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Topics in Companion Animal Medicine Jun 2021Functional ovarian cysts occur as solitary or multiple fluid-filled structures of variable size that are unilateral or bilateral in the bitches of age 6-8 years. Though... (Review)
Review
Functional ovarian cysts occur as solitary or multiple fluid-filled structures of variable size that are unilateral or bilateral in the bitches of age 6-8 years. Though the pathogenesis is obscure, insufficient LH surge, intrafollicular changes in gonadotrophin receptors and growth factors are the possible reasons behind the occurrence of hormonally active ovarian cysts that predisposes the bitch to the development of cystic endometrial hyperplasia-pyometra complex and occasionally hyper estrogenism. In the presence of suggestive signs, ultrasonography is the practical imaging modality for the clinical diagnosis that can be confirmed by assay of ovarian steroids and histopathology. Medical management with gonadotrophin-releasing hormone analogues and human chorionic gonadotrophin is not preferred as they are not always successful. As uterine pathologies are highly likely by the time of diagnosis, ovariohysterectomy is the treatment of choice for the follicular and luteal cysts. Understanding the cellular and molecular changes in the hypothalamo-hypophyseal ovarian axis will improve our understanding on the canine ovarian cysts.
Topics: Animals; Dog Diseases; Dogs; Endometrial Hyperplasia; Female; Humans; Ovarian Cysts; Pyometra
PubMed: 33434678
DOI: 10.1016/j.tcam.2021.100511 -
American Journal of Obstetrics and... Nov 2021
Topics: Delivery, Obstetric; Diagnosis, Differential; Female; Humans; Ovarian Cysts; Pregnancy; Prognosis; Ultrasonography, Prenatal
PubMed: 34507793
DOI: 10.1016/j.ajog.2021.06.042 -
Advances in Clinical and Experimental... Mar 2019An approach to ovarian endometrial cysts has changed considerably during recent years, especially in regard to treatment of recurrent endometriosis, fertility sparing... (Review)
Review
An approach to ovarian endometrial cysts has changed considerably during recent years, especially in regard to treatment of recurrent endometriosis, fertility sparing and infertility management. Surgical treatment is the primary therapeutic option. The most efficient types of treatment are radical procedures involving adhesiolysis, removal of the cyst along with its capsule and any remaining endometriotic foci. However, small asymptomatic cysts should not be treated surgically, especially in patients older than 35 years. Surgical treatment can be considered in infertile women and those who failed to get pregnant despite 1-1.5 years of trials, as well as in cases in which in vitro fertilization is not an option. Also large cysts, with more than 4 cm in diameter, should be treated surgically due to the risk of their rupture or torsion. The most efficient preventive measure for recurrent ovarian endometriosis is unilateral oophorectomy with sparing the contralateral ovary. Such a procedure should be considered in women who are no longer interested in childbearing or present with another endometriotic cyst in the same ovary. The role of pharmacotherapy is fairly limited; it should be considered in patients in whom diffuse endometriosis is associated with pain. Therapeutic agents from the following groups can be used: estrogen-progestin preparation, gestagens, including progesteronereleasing intrauterine systems and gonadotropin-releasing hormone agonists. Women with infertility should get pregnant as soon as possible, and in patients who failed to get pregnant and/or are older than 35 years, in vitro fertilization should be the treatment of choice.
Topics: Endometriosis; Endometrium; Female; Humans; Infertility, Female; Laparoscopy; Neoplasm Recurrence, Local; Ovarian Cysts; Ovariectomy; Pregnancy
PubMed: 30659784
DOI: 10.17219/acem/90767 -
Radiographics : a Review Publication of... 2021Adnexal torsion is the twisting of the ovary, and often of the fallopian tube, on its ligamental supports, resulting in vascular compromise and ovarian infarction. The... (Review)
Review
Adnexal torsion is the twisting of the ovary, and often of the fallopian tube, on its ligamental supports, resulting in vascular compromise and ovarian infarction. The definitive management is surgical detorsion, and prompt diagnosis facilitates preservation of the ovary, which is particularly important because this condition predominantly affects premenopausal women. The majority of patients present with severe acute pain, vomiting, and a surgical abdomen, and the diagnosis is often made clinically with corroborative US. However, the symptoms of adnexal torsion can be variable and nonspecific, making an early diagnosis challenging unless this condition is clinically suspected. When adnexal torsion is not clinically suspected, CT or MRI may be performed. Imaging has an important role in identifying adnexal torsion and accelerating definitive treatment, particularly in cases in which the diagnosis is not an early consideration. Several imaging features are characteristic of adnexal torsion and can be seen to varying degrees across different modalities: a massive, edematous ovary migrated to the midline; peripherally displaced ovarian follicles resembling a string of pearls; a benign ovarian lesion acting as a lead mass; surrounding inflammatory change or free fluid; and the uterus pulled toward the side of the affected ovary. Hemorrhage and absence of internal flow or enhancement are suggestive of ovarian infarction. Pertinent conditions to consider in the differential diagnosis are a ruptured hemorrhagic ovarian cyst, massive ovarian edema, ovarian hyperstimulation, and a degenerating leiomyoma. RSNA, 2021.
Topics: Adnexal Diseases; Female; Humans; Magnetic Resonance Imaging; Ovarian Cysts; Ovarian Torsion; Torsion Abnormality
PubMed: 33577417
DOI: 10.1148/rg.2021200118 -
The Medical Clinics of North America Mar 2023Fibroids, endometriosis, and ovarian cysts are common conditions. Fibroids can be asymptomatic or present with heavy menstrual bleeding, pelvic pressure, and pain.... (Review)
Review
Fibroids, endometriosis, and ovarian cysts are common conditions. Fibroids can be asymptomatic or present with heavy menstrual bleeding, pelvic pressure, and pain. Endometriosis is a common cause of cyclical pelvic pain. Ovarian cysts are generally diagnosed incidentally. Transvaginal ultrasound is the performed imaging modality for all structural gynecological disease. Symptomatic management is recommended for each condition. Fibroids can be managed medically or surgically depending on the patient's symptoms and desire for future fertility. Nonsteroidal anti-inflammatory drugs are the first-line therapy for endometriosis followed by oral contraceptives and surgical management. Ovarian cysts can be managed expectantly.
Topics: Female; Humans; Endometriosis; Genital Diseases, Female; Leiomyoma; Ultrasonography; Ovarian Cysts
PubMed: 36759100
DOI: 10.1016/j.mcna.2022.10.010 -
Obstetrics and Gynecology Jun 2024Ovarian endometriomas affect many patients with endometriosis and have significant effects on quality of life, fertility, and risk of malignancy. Endometriomas range... (Review)
Review
Ovarian endometriomas affect many patients with endometriosis and have significant effects on quality of life, fertility, and risk of malignancy. Endometriomas range from small (1-3 cm), densely fibrotic cysts to large (20 cm or greater) cysts with varying degrees of fibrosis. Endometriomas are hypothesized to form from endometriotic invasion or metaplasia of functional cysts or alternatively from ovarian surface endometriosis that bleeds into the ovarian cortex. Different mechanisms of endometrioma formation may help explain the phenotypic variability observed among endometriomas. Laparoscopic surgery is the preferred first-line modality of diagnosis and treatment of endometriomas. Ovarian cystectomy is preferred over cyst ablation or sclerotherapy for enabling pathologic diagnosis, improving symptoms, preventing recurrence, and optimizing fertility outcomes. Cystectomy for small, densely adherent endometriomas is made challenging by dense fibrosis of the cyst capsule obliterating the plane with normal ovarian cortex, whereas cystectomy for large endometriomas can carry unique challenges as a result of adhesions between the cyst and pelvic structures. Preoperative and postoperative hormonal suppression can improve operative outcomes and decrease the risk of endometrioma recurrence. Whether the optimal management, fertility consequences, and malignant potential of endometriomas vary on the basis of size and phenotype remains to be fully explored.
Topics: Humans; Female; Endometriosis; Ovarian Diseases; Laparoscopy; Ovarian Cysts
PubMed: 38626453
DOI: 10.1097/AOG.0000000000005587 -
The Journal of Obstetrics and... Sep 2021During pregnancy, the ovarian endometrioma generally decreases in size and occasionally ruptures. We evaluated (1) whether and how ovarian-endometrioma size changes from...
AIM
During pregnancy, the ovarian endometrioma generally decreases in size and occasionally ruptures. We evaluated (1) whether and how ovarian-endometrioma size changes from the first trimester to the postdelivery period, and (2) the type of endometrioma more likely to rupture during pregnancy.
METHODS
During an 18-year period (2000-2018), ultrasound in the first trimester revealed ovarian endometrioma in 149 pregnant women at our tertiary institute. Among these, we subjected 138 endometriomas in 145 patients to expectant management (wait-and-watch approach during pregnancy). We compared the cyst sizes in the first trimester and the postdelivery period, and defined a >1 cm diameter size-change as a significant increase/decrease. We analyzed four patients with rupture and characterized the predictors of rupture.
RESULTS
A comparison of cyst sizes in the first trimester and the postdelivery period revealed that the size of 94 (68%), 37 (27%), and 7 ovaries (5.0%), respectively, decreased, remained unchanged, and increased; in 56 ovaries (40%), apparent cysts were no longer present. Of the 145 patients, four (2.8%) required emergency surgery for cyst rupture. Adhesion to the surroundings, an increase in cyst size, large size (diameter of ≥6 cm), and compression due to the enlarged uterus in late pregnancy were factors clinically related to rupture.
CONCLUSIONS
Approximately two-thirds of ovarian endometriomas decreased in size during pregnancy (40% disappeared), 27% remained unchanged, and only 5% increased in size. However, 2.8% of pregnant women with endometrial cysts experienced rupture. We characterized risk factors for rupture; however, clinical application requires further evaluation.
Topics: Endometriosis; Female; Humans; Ovarian Cysts; Ovarian Diseases; Ovary; Pregnancy; Pregnancy Trimester, First; Risk Factors; Ultrasonography
PubMed: 34155737
DOI: 10.1111/jog.14862 -
Pediatric Emergency Care Oct 2021Vomiting in young infants is a common presentation to the pediatric emergency department with a broad differential diagnosis. We present 2 cases seen in our emergency...
Vomiting in young infants is a common presentation to the pediatric emergency department with a broad differential diagnosis. We present 2 cases seen in our emergency department of infant females with symptomatic complex ovarian cysts who presented with vomiting. The first case study describes a patient with a prenatally diagnosed ovarian cyst that was being followed with serial ultrasounds by general surgery. The second case study describes a patient with reportedly normal prenatal ultrasounds with a subsequent diagnosis of a large complex ovarian cyst. These cases were selected to review pertinent imaging findings, discuss management decisions, and expand the differential of vomiting in the young female infants.
Topics: Child; Diagnosis, Differential; Female; Fetal Diseases; Humans; Infant; Ovarian Cysts; Pregnancy; Ultrasonography, Prenatal
PubMed: 32796350
DOI: 10.1097/PEC.0000000000002209 -
Journal of Minimally Invasive Gynecology 2017To investigate the safety and technical feasibility of needleoscopic fertility-sparing staging of borderline ovarian tumors. (Review)
Review
STUDY OBJECTIVE
To investigate the safety and technical feasibility of needleoscopic fertility-sparing staging of borderline ovarian tumors.
DESIGN
Video article and review of the literature (Canadian Task Force classification Level III).
SETTING
This 29-year-old woman had a right ovarian cyst suspicious for borderline ovarian tumor on preoperative magnetic resonance imaging and ultrasound showing the presence of a right unilocular ovarian cyst with a papillary projection. Informed consent for abdominal or laparoscopic approach was obtained from the patient in accordance with the local legislation. The patient also provided informed consent to use images and videos of the procedure. Institutional Review Board approval was not required for this kind of procedure.
INTERVENTIONS
Treatment involved conservative staging with right ovarian cystectomy, peritoneal biopsies, infracolic omental biopsy, and peritoneal cytology. Instrumentation included two 2.4-mm needleoscopic instruments. The total operative time was 62 minutes, and estimated blood loss was <10 mL. No intraoperative complications were recorded. At the end of the surgical procedure, the outer diameter of the incision was increased by only up to 3 mm. The patient was discharged the day after the procedure. Histopathological analysis confirmed a serous borderline ovarian tumor. A 30 days postoperative follow-up, a satisfactory cosmetic result was reported by both the patient (score of 10 of out of a possible 10) and the surgeon (10 of 10).
CONCLUSION
To the best of our knowledge, there are no previously published reports of needleoscopic treatment of borderline ovarian tumor, which represents a great challenge for ultra-minimally invasive approaches [1-3]. Based on our initial experience, the needleoscopic instruments could prove to be a beneficial tool in adnexal benign or borderline disease. At present, only a hybrid operative setting should be considered to overcome the lack of bipolar energy [4-6]. Further studies are needed to define the benefits, advantages, and costs of this novel approach.
Topics: Adult; Biopsy, Needle; Diagnosis, Differential; Female; Humans; Neoplasm Staging; Operative Time; Ovarian Cysts; Ovarian Neoplasms; Ovariectomy
PubMed: 27989810
DOI: 10.1016/j.jmig.2016.10.009 -
Journal of Obstetrics and Gynaecology :... 2015Ovarian torsion is a relatively common gynaecological emergency, usually presenting as acute lower abdominal pain. The underlying pathophysiology involves torsion of the... (Review)
Review
Ovarian torsion is a relatively common gynaecological emergency, usually presenting as acute lower abdominal pain. The underlying pathophysiology involves torsion of the ovarian tissue on its pedicle leading to reduced venous return, stromal oedema, internal haemorrhage and infarction with the subsequent sequelae. It is not clear from looking at the literature which factors are responsible for the development of ovarian torsion and what are the odds of a particular clinical feature in determining the likelihood of developing ovarian torsion. In order to assess the likelihood of a particular clinical feature to be a risk factor for ovarian torsion, we studied the prevalence of each presenting clinical feature in the background population of women, for instance, looking at ovarian cysts and compared this with the odds of the feature occurring in the affected population of torsion patients. Thus we compared the odds of various clinical variables in ovarian torsion patients against the odds of the same feature occurring in the background population of women. Ovarian cysts are three times more common in ovarian torsion cohorts than in the general population. Evidence suggests that ovarian cysts are very common in the asymptomatic pregnant cohorts; however, they spontaneously resolve as the pregnancy progresses. Pregnancy is a risk factor for torsion (odds ratio: 18:1); however, it remains an uncommon event (0.167%). Tubal sterilisation practices vary according to geographical location and over chronology of the published literature. After considering the extremes of variation in tubal sterilisation practices, the risk of torsion increases by at least 8-fold following surgery. Hysterectomy with ovarian conservation is not a risk factor of torsion.
Topics: Female; Humans; Ovarian Cysts; Ovarian Diseases; Pregnancy; Pregnancy Complications; Prevalence; Risk Factors; Sterilization, Tubal; Torsion Abnormality
PubMed: 26212687
DOI: 10.3109/01443615.2015.1004524