-
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 -
Cureus Oct 2022Luteoma of pregnancy is a rare, benign neoplasm arising from the ovary, which occurs due to pregnancy-induced hormones.This rare ovarian lesion was first described by...
Luteoma of pregnancy is a rare, benign neoplasm arising from the ovary, which occurs due to pregnancy-induced hormones.This rare ovarian lesion was first described by Sternberg and Barclay in 1966. Our case is unusual as the ovarian mass was misdiagnosed as ruptured ectopic pregnancy. Only three such cases have been previously reported in the literature. A 28-year-old multigravida with three months of amenorrhea presented with vaginal bleeding, abdominal pain, and gradually increasing vertigo for six days with increased intensity in the last four hours. On examination, she was conscious and oriented, clinically moderate pallor was present, her pulse rate was 112 beats per minute (bpm), and her blood pressure (BP) was 98/68 mm Hg. On abdominal examination, there was no palpable abdominal mass, but left iliac fossa guarding and tenderness were present. On per-vaginal examination, the uterus was eight weeks in size, the right fornix was free, the left fornix was full and tender, and cervical motion tenderness was present. Her urine pregnancy test was positive. Transvaginal sonography was performed in the emergency setting, which showed a bulky uterus with thickened endometrium and a non-visualized right ovary, and the left ovary was seen adjacent to a hyperechoic collection in the pouch of Douglas of size 3.5×3.5×1.8 cm, likely organized hematoma; there was free fluid in the pouch of Douglas, and left forniceal tenderness was also present. In view of the clinical evidence of tachycardia and hypotension, an exploratory laparotomy was performed for suspected ruptured ectopic pregnancy, and the ovarian mass was excised. The histopathological examination (HPE) of the ovarian mass showed findings suggestive of luteoma of pregnancy. There is an extreme paucity of literature on luteoma of pregnancy. That, along with the rarity of the lesion, results in it often not being kept in mind as a differential diagnosis on clinical or radiological examination, thereby leading to more aggressive management. Obstetricians and gynecologists need to be aware of this condition so that it is kept as a differential diagnosis in patients presenting with adnexal masses. A vigilant outlook will help in preventing unnecessary radical surgery during pregnancy, thereby preserving the ovary and reducing morbidity in these young females.
PubMed: 36465744
DOI: 10.7759/cureus.30900 -
European Cytokine Network Jun 1997Cytokines, originally identified as products of immune cells, are synthesized throughout the female reproductive tract. Evidence has accumulated supporting the role of... (Review)
Review
Cytokines, originally identified as products of immune cells, are synthesized throughout the female reproductive tract. Evidence has accumulated supporting the role of cytokines in reproduction, including gamete and follicle development and steroidogenesis. In these processes, cytokines act either through a paracrine or autocrine mechanism. The present article focuses on the role of cytokines during ovulation, which shares many of the features of the inflammatory reaction. The intraovarian production of cytokines, as well as its regulation by sex steroid and peptide hormones, is considered. The role of cytokines in follicle rupture and remodelling, leukocyte infiltration, angiogenesis, steroid hormone production and oocyte maturation is also described.
Topics: Animals; Chemotactic Factors; Cytokines; Estradiol; Female; Humans; Inflammation Mediators; Mammals; Mice; Neovascularization, Physiologic; Oocytes; Ovarian Follicle; Ovary; Ovulation; Progestins
PubMed: 9262962
DOI: No ID Found -
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 -
Advances in Clinical and Experimental... Apr 2019Pregnancy with an adnexal mass is one of the most common complications during pregnancy and clinicians are sometimes caught in a dilemma concerning the decision to be...
BACKGROUND
Pregnancy with an adnexal mass is one of the most common complications during pregnancy and clinicians are sometimes caught in a dilemma concerning the decision to be made regarding clinical management.
OBJECTIVES
The objective of this study was to outline and discuss the clinical features, management and outcomes of adnexal masses that were encountered during a cesarean section (CS) at a university affiliated hospital in China.
MATERIAL AND METHODS
The medical records of the patients with an adnexal mass observed during a CS were retrospectively collected at Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China, from January 1991 to December 2011.
RESULTS
The incidence of adnexal masses was 16.40 per 1000 CSs. The most common pathologic diagnosis was benign ovarian tumor, the 2nd was ovarian endometrioma and the 3rd was theca lutein cyst. Thirteen cases of ovarian malignancies were diagnosed during a CS. Only 388 cases (29.78%) were detected by an ultrasonography (USG) examination before a CS. Eight cases required emergency CS due to abdominal pain; all other patients were clinically asymptomatic. The reasons for abdominal pain included torsion (n = 5), rupture (n = 2) and ovarian enlargement (n = 1). In 13 cases with ovarian endometrioma, cysts ruptured during a CS without any clinical manifestation. No maternal and fetal complications related to surgery were observed.
CONCLUSIONS
Preconception care and routine prenatal care, including USG examination, may optimize the detection and management of an adnexal mass. The presumptive ovarian endometrioma detected before pregnancy could be the indication for surgery due to the possibility of spontaneous hemoperitoneum. Theca lutein cysts might be huge and exist throughout the whole pregnancy period. Expectant management is reasonable for an adnexal mass that emerged during pregnancy without suspicion of malignancy. Abdominal pain might be a clue for cyst torsion or rupture.
Topics: Adnexa Uteri; Adnexal Diseases; Adult; Cesarean Section; China; Female; Humans; Incidence; Incidental Findings; Ovarian Cysts; Ovarian Neoplasms; Pregnancy; Pregnancy Complications, Neoplastic; Pregnancy Outcome; Retrospective Studies
PubMed: 30085429
DOI: 10.17219/acem/77099 -
Radiology Case Reports Nov 2021Spontaneous rupture of an ovarian artery aneurysm is extremely rare. It can lead to retroperitoneal hemorrhage that is often life-threatening. We report a case of...
Spontaneous rupture of an ovarian artery aneurysm is extremely rare. It can lead to retroperitoneal hemorrhage that is often life-threatening. We report a case of pregnancy-unrelated spontaneous rupture of a right ovarian artery aneurysm in a multiparous woman. A 29-year-old woman, gravida 3, para 3, whose latest pregnancy involved uneventful gestation and delivery 2 years previously, was admitted for right flank pain. The urine test result for pregnancy was negative. Computed tomography revealed a large retroperitoneal hematoma and right ovarian artery aneurysm with contrast extravasation. After selective angiography, embolization of the right ovarian artery was successfully achieved using microcoils. Diagnostic angiography with subsequent transcatheter arterial embolization is an effective and less invasive technique for the management of ovarian artery aneurysm.
PubMed: 34484529
DOI: 10.1016/j.radcr.2021.07.086 -
Medicine Jul 2023Ovarian hyperstimulation syndrome (OHSS) is a common complication during assisted conception treatment, mostly seen in patients with ovarian hyperresponsiveness such as...
INTRODUCTION
Ovarian hyperstimulation syndrome (OHSS) is a common complication during assisted conception treatment, mostly seen in patients with ovarian hyperresponsiveness such as polycystic ovary syndrome, especially in post-invitro fertilization and embryo transfer (IVF-ET) pregnancies. Its main symptoms are abdominal distension, abdominal pain, nausea and vomiting with ascites, pleural fluid, leukocytosis, hemoconcentration and hypercoagulation. This disease is a self-limiting disease and can be gradually cured by rehydration, albumin infusion and correction of electrolyte disorders in moderate to severe cases. Luteal rupture is a more common gynecological emergency abdomen. The combination of twin pregnancy, OHSS and ruptured corpus luteum is very rare. We successfully avoided the stimulation of the risk of pregnancy abortion by surgical exploration through dynamic ultrasound monitoring and vital signs observation in the absence of experience in primary care, and the patient hard-won twin pregnancy was successfully treated conservatively.
PATIENT CONCERNS
The patient is a 30-year-old post-IVF-ET woman with an established twin pregnancy, OHSS and sudden onset of lower abdominal pain.
DIAGNOSIS
Twin pregnancy, OHSS combined with ruptured corpus luteum.
INTERVENTIONS
Rehydration, albumin infusion, low molecular heparin for thromboprophylaxis, luteinizing support, ambulatory ultrasound monitoring.
OUTCOMES
After more than 10 days of standardized treatment for OHSS, dynamic ultrasound monitoring and close observation of vital signs, the patient was discharged cured of her condition and is continuing her pregnancy.
CONCLUSION
Our case shows that the possibility of acute abdominal rupture of the corpus luteum is still present in the case of combined OHSS in pregnancy, and that some patients with corpus luteum rupture can heal spontaneously during close testing to avoid the increased risk of miscarriage with surgical exploration.
Topics: Humans; Pregnancy; Female; Adult; Ovarian Hyperstimulation Syndrome; Pregnancy, Twin; Fertilization in Vitro; Anticoagulants; Venous Thromboembolism; Corpus Luteum; Abortion, Spontaneous; Embryo Transfer; Abdominal Pain; Albumins; Ovulation Induction
PubMed: 37417637
DOI: 10.1097/MD.0000000000034238 -
International Journal of Women's Health 2022Undescended ovary (UO) is an uncommon congenital condition characterized by the presence of the adnexa above the common iliac vessels, with an estimated incidence of... (Review)
Review
Undescended ovary (UO) is an uncommon congenital condition characterized by the presence of the adnexa above the common iliac vessels, with an estimated incidence of 0.3-2%. Because of its rarity, it is usually presented as a case report. A thorough knowledge of the ovarian embryological development is essential for the clinician, who must be warned about the possibility of associated Müllerian and renal malformations. There may be asymptomatic patients, incidentally diagnosed during infertility evaluation, but when symptoms occur, these are unspecific and most often this disorder is misdiagnosed, the accurate diagnosis being established intraoperatory. The malignant potential of an UO is accepted, although no such cases were reported. The role of the UO in infertility is still unclear, despite evidence of its normal function. Complications are linked to the ovary (cyst formation, cyst ruptures or tumors) or to the undescended fallopian tube (ectopic pregnancies). The management should be conservative, but there is no consensus about whether it is necessary to excise the ipsilateral undescended tube. We included a short case presentation of an UO cystadenoma misdiagnosed as a renal cyst, which depicts all diagnostic and management dilemmas and inspired us to write this review. The present literature review includes all the cases reported from the early 20th century to the present, with updated data about epidemiology, pathophysiology, clinical and imaging diagnosis, treatment options and prognosis of this rare condition. This paper aims to establish some directions in the diagnosis and management of similar patients and to remind us that, no matter how advanced the imaging investigation techniques might be, a correct preoperative diagnosis may often be missed.
PubMed: 35046732
DOI: 10.2147/IJWH.S345742 -
Journal of Medicine and Life Sep 2022The present experimental model aimed to investigate the possible effect of endometriosis on ovarian function by altering follicular maturation and development. This...
The present experimental model aimed to investigate the possible effect of endometriosis on ovarian function by altering follicular maturation and development. This single-blind, randomized study included twenty-four female Sprague Dawley mice, 2.5 months old, weighing 160-200 grams. The animals were randomly separated into four groups on the day of the surgery. Each group consisted of 6 mice. The first group (A) consisted of healthy female mice (control group). The second group (B) consisted of mice subjected to surgical insertion of ovarian endometrioma. The third group (C) consisted of mice subjected to surgically induced diffuse intraperitoneal endometriosis, and the fourth group (D) consisted of mice subjected to surgically induced extraperitoneal endometriosis. According to our experimental model, endometriosis may affect ovarian function by increasing the number of luteinized unruptured follicles (follicles that have undergone luteinization without prior rupture).
Topics: Humans; Female; Mice; Animals; Endometriosis; Single-Blind Method; Infertility, Female; Fertility; Models, Animal
PubMed: 36415526
DOI: 10.25122/jml-2021-0391 -
Journal of Medical Case Reports Dec 2021Nutcracker syndrome is a condition in which the left renal vein is pinched between the abdominal aorta and the superior mesenteric artery, resulting in an increase in...
BACKGROUND
Nutcracker syndrome is a condition in which the left renal vein is pinched between the abdominal aorta and the superior mesenteric artery, resulting in an increase in renal vein pressure and certain symptoms. We report a very rare case of retroperitoneal hematoma caused by the rupture of varicose veins of the left ovary.
CASE PRESENTATION
A 77-year-old Japanese woman, para 7, experienced sudden left lower abdominal pain. She had no history of trauma or treatment complications. Computed tomography revealed a left retroperitoneal hematoma, but her abdominal pain subsided quickly; thus, urgent treatment was not required. We then scheduled her for an assessment regarding the cause of her bleeding. However, 6 days after the pain onset, abdominal pain symptoms recurred, confirming hematoma regrowth. Magnetic resonance imaging and three-dimensional computed tomography revealed an abnormal vascular network from the left side of the uterus to the left adnexa. Subsequent angiography revealed that the retroperitoneal bleeding originated from rupture of the distended left ovarian vein, which caused blood reflux from the left renal vein to the left ovarian vein. Although angiography confirmed a passage between the left renal vein and inferior vena cava, computed tomography showed obvious stenosis in the left renal vein. In accordance with these findings, we diagnosed the cause of the distention and rupture of the left ovarian vein as nutcracker syndrome. She underwent embolization of the left ovarian vein as hemostasis treatment, and had a good course thereafter.
CONCLUSIONS
This is the first report of a spontaneous rupture of the left ovarian vein caused by nutcracker syndrome. Nutcracker syndrome is not yet well known to clinicians and should be considered as part of the differential diagnosis when an abnormal vascular network in the pelvis is found.
Topics: Aged; Humans; Pelvis; Rupture, Spontaneous; Vena Cava, Inferior
PubMed: 34920758
DOI: 10.1186/s13256-021-03192-8