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Journal of Nepal Health Research Council Mar 2022A 32-year-old unmarried female on an atypical antipsychotic presented with massive abdominal distension and progressive difficulty in breathing and ambulation. Imaging...
A 32-year-old unmarried female on an atypical antipsychotic presented with massive abdominal distension and progressive difficulty in breathing and ambulation. Imaging revealed a giant ovarian mass originating on the right side. A fertility sparing laparotomy was carried out, without complication. Histopathological evaluation revealed a seromucinous cystadenoma. Giant ovarian cysts are seldom encountered in current medical practice secondary to easy availability of imaging modalities and treatment facilities. In spite of their considerable size, such tumors are usually benign and have a good prognosis. Keywords: Fertility sparing laparotomy; giant ovarian cysts; Seromucinous cystadenomas.
Topics: Adult; Female; Humans; Nepal; Ovarian Cysts
PubMed: 35615849
DOI: 10.33314/jnhrc.v19i04.3851 -
Obstetrics and Gynecology Dec 2023To estimate surveillance intervals of incident ovarian cysts, and describe variables associated with cyst resolution times. (Clinical Trial)
Clinical Trial
OBJECTIVE
To estimate surveillance intervals of incident ovarian cysts, and describe variables associated with cyst resolution times.
METHODS
The UK-OCST (University of Kentucky Ovarian Cancer Screening Trial) was a prospective cohort that enrolled 47,762 individuals over 30 years, including 2,638 individuals with incident cysts. Cyst diameter and structure and patient age, body mass index, use of hormone therapy (HT), family history of ovarian cancer, and menopausal status were examined as variables associated with cyst resolution using t tests, χ 2 test, Kaplan Meier, and Cox multiple regression.
RESULTS
Of 2,638 individuals with incident cysts, 1,667 experienced resolution (63.2%) within 1.2 years, and 971 experienced persistence (36.8%). Within 1 year, unilocular and septated cysts had similar resolution rates (35.4% and 36.7%, respectively, P >.05), but time to resolution was shorter for unilocular cysts compared with septated cysts (mean 1.89 years vs 2.58 years, respectively, P <.001). Both unilocular and septated cysts smaller than 3 cm resolved faster than cysts larger than 6 cm ( P <.001). Variables associated with percent resolution included being of younger age, premenopausal status (but not for synchronous bilateral cysts), and those reporting a family history of ovarian cancer ( P <.05). Variables associated with a faster cyst resolution rate included being older than age 70 years and not using hormone therapy. Body mass index and family history were not associated with cyst resolution time.
CONCLUSION
Different surveillance times may be appropriate depending on cyst structure and size and patient age and HT use.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov , NCT04473833.
Topics: Adult; Aged; Female; Humans; Middle Aged; Cysts; Hormones; Ovarian Cysts; Ovarian Neoplasms; Prospective Studies; Ultrasonography
PubMed: 38051292
DOI: 10.1097/AOG.0000000000005411 -
The American Journal of Case Reports Nov 2021BACKGROUND Adnexal torsion is a gynecologic emergency that dictates immediate surgical intervention. Twisted ovarian cysts are rare in adolescents, but they can cause... (Review)
Review
BACKGROUND Adnexal torsion is a gynecologic emergency that dictates immediate surgical intervention. Twisted ovarian cysts are rare in adolescents, but they can cause significant distress to patients. Idiopathic ovarian torsion is uncommon in adolescents and the incidence is reportedly higher in women aged 20 to 40 years. Most twisted cysts in adolescents are benign. In the past, oophorectomy was commonly performed for a torsed ovary, but currently there is a trend toward ovary preservation. The diagnosis of twisted ovarian cyst is based on pathognomonic symptoms and findings from a focused clinical examination and ultrasound. Because the differential diagnosis includes acute appendicitis and gastroenteritis, referral to a gynecologist may be delayed. CASE REPORT We present the case of a huge, twisted ovarian cyst in a 16-year-old girl who presented with an acute abdomen. The initial diagnosis was acute appendicitis, which delayed her referral to a gynecologist. An emergency laparotomy and left salpingo-oophorectomy were performed. The histopathology of the ovarian cyst was reported as serous cystadenoma. CONCLUSIONS The optimal management of a twisted ovarian cyst in adolescents is the subject of much debate. Here, we review the literature on ovarian torsion in children and adolescents. The patient in the case we present had a twisted ovarian cyst that was managed with salpingo-oophorectomy.
Topics: Adolescent; Child; Female; Humans; Ovarian Cysts; Ovarian Torsion; Ovariectomy; Salpingo-oophorectomy; Torsion Abnormality
PubMed: 34785630
DOI: 10.12659/AJCR.933438 -
BMC Pregnancy and Childbirth Apr 2021A uterine manipulator cannot be used to elevate the ovary in benign ovarian surgery during pregnancy. This report describes our method of elevation of the ovary using a...
BACKGROUND
A uterine manipulator cannot be used to elevate the ovary in benign ovarian surgery during pregnancy. This report describes our method of elevation of the ovary using a metreurynter with the success rate of the procedure and a comparison of surgical results and pregnancy outcomes between the successful and unsuccessful cases.
METHODS
Between August 2003 and February 2020, 11 pregnant patients with a tumor found sunk in the Cul-de-sac underwent laparoscopic cystectomy for a benign ovarian cyst with a metreurynter. The surgical results, success and failure of the elevation by a metreurynter, pregnancy outcomes, and fetal status at delivery were evaluated.
RESULTS
Elevation of ovarian tumors with a metreurynter was successful in nine cases. However, it was unsuccessful in the remaining two cases wherein the ovary was lifted with forceps while the uterus was in a compressed state. The operative time was also longer in these cases. The pregnancy prognosis, however, was good for both, successful and unsuccessful cases.
CONCLUSIONS
The metreurynter is an inexpensive and practical obstetric device, and its optimal use allows the performance of a procedure with minimal burden on a pregnant uterus. Therefore, we recommend the appropriate use of this method to enable effective laparoscopic cystectomy of ovarian tumors during pregnancy.
Topics: Adult; Douglas' Pouch; Female; Humans; Intraoperative Complications; Laparoscopy; Lifting; Operative Time; Ovarian Cysts; Ovariectomy; Pneumoperitoneum, Artificial; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Surgical Instruments; Uterus
PubMed: 33892651
DOI: 10.1186/s12884-021-03774-w -
International Journal of Gynaecology... May 2024The aim of this study was to evaluate the impact of having an ovarian cyst and undergoing cystectomy on the expression of ovarian reserve markers among adolescent...
OBJECTIVE
The aim of this study was to evaluate the impact of having an ovarian cyst and undergoing cystectomy on the expression of ovarian reserve markers among adolescent females who live in Armenia.
METHODS
We conducted a prospective case-control study. Cases were arranged into two groups. The postoperative group (POG) included those who underwent unilateral ovarian cystectomy, and those in the benign ovarian cyst group (BOCG) had complex ovarian cysts with a diameter of 5 cm or more. Adolescents without ovarian pathologies were included in the reference group (RFG). Levels of anti-Mullerian hormone (AMH) and follicular stimulating hormone (FSH) were measured, and an ultrasound investigation of antral follicular count (AFC) was also done.
RESULTS
Mean differences between baseline and 6-month follow-up levels of AMH, AFC significantly decreased in both the POG and BOCG compared to the RFG. However, the decrease was more significant in the POG: a decrease of 0.86 ng/mL for AMH and 3.11 ng/mL for AFC versus decreasing by 0.61 ng/mL for AMH and 1.68 ng/mL for AFC. Meanwhile, in the BOCG, 6-month FSH levels did not show any significant changes compared to the baseline measurement. In comparison with the reference group, there was a significant decrease in the levels of AMH and AFC among participants who had endometriomas and cystadenomas.
CONCLUSION
Benign ovarian cysts 5 cm or more in diameter, as well as cystectomy, statistically affect OR after 6 months. Therefore, adolescents with ovarian cyst or cystectomy need individualized support to maintain reproductive age fertility.
Topics: Female; Adolescent; Humans; Ovarian Reserve; Case-Control Studies; Ovarian Cysts; Fertility; Follicle Stimulating Hormone; Endometriosis; Anti-Mullerian Hormone; Laparoscopy
PubMed: 38059670
DOI: 10.1002/ijgo.15284 -
Journal of Minimally Invasive Gynecology Jul 2021
Topics: Dermoid Cyst; Fallopian Tubes; Female; Humans; Ovarian Cysts; Ovarian Neoplasms; Teratoma
PubMed: 32911089
DOI: 10.1016/j.jmig.2020.09.001 -
Journal of Minimally Invasive Gynecology Sep 2022In this video, we describe a 5-step surgical technique that allows us to safely incise and aspirate the content of large ovarian cysts through a single-port laparoscopic...
STUDY OBJECTIVE
In this video, we describe a 5-step surgical technique that allows us to safely incise and aspirate the content of large ovarian cysts through a single-port laparoscopic incision. This allows performing laparoscopic oophorectomies instead of large xipho-pubic laparotomies.
DESIGN
A stepwise demonstration of the technique with narrated video footage.
SETTING
Ovarian masses, especially cysts, are common gynecologic conditions [1]. However, depending on their size, large adnexal cysts are usually managed with transverse or midline laparotomies [2]. This is to prevent cyst ruptures and abdominal contamination and ensure oncological safety of the procedure [3-5]. Different leak-proof aspiration techniques have been described in the literature allowing for safe large cyst aspiration and adnexectomy through a mini-laparotomy incision or via laparoscopy [2,3,6-10]. We describe a 5-step surgical technique allowing for closed aspiration of ovarian intracystic fluid and adnexectomy while respecting oncological safety.
INTERVENTIONS
Step 1: Perform diagnostic laparoscopy to rule out peritoneal carcinomatosis contraindicating this procedure and then after cyst exposition, thoroughly dry the cyst wall. Step 1 Bis: Cut the cuff of a sterile glove to prepare a square piece of membrane. Step 2: Place a protective gauze and then apply the surgical glue to the ovarian cyst wall followed by the glove/membrane application. Perform a purse suture through the glove/membrane and the ovarian wall superficially to ensure further adhesion and prevent ovarian fluid spillage. Step 3: Incise the ovarian wall, introduce the aspiration cannula and tighten the purse suture to aspirate the cystic fluid. Step 4: After aspiration is complete, tighten the suture and close the glove to guarantee a closed space and prevent abdominal contamination. Step 5: Perform laparoscopic oophorectomy or cystectomy. Safely remove the specimen in an endoscopic retrieval bag through the trocar incision.
CONCLUSION
This technique allows safe laparoscopic large ovarian cysts resections while respecting oncologic safety and preventing intra-abdominal spillage and contamination.
Topics: Cysts; Female; Humans; Laparoscopy; Laparotomy; Ovarian Cysts; Ovariectomy
PubMed: 35753617
DOI: 10.1016/j.jmig.2022.06.018 -
Journal of Pediatric and Adolescent... Oct 2015Precocious pseudopuberty in girls occurs as a result of peripheral estrogen production, most commonly through an autonomous ovarian cyst or in patients with McCune... (Review)
Review
STUDY OBJECTIVE
Precocious pseudopuberty in girls occurs as a result of peripheral estrogen production, most commonly through an autonomous ovarian cyst or in patients with McCune Albright syndrome. Current management is either conservative or surgical. The aim of this study was to identify available literature on presentation, course and treatment of such cases.
DESIGN
We performed a medline literature search using the key words 'ovarian autonomous cyst' and 'pseudopuberty'. We included articles published in English, from 1980 to date relating to females aged 2 to 8 years. We excluded papers on other endocrine conditions resulting in premature puberty.
OUTCOME MEASURES
Type of management, time of resolution, recurrence, progression to Central Precocious Puberty and McCune Albright Syndrome.
RESULTS
We identified 9 articles referring to 26 cases of autonomous ovarian cysts. All patients had suppressed LHRH testing and had simple ovarian cysts producing estradiol. Median age of patients was 5 years (range 2.2-8) and size of cyst was 41.5mm (9-60). Ten patients underwent cystectomy or oophorectomy, three were given cyproterone acetate and 13 were managed conservatively. Nine of 13 patients that were managed conservatively and two of those that had a cystectomy had a recurrence. There were three cases that progressed to central precocious puberty (CPP) and one case that was then identified to have McCune Albright (MCA) syndrome. One further case with multiple recurrences was given long term treatment with letrozole.
CONCLUSION
We conclude that although a conservative approach should always be proposed in the first instance, one should be aware of the risk of recurrence and progression to CPP or MCA. Antiestrogen treatment appears promising; however data comparing it with surgical options and particularly long term consequences with regards to future reproductive outcomes are not available.
Topics: Child; Child, Preschool; Estrogens; Female; Humans; Neoplasm Recurrence, Local; Ovarian Cysts; Prognosis; Puberty, Precocious
PubMed: 26228588
DOI: 10.1016/j.jpag.2015.05.004 -
BMC Women's Health Jul 2022Cervical cancer is the most common indication for ovarian transposition in reproductive-age women. Ovarian transposition should be performed in premenopausal women... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Cervical cancer is the most common indication for ovarian transposition in reproductive-age women. Ovarian transposition should be performed in premenopausal women undergoing pelvic irradiation to preserve ovarian function, and prevent early menopause. As women become more knowledgeable about their fertility options, it is still unclear who will benefit from the intervention. We updated our previous meta-analysis of ovarian function preservation, symptomatic ovarian cysts, and metastases to the transposed ovaries following ovarian transposition in cervical cancer patients to further guide current clinical practice.
METHODS
A systematic search of Medline, Embase, Web of Science, and The Cochrane Library databases, dating from January 1980 to July 2021, was conducted. We computed the summary proportions of women who had ovarian function preservation, non-ovarian cyst formation and metastases to the transposed ovaries following ovarian transposition by random-effects meta-analysis and we explored study heterogeneity by type of radiotherapy.
RESULTS
There were 29 publications reporting on 1160 women with cervical cancer who underwent ovarian transposition. In the group that underwent surgery alone, 91% of the women had preserved ovarian function (95% CI 83-100), 89% (95% CI 80-99) of women who did not develop ovarian cysts, and 99% (95% CI 1-5) of women who did not suffer metastases to the transposed ovaries. In the surgery ± brachytherapy (BR) group, the proportion of women with the preserved ovarian function was 93% (95% CI 76-113), 84% (95% CI 69-103) of women who did not develop ovarian cysts, and 99% (95% CI 82-120) of women who did not suffer metastases to the transposed ovaries. In the external beam pelvic radiotherapy (EBRT) ± BR ± surgery group, the proportion of women with the preserved ovarian function was 61% (95% CI 55-69), and 95% (95% CI 85-107) of women who developed ovarian cysts. There were no metastases to the transposed ovaries in that group.
CONCLUSIONS
In women with cervical cancer, ovarian transposition offers a significant preservation of the ovarian function. Despite an expected incidence of ovarian cyst formation, it carries almost no risk for metastases to the transposed ovaries.
Topics: Brachytherapy; Female; Humans; Ovarian Cysts; Pelvis; Uterine Cervical Neoplasms
PubMed: 35869476
DOI: 10.1186/s12905-022-01887-8 -
Journal of Clinical Ultrasound : JCU Jan 2021Ovary detection is the first step in confirming ovarian lesions. The daughter cyst sign is widely used for this purpose; however, it is not always applicable. Recent... (Review)
Review
Ovary detection is the first step in confirming ovarian lesions. The daughter cyst sign is widely used for this purpose; however, it is not always applicable. Recent improvements in image resolution allow Fallopian tube delineation, which can serve as a guide to identify the ovary. This anatomical approach ("follow the Fallopian tube" technique) comprises three steps: (1) confirm the uterus; (2) follow the Fallopian tube; and (3) find the ovary. Other applications of this approach include the differentiation between nonovarian and ovarian masses and ruling out ovarian torsion and an auto-amputated ovary.
Topics: Child; Fallopian Tubes; Female; Humans; Ovarian Cysts; Ovarian Neoplasms; Ovarian Torsion; Ultrasonography
PubMed: 32827154
DOI: 10.1002/jcu.22906