Tubal ligation and salpingectomy and the risk of epithelial ovarian cancer: A case-control study / Philippine Journal of Obstetrics and Gynecology

BACKGROUND: Epithelial ovarian carcinoma is the most lethal of the gynecologic malignancies. Recent theories on the etiopathogenesis of epithelial ovarian carcinoma supported the presence of occult, early stage neoplasms in the fimbriated end of the fallopian tube even before development of ovarian carcinoma. This study is interested in correlating opportunistic salpingectomy or tubal ligation as a possible effective prevention strategy in the occurrence of epithelial ovarian carcinoma. OBJECTIVE: To determine the association between the occurrence of epithelial ovarian carcinoma and a previous history of tubal ligation and/ or salpingectomy METHODS: This is a case-control study involving chart review of patients who underwent total hysterectomy with bilateral salpingoophorectomy with a histologically verified epithelial ovarian cancer (cases) and patients who underwent same surgical procedure for benign gynecologic conditions specifically myoma uteri and adenomyosis with normal ovaries on final histology report (controls). The association between the occurrence of epithelial ovarian carcinoma and previous tubal ligation and/or salpingectomy was determined using appropriate statistical methods. RESULTS: A total of 558 patients were included in this review. They were divided into 158 post-surgical patients with histologically verified epithelial ovarian cancer (cases) and 400 post-surgical patients for benign gynecologic conditions with normal ovaries on final histology report (controls). Adjusted for age, parity and obesity the odds of developing epithelial ovarian carcinoma in subjects without previous tubal ligation and/or salpingectomy is 29%. CONCLUSION: The result of the study showed that tubal ligation and/or salpingectomy reduces the risk of developing epithelial ovarian carcinoma hence for patients at average risk of ovarian cancer, risk-reducing salpingectomy should be discussed and at the time of abdominal or pelvic surgery. It must also be included in the counseling of women planning a hysterectomy for benign indications to conserve ovarian function and prevent ovarian epithelial carcinoma.

Recognizing the link between ovarian teratoma and autoimmune encephalitis: A case report of ovarian teratoma-associated anti-N-methyl-D-aspartate receptor encephalitis / Philippine Journal of Obstetrics and Gynecology

A 36-year old nulligravid who initially presented with a one-week history of flu-like symptoms suddenly developed behavioral changes, agitation and irritability. Diagnostic tests were done and empiric treatment for viral encephalitis were initiated. Symptoms persisted with progressive unresponsiveness and episodes of seizure. Hypoventilation from dysautonomia required mechanical ventilation. Elevated levels of immunoglobulin on cerebrospinal fluid (CSF) and deterioration despite treatment raised suspicion for an autoimmune encephalitis. A referral to a gynecologist to rule out an ovarian focus was done. Ultrasound and biopsy established the presence of ovarian teratoma. The diagnosis of anti-N-methy-D-Aspartate receptor encephalitis was confirmed when the patient's serum and CSF tested positive for these antibodies. In addition, her CSF was also positive for anti-alpha-amino-3-hydroxy-5-methylisoxazole-4 propionic acid receptor (Anti-AMPar) antibodies. In the Philippines, this was the second documented case of Anti-NMDar encephalitis associated with ovarian teratoma and the first to have antibodies present causing encephalitis.

A case of ovotesticular disorder of sexual development (45 XO/46 XY: Mosaicism versus chimerism) / Philippine Journal of Obstetrics and Gynecology

Ovotesticular disorder of sex development (OT-DSD), previously known as true hermaphrodite, is a rare disorder of sexual differentiation in which the gonads of an individual are characterized by the presence of both mature ovarian and testicular tissues. The diagnosis has traditionally been applied only if an individual has 1) histologically verified ovarian follicles or proof of their prior existence (e.g. corpora albicantia) and 2) seminiferous tubules or spermatozoa. This paper introduces you to a 14 year-old, who presented with primary amenorrhea and enlarging abdominal mass, underwent exploratory laparotomy, salphingooophorectomy, histologically diagnosed as a possible case of a true hermaphrodite and chromosomally diagnosed as 45XO/46XY who developed endodermal sinus tumor, a germ cell tumor, considered highly malignant.