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Indian Journal of Surgical Oncology Jun 2023Primary peritoneal mesothelioma (PM) is a rare and aggressive malignancy that arises from the peritoneum and classified into diffuse malignant peritoneum mesothelioma... (Review)
Review
Primary peritoneal mesothelioma (PM) is a rare and aggressive malignancy that arises from the peritoneum and classified into diffuse malignant peritoneum mesothelioma (DMPM) and borderline variants, viz. multicystic peritoneal mesothelioma (MCPM) and well-differentiated papillary peritoneal mesothelioma (WDPPM). The borderline variants are rarer than conventional DMPM, are less aggressive form accounting for 3-5% of all cases of peritoneal mesothelioma. In this narrative review article, we have discussed the pathogenesis, clinical presentation, natural history, and management of these rarer variants of PM, viz. MCPM and WDPPM. Histologically, MCPM typically consists of small cysts composed of mesothelial epithelium with benign bland cuboidal cells with clear fluids; cells lack cellular atypia and have increased number of mitoses. WDPPM has specific papillary component with myxoid plump cores and single layer of bland mesothelial cells. Both the variants commonly present as incidental finding or symptoms of chronic abdominal pain, chronic pelvic inflammatory disease, pelvic mass, and infertility. In the absence of treatment, these diseases are slow growing with major concerns being that both the variants have malignant transformation capabilities and a high rate of recurrence. In the light of current evidences, it is recommended that MCPM and WDPPM patients should be offered a complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy consisting of cisplatin and doxorubicin. Collaborative multi-institutional studies are needed to generate more data and formulate robust guidelines.
PubMed: 37359922
DOI: 10.1007/s13193-023-01754-4 -
The Pan African Medical Journal 2020With the increased use and quality of ultrasound in pregnancy, adnexal masses are being encountered with greater frequency. Most of the time such masses are... (Review)
Review
With the increased use and quality of ultrasound in pregnancy, adnexal masses are being encountered with greater frequency. Most of the time such masses are asymptomatic. It can be discovered in an emergency. Surgical intervention may cause risks to the mother and her fetus, while observation without intervention may also lead to unfavorable complications, such as ovarian torsion or the development of a tumor. Therefore, the management requires a balance between the maternal and fetal risks. We report two cases of torsion of adnexal masses during pregnancy, and we provide a brief literature review on the management and prognosis of this condition in pregnancy.
Topics: Adnexal Diseases; Adolescent; Adult; Female; Humans; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prognosis; Torsion Abnormality
PubMed: 33062119
DOI: 10.11604/pamj.2020.37.17.23869 -
Medicina (Kaunas, Lithuania) Sep 2023: Meigs syndrome is represented by a benign adnexal tumor, ascites, and hydrothorax. Even though the ovarian mass is often characterized by a fibroma-like origin, cancer... (Review)
Review
: Meigs syndrome is represented by a benign adnexal tumor, ascites, and hydrothorax. Even though the ovarian mass is often characterized by a fibroma-like origin, cancer antigen-125 (CA-125) serum levels could be elevated as in the development of ovarian cancer. Here, we present the case of a patient with Meigs syndrome and increased CA-125. : We performed systematic research for articles including similar cases in PubMed, EMBASE, and Scopus in February 2023, adopting the string of idioms: "Meigs syndrome AND Cancer antigen 125", and following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. : Eligible records were 25. Hydrothorax was right-sided in 10 cases over 25; left-sided in two patients over 25. Concerning ascites, two patients showed more than 6 L of ascitic fluid, whereas three patients had 6 L or less. CA-125 elevation ranged from 149 IU/mL to 3803 IU/mL. Adnexal mass histotypes were: struma ovarii (12 cases), thecomas (two cases), fibrothecomas (five cases), fibromas (five cases), and one sclerosing stromal tumor (SST). : In postmenopausal women with elevated CA-125 serum levels and an adnexal mass suspicious for malignancy at ultrasound (US), ascites and pleural effusion, surgery, and histopathological examination are necessary. MS is a diagnostic option, with an excellent prognosis after exeresis of the mass.
PubMed: 37763803
DOI: 10.3390/medicina59091684 -
Przeglad Menopauzalny = Menopause Review Mar 2020Most ovarian and/or adnexal torsions occur in reproductive age and are less common in postmenopausal age. A 49-year-old menopausal woman presented to the Emergency...
Most ovarian and/or adnexal torsions occur in reproductive age and are less common in postmenopausal age. A 49-year-old menopausal woman presented to the Emergency Department with abdominal pain. She had a palpable pelvi-abdominal mass and abdominal tenderness on examination. Departmental ultrasound and magnetic resonance imaging (MRI) showed a large multilocular right adnexal cyst (15 × 12 cm) containing fluid with variable signal intensities on both T1 and T2 sequences (stained glass appearance) - most probably mucinous cystadenoma. The studied woman signed an informed consent form and agreed to exploratory laparotomy and adnexectomy. After the pre-operative investigations, which were done according to the hospital protocol, including CA-125 (26 IU/ml) and anaesthesia consultation, she was scheduled for laparotomy. At laparotomy an ovarian cyst originating from the right ovary was found with evidence of torsion of the infundibulopelvic and utero-ovarian ligaments (adnexal torsion). The right adnexa including the right ovary containing the ovarian cyst and the right fallopian tube was excised (adnexectomy). The histological examination of the excised adnexa confirmed the diagnosis of mucinous cystadenoma of the ovary. This report represents a rare case of an adnexal torsion in postmenopausal woman, to highlight that adnexal torsion can occur at any age and that the presence of ovarian mass or cyst predispose to adnexal torsion at any age.
PubMed: 32699544
DOI: 10.5114/pm.2020.95295 -
Annals of Translational Medicine Jun 2021The composition of pelvic masses during pregnancy is complex, and over >70% of masses are physiology. Determining the source and nature of tumor tissue is incredibly...
BACKGROUND
The composition of pelvic masses during pregnancy is complex, and over >70% of masses are physiology. Determining the source and nature of tumor tissue is incredibly important in clinical practice, as the proportion of metastatic and low-grade tumors in adnexal masses increase during pregnancy. This study sought to analyze the pathological features of persistent adnexal masses in pregnancy.
METHODS
A retrospective case analysis method was adopted to summarize the pathologic features of persistent adnexal masses in pregnancy in 228 patients at the Beijing Chao-Yang Hospital, Capital Medical University.
RESULTS
Mature teratoma was the most common histopathological type of persistent adnexal masses in pregnancy (66/228, 28.95%), followed by the corpus luteum of pregnancy (38/228, 16.67%). Borderline/malignant tumors accounted for 5.70% (13/228) of tumors. Malignant adnexal tumor tissues were derived from multiple types of tissues. a single-factor analysis showed that borderline/malignant tumors had a significant relationship with the morphological features of mass in the ultrasound (P=0.000), and had a significant relationship with initial mass size (P=0.018). A multivariate binary logistic regression analysis indicated no certain independent risk factor. A significant difference in tumor pathology distribution was noted between those who underwent emergency surgery during pregnancy, elective surgery during pregnancy, and simultaneous tumor removal during cesarean section (χ=24.22, P=0.000).
CONCLUSIONS
A special particularity exists in the pathology distribution of persistent adnexal masses in pregnancy. Additionally, extensive histological sources and the need to rule out borderline/malignancy for solid cystic tumors were noted.
PubMed: 34277773
DOI: 10.21037/atm-21-2137 -
Frontiers in Oncology 2022Quantitative contrast-enhanced ultrasonography parameters are affected by various factors. We evaluated corrected quantitative contrast enhanced ultrasonography in...
BACKGROUND
Quantitative contrast-enhanced ultrasonography parameters are affected by various factors. We evaluated corrected quantitative contrast enhanced ultrasonography in differentiating benign adnexal tumors from malignant tumors.
METHODS
Patients with adnexal masses who underwent conventional and contrast-enhanced ultrasonography were included. Contrast-enhanced ultrasonography parameters such as base intensity, arrival time, peak intensity, time to peak intensity, ascending slope, and descending slope were measured. Corrected (time to peak intensity - arrival time) (time to peak intensity - arrival time) and (peak intensity - base intensity) (peak intensity - base intensity) were calculated. Lesions were confirmed by pathologic examination of surgical specimens.
RESULTS
This study included 31 patients with 35 adnexal lesions including 20 (57.10%) benign and 15 (42.90%) malignant lesions. The corrected contrast-enhanced ultrasonography quantitative parameters in lesions were statistically different between malignant and benign groups (<0.05). The optimal cut-off value for (time to peak intensity - arrival time) /(time to peak intensity - arrival time) , ascending slope, and (peak intensity - base intensity) /(peak intensity - base intensity) , and descending slope for differentiating malignant adnexal masses from benign tumors were 1.05 (area under curve: 0.93,<0.05), 1.11 (area under curve: 0.83, <0.05), 0.82 (area under curve: 0.73, <0.05), and -0.27 (area under curve: 0.66, =0.16), with sensitivity and specificity of 93.33% and 85.00%, 86.67% and 75.00%, 86.67% and 60.00%, and 54.55% and 66.67%, respectively.
CONCLUSIONS
Corrected contrast-enhanced ultrasonography parameters provide practical differential diagnosis value of adnexal lesions with high reliability for sonologists.
PubMed: 36338700
DOI: 10.3389/fonc.2022.968759 -
Advanced Biomedical Research 2022CA125 is the most used tumor marker for ovarian cancer monitoring and diagnosis. This study aimed to evaluate the capacity to predict malignancy in women with adnexal...
BACKGROUND
CA125 is the most used tumor marker for ovarian cancer monitoring and diagnosis. This study aimed to evaluate the capacity to predict malignancy in women with adnexal tumors using CA125 measurement and ultrasound criteria before the pathological examination.
MATERIALS AND METHODS
This observational diagnostic study was conducted on 300 patients with obvious diagnosis of adnexal mass consists of ovarian masses, fallopian tubes, and masses within the broad ligament referring to Alzahra and Beheshti Hospitals from 2018 to 2019. Ultrasound examinations were done before surgery and malignancy risk was investigated by the ADNEX criterion. Sensitivity, specificity, positive and negative likelihood ratio (likelihood ratio [LR]+ and LR-), and area under the curve (AUC) were calculated.
RESULTS
From 284 patients, 260 masses were categorized in benign, 18 were in borderline, and 18 masses were malignant. The mean age of patients with malignant tumors was significantly higher than the others ( = 0.01). Differences in the level of CA-125 were not statistically significant ( = 0.78). Furthermore, the proportion of ascites in the malignant group (16.3%) was significantly higher than the others ( = 0.003). The AUC in ADNEX model (cutoff ≥9%) for differentiation of benign and malignant tumors was 0.75 (95% confidence interval [CI]: 0.69-0.80) with a sensitivity of 0.63 (95% CI: 0.41-0.81) and a specificity of 0.80 (95% CI: 0.74-0.84). Receiver operating characteristic analysis for CA-125 revealed that this variable is not capable for discrimination between benign and malignant tumors as the AUCs of the aforementioned variable were 0.60, 0.60, and 0.52 for the whole patients, premenopause, and postmenopause categories.
CONCLUSION
CA-125 marker, along with other ultrasound findings, can be more accurate in identifying the malignancy of the adnexa tumor.
PubMed: 35386543
DOI: 10.4103/abr.abr_164_20 -
The International Journal of Biological... Nov 2015The aim of this study was to estimate the diagnostic accuracy of serum carcinoembryonic antigen (CEA) levels in conjunction with Ca125 in the triage of adnexal masses. (Review)
Review
BACKGROUND
The aim of this study was to estimate the diagnostic accuracy of serum carcinoembryonic antigen (CEA) levels in conjunction with Ca125 in the triage of adnexal masses.
METHODS
This retrospective cohort study was carried out in 495 patients referred to the Gynecology Department at Carmel Medical Center due to adnexal mass, between 2005 and 2012. All patients underwent surgery with histopathologically confirmed diagnosis and preoperative measurements of serum Ca125 and CEA. For each marker, sensitivity, specificity, positive predictive value, negative predictive value and risk ratio were calculated.
RESULTS
Combination of CEA with Ca125, compared with Ca125 levels alone, yielded a nonsignificant effect on sensitivity (87.4% vs. 88.9%, respectively, p = 0.64) and specificity (79.3% vs. 74.3%, p = 0.18) in differentiating malignant from benign adnexal masses. CEA levels were higher in mucinous histological types, but were not helpful in detection of borderline tumors. Significantly higher CEA (21.4 ± 53.6 vs. 3.2 ± 11.9 ng/mL, p = 0.0002) and lower Ca125 values (103.9 ± 84.9 vs. 796 ± 1,331.5 U/mL, p = 0.0338) were demonstrated in the 17 metastatic cases compared with 181 primary ovarian malignancies.
CONCLUSIONS
The combination of the tumor markers CEA and Ca125 did not contribute significantly to the detection of malignant adnexal masses compared with Ca125 alone. As our results suggest that higher CEA levels could be useful in differentiating metastatic tumors from primary ovarian malignancy and in diagnosis of mucinous histology, this issue should be investigated in large, well-designed, prospective cohort trials.
Topics: Adnexal Diseases; Adolescent; Adult; Aged; Aged, 80 and over; CA-125 Antigen; Carcinoembryonic Antigen; Female; Humans; Membrane Proteins; Middle Aged; Neoplasms, Cystic, Mucinous, and Serous; Ovarian Neoplasms; Retrospective Studies; Sensitivity and Specificity; Young Adult
PubMed: 26109367
DOI: 10.5301/jbm.5000158 -
International Journal of Surgery Case... 2018Epithelioid hemangioendothelioma is a malignant mesenchymal tumor of unknown etiology. They tend to be asymptomatic or with non-specific symptoms. The lesion is usually...
INTRODUCTION
Epithelioid hemangioendothelioma is a malignant mesenchymal tumor of unknown etiology. They tend to be asymptomatic or with non-specific symptoms. The lesion is usually multiple and variable size.
PRESENTATION OF CASE
We describe a clinical case of a 23-years-old patient diagnosed with a pelvic mass, a possible uterine fibroid or adnexal mass, and multiple liver lesions that seemed an advanced ovarian cancer presentation and after liver biopsy turned out to be a hepatic epithelioid hemangioendothelioma.
DISCUSSION
It may be confused with a metastatic process in diagnostic imaging. There have been described some possible risk factors but the etiology remains unknown. The prognosis is usually lethal in 50% of cases. The surgical removal of the lesion and liver transplant appear to be the only hope for these patients.
CONCLUSION
Epithelioid hemangioendothelioma must be part of our differential diagnosis when we find a liver tumour, especially in young women. Treatment is excision of the tumour in limited disease. In the case of unresectable disease are candidates for liver transplantation.
PubMed: 30366173
DOI: 10.1016/j.ijscr.2018.10.013 -
Ultrasound in Obstetrics & Gynecology :... Mar 2023To evaluate the diagnostic accuracy of different ultrasound signs for diagnosing adnexal torsion, using surgery as the reference standard. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate the diagnostic accuracy of different ultrasound signs for diagnosing adnexal torsion, using surgery as the reference standard.
METHODS
This was a systematic review and meta-analysis of studies published between January 1990 and November 2021 evaluating ovarian edema, adnexal mass, ovarian Doppler flow findings, the whirlpool sign and pelvic fluid as ultrasound signs (index tests) for detecting adnexal torsion, using surgical findings as the reference standard. The search for studies was performed in PubMed/MEDLINE, CINAHL, Scopus, The Cochrane Library, ClinicalTrials.gov and Web of Science databases. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to evaluate the quality of the studies. Pooled sensitivity, specificity, and positive and negative likelihood ratios were calculated separately, and the post-test probability of adnexal torsion following a positive or negative test was also determined.
RESULTS
The search identified 1267 citations after excluding duplicates. Eighteen studies were ultimately included in the qualitative and quantitative syntheses. Eight studies (809 patients) analyzed the presence of ovarian edema, eight studies (1044 patients) analyzed the presence of an adnexal mass, 14 studies (1742 patients) analyzed ovarian Doppler flow, six studies (545 patients) analyzed the whirlpool sign and seven studies (981 patients) analyzed the presence of pelvic fluid as ultrasound signs of adnexal torsion. Overall, the quality of most studies was considered to be moderate or good. However, there was a high risk of bias in the patient-selection and index-text domains (with the exception of the whirlpool sign) in a significant proportion of studies. Pooled sensitivity, specificity, and positive and negative likelihood ratios of each ultrasound sign were 58%, 86%, 4.0 and 0.49 for ovarian edema, 69%, 46%, 1.3 and 0.67 for adnexal mass, 65%, 91%, 7.6 and 0.38 for the whirlpool sign, 53%, 95%, 11.0 and 0.49 for ovarian Doppler findings and 55%, 69%, 1.7 and 0.66 for pelvic fluid. Heterogeneity was high for all analyses.
CONCLUSIONS
The presence of an adnexal mass or pelvic fluid have poor diagnostic accuracy as ultrasound signs of adnexal torsion, while the presence of ovarian edema, the whirlpool sign and decreased or absent ovarian Doppler flow have good specificity but moderate sensitivity for detecting adnexal torsion. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Female; Pregnancy; Humans; Ovarian Torsion; Torsion Abnormality; Adnexal Diseases; Ovarian Diseases; Edema
PubMed: 35751902
DOI: 10.1002/uog.24976