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Abdominal Radiology (New York) May 2023Adnexal masses during pregnancy are a relatively uncommon entity. Their clinical management is challenging given the overlapping features of certain entities on imaging... (Review)
Review
Adnexal masses during pregnancy are a relatively uncommon entity. Their clinical management is challenging given the overlapping features of certain entities on imaging and histopathology, which can mimic malignancy, and the potential side effects to the mother and fetus, whether expectant management versus surgery is pursued. Ultrasonography with Doppler evaluation is the modality of choice for evaluating adnexal masses during pregnancy. Magnetic resonance imaging is the second-line modality useful when US findings are inconclusive/indeterminate. Most adnexal masses in pregnant patients are benign in origin (e.g., functional cysts, mature cystic teratoma, decidualization of endometrioma), but a few are malignant in origin (e.g., dysgerminoma, granulosa cell tumor). Most cases of adnexal masses are asymptomatic, but complications such as ovarian torsion can occur. This review aims to familiarize the radiologist with the imaging of adnexal lesions during pregnancy so that the radiologist can identify ovarian cancer. Specifically, the review will detail the most common benign and malignant adnexal masses in pregnancy, mimickers, and their corresponding imaging findings on US and MRI.
Topics: Pregnancy; Humans; Female; Ovarian Neoplasms; Adnexal Diseases; Magnetic Resonance Imaging; Granulosa Cell Tumor; Dermoid Cyst
PubMed: 36538079
DOI: 10.1007/s00261-022-03768-y -
Diagnosis and Management of Pediatric Ovarian Torsion in the Emergency Department: Current Insights.Open Access Emergency Medicine : OAEM 2022Ovarian torsion is defined as twisting of the ovary around an axis consisting of its vascular pedicle, the infundibulopelvic ligament and the tubo-ovarian ligament, and... (Review)
Review
Ovarian torsion is defined as twisting of the ovary around an axis consisting of its vascular pedicle, the infundibulopelvic ligament and the tubo-ovarian ligament, and can occur in females of any age. Torsion can be a result of ovarian mass causing asymmetry and subsequent torsion, or can be spontaneous. While ovarian torsion is a surgical emergency, early diagnosis and treatment can preserve ovarian viability even if necrosis is seen operatively. Presentation classically involves sudden onset severe abdominal pain and vomiting but diagnostic delay can follow subtler presentations. Diagnosis is most commonly based on sonographic findings, but advanced imaging such as CT or MRI may be required if sonography is not diagnostic. Treatment is surgical, with ovarian preservation preferred in almost all cases. In this review, I present the most recent evidence on epidemiology, diagnosis, and management of pediatric ovarian torsion, with a focus on point-of-care ultrasound for the emergency care provider.
PubMed: 35770141
DOI: 10.2147/OAEM.S342725 -
Ginekologia Polska Jan 2022Ovarian torsion is defined as partial or complete rotation of the ovarian vascular pedicle and causes obstruction to venous outflow and arterial inflow. Teenage patient...
Ovarian torsion is defined as partial or complete rotation of the ovarian vascular pedicle and causes obstruction to venous outflow and arterial inflow. Teenage patient was referred to the gynecology ward with pain located in the lower, right abdomen, after an initial misdiagnosis of a dermoid cyst. The patient was diagnosed with a torsion of the right ovarian peduncle. The patient was given diastolic drugs and was discharged in good general condition two days later after the symptoms had resolved. Final USG showed normally vasculated corpus luteum. Among the various treatment options, the wait-and-watch attitude turned out to be the best solution. It is particularly important in the case of young patients, who are planning pregnancy in the future.
PubMed: 35072260
DOI: 10.5603/GP.a2021.0213 -
Cureus Dec 2022Ovarian torsion is a rare, emergent occurrence seen in the premenarchal population. If detected promptly, ovarian torsion can be treated via detorsion. We present a case...
Ovarian torsion is a rare, emergent occurrence seen in the premenarchal population. If detected promptly, ovarian torsion can be treated via detorsion. We present a case of a three-year-old girl whose ovary spontaneously torsed and was corrected via ovarian detorsion. The patient presented with sudden-onset abdominal pain and emesis; a transabdominal ultrasound with Doppler was performed, which led to the diagnosis of ovarian torsion. The patient was directly taken into surgery for correction, after which she quickly recovered and was subsequently discharged. The choice of ovarian detorsion to protect fertility in pediatric patients is supported by this case and by the related literature. The key to safeguarding fertility in these patients lies in rapid detection, which remains a challenge in the pediatric population. By raising widespread awareness of the use of Doppler ultrasound as well as symptom presentation, the protection of fertility in cases of pediatric ovarian torsion can be improved.
PubMed: 36601187
DOI: 10.7759/cureus.32132 -
Innovative Surgical Sciences Dec 2021Ovarian lesions are rare but frequent in children. Patients could present with abdominal pain, but ovarian lesions could also be incidentally found on ultrasound....
OBJECTIVES
Ovarian lesions are rare but frequent in children. Patients could present with abdominal pain, but ovarian lesions could also be incidentally found on ultrasound. Awareness is required in cases with acute, severe lower abdominal pain, as ovarian torsion could be the cause. Other lesions can be cysts or benign or malignant ovarian tumors. Thus, the aim of this paper is to review typical ovarian lesions according to age, imaging and laboratory findings, and surgical management.
METHODS
We retrospectively analysed the patient charts of 39 patients aged 10.4 ± 6.1 years (from 3 months to 18 years) with ovarian lesions treated in our institution between 01/2009 and 08/2020. All clinical and pathological findings of infants and children operated on for ovarian lesions were included.
RESULTS
Ovarian lesions in children younger than 2 years of age were typically ovarian cysts, and ovarian tumors were not observed in this age group. In older children over 10 years of age, tumors were more common - with mostly teratoma or other germ cell tumors, followed by epithelial tumors. Moreover, acute or chronic ovarian torsion was observed in all age groups. In general, ovarian tumors were much larger in size than ovarian cysts or twisted ovaries and eventually showed tumor marker expression of AFP or ß-HCG. Simple ovarian cysts or twisted ovaries were smaller in size. Surgery for all ovarian lesions should aim to preserve healthy ovarian tissue by performing partial ovariectomy.
CONCLUSIONS
In adolescent girls with acute abdominal pain, immediate laparoscopy should be performed to rule out ovarian torsion. Careful imaging evaluation and the assessment of tumor markers should be performed in painless ovarian lesions to indicate an adequate surgical ovarian-sparing approach.
PubMed: 35937851
DOI: 10.1515/iss-2021-0006 -
BMJ Case Reports May 2020A 9-year-old girl attended the emergency department with right-sided abdominal pain and vomiting. Due to history and following examination, an ultrasound was requested... (Review)
Review
A 9-year-old girl attended the emergency department with right-sided abdominal pain and vomiting. Due to history and following examination, an ultrasound was requested which demonstrated a large complex midline mass. The most likely diagnosis was ovarian torsion, for which the patient underwent laparoscopy, detorsion and ovarian cystectomy. Histology revealed a mature cystic teratoma. Although less common than in the adult population, it is important to consider ovarian torsion in children and adolescents. Presentation is usually with pain accompanied by vomiting and fever, although these symptoms are not always present. Current management is organ-sparing, with laparoscopy±cystectomy. We discuss the adaptations for this procedure with regard to the paediatric and adolescent population. Differences in the anatomy and physiology must lead to consideration for alterations in surgical technique and positioning to ensure the safest and best quality care for these young patients.
Topics: Child; Diagnosis, Differential; Female; Humans; Laparoscopy; Ovarian Neoplasms; Ovarian Torsion; Teratoma
PubMed: 32404320
DOI: 10.1136/bcr-2019-232610 -
Taiwanese Journal of Obstetrics &... Dec 2011
Topics: Female; Gynecologic Surgical Procedures; Humans; Laparoscopy; Ovarian Diseases; Pregnancy; Pregnancy Complications; Torsion Abnormality
PubMed: 22212309
DOI: 10.1016/j.tjog.2011.10.002 -
International Journal of Surgery Case... Jul 2022Ovarian small cell carcinomas are a rare type of ovarian cancer that is highly aggressive and consists of two distinct types the hypercalcemic type (SCCOHT) and...
INTRODUCTION AND IMPORTANCE
Ovarian small cell carcinomas are a rare type of ovarian cancer that is highly aggressive and consists of two distinct types the hypercalcemic type (SCCOHT) and pulmonary type (SCCOPT).
CASE PRESENTATION
A 23 years old girl was admitted to the emergency room with the presentation of acute abdomen. The ultrasound and Magnetic resonance imaging revealed a right adnexal huge mass with adnexal torsion. In laparotomy, she underwent unilateral salpingo-oophorectomy due to ovarian torsion and possible malignancy. The histopathological evaluation was challenging and was finalized by a team of pathologists as hypercalcemic small cell carcinoma. She refused reoperation and unfortunately relapsed during chemotherapy and died 6 months after the initial diagnosis.
CLINICAL DISCUSSION
Conclusion: We do not yet have comprehensive information on small cell ovarian cancer. Cytopathology diagnosis is still challenging and the treatments are not usually effective. Further clinical trials and studies are recommended to find appropriate treatments for these patients.
PubMed: 35797874
DOI: 10.1016/j.ijscr.2022.107337 -
Ginekologia Polska 2020This study aims to analyze the conditions of ovarian preservation during adnexal torsion surgery, and safety of ovarian preservation.
OBJECTIVES
This study aims to analyze the conditions of ovarian preservation during adnexal torsion surgery, and safety of ovarian preservation.
MATERIAL AND METHODS
A retrospective analysis of 130 patients, who underwent surgery for ovarian benign tumor pedicle torsion in Fujian Provincial Maternal and Child Health Hospital from June 2013 to June 2018, was conducted. This study analyses the possible risk factors affecting the operation method using multiple logistic regression and analyses the complications and the recovery of ovarian function after the treatment of the ovarian preservation.
RESULTS
Among these patients, 58 received ovarian cystectomy, while 72 received ovariectomy. There was no significant difference in terms of age, preoperative blood, operation time and surgical bleeding volume between the two groups (p > 0.05). However, there was a significant difference in preoperative adnexal blood flow, abdominal pain to the surgical interval, and a collection of torsion cycles (p < 0.05). There was an increased risk of ovarian resection in patients whose blood flow of the annex disappeared, whose time of abdominal pain was long, and whose number of twists were significant. For the preservation group, there were no increases in postoperative complications.
CONCLUSIONS
According to clinical indicators, such as preoperative adnexal blood flow, abdominal pain to the interval of surgery and the number of torsion cycles, it was determined whether it was feasible to keep the ovary. Retaining the ovary is safe, effective and feasible in adnexal torsion.
Topics: Adnexal Diseases; Adolescent; Adult; Child; Female; Fertility Preservation; Humans; Japan; Middle Aged; Ovarian Torsion; Postoperative Complications; Prognosis; Retrospective Studies; Risk Factors; Young Adult
PubMed: 32495934
DOI: 10.5603/GP.2020.0066 -
Journal of Minimally Invasive Gynecology Feb 2022To quantitatively evaluate the blood flow in ovaries (ischemic ovaries) that underwent torsion using indocyanine green angiography (ICGA) and assess the use of ICGA as...
STUDY OBJECTIVE
To quantitatively evaluate the blood flow in ovaries (ischemic ovaries) that underwent torsion using indocyanine green angiography (ICGA) and assess the use of ICGA as an indicator for functional preservation of the ovaries.
DESIGN
In vivo animal study.
SETTING
The University of Yamanashi Animal Experimentation Center.
SUBJECTS
Eighteen female Wistar albino rats.
INTERVENTIONS
As an alternative to ovarian torsion, we occluded an ovary in each rat for 24 hours, after which we performed ICGA before and after releasing ischemia and extracted the following 8 parameters: F (maximum F value before releasing ischemia); T (time taken from the onset of an increase in F to reaching F); T (time taken from the onset of an increase in F to reaching half of F); slope (F/T); time ratio (T/T); F' (maximum F value after releasing ischemia); reperfusion rate (F'/F); and reperfusion gap (F' - F). Four weeks later, we counted the total number of primordial and primary follicles and classified the rats into functional and nonfunctional groups.
MEASUREMENTS AND MAIN RESULTS
On the basis of the total number of primordial and primary follicles, 13 rats had "functional" ovaries on the clamped side, and 5 rats had "nonfunctional" ovaries. The area under the curve values for each parameter were as follows: F, 0.908; T, 0.569; T, 0.546; time ratio, 0.746; slope, 0.877; F', 0.723; reperfusion rate, 0.938; and reperfusion gap, 0.862.
CONCLUSION
ICGA can be used to quantitatively evaluate ovaries that have been subjected to ischemia, and the magnitude of fluorescence intensity can be an excellent predictor of ovarian necrosis. Quantifying the degree of reperfusion immediately after the release of ischemia can be an equally excellent predictor of necrosis.
Topics: Angiography; Animals; Female; Humans; Indocyanine Green; Ovarian Diseases; Ovarian Torsion; Rats; Rats, Wistar; Reperfusion Injury; Torsion Abnormality
PubMed: 34375741
DOI: 10.1016/j.jmig.2021.08.003