ArticleLiterature Review

Current diagnosis and management of ovarian cysts

Clinical and Experimental Obstetrics & Gynecology

December 2014
41(6):609-12

DOI:10.12891/ceog20322014

Source
PubMed

Authors:

Samir Farghaly

Weill Cornell Medicine

The epidemiology of ovarian cysts is unclear due to the lack of consistent reporting and a high likelihood of spontaneous resolution. In the USA, postmenopausal women have an ovarian cyst incidence of 18% over a 15-year period. Worldwide, about 7% of women have an ovarian cyst at some point in their lives. In Europe, a large screening trial revealed a 21.2% incidence of ovarian cysts among healthy postmenopausal women. The American College of Obstetricians and Gynecologists (ACOG) stated that simple cysts found on ultrasound may be safely followed without intervention, even in postmenopausal women. These cysts are not likely cancer precursors, nor markers of increased risk, and can be managed conservatively. Simple ovarian cysts appear to be stable or resolve by the next annual examination. These findings support recent recommendations to follow unilocular simple cysts in postmenopausal women without intervention. For those patients, ovarian cancer screening and follow up include a CA-125 blood test and transvaginal ultrasonography (TVU) at baseline, an annual TVU for three additional years, and annual CA-125 tests for five years beyond baseline. The TVU screening examination is considered positive (abnormal and suspicious for ovarian cancer) when findings included: 1) ovarian volume greater than 10 cubic cm; 2) cyst volume greater than ten cubic cm; 3) any solid area or papillary projection extending into the cavity of a cystic ovarian tumor of any size; or, 4) any mixed (solid/cystic) component within a cystic ovarian tumor. Women with positive screening examinations are referred to gynecologic oncology unit for follow-up investigation. Diagnostic consideration and surgical management of ovarian cysts are discussed.

Transumbilical laparoendoscopic single-site surgery vs. multiport laparoscopic surgery for benign ovarian cysts: a retrospective cohort study

Article

Full-text available

Dec 2024
BMC Surg

Background Transumbilical laparoendoscopic single-site surgery (TU-LESS) has gained increasing attention due to the potential to maximize the benefits of laparoscopic surgery. This study aimed to compare outcomes of TU-LESS and multiport laparoscopic surgery (MLS) for the treatment of benign ovarian cysts. Methods This retrospective cohort study included patients with benign ovarian cysts that were admitted to the Second Hospital of Hebei Medical University between September 2010 and September 2022. Inverse probability of treatment weighting (IPTW) approach weighting were used to compare outcomes of TU-LESS and MLS for benign ovarian cysts. The primary outcome was the rate of cystic content spillage. Results A total of 528 patients with benign ovarian cysts were included and 236 (44.6%) patients underwent TU-LESS. The risk of cystic content spillage [relative risk (RR) = 4.37, 95% confidence interval (CI): 2.59–7.38), P < 0.001] and operation time (β = 4.94, 95% CI: 1.40–8.48, P = 0.017) during TU-LESS was significantly higher than that during MLS. While hospital stay (β=-0.10, 95% CI: -0.198 - -0.004, P = 0.043) during TU-LESS was significantly shorter. IPTW analyses yielded similar patterns of results. For ovarian cysts < 10 cm, the risk of cystic content spillage, operation time and EBL during TU-LESS was significantly higher than that during MLS (all P < 0.05). On the contrast, for ovarian cysts ≥ 10 cm, the risk of cystic content spillage, operation time and EBL during TU-LESS was significantly lower than that during MLS (all P < 0.05). Conclusions TU-LESS had a significantly higher risk of cystic content spillage, longer operation time than MLS. While for ovarian cysts ≥ 10 cm, TU-LESS had a lower risk of cystic content spillage, shorter operation time, and less EBL than MLS. More experienced surgeons are needed to perform TU-LESS in benign ovarian cysts.

A giant ovarian atypical proliferative mucinous tumor in a young adult: A rare case report and review of the literature

Article

Full-text available

Dec 2024

Introduction and importance Ovarian atypical proliferative mucinous tumor (APMT) is a low-malignant or borderline tumor that originates from the ovary's surface epithelium. This tumor can grow to a massive size, causing abdominal distention, which can result in a variety of compression symptoms if it is not discovered early. Case presentation A 23-year-old female presented with a chronic, gradually developing abdominal distention that had been persistent for a year. A large peritoneal cyst was suggested by an abdominal CT scan. A massive left ovarian tumor was discovered during an exploratory laparotomy. Salpingo-oophorectomy was performed, and the pathology report confirmed the diagnosis of APMT. No recurrence has been observed during a year of follow-up. Clinical discussion Diagnosis of ovarian APMBT involves clinical assessment, history, and symptoms of the patient. Imaging studies are useful in identifying these lesions. Ultrasound demonstrates a large, unilocular or multilocular cystic mass with thin septations. Further characterization requires an MRI or CT scan. Serum tumor markers such as CEA, CA-125, and β-hCG are helpful in diagnosing these lesions. The definitive diagnosis requires histopathological examination. Unilateral salpingo-oophorectomy is the mainstay of treatment. Adjuvant therapy is not required. Lifelong follow-up is essential, especially for fertility-sparing surgeries due to recurrence risk. Conclusion Due to the substantial overlap of clinicopathological characteristics with other tumors, accurate diagnosis of APMT can be difficult. Large tumor sizes may cause alarm for other pathologies such as cancer. The attending physician should be reassured with the imaging examinations, and the diagnosis is confirmed by the histopathology examination.

Clinical and anamnestic characteristics of patients with functional ovarian cysts (Retrospective study)

Article

Full-text available

Nov 2024

Ovarian cysts are common in young women of reproductive age. It is estimated that around 7% of women worldwide experience a symptomatic cyst during their lifetime. Functional ovarian cysts (FOCs) occupy one of the leading places in the structure of gynecological diseases (45-55%) in women of reproductive age. Functional cysts are not true neoplasms and are considered as a variant of a normal physiological process.Ovarian retention formations are found in 7.8% of clinically healthy women and in every second (52.3%) patient with lower abdominal pain or menstrual cycle disorders. Studies of FOCs have mainly concerned cysts that arose after ovulation induction, studies of spontaneous follicular cysts are limited, the question of the effect of FOCs on fertility and ovarian reserve is debated.The objective: to analyze the management of patients with FOCs in real clinical practice.Materials and methods. A retrospective case-control cohort study was conducted with the participation of 350 women aged 19 to 39 years who were diagnosed with ovarian neoplasms between 2020 and 2022. Complaints, anamnesis data, applied methods of diagnosis and treatment of neoplasms were analyzed. Results. According to clinical data, the cases were divided into 3 groups. The I group included 122 (34.9%) women in whom, in the absence of symptoms and complaints, ovarian neoplasms were detected for the first time during pelvic ultrasound.The II group consisted of 116 (33.1%) female patients, who for the first time applied for an examination due to complaints of periodic unilateral pain of various nature, a feeling of discomfort in the lower abdomen.The III group included 112 (32.0%) women who were urgently hospitalized with complaints of acute pain and pressure in the lower abdomen, bloating, weakness, dizziness. Among the patients of this group, 53 (47.3%) women had ovarian neoplasms diagnosed earlier (within 2.6±0.7 years).Among the studied cohort, according to ultrasound data, functional (follicular cysts and corpus luteum cysts) ovarian cysts were verified among the detected neoplasms in 253 (72.3%) women.Conclusions. The prevalence of functional ovarian cysts in women that do not have clinical manifestations as ultrasound findings is 78.7%, among them follicular cysts predominate (66.4%). Infertility occurs in 23.8% of asymptomatic women with functional ovarian cysts. In 34.5% of women with functional ovarian cysts who have clinical symptoms, menstrual cycle disorders prevail.

Ultrasound-Guided Diagnosis of Multiple Uterine Fibroids in a Patient With Polycystic Ovaries and Treatment With Relugolix, Estradiol, and Norethisterone Acetate

Article

Full-text available

May 2023

Uterine fibroids and ovarian cysts are common gynecological conditions that, while benign, when present simultaneously with bacterial vaginosis, can present a more complicated course of management. Symptoms of uterine fibroids include menorrhagia and dysmenorrhea, while ovarian cysts may present with pelvic pain and an adnexal mass. Each condition is typically managed separately; however, they can coexist in some patients, leading to a more complex presentation. This case report presents a 35-year-old African American female patient with the simultaneous occurrence of uterine fibroids and ovarian cysts, complicated by recurrent vaginitis, along with the treatment approach. The treatment choice, relugolix, estradiol, and norethisterone (norethindrone) acetate, is the first once-daily U.S. Food and Drug Administration (FDA) combination hormonal medication approved for menorrhagia due to fibroids. This case is unique in that although the diagnoses are common, their coexistence makes for a more complex presentation, and the course of management presents a newly approved fixed-dose combination hormonal medication. This report discusses the incidence, pathophysiology, diagnosis, and management of uterine fibroids and ovarian cysts. Factors that may contribute to the concurrence of these conditions, such as genetic, hormonal, and environmental risks, are also explored. Diagnostic modalities and ultrasound techniques are reviewed, and treatment options, such as surgery and medical management, are discussed. The importance of a patient-centered approach in the treatment of multi-symptom gynecological disorders and the need to consider conservative management are emphasized.

Left Ovarian Cyst With Overlying Sigmoid Colon

Article

Full-text available

Sep 2022

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.

Evaluation of Pelvic Organ by Laparoscopy among Patients with Adnexal Mass Attending Bangabandhu Sheikh Mujib Medical University

Article

Jul 2022

Introduction: Adnexal masses consist of anomalies which can be noticed in any age of women. These abnormalities determine different features during reproductive age, entail surgical treatment, and are monitored with clinical and laboratory findings. Adnexal masses may result from benign or malignant lesions of ovarian, tubal, and para tubal origin, as well as pregnancy-related causes such as ectopic pregnancy. The study intends to evaluate the adnexal masses by laparoscopy among patients admitted to Bangabandhu Sheikh Mujib Medical University from March 2016 to August 2016. Methods: This cross-sectional study was carried out at Bangabandhu Sheikh Mujib Medical University, Dhaka. The sample was collected by the purposive consecutive sampling method. Subjects were selected by appropriate inclusion criteria. Data were collected after appropriate verbal consent from the guardian of patients and the result was subjected to standard statistical evaluation and was analyzed by the SPSS programme. Result: This study shows the average age was 27.82 years. Regarding parity majority (31, 62.0%) were nulliparous women and the majority (31, 62.0%) were from a lower-middle-class families. The primary complaints in the study group (27, 54.0%) were dysmenorrhoea followed by infertility (21, 42%). Eighteen women (18, 36.0%) complained of dyspareunia. Twenty-six patients (26, 52.0%) had tender mass. Size of the uterus, twenty-two (22, 44%) patients had an enlarged uterus. The commonest finding was tubo-ovarian mass in thirteen (13, 26.0%) patients followed by an endometriotic cyst in twelve patients (12, 24%). The findings of diagnostic laparoscopy, maximum (22, 44.0%) were enlarged uterus followed by fourteen patients (14, 28.0%) who had ovarian cysts. Conclusion: This study observed laparoscopic findings are far way better than ultrasonography. As a result, laparoscopy is a gold standard for the estimation of patients with pelvic adnexal masses.

Benign Ovarian Cysts with Raised CA-125 Levels: Do We Need to Evaluate the Fallopian Tubes?

Article

Full-text available

Dec 2020

Objectives It is not clearly known whether some benign (simple) ovarian cysts can convert into cancerous cysts. Size of cyst and wall abnormalities do predict the potentiality of malignancy. Not many studies have been done to explore the malignant potential of large-sized (> 5 cm) unilocular ovarian cysts without wall abnormalities. This study evaluated the correlation between ultrasonographic size of benign ovarian cysts and carbohydrate antigen 125 (CA-125) levels. Methodology Sixty (60) premenopausal women were recruited for the study preoperatively, based on transvaginal ultrasound (TVUS) findings present in the case record sheet received along with the CA-125 sample in the biochemistry laboratories. Those cases with elevated CA-125 levels were selected, where patients had unilocular ovarian cysts without wall abnormalities. CA-125 was done using ECLIA methodology (Cobas e411, Germany). Statistical correlation was calculated between the ovarian cyst size and CA-125 levels using Spearman’s Rho coefficient. Results Mean age group of subjects were 29.7 ± 7.3 years and mean value of CA-125 (normal < 35 IU/mL) was found to be increased: 118.0 ± 147.1 IU/mL so was the mean diameter of cysts (cut off ≤ 5 cm): 48.6 ± 59.8 cm. No correlation was found between CA-125 levels and volume of ovarian cyst (r = 0.005, p = 0.680) for all subjects. Conclusions The lack of correlation between size of ovarian cysts and CA-125 levels provides a hint that the ovarian cyst epithelium does not directly express CA-125 and it may come from sites like the fallopian tube. Thus, raised level of CA-125 in benign ovarian cyst should be followed-up more closely, demanding assessment of fallopian tubes for early diagnosis of ovarian cancer. Also, algorithms can be explored to include size of ovarian cyst and CA 125 levels to predict ovarian cancer.

Conservative management of unilateral and unilocolor ovarian cysts ≥ 10 cm in diameter in postmenopausal women

Article

Full-text available

Apr 2021
CLIN EXP OBSTET GYN

Objective: To evaluate and follow up the native behaviour of large ovarian cysts in postmenopausal women and establish the best approach based on advanced imaging technology. Study Design: The number of patients that were evaluated from January 2015 to September 2019 were 417. At the end of this study period, 375 patients were considered for this prospective evaluation. The patients with an ultrasound diagnosis of unilateral and unilocular ovarian cysts with regular septa ≥ 10 cm in diameter at menopause were enrolled in this study. During the follow-ups, the patients who developed irregular or thick septa, papillary formation or solid areas, exhibited any suspicious sign of malignancy in magnetic resonance imaging (MRI) results or displayed an augmentation in CA-125 levels were excluded from the study. In this study cancer antigen-125 (CA-125) values > 65 IU/mL were considered abnormal. The patients who met these criteria were followed with periodical ultrasounds and yearly MRI. Results: The 42 patients who were excluded from the study had significant morphological changes. These patients were showing an increase in CA-125 levels along with abnormal MRI findings during the follow-ups and in addition, they had surgical removal of cysts. All the significant morphological changes were detected by transvaginal ultrasounds. Postoperative histopathological diagnosis of these ovarian cysts revealed no abnormality. From 375 patient’s cysts samples one hundred and twenty-five (33.3%) cysts had significantly decrease in size, one hundred and eleven (29.6%) of the cysts had spontaneous resolution and one hundred thirty-nine (37%) cysts persistently remained unchanged during the follow up period. The diameter of the cysts ranged from 10.4 to 18.4 cm. The cysts were categorized into three groups corresponding to a range of diameters i.e., 10–12.9 cm (62%), 13–15.9 cm (24.1%) and ≥ 16 cm (13.8%) respectively. The patients who showed spontaneous resolution were discontinued with the follow-ups while the rest of the patients were continued with their regular follow up examinations. Conclusion: The cysts should be monitored conservatively as long as possible before proceeding to a surgical treatment regardless of the size of the unilateral and unilocular ovarian cysts at postmenopausal period with limited oncogenic potential and without significant morphological changes.

Age at first birth, age at menopause, and risk of ovarian cyst: a two-sample Mendelian randomization study

Article

Full-text available

Jan 2024

Background Increasing observational studies have indicated that hormonal reproductive factors were associated with ovarian cyst, a common gynecological disease. A two-sample Mendelian randomization (MR) was carried out by investigating the causality of reproductive factors including age at first birth (AFB), age at natural menopause (ANM), and age at menarche (AAM), and the risk of ovarian cyst (OC). Method Summary statistics were collected from a large genome-wide association study (GWAS), and we used a two-sample MR study to clarify the causal association between the exposure of AFB (N = 542,901), ANM (N = 69,360), and AAM (N = 29,346) and the outcome of the OC (N case = 20,750, N control = 107,564). We separately selected 51, 35, and 6 single-nucleotide polymorphisms (SNPs) as instrumental variables (IVs) for assaying the influence of AFB, ANM, and AAM on OC, respectively. Then, the causal relationship was tested through multiple approaches including an inverse-variance weighted method, an MR-Egger regression, and a weighted median method. In addition, the MR-PRESSO method was also used to verify the horizontal pleiotropy. Subsequently, we adjust the confounders for MR design. Results The MR analysis results showed that AFB was negatively associated with the OC (IVW Beta: −0.09, OR: 0.91, 95% CI: 0.86–0.96, p = 0.00185), and the greater AAM decreased the risk of OC (IVW Beta: −0.10, OR: 0.91, 95% CI: 0.82–0.99, p = 0.0376). However, ANM has a positive correlation with the OC (IVW Beta: 0.05, OR: 1.05, 95% CI: 1.03–1.08, p = 8.38 × 10⁻⁶). After adjusting BMI, alcohol intake frequency, and ever smoked, we also obtained a negative relationship between AFB and OC (p < 0.005). Meanwhile, we adjusted weight, alcohol intake frequency, and height, and then found a causal relationship between older AMN and an increased risk of OC (p < 0.005). Conclusion A causal effect of reproductive factors on the development of OC, affected by AFB, ANM, and AAM, was found convincingly. After adjusting the confounders, we also successfully found the substantial causal effect of younger AFB, younger AAM, and older ANM on an increased risk of OC.

Differentiation between Benign and Malignant Ovarian Cysts: Contemporary Diagnostic Procedures.

Chapter

Full-text available

Apr 2016

Surgery for giant ovarian cysts in Guyana using single-port laparoscopy: a retrospective case series analysis

Article

Dec 2024
Afr J Reprod Health

Giant ovarian cysts (GOCs) have become less common in developed countries due to routine health screenings, but they remain prevalent in economically underdeveloped regions. Treatment options for GOCs depend on factors such as age, cyst characteristics, and pregnancy status. Minimally invasive single-port laparoscopic surgery has largely replaced traditional open surgery due to its aesthetic advantages and effectiveness. In this case series, six patients with giant ovarian cysts, including two pregnant women, underwent single-port laparoscopic surgery. The procedure was aimed to reduce scarring, ensure safety, and preserve fertility. Strict criteria were used to rule out malignancy and assess suitability for the minimally invasive approach. Five patients had successful surgeries with positive cosmetic outcomes, while one required conversion to a mini-laparotomy due to technical difficulties. Postoperative recovery was smooth, with patients expressing satisfaction with the aesthetic results. This study demonstrates that single-port laparoscopic surgery is a safe and effective method for treating large ovarian cysts, combining the advantages of traditional laparoscopy with enhanced cosmetic results. The approach is particularly beneficial for younger and pregnant patients, with careful timing of surgery recommended to minimize pregnancy-related risks.

Does amide proton transfer-weighted MRI have diagnostic and differential value in ovarian cystic and predominantly cystic lesion?

Article

Full-text available

Dec 2024

Objectives This study aims to evaluate the diagnostic value of amide proton transfer-weighted (APTw) imaging in distinguishing cystic or predominantly cystic ovarian lesions. Materials and methods 49 patients underwent APTw imaging at 3T-MR before surgery, with 20 volunteers serving as the control group. Participants were divided into the following groups: solid components of normal ovaries (Group A, n = 29), solid components of malignant lesions (Group B, n = 7), cystic fluid of follicles (Group C, n = 31), cystic fluid of benign lesions (Group D, n = 46), functional cysts (Group d1, n = 8), endometriomas (Group d2, n = 28), cystadenomas (Group d3, n = 10), and cystic fluid of malignant lesions (Group E, n = 12). Independent t-tests or Mann-Whitney U tests and one-way ANOVA were used to compare group differences. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic efficacy in distinguishing between different lesions. Results For solid components, significant differences in MTRasym values were observed between Groups A and B (P < 0.001). For cystic components, significant differences were found between Groups C and D, C and E, d1 and d2, d2 and d3, d1 and d3, C and d2, C and d3, E and d1, and E and d2 (all P < 0.01). ROC analysis of these results showed high AUC values (ranging from 0.813 to 1.0), all P < 0.05. Conclusions APTw can reveal differences in MTRasym values between normal and diseased ovarian tissues, demonstrating high clinical value in differentiating functional cysts, endometriomas, and cystadenomas, as well as distinguishing benign lesions (functional cysts or endometriomas) from malignant tumors.

An Extremely Rare Case of Ovarian Cyst Infiltrated the Urinary Bladder Manifesting as Urinary Bladder Neoplasm

Article

Jul 2017

Miah M Z I

This is a case report of Ovarian dermoid cyst perforating into the urinary bladder presenting with irritative lower urinary tract symptoms characterized by burning micturtion with total haematuria for the last two months. Ovarian dermoid cyst is perforating into urinary bladder pose a diagnostic dilemma for urologist, gynecologist, radiologist and for histopathologist.

Efficacy of Progestins in the Treatment of Functional Ovarian Cyst

Article

Aug 2024

HISTOPATHOLOGICAL SPECTRUM OF OVARIAN TUMOURS WITH DIAGNOSTIC ACCURACY OF SERUM CA125 AND HE4

Article

Full-text available

Jun 2024

A Clinicopathological Study of 236 Cystic Ovarian Lesions at Jos University Teaching Hospital, Jos, Nigeria

Article

Full-text available

May 2022

Background Cystic ovarian lesions are defined by an ovarian fluid containing space limited by a membrane. The exact prevalence of the disease is unknown. A proper diagnosis is imperative for the choice of appropriate therapy. The objective of this study is to establish the different histological variants of ovarian cysts diagnosed at the Histopathology Department of Jos University Teaching Hospital between January 1, 2000, and December 31, 2019. Methodology This is a descriptive study of consecutive cases of ovarian cysts at the Jos University Teaching Hospital, Jos, Nigeria between January 1, 2000, and December 31, 2019. Demographic and histopathologic data were collated from patients' request forms and duplicate copies of histology reports of all histologically diagnosed cases of ovarian cysts at the Histopathology Department during the study period. Result A total of 236cases of cystic ovarian lesions were seen during the period of the study. Benign and malignant cases constituted 226(95.76%) and 10(4.24%) cases respectively. Corpus luteum cyst was the commonest histological type accounting for 28.33% of cases. Lesions located on the right ovary were 145(61.44%), while those on the left were 95(40.25%). The commonest symptom was abdominal pain. The age range was 4-70years, with a mean, median and mode of 35.02+11.9 years, 33.0 years, and 35.0 years respectively. Conclusion The vast majority of ovarian cysts in our environment are benign, and commonly occurs in women during their reproductive age. Abdominal pain is the commonest presentation and cysts of the ovary occur more on the right.

Surgical outcomes of transvaginal natural orifice transluminal endoscopy in treating ovarian cysts and risk factors for surgical conversions

Article

Full-text available

May 2024

Objective This study aimed to assess the surgical outcomes and identify the conversion risk factors of Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) in treating ovarian cyst. Methods This was a retrospective study of 505 patients who underwent vNO TES for treating ovarian cyst from March 2019 to February 2022 wherein the patients were classified into “converted” or “nonconverted” groups. T-tests, χ² tests, and logistic regression were used for statistical analyses. Results There were 16 (3.17 %) surgical conversions and 12 (2.38 %) other surgical complications in our study cohort. Teratomas accounted for 56.8 % of complications in nonconverted cases and 18.8 % in converted cases. Adenocystomas were found in 12.3 % of nonconverted cases and 18.8 % of converted cases. Other types included paraovarian cysts (3.3 % and 0 %), fibroma, granulosa cell tumor, Brenner tumor (1.2 % and 0 %), corpus luteum cysts, follicular cysts (7.6 % and 6.3 %), old abscess (0.2 % and 0 %), and simple cysts (17.6 % and 12.5 %) in the nonconverted and converted groups, respectively. The converted group included more cases of endometriotic cysts (43.8 % vs 12.3 %, p = 0.023), bilateral cysts (37.5 % vs 8.2 %, p < 0.001), severe pelvic adhesion (68.8 % vs 3.3 %, p < 0.001), deep endometriosis (12.5 % vs 0.4 %, p < 0.001), and at least two cysts (37.5 % vs 8.81 %; p < 0.001). Severe pelvic adhesion (adjusted odds ratio [OR], 86.96; range, 18.33–431.77; p < 0.001), bilateral cysts (adjusted OR, 4.75; range, 1.05–21.57, p = 0.043) and endometriotic cysts (adjusted OR, 7.69; range, 3.11–17.08; p < 0.001) were also predictors of surgical conversion. Conclusion vNOTES demonstrates low complication and conversion rates in treating ovarian cyst compared with TU-LESS. Surgical conversion is associated with severe pelvic adhesions, bilateral cysts, and endometriotic cysts.

Anaplastic Carcinoma Arising From a Mural Nodule in Benign Mucinous Cystadenoma

Article

Full-text available

Feb 2024

Giant abdominopelvic tumors continue to present a diagnostic and therapeutic challenge for all surgeons despite all the advances in the world of imaging. Particularly, one of the most important challenges is to determine its probable origin for adequate surgical planning. Even though mostly all of these tumors are benign ovarian tumors, extraordinarily, malignant mural nodules may develop from the wall of these benign tumors, carrying an invariable unfavorable prognosis for the patient. This case highlights the importance of a correct diagnostic approach using ultrasound and abdominal computed tomography scans and confirming the diagnosis through a histopathologic examination. The treatment for these cases is surgical resection and posterior oncological treatment if needed. This case shows how timely treatment is one of the principal determinators of morbidity and mortality.

Ayurvedic treatment regime of Ovarian Cyst: A Case Report

Article

Full-text available

Sep 2023

Introduction: Ovarian cysts are fluid-filled sacs that develop on or within the ovaries, which are part of a woman's reproductive system. Most ovarian cysts are benign (non-cancerous) and do not cause any symptoms. However, in some cases, ovarian cysts can grow larger, rupture, become painful, or cause other complications. Hormonal contraceptives and Surgery only the treatment follow by modern system of medicine. A hormonal contraceptive contributes untoward effect. In Ayurveda it can be correlated with Granthi (Kaphaja Granthi). Methods: In this present case study, a 36 years old woman patient consulted to the OPD with the complaint of Pelvic pain come and go, Bloating in the abdomen, Changes in menstrual patterns, and Pain during sexual intercourse. She had also brought her ultrasonography (USG) and finding suggested a right ovarian complex cyst measuring 36mm×36mmx34mm. She was supposed to be treated with traditional ayurvedic formulations; the case was treated for three months with a combination of different traditional Ayurvedic drugs, with the goal of relieving symptoms and dissolving the ovarian cyst. This patient was treated with traditional Ayurvedic formulations like Varunadi Kashyam, Guggulu Panchapala Churnam, Dashmoola Kwatha, Ajmoodadi Choorna. Result: Only Ayurvedic medicines were used during the course of the treatment. Follow-up USG showed complete disappearance of cyst and symptoms also subsided to a great extent. Discussion: The present study emphasizes the role of Ayurveda in bringing a positive result in the management of ovarian cyst.

Laparoendoscopic Single-Site Technique Contrasted with Conventional Laparoscopy in Cystectomy for Benign Ovarian Cysts

Article

Full-text available

Jul 2023
CURR THER RES CLIN E

Objective: To compare the laparoendoscopic single-site (LESS) technique with conventional laparoscopy in cystectomy for benign ovarian cysts. Materials and methods: A retrospective analysis was performed at Yixing People's Hospital from April 2020 until December 2021. Results: Thirty-seven patients using the LESS technique were compared with a control group of 45 patients who underwent a traditional laparoscopic ovarian cystectomy. There was no statistically significant difference in the perioperative hemoglobin level changes, cyst rupture rate, postoperative recovery of exhausting time, or pain score at 24 hours after surgery between the 2 groups (P > 0.05). The mean operating time was significantly longer in the LESS group than that of the control group (88.38 ± 30.57 minutes vs 59.44 ± 24.22 minutes; P = 0.001). However, the length of postoperative hospital stay was significantly shorter in the LESS group (3.70 ± 0.57 days vs 4.38 ± 0.86 days; P = 0.001). In addition, total hospitalization expenses were higher in the LESS group (14,709.78 ± 1618.63 yuan vs 12,676.73 ± 1411.78 yuan; P = .001) and the satisfaction score was also significantly higher in the LESS group (z = -2.272; P = 0.023). After a follow-up time of 12 to 24 months, no patient in either group showed wound infection, umbilical hernia, or recurrent cysts. Conclusions: The LESS technique for benign ovarian cystectomy is safe, feasible, and equally effective compared with the multiport laparoscopic oophorocystectomy. Although it currently costs more, patients with benign ovarian cysts are highly satisfied with the LESS technique.

The Histopathological Patterns of Ovarian Neoplasms in Different Age Groups: A Retrospective Study in a Tertiary Care Center

Article

Full-text available

Dec 2022

Objectives Ovarian cancer is one of the most prevalent neoplasms worldwide and it affects women of all ages. This study aimed to identify the common histopathological patterns of ovarian cancer among different age groups in the western region of Saudi Arabia. Methods This was a retrospective study that reviewed all ovarian specimens diagnosed as “ovarian tumors” by the Pathology Department from January 2016 to December 2020 at King Abdulaziz University Hospital, Saudi Arabia. The frequencies of ovarian neoplasm subtypes and their frequencies in different age groups were calculated. Results Out of 565 ovarian specimens studied, 63.2% were ovarian neoplasms while 36.8% were non-neoplastic functional cysts. Benign neoplasms 64.4% were more common than borderline 6.2% and malignant ones 29.4% in all age groups, except above the age of 60. Collectively as a category, surface epithelial neoplasms were the most common (59.4%). However, germ cell tumor in the form of mature cystic teratoma was the most common benign neoplasm 33.9% and the most common malignant was serous cystadenocarcinoma (40%). Conclusion Documenting new trends of histopathological patterns of ovarian neoplasms helps to detect variation among different age groups and to understand probable predisposing factors. This study found that the percentage of ovarian malignancy has increased over the years in the western region of Saudi Arabia. This signifies the need to increase awareness in order to achieve timely diagnosis and management.

Septated Ovarian Mass restored to normal by Homoeopathic Treatment

Article

Full-text available

Aug 2018

An ovarian cyst with septation needs a special discussion as based on the thickness of septa chances of it being malignant is assessed. Studies reveal that septated cystic ovarian masses without solid areas or papillary projections have low risk of malignancy and can be followed sonographically without surgery. A young girl complained of pain in lower abdomen in the left iliac region for the last 6 months. USG (ultrasonography) of lower abdomen stated – ‘Right ovarian cyst (5.51 x 4.33 cm) with multiple septation’. She opted for homoeopathy treatment and came to OPD on 13.12.16. After analysing the symptoms of the case, the characteristic mental and physical generals and particular symptoms were considered for framing the totality. Miasmatic evaluation of all the presenting symptoms was also done which showed the predominance of psoric miasm with sycotic adulteration. After repertorisation, Thuja was prescribed as it scored the highest of all the drugs and also covering maximum number of symptoms. Follow�up USG was done on 11.07.17 which revealed a normal ovarian mass. Irrespective of the peculiarities in this particular case i.e. cyst with septation and left sided pain of a right sided pathology, restoration of normal ovarian echo-texture was another success story in list of homoeopathic efficacies.

Laparoscopic surgeries for uterine fibroids and ovarian cysts reduce ovarian reserve via age- and surgical type-manner

Article

Full-text available

Oct 2022

Aim: Diminished ovarian reserve can be characterized by poor response to ovulation and low number of eggs. The risk factors include endometriosis, receiving cancer treatment, luteal phase deficiency and gynecologic surgery. Uterine fibroids and ovarian cysts are the most common benign gynecological diseases in women globally. This prospective study evaluated the influence of laparoscopic surgery treating benign gynecological diseases on ovarian reserve. Methods: A total of 121 patients with uterine fibroids or benign ovarian cysts who received laparoscopic surgeries (41 with hysterectomy, 36 with myomectomy, 18 with adnexectomy, and 26 with ovarian cystectomy) were included. The ovarian reserve status defined as serum anti-Mullerian hormone concentration was assessed at 1 month before and after surgery, respectively. Results: The anti-Mullerian hormone reduction level was 22.34% in cystectomy, 44.1% in adnexectomy, 24.92% in myomectomy, and 47.61% in hysterectomy (p < 0.001). Multivariate analysis showed that adnexectomy had significantly high risk of high serum anti-Mullerian hormone reduction level (adjusted odds ratio (aOR): 14.90, 95% confidence interval (CI): 2.56-86.93, p = 0.003). Conclusions: These 4 laparoscopic surgeries all reduced the AMH levels 1 month after the procedure. Further prospective studies with longer follow-up are necessary to know the real impact on the ovarian reserve. Adnexectomy was an independent factor of reduced ovarian reserve in 1 month after surgery.

Giant Ovarian Mucinous Borderline Tumors. A Report of Two Cases and Literature Review

Article

Dec 2021

Introduction: Adnexal masses are a common finding in gynecological sonographic examinations. Usually, these tumors are detected in early stages while they are asymptomatic. However, in some cases ovarian masses remain undetected and grow to giant size. The majority of these giant tumors are benign. Here we report two cases of giant ovarian mucinous tumors with areas of borderline malignancy. Case description:We present the cases of two women, aged 45 and 54 years, with abdominal masses causing vague symptoms. Abdominal imaging revealed giant cystic masses arising from the pelvis. Both women treated surgically. The first woman underwent right adnexectomy and the second one a total hysterectomy with bilateral adnexectomy and omentectomy. In both cases, the histopathological diagnosis was giant ovarian mucinous borderline cystadenoma. On the 12-month follow up they do not report any discomfort. Discussion and conclusion:Giant ovarian mucinous borderline tumors are uncommon and need surgical resection to eliminate the compressive symptoms that they usually cause. A giant abdominal mass must be always suspected in women with vague compressive symptoms.

Effect modification of body mass index on the association between ovarian cysts and endometrial cancer

Article

Jun 2022
CANCER EPIDEMIOL

Background Ovarian cysts represent a common condition among women. Epidemiologic studies are inconsistent in determining if women with cysts are more likely to develop endometrial cancer (EC) regardless of overweight/obesity. We investigated the combined role of cysts and body mass index (BMI) on EC risk. Methods We pooled data from three case-control studies conducted in Italy and Switzerland on 920 women with EC and 1700 controls. The prevalence of cysts was 5% among both cases and controls, with 63% of cases being overweight/obese. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) using logistic regression models, adjusting for potential confounders. We conducted stratified analyses according to BMI, and estimated the interaction between cysts and BMI; we carried out additional analyses according to age at diagnosis of cysts. Results Overall, history of cysts was not associated to EC (OR=1.27, 95% CI=0.82–1.97, P = 0.29). Normal weight women reporting cysts had an increased risk of EC (OR=2.49, 95% CI=1.31–4.74), while no such effect was found among overweight/obese women (OR=0.65, 95% CI=0.36–1.18; P for interaction=0.004). The association was limited to women below 65 years of age and was stronger in those who reported cysts at age 48 or older. Conclusions Cysts appeared to be a risk factor for EC in lean women but not in overweight/obese ones; these results are consistent with an effect of cysts and obesity on EC along common pathways.

Differential diagnosis of benign ovarian cysts using tumor markers in serum and cyst fluid

Article

Full-text available

Sep 2021

Giant Ovarian Cysts Treated by Single-Port Laparoscopic Surgery: A Case Series

Article

Full-text available

Dec 2021

Background Ovarian cysts are very common diseases of the female reproductive system. Giant ovarian cysts refer to the tumors with diameters greater than 10 cm. In recent years, due to the development of clinical diagnosis, imaging modalities, and the improvement of patients’ cognition of the diseases, the occurrence of giant ovarian cysts has become rare. The purpose of this study was to show a new operation method of single-port laparoscopy to treat giant ovarian cysts. Methods We report a case series of five patients with giant ovarian cysts who underwent single-port laparoscopic surgery in the gynecology department of the Shengjing Hospital of China Medical University between June 2020 and March 2021. The inclusion criteria were ovarian cysts at least 20 cm in diameter, and cases when the tumor might be malignant were excluded. Results The patients’ mean age was 26.2years. The most common clinical presentation was progressive abdominal distension. Median size of the cysts at imaging was 39.2 cm (range 21–63 cm). All patients underwent single-port laparoscopic surgery, and none of them converted to laparotomy. On final pathological reports, two cysts were serous cystadenomas, and three were mucinous cystadenomas. All patients recovered well and were discharged on time. Conclusion Giant ovarian cysts can be treated by single-port laparoscopic surgery. In addition to the well-known advantages of laparoscopic surgery (e.g., small pelvic interference, fast postoperative recovery), it can also play the role of perfect cosmetic results, which has more advantages for young women.

Evaluation of A Disintegrin and Metalloprotein33 Gene Polymorphism in Bronchial Asthma

Research

Jul 2021

Meraim Attyah Kazaal

Role Genetic polymorphism in bronchial asthma

The Histopathological Analysis of 122 Cases of Ovarian Lesions

Article

Jun 2021

Aim: To outline various histopathological types of ovarian cysts received in our teaching hospital along with their prevalence and mode of presentation and to assess the proportion of physiologic versus pathological cysts and benign versus malignant ovarian cysts. Duration of study: From Jan 2019 to March 2021. Methods: Histopathology Department of Bakhtawar Amin Medical & Dental College & Hospital, Multan. A retrospective review of 122 ovarian lesions including physiological/functional cysts, pathological non neoplastic cysts as well as benign, borderline and malignant neoplasm. Histopathology reports of all ovarian specimens were reviewed and counted. Details like age, marital status, parity, presenting complaints, procedure opted, laterality, size, gross and microscopic details and final histological diagnosis etc were recorded. H&E stained slides of all cases were reviewed. In difficult suspicious cases, immunohistochemistry was also carried out. Percentage and proportions were calculated for all the variables. Relevant tables and charts were computed. Results: A total of 122 ovarian specimens with some lesion were segregated in histopathology department of Bakhtawar Amin Hospital from 117 patients with 5 patients having bilateral lesions. The mean age was 33.2 years (ranging from 13-71 years). Most ladies presented between 25-45 years of age. Out of these 117 patients, 18 ladies were unmarried. Out of the 99 married, 12 were nulliparous. Sixty four ladies (54.7%) found to have cysts/neoplasm in right sided ovary, forty eight (41%) presented with left sided ovarian involvement and 5 (4.3 %) presented with bilateral ovarian lesions. Conclusion: Non neoplastic ovarian cysts are more frequent as compared to neoplastic masses. Histopathological diagnosis is mandatory for final confirmatory diagnosis. Keywords: Ovarian lesions, reproductive cells, cyst

Development of an auxiliary device for ultrasound-guided aspiration of pelvic cystic masses: a simulation study

Article

Full-text available

Jul 2021

Background: Pelvic cystic masses are a common gynecological condition. Ultrasound-guided aspiration is a minimally invasive surgical technique for the treatment of pelvic cystic masses. However, further developments to improve its stability and safety are wanting. This study evaluated the application and safety of a self-developed auxiliary device for pelvic cystic masses' ultrasound-guided aspiration through phantom testing. Methods: Saline and coupling agents were used at different viscosity levels to simulate simple cysts, medium viscosity cysts (such as pelvic effusions), and ovarian, endometrial cysts. An auxiliary device consisting of a three-way valve, a negative pressure aspirator, and a pressurized infusion bag was developed. Phantom testing was performed to evaluate the application of this device in ultrasound-guided aspiration of pelvic cystic masses. The indicators, including the time of aspiration, time of injection, and the incidence of complications, were compared to cases in which ultrasound-guided aspiration was performed manually with a syringe. Results: The incidence of complications in the auxiliary device group was significantly lower compared to the manual operation group (P<0.05). The ovarian cystic aspiration times and operation times were significantly shorter in the auxiliary device group compared to the traditional manual puncture group (P<0.05). Conclusions: Ultrasound-guided aspiration is repeatable and minimally invasive for the treatment of pelvic cystic masses. Using the auxiliary device designed in this report resulted in shorter operation times, definite needle fixation, and fewer complications, which may allow for a more stable and safer aspiration procedure for the treatment of pelvic cystic masses.

ASSESSMENT OF WOMEN'S KNOWLEDGE LEVEL ABOUT OVARIAN CYST

Article

Full-text available

May 2021

Background: The research plan is a field study aimed to identify women's Knowledge about the reasons and symptoms of ovarian cysts and how to prevent them. Methods: The study included 40 women who had ovarian cysts and visited the consulting clinics at the Maternity and Children Hospital in Diwaniyah city for the period from 15/11/2019 to 15/12/2019, the information was collected by filling in the questionnaire form and the frequency and percentage distribution were adopted as a statistical method in analyzing the information. Results: The results showed that most of the patients are in the age group from 23 to 27 years (37.5%) followed by 28 to 32 years (25%) and 18-22 years (20%) whereas only 5% and 12.5% of patients detected in age groups 14-17 years and ≥32 year respectively. The results showed that the highest percentage of ovarian cysts is due to the increase in male hormones by 100%, followed by obesity 87.5%, presence of infections 75% and body's insulin resistance 62.5%. moreover, the most important symptoms ovarian cysts are irregular menstruation (100%), increased hair on the face, chest and thighs (100%), pain in the pelvis (80%) and acne (75%). In conclusion, from the most prominent recommendations of the research is health awareness and education for women through various media about the causes of ovarian cysts and ways to prevent this problem through regular review of the specialist doctor, a healthy diet and exercise.

Different Doses of Nalbuphine Combined with Dexmedetomidine in Laparoscopic Oophorocystectomy

Article

Full-text available

May 2021
MED SCI MONITOR

Background The goal of this study was to investigate different doses of nalbuphine combined with dexmedetomidine in the postoperative treatment of laparoscopic oophorocystectomy. Material/Methods This prospective single-blinded randomized controlled study included 219 patients with benign ovarian cysts who received laparoscopic oophorocystectomy from March 2017 to October 2019. Patients were randomized into 4 groups: low (0.5 mg/kg), middle (1.0 mg/kg), and high (1.5 mg/kg) doses of nalbuphine combined with dexmedetomidine (4 μg/kg) (LND, MND, and HND groups, respectively) and a control group with sufentanil (2.5 μg/kg), with different patient-controlled intravenous analgesia pump (PCIA) strategies. Rest and active visual analog scale (VAS) scores measured postoperative pain, and Ramsay scores were used to measure sedation. Results The HND group showed the lowest rest and cough VAS scores at 2 h, 8 h, 12 h, and 24 h after surgery, the lowest PCIA pressing time within 48 h after surgery, and the highest Ramsay scores at 2 h, 8 h, 24 h and 48 h after surgery. Rest and cough VAS scores decreased with higher nalbuphine doses in a dose-dependent manner. One day after surgery, IL-1β and IL-6 levels increased in all groups, with the lowest levels of IL-1β and IL-6 in the HND group. Hospitalization time was significantly shorter in the HND group compared with the LND and MND groups. There were no significant differences in complications among groups. Conclusions Combined nalbuphine and dexmedetomidine improved postoperative pain and sedative conditions, reduced inflammation in a nalbuphine dose-dependent manner, and might facilitate patient recovery.

A Clinical Study on Efficacy of Dawae Akyas in Management of Benign Ovarian Cyst

Article

Nov 2020

Asiya Farheen

A case of large ovarian cyst in 38 years old female patient

Article

Jan 2019

Omar Massoud

Clinician Beware, Giant Ovarian Cysts are Elusive and Rare PMID: 32140321

Article

Full-text available

Jan 2020

Giant ovarian cysts, which are described in the literature as measuring more than 10 cms in size in their largest diameter, are rare in occurrence. With the availability of multiple imaging modalities and routine physical examinations, it has become even rarer to find such cases. Ovarian serous cystadenomas, which are benign tumors arising from the ovarian epithelium,represent the most common type. We present a case of a 58-year-old female who came to establish primary care in our clinic. She reported ongoing symptoms of constipation, abdominal discomfort, bloating, as well as intermittent postmenopausal bleeding for the past few months. The patient reported taking over-the-counter medications for her predominant gastrointestinal symptoms with no improvement at all. Transvaginal ultrasonography (TVUS) and magnetic resonance imaging (MRI) of the pelvis revealed the presence of giant bilateral ovarian masses measuring more than 17 X 10 cms each. Further testing revealed highly elevated levels of tumor markers cancer antigen 125 (CA-125) and human epididymis protein 4 (HE-4). The patient subsequently underwent total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO). Her histopathology report revealed the presence of bilateral benign cystadenomas. From a primary care physician's perspective, this case highlights the importance of possible rare pathologies that can present with symptoms of a completely unrelated organ system. Even with the rarity of these cases, a clinician may encounter such a case in their everyday practice. Patients can endorse a plethora of vague complaints, often masquerading other entities seen commonly in the clinic.

Adnexal Mass Risk Assessment: A Multivariate Index Assay for Malignancy Risk Stratification

Article

Full-text available

Oct 2019

Aims: Adnexal mass risk assessment (AMRA) stratifies patients with adnexal masses, identifying the relatively small number of malignancies from benigns which might take a ‘watchful waiting’ approach. Methods: AMRA uses seven biomarkers and derived from women with adnexal masses scheduled for surgery. Estimated clinical performance was calculated using fixed prevalence. Results: At 5% prevalence, the high-risk group, 7.9% total, captured 75.9% of invasive malignancies at a positive predictive value of 35.8%. High risk/intermediate risk combined had a sensitivity of 89.7 and 95.6% for pre- and post-menopausal cancers, respectively. The low-risk group, 67.8% total, had an negative predictive value of 99.0%. Conclusion: With highly differentiating risk stratification capability across histological subtypes and stages, AMRA is potentially applicable to patients with adnexal masses to assist deciding whether immediate surgery is recommended.

Improvement and effect of stress responses and ovarian reserve function in patients with ovarian cysts after laparoscopic surgery

Article

Full-text available

Jul 2019
J INT MED RES

Objectives This study aimed to examine improvement and the effect of stress responses and ovarian reserve function in patients with ovarian cysts after laparoscopic surgery. Methods A retrospective analysis was performed on 117 patients with ovarian cysts. Fifty-one patients who were treated with abdominal ovarian cyst dissection were in the control group. Sixty-six patients who were treated with laparoscopic ovarian cyst dissection were in the experimental group. Results Operative conditions and recovery in the experimental group were better than those in the control group. After surgery, changes in most ovarian reserve function indices in the experimental group were significantly less than that in the control group. The maximum diameter of the ovary and the number of antral follicles after surgery were less in the experimental group than in the control group. Changes in stress response indices after surgery were significantly less in the experimental group than in the control group. Conclusions Laparoscopic ovarian cyst surgery may have a relatively small adverse effect on multiple related indices of ovarian reserve function. The patient’s stress response level is also lower after this surgery. Therefore, laparoscopic ovarian cyst surgery is suitable for treating patients with ovarian cysts.

Abdominal Gynecologic Procedures in Pancreas Transplant Recipients

Article

Oct 2024

Introduction With the growing population of pancreas transplant recipients followed long‐term, some female recipients are going to require surgical intervention for gynecologic symptoms and pathologies. Currently, there is a lack of literature describing how to approach this population and whether pelvic gynecologic procedures (GYN) can be performed safely given the proximity of the pancreatic (and possibly renal) allograft. In this single‐center retrospective analysis, all pancreas transplant recipients that subsequently underwent GYN were reviewed. Methods Subjects were identified by cross‐referencing all pancreas transplants performed between January 2003 and December 2022 for any subsequent GYN. Demographics at transplant and GYN, indications and procedure performed, operative time, presence and involvement of a transplant surgeon, complications length of stay, and readmissions were reviewed. Results Seventeen patients who underwent a total of 19 GYN after pancreas transplantation were identified. Operations performed included tubal ligation ( n = 2), total abdominal hysterectomy with ( n = 6) or without bilateral salpingectomy ( n = 2), oophorectomy versus cyst drainage ( n = 2), bilateral oophorectomy ( n = 1), and unilateral ( n = 4) versus bilateral ( n = 2) salpingectomy. Four were performed through an open laparotomy and 15 were performed laparoscopically. In 11 cases, a transplant surgeon was involved intra‐operatively. Eight of the 17 patients developed post‐operative complications including post‐operative fevers, fluid overload, neutropenia, elevated creatinine ( n = 2), nephrolithiasis, urinary tract infection, and incisional hernia. Five required readmission. Conclusion GYN can be performed safely following pancreas transplantation, but careful planning and the involvement of the transplant surgery team are advised.

Influence of ovarian cysts on ovarian reserve and fertility: A case–control study

Article

Full-text available

Dec 2023
INT J GYNECOL OBSTET

Objective The aim of this study was to evaluate the impact of having an ovarian cyst and undergoing cystectomy on the expression of ovarian reserve markers among adolescent females who live in Armenia. Methods We conducted a prospective case–control study. Cases were arranged into two groups. The postoperative group (POG) included those who underwent unilateral ovarian cystectomy, and those in the benign ovarian cyst group (BOCG) had complex ovarian cysts with a diameter of 5 cm or more. Adolescents without ovarian pathologies were included in the reference group (RFG). Levels of anti‐Mullerian hormone (AMH) and follicular stimulating hormone (FSH) were measured, and an ultrasound investigation of antral follicular count (AFC) was also done. Results Mean differences between baseline and 6‐month follow‐up levels of AMH, AFC significantly decreased in both the POG and BOCG compared to the RFG. However, the decrease was more significant in the POG: a decrease of 0.86 ng/mL for AMH and 3.11 ng/mL for AFC versus decreasing by 0.61 ng/mL for AMH and 1.68 ng/mL for AFC. Meanwhile, in the BOCG, 6‐month FSH levels did not show any significant changes compared to the baseline measurement. In comparison with the reference group, there was a significant decrease in the levels of AMH and AFC among participants who had endometriomas and cystadenomas. Conclusion Benign ovarian cysts 5 cm or more in diameter, as well as cystectomy, statistically affect OR after 6 months. Therefore, adolescents with ovarian cyst or cystectomy need individualized support to maintain reproductive age fertility.

Variables Associated With Resolution and Persistence of Ovarian Cysts

Article

Oct 2023
OBSTET GYNECOL

OBJECTIVE To estimate surveillance intervals of incident ovarian cysts, and describe variables associated with cyst resolution times. METHODS The UK-OCST (University of Kentucky Ovarian Cancer Screening Trial) was a prospective cohort that enrolled 47,762 individuals over 30 years, including 2,638 individuals with incident cysts. Cyst diameter and structure and patient age, body mass index, use of hormone therapy (HT), family history of ovarian cancer, and menopausal status were examined as variables associated with cyst resolution using t tests, χ ² test, Kaplan Meier, and Cox multiple regression. RESULTS Of 2,638 individuals with incident cysts, 1,667 experienced resolution (63.2%) within 1.2 years, and 971 experienced persistence (36.8%). Within 1 year, unilocular and septated cysts had similar resolution rates (35.4% and 36.7%, respectively, P >.05), but time to resolution was shorter for unilocular cysts compared with septated cysts (mean 1.89 years vs 2.58 years, respectively, P <.001). Both unilocular and septated cysts smaller than 3 cm resolved faster than cysts larger than 6 cm ( P <.001). Variables associated with percent resolution included being of younger age, premenopausal status (but not for synchronous bilateral cysts), and those reporting a family history of ovarian cancer ( P <.05). Variables associated with a faster cyst resolution rate included being older than age 70 years and not using hormone therapy. Body mass index and family history were not associated with cyst resolution time. CONCLUSION Different surveillance times may be appropriate depending on cyst structure and size and patient age and HT use. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT04473833.

Large follicular ovarian cyst in an adolescent girl

Article

Full-text available

Jan 2023

Comparing outcomes of ovarian cystectomy by vaginal natural orifice transluminal endoscopic surgery versus laparoendoscopic single-site surgery: A retrospective cohort study

Article

Apr 2023

Background: We aimed to compare the outcomes of ovarian cystectomy (OC) performed by vaginal natural orifice transluminal endoscopic surgery (vNOTES) versus transumbilical laparoendoscopic single-site surgery (LESS). Methods: We retrospectively analyzed the data of patients in our hospital who underwent OC either by vNOTES or LESS between January 2015 and September 2021. Demographic data were collected. The primary outcome was the conversion rate. The secondary outcomes were the duration of surgery, length of hospital stay, estimated blood loss, maximum body temperature within 48 h after operation, and duration of maximum body temperature (h), among others. Statistical analysis was done using the SPSS software. Results: Exactly 284 patients were screened. The vNOTES and LESS groups consisted of 21 and 47 patients, respectively. There was no significant difference in the conversion rates between the two groups (0 vs. 8.5% in vNOTES and LESS, respectively, p=0.303). Compared with the vNOTES group, the LESS group had a larger cyst diameter (6.00±2.32 cm vs. 4.69±1.29 cm, p=0.004), more endometriotic cysts (42.6% vs. 9.5%, p<0.001), and more pelvic adhesions requiring adhesiolysis (57.4% vs. 19.0%, p=0.003). At baseline, there were no other differences between the groups. The secondary outcomes included a shorter duration of surgery (70.14±27.30 min vs. 99.57±36.26 min, p=0.001) and lower estimated blood loss (64.29±39.19 mL vs. 163.43±251.20 mL, p=0.011) in the vNOTES group. Regression analysis showed the diameter of the ovarian cyst correlated with surgical time. The complication was comparable between the two groups. Conclusion: Above all, the advantages of vNOTES include an absence of visible scars, shorter surgical duration, and less blood loss when compared with LESS. Further large-scale prospective trials should confirm the results of our study.

Laporan Kasus: Kista Ovarium Permagna

Article

Full-text available

Nov 2022

Giant ovarian cyst is a mass on the adnexa with a size of 10 cm before surgery. About 10% of women will have tumor growths on the ovaries and almost all of them are benign. In this case a 50-year-old woman with complaints of an enlarged abdomen, abdominal fullness and malaise. The result of the ultrasonography picture obtained lobed masses with a diameter of 20 cm. After that, a total abdominal hysterectomy operation with bilateral salphyngoophorectomy is performed. The operation went well and the patient went home without any follow-up problems. Lab results found CA 125 levels of 20.87 U/mL, with histological descriptions stating these cysts are benign and contain mucin fluid. Keywords: ovarian, cyst, giant, mucinous, benign Abstrak—Kista ovarium permagna merupakan massa pada adneksa dengan ukuran 10 cm sebelum operasi. Sekitar 10% wanita akan mengalami pertumbuhan tumor pada ovarium dan hampir semuanya jinak. Pada kasus ini wanita berusia 50 tahun dengan keluhan perut semakin membesar, rasa penuh dan tidak enak. Hasil gambaran ultrasonography didapatkan massa berlobus – lobus dengan diameter 20 cm. Setelah itu, dilakukan operasi total abdominal hysterectomy dengan bilateral salphyngoophorectomy. Operasi berjalan dengan baik dan pasien pulang tanpa ada masalah lanjutan. Hasil lab ditemukan kadar CA 125 20.87 U/mL, dengan gambaran histologi menyatakan kista ini jinak dan berisi cairan mucin. Kata kunci: kista, ovarium, mucin, permagna

Natural history and malignant potential of simple ovarian cysts in postmenopausal women: a systematic review and meta-analysis

Article

Feb 2023

Importance: Postmenopausal ovarian masses are not uncommon, and the incidence of ovarian cancer rises sharply after menopause. Objective: We conducted a systematic review and meta-analysis to investigate the natural history and malignant potential of postmenopausal simple ovarian cysts. Evidence review: PubMed, MEDLINE, EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), ClinicalTrials.gov, and ISRCTN (International Standard Randomized Controlled Trial Number Register) were searched from inception to January 31, 2022. Meta-analyses were conducted using R software. Findings: Twelve cohort studies with 1,672 participants and 1,513 ovarian cysts were included. The rates of simple cysts remaining unchanged (38.90%; 95% CI, 19.79%-59.85%; P < 0.01) or disappearing (34.17%; 95% CI, 19.13%-50.93%; P < 0.01) were the highest during conservative observation. The surgery rate for the simple cyst was 19.04% (95% CI, 8.19%-32.92%; P < 0.01). The malignancy rate (including borderline tumors) was very low, approximately 1/10,000 (95% CI, 0% to 0.23%; P = 0.79). Conclusions: Simple ovarian cysts in postmenopausal women were most likely to remain unchanged or disappear during follow-up. The malignancy rate was approximately 1 in 10,000. Personal preference is the most common reason for surgery.

Fertility-Enhancing Ovarian Cystectomy

Chapter

Sep 2022

Ovarian cysts are a frequent surgical diagnosis in women of reproductive age. While most ovarian cysts in this age group are benign, a careful preoperative evaluation will identify those who would benefit from surgical intervention and, furthermore, when referral to a gynecologic oncologist may be warranted. The most common cysts encountered in women of reproductive age include simple cysts, serous or mucinous cystadenomas, endometriomas, and mature cystic teratomas. Important aspects of a preoperative evaluation to assist in evaluating for a potentially malignancy ovarian mass include a detailed medical history, physical examination, imaging studies, and laboratory evaluation. Fertility-sparing ovarian cystectomy, typically performed laparoscopically, can be offered to women with benign ovarian cysts who desire future fertility. Prior to ovarian cystectomy, women should be counseled regarding the potential impact on ovarian reserve.

Rectal mature teratoma: A case report

Article

Full-text available

Aug 2022

Background: Rectal mature teratoma is rare and has been reported as a case report in this study. Herein, clinical presentation, magnetic resonance imaging findings, and immunohistochemistry showed a pelvic rectal mature teratoma. The case report and the surgical treatment procedure have been discussed below. Case summary: A 29-year-old Chinese female showed up with over a 1-mo history of perianal mass that emerged after defecation. Physical examination indicated that the mass was 4 cm × 3 cm × 3 cm. The intraoperative procedure involved ligation of the sigmoid colon 10 cm above the upper edge of the tumor, followed by ligation of the rectum 3.5 cm above the upper edge of the tumor, and subsequent complete removal of the mass. The histopathology confirmed the mature teratoma. Conclusion: The tumor can be completely removed using surgery to prevent its recurrence.

Diagnostic workflow for small intestine diverticulitis: case series and systematic review.

Article

Full-text available

Jan 2020

Objective: to assess new strategies in order to promptly diagnose small intestine diverticulitis. Methods: we thoroughly analyzed a case series of small intestine diverticulitis in order to describe three of the typical presentations of such disease (intestinal perforation, intestinal obstruction and obstruction developing perforation). A systematic review of the literature was then conducted in five different scientific databases using six different keywords. Imaging technique's sensitivity for small intestine diverticulitis was assessed, as well as the frequency of signs and symptoms of such pathology. A complete description of the signs and symptoms of acute abdomen-type pathologies was also investigated in order to provide differential traits to distinguish small intestine diverticulitis. Results: No pathognomonic signs or symptoms were detected for the pathology, although we found that all the other pathologies in the “acute abdomen” type of diseases have distinguishing traits that could be used to perform a differential diagnosis of small intestine diverticulitis. Moreover, contrast-enhanced computed tomography is the best imaging technique for the confirmation of such disease, when guided by an initial suspicion. Conclusion: Small intestine diverticulitis cannot be diagnosed by clinical exploration only, but patients that have acute abdomen characteristics, and are negative to signs and symptoms that are characteristic of the other diseases in its type should be suspected for such disease. The aforementioned suspicion may guide a better imaging technique selection and exploration through it.

Efficacy of intraperitoneal bupivacaine, hydrocortisone, and magnesium sulfate in different combinations for pain relief after laparoscopic ovarian cystectomy: a double-blind randomized controlled trial

Article

Full-text available

Oct 2019
MINERVA ANESTESIOL

Background: We aimed to assess the efficacy of intraperitoneal different combinations for postoperative pain relief in patients undergoing laparoscopic unilateral ovarian cystectomy. Methods: We conducted a double-blind randomized controlled trial that enrolled patients who were included to undergo laparoscopic unilateral ovarian cystectomy. Patients received one of the following combinations (30 patients each): group I: received bupivacaine plus magnesium sulfate, group II: received bupivacaine plus hydrocortisone, group III: received magnesium sulfate plus hydrocortisone, and group IV: received saline 0.9% only. The primary outcomes in the present study were the severity of postoperative abdominal and shoulder pain assessed by visual analog scale (VAS) every two hours till the end of the first day, and time for first postoperative analgesia requirement. Results: Group I had statistically significant lower abdominal static and dynamic pain scores than the other groups till 18 hours postoperatively (p <0.001). In addition, group II had statistically significant lower abdominal static and dynamic pain scores than group III in the most of assessment points (p <0.05). The time for first required analgesics was significantly longer in group I (336.2 ± 67.54 minutes) than other groups (p <0.001). The proportion of patients who required two or more doses of ketorolac was significantly lower in group I than other groups (p <0.001). The proportion of patients with nausea or vomiting was not significantly different across study's groups (p >0.05). Conclusions: Intraperitoneal bupivacaine-magnesium combination provides better analgesia and reduces postoperative morphine consumption than bupivacaine-hydrocortisone or magnesium-hydrocortisone combinations after laparoscopic ovarian cystectomy.

Amide proton transfer imaging for differentiating benign ovarian cystic lesions: Potential of first time right

Article

Sep 2019
EUR J RADIOL

Purpose: To investigate whether amide proton transfer (APT) imaging is useful to differentiate benign ovarian cystic lesions. Materials and methods: This prospective study enrolled a total of 19 lesions in 18 patients with benign ovarian cystic lesion: serous cystadenoma (SCA), n = 4; mucinous cystadenoma (MCA), n = 9; or functional cyst (FC), n = 6. APT imaging was performed with three different presaturation pulse durations: 0.5, 1.0 and 2.0 s. APT signal was defined as magnetization transfer ratio asymmetry at 3.5 ppm. The SI ratios of cyst to muscle calculated on T1- and T2-weighted images were defined as T1- and T2-ratios. Apparent diffusion coefficient (ADC) maps were also generated. We compared the three cystic lesion groups' APT signals, T1-ratio, T2-ratio, and ADC. Results: When using 2.0 s of presaturation, the APT signals were 1.41 ± 0.71% in SCA, 5.15 ± 1.92% in MCA and 8.52 ± 1.17% in FC. Significant differences were observed between SCA and MCA (p < .01) and MCA and FC (p < .05), as well as between SCA and FC (P < .0001). When 1.0 s presaturation pulse was used, similar results were obtained. On the other hand, ADC value shows significance only between SCA (2.91±0.03×10-3 mm2/s) and MCA (2.59 ± 0.49 × 10-3 mm2/s, p < .05). Further, there was no significant difference in the T1-ratio, T2-ratio among the three groups. Conclusions: APT imaging might be useful for the non-invasive diagnosis of benign ovarian cystic lesions. With the use of the longer presaturation pulse as possible, APT imaging may provide an early and correct diagnosis of ovarian cystic lesions without additional follow-up studies.

The state of ovarian reserve in patients with functional ovarian cysts

Article

Full-text available

Jan 2019

Laparoscopic vs. laparotomic ovarian cystectomy in reproductive age women: An economic evaluation

Article

Full-text available

Jul 2008
Gynaecol Endosc

Objective This study was carried out to assess both the efficacy and the economic advantages of two different surgical techniques in the treatment of ovarian cysts in women of reproductive age.DesignA prospective randomized clinical study.SettingEndocrinological Gynaecology Department of the Catholic University of S. Cuore, Rome.SubjectsThese were 68 women of reproductive age (16–39 years) who were hospitalized for ovarian cysts which had persisted for at least 3 months, or who were noted to have an increase in ovarian volume detected by consecutive ultrasound investigations.InterventionsOf these patients, 34 received laparotomic treatment using a Pfannewstiel incision and traditional techniques. The other 34 patients underwent a laparoscopic stripping of the capsule of the cyst with no sutures on the ovary.ResultsThe two techniques showed similar levels of safety and efficacy. The comparison of direct and indirect costs for the two procedures showed an average total cost of

4940 for laparotomic surgery and

3543 for laparoscopy.Conclusions The present study demonstrates that ovarian cysts can be as well treated using laparoscopic access as with laparotomy, but with an average cost reduction of 28% for the former.

Laparoscopic Management of Paratubal and Paraovarian Cysts

Article

Full-text available

Mar 2003

To define the proportion, methods of diagnosis, and a simplified laparoscopic technique for treating paratubal and paraovarian cysts. We conducted a prospective cross-sectional study in the Gynecologic Endoscopy Unit of Assiut University Hospital in Assiut, Egypt in 1853 patients undergoing video-assisted laparoscopy. Transvaginal ultrasonography (TVS) was performed to detect paratubal or paraovarian cysts. Tubal shape and patency were evaluated with hysterosalpingography (HSG) in the infertile group. Diagnostic laparoscopy was performed to confirm the diagnosis of paratubal or paraovarian cysts. Small cysts were punctured and coagulated, and larger cysts required cystectomy and extraction of the cysts by using bipolar electrosurgery. Cystectomy was preceded by endocystic visualization in all cases. The primary outcomes measured included (1) correlation of the preoperative TVS, HSG, or both of these, with the laparoscopic diagnosis; (2) estimation of the success of the laparoscopic management of paratubal cysts; (3) assessment of the value of endocystic visualization prior to cystectomy; and (4) evaluation of tubal patency after laparoscopic management. Laparoscopically, only 118 patients (15.7%) were proved to have paratubal or paraovarian cysts. Preoperatively, TVS confirmed paratubal or paraovarian cysts in 52 (44%) patients. Cysts less than 3 cm in size (34 cases) were treated with simple puncture and bipolar coagulation of the cyst wall, whereas larger cysts (84 cases) were treated by cystectomy. Endocystic visualization using the 4-mm rigid hysteroscope was performed in 84 (71%) patients with large cysts. Statistically significant improvement occurred in tubal patency after laparoscopic management. Sonographic diagnosis of not uncommon paratubal and paraovarian cysts is not always feasible and requires greater awareness and accuracy. The characteristic laparoscopic differentiation of ovarian cysts is the crossing of vessels over them. Endocystic-endoscopic visualization is a simple, valuable step prior to cystectomy. Bipolar coagulation or extraction of these cysts diagnosed at laparoscopy is easy, not time-consuming, and should be routinely performed in all cases following microsurgical laparoscopic principles.

A prospective randomized study of laparoscopy and minilaparotomy in the management of benign adnexal masses

Article

Full-text available

Nov 2004

Recent prospective and randomized studies have demonstrated that laparoscopy is better than laparotomy in the treatment of benign adnexal masses. The aim of this study is to analyse the perioperative outcomes of laparoscopy and minilaparotomy in these patients, in a prospective and randomized manner. Between January 2003 and August 2003, 100 consecutive women with a diagnosis of presumed benign adnexal mass and requiring surgical treatment were randomly assigned to minilaparotomy and laparoscopy. Randomization was centralized and computer-based. All operative procedures were performed without conversion to laparotomy. In the group of patients submitted to minilaparotomy, a shorter operating time than patients submitted to operative laparoscopy (mean+/-SD: 71.9+/-31.8 versus 87.0+/-44.8 min; P<0.05) was found. On the other hand, there were significant differences in terms of postoperative ileus (1.1+/-0.4 days in laparoscopy and 1.4+/-0.6 in minilaparotomy P<0.023), without affecting the day of discharge. No intraoperative or early complications were registered in either group. Taking into account that laparoscopy has to be considered the first choice for benign adnexal surgery, our data suggest that minilaparotomy could offer the gynaecology surgeon a valid alternative in the minimally invasive surgery field, especially in specific settings.

Management of large cystic adnexal tumor by gasless laparoscopic-assisted surgery with wound retractor

Article

Full-text available

Sep 2007
J MINIM INVAS GYN

We used a retrospective analysis to evaluate the efficacy of a wound retractor used in gasless laparoscopic-assisted surgery by the subcutaneous abdominal wall-lift method for the management of large cystic adnexal tumors. In the department of gynecology at a general hospital, 39 patients with large cystic adnexal tumors with an excised tissue weight including cystic contents exceeding 1000 g were treated by gasless laparoscopic-assisted surgery with a wound retractor from January 2001 through December 2006. Intervention was with a gasless laparoscopic-assisted adnexal surgery with a wound retractor. The median age of the patients was 51.5 years (range 16-79 years). The median weight of the excised tissue including cystic contents was 1857 g (range 1044-9454 g). The median blood loss was 30 mL (range 10-570 mL). The median surgical duration was 62 minutes (range 26-107 minutes). There were no major surgical complications. Histopathologic diagnosis of the excised tumor was mucinous cystadenoma, 18 cases; serous cystadenoma, 8 cases; mucinous cystadenocarcinoma of low-grade malignancy, 5 cases; dermoid cyst, 4 cases; paraovarian cyst, 2 cases; endometriotic cyst, 1 case; and clear cell adenocarcinoma, 1 case. Bilateral adnexal tumors were noted in 3 cases. We determined that gasless laparoscopic-assisted adnexal surgery with a wound retractor is an effective, minimally invasive procedure to treat large cystic adnexal tumors.

Robot-assisted laparoscopic surgery in patients with advanced ovarian cancer: Farghaly's technique

Article

Aug 2013

Samir Farghaly

A detailed analysis of the learning curve: Robotic hysterectomy and pelvic-aortic lymphadenectomy for endometrial cancer

Article

Aug 2009
GYNECOL ONCOL

Objective: To define the learning curve for robotic hysterectomy and pelvic-aortic lymphadenectomy for endometrial carcinoma. Methods: Patient demographics and segmental operative times on all patients at one institution who underwent robotic comprehensive surgical staging (hysterectomy, pelvic and aortic lymphadenectomy) for endometrial cancer were prospectively collected. Patients were arranged in order based on surgery date and outcomes were compared between quartiles (cases 1-20, 21-40, 41-60, and 61-79). Proficiency was defined as the point at which the slope of the curve becomes less steep for operative times. Efficiency was defined as the point at which the slope is zero. ANOVA or Fisher's exact test was used to compare the procedure times. Locally weighted regression generated smoothed lines that represent operative time over the sequence of the operations. Results: 79 patients were comprehensively staged robotically. While age, the percentage of patients with >/=2 co-morbidities, number of patients with previous laparotomy, EBL, LOS and lymph node counts do not differ between groups, the first 20 patients had a lower BMI compared to the next 20 (27 vs. 34 kg/m(2), P=0.009). Operative times decreased from the first 20 cases to next 20, but was not significantly changed over the next three quartiles. Each component of the procedure has a separate learning curve. Conclusions: Proficiency for robotic hysterectomy with pelvic-aortic lymphadenectomy for endometrial cancer is achieved after 20 cases; however, the number of procedures to gain efficiency varies for each portion of the case and continues to improve over time.

Robotic approach for ovarian cancer: Perioperative and survival results and comparison with laparoscopy and laparotomy

Article

Dec 2010
GYNECOL ONCOL

Comparison of perioperative outcomes and survival of patients undergoing primary surgical treatment for epithelial ovarian cancer (EOC) by a robotic, laparoscopy, or laparotomy approach. Retrospective case-control analysis of 25 patients with EOC undergoing robotic surgical treatment between March 2004 and December 2008. Comparison was made with similar patients treated by laparoscopy and laparotomy and matched by age, body mass index (BMI), and type of procedures between January 1999 and December 2006. The mean operating times were 314.8, 253.8 and 260.7 min for robotic, laparoscopy and laparotomy patients, respectively (p<0.05); the mean blood loss was 164.0, 266.7, and 1307.0 ml, respectively (p=0.001); the mean length of hospital stay was 4.2, 3.2, and 9.4 days, respectively (p=0.001). The overall survival (OS) for robotics, laparoscopy and laparotomy patients was 67.1%, 75.6% and 66.0%, respectively (p=0.08). Patients were subdivided and compared according to the extent of surgery by the type and number of major procedures. Type I and II debulking patients operated by robotics and laparoscopy had improved perioperative outcomes as compared to laparotomy. For patients undergoing a type III debulking, robotic outcomes were not improved over laparotomy. Laparoscopy and robotics are preferable to laparotomy for patients with ovarian cancer requiring primary tumor excision alone or with one additional major procedure. Laparotomy is preferable for patients requiring two or more additional major procedures. Survival is not affected by the type of surgical approach.

Ovarian Frozen Section Diagnosis Use of Whole-Slide Imaging Shows Excellent Correlation Between Virtual Slide and Original Interpretations in a Large Series of Cases

Article

Jul 2010
ARCH PATHOL LAB MED

Whole-slide images (WSI) are a tool for remote interpretation, archiving, and teaching. Ovarian frozen sections (FS) are common and hence determination of the operating characteristics of the interpretation of these specimens using WSI is important. To test the reproducibility and accuracy of ovarian FS interpretation using WSI, as compared with routine analog interpretation, to understand the technology limits and unique interpretive pitfalls. A sequential series of ovarian FS slides, representative of routine practice, were converted to WSI. Whole-slide images were examined by 2 pathologists, masked to all prior results. Correlation characteristics among the WSI, the original, and the final interpretations were analyzed. A total of 52 cases, consisting of 71 FS slides, were included; 34 cases (65%) were benign, and 18 cases (35%) were malignant, borderline, and of uncertain potential (9 [17%], 7 [13%], and 2 [4%] of 52 cases, respectively). The correlation between WSI and FS interpretations was 96% (50 of 52) for each pathologist for benign versus malignant, borderline, and uncertain entities. Each pathologist undercalled 2 borderline malignant cases (4%) as benign cysts on WSI. There were no overcalls of benign cases. Specific issues within the benign and malignant groups involved endometriosis versus hemorrhagic corpora lutea, and granulosa cell tumor versus carcinoma, respectively. The correlation between original FS and WSI interpretations was very high. The few discordant cases represent recognized differential diagnostic issues. Ability to examine gross pathology and real-time consultation with surgeons might be expected to improve performance. Ovarian FS diagnosis by WSI is accurate and reproducible, and thus, remote interpretation, teaching, and digital archiving of ovarian FS specimens by this method can be reliable.

Robotic Adnexectomy Compared With Laparoscopy for Adnexal Mass

Article

Oct 2009
OBSTET GYNECOL

To evaluate whether the application of robotic technology in the performance of adnexectomy resulted in benefits for the patient when compared with patients operated by laparoscopy. Evaluation of 85 patients undergoing robotic adnexectomy and comparison with a group of 91 patients operated on by laparoscopy during the same period of time and by the same surgeons. Patients were compared by age, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status classification, indications, unilateral compared with bilateral adnexectomy, adhesions, size or weight or both of the adnexal mass, and previous abdominal or pelvic surgery. Univariate and multivariate analysis was used to determine factors favorable to each technique. Comparison between the groups was evaluated using the Fisher exact test from a one-way analysis of variance. The robotic group had an increased number of obese (BMI 30 or more) and higher anesthetic risk (ASA classification 2 and 3) patients as compared with laparoscopy patients. The mean operating time was 12 minutes longer in the robotic group (P=.01). The mean blood loss (80 mL robotic, 71 mL laparoscopic), length of hospital stay (0.15 days robotic, 0.28 days laparoscopic), intraoperative complications (1% robotic, 2% laparoscopic), and postoperative complications (12% robotic, 11% laparoscopic) were similar in both groups. : Laparoscopy and robotics provided similar results for the performance of adnexectomy, with similar blood loss, intraoperative and postoperative complications, and length of hospital stay. Robotics mean operating time was 12 minutes longer. II.

Laparoscopic excision of ovarian neoplasm subsequently found to be malignant

Article

May 1991
OBSTET GYNECOL

One hundred fifty-six members and candidate members of the Society of Gynecologic Oncologists responded to a survey concerning the "laparoscopic management of ovarian neoplasms subsequently found to be malignant." Twenty-nine responders (19%) reported a total of 42 cases of ovarian malignancy. The laparoscopic procedure was aborted or the cyst was aspirated in 38% of the cases, and partial or complete excisions were attempted in 33 and 29%, respectively. The characteristics of the masses were as follows: less than 8 cm 67%, cystic 62%, unilocular 48%, and unilateral 81%. All four "benign" characteristics were present in 31% of the cases found to be malignant, and three of four characteristics were present in 24%. Laparotomy was performed at the time of laparoscopy in 17% of cases, after laparoscopy in 71% with an average interval of 4.8 weeks, and not at all in 12%. Fifty-seven percent of the cases were invasive epithelial malignancies, whereas 29% were tumors of low malignant potential. At least 50% of the patients had stages II-IV. We conclude that attempted laparoscopic excisions of adnexal masses that are subsequently found to be malignant are not uncommon, and that the presence of so-called "benign" characteristics does not preclude malignancy. Attempts at partial or complete excision are common, as are delays in subsequent definitive surgery. The stage of disease is often advanced, and all histologic types of malignancy are encountered. We advocate careful evaluation of this practice, with development of strict guidelines to ensure optimal patient care.

Adhesion formation after laparoscopic surgery in tubal pregnancy: a randomized trial versus laparotomy

Article

Jun 1991
FERTIL STERIL

Women with ectopic pregnancy (EP) who have been operated on by laparoscopy are thought to have improved subsequent fertility, probably because of less adhesion formation. We aimed to evaluate the adhesion formation after laparoscopy as compared with laparotomy in a randomized trial. One hundred five patients with tubal pregnancy were stratified with regard to age and risk factors and randomized to surgery by laparoscopy or laparotomy. To evaluate adhesion formation and tubal status, 73 patients with strong desire of pregnancy underwent a second-look laparoscopy. The adhesion status at the ipsilateral and contralateral side at primary surgery was compared with the status at second-look laparoscopy. Patients operated on by laparotomy developed significantly more adhesions at the operated side than patients operated on by laparoscopy (P less than 0.001). Substantially more patients in the laparotomy group underwent adhesiolysis at second-look laparoscopy than did patients in the laparoscopy group. Tubal patency did not differ between the groups. Laparoscopic treatment of EP results in less impairment of the pelvic status compared with conventional conservative surgery.

Prognostic factors in patients with Stage I epithelial ovarian cancer

Article

Mar 1990
OBSTET GYNECOL

We analyzed factors predictive of relapse risk in patients with stage I invasive epithelial ovarian cancer: 252 patients from the Princess Margaret Hospital provided a data base for hypothesis generation, and data on 267 patients from the Norwegian Radium Hospital were used for hypothesis testing. The outcomes in most analyses in the two series were very similar, validating the following conclusions. Differentiation (grade) was the most powerful predictor of relapse, followed by dense adherence (which resulted in outcomes equivalent to those in stage II) and, finally, large-volume ascites. When the effects of these three factors were accounted for, then none of the following were prognostic: bilaterality (stage Ib), cyst rupture (stage Ic), capsular penetration (stage Ic), tumor size, histologic subtype, patient age, year of diagnosis, and postoperative therapy. These results allow simplification of stage I substaging, as only differentiation, dense adherence, and large-volume ascites (? peritoneal cytology) need be considered. The 5-year relapse-free rate was 98% in patients with grade 1 tumors in whom both dense adherence and large-volume ascites were absent. These patients are adequately treated by operation alone. Although the relapse risk was high enough in the remaining patients to warrant postoperative treatment, a significant benefit could be shown only for a small subset of patients, namely those with densely adherent tumors treated with abdominopelvic radiotherapy. In grades 2 and 3, none of the therapies used in either series was superior to pelvic radiotherapy or operation alone.

Factor influencing survival in Stage I ovarian cancer

Article

Jun 1973
AM J OBSTET GYNECOL

A total of 271 patients with Stage I epithelial cancer of the ovary were treated at the Mayo Clinic from 1950 through 1966. Data related to various forms of treatment show that many factors in addition to the stage of the lesion influence survival. Among these are cell type, grade of malignancy, and gross characteristics of the lesion. These factors should be considered in the selection of the proper treatment of the specific lesion. Such individualized treatment should give a highly satisfactory survival.

Surgical treatment of ovarian dermoid cysts

Article

Nov 1998
EUR J OBSTET GYN R B

To evaluate the efficacy of laparoscopic ovarian cystectomy and to compare the surgical course, post-surgical course and particularly post-surgical pain of the laparoscopic and laparotomic methods. We conducted a surgical study on dermoid cysts at the Gynecology Department of Siena University between 1 January 1992 and 31 December 1996. The selected cases were randomized into two groups based on surgical approach: via laparotomy (n=22) or laparoscopy (n=22). Surgical times, estimated blood loss, post-surgical pain, time in hospital, speed of recovery and complications were compared. Mean blood loss was significantly less for laparoscopy (58.64+/-30.17 ml versus 103.84+/-38.45 ml, P<0.05). Mean hospitalization was 6.32+/-1.09 days for laparotomy and 3.18+/-0.39 days for laparoscopy (P<0.05). Post-surgical pain was significantly less in laparoscopy patients (P<0.05). The laparoscopic technique had fewer post-surgical complications. The laparoscopic approach had many advantages. Laparoscopy should be the elective treatment for women with dermoid cysts, because it has many advantages for the patient and lower costs for the national health system.

Prognostic importance of degree of differentiation and cyst rupture in stage I invasive epithelial ovarian carcinoma

Article

Feb 2001

Previous studies on prognostic factors in stage I invasive epithelial ovarian carcinoma have been too small for robust conclusions to be reached. We undertook a retrospective study in a large international database to identify the most important prognostic variables. 1545 patients with invasive epithelial ovarian cancer (International Federation of Gynaecology and Obstetrics [FIGO] stage I) were included. The records of these patients were examined and data extracted for univariate and multivariate analysis of disease-free survival in relation to various clinical and pathological variables. The multivariate analyses identified degree of differentiation as the most powerful prognostic indicator of disease-free survival (moderately vs well differentiated hazard ratio 3.13 [95% CI 1.68-5.85], poorly vs well differentiated 8.89 [4.96-15.9]), followed by rupture before surgery (2.65 [1.53-4.56]), rupture during surgery (1.64 [1.07-2.51]), FIGO 1973 stage Ib vs Ia 1.70 [1.01-2.85]) and age (per year 1.02 [1.00-1.03]). When the effects of these factors were accounted for, none of the following were of prognostic value: histological type, dense adhesions, extracapsular growth, ascites, FIGO stage 1988, and size of tumour. Degree of differentiation, the most powerful prognostic indicator in stage I ovarian cancer, should be used in decisions on therapy in clinical practice and in the FIGO classification of stage I ovarian cancer. Rupture should be avoided during primary surgery of malignant ovarian tumours confined to the ovaries.

Different types of rupture of the tumor capsule and the impact on survival in early ovarian carcinoma

Article

Oct 1994
INT J GYNECOL CANCER

The significance of tumor spill in the early stages of ovarian carcinoma has been the subject of controversy. Since rupture of the capsule of the tumor may occur in several different ways, we analyzed all cases of early ovarian cancer treated at Radiumhemmet, Stockholm, Sweden, during the period 1974-1986, in which possible spill of tumor cells was catalogued in different groups. In 247 out of 394 patients (62%) the risk of spill had to be considered. There was no difference in survival between patients whose tumors had intact capsules and patients in whom rupture occurred during surgery-78% and 85%, respectively. On the other hand, a significant difference in survival was found between patients in whom rupture occurred before surgery and those with intraoperative rupture-59% and 85%, respectively. The conclusion can be drawn that manipulation during surgery which results in puncture or rupture does not have a negative influence on the outcome for the patients.

Doppler ultrasonography in the diagnosis of ovarian cysts: Indications, pertinence and diagnostic criteria

Article

Dec 2001
J Gynecol Obstet Biol Reprod

H Marret

To discriminate ovarian lesions is of particular importance in gynecological practice. Two main problems need answers: discrimination of benign and malignant adnexal masses and choice of the appropriate surgical treatment if necessary. Nearly 2% of the adnexal masses are ovarian carcinomas or border line tumors. It is now well established that ultrasonography is the gold standard for ovarian cyst diagnosis. The purpose of this work was to review the literature and to establish, with the evidence based medicine model, which parameters and existing diagnostic models using ultrasound and Doppler performs best in the evaluation of adnexal masses. Transvaginal sonography has demonstrated considerable advantage over conventional transabdominal sonography. However, transparietal sonography is still useful in large tumors. It is no longer reasonable to subject all patients undergoing pelvic sonography to bladder distension. Functional ovarian cyst characterization seems easy using sonography and Doppler. In case of complication, discrimination of such functional cyst may be difficult but spontaneous regression confirms usually the expectative management. Dermoid cysts and endometriomas seem to be easier to discriminate from other adnexal masses. Papillary formations on the inside of the cyst wall and masses with a non hyperechoic solid component are the most statistically significant predictors of a malignant ovarian mass. Ultrasound and morphologic parameters have a sensitivity of 80% and a specificity of 93%, that make this exam the gold standard for ovarian masses diagnosis. Another parameter is important: experienced hands with subjective evaluation seems to be one of the best ultrasound method for adnexal masses discrimination. Scoring system help differentiate benign from malignant masses (sensitivity 90%, VPP 50%). Doppler flow measurement and assessment of tumor vascularity by doppler energy increase the confidence with which a correct diagnosis is made. Moreover, combined US techniques and a diagnostic algorithm perform significantly better than morphologic assessment, color doppler or CA125 measurement alone. Logistic regression and neural network models are good methods and may be useful for malignancy prediction but the improvement is small and the concordance with histology far from 100%. In front of a benign and maybe functional cyst, spontaneous resolution may be controlled by sonographic exam at 3 and 6 months. Three-dimensional ultrasound and power doppler, contrast enhanced sonography, and sonography during the laparoscopic procedure are not still validated. Every suspicious ovarian mass needs sonography by an expert which can first use all the techniques and the different parameters to discriminate benign and malignant tumors. Secondly, after control if necessary, he can propose the patient for appropriate surgical treatment.

Laparoscopic Management of Extremely Large Ovarian Cysts

Article

Jul 2005
OBSTET GYNECOL

To assess the feasibility and outcome of laparoscopic surgery for the management of extremely large ovarian cysts. From July 2000 to December 2003, 21 patients with extremely large ovarian cysts were managed laparoscopically. The masses were cystic or complex, reached the umbilicus or higher, and were not associated with ascites or enlarged pelvic or para-aortic lymph nodes on computed tomography scan. Serum CA 125 levels were within the normal range or mildly elevated (< 130 mIU/mL). The mean and median ages of the patients were 45 +/- 20 and 46 years, respectively (range 17-89 years). Seven women were postmenopausal and the rest were premenopausal. The patients underwent cystectomy or adnexectomy depending on each patient's age and obstetric history. Two laparoscopies were converted to laparotomy, one because of ovarian malignancy and the second because of technical difficulties related to morbid obesity and severe intra-abdominal adhesions. The postoperative recovery was uneventful in all women. With proper patient selection, the size of an ovarian cyst is not necessarily a contraindication for laparoscopic surgery.

Laparoscopy versus laparotomy for benign ovarian tumour

Article

Feb 2005

Laparoscopy is modern surgical technique in which operations are performed through small incisions (usually 2-3cm) using a laparoscope: a telescopic rod lens system, that is usually connected to a video camera. In 12 studies identified was associated with reduced risk of any adverse events from surgery, less pain, and fewer days in the hospital when compared to laparotomy, the traditional surgical technique.There was no difference between the procedures with regard to outcomes of fever, post operative infections and tumour recurrence.

Laparoscopic Management of the Adnexal Mass

Article

Oct 2006
CLIN OBSTET GYNECOL

Ovarian neoplasms are common in women of all ages. As many as 10% of women in the United States will undergo surgical removal of an adnexal mass sometime in their lifetime. Gynecologic surgeons have pioneered laparoscopic surgery, developing what was originally a diagnostic tool into a safe and effective approach to management of adnexal masses. Accumulating scientific data support the laparoscopic approach to the adnexal mass as the preferred treatment.

Minimal access approach to the management of large ovarian cysts

Article

Mar 2008
SURG ENDOSC

Laparoscopy-assisted cystectomy for large adnexal cysts

Article

May 2008
ARCH GYNECOL OBSTET

To evaluate the feasibility and surgical outcome of laparoscopy-assisted surgery for large adnexal cysts. From January 1998 to October 2007, 46 women underwent laparoscopy-assisted surgery for large adnexal cysts whose maximum diameter were between 10 and 20 cm, radiologic and laboratory features suggestive of benign disease. All the patients had a pre-operative ultrasound with or without computed tomography and CA-125 assessment. Patients' demographics, clinical and ultrasound features, CA-125 values, surgical procedures, operative and post-operative complications, estimated amount of blood loss (EBL), operative time, conversion to laparotomy and the pathological findings were recorded. Fourty-six consecutive patients underwent laparoscopy-assisted surgery over 9 years. The mean and range of the patients' age and body mass index were 34.1 +/- 6.3 and (21-45) years and 27.4 +/- 5.9 and (22-40), respectively. In all the patients, except one with borderline ovarian tumor, laparoscopy-assisted surgery was successful. There were no operative or post-operative complications. The mean and range of the operative time, EBL and hospital stay were 48.4 +/- 7.3 and (35-65) min, 55.0 +/- 28.9 and (25-150) mL, 1.49 +/- 0.50 and (1-3) days, respectively. The mean and range of the extracorporeal cystectomy time were 10.2 +/- 2.7 and (8-14) min. The surgical procedures performed were: ovarian and paraovarian cystectomy (n = 45), unilateral salpingo-oophorectomy, pelvic-paraaortic lymphadenectomy and omentectomy (n = 1). Pathologic findings included serous cystadenoma (n = 26), mucinous cystadenoma (n = 7), dermoid (n = 6), endometriosis (n = 6), and borderline ovarian tumor (n = 1). Laparoscopy-assisted surgery is feasible and safe for women with large benign adnexal cysts and result s in a short surgery time.

Current diagnosis and management of ovarian cysts

Abstract

No full-text available

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