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Journal of Ovarian Research Feb 2018Pelvic masses are a common gynecologic problem, and majority of them are diagnosed as ovarian tumors finally. Sometimes, it is hard to distinguish the origin of these... (Review)
Review
BACKGROUND
Pelvic masses are a common gynecologic problem, and majority of them are diagnosed as ovarian tumors finally. Sometimes, it is hard to distinguish the origin of these pelvic masses. The following case is a solitary neurofibroma arising from the right-side obturator nerve, which was impressed as a right-side ovarian tumor initially. We reported this case, and also performed a PRISMA-driven systematic review to summary the similar cases in the literature. This review includes image, molecular and pathological findings and outcome of neurofibroma.
CASE PRESENTATION
A 33-year-old woman with a regular menstrual period denied any symptoms or signs. During her physical check-up, image examination revealed a right-side heterogeneous pelvic mass; it was suggestive of a complex of right-side ovarian tumor. A provisional diagnosis of retroperitoneal pelvic mass, probably a benign ovarian tumor, was made. Excision of the right-side pelvic mass was performed. We sent the specimens for frozen pathology, which indicated neurofibroma and lipomatous tumor and that the possibility of liposarcoma cannot be excluded. A segment of the obturator nerve was attached to the tumor and was severed. A right-side obturator nerve tear during tumor excision was observed, and a neurosurgeon was consulted for obturator nerve grafting and repair. The patient complained of mild weakness and paresthesia affecting the right leg, and we consulted a rehabilitation doctor for neuron injury. The patient's recovery was uneventful, and she was discharged eight days after the drain was removed. Further rehabilitation treatment was arranged.
CONCLUSION
A neurofibroma is an uncommon pelvic retroperitoneal tumor, and it can be misdiagnosed as an adnexal mass. To our knowledge, this is a rare case of a solitary neurofibroma arising from the obturator nerve. It usually does not have any neurological deficit. We present this case to demonstrate that pelvic neurofibroma can be mistaken for an adnexal mass. This fact should be borne in mind during the diagnosis process.
Topics: Adnexal Diseases; Adult; Biopsy; Diagnosis, Differential; Disease Management; Female; Histocytochemistry; Humans; Neurofibroma; Obturator Nerve; Physical Examination; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography; Workflow
PubMed: 29426349
DOI: 10.1186/s13048-018-0386-z -
International Journal of Gynecological... Jun 2023In endometrial carcinoma patients, sentinel lymph node bilateral mapping fails in 20-25% of cases, with several factors affecting the likelihood of detection. However,... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
In endometrial carcinoma patients, sentinel lymph node bilateral mapping fails in 20-25% of cases, with several factors affecting the likelihood of detection. However, pooled data about predictive factors of failure are lacking. The aim of this systematic review and meta-analysis was to assess the predictive factors of sentinel lymph node failed mapping in endometrial cancer patients undergoing sentinel lymph node biopsy.
METHODS
A systematic review and a meta-analysis was performed searching all studies assessing predictive factors of sentinel lymph node failed mapping in apparent uterine-confined endometrial cancer patients undergoing sentinel lymph node biopsy through the cervical injection of indocyanine green. The associations between sentinel lymph node failed mapping and predictive factors of failure were assessed, calculating the odds ratio (OR) with 95% confidence intervals.
RESULTS
Six studies with a total of 1345 patients were included. Compared with patients with sentinel lymph node bilateral successful mapping, patients with sentinel lymph node failed mapping showed: OR 1.39 (p=0.41) for body mass index >30 kg/m; OR 1.72 (p=0.24) for menopausal status; OR 1.19 (p=0.74) for adenomyosis; OR 0.86 (p=0.55) for prior pelvic surgery; OR 2.38 (p=0.26) for prior cervical surgery; OR 0.96 (p=0.89) for prior Cesarean section; OR 1.39 (p=0.70) for lysis of adhesions during surgery before sentinel lymph node biopsy; OR 1.77 (p=0.02) for indocyanine green dose <3 mL; OR 1.28 (p=0.31) for deep myometrial invasion; OR 1.21 (p=0.42) for International Federation of Gynecology and Obstetrics (FIGO) grade 3; OR 1.89 (p=0.01) for FIGO stages III-IV; OR 1.62 (p=0.07) for non-endometrioid histotype; OR 1.29 (p=0.25) for lymph-vascular space invasion; OR 4.11 (p<0.0001) for enlarged lymph nodes; and OR 1.71 (p=0.022) for lymph node involvement.
CONCLUSION
Indocyanine green dose <3 mL, FIGO stage III-IV, enlarged lymph nodes, and lymph node involvement are predictive factors of sentinel lymph node failed mapping in endometrial cancer patients.
Topics: Pregnancy; Humans; Female; Sentinel Lymph Node; Indocyanine Green; Lymph Node Excision; Cesarean Section; Sentinel Lymph Node Biopsy; Lymph Nodes; Endometrial Neoplasms; Lymphadenopathy; Coloring Agents
PubMed: 36914172
DOI: 10.1136/ijgc-2022-004014 -
Neurourology and Urodynamics Sep 2020To identify the factors associated with unsuccessful pessary fitting and reasons for discontinuation for women with symptomatic pelvic organ prolapse (POP). (Meta-Analysis)
Meta-Analysis
AIMS
To identify the factors associated with unsuccessful pessary fitting and reasons for discontinuation for women with symptomatic pelvic organ prolapse (POP).
METHODS
This systematic review is registered at the PROSPERO database. We have included all studies, regardless of the study design whose primary outcomes were factors associated with unsuccessful pessary fitting and discontinuation for symptomatic POP women. Exclusion criteria were case series, literature reviews, other forms of conservative treatment. Data selection/extraction was performed by two investigators. For pessary fitting, a meta-analysis was performed for at least two studies pooled in a forest plot. The risk of bias was classified by the ROBINS-I and ROB-2 classification.
RESULTS
From 409 studies retrieved after data search, only twenty-one articles remained for final analysis (18 cohort studies, 1 cross-sectional study, and 2 RCTs). Meta-analysis was performed in nine studies for pessary fitting and the associated factors were: higher body mass index (BMI) (MD = 0.688 [0.233-1.143]; P = .03; i = 0%), previous reconstructive surgery (OR = 1.705 [1.016-2.860]; P = .043; i = 69%) and advanced POP (OR = 4.2 [2.9-6.1]; P < .05; i = 92%). Older age, larger total vaginal length (TVL), and genital hiatus and previous hysterectomy were not associated factors. Regarding discontinuation, thirteen reasons were quoted, and the most frequent were: the desire for surgical treatment (111/3.601), pessary extrusion (385/3.601), and pain/discomfort (163/3.601).
CONCLUSION
Obese, previously reconstructive pelvic surgery, advanced prolapse are at risk for unsuccessful pessary fitting. Pain is the most quoted reason for discontinuation. These pooled data may help clinicians to identify patients that may not succeed in their attempt for pessary treatment.
Topics: Adult; Aged; Female; Humans; Middle Aged; Pelvic Organ Prolapse; Pessaries; Treatment Failure; Urologic Surgical Procedures
PubMed: 32649024
DOI: 10.1002/nau.24458 -
Surgical Endoscopy Mar 2024The use of direct oral anticoagulants (DOACs) as an alternative to low-molecular-weight heparin (LMWH) for extended thromboprophylaxis of abdominal/pelvic cancer-related... (Meta-Analysis)
Meta-Analysis Review
Direct oral anticoagulants (DOACs) versus low-molecular-weight heparin (LMWH) for extended thromboprophylaxis following major abdominal/pelvic cancer-related surgery: a systematic review and meta-analysis.
BACKGROUND
The use of direct oral anticoagulants (DOACs) as an alternative to low-molecular-weight heparin (LMWH) for extended thromboprophylaxis of abdominal/pelvic cancer-related postoperative thromboembolism (VTE) is unclear. We aim to investigate the efficacy and safety of DOACs vs. LMWH in these patients.
METHODS
A systematic review was conducted using EMBASE, MEDLINE, CENTRAL, and Web of science through May 19th, 2023 for all randomized controlled trials (RCTs) and observational studies that compared the outcomes with DOACs vs. LMWH for extended thromboprophylaxis among patients undergoing abdominal/pelvic cancer surgery. Primary efficacy outcome was clinical VTE, and safety outcome was clinically relevant bleeding complications reported within the 30-day postoperative period. This study was registered in PROSPERO (CRD42023413175).
RESULTS
We identified 5078 articles and selected 29 full-text articles for eligibility. A total of 9 studies (2 RCTs and 7 observational studies) encompassing 2651 patients were included for systematic review and 7 for meta-analysis. When compared with LMWH extended thromboprophylaxis, DOACs had a similar incidence of VTE (RR: 0.65 [95% CI: 0.32-1.33], I = 0%), major bleeding (RR: 1.68 [95% CI: 0.36-7.9], I = 26%), and clinically relevant non-major bleeding (RR: 0.68 [95% CI: 0.39-1.19], I = 0%). Subgroup analysis suggested no difference according to the study type (RCTs versus observational studies) regarding clinical VTE or major bleeding (P = 0.43 and P = 0.71, respectively).
CONCLUSION
Our results suggest that DOACs for extended thromboprophylaxis were an effective and safe alternative to LMWH after major abdominal/pelvic cancer-related surgery.
Topics: Humans; Heparin, Low-Molecular-Weight; Anticoagulants; Pelvic Neoplasms; Venous Thromboembolism; Hemorrhage; Neoplasms
PubMed: 38267639
DOI: 10.1007/s00464-023-10649-y -
European Journal of Obstetrics,... Oct 2014Uterine tumor resembling ovarian sex-cord tumors (UTROSCT) is an extremely rare type of uterine tumor, and its clinical characteristics are not fully understood. A... (Review)
Review
Uterine tumor resembling ovarian sex-cord tumors (UTROSCT) is an extremely rare type of uterine tumor, and its clinical characteristics are not fully understood. A systematic literature search was conducted in PubMed and MEDLINE using the keywords, "uterine tumors resembling ovarian sex cord tumors", limited to case reports. Clinico-pathological characteristics and survival data were abstracted and evaluated for the analysis. Among 43 cases reporting UTROSCT, Type I (endometrial stromal tumors with sex cord-like elements, ESTSCLE) and Type II (classic UTROSCT) were reported in 5 (11.6%) and 17 (39.5%), respectively, and nearly half of reported UTROSCT did not subcategorize the histology pattern into Type I or II (unspecified, n=21, 48.8%). Mean age was 52.2. The two most common symptoms were postmenopausal vaginal bleeding (44.2%) and abnormal menstruation (39.5%). The majority underwent total hysterectomy with adnexectomy (65.1%) followed by hysterectomy alone (18.6%) and tumor resection alone (14.0%). Mean tumor size was 6.2cm, and extra-uterine spread was seen in 7.0%. By immunohistochemistry, calretinin expression was significantly correlated with CAM5.2, inhibin, and progesterone receptor expression (all, p<0.05). In survival analysis, disease-free survival (DFS) rates for all 43 cases at 1, 2, and 5 years for all cases were 97.0%, 92.7%, and 69.7%, respectively. Among recurrent cases, median time to recur was 24 months (range 9-48). Decreased DFS was significantly associated with pelvic pain (2-year rate, 81.8% versus 94.7%, p=0.006), histology subcategory (Type I versus II, 23.8% versus 100%, p=0.006), tumor size ≥10cm (75.0% versus 100%, p=0.046), cervical/extra-uterine metastasis (46.7% versus 100%, p=0.024), and lymphovascular space involvement (50% versus 100%, p=0.002). Treatment patterns were not statistically associated with DFS (hysterectomy, p=0.28; and adnexectomy, p=0.38). When histology patterns were examined, Type II disease was associated with less aggressive tumor behavior when compared to Type I disease: extra-uterine spread (Type I versus II, 40% versus 5.9%, p=0.007) and lymphovascular space invasion (50% versus 6.7%, p=0.012). Among 17 cases of Type II disease, disease recurrence was reported in 1 (5.9%) case at 3 years after the initial treatment. In conclusion, our study showed that UTROSCT was often not subcategorized. Because classic UTROSCT has a distinct clinical outcome and characteristic histological patterns when compared to ESTSCLE, distinguishing UTROSCT from ESTSCLE is an integral component of the diagnosis. While classic UTROSCT typically has a favorable prognosis, it has been known to develop a late recurrence. If risk factors for recurrence are absent, both hysterectomy and mass resection alone are possible options for management.
Topics: Disease-Free Survival; Endometrial Stromal Tumors; Female; Humans; Menstruation Disturbances; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Salvage Therapy; Sex Cord-Gonadal Stromal Tumors; Survival Rate; Uterine Hemorrhage; Uterine Neoplasms
PubMed: 25150955
DOI: 10.1016/j.ejogrb.2014.07.050 -
Annals of Palliative Medicine Mar 2021Laser therapy has recently been proposed as a novel treatment for stress urinary incontinence (SUI) due to offering several advantages. This study aimed to evaluate the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Laser therapy has recently been proposed as a novel treatment for stress urinary incontinence (SUI) due to offering several advantages. This study aimed to evaluate the safety and efficacy of laser treatment of SUI by a meta-analysis.
METHODS
The systematic review registration number is INPLASY202080001. A comprehensive search to identify relevant studies was conducted using the PubMed, Embase, Cochrane Library, CNKI, VIP and Wanfang databases with a cutoff date of 1 November, 2020. Outcome measures were extracted based on subjective and objective indexes, including International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), and objective measurements "1-hour pad test" (1-hour test under standardized conditions). Score changes before and after treatment were evaluated through meta-analysis. Subgroup analysis was performed according to geographic region, type of urinary incontinence (UI), severity of UI, age, and body mass index (BMI).
RESULTS
Sixteen published clinical research studies, involving 899 patients with SUI, were included in this study. After laser treatment, the change in the ICIQ-SF score at 1, 2, and 6 months was -5.49 (95% CI: -6.74--4.24; I2=91%, P<0.01), -4.97 (95% CI: -6.24--3.71), and -5.48 (95% CI: -6.15--4.81), respectively. The improvement in 1-hour pad weight test results at 1, 3, and 12 months post treatment was -5.59 (95% CI: -6.93--4.25), -4.96 (95% CI: -6.73--3.20), and -5.82 (95% CI: -6.77--4.87), respectively. The PISQ-12 score increased by 5.39 (95% CI: 1.20-9.58) following treatment. Subgroup analysis identified the type and severity of UI as the potential source of heterogeneity. Adverse effects were reported in 6 of the 16 trials and affected only a small number of patients. Most adverse events were mild or moderate and required no medical intervention or resolved in a few days.
CONCLUSIONS
Vaginal laser therapy appears to be a safe, effective, and minimally invasive treatment option for SUI that can be well tolerated by patients.
Topics: Female; Humans; Laser Therapy; Lasers; Pelvic Organ Prolapse; Surveys and Questionnaires; Treatment Outcome; Urinary Incontinence, Stress
PubMed: 33549008
DOI: 10.21037/apm-20-1440 -
Turning problems and freezing of gait in Parkinson's disease: a systematic review and meta-analysis.Disability and Rehabilitation Dec 2019To understand the differences of step and turn parameters between freezers and non-freezers during turning and determine the influence of turn angle and turn... (Meta-Analysis)
Meta-Analysis
To understand the differences of step and turn parameters between freezers and non-freezers during turning and determine the influence of turn angle and turn characteristics on freezing of gait. PubMed and Web of Science were searched from the earliest data available to August 2017. Case-control studies that examined the differences in turning while walking between freezers and non-freezers were included. Two reviewers selected studies independently. Methodological quality was evaluated by two independent reviewers using the STROBE checklist for case-control studies. Mean differences and 95% confidence intervals were calculated from pooled data for turn duration, peak turn velocity, number of steps and cadence. Center of mass deviation, segmental rotation, phase coordination and freezing of gait frequency were also extracted. When possible, different turning angles or spatial confounds were compared. Sixteen studies met the inclusion criteria. Freezing of gait occurred in 38.2% of the freezers. Freezing appeared most frequently at the end of a turn and at the inner leg of the turn cycle. The meta-analysis revealed that turning in freezers was characterized by an increased turn duration, cadence and number of steps and a decreased peak turn velocity. Qualitative analysis showed that results concerning step width, step length and step time variability were inconsistent. Turning was characterized by an increased head-pelvis coupling and worse coordination in freezers compared to non-freezers. A decreased medial deviation of the center of mass was present prior to a freezing episode. Both step and rotational parameters differed in freezers compared to non-freezers while turning. These differences increased with increasing task complexity (i.e., larger turning angle or spatial confounds during turning). The results suggest that improving axial rotation could be a valuable rehabilitation target to ameliorate freezing.Implications for rehabilitationPatients with freezing of gait turn with a larger arc and a smaller angle compared to non-freezing patientsFreezing-related turning deficits have both spatiotemporal and rotational motor control componentsImproving axial rotation could be a novel rehabilitation target to ameliorate freezing.
Topics: Gait Disorders, Neurologic; Humans; Parkinson Disease; Postural Balance; Rotation
PubMed: 29961369
DOI: 10.1080/09638288.2018.1483429 -
JBJS Reviews Sep 2022Heterotopic ossification (HO) following acetabular fractures is a common complication that may affect clinical outcomes. However, the effects of prophylactic treatment...
BACKGROUND
Heterotopic ossification (HO) following acetabular fractures is a common complication that may affect clinical outcomes. However, the effects of prophylactic treatment with nonsteroidal anti-inflammatory drugs or radiation therapy remain controversial. While several factors have been related to the development of HO, there is considerable uncertainty regarding their importance or effect size in the setting of acetabular surgery. Therefore, this systematic review aims to summarize the risk factors for HO following the operative fixation of acetabular fractures and clarify their interrelationships.
METHODS
In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, PubMed, MEDLINE, Embase, and CINAHL databases were searched from inception to February 2021. Studies that assessed factors related to HO development among patients with operatively repaired acetabular fractures were included. Outcomes were risk factors and their effect size (p values, odds ratios, and 95% confidence intervals).
RESULTS
Twenty-five studies and 1 conference abstract with a total of 3,940 patients were included. The following risk factors for HO were identified. Patient factors were increased body mass index, male sex, and increased age. Injury factors were intensive care unit (ICU) admission and length of stay, non-ICU hospitalization for >10 days, the need for mechanical ventilation for ≥2 days, abdominal and/or chest injuries, the number and type of associated fractures, traumatic brain injuries, T-type acetabular fractures, pelvic ring injuries, and hip dislocation. Care factors were a delay to surgery, extensile and posterior surgical approaches to the hip, trochanteric osteotomy, postoperative step-off of >3 mm, and a delay to prophylaxis following injury or surgery. Ethnicity, Injury Severity Score, cause of the fracture, femoral head injuries, degloving injuries, comminution, intra-articular debris, the type of bone void filler, gluteus minimus muscle preservation, prolonged operative time, and intraoperative patient position were not risk factors for developing HO.
CONCLUSIONS
HO following operative fixation of acetabular fractures is not uncommon, with severe-grade HO associated with substantial disability. Careful consideration of the risk factor effect sizes and interdependencies could aid physicians in identifying patients at risk for developing HO and guide their prophylactic management. The results of this study could establish a framework for future studies.
LEVEL OF EVIDENCE
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Topics: Acetabulum; Anti-Inflammatory Agents, Non-Steroidal; Hip Fractures; Humans; Male; Ossification, Heterotopic; Retrospective Studies; Spinal Fractures
PubMed: 36137013
DOI: 10.2106/JBJS.RVW.20.00263 -
Przeglad Menopauzalny = Menopause Review Mar 2023A possible cause for acute abdomen is haemoperitoneum resulting from the rupture of an ovarian tumour. Here we discuss a case of spontaneous haemoperitoneum caused by... (Review)
Review
INTRODUCTION
A possible cause for acute abdomen is haemoperitoneum resulting from the rupture of an ovarian tumour. Here we discuss a case of spontaneous haemoperitoneum caused by granulosa cell tumour (GCT) rupture in a postmenopausal woman.
MATERIAL AND METHODS
We present a systematic review of the current literature to draw attention to this rare gynaecological complication and provide guidance about the most appropriate management.
RESULTS
Eight case reports and one retrospective study were identified. A total of 11 patients were analysed in this review including the present case report. The first case was described in 1948, while the last one was in 2019. The mean age of the patients was 60.8 years. All cases were treated with primary surgery. The mean diameter of the masses was 10.1 cm.
DISCUSSION
We found endometrial pathology in 45% of the cases, of which 4 (36%) were associated with postmenopausal bleeding. The presentation of GCT is not always in the form of overt endocrine disturbance but can onset (10-15%) with acute abdomen.
CONCLUSIONS
Granulosa cell tumour should remain in the differential diagnosis of all patients presenting with acute abdomen and imaging suspicious for gynaecological malignancy originating from the ovary.
PubMed: 37206680
DOI: 10.5114/pm.2023.126399 -
International Journal of Gynecological... Sep 2023To assess the oncologic outcomes of sentinel lymph node biopsy alone as part of surgical management in patients with early-stage cervical cancer.
OBJECTIVE
To assess the oncologic outcomes of sentinel lymph node biopsy alone as part of surgical management in patients with early-stage cervical cancer.
METHODS
A systematic search of the literature was performed following the PRISMA checklist. MEDLINE (through PubMed), EMBASE, and Scopus databases were searched from June 1991 to May 2023. Studies of women with early-stage cervical cancer International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IA-IIA, of any age or histology, and articles only in English language were included. After the removal of duplicates, only articles including sentinel node mapping alone compared with full pelvic lymphadenectomy were retained.
RESULTS
Four studies with a total of 2226 patients were included. Among these, 354 (15.9%) underwent sentinel lymph node biopsy alone. A total of 2210 (99.2%) patients had FIGO 2009 stage I disease and 1514 (68%) patients had squamous cell carcinoma. Median body mass index was 25.5 kg/m (range 23.5-27). Lymph vascular space invasion was present in 633 patients (34%) who underwent full lymphadenectomy and in 78 patients (22%) who underwent sentinel node biopsy alone. The results of the survival analysis showed that there was no significant difference in the 3-year progression-free survival rates of patients who underwent either sentinel biopsy alone or lymphadenectomy. Three-year recurrence-free survival was 93.1% (95% CI 28.3% to 64.7%) for patients who underwent sentinel node biopsy alone and 92.5% (95% CI 39.0% to 53.4%) for patients who underwent sentinel node biopsy and lymphadenectomy (p=0.773).
CONCLUSIONS
In patients with early-stage cervical cancer, performing sentinel lymph node biopsy alone compared with pelvic lymphadenectomy does not appear to independently confer a higher risk or recurrence.
Topics: Humans; Female; Sentinel Lymph Node Biopsy; Uterine Cervical Neoplasms; Lymphatic Metastasis; Neoplasm Staging; Sentinel Lymph Node; Lymph Node Excision; Lymph Nodes; Retrospective Studies
PubMed: 37586759
DOI: 10.1136/ijgc-2023-004692