Thirty-eight cases of paraovarian cysts in children and adolescents: a retrospective study.

PURPOSE: Paraovarian cysts in children and adolescents can be challenging to accurately diagnose prior to surgery. Our objective is to outline the clinical characteristics of paraovarian cysts and enhance the precision of diagnosing paraovarian cysts in this age group. METHODS: We retrospectively analyzed all patients with paraovarian cysts who underwent surgery in our department from 2013 to 2021. The review focused on demographic characteristics, clinical manifestations, intraoperative findings, and postoperative pathology of these patients. RESULTS: This cohort was composed of 38 children with paraovarian cysts. The average diameter of the cysts was 4.8 cm (range 0.5-10 cm). Among the cases, 25 (65.8%) had adnexal torsion. Postoperative pathology showed that all cases were simple cysts with serous fluid. After the procedure, the patients were monitored for a period ranging from 12 to 108 months. B-ultrasound and physical examination did not reveal any significant abnormalities. CONCLUSIONS: B-ultrasound can help diagnose paraovarian cysts by detecting slight deviation movement between the cyst and the uterus. The presence of adnexa torsion in children and adolescents with paraovarian cysts does not depend on BMI, but rather on the size of cysts. Laparoscopic cyst removal has proven to be an effective surgical approach with favorable outcomes.

[Differential diagnosis of abdominal cysts in children]. / Hasi cysták és cystosus képletek differenciáldiagnózisa gyermekkorban.

19 children were diagnosed with abdominal cysts of different origin in the Surgical Unit of the Department of Pediatrics, Medical University of Pécs, Hungary between 2010 and 2013. The authors discuss the details of representative cases of a parovarial cyst, an intestinal duplication, and an omental cyst with emphasis on the clinical symptoms, diagnostic tools, and surgical interventions. The authors conclude that abdominal cysts often cause mild symptoms only, and they are discovered accidentally by ultrasound imaging performed for other reasons. In some cases, the cyst can cause severe complaints or even acute abdomen requiring emergency surgery. Laporoscopy may be a valuable method both in diagnosis and surgical therapy. Abdominal CT or MRI are not required in the majority of the patients.

[Giant paraovarian cyst in childhood - Case report]. / Quiste paraovárico gigante en la infancia. Reporte de un caso.

INTRODUCTION: Paraovarian cysts are very uncommon in children OBJECTIVE: To present a case of giant paraovarian cyst case in a child and its management using a modified laparoscopic-assisted technique CASE REPORT: A 13-year-old patient with a 15 day-history of intermittent abdominal pain, located in the left hemiabdomen and associated with progressive increase in abdominal volume. Diagnostic imaging was inconclusive, describing a giant cystic formation that filled up the abdomen, but without specifying its origin. Laboratory tests and tumor markers were within normal range. Video-assisted transumbilical cystectomy, a modified laparoscopic procedure with diagnostic and therapeutic intent, was performed with a successful outcome. The histological study reported giant paraovarian cyst. Cytology results were negative for tumor cells. The patient remained asymptomatic during the postoperative follow-up. CONCLUSIONS: The video-assisted transumbilical cystectomy is a safe procedure and an excellent diagnostic and therapeutic alternative for the treatment of giant paraovarian cysts.

Paratubal cancer found at the time of laparoscopic surgery for adnexal torsion: a case report and literature review.

INTRODUCTION: Paratubal cysts are common incidental finding, but malignant paratubal cancers have rare occurrence and have not been sufficiently described and discussed in previous studies. CASE REPORT: This report describes a case of a 70-year-old female who underwent emergent laparoscopy for adnexal torsion. A serous cystadenocarcinoma arising in a paratubal cyst and accompanied by tubal torsion was revealed by frozen section and successfully treated with laparoscopic cytoreductive surgery and adjuvant chemotherapy. CONCLUSION: This report is the first case of paratubal cancer with bilateral tubal torsion which was diagnosed and treated with laparoscopic surgery, and the third report describing serous cystadenocarcinoma arising in a paratubal cyst. In the laparoscopic surgery for the paratubal cyst clinically presumed as accompanied with tubal torsion, surgeons should not ignore the possibility of malignancy in spite of the rare incidence of paratubal cancers and the preconception that adnexal malignancies are seldom accompanied by tubal torsion.

Laparoscopic management of an isolated left fallopian tube torsion due to twisted Morgagni hydatid in a pre-menarcheal girl.

Isolated torsion of fallopian tube, meanwhile uncommon, should be considered in diagnosis of pelvic and lower abdominal pain. US investigation is an useful diagnostic tool. A prompt diagnosis could avoid salpingectomy and preserve fertility. Laparoscopy, as the first approach, should be preferred. We report a case of isolated tubal torsion occurring in a premenarcheal girl successfully managed by laparoscopy.

Acute abdomen due to ovarian congestion: a fallopian tube accompanied by a paratubal cyst, coiling tightly round the ovary.

We experienced an unreported rare case with an adnexal mass causing severe acute abdomen during pregnancy. A 30-year-old Japanese pregnant woman was transported to our hospital for her right lower abdominal pain at 30 weeks of gestation. Magnetic resonance imaging and ultrasound demonstrated a cyst measuring 3-4 cm in diameter adjacent to the right ovary, and a parovarian cyst was considered to be the most probable diagnosis. We strongly suspected torsion of the ovarian pedicle or fallopian tube in conjunction with her clinical symptoms. Laparotomy revealed that the elongated right fallopian tube accompanied by a paratubal cyst was coiling tightly 2.5 times round the right ovary, causing apparent congestion and enlargement of the right ovary. Soon after we released the congested right ovary from the coiling of the fallopian tube, the congestion subsided. The postoperative course was favorable, and pregnancy and delivery were uneventful.

Laparoscopic removal of a giant paratubal cyst complicated by hydronephrosis.

Paratubal cysts represent approximately 10% of all adnexal masses. In most cases they are very small, but very few cases are reported in the literature where they exceed 15 cm of diameter. Furthermore, giant paratubal cysts complicated by bilateral hydronephrosis are unique. The Authors describe a case of a huge paratubal cyst (30 cm in diameter), in a 14 year old obese girl, treated by complete laparoscopic enucleation.

Giant paratubal cyst: report of a case in second level public hospital.

BACKGROUND: Giant paratubal cysts are mostly benign tumors, with an incidence of 10%. The incidence rate of neoplasms is 2% to 3%, including papillary carcinoma and serous papillary neoplasms. CASE REPORT: A 35-year-old woman who began her current condition 3 years after her pregnancy, with urgency when urinating, abdominal pain and sensation of abdominal mass, who was diagnosed and protocolized in a second public level hospital of the State of Mexico, treated with open surgery, and good postoperative evolution.

ANTECEDENTES: Los quistes paratubáricos gigantes son en su mayoría tumores benignos, con una incidencia del 10%. La tasa de incidencia de neoplasias es del 2 al 3%, incluyendo carcinoma papilar y neoplasias papilares serosas. CASO CLÍNICO: Mujer de 35 años que comenzó su condición actual 3 años después de un embarazo, con urgencia al orinar, dolor abdominal y sensación de masa abdominal, que fue diagnosticada y protocolizada en un hospital público de segundo nivel del Estado de México, tratada con cirugía abierta y con buena evolución posoperatoria.

Giant paraovarian cysts in young adolescents: a report of three cases.

BACKGROUND: Very large pelvic cysts in young adolescents present a challenge in diagnosis and management. When such cysts present shortly after menarche, measure > 20 cm and appear simple on ultrasound or MRI, the diagnosis is likely a benign paraovarian cyst. CASES: Three young adolescents within 2 years of menarche presented with abdominal distention and masses. On ultrasound and MRI each was confirmed to be a large simple cyst ranging from 20-26 cm in diameter. In each case the simple cyst was drained through a very small incision, allowing the decompressed cyst and adnexa to be externalized and a cystectomy to be performed. The final pathology in each case was consistent with a paraovarian cyst. CONCLUSION: The peak incidence of paraovarian cysts is in the fourth and fifth decades of life; however, larger paraovarian cysts are more common in postpubertal teenagers. This is likely due to the fact that smaller asymptomatic cysts go unrecognized until later in life when they are found incidentally. Ultrasound is helpful in making the diagnosis in a young patient. Such cysts are unlikely to be malignant, and the least invasive approach possible in a young patient is preferable.

Clinical diagnosis and complications of paratubal cysts: review of the literature and report of uncommon presentations.

INTRODUCTION: Paraovarian or paratubal cysts (PTCs) constitute about 10 % of adnexial masses. Although they are not uncommon; they rarely cause symptoms and are usually incidentally found. Actual incidence is not known. The symptoms occur when they grow excessively, or in case of hemorrhage, rupture or torsion. METHODS: Here, literature review reporting the incidence, presentation and complications of PTCs is performed. Uncommon presentations of PTCs in three different cases, a giant PTC, torsion of PTC and borderline paratubal tumor, are also reported and discussed. RESULTS: Ultrasonography, CT or MRI may be performed in preoperative evaluation; but none of these imaging techniques have specific criteria for diagnosis. So, in most cases misdiagnosis as an ovarian mass remains to be a problem. CONCLUSION: Paratubal cysts can become extremely big before causing symptoms. Torsion is another urgent issue regarding PTCs, necessiating urgent surgery for preservation of the ovary and the tube. Although malignancy is rare, borderline paratubal tumors have been reported in the literature.

[Morphologic and immunohistochemical features of Fallopian tubes and ovaries in women with genetic predisposition to ovarian cancer].

The fallopian tubes and ovaries samples from 5 breast cancer patients and 12 practically healthy women considered to be at high risk for developing ovarian cancer underwent evaluation for morphological features and immunohistochemical expression of Ki-67 and p53. In high-risk patients the multiple follicular, serous, epithelial inclusion cysts (often with epithelial hyperplasia), surface papillomatosis, fibromatosis, cortical stromal hyperplasia in ovaries and fibres' sclerosis, paratubal cysts in fallopian tubes were discovered. Immunohistochemical study revealed strong expression of Ki-67 (LI 16-53,6%) in epithelial cells of follicular and inclusion cysts in 25% (3/12) of practically healthy women of reproductive age. P53 expression was determined in epithelium of inclusion cysts with high proliferative activity in 16,6% (2/12) of practically healthy women with BRCAI/2 mutation. The current results suggest histological evidence for the existent of pre-neoplastic phenotype defined by above-described histologic features in the high-risk ovaries, especially in carriers of BRCA1/2 mutations. P53 and Ki-67 expression in epithelium of inclusion cysts in women with BRCA1/2 mutations indicates the early genetic alterations in these cells and high risk of malignant transformation.

Clinical experience of adnexal torsion: evaluation of 143 cases.

We conducted this retrospective study to evaluate the outcomes, indications and post-operative findings of adnexal torsion cases and compared the features of benign cystic teratoma with the other cases. We analyzed a series of 143 cases of adnexal torsion from 2000 to 2009 at current clinic, retrospectively. The data were collected from the patient's specific files and hospital records descriptively. The demographic characteristics, sonographic findings and post-operative invention were evaluated. Statistical analyses were carried out by using the statistical packages for SPSS 15.0 for Windows (SPSS Inc., Chicago, IL, USA). A total of 143 cases were operated for adnexal torsion during the study period at our clinic. The clinical and demographic characteristics of the cases are shown in table 1. Of all patients, forty of them were diagnosed as benign cystic teratoma and this group of the adnexal torsion cases had statistically different gravidy, mass size and torsion number from the non-benign cystic teratoma group. Age was not a statistically different between two groups. According to this study, benign cystic teratoma increases risk of adnexal torsion. When detecting benign cystic teratoma the patients should be informed about the risk of torsion and explained the signs of this situation. The early diagnosis and appropriate surgical management of adnexal torsion is the only way to prevent complications and to preserve future fertility. Being aware of the different sonographic findings of torsionated adnexa may assist in the correct diagnosis of these patients.

Borderline mucinous tumor arising in a paratubal cyst: a case report.

BACKGROUND: Paratubal borderline tumors (PBTs) are found incidentally at frozen section or permanant pathology, and are extremely rare. We describe the first case of a paratubal borderline mucinous tumor (PBMT). CASE REPORT: A 20-year-old woman was referred with a complex right adnexal mass on pelvic sonogram. She underwent laparoscopic paratubal cyst enucleation. We used an endobag for cyst extraction. Cyst rupture or tearing of the endobag in the laparoscopic field was absent. Frozen section analysis was reported as a borderline mucinous tumor of low malignant potential. Currently, she has had no evidence of disease recurrence after a laparoscopic fertility-sparing staging procedure. CONCLUSION: A proper preoperative differential diagnosis of an adnexal mass is difficult. Thus, laparoscopy is needed in large or symptomatic cysts. Although growth, torsion and malignancy are rare in paratubal cysts, the possibility of tumor seeding should be excluded with use of an endobag.

Parovarian tumors of borderline malignancy.

The incidence of a parovarian tumor is 10-20% of all uterine adnexal masses, however, it is benign in most cases, and a borderline or malignant tumor is extremely rare. The classification of disease stage and treatment is still controversial owing to its scarcity. We have managed one mucinous and two serous cystadenomas of borderline malignancy originating from paraovarian cysts in our institute over ten year. We report and discuss the cases herein.

Leiomyoma with Bizarre Nuclei (Symplastic Leiomyoma) in the Paratubal Cyst Wall: Report of a Rare Case.

Leiomyoma is a benign mesenchymal tumor that develops from smooth muscle cells. It can present in various histological variants. Leiomyoma with bizarre nuclei is an infrequent variant of uterine smooth muscle neoplasm. It is characterized by focally or diffusely distributed bizarre cells on the background of a typical leiomyoma. These bizarre cells are large, multinucleated, or multilobulated and have an eosinophilic cytoplasm. Even though leiomyomas with bizarre nuclei display benign clinical behavior, their differential diagnosis from leiomyosarcoma can sometimes be difficult. Leiomyoma has been described most commonly in the uterus. There is no case of leiomyoma originating from paratubal cysts described in the literature. In this article, we present a rare case of leiomyoma with bizarre nuclei originating from a paratubal cyst.

Liesegang rings in paratubal cysts: case report and literature review.

Liesegang rings (LRs) are laminated precipitation structures well recognized in the field of chemistry. I present a rare case of a 53-year-old female who consulted for pelvic pain and abnormal uterine bleeding. The pelvic ultrasound revealed intramural and submucous uterine leiomyomas, and she underwent hysterectomy and bilateral salpingo-oophorectomy. Gross examination showed several paratubal cysts, which contained multiple eosinophilic concentrically spherical and oval structures of variable size compatible with LRs. In the female genital tract only 8 cases with LRs have been reported. This is the first documented case of LRs appearing in paratubal cysts. LRs formation should be taken into account during the histopathologic examination of paratubal cysts and not be misdiagnosed as a parasitic infection or foreign material within the female genital tract.

Paratubal Cyst Recurrence in Children and Adolescents.

STUDY OBJECTIVE: To examine the association between patient characteristics and risk for recurrence risk of paratubal cysts (PTC) in children and adolescents. DESIGN: Retrospective chart review at a single institution. SETTING: Single academic children's hospital. PARTICIPANTS: Pediatric patients presenting to Texas Children's Hospital between July 2007 and March 2019. Patients were identified for the study by reviewing pathology reports and were included if they met inclusion criteria of a pathologic diagnosis of a paratubal or paraovarian cyst removed during any surgical procedure between July 2007 and March 2019. INTERVENTIONS: Subjects with pathologic diagnoses of a paratubal cyst during the study period underwent chart review for the following data points: age at presentation, ethnicity, pathologic recurrence of paratubal cysts, pubertal status, body mass index (BMI), diagnosis of polycystic ovary syndrome (PCOS), size of cyst, laterality of cysts, and number of cysts. MAIN OUTCOME MEASURE(S): Recurrence, Pathology types. RESULTS: Of the 627 patients that met inclusion criteria, the incidence of recurrence was 11.3%. Group 1 included those with recurrence of PTC (N = 70). Group 2 was identified as those without recurrence of PTC (N = 557). There were no differences related to age, BMI, ethnicity, history of PCOS, cyst size, laterality or number of cysts present. PTC NOS and serous PTC occurred most frequently. Of the unique cases involving recurrence, 70.1% recurred on the ipsilateral side. There were no cases of paratubal cyst malignancies in this cohort. The range of pathology diagnoses included pathologies that may occur in ovarian cysts. This is particularly interesting, given the known origins of ovarian cancer from fallopian tube transformations. Rare pathology diagnoses likely did not occur with frequency to determine definitive risks of recurrence in these cases. CONCLUSIONS: There appears to be a baseline recurrence risk for PTC, for which patients can be counseled. Recurrence does not appear to be associated with any particular pathology type, cyst size, number of cysts, BMI, PCOS, or puberty stage. Recurrence, should it occur, appears to occur more commonly on the ipsilateral side.

Giant Paratubal Serous Cystadenoma in an Adolescent Female: Case Report and Literature Review.

BACKGROUND: Paraovarian/paratubal cysts constitute 5-20% of all adnexal lesions and typically originate from the paramesonephric or Müllerian duct. The primary epithelial tumors arising from paraovarian cysts account for 25% of the cases, but giant cystadenomas of paraovarian origin are extremely uncommon during childhood and adolescence with very few cases reported in the literature. CASE: We present the case of a 15-year-old female that presented with a bulky mass in the abdomen and pelvis. An initial clinical and radiological examination indicated an ovarian cyst measuring ∼25 × 20 cm. However, explorative laparotomy revealed a giant paratubal cyst that was successfully treated with complete excision using fertility-sparing surgery. Histopathological examination was consistent with a serous cystadenoma. The postoperative course was uneventful and the girl was discharged on the seventh postoperative day. At the follow-up of 6 months, the patient was doing well.

Paratubal borderline serous tumor in a postmenopausal woman: a case report.

Unlike borderline ovarian tumors, paratubal borderline tumors are extremely rare gynecologic tumors. They occur in reproductive-aged females at an earlier stage of disease and have a good prognosis. A 61-year-old woman, gravida 3 para 3, presented with progression of ovarian cyst. Computed tomography revealed a 6-cm simple cystic lesion without enhancing papillary projections. The patient underwent total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. Frozen specimens showed that the tumor was benign, thereby confirming a final diagnosis of paratubal borderline serous tumor. The patient refused comprehensive surgical staging and opted for close follow-up. The patient remains asymptomatic with no evidence of recurrence at the 24-month follow-up. To the best of our knowledge, this is the first reported case of paratubal borderline serous tumor in a postmenopausal patient. The findings of this study and those of other case reports can contribute to the understanding, diagnosis, treatment and prognosis of these rare tumors.

An incidental diagnosis of a giant paraovarian cyst in a female teenager: A case report.

RATIONALE: Paraovarian cysts (PCs) are cystic tumors that can be encountered between the ovarian hilum and the ovarian fimbria located within the mesosalpinx and broad ligament, being usually diagnosed within the 3rd and 4th decade of life. PATIENT CONCERNS: We report the case of a 15-year-old female admitted in our clinic for consciousness loss, who was incidentally diagnosed with a giant pelvic cystic at ultrasound. DIAGNOSES: The magnetic resonance image showed a cystic mass of 170/140/85 mm, suggesting an origin from the left ovary, reaching the subhepatic area. INTERVENTIONS AND OUTCOMES: The surgical intervention revealed 3 PCs, a giant one and 2 smaller ones within the large ligament. The cysts were removed by laparoscopic approach, and the histologic examination did not reveal any signs of neoplasia. LESSONS: In addition to their rarity, giant PCs can be an incidental diagnosis in patients presenting unrelated symptoms resulting in increased difficulties related to the diagnosis. Moreover, the imagistic tools might not establish precisely the origin of these cysts, and therefore, the final diagnosis and treatment approach could be determined sometimes only during the surgical intervention.