RESUMEN
BACKGROUND: Tubal mesosalpinx cysts are paratubal cysts, that account for approximately 10% of adnexal masses, and the presence of these cysts combined with adnexal torsion is a rare acute abdominal condition, with few cases reported in the literature. We reported two cases of adolescent tubal mesosalpinx cysts combined with adnexal torsion and reviewed the literature to help improve the diagnosis of the disease. CASE REPORTS: The first patient was an 11-year-old girl with left lower abdominal pain for 5 days and fever with nausea and vomiting for 3 days, who was found to have a cystic pelvic mass on preoperative imaging and was diagnosed intraoperatively and postoperatively on pathology as having a left tubal mesosalpinx cyst combined with adnexal torsion. The second patient was a 13-year-old girl with right lower abdominal pain for 16 h and a palpable mass in the lower and middle abdomen on examination, which was hard and tender to palpate. Preoperative imaging revealed a large cystic mass in the right adnexal region, and intraoperative and postoperative pathology revealed a right tubal mesosalpinx cyst combined with adnexal torsion. CONCLUSIONS: Tubal mesosalpinx cysts combined with adnexal torsion are rare causes of acute lower abdominal pain. Early diagnosis and timely surgery are necessary to ensure ovarian and tubal function. Accurate preoperative imaging diagnosis is challenging, and MRI is a beneficial supplement to ultrasound and CT examinations, providing more objective imaging information and reducing the incidence of adverse outcomes.
Asunto(s)
Anomalía Torsional , Humanos , Femenino , Adolescente , Niño , Anomalía Torsional/cirugía , Anomalía Torsional/complicaciones , Anomalía Torsional/diagnóstico por imagen , Anomalía Torsional/diagnóstico , Quiste Paraovárico/complicaciones , Quiste Paraovárico/cirugía , Quiste Paraovárico/diagnóstico , Torsión Ovárica/cirugía , Torsión Ovárica/complicaciones , Enfermedades de los Anexos/cirugía , Enfermedades de los Anexos/complicaciones , Enfermedades de los Anexos/diagnóstico por imagen , Enfermedades de los Anexos/diagnósticoRESUMEN
We describe the case of a 32-year-old female who presented to the emergency department (ED) with a 3-day history of severe epigastric abdominal pain accompanied by nausea, vomiting, and constipation. Past medical history was significant for known right hydrosalpinx and previous pelvic inflammatory disease (PID), without past surgical history. Clinical examination revealed a hemodynamically stable patient with a soft but distended abdomen, tenderness in the epigastric region, without signs of peritonitis. Bloodwork including white blood cell count, electrolytes, and lactic acid was unremarkable. Initial computed tomography (CT) scan of the abdomen and pelvis with contrast demonstrated a small bowel obstruction (SBO) with a transition point in the right lower quadrant, accompanied by mesenteric edema and free fluid. Exploratory laparotomy was performed and revealed obstruction secondary to dense adhesions involving the terminal ileum, appendix, sigmoid colon, and right ovary. Lysis of adhesions, appendectomy, and excision of a right paratubal cyst were performed. Histopathology demonstrated endometriosis of the appendix and a benign paratubal cyst.
Asunto(s)
Endometriosis , Obstrucción Intestinal , Quiste Paraovárico , Femenino , Humanos , Adulto , Endometriosis/complicaciones , Endometriosis/cirugía , Endometriosis/diagnóstico , Quiste Paraovárico/complicaciones , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Intestino Delgado , Íleon , Adherencias Tisulares/complicaciones , Adherencias Tisulares/cirugíaRESUMEN
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.
Asunto(s)
Leiomioma/diagnóstico , Quiste Paraovárico/diagnóstico , Neoplasias Uterinas/diagnóstico , Útero/patología , Núcleo Celular/patología , Diagnóstico Diferencial , Femenino , Células Gigantes/citología , Células Gigantes/patología , Humanos , Histerectomía , Leiomioma/complicaciones , Leiomioma/patología , Leiomioma/cirugía , Leiomiosarcoma/diagnóstico , Persona de Mediana Edad , Quiste Paraovárico/complicaciones , Quiste Paraovárico/patología , Quiste Paraovárico/cirugía , Salpingooforectomía , Neoplasias Uterinas/complicaciones , Neoplasias Uterinas/patología , Neoplasias Uterinas/cirugía , Útero/cirugíaRESUMEN
A 19-year old woman with acute pain in the lower right quadrant of the abdomen was seen in the emergency room. Because we suspected an anomaly of the appendix, we performed a laparoscopy. We unexpectedly found a torsion of a Hydatid of Morgagni, a stalked cyst of the fallopian tube.
Asunto(s)
Abdomen Agudo/diagnóstico , Enfermedades de las Trompas Uterinas/diagnóstico , Trompas Uterinas/anomalías , Quiste Paraovárico/diagnóstico , Anomalía Torsional/diagnóstico , Abdomen Agudo/etiología , Apéndice , Servicio de Urgencia en Hospital , Enfermedades de las Trompas Uterinas/complicaciones , Femenino , Humanos , Hallazgos Incidentales , Laparoscopía , Quiste Paraovárico/complicaciones , Anomalía Torsional/complicaciones , Adulto JovenRESUMEN
STUDY OBJECTIVE: Paratubal cysts (PTCs) occur in 7%-10% of women, regardless of age. Although common, PTCs often are found incidentally because of the potential for these cysts to be asymptomatic. The specific aims of the study were to determine if PTC number and size correlated with signs of hyperandrogenism and obesity, as well as to investigate the molecular profiles of these PTCs in samples derived from female adolescents. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A prospective cohort study was performed in a single children's hospital. Girls 18 years of age or younger who underwent surgery for PTC suspected on the basis of the presence of a persistent adnexal cyst on imaging or a concern for adnexal torsion involving a cyst were consented to participate in the study. RESULTS: Nineteen patients met enrollment criteria with a mean age at menarche of 11.2 ± 1.3 years. Most of the patients (84%; n = 16/19) had adnexal torsion at the time of diagnosis of PTC. Irregular menses and hirsutism was found in 52.6% (n = 10/19) of the patients, among whom 36.8% (n = 7/19) were obese. The mean PTC size was 10.4 ± 4.3 cm with 57.9% (n = 11/19) of the cohort having more than 1 PTC. When patients were compared on the basis of their body mass index, the size of PTCs was significantly larger in the overweight/obese group. The wingless-type (WNT) signaling members catenin beta 1 (CTNBB1) and wingless-type MMTV integration site family, member 7A (WNT7A) were upregulated in 86% (n = 12/14) and 79% (n = 11/14) of the patients, respectively. WNT7A was significantly upregulated in girls with 1 cyst and low body mass index. CONCLUSION: A correlation exists between obesity, cyst size, and hyperandrogenism. Activation of the WNT/CTNBB1 pathway via WNT7A might play a role in PTC development.
Asunto(s)
Hiperandrogenismo/complicaciones , Obesidad/complicaciones , Quiste Paraovárico/complicaciones , Proteínas Wnt/metabolismo , Adolescente , Adulto , Niño , Estudios de Cohortes , Femenino , Hirsutismo , Hospitales Pediátricos , Humanos , Menarquia , Quiste Paraovárico/metabolismo , Quiste Paraovárico/cirugía , Estudios Prospectivos , Vía de Señalización WntRESUMEN
STUDY OBJECTIVE: To report on the presence and rate of endometriosis in hydatid cysts of Morgagni found at the time of excision surgery for endometriosis and to describe any association of endometriosis in hydatid cysts of Morgagni with preoperative or operative factors. DESIGN: A retrospective cohort study (Canadian Task Force Classification II-2). SETTING: The Center for Endometriosis at Saint Louis University, a tertiary referral center for endometriosis. PATIENTS: Women who underwent optimal excision surgery for suspected endometriosis because of chronic pelvic pain and/or infertility and who also had hydatid cysts of Morgagni removed at the time of surgery when found. INTERVENTIONS: Preoperative and operative data were collected prospectively. MAIN OUTCOME MEASURES: The rate of endometriosis in hydatid cysts of Morgagni. Secondary measures included are the rate of hydatid cysts of Morgagni in patients with pelvic pain or infertility with and without endometriosis in the cysts. RESULTS: The overall prevalence of endometriosis in hydatid cysts of Morgagni was 11.3%. Patients with pelvic pain had a higher rate (although not statistically significant) of hydatid cysts of Morgagni compared with those without pain (21.1% vs 12.5 %, p = .54). Patients with infertility had a higher rate of hydatid cysts of Morgagni compared with those without infertility (38.1% vs 16.7%, p < .001), and there was a higher rate of endometriosis in the hydatid cysts of Morgagni in patients with infertility compared with those without (11.1% vs 0.0%, p < .001). CONCLUSIONS: This study is the first known report of endometriosis found within hydatid cysts of Morgagni. With a rate of 11.3% of cysts of Morgagni having endometriosis within them, this study supports a practice of removing hydatid cysts of Morgagni at the time of surgery in order to achieve optimal excision of endometriosis. The rates of hydatid cysts of Morgagni and of endometriosis found within hydatid cysts of Morgagni were higher in patients with infertility. Further studies are needed to evaluate whether excising cysts of Morgagni affects clinical outcomes.
Asunto(s)
Endometriosis/complicaciones , Quiste Paraovárico/complicaciones , Adulto , Femenino , Humanos , Infertilidad Femenina/etiología , Persona de Mediana Edad , Dolor Pélvico/etiología , Estudios RetrospectivosAsunto(s)
Enfermedades de las Trompas Uterinas/diagnóstico , Quiste Paraovárico/diagnóstico , Anomalía Torsional/diagnóstico , Niño , Enfermedades de las Trompas Uterinas/etiología , Enfermedades de las Trompas Uterinas/cirugía , Femenino , Humanos , Quiste Paraovárico/complicaciones , Quiste Paraovárico/cirugía , Anomalía Torsional/etiología , Anomalía Torsional/cirugíaRESUMEN
A retrospective analysis was conducted on the case files of patients operated on for adnexal pathology between January 2004 and December 2015 at our institution. The data of the patients with a diagnosis of paratubal cysts (PTCs) was extracted. A total of eighty-seven children were operated on for adnexal pathology. Twenty-six (29.9%) patients had PTCs. The patients were predominantly grouped as adolescents (n=22) and newborns (n=3). One of the patients was a pre-pubertal girl. Of the 26 PTC cases, 18 of them occurred on the contralateral side to ovarian pathology (OP) or physiologic ovarian changes (POC) such as corpus luteum cyst or follicular cyst which their final diagnosis confirmed by histopathology examination; in one case, the PTCs were bilateral; and in three cases, PTCs were ipsilateral with OP or POC. There were only 4 solitary PTC cases identified among the 26 cases. Paratubal cysts can be observed at every age, even in newborns. Their association with OP or POC in childhood cases needs to be clarified to further understand the hormonal mechanisms that are influencing the occurrence of these cysts.
Asunto(s)
Trompas Uterinas/anomalías , Quiste Paraovárico/epidemiología , Adolescente , Niño , Femenino , Humanos , Incidencia , Recién Nacido , Quiste Paraovárico/complicaciones , Estudios RetrospectivosAsunto(s)
Dolor Abdominal/etiología , Hemorragia/diagnóstico , Enfermedades del Ovario/diagnóstico , Quiste Paraovárico/diagnóstico , Anomalía Torsional/diagnóstico , Dolor Abdominal/diagnóstico , Adolescente , Servicio de Urgencia en Hospital , Femenino , Hemorragia/complicaciones , Humanos , Enfermedades del Ovario/complicaciones , Quiste Paraovárico/complicaciones , Anomalía Torsional/complicacionesAsunto(s)
Radioisótopos de Flúor/farmacocinética , Fluorodesoxiglucosa F18/farmacocinética , Quiste Paraovárico/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Radiofármacos/farmacocinética , Salpingitis/diagnóstico por imagen , Nódulo Pulmonar Solitario/diagnóstico por imagen , Adulto , Femenino , Reacción a Cuerpo Extraño/diagnóstico por imagen , Humanos , Hallazgos Incidentales , Dispositivos Intrauterinos , Quiste Paraovárico/complicaciones , Nódulo Pulmonar Solitario/complicaciones , Distribución Tisular , Tomografía Computarizada por Rayos XRESUMEN
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.
Asunto(s)
Hidronefrosis/cirugía , Laparoscopía , Quiste Paraovárico/cirugía , Adolescente , Femenino , Humanos , Hidronefrosis/etiología , Quiste Paraovárico/complicaciones , Quiste Paraovárico/patologíaRESUMEN
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.
Asunto(s)
Abdomen Agudo/etiología , Enfermedades de las Trompas Uterinas/complicaciones , Trompas Uterinas/cirugía , Quiste Paraovárico/complicaciones , Complicaciones del Embarazo/cirugía , Abdomen Agudo/patología , Abdomen Agudo/cirugía , Enfermedades de las Trompas Uterinas/patología , Enfermedades de las Trompas Uterinas/cirugía , Trompas Uterinas/patología , Femenino , Humanos , Laparotomía , Quiste Paraovárico/patología , Quiste Paraovárico/cirugía , Embarazo , Complicaciones del Embarazo/patología , Resultado del TratamientoRESUMEN
BACKGROUND: Though paratubal and paraovarian cysts are rare in adolescent females, the influence of post-menarchal hormonal stimulation on these tubal derivates can produce large and clinically significant adnexal pathology. Ovarian torsion secondary to paratubal cysts is rare due to the cyst's location and ipsilateral recurrence is uncommon. CASE: We report a case of an 11-year-old female with a large right paratubal cyst causing ovarian torsion on two separate occasions within one year and our approach to surgical management. CONCLUSION: Excision of a paratubal or paraovarian cyst that causes ovarian torsion is necessary to decrease the risk of cyst recurrence and ovarian torsion in the future. Timely diagnosis and treatment of ovarian torsion enables preservation of ovarian function and patient fertility.
Asunto(s)
Enfermedades del Ovario/etiología , Quiste Paraovárico/complicaciones , Quiste Paraovárico/cirugía , Anomalía Torsional/etiología , Niño , Femenino , Humanos , Enfermedades del Ovario/cirugía , Quiste Paraovárico/diagnóstico , Recurrencia , Anomalía Torsional/cirugíaRESUMEN
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.
Asunto(s)
Quiste Paraovárico/complicaciones , Quiste Paraovárico/diagnóstico , Adolescente , Adulto , Errores Diagnósticos , Femenino , Humanos , Quiste Paraovárico/patología , Anomalía Torsional/diagnóstico , Anomalía Torsional/diagnóstico por imagen , Anomalía Torsional/patología , Anomalía Torsional/cirugía , Resultado del Tratamiento , Ultrasonografía , Adulto JovenRESUMEN
Borderline para-ovarian cysts (PCs) are rare entities. They are commonly present in the third decade. Borderline PCs are often discovered fortuitously on routine ultrasound examination or they are common incidental findings during a laparotomy. They must be differentiated from simple ovarian cysts, peritoneal inclusion cysts and hydrosalpinges on ultrasound sonography. Papillary projections on the cyst wall should be searched carefully to suggest diagnosis. The treatment is surgical including fertility -sparing operation or more radical surgery depending on the case. The prognosis is good because borderline PCs are usually early-stage at diagnosis. Here is a report of a 38- year old woman with a borderline paratubal cyst. Adnexal torsion of hydrosalpinx was suspected; thus, she underwent an urgent surgery. Cystectomy was performed without rupture. The final diagnosis revealed a borderline PC. The patient underwent a radical surgery. Currently, she has had no evidence of disease recurrence.
Asunto(s)
Quiste Paraovárico/diagnóstico , Lesiones Precancerosas/diagnóstico , Adulto , Femenino , Humanos , Laparotomía , Quistes Ováricos/complicaciones , Quistes Ováricos/diagnóstico , Quistes Ováricos/cirugía , Quiste Paraovárico/complicaciones , Quiste Paraovárico/cirugía , Lesiones Precancerosas/cirugíaRESUMEN
A 24-year-old woman with no significant past medical or surgical history presented with diffuse abdominal pain and distention with decreased frequency of bowel movements for 1 month. A computerized tomography scan showed a massively dilated cecum suggesting obstruction. Exploratory laparotomy revealed bowel obstruction secondary to a band of fibroadipose tissue associated with paratubal cysts originating from the left fallopian tube. Removal of the band was performed with thorough examination of the bowel confirming absence of perforation or necrosis.
Asunto(s)
Enfermedades del Ciego/etiología , Obstrucción Intestinal/etiología , Quiste Paraovárico/diagnóstico , Enfermedades del Ciego/diagnóstico , Femenino , Humanos , Obstrucción Intestinal/diagnóstico , Quiste Paraovárico/complicaciones , Adulto JovenRESUMEN
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.
Asunto(s)
Enfermedades de los Anexos/etiología , Cistoadenoma/complicaciones , Neoplasias de los Genitales Femeninos/complicaciones , Quistes Ováricos/complicaciones , Complicaciones Neoplásicas del Embarazo , Teratoma/complicaciones , Enfermedades de los Anexos/patología , Adolescente , Adulto , Anciano , Cistoadenoma/patología , Femenino , Neoplasias de los Genitales Femeninos/patología , Humanos , Persona de Mediana Edad , Quistes Ováricos/patología , Quiste Paraovárico/complicaciones , Quiste Paraovárico/patología , Embarazo , Complicaciones Neoplásicas del Embarazo/patología , Estudios Retrospectivos , Teratoma/patología , Anomalía TorsionalRESUMEN
Hydatids of Morgagni are very common incidental findings during laparoscopy in women of all age groups. However, torsion of these hydatids is very rarely reported in the literature. This report discusses the importance of considering torsion of hydatids of Morgagni in young adolescent girls who present with acute-onset lower abdominal pain.
Asunto(s)
Quiste Paraovárico/complicaciones , Anomalía Torsional/complicaciones , Adolescente , Niño , Femenino , Humanos , MenarquiaRESUMEN
OBJECTIVE: To evaluate the possible role of hydatid of Morgagni in patients with unexplained infertility. STUDY DESIGN: This was a non-randomized controlled trial conducted at the Department of Obstetrics and Gynecology of Sohag University, Egypt. Two hundred and thirteen patients with unexplained infertility and hydatid of Morgagni diagnosed at laparoscopy were included. The laterality (bilateral vs unilateral), location (fimbrial vs juxta-fimbrial), number (single vs multiple) and diameter of the hydatids of Morgagni were recorded. Patients were allocated to a study group (n=127) who underwent laparoscopic excision of hydatid of Morgagni and a control group (n=86) who underwent no intervention. Patients were followed for six months without any infertility or hormonal treatment to detect spontaneous pregnancy. Patients missed during the follow-up or who received infertility treatment were excluded. Statistical analysis was done using Chi-square test and Student's t-test. To find the most important character of hydatid of Morgagni which impedes pregnancy, logistic regression analysis of the dependent variable (no pregnancy) and independent variables (different characters of hydatid of Morgagni) was carried out in the control group. RESULTS: Hydatid of Morgagni was detected in 52.1% of patients with unexplained infertility compared to 25.6% of those with explained infertility (p<0.001). The pregnancy rate was higher in the study group than the control group (58.7% vs 20.6%, p<0.001). The pregnancy rate was significantly higher in the study group than the control group if the hydatid cyst was bilateral (85.7% vs 5.3%, p<0.001), fimbrial (85.6% and 9.1%, p<0.001), single (57.6% and 30.3%, p<0.001) or 1-2 cm in diameter (58.1% and 25.5%, p<0.001). Logistic analysis showed that the bilaterality and fimbrial location of the hydatid of Morgagni were the most significant characteristics impeding pregnancy (odds ratio=7.27 and 3.67 respectively). CONCLUSIONS: Hydatid of Morgagni is a possible underestimated cause of unexplained infertility. Laparoscopic removal of hydatid of Morgagni in patients with unexplained infertility was followed with a high spontaneous pregnancy rate. This is particularly obvious with bilateral and fimbrial hydatid of Morgagni.