Adnexal torsion recurrence-is the adnexal twist degree a risk factor? A retrospective cohort study

OBJECTIVE

To evaluate whether the adnexal twist degree is related to torsion recurrence and whether there is a dose-dependent correlation.

DESIGN

A retrospective cohort study.

SETTING

Single tertiary medical centre.

POPULATION

The study includes non-pregnant patients operated, for the first time, for adnexal torsion, between 2011 and 2018.

METHODS

Information regarding the degree of adnexal twist was collected from surgical reports. Recurrence was identified using a computerised database and ascertained via telephone with a response rate of 87.2% (253/290).

MAIN OUTCOME MEASURES

Adnexal torsion recurrence rate.

RESULTS

A total of 182 women who had undergone laparoscopic detorsion met the inclusion criteria. Twenty-two had torsion recurrence (12.1%). Adnexal twist degree in the primary event was associated with a higher recurrence risk: 4.3% of women with twist degree ≤360 (n = 3/70), 14.5% of women with twist degree of 361-720 (n = 9/62) and 20% of women with twist degree >720 (n = 10/50) (P = 0.03). The median twist degree was 540 (interquartile range [IQR] 360-855) and 720 (IQR 675-1080) degrees in the control and study groups, respectively (P = 0.005). Additional possibly associated factors for recurrence were evaluated. Age emerged as a possible risk factor, with a median age of 19 years in the recurrence group (IQR 14-27 years) versus 28.5 (IQR 19-36 years) in the non-recurrence group (P < 0.01). Logistic regression analysis revealed that together with age, adnexal twist degree remained significantly associated with torsion recurrence (odds ratio [OR] 1.98, 95% CI 1.09-3.61; P = 0.02).

CONCLUSION

Adnexal twist degree was found to be positively associated with the risk of torsion recurrence.

TWEETABLE ABSTRACT

Adnexal twist degree was found to be positively associated with the risk of torsion recurrence.

Size threshold for follow-up of postmenopausal adnexal cysts: 1 cm versus 3 cm

OBJECTIVES

To assess 3 cm size threshold for follow-up of simple cysts in postmenopausal women.

MATERIALS AND METHODS

Radiology information system was retrospectively queried for "US pelvis complete" over 8 years in women > 50 years, with keywords ovarian cyst, adnexal cyst, ovarian mass, cystic mass, cystic neoplasm, ovarian neoplasm, and ovarian mass. Premenopausal women were excluded. Cysts, were classified as ≤ 1 cm, 1-3 cm, 3-5 cm, and ≥ 7 cm. Largest cysts on each ovary was recorded. EMR and imaging archives were reviewed for assessing size, stability duration, and surgical records. Descriptive statistics and confidence interval were performed.

RESULTS

4388 patients met the initial search criteria. 919 cysts in 896 women (age: 50-91 years, mean: 61.5 years) were identified. We found 162 cysts ≤ 1 cm, 352 1-3 cm, 296 3-7 cm , and 51 ≥ 7 cm cysts. 127 patients with 1-3 cm cysts had no follow-up. Final analysis of 225 1-3 cm cysts included 203 ovarian and 22 paraovarian cysts (average size = 1.95 cm (1.1-3.0 cm)). 103 ovarian cysts had less than 2 years, and 100 cysts had more than 2 years follow-up. All except one ovarian cyst were stable for the entire duration of their follow-up (Mean duration of follow-up 5.4 years) (0.3%, 95% CI 0.0-0.05). 40 cysts resolved. One simple cyst increased in size (followed over 3.25 years) without suspicious imaging features and benign on surgery.

CONCLUSION

1-3 cm cysts represented the most common size range (> 40%) in postmenopausal women, majority of which are stable over follow-up with benign outcome. 3 cm size threshold is appropriate for simple cyst follow-up in postmenopausal women.

Primary hydatic cyst of the fallopian tube

•Hydatid disease is an endemic infection in the Mediterranean region, and Tunisia is one of the most affected countries.

•The involvement of the female genital tract is uncommon, and the occurrence in the fallopian tube is extremely rare.

•In reproductive organs, the involvement is always secondary. Primary involvement of the fallopian tube is rarely reported.

Hydatid disease is endemic in Tunisia. The involvement of the female genital tract is uncommon, and the occurrence in the fallopian tube is exceptional. We present a case of a 42-year-old woman who had complained of a 4-month history of lower abdominal pain. The abdominal ultrasonography and CT scan showed a multiloculated cystic lesion in the left adnexa. The exploratory laparotomy found a cystic mass developing in the left fallopian tube. Left salpingectomy was performed. The pathological examination confirmed the diagnosis of hydatid cyst disease. No recurrence was detected at the 2-year follow-up. Tubal hydatid cyst is an extremely rare condition that should be considered in the differential diagnosis of any cystic lesion in patients from endemic areas.

Adnexal lesions detected on CT in postmenopausal females with non-ovarian malignancy: do simple cysts need follow-up?

PURPOSE

To assess whether CT morphology of adnexal lesions in postmenopausal women with history of non-ovarian cancer could be used to discriminate benign and malignant lesions, particularly focusing on applicability of the ACR criteria.

MATERIALS AND METHODS

This was an IRB-approved HIPAA-compliant retrospective review of contrast-enhanced CTs of 199 women, 55 years and older. Lesions were classified as simple cystic, complex cystic, solid-cystic, or solid based on CT morphology, and were diagnosed as benign, indeterminate, or malignant on follow-up imaging or pathology. Associated metastatic disease was noted, if present. Findings were analyzed to correlate CT morphology, primary tumor pathology, and metastatic disease pattern with eventual lesion diagnosis.

RESULTS

There were 223 adnexal lesions, including 123 (55%) simple cystic, 48 (22%) complex cystic, 40 (18%) solid-cystic, and 12 (5%) solid lesions. 186/223 (83%) lesions were benign, and 37/223 (17%) were malignant. Primary colorectal cancer was significantly associated with an increased likelihood of malignant adnexal lesions (OR 10.2, p < 0.001) compared to patients with other cancers. Adnexal malignancy was significantly associated with the presence of non-ovarian peritoneal metastases (p < 0.001). None of the simple cysts (including 85 cysts between 1-3 cm and 38 cysts > 3 cm) were found to be malignant (malignancy rate: 0.0%, 95% CI 0.0-3.0%). Complex cysts were more likely to be malignant than simple cysts (p = 0.002) and solid-cystic lesions were more likely to be malignant than complex cysts (p < 0.001).

CONCLUSION

Simple adnexal lesions on CT in this cohort were unlikely to be malignant, supporting the ACR guidelines. A higher size threshold of 3 cm (vs. 1 cm) may be preferred in all cases of simple cysts for recommending further follow-up. However, more complex-appearing cysts need further evaluation as the risk of malignancy is increased. Peritoneal metastases have a significant correlation with malignant adnexal involvement.

A systematic approach to adnexal masses discovered on ultrasound: the ADNEx MR scoring system

Adnexal lesions are a common occurrence in radiology practice and imaging plays a crucial role in triaging women appropriately. Current trends toward early detection and characterization have increased the need for accurate imaging assessment of adnexal lesions prior to treatment. Ultrasound is the first-line imaging modality for assessing adnexal lesions; however, approximately 20% of lesions are incompletely characterized after ultrasound evaluation. Secondary assessment with MR imaging using the ADNEx MR Scoring System has been demonstrated as highly accurate in the characterization of adnexal lesions and in excluding ovarian cancer. This review will address the role of MR imaging in further assessment of adnexal lesions discovered on US, and the utility of the ADNEx MR Scoring System.

Genital Tuberculosis Mimicking Carcinoma Ovary: Can Ultrasound Guided Biopsy Be A Resolution!

Genital tuberculosis mimicking carcinoma ovary is a well-known dilemma as there is no definitive serological or imaging modality for diagnosing abdominopelvic tuberculosis. A 20-years-old unmarried girl presented with complex adnexal mass, mild ascites and CA 125 >1000. Her staging laparotomy and frozen section was planned. Laparotomy revealed miliary tuberculosis and frozen section confirmed the diagnosis of tuberculosis. Patient was started with anti-tuberculosis treatment and follow up showed resolution of cysts. Another case is of 31 years old unmarried lady presented with history of abdominal pain. Her ultrasound revealed complex adnexal mass. CT scan revealed bilateral adnexal masses with solid and cystic lesion, ascites, para aortic lymphadenopathy; features suggestive of mitotic lesion. Her CA 125 was >1000. Family history of tuberculosis was positive. Keeping her age group and family history in view; workup of tuberculosis was performed. X ray chest was normal. Tuberculin skin test was 10mm and Quantiferon gold test was negative. In this case a decision of ultrasound guided biopsy was made. Result of biopsy showed granulomatous inflammation confirming pelvic tuberculosis. Ultrasound guided biopsy is a minimally invasive procedure with high diagnostic yield can be very helpful in such case. Clear guidelines should be developed nationally owing to the high prevalence of tuberculosis in our country to avoid unnecessary laparotomies.

Laparoscopic Management of Autoamputated Ovary in Newborns: A Report of 2 Cases

Intrauterine autoamputation of the ovary is an extremely rare diagnosis in the pediatric population. The current literature is limited to contradictory recommendations, while a standard management protocol for autoamputated adnexa secondary to intrauterine ovarian torsion is yet to be established. We report 2 cases of auto-amputation of the ovary, leading to a free-floating intra-abdominal cyst in the newborn. Laparoscopic management was successful in both cases.

Two rare presentations of epidermal cyst

Epidermal cysts are very rare. It is more common in males than in females and the most common site of presentation are the hairy sites. We came across two rare cases of epidermal cysts. In one case, a parous lady presented with an adnexal mass and D/D of broad ligament fibroid or ovarian mass was considered which turned out to be a cyst containing cheesy pultaceous material. In the other case, a parous lady presented with a mass arising from the posterior fourchette that contained cheesy pultaceous material on excision. In both cases histopathology confirmed it to be epidermal cysts. Epidermal cysts known for its rare incidence by itself is now found to be presenting at rare sites which emphasizes on the need for further research into the etiopathogenesis of these cysts and its development at the various sites of the body.