Giant paratubal cyst: report of a case in second level public hospital.

BACKGROUND: Giant paratubal cysts are mostly benign tumors, with an incidence of 10%. The incidence rate of neoplasms is 2% to 3%, including papillary carcinoma and serous papillary neoplasms. CASE REPORT: A 35-year-old woman who began her current condition 3 years after her pregnancy, with urgency when urinating, abdominal pain and sensation of abdominal mass, who was diagnosed and protocolized in a second public level hospital of the State of Mexico, treated with open surgery, and good postoperative evolution.

ANTECEDENTES: Los quistes paratubáricos gigantes son en su mayoría tumores benignos, con una incidencia del 10%. La tasa de incidencia de neoplasias es del 2 al 3%, incluyendo carcinoma papilar y neoplasias papilares serosas. CASO CLÍNICO: Mujer de 35 años que comenzó su condición actual 3 años después de un embarazo, con urgencia al orinar, dolor abdominal y sensación de masa abdominal, que fue diagnosticada y protocolizada en un hospital público de segundo nivel del Estado de México, tratada con cirugía abierta y con buena evolución posoperatoria.

Leiomyoma with Bizarre Nuclei (Symplastic Leiomyoma) in the Paratubal Cyst Wall: Report of a Rare Case.

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.

Paratubal Cyst Recurrence in Children and Adolescents.

STUDY OBJECTIVE: To examine the association between patient characteristics and risk for recurrence risk of paratubal cysts (PTC) in children and adolescents. DESIGN: Retrospective chart review at a single institution. SETTING: Single academic children's hospital. PARTICIPANTS: Pediatric patients presenting to Texas Children's Hospital between July 2007 and March 2019. Patients were identified for the study by reviewing pathology reports and were included if they met inclusion criteria of a pathologic diagnosis of a paratubal or paraovarian cyst removed during any surgical procedure between July 2007 and March 2019. INTERVENTIONS: Subjects with pathologic diagnoses of a paratubal cyst during the study period underwent chart review for the following data points: age at presentation, ethnicity, pathologic recurrence of paratubal cysts, pubertal status, body mass index (BMI), diagnosis of polycystic ovary syndrome (PCOS), size of cyst, laterality of cysts, and number of cysts. MAIN OUTCOME MEASURE(S): Recurrence, Pathology types. RESULTS: Of the 627 patients that met inclusion criteria, the incidence of recurrence was 11.3%. Group 1 included those with recurrence of PTC (N = 70). Group 2 was identified as those without recurrence of PTC (N = 557). There were no differences related to age, BMI, ethnicity, history of PCOS, cyst size, laterality or number of cysts present. PTC NOS and serous PTC occurred most frequently. Of the unique cases involving recurrence, 70.1% recurred on the ipsilateral side. There were no cases of paratubal cyst malignancies in this cohort. The range of pathology diagnoses included pathologies that may occur in ovarian cysts. This is particularly interesting, given the known origins of ovarian cancer from fallopian tube transformations. Rare pathology diagnoses likely did not occur with frequency to determine definitive risks of recurrence in these cases. CONCLUSIONS: There appears to be a baseline recurrence risk for PTC, for which patients can be counseled. Recurrence does not appear to be associated with any particular pathology type, cyst size, number of cysts, BMI, PCOS, or puberty stage. Recurrence, should it occur, appears to occur more commonly on the ipsilateral side.

Paratubal borderline serous tumor in a postmenopausal woman: a case report.

Unlike borderline ovarian tumors, paratubal borderline tumors are extremely rare gynecologic tumors. They occur in reproductive-aged females at an earlier stage of disease and have a good prognosis. A 61-year-old woman, gravida 3 para 3, presented with progression of ovarian cyst. Computed tomography revealed a 6-cm simple cystic lesion without enhancing papillary projections. The patient underwent total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. Frozen specimens showed that the tumor was benign, thereby confirming a final diagnosis of paratubal borderline serous tumor. The patient refused comprehensive surgical staging and opted for close follow-up. The patient remains asymptomatic with no evidence of recurrence at the 24-month follow-up. To the best of our knowledge, this is the first reported case of paratubal borderline serous tumor in a postmenopausal patient. The findings of this study and those of other case reports can contribute to the understanding, diagnosis, treatment and prognosis of these rare tumors.

[A young woman with acute pain in the lower right abdomen]. / Een jonge vrouw met acute pijn rechtsonder in de buik.

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.

[Adnexal torsion during the second trimester of pregnancy: about two cases]. / Torsion d'annexe au second trimestre de la grossesse, à propos de deux cas.

Acute pelvic pain during pregnancy makes the differential diagnosis more challenging. We here report two cases of adnexal torsion during the second trimester of pregnancy in order to draw attention to this diagnosis and to highlight the importance of early treatment to avoid irreversible damages due to ischemia which can be fertility-threatening. The first patient, G1P0, 20 weeks pregnant, initially presented with appendix syndrome. Exploration with a small McBurney incision showed a right ovarian necrosis, hence ovariectomy was performed. The postoperative course was uneventful. The second patient, G2P2, 26 weeks pregnant, presented to the emergency departments with acute left iliac fossa pain. Laparotomy revealed the torsion of a hydatid of Morgagni whose necrotic appearance due to twisting required hydatid ablation. No postoperative complications were noted in the two patients. Adnexal torsion is an emergency condition that should not be ignored in the case of acute pelvic pain in pregnant women. Conservative treatment represents the gold standard and proper management is necessary to avoid possible maternal and fetal complications.

Paratubal Borderline Malignancy: A Case of a 17-Year-Old Adolescent Female Treated with Laparo-Endoscopic Single-Site Surgery and a Review of the Literature.

BACKGROUND: Although paratubal cysts are common, borderline paratubal cysts are extremely rare. We describe the case of a large borderline paratubal cyst in a 17-year-old adolescent female treated with laparo-endoscopic single-site surgery (LESS), and review the literature. CASE: A 17-year-old female was referred due to a large right adnexal cyst on pelvic sonogram. A CT scan showed a 19-cm cystic lesion with enhancing papillary projection along the wall. Laparo-endoscopic single-site surgery confirmed a large cystic mass that originated from the right salpinx. Right salpingectomy and right ovarian wedge resection were performed, and intraoperative frozen section analysis was conducted. The result of the frozen section analysis and final pathologic review indicated that the cyst was a serous papillary-type borderline tumor in a paratubal cyst. SUMMARY AND CONCLUSION: To the best of our knowledge, this is the first case report of a BPC treated with LESS. We suggest that minimally invasive, fertility-preserving surgery should be considered as a standard treatment of borderline paratubal cysts if patients desire future fertility.

[Differential diagnosis of abdominal cysts in children]. / Hasi cysták és cystosus képletek differenciáldiagnózisa gyermekkorban.

19 children were diagnosed with abdominal cysts of different origin in the Surgical Unit of the Department of Pediatrics, Medical University of Pécs, Hungary between 2010 and 2013. The authors discuss the details of representative cases of a parovarial cyst, an intestinal duplication, and an omental cyst with emphasis on the clinical symptoms, diagnostic tools, and surgical interventions. The authors conclude that abdominal cysts often cause mild symptoms only, and they are discovered accidentally by ultrasound imaging performed for other reasons. In some cases, the cyst can cause severe complaints or even acute abdomen requiring emergency surgery. Laporoscopy may be a valuable method both in diagnosis and surgical therapy. Abdominal CT or MRI are not required in the majority of the patients.

[Giant paraovarian cyst in childhood - Case report]. / Quiste paraovárico gigante en la infancia. Reporte de un caso.

INTRODUCTION: Paraovarian cysts are very uncommon in children OBJECTIVE: To present a case of giant paraovarian cyst case in a child and its management using a modified laparoscopic-assisted technique CASE REPORT: A 13-year-old patient with a 15 day-history of intermittent abdominal pain, located in the left hemiabdomen and associated with progressive increase in abdominal volume. Diagnostic imaging was inconclusive, describing a giant cystic formation that filled up the abdomen, but without specifying its origin. Laboratory tests and tumor markers were within normal range. Video-assisted transumbilical cystectomy, a modified laparoscopic procedure with diagnostic and therapeutic intent, was performed with a successful outcome. The histological study reported giant paraovarian cyst. Cytology results were negative for tumor cells. The patient remained asymptomatic during the postoperative follow-up. CONCLUSIONS: The video-assisted transumbilical cystectomy is a safe procedure and an excellent diagnostic and therapeutic alternative for the treatment of giant paraovarian cysts.

Massive Hydronephrosis from Ureteropelvic Junction Obstruction Masquerading as a Paratubal Cyst in an 11-Year-Old Girl.

BACKGROUND: The differential diagnosis of a cystic pelvic mass in an adolescent girl is broad, and includes gastrointestinal, urologic, and gynecologic conditions. CASE: A premenarchal 11-year-old girl presented with abdominal pain. On transabdominal ultrasonography, abutting the lateral side of the left ovary was a large mass with an appearance compatible with a large paratubal cyst measuring 16.7 × 11.9 cm. On exploratory laparotomy, the patient's uterus, tubes and ovaries were normal and a massively dilated and displaced left kidney due to an ureteropelvic junction obstruction was ultimately diagnosed. SUMMARY AND CONCLUSION: A cystic pelvic mass in an adolescent girl may not always be of ovarian or müllerian origin. Urinary tract obstruction is often silent; an incidental finding of hydronephrosis on ultrasonography may be the first clue of the possibility of ureteropelvic junction obstruction as the underlying diagnosis. It is always best to know which organ system is involved prior to surgery, so that the correct surgical team is present and the correct surgical approach is utilized.

Quiste paraovárico gigante en la infancia: Reporte de un caso / Giant paraovarian cyst in childhood: Case report

Introducción: Los quistes paraováricos son de diagnóstico infrecuente en la edad pediátrica. Objetivos: Dar a conocer un caso clínico de quiste paraovárico gigante en la infancia y su manejo a través de una técnica laparoscópica modificada. Caso Clínico: Paciente de 13 años con cuadro de dolor abdominal intermitente de 15 días de evolución, localizado en el hemiabdomen izquierdo, asociado a aumento de volumen abdominal progresivo. Las imágenes diagnósticas no fueron concluyentes, describiendo una formación quística gigante que ocupaba todo el abdomen, sin precisar su origen. Exámenes de laboratorio y marcadores tumorales dentro de los parámetros normales. Se realizó quistectomía transumbilical videoasistida, un procedimiento laparoscópico modificado, con intención diagnóstica y terapéutica con resultado exitoso. Estudio histológico compatible con quiste paraovárico gigante. El examen citológico resultó negativo para células tumorales. La paciente permaneció asintomática durante el seguimiento postoperatorio. Conclusiones: La quistectomía transumbilical videoasistida es una técnica segura y constituye una excelente alternativa diagnóstica y terapéutica para el tratamiento de quistes paraováricos gigantes.

Introduction: Paraovarian cysts are very uncommon in children. Objective: To present a case of giant paraovarian cyst case in a child and its management using a modified laparoscopic-assisted technique. Case report: A 13-year-old patient with a 15 day-history of intermittent abdominal pain, located in the left hemiabdomen and associated with progressive increase in abdominal volume. Diagnostic imaging was inconclusive, describing a giant cystic formation that filled up the abdomen, but without specifying its origin. Laboratory tests and tumor markers were within normal range. Video-assisted transumbilical cystectomy, a modified laparoscopic procedure with diagnostic and therapeutic intent, was performed with a successful outcome. The histological study reported giant paraovarian cyst. Cytology results were negative for tumor cells. The patient remained asymptomatic during the postoperative follow-up. Conclusions: The video-assisted transumbilical cystectomy is a safe procedure and an excellent diagnostic and therapeutic alternative for the treatment of giant paraovarian cysts.

Laparoscopic management of an isolated left fallopian tube torsion due to twisted Morgagni hydatid in a pre-menarcheal girl.

Isolated torsion of fallopian tube, meanwhile uncommon, should be considered in diagnosis of pelvic and lower abdominal pain. US investigation is an useful diagnostic tool. A prompt diagnosis could avoid salpingectomy and preserve fertility. Laparoscopy, as the first approach, should be preferred. We report a case of isolated tubal torsion occurring in a premenarcheal girl successfully managed by laparoscopy.

Recurrent ovarian torsion due to paratubal cysts in an adolescent female.

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.

Clinical diagnosis and complications of paratubal cysts: review of the literature and report of uncommon presentations.

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.