HISTOPATHOLOGICAL ANALYSIS OF NON-NEOPLASTIC OVARIAN LESIONS SEEN IN A TERTIARY HEALTH CENTRE IN NORTH WESTERN NIGERIA

Introduction

Ovarian lesions may present as enlargements of the ovary and may occur at any age. Non-neoplastic enlargements develop almost exclusively during the childbearing years. They may be asymptomatic or, in rare cases, cause acute symptoms due to complications and account for the most prevalent cause of hospital admissions. They frequently form a pelvic mass and potentially mimic an ovarian neoplasm.

Objective

To study the frequency and histopathological classification of non-neoplastic ovarian lesions in a tertiary institution in North-western Nigeria.

Methodology

A retrospective study in which surgical biopsy specimens seen over a 9-year period were reviewed with respect to age and histopathological characteristics.

Results

A total of 83 non-neoplastic lesions were histologically diagnosed during the period under review. They constitute 5.16 % and 40.9 % of both gynaecological and ovarian samples received respectively. Of which 33.7% were Corpus luteum, 13.3% were both Follicular cysts and simple cysts respectively. Luteoma of pregnancy and Infarction constitute 9.6% each respectively. Endometriosis and no pathology as part of TAH, 6.0% respectively. Ovarian ectopic gestation was 4.8% cases, Nonspecific inflammation (oophoritis) 2.4%, and 1.2% complex cyst. Majority of cases 45.8% occurred among women in the third decade and 26.5% in the fourth decade, cases within the fifth decade were 9.6% and the second decade constituted 8.4% cases.

Conclusion

Ovarian non-neoplastic lesions are common in our environment; they potentially mimic ovarian neoplasms thereby posing a diagnostic challenge. Proper classifications are important for appropriate management.

Role of scrape cytology smear preparation in the diagnosis of ovarian masses-utility and pitfalls

BACKGROUND

Scrape cytology technique is useful for rapid intraoperative diagnosis of ovarian mass lesions that acts as an adjunct to frozen section examination. Though ovaries can be accessed by laparoscopy and USG guided FNAC, there are controversial reports regarding the safety of these procedures. The present study has been designed to evaluate the role of scrape cytology in a variety of ovarian mass lesions.

OBJECTIVES

To study the cyto-morphology of ovarian mass lesions and to evaluate the role of scrape cytology technique in correctly diagnosing the ovarian lesions taking histopathological diagnosis as gold standard.

MATERIAL AND METHODS

This is a prospective observational study done on 61 ovarian mass lesions as received from the Obstetrics and Gynecology department of our Institution.

RESULT

Out of 61 cases, 58 (95.08%) cases were correctly diagnosed with respect to categorization and typing. The age ranged from 14 to 65 years with the mean age being 38.1 years. On histopathology, out of 61 cases, 39 (63.93%) were epithelial along with sub categorization of benign, borderline, and malignant, 13 (22.9%) were germ cell tumors, 5(8.19%) were sex cord stromal tumors, 3 (4.91%) were hemorrhagic cysts and the remaining 1 (1.63%) was massive ovarian edema. Thus, on comparing with histopathology, the sensitivity and specificity of scrape cytology technique were 93.55% and 96.67%, and the diagnostic accuracy was 95.08%.

CONCLUSION

Scrape cytology of ovarian lesions can give quick and reliable results. Also, proper training of cytopathologists chiefly regarding the sampling technique, gross presentation of ovarian lesions and interpretation of scrape cytology smears is needed. Further studies to provide standard guidelines and reporting criteria will prove to be helpful.

Comprehensive Review of Serous Tumors of Tubo-Ovarian Origin: Clinical Behavior, Pathological Correlation, Current Molecular Updates, and Imaging Manifestations

Ovarian cancer is the eighth most common women's cancer worldwide, with the highest mortality rate of any gynecologic malignancy. On a global scale, the World Health Organization (WHO) reports that ovarian cancer has approximately 225,000 new cases every year with approximately 145,000 deaths. According to the National Institute of Health, Surveillance Epidemiology and End Results program (SEER) database, 5-year survival for women with ovarian cancer in the United States is 49.1%. High-grade serous ovarian carcinoma typically presents at an advanced stage and accounts for the majority of these cancer deaths. Given their prevalence and the lack of a reliable method for screening, early and reliable diagnosis of serous cancers is of paramount importance. Early differentiation of borderline, low and high-grade lesions can assist in surgical planning and support challenging intraoperative diagnoses. The objective of this article is to provide a review of the pathogenesis, diagnosis, and treatment of serous ovarian tumors, with a specific focus on the imaging characteristics that help to preoperatively differentiate borderline, low-grade, and high-grade serous ovarian lesions.

Surgical Resection of Bilateral Polycystic Ovaries Causing Ureteral Obstruction

Ovarian cysts in adolescents are typically managed conservatively given the low rate of malignancy and the cysts typically regress over time. We present a case of a 14 year-old female with large bilateral adnexal cysts causing ureteral obstruction which was successfully treated with surgical resection and ensuring maximum preservation of ovarian tissue.

[Neonatal bilateral ovarian cystadenoma: Conservative or surgical treatment?]

INTRODUCTION

Bilateral complex ovarian cysts in newborns are rare and their reporting becomes imperative to in crease knowledge about the best therapeutic management.

OBJECTIVE

To describe the clinical case of a newborn with a diagnosis of bilateral complex ovarian cysts and to discuss the conditions for conservative or surgical management according to the ultrasound characteristics of the cyst.

CLINICAL CASE

At 35 weeks of gestational age, prenatal ultrasound identified the presence of cystic masses in both adnexa, so it was decided to interrupt the pregnancy by cesarean section at 37 weeks. After birth, bilateral ovarian cysts of 3.5 x 4.4 x 2.7 and 3.4 x 2.4 x 3.3 cm, right and left, respectively, were corro borated. The right cyst had a septum of 1.4 mm thick and thickened wall of 3 mm which was com patible with complex cysts. On the 4th day of extrauterine life, laparoscopic vacuum aspiration and deroofing with electrocautery of the upper wall of both cysts was performed, without complications. The diagnosis of ovarian serous cystadenoma was made by pathological anatomy.

CONCLUSIONS

We describe a case with adequate prenatal diagnosis and laparoscopic surgical intervention of a bilateral ovarian cyst > 4 cm. Prenatal diagnosis is essential for choosing the best therapy management (con servative or surgical) depending on the echography characteristics of the cyst. Neonatal surgery is recommended for simple ovarian cysts >4 cm, complex cysts regardless of their size, and those that become complex cysts during conservative management.

Controlled aspiration of large paediatric ovarian cystic tumours

AIM

Cystic ovarian masses in children may be physiological or neoplastic. It is mandatory that suspected neoplastic lesions are resected without tumour spillage. However, a large midline incision is cosmetically unappealing incision to young women. Here we describe our experience of using controlled drainage without spillage that allows a cosmetic pfannenstiel approach without compromising oncological principles.

METHOD

All girls treated with large ovarian cystic masses since 2008 in our centre were identified and data was collected prospectively. A small pfannenstiel incision was performed followed by peritoneal washings; tissue glue was used to stick an Opsite™ dressing to the cyst surface and fluid drained so there was no leakage back into the patient. Once aspirated the cyst was delivered and an ovarian preserving cystectomy was performed where possible.

RESULTS

Twenty-three girls (median age 14.5 years (8.1 to 16.5 years) were included. Pre-operative MRI scan showed a complex lesions with median volume of 1169 ml (range 252-7077 ml). At surgery 22/23 cysts were intact and removed without spillage.

HISTOLOGY

mature teratoma (11), serous cyst (3), mucinous cyst adenocarcinoma (2), mucinous cystadenoma (5), Sertoli-Leydig tumour, sclerosing stromal tumour. One girl with pre-operative rupture of a mucinous adenocarcinoma subsequently died. Ovarian sparing cystectomy was performed in 17/23 girls. All other patients are well without evidence of recurrence.

CONCLUSION

This is the largest series in children and adolescents using controlled drainage of cystic ovarian tumours. Though there were a range of diagnoses we have shown that these can be removed safely with a cosmetic pfannenstiel approach while following oncological principles.

The Optimal Time of Ovarian Reserve Recovery After Laparoscopic Unilateral Ovarian Non-Endometriotic Cystectomy

Background

Laparoscopic ovarian cystectomy is established as the standard surgical approach for the treatment of benign ovarian cysts. However, previous studies have shown that potential fertility can be directly impaired by laparoscopic ovarian cystectomy, diminished ovarian reserve (DOR), and even premature ovarian failure. Therefore, fertility-preserving interventions are required for benign gynecologic diseases. However, there are still little data on the time period required for recovery of ovarian reserve after the laparoscopic unilateral ovarian cystectomy, which is very important for the individualization of treatment protocols. This study aimed at investigating the time needed for the ovarian reserve to recover after laparoscopic unilateral ovarian non-endometriotic cystectomy.

Materials and Methods

Sixty-seven patients with unilateral ovarian non-endometriotic cyst from Zhoupu and Punan Hospitals who underwent laparoscopic unilateral ovarian cystectomy were recruited as a postoperative observation group (POG). Also, 69 healthy age-matched women without ovarian cyst who did not undergo surgery were recruited as a referent group (RFG). Ovarian reserve with the serum anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), estradiol (E2) levels, ovarian arterial resistance index (OARI), and antral follicle counts (AFCs) were measured on the third to fifth days of the same menstrual cycle. A postoperative 6-month follow-up of cases was performed.

Results

Compared with RFG, AFC of cyst side in the POG group showed no difference in the first, third, and sixth postoperative month (F = 0.03, F = 0.02, F = 0.55, respectively; p = 0.873, p = 0.878, p = 0.460, respectively). The OARI of cyst side in the POG group revealed no differences in the first, third, and sixth postoperative month (F = 0.73, F = 3.57, F = 1.75, respectively; p = 0.395, p = 0.061, p = 0.701, respectively). In the first month, the postoperative AMH levels significantly declined, reaching 1.88 ng/ml [interquartile range (IQR): 1.61-2.16 ng/ml] in POG and 2.57 ng/ml (IQR: 2.32-2.83 ng/ml) in RFG (F = 13.43, p = 0.000). For the data of AMH levels stratified by age, the same trend was observed between less than 25 and more than 26 years old. At this same time interval, the postoperative rate of decline was significantly lower compared to the preoperative one in POG (32.75%). The same trend was observed between the POG and RFG groups (26.67%).

Conclusions

The optimal time for recovery of ovarian reserve after laparoscopic unilateral ovarian cystectomy is estimated to be 6 months.

Management of Large Pediatric and Adolescent Ovarian Neoplasms with a Leak-Proof Extracorporeal Drainage Technique: Our Experience Using a Hybrid Minimally Invasive Approach

STUDY OBJECTIVE

In a pediatric setting, laparoscopic management of large cystic ovarian neoplasms with low malignancy probability is not suitable, because of the mass size; nevertheless, an effort should be made to be as minimally invasive as possible, without violating the principles of oncologic surgery. We describe our experience in managing these neoplasms with leak-proof extracorporeal drainage through mini laparotomy, followed by cyst excision or oophorectomy.

DESIGN

Case series study, describing interventions and outcomes.

SETTING

Department of pediatric surgery in a tertiary pediatric and adult university hospital.

PARTICIPANTS

Pediatric patients affected by large cystic ovarian mass.

INTERVENTIONS

Hybrid minimally invasive approach using leak-proof extracorporeal drainage.

MAIN OUTCOME MEASURES

Data on demographic characteristics, tumor marker values, and imaging findings were collected and analyzed. Outcome of surgical technique was evaluated and reported.

RESULTS

Between 2011 and 2018, 17 patients (mean age, 10.2 years; range, 2-14 years) affected by large cystic ovarian mass, were eligible for this technique. All patients had negative preoperative tumor markers. Of the seventeen subjects, 13/17 girls (76%) underwent pelvic magnetic resonance imaging. No sign of lymphadenopathy or metastasis was found. Surgery was successful in all patients, with ovarian preservation in 5/17 cases (29.4%). Mean surgical time was 98 minutes; no intra-abdominal leakage of neoplasm content or postoperative complications occurred. Mature cystic teratoma was the most frequent histopathological diagnosis (71%).

CONCLUSION

After a thorough patient selection, the management of large cystic ovarian neoplasms with leak-proof extracorporeal drainage performed through a mini laparotomy is a feasible and safe approach, with excellent cosmetic results. When achievable, ovarian-sparing surgery has to be considered.

Mast cells and Kurloff cells - Their detection throughout the oestrous cycle in normal guinea pig ovaries and in guinea pigs with cystic rete ovarii

Mast cells (MCs) and Kurloff cells (KCs) were detected in guinea pig ovaries in the follicular and luteal phases of the oestrous cycle. The samples of ovaries were fixed in Mota's basic lead acetate. Toluidine blue was used for detection of MCs and periodic acid-Schiff for detection of KCs. The percentage of KCs in a differential leukocyte count was determined in blood smears stained according to the Pappenheim method. Non-pregnant females with normal ovaries and with cystic rete ovarii were included in the study and the numbers of MCs and KCs were compared in these two groups and in follicular and luteal phases of the oestrous cycle. MCs' distribution in ovaries was different in the guinea pig in comparison to previously studied species: MCs were found exclusively in the superficial layers of cortical stroma and no significant difference was found between the number of MCs in the follicular and luteal phases, neither in normal ovaries, nor in ovaries with cystic rete ovarii. Significantly lower numbers of MCs were found in ovaries with cystic rete ovarii (P < 0.01) in contrast to normal ovaries. A significantly higher percentage of KCs in the peripheral blood was found in the follicular phase (P < 0.05), whereas no significant difference was found in relation to the presence of cystic rete ovarii. Interestingly, no KCs were found in the samples of ovaries (either in the follicular or luteal phase, and with or without cysts). Thus, the expected role of KCs in ovarian physiology or in the aetiology of the cystic rete ovarii can be excluded.

Salpingo-oophorectomy versus cystectomy in patients with borderline ovarian tumors: a systemic review and meta-analysis on postoperative recurrence and fertility

BACKGROUND

To compare the postoperative recurrence and fertility in patients with borderline ovarian tumors (BOTs) who underwent different surgical procedures: salpingo-oophorectomy versus cystectomy.

METHODS

Potentially relevant literature from inception to Nov. 06, 2020, were retrieved in databases including Cochrane Library, EMBASE (Ovid), and MEDLINE (Pubmed). We applied the keywords "fertility-sparing surgery," or "conservative surgery," or "cystectomy," or "salpingo-oophorectomy," or "oophorectomy," or "adnexectomy," or "borderline ovarian tumor" for literate searching. Systemic reviews and meta-analyses were performed on the postoperative recurrence rates and pregnancy rates between patients receiving the two different surgical methods. Begger's methods, Egger's methods, and funnel plot were used to evaluate the publication bias.

RESULT

Among the sixteen eligible studies, the risk of recurrence was evaluated in all studies, and eight studies assessed the postoperative pregnancy rates in the BOT patients. A total of 1839 cases with borderline ovarian tumors were included, in which 697 patients (37.9%) received unilateral salpingo-oophorectomy and 1142 patients (62.1%) underwent unilateral/bilateral cystectomy. Meta-analyses showed that BOT patients with unilateral/bilateral cystectomy had significantly higher recurrence risk (OR=2.02, 95% CI: 1.59-2.57) compared with those receiving unilateral salpingo-oophorectomy. Pooled analysis of four studies further confirmed the higher risk of recurrence in patients with cystectomy (HR=2.00, 95% CI: 1.11-3.58). In addition, no significant difference in postoperative pregnancy rate was found between patients with the two different surgical procedures (OR=0.92, 95% CI: 0.60-1.42).

CONCLUSION

Compared with the unilateral/bilateral cystectomy, the unilateral salpingo-oophorectomy significantly reduces the risk of postoperative recurrence in patients with BOT, and it does not reduce the pregnancy of patients after surgery.

TRIAL REGISTRATION

PROSPERO CRD42021238177.

Malignant transformation arising from mature ovarian cystic teratoma: A case series

Malignant transformation arising in mature cystic teratoma (MT-MCT) is a rare neoplasm of the ovary. Herein, we aimed to evaluate the clinicopathological features and treatment outcome of the Han Chinese women with MT-MCT.In this retrospective study, the clinical data of patients who had been surgically treated from January 2000 to November 2019 and in whom the diagnosis of MCT was confirmed based on the pathology were included. Fourteen patients with MT-MCT from a total of 569 cases (2.46% incidence) of MCT were reviewed.The mean age of patients with MT-MCT was 51.3 (range, 31-71) years, while the mean age of patients with MCT was 45.3 (range, 17-62) years. Upon gross examination, the mean size of MT-MCT was 14.0 (range, 11-25) cm, whereas the mean size of MCT was 7.5 (range, 4-10) cm. Primary surgical staging was performed in all cases. Complete cytoreduction and suboptimal surgical resection were performed in 12 (85.7%) and 2 (14.3%) cases, respectively. Thirteen patients with malignant transformation of squamous cell carcinoma (SCC) whose Federation International of Gynecology and Obstetrics stage was >1 received chemotherapy, comprising carboplatin and paclitaxel. Response to the chemotherapy regimen was complete in 12 patients; 1/12 patients died within the median follow-up period of 16.5 months. The 5-year overall survival rate and disease-free survival rates were 31.2% and 31.6%, respectively.From the data generated, we conclude that the rate of MT-MCT increases with age. The MT-MCT was much higher in women of postmenopausal age than in younger women. We described our experience of successfully treating patients with malignant transformation of SCC with primary surgical staging and adjuvant chemotherapy (cisplatin, paclitaxel, bleomycin, and etoposide) that might improve survival in patients with advanced-stage disease.

Misdiagnosis of High-grade Serous Ovarian Cancer With BRCA Mutation as Endometriotic Cyst Due to Its Unique Gross Morphology: A Case Report and Literature Review

It is believed that high-grade serous ovarian cancer (HGSOC) is a solid or multilocular-solid cancer. Here, we report the case of a 40-yr-old woman with a left ovarian unilocular cyst. Ultrasonography and computed tomographic examination confirmed that the cyst was thin-walled and homogenous in thickness without mural nodules. It was considered to be an endometriotic cyst. Left ovarian cyst excision specimens proved it to be HGSOC after pathologic examination. Therefore, the patient underwent radical surgery for HGSOC. Pathologic examination of radical resection specimens confirmed that the HGSOC was still in FIGO stage IA and no fallopian tube lesion was found. Considering that the patient had a history of breast cancer in both the breasts at a young age, it was hypothesized that the breast cancer susceptibility gene (BRCA) gene may have a germline mutation. Next-generation sequencing confirmed the BRCA1 (c.3770_3771delAG) germline mutation in this patient. Previous studies have reported the special morphological characteristics and growth pattern of HGSOC with BRCA mutation in the advanced stage. Our case demonstrates that HGSOC with the BRCA mutation can also be a unilocular cyst with a thin wall and uniform thickness without a mural nodule, and in the early stage, may have unique gross morphology.

Adult granulosa cell tumors of bilateral ovaries with pure cystic presentation: A case report and review of literature

RATIONALE

Granulosa cell tumors (GCTs) are rare, hormonally active sex cord-stromal tumors that generally present as solid unilateral ovarian lesions. It's quite uncommon that they present as pure bilateral ovarian cysts. Histopathology remains the gold standard for making a diagnosis of GCTs. However, as the differential diagnosis is difficult, cystic GCTs are frequently misdiagnosed as benign or other cystic tumors either prior to surgery or during pathologic diagnosis. Accordingly, herein, we describe a fairly rare case of bilateral ovarian cystic GCTs, along with a review of the related literature.

PATIENT CONCERNS

A 43-year-old woman presented with abdominal distension and chronic pain since 1 day. The patient had a history of dysmenorrhea.

DIAGNOSES

Physical examination revealed palpable bilateral adnexal tumors; ultrasonography revealed cystic and septate masses with a maximum diameter of 7.8 and 10.7 cm, respectively, in the bilateral ovaries. Hormonal analysis revealed that the blood estradiol levels were elevated. Postoperative pathological and immunohistochemical examinations of the surgical specimens revealed a final diagnosis of cystic adult GCTs of the ovaries.

INTERVENTIONS

The patient first underwent laparoscopic bilateral ovarian cystectomy. On the basis of the final pathological diagnosis report, abdominal total hysterectomy, bilateral oophoro-salpingectomy, and partial omentectomy were then performed. Microscopic examination revealed that there were no residual CGT cells. The patient's federation international of gynecology and obstetrics (FIGO) Stage was IB period.

OUTCOMES

The surgeries were successful. The tumor was a FIGO Stage IB tumor, and the patient did not require any additional treatment. The patient had been followed-up regularly for 2 years after surgery; she did not experience any complications and remained disease-free.

LESSONS SUBSECTIONS

Cystic GCTs should be considered in the differential diagnosis if a female patient shows bilateral ovarian cysts. They are extremely rare ovarian malignant tumors that must be differentiated from other ovarian tumors, especially purely cystic tumors and benign cysts. Although pathological and immunohistochemical findings are important for making the diagnosis, the varying histopathological features on microscope make diagnosis difficult, including tumor cells with luteinization or free cell clusters. The current case highlights the importance of physicians being aware of and suspecting cystic CGTs in similar cases, along with knowing the characteristics of GCTs for the diagnosis and differential diagnosis.

Comparison of the efficacy between bilateral proximal tubal occlusion and total salpingectomy on ovarian reserve and the cholinergic system: an experimental study

Background and aim

To compare the effects of bilateral proximal tubal occlusion and bilateral total salpingectomy on ovarian reserve and the cholinergic system via rat experiment.

Materials and methods

Twenty-one adult female rats were randomly divided into the following three groups:G1 (n = 7), sham group;G2 (n = 7), bilateral total salpingectomy group; and G3 (n = 7), bilateral proximal tubal occlusion group. Four weeks later, the abdomen of the rats was opened. The right ovarian tissues were stored in 10% formaldehyde, whereas the left ovarian tissues were stored at –80 °C in aluminum foil. Serum samples were evaluated for antimullerian hormone. The right ovary was used for histological and immunoreactive examination, and the left ovary was used for tissue MDA analysis. Tissue samples were analyzed for MDA levels with spectrophotometric measurement, apoptosis with TUNEL staining, fibrosis score with Mason trichrome staining, ovarian reserve with HE staining, and cholinergic receptor muscarinic 1 (CHRM1) level with immunoreactivity method.

Results

Compared to G1 and G3, the number of corpus luteum with secondary follicles was significantly lower in G2, whereas the number of ovarian cysts and fibrosis and apoptosis scores increased significantly. The CHRM1 immunoreactivity was significantly lower in G2 than in G1 and G3.

Conclusions

Compared to the bilateral proximal tubal occlusion performed by using bipolar cautery, bilateral total salpingectomy in rats leads to a significant damage in ovarian histopathology and the cholinergic system.

Giant Mesenteric Mixed Hemangioma Misdiagnosed as Ovarian Cyst: A Case Report and a Literature Review

Hemangiomas are congenital vascular disorders that occur primarily in the face and neck, extremely rare in the mesentery. Here, we report a rare small mesenteric mixed hemangioma. A 34-year-old woman was admitted to the gynecology department for an extended menstrual cycle. A cystic multi-atrial mass at the right anterior of uterus was observed by ultrasound examination, which was about 12.5 × 9.5 × 14.9 cm in size. The gynecologist mostly considered the possibility of the ovarian cyst. However, there was a huge multi-atrial cyst in the small intestine mesentery without the right ovarian cyst in the surgical exploration. The grape-like cystic mass about 15 cm in diameter adhered to the mesenteric root of the small intestine. The cyst was diagnosed as the mesenteric mixed hemangioma in the final histopathology.

The effects of chronic oxytocin administration on body weight and food intake in DHT-induced PCOS model rats

Polycystic ovary syndrome (PCOS) is commonly associated with metabolic disorders, which are exacerbated by obesity. Recent studies have revealed that oxytocin contributes to metabolic, appetite, and body weight regulation. In the present study, we evaluated the effects of chronic administration of oxytocin on body weight, food intake, and fat mass in a dihydrotestosterone-induced rat model of PCOS. Body weight, body weight change, and relative cumulative food intake were significantly lower in the oxytocin-treated PCOS rats than in the vehicle-treated control PCOS rats. Similarly, visceral adipocyte size was significantly smaller in the oxytocin-treated PCOS rats than in the vehicle-treated control PCOS rats. On the other hand, the numbers of cystic follicles in the ovary did not differ between the two groups. The chronic administration of oxytocin did not affect the rats' serum aspartate aminotransferase, alanine aminotransferase, or lactate dehydrogenase levels, indicating that it does not have adverse effects on hepatic function. These findings suggest that oxytocin could be a candidate drug for preventing the onset of obesity-related metabolic disorders in PCOS patients.

Substrate curvature induces fallopian tube epithelial cell invasion via cell-cell tension in a model of ovarian cortical inclusion cysts

Throughout the body, epithelial tissues contain curved features (e.g. cysts, ducts and crypts) that influence cell behaviors. These structures have varied curvature, with flat structures having zero curvature and structures such as crypts having large curvature. In the ovary, cortical inclusion cysts (CICs) of varying curvatures are found, and fallopian tube epithelial (FTE) cells have been found trapped within these cysts. FTE are the precursor for ovarian cancer, and the CIC niche has been proposed to play a role in ovarian cancer progression. We hypothesized that variations in ovarian CIC curvature that occur during cyst resolution impact the ability of trapped FTE cells to invade into the surrounding stroma. Using a lumen model in collagen gels, we determined that increased curvature resulted in more invasions of mouse FTE cells. To isolate curvature as a system parameter, we developed a novel technique to pattern concave curvatures into collagen gels. When FTE cells were seeded to confluency on curved substrates, increases in curvature increased the number of invading FTE cells and the invasion distance. FTE invasion into collagen substrates with higher curvature depended on matrix metalloproteinases (MMPs), but expression of collagen I degrading Mmps was not different on curved and flat regions. A finite-element model predicted that contractility and cell-cell connections were essential for increased invasion on substrates with higher curvature, while cell-substrate interactions had minimal effect. Experiments supported these predictions, with invasion decreased by blebbistatin, ethylene glycol-bis(β-aminoethyl ether)-N,N,N',N'-tetraacetic acid (EGTA) or N-cadherin-blocking antibody, but with no effect from a focal adhesion kinase inhibitor. Finally, experimental evidence supports that cell invasion on curved substrates occurs in two phases-a cell-cell-dependent initiation phase where individual cells break away from the monolayer and an MMP-dependent phase as cells migrate further into the collagen matrix.

Hemodynamic changes detected by Doppler ultrasonography in the ovaries of cattle during early development of cystic ovarian disease

A common reproductive disease in dairy cattle is Cystic Ovarian Disease. To study its development, there was use of an experimental model of follicular persistence to detect hemodynamic changes occurring in ovaries by using Doppler ultrasonography. After estrous synchronization, control cows received no additional treatment and were evaluated at proestrus (CG), whereas treated cows (PG) received sub-luteal doses of progesterone for 15 days and were evaluated at proestrus, and after 0, 5, 10 and 15 days of follicular persistence. Spectral Doppler was used to evaluate blood flow in the ovarian artery, and power Doppler for evaluation of blood flow in the ovarian parenchyma and follicular wall of persistent and dominant preovulatory follicles. Findings using power Doppler signals indicated there were no differences between groups in the parenchyma of both right (P =  0.455) and left (P =  0.762) ovaries. In contrast, power Doppler signals of blood flow were less in walls of persistent follicles from day 0 to 15 when there was follicular persistence than in dominant follicles of the CG (P <  0.001). Blood flow in ovarian arteries was less (P <  0.05) in diastolic velocity and time averaged maximum velocity in all PG groups than in the CG. Peak systolic velocity was less (P <  0.05) in all PG than in the CG, with the exception of P15 (P >  0.05). These findings indicate there are marked changes in blood irrigation area of walls of persistent follicles during the 15 days of follicular persistence.

Novel diagnosis of mesenteric endometrioma: Case report

RATIONALE

Mesenteric cysts are benign gastrointestinal cystic lesions, with an incidence of <1/100 000. They usually develop in the small bowel mesentery, mesocolon (24%), retroperitoneum (14.5%), and very rarely originate from the sigmoid mesentery. Endometriomas represent a localized type of endometriosis and are usually within the ovary. Our case is unique because there are no reports in the literature of endometrial mesenteric cysts.

PATIENT CONCERNS

We present a case of a 29-year-old woman who underwent a routine gynecologic control.

DIAGNOSIS

Clinical examination and imaging identified 2 endometriomas on the left and posterior to the uterus.

INTERVENTIONS

The patient underwent exploratory laparoscopy. Unexpectedly, a 10 cm mesenteric cyst was identified; this was associated with adhesions in the left adnexal area and a left ovarian endometrioma. The classic surgical approach which was necessary identified the mesenteric cyst with cranial mesosigmoid and ileal adhesions, as well as distal adhesions which included the uterus, ileum, left ovarian endometrioma, left hydrosalpinx, left ureter, and rectum. The cyst was removed completely and a left adnexectomy was performed because of the presence of the endometrioma and adhesions.

OUTCOMES

The patient's outcome was favorable, with discharge at 72 hours after surgery. The histopathological report revealed that both the mesenteric and ovarian cysts were endometriomas.

LESSONS

Our case is unusual in that a mesenteric cyst was identified in a patient with no clinical symptoms. Furthermore, the histopathological examination revealed the endometriotic origin of the mesenteric cyst which has not previously been reported in the literature.

Analysis of adnexal mass managed during cesarean section

BACKGROUND

Pregnancy with an adnexal mass is one of the most common complications during pregnancy and clinicians are sometimes caught in a dilemma concerning the decision to be made regarding clinical management.

OBJECTIVES

The objective of this study was to outline and discuss the clinical features, management and outcomes of adnexal masses that were encountered during a cesarean section (CS) at a university affiliated hospital in China.

MATERIAL AND METHODS

The medical records of the patients with an adnexal mass observed during a CS were retrospectively collected at Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China, from January 1991 to December 2011.

RESULTS

The incidence of adnexal masses was 16.40 per 1000 CSs. The most common pathologic diagnosis was benign ovarian tumor, the 2nd was ovarian endometrioma and the 3rd was theca lutein cyst. Thirteen cases of ovarian malignancies were diagnosed during a CS. Only 388 cases (29.78%) were detected by an ultrasonography (USG) examination before a CS. Eight cases required emergency CS due to abdominal pain; all other patients were clinically asymptomatic. The reasons for abdominal pain included torsion (n = 5), rupture (n = 2) and ovarian enlargement (n = 1). In 13 cases with ovarian endometrioma, cysts ruptured during a CS without any clinical manifestation. No maternal and fetal complications related to surgery were observed.

CONCLUSIONS

Preconception care and routine prenatal care, including USG examination, may optimize the detection and management of an adnexal mass. The presumptive ovarian endometrioma detected before pregnancy could be the indication for surgery due to the possibility of spontaneous hemoperitoneum. Theca lutein cysts might be huge and exist throughout the whole pregnancy period. Expectant management is reasonable for an adnexal mass that emerged during pregnancy without suspicion of malignancy. Abdominal pain might be a clue for cyst torsion or rupture.

Treatment of ovarian endometrial cysts in the context of recurrence and fertility

An approach to ovarian endometrial cysts has changed considerably during recent years, especially in regard to treatment of recurrent endometriosis, fertility sparing and infertility management. Surgical treatment is the primary therapeutic option. The most efficient types of treatment are radical procedures involving adhesiolysis, removal of the cyst along with its capsule and any remaining endometriotic foci. However, small asymptomatic cysts should not be treated surgically, especially in patients older than 35 years. Surgical treatment can be considered in infertile women and those who failed to get pregnant despite 1-1.5 years of trials, as well as in cases in which in vitro fertilization is not an option. Also large cysts, with more than 4 cm in diameter, should be treated surgically due to the risk of their rupture or torsion. The most efficient preventive measure for recurrent ovarian endometriosis is unilateral oophorectomy with sparing the contralateral ovary. Such a procedure should be considered in women who are no longer interested in childbearing or present with another endometriotic cyst in the same ovary. The role of pharmacotherapy is fairly limited; it should be considered in patients in whom diffuse endometriosis is associated with pain. Therapeutic agents from the following groups can be used: estrogen-progestin preparation, gestagens, including progesteronereleasing intrauterine systems and gonadotropin-releasing hormone agonists. Women with infertility should get pregnant as soon as possible, and in patients who failed to get pregnant and/or are older than 35 years, in vitro fertilization should be the treatment of choice.

Hyperreactio luteinalis - two accidental findings during cesarean section

OBJECTIVE

To present two cases of patients with hyper-reactio luteinalis at the cesarean section.

DESIGN

Case report.

SETTING

Department of Obstetrics and Gynaecology, Hospital Tren&#269;ín; Medirex Group Academy n.o., Bratislava.

CASE REPORT

We report two cases of women with preeclampsia who we diagnosed with bilateral multi-cystic ovarian enlargement by chance during cesarean section. At both of them the level of human chorionic gonadotropin was above normal, one of the patients had medical history of ovarian serous borderline tumor and this pregnancy was multiple after in vitro fertilization and embryo transfer. Adnexectomy, resection of ovaries and biopsy were carried out. Histologically hyperreactio luteinalis was confirmed in both patients.

CONCLUSION

We discuss the necessity of surgical treat-ment, the authors want to emphasize the need for proper preoperative diagnosis and indication of conservative management of patients with hyperreactio luteinalis.

Cytology of Ovarian cysts

Ovarian cysts are often found in both the clinically predicted and the unexpected context at the current level of imaging techniques. The cytological examination of the transvaginally obtained cystic fluid can help to diagnose the nature of the cystic lesion via identification the lining structures. It is essential to distinguish functional cysts (follicular, corpusluteal) and implantation (inclusion and endometrial) from tumour cysts (dermoid, epithelial ovarian tumours, cystic metastases). A part of the cystic lesions remains unspecified for the absence of the defining structures after the cytological examination. Nevertheless, for its minimal invasiveness, high negative predictive value proven, and the possibility of contributing to diagnosis of selected patients (frequently with contraindications for larger diagnostic procedures), this investigation maintains its position in collaboration of a clinical specialist and a pathologist.

Ovarian hydatid cyst - systematic review of clinicopathological and immunohistochemical characteristics of an unusual entity

Primary ovarian hydatid disease (HD) is a rare entity, produced by the larval stage of Echinococcus granulosus. HD commonly involves liver, lung, abdomen cavity, spleen and is unusually identified in pelvic organs. Based on our knowledge, the paper reviews 27 literature reports of ovarian HD, diagnosed during the last 20 years, providing a valuable database. Patients' ages ranged between 12-76 years, the gross appearance was that of 40-330 mm diameter hydatid cysts (HCs), 66.66% of them being primary. According to these reports, ovarian HD has non-specific clinical manifestations, such as abdominal or pelvic pain, nausea, dysmenorrhea or amenorrhea. The diagnosis may be achieved by abdominal ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI), serological exams, such as eosinophilia (in 10-30% of patients) or indirect hemagglutination and immunoglobulin (IgG) antibodies detection. Ovarian HC microscopic pattern is characterized by three layers: pericyst or adventitia (host origin), germinal layer (endocyst), and laminated membrane (ectocyst). The immunoreaction triggered by parasites is initially rich in macrophages and neutrophils, followed by eosinophils and lymphocytes, with numerous cluster of differentiation 8 (CD8)-positive T-cells in active lesions and progressive forms. Concomitant ovarian diseases are relatively rare, being represented by borderline tumors (n=2 cases), mucinous cystadenoma (n=1 case), hemorrhagic cyst (n=1 case), and serous adenocarcinoma (n=1 case). In conclusion, the ovarian location of HD should be considered in any differential diagnosis of a cystic lesion, while it does not exclude synchronous ovarian tumors. These cases reinforce the necessity of better measures of prophylaxis and screening of HD in endemic areas.

Squamous cell carcinoma arising from mature cystic teratoma of the ovary: A challenging question for gynecologic oncologists

Mature cystic teratomas of the ovary have an incidence of 1.2-14.2 cases per 100.000 people per year. Malignant transformation occurs in approximately 2% of the cases, and usually consists of squamous cell carcinoma. The preoperative detection is difficult and the diagnostic accuracy of ultrasound, magnetic resonance imaging, and computed tomography is debated. The diagnosis is frequently made in the operating room or on final histological examination. Standard treatment consists of bilateral salpingo-oophorectomy, total hysterectomy and comprehensive surgical staging in early disease and optimal cytoreductive surgery in advanced disease. Paclitaxel/carboplatin- based chemotherapy is the most used adjuvant treatment, whereas more aggressive regimens can be adopted in patients with high tumor burden or recurrent disease. The efficacy of radiotherapy is still unproven. The prognosis is poor when the tumor has spread beyond the ovary. There are few information to provide commonly accepted guidelines for this malignancy.

Relation between Ovarian Carcinoma-Associated Antigens in Tumor Tissue and Detached Cyst Fluid Cells of Patients with Ovarian Neoplasms

Aims

The expression and potential diagnostic value of ovarian carcinoma-associated antigens were estimated in different types of epithelial ovarian neoplasms. The comparison of antigenic expression was performed on solid tumor tissues and loose cyst fluid cells in individual cases of malignant and benign ovarian neoplasms.

Methods

All studies were performed using monoclonal antibodies (mAbs) against ovarian carcinoma-associated antigens (OC125, OV-TL3, OV632, 10B, 8C) by 3-step peroxidase-antiperoxidase test.

Results

All ovarian carcinoma-associated antigens were detected in most serous and endometrioid carcinomas. In mucinous carcinomas as well as in benign ovarian neoplasms these antigens were present only in some cases. Significant inter- and intratumoral immunological heterogeneity was evident; however, the antigens detectable in tissue sections were also found in detached cyst fluid cells.

Conclusions

Our results show that mAb show OV-TL3 is the best marker for endometrioid carcinomas and confirmed that mAbs OV632, OC125 and OV-TL3 could be good complementary markers for differentiating malignant and benign lesions in the ovary. The percentage content of all ovarian carcinoma-associated antigens in solid tumors and respective cyst fluid cells was comparable.

Struma Ovarii and Brenner Tumor

One struma ovarii with agregates of epithelial nests indistinguishable from Brenner tumor was studied. The presence of a communication between the nests and the follicles and the association of Brenner, mucinous and respiratory epithelium in the lining of 1 cyst in the same tumor strongly support the germ cell theory of Brenner tumors associated with teratomatous elements.

Morphologic Heterogeneity of Cell Populations Isolated by Density Gradient Centrifugation from Serous Fluids of Ovarian Tumors

The cells of tumor fluid from patients with malignant and benign serous ovarian neoplasms were fractionated using Ficoll-Uropoline density gradient centrifugation. Density distribution and morphologic characteristics of cell fractions were analyzed. It was found that serous ovarian adenocarcinomas contained three to four types of morphologically malignant cells focused in low density layers. Borderline ovarian neoplasms showed the presence of one subpopulation of cells with some features of malignancy and cells with some atypical but non-malignant features. The fluids of serous cysts contained mainly normal epithelial cells representing different stages of morphological maturity and were focused in denser layers. The results allowed us to catalogue ovarian tumor cell subpopulations present in each density fraction of individual patients and confirmed that ovarian tumors could be diagnosed by morphologic identification of cells from tumor fluids.

Importance of basal fibroblast growth factor levels in patients with ovarian tumor

OBJECTIVE

Evaluation of importance of serum levels of basic fibroblast growth factor (bFGF) in patients with ovarian cancer, patients with border-line ovarian tumor, patients with benign ovarian cyst and women with normal ovarian tissue.

DESIGN

Prospective clinical study.

SETTING

Department of Gynecology and Obstetrics, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital Hradec Kralove.

METHODS

Measurement of serum levels of bFGF by ELISA using reagents of company R&D Systems prior to treatment in a total of 74 consecutive coming women.

RESULTS

Serum level of bFGF from peripheral blood before treatment was significantly higher (p &lt; 0.05) in patients with newly diagnosed ovarian cancer (n = 22), Med = 10.35 pg/ml (1.2-46.2 pg/ml) compared to patients with a border-line ovarian tumor (n = 9), Med = 5.4 pg/ml (1.6-6.8 pg/ml), patients with benign ovarian cyst (n = 24), Med = 5.2 pg/ml (0.1-67.2 pg/ml), and to women with normal ovarian tissue (n = 19) Med = 4.3 pg/ml (0.9-13.4 pg/ml). There isnt strong linear correlation (Spearmans rank correlation coefficient = 0.208791) between the serum level of bFGF and CA125 collected from peripheral blood before primary surgery or neoadjuvant chemotherapy in a group of patients with ovarian cancer (n = 14). We have not found significance correlation between age and serum levels of bFGF in patients with ovarian cancer, with border-line ovarian tumor, with benign ovarian cyst and in women with normal ovarian tissue.

CONCLUSION

Serum levels of bFGF in patients with ovarian cancer are significantly higher than in patients with a border-line ovarian tumor, with benign ovarian cyst and in women with normal ovarian tissue regardless of age of patients.

[Hirsutism secondary to a luteal cyst of the right ovary at the department of internal medicine and endocrinology of the Mali Hospital]

The authors are reporting here for the first time a documented case of androgen-secreting luteal cyst responsible for primary sterility in Mali. A 26-year married woman with a history of familial hyper androgenia of diabetes and high blood pressure who consulted for hyper androgen syndrome and primary infertility. Hirsutism with the presence of hairs on her chin, upper lips, thorax, forearms, arms, and her legs under waxing which made a Ferriman and Galloway scoreof10. A pelvic ultrasound coupled with a laparoscopy allowed us to retain the diagnosis of luteal cyst.

CONCLUSION

Hyper androgenicity in women is rare and the luteal cystis one of its multiple etiologies.

Phenotypic variation in anti-Mullerian hormone (AMH) production per follicle in women with polycystic ovary syndrome (PCOS) and isolated polycystic ovarian morphology (PCOM): an observational cross-sectional study

This observational study compares the ratio of serum anti-Mullerian hormone (AMH) to the total antral follicle count (AFC) (as a marker of AMH production per follicle) in the various phenotypes of women with polycystic ovary syndrome (PCOS) and isolated polycystic ovarian morphology (PCOM). Two hundred and sixty-two women were recruited. Women with PCOS were divided into four phenotypes based on the diagnostic inclusion criteria of oligo-anovulation (OA), hyperandrogenism (HA) and polycystic ovarian morphology (PCOM). These included Group A (OA + HA + PCOM), Group B (OA + HA), Group C (HA + PCOM) and Group D (OA + PCOM). A ratio of serum AMH to total AFC was calculated and expressed as the AMH/AFC ratio which was compared in the phenotypes of PCOS and isolated PCOM. The median AMH/AFC ratios in PCOS-A, PCOS-D, PCOS-C and PCOM were 1.5, 1.6, 1.2 and 1.1, respectively. There were significant differences in the groups compared [F(3, 238) = 6.14, p = 0.000)]. The ratios were significantly higher in the oligo-anovulatory phenotypes PCOS-A and PCOS-D than the PCOM (p = 0.004 and 0.002, respectively). There was no significant difference in the ratio between ovulatory phenotype PCOS-C and PCOM (p = 0.59). The role of androgens and LH in per-follicle AMH production remains limited. The findings support the hypothesis of a key role for AMH in the mechanism of anovulation in PCOS.

Haemoperitoneum due to ruptured ovarian cyst in a 13-year-old girl with factor V deficiency- A case report

Factor V deficiency is a rare autosomal recessive coagulation disorder. We are reporting a case of a 13 year old girl with factor V deficiency presenting as life threatening haemoperitoneum, following bleeding from ruptured ovarian cyst. Prolonged Prothrombin Time, Activated Partial Thromboplastin Time and a normal platelet count pointed towards a disorder of coagulation. Mixing study with factor V deficient plasma and coagulation factor assay revealed markedly reduced plasma factor V clotting activity.

[LIFTING LAPAROSCOPY IN SIMULTANT SURGERY]

Results of treatment of 84 patients, to whom simultant operative interventions on abdominal, the small pelvis and retroperitoneal organs were performed for concomitant somatic diseases, were analyzed. The author’s technology of laparolifting was applied in 36 patients, and classical technology with carboxyperitoneum adjustment - in 48. Variants of optimal operative accesses were determined, structure and rate of postoperative complications, peculiarities of the early postoperative period course studied. Indisputable advantages of the lifting laparoscopic operations were established, including reduction of the postoperative complications rate and severity, the postoperative pain syndrome intensity, the concurrent chronic diseases exacerbation rate, and postoperative stationary stay.

Minimally Invasive Management of Ovarian Cysts During Pregnancy Using Ethanol Sclerosis

Traditionally, the management of symptomatic ovarian cysts in pregnancy has been limited to laparoscopy or laparotomy with the associated morbidity. However, in select patients requiring intervention, the risks of surgery may be minimized with sclerotherapy. We present the first case report, to our knowledge, of ethanol sclerosis of an ovarian cyst during pregnancy. A description of the surgical technique to complete such a procedure is provided as well as a brief review of the current literature with respect to the use of sclerotherapy for the management of ovarian cysts.

[Ovarian cysts and hyperestrogenia as a result of treatment with tamoxifen in breast cancer patients of reproductive age]

There is considered one of the side effects of tamoxifen - the formation of ovarian cysts associated by also excessive production of estradiol. Data on likely mechanism of development of hyperestrogenia and its possible influence on anti-tumor effect of tamoxifen are presented.

Accuracy of intra-operative frozen section and its role in the diagnostic evaluation of ovarian tumors

Summary

OBJECTIVE

This retrospective study was undertaken to evaluate the accuracy and role of intra-operative frozen section in the diagnosis of ovarian tumors.

MATERIALS AND METHODS

Retrospective study of 804 ovarian frozen section results between June 2010 and June 2014 was examined to determine the accuracy of frozen section diagnosis. The intra-operative frozen section diagnosis was compared with the permanent (paraffin) section and the overall accuracy, sensitivity, specificity, and positive and negative predictive values of the frozen section were studied.

RESULTS

The overall accuracy to determine the status of malignancy was 92.6%. There were 38 (7.4%) false negative and no false positive frozen section diagnoses.The sensitivity, specificity, and positive predictive and negative predictive values for benign ovarian tumors were 100.0%, 97.0%, 91.3%, and 100.0%, respectively; for borderline tumors they were 64.3%, 97.0%, 91.5%, and 94.0%, respectively, and for malignant tumors they were 90.0%, 100.0%, 100.0%, and 85.5%, respectively.

CONCLUSION

This study concluded that frozen section appears to be an adequate technique for the histopathological diagnosis of ovarian tumors, with some limitations observed among borderline and mucinous tumors.

Clinicomorphological Spectrum of Ovarian Cystic Lesions

Background Ovarian cysts, which present as neoplastic and non-neoplastic lesions, are the most common gynaecological cause of hospital admissions. Early diagnosis is difficult due to asymptomatic nature. Clinical, radiological and gross examination alone cannot distinguish benign from malignant lesions, hence, histopathological examination is important for diagnostic, therapeutic and prognostic approach. Objective The objective of the study is to analyze the spectrum of ovarian cystic lesions with their clinico-morphorgical features. Method This is a prospective study done in between July 2014 and July 2015 in Dhulikhel Hospital-Kathmandu University Hospital. Clinical data of patients were obtained from hospital records and requisition submitted along with the tissue specimens received in the department. Result A total 84 cases of ovarian cystic lesions were studied. Among these, 47 (55.9%) were non-neoplastic lesions, 33 (39.3%) were benign neoplasms, two (2.4%) were borderline and two (2.4%) were malignant neoplasms. The most common nonneoplastic lesions were follicular cysts, 26 (55.3%) followed by simple cysts 14 (29.8%), hemorrhagic cysts five (10.6%) and corpus luteal cysts two (4.3%). Among all neoplasms, 19 (51.4%) were mature cystic teratoma followed by 10 (27.0%) cases of mucinous cystadenoma and four (10.8%) cases of serous cystadenoma. Between two (5.4%) malignant cases, one was immature cystic teratoma and the other was mucinous cystadenocarcinoma. Besides these, two (5.4%) cases of borderline mucinous cystadenoma were also present. Conclusion Ovarian cystic lesions are difficult to categorize on the basis of clinical and radiological findings. Histopathological examination plays a significant role to differentiate benign lesion from malignant as well as for the proper management.

[Laparoscopic Operations in Ovarian Endometriosis.]

OBJECTIVE

The Sudy aimed to analyze performed laparoscopic operations in ovarian endometriosis.

MATERIAL AND METHODS

A retrospective study was carried out including 336 patients with pelvic endometriosis who were operated laparoscopically in St.Marina Hospital - Pleven from January 2008 to July 2014.

RESULTS AND DISCUSSION

The ovaries are the pelvic organs most affected (76%) by endometriosis. The most done intervention is laparoscopic cystectomy (64.9%), followed by cystadnexectomy- (6,8%). The rarest are radical interventions - laparoscopic hysterectomies with adnexa (4.8%).

CONCLUSION

The size of the endometriotic cyst, the severity of disease, the age and the reproductive condition are crucial for makina decisions concernina the extent of suraical intervention.

Borderline Brenner tumors associated with ovarian cyst - case presentation

Borderline Brenner tumors represent quite a rare entity of ovarian tumors (about 2%) that develop from the surface ovarian epithelium. They are formed from papillary structures made of fibrovascular conjunctive axes covered by a transition epithelium, similar to the urinary bladder epithelium. According to the WHO classification, Brenner tumors present the following forms: benign, borderline and malignant. The benign ones are the most frequent, representing about 95%, the borderline represent about 5%, and the malignant ones less than 1%. We present the case of a 64-year patient who was diagnosed with right ovary cyst. The histopathological examination highlighted the presence of a borderline Brenner tumor at the same time with the cystic lesion, on the same ovary. The surgical treatment led to a complete cure of the patient, so that the yearly ultrasound reexamination did not trace the presence of any tumoral relapse.

Ultrasound-guided percutaneous aspiration of hyperreactio luteinalis avoids laparoscopic untwisting of ovarian torsion

Hyperreactio luteinalis (HL) is characterized by multicystic bilateral enlargement of the ovaries and is a self-limiting benign condition associated with pregnancy or trophoblastic disease. Since HL regresses spontaneously over time, it should be managed conservatively as long as the patient's condition permits; torsion of the enlarged ovaries is believed to be the only exception that mandates surgical intervention. Here, we describe a case of HL complicated by ovarian torsion that was treated successfully without surgical intervention. A 33-year-old woman was admitted to our hospital owing to acute abdomen. Nine days previously, she had had a stillbirth caused by hydrops fetalis at 24 weeks' gestation. The characteristic findings observed on magnetic resonance imaging (MRI) led to the diagnosis of HL complicated by torsion of the enlarged left ovary. Emergency laparoscopic detorsion of the ischemic left ovary was planned. Aiming to reduce the risk of cystic injury and bleeding at the trocar insertion site, volume reduction of the left ovarian cyst was performed by percutaneous aspiration. The patient's pain diminished rapidly and laparoscopic surgery was deferred. Subsequent MRI revealed that gadolinium enhancement of the left ovarian tumor had been restored, indicating spontaneous detorsion of the left ovary. The patient remained asymptomatic and was discharged from the hospital 12 days after aspiration of the cyst. From this experience, we propose that, in cases of ovarian torsion occurring in large functional cysts, including HL, volume reduction by percutaneous cyst aspiration should be considered before performing emergency laparoscopic surgery.

Evaluation of Ultrasound-Guided Fine-Needle Aspiration Cytology of Ovarian Masses with Histopathological Correlation

BACKGROUND

Preoperative cytodiagnosis of ovarian masses is a difficult process, and sampling of pelvic masses is quite easier after the improvement of imaging techniques. Though histopathology is the gold standard, fine-needle aspiration cytology (FNAC) under ultrasound (US) guidance can be a valuable tool for pre-operative diagnosis of ovarian lesions, especially in the hands of an experienced pathologist.

OBJECTIVE

The present study was performed to evaluate the role of US-guided FNAC in pre-operative cytological diagnosis of ovarian masses in comparison with histopathology, and to assess the pitfalls and limitations of cytological interpretation.

MATERIALS AND METHODS

This study was conducted over a 2-year period on 70 cases of ovarian masses, which were evaluated by US-guided FNAC. Sensitivity, specificity and diagnostic efficacy were calculated using histopathology as gold standard.

RESULTS

On cytological evaluation, non-neoplastic cysts, and benign and malignant ovarian tumours were diagnosed in 8, 18 and 40 cases, respectively. On histopathology, 62 cases were concordant with cytology. Sensitivity and specificity were 95.23 and 95.83%, respectively, in the present study. Diagnostic accuracy was 93.94% in respect to the correct diagnosis. Cytohistological discrepancies and limitations of the study are discussed.

CONCLUSION

US-guided FNAC has proved as a quick, economic and safe procedure in diagnosing ovarian masses with brilliant accuracy.

[A rare variant of enterocele entrapment in the abdominal cavity of a woman]

Abdominal enterocele is a result of entering abdominal organs into peritoneal pockets and folds through the holes in mesenterium or into the adjoining cavities through defects in their walls. Enteroceles are localized at the sites where one segment of the gastrointestinal tract passes into another, in a pocket behind the cecum and sigmoid, between mesenteric layers of small intestine and colon, in the holes of mesenterium of vermiform appendage, gastrocolic and falciform ligaments, pockets and holes of broad ligament of the uterine, omental foramen, rectouterine excavation, and diaphragmal defects. We observed a 26 year old woman with enterocele entrapment in the abdominal cavity complicated by necrosis of part of the small intestine.

Serum salusins levels are increased and correlated positively with cyst size in ovarian endometrioma

OBJECTIVES

The objective of this study is to evaluate plasma concentrations of salusin-α and salusin-β levels in women with endometrioma and non-endometriotic benign ovarian cysts.

METHOD

Endometrioma patients (n = 14), non-endometriotic ovarian cysts (n = 14), and age-matched normal healthy fertile subjects (n = 14) participated in this study. Plasma salusin-α and salusin-β levels at the time of mid-luteal phase before and 3 months after L/S cystectomy were measured using ELISA and EIA tests, and their relation with demographic parameters was also assessed.

RESULTS

The mean salusin-α and salusin-β levels were significantly higher in women with endometrioma before the removal of cyst compared with cases with non-endometriotic cyst and fertile cases. Surgical removal of the endometrioma decreased the mean salusin-α and salusin-β levels to the level of those with non-endometriotic cyst before and after the cystectomy and fertile women, in both unilateral and bilateral endometrioma cases. Plasma salusin-β concentrations were found to be positively correlated with age, size of cyst, bilaterality, and salusin-α levels. Salusin-β values showed no correlations to BMI and size of the ovarian cysts.

CONCLUSIONS

Plasma salusin-α and salusin-β levels are increased in endometrioma patients and positively correlated with endometrioma size. Laparoscopic removal of the endometrioma by stripping technique decreases the salusin levels to a similar level of fertile women.

Comparison of nine morphological scoring systems to detect ovarian malignancy

PURPOSE OF INVESTIGATION

The aim of this study was to prospectively compare the diagnostic performances of nine gray-scale sonographic prediction models to detect ovarian malignancy.

MATERIALS AND METHODS

Clinical data of 322 women presenting with an adnexal mass were obtained and used in nine scoring systems. For each model a ROC curve demonstrating the capacity of the model to diagnose malignancy was constructed for all cases and for the subgroups of premenopause and postmenopause. The performance of each model was expressed as area under the ROC curve, sensitivity, and specificity.

RESULTS

The area under the ROC curve, sensitivity, and specificity of these models in the present study varied between 0.737 and 0.929, 70.7% and 87.9%, 60.2% and 80.3%, respectively.

CONCLUSIONS

This study has revealed the usefulness of morphological scoring systems to correctly discriminate between benign and malignant pelvic masses.

[Recommended guidelines of diagnosis for women with an ovarian cyst or tumour]

Transvaginal ultrasonography is the first-line and best imaging technique for characterising adnexal masses preoperatively. The optimal approach is the subjective assessment of ultrasound images by experts. An alternative evidence-based approach to the pre-surgical diagnosis of adnexal tumours is to use simple ultrasound rules or logistic regression model LR2 developed by the International Ovarian Tumor Analysis (IOTA) group. Their test performance matches subjective assessment by experienced examiners and should be adopted as the principal test to characterize masses as benign or malignant. Measurements of serum CA 125 are not necessary for characterization of ovarian pathology in premenopausal women and are unlikely to improve the performance of experienced ultrasound examiners, even in the postmenopausal group. However, in postmenopausal patients, serum CA 125 may play a role as a second-stage test, especially in centers with less-experienced ultrasound examiners.

Significant simultaneous changes in serum CA19-9 and CA125 due to prolonged torsion of mature cystic teratoma of the ovary

Mature cystic teratoma is a common benign neoplasm of the ovary. Complications occur in approximately 20% of cases. Clinical manifestations, laboratory findings, and imaging studies can assist in making a diagnosis of ovarian torsion of mature cystic teratoma. Furthermore, serum tumor markers may be helpful for diagnosing mature cystic teratoma and its torsion and, thus, can lead to early surgical intervention. A 56-year-old woman presented with a huge pelvic mass and pelvic pain. Serum CA19-9, CA125, and carcinoembryonic antigen levels were abnormally elevated at >700 U/ml, 282.5 U/ml, and 3.94 U/ml, respectively. The tumor was surrounded by extensive adhesions and showed inflammatory changes. The serum levels of these markers returned to normal levels after surgery.

Increased levels of oxidative and carbonyl stress markers in normal ovarian cortex surrounding endometriotic cysts

Many evidence support the view that endometriotic cyst may exert detrimental effect on the surrounding ovarian microenvironment so representing a risk to functionality of adjacent follicles. Patients with benign ovarian cyst (endometriotic, follicular and dermoid cysts) subjected to laparoscopic cystectomy were enrolled in the present retrospective study in order to analyze whether endometriotic tissue could negatively affect the surrounding normal ovarian cortex more severely than other ovarian cysts. To this end we carried out immunohistochemistry analysis and comparative determination of the transcription factor FOXO3A, oxidized DNA adduct 8-OHdG (8-hydroxy-2'-deoxyguanosine) and damaged proteins known as AGEs (Advanced Glycation End products) as markers of ovarian stress response and molecular damage. Our results show that all the markers analyzed were present in normal ovarian tissue surrounding benign cysts. We observed higher levels of FOXO3A (15.90 ± 0.28), 8-OHdG (13.33 ± 2.07) and AGEs (12.58 ± 4.34) staining in normal ovarian cortex surrounding endometriotic cysts in comparison with follicular cysts (9.04 ± 0.29, 2.67 ± 2.67, 11.31 ± 2.95, respectively) and dermoid cysts (2.02 ± 0.18, 4.33 ± 2.58 and 10.56 ± 4.03, respectively). These results provide evidence that ovarian endometrioma is responsible for more severe alterations to cellular biomolecules than follicular and dermoid cysts.