of Obstetrics and Gynaecology, Armed Forces Medical College, Pune - 411040
| | - S K Kathpalia
- Associate Professor, Department of Obstetrics and Gynaecology, Armed Forces Medical College, Pune - 411040
| | - Sps Kochar
- Reader, Department of Obstetrics and Gynaecology, Armed Forces Medical College, Pune - 411040
| | - P R Lele
- Clinical Tutor, Department of Obstetrics and Gynaecology, Armed Forces Medical College, Pune - 411040
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