Factors affecting anxiety, depression, and stress among patients with hepatocellular carcinoma during COVID-19 pandemic.

OBJECTIVE: Patients with chronic disease whose treatments are limited may experience depression, anxiety, and stress-related symptoms, as well as an increase in the levels of these conditions. This study aims to determine the factors affecting the depression, stress, and anxiety levels of hepatocellular carcinoma (HCC) patients due to the fear of COVID-19 exposure. PATIENTS AND METHODS: 118 patients with advanced HCC treated with non-transplant treatment options or on the waiting list due to the lack of a donor were enrolled. To evaluate the stress, depression, and anxiety levels during the COVID-19 process, Depression Anxiety Stress Scales (DASS-21) and the Coronavirus Anxiety Scale (CAS) were administered to 118 patients through a face-to-face interview. Sociodemographic and clinical characteristics were recorded, and the primary endpoint measure was the total score of DASS. In addition, the multilayer perceptron (MLP) model was constructed to predict the scores of the DASS-21 total. RESULTS: There were significant differences between DASS depression (p=0.010; p=0.030) DASS anxiety (p=0.010; p=0.010) and DASS total (p=0.046; p=0.023) scores in terms of gender and protective effect of the vaccine. Also, a significant difference between gender for the CAS scale was determined (p=0.044). The median score of the DASS total in the COVID-19 group was higher than in the non-COVID-19 group; however, the increase was not significant. MLP model revealed that chronic disease, gender, age, place of residence, smoking, type of vaccine, and COVID-19 exposure were the most important predictors for the DASS total. CONCLUSIONS: Chronic disease, gender, and age were prominent factors in predicting the DASS-21 total score in HCC patients. Therefore, the crucial factors were clinically considered for managing depression, stress, and anxiety in HCC patients.

Management of wet ascitic type of peritoneal tuberculosis: single center experience.

OBJECTIVE: We aimed to present our experience with the management of 17 patients with ascites who underwent diagnostic laparoscopy or laparotomy, and histologic confirmation of wet ascitic type of peritoneal tuberculosis (TB). PATIENTS AND METHODS: Between January 2008 and March 2019, 17 patients whose ascites were investigated by a gastroenterologist and who were thought to have non-cirrhotic ascites were referred to our Surgery clinic for peritoneal biopsy. The clinical, biochemical, radiological, microbiological, and histopathological data of the patients who underwent diagnostic laparoscopy or laparotomy were analyzed retrospectively. Histopathological examination of peritoneal tissue samples in hematoxylin-eosin-stained preparations revealed necrotizing granulomatous inflammation with caseous necrosis and Langhans type giant cells. Ehrlich-Ziehl-Neelsen (EZN) staining was studied with the suspicion of TB. Acid-fast bacilli (AFB) were detected in EZN stained slide. Histopathological findings were also considered. RESULTS: Seventeen patients aged 18 to 64 years were included in this study. The most common symptoms were ascites and abdominal distention, weight loss, night sweats, fever and diarrhea. Radiological examination revealed peritoneal thickening, ascites, omental cacking, and diffuse lymphadenopathy. Histopathologically, necrotizing granulomatous peritonitis consistent with peritoneal TB were detected. While direct laparoscopy was preferred in sixteen patients, laparotomy was preferred in the remaining one due to previous surgical procedures.  However, seven were converted to open laparotomy. CONCLUSIONS: Diagnosis of abdominal TB requires high index of suspicion, and the treatment should be prompt to reduce the morbidity and mortality associated with delay in treatment.

Ectopic bone formation in thyroid gland: report of sixteen cases and comprehensive literature review.

OBJECTIVE: This study aimed to analyze the outcomes of patients with ectopic bone formation (EBF) diagnosed in thyroidectomy specimen. PATIENTS AND METHODS: We retrospectively analyzed the data of 16 patients who underwent thyroidectomy between February 2009 and June 2018 and whose pathology examination diagnosed EBF. RESULTS: Fourteen patients underwent bilateral total thyroidectomy (BTT), one patient required BTT with central lymph node dissection, and one patient was subjected to BTT with functional lymph node dissection. On histopathological examination, left lobe EBF was diagnosed in four patients; left lobe EBF with bilateral papillary thyroid carcinoma (PTC) in two; left lobe EBF with left lobe PTC in one; left lobe EBF with left follicular adenoma in one; left lobe EBF with right lobe papillary thyroid microcarcinoma in one; bilateral EBF in one; right lobe EBF with extramedullary hematopoiesis in one; right lobe EBF in three; right lobe EBF with right lobe medullary thyroid carcinoma in one, and right lobe EBF with bilateral lymphocytic thyroiditis in one. One of the five patients who underwent bone marrow biopsy was diagnosed with myeloproliferative dysplasia, and another with polycythemia vera. Three patients were treated medically for anemia because no other pathological findings could be observed. CONCLUSIONS: There is a lack of literature data about the clinical significance of EBF in the thyroid gland in cases with no concomitant hematological diseases. People who have been diagnosed with EBF in the thyroid gland should be checked for hematological diseases.

Vessel sealing system vs. conventional knot-tying for hilar dissection during living donor hepatectomy: a prospective, randomized, double-blinded study.

OBJECTIVE: LT has become the gold standard treatment for many liver diseases, especially chronic liver disease. A commonly seen problem, even in donors who do not develop any major complications after living donor hepatectomy (LDH), is the persistent drainage of lymphatic fluid from the hepatectomy site drain, which causes extensive hospitalization and consequent loss to the workforce. To our knowledge, no study has yet been published comparing LVSS and conventional knot-tying methods for hilar dissection, which is an important stage of the LDH procedure. We aimed to prospectively compare the outcomes of these two treatment methods. PATIENTS AND METHODS: Donor candidates were divided into two groups: conventional suture tying (conventional knot tying group; n=34) and Ligasure vessel sealing system (LVSS; n=34). A simple randomization method of drawing lots was used to assign the patients to each group. The following parameters were analyzed for all patients: age, gender, BMI, duration of surgery, postoperative drainage amounts, drain removal times and complications, length of hospital stay, morbidity, and mortality. RESULTS: There were no significant differences in terms of operative times, postoperative drainage levels, hospital stay or drain removal times. CONCLUSIONS: In this study, the use of LVSS in LDH was found to be safe, although it did not offer any advantage over conventional methods. Nevertheless, it seems probable that the use of LVSS could reduce operative time and amounts of lymphatic drainage, especially in centers with minimal experience with LDH, such as new LDH centers.

Hepatitis B/D-Related Hepatocellular Carcinoma. A Clinical Literature Review.

AIM: Given the current literature data, this article aims to shed light on the epidemiological and clinical effects of HBV, as well as its impact on the development of hepatocellular carcinoma (HCC). METHODS: A review of the English language literature based on a MEDLINE (PubMed) database was searched. The keywords were cirrhosis, hepatocellular carcinoma, epidemiology, hepatitis delta virus, hepatitis B virus, and co-infection. All references from retrieved papers were reviewed systematically to find additional collection of reports. RESULTS: The study has broadly confirmed the contribution of HDV viremia to liver disease and cirrhosis. However, uncertainty over the mechanism of action on HCC development remains. As the recent data has demonstrated, the HCC-HDV has a unique molecular profile which is distinct from that of HBV-HCC. CONCLUSION: Owing to the dependence of HDV on HBV, it is not clear whether HCC is a consequence of the cumulative effect of both HBV and HDV, an effect of the underlying cirrhosis, or a direct oncogenic effect of HDV. Many questions concerning the oncogenic role of HDV remain unanswered. To better understand the role of HDV in carcinogenesis, studies at the molecular level that consider genotype differences should be increased. Multicenter, high-volume, and prospective studies that compare HBV/HDV co-infected and HBV-infected individuals will be pivotal in determining the oncogenic role of HDV.

Narrowing of the Inferior Vena Cava following Closure of the Right Hepatic Vein Stump in a Patient undergoing Living Donor Hepatectomy.

Living donor hepatectomy is not without risks, and some complications can end up with serious morbidities if not timely diagnosed and appropriately managed. In this report, we described a very unusual but significant surgical problem in living liver donor surgery in which a significant narrowing occurred in the inferior vena cava after the closure of the stump of the right hepatic vein and inferior right hepatic vein close to the right hepatic vein together, and describe the cavoplasty technique used to repair this narrowing. To the best of our knowledge, the technique of solving this problem in living liver donors was described only once in literature, which was previously published by our team.

Aborted donor hepatectomy in living donor liver transplantation: lessons learned.

BACKGROUND: Aborted donor hepatectomy (ADH) during any stage of living donor hepatectomy (LDH) is a rare event. We describe our experience and discuss the lessons from these events. METHODS: From September 2005 to January 2019, 77 of 2 031 (3.79%) LDH were aborted at various stages of surgical procedure due to donor or recipient related reasons. Demographic and clinical data of aborted donor candidates and the clinical course of their potential recipients were analysed. RESULTS: LDH of 77 donor candidates was aborted due to donor (n = 53) or recipient (n = 24) related reasons. The most common donor related reason was the quality of liver parenchyma (n = 31). The most common recipient related reason was haemodynamic instability (n = 11). Twenty-three recipients underwent either living donor liver transplantation (LDLT) (n = 21) or deceased donor liver transplantation (DDLT) (n = 2) at a median of 6 days following ADH. In one aborted due to a donor reason and two aborted for recipient reasons, LDLT was performed using the same donor candidates. Thirty-six recipients had no liver transplantation (LT) and died a median of 17.5 days following ADH. CONCLUSIONS: We believe that ADH will decrease with experience and meticulous preoperative clinical and radiological evaluations. Abandoning the donor hepatectomy is always a valid option at any stage of the surgery when the unexpected is encountered.

Is there any relationship between clinical parameters and histopathologic features of gallbladder specimens obtained from living liver donors?

OBJECTIVE: To investigate whether there is any relationship between the clinical parameters and the histopathological features of the gallbladder (GB) specimens obtained from living liver donors (LLDs). METHODS: The demographic (age, sex, height, weight, and BMI), clinical (liver graft type, liver graft weight, and GB volume), microbiological (bile culture), and histopathological (width, length, wall thickness, and microscopic properties of the GB specimen) data of 169 LLDs, who underwent living donor hepatectomy between October 2015 and October 2017, were prospectively recorded and retrospectively analyzed. The LLDs were compared with respect to sex (male vs. female) and the histopathological features of the GB (normal structure vs. chronic cholecystitis vs. cholesterolosis/polyps/cholelithiasis). RESULTS: There were no significant differences between both sexes with respect to age, graft type, and some features of GB (volume, wall thickness, width, length, and bile culture). On one hand, there were significant differences between both sexes with regard to height (P < 0.001), weight (P < 0.001), BMI (P < 0.001), histopathological findings (P = 0.003), and graft size (P = 0.003). Comparison with regard to GB's histopathological features revealed no significant differences between the three groups with respect to age, weight, and some features of GB (volume, length, width, and bile culture). On the other hand, the three groups were significantly different in terms of sex (P = 0.003), height (P = 0.008), BMI (P = 0.002), and wall thickness (P = 0.044). Bile culture proliferation occurred in none of the patients except for one patient. CONCLUSION: This study is the first to assess GB's volume, dimensions, and bile culture in healthy individuals such as LLDs.

Salivary gland anlage tumour of the nasopharynx: A case report and review for histopathological characteristics.

INTRODUCTION: Congenital salivary gland anlage tumour of the nasopharynx is a lesion which usually presents with nasal and upper respiratory tract obstruction in the neonatal period. Timely diagnosis is essential to prevent the occurrence of respiratory complications in later childhood. CASE REPORT: We present a 8-year-old boy complaining from difficulty in breathing and breastfeeding in the neonatal period due to an adenoid-like nasopharyngeal mass. Histological examination revealed solid and cystic squamous nests and numerous duct-like structures within collagenised stroma. Both epithelial and myoepithelial differentiation were noted in the tubular component. DISCUSSION: A review of the clinical and histopathological features of published cases revealed that ancient lesions showed more prominent and complex epithelial component and more collagen rich stroma. We would like to suggest the possibility of salivary gland anlage tumour to be considered in the differential diagnosis of neonatal respiratory distress cases.

The effect of peritoneal dialysis with alkaline dialysate in peritonitis carcinomatosis: an experimental study in mice.

OBJECTIVE: The aim of this study was to neutralize acidic pH using an alkaline dialysate for continuous ambulatory peritoneal dialysis (CAPD) in mice with peritoneal carcinomatosis (PC) and to investigate the change of the pH level in the acidic fluid along with its effects on liver oxidative stress, liver and kidney histopathology and the lifespan of the body. MATERIALS AND METHODS: A total of 38 mice were randomly divided into 4 groups.PC development was inhibited by intraperitoneal injection of Ehrlich tumor cells in all mice in each group. RESULTS: In the group-1 receiving CAPD, the pH levels of acidic liquid were higher; and the levels of liver TBARS were lower with higher reduced glutathione levels. Histopathological damage in group-1 was less than in group-2. In Group 3 receiving CAPD, the average lifespan extended by 10.4%. The average lifespan extended by 26.1%. CONCLUSION: This study indicated that applying CAPD with alkaline dialysate in PC contributed to the neutralization of acidosis of the intraperitoneal acid structure;had favorable effects on oxidative stress markers in liver tissue; prevented histopathological injury in liver and kidney tissues, and extended the life span of the body in mice. As this is a simple, inexpensive, and easily available method, larger studies are warranted to evaluate its effects.

Laparoscopic management of hydatid cyst of the liver.

BACKGROUND: Hydatid liver disease management has evolved from traditional operative approaches to the increasing application of laparoscopic treatments. We aimed to prospectively assess the early outcomes of laparoscopic treatment at our institution. PATIENTS AND METHODS: Forty-four patients with hydatid disease of liver were screened with ultrasonography and computed tomography of the abdomen to exclude Gharbi type V cysts. The distribution of cyst sizes was: 1-4 cm, 10; 5-10 cm, 24; 10-15 cm, 8; > 15 cm, 2 patients. The following laparoscopy therapies were performed: 30 patients had cystectomy alone, 14 patients had partial pericystectomy. Pericystectomy was performed using a hook and harmonic tissue sealers with the resection made through normal liver tissue. RESULTS: Three patients were converted to open surgery. Seven patients had biliary leakage through their cystic cavity drains. Five stopped spontaneously by the 7th postoperative day and 2 responded to ERCP sphincterotomy. There were no deaths and no recurrence of disease noted by 6 months. CONCLUSION: In selected patients with hepatic hydatid disease, a laparoscopic treatment is feasible and safe with low conversion rate and short term recurrences.

Circumferential Fence With the Use of Polyethylene Terephthalate (Dacron) Vascular Graft for All-in-One Hepatic Venous Reconstruction in Right-Lobe Living-Donor Liver Transplantation.

Integration of hepatic vein tributaries with a diameter ≥ 5 mm into the drainage system in right-lobe living-donor liver transplantation (LDLT) is of vital importance for graft function. Recently, the most commonly emphasized hepatic venous reconstruction model is the all-in-one reconstruction model. In the final stage of this model that aims to form a common large opening, allogeneic vascular grafts are almost always used to construct a circumferential fence. To date, no other study has reported the use of polyethylene terephthalate (Dacron) vascular graft as a circumferential fence in LDLT. We aimed to present the 1st 4 cases of circumferential fences created with Dacron vascular graft. Four right-lobe grafts weighing 522-1,040 g were used. A polytetrafluoroethylene vascular graft was used for the integration of segment 5 vein and segment 8 vein into the drainage model, whereas a Dacron graft was used to creating a circumferential fence. The patency of hepatic outflow evaluated with the use of multidetector computerized tomography at postoperative day 7. Venous outflow obstruction was not detected in any cases. This study suggested that owing to its flexible structure the polyethylene terephthalate vascular graft can be an alternative to allogeneic vascular grafts in forming circumferential fence.

Histopathologic Findings of Cholecystectomy Specimens in Patients Who Underwent Donor Hepatectomy for Living Donor Liver Transplantation.

BACKGROUND: The aim of this study was to discuss the macroscopic and microscopic properties of gallbladder specimens obtained from living liver donors. METHODS: The study retrospectively analyzed the clinical and histopathological data of 1088 donors who underwent living donor hepatectomy between March 2005 and September 2014 at Inonu University Faculty of Medicine, Liver Transplantation Center. Age, sex, macroscopic, and microscopic properties of the gallbladder (bladder length, diameter, content, and histopathological properties) were recorded by 2 researchers. RESULTS: A total of 1009 donors aged 17 to 66 years (31.1 ± 9.5) met the inclusion criteria, whereas 79 donors were excluded due to missing data. In total, 587 donors were male (30.5 ± 9.1 years [16-63 years]) and 422 were female (31.8 ± 9.8 years [18-66 years]). Preoperative tests revealed Gilbert syndrome in 3 subjects, whereas other donors' biochemical tests were within normal ranges. The macroscopic examination of gallbladders revealed mean gallbladder wall thickness, length, and width of 1.82 ± 0.8 mm (1-10 mm), 72 ± 11.4 mm (40-120 mm), and 52.5 ± 14 mm (15-90 mm), respectively. The microscopic gallbladder examination showed that 740 donors had a normal gallbladder, 193 had chronic cholecystitis (1 donor had antral metaplasia and 1 had intestinal metaplasia), 40 had cholesterolosis (1 donor had both tubular adenoma and intestinal metaplasia), 15 had minimal chronic cholecystitis (1 donor had pyloric metaplasia), 14 had cholelithiasis, 2 had adenomyosis, 2 had muscular hypertrophy, 1 had papillary hyperplasia, 1 had microdiverticulitis, and 1 had mucosal lymphatic ectasia. CONCLUSION: The results of this study reflect the actual gallbladder pathologies that can be detected in healthy people. Clearer conclusions can be reached about the epidemiological data on gallbladder as the number of living liver donors increases in the future.

Unusual cause of defecation disturbance: a presacral tailgut cyst.

BACKGROUND: The aim of this study was to provide an overview of the literature on Tailgut cysts (TGCs) arising in the presacral space. MATERIALS AND METHODS: We present a new case of presacral TGC and a literature review of English-language studies of presacral TGCs, accessed through the PubMed and Google Scholar databases. Keywords used were presacral or retrorectal tailgut cyst, presacral mucus-secreting cyst, retrorectal cystic hamartoma, retrorectal tumor, vestigial retrorectal or presacral cyst, and presacral cystic tumor. RESULTS: A 29-year-old woman presented to our Clinic with defecation disturbance caused by a presacral TGC. Our literature review resulted in the inclusion of 94/111 articles and 155/332 described cases (129 women, 26 men; age, 0-80 years) of presacral TGC in this study. Although most patients presented with complaints such as rectal bleeding, rectal fullness, perianal pain, constipation, and pain reflected to the back, some asymptomatic cases were identified incidentally and others were detected during the investigation of atypical complaints such as pilonidal abscess, sinus, vaginal obstruction, and perianal abscess. Malignant transformation was found in 47/332 cases, including adenocarcinoma (n = 26); carcinoid tumor (n = 16); endometrioid, adenosquamous, and squamous carcinomas; sarcoma; and paraganglioma. CONCLUSIONS: The high rate of malignant disease development from TGCs, which comprise a significant proportion of presacral masses; the development of significant postoperative recurrence, causing atypical conditions such as perianal fistula; and the high rates of infection due to partial resections make it essential to perform complete tumor resection with adequate margins.

Liver transplantation with piggyback anastomosis using a linear stapler: a case report.

The so-called piggyback technique of liver transplantation (PB-LT) preserves the recipient's caval vein, shortening the warm ischemic time. It can be reduced even further by using a linear stapler for the cavocaval anastomosis. Herein, we have presented a case of a patient undergoing a side-to-side, whole-organ PB-LT for cryptogenic cirrhosis. Upper and lower orifices of the donor caval vein were closed at the back table using a running 5-0 polypropylene suture. Three stay sutures were then placed on caudal parts of both the recipient and donor caval with a 5-mm venotomies. The endoscopic linear stapler was placed upward through the orifices and fired. A second stapler was placed more cranially and fired resulting in a 8-9 cm long cavocavostomy. Some loose clips were flushed away from the caval lumen. The caval anastomosis was performed within 4 minutes; the time needed to close the caval vein stapler insertion orifices (4-0 polypropylene running suture) before reperfusion was 1 minute. All other anastomoses were performed as typically sutured. The presented technique enables one to reduce the warm ischemic time, which can be of particular importance with marginal grafts.

Liver transplant with a marginal donor graft containing a hydatid cyst--a case report.

Liver transplantation has become the standard treatment for acute failure and end-stage liver disease, but there are fewer donor organs available than patients on the waiting list. The donor pool may be increased by using marginal donor candidates. Some infectious and metabolic diseases have been transmitted to the recipient via marginal donor grafts. Hydatid cyst disease is rarely transmitted to a recipient from the donor graft. A literature search showed only 2 previous cases of liver transplantation using a donor graft that contains a hydatid cyst. We treated a 19-year-old woman who experienced acute on chronic end-stage liver failure secondary to cryptogenic cirrhosis. The liver graft from a 97-year-old marginal cadaveric donor contained a calcified hydatid cyst. No complication was associated with the hydatid cyst at 3 years after transplantation. The present case shows that donor livers with an inactive, calcified hydatid cyst may be used for emergency liver transplantation after considering the location, size, and relation of the cyst to vascular and biliary structures. The cyst may be resected on the back table with a successful treatment outcome.

Unusual cause of adult intussusception: diffuse large B-cell non-Hodgkin's lymphoma: a case report and review.

BACKGROUND: Intussusception is defined as the telescoping of a segment of the gastrointestinal tract into an adjacent one. A demonstrable etiology is found in 70% to 90% of cases in adult patients, and about 40% of them are caused by a primary or secondary malignant tumor. The aims of this study were to give an overview of the literature on intussusception due to gastrointestinal lymphoma. MATERIALS AND METHODS: We present a case of ileocecal intussusception secondary to non-Hodgkin's lymphoma (NHL), as well as a literature review of studies published in the English language on intussusception secondary to lymphoma, accessed through PubMed and Google Scholar databases. RESULTS: Thirty-six published cases of intussusception caused by lymphoma were evaluated, and a case of ileocecal lymphoma in a 62 year-old woman is herein presented. In the reviewed literature, 33 reports meeting the aforementioned criteria were included in this review. The patients were aged from 16 to 86 years (mean, 48.2 +/- 19.0 y). Twenty-nine were male and seven were female. According to the localization of lymphoma, 24 patients had ileo-colic intussusception, 10 had enteric, and 2 had colic intussusception. In terms of the diagnosis, 34 patients were diagnosed with various types of NHL, and two patients were diagnosed with HL. CONCLUSIONS: Despite the rarity of intussusception cases secondary to malignant causes, particularly lymphoma, it is rather difficult to diagnose preoperatively by surgeons. Because there exists a risk of malignancy in a substantial portion of adult intussusception cases, resection should be performed in a manner consistent with the oncological principles.

Chronic graft-versus-host disease after liver transplantation: a case report.

Graft-versus-host disease (GVHD) after orthotopic liver transplantation (OLT) is a rare but significant complication, occurring in 1%-2% of cases with a mortality rate of 85%- 90%. It occurs when donor passenger lymphocytes mount an alloreactive response against the host's histocompatibility antigens. It presents as fever, rash, and diarrhea with or without pancytopenia. Between March 2002 and September 2011, among 656 OLT patients 1 (0.15%) had acute GVHD. A biopsy at the 7th posttransplantation month revealed chronic GVHD. Consequently, in the cases that had fever, rash, and/or desquamation of the any part of body after liver transplantation, GVHD must be considered and skin biopsies must be planned for the diagnosis.

Scar endometriosis in the abdominal wall: a predictable condition for experienced surgeons.

PURPOSE: Endometriosis in surgical scars develops in 0.1% of those women who undergo Caesarean section or other obstetric surgery. Herein we analyse and discuss the clinico-pathological characteristics of 15 patients with scar endometriosis in the abdominal wall. METHODS: Fifteen cases of scar endometriosis in the abdominal wall that were treated surgically in our department between 2003 and 2009 were examined retrospectively. Age, parity, complaint, medical or surgical history, pre/postoperative hormonotherapy, size of the mass, surgical procedure, follow-up and disease recurrence were analysed. RESULTS: This retrospective study included 15 patients presenting with 17 postoperative abdominal wall masses. The mean age of the patients was 32.1 +/- 6.0 years (range, 23-48). Eleven of the patients had a painful mass that became bigger before menstruation, two had palpable masses only, and two were hospitalised because of a mass with persistent pain. The locations of the masses were as follows: eight were close to the right side and three were close to the left side; two were in the middle of the Pfanenstiel incision and two were in trocar tracts. The patients' surgical histories included Caesarean section in thirteen, bilateral laparoscopic ovarian cyst excision in one, and laparoscopic appendectomy in one. CONCLUSIONS: If a patient presents with incision pain and a palpable mass after gynaecologic surgery, an incisional endometrioma should be considered. Surgical excision and hormone therapy are effective treatment approaches in these patients.