Effect of laparoscopic ovarian cystectomy on ovarian reserve and the outcomes of in vitro fertilization patients with benign ovarian cysts / 中华妇产科杂志

Objective:To investigate the effect of laparoscopic ovarian cystectomy on anti-Mullerian hormone (AMH) level, ovarian response to gonadotropin stimulation and pregnancy rate for in vitro fertilization (IVF) patients with benign ovarian cysts.Methods:Patients with benign ovarian cysts who were admitted for cystectomy and had undergone IVF treatment were enrolled in the study. There were 373 participants with ovarian cysts underwent laparoscopic ovarian cystectomy in the experimental group. According to duration of post-surgery, there were four sub-groups: 1 year post-surgery (1Y POST), 2 years post-surgery (2Y POST), 4 years post-surgery (4Y POST) and ≥5 years post-surgery (≥5Y POST) in the experimental group. According to histopathologic types of ovarian cysts, there were two sub-groups: ovarian endometriotic cysts and ovarian non-endometriotic cysts. Two hundreds and three patients with no history of ovarian cysts and ovarian surgery were in the control group. The level of AMH and basic concentrations of follicle stimulating hormone (FSH), luteinizing hormone (LH), progesterone (P), estradiol (E 2) were measured. Antral follicle counts (AFC) were calculated. There were other study variables: total dose of gonadotropins, duration of ovarian stimulation, the number of oocyte retrieved, the number of embryo obtained, blastocyst transfer rate and pregnancy rate. Results:The control group was matched as closely as possible to the experimental group, including age, body mass index and menstrual cycle (all P>0.05). Compared to the women in control group, the women in ovarian endometriotic cystectomy sub-group had significantly higher levels of basal FSH and basal P, lower level of AMH (all P<0.05); the women in ovarian endometriotic cysts sub-group had significantly higher dose of gonadotropins (all P<0.05); the women in ovarian endometriotic cysts ≥5Y POST sub-group had significantly lower number of oocyte retrieved, lower number of embryo obtained, lower blastocyst transfer rate, and lower pregnancy rate (all P<0.05). Compared to the women in control group, the women in ovarian non-endometriotic cysts sub-group had a significantly higher level of basal FSH and basal P (all P<0.05). The women in ovarian non-endometriotic cysts sub-group had lower level of AMH, higher dose of gonadotropins, lower number of oocyte retrieved, lower number of embryo obtained, lower rate of blastocyst transfer and lower rate of pregnancy than the control group but there were no statistically significant differences among them (all P>0.05). The women with unilateral ovarian endometriotic cysts had significantly lower number of oocyte retrieved on the side of surgery than another side ( P<0.05). Conclusions:In short term laparoscopic ovarian cystectomy has no significant effect on ovarian reserve. But with long-term follow-up ovarian reserve, ovarian response to gonadotropin stimulation and pregnancy rate are decreased. The effect of laparoscopic ovarian cystectomy in benign cysts on ovarian is associated with whether or not it is the surgical side.

Ovarian hydatid cyst: an uncommon site of presentation

ABSTRACT Hydatid cyst is a parasitic infestation caused by Echinococcus larvae. Hydatid cyst of the ovary is a highly unusual presentation. Herein, we present a case of a young woman who complained of episodic lower abdominal pain. Ultrasound of the abdomen revealed a multi-cystic left adnexal mass measuring 86 mm x 67 mm. A possibility of ovarian cystic neoplasm was suggested. Unilateral salpingo-oophorectomy was performed. On histopathological examination, a cyst measuring 8.0 x 5.5 x 4.5 cm was found, replacing the entire ovary. The cyst cavity was filled with serous fluid and multiple pearly white membranous structures, giving a multiloculated appearance. Microscopic examination showed a cyst lined by a lamellar membrane containing protoscolices and hooklets. Hydatid disease is a zoonotic ailment caused by tapeworms (Echinococcus granulosus or, less commonly, Echinococcus multilocularis). The definitive hosts are carnivores. Humans are the accidental intermediate hosts. The hydatid cyst commonly affects the liver and the lungs. The primary hydatid cyst of the ovary is quite rare, with few case reports in the literature. In most cases, symptoms are vague, and the lesion is misdiagnosed as benign or malignant ovarian cystic neoplasm on clinical and radiological examination. Ovarian hydatid cyst is treated by surgery with ovarian cystectomy as the gold standard. The possibility of a hydatid cyst should be kept under differential diagnoses while evaluating the cystic diseases of the ovary.

Immature cystic teratoma with contralateral mature cystic teratoma in a pediatric patient: Operative and ethical considerations to management

@#Immature cystic teratoma (IMCT) is a rare ovarian malignancy, usually presenting as a huge unilateral pelvoabdominal mass in the pediatric age. Even rarer is the occurrence of a concomitant contralateral mature cystic teratoma. Management issues include use of fertility sparing versus complete surgical staging, and the use of chemotherapy. Fortunately, IMCT carries a good prognosis, especially when diagnosed early. Chemotherapy is used only in higher stage disease and recurrence.

Clinical advantages of transumbilical single-site laparoscopy in surgery for giant ovariotubal cysts / 中国医师杂志

Objective:To observe the efficacy and safety of single-port laparoscopy for giant ovariotubal cysts.Methods:38 patients with giant ovarian and fallopian tube cysts in Ruijin Hospital Affiliated to Shanghai Jiaotong University Hospital from January 2018 to June 2019 were retrospectively analyzed. They were divided into transumbilical single-port laparoscopy group (18 cases) and traditional laparoscopy group (20 cases). The perioperative related indexes such as operation time, intraoperative bleeding and the number of analgesic cases were compared between the two groups.Results:All 38 patients successfully completed the operation without conversion to laparotomy, and no auxiliary hole was added in the single-port laparoscopy group; There were no postoperative complications and no cystic fluid leakage. In the single-port laparoscopy group, 18 patients were satisfied with the concealment of umbilical scar. There was no statistically significant difference in operation time [(51.67±13.72)min vs (55.50±14.59)min], intraoperative blood loss [(52.22±24.38)ml vs (61.50±28.88)ml] and first postoperative anal exhaust time [(25.77±8.59)h vs (27.60±6.67)h] between single-port laparoscopy group and traditional laparoscopy group (all P>0.05); The number of cases requiring postoperative analgesia in the single-port laparoscopy group (2 cases vs 12 cases) was less than that in the traditional laparoscopy group ( P<0.05); The out of bed activity time [(20.95±3.65)h vs (26.95±5.43)h] and postoperative discharge time [(3.11±0.68)h vs (4.30±1.21)h] were shorter than those in the traditional laparoscopy group (all P<0.05). All 38 patients were followed up in the gynecological clinic for 6-24 months. The incision healed well without recurrence. Conclusions:Transumbilical single-port laparoscopic surgery for giant ovarian and fallopian tube cysts is reliable and safe when the possibility of malignant ovarian and fallopian tube tumors was excluded before operation.

Effects of oxycodone multimodal analgesia on quality of awakening and hemodynamics in patients undergoing laparoscopic gynaecological surgery / 中国基层医药

Objective:To investigate the effects of oxycodone multimodal analgesia on quality of awakening and hemodynamics in patients undergoing laparoscopic gynaecological surgery.Methods:Ninety patients who underwent laparoscopic ovarian cyst removal in Weihai Central Hospital from September 2018 to March 2019 were included in this study. They were randomly divided into observation and control groups, with 45 patients in each group. Both groups were given intravenous flurbiprofen axetil (1 mg/kg) for preemptive analgesia. Combined intravenous and inhalation anesthesia was used. The depth of anesthesia was monitored. The observation group was intravenously given 0.10 mg/kg oxycodone and the control group was intravenously given 5 μg sufentanil. Quality of awakening, hemodynamic indexes, postoperative pain score, and incidences of nausea and vomiting were compared between the two groups.Results:Cough score in the observation group was significantly lower than that in the control group [(1.1 ± 0.4) points vs. (1.7 ± 0.7) points, t = -4.99, P < 0.05]. Ramsay Sedation Scale score in the observation group was significantly higher than that in the control group [(3.6 ± 1.0) points vs. (2.8 ± 0.8) points, t = 7.44, P < 0.05]. At 0 (T 1) and 5 minutes (T 2) after extubation, systolic blood pressure in the observation group was (117.7 ± 18.2) mmHg and (118.1 ± 16.2) mmHg, respectively, which were significantly lower than (134.2 ± 16.2) mmHg and (134.5 ± 15.2) mmHg in the control group ( t =-4.54, -4.95, both P < 0.05). There were no significant differences in the incidences of nausea and vomiting between the two groups (both P > 0.05). At 6 and 12 hours after surgery, visual analogue scale score in the observation group was (2.5 ± 0.8) points and (1.1 ± 0.5) points, respectively, which were significantly lower than (3.4 ± 0.9) points and (1.9 ± 0.8) points in the control group ( t = 5.01, -5.68, both P < 0.05). Conclusion:Oxycodone multimodal analgesia for laparoscopic gynaecological surgery can improve the quality of awakening, decrease systolic blood pressure, reduce the degree of postoperative pain, and does not increase the incidences of postoperative nausea and vomiting.

Analysis of the curative effect of transumbilical single-incision laparoscopy with fascial platform for ovarian cystectomy / 中国医师进修杂志

Objective:To investigate the safety and curative effect of transumbilical single-incision laparoscopy with fascial platform for ovarian cystectomy.Methods:The clinical data of 105 patients underwent laparoscopy ovarian cystectomy in Fujian Maternity and Child Health Hospital from June 2018 to December 2021 were retrospectively analyzed. Among them, 45 patients underwent transumbilical single-incision laparoscopy with fascial platform for ovarian cystectomy (observation group), and 60 patients underwent multi-port laparoscopy for ovarian cystectomy (control group). The operative time, intraoperative bleeding, conversion to open surgery, cyst rupture, surgical collateral injury, postoperative exhaust time, postoperative hospital stays, hospitalization cost and postoperative infection, etc were recorded. The face rating scale (FRS) was used to evaluate the pain at 6 and 24 h after operation; the incision satisfaction was evaluated by the Kiyak satisfaction scale at 2 months after operation.Results:The operation was carried out successfully in both groups without surgical collateral injury or conversion to open surgery. There were no significant differences in operative time, intraoperative bleeding, postoperative hospital stays, hospitalization cost, cyst rupture rate and postoperative infection rate between 2 groups ( P>0.05); the postoperative exhaust time and FRS 6 and 24 h after operation in observation group were significantly less than those in control group: (22.1 ± 3.5) h vs. (23.9 ± 3.8) h, 1 (0, 2) scores vs. 2 (1, 4) scores and 1 (0, 1) scores vs. 1 (0, 2) scores, the incision satisfaction score was significantly higher than that in control group: 5 (4, 5) scores vs. 4 (3, 4) scores, and there were statistical differences ( P<0.05 or <0.01). Conclusions:Transumbilical single-incision laparoscopy with fascial platform for ovarian cystectomy is safe and feasible, with concealed incision and high patient satisfaction, and has good clinical application value.

Tumores anexiales incidentales en cirugía abdominal / Incidental adnexal tumors in abdominal surgery

La posibilidad de encontrar una neoplasia benigna o maligna del ovario, de forma inesperada durante una intervención quirúrgica abdominal, es una realidad para todos los especialistas en cirugía. Si bien en muchos casos se tratará de una lesión benigna, el riesgo de cáncer no debe subestimarse, ya que, por ejemplo, la ruptura intraoperatoria de una lesión quística maligna puede reestadificar a una paciente con cáncer de ovario del estadio IA al IC, con todas las consecuencias que esto implica, como la necesidad de requerir quimioterapia adyuvante y tener un peor pronóstico. Por otro lado, en mujeres premenopáusicas debe discutirse con la familia o la paciente (idealmente) el riesgo e implicaciones de la ooforectomía uni o bilateral, incluso si esto amerita dejar el quirófano para obtener el consentimiento, o posponer el procedimiento definitivo para un segundo tiempo. La consulta intraoperatoria a un ginecólogo, siempre que sea posible, se debe llevar a cabo con el fin de respaldar la conducta adoptada. Conocer el manejo adecuado de las masas anexiales encontradas de forma incidental durante una cirugía abdominal, es una prioridad para todos los cirujanos generales.

The possibility of finding a benign or malignant neoplasm of the ovary unexpectedly during abdominal surgery is a reality for all specialists in surgery. Although in many cases it will be a benign lesion, the risk of cancer should not be underestimated, since, for example, the intraoperative rupture of a malignant cystic lesion may well re-stage a patient with ovarian cancer from stage IA to IC, with the consequences that this implies, such as the need for adjuvant chemotherapy and a worse prognosis. On the other hand, in premenopausal women, the risk and implications of unilateral or bilateral oophorectomy should be discussed with the family or the patient (ideally), even if this implies leaving the operating room to obtain consent, or postponing the definitive procedure for a second time. Intraoperative consultation with a gynecologist, whenever possible, should be carried out in order to support the adopted behavior. Knowing the proper management of adnexal masses found incidentally during abdominal surgery is a priority for all general surgeons.

Prognosis and treatment of fetal/neonatal ovarian cysts: clinical analysis of 35 cases / 中华围产医学杂志

Objective:To explore the prognosis and treatment experience of fetal/neonatal ovarian cyst.Methods:Clinical data of 35 cases of fetal/neonatal ovarian cyst (38 ovarian cysts) admitted to Guangdong Women and Children Hospital from June 2014 to December 2019 were retrospectively collected, including the cyst size before and after birth, ultrasonic features, intraoperative conditions, and pathology. According to the ultrasonic features at the first prenatal detection, the ovarian cysts were divided into two groups: simple cyst group (25 cysts) and complex cyst group (13 cysts). Two independent samples t-test and Fisher exact test were used to compare the characteristics of cysts between the two groups. The outcomes and treatment experience were summarized. Results:(1) The ratio of intraoperative torsion in the complex cysts group was higher than that in the simple cysts group [10/13 vs 32% (8/25), Fisher exact test, P<0.05]. (2) Twenty-five simple cysts were found on the first prenatal ultrasound scan, and 32% (8/25) of them eventually transformed into complex cysts. Among these eight cysts, the maximum diameter of five cysts was >4 cm before the transformation. (3) Postnatal ultrasound found one cyst regressed spontaneously and among the remaining 37 cysts, simple and complex type cysts were accounted for 16 and 21, respectively. Among the complex type cysts, 90% (19/21) were consistent with prenatal ultrasound. (4) Out of the 21 complicated cysts, 19 were surgically removed; the remaining two cysts (maximum diameter <3 cm) were observed conservatively and disappeared spontaneously within one year. During the operation, 81% (17/21) of the complicated cysts were found with torsion and 24% (5/21) with ovarian loss. Conclusions:Simple cysts can transform into complex cysts, especially the biggest diameter >4 cm. Complex fetal/neonatal ovarian cysts indicated by ultrasonography were more prone to torsion, which required postnatal operation.

Principais causas ginecológicas de dor pélvica aguda em mulheres / Main gynecological causes of acute pelvic pain in women

Este trabalho buscou reunir dados essenciais sobre as etiologias de dor pélvica aguda, uma queixa constante nos serviços de emergências e ambulatórios de ginecologia, responsável por grande desconforto e impacto na qualidade de vida de pacientes mulheres. É uma condição laboriosa por causa de seu amplo espectro de causas, devendo ser abordada com cuidado e atenção pelo profissional médico, o qual deve considerar os diversos diagnósticos diferenciais, sendo a ultrassonografia o exame de maior importância para auxiliar em seu diagnóstico. As principais etiologias não obstétricas podem ser não ginecológicas e ginecológicas; essas últimas são divididas em anexiais e uterinas. Entre as causas ginecológicas, devem- -se investigar cistos ovarianos, torções anexiais, leiomiomas, doença inflamatória pélvica, abscesso tubo-ovariano, dismenorreia e complicações de dispositivos intrauterinos. A maioria das causas tem tratamento eficaz, com retorno da função do órgão e melhora da qualidade de vida, sem complicações, especialmente se diagnosticada precocemente.(AU)

The aim of this study was to gather important data on acute pelvic pain etiologies, a usual complaint in the emergency services and gynecology outpatient clinics, responsible for great discomfort and impact on quality of life in female patients. It is a laborious condition due to its wide spectrum of causes, which needs to be approached with attention by the physician, who must consider all the possible diagnoses, being the ultrasonography the most important exam to detect it. The main non-obstetric etiologies can be non-gynecological and gynecological, which are separated in adnexal and uterine causes. Among the gynecological causes, ovarian cysts, adnexal torsions, leiomyomas, pelvic inflammatory disease, ovarian tube abscess, dysmenorrhea and complications of intrauterine devices should be investigated. Most causes can be effectively treated, with return of organ function and improved quality of life, without complications, especially if diagnosed early.(AU)

Clinical features and long-term outcomes after laparoscopic surgery in patients co-existing with ovarian endometrioma and deep infiltrating endometriosis / 中华妇产科杂志

Objective:To investigate the clinical features and long-term prognosis of patients co-existing with ovarian endometrioma (OMA) and deep infiltrating endometriosis (DIE).Methods:Totally 358 OMA patients were retrospectively analyzed, who had a minimum of 8 years follow-up after laparoscopic cystectomy, which was performed by one professional endometriosis surgery team at Peking Union Medical College Hospital from January 2009 to April 2013. All women were divided into DIE group and non-DIE group, and analysis was performed in preoperative characteristics, surgical findings and postoperative outcomes during follow-up.Results:A total of 358 OMA patients were included, of which 190 patients (53.1%, 190/358) were in the DIE group, while other 168 patients (46.9%, 168/358) in the non-DIE group. The average ages between the two groups were (33.7±5.4), (32.5±5.3) years ( P=0.047), the average parity was (0.4±0.6) times vs (0.3±0.5) times ( P=0.079). There were significant differences in the proportions of moderate to severe dysmenorrhea [67.4% (128/190) vs 56.5% (95/168)], chronic pelvic pain [24.2% (46/190) vs 7.7% (13/168)], and the increase in CA 125 [79.9% (139/190) vs 65.2% (101/168)] between the two groups (all P<0.05). The average operation time in the DIE and non-DIE groups was (75±21) vs (39±36) minutes ( P<0.01). There was a significant difference in adenomyosis presence between the two groups [41.6% (79/190) vs 22.0% (37/168); P=0.001]. All patients were followed up for at least 8 years. At the end of the follow-up, though the DIE group was with higher total rate of disease relapse, yet no significant difference was found between the two groups in statistical comparison [21.6% (41/190) vs 16.1% (27/168); P=0.185]. A total of 41 cases in the DIE group recurred, the recurrence rate of pain was 15.8% (30/190), and the recurrence rate of cyst was 8.4% (16/190); 27 cases had recurrence after operation in the non-DIE group, the recurrence rate of pain was 8.9% (15/168), and the recurrence rate of cyst was 10.7% (18/168). There were no significant differences in the pain recurrence rate ( P=0.067) and cyst recurrence rate ( P=0.460) between the two groups. As for the successfully pregnant patients, live birth rates were 100.0% (65/65) vs 94.4% (68/72) between DIE group and non-DIE groups ( P=0.120). Conclusions:Compared with the non-DIE group, OMA patients with concurrent DIE might have severe pain symptoms, higher probability of abnormal CA 125 levels and more severe pelvic adhesions. Although there are no significant differences in the total recurrence rate and the recurrence rate of various types between the two groups, the proportion of pain recurrence in the DIE group is higher than that in the non-DIE group. In terms of fertility outcomes, patients in the DIE group are with lower likelihood of pregnancy after surgery during the long-time follow-up. DIE has no significant influence on the fertility outcome.

Laparoscopia de urgencia en la adolescente. A propósito de tres casos / Emergency laparoscopy in the adolescent. A report of three cases

Introducción: Está demostrada la importancia de la cirugía de mínimo acceso en las urgencias pediátricas a cualquier edad, por lo que constituye el enfoque actual tanto diagnóstico como terapéutico. Objetivo: Resaltar la utilidad de la laparoscopia para la cirugía de urgencia en las adolescentes. Presentación de casos: Tres adolescentes femeninas entre 14 y 18 años de edad, intervenidas por abdomen agudo quirúrgico por vía laparoscópica, se encontraron los siguientes hallazgos: Paciente 1: hemoperitoneo por quiste de cuerpo lúteo de ovario izquierdo, tratamiento por cirugía de mínimo acceso. Paciente 2: apendicitis aguda no complicada y quiste simple de ovario izquierdo no complicado, tratado por cirugía de mínimo acceso y la apendicectomía asistida. Paciente 3: torsión de quiste paraovárico de la trompa de Falopio derecha, tratamiento convencional a través de una minilaparotomía. Conclusiones: La laparoscopia de urgencia en estas adolescentes le facilitó al cirujano pediátrico un diagnóstico certero, con hallazgos ginecológicos transoperatorio y tratamiento quirúrgico variado a través de una cirugía mínimamente invasiva con múltiples ventajas para las pacientes(AU)

Introduction: The importance of minimal access surgery in pediatric emergencies at any age has been demonstrated, being the current diagnostic and therapeutic approach. Objective: To highlight the utility of laparoscopy for emergency surgery in adolescents. Case presentation: Three female adolescents between 14 and 18 years of age underwent laparoscopic surgery for acute abdomen. The main findings were: Patient 1: Hemoperitoneum due to corpus luteum of the left ovary, treated by minimal access surgery. Patient 2: Acute uncomplicated appendicitis and simple uncomplicated left ovary cyst, treated by minimal access surgery and assisted appendectomy. Patient 3: Torsion of the paraovarian cyst of the right fallopian tube, treated by conventional minilaparotomy. Conclusions: Emergency laparoscopy in these adolescents provided the pediatric surgeon an accurate diagnosis with intraoperative gynecological findings and varied surgical treatment through minimally invasive surgery, with multiple advantages for patients(AU)

Quiste ovárico fetal. reporte de un caso / Fetal ovarian cyst. a case report / Fetal ovarian cyst. a case report

RESUMEN Los quistes ováricos representan el tumor abdominal más frecuente en las recién nacidas. Entre las complicaciones agudas y a largo plazo, la más frecuente es la torsión anexial, que es de difícil reconocimiento en la etapa neonatal. El diagnóstico prenatal es fundamental para el manejo oportuno de las pacientes y el seguimiento ecográfico de los quistes anexiales. Existen diferentes alternativas terapéuticas, donde la cirugía mínimamente invasiva y conservadora tiene un rol importante.

ABSTRACT Ovarian cysts are the most common abdominal tumors in female newborns. Among the acute and long-term complications, the most frequent is the adnexal torsion, which is difficult to recognize in the neonatal stage. Prenatal diagnosis is essential for the timely management of patients and ultrasound monitoring of adnexal cysts. There are different therapeutic alternatives where minimally invasive and conservative surgery plays an important role.

Practical recommendations for the management of benign adnexal masses / Recomendações práticas para o tratamento de massas anexiais benignas

Abstract Objective To performa comprehensive review to provide practical recommendations regarding the diagnosis and treatment of benign adnexal masses, as well as information for appropriate consent, regarding possible loss of the ovarian reserve. Methods A comprehensive review of the literature was performed to identify the most relevant data about this subject. Results In total, 48 studies addressed the necessary aspects of the review, and we described their epidemiology, diagnoses, treatment options with detailed techniques, and perspectives regarding future fertility. Conclusions Adnexal masses are extremely common. The application of diagnosis algorithms is mandatory to exclude malignancy. A great number of cases can bemanaged with surveillance. Surgery, when necessary, should be performed with adequate techniques. However, even in the hands of experienced surgeons, there is a significant decrease in ovarian reserves, especially in cases of endometriomas. There is an evident necessity of studies that focus on the long-term impact on fertility.

Resumo Objetivo Realizar uma revisão abrangente para fornecer recomendações práticas sobre o diagnóstico e tratamento demassas anexiais benignas, bemcomo informações para um consentimento adequado com relação à possível perda da reserva ovariana. Métodos Uma revisão abrangente da literatura foi realizada para identificar os dados mais relevantes sobre o assunto. Resultados No total, 48 estudos abordaram os aspectos necessários da revisão, e descrevemos sua epidemiologia, diagnósticos, opções de tratamento com técnicas detalhadas, e perspectivas sobre fertilidade futura. Conclusões As massas anexiais são extremamente comuns. A aplicação de algoritmos de diagnóstico é obrigatória para excluiramalignidade. A maioria dos casos pode ser manejada conservadoramente. A cirurgia, quando necessária, deve ser realizada com técnicas adequadas. No entanto, mesmo nas mãos de cirurgiões experientes, há diminuição significativa da reserva ovariana, principalmente nos casos de endometriomas. Há uma evidente necessidade de estudos que enfoquemo impacto das massas anexiais benignas na fertilidade em longo prazo.

Validación de los criterios ecográficos IOTA en la práctica clínica con marcadores tumorales y patología / Validation of IOTA simple ultrasound rules in clinical practice with tumor markers and pathology / Validation of IOTA simple ultrasound rules in clinical practice with tumor markers and pathology

RESUMEN Objetivos . Correlacionar la ecografía prequirúrgica de las masas anexiales aplicando los criterios IOTA y el diagnóstico anatomopatológico tras intervención quirúrgica. Valorar la utilidad de los marcadores tumorales bioquímicos. Método . Estudio observacional prospectivo en 102 pacientes con diagnóstico ecográfico de tumoración anexial, intervenidas quirúrgicamente entre enero 2017 y febrero 2020. El análisis estadístico se realizó con SPSS 17.0. Las variables categóricas se analizaron mediante pruebas de Fisher y chi-cuadrado, las variables cuantitativas mediante prueba t-student. La concordancia entre la valoración de la ecografía transvaginal mediante criterios IOTA y el resultado anatomopatológico, se estudió con el coeficiente de contingencia y el índice kappa. Resultados . Según criterios IOTA, se clasificó como benignas a 48% de las tumoraciones, como malignas 24,5%, y 27,5% resultaron no clasificables. La anatomía patológica confirmó que 68,1% de las benignas y 72,8% de las malignas fueron correctamente filiadas por la ecografía. La concordancia entre la ecografía transvaginal prequirúrgica y la anatomía patológica fue significativa, con coeficiente de contingencia 0,58, índice kappa 0,47, p <0,05 y con sensibilidad 94,1% y especificidad 92,1%. Los valores de la proteína epididimal humana 4 (HE4) y el antígeno del cáncer 125 (CA 125) tuvieron correlación con la anatomía patológica, también con significación estadística, siendo mayor en las pacientes menopáusicas. Conclusiones . Los criterios IOTA discriminaron de forma satisfactoria las masas benignas de las malignas. La proteína HE4 resultó mejor marcador bioquímico que el CA125.

ABSTRACT Objectives: To determine correlation between preoperative ultrasound evaluation of adnexal masses applying IOTA simple rules and pathology diagnosis. To assess usefulness of biochemical tumor markers in these cases. Methods: A prospective study was performed between January 2017 and February 2020. Patients with suspected ovarian pathology were evaluated using IOTA ultrasound rules and designated as benign or malignant. Findings were correlated with histopathological findings. Collected data was statistically analyzed using the chi-square test and kappa statistical method. Results: During this period, 102 women were eligible for the study. According to IOTA ultrasound criteria, 48% of the adnexal masses were classified as benign, 24.5% malignant and 27.5% were not classifiable. Pathology confirmed 68.1% of benign and 72.8% of malignant tumors were correctly classified by ultrasound. Statistically, the agreement between pre-surgical transvaginal ultrasound and pathology result was significant with contingency coefficient 0.58 and Kappa index 0.47, both with p <0.05 significance. The sensitivity for detection of malignancy with IOTA simple rules was 94.1% and specificity 92.1%. As for biochemical tumor markers, human epididymal protein 4 (HE4) and cancer antigen 125 (CA 125) values had statistically significant correlation with pathology results. Conclusions: IOTA simple rules may be used in clinical practice for diagnosis of ovarian tumors. Human epididymis 4 appeared a better diagnostic tool than CA 125 in discrimination of malignant adnexal masses.

A 5 Year Retrospective Study of Ovarian Tumours and Tumour-like Lesions in a Tertiary Referral Centre, Gandhi Medical College, Bhopal

Ovaries can be afflicted by various lesions, which can be non-neoplastic or neoplastic. Varied spectrum of clinical features and histopathological patterns are seen in these lesions. The present study was done to study the histopathological patterns of ovarian neoplastic and non-neoplastic lesions and their distribution in women of different age groups.METHODSThis was retrospective study of all cases of neoplastic ovarian tumours, and non-neoplastic ovarian tumours including functional ovarian cysts received during 5-year period from January 2014 to December 2018 in the Department of Pathology of Gandhi Medical College and Hamidia Hospital, Bhopal (M.P.). Data regarding age and tumour histopathology were recorded from pathology records. Routine H/E staining was performed.RESULTSA total of 541 different non-neoplastic and neoplastic lesions of ovaries were seen. Neoplastic tumours were more common (350; 64.6%) than tumour-like lesions of the ovary (191; 35.3%). Non neoplastic ovarian tumours were found to be more common than neoplastic ones in all age groups. Maximum number of ovarian tumours were seen in the age group of 21 - 50 years (272, 77.7%). Among tumour-like ovarian lesions, the most common were corpus luteal cysts (75, 13.8%). These were found to be more common in the age group of 31 – 50 years (123, 65%). Surface epithelial tumours were the most common (253, 72.2%) followed by germ cell tumours (70, 12.9%).CONCLUSIONSNeoplastic tumours of ovaries are more common than tumour-like lesions of ovary. For all age groups, benign tumours are more common than malignant ones.

Malignant transformation of ovarian mature teratoma: 04 cases report, review of the literature

Mature ovarian teratomas or dermoid cysts are the most common ovarian germinal tumors and account for 20 to 25% of ovarian organ tumors. The malignant transformation of a mature teratoma is a rare event (1 to 3%), mainly found in the post-menopausal period. This is carcinomatous degeneration (80% of cases) or sarcomatous differentiated tissues of the dermoid cyst. The diagnosis of certainty is established by anatomopathological study of the surgical piece. Treatment of carcinoma teratomas is surgical and same to ovarian malignant epithelial tumors. We report four cases we managed in our health care center with a review of the literature.

Application value of B-mode ultrasound in gynecologic acute abdomen / 中国基层医药

Objective@#To explore the application value of B-ultrasound examination in gynecological acute abdomen.@*Methods@#From October 2015 to October 2017, 150 patients with suspected gynecological acute abdomen were selected in the People's Hospital of Lishui.The effect of B-ultrasound examination in diagnosis of gynecological acute abdomen was analyzed.@*Results@#The sensitivity, specificity and total accuracy of abdominal ultrasound in the diagnosis of gynecological acute abdomen were 75.00%(99/132), 44.44%(8/18) and 71.33%(107/150), respectively.The sensitivity, specificity and total accuracy of transvaginal ultrasound in the diagnosis of gynecological acute abdomen were 87.12%(115/132), 72.22%(13/18) and 85.33%(128/150), respectively.The sensitivity, specificity and total accuracy of abdominal combined with transvaginal ultrasonography in the diagnosis of gynecological acute abdomen were 98.48%(130/132), 94.44%(17/18) and 98.00%(147/150), respectively.The sensitivity, specificity and total accuracy of abdominal combined with transvaginal ultrasound in the diagnosis of gynecological acute abdomen were significantly higher than those of abdominal ultrasound and transvaginal ultrasound(χ2=8.658, 10.699, 9.075, all P<0.05). The diagnosis of acute pelvic inflammation, ectopic pregnancy, rupture of luteal cyst and torsion of ovarian cyst by abdominal combined with transvaginal ultrasound was better than abdominal ultrasound(χ2=13.748, 5.984, 13.524, 6.874, all P<0.05).@*Conclusion@#Abdominal ultrasound and transvaginal ultrasound can be used to diagnose gynecological acute abdomen.However, abdominal combined with vaginal ultrasound is more effective in the diagnosis of gynecological acute abdomen, and it can effectively improve the accuracy of diagnosis.

Analysis of the effect of laparoscopic excision in the treatment of 53 patients ovarian cyst / 中国基层医药

Objective@#To study the clinical effect of laparoscopic excision of ovarian cyst in the treatment of patients with ovarian cyst.@*Methods@#From August 2016 to August 2018, 106 patients with ovarian cyst were selected in the Second People's Hospital of Yuyao.According to the different operation methods, 106 patients were divided into two groups, with 53 cases in each group.The control group was treated with open excision of ovarian cyst.The observation group was treated by laparoscopic excision of ovarian cyst.The clinical effect was observed and compared between the two groups.@*Results@#In the observation group, the time of operation, the amount of blood lost during operation, the time of anal exhaust, the time of getting out of bed and the time of hospitalization were (38.95±3.64)min, (45.12±4.48)mL, (1.01±0.08)d, (30.58±3.07)h, (4.97±0.46)d, respectively, which in the control group were (59.72±5.33)min, (86.62±8.52)mL, (2.07±0.20)d, (44.20±4.28)h, (7.14±0.72)d, respectively, the differences between the two groups were statistically significant(t=23.242, 31.386, 35.825, 18.825, 18.490, all P<0.05). The pregnancy rate in the observation group was 79.25%(42/53), which in the control group was 49.06%(26/53), the difference was statistically significant(χ2=10.502, P<0.01).@*Conclusion@#Laparoscopic excision of ovarian cyst can shorten the operation time, anal exhaust time, the time of getting out of bed after operation, hospital stay, reduce the amount of bleeding and improve the pregnancy rate of the patients.

Application value of B-mode ultrasound in gynecologic acute abdomen / 中国基层医药

Objective To explore the application value of B -ultrasound examination in gynecological acute abdomen.Methods From October 2015 to October 2017,150 patients with suspected gynecological acute abdomen were selected in the People's Hospital of Lishui.The effect of B-ultrasound examination in diagnosis of gynecological acute abdomen was analyzed.Results The sensitivity,specificity and total accuracy of abdominal ultrasound in the diagnosis of gynecological acute abdomen were 75.00%( 99／132),44.44%(8／18) and 71.33%(107／150), respectively.The sensitivity,specificity and total accuracy of transvaginal ultrasound in the diagnosis of gynecological acute abdomen were 87.12%(115／132),72.22%(13／18) and 85.33%(128／150),respectively.The sensitivity, specificity and total accuracy of abdominal combined with transvaginal ultrasonography in the diagnosis of gynecological acute abdomen were 98.48%(130／132),94.44%(17／18) and 98.00%(147／150),respectively.The sensitivity, specificity and total accuracy of abdominal combined with transvaginal ultrasound in the diagnosis of gynecological acute abdomen were significantly higher than those of abdominal ultrasound and transvaginal ultrasound (χ2 ＝8.658, 10.699,9.075,all P＜0.05).The diagnosis of acute pelvic inflammation ,ectopic pregnancy ,rupture of luteal cyst and torsion of ovarian cyst by abdominal combined with transvaginal ultrasound was better than abdominal ultrasound (χ2 ＝13.748,5.984,13.524,6.874,all P＜0.05).Conclusion Abdominal ultrasound and transvaginal ultrasound can be used to diagnose gynecological acute abdomen.However,abdominal combined with vaginal ultrasound is more effective in the diagnosis of gynecological acute abdomen ,and it can effectively improve the accuracy of diagnosis.

Analysis of the effect of laparoscopic excision in the treatment of 53 patients ovarian cyst / 中国基层医药

Objective To study the clinical effect of laparoscopic excision of ovarian cyst in the treatment of patients with ovarian cyst.Methods From August 2016 to August 2018,106 patients with ovarian cyst were selected in the Second People's Hospital of Yuyao .According to the different operation methods ,106 patients were divided into two groups,with 53 cases in each group.The control group was treated with open excision of ovarian cyst .The observation group was treated by laparoscopic excision of ovarian cyst .The clinical effect was observed and compared between the two groups.Results In the observation group,the time of operation,the amount of blood lost during operation,the time of anal exhaust,the time of getting out of bed and the time of hospitalization were (38.95 ±3.64)min,(45.12 ± 4.48)mL,(1.01 ±0.08) d,(30.58 ±3.07) h,(4.97 ±0.46) d,respectively,which in the control group were (59.72 ±5.33)min,(86.62 ±8.52) mL,(2.07 ±0.20) d,(44.20 ±4.28) h,(7.14 ±0.72) d,respectively,the differences between the two groups were statistically significant (t=23.242,31.386,35.825,18.825,18.490,all P<0.05).The pregnancy rate in the observation group was 79.25％(42/53),which in the control group was 49.06％(26/53),the difference was statistically significant(χ2 =10.502,P<0.01).Conclusion Laparoscopic excision of ovarian cyst can shorten the operation time ,anal exhaust time,the time of getting out of bed after operation ,hospital stay,reduce the amount of bleeding and improve the pregnancy rate of the patients .