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1.
Rozhl Chir ; 101(9): 456-459, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36257805

RESUMO

INTRODUCTION: Internal hernias are rare and are encountered in a small percentage of cases. The hernia in the broad ligament of uterus (Allen-Masters syndrome) is a unique type of internal hernia which represents only approximately 4% of all internal hernias. CASE REPORT: We present the case of a 39-year-old woman admitted for clinical signs of mechanical bowel obstruction. CT examination revealed a dilated loop of small intestine in the left lower abdomen. The patient underwent laparoscopic surgery with the finding of an incarcerated small bowel loop in the ligamentum latum uteri. Small bowel deliberation and ligament defect suture were performed. CONCLUSION: A defect in the ligamentum latum uteri (Allen-Masters syndrome) is a rare diagnosis, usually discovered as an incidental finding in female patients with ileus. This syndrome may explain the vague problems of many patients whose symptoms include dyspareunia, dysmenorrhea, acute and chronic pelvic pain. Allen-Masters syndrome can be diagnosed and successfully managed by laparoscopic approach.


Assuntos
Ligamento Largo , Hérnia Abdominal , Íleus , Obstrução Intestinal , Humanos , Feminino , Adulto , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Íleus/cirurgia , Íleus/complicações , Hérnia Interna
3.
Sci Rep ; 12(1): 8122, 2022 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-35581254

RESUMO

Currently, there are no effective approaches for differentiating ovarian fibrothecoma (OF) from broad ligament myoma (BLM). This retrospective study aimed to construct a nomogram prediction model based on MRI to differentiate OF from BLM. The quantitative and qualitative MRI features of 41 OFs and 51 BLMs were compared. Three models were established based on the combination of these features. The ability of the models to differentiate between the two cancers was assessed by ROC analysis. A nomogram based on the best model was constructed for clinical application. The three models showed good performance in differentiating between OF and BLM. The areas under the curve (AUC) of the models based on quantitative and qualitative variables were 0.88 (95% CI: 0.79-0.96) and 0.85 (95% CI: 0.76-0.93), respectively. The combined model designed from the significant variables exhibited the best diagnostic performance with the highest AUC of 0.92 (95% CI: 0.86-0.98). Calibration of the nomogram showed that the predicted probability matched the actual probability well. Analysis of the decision curve demonstrated that the nomogram was clinically useful. Relative T1 value, stone paving sign, enhancement patterns, and ascites were identified as valuable predictors for identifying OF or BLM. The MRI-based nomogram can serve as a preoperative tool to differentiate OF from BLM.


Assuntos
Ligamento Largo , Mioma , Feminino , Humanos , Imageamento por Ressonância Magnética , Nomogramas , Estudos Retrospectivos
4.
J Investig Med High Impact Case Rep ; 10: 23247096221100500, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35610939

RESUMO

Small bowel obstruction is a common surgical emergency and frequent cause of hospitalization. Internal hernias account for less than 6% of all small bowel obstruction cases. Less frequently, hernias through the broad ligament of the uterus can occur and account for only 4-7% of total internal hernia cases. We report a case of a small bowel hernia through broad ligament of the uterus in a young female. Multiple diagnostic modalities suggested a ruptured ovarian cyst as the most probable cause for her abdominal pain. However, her symptoms were much more severe than an ovarian cyst would normally produce. Therefore, a diagnostic laparotomy was performed, which found a small intestine hernia through the left broad ligament of the uterus. The diagnosis of intestinal hernias, specifically through the broad ligament, is often delayed due to the infrequent occurrence, varied presentation, and difficulty of confirmation on computed tomography (CT) scan. Surgery is the gold standard for the diagnosis and treatment of internal hernias. This article draws attention toward a rare and potentially life-threatening cause of abdominal pain.


Assuntos
Ligamento Largo , Hérnia Abdominal , Obstrução Intestinal , Cistos Ovarianos , Neoplasias Ovarianas , Dor Abdominal/etiologia , Feminino , Hérnia Abdominal/complicações , Hérnia Abdominal/diagnóstico , Hérnia Abdominal/cirurgia , Humanos , Hérnia Interna , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Cistos Ovarianos/complicações , Cistos Ovarianos/diagnóstico , Neoplasias Ovarianas/complicações , Útero
5.
Histopathology ; 81(3): 280-296, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35395118

RESUMO

Mesonephric lesions in the female genital tract are uncommon, with those arising from the upper tract being much less frequent than those developing in the lower tract (mesonephric hyperplasia and carcinoma). The most common upper tract lesions include rete cyst/cystadenoma and female adnexal tumour of Wolffian origin (FATWO). The integration of morphological, immunohistochemical and molecular studies on FATWOs has enabled recognition of a novel entity, the STK11 adnexal tumour, which is often associated with Peutz-Jeghers syndrome (~50%) and frequently has a salivary gland morphology but an unknown origin. Similarly, 'mesonephric-like' adenocarcinoma, an entity with striking similarities to mesonephric carcinoma but currently favoured to be of Müllerian derivation based on its association with other Müllerian tumours and molecular findings, has also been recently described, and may histologically mimic both FATWOs and STK11 adnexal tumours. In this review, we provide a historical overview of upper female genital tract mesonephric proliferations and discuss mesonephric lesions, STK11 adnexal tumour, mesonephric-like adenocarcinoma, and mimickers, the most common being endometrioid carcinoma.


Assuntos
Adenocarcinoma , Adenoma , Ligamento Largo , Carcinoma Endometrioide , Neoplasias dos Genitais Femininos , Neoplasias de Anexos e de Apêndices Cutâneos , Quinases Proteína-Quinases Ativadas por AMP , Adenocarcinoma/patologia , Adenoma/patologia , Ligamento Largo/patologia , Carcinoma Endometrioide/patologia , Feminino , Neoplasias dos Genitais Femininos/patologia , Humanos , Neoplasias de Anexos e de Apêndices Cutâneos/patologia , Proteínas Serina-Treonina Quinases , Ductos Mesonéfricos/patologia
6.
Am J Obstet Gynecol ; 227(2): 333-337, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35339480

RESUMO

Cervical insufficiency is a major cause of second-trimester pregnancy loss and spontaneous preterm delivery. Transabdominal cervicoisthmic cerclage is usually performed before pregnancy for patients of cervical insufficiency, in whom transvaginal cervical cerclage procedure cannot be placed or has failed previously. Performing a transabdominal cerclage becomes a huge challenge owing to the enlargement of the pregnant uterus in patients who were indicated for transabdominal cervicoisthmic cerclage but were missed before pregnancy. Here, we have outlined an easy and effective surgical procedure as needle-free laparoscopic trans-broad-ligament cervicoisthmic cerclage during early second-trimester. Laparoscope with 4 trocars was established, after expanding the trigonum of ureter, ovarian vascular and ascending branch of uterine artery. The needleless Mersilene tape was inserted in a posterior-to-anterior direction of bilateral trigonums, tightening the knot toward the bladder uterine reflection and simultaneously pushing the loop behind the uterus, directed to the cervix progressively. The tape was then tied anteriorly at the cervico-isthmic junction with 5 to 6 intracorporeal square knots after transvaginal ultrasound determined the presence of systolic velocity of uterine artery with first knot. The primary feature of our procedure was that the needleless Mersilene tape was inserted centrally from the broad ligaments, lateral to the uterine vessels, and finally tied above the uterosacral ligament at the level of the uterine isthmus, without dissecting the bladder off from lower uterine segment and without separating the uterine vessels from the lateral wall of the cervix. We performed this procedure on 10 patients with pregnancy outcomes and there was no pregnancy loss. This procedure proved to be an accessible and effective surgical technique for transabdominal cerclage of the uterine cervix during early-second trimester, with affirmative prognosis.


Assuntos
Ligamento Largo , Cerclagem Cervical , Laparoscopia , Incompetência do Colo do Útero , Abdome , Cerclagem Cervical/métodos , Feminino , Humanos , Recém-Nascido , Laparoscopia/métodos , Gravidez , Resultado da Gravidez , Incompetência do Colo do Útero/diagnóstico por imagem , Incompetência do Colo do Útero/cirurgia
8.
Bull Exp Biol Med ; 172(3): 373-376, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35001309

RESUMO

Using the biomicroscopy method, we studied the reaction of arterial and venous vessels of the broad ligament of the uterus in outbred female rats to irradiation with helium-neon laser (λ=632.8 nm; power output 2 mW). Small arteries were found to be most sensitive to laser irradiation. The veins of the broad ligament of the uterus demonstrated lower reactivity to laser irradiation of the same duration than arterial vessels, which can be explained by morphological, functional, and hemodynamic differences.


Assuntos
Ligamento Largo , Animais , Artérias , Feminino , Lasers , Ratos , Útero , Veias
9.
Alerta (San Salvador) ; 5(1): 6-11, ene. 28, 2022. ilus
Artigo em Espanhol | LILACS, BISSAL | ID: biblio-1354292

RESUMO

El quiste paraovárico se desarrolla en el ligamento ancho, entre la trompa de Falopio y el ovario. Son estructuras redondeadas de pared lisa, llenas de líquido seroso, que se ubican en el mesosálpinx, el ligamento ancho o sobre la propia trompa uterina. Tienen una incidencia aproximada de 1 en 1 500 0002 son frecuentes en la tercera y cuarta década de la vida; raramente se presentan en la edad pediátrica. Generalmente, son benignos y tiene un crecimiento lento y progresivo, suelen ser asintomáticos por lo que el diagnóstico suele ser incidental. En casos de quistes de gran volumen, los síntomas son dolor pélvico o la tumoración ab-dominal. Usualmente son diagnosticados clínicamente y se confirman por imágenes ultrasonográficas. La importancia de este caso es la poca frecuencia de estos tumores en la edad pediátrica y su identificación oportuna por parte de los profesionales de la salud


The paraovarian cyst develops in the broad ligament, between the fallopian tube and the ovary. They are rounded structures with a smooth wall, filled with serous fluid, which are located in the mesosalpinx, the broad ligament or on the uterine tube itself. They have an approximate incidence of 1 in 1,500,0002 and are common in the third and fourth decades of life; they rarely occur in childhood. Generally, they are benign and have a slow and progressive growth, they are usually asymptomatic, so the diagnosis is usually incidental. In cases of large volume cysts, the symptoms are pelvic pain or abdominal mass. They are usually diagnosed clinically and confirmed by ultrasonographic images. The importance of this case is the infrequency of these tumors in the pediatric age and their timely identification by health professionals


Assuntos
Cisto Parovariano , Pediatria , Diagnóstico , Ovário , Ligamento Largo , Dor Pélvica
10.
J Clin Ultrasound ; 50(1): 138-147, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34647631

RESUMO

A 33-year-old woman of giant broad ligament leiomyoma with myxoid degeneration was misdiagnosed as ovarian tumor. The patient underwent a transabdominal myomectomy and developed a pelvic infection after operation diagnosed with contrast-enhanced ultrasound. She was cured and ultimately discharged after symptomatic treatment. Only 21 cases of giant broad ligament leiomyomas with a diameter larger than 12 cm were included. The present systematic review aimed to increase awareness of the clinical characteristics and treatment methods of giant broad ligament leiomyoma, and reduce the rates of misdiagnosis and postoperative complications.


Assuntos
Ligamento Largo , Leiomioma , Neoplasias Uterinas , Adulto , Ligamento Largo/diagnóstico por imagem , Ligamento Largo/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Leiomioma/diagnóstico por imagem , Leiomioma/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/cirurgia
12.
Virchows Arch ; 480(4): 933-938, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34351486

RESUMO

A novel molecular subset of epithelioid leiomyosarcomas with rhabdoid features harboring PGR gene rearrangements has recently been documented. Herein, we present a unique case of PGR-rearranged smooth muscle tumor with both PGR-NR4A3 and UBR5-PGR gene fusions reported in a 30-year-old woman who had a mass in the broad ligament. The histological examination showed a round/polygonal to spindle cell tumor with abundant myxoid matrix and focal hyalinization, resulting in an epithelioid pattern. Immunohistochemical examination revealed that the tumor had variable staining for desmin, SMA, and h-caldesmon and diffuse nuclear staining of ER, PR, and WT1. Furthermore, targeted RNA sequencing analysis revealed PGR-NR4A3 and UBR5-PGR gene fusions. Our case in addition with the reported cases suggest that myxoid matrix with two types of tumor cells (round/polygonal epithelioid cells and spindle cells) may be significant for the diagnosis of PGR-NR4A3 fusion-positive leiomyosarcoma. UBR5-PGR gene fusion is a novel finding in epithelioid leiomyosarcoma.


Assuntos
Ligamento Largo , Leiomiossarcoma , Receptores de Esteroides , Tumor de Músculo Liso , Adulto , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/genética , Ligamento Largo/química , Ligamento Largo/patologia , Proteínas de Ligação a DNA/genética , Feminino , Fusão Gênica , Rearranjo Gênico , Humanos , Leiomiossarcoma/diagnóstico , Receptores de Esteroides/genética , Receptores dos Hormônios Tireóideos/genética , Tumor de Músculo Liso/genética , Ubiquitina-Proteína Ligases/genética
14.
J Obstet Gynaecol Res ; 48(1): 266-270, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34716641

RESUMO

Ependymomas arise from ependymal cells lining the ventricles and central canal of the spinal cord and can occur throughout the whole neuraxis. The lesion rarely occurs in extracranial or extraspinal regions, particularly in the uterine broad ligament. Thus, for the pathogenesis of nonsacral extra-central nervous system (CNS) ependymomas remains elusive. Here, we describe a rare case of primary uterine broad ligament. ependymoma with cell-cycle-checkpoint kinase 2 (CHEK2) p.H371Y germline mutation. A 45-year-old woman presented with a uterine mass. The transvaginal sonographic examination confirmed a 4.4 cm × 3.7 cm, cystic and solid, mass located on the right side uterine wall near isthmus. First, laparoscopy with the neoplasm resection was carried out. Based on morphological and immunohistochemical characteristics of tumor cells that expressed glial fibrillary acidic protein (GFAP), S-100, and vimentin, the tumor was diagnosed as an ependymoma. After that, she underwent a laparotomic total hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy. Furthermore, we performed next-generation sequencing (NGS) of the patient's resected tumor tissue and peripheral blood and identified a novel CHEK2 p.H371Y germline mutation. Following surgery, the patient received oral tamoxifen (10 mg 2/day) and followed by letrozole (2.5 mg/day) for 6 months. The patient remained disease-free after 4 years of follow-up. Conceivably, CHEK2 p.H371Y is a driving gene for the development of extra-CNS ependymoma.


Assuntos
Ligamento Largo , Ependimoma , Ligamento Largo/cirurgia , Quinase do Ponto de Checagem 2/genética , Ependimoma/diagnóstico por imagem , Ependimoma/genética , Feminino , Mutação em Linhagem Germinativa , Humanos , Histerectomia , Pessoa de Meia-Idade
15.
J Obstet Gynaecol Res ; 48(2): 467-470, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34796589

RESUMO

We present a case of spontaneous pregnancy after laparoscopic surgery for a broad ligament pregnancy. A 34-year-old nulliparous woman presented with 6 weeks of amenorrhea. Due to the presence of an empty uterus with a 10 mm right adnexal mass on transvaginal ultrasonography and elevated serum human chorionic gonadotropin (hCG), ectopic pregnancy was suspected. Upon diagnostic laparoscopy, the presence of a 2 cm broad ligament ectopic pregnancy was confirmed. Laparoscopic removal of the gestational tissues was performed. Six months after surgery, a spontaneous pregnancy was established. At the 40th week of gestation, a cesarean section was performed due to arrested labor, resulting in live birth. To the best of our knowledge, there have been no reports of a spontaneous pregnancy occurring after laparoscopic surgery for broad ligament pregnancy. Laparoscopic surgery as a treatment option for broad ligament pregnancy may be useful in early gestational age because it can be completed without complications.


Assuntos
Ligamento Largo , Laparoscopia , Gravidez Ectópica , Adulto , Ligamento Largo/cirurgia , Cesárea , Feminino , Humanos , Gravidez , Gravidez Ectópica/diagnóstico por imagem , Gravidez Ectópica/cirurgia , Útero
16.
Int J Hyperthermia ; 38(2): 18-23, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34420440

RESUMO

OBJECTIVE: To investigate the feasibility, efficacy and safety of ultrasound-guided high-intensity focused ultrasound (HIFU) ablation for treating the broad ligament uterine fibroid (BLUF). METHODS: A total of 236 patients with symptomatic uterine fibroids were enrolled and treated with JC-200 extracorporeal ultrasound-guided HIFU under conscious sedation between January 2017 and December 2018. Of them, data of 12 patients with 13 broad ligament fibroids were retrospectively analyzed. The patients' mean age was 38.6 ± 6.3 years. The focused ultrasound target was deployed and moved from the deeper layer to the superficial layer of BLUFs. All patients underwent contrast-enhanced MRI (CE-MRI) before, immediate post-operation, and six months after the HIFU ablation procedure. The fibroid size, non-perfusion volume (NPV) ratio, the reduction of fibroid volumes, adverse events, symptom changes, and abnormal MRI findings associated with the HIFU treatment were analyzed. RESULTS: Ultrasound-guided HIFU ablation in the twelve patients was technically successful with one session treatment. The mean longest diameter of BLUFs was 6.2 ± 2.3 cm. The mean NPV ratio of fibroids was 84.08%± 9.4%. After HIFU ablation, lower abdominal pain occurred in 7 cases, sacrococcygeal pain in 3 cases, and mild skin pain in 6 cases. There were no severe adverse events and complications associated with the treatment. At 6 months post-treatment follow-up, the mean fibroid volume decreased by 56.2%± 9.0% (p < 0.05), and the symptoms related to broad ligament fibroids were improved or disappeared. CONCLUSIONS: Ultrasound-guided high-intensity focused ultrasound ablation is feasible, effective, and safe for treating broad ligament fibroids.


Assuntos
Ligamento Largo , Ablação por Ultrassom Focalizado de Alta Intensidade , Leiomioma , Neoplasias Uterinas , Adulto , Feminino , Humanos , Leiomioma/diagnóstico por imagem , Leiomioma/cirurgia , Imageamento por Ressonância Magnética , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia de Intervenção , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/cirurgia
20.
JSLS ; 25(2)2021.
Artigo em Inglês | MEDLINE | ID: mdl-34248336

RESUMO

BACKGROUND: We sought to assess hernia characteristics and classification through comprehensive review of the literature involving broad ligament herniation. METHODS: A literature search via MEDLINE and Embase databases was conducted to identify and select broad ligament herniation studies published between January 1, 2000 and September 30, 2020. Extracted data included previous surgical history, previous obstetric history, diagnostic imaging, herniated organ, hernia classification, and repair performed. The reported data has been compared to a unique case of broad ligament herniation that presented to our institution. RESULTS: A total of 44 articles with 49 cases were identified for the study. Eighteen (36.7%) patients had a history of previous abdominal surgery while 29 (59.2%) had a history of previous childbirth. Type I (51.0%) and Type II (18.4%) defects were most commonly reported with most patients reporting only one defect (85.7%) using the Cilley classification. Twenty-nine patients underwent primary laparoscopic repair of the defect while 19 patients underwent exploratory laparotomy. CONCLUSIONS: The analysis of previously reported cases adds to the limited literature on broad ligament hernias and highlights the surgical management of this uncommon pathology. It also highlights the need for a broad differential diagnosis when female patients present with pelvic pain or symptoms of small bowel obstruction. The broad ligament should be fully inspected when mesenteric defects are suspected as multiple defects can be present as evidenced by the attached case study.


Assuntos
Ligamento Largo/patologia , Hérnia/diagnóstico , Dor Pélvica/diagnóstico , Adulto , Ligamento Largo/cirurgia , Diagnóstico Diferencial , Feminino , Hérnia/patologia , Herniorrafia/métodos , Humanos , Obstrução Intestinal/diagnóstico , Intestino Delgado/patologia , Laparoscopia/métodos , Laparotomia/métodos , Pessoa de Meia-Idade , Dor Pélvica/patologia
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