Voluminous bilateral adnexal cysts in a young female: the challenge of fertility preservation.

An ovarian benign cyst is a common finding in women of reproductive age. However both the disease and its treatment may have an impact on ovarian reserve, resulting in a significant risk of premature ovarian insufficiency. The counselling on fertility preservation is of paramount importance in such cases. We report the management of a young woman with giant bilateral benign adnexal cysts, highlighting the complexity of fertility preservation in such scenario.

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)

Iatrogenic ureteral obstruction during transvaginal ocyte retrieval

ABSTRACT Transvaginal oocyte retrieval is a crucial step in assisted reproductive technology. Various complications may arise during this procedure. Ureteral injury is a rare, but a serious complication in gynecological practice. During oocyte retrieval, ureteral injuries, detachment and obstruction can be seen, though rare. In this study, we will present ureteral obstruction that develops secondary to small hematoma, which mimics ovarian cyst torsion or ruptured ovarian cyst.

Iatrogenic Ureteral Obstruction During Transvaginal Oocyte Retrieval.

Transvaginal oocyte retrieval is a crucial step in assisted reproductive technology. Various complications may arise during this procedure. Ureteral injury is a rare, but a serious complication in gynecological practice. During oocyte retrieval, ureteral injuries, detachment and obstruction can be seen, though rare. In this study, we will present ureteral obstruction that develops secondary to small hematoma, which mimics ovarian cyst torsion or ruptured ovarian cyst.

An unusual case of a borderline Brenner tumor associated with bilateral serous cystadenoma and endometrial carcinoma.

Brenner tumor accounts for 1.5 to 2.5% of ovarian tumors. Nearly all are benign and 1% malignant. Less than twenty-five cases of borderline Brenner tumor have been reported worldwide. Our case is the first one related to a bilateral ovarian serous cystadenofibroma and endometrioid adenocarcinoma. This unusual case increases the limited data for borderline Brenner tumors.

Laparoscopic ovarian ligament plication in pregnancy / Plicatura laparoscópica del ligamento ovárico en el embarazo

This 32-year old patient presented at seven weeks gestation with severe left-sided lower abdominal pain. This was against the background of a previous history of left salpingectomy from a ruptured ectopic gestation seven years previously. Transvaginal sonographic evaluation revealed a viable seven week intrauterine embryo, a 2 cm left corpus luteum cyst and Doppler studies revealed reduced internal flow. This led the way for a conservative approach via laparoscopy of untwisting the pedicle to restore blood flow. In this case, the ovarian ligament was shorted using 1/0 vicryl and the pregnancy went to term.

Esta paciente de 32 años se presentó en la séptima semana de gestación con un severo dolor abdominal en el lado inferior izquierdo. Esto ocuría teniendo la paciente por antecedente una historia previa de salpingectomía izquierda a partir de la ruptura de un embarazo ectópico siete años antes. La evaluación sonográfica transvaginal reveló un embrión intrauterino viable de siete semanas, un quiste del 2 cm en el cuerpo lúteo izquierdo, y los estudios de Doppler revelaron un flujo interno reducido. Esto abrió el camino para un abordaje conservador vía laparoscopia encaminada a deshacer la torsión del pedículo y restablecer así el flujo sanguíneo. En este caso, el ligamento ovárico fue acortado usando vicryl 1/0, y el embarazo continuó a término.

Laparoscopic ovarian ligament plication in pregnancy.

This 32-year old patient presented at seven weeks gestation with severe left-sided lower abdominal pain. This was against the background of a previous history of left salpingectomy from a ruptured ectopic gestation seven years previously. Transvaginal sonographic evaluation revealed a viable seven week intrauterine embryo, a 2 cm left corpus luteum cyst and Doppler studies revealed reduced internal flow. This led the way for a conservative approach via laparoscopy of untwisting the pedicle to restore blood flow In this case, the ovarian ligament was shorted using 1/0 vicryl and the pregnancy went to term.

Quiste ovárico fetal: diagnóstico prenatal y manejo quirúrgico postnatal exitoso / Prenatal diagnosis of fetal ovarian cyst

Los quistes ováricos son el tumor abdominal mas frecuente en las recién nacidas. Presentan complicadones agudas y a largo plazo. La más frecuente es la torsión anexial que presenta dificultades diagnósticas en la etapa neonatal. El diagnóstico prenatal es fundamental para el manejo oportuno de las pacientes. Existen diferentes alternativas terapéuticas donde la cirugía mínimamente invasiva y conservadora juega un importante rol. Presentamos el caso de una recién nacida macrosómica con diagnóstico prenatal de quiste ovárico no complicado que sufrió torsión durante los primeros días de vida y se resolvió exitosamente en forma quirúrgica conservadora gracias a un manejo multidisciplinario.

Ovarian cysts are the most common abdominal tumor in female newborns. They could develop acute or long term complications. The most frequent complication is adnexal torsion, which presents with diagnostic difficulties in the neonatal period. Prenatal diagnosis is essential for the prompt management of patients. There are different treatment options where conservative and minimally invasive surgery plays an important role. We report a female newborn with prenatal diagnosis of macrosomia and uncomplicated ovarian cyst, which suffered adnexal torsion during the first days of life and was successfully resolved with a conservative surgical management by a multidisciplinary staff.

Manejo laparoscópico de quistes ováricos complicados o persistentes durante el embarazo / Laparoscopic management of complicated or persistent adnexal cysts during pregnancy

Antecedentes: El incremento en el hallazgo de quistes anexiales durante el embarazo sería el mayor uso de técnicas de reproducción asistida con hiperestimulación ovárica controlada. La complicación más frecuente sigue siendo la torsión anexial. Objetivo: Revisar el manejo de quistes anexiales complicados o persistentes, durante el embarazo, con resolución laparoscópica. Método: Revisión retrospectiva de 9 pacientes consecutivas, ingresadas al Departamento de Obstetricia y Ginecología Clínica Las Condes. Resultados: La edad gestacional de ingreso fue entre 5+5 y 27 semanas. Cinco casos fueron producto de fertilización asistida y cuatro espontáneos. Ocho (85,6 por ciento) embarazadas, ingresaron por dolor abdominal agudo. Otro caso ingresó a cirugía electiva por quiste ovárico persistente. Los quistes tenían entre 6 y 13 cm. En 5 se realizó sólo destorsión ovárica, en 1 ooforectomía y en 1 quistectomía. Se realizó punción, destorsión y fijación a ligamento útero ovárico, bilateral, en la otra paciente. Se registró un caso de fiebre en el postoperatorio. El alta hospitalaria fue a las 48 horas en 6 (67 por ciento), a las 72 en 2 y a las 96 en 1. El estudio biópsico diferido en 3 pacientes demostró: 1 quiste seroso paratubario, 1 quiste luteínico parcialmente hemorrágico y 1 infarto anexial. Todos los embarazos evolucionaron normalmente. Conclusión: Nuestra experiencia confirma que en el embarazo la laparoscopía es una buena opción al requerir una cirugía por quiste anexial complicado o persistente.

Background: Recent reviews show an increase in the finding of adnexal cysts during pregnancy. One reason could be the use of assisted reproductive techniques with controlled ovarian hyperstimulation. Objective: To review the experience in managing via laparoscopy complicated or persistent adnexal cysts during pregnancy. Method: Retrospective review of 9 consecutive patients, admitted at the Department of Obstetrics and Gynecology, Clínica Las Condes. Results: The gestational age was between 5+5 and 27 weeks. Five were the product of assisted fertilization and four spontaneous. Eight (85.6 percent) pregnant women were admitted by emergency room because of acute abdominal pain and another one went through elective surgery for persistent ovarian cyst. Preoperative diagnosis of the 8 patients admitted by emergency: adnexal cyst complicated with torsion in 6 (1 adnexal infarction) and 2 cases of acute abdomen. The cysts were between 6 and 13 cm. Type of surgery: in 5, only distortion; ovarian oophorectomy in 1 and cystectomy in one. Puncture, detorsión and bilateral fixation of uterine ovarian ligament, in another patient. One case required conversion to laparotomy with adnexectomy. Postoperative fever was observed in one patient. Discharge was at 48 hrs in 6 (67 percent) cases, at 72 hrs. in 2 and 96 hrs. in 1. Deferred biopsy performed in 3 patients showed: paratu-barian serous cyst, partially hemorrhagic luteal cyst, adnexal infarction. All pregnancies went on normally. Premature births are not reported. Conclusion: Our experience suggests that laparoscopic approach is a valid option for complicated or persistent adnexal cysts in pregnant women.

A laparoscopic approach to treating torsion of a nonpregnant uterus accompanied by a large ovarian cyst in a premenarchal girl.

A 10-year-old premenarchal girl was admitted to our hospital with moderate abdominal pain, although presenting no vomiting or abdominal rebound tenderness. A large abdominal mass was visible and palpable in the periumbilical and epigastric regions. Results of physical examination revealed that the general health status was satisfactory. Computed tomographic scan revealed a large, thin-walled cyst occupying nearly the entire peritoneal cavity. The other viscera were of normal aspect. A laparoscopic approach revealed a left ovarian cystic tumor that was twisted 360 degrees in conjunction with the uterine corpus with hemorrhagic infarction. A partial hysterectomy and a left salpingo-oophorectomy were carried out. The tumor was classified as mature cystic teratoma of the ovary accompanied by hemorrhagic necrosis, not only of the cyst but also of the left uterine tube and the uterine corpus.

Ovarian clear cell carcinoma associated with endometriosis: a case report with immunohistochemical study.

Endometriosis is a frequent benign gynecological disease; nonetheless, it can demonstrate some aspects that resemble malignant disease. Malignant transformation of endometriosis occurs mainly in the ovary. A rare case of transition between typical endometriosis and clear cell carcinoma with immunohistochemical study is presented. The patient, a 30-year-old Caucasian woman (para 0), was diagnosed with endometriosis ten years before. Six months later she developed a left cystic ovarian tumor (58 cm3) that persisted after two ultrasounds in a four-month period. Tumor markers were normal (CA125, CA 15.3, CA 19.9, alpha-fetoprotein, carcinoembrionary antigen A1). There was no ascites. The left ovarian mass was removed by laparotomy and endometriosis in continuity with carcinoma positive for cytokeratin 7 and estrogen receptor was revealed. CD10 was positive in the stromal cells of the endometriosis. Clear cell carcinoma grade 3 was diagnosed. In conclusion, although a rare event, the association of typical endometriosis and clear cell carcinoma of the ovary should be kept in mind, mainly in patients with a persistent ovarian cyst.

An unusual presentation of actinomycosis in a young woman, after surgery.

Actinomycosis is an unusual, chronic granulomatous disease. Actinomyces israelli has been found to be related to infectious processes in those patients with affected skin integrity leading to abscess formation, fistulae or mass lesions. Actinomycosis mainly presents in three forms cervicofacial (50%), abdominal (20%) and thoracic (15%). Pelvic cases have been rarely reported and are usually associated with the use of intrauterine devices. We describe a case of a 23 y/o female without history of intrauterine device use, who was admitted with an ovarian cyst following an appendectomy. An ovarian abscess was drained. The pathology showed a granuloma and focal sulfur granules like particles compatible with Actinomyces. This is a case of pelvic Actinomyces, not related to the use of an intrauterine device.

An unusual presentation of actinomycosis in a young woman, after surgery

Actinomycosis is an unusual, chronic granulomatous disease. Actinomyces israelli has been found to be related to infectious processes in those patients with affected skin integrity leading to abscess formation, fistulae or mass lesions. Actinomycosis mainly presents in three forms cervicofacial (50%), abdominal (20%) and thoracic (15%). Pelvic cases have been rarely reported and are usually associated with the use of intrauterine devices. We describe a case of a 23 y/o female without history of intrauterine device use, who was admitted with an ovarian cyst following an appendectomy. An ovarian abscess was drained. The pathology showed a granuloma and focal sulfur granules like particles compatible with Actinomyces. This is a case of pelvic Actinomyces, not related to the use of an intrauterine device

Patología tumoral de ovario en edad pediátrica: experiencia del Hospital de Niños "Superiora Sor María Ludovica" / Pediatric ovarian tumors

Se evalúan 44 pacientes ingresadas en el período comprendido entre 1984-2001 con patología ovárica. El 79,5 por ciento (n=35) correspondieron a tumores y el 20,5 por ciento (n=9) a lesiones quísticas. Dentro del primer grupo 31/35 correspondieron a tumores germinales y 16/31 fueron teratomas maduros. Luego de evaluación clínica, imaginológica y de marcadores tumorales en aquellos con marcadores positivos y contenido mixto o sólido se realizó Punción Aspiración con Aguja Fina (PAAF) para corroborar diagnóstico. La conducta inicial fue la cirugía en 32/34 tumores y en 9/9 lesiones quísticas no tumorales. El 67 por ciento de las últimas ingresó con cuadro abdominal agudo por lo que recibió cirugía de urgencia. De obtenerse el diagnóstico sin cuadro de abdomen agudo y con marcadores tumorales negativos se utilizó la vía laparoscópica en 3 pacientes (2 quistes simples y 1 teratoma maduro). De las 15 pacientes con tumores germinales malignos 11 recibieron quimioterapia de acuerdo a protocolos SIOP (consecutivos por el tiempo de estudio) y 2 recibieron radioterapia luego de haberse diagnosticado disgerminoma. Sólo 2 pacientes, por considerarse los tumores irresecables al ingreso, recibieron quimioterapia preoperatoria. La sobrevida global fue del 94.5 por ciento (33/35) y la sobrevida libre de reactivaciones del 90 por ciento (31/35). Las dos pacientes fallecidas correspondieron al período inicial del estudio (1984-5) ingresando con diagnóstico tardío. Cinco pacientes (34 por ciento) de las portadoras de tumores malignos y que recibieron quimioterapia se han casado y tres de ellas tienen actualmente 5 hijos sanos que se controlan en nuestro Hospital