Cytomegalovirus Oophoritis Mimicking Burkitt's Lymphoma Recurrence: A Case Report and Literature Review.

Cytomegalovirus (CMV) oophoritis is an extremely rare and fatal condition. We encountered a 63-year-old woman with CMV oophoritis who had been treated for Burkitt's lymphoma. Positron emission tomography/computed tomography performed after chemotherapy showed a high 18F-fluoro-2deoxy-D-glucose uptake in both ovaries, which required distinguishing relapse. CMV oophoritis was diagnosed on histology following bilateral salpingo-oophorectomy. Although the patient later developed recurrent episodes of CMV antigenemia, after which complications of CMV retinitis appeared, and she ultimately died of CMV meningitis, surgical resection with antiviral medication resolved her abdominal symptoms and cleared CMV antigenemia for several weeks. It is therefore worth considering surgical resection in combination with antiviral drugs as a treatment option.

Idiopathic pyometra and tubo-ovarian abscess in a postmenopausal patient treated conservatively.

Background: Pyometra is a rare gynecological condition and is characterized by pus accumulation in the uterine cavity. It occurs more frequently in postmenopausal women than tubo-ovarian abscesses, which constitute a more common gynecological complication among premenopausal women. Objective: A 72-year-old woman was admitted to our emergency department with lower abdominal pain, diarrhea and fever for the last three days. The laboratory results were indicative to sepsis. The clinical examination revealed sensitivity by palpation of the lower abdomen without any signs of acute abdomen. The gynecological assessment showed pus outflow through the cervix and a pus culture was done. The ultrasound examination found an enlarged uterus, full of hypoechoic fluid, unclear borders between endometrium-myometrium, a mixed echogenicity adnexal mass and no free fluid in the pouch of Douglas. A computed tomography (CT) of the abdomen showed the presence of pyometra and a tubo-ovarian abscess of the right adnexa. Method: The patient was treated with intravenous antibiotic therapy. When the patient was hemodynamically stable and afebrile, she underwent ultrasound-guided dilatation and curettage of the cervical canal and the endometrium in order to exclude an underlying malignancy, under general anesthesia. Results: The patient responded promptly to the intravenous antibiotic therapy which was adapted to the pus culture result. The laboratory results withdrew to normal values and the patient was discharged after fifteen days of hospitalization in an afebrile and hemodynamically stable condition. Conclusion: Pyometra and tubo-ovarian abscess in postmenopausal women could be a lethal complication of pelvic inflammatory disease. The key in treatment is the dilatation of the cervix and drainage of the pyometra. The administration of intravenous antibiotics and drainage through the cervix could be a suitable method of treatment for pyometra in older patients or those with poor performance status if only the histological examination is negative for malignancy.

Bidirectional Estrogen-Like Effects of Genistein on Murine Experimental Autoimmune Ovarian Disease.

This study was to investigate the bidirectional estrogen-like effects of genistein on murine experimental autoimmune ovarian disease (AOD). Female BALB/c mice were induced by immunization with a peptide from murine zona pellucida. The changes of estrous cycle, ovarian histomorphology were measured, and the levels of serum sex hormone were analyzed using radioimmunoassay. Proliferative responses of the ovary were also determined by immunohistochemistry. Administration of 25 or 45 mg/kg body weight genistein enhanced ovary development with changes in serum sex hormone levels and proliferative responses. Meanwhile, the proportions of growing and mature follicles increased and the incidence of autoimmune oophoritis decreased, which exhibited normal ovarian morphology in administration of 25 or 45 mg/kg body weight genistein, while a lower dose (5 mg/kg body weight genistein) produced the opposite effect. These findings suggest that genistein exerts bidirectional estrogen-like effects on murine experimental AOD, while a high dose (45 mg/kg body weight) of genistein may suppress AOD.

Nigella sativa reduces tissue damage in rat ovaries subjected to torsion and detorsion: oxidative stress, proinflammatory response and histopathological evaluation.

BACKGROUND: To evaluate biochemically and histopathologically the effects of Nigella sativa (NS) in experimental ischemia and ischemia/reperfusion (I/R) injury in rat ovaries. METHODS: Thirty-six female rats were divided into 6 groups: group I = sham operation; group II = 500 mg/kg NS + sham operation; group III = bilateral ovarian ischemia; group IV = 500 mg/kg NS + ischemia; group V = 3-hour period of ischemia + 3-hour reperfusion, and group VI: 3-hour period of ischemia + 500 mg/kg NS 2.5 h after the induction of ischemia + 3-hour reperfusion. At the end of ischemia, the bilateral vascular clips were removed, and 3-hour reperfusion was continued. IL-1ß, IL-6, and TNF-α cytokine levels in serum, and superoxide dismutase (SOD), myeloperoxidase (MPO), glutathione (GSH), and malondialdehyde (MDA) levels were determined. RESULTS: I/R increased the MDA level and MPO activity while significantly decreasing the SOD activity and GSH level when compared to the sham. The 500-mg/kg dose of NS before I/R reversed the trend in MDA levels, MPO activity, SOD activity, and GSH levels. Ischemia and I/R increased the serum levels of IL-1ß, IL-6, and TNF-α, while the administration of NS decreased the serum levels of these cytokines. CONCLUSIONS: The administration of NS is effective in reversing tissue damage induced by ischemia and/or I/R in ovaries.

[Low-intensity laser irradiation in the combined treatment of depressive disoreders in patients with chronic salpingo-oophoritis].

This study was designed to evaluate the possibility to use low-intensity laser radiation in combined therapy of somatogenic depressions in patients having gynecological problems, such as inflammatory disease of uterine appendages. It was shown that the combined treatment including administration ofantidepressants significantly accelerated the development of beneficial changes and stabilized depressive manifestations. Inclusion of low-intensity laser irradiation in the combined therapy further improved its positive effect. Nevertheless, the complete recovery could not be achieved in the absence of specific antidepressant treatment despite the alleviation of depressive symptoms.

Autoimmune oophoritis in the adolescent.

Autoimmune oophoritis presents in adolescents as a component of autoimmune polyendocrine syndrome type I or type II. Autoimmune oophoritis can be diagnosed in women with primary ovarian insufficiency in the presence of adrenal cortical or steroid cell antibodies, and/or antibodies to adrenal and ovarian steroidogenic enzymes. The ovaries are cystic macroscopically, with a lymphocytic infiltrate in the steroidogenic theca cells. The immune infiltrate results in low estradiol levels and a compensatory increase in FSH levels. Granulosa cells are spared, and inhibin A and B levels are normal to high. Treatment is aimed at symptom relief with further investigation needed to assess treatment options such as immunosuppression.

Eosinophilic oophoritis: association with positive Strongyloides stercoralis serology and clinical response to ivermectin.

BACKGROUND: Localized eosinophilic infiltration causing ovarian dysfunction is an unusual clinical problem. CASE: We report a 16-year-old girl with abdominal pain, ovarian cysts, and biopsy-proven eosinophilic oophoritis, which resulted in right oophorectomy. Subsequently, a large cyst developed in the left ovary, causing abdominal pain that was worse at the time of her menses, and biopsy again showed numerous eosinophilic microabscesses. Unexpectedly, a parasite serology test to Strongyloides stercoralis was positive, although stool tests for ova and parasites were negative and the total IgE and total eosinophil count were normal. After treatment with ivermectin, the patient's abdominal pain resolved, the serologic antibody titers to S stercoralis returned to normal, and subsequent ultrasonographic evaluations showed involution of the large cyst in the remaining ovary. CONCLUSION: Eosinophilic oophoritis is a new disorder of localized tissue eosinophilia.

Effects of alpha-MSH on progesterone and nitric oxide release by cultured ovarian granulosa cells in experimental rat autoimmune oophoritis.

The peptide alpha-melanocyte-stimulating hormone (alpha-MSH) occurs within the pituitary, brain, skin, ovary and other tissues, and has potent anti-inflammatory activity. For this reason, we examined its effects on an autoimmune disease: the experimental autoimmune-oophoritis (EAO). We analyzed the effect of the peptide on the release of nitric oxide (NO) and progesterone from cultured ovarian granulosa (GL) cells at 0, 7, 14, 21 and 28 days after sensitization of the rats. On day 0 the progesterone levels were higher in estrous rats than those in proestrus and diestrus. The NO amount did not differ among the diverse days of the cycles. The administration of alpha-MSH induced a decrease of NO in estrus and diestrus, but did not affect progesterone release. The EAO rats showed a period of constant diestrus ranging from about 7 to 14 days after immunization. At the onset (day 7) and the end of this period (day 14), the NO significantly increased in estrous rats which was correlated with a reduction in progesterone concentration. This effect was reverted by alpha-MSH. At 21 and 28 days, progesterone release increased only when the rats were in proestrus, while NO production was similar to that on day 0. Administration of alpha-MSH reduced progesterone release when the rats were in proestrus and these results were correlated with an increase in NO only at day 14. The results obtained suggest that alpha-MSH could act as a modulator of EAO, specially when the rats are in estrus.

[Secondary infection of the ovarian endometriotic cysts].

OBJECTIVE: To explore the clinic manifestations, diagnostic methods and principles of management in the secondary infection of the endometriotic cysts of ovary. METHODS: Thirteen cases of the infected ovarian endometriotic cysts were analysed retrospectively in our hospital from Jan. 1990 to Dec. 1996. The diagnosis was confirmed by the operation and pathologic findings. RESULTS: The clinic manifestations were divided into five types, namely acute, subacute, chronic, occult and stabile types. The definitive diagnosis can be made by abdominal pain, fever and adnexal mass combined with B-scan findings and chocolate-brown purulent fluid which was punctured from the adnexal mass. Operation was the main method for treatment. CONCLUSIONS: Secondary infection of the endometriotic cyst is one of the gynecologic emergency. Correct diagnosis and prompt management are of vital importance.

Lymphocyte dysfunction in autoimmune oophoritis. Resumption of menses with corticosteroids.

In a 32-year-old woman with secondary amenorrhea and biopsy-proven oophoritis, the circulating T lymphocytes were examined utilizing monoclonal antibody L243 to the nonpolymorphic region of the Ia antigen. The percentage of peripheral T cells expressing the Ia "immune-associated' antigen was 5.6 percent (normal 3 percent or less). With corticosteroid therapy, the percentage decreased to 2 percent and menses resumed after secondary amenorrhea of two years' duration. Following cessation of steroid administration, the percentage of Ia-positive T cells rose to 7.0 percent and secondary amenorrhea redeveloped in the patient. After corticosteroid therapy was reinstituted, menses resumed and the percentage of Ia-positive T cells fell to normal. This report represents additional new evidence of immune dysfunction in patients with "autoimmune" oophoritis.

Tubo-ovarian abscess: a review of 46 cases.

Forty-six patients with tubo-ovarian ascess are analysed. The abscess developed mostly in young multiparous women soon after menstruation. Coliforms were the main causative organism. The abscess resolved with conservative management in 21 cases and surgical intervention was necessary in 25. The mortality (4.4%) due to conservative medical and surgical management was nearly half that of radical surgery.