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Liu Q, Li Z, Zhou H, Cao D, Yang J, Shen K, Lang J. Clinicopathological features and surgical procedures of adnexal masses with abdominal pain in pediatric and adolescent patients. Orphanet J Rare Dis 2024; 19:132. [PMID: 38515195 PMCID: PMC10958921 DOI: 10.1186/s13023-024-03101-4] [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: 02/09/2023] [Accepted: 02/23/2024] [Indexed: 03/23/2024] Open
Abstract
PURPOSE This study investigated the clinicopathological features and surgical procedures of adnexal masses with abdominal pain in pediatric and adolescent patients. Our objective was to better define the clinical presentation of adnexal torsion and to distinguish characteristics of those with torsion and those with an alternate diagnosis. METHODS Retrospective cohort study of 212 pediatric and adolescent patients was performed who admitted for abdominal pain and presenting with an adnexal mass between March 2012 to December 2019.Medical records were reviewed for age at operation, including presentation of symptoms and signs; the levels of tumor markers; imaging examinations; pathologic findings; the size of masses; treatment; and outcome. Data management and descriptive analyses were performed using SPSS 26.0. RESULTS The median age of the patients was 14.5 ± 3.6 years at the operation. 126 (59.4%, 126/212) patients presented with an abrupt onset of abdominal pain. A total of 82.1% (174/212) of the participants underwent adnexal conservative surgery. 179 (84.5%, 179/212) patients underwent laparoscopic surgery with an average tumor size of 7.7 ± 3.4 cm, while 33 patients ( 15.6%, 33/212) underwent laparotomy. Rupture of mass and ectopic pregnancy accounted for 7.5% (16/212) and 0.9%(2/212), respectively. Torsion was responsible for 36.8% (78/212) of all patients. Among the patients with torsion, the symptom of nausea and vomiting was more common among girls without torsion (P < 0.0001). 88.5% of the girls with torsion had acute onset of abdominal pain, while 92.3% had persistent pain that could not be relieved or occurred repeatedly, which significantly higher than that in the patients without torsion (P < 0.001). 69.2% of patients with torsion had fixed pain sites, compared with 42.2% in patients without torsion (P < 0.001). 88.5% of girls with torsion had an ovarian cyst/mass ≥ 5 cm, compared with 75.0% in girls without torsion (P = 0.038). 66.7% of girls underwent ovary-preserving surgery, compared with 92.2% in patients without torsion. The most common pathologic types were mature teratoma and simple cyst, accounting for 29.4% and 25.6%, respectively. The multivariate analyses confirmed that mass size greater than 5 cm (OR 4.134, 95% CI: 1.349-12.669,P = 0.013), acute onset pain (OR 24.150,95%CI: 8.398-69.444,P = 0.000), persistent or recurrent pain (OR 15.911,95%CI: 6.164-41.075,P = 0.000) were significantly associated with increased risk of torsion. CONCLUSIONS Torsion which is a relatively rare event in the pediatric population was not an uncommon condition and responsible for more than one third of all pediatric and adolescent patients presented with adnexal masses and abdominal pain. Pain assessment in children and adolescents is important to distinguish characteristics of those with torsion and those with an alternate diagnosis.Thus, pediatric and adolescent patients particularly with a pelvic mass size greater than 5 cm, acute onset pain, persistent or recurrent pain have a benign cause and not missing the devastating condition that needs emergent attention. Thus, a strategy of earlier and liberal use of Diagnostic Laparoscopy (DL) may improve ovarian salvage.
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Affiliation(s)
- Qian Liu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, No. 1 ShuaiFu Yuan, Dongcheng District, 100730, Beijing, China
| | - Zhiqiang Li
- Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, 250062, Jinan, China
| | - Huimei Zhou
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, No. 1 ShuaiFu Yuan, Dongcheng District, 100730, Beijing, China.
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, No. 1 ShuaiFu Yuan, Dongcheng District, 100730, Beijing, China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, No. 1 ShuaiFu Yuan, Dongcheng District, 100730, Beijing, China
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, No. 1 ShuaiFu Yuan, Dongcheng District, 100730, Beijing, China
| | - Jinghe Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, No. 1 ShuaiFu Yuan, Dongcheng District, 100730, Beijing, China
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Chmel R, Chubanovová N, Kelčík R, Nováčková M. Adnexal torsion in childhood and adolescence. Ceska Gynekol 2023; 88:120-125. [PMID: 37130738 DOI: 10.48095/cccg2023120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The incidence of adnexal torsion in childhood and adolescence is 4.9 per 100,000 girls. Torsion of the adnexa is caused by rotation of the ovary usually with the fallopian tube around the infundibulopelvic ligament. The torsion leads primarily to the interruption of both venous outflow and lymphatic drainage. It causes enlargement of the ovary due its edema with occurrence of hemorrhagic infarctions. Interruption of the arterial inflow leads finally to the necrosis of ovarian tissue. Torsion of the adnexa in childhood occurs usually in enlarged ovary, particularly by a cyst, or when the non-enlarged ovary is excessively mobile due to the extended infundibulopelvic ligament. The characteristic clinical symptoms of adnexal torsion are sudden pain in the lower abdomen with nausea and vomiting. The dia-gnosis of adnexal torsion is based on the typical symptoms, clinical course, and the results of physical and ultrasound examinations. Torsion of the adnexa should be considered in every girl with sudden abdominal pain. To preserve reproductive functions, an early surgery with detorsion of the adnexa should be performed.
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Chen Y, Liu M, Zhang M, Yang M, Weng Z, Wu Q, He S. Ultrasonographic scoring system for the diagnosis of adnexal torsion. J Clin Ultrasound 2022; 50:525-531. [PMID: 35244941 DOI: 10.1002/jcu.23178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE To establish the utility of an ultrasonographic scoring system for the diagnosis of adnexal torsion. METHODS We retrospectively analyzing 358 adnexal torsion cases. Using Pearson's χ2 test we determined whether ultrasonographic signs were significantly associated with adnexal torsion. Receiver operating characteristic curves were used to evaluate the diagnostic efficacy of the system. Ultimately by using binary logistic regression we established a precise and convenient scoring system. RESULTS The torsion score was based on five criteria that were identified to be independently associated with adnexal torsion: (1) abnormal position of the index adnexa (odds ratio [OR], 2.311); (2) presence of a mass or cyst (OR, 3.495); (3) unilateral ovarian enlargement (OR, 3.051); (4) vascular pedicle twisting (OR, 2.105); and (5) peripheral hypervascularity of the corpus luteum with ovarian edema(encapsulating cyst sign) (OR, 4.164).patients with torsion who scored 0, have a predicted diagnosis rate of 20.9%; patients whose scores were 1,2 have a predicted probability of 41.8% and 66.15%, respectively. For patients with torsion scores of 3, 4, and 5, predicted diagnosis rates were 84.16%, 93.52%, and 98.27%, respectively. CONCLUSION The ultrasonographic scoring system is feasible and precisely diagnoses adnexal torsion using ultrasound.
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Affiliation(s)
- Yan Chen
- Department of Ultrasound, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Min Liu
- Department of Ultrasound, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Meilian Zhang
- Department of Ultrasound, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Minmin Yang
- Department of Ultrasound, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Zongjie Weng
- Department of Ultrasound, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Qiumei Wu
- Department of Ultrasound, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Suhui He
- Department of Ultrasound, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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Palaia I, Bardhi E, Boccia SM, Pecorini F, Musella A, Panici PB. Severe hemoperitoneum due to endometriosis in a non-pregnant woman under dienogest therapy: a case report. Gynecol Endocrinol 2020; 36:211-212. [PMID: 31407617 DOI: 10.1080/09513590.2019.1653843] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Endometriosis is a chronic, estrogen-dependent, inflammatory disease that mainly affects women of reproductive age and is defined by the presence of endometrial glands and stroma at ectopic sites. Spontaneous hemoperitoneum due to bleeding of pelvic endometriotic foci represents a very rare and severe complication of endometriosis, although most cases described in literature regard pregnant women. We hereby present a case of a severe hemoperitoneum in a non-pregnant, 42 years old woman, under dienogest therapy for deep endometriosis. This life-threatening condition was promptly managed by performing an exploratory laparoscopy where the source of bleeding was found and hemostasis successfully achieved.Bleeding from pelvic endometriotic foci ought to be considered in the differential diagnosis of gynecological causes of acute abdomen and hemoperitoneum, even under medical therapy.
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Affiliation(s)
- Innocenza Palaia
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
| | - Erlisa Bardhi
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
| | - Serena Maria Boccia
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
| | - Francesco Pecorini
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
| | - Angela Musella
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
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Pickhardt PJ, Nelson L. Acute non-traumatic abdominal pain by quadrant: relative yield of CT and clinical evaluation for diagnosis in 1000 patients. Abdom Radiol (NY) 2019; 44:2963-2970. [PMID: 31104074 DOI: 10.1007/s00261-019-02064-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine the relative diagnostic yield of contrast-enhanced CT in adults presenting with symptoms referable to a specific abdominal quadrant. METHODS Electronic health records review systematically identified patients meeting the following inclusion criteria: adults (≥ 18 years) undergoing IV contrast-enhanced abdominopelvic CT for acute non-traumatic symptoms referable to a specific abdominal quadrant (RLQ/LLQ/LUQ/RUQ). The CT-based diagnosis and any clinical diagnosis in the absence of CT diagnosis were recorded. The final cohort of 1000 subjects (mean age, 48.1 years; 647F/353M) consisted of consecutive sub-cohorts of 250 patients for each abdominal quadrant. Positive oral contrast was utilized in 91.6% (916/1000) of cases. RESULTS A positive CT diagnosis was provided in 47.3% (473/1000) of all patients, and was highest for LLQ (58.8%) and RLQ (58.0%) symptoms, including diverticulitis and appendicitis in 23.6% and 24.8% cases, respectively. CT positivity was lower for the LUQ (34.4%) and RUQ (38.0%) (p < 0.0001), with no single diagnosis representing > 5% of cases. However, all quadrants provided valuable triage of 218 hospital admissions (21.8%), 83.0% were CT positive, whereas 62.7% of 782 discharged patients were CT negative. Only 7.0% of CT-negative patients were admitted. A clinical-only diagnosis was provided in 9.3% of the total cohort (93/1000), representing 17.6% of the CT-negative cohort (93/527). CONCLUSION The rate of positive CT diagnosis is considerably higher for the lower abdominal quadrants, predominately due to appendicitis and diverticulitis. However, CT results (positive vs. negative) for all four quadrants strongly correlated with hospital admission versus discharge. Clinical-only diagnosis represented < 10% of all cases.
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Affiliation(s)
- Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA.
| | - Leslie Nelson
- Department of Radiology, University of Kentucky College of Medicine, Lexington, KY, USA
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Dafna L, Ganer Herman H, Ginath S, Shalev A, Kerner R, Keidar R, Bar J, Sagiv R. Comparison of Emergent and Elective Surgeries of Endometriomas: Is Adnexal Torsion a Concern? Isr Med Assoc J 2019; 21:251-254. [PMID: 31032566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND When a woman with an endometrioma presents with acute abdominal pain, it is unclear whether ovarian torsion should be suspected. OBJECTIVES To compare patient characteristics, imaging results, and surgical management of endometriomas in elective versus emergent surgeries. METHODS This retrospective cohort study included women treated at our institution during the period 1990-2015 who presented with histologically verified endometrioma and who underwent either planned surgery or emergent surgery due to suspected adnexal torsion. RESULTS Of 225 surgeries performed, 174 were elective and 51 emergent. Patients in the emergent group were significantly younger (33.9 ± 11.1 vs. 39.01 ± 10.9 years, P = 0.004). Abdominal pain was the main complaint of all the emergent surgery patients and the leading complaint in 21% of the elective surgery patients (P < 0.001), with right-sided predominance in both groups. Sonographic parameters were similar in both groups. Bilateral ovarian cysts were noted in 11.7% and 11.0% of emergent and elective patients, respectively (P = 0.87). Laboratory evaluation was notable for a higher white blood cell count and CA125 levels among emergent patients. All patients in the emergent group and 93% of patients in the elective group were managed laparoscopically. No cases of torsion were noted. The rate of intra-pelvic adhesions was similar in both groups (56.8% vs. 66.6%, P = 0.19). CONCLUSIONS Endometrioma may present with acute abdominal pain. However, adnexal torsion in these patients is rare. These cases can be managed using a minimally invasive approach, assuming an optimal surgical setting.
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Affiliation(s)
- Lotem Dafna
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadas Ganer Herman
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shimon Ginath
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Shalev
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ram Kerner
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Keidar
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Sagiv
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Sim BNH, Hui LY, Krishnan D, Joseph JP. Idiopathic CD4 lymphopenia in a case of disseminated cryptococcosis with brain, vertebral spine and reproductive organ involvement. Clin Med (Lond) 2019; 19:133-134. [PMID: 30872296 PMCID: PMC6454367 DOI: 10.7861/clinmedicine.19-2-133] [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] [Indexed: 11/27/2022]
Abstract
Cryptococcosis is an opportunistic fungal infection commonly seen in HIV cases. We present a case of disseminated cryptococcosis with multiple non-continuous infective foci in a non-HIV, non-transplant case.
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Affiliation(s)
| | - Lau Yue Hui
- Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
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Abstract
INTRODUCTION Solitary fibrous tumors (SFTs) are uncommon mesenchymal neoplasms and are particularly rare in the female genital tract. Doege-Potter syndrome is a paraneoplastic syndrome involving SFT-associated hypoglycemia. We report, for the first time, on a broad ligament SFT with Doege-Potter syndrome; additionally, we review 30 cases of women with SFTs reported in the literature. PATIENT CONCERNS A 37-year-old woman who presented with life-threatening hypoglycemia and a pelvic mass (16 × 15 × 15 cm). DIAGNOSES The patient was diagnosed with broad ligament SFT with Doege-Potter syndrome. INTERVENTIONS Tumor resection, sub-extensive hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy were performed, and 6 cycles of adjuvant chemotherapy were administered. OUTCOMES Serum glucose levels returned to normal as soon as the tumor was resected. Forty-3 months after operation, there was recurrence in the posterior peritoneal tissues. She underwent tumor resection and has remained tumor-free 28 months after this excision. CONCLUSION Even though it is extremely rare, SFT should be quickly identified to prevent undue treatment delay and avoid unnecessary examination; surgery and long-term follow-up are recommended. SFT can be considered a highly invasive cancer, and intraoperative bleeding may occur. Although no correlation between adjuvant therapy and improved prognosis was found, further studies are required because of the small number of cases reported to date.
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Affiliation(s)
- Sijing Chen
- Department of Gynecologic Oncology, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China
| | - Ying Zheng
- Department of Gynecologic Oncology, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China
| | - Lin Chen
- Department of Gynecologic Oncology, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China
| | - Qihua Yi
- Department of Gynecologic Oncology, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China
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Goldberg HR, Allen L, Kives S. Fetiform Teratoma in the Ovary of a 7-Year-Old Girl: A Case Report. J Pediatr Adolesc Gynecol 2017; 30:256-258. [PMID: 27769689 DOI: 10.1016/j.jpag.2016.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 08/29/2016] [Revised: 10/10/2016] [Accepted: 10/11/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Fetiform teratoma, a highly differentiated mature cystic teratoma resembling a fetus, is rare and typically found in the ovaries of women of reproductive age. In this report we describe, to our knowledge, the youngest case of ovarian fetiform teratoma. CASE A 7-year-old girl presented with acute abdominal pain. Radiological examinations revealed a 5.2-cm ovarian complex cystic mass with fetal-like components in favor of fetus in fetu and teratoma. After surgical removal, the mass resembled a fetus consisting of a head, two eye slits, two small upper limb projections, and hair. Pathology indicated mature cystic teratoma supporting the diagnosis of fetiform teratoma. SUMMARY AND CONCLUSION Although not commonly found in children, fetiform teratoma must be considered in the diagnosis of a child who presents with an adnexal mass resembling a fetus.
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Affiliation(s)
- Hanna R Goldberg
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Allen
- Section of Gynecology, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada
| | - Sari Kives
- Section of Gynecology, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada.
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Takeda A, Watanabe K, Hayashi S, Imoto S, Nakamura H. Gynandroblastoma with a Juvenile Granulosa Cell Component in an Adolescent: Case Report and Literature Review. J Pediatr Adolesc Gynecol 2017; 30:251-255. [PMID: 27751908 DOI: 10.1016/j.jpag.2016.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 05/19/2016] [Revised: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Gynandroblastoma is an extremely rare ovarian sex cord tumor with malignant potential. CASE An 18-year-old adolescent experienced intermittent vaginal bleeding. A year later, a right adnexal mass with a heterogeneous imaging appearance was identified. Laparoendoscopic single-site ovarian tumorectomy was performed. A histopathological examination showed gynandroblastoma composed of juvenile granulosa and Sertoli-Leydig cells. Because the tumor was upstaged to stage Ic because of cyst rupture during surgery, three cycles of adjuvant chemotherapy with carboplatin and paclitaxel were added. Three years after surgery, no signs of recurrence have been noted. SUMMARY AND CONCLUSION The present findings can help clinicians make an accurate preoperative imaging diagnosis of gynandroblastoma with a juvenile granulosa cell component and plan an adequate treatment strategy for this rare, potentially malignant neoplasm.
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Affiliation(s)
- Akihiro Takeda
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan.
| | - Kazuko Watanabe
- Department of Diagnostic Pathology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Shotaro Hayashi
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Sanae Imoto
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Hiromi Nakamura
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
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Affiliation(s)
- Keun Ho Lee
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Jong Song
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Kyung Park
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Pannu D, Malik S, Shamsunder S, Bhatnagar A. Ascites and Adnexal Mass with Raised CA125: How Arduous can be the Path of Diagnosis. JNMA J Nepal Med Assoc 2016; 54:36-39. [PMID: 27935910] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Ascites, adnexal mass and elevated CA125 levels almost always suggest advanced ovarian carcinoma. We present a case of a 37 years old multiparous lady who presented with such a classical picture. Radiological picture was suggestive of ovarian carcinoma with peritoneal metastasis. However, ascitic fluid cytology was negative for malignant cells. A differential diagnosis of tubercular mass was made. Ascitic fluid was sent for adenosine deaminase test that was negative. Fine needle aspiration cytology failed to reveal any sufficient sample for evaluation. Open laparotomy and biopsy was done that showed granulomas suggestive of tuberculosis. Category one anti tubercular treatment was started and symptoms resolved within one month.
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Affiliation(s)
- D Pannu
- Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital, New Delhi, India
| | - S Malik
- Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital, New Delhi, India
| | - S Shamsunder
- Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital, New Delhi, India
| | - A Bhatnagar
- Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital, New Delhi, India
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14
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Otjen JP, Stanescu L, Goldin A, Parisi MT. A normal ovary in an abnormal location: A case of torsion. J Clin Ultrasound 2015; 43:578-580. [PMID: 25110990 DOI: 10.1002/jcu.22223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 07/22/2014] [Indexed: 06/03/2023]
Abstract
The clinical and radiologic diagnosis of adnexal torsion is challenging. The patient's history, physical examination, and laboratory evaluation may overlap significantly with other causes of abdominal pain. Ultrasound is the most common radiologic tool to assess for torsion, and the imaging findings can be equally equivocal. We present a case of adnexal torsion in an 18-year-old emergency room patient with abdominal pain, diagnosed by ultrasound based solely on an abnormal medial position of the ovary-a finding that has been only rarely mentioned in the literature, and never in isolation.
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Affiliation(s)
- Jeffrey P Otjen
- Department of Radiology, Seattle Children's Hospital, University of Washington, Mail Stop MA.7.220, 4800 Sand Point Way NE, Seattle, WA, 98105
| | - Luana Stanescu
- Department of Radiology, Seattle Children's Hospital, University of Washington, Mail Stop MA.7.220, 4800 Sand Point Way NE, Seattle, WA, 98105
| | - Adam Goldin
- Department of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Mail Stop OA.9.220, 4800 Sand Point Way NE, Seattle, WA, 98105
| | - Marguerite T Parisi
- Department of Radiology, Department of Pediatrics, Seattle Children's Hospital, Mail Stop MA.7.220, 4800 Sand Point Way NE, Seattle, WA, 98105
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Kuna K, Grbavac I, Vuković A, Bilić N, Kraljević Z, Butorac D. Coexistence of ruptured ectopic tubal pregnancy, dermoid and endometriotic cyst with tubo-ovarian abscess in the same adnexa: case report. Acta Clin Croat 2015; 54:103-106. [PMID: 26058252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
A 32-year-old pregnant woman presented to the hospital with abdominal pain and minimal vaginal bleeding. Transvaginal ultrasound revealed visible fluid in pelvic region with suspected tubal rupture, and subsequently laparoscopy was performed. During laparoscopy, additional gynecologic pathologies were noticed. Histopathologic finding showed dermoid and endometriotic cyst, as well as tubo-ovarian abscess in the same adnexa. This case report highlights the necessity of considering multiple diagnoses in the same organic system, which may be encountered by surgeon and histopathologist.
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Sahlu Z, Negash S, Yusuf L. ADNEXAL TORSION A FIVE-YEARS RETROSPECTIVE REVIEW IN TWO HOSPITALS. Ethiop Med J 2014; 52:155-164. [PMID: 26410988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Adnexal torsion remains a challenging diagnosis, often leading to delayed operative intervention and resultant ovarian loss. Objective: To describe the clinical profile and therapeutic approaches of adnexal torsion in the Ethiopian setting. METHODS A retrospective cross sectional descriptive chart review ofwomen with surgically proven adnexal torsion was conducted in two teaching hospitals from Jan 1 2007 - Dec 31, 2011. RESULTS A total of 53 women with AT were analyzed. About 33(62%) of torsion occurred in the age group of 20 - 29 years. The most common symptoms were lower abdominal pain 52 (98.1 %) followed by nausea and vomiting 46 (86.8%), whereas, the common physical findings were lower abdominal tenderness 49(92.5%) and palpable pelvic mass 40 (76.9%). Adnexal torsion was considered in the diferential diagnosis upon initial evaluation only in 27 (51%) of the cases. Of the study subjects, only 7(13.2%) had surgery within 24 hours of arrival to the facility and the mean time from initial evaluation to surgery was 53.8±44.5 hours. Moderately positive correlation was observed between ultrasound and intra-operative adnexal size measurement (r = 0.716, p = 0.000). Using non-parametric independent sample test, none of the clinical profile categories studied show significant difference in mean time from initial evaluation to surgery. Despite the overwhelmingly benign pathology, most 46 (86.8%) ofpatients underwent adnexectomy_with only 3(5.7%) adnexal salvage rate. CONCLUSION Delayed surgical intervention and low ovarian salvage rate inspite of predominantly benign pathology was observed. Therefore, high degree of suspicion, especially in patients with high risk factors, and timely intervention must be exercised in an effort to salvage the adnexae.
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Steinthorsdottir KJ, Folmer L, Bisgaard T. [Acute lower abdominal pain caused by adnexal torsion in a ten-year-old girl]. Ugeskr Laeger 2014; 176:V03140193. [PMID: 25292479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A ten-year-old girl presented with four days of lower abdominal pain. A diagnostic laparoscopy on the suspicion of acute appendicitis revealed left-sided adnexal torsion. The cyanotic ovary was detorsed and recovered. At three-month follow-up there were no clinical or ultrasonic signs of pathology. The clinical presentation of adnexal torsion is unspecific and mimics several differential diagnosis. Adnexal torsion is a rare condition, especially in pre-pubertal girls. However, it must still be kept in mind when evaluating girls regardless of age with lower abdominal pain.
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Vornicova O, Hershkovitz D, Yablonski-Peretz T, Ben-Itzhak O, Keidar Z, Bar-Sela G. Treatment of metastatic extramammary Paget's disease associated with adnexal adenocarcinoma, with anti-HER2 drugs based on genomic alteration ERBB2 S310F. Oncologist 2014; 19:1006-7. [PMID: 25085898 DOI: 10.1634/theoncologist.2014-0054] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Olga Vornicova
- Division of Oncology, Rambam Health Care Campus and Technion-Israel Institute of Technology, Haifa, Israel
| | - Dov Hershkovitz
- Institute of Pathology, Rambam Health Care Campus and Technion-Israel Institute of Technology, Haifa, Israel
| | - Tamar Yablonski-Peretz
- Sharett Institute of Oncology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Ofer Ben-Itzhak
- Institute of Pathology, Rambam Health Care Campus and Technion-Israel Institute of Technology, Haifa, Israel
| | - Zohar Keidar
- Department of Nuclear Medicine, Rambam Health Care Campus and Technion-Israel Institute of Technology, Haifa, Israel
| | - Gil Bar-Sela
- Division of Oncology, Rambam Health Care Campus and Technion-Israel Institute of Technology, Haifa, Israel
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Abstract
AIM Adnexal torsion is an infrequent and serious gynecologic surgical emergency. Adnexal torsion may result from pre-existing tubal or ovarian pathology or hyperstimulation of the ovary during ovulation. Early diagnosis and emergency surgical treatment (detorsion) are important to preserve fertility and to prevent peritonitis or loss of the adnexa. However, during reperfusion, tissue damage is more severe than during ischemia because of oxygen-derived radicals. The present study aimed to investigate the protective effect of gradual detorsion on adnexal torsion. MATERIALS AND METHODS Twenty-one adult female rats were divided into three groups as sham-operated (Sh group, n = 7); torsion + detorsion (TD group, n = 7); and torsion + gradual detorsion (TGD group, n = 7). A midline laparotomy was performed under anesthesia. In the TD and TGD groups, the left adnexa along with tubal and ovarian vessels were twisted three times in a clockwise direction and fixed to the abdominal wall. After 30 h, detorsion was performed on the mesenteries of both TD and TGD groups. In the TGD group, however, detorsion was performed gradually: the ovarian mesentery was detorsioned 360°, followed by a 5-min pause, then a repeat of the cycle until full detorsion was achieved. Rats were killed 1 week later. Left ovaries were removed and evaluated histopathologically. RESULTS The histopathological mean grade was significantly higher in the TD than in the TGD group (p < 0.05). CONCLUSION Gradual detorsion can reduce reperfusion injury in a rat model of ovarian torsion. This method is easily applicable and may be a useful method for human patients with ovarian torsion.
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Affiliation(s)
- Sezen Ozkisacik
- Department of Pediatric Surgery, Adnan Menderes University Faculty of Medicine, Aydin, Turkey,
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20
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Appelbaum H, Abraham C, Choi-Rosen J, Ackerman M. Key clinical predictors in the early diagnosis of adnexal torsion in children. J Pediatr Adolesc Gynecol 2013; 26:167-70. [PMID: 23566796 DOI: 10.1016/j.jpag.2012.12.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 12/11/2012] [Accepted: 12/28/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Adnexal torsion (AT) accounts for 2.7% of cases of acute abdominal pain in children. When AT is undiagnosed, ovarian blood supply is compromised, eventually leading to tissue necrosis. Because the clinical presentation of AT is nonspecific, preoperative diagnosis is challenging. The purpose of this study was to identify predictors that differentiate AT from other sources of acute abdominal pain. METHODS This study was an IRB-approved retrospective chart review of girls age 4-18 y/o with acute abdominal pain who then underwent surgical evaluation. Data collected included age, menarchal status, symptoms, physical exam findings, laboratory tests, imaging studies, operative procedures and postoperative diagnosis. Factors associated with AT were included in a logistic regression model. A receiver operator characteristic (ROC) curve based on this model was then constructed in order to determine its ability to predict AT. RESULTS 94 patients presented with acute abdominal pain; 45 were diagnosed with AT and 49 with other causes of abdominal pain. Presence of intermittent pain (P < .0217), non-radiating pain (P < .0229) and increased adnexal size (P < .0032) were significantly associated with AT in the final model. The area under the ROC curve was equal to 0.8601, suggesting excellent discrimination between AT and other causes of acute abdominal pain by using these 3 parameters. CONCLUSION Key clinical and imaging findings can aid in the early diagnosis of AT in children. Future prospective studies will focus on development of a clinical predictive model for the diagnosis of AT in the pediatric population.
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Affiliation(s)
- Heather Appelbaum
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Hofstra NSLIJ School of Medicine/Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, NY 11040, USA.
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21
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Frederick S, Frederick J, Harriot J, Christie L. Laparoscopic ovarian ligament plication in pregnancy. W INDIAN MED J 2013; 62:158-160. [PMID: 24564070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This 32-year old patient presented at seven weeks gestation with severe left-sided lower abdominal pain. This was against the background of a previous history of left salpingectomy from a ruptured ectopic gestation seven years previously. Transvaginal sonographic evaluation revealed a viable seven week intrauterine embryo, a 2 cm left corpus luteum cyst and Doppler studies revealed reduced internal flow. This led the way for a conservative approach via laparoscopy of untwisting the pedicle to restore blood flow In this case, the ovarian ligament was shorted using 1/0 vicryl and the pregnancy went to term.
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Affiliation(s)
- S Frederick
- Hugh Wynter Fertility Management Unit, The University of the West Indies, Kingston 7, Jamaica.
| | - J Frederick
- Hugh Wynter Fertility Management Unit, The University of the West Indies, Kingston 7, Jamaica
| | - J Harriot
- Hugh Wynter Fertility Management Unit, The University of the West Indies, Kingston 7, Jamaica
| | - L Christie
- Hugh Wynter Fertility Management Unit, The University of the West Indies, Kingston 7, Jamaica
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22
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23
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Prins RC, Gladwin M, Brod LS, Bhardwaj A, Hunter AJ. Chance favors the prepared mind. J Hosp Med 2012; 7:717-20. [PMID: 23024002 DOI: 10.1002/jhm.1976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 07/24/2012] [Accepted: 07/30/2012] [Indexed: 11/10/2022]
Affiliation(s)
- Renee C Prins
- Knight Cancer Institute, Division of Hematology/Medical Oncology, Oregon Health & Science University, Portland, OR 97239, USA. prinsr@ohsu
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Rousset P, Chaillot PF, Bats AS, Le Frère Belda MA, Buy JN. A regressive Meigs syndrome after definitive adnexal torsion. Am J Obstet Gynecol 2011; 205:e4-5. [PMID: 21714950 DOI: 10.1016/j.ajog.2011.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 04/08/2011] [Accepted: 04/11/2011] [Indexed: 11/27/2022]
Abstract
The Meigs syndrome is a rare but well known syndrome in which removal of the tumor results in cure. We report a case of a regressive Meigs syndrome after a definitive adnexal torsion which highlights the major role of the vascular phenomena in the physiopathology of this puzzling syndrome.
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Affiliation(s)
- Pascal Rousset
- Université Paris Descartes, Assistance Publique des Hôpitaux de Paris, Department of Radiology, Hôpital Hôtel Dieu, Paris, France
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Farhi J, Ben-Haroush A. Distribution of causes of infertility in patients attending primary fertility clinics in Israel. Isr Med Assoc J 2011; 13:51-54. [PMID: 21446238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Infertility is one of the most prevalent health disorders in young adults. OBJECTIVES To study the distribution of causes of infertility in couples referred to primary infertility clinics in Israel. METHODS Data for a 9 year period were derived from two clinics of major women's hospitals run by the country's largest health insurance fund. All patients were treated by one physician. Laparoscopy was not performed to rule out endometriosis. RESULTS Of the 2515 couples identified, 1991 (79.2%) had a definitive diagnosis following complete workup (including hysterosalpingography). Mean age was 29.6 +/- 6.0 years; mean duration of infertility was 1.7 +/- 1.8 years. Primary infertility accounted for 65% of cases. Causes of infertility were male factor (45%), oligo-ovulation disorders (37%), and tubal damage (18%). Infertility factors were identified in the woman alone in 30.6% of cases and the man alone in 29.2%. Two combined infertility factors were found in 18% of patients, and three combined factors in 0.5%. The rate of unexplained infertility (which probably includes non-tubal endometriosis) was 20.7%. CONCLUSIONS As male factor accounts for almost half of all cases of infertility in couples, sperm analysis is mandatory before any treatment.
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Affiliation(s)
- Jacob Farhi
- Fertility Clinics, Women's Health Centers, Clalit Medical Services, Ashdod and Holon, Israel
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Pusiol T, Zorzi MG, Morichetti D. Extracutaneous seborrheic inclusion cyst: an unusual presentation. Pathologica 2010; 102:420-422. [PMID: 21361125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Seborrheic inclusion cyst is an unusual variant of epidermal cyst characterized by parietal histology similar to seborrheic keratosis. Cysts with such changes have been called "seborrheic keratosis-like changes in epidermal cyst" or "epidermoid cyst with seborrheic verruca-like cyst wall" or simply "seborrheic cyst". To date, this lesion has been described exclusively in cutaneous sites. We describe the first case of an extracutaneous seborrheic inclusion cyst arising from round ligament. A 30-year-old female was referred to our institution for abdominal pain. Ultrasonography showed a hypoechoic heterogeneous, round mass adjacent to the lower extremity of the left ovary, measuring 4.5 cm in maximum diameter. Contrast-enhanced computed tomography of the pelvis in the venous phase showed a round (4.5 cm in diameter) cystic lesion with inhomogeneous fluid content in the side of the left large ligament and anterior to the homolateral adnexa. Laparoscopic resection of the mass was performed. Intraoperatively, an extraperitoneal glistening pelvic mass was discovered: the lesion was attached to the intrapelvic 1/3 middle portion of the left round ligament. Macroscopically, the mass measured 6 cm x 6 cm x 3.5 cm and exhibited a smooth and glistening external surface. On cut sections, the mass was an unilocular cyst filled with soft, yellow, amorphous material. Histologically, the cystic wall was lined by a stratified squamous epithelium with a granular cell layer. The cavity contained keratin-like material. The cystic wall showed numerous areas with close-set basaloid cells and pseudohorn cysts. The latter aspect consisted of cystic invaginations of the epithelium filled with surface keratin, which in a given microscopic section may be cut in cross-section, thereby appeared as "cysts" within the involved epithelium. Parietal rupture was present, accompanied by granulomatous inflammation. There were no postoperative complications, and the patient was discharged 3 days after the procedure. The present case is unique in that it is the first reported case of an extracutaneous seborrheic inclusion cyst arising from a very unusual site, namely the round ligament. The site of origin of the lesion and its cystic nature were established by computed tomography findings. Conservative treatment with enbloc resection was possible. Histological examination confirmed computed tomography findings. The present report described a lesion typically found in dermatopathology practice, but which had arisen in an extracutaneous site.
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Affiliation(s)
- T Pusiol
- Institute of Anatomic Pathology, S. Maria del Carmine Hospital, Rovereto (TN), Italy.
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27
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Parma P, Dall'Oglio B, Samuelli A, Bondavalli C, Bellomi A. [Laparoscopic removal of voluminous right seminal vesicle neoplasm]. Urologia 2010; 77 Suppl 17:46-49. [PMID: 21308675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2010] [Indexed: 05/30/2023]
Abstract
INTRODUCTION We present the case of a male adnexal tumor of probable Wolffian origin occurred to the right seminal vesicle of a 47-year-old man. MATERIALS AND METHODS The patient presented with a 2-month history of hematospermia. The diagnosis was achieved by transrectal ultrasound, CT of the abdomen and pelvis, and biopsy of both prostate and seminal vesicle. The patient was counseled for laparoscopic excision of the right seminal vesicle. RESULTS The right seminal vesicle, along with the tumor and the right vas deferens, were excised and clear margins were ensured by frozen section. Total operative time was 180 with 200 mL blood loss. The patient's recovery was uncomplicated and he was discharged on the fourth post-operative day. The histologic examination demonstrated a male adnexal tumor of probable Wolffian origin, which is a rare low-grade malignant neoplasm that has been previously described in the broad ligament, ovaries and retroperitoneum of females. The patient is free of relapse at a 20-month follow-up. CONCLUSIONS This is the second report of this entity in a male. The laparoscopic approach for the excision of seminal vesicle neoplasms is a good treatment for its obvious benefits of minimal blood loss, short hospital stay and quick return to normal activity. The magnifications of the anatomical details of the pelvic floor help the surgeon in the dissection of the seminal vesicle from the other structures.
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Affiliation(s)
- Paolo Parma
- Divisione di Urologia, Ospedale Carlo Poma Mantova, Italy.
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28
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H'ng MWC, Wanigasiri UIDK, Ong CL. Perineural (Tarlov) cysts mimicking adnexal masses: a report of three cases. Ultrasound Obstet Gynecol 2009; 34:230-233. [PMID: 19644949 DOI: 10.1002/uog.6448] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Perineural (Tarlov) cysts are usually incidental findings during magnetic resonance imaging (MRI) performed for low back pain. However, in a tertiary women's hospital, they may present as incidental findings on gynecological ultrasound imaging. Approximately 40,000 pelvic scans are performed annually in our department. Tarlov cysts were identified in three women between August 2007 and September 2008. In two patients (Cases 1 and 3), these cysts were initially misdiagnosed as hydrosalpinges on ultrasound examination, the latter having a differential diagnosis of an ovarian cyst. Two patients (Cases 1 and 2) were symptomatic, although Case 2 had symptoms that could not entirely be accounted for by the location of the cyst. Although asymptomatic, Case 3 underwent laparoscopy with a view to salpingectomy/cystectomy. In these patients, confirmation of Tarlov cysts was subsequently made on either computed tomography (CT) or MRI. All three patients were managed conservatively. Here we describe their clinical presentation, the appearance of the cysts on ultrasound imaging and on CT or MRI, and their eventual outcomes.
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Affiliation(s)
- M W C H'ng
- Department of Diagnostic Imaging, Kandang Kerbau Women's and Children's Hospital, Singapore.
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29
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Affiliation(s)
- M Quinn
- Department of Obstetrics and Gynaecology, Hope Hospital, Salford, UK.
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30
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Sakowska MM, Short J, Eglinton T. Medical image. An unusual case of inguinal pain. N Z Med J 2009; 122:69-72. [PMID: 19652684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Markova D, Milchev N, Gurova A, Batashki I. [Adnexal torsion and concominant appendicitis during third trimester of pregnancy--a case report]. Akush Ginekol (Sofiia) 2009; 48:59-61. [PMID: 20225501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Adnexial torsion is a rare, but important cause for abdominal pain during pregnancy. During pregnancy, its frequency is 10-20%, with highest frequency in the first trimester. We present a case of 24 year primigravida, with an acute onset of clinical symptoms with concominant disease chronic pyelonephritis. The initial diagnosis was exacerbation of the concominant disease and acute inflammation of the appendix. The intraoperative diagnosis was right adnexial torsion and inflammation of the appendix; the diagnosis was pathologically proved. Although rare, it can be included in the differential diagnosis of acute abdomen during pregnancy.
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Napolitano L, Waku M, Liddo G, Innocenti P. [Laparoscopic approach to acute abdomen: a single-center clinical experience]. G Chir 2008; 29:47-50. [PMID: 18252150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
INTRODUCTION in patients with acute abdomen laparoscopic procedure provides, in most cases, the simultaneous accomplishment of diagnosis and therapy with undoubted advantages. PATIENTS AND METHODS from January 2000 to December 2006, 97 patients who presented with acute abdomen were operated by laparoscopic approach in the Unit of Laparoscopic Surgery in the University of Chieti. Of these, 53 were females and 44 males. Average age was 48 years. Seven had perforated peptic ulcer, 61 acute cholecystitis, 15 acute appendicitis, 2 idiopathic segmental necrosis of the great omentum, 6 small bowel obstruction, 6 adnexal pathologies. Pre-operative diagnosis was established in 76 patients (78.3%). RESULTS in 92 patients (94.8%) it was possible to treat the cause of the acute abdomen by laparoscopic means. In 5 cases (5.2%) it was necessary to convert the laparoscopic procedure. No mortality was noted. The morbidity was observed in 5 patients (5.2%): 3 cases of post-operative pneumonia and 2 cases of post-operative anaemia, all treated conservatively. None of the patients was re-operated. Advantages in terms of reduction in hospital stay were observed in patients operated either for acute cholecystitis or for intestinal obstruction, not in patients operated for appendectomy, adnexal pathologies or perforated peptic ulcer. CONCLUSION we believe that laparoscopic approach in patients with acute abdomen is safe and advantageous in most cases; however we think that it should always be preceded by non invasive diagnostic techniques.
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Affiliation(s)
- L Napolitano
- Università degli Studi G D'annunzio di Chieti, Dipartimento di Scienze Chirurgiche, Italy
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Abstract
Female adnexal tumors of probable Wolffian origin are rare. Although the histological features of the benign tumors are recognized, features of malignancy are not well defined in published work because these tumors are particularly rare. In this study, we report an 81-year-old woman presenting with a 6-month history of postmenopausal bleeding. A pelvic transvaginal ultrasound scan demonstrated a midline, highly vascular, predominantly solid pelvic mass, approximately 14 cm, posterior to the uterus. CA-125 was moderately raised. She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and infracolic omentectomy. Immunohistochemical staining and electron microscopy supported the diagnosis of female adnexal tumor of probable Wolffian origin. There was significant and widespread nuclear pleomorphism with increased mitotic activity endorsing the diagnosis of a malignant tumor. Seven months after initial surgery, follow-up magnetic resonance imaging showed a mass with a maximum diameter of 7 cm in the region of the right adnexa consistent with a recurrence. The patient declined further treatment.
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Affiliation(s)
- Suha Deen
- Histopathology Department, Nottingham University Hospitals, Nottingham, UK.
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Aharoni A, Leibovitz Z, Levitan Z, Degani S, Ohel G. Complication of laparoscopic detorsion of adnexal mass. Gynecol Obstet Invest 2007; 65:39-40. [PMID: 17703093 DOI: 10.1159/000107459] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Accepted: 03/20/2007] [Indexed: 11/19/2022]
Abstract
Detorsion of an ischemic adnexal mass has recently been advocated for most cases of twisted adnexa. Usually, the affected ovary regains some or all of its vitality and function. However, when the ovary is completely necrotic, it may form an abscess if it contains tissue components that cannot be eliminated by the peritoneal immune system. We report a case of pelvic abscess formation in a detorsed ovary that previously contained an unsuspected dermoid cyst. We call for an extensive inspection of the detorsed ovary before ending the laparoscopic operation, and if it remains necrotic and is suspected of containing a dermoid cyst, it should be removed promptly.
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Affiliation(s)
- A Aharoni
- Gynecology and Obstetrics Department, Bnai-Zion Medical Center and the Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.
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Affiliation(s)
- Garrett W Colby
- University of Alabama School of Medicine, Birmingham, AL, USA
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36
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Abstract
OBJECTIVE Hydatids of Morgagni are common embryonal remnants of the müllerian duct and among the infrequent causes of adnexal torsion. The purpose of this study was to investigate the occurrence of adnexal torsion involving hydatids of Morgagni, as well as its possible mechanisms. METHODS A database search was conducted for cases of adnexal torsion treated in our institution from January 2002 to July 2005. These cases were analyzed, focusing on a subgroup of adolescents with adnexal torsion involving the hydatids of Morgagni. RESULTS There were 76 patients with adnexal torsion. The rate of hydatid of Morgagni torsion was 26% (4 of 15 cases, 95% confidence interval [CI] 0.15-0.51) in the adolescent subgroup (10-19 years old), compared with 0% (0 of 61 cases, 95% CI 0-0.048) in the adult subgroup. The difference between the hydatid torsion rates in the two subgroups was statistically significant (P = .01, 95% CI 0.001-0.532). The four patients with hydatid torsion (postmenarchal girls, aged 13-18 years) were managed with laparoscopic adnexal detorsion and cystectomy of the affected hydatid of Morgagni. At surgery, we noted three different mechanisms of hydatid torsion: torsion of the adnexa together with torsion of the hydatid of Morgagni, torsion of the hydatid of Morgagni with intact adnexa (n = 2), and entanglement of the hydatid's pedicle around the distal fallopian tube. The hydatids of Morgagni were observed on the preoperative transabdominal ultrasonogram in only one patient and appeared as a simple cyst. CONCLUSION Adnexal torsion involving the hydatids of Morgagni appears to be more common in adolescents than previously thought. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Moty Pansky
- Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, Zerifin, Israel.
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Haslík L, Mára M, Kuzel D, Zizka Z, Dundr P. [Present occurrence of benign teratoma of ovary and fallopian tube in a patient with adnexal torsion]. Ceska Gynekol 2006; 71:342-4. [PMID: 16956051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE The authors demonstrate the case of left adnexal torsion caused by 2 benign teratomas in its ovarian and tubal location. DESIGN Case report. SETTING Department of Obstetrics and Gynecology, 1st Faculty of Medicine and General Teaching Hospital, Charles University, Prague. CASE 24-years old woman underwent laparoscopy for several days lasting pain in lower abdomen and ultrasound finding of semicystic mass in the left adnexal region with suspicion of teratoma. The benign teratoma of the left ovary together with a torsion of the left Fallopian tube distended by teratoma was revealed during surgery. Left side salpingectomy and enucleation of the ovarian teratoma has been performed. This surprising finding was confirmed by histopathological examination. CONCLUSION The acute gynaecological torsion event may be caused not only by torsion of uterine fibroid or enlarged tumorous ovary but rarely also by a teratoma of the Fallopian tube.
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Affiliation(s)
- L Haslík
- Department of Obsterics and Gynecology, 1st Faculty of Medicine and General Teaching Hospital, Charles University, Prague
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Abstract
OBJECTIVES To present a case of hydronephrosis and hydroureter secondary to pelvic endometriosis and to discuss the pitfalls in laparoscopic management. CASE REPORT A 37-year-old nulligravida woman had mild elevation of blood pressure for about 1 year without abdominal pain, dyspareunia, or dysmenorrhea. Renal ultrasound revealed left hydronephrosis and a 4-cm pelvic cyst. Intravenous pyelogram showed distal ureteral obstruction. An MRI with fat saturation disclosed a left ovarian endometrioma and a lesion in the uterosacral ligament causing periureteral compression. Laparoscopic findings included a dilated left ureter above the uterosacral ligament, left uterosacral ligament endometriosis with adhesions, and a 4-cm left ovarian endometrioma. Cystoureteroscopy showed external ureteral compression 2 cm above the ureteral orifice. A ureteral catheter was placed. The left endometrioma was enucleated and ureterolysis was performed. The latter procedure had to be discontinued because of bleeding from descending uterine vessels. The ureteral catheter was removed 2 months later and her blood pressure gradually returned to normal. However, after 1 year, she was found to have recurrent hydronephrosis and underwent segmental resection of the distal ureter and reconstruction by end-to-end reanastomosis. CONCLUSION In women of reproductive age, hydronephrosis and hypertension may be the only symptoms of endometriosis. While laparoscopic treatment is useful in endometriosis, it may fail in the presence of chronic inflammation and severe fibrosis.
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Affiliation(s)
- Hsing-Yu Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
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Daponte A, Pournaras S, Hadjichristodoulou C, Lialios G, Kallitsaris A, Maniatis AN, Messinis IE. Novel serum inflammatory markers in patients with adnexal mass who had surgery for ovarian torsion. Fertil Steril 2006; 85:1469-72. [PMID: 16616744 DOI: 10.1016/j.fertnstert.2005.10.056] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Revised: 10/25/2005] [Accepted: 10/25/2005] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the diagnostic value of preoperative levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), interleukin-8 (IL-8), and E-selectin in patients with an adnexal mass who had surgery for ovarian torsion. DESIGN Prospective study. SETTING University hospital. PATIENT(S) Fifty consecutive women with adnexal mass who were admitted with a diagnosis of ovarian torsion. INTERVENTION(S) All had a single preoperative measurement of IL-6, IL-8, TNF-alpha, and E-selectin by ELISA. MAIN OUTCOME MEASURE(S) To determine if a single preoperative serum sampling of IL-6, IL-8, TNF-alpha, and E-selectin by ELISA can diagnose ovarian torsion. RESULT(S) Thirteen patients had proven torsion of the ovary. Serum levels of IL-6 were significantly higher in the 13 patients with proven ovarian torsion compared with the 37 without ovarian torsion. Patients with IL-6 serum values > or =10.2 pg/mL had a 16 times higher risk of having ovarian torsion. No significant difference was found in TNF-alpha, IL-8, and E-selectin between the two groups. CONCLUSION(S) The IL-6 levels might assist in the prompt diagnosis of ovarian torsion and allow a timely surgical intervention.
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Affiliation(s)
- Alexandros Daponte
- Department of Obstetrics and Gynaecology, University Hospital of Larissa, Larissa, Greece.
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Marana R, Muzii L, Ferrari S, Catalano GF, Zannoni G, Marana E. Management of adnexal cystic masses with unexpected intracystic vegetations detected during laparoscopy. J Minim Invasive Gynecol 2006; 12:502-7. [PMID: 16337577 DOI: 10.1016/j.jmig.2005.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2005] [Accepted: 07/14/2005] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE To evaluate a prospective series of consecutive patients with unexpected intracystic vegetations detected during operative laparoscopy for adnexal masses. DESIGN Prospective series of consecutive patients (Canadian Task Force classification: II-2). SETTING Tertiary care university hospitals. PATIENTS Consecutive patients found during surgery to have unexpected intracystic vegetations and treated by operative laparoscopy, out of a total series of 667 patients under 40 years of age with ultrasonographic evidence of an adnexal cystic mass without thick septa, internal wall papillarities, or solid components. INTERVENTIONS Operative laparoscopy and follow-up. MEASUREMENTS AND MAIN RESULTS Thirty-five (5.2%) of 667 patients were found at surgery to have unexpected intracystic vegetations. A frozen section was sent for pathologic analysis in all 35 patients. Frozen section diagnosis was benign in 32 patients and borderline in 3 patients. Final pathology diagnosis was borderline ovarian tumor in five of the 35 patients (14.3%), and benign in 30 patients (85.7%). No case of invasive carcinoma was diagnosed either at frozen section or at final pathology examination. The patients with borderline tumors are alive with no evidence of disease after a mean follow-up of 60 months. CONCLUSIONS In the present series, with accurate preoperative selection, the rate of adnexal cysts with unexpected intracystic vegetations was 5%, of which 14% were borderline tumors. The laparoscopic management of these adnexal masses did not adversely affect the prognosis.
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Affiliation(s)
- Riccardo Marana
- Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Italy.
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41
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Abstract
A retrospective analysis of all pregnant women who had an adnexal mass surgically resected at the Government Medical College and Hospital, Chandigarh, over a 5-year period found an incidence of 20 in 16,260 deliveries during the study period. The most frequent complication was torsion (25% of the cases) and the majority of cases occurred in the first trimester of pregnancy. Two of the women had malignant ovarian tumours. There was no difference in gestational age at delivery or birth weight in patients undergoing emergency surgery versus elective surgery.
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Affiliation(s)
- Ibha Kumari
- Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Chandigarh, India
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Alcázar JL, Mercé LT, García Manero M. Three-dimensional power Doppler vascular sampling: a new method for predicting ovarian cancer in vascularized complex adnexal masses. J Ultrasound Med 2005; 24:689-696. [PMID: 15840800 DOI: 10.7863/jum.2005.24.5.689] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE The purpose of this study was to explore the role of a new concept ("vascular sampling") as a third step to discriminate benign and malignant lesions in B-mode and color Doppler sonographically suggestive adnexal masses. METHODS Forty-five women (mean age, 52.3 years; range, 17-82 years) with the diagnosis of complex adnexal masses on B-mode sonography were evaluated using 3-dimensional power Doppler sonography. Four women had bilateral masses. After a morphologic reevaluation was done, color pulsed Doppler sonography was used to obtain flow velocity waveforms, and velocimetric indices were calculated (resistive index, pulsatility index, and peak systolic velocity). Thereafter, 3-dimensional power Doppler sonography was used to assess vascularization of highly suggestive areas (gross papillary projections, solid areas, and thick septations), meaning a focused assessment ("sampling") of a suggestive area of the tumor. With a virtual organ computer-aided analysis program, vascular indices (vascularization index, flow index, and vascular flow index) were automatically calculated. A definitive histologic diagnosis was obtained in each case. RESULTS Forty masses (82%) were malignant and 9 (18%) were benign. Morphologic evaluation revealed 10 (20%) unilocular solid masses, 20 (41%) multilocular solid masses, and 19 (39%) mostly solid masses. Blood flow was found in all cases. Median vascularization index (15.5% versus 8.2%; P = .002), flow index (33.6 versus 20.8; P = .007), and vascular flow index (5.2 versus 2.3; P = .001) were significantly higher in malignant tumors. No differences were found in resistive index (0.43 versus 0.45; P = .770), pulsatility index (0.62 versus 0.65; P = .694), and peak systolic velocity (15.6 versus 12 cm/s; P = .162). CONCLUSIONS Three-dimensional power Doppler vascular sampling seems to be a promising tool for predicting ovarian cancer in vascularized complex adnexal masses. It could be better than conventional color pulsed Doppler imaging.
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Affiliation(s)
- Juan Luis Alcázar
- Department of Obstetrics and Gynecology, Clínica Universitaria de Navarra, Avenida Pio XII 36, 31008 Pamplona, Spain.
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43
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Abstract
Paratubal cysts rarely undergo torsion. When they do, typically they involve the infundibulopelvic ligament and affect the ovary and fallopian tube. We present a case and discussion of torsion of the uteroovarian ligament secondary to a large paratubal cyst with preservation of the ovary and fallopian tube.
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Affiliation(s)
- Jennifer E Dietrich
- University of Louisville School of Medicine, Department of Obstetrics and Gynecology, Division of Pediatric and Adolescent Gynecology, Louisville, Kentucky 40202, USA.
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Popović J, Sulović V, Vucetić D. Laparoscopy treatment of adnexal sterility. CLIN EXP OBSTET GYN 2005; 32:31-4. [PMID: 15864933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
A total of 113 patients who were examined and treated for matrimonial infertility underwent surgical laparoscopy at the Sterility and Infertility Department, Clinic of Gynecology and Obstetrics, Clinical Center of Nis. Age distribution in the group of patients who were subjected to surgical laparoscopy after diagnosis was 31.39 +/- 6.1 years, out of whom 74.3% were treated for primary sterility. Out of corrective interventions in laparoscopy, the following procedures were performed: adnexiolysis, salpingo-ovariolysis, fimbrioplasty, terminal salpingoneostomy, cyst puncture and ovarian incision. During any surgical laparoscopy, ovarian biopsy was performed for evaluation of ovarian potency and verification of probable histopathological findings. The most commonly used technique was salpingo-ovariolysis--in 22.88% of cases, followed by fimbrioplasty--18.81%. A total of 42 pregnancies were verified: 36 intrauterine (29 completed at full term) and 6 extrauterine pregnancies. Average conception rate in our patients was 37.17%, while rate of parturition was 25.66%. The rate of pregnancy in different corrective laparoscopic procedures ranged from 18.18%-61.54%. The rate of intrauterine pregnancy was the highest after bilateral fimbrioplasty (47.83%), and the lowest after bilateral neosalpingostomy--9.09%. The rate of delivery after adhesiolysis was 30.8%, after salpingo-ovariolysis--28.8%, after fimbrioplasty--18.3%, and after neostomy--12.5% of the time.
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Affiliation(s)
- J Popović
- Clinic of Gynecology and Obstetrics, Clinical Center of Nis, Serbia and Montenegro
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45
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Abstract
BACKGROUND Hemoperitoneum resulting from spontaneous rupture of the uterine vessels in pregnancy is rare and associated with high maternal and fetal mortality. CASE A woman presented with acute abdominal pain and hypovolemic shock at 20 weeks of gestation. Immediate laparotomy revealed massive hemoperitoneum resulting from spontaneous rupture of the left uterine vessels associated with a left adnexal mass consisting of decidualized endometriosis. The fetus was delivered by hysterotomy, hemostasis was achieved, and the woman made a good recovery. CONCLUSION We report a case of hemoperitoneum in pregnancy that resulted from spontaneous rupture of the uterine vessels associated with decidualized endometriosis.
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Affiliation(s)
- Uzma Aziz
- Department of Obstetrics and Gynecology, Great Western Hospital, Swindon, United Kingdom
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46
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Abstract
Lymphangioleiomyomatosis (LAM) is a rare parenchymal lung disease, which affects young women of childbearing age and is characterized pathologically by proliferation of interstitial smooth muscle and formation of cysts in the lung. While LAM is usually predominantly a respiratory disorder, it can also initially involve other extrapulmonary organs. We report the case of a 35-year-old Chinese woman, who presented with a 4-week history of left thigh swelling which was found to be secondary to compression of pelvic veins by a mass lesion. The latter was found histologically to show LAM. Despite the patient being asymptomatic and displaying normal lung function, a thoracic high resolution CT scan showed typical features of early LAM. This case further illustrates that LAM can have multisystem involvement, and demonstrates the importance of being aware of the diagnosis in cases presenting with extrapulmonary manifestation, in order that patients are diagnosed and managed appropriately.
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Affiliation(s)
- Bing Lam
- University Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
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47
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Schnee DM. The adnexal mass in pregnancy. Mo Med 2004; 101:42-5. [PMID: 15017752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The management of the adnexal mass in pregnancy can place the patient and/or fetus at risk. Adnexal masses occur in approximately one in 600 pregnancies, of which the risk of malignancy is up to 5%. The decision to proceed with conservative versus operative intervention is discussed in this article.
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Affiliation(s)
- D Mark Schnee
- Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, USA
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48
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Carter JF, Soper DE. Operative laparoscopy in pregnancy. JSLS 2004; 8:57-60. [PMID: 14974665 PMCID: PMC3015514] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE We compared the surgical outcomes of pregnant women undergoing laparotomy in the first 2 trimesters of pregnancy with those undergoing laparoscopy for the management of acute pelvic pain. METHODS We performed a systematic retrospective chart review of patients whose discharge diagnosis included intrauterine pregnancy with exploratory laparotomy or laparoscopy from August 1, 1993 to October 31, 1999. The following factors were assessed: preoperative diagnosis, postoperative diagnosis, gestational age at the time of surgery, operative time, hospital stay, pathology, gestational age at delivery, complications, and outcome of the pregnancy in both groups. RESULTS Sixteen pregnant patients underwent surgery during the study period. All but one had abdominopelvic pain, and all patients had an associated adnexal mass. The mean gestation age at the time of surgery was 15+/-6 weeks versus 13+/-4 weeks in the laparoscopic and laparotomy groups, respectively (P=NS). All patients undergoing laparoscopy remained in the hospital for one day compared with a mean of 4.4+/-1.1 days in the laparotomy group (P<0.0001). Pregnancy outcomes were similar and uniformly good. CONCLUSION Laparotomy can be avoided and pregnant patients managed safely by operative laparoscopy, with shorter hospital stays.
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Affiliation(s)
- James F Carter
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston 29425, USA.
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49
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Pŭnevska M, Nalbanski B, Nalbanski A, Georgiev S. [Salpingitis isthmica nodosa--frequency and etiology in infertile women]. Akush Ginekol (Sofiia) 2003; 42 Suppl 1:20-2. [PMID: 12858499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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50
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Abstract
The scope of gynecologic infections presenting to the emergency department is quite diverse. This article presents an update on the current literature for vaginitis, cervicitis, pelvic inflammatory disease, tubo-ovarian abscesses, the Fitz-Hugh-Curtis syndrome, herpes, and syphilis. Inadequate identification or treatment of these diseases can result is significant morbidity or mortality for the patient and for the fetus.
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Affiliation(s)
- Wesley Zeger
- Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, WA 98431, USA.
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