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Journal of Obstetrics and Gynaecology :... Jul 2022Endometriotic ovarian cysts are one of the more common gynecological disorders found in reproductive-aged and infertile women. The aim of this review is to summarise... (Review)
Review
Endometriotic ovarian cysts are one of the more common gynecological disorders found in reproductive-aged and infertile women. The aim of this review is to summarise information regarding the effect of surgical treatment of endometrioma on ovarian reserve. In women with endometrioma ovarian reserve is decreased compared to similarly aged healthy women and surgical management techniques cause an additional reduction. Evidence suggests that laparoscopic ovarian cystectomy via stripping is the preferable surgical technique for management of endometrioma, compared with excisional/ablative techniques, in the fields of pain improvement, spontaneous pregnancy rates, and ovarian cyst recurrences. Ablation techniques, combined technique and three-step approach demonstrate a less decline in anti-Müllerian hormone postoperatively. A successful operation involves not only removal of ovarian pathology, but also maintenance of ovarian function and future reproductive potential. Patients should be counselled about the risks of surgery and the management plan should be individualised to patient's symptoms and reproductive goals.
Topics: Adult; Anti-Mullerian Hormone; Endometriosis; Female; Humans; Infertility, Female; Laparoscopy; Ovarian Cysts; Ovarian Reserve
PubMed: 34693862
DOI: 10.1080/01443615.2021.1962817 -
Ginekologia Polska 2022This study presents current recommendations of the Polish Association of Pediatric Surgeons (PTChD) regarding diagnostics and treatment of ovarian lesions in girls. They... (Review)
Review
This study presents current recommendations of the Polish Association of Pediatric Surgeons (PTChD) regarding diagnostics and treatment of ovarian lesions in girls. They are based on many years of the authors' clinical experience as well as a review of international literature and include practical clinical guidelines. The recommendations were formulated in cooperation with the Polish Association of Pediatric Oncology and Hematology (PTOHD), Polish Pediatric and Adolescent Gynecology Section of the Polish Society of Gynecologists and Obstetricians (PTG) and Polish Pediatric Section of the Polish Society of Radiology (PLTR). Only better understanding of prepubertal ovarian biology and natural history of its pathology may help to introduce efficient and safe diagnostic and therapeutic strategies for girls. The prepared document has been supplemented with treatment algorithms.
Topics: Female; Adolescent; Child; Humans; Ovarian Cysts; Ovarian Neoplasms; Gynecology; Societies, Medical; Surgeons; Poland
PubMed: 35072262
DOI: 10.5603/GP.a2021.0170 -
Pediatric Surgery International Nov 2022Antenatal auto-amputation of the ovary is an extremely rare event, and its diagnosis is difficult. We aimed to retrospectively review the cases with antenatal...
PURPOSE
Antenatal auto-amputation of the ovary is an extremely rare event, and its diagnosis is difficult. We aimed to retrospectively review the cases with antenatal auto-amputation, where the diagnosis was made based on detection of free-floating cyst during surgery.
METHODS
Patients diagnosed with auto-amputated ovary during the surgery between 2012 and 2021 were included in the study. The data were reviewed retrospectively. Clinical, radiological, surgical, and histopathological findings were recorded.
RESULTS
Eight patients underwent surgery for an abdominal cystic mass. The age range of patients who were operated was from 21 days to 9 months. None of the patients had symptoms, except one patient who had a large cyst and was vomiting. Prenatal ultrasound examination indicated an intra-abdominal cyst in all patients, but auto-amputated ovary diagnosis was not made. Differential postnatal diagnoses included an ovarian cyst, ovarian teratoma, tuba-ovarian torsion, mesenteric lymphatic malformation, and intestinal duplication cyst. Only one patient had an auto-amputated ovary suspicion in computed tomography. Laparoscopic exploration (n: 7) or laparotomy (n: 1) was performed. Histopathologic examination was necrosis and calcification (n: 6), necrosis (n: 1), and serous cystadenoma and necrosis (n: 1).
CONCLUSION
We suggest that laparoscopy should be used for diagnosis and treatment of antenatal intra-abdominal cysts that persist postnatally because of diagnostic dilemmas. We recommend in patients diagnosed with auto-amputated ovary that the other ovary should be carefully monitored and followed up in terms of ovarian cyst, due to the possible risk of torsion.
Topics: Cysts; Female; Humans; Infant; Infant, Newborn; Laparoscopy; Necrosis; Ovarian Cysts; Pregnancy; Retrospective Studies; Torsion Abnormality
PubMed: 35964259
DOI: 10.1007/s00383-022-05192-1 -
Medicina (Kaunas, Lithuania) Apr 2023: Fetal ovarian cysts (FOCs) are a very rare pathology that can be associated with maternal-fetal and neonatal complications. The aim of this study was to assess the...
: Fetal ovarian cysts (FOCs) are a very rare pathology that can be associated with maternal-fetal and neonatal complications. The aim of this study was to assess the influence of ultrasound characteristics on FOC evolution and therapeutic management. : We included cases admitted to our perinatal tertiary center between August 2016 and December 2022 with a prenatal or postnatal ultrasound evaluation indicative of FOC. We retrospectively analyzed the pre- and postnatal medical records, sonographic findings, operation protocols, and pathology reports. : This study investigated 20 cases of FOCs, of which 17 (85%) were diagnosed prenatally and 3 (15%) postnatally. The mean size of prenatally diagnosed ovarian cysts was 34.64 ± 12.53 mm for simple ovarian cysts and 55.16 ± 21.01 mm for complex ovarian cysts ( = 0.01). The simple FOCs ≤ 4 cm underwent resorption (n = 7, 70%) or size reduction (n = 3, 30%) without complications. Only 1 simple FOC greater than 4 cm reduced its size during follow-up, while 2 cases (66.6%) were complicated with ovarian torsion. Complex ovarian cysts diagnosed prenatally underwent resorption in only 1 case (25%), reduced in size in 1 case (25%), and were complicated with ovarian torsion in 2 cases (50%). Moreover, 2 simple (66.6%) and 1 complex (33.3%) fetal ovarian cysts were postnatally diagnosed. All of these simple ovarian cysts had a maximum diameter of ≤4 cm, and all of them underwent size reduction. The complex ovarian cyst of 4 cm underwent resorption during follow-up. : Symptomatic neonatal ovarian cysts, as well as those that grow in size during sonographic follow-up, are in danger of ovarian torsion and should be operated on. Complex cysts and large cysts (with >4 cm diameter) could be followed up unless they become symptomatic or increase in dimensions during serial ultrasounds.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Retrospective Studies; Ovarian Torsion; Ultrasonography, Prenatal; Fetal Diseases; Ovarian Cysts
PubMed: 37109673
DOI: 10.3390/medicina59040715 -
BMC Complementary Medicine and Therapies Dec 2023Polycystic ovary syndrome (PCOS) is a complex endocrine and metabolic disorder that is common in women of reproductive age. The clinical features of PCOS include...
BACKGROUND
Polycystic ovary syndrome (PCOS) is a complex endocrine and metabolic disorder that is common in women of reproductive age. The clinical features of PCOS include hyperandrogenemia and polycystic ovarian changes. Bailing capsule (BL), a proprietary Chinese medicine that contains fermented Cordyceps sinensis powder, has been applied to treat PCOS. However, the specific active ingredients of BL and its mechanisms of action are yet to be elucidated.
METHODS
Initially, the effectiveness of BL on PCOS model mice was evaluated. Subsequently, the active ingredients of BL were searched in the TCMSP and TCM Systems Pharmacology databases, and their targets were predicted using Swiss Target Prediction and SEA databases. Furthermore, the GEO gene database was used to screen for differentially expressed genes (DEGs) related to PCOS. Data from Gene Card, OMIM, DDT, and Drugbank databases were then combined to establish a PCOS disease gene library. Cross targets were imported into the STRING database to construct a protein-protein interaction network. In addition, GO and KEGG pathway enrichment analyses were performed using Metascape and DAVID databases and visualized using Cytoscape software and R 4.2.3. The core targets were docked with SYBYL-X software, and their expressions in PCOS mice were further verified using qPCR.
RESULTS
The core active ingredients of BL were identified to be linoleyl acetate, cholesteryl palmitate, arachidonic acid, among others. Microarray data sets from four groups containing disease and normal samples were obtained from the GEO database. A total of 491 DEGs and 106 drug-disease cross genes were selected. Estrous cycle and ovarian lesions were found to be improved in PCOS model mice following BL treatment. While the levels of testosterone, progesterone, and prolactin decreased, that of estradiol increased. qPCR findings indicated that the expressions of JAK2, PPARG, PI3K, and AKT1 were upregulated, whereas those of ESR1 and IRS1 were downregulated in PCOS model mice. After the administration of BL, the expressions of associated genes were regulated. This study demonstrated that BL exerted anti-PCOS effects via PIK3CA, ESR1, AKT, PPARG, and IRS1 targets affecting PI3K-Akt signaling pathways.
DISCUSSION
This research clarified the multicomponent, multitarget, and multichannel action of BL and provided a theoretical reference for further investigations on its pharmacological basis and molecular mechanisms against PCOS.
Topics: Female; Humans; Animals; Mice; Polycystic Ovary Syndrome; Network Pharmacology; Ovarian Cysts; PPAR gamma; Phosphatidylinositol 3-Kinases; Proto-Oncogene Proteins c-akt; Ovarian Neoplasms; Computational Biology
PubMed: 38102584
DOI: 10.1186/s12906-023-04280-6 -
Neuro-Chirurgie Apr 2021Abdominal pseudocysts are common complications of ventriculoperitoneal shunt (VPS). We report the case of a 37-year-old woman treated by VPS for congenital obstructive...
Abdominal pseudocysts are common complications of ventriculoperitoneal shunt (VPS). We report the case of a 37-year-old woman treated by VPS for congenital obstructive hydrocephalus, who presented shunt dysfunction related to a voluminous abdominal cyst initially diagnosed as cerebrospinal fluid pseudocyst. The cyst was drained and the VPS was removed after endoscopic third ventriculocisternostomy (ETV). A few months later, a large new abdominal cyst appeared and was operated on. Diagnosis was rectified as massive ovarian mucinous cystadenoma. In any intra-abdominal cyst, differential diagnoses need considering to avoid mis-diagnosis in shunted patients, especially if the cyst is very large. The etiology of the hydrocephalus should also be investigated in case of shunt dysfunction. Even in case of longstanding shunt, ETV can be an alternative to shunt revision surgery in obstructive hydrocephalus, enabling VPS withdrawal and treatment of the hydrocephalus.
Topics: Adult; Diagnostic Errors; Female; Humans; Hydrocephalus; Laparotomy; Ovarian Cysts; Postoperative Complications; Reoperation; Ventriculoperitoneal Shunt; Ventriculostomy
PubMed: 33166567
DOI: 10.1016/j.neuchi.2020.09.012 -
Menopause (New York, N.Y.) May 2023
Topics: Female; Humans; Follow-Up Studies; Ovarian Cysts; Ultrasonography; Retrospective Studies; Ovarian Neoplasms
PubMed: 37074211
DOI: 10.1097/GME.0000000000002189 -
Gynecological Endocrinology : the... Dec 2022Diminished ovarian reserve can be characterized by poor response to ovulation and low number of eggs. The risk factors include endometriosis, receiving cancer...
Diminished ovarian reserve can be characterized by poor response to ovulation and low number of eggs. The risk factors include endometriosis, receiving cancer treatment, luteal phase deficiency and gynecologic surgery. Uterine fibroids and ovarian cysts are the most common benign gynecological diseases in women globally. This prospective study evaluated the influence of laparoscopic surgery treating benign gynecological diseases on ovarian reserve. A total of 121 patients with uterine fibroids or benign ovarian cysts who received laparoscopic surgeries (41 with hysterectomy, 36 with myomectomy, 18 with adnexectomy, and 26 with ovarian cystectomy) were included. The ovarian reserve status defined as serum anti-Mullerian hormone concentration was assessed at 1 month before and after surgery, respectively. The anti-Mullerian hormone reduction level was 22.34% in cystectomy, 44.1% in adnexectomy, 24.92% in myomectomy, and 47.61% in hysterectomy ( < 0.001). Multivariate analysis showed that adnexectomy had significantly high risk of high serum anti-Mullerian hormone reduction level (adjusted odds ratio (aOR): 14.90, 95% confidence interval (CI): 2.56-86.93, = 0.003). These 4 laparoscopic surgeries all reduced the AMH levels 1 month after the procedure. Further prospective studies with longer follow-up are necessary to know the real impact on the ovarian reserve. Adnexectomy was an independent factor of reduced ovarian reserve in 1 month after surgery.
Topics: Female; Humans; Prospective Studies; Ovarian Reserve; Anti-Mullerian Hormone; Ovarian Cysts; Endometriosis; Leiomyoma; Laparoscopy
PubMed: 36198327
DOI: 10.1080/09513590.2022.2128104 -
Journal of Gynecology Obstetrics and... Jun 2021Ovarian masses in pediatric population are the most common genital neoplasms, and these masses are often benign. The purpose of this study is to evaluate the pediatric...
PURPOSE
Ovarian masses in pediatric population are the most common genital neoplasms, and these masses are often benign. The purpose of this study is to evaluate the pediatric ovarian masses operated in our hospital.
METHOD
The records of patients, under the age of 18 who were operated in our hospital due to ovarian mass between 2012 and 2018 were reviewed retrospectively. Clinical findings, operational procedures, histopathologies, tumor markers and radiological images were evaluated.
FINDINGS
During the study, 146 patients (5 patients were bilateral) were evaluated. The average age of the study patients was 14.01 ± 4.02 years. 107 of the study patients were benign, 37 were malignant and 2 were borderline. The most common symptom in benign masses was tenderness in lower abdominal (75.7 %). 124 of the patients (86.1 %) were in post-menarche period. 34 of the patients had ovarian torsion. Open surgery was conducted on 79.5 % (116/146) of the patients, and laparoscopic surgery was conducted on 20.5 % (30/146). The rate of oophorectomy was 24.6 % (36/146) throughout the operations. The most frequently conducted surgical procedure was cyst excision in benign masses and oophorectomy in malignant masses. In neoplastic masses, the ratio of pelvic mass palpation; and in non-neoplastic masses, lower abdominal tenderness was more apparent. The rate of ovarian torsion was 23.6 % (25/107) in benign masses and 24.3 % (9/37) in malignant masses.
OUTCOMES
Pediatric and adolescent ovarian masses are mostly benign and majority of these occur at post-menarche period. The most common symptom was pelvic tenderness in benign masses, and palpable pelvic masses in malignant masses. For future fertility and low incidence of malignancy in these patients, ovarian preserving surgery should be considered for the first operation.
Topics: Abdominal Pain; Adolescent; Child; Cystadenocarcinoma; Dysgerminoma; Female; Humans; Laparoscopy; Ovarian Cysts; Ovarian Neoplasms; Ovarian Torsion; Ovariectomy; Retrospective Studies; Teratoma
PubMed: 32889112
DOI: 10.1016/j.jogoh.2020.101901 -
Journal of Minimally Invasive Gynecology Aug 2022To show a new mini-invasive surgical technique of ovarian drilling and fertility workup using transvaginal natural orifice transluminal endoscopic surgery (vNOTES).
STUDY OBJECTIVE
To show a new mini-invasive surgical technique of ovarian drilling and fertility workup using transvaginal natural orifice transluminal endoscopic surgery (vNOTES).
DESIGN
Stepwise demonstration of the technique with narrated video footage.
SETTING
Ovarian drilling is a surgical technique for patients with dysovulatory polycystic ovary syndrome. The aim of this technique is to destroy 5% to 10% of the ovarian cortex to restore spontaneous ovulation. Drilling is proposed as a second-line treatment in case of failure of treatments with clomid, metformin, or letrozole. The Cochrane 2020 review shows that drilling has the same pregnancy rate as the other second-line treatment: stimulation with gonadotropins [1]. After ovarian drilling, the results show 80% of spontaneous ovulation within 3 months and 50% of spontaneous pregnancy within a year; these results are effective in the long term [2]. The techniques used until now were either classic laparoscopy or transvaginal hydrolaparoscopy, which is currently not feasible owing to the cessation of the kit [3,4]. We present to you a new surgical technique: ovarian drilling by vNOTES. This new technique is minimally invasive, without scarring on the abdomen, and very well tolerated. It allows simultaneous ovarian drilling and fertility workup with assessment of tubal patency and uterine cavity by hysteroscopy. It is recommended to use bipolar energy to reduce ovarian lesions and limit the risk of adhesion [5].
INTERVENTIONS
Transvaginal laparoscopic ovarian drilling is a minimally invasive surgical technique using a vNOTES kit from Applied Medical (Rancho Santa Margarita, CA), a hysteroscope of 5 mm with an operating channel from Delmont Imaging (La Ciotat, France), and a bipolar spring electrode, Versapoint from Olympus (Hamburg, Germany). The key steps to perform this surgery are as follows: 1. Perform a diagnostic hysteroscopy with vaginoscopy 2. Perform a posterior colpotomy 3. Introduce the Alexis retractor into the Douglas and place the GelPOINT with 2 sleeves 4. Introduce the hysteroscope into the pelvic cavity with serum saline, using a pressure of approximately 150 mm Hg 5. Drill approximately 10 holes on each ovary using the bipolar electrode 6. Explore the pelvic cavity with the possibility of performing a blue test for tubal patency 7. Suture the posterior vagina CONCLUSION: Ovarian drilling is a surgical treatment proposed after the failure of first-line treatments in polycystic ovary syndrome to obtain long-term spontaneous ovulations. The development of minimally invasive techniques such as vNOTES will highlight this treatment and allow it to be performed easily and with minimal adverse effects on patients, especially in bariatric women for whom the vNOTES technique provides easier access to their pelvic cavity than abdominal laparoscopy.
Topics: Colpotomy; Female; Humans; Laparoscopy; Natural Orifice Endoscopic Surgery; Ovarian Cysts; Ovarian Neoplasms; Polycystic Ovary Syndrome; Pregnancy
PubMed: 35697286
DOI: 10.1016/j.jmig.2022.06.007