-
Cureus Nov 2023Ureteric leiomyosarcoma is a rare but aggressive tumor among other sarcomas. There is no established epidemiological data due to the scarcity of literature on this...
Ureteric leiomyosarcoma is a rare but aggressive tumor among other sarcomas. There is no established epidemiological data due to the scarcity of literature on this uncommon disorder. The present literature comprises about 20 case reports mostly of women above 40 years of age. The presenting complaint is mostly pain in the abdomen with only a few reporting urological symptoms like hematuria. Understandably, this tumor is diagnosed by histopathological examination with immunohistochemistry. We report one such case of a 32-year-old female who underwent an exploratory laparotomy with preoperative suspicion of adnexal neoplastic mass only to find normal ovaries and left ureteric tumor intraoperatively. She was managed with excision of the tumor with partial resection of the involved ureter and end-to-end anastomosis of the ureter followed by chemotherapy and radiation.
PubMed: 38161829
DOI: 10.7759/cureus.49758 -
Radiology Sep 2023First published in 2019, the Ovarian-Adnexal Reporting and Data System (O-RADS) US provides a standardized lexicon for ovarian and adnexal lesions, enables... (Review)
Review
First published in 2019, the Ovarian-Adnexal Reporting and Data System (O-RADS) US provides a standardized lexicon for ovarian and adnexal lesions, enables stratification of these lesions with use of a numeric score based on morphologic features to indicate the risk of malignancy, and offers management guidance. This risk stratification system has subsequently been validated in retrospective studies and has yielded good interreader concordance, even with users of different levels of expertise. As use of the system increased, it was recognized that an update was needed to address certain clinical challenges, clarify recommendations, and incorporate emerging data from validation studies. Additional morphologic features that favor benignity, such as the bilocular feature for cysts without solid components and shadowing for solid lesions with smooth contours, were added to O-RADS US for optimal risk-appropriate scoring. As O-RADS US 4 has been shown to be an appropriate cutoff for malignancy, it is now recommended that lower-risk O-RADS US 3 lesions be followed with US if not excised. For solid lesions and cystic lesions with solid components, further characterization with MRI is now emphasized as a supplemental evaluation method, as MRI may provide higher specificity. This statement summarizes the updates to the governing concepts, lexicon terminology and assessment categories, and management recommendations found in the 2022 version of O-RADS US.
Topics: Humans; Female; Retrospective Studies; Ovary; Cysts; Extremities; Radiology
PubMed: 37698472
DOI: 10.1148/radiol.230685 -
Radiologic Clinics of North America Jul 2023Several recent guidelines have been published to improve accuracy and consistency of adnexal mass imaging interpretation and to guide management. Guidance from the... (Review)
Review
Several recent guidelines have been published to improve accuracy and consistency of adnexal mass imaging interpretation and to guide management. Guidance from the American College of Radiology (ACR) Appropriateness Criteria establishes preferred adnexal imaging modalities and follow-up. Moreover, the ACR Ovarian-Adnexal Reporting Data System establishes a comprehensive, unified set of evidence-based guidelines for classification of adnexal masses by both ultrasound and MR imaging, communicating risk of malignancy to further guide management.
Topics: Female; Humans; Adnexal Diseases; Ultrasonography; Adnexa Uteri; Magnetic Resonance Imaging; Ovary; Ovarian Neoplasms
PubMed: 37169431
DOI: 10.1016/j.rcl.2023.02.002 -
Cureus Feb 2024Lymphangioma are benign, slow-growing and rare lymphatic tumors, which may emerge at any location in the body with ovary being a very rare location. Axillary region and...
Lymphangioma are benign, slow-growing and rare lymphatic tumors, which may emerge at any location in the body with ovary being a very rare location. Axillary region and neck are the most common sites, while retroperitoneum and mesentery account for <1%. We present a case of a young female of 33 years who had symptomatic pelvic mass and was presented with a complaint of lower abdominal pain of six-month duration and weight loss. Investigation revealed an oval-shaped complex cystic density lesion in the right adnexal region, which was likely neoplastic. Elective laparotomy with right ovarian cystectomy was performed. Histopathological examination revealed ovarian lymphangioma.
PubMed: 38550405
DOI: 10.7759/cureus.54983 -
American Family Physician Dec 2023Pelvic masses occur in up to 20% of women throughout their lifetime. These masses represent a spectrum of gynecologic and nongynecologic conditions. Adnexal masses-found...
Pelvic masses occur in up to 20% of women throughout their lifetime. These masses represent a spectrum of gynecologic and nongynecologic conditions. Adnexal masses-found in the fallopian tubes, ovaries, and surrounding areas-are mostly benign. Evaluation includes assessment for symptoms that may suggest malignancy, such as abdominal pain, abdominal bloating, and early satiety. A family history of ovarian, breast, or certain heritable syndromes increases the risk of malignancy. For women of reproductive age, ectopic pregnancies must be considered; a beta human chorionic gonadotropin level should be obtained. Transvaginal ultrasonography is the imaging test of choice for evaluating adnexal masses for size and complexity. Adnexal cysts that are greater than 10 cm, contain solid components, or have high color flow on Doppler ultrasonography are high risk for malignancy. Further imaging, if warranted, should be completed with computed tomography or magnetic resonance imaging, particularly if there is concern for disease outside the ovary. Multimodal assessment tools that use ultrasonography and biomarkers, such as the risk of malignancy index, are useful in the diagnosis and exclusion of malignant causes. Asymptomatic masses that are determined to be benign may be observed and managed expectantly. In symptomatic or emergent cases, such as ectopic pregnancy or ovarian torsion, a gynecologist should be consulted. In any adnexal mass with high risk for malignancy, a consultation with gynecologic oncology is indicated.
Topics: Pregnancy; Female; Humans; Adnexal Diseases; Ultrasonography; Pregnancy, Ectopic; Diagnosis, Differential; Neoplasms; Ovarian Neoplasms
PubMed: 38215419
DOI: No ID Found -
Seminars in Ultrasound, CT, and MR Dec 2023The most common origin of a non-uterine pelvic mass is from the ovary. Ultrasound is the initial imaging modality of choice, additional imaging with computed tomography... (Review)
Review
The most common origin of a non-uterine pelvic mass is from the ovary. Ultrasound is the initial imaging modality of choice, additional imaging with computed tomography (CT) and/or magnetic resonance imaging (MRI) is performed in selected cases. Adnexal masses are also encountered as incidental findings during ultrasound, CT or MRI. Many of the adnexal masses that are surgically removed are benign. For optimal outcome and cost effective management, noninvasive risk stratification of such adnexal masses is necessary when discovered incidentally or when identified in a patient with a clinically detected pelvic mass. The American College of Radiology Ovarian-Adnexal Reporting Data System is a pattern-based scoring system for adnexal masses imaged with ultrasound and MRI, which assists clinicians to guide in the appropriate management based on evidence-based risk categories. Non-ovarian and non-uterine pelvic masses include fallopian tube abnormalities, paraovarian cysts, peritoneal inclusion cysts, and rare causes include masses that arise from the gastrointestinal tract or the sacrum. To distinguish non-ovarian masses from an ovarian tumor, a critical step is to identify a normal appearing ovary separate from the pelvic mass. This may be challenging in the post-menopausal woman with an atrophic ovary. MRI is a useful adjunctive modality in such cases. Extraovarian masses typically displace pelvic side wall vasculature medially, compress, encase or medially displace the ureters.
Topics: Female; Humans; Ultrasonography; Tomography, X-Ray Computed; Ovarian Neoplasms; Magnetic Resonance Imaging; Adnexal Diseases; Cysts
PubMed: 37839652
DOI: 10.1053/j.sult.2023.10.005