Van Wyk-Grumbach Syndrome and Gonadectomy.

Van Wyk-Grumbach syndrome (VWGS) refers to the development of peripheral precocious puberty, long-standing hypothyroidism, and gonadal masses; when not diagnosed, an unnecessary gonadectomy may be performed. Herein, we present a case of a 10-year-old girl with Down's syndrome, short stature, and vitiligo who presented to our hospital with vaginal bleeding and a palpable pelvic mass. Upon ultrasound and topographical examination, bilateral ovarian masses with negative tumor markers were detected. After bilateral gonadectomy, endocrine studies revealed profound hypothyroidism and peripheral puberty that led to the VWGS syndrome diagnosis (TSH 367.3 mUI/mL, isolated menstruation, indetectable LH, and elevated estradiol). Levothyroxine treatment improved obesity and short stature, and sexual hormone replacement began at 13 years of age. The literature on Van Wyk-Grumbach syndrome shows that it presents most often in women, and classic hypothyroidism symptoms always precede the diagnosis. Approximately 11% of patients have Down's syndrome, sometimes tumor markers are elevated, and some develop severe symptoms (myopathy, short stature, mental delay, ascites, pericardial effusion, Cullen's sign, pituitary hyperplasia, and severe anemia) that respond to levothyroxine treatment. Conclusions: Children with peripheral precocious puberty and gonadal masses must be studied for hypothyroidism before any radical decision is made.

Cistoadenoma mucinoso gigante de ovario / Giant ovarian mucinous cystadenoma

Aunque el cistoadenoma mucinoso de ovario tiene un crecimiento benigno, puede crecer hasta tener grandes dimensiones. Se presenta el caso de una paciente de 70 años que acudió a consulta por presentar dolor abdominal recurrente y difuso. A la exploración física se palpó una gran masa que ocupaba toda la cavidad abdominal, hasta la apófisis xifoides, redondeada, renitente, de bordes definidos, no dolorosa, no movible. Presencia de edema en miembros inferiores. Durante el acto operatorio se identificó útero miomatoso y quiste gigante de ovario izquierdo, aproximadamente de 40 x 30 cm y 13,6 kg de peso. Se realizó histerectomía total abdominal y salpingooforectomía bilateral. La biopsia confirmó el diagnóstico de cistoadenoma mucinoso benigno de ovario y leiomiomatosis uterina. El posoperatorio transcurrió favorablemente. La incidencia de cistoadenoma gigante de ovario es desconocida, debido a la falta de un concepto estandarizado y las modalidades de imagen avanzadas disponibles en la actualidad(AU)

Although ovarian mucinous cystadenoma has a benign growth, it can grow to be very large. We present the case of a 70-year-old patient who came to the clinic for recurrent and diffuse abdominal pain. On physical examination, a large mass was palpated that occupied the entire abdominal cavity, up to the xiphoid appendix, rounded, retentive, with defined edges, non- painful, non-movable. Presence of edema in lower limbs. During the surgical act, a myomatous uterus and a giant left ovarian cyst measuring approximately 40 x3 0 cm and weighing 13.6 kg were identified. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. The biopsy confirmed the diagnosis of benign ovarian mucinous cystadenoma and uterine leiomyomatosis. The postoperative period progressed favorably. The incidence of giant ovarian cystadenoma is relatively unknown due to the lack of a standardized concept and currently available advanced imaging modalities(AU)

Ovarian hydatid cyst: an uncommon site of presentation.

Hydatid cyst is a parasitic infestation caused by Echinococcus larvae. Hydatid cyst of the ovary is a highly unusual presentation. Herein, we present a case of a young woman who complained of episodic lower abdominal pain. Ultrasound of the abdomen revealed a multi-cystic left adnexal mass measuring 86 mm x 67 mm. A possibility of ovarian cystic neoplasm was suggested. Unilateral salpingo-oophorectomy was performed. On histopathological examination, a cyst measuring 8.0 x 5.5 x 4.5 cm was found, replacing the entire ovary. The cyst cavity was filled with serous fluid and multiple pearly white membranous structures, giving a multiloculated appearance. Microscopic examination showed a cyst lined by a lamellar membrane containing protoscolices and hooklets. Hydatid disease is a zoonotic ailment caused by tapeworms (Echinococcus granulosus or, less commonly, Echinococcus multilocularis). The definitive hosts are carnivores. Humans are the accidental intermediate hosts. The hydatid cyst commonly affects the liver and the lungs. The primary hydatid cyst of the ovary is quite rare, with few case reports in the literature. In most cases, symptoms are vague, and the lesion is misdiagnosed as benign or malignant ovarian cystic neoplasm on clinical and radiological examination. Ovarian hydatid cyst is treated by surgery with ovarian cystectomy as the gold standard. The possibility of a hydatid cyst should be kept under differential diagnoses while evaluating the cystic diseases of the ovary.

[Pseudoascitis by giant ovaric cyst] / Pseudoascitis por quiste ovárico gigante.

The term pseudoascitis is used in patients who give the false impression of ascites, with abdominal distension but without peritoneal free fluid. The case of a 66-year-old woman, hypertensive and hypothyroid with occasional alcohol consumption, who consults due to progressive abdominal distension of 6 months of evolution and diffuse percussion dullness is presented, in whom a paracentesis is performed with the wrong endorsement of examination ultrasound that reports abundant intrabdominal free fluid (Fig. 1), later finding in the CT scan of the abdomen and pelvis an expansive process of cystic appearance of 295mm x 208mm x 250mm. Left anexectomy is programmed (Fig. 2) with pathological report of mucinous ovarian cystadenoma. The case report refers to the availability of the giant ovarian cyst within the differential diagnosis of ascites. If no symptoms or obvious signs of liver, kidney, heart or malignant disease are found and / or ultrasound does not reveal typical signs of intra-abdominal free fluid (fluid in the bottom of the Morrison or Douglas sac, presence of floating free intestinal handles), a CT scan and / or an RMI should be requested before performing paracentesis, which could have potentially serious consequences.

El término pseudoascitis, se utiliza en los pacientes que dan la falsa impresión de ascitis, con distensión abdominal pero sin líquido libre peritoneal. Se presenta el caso de una mujer de 66 años, hipertensa e hipotiroidea con consumo ocasional de alcohol, que consulta por distensión abdominal progresiva de 6 meses de evolución y matidez difusa a la percusión, en quien se realiza una paracentesis con el aval equivoco de examen ecográfico que informa abundante líquido libre  intrabdominal (Fig. 1), hallando posteriormente en TAC de abdomen y pelvis un proceso expansivo de aspecto quístico de 295mm x 208mm x 250mm. Se programa anexectomia izquierda (Fig. 2) con informe anatomopatológico de cistoadenoma mucinoso de ovario. La comunicación del caso remite a tener disponible el quiste ovárico gigante dentro de los diagnósticos diferenciales de ascitis. Si no se hallan síntomas o signos evidentes de insuficiencia hepática, renal, cardiaca o enfermedad maligna y/o la ecografía no revela signos típicos de líquido libre intrabdominal  (líquido en el fondo de saco de Morrison o de Douglas, presencia de asas intestinales libres flotantes), se debería solicitar una TAC y/o una RMI antes de realizar una paracentesis, la cual podría tener consecuencias potencialmente graves.

Ovarian hydatid cyst: an uncommon site of presentation

ABSTRACT Hydatid cyst is a parasitic infestation caused by Echinococcus larvae. Hydatid cyst of the ovary is a highly unusual presentation. Herein, we present a case of a young woman who complained of episodic lower abdominal pain. Ultrasound of the abdomen revealed a multi-cystic left adnexal mass measuring 86 mm x 67 mm. A possibility of ovarian cystic neoplasm was suggested. Unilateral salpingo-oophorectomy was performed. On histopathological examination, a cyst measuring 8.0 x 5.5 x 4.5 cm was found, replacing the entire ovary. The cyst cavity was filled with serous fluid and multiple pearly white membranous structures, giving a multiloculated appearance. Microscopic examination showed a cyst lined by a lamellar membrane containing protoscolices and hooklets. Hydatid disease is a zoonotic ailment caused by tapeworms (Echinococcus granulosus or, less commonly, Echinococcus multilocularis). The definitive hosts are carnivores. Humans are the accidental intermediate hosts. The hydatid cyst commonly affects the liver and the lungs. The primary hydatid cyst of the ovary is quite rare, with few case reports in the literature. In most cases, symptoms are vague, and the lesion is misdiagnosed as benign or malignant ovarian cystic neoplasm on clinical and radiological examination. Ovarian hydatid cyst is treated by surgery with ovarian cystectomy as the gold standard. The possibility of a hydatid cyst should be kept under differential diagnoses while evaluating the cystic diseases of the ovary.

Pathomorphological lesions in the ovaries of water buffaloes

Background: Buffalo breeding is common in many countries. Buffalo's milk is used in the production of mozzarella, yoghurt, ice cream, and various dairy desserts; meat is preferred in sausage production. The female buffaloes are bred to benefit from their milk and to obtain offspring. These animals, which are not suitable for feeding in barns, generally live in pastures, especially on wet land, and are very difficult to follow. Therefore, diseases occur randomly in slaughterhouses. Studies on genital system problems are very limited. Water buffaloes (Bubalus bubalis) are animals with economic value as many buffalo products are provided. In this respect, inspection and control of female genital disorders is fundamental to ensure good reproductive performance of female buffaloes. The aim of the study was to investigate pathomorphological lesions occurring in the ovaries of water buffaloes which were sent to slaughterhouses. Materials, Methods & Results: A total of 198 ovaries of water buffaloes were collected from various slaughterhouses located in Adapazari, Istanbul, Kocaeli, Samsun and Trabzon cities of Turkey. After macroscopic examination; tissue samples were fixed in 10 % buffered formalin, processed routinely and were stained with hematoxylin-eosin (HE). As a histochemical staining, Masson's trichrome staining was applied to characterize the lesions. Immunohistochemistry (IHC) was performed on 10 % neutral formalin fixed, paraffin-embedded, 4-6-µm-thick sections from ovaries using progesterone receptor (PR) with streptavidin-biotin complex peroxidase (StrepABC-P) method. Histopathologically, follicular cysts (n:147) and luteal cysts (n:22) were seen. While the cyst lumens were sometimes surrounded by granulosa and/or luteal cells, most of them were limited by the connective tissue capsule structure. This capsule structure was shown in blue by Masson's trichrome staining. Hemorrhage was observed in some cystic corpus luteum, diagnosed as corpus hemorrhagicum. In addition, cysts giving papillary extension into the lumen and inflammation of some ovaries were observed. Immunohistochemically, the staining with PR antibody in ovarian cysts showed no immunolabelling around the follicular cyst, while the nuclei of some of the luteal cells forming the luteal cyst had strongly nuclear positivity and slightly cytoplasmic positivity. In the biochemical examination of the fluids obtained from cystic ovaries (n: 37), the average of estradiol was 2.84 ng/mL (min: 0.01 ng/mL, max: 4.30 ng/mL) and progesterone average is 49.09 ng/mL (min: 1.88 ng/mL, max: 254.2 ng/mL). Discussion: Ovarian cysts in buffaloes seem to be among the serious fertility problems as in cattle. Although the exact cause of ovarian cyts has not been determined yet, it is known that the hypothalamic-pituitary-gonadal (HPG) axis is disrupted in cyst formation in general. In this study, the mean estradiol value was within the standard range but close to the lower limit; progesterone value was above the limit. The increase in progesterone level was compatible with the pathogenesis of cyst genesis. Beside this result, staining with PR was positive in the luteal cells that formed the luteal cyst immunohistochemically. In addition, although the hemorrhages observed in the corpus luteum are considered physiological, it should not be forgotten that they can be vital if they rupture. All these results show us the animals sent for slaughtering mostly have serious genital problems threatening their fertility.

Spontaneous ovarian hyperstimulation syndrome in a pregnant woman with hypothyroidism: a case report.

OBJECTIVE: To study a rare case of spontaneous ovarian hyperstimulation syndrome in a naturally conceived pregnancy associated with overt hypothyroidism. DESIGN: Case report. SETTING: Endocrinology private practice. PATIENTS: A 32-year-old woman who was 13 weeks pregnant with bilaterally enlarged ovaries presumed to be secondary to hypothyroidism. INTERVENTIONS: Administration of levothyroxine and titration of the dose. MAIN OUTCOME MEASURES: Regression of signs and symptoms of spontaneous ovarian hyperstimulation syndrome after 12 weeks of therapy. RESULTS: The patient was diagnosed with severe hypothyroidism, as confirmed by her elevated thyroid-stimulating hormone level. Ultrasound evaluation revealed ovarian enlargement secondary to multiple contiguous cysts with anechoic content. The patient was administered levothyroxine 175 µg/day. Results of hormonal studies demonstrated thyroid function normality at week 12 after treatment. Incomplete regression of ovarian cysts was also noticed within this period. At week 37, the patient developed preeclampsia, and cesarean delivery was recommended. An 8-month postpartum ultrasound evaluation revealed complete regression of the cysts. CONCLUSIONS: Spontaneous ovarian hyperstimulation syndrome secondary to hypothyroidism may be the cause of ovarian enlargement, and levothyroxine replacement seems an appropriate primary therapeutic option. Proper endocrinological assessment of patients is recommended as it may avoid unfavorable outcomes.

Tumores anexiales incidentales en cirugía abdominal / Incidental adnexal tumors in abdominal surgery

La posibilidad de encontrar una neoplasia benigna o maligna del ovario, de forma inesperada durante una intervención quirúrgica abdominal, es una realidad para todos los especialistas en cirugía. Si bien en muchos casos se tratará de una lesión benigna, el riesgo de cáncer no debe subestimarse, ya que, por ejemplo, la ruptura intraoperatoria de una lesión quística maligna puede reestadificar a una paciente con cáncer de ovario del estadio IA al IC, con todas las consecuencias que esto implica, como la necesidad de requerir quimioterapia adyuvante y tener un peor pronóstico. Por otro lado, en mujeres premenopáusicas debe discutirse con la familia o la paciente (idealmente) el riesgo e implicaciones de la ooforectomía uni o bilateral, incluso si esto amerita dejar el quirófano para obtener el consentimiento, o posponer el procedimiento definitivo para un segundo tiempo. La consulta intraoperatoria a un ginecólogo, siempre que sea posible, se debe llevar a cabo con el fin de respaldar la conducta adoptada. Conocer el manejo adecuado de las masas anexiales encontradas de forma incidental durante una cirugía abdominal, es una prioridad para todos los cirujanos generales.

The possibility of finding a benign or malignant neoplasm of the ovary unexpectedly during abdominal surgery is a reality for all specialists in surgery. Although in many cases it will be a benign lesion, the risk of cancer should not be underestimated, since, for example, the intraoperative rupture of a malignant cystic lesion may well re-stage a patient with ovarian cancer from stage IA to IC, with the consequences that this implies, such as the need for adjuvant chemotherapy and a worse prognosis. On the other hand, in premenopausal women, the risk and implications of unilateral or bilateral oophorectomy should be discussed with the family or the patient (ideally), even if this implies leaving the operating room to obtain consent, or postponing the definitive procedure for a second time. Intraoperative consultation with a gynecologist, whenever possible, should be carried out in order to support the adopted behavior. Knowing the proper management of adnexal masses found incidentally during abdominal surgery is a priority for all general surgeons.

Ovarian responses and FSH profiles at superovulation with a single epidural administration of gonadotropin in the Thai-Holstein crossbreed.

The conventional method of ovarian superstimulation requires multiple injections of gonadotropins which is time-consuming and may be stressful for the cows. This study was designed to determine whether a single epidural injection of FSH (EI group) would induce the superovulatory response in the Thai-Holstein crossbreed and evaluate FSH plasma hormone concentrations. Eight cows (replication = 3; n=24) were assigned to one of 2 treatments in switch back design. Control group (n=12): cows were received 400 mg FSH twice daily by intramuscularly for 4 days (80, 80, 60, 60, 40, 40, 20 and 20 mg), EI group (n=12): cows were received 400 mg FSH by single epidural injection. Data were collected in term of ovarian follicle responses, superovulatory responses, ova/embryo collection. FSH concentrations were examined using ELISA. The total follicular responses during oestrus were not different between treatments; however, the large follicles were less frequent (P < 0.01) while the medium follicle sizes were higher (P < 0.05) in the EI group. The plasma concentration of FSH in EI was dramatically increased within 2 hours before decreasing sharply thereafter (P < 0.01) and did not remain above baseline after 10 hours of administration. The embryo quality was better in the control than the EI groups (P < 0.05). Interestingly, the number of ovulation cysts in the EI group was 50%. The ovarian responses and embryo quality in the cows with cysts were worse compared with the non-cyst groups (P < 0.05). In conclusion, alternative protocols decreased the superovulatory response and increased poor embryo quality in Thai-Holstein crossbred. Also, the incidence of ovarian follicular cysts is higher in the EI group.

Ovarian responses and FSH profiles at superovulation with a single epidural administration of gonadotropin in the Thai-Holstein crossbreed

Abstract The conventional method of ovarian superstimulation requires multiple injections of gonadotropins which is time-consuming and may be stressful for the cows. This study was designed to determine whether a single epidural injection of FSH (EI group) would induce the superovulatory response in the Thai-Holstein crossbreed and evaluate FSH plasma hormone concentrations. Eight cows (replication = 3; n=24) were assigned to one of 2 treatments in switch back design. Control group (n=12): cows were received 400 mg FSH twice daily by intramuscularly for 4 days (80, 80, 60, 60, 40, 40, 20 and 20 mg), EI group (n=12): cows were received 400 mg FSH by single epidural injection. Data were collected in term of ovarian follicle responses, superovulatory responses, ova/embryo collection. FSH concentrations were examined using ELISA. The total follicular responses during oestrus were not different between treatments; however, the large follicles were less frequent (P < 0.01) while the medium follicle sizes were higher (P < 0.05) in the EI group. The plasma concentration of FSH in EI was dramatically increased within 2 hours before decreasing sharply thereafter (P < 0.01) and did not remain above baseline after 10 hours of administration. The embryo quality was better in the control than the EI groups (P < 0.05). Interestingly, the number of ovulation cysts in the EI group was 50%. The ovarian responses and embryo quality in the cows with cysts were worse compared with the non-cyst groups (P < 0.05). In conclusion, alternative protocols decreased the superovulatory response and increased poor embryo quality in Thai-Holstein crossbred. Also, the incidence of ovarian follicular cysts is higher in the EI group.

Ovarian responses and FSH profiles at superovulation with a single epidural administration of gonadotropin in the Thai-Holstein crossbreed

The conventional method of ovarian superstimulation requires multiple injections of gonadotropins which is time-consuming and may be stressful for the cows. This study was designed to determine whether a single epidural injection of FSH (EI group) would induce the superovulatory response in the Thai-Holstein crossbreed and evaluate FSH plasma hormone concentrations. Eight cows (replication = 3; n=24) were assigned to one of 2 treatments in switch back design. Control group (n=12): cows were received 400 mg FSH twice daily by intramuscularly for 4 days (80, 80, 60, 60, 40, 40, 20 and 20 mg), EI group (n=12): cows were received 400 mg FSH by single epidural injection. Data were collected in term of ovarian follicle responses, superovulatory responses, ova/embryo collection. FSH concentrations were examined using ELISA. The total follicular responses during oestrus were not different between treatments; however, the large follicles were less frequent (P < 0.01) while the medium follicle sizes were higher (P < 0.05) in the EI group. The plasma concentration of FSH in EI was dramatically increased within 2 hours before decreasing sharply thereafter (P < 0.01) and did not remain above baseline after 10 hours of administration. The embryo quality was better in the control than the EI groups (P < 0.05). Interestingly, the number of ovulation cysts in the EI group was 50%. The ovarian responses and embryo quality in the cows with cysts were worse compared with the non-cyst groups (P < 0.05). In conclusion, alternative protocols decreased the superovulatory response and increased poor embryo quality in Thai-Holstein crossbred. Also, the incidence of ovarian follicular cysts is higher in the EI group.(AU)

Principais causas ginecológicas de dor pélvica aguda em mulheres / Main gynecological causes of acute pelvic pain in women

Este trabalho buscou reunir dados essenciais sobre as etiologias de dor pélvica aguda, uma queixa constante nos serviços de emergências e ambulatórios de ginecologia, responsável por grande desconforto e impacto na qualidade de vida de pacientes mulheres. É uma condição laboriosa por causa de seu amplo espectro de causas, devendo ser abordada com cuidado e atenção pelo profissional médico, o qual deve considerar os diversos diagnósticos diferenciais, sendo a ultrassonografia o exame de maior importância para auxiliar em seu diagnóstico. As principais etiologias não obstétricas podem ser não ginecológicas e ginecológicas; essas últimas são divididas em anexiais e uterinas. Entre as causas ginecológicas, devem- -se investigar cistos ovarianos, torções anexiais, leiomiomas, doença inflamatória pélvica, abscesso tubo-ovariano, dismenorreia e complicações de dispositivos intrauterinos. A maioria das causas tem tratamento eficaz, com retorno da função do órgão e melhora da qualidade de vida, sem complicações, especialmente se diagnosticada precocemente.(AU)

The aim of this study was to gather important data on acute pelvic pain etiologies, a usual complaint in the emergency services and gynecology outpatient clinics, responsible for great discomfort and impact on quality of life in female patients. It is a laborious condition due to its wide spectrum of causes, which needs to be approached with attention by the physician, who must consider all the possible diagnoses, being the ultrasonography the most important exam to detect it. The main non-obstetric etiologies can be non-gynecological and gynecological, which are separated in adnexal and uterine causes. Among the gynecological causes, ovarian cysts, adnexal torsions, leiomyomas, pelvic inflammatory disease, ovarian tube abscess, dysmenorrhea and complications of intrauterine devices should be investigated. Most causes can be effectively treated, with return of organ function and improved quality of life, without complications, especially if diagnosed early.(AU)

Laparoscopia de urgencia en la adolescente. A propósito de tres casos / Emergency laparoscopy in the adolescent. A report of three cases

Introducción: Está demostrada la importancia de la cirugía de mínimo acceso en las urgencias pediátricas a cualquier edad, por lo que constituye el enfoque actual tanto diagnóstico como terapéutico. Objetivo: Resaltar la utilidad de la laparoscopia para la cirugía de urgencia en las adolescentes. Presentación de casos: Tres adolescentes femeninas entre 14 y 18 años de edad, intervenidas por abdomen agudo quirúrgico por vía laparoscópica, se encontraron los siguientes hallazgos: Paciente 1: hemoperitoneo por quiste de cuerpo lúteo de ovario izquierdo, tratamiento por cirugía de mínimo acceso. Paciente 2: apendicitis aguda no complicada y quiste simple de ovario izquierdo no complicado, tratado por cirugía de mínimo acceso y la apendicectomía asistida. Paciente 3: torsión de quiste paraovárico de la trompa de Falopio derecha, tratamiento convencional a través de una minilaparotomía. Conclusiones: La laparoscopia de urgencia en estas adolescentes le facilitó al cirujano pediátrico un diagnóstico certero, con hallazgos ginecológicos transoperatorio y tratamiento quirúrgico variado a través de una cirugía mínimamente invasiva con múltiples ventajas para las pacientes(AU)

Introduction: The importance of minimal access surgery in pediatric emergencies at any age has been demonstrated, being the current diagnostic and therapeutic approach. Objective: To highlight the utility of laparoscopy for emergency surgery in adolescents. Case presentation: Three female adolescents between 14 and 18 years of age underwent laparoscopic surgery for acute abdomen. The main findings were: Patient 1: Hemoperitoneum due to corpus luteum of the left ovary, treated by minimal access surgery. Patient 2: Acute uncomplicated appendicitis and simple uncomplicated left ovary cyst, treated by minimal access surgery and assisted appendectomy. Patient 3: Torsion of the paraovarian cyst of the right fallopian tube, treated by conventional minilaparotomy. Conclusions: Emergency laparoscopy in these adolescents provided the pediatric surgeon an accurate diagnosis with intraoperative gynecological findings and varied surgical treatment through minimally invasive surgery, with multiple advantages for patients(AU)

Quiste ovárico fetal. reporte de un caso / Fetal ovarian cyst. a case report / Fetal ovarian cyst. a case report

RESUMEN Los quistes ováricos representan el tumor abdominal más frecuente en las recién nacidas. Entre las complicaciones agudas y a largo plazo, la más frecuente es la torsión anexial, que es de difícil reconocimiento en la etapa neonatal. El diagnóstico prenatal es fundamental para el manejo oportuno de las pacientes y el seguimiento ecográfico de los quistes anexiales. Existen diferentes alternativas terapéuticas, donde la cirugía mínimamente invasiva y conservadora tiene un rol importante.

ABSTRACT Ovarian cysts are the most common abdominal tumors in female newborns. Among the acute and long-term complications, the most frequent is the adnexal torsion, which is difficult to recognize in the neonatal stage. Prenatal diagnosis is essential for the timely management of patients and ultrasound monitoring of adnexal cysts. There are different therapeutic alternatives where minimally invasive and conservative surgery plays an important role.

Practical recommendations for the management of benign adnexal masses / Recomendações práticas para o tratamento de massas anexiais benignas

Abstract Objective To performa comprehensive review to provide practical recommendations regarding the diagnosis and treatment of benign adnexal masses, as well as information for appropriate consent, regarding possible loss of the ovarian reserve. Methods A comprehensive review of the literature was performed to identify the most relevant data about this subject. Results In total, 48 studies addressed the necessary aspects of the review, and we described their epidemiology, diagnoses, treatment options with detailed techniques, and perspectives regarding future fertility. Conclusions Adnexal masses are extremely common. The application of diagnosis algorithms is mandatory to exclude malignancy. A great number of cases can bemanaged with surveillance. Surgery, when necessary, should be performed with adequate techniques. However, even in the hands of experienced surgeons, there is a significant decrease in ovarian reserves, especially in cases of endometriomas. There is an evident necessity of studies that focus on the long-term impact on fertility.

Resumo Objetivo Realizar uma revisão abrangente para fornecer recomendações práticas sobre o diagnóstico e tratamento demassas anexiais benignas, bemcomo informações para um consentimento adequado com relação à possível perda da reserva ovariana. Métodos Uma revisão abrangente da literatura foi realizada para identificar os dados mais relevantes sobre o assunto. Resultados No total, 48 estudos abordaram os aspectos necessários da revisão, e descrevemos sua epidemiologia, diagnósticos, opções de tratamento com técnicas detalhadas, e perspectivas sobre fertilidade futura. Conclusões As massas anexiais são extremamente comuns. A aplicação de algoritmos de diagnóstico é obrigatória para excluiramalignidade. A maioria dos casos pode ser manejada conservadoramente. A cirurgia, quando necessária, deve ser realizada com técnicas adequadas. No entanto, mesmo nas mãos de cirurgiões experientes, há diminuição significativa da reserva ovariana, principalmente nos casos de endometriomas. Há uma evidente necessidade de estudos que enfoquemo impacto das massas anexiais benignas na fertilidade em longo prazo.

Validación de los criterios ecográficos IOTA en la práctica clínica con marcadores tumorales y patología / Validation of IOTA simple ultrasound rules in clinical practice with tumor markers and pathology / Validation of IOTA simple ultrasound rules in clinical practice with tumor markers and pathology

RESUMEN Objetivos . Correlacionar la ecografía prequirúrgica de las masas anexiales aplicando los criterios IOTA y el diagnóstico anatomopatológico tras intervención quirúrgica. Valorar la utilidad de los marcadores tumorales bioquímicos. Método . Estudio observacional prospectivo en 102 pacientes con diagnóstico ecográfico de tumoración anexial, intervenidas quirúrgicamente entre enero 2017 y febrero 2020. El análisis estadístico se realizó con SPSS 17.0. Las variables categóricas se analizaron mediante pruebas de Fisher y chi-cuadrado, las variables cuantitativas mediante prueba t-student. La concordancia entre la valoración de la ecografía transvaginal mediante criterios IOTA y el resultado anatomopatológico, se estudió con el coeficiente de contingencia y el índice kappa. Resultados . Según criterios IOTA, se clasificó como benignas a 48% de las tumoraciones, como malignas 24,5%, y 27,5% resultaron no clasificables. La anatomía patológica confirmó que 68,1% de las benignas y 72,8% de las malignas fueron correctamente filiadas por la ecografía. La concordancia entre la ecografía transvaginal prequirúrgica y la anatomía patológica fue significativa, con coeficiente de contingencia 0,58, índice kappa 0,47, p <0,05 y con sensibilidad 94,1% y especificidad 92,1%. Los valores de la proteína epididimal humana 4 (HE4) y el antígeno del cáncer 125 (CA 125) tuvieron correlación con la anatomía patológica, también con significación estadística, siendo mayor en las pacientes menopáusicas. Conclusiones . Los criterios IOTA discriminaron de forma satisfactoria las masas benignas de las malignas. La proteína HE4 resultó mejor marcador bioquímico que el CA125.

ABSTRACT Objectives: To determine correlation between preoperative ultrasound evaluation of adnexal masses applying IOTA simple rules and pathology diagnosis. To assess usefulness of biochemical tumor markers in these cases. Methods: A prospective study was performed between January 2017 and February 2020. Patients with suspected ovarian pathology were evaluated using IOTA ultrasound rules and designated as benign or malignant. Findings were correlated with histopathological findings. Collected data was statistically analyzed using the chi-square test and kappa statistical method. Results: During this period, 102 women were eligible for the study. According to IOTA ultrasound criteria, 48% of the adnexal masses were classified as benign, 24.5% malignant and 27.5% were not classifiable. Pathology confirmed 68.1% of benign and 72.8% of malignant tumors were correctly classified by ultrasound. Statistically, the agreement between pre-surgical transvaginal ultrasound and pathology result was significant with contingency coefficient 0.58 and Kappa index 0.47, both with p <0.05 significance. The sensitivity for detection of malignancy with IOTA simple rules was 94.1% and specificity 92.1%. As for biochemical tumor markers, human epididymal protein 4 (HE4) and cancer antigen 125 (CA 125) values had statistically significant correlation with pathology results. Conclusions: IOTA simple rules may be used in clinical practice for diagnosis of ovarian tumors. Human epididymis 4 appeared a better diagnostic tool than CA 125 in discrimination of malignant adnexal masses.

Twist and shout: magnetic resonance imaging findings in ovarian torsion / Twist and shout: achados da ressonância magnética na torção ovariana

Abstract Adnexal torsion is characterized by partial or complete rotation of the suspensory ligament of the ovary and its corresponding vascular pedicle, resulting in vascular impairment that can culminate in hemorrhagic infarction, as well as necrosis of the ovary and fallopian tube. Because there are myriad causes of acute pelvic pain, the differential diagnosis of ovarian torsion is often challenging. Consequently, radiologists should be familiar with the main imaging findings. In this regard, there are typical signs of ovarian torsion on magnetic resonance imaging, including increased ovarian volume with stromal edema and peripheral distribution of the ovarian follicles, as well as thickening of the fallopian tube, an adnexal mass (causal factor) that shifts toward the midline, and the classic, pathognomonic "whirlpool sign". The objective of this essay was to review and illustrate the various magnetic resonance imaging findings in ovarian torsion.

Resumo A torção anexial é caracterizada por rotação parcial ou completa do ligamento suspensor do ovário e seu pedículo vascular correspondente, resultando em comprometimento vascular que pode culminar em infarto hemorrágico e necrose tecidual do ovário e da tuba uterina. Diante da gama de diagnósticos diferenciais de dor pélvica aguda, o diagnóstico é muitas vezes considerado desafiador, devendo o radiologista estar familiarizado com os principais achados de imagem. Nesse quesito, destacam-se os sinais característicos de torção anexial na ressonância magnética, incluindo aumento do volume ovariano com edema estromal, distribuição periférica de seus folículos, espessamento e edema da tuba uterina correspondente associados ou não à massa anexial - às vezes, fator predisponente - que se insinua para a linha média e, ainda, o clássico e patognomônico "sinal do redemoinho". O objetivo deste ensaio é ilustrar e revisar os diferentes achados de torção ovariana detectados pela ressonância magnética.

Lectin histochemical pattern on the normal and cystic ovaries of sows.

The lectin histochemical pattern (LHP) was characterized and compared in normal and cystic ovaries of sows. Six biotinylated lectins (PNA, SBA, WGA, RCA-1, DBA and UEA-1) were used on tissue sections. In the normal ovaries, the reaction to UEA-1 and SBA was mild to moderate in mesothelial and endothelial cells. RCA-1 staining was mild to moderate in theca interna of growing follicles, corpora luteum and mesothelium. In addition, this lectin presented strong reaction in endothelial cells, granulosa cells of atretic follicles, zona pellucida of growing follicles and plasma. DBA showed strong intensity in mesothelial and endothelial cells. There was mild to moderate reactivity to WGA in granulosa cells, corpus luteum and theca interna of follicles in development, and moderate in zona pellucida, in granulosa cells of atretic follicles and mesothelium. PNA staining was mild to moderate in oocytes and in the adventitia and media of medullary arteries. Changes in the LHP of the cystic ovaries were noted; however, there were no differences in these findings between the follicular and luteinized cysts. UEA-1 reactivity in the cystic ovaries was moderately reduced in the mesothelial and endothelial cells, whereas there was mild reduction in the DBA staining in the granulosa cells. Reaction to RCA-1 and WGA in the cysts also was decreased in theca interna, zona pellucida and granulosa cells of atretic follicles. Furthermore, endothelium and theca interna in the cystic ovaries presented mild reduction of marcation to SBA, whereas there was decreased reactivity to PNA in the oocytes and adventitia and media layers of the medullary arteries. The results of the current study show that cysts modify the LHP in swine ovaries. These changes of glycoconjugates in many ovarian structures could modify diverse process and may be one of the reasons for decreased fertility in sows.