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Indian Journal of Pathology &... 2024The synchronous occurrence of bilateral ovarian tumors and breast malignancy often raise the suspicion of a Krukenberg tumor or a hereditary breast and ovarian cancer...
The synchronous occurrence of bilateral ovarian tumors and breast malignancy often raise the suspicion of a Krukenberg tumor or a hereditary breast and ovarian cancer syndrome, both of which are uncommon in clinical practice. A 58-years-old postmenopausal woman had a right breast lump and was diagnosed as infiltrating duct carcinoma, no special type, and incidentally detected bilateral adnexal mass with the clinical suspicion of Krukenberg tumor. However, following the radical surgical excision of the right breast and bilateral ovaries, the right breast showed invasive micropapillary carcinoma (IMPC) while the ovaries showed mature cystic teratoma (MCT) with benign Brenner tumor. IMPC of the breast along with bilateral ovarian MCT with benign Brenner tumor is an unusual clinical occurrence in a postmenopausal female and thus worthy of documentation. It should be categorized as a non-hereditary synchronous tumor. The histomorphology augmented by immunohistochemistry and appropriate clinical context is pivotal in rendering a correct diagnosis.
Topics: Female; Humans; Middle Aged; Brenner Tumor; Krukenberg Tumor; Postmenopause; Ovarian Neoplasms; Teratoma; Carcinoma
PubMed: 38358219
DOI: 10.4103/ijpm.ijpm_1207_21 -
Acta Obstetricia Et Gynecologica... Jun 2024Salpingitis is caused by ascending microbes from the lower reproductive tract and contributes to tubal factor infertility, ectopic pregnancy, and chronic pelvic pain.... (Observational Study)
Observational Study
INTRODUCTION
Salpingitis is caused by ascending microbes from the lower reproductive tract and contributes to tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. The aim of this study was to analyze if the risk for complications and dissatisfaction after hysterectomy and adnexal surgery was increased in women reporting previous salpingitis.
MATERIAL AND METHODS
This is an observational cohort study including women undergoing gynecologic surgery from 1997 to 2020, registered in the Swedish National Quality Register of Gynecologic Surgery (GynOp). Patient-reported previous salpingitis was the exposure. Complications up to 8 weeks and satisfaction at 1 year postoperatively were the outcomes. Multivariable logistic regression and ordinal regression were performed. Results were adjusted for potential confounders including age, body mass index, smoking and year of procedure as well as endometriosis and previous abdominal surgery. Multiple imputation was used to handle missing data.
RESULTS
In this study, 61 222 women were included, of whom 5636 (9.2%) women reported a previous salpingitis. There was an increased risk for women reporting previous salpingitis in both the unadjusted and fully adjusted models to have complications within 8 weeks of surgery (adjusted odds ratio [aOR] 1.22, 95% confidence interval [CI] 1.14-1.32). The highest odds ratios were found for bowel injury (aOR 1.62, 95% CI 1.29-2.03), bladder injury (aOR 1.52, 95% CI 1.23-1.58), and postoperative pain (aOR 1.37, 95% CI 1.22-1.54). Women exposed to salpingitis were also more likely to report a lower level of satisfaction 1 year after surgery compared with unexposed women (aOR 0.87, 95% CI 0.81-0.92).
CONCLUSIONS
Self-reported salpingitis appears to be a risk factor for complications and dissatisfaction after gynecologic surgery. This implies that known previous salpingitis should be included in the risk assessment before gynecologic procedures.
Topics: Humans; Female; Sweden; Adult; Hysterectomy; Salpingitis; Registries; Cohort Studies; Middle Aged; Postoperative Complications; Patient Reported Outcome Measures; Patient Satisfaction; Adnexal Diseases
PubMed: 38358021
DOI: 10.1111/aogs.14797 -
Cureus Jan 2024Torsion of pedunculated subserosal leiomyoma of the uterus is a rare cause of acute abdomen. A 27-year-old female patient with twisted subserosal pedunculated uterine...
Torsion of pedunculated subserosal leiomyoma of the uterus is a rare cause of acute abdomen. A 27-year-old female patient with twisted subserosal pedunculated uterine leiomyoma misdiagnosed as an adnexal mass underwent laparotomy. The patient came to the Emergency Department of General Hospital of Trikala with symptoms of acute abdomen. Primarily, clinical-laboratory examination, transabdominal ultrasound, raised the suspicion of a twisted adnexal mass. Intraoperatively, a twisted pedunculated subserosal leiomyoma of the uterus was identified and myomectomy was performed. Histological examination of the surgical specimen confirmed the diagnosis. On the third postoperative day, our patient was discharged. This paper underscores the rarity of torsion of the uterine pedunculated subserosal leiomyoma and emphasizes the necessity of urgent surgical intervention. The challenges of preoperative diagnosis are highlighted, especially when modern diagnostic imaging modalities are unavailable.
PubMed: 38344570
DOI: 10.7759/cureus.52136 -
Journal of Surgical Case Reports Feb 2024Uterine lipoleiomyomas are rare variants of uterine leiomyomas which is composed of adipocytes and smooth muscle cells. In this report, we describe the case of a...
Uterine lipoleiomyomas are rare variants of uterine leiomyomas which is composed of adipocytes and smooth muscle cells. In this report, we describe the case of a 39-year-old patient who presented with persistent, isolated pelvic pain. Ultrasonography showed an oval, well-defined left ovarian mass. Computed tomography (CT) scanning showed a predominantly-fatty mass with tissular components, no calcifications and heterogeneously enhanced after injection, suggesting initially a mature teratoma. Magnetic resonance imaging (MRI) findings revealed a latero-uterine mass, suggesting the presence of a left ovarian dermoid cyst with a potentially-malignant fleshy component. A subsequent pathology report revealed a lipoleiomyoma with cartilaginous metaplasia. Most notably, despite the fatty nature of the tumour and the use of MRI, the pedunculated appearance of the lipoleiomyoma observed intraoperatively mimicked a dermoid tumour even on imaging. Improved understanding of leiomyoma variants and secondary degenerative changes can help prevent misdiagnosis.
PubMed: 38344139
DOI: 10.1093/jscr/rjae041 -
Cureus Dec 2023Primary broad ligament fibroids, whose surgical treatment is challenging, are extremely rare. Our case concerns the surgical treatment of a large broad ligament fibroid....
Primary broad ligament fibroids, whose surgical treatment is challenging, are extremely rare. Our case concerns the surgical treatment of a large broad ligament fibroid. A 48-year-old patient, asymptomatic and with a medical history of uterine leiomyomas, came to the gynecology outpatient clinic to undergo a routine gynecological examination. On bimanual pelvic examination, the presence of a painless palpable pelvic mass was found, without being able to clinically demarcate it. Computed tomography imaging confirmed the clinical suspicion of a pelvic mass. The pelvic mass was more consistent with the subserosal pedunculated fibroid of the uterine corpus, but the preoperative diagnosis of adnexal mass cannot be excluded. It was decided to surgical treatment of the patient with a total hysterectomy and bilateral salpingectomy-oophorectomy. Intraoperatively, the presence of a large intraligamental mass was detected. The uterus, cervix, and ovaries were normal but displaced by the tumor. After resection of the leiomyoma from the broad ligament, where it was not found to be connected to a vascular pedicle from the lateral wall of the uterine corpus or the cervix, total hysterectomy and bilateral salpingectomy-oophorectomy were performed, due to the necessary resection of the right fallopian tube and ovary and the extensive injuries in the area. The postoperative course was uneventful. In this paper, following the case presentation, a brief review of primary broad ligament fibroids is presented, emphasizing the significance of comprehensive preoperative planning in the challenging intraoperative management of these patients, who have an increased risk of intraoperative complications.
PubMed: 38299131
DOI: 10.7759/cureus.51415 -
JNMA; Journal of the Nepal Medical... Sep 2023Immature teratoma is one of the rare malignant germ cell tumours presented in pregnancy. Here, we present 26-year-old pregnant women who had an incidental finding of...
UNLABELLED
Immature teratoma is one of the rare malignant germ cell tumours presented in pregnancy. Here, we present 26-year-old pregnant women who had an incidental finding of left adnexal mass in an anomaly scan at 19 weeks of pregnancy. Laparotomy with peritoneal fluid cytology, left salpingo-oophorectomy and omental biopsy at 20 weeks of pregnancy revealed immature teratoma stage 1A, grade 2 in the histopathology report. However, she followed up with the metastatic mass in the pouch of Douglas at 30 weeks of pregnancy in magnetic resonance imaging despite being counselled for possible chemotherapy and surveillance. A baby with a good Apgar score and grade 3 immature teratoma in the metastatic mass was revealed following the exploratory laparotomy and cesarean section at 36 weeks of pregnancy. Fertility-sparing surgery with chemotherapy during pregnancy for high-grade tumours may result in a good prognosis.
KEYWORDS
case reports; chemotherapy; immature teratoma; pregnancy; surgery.
Topics: Pregnancy; Female; Humans; Adult; Ovarian Neoplasms; Cesarean Section; Teratoma; Salpingo-oophorectomy; Pregnancy Complications, Neoplastic
PubMed: 38289795
DOI: 10.31729/jnma.8267 -
Insights Into Imaging Jan 2024Eighteen to 35% of adnexal masses remain non-classified following ultrasonography, leading to unnecessary surgeries and inappropriate management. This finding led to the...
Eighteen to 35% of adnexal masses remain non-classified following ultrasonography, leading to unnecessary surgeries and inappropriate management. This finding led to the conclusion that ultrasonography was insufficient to accurately assess adnexal masses and that a standardized MRI criteria could improve these patients' management. The aim of this work is to present the different steps from the identification of the clinical issue to the daily use of a score and its inclusion in the latest international guidelines. The different steps were the following: (1) preliminary work to formalize the issue, (2) physiopathological analysis and finding dynamic parameters relevant to increase MRI performances, (3) construction and internal validation of a score to predict the nature of the lesion, (4) external multicentric validation (the EURAD study) of the score named O-RADS MRI, and (5) communication and education work to spread its use and inclusion in guidelines. Future steps will include studies at patients' levels and a cost-efficiency analysis. Critical relevance statement We present translating radiological research into a clinical application based on a step-by-step structured and systematic approach methodology to validate MR imaging for the characterization of adnexal mass with the ultimate step of incorporation in the latest worldwide guidelines of the O-RADS MRI reporting system that allows to distinguish benign from malignant ovarian masses with a sensitivity and specificity higher than 90%. Key points • The initial diagnostic test accuracy studies show the limitation of a preoperative assessment of adnexal masses using solely ultrasonography.• The technical developments (DCE/DWI) were investigated with the value of dynamic MRI to accurately predict the nature of benign or malignant lesions to improve management.• The first developing score named ADNEX MR Score was constructed using multiple easily assessed criteria on MRI to classify indeterminate adnexal lesions following ultrasonography.• The multicentric adnexal study externally validated the score creating the O-RADS MR score and leading to its inclusion for daily use in international guidelines.
PubMed: 38289563
DOI: 10.1186/s13244-023-01598-0 -
International Journal of Molecular... Jan 2024Hydrosalpinx is a fluid occlusion and distension of the fallopian tubes, often resulting from pelvic inflammatory disease, which reduces the success of artificial...
Hydrosalpinx is a fluid occlusion and distension of the fallopian tubes, often resulting from pelvic inflammatory disease, which reduces the success of artificial reproductive technologies (ARTs) by 50%. Tubal factors account for approximately 25% of infertility cases, but their underlying molecular mechanisms and functional impact on other reproductive tissues remain poorly understood. This proteomic profiling study applied sequential window acquisition of all theoretical fragment ion spectra mass spectrometry (SWATH-MS) to study hydrosalpinx cyst fluid and pre- and post-salpingectomy endometrial fluid. Among the 967 proteins identified, we found 19 and 17 candidate biomarkers for hydrosalpinx in pre- and post-salpingectomy endometrial fluid, respectively. Salpingectomy significantly affected 76 endometrial proteins, providing insights into the enhanced immune response and inflammation present prior to intervention, and enhanced coagulation cascades and wound healing processes occurring one month after intervention. These findings confirmed that salpingectomy reverses the hydrosalpinx-related functional impairments in the endometrium and set a foundation for further biomarker validation and the development of less-invasive diagnostic strategies for hydrosalpinx.
Topics: Female; Humans; Pilot Projects; Proteomics; Pelvic Inflammatory Disease; Fallopian Tubes; Endometrium
PubMed: 38256043
DOI: 10.3390/ijms25020968 -
International Journal of Surgery Case... Feb 2024Although IUD has become more popular in recent years, its migration through uterine perforation is a rare but serious complication.
INTRODUCTION AND IMPORTANCE
Although IUD has become more popular in recent years, its migration through uterine perforation is a rare but serious complication.
PRESENTATION OF CASE
We present the case of a young otherwise healthy woman with a missing IUD that had penetrated terminal ileum.
CLINICAL DISCUSSION
The incidence of uterine perforation after IUD insertion has been reported 1.3 to 1.6 per 1000 insertions. Although a rare complication, it can cause serious problems requiring major surgery.
CONCLUSION
Uterine perforation and migration of IUD is a rare but serious complication that should be considered in all missing IUD threads.
PubMed: 38245947
DOI: 10.1016/j.ijscr.2024.109279 -
European Journal of Obstetrics,... Mar 2024To assess the potential impact of the O-RADS MRI score on the decision-making process for the management of adnexal masses. (Observational Study)
Observational Study
OBJECTIVE
To assess the potential impact of the O-RADS MRI score on the decision-making process for the management of adnexal masses.
METHODS
EURAD database (prospective, European observational, multicenter study) was queried to identify asymptomatic women without history of infertility included between March 1st and March 31st 2018, with available surgical pathology or clinical findings at 2-year clinical follow-up. Blinded to final diagnosis, we stratified patients into five categories according to the O-RADS MRI score (absent i.e. non adnexal, benign, probably benign, indeterminate, probably malignant). Prospective management was compared to theoretical management according to the score established as following: those with presumed benign masses (scored O-RADS MRI 2 or 3) (follow-up recommended) and those with presumed malignant masses (scored O-RADS MRI 4 or 5) (surgery recommended).
RESULTS
The accuracy of the score for assessing the origin of the mass was of 97.2 % (564/580, CI 0.96-0.98) and was of 92.0 % (484/526) for categorizing lesions with a negative predictive value of 98.1 % (415/423, CI95% 0.96-0.99). Theoretical management using the score would have spared surgery in 229 patients (87.1 %, 229/263) with benign lesions and malignancy would have been missed in 6 borderline and 2 invasive cases. In patients with a presumed benign mass using O-RADS MRI score, recommending surgery for lesions >= 100 mm would miss only 4/77 (4.8 %) malignant adnexal tumors instead of 8 (50 % decrease).
CONCLUSION
The use of O-RADS MRI scoring system could drastically reduce the number of asymptomatic patients undergoing avoidable surgery.
Topics: Female; Humans; Adnexa Uteri; Adnexal Diseases; Magnetic Resonance Imaging; Ovarian Neoplasms; Predictive Value of Tests; Prospective Studies; Sensitivity and Specificity; Ultrasonography
PubMed: 38237312
DOI: 10.1016/j.ejogrb.2024.01.016