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.

Non-Tender Huge Abdominal Mass in an Adolescent: Bilateral paraovarian cysts.

Paraovarian cysts constitute about 10% of all adnexal masses in females and occur most commonly in the third and fourth decades of life. These cysts are benign and usually uncommon in adolescence. Such cysts pose a diagnostic challenge while distinguishing them from ovarian cysts clinically and during radiological investigations. We report a rare case of a 13-year-old female patient with bilateral paraovarian cysts, including a giant cyst in right mesosalpinx presenting to Sohar hospital, Oman in 2018. The definitive origin of the huge mass on the right side of abdominal cavity could not be established in the current case despite contrast enhanced computerized tomography. It was only on laparoscopic exploration that this mass was identified as a giant paraovarian cyst. Both the giant cyst and a smaller paraovarian cyst on the left side were enucleated with minimally invasive surgery while preserving the fertility of the patient. Only one other similar case of bilateral paraovarian cysts in an adolescent, including a giant cyst managed with laparoscopy, has been documented previously.

Paraovarian Cyst Torsion in a Patient with Rubinstein-Taybi Syndrome: A Case Report.

Rubinstein-Taybi syndrome is an extremely rare autosomal dominant genetic disorder that occurs in 1/125,000 and is characterized by distinctive facial appearance, short stature, mild to severe mental retardation, and higher risk for cancer. In addition, variable organ anomalies had been reported. Paraovarian cyst causing torsion of the ipsilateral fallopian tube is less common, with an estimated incidence of 1/1,500,000, but it can adversely affect tubal function. It occurs mainly in women in the reproductive age and is very rare in prepubescent girls. Here, we described the successful treatment of an extremely rare case of paraovarian cyst causing torsion of the ipsilateral fallopian tube in a patient with Rubinstein-Taybi syndrome. A 14-year-old girl with Rubinstein-Taybi syndrome was referred to our hospital for abdominal pain. Her medical history was unremarkable, except for moderate hirsutism and keloid scar. Physical examination revealed tenderness in the lower abdominal midline. The preoperative diagnosis was torsion of a left ovarian cyst. An exploratory laparoscopy was performed because of acute abdominal pain and revealed a left fallopian tube that was twisted twice due to an ipsilateral paraovarian cyst. The huge paraovarian cyst required laparotomy cystectomy, and the left ovary was preserved. Her postoperative course was uncomplicated. Preoperative diagnosis of paraovarian cysts can be difficult. The moderate hirsutism seen in our patient suggested the presence of a large paraovarian cyst due to androgen receptor-mediated effects. Therefore, Rubinstein-Taybi syndrome patients with hirsutism should be screened and assessed by pediatric surgeons for the presence of paraovarian cysts.

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.

Laparoscopic Management of Large Right Paratubal Cyst: A Case Report.

Paratubal cysts are generally small but there are rare cases of large paratubal cyst and this case is one of them. Here we report a case of a young female with complains of abdominal fullness since 3 months. On examination, a huge mass (25 x 25 cm) extending from symphysis pubis upto xiphisternum was noted. Ultrasongraphy showed a cystic mass of 27 x 27 cm. Intraoperatively, the cyst was paratubal. It was drained with the help of veress needle and laparoscopic cystectomy was done. A large adnexal cyst extending above umbilicus is traditionally managed by laparotomy. But with the advent of laparoscopy, even a huge cyst can be managed by laparoscopy.

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.

Paratubal cyst: a case report.

Paratubal cyst can undergo torsion that can make it difficult to diagnose since tubal cysts mimic ovarian cysts. Most reported cases of paratubal cysts have occurred in pediatric patients, and this type of cyst rarely causes symptoms of lower abdominal pain mimicking appendicitis. We present the case of a 28-year-old female who was taking Carbergoline for hyperprolactinoma associated with a pituitary adenoma who came to the ER at Henry Ford Hospital in Detroit experiencing severe abdominal pain. Her pain was not accompanied by nausea, vomiting or other gastrointestinal symptoms. A transvaginal ultrasound revealed a normal uterus with the right ovary containing a cyst measuring 3 cm. x 2 cm. She was released on analgesics and seen at the clinic at Henry Ford Hospital three days later. She was still experiencing pain and was given antibiotics and Darvocet. When the pain had not subsided 48 hours later, a decision was made to perform diagnostic laparoscopy. Surgery was performed 10 days later and a paratubal cyst was removed that was twisted twice on its pedicle. This case illustrates the fact that torsion of paratubal cyst should be included in the differential diagnosis of adnexal pain.

Value of ultrasound-guided fine-needle aspiration in the management of ovarian and paraovarian cysts.

This study was designed to assess if cytology was accurate for an appropriate diagnosis of ovarian and paraovarian cysts, and if the ultrasound-cytology-estradiol (UCE) triad was sufficient to discriminate functional vs. nonfunctional cysts, the latter requiring surgical resection. One hundred twenty-two ultrasound-diagnosed adnexal cysts were punctured and surgically removed, and then subjected to cytologic and histologic examinations; 90 of these fluids were assayed for estradiol. Histologically, 30 cysts were functional and 92 were nonfunctional. A correct discrimination between functional and nonfunctional origin was obtained in 54.9% of cases with cytology, in 94.4% with estradiol assay, in 50.8% with ultrasonography, and in 97.8% with these three examinations combined (UCE triad). Among the 34 patients with no criteria of neoplastic origin (age >40, ultrasonographic findings), the UCE triad diagnosed six functional cysts. Therefore, 17.6% (6/34) of these young women could have avoided unnecessary surgery. Diagn. Cytopathol. 2000;22:70-80.

A voluminous twisted paraovarian cyst in a 74-year-old patient: case report and review of the literature.

Although paraovarian cysts rarely cause symptoms, they may be complicated due to massive size, torsion or internal haemorrhage from rupture. Moreover, benign or malignant neoplasms may occasionally develop in paraovarian cysts. The risks from voluminous ovarian or paraovarian cysts are due to severe cardiovascular, pulmonary, and circulatory problems including surgical and postoperative complications. We present a case of a 74-year-old patient who suffered from a twisted voluminous right paraovarian cyst. Her preoperative respiratory function required attention. The patient was treated surgically with good results and she showed notable improvement of her respiratory function, postoperatively. The maximum diameter of the mass was 26 cm and its total weight was 5,100 g. In addition, a simple cyst was found in the left ovary with a maximum diameter of 9.5 cm and total weight of 300 g. In conclusion, paraovarian cysts, even in elderly patients, can reach large sizes requiring awareness of the problems that these large masses may cause.

Uterine adnexal torsion: pathologic and gray-scale ultrasonographic findings.

INTRODUCTION: Uterine adnexal torsion is a rare and potentially lethal condition that may arise most unexpectedly in women of any age. It may be partial or complete, the later often resulting in necrosis, gangrene and peritonitis if untreated. The purpose of the study was to determine the spectrum of the histologic and gray-scale sonographic pictures in a series of surgically proven cases of uterine adnexal torsion. METHODS: The study population for the pathologic analysis of twisted uterine adnexa included 92 patients with surgical confirmation of torsion of the uterine adnexa; all the patients were treated radically. All the pathology records were reviewed retrospectively over a 10-year period (from 1992 to 2002) by the coding of ovarian, fallopian tube or adnexal torsion. The gray-scale sonographic findings were analysed in 20 patients who underwent sonographic examination before surgery and adnexal torsion was confirmed at surgery. RESULTS: Neoplasms constituted 46% (42/92) and cysts formed 48% (44/92) of all the twisted uterine adnexa. Normal-sized twisted adnexa were found in five patients (5%) while in one patient simultaneous torsion of both normal fallopian tubes was found (1%). The prevalence of the twisted neoplasms was 16 mature teratomas, nine serous cystadenomas, five mucinous cystadenomas, three serous borderline carcinomas, two fibroma/thecomas, two mucinous borderline carcinomas, two malignant granulosal-stromal cell tumours, one malignant dysgerminoma, one immature teratoma and one clear cell adenocarcinoma. The twisted cysts were 18 serous cysts, 11 paraovarian cysts, nine corpus luteum cysts, three hydrosalpinges, one mucinous cyst and one endometrioma. In one case the torsion of the right ovary was due to hyperstimulation of the ovaries with gonadotropin therapy for IVF treatment. Gray-scale sonographic examination demonstrated cystic lesions in 80% (16/20), solid masses in 5% (1/20) and normal adnexa in 15%; cul-de-sac fluid was present in 55% (11/20). Laparotomy revealed reactive cul-de-sac fluid in ten of these cases (50%) and haemoperitoneum in one (5%). CONCLUSION: Adnexal torsion is most commonly associated with benign processes (89%) and usually occurs in patients under 50 years old (80%). The spectrum of sonographic findings varies due to the adnexal pathology, the degree and the duration of adnexal torsion.

Torsion of parovarian cyst--report of two cases.

A parovarian cyst oxiginates from the tissue of the broad ligament, predominantly from mesothelium covering the peritoneum but also from paramesonephric and mesonephric remnants. Clinically, torsion of a parovarian cyst is uncommon, and it is difficult to distinguish it from torsion of other adnexal masses, an ovarian accident, appendicitis, etc. Recently, we experienced two cases of torsion of parovarian cysts. In one case, it was associated with 32 weeks' intrauterine gestation. In this case, pelvic sonography during the first and second trimester showed no cystic lesions. In the other case, a lower abdominal pain continued about two weeks. A sonogram revealed a very small cyst like a follicle. These twisted parovarian cysts were removed at laparotomy. The clinical and pathological features of the torsion of parovarian cysts are briefly discussed and the literature is reviewed.

Paratubal borderline tumor diagnosed in the adolescent period: a case report and review of the literature.

BACKGROUND: Borderline paratubal cysts are rare entities. These tumors are identified as epithelial proliferation without stromal invasion. CASE: A 19-year-old virgin patient was admitted to our clinic with abdominal pain and nausea. The sonographic evaluation showed a left adnexal mass 89 × 80 mm in diameter with solid tissue projections. Doppler examination revealed no significant blood supply. At surgery, a torsed left paratubal cyst 10 cm in diameter and normal bilateral ovaries were encountered. Cystectomy was performed and of frozen section revealed a borderline Fallopian tube neoplasm. Final pathology review was reported as a serous borderline paratubal tumor. CONCLUSION: The evaluation of the structure of cyst by ultrasound and the performance of intraoperative frozen section analysis are two important issues to diagnose the nature of a cyst. Fertility-sparing surgery is the main point of management.