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Gynecologic Oncology Reports Apr 2023Giant malignant tumors have an increased risk of intraoperative rupture, which might lead to a worse disease condition and tumor recurrence. We performed a clinical...
BACKGROUND
Giant malignant tumors have an increased risk of intraoperative rupture, which might lead to a worse disease condition and tumor recurrence. We performed a clinical study on patients with a giant ovarian mass who underwent laparoscopy combined with an Aron Alpha method.
METHODS
This retrospective clinical study spanned from January 2016 to September 2022 and included 23 patients with giant ovarian tumors treated with an Aron Alpha method.
RESULTS
The mean age of the subjects was 47.6 ± 17.8 years, mean tumor diameter 20.4 ± 5.8 cm, mean surgical duration 87.2 ± 33.1 min, and mean hemorrhage volume 94.1 ± 92.2 mL. No patient experienced intraoperative tumor rupture or surgery-related symptoms. Histopathology of excised samples revealed serous cyst adenoma and mucinous cystadenoma, mucinous cystadenoma of borderline malignancy and mature cystic teratoma, and endometriotic cyst adenoma in 6, 4, and 3 patients, respectively. The mean hospitalization period was 6.0 ± 1.2 days, and the hospitalization period was not extended in any subject.
CONCLUSION
The Aron Alpha method allows tumor resection without capsular rupture and is a useful, minimally invasive surgical method for resecting giant ovarian tumors in which malignancy cannot be ruled out.
PubMed: 37033210
DOI: 10.1016/j.gore.2023.101167 -
Medicina (Kaunas, Lithuania) Jul 2021: To introduce a new technique for fast leakage-proof, intraumbilical, single-incision laparoscopic ovarian cystectomy for huge ovarian masses (>10 cm) : Seven...
: To introduce a new technique for fast leakage-proof, intraumbilical, single-incision laparoscopic ovarian cystectomy for huge ovarian masses (>10 cm) : Seven consecutive, reproductive-aged women, including three adolescents, with huge ovarian masses (mature cystic teratoma, = 4; endometrioma, = 2; and mucinous cystadenoma, = 1) who underwent transumbilical single-incision ovarian cystectomy with the new "hybrid cystectomy and reimplantation" method were included. The procedure was: (1) trans-umbilical single-incision laparoscopy; (2) inspection of the pelvic cavity and placing the mass in a laparoscopic endo-bag for cystic content leakage prevention; (3) in-bag resection using cold scissors and minimal cauterization of the cystectomy site; (4) in-bag tissue extraction; (5) rapid extracorporeal cystectomy with traction without electrocautery; (6) re-insertion of the retrieved ovarian cortex intracorporeally through the single port, and (7) intracorporeal suture of the retrieved tissue to the in situ ovary. : The mean patient age was 24.71 ± 6.56 (range 17-37) years and the mean maximal diameter of the masses was 17.71 ± 2.86 (range 13-22) cm. There was no case of unintended intracorporeal cyst rupture and no need for copious irrigation for washing and suctioning the leaked mass content. The mean total operating time was 76.42 ± 6.39 (range 65-85) min, the total volume of saline used for irrigation was 814.28 ± 331.35 (range 500-1500) mL, and the estimated blood loss was 107.14 ± 47.72 (range 50-200) mL. There were no perioperative complications. All patients except the two endometriosis patients had regular, normal menstruation. : Our preliminary findings were encouraging in terms of the safety and efficiency of the new method. Future trials need to elucidate the benefits of this method in terms of fertility preservation.
Topics: Adolescent; Adult; Cystectomy; Female; Humans; Laparoscopy; Ovarian Neoplasms; Ovariectomy; Replantation; Young Adult
PubMed: 34356961
DOI: 10.3390/medicina57070680 -
The Journal of International Medical... May 2023To clarify the clinical characteristics and laparoscopic surgical outcomes of dermoid cysts complicated by spontaneous rupture. (Review)
Review
OBJECTIVE
To clarify the clinical characteristics and laparoscopic surgical outcomes of dermoid cysts complicated by spontaneous rupture.
METHODS
This was a single-center retrospective observational study of patients with dermoid cysts treated between January 2005 and December 2021.
RESULTS
Among 1205 cases of dermoid cysts, spontaneous rupture occurred in nine and torsion occurred in 83 cases. No obvious triggers for rupture were identified, except for one postpartum case with fundal uterine pressure maneuver. Rupture was identified by computed tomography (CT) in six cases. Patients with ruptured cysts had significantly higher serum C-reactive protein (CRP), cancer antigen 125 (CA125), carbohydrate antigen 19-9 (CA19-9), and squamous cell carcinoma antigen (SCC) levels compared with patients with uncomplicated dermoid cysts or cysts with torsion. Laparoscopic management was possible except for one case with severe adhesion, which required laparotomy. Two patients required prolonged postoperative administration of antibiotics due to refractory chemical peritonitis.
CONCLUSION
Combined use of CT imaging and elevated levels of CRP, CA125, CA19-9, and SCC may help to differentiate cyst rupture from torsion. Laparoscopic surgery may be a feasible option; however, prompt laparotomic conversion should be considered in cases with difficult adhesiolysis. Refractory chemical peritonitis may occur after successful surgical management.
Topics: Female; Humans; Dermoid Cyst; Rupture, Spontaneous; CA-19-9 Antigen; Retrospective Studies; Laparoscopy; Ovarian Neoplasms; Peritonitis; Burns, Chemical; C-Reactive Protein; CA-125 Antigen; Treatment Outcome; Observational Studies as Topic
PubMed: 37138472
DOI: 10.1177/03000605231171023 -
Annals of Medicine and Surgery (2012) Jun 2023Ovarian vein thrombosis (OVT) is a rare condition most frequently seen in the immediate postpartum period. Typical symptoms include pelvic pain, fever, and abdominal...
UNLABELLED
Ovarian vein thrombosis (OVT) is a rare condition most frequently seen in the immediate postpartum period. Typical symptoms include pelvic pain, fever, and abdominal mass. Although a rare diagnosis, OVT can potentially cause fatal complications; thus, early recognition and prompt treatment is important.
CASE PRESENTATION
We present a case of a 30-year-old lady, G4P3A0, previously healthy, who presented at 29+3 weeks to the hospital for preterm premature rupture of membrane. The patient had a Cesarean section (C-section), which was complicated with uterine atony and massive bleeding controlled by emergent intrauterine balloon tamponade and uterine artery embolization. The next day, the patient complained of new-onset right lower quadrant abdominal pain, for which she had an abdominal and pelvic computed tomography (CT) scan that showed OVT. Thus, she was started on anticoagulants, and discharged home.
CONCLUSION
OVT is a rare disorder that has been described as occurring mainly during the postpartum period, after pelvic surgery, or in women with gynecological malignancies. Clinical features of OVT include fever, abdominal pain and tenderness, and a palpable abdominal mass. Diagnosis can be obtained using CT, magnetic resonance (MR), or ultrasound (US) Doppler. Treatment includes a combination of anticoagulants and antibiotics. Mortality is low nowadays.
PubMed: 37363500
DOI: 10.1097/MS9.0000000000000838 -
International Journal of Molecular... Sep 2019Progesterone is widely used to induce maturation of isolated fully grown oocytes of the African clawed frog, . However, the hormone fails to release oocytes from the...
Progesterone is widely used to induce maturation of isolated fully grown oocytes of the African clawed frog, . However, the hormone fails to release oocytes from the layer of surrounding follicle cells. Here, we report that maturation and follicle rupture can be recapitulated in vitro by treating isolated follicular oocytes with progesterone and low doses of the matrix metalloproteinase (MMP), collagenase, which are ineffective in the absence of the steroid. Using this in vitro ovulation model, we demonstrate that germinal vesicle breakdown (GVBD) and oocyte liberation from ovarian follicles occur synchronously during ovulation. Inhibition of the MAPK pathway in these experimental settings suppresses both GVBD and follicular rupture, whereas inhibition of MMP activity delays follicular rupture without affecting GVBD. These results highlight importance of MAPK and MMP activities in the ovulation process and provide the first evidence for their involvement in the release of oocytes from ovarian follicles in frogs. The in vitro ovulation model developed in our study can be employed for further dissection of ovulation.
Topics: Animals; Cell Culture Techniques; Cells, Cultured; Female; Gonadal Steroid Hormones; MAP Kinase Signaling System; Matrix Metalloproteinase Inhibitors; Oocytes; Ovarian Follicle; Ovulation; Sexual Maturation; Xenopus laevis
PubMed: 31561408
DOI: 10.3390/ijms20194766 -
BMC Pediatrics Aug 2023Hepatocellular adenomas (HCAs) are rare benign tumors of the liver that occur predominantly in women taking oral contraceptives. In children, HCAs comprise < 5% of... (Review)
Review
BACKGROUND
Hepatocellular adenomas (HCAs) are rare benign tumors of the liver that occur predominantly in women taking oral contraceptives. In children, HCAs comprise < 5% of hepatic tumors. We report a case of HCAs in a 7-year-old girl with estrogen and glucose imbalance.
CASE PRESENTATION
A 7-year-old girl was presented to our hospital with bilateral breast enlargement for 2 months, polydipsia, polyuria, polyphagia, hyperglycemia, and significant weight gain. Computed tomography (CT) showed a 7.2 cm×6.9 cm×5.3 cm round-shaped mass in the left inner lobe of the liver, ovarian ultrasound showed multiple follicles in the ovaries bilaterally, and cranial magnetic resonance imaging (MRI) showed an enlarged superior pituitary. Hematological and biochemical results were as follows: fasting glucose was 19.7 mmol/L, estradiol was 122.9 pmol/L, follicle-stimulating hormone 10.81 IU/L, luteinizing hormone 10.99 IU/L, insulin-like growth factor 1,513 ng/mL, glutamine aminotransferase 86 U/L, and alkaline phosphatase 362 U/L. Thyroid functions, methemoglobin, fetal protein, carcinoembryonic antigen, and chorionic gonadotropin were normal. The patient had a complete surgical resection of the liver tumor, and the postoperative histopathological diagnosis was HCAs. After the surgery, insulin was injected and the glucose levels were stable. During the 36-month follow-up period, neither tumor recurrence nor significant abnormalities were detected using color Doppler ultrasound of the liver. The child's precocious puberty is currently under control.
CONCLUSIONS
HCAs are particularly rare in children with liver tumors, and risk factors for the development of HCAs in children include sex hormone imbalance, obesity, Fanconi anemia (FA), glycogen storage diseases (GSDs) type I, III, and IV, galactosemia, immunodeficiency, congenital portosystemic shunts (CPSS), cardiac hepatopathy status-post Fontan procedure, Hurler syndrome, familial adenomatous polyposis, germline HNF1A mutations, and maturity-onset diabetes of the young type 3. Most HCAs are detected during a physical examination without clinical symptoms, and some patients may present with symptoms such as abdominal pain, abdominal distension, and abdominal masse. Serum liver function tests can show increased alkaline phosphatase (ALP) and γ- glutamyl transferase (GT), whereas α-Fetoprofein (AFP) levels are normal. The definitive diagnosis relies mainly on histopathological examination. Because HCAs can rupture and bleed and become malignant. Early surgical treatment is recommended after detection.
Topics: Child; Humans; Female; Adenoma, Liver Cell; Alkaline Phosphatase; Neoplasm Recurrence, Local; Liver Neoplasms
PubMed: 37620840
DOI: 10.1186/s12887-023-04209-5 -
Frontiers in Oncology 2022The study retrospectively analyzed the clinical characteristics and prognosis of 17 cases of pregnancy complicated by borderline ovarian tumors to provide help for...
OBJECTIVE
The study retrospectively analyzed the clinical characteristics and prognosis of 17 cases of pregnancy complicated by borderline ovarian tumors to provide help for clinical workers.
MATERIALS AND METHODS
The clinicopathological data of 17 patients with ovarian borderline tumors during pregnancy at the Shengjing Hospital of China Medical University from January 2015 to June 2021 were collected and analyzed retrospectively. The average age of the patients was 31.82 years (25-45 years), the average number of pregnancies was 2.06 times (1-6 times), and the average number of births was 0.41 times (0-1 time).
RESULTS
Among the 17 patients, 4 were diagnosed in the first trimester, 2 in the second trimester, and 11 in the third trimester. Most of the first symptoms were cysts, cyst enlargement, or cyst rupture. Among them, 3 cases (1 in the first trimester and 2 in the second trimester) continued pregnancy after a conservative operation, 9 cases underwent cesarean section and a conservative operation simultaneously, and the mother and child had a good outcome. Two cases underwent conservative operations and induced abortion, and 1 case underwent an ectopic pregnancy operation at the same time. The prognosis of the patients was good without recurrence.
CONCLUSION
Preoperative diagnosis of borderline ovarian tumors in pregnancy is delayed, and imaging and tumor markers are not specific. The coincidence rate between intraoperative frozen pathology and postoperative paraffin pathology was not high. Borderline tumors are mainly treated by surgery, and the prognosis for mothers and infants is good.
PubMed: 35912239
DOI: 10.3389/fonc.2022.934751 -
The British Journal of Radiology Jan 2021Corpus luteum rupture presenting as acute abdomen is an underdiagnosed condition. Though a self-limiting entity, its differentiation from other causes is essential to... (Review)
Review
Corpus luteum rupture presenting as acute abdomen is an underdiagnosed condition. Though a self-limiting entity, its differentiation from other causes is essential to prevent unnecessary surgical procedures. The radiologist should be aware of the possibility of a ruptured haemorrhagic ovarian cyst in a female of reproductive age group presenting with pelvic pain and a large amount of haemorrhagic ascites. Imaging characteristically reveals a thick-walled cystic structure in the adnexa with internal echoes, focal discontinuity or irregularity of its wall with haemoperitoneum. While sonography is usually indicative of corpus luteum rupture, cross-sectional imaging (CT/MRI) can be used to confirm the diagnosis.
Topics: Abdomen, Acute; Corpus Luteum; Diagnosis, Differential; Female; Hemoperitoneum; Humans; Magnetic Resonance Imaging; Multimodal Imaging; Rupture, Spontaneous; Tomography, X-Ray Computed; Ultrasonography
PubMed: 32822245
DOI: 10.1259/bjr.20200383 -
Radiology Case Reports Jan 2023Cryptorchidism is a relatively common and important clinical entity and can lead to an array of downstream complications if it is not corrected in a timely manner, most...
Cryptorchidism is a relatively common and important clinical entity and can lead to an array of downstream complications if it is not corrected in a timely manner, most notably with the development of testicular germ cell tumors. However, beyond the development of malignancy, there are other rare complications associated with cryptorchid testicular germ cell tumors which are more commonly seen in females with ovarian germ cell tumors, including torsion, rupture, and paraneoplastic syndromes. Presented is an instructive case (with literature review) of a patient who presented with NMDA encephalitis due to a torsed mixed germ cell tumor of an undescended testis, which subsequently ruptured leading to growing teratoma syndrome.
PubMed: 36345463
DOI: 10.1016/j.radcr.2022.10.022 -
Contraception Jun 2021To evaluate the effects of estetrol 15 mg/drospirenone 3 mg on ovarian function. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To evaluate the effects of estetrol 15 mg/drospirenone 3 mg on ovarian function.
STUDY DESIGN
Single-center, randomized, open-label, parallel study in healthy young women with proven ovulatory cycles. Participants received either estetrol 15 mg/drospirenone 3 mg (E4/DRSP) (n = 41) or ethinylestradiol 20 µg/drospirenone 3 mg (EE/DRSP) (n = 41) in a 24/4-day regimen for 3 consecutive cycles. Follicular size and endometrial thickness were measured by transvaginal ultrasound every 3 days in cycles 1 and 3. Blood was sampled for hormone analysis. Ovarian function expressed as Hoogland score was based on follicular size, serum estradiol (E2) and progesterone (P) concentrations. Ovulation was defined as a ruptured follicle-like structure >13 mm with serum E2 concentrations >100 pmol/L and serum P concentrations >5 nmol/L. We assessed return of ovulation after treatment cessation, and safety throughout the study.
RESULTS
None of the participants ovulated with E4/DRSP use, while one participant ovulated once and one participant ovulated twice during EE/DRSP treatment. Most participants had a Hoogland score of 1 (no ovarian activity) in cycle 1 (85.0% and 82.9% of participants on E4/DRSP and EE/DRSP, respectively) and in cycle 3 (65.8% and 83.8%, respectively). E4/DRSP suppressed follicle-stimulating hormone and luteinizing hormone to a lesser extent than EE/DRSP, whereas both treatments comparably suppressed E2 and P and endometrial thickness. Return of ovulation occurred, on average, 15.5 days after E4/DRSP treatment discontinuation. E4/DRSP was safe and well-tolerated.
CONCLUSIONS
E4 15 mg/DRSP 3 mg results in adequate ovulation inhibition and ovarian function suppression, comparable to a marketed combined oral contraceptive containing EE/DRSP.
IMPLICATIONS STATEMENT
Treatment with E4 15 mg/DRSP 3 mg showed complete ovulation inhibition, despite less suppression of follicle-stimulating hormone and luteinizing hormone compared to EE/DRSP. If it becomes commercially available, E4/DRSP, containing a naturally occurring estrogen, should be as effective as EE/DRSP.
Topics: Androstenes; Contraceptives, Oral, Combined; Estetrol; Estradiol; Estrogens; Ethinyl Estradiol; Female; Humans
PubMed: 33689786
DOI: 10.1016/j.contraception.2021.03.003