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1.
World J Surg Oncol ; 19(1): 132, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33882931

RESUMO

BACKGROUND: To compare the postoperative recurrence and fertility in patients with borderline ovarian tumors (BOTs) who underwent different surgical procedures: salpingo-oophorectomy versus cystectomy. METHODS: Potentially relevant literature from inception to Nov. 06, 2020, were retrieved in databases including Cochrane Library, EMBASE (Ovid), and MEDLINE (Pubmed). We applied the keywords "fertility-sparing surgery," or "conservative surgery," or "cystectomy," or "salpingo-oophorectomy," or "oophorectomy," or "adnexectomy," or "borderline ovarian tumor" for literate searching. Systemic reviews and meta-analyses were performed on the postoperative recurrence rates and pregnancy rates between patients receiving the two different surgical methods. Begger's methods, Egger's methods, and funnel plot were used to evaluate the publication bias. RESULT: Among the sixteen eligible studies, the risk of recurrence was evaluated in all studies, and eight studies assessed the postoperative pregnancy rates in the BOT patients. A total of 1839 cases with borderline ovarian tumors were included, in which 697 patients (37.9%) received unilateral salpingo-oophorectomy and 1142 patients (62.1%) underwent unilateral/bilateral cystectomy. Meta-analyses showed that BOT patients with unilateral/bilateral cystectomy had significantly higher recurrence risk (OR=2.02, 95% CI: 1.59-2.57) compared with those receiving unilateral salpingo-oophorectomy. Pooled analysis of four studies further confirmed the higher risk of recurrence in patients with cystectomy (HR=2.00, 95% CI: 1.11-3.58). In addition, no significant difference in postoperative pregnancy rate was found between patients with the two different surgical procedures (OR=0.92, 95% CI: 0.60-1.42). CONCLUSION: Compared with the unilateral/bilateral cystectomy, the unilateral salpingo-oophorectomy significantly reduces the risk of postoperative recurrence in patients with BOT, and it does not reduce the pregnancy of patients after surgery. TRIAL REGISTRATION: PROSPERO CRD42021238177.


Assuntos
Preservação da Fertilidade , Infertilidade Feminina , Neoplasias Ovarianas , Ovariectomia , Salpingo-Ooforectomia , Feminino , Humanos , Infertilidade Feminina/etiologia , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Cistos Ovarianos/patologia , Cistos Ovarianos/cirurgia , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Ovariectomia/efeitos adversos , Gravidez , Prognóstico , Estudos Retrospectivos , Salpingo-Ooforectomia/efeitos adversos
2.
BMJ Case Rep ; 14(3)2021 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-33727290

RESUMO

We present a case of a giant ovarian cyst in a 20-year-old woman who presented atypically at our Emergency Department with left-sided back pain followed by acute left leg swelling. Blood tests showed significantly raised C-Reactive Protein and D-Dimer. CT-Abdomen-Pelvis demonstrated a large mass in the region of the right ovary with suspicious heterogeneous filling defects in the left external iliac vein, confirmed as a left-sided deep-vein thrombosis on ultrasound Doppler. MRI revealed the lesion to be cystic and the deep venous thrombosis was treated with twice-daily Clexane. Prior to removal of the cyst, an Inferior Vena Cava Filter was placed to reduce thromboembolic risk. The cyst was resected without complication and the postoperative period was uneventful. This case occurred while face-to-face services were limited by COVID-19 and illustrates the need for robust systemic measures to safeguard patients against the emergency sequelae of insidious gynaecological pathology.


Assuntos
Dor nas Costas/etiologia , Diagnóstico por Imagem/métodos , Cistos Ovarianos/complicações , Cistos Ovarianos/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia , Adulto , Diagnóstico Diferencial , Enoxaparina/uso terapêutico , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Perna (Membro) , Imagem por Ressonância Magnética , Cistos Ovarianos/cirurgia , Ovário/diagnóstico por imagem , Ovário/cirurgia , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler , Trombose Venosa/tratamento farmacológico , Adulto Jovem
3.
Isr Med Assoc J ; 23(1): 48-51, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33443343

RESUMO

BACKGROUND: Adnexal torsion in pregnancy is often associated with functional adnexal cysts, especially in pregnancies conceived by ovulation induction (OI) or in-vitro fertilization (IVF). During laparoscopy for adnexal de-torsion, drainage of the functional cysts can be attempted, although this procedure may cause bleeding. OBJECTIVES: To investigate the characteristics of ovarian torsion in pregnancy associated with functional cysts and to compare the rate of torsion recurrence following de-torsion alone versus cyst drainage. METHODS: All cases of surgically diagnosed adnexal torsion occurring during pregnancy between January 2007 and April 2019 in our department were retrospectively analyzed. The cases of torsion associated with presumed functional ovarian cysts were selected. The rate of recurrent torsion during the same pregnancy was compared for de-torsion alone versus de-torsion and cyst aspiration. RESULTS: Of the 113 women who experienced adnexal torsion during pregnancy, 71 (67.0%) of torsion cases were caused by presumed functional ovarian cysts. Among women with torsion of functional ovarian cysts, the rate of torsion recurrence was significantly higher in patients who underwent de-torsion alone (n=28) compared to women who underwent aspiration and drainage of the ovarian cysts (n=43) (14.3% vs. 0, P = 0.021). There were no cases of intra- or post-operative bleeding in the study cohort. CONCLUSIONS: Functional ovarian cysts are the most common adnexal pathology encountered in pregnant women with torsion. Intra-operative cyst aspiration and drainage may reduce the risk of recurrent torsion. Further multi-center studies are required to validate our data prospectively.


Assuntos
Doenças dos Anexos , Drenagem/métodos , Cistos Ovarianos , Paracentese/métodos , Complicações na Gravidez , Doenças dos Anexos/diagnóstico , Doenças dos Anexos/etiologia , Doenças dos Anexos/cirurgia , Adulto , Feminino , Humanos , Cistos Ovarianos/complicações , Cistos Ovarianos/diagnóstico , Cistos Ovarianos/cirurgia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/etiologia , Complicações na Gravidez/cirurgia , Risco Ajustado/métodos , Prevenção Secundária/métodos , Anormalidade Torcional/diagnóstico , Anormalidade Torcional/etiologia , Anormalidade Torcional/cirurgia
4.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 47(4): 149-152, oct.-dic. 2020. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-197642

RESUMO

Los quistes ováricos son los tumores abdominales más frecuentemente diagnosticados en los fetos femeninos, con una incidencia estimada de 1 en 1.000-2.600 embarazos. La probabilidad de malignidad es extremadamente baja y la asociación a malformaciones resulta excepcional. Se presenta un quiste ovárico en el diagnóstico ultrasonográfico prenatal, se observa por ecografía bidimensional en la región pélvica fetal una imagen anecoica con diámetro de 89mm y volumen de 242cc. El beneficio más importante es realizar un buen diagnóstico diferencial para así establecer un buen manejo del caso


Ovarian cysts are the most frequently diagnosed abdominal tumours in the female foetus, with an estimated incidence of 1 in 1,000-2,600 pregnancies. The probability of malignancy is extremely low and the association with malformations is exceptional. A case is presented of an ovarian cyst in the prenatal ultrasound diagnosis, with an anechoic image of 89mm diameter and 242cc of volume being observed in the fetal pelvic region with the two-dimensional ultrasound. The most important benefit is to make an optimal differential diagnosis in order to establish the treatment of the case


Assuntos
Humanos , Feminino , Adulto , Cistos Ovarianos/diagnóstico por imagem , Cistos Ovarianos/cirurgia , Doenças Fetais/diagnóstico por imagem , Doenças Fetais/cirurgia , Ultrassonografia Pré-Natal/métodos , Cistos Ovarianos/ultraestrutura , Diagnóstico Diferencial , Procedimentos Cirúrgicos Minimamente Invasivos
5.
Medicine (Baltimore) ; 99(40): e22511, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019452

RESUMO

RATIONALE: Granulosa cell tumors (GCTs) are rare, hormonally active sex cord-stromal tumors that generally present as solid unilateral ovarian lesions. It's quite uncommon that they present as pure bilateral ovarian cysts. Histopathology remains the gold standard for making a diagnosis of GCTs. However, as the differential diagnosis is difficult, cystic GCTs are frequently misdiagnosed as benign or other cystic tumors either prior to surgery or during pathologic diagnosis. Accordingly, herein, we describe a fairly rare case of bilateral ovarian cystic GCTs, along with a review of the related literature. PATIENT CONCERNS: A 43-year-old woman presented with abdominal distension and chronic pain since 1 day. The patient had a history of dysmenorrhea. DIAGNOSES: Physical examination revealed palpable bilateral adnexal tumors; ultrasonography revealed cystic and septate masses with a maximum diameter of 7.8 and 10.7 cm, respectively, in the bilateral ovaries. Hormonal analysis revealed that the blood estradiol levels were elevated. Postoperative pathological and immunohistochemical examinations of the surgical specimens revealed a final diagnosis of cystic adult GCTs of the ovaries. INTERVENTIONS: The patient first underwent laparoscopic bilateral ovarian cystectomy. On the basis of the final pathological diagnosis report, abdominal total hysterectomy, bilateral oophoro-salpingectomy, and partial omentectomy were then performed. Microscopic examination revealed that there were no residual CGT cells. The patient's federation international of gynecology and obstetrics (FIGO) Stage was IB period. OUTCOMES: The surgeries were successful. The tumor was a FIGO Stage IB tumor, and the patient did not require any additional treatment. The patient had been followed-up regularly for 2 years after surgery; she did not experience any complications and remained disease-free. LESSONS SUBSECTIONS: Cystic GCTs should be considered in the differential diagnosis if a female patient shows bilateral ovarian cysts. They are extremely rare ovarian malignant tumors that must be differentiated from other ovarian tumors, especially purely cystic tumors and benign cysts. Although pathological and immunohistochemical findings are important for making the diagnosis, the varying histopathological features on microscope make diagnosis difficult, including tumor cells with luteinization or free cell clusters. The current case highlights the importance of physicians being aware of and suspecting cystic CGTs in similar cases, along with knowing the characteristics of GCTs for the diagnosis and differential diagnosis.


Assuntos
Tumor de Células da Granulosa/patologia , Tumor de Células da Granulosa/cirurgia , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Adulto , Feminino , Humanos , Cistos Ovarianos/patologia , Cistos Ovarianos/cirurgia
6.
Rev. cuba. med. mil ; 49(3): e457, jul.-set. 2020. fig
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1144487

RESUMO

Introducción: Los tumores de gran tamaño han sido descritos a través de la historia, entre ellos los ginecológicos y los de ovario cuando pesan más de 12 kg constituyen una rareza médica. Las masas tumorales en hemiabdomen inferior son causas frecuentes de consulta en cirugía general. Dentro de estas, los quistes de ovarios son los que con más frecuencia se diagnostican. Objetivo: Describir el caso de un quiste gigante de ovario en una paciente que fue atendida en consulta de cirugia general por aumento de tamaño en el abdomen de varios años de evolución. Caso clínico: Se expone el caso de una paciente femenina, con antecedentes de salud, que acude al servicio de cirugía general por aumento de volumen del abdomen, progresivo, insidioso de 2 años de evolución. Se diagnostica masa quística dependiente de ovario y en el transoperatorio se constata una tumoración quística del ovario que en el análisis histopatológico informa un cistoadenoma seroso de ovario. Conclusión: Los tumores del ovario no son tan frecuentes como los del útero y los de la mama, pero constituyen el tercer grupo de tumores benignos y malignos de la mujer. Se presentó el caso por lo infrecuente que resulta, la escasa frecuencia de reporte de estos casos lo cual aporta conocimiento a la comunidad médica sobre el tema(AU)


Introduction: Large tumors have been described throughout history, including gynecological tumors, and ovarian tumors when they weigh more than 12 kg constitute a medical rarity. Tumor masses in lower hemiabdomen are frequent causes of consultation in general surgery. Within these, ovarian cysts are the most frequently diagnosed. Objective: To describe the case of a giant ovarian cyst in a patient who was treated in a general surgery consultation due to an increase in abdomen size of several years of evolution. Clinical case: The case of a female patient, with a history of health, which goes to the general surgery service due to an increase in abdomen volume, progressive, insidious of 2 years of evolution, is presented. Ovarian-dependent cystic mass is diagnosed and a cystic tumor of the ovary is found in the transoperative period, which in the histopathological analysis reports a serous ovarian cystadenoma. Conclusion: Ovarian tumors are not as frequent as those of the uterus and those of the breast, but they constitute the third group of benign and malignant tumors of women. The case was presented because of the infrequent result, the low frequency of reporting these cases, which brings knowledge to the medical community on the subject(AU)


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Cistos Ovarianos/cirurgia , Ovário/diagnóstico por imagem , Útero , Abdome
7.
Adv Clin Exp Med ; 29(7): 853-856, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32735089

RESUMO

BACKGROUND: Clinical cases have been reported with women who got pregnant with confirmed low serum anti-Müllerian hormone (AMH) concentrations, thus demonstrating that low serum AMH concentration cut-points could be fairly specific for poor ovarian response (POR) to gonadotrophin stimulation, but not for pregnancy. That observation prompted the question whether serum AMH concentration accurately corresponded to the whole amount of AMH secreted by granulosa cells. OBJECTIVES: To measure AMH levels in peritoneal fluid and their correlations with serum AMH concentrations. MATERIAL AND METHODS: The reported study involved 48 female patients, aged 18-40 years, diagnosed with benign ovarian cysts and qualified for a laparoscopic cystectomy. Prior to surgery, the ovarian reserve was assessed using serum AMH concentration assay. The peritoneal fluid was also collected during the laparoscopy and AMH concentrations in peritoneal fluid were measured. RESULTS: The AMH present in the peritoneal fluid strongly correlated with AMH levels in blood serum (r = 0.54; p < 0.001) and higher serum AMH concentrations corresponded to higher AMH concentrations in the peritoneal fluid. There was also a significant correlation between AMH levels in serum and in peritoneal fluid, collected from patients with endometrioma and other benign cysts (r = 0.61; p = 0.001 vs r = 0.43; p = 0.03). CONCLUSIONS: The AMH is present in the peritoneal fluid and its concentrations significantly correlate with AMH levels in serum. The assessment of AMH concentration in the peritoneal fluid may be a valuable complement to the evaluation of ovarian reserve and the diagnosis of infertility after adnexal surgery.


Assuntos
Endometriose , Cistos Ovarianos , Reserva Ovariana , Adolescente , Adulto , Hormônio Antimülleriano , Líquido Ascítico , Endometriose/diagnóstico , Endometriose/cirurgia , Feminino , Humanos , Cistos Ovarianos/diagnóstico , Cistos Ovarianos/cirurgia , Gravidez , Soro , Adulto Jovem
8.
Medicine (Baltimore) ; 99(10): e18988, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150047

RESUMO

INTRODUCTION: Carbohydrate antigen 19-9 (CA 19-9) is a tumor glycolipid, frequently elevated in the serum of patients due to malignancies from gastrointestinal organs; in particular, the pancreas. This carbohydrate antigen is also expressed in benign diseases. PATIENT CONCERNS: A case of a 27-year-old female who has an unknown origin CA 19-9 elevation for 2 years. DIAGNOSIS: After the left ovarian cystectomy and microscopic examination, the final diagnosis is a dermoid cyst. The dermoid cyst shows increased F-fluorodeoxyglucose (F-FDG) uptake in the F-FDG positron emission tomography (PET)/computed tomography (CT) study. INTERVENTION AND OUTCOMES: The laparoscopic oophorocystectomy was performed. It was observed that the patient's CA 19-9 level returned to normal after the surgery 6 months later. This showed that the dermoid cyst was responsible for the abnormal CA 19-9 level. CONCLUSION: In this case, we can learn that the F-FDG PET/CT scan has potential use in patients with unknown origin of elevation CA 19-9.


Assuntos
Antígeno CA-19-9/sangue , Cisto Dermoide/diagnóstico , Cistos Ovarianos/diagnóstico , Adulto , Biomarcadores Tumorais/sangue , Cisto Dermoide/sangue , Cisto Dermoide/diagnóstico por imagem , Cisto Dermoide/cirurgia , Diagnóstico Diferencial , Feminino , Fluordesoxiglucose F18 , Humanos , Cistos Ovarianos/sangue , Cistos Ovarianos/diagnóstico por imagem , Cistos Ovarianos/cirurgia , Ovariectomia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos
9.
Am J Obstet Gynecol ; 223(2): 234.e1-234.e8, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32087147

RESUMO

BACKGROUND: Improved patient outcomes and satisfaction associated with enhanced recovery after surgery protocols have increasingly replaced traditional perioperative anesthesia care. Fast-track surgery pathways have been extensively validated in patients undergoing hysterectomies, yet the impact on fertility-sparing laparoscopic gynecologic operations, particularly those addressing chronic pain conditions, has not been examined. OBJECTIVE: The objective of the study was to determine the effects of enhanced recovery after surgery pathway implementation compared with conventional perioperative care in women undergoing laparoscopic minimally invasive nonhysterectomy gynecologic procedures. STUDY DESIGN: We conducted a retrospective cohort study of women undergoing uterine-sparing laparoscopic gynecologic procedures for benign conditions (tubal/adnexal pathology, endometriosis, or leiomyomas) during a 24 month period before and after enhanced recovery after surgery implementation at a tertiary care center. We compared immediate perioperative outcomes and 30 day complications. The primary outcome was same-day discharge rates. Factors influencing unplanned admissions, postoperative pain, sedation, nausea, and vomiting represented secondary analyses. RESULTS: A total of 410 women (enhanced recovery after surgery, n = 196; conventional perioperative care, n = 214) met inclusion criteria. Following enhanced recovery after surgery implementation, same-day discharge rates increased by 9.4% (P = .001). Reductions in postoperative pain and nausea/vomiting represented the primary driving factor behind lower unplanned admissions. Higher preoperative antiemetic medication administration in the enhanced recovery after surgery group resulted in a 57% reduction in postanesthesia care unit antiemetics (P < .001). Total perioperative narcotic medication use was also significantly reduced by 64% (P < .001), and the enhanced recovery after surgery cohort still demonstrated significantly lower postanesthesia unit care pain scores at hours 2 and 3 (P < .001). A 19 minute shorter postanesthesia care unit stay was noted in the enhanced recovery after surgery cohort (P = .036). Increased same-day discharge did not lead to higher postoperative complications or changes in 30 day emergency department visits or readmissions in patients with enhanced recovery after surgery. CONCLUSION: Enhanced recovery after surgery implementation resulted in increased same-day discharge rates and improved perioperative outcomes without affecting 30 day morbidity in women undergoing laparoscopic minimally invasive nonhysterectomy gynecologic procedures.


Assuntos
Recuperação Pós-Cirúrgica Melhorada , Doenças dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/métodos , Hospitalização/estatística & dados numéricos , Laparoscopia/métodos , Alta do Paciente/estatística & dados numéricos , Dor Pélvica/cirurgia , Adulto , Período de Recuperação da Anestesia , Denervação/métodos , Endometriose/cirurgia , Feminino , Humanos , Infertilidade Feminina/cirurgia , Leiomioma/cirurgia , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Cistos Ovarianos/cirurgia , Dor Pós-Operatória/epidemiologia , Náusea e Vômito Pós-Operatórios/epidemiologia , Procedimentos Cirúrgicos Profiláticos/métodos , Estudos Retrospectivos , Salpingo-Ooforectomia , Esterilização Reprodutiva/métodos , Miomectomia Uterina/métodos , Neoplasias Uterinas/cirurgia , Adulto Jovem
10.
G Chir ; 41(1): 110-113, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32038021

RESUMO

Corpus luteum cyst rupture with consequent hemoperitoneum is a common cause of admission to the emergency room. This condition is frequently misdiagnosed because of overlapping of clinical findings in acute gynecologic diseases. However, an incorrect identification may lead to delay in surgical treatment, which can Romabe a life-threatening condition. Ultrasound (US) is the first technique used for diagnosis that can confirm or dismiss the presence of intraperitoneal fluid. Secondly, the contrast-enhanced computed tomography (CT) is the quickest way to identify the site of active bleeding and to establish the correct management of the clinical condition. Herein, we report a case of a 19-years-old girl with acute abdominal pain correctly identified by diagnostic images and treated with mini-invasive surgery techniques in order to quickly act without clinic and aesthetic sequelae.


Assuntos
Corpo Lúteo/cirurgia , Hemoperitônio/cirurgia , Laparoscopia/métodos , Cistos Ovarianos/cirurgia , Dor Abdominal/etiologia , Dor Aguda/etiologia , Meios de Contraste , Corpo Lúteo/diagnóstico por imagem , Feminino , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/etiologia , Humanos , Cistos Ovarianos/complicações , Cistos Ovarianos/diagnóstico por imagem , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/cirurgia , Ferida Cirúrgica , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia , Adulto Jovem
11.
J Minim Invasive Gynecol ; 27(2): 260-261, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31376583

RESUMO

OBJECTIVE: Laparoscopic cystectomy for endometrioma has the advantages of a minimally invasive approach. The standardization and description of the technique are the main objectives of this video. We described the surgery in 10 steps, which could help to make this procedure easier and safer. DESIGN: Step-by-step video demonstration of the technique. SETTING: A French university tertiary care hospital. INTERVENTION: Two standardized laparoscopic cystectomy were recorded to realize the video. The local institutional review board ruled that approval was not required because the video describes a technique and does not report a clinical case. This video presents a systematic approach to cystectomy for endometrioma clearly divided into 10 steps: (1) preoperative evaluation [1]; (2) diagnosis and exploration [2]; (3) adhesiolysis, mobilization of the ovary; (4) cyst rupture, exposition of the entry site; (5) identification of the cleavage plan; (6) endometrioma easy dissection; (7) endometrioma difficult dissection; (8) hemostasis, reconstruction of the ovary [3]; (9) exploration of the ovarian fossa; and (10) washing, extraction of the cyst [3,4]. CONCLUSION: Standardization of laparoscopic cystectomy for endometrioma could make this procedure easier and safer to perform. The 10 steps presented help to perform each part of the surgery in a logical sequence, making the procedure easier to realize. Moreover, the standardization of the surgical techniques may reduce the learning curve.


Assuntos
Endometriose/cirurgia , Procedimentos Cirúrgicos em Ginecologia/métodos , Laparoscopia/métodos , Cistos Ovarianos/cirurgia , Dissecação/métodos , Endometriose/patologia , Feminino , Humanos , Cistos Ovarianos/patologia , Ovariectomia/métodos , Ovário/patologia , Ovário/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos
12.
Acta Obstet Gynecol Scand ; 99(1): 105-111, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31449329

RESUMO

INTRODUCTION: The purpose of this study was to investigate the epidemiology and characteristics of surgically treated ovarian lesions in preadolescent girls. MATERIAL AND METHODS: This was a retrospective cohort study including all 0- to 11-year-old girls operated at a single center from 1999 to 2016 for ovarian cysts, neoplasms or torsions. Patient charts were reviewed for symptoms, preoperative radiological imaging, operative details and histopathology. RESULTS: We identified 78 girls, resulting in a population-based incidence of 4.2/100 000. Infants (n = 44) presented with benign cysts (42/44, 95%, one bilateral), a benign neoplasm (1/44, 2%) and a torsion without other pathology (1/44, 2%). Torsion was found in 25/29 (86%) ovaries with complex cysts and in 3/15 (21%) ovaries with simple cysts in preoperative imaging (P < 0.001). Most infants were symptomless. Lesions in 1- to 11-year-old girls (n = 34) included benign neoplasms (n = 21/34, 62%), malignant neoplasms (n = 5/34, 15%), a cyst with torsion (n = 1/34, 3%) and torsions without other pathology (n = 7/34, 21%). Torsion was more common in benign (17/21, 81%) than in malignant neoplasms (1/5, 20%) (P < 0.020). Ovarian diameter did not differ between ovaries with or without torsion (P = 0.238) or between benign and malignant neoplasms (P = 0.293). The duration of symptoms in lesions with or without torsion was similar. CONCLUSIONS: The majority of surgically treated ovarian lesions in preadolescent are benign lesions with torsion. Surgery should be ovary-preserving and performed without delay.


Assuntos
Doenças Ovarianas/cirurgia , Anormalidade Torcional/cirurgia , Criança , Pré-Escolar , Feminino , Finlândia/epidemiologia , Humanos , Incidência , Lactente , Recém-Nascido , Cistos Ovarianos/epidemiologia , Cistos Ovarianos/cirurgia , Doenças Ovarianas/epidemiologia , Neoplasias Ovarianas/epidemiologia , Neoplasias Ovarianas/cirurgia , Estudos Retrospectivos , Anormalidade Torcional/epidemiologia
13.
J Pediatr Adolesc Gynecol ; 33(1): 89-92, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31254617

RESUMO

STUDY OBJECTIVE: Children with adnexal masses might be managed by pediatric surgeons, urologists or gynecologists, with the potential for different management strategies between specialties. In this study we compared ovarian conservation rates and surgical approach for adnexal masses in children and adolescents managed either by pediatric surgeons/urologists or gynecologists at a tertiary care institution. DESIGN: Retrospective cohort review. SETTING: Tertiary pediatric and adult university hospital. PARTICIPANTS: Patients younger than 18 years of age with an adnexal mass managed surgically with removal of histologically confirmed ovarian or fallopian tube tissue from 2008 to 2015. INTERVENTIONS: Laparoscopic or open procedure for adnexal mass. MAIN OUTCOME MEASURES: The primary outcome was rate of ovarian conservation relative to surgical specialty. The secondary outcome was surgical approach relative to surgical specialty. RESULTS: Forty-eight patients underwent surgery for adnexal masses; 26 (54%) under pediatric surgery/urology and 22 (46%) under gynecology care. Laparoscopy was performed in 5 (19%) pediatric and 19 (86%) gynecology cases (P = .000006). Of 24 patients older than 12 years of age with a benign tumor, 10 (42%) underwent procedures resulting in loss of an ovary with or without fallopian tube; 8 of these (80%) were under pediatric care. Of the remaining 14 (58%) who underwent ovarian conserving surgery, 12 (80%) were under gynecology care (P = .0027). CONCLUSION: Patients with a benign tumor were significantly more likely to undergo ovary-preserving surgery under gynecology care than under pediatric surgery/urology care. A multidisciplinary team approach involving gynecology and pediatric surgical specialties would be valuable in assessing the merits of ablative or conservative surgery in each case.


Assuntos
Neoplasias das Tubas Uterinas/cirurgia , Cistos Ovarianos/cirurgia , Neoplasias Ovarianas/cirurgia , Especialização , Adolescente , Criança , Estudos de Coortes , Neoplasias das Tubas Uterinas/diagnóstico por imagem , Feminino , Preservação da Fertilidade/métodos , Ginecologia/métodos , Humanos , Laparoscopia/métodos , Tratamentos com Preservação do Órgão/normas , Cistos Ovarianos/diagnóstico por imagem , Neoplasias Ovarianas/diagnóstico por imagem , Estudos Retrospectivos
15.
Minim Invasive Ther Allied Technol ; 29(4): 224-231, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31154886

RESUMO

Objective: The surgical approach, hemostatic approach, histologic findings, and cyst size and location may have a role in reducing the ovarian reserve. The aim of this study was to investigate the impact of single-port laparoscopic cystectomy (SLC) and conventional laparoscopic cystectomy (CLC) on the ovarian reserve based on serum anti-Mullerian hormone (AMH) concentrations.Material and methods: This non-randomized concurrent control trial enrolled 79 female patients aged 18-45 years with benign ovarian cysts, including 47 patients in the SLC group and 32 patients in the CLC group. Outcome measures, including hospital stay, operative time, blood loss, analgesic use, body temperature, hospitalization cost, and serum AMH concentration, were evaluated preoperatively, two to three days postoperatively, and four to six weeks postoperatively.Results: The reduction in the AMH concentration after cystectomy was significantly different preoperatively, two to three days postoperatively (p < .001), and four weeks postoperatively (p < .001) regardless of the surgical approach (SLC or CLC) [F (1.00,31.00) = 0.026, p = .873]. Moreover, the hemostatic approach and histologic findings yielded significant differences in the serum AMH concentration regardless of the surgical approach (p < .05). The serum AMH concentration was higher in unilateral cysts (2.70 ± 1.80 ng/mL) than in bilateral cysts (1.73 ± 1.11 ng/mL) postoperatively (p < .05). In the SLC group, the serum AMH concentration in the patients with ovarian endometriomas (1.58 ± 1.39 ng/mL) was significantly lower than that in the patients with other cysts (3.22 ± 1.68 ng/mL) postoperatively (p < .05).Conclusion: The serum AMH concentration decreased over time postoperatively but did not significantly differ between SLC and CLC.


Assuntos
Cistectomia/métodos , Laparoscopia/métodos , Cistos Ovarianos/cirurgia , Reserva Ovariana , Adolescente , Adulto , Hormônio Antimülleriano/sangue , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Temperatura Corporal , Endometriose/sangue , Endometriose/etiologia , Endometriose/cirurgia , Feminino , Preços Hospitalares/estatística & dados numéricos , Humanos , Laparoscopia/efeitos adversos , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Duração da Cirurgia , Período Pós-Operatório , Estudos Prospectivos , Adulto Jovem
17.
Infect Dis Obstet Gynecol ; 2019: 4149587, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31871398

RESUMO

Tubo-ovarian abscess may develop in women with endometrioma following assisted reproductive technology (ART). The infection, though rare, is typically late in onset and may present several months after the procedure, and in pregnancy-with the risks of abortion and premature labor. It is thought that transcutaneous oocyte retrieval during ART is the route for bacterial contamination resulting in infection of the endometrioma. Pathogens reported in the literature include Escherichia coli (E. coli) and Group B streptococcus (GBS) but Staphylococcus lugdunensis (S. lugdunensis), a coagulase-negative staphylococcus (CoNS), and groin and perineal skin commensal was isolated from the endometrioma in this case. We discuss the challenges in diagnosis and treatment of this rare condition and the implications of the discovery that an organism previously dismissed as a contaminant has emerged as a causative organism in severe, deep-seated infections of soft tissues in recent literature.


Assuntos
Coagulase/metabolismo , Endometriose/microbiologia , Cistos Ovarianos/microbiologia , Técnicas de Reprodução Assistida/efeitos adversos , Infecções Estafilocócicas/diagnóstico , Staphylococcus lugdunensis/metabolismo , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Cefalexina/administração & dosagem , Cefalexina/uso terapêutico , Clindamicina/administração & dosagem , Clindamicina/uso terapêutico , Endometriose/cirurgia , Feminino , Humanos , Contagem de Leucócitos , Recuperação de Oócitos/efeitos adversos , Cistos Ovarianos/cirurgia , Gravidez , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/cirurgia , Staphylococcus lugdunensis/isolamento & purificação , Resultado do Tratamento
18.
Taiwan J Obstet Gynecol ; 58(6): 885-887, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31759549

RESUMO

OBJECTIVE: To report a case with benign bilateral ovarian tumor during pregnancy mimicking malignancy. CASE REPORT: A 32-year-old women at 20 weeks gestation with large bilateral adnexal masses found on prenatal ultrasound. The cysts had been growing gradually over the course of the pregnancy. MRI show huge multiple cysts in both ovaries. CA-125 was elevated at 260 U/mL. Due to initial impression was malignancy, an excisional surgery was done. Pathology revealed multiple luteinized granulosa cells with benign nature. CONCLUSION: Hyperreactio luteinalis (HL) is often asymptomatic and discovered incidentally on ultrasound or at the time of cesarean section. As the lesions are self-resolving, management is conservative and surgical intervention is required only in cases with severe complications. HL can be mistaken for malignancy, especially in cases in which the tumor marker CA-125 is elevated, leading to inadvertent surgery.


Assuntos
Antígeno Ca-125/sangue , Imagem por Ressonância Magnética/métodos , Cistos Ovarianos/diagnóstico , Neoplasias Ovarianas/diagnóstico , Complicações Neoplásicas na Gravidez , Ultrassonografia Pré-Natal/métodos , Adulto , Diagnóstico Diferencial , Evolução Fatal , Feminino , Morte Fetal , Humanos , Laparotomia/métodos , Cistos Ovarianos/sangue , Cistos Ovarianos/cirurgia , Ovariectomia/métodos , Gravidez
19.
Hum Reprod ; 34(11): 2153-2162, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31732726

RESUMO

STUDY QUESTION: Are selective markers for the neuronal differentiation such as microtubule-associated protein 2 (MAP-2) and synaptophysin (SYP) as well as the nerve growth factor (NGF) expressed by fibroids, myometrium and eutopic endometrium? SUMMARY ANSWER: Neuronal markers NGF, MAP-2 and SYP are highly expressed in fibroids compared with matched myometrium, and this neurogenic pathway is upregulated by tumor necrosis factor (TNF) alpha in cultured smooth muscle cells (SMCs). WHAT IS KNOWN ALREADY: Uterine fibroids or leiomyomas are the most common benign tumors, accounting for approximately one-third of hysterectomies. The present trend is to improve the medical treatment avoiding surgery, also for fertility sparing; hence, the pathogenic mechanisms are investigated, aiming to develop new therapeutic strategy. STUDY DESIGN, SIZE, DURATION: This laboratory-based case-control study is focused on fibroids and myometrial specimens obtained between 2015 and 2017 from 15 women of reproductive age at the proliferative phase of the menstrual cycle. Leiomyomas, matched myometrium and endometrium from each woman were analyzed. Control endometrium was obtained from women undergoing surgery for ovarian cyst (n = 15). PARTICIPANTS/MATERIALS, SETTING, METHODS: qRT-PCR, western blotting and immunostaining were applied to evaluate the expression of neurogenic markers; the effects of TNF on NGF, MAP-2 and SYP expression in cultured SMCs from leiomyomas and matched myometrium were analyzed. MAIN RESULTS AND THE ROLE OF CHANCE: qRT-PCR analyses using tissues from clinical patients showed that the levels of NGF, MAP-2 and SYP mRNA were significantly higher in uterine leiomyomas compared with their matched myometrium (P < 0.05), whereas only NGF was significantly increased in eutopic endometrium compared with healthy endometrium. In primary SMCs, isolated from fibroids or from the adjacent myometrium, NGF, MAP-2 and SYP mRNA expression were significantly increased by TNF treatment (P < 0.05). Finally, human endometrial stromal cells prepared from the endometrium of patients affected by uterine fibroids display higher TNF expression (P < 0.001). LIMITATIONS, REASONS FOR CAUTION: qRT-PCR analysis and immunofluorescence validation are robust methods demonstrating a clear upregulation of neurogenic factors in leiomyomas, even though additional studies are needed to establish a correlation between increased neuronal gene expression and degree of pain, as well as the involvement of inflammation mediators in the development of the neurogenic unhinge. Therefore, more in vivo studies are needed to confirm the results achieved from primary cultured SMCs. WIDER IMPLICATIONS OF THE FINDINGS: The increased expression of neurogenic factors in uterine fibroids and endometrium may contribute to explain the painful stimuli. Accordingly, these neurogenic pathways may represent potential therapeutic avenues to treat the fibroid-related disorders. STUDY FUNDING/COMPETING INTEREST(S): This study was supported by research grants from the University of Siena. The authors declare no conflict of interest. TRIAL REGISTRATION NUMBER: N/A.


Assuntos
Leiomioma/diagnóstico por imagem , Proteínas Associadas aos Microtúbulos/metabolismo , Fator de Crescimento Neural/metabolismo , Neurônios/metabolismo , Sinaptofisina/metabolismo , Adulto , Estudos de Casos e Controles , Diferenciação Celular , Endométrio/diagnóstico por imagem , Feminino , Regulação da Expressão Gênica , Humanos , Leiomioma/metabolismo , Leiomioma/cirurgia , Pessoa de Meia-Idade , Miócitos de Músculo Liso/metabolismo , Miométrio/diagnóstico por imagem , Miométrio/metabolismo , Neurogênese , Cistos Ovarianos/diagnóstico por imagem , Cistos Ovarianos/metabolismo , Cistos Ovarianos/cirurgia , Fator de Necrose Tumoral alfa/metabolismo , Fator de Necrose Tumoral alfa/farmacologia
20.
Am J Case Rep ; 20: 1601-1606, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31672957

RESUMO

BACKGROUND Mucinous cystadenoma is a benign cystic ovarian tumor arising from the surface epithelium of the ovary; it usually presents with vague, unspecific abdominal symptoms. If not detected early, they have the potential to grow to a substantial size and can present with huge abdominal distention leading to various compression symptoms. Mucinous cystadenomas most commonly occur in the third to sixth decades of life, and rarely occur in extremes of age. The reported incidence of giant ovarian cystadenoma in postmenopausal women is low or relatively unknown due to widespread use of ultrasound and other radiological imaging modalities these days. Here, we report a case of giant mucinous cystadenoma in a 72-year-old postmenopausal woman with multiple comorbidities. CASE REPORT We present the case of a 72-year-old postmenopausal high-risk patient who presented with a huge abdominal distention which started gradually 1 year before. Abdominopelvic ultrasound showed a left giant multiloculated abdominal cyst. An intact 27-kg ovarian cyst was removed, and a total abdominal hysterectomy (TAH) along with bilateral salpingo-oophorectomy (BSO) was performed. The final histopathological report showed a benign ovarian mucinous cystadenoma. CONCLUSIONS Mucinous cystadenoma is a benign neoplastic disease that can reach a massive size. They are rare in the postmenopausal age group, but when they do occur, they pose a diagnostic and therapeutic challenge. This case report highlights the importance of early detection and management of adnexal masses in postmenopausal high-risk patients to decrease preoperative and postoperative complications and improve quality of life.


Assuntos
Cistadenoma Mucinoso/diagnóstico , Cistadenoma Mucinoso/cirurgia , Cistos Ovarianos/diagnóstico , Cistos Ovarianos/cirurgia , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/cirurgia , Idoso , Feminino , Humanos , Histerectomia , Pós-Menopausa , Salpingo-Ooforectomia
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