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Quantitative Imaging in Medicine and... Jan 2020Differences in the ultrasonographic features and histological diagnosis of ovarian torsion in pregnant and non-pregnant women have not been defined. A better...
BACKGROUND
Differences in the ultrasonographic features and histological diagnosis of ovarian torsion in pregnant and non-pregnant women have not been defined. A better characterization of these features may help improve the accuracy of preoperative diagnosis. The present study aimed to compare the clinical characteristics, sonographic findings, operative procedures, and histological spectrum of ovarian torsion in pregnant and non-pregnant women.
METHODS
This was a retrospective investigation of female patients at reproductive age with ovarian torsion between January 2010 and May 2017. Each patient received a detailed preoperative ultrasound, and the diagnosis was confirmed by surgery. The clinical characteristics, ultrasonic features, operative procedures, and histological diagnosis of ovarian torsion were retrieved from medical records and were compared in non-pregnant and pregnant patients according to the method of conception.
RESULTS
The overall preoperative ultrasonic detection rate of ovarian torsion was 0.84, which was significantly different between pregnant and non-pregnant women. The presence of ovarian edema and abnormal adnexal positions also differed between pregnant and non-pregnant women. The ultrasonic features were not significantly different between the two pregnant sub-groups. The most common histologic diagnoses in the pregnant group and the non-pregnant group were a normal ovary and teratoma, respectively. The incidence of ovarian neoplasm was significantly lower in pregnant women. There were significant differences in the surgical procedures between the groups based on neoplastic or non-neoplastic lesions.
CONCLUSIONS
Ovarian edema, absence/decreased blood flow in the ovary, and the whirlpool sign were reliable ultrasonic markers for ovarian torsion at reproductive ages. The preoperative ultrasonic detection rate of ovarian torsion was higher in pregnant women, and ovarian edema was more common. The clinical features of ovarian torsion in pregnant women were similar, independent of the method of conception. In women with ovarian torsion, the incidence of non-neoplastic lesions was more frequent in pregnant women, whereas neoplastic lesions were more common in non-pregnant women. Ultrasonography provides useful parameters for the preclinical diagnosis of ovarian torsion to improve patient management.
PubMed: 31956537
DOI: 10.21037/qims.2019.11.06 -
Cureus Sep 2022Ovarian cysts are usually asymptomatic and self-resolvable, but large cysts can increase the risk of ovarian torsion or rupture and may be indicated for surgical...
Ovarian cysts are usually asymptomatic and self-resolvable, but large cysts can increase the risk of ovarian torsion or rupture and may be indicated for surgical intervention. We present the case of a large left ovarian cyst in which laparoscopic left salpingo-oophorectomy was challenged by an overlying sigmoid colon with dense adhesions. A 47-year-old female patient presented to the emergency department with abdominal pain in the right lower quadrant. Ultrasound and computed tomography scans found a large left ovarian cyst and multiple small right ovarian cysts. Due to the size of the left ovarian cyst increasing the risk for torsion, the patient was indicated for laparoscopic left salpingo-oophorectomy. However, the cyst was inaccessible due to the overlying sigmoid colon and dense adhesions on all sides. The surgeons elected to drain the cyst, and the patient was counseled that it was safe to monitor for postoperative recurrence over the next three months. Though laparoscopic surgery is considered a gold standard modality for minimally-invasive ovarian cystectomy/oophorectomy, our case illustrates how it can be challenging when treating left-sided adnexal masses in post-hysterectomy patients due to rectosigmoid and adhesional obstruction. In the context of this challenge, our case further demonstrates the importance of preoperative ovarian cancer screening and favoring conservative treatment options whenever possible.
PubMed: 36237789
DOI: 10.7759/cureus.28927 -
Acta Obstetricia Et Gynecologica... Jan 2020The purpose of this study was to investigate the epidemiology and characteristics of surgically treated ovarian lesions in preadolescent girls.
INTRODUCTION
The purpose of this study was to investigate the epidemiology and characteristics of surgically treated ovarian lesions in preadolescent girls.
MATERIAL AND METHODS
This was a retrospective cohort study including all 0- to 11-year-old girls operated at a single center from 1999 to 2016 for ovarian cysts, neoplasms or torsions. Patient charts were reviewed for symptoms, preoperative radiological imaging, operative details and histopathology.
RESULTS
We identified 78 girls, resulting in a population-based incidence of 4.2/100 000. Infants (n = 44) presented with benign cysts (42/44, 95%, one bilateral), a benign neoplasm (1/44, 2%) and a torsion without other pathology (1/44, 2%). Torsion was found in 25/29 (86%) ovaries with complex cysts and in 3/15 (21%) ovaries with simple cysts in preoperative imaging (P < 0.001). Most infants were symptomless. Lesions in 1- to 11-year-old girls (n = 34) included benign neoplasms (n = 21/34, 62%), malignant neoplasms (n = 5/34, 15%), a cyst with torsion (n = 1/34, 3%) and torsions without other pathology (n = 7/34, 21%). Torsion was more common in benign (17/21, 81%) than in malignant neoplasms (1/5, 20%) (P < 0.020). Ovarian diameter did not differ between ovaries with or without torsion (P = 0.238) or between benign and malignant neoplasms (P = 0.293). The duration of symptoms in lesions with or without torsion was similar.
CONCLUSIONS
The majority of surgically treated ovarian lesions in preadolescent are benign lesions with torsion. Surgery should be ovary-preserving and performed without delay.
Topics: Child; Child, Preschool; Female; Finland; Humans; Incidence; Infant; Infant, Newborn; Ovarian Cysts; Ovarian Diseases; Ovarian Neoplasms; Retrospective Studies; Torsion Abnormality
PubMed: 31449329
DOI: 10.1111/aogs.13717 -
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 -
Medical Journal of the Islamic Republic... 2022Lower abdominal or pelvic pain is a common complaint among women and one of the most challenging findings to evaluate. We performed the present study to construct a new...
Lower abdominal or pelvic pain is a common complaint among women and one of the most challenging findings to evaluate. We performed the present study to construct a new algorithm for predicting the chance of ovarian torsion among women with acute lower abdominal pain. This diagnostic retrospective cross-sectional study was performed on all female individuals who were referred to Imam Hossein Medical Center, Tehran, Iran, with the chief complaint of acute lower abdominal pain, and underwent laparotomy between 2010 and 2016. Clinical and paraclinical findings were evaluated to construct a predictive model for ovarian torsion. The variables were compared in 2 groups. The first group included individuals with a final diagnosis of ovarian torsion and the second group included those individuals with any diagnosis other than ovarian torsion. All data were compared between these 2 groups using SPSS software Version 21 to find the related findings with a predictive value for ovarian torsion. A total of 372 participants were evaluated, of whom 116 participants (31.2%) had ovarian torsion (case group) and 256 participants had other diagnoses for their lower abdominal pain (control group). Nausea and vomiting ( < 0.001), tenderness ( < 0.001), the size of ovarian mass ( = 0.004), and the percentage of polymorphonuclear ( < 0.001) showed significant relationships with ovarian torsion as the final diagnosis. Multiple logistic regression models were constructed to predict the factors affecting ovarian torsion, and a scoring system was designed to predict ovarian torsion, with a sensitivity of 77.59% (68.9%- 84.8%) and specificity of 74.61% (68.8% 79.8%). The proposed model is suitable for predicting ovarian torsion and its necessary information is readily available from individuals' history, examination findings, laboratory results, and an ultrasound exam.
PubMed: 36654847
DOI: 10.47176/mjiri.36.147 -
Pediatric Surgery International Jun 2024The management of ovarian torsion in pediatric patients has evolved over time. Ovarian salvage is currently recommended given concerns for fertility preservation and the...
PURPOSE
The management of ovarian torsion in pediatric patients has evolved over time. Ovarian salvage is currently recommended given concerns for fertility preservation and the low likelihood of malignancy. Studies have shown that the incidence of oophorectomy is higher amongst pediatric surgeons in comparison to gynecologists. Using a national database, this study examined how the surgical management of ovarian torsion has evolved.
METHODS
Children with a discharge diagnosis of ovarian torsion (ICD-9 code 620.5, ICD-10 code N835X) and procedure codes for oophorectomy (CCS code 119) were identified within the KID database from 2003, 2006, 2009, 2012, 2016, and 2019. Diagnosis of ovarian pathology was based upon ICD-9 and ICD-10 codes at the time of discharge.
RESULTS
A total of 7008 patients, ages 1-20, had a discharge diagnosis of ovarian torsion. Of those patients, 2,597 (37.1%) were diagnosed with an ovarian cyst, 1560 (22.2%) were diagnosed with a benign ovarian neoplasm, and 30 (0.4%) were diagnosed with a malignant neoplasm. There was a decreased risk of oophorectomy in urban-teaching versus rural hospitals (OR: 0.64, p < 0.001). The rate of oophorectomy has decreased overtime. However, patients with benign or malignant neoplasms were more likely to undergo oophorectomy than those without a diagnosis (OR: 2.03, p < 0.001; 4.82, p < 0.001).
CONCLUSION
The rate of oophorectomy amongst children with ovarian torsion has decreased over time. Yet, despite improvements, oophorectomy is common amongst patients with benign ovarian neoplasms and those treated at rural hospitals. Continued education is needed to optimize patient care in all clinical scenarios.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Female; Ovariectomy; Child; Adolescent; Risk Factors; Ovarian Torsion; Child, Preschool; Infant; Young Adult; Retrospective Studies; Ovarian Neoplasms; United States; Ovarian Cysts; Databases, Factual
PubMed: 38910201
DOI: 10.1007/s00383-024-05743-8 -
Case Reports in Women's Health Jun 2024Torsion occurs as a complication in 10% of cases of ovarian tumors. It predominantly occurs in benign ones, while malignant tumors are less prone to torsion....
Torsion occurs as a complication in 10% of cases of ovarian tumors. It predominantly occurs in benign ones, while malignant tumors are less prone to torsion. Sertoli-Leydig cell tumors are highly unusual sex cord-stromal tumors of the ovary, accounting for less than 0.2% of all ovarian cancers. A 39-year-old patient presented to the emergency department with a Sertoli-Leydig cell tumor diagnosed due to ovarian torsion. The clinical presentation was characterized by abdominal pain. Ultrasound indicated signs of torsion, and torsion of the right ovary was subsequently confirmed during laparotomy. A salpingo-oophorectomy was performed, and histological examination revealed a moderately differentiated Sertoli-Leydig cell tumor. Sertoli-Leydig cell tumors often present with hormone-related or non-hormonal symptoms. Surgery plays a crucial role in both diagnosis and treatment. Postoperative treatment is not necessary for well-differentiated Sertoli-Leydig cell tumors in stage IA-IB. However, patients with grade 2-3 disease, advanced stage, or heterologous elements may consider adjuvant treatment. As these tumors are rare, this case contributes to the documentation of Sertoli-Leydig cell tumors, with a case diagnosed due to ovarian torsion. The case highlights the importance of establishing international registries of Sertoli-Leydig cell tumor cases for standardized management.
PubMed: 38746058
DOI: 10.1016/j.crwh.2024.e00614 -
F&S Reports Dec 2021To highlight the management of massive ovarian edema in young reproductive-age women.
OBJECTIVE
To highlight the management of massive ovarian edema in young reproductive-age women.
DESIGN
A case report of a healthy female with clitoromegaly and elevated androgen levels secondary to massive ovarian edema.
SETTING
Reproductive Endocrinology and Infertility Department of an academic hospital.
PATIENT
A healthy 20-year-old woman who presented for routine gynecological care and was found to have a 2-cm clitoromegaly and elevated androgen levels.
INTERVENTIONS
The patient underwent a diagnostic laparoscopy and right oophorectomy.
MAIN OUTCOME MEASURES
Measurement of androgen levels.
RESULTS
Final pathology showed massive edema of the ovary with no evidence of malignancy or androgen-secreting tumor cells. In addition, resolution of the elevated androgen levels was observed.
CONCLUSIONS
Massive ovarian edema due to asymptomatic subacute torsion should be included in the differential diagnosis of reproductive-age patients who present with ovarian mass and hyperandrogenemia within the tumor range. Although not performed in our case, conservative management that involves detorsion, ovarian biopsy, and oophoropexy to prevent a recurrence should be the treatment of choice.
PubMed: 34934989
DOI: 10.1016/j.xfre.2021.09.006 -
Case Reports in Obstetrics and... 2022Adnexal torsion is the fifth most common gynecologic emergency accounting for approximately 20 to 30% of ovarian surgeries in pediatric patients.
BACKGROUND
Adnexal torsion is the fifth most common gynecologic emergency accounting for approximately 20 to 30% of ovarian surgeries in pediatric patients.
CASE
The patient is a ten-year-old female who presented to the emergency room for severe left lower quadrant abdominal pain. On presentation, she was hemodynamically stable with an acute abdomen. A transabdominal ultrasound showed a predominantly anechoic structure measuring up to 5.6 cm without definitive Doppler flow, concerning for a large cyst causing ovarian torsion. Gynecology was consulted, and the patient underwent a diagnostic laparoscopy, aspiration of the left ovarian cyst, and left ovarian detorsion. Pathology results were consistent with benign cystic contents.
CONCLUSION
Appropriate diagnosis and timely surgical gynecological intervention allowed this pediatric patient to salvage and preserve ovarian function.
PubMed: 35402055
DOI: 10.1155/2022/9419963 -
Turkish Journal of Obstetrics and... Jun 2023Ischemia/reperfusion (I/R) damage following detorsion treatment, tissue fibrosis, and adhesions cause secondary tissue damage in the ovaries. Many studies have been...
OBJECTIVE
Ischemia/reperfusion (I/R) damage following detorsion treatment, tissue fibrosis, and adhesions cause secondary tissue damage in the ovaries. Many studies have been evaluated to minimize antioxidant damage in ovarian reserve loss while minimizing I/R damage. However, no study observed long-term effects on the ovarian torsion model in rats. In this study, we evaluated the profibrotic effects of A. cepa on an ovarian torsion model on rats.
MATERIALS AND METHODS
Group I (n=7) rats were the sham group. Group II (n=7) rats were the torsion group and Group III (n=7) rats were the torsion + A. cepa group. To observe the long-term effects of allium cepa, rats were fed for 21 days. Cellular damage I/R is evaluated by histopathological damage score, and transforming growth factor-beta 1 (TGF-β1) and alpha-smooth muscle actin (α-SMA) is measured to analyze the profibrotic effect.
RESULTS
A. cepa altered cellular damage due to improvement in the histopathological damage score with A. cepa intake. However, the profibrotic mediators TGF-β1 and α-SMA are non- significantly changed by the A. cepa (p=0.477 and p=0.185 respectively).
CONCLUSION
A. cepa is a potent protective on cellular tissue, minimizing I/R damage on ovarian tissue histologically. Our study implies that A. cepa does not affect fibrosis-related mediators in the rat ovary.
PubMed: 37260222
DOI: 10.4274/tjod.galenos.2023.41763