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.

Tumores anexiales en niñas y adolescentes: experiencia del Hospital Clínico de la Universidad de Católica de Chile, 1991-2003 / Adnexal mass in girls and teenagers: experience of Hospital Clínico de la Universidad de Católica de Chile, 1991-2003

Se analiza retrospectivamente la experiencia de los últimos 13 años en el manejo de la patología anexial quirúrgica en niñas y adolescentes menores de 19 años. Se revisa la forma de presentación clínica y los hallazgos anatopatológicos de 106 pacientes. Del total de lesiones anexiales, un 62 por ciento correspondieron a lesiones neoplásicas benignas y malignas, la mayoría de ellas originadas en el ovario. El riesgo de malignidad para las lesiones neoplásicas fue de un 26,7 por ciento. La neoplasia ovárica benigna más frecuente fue el teratoma maduro (31,1 por ciento). Las neoplasias malignas más frecuentes fueron las originadas en el estroma gonadal específico y en el tejido germinal (en conjunto 37,5 por ciento del total de neoplasias malignas). La forma de presentación clínica más frecuente fue el dolor abdominal habitualmente como manifestación de complicación de una neoplasia benigna. La vía de abordaje más frecuente fue por laparotomía y se privilegió la cirugía conservadora para preservar el potencial reproductivo.

[Laparoscopic treatment of adnexal abscess - about 86 cases]

To Specify the epidemiological profile of the patients presenting an adnexal abscess the therapeutic modes and the ulterior fertility. Retrospective clinic survey about 86 cases of adnexal abscess collected in the Service A of the Center of Motherhood and Neonatology the Rabta Turns during a period of 7 years going from January 1996 to December 2002 A laparoscopic drainage has been achieved in all patients; 35 patients underwent a second laparoscopy 3 to 6 months later. The clinic symptomatology was dominated by the pelvic pain [97% and the fever in 65% of cases A latero - uterine adnexal mass has been discerned m 56% of patients. The echography practiced in all cases evoked the diagnosis in 49 cases. The exclusive laparoscopy permitted a conservative treatment in 52% of the cases. No new immediate operation was necessary in the first two months after the initial surgery. At the time of the control laparoscopy an adhesiolysis was made in any case necessary. A distal tuboplasty has been achieved in 17 patients and 6 patients were sent in IVF. Thereafter, 12 patients out of 19 that didn't use a contraceptive mean had a spontaneous intra-uterine pregnancy [63%]. Conclusion this survey confirms that the laparoscopic surgery is a sure and efficient technique for the treatment of the adnexal abscesses The anatomical results observed at the time of the control suggests that this second surgical phase is essential for the patients who want a future pregnancy

Adnexal masses in pregnancy.

OBJECTIVE: To determine incidence and maternal and fetal outcomes of pregnant women undergoing surgical management for adnexal mass. MATERIAL AND METHOD: A cohort study was performed in patients who presented with adnexal masses in pregnancy that required surgical management during April, 1986 to March, 2001. The maternal and fetal outcomes were analyzed. RESULTS: One hundred eighteen patients of 116,323 deliveries were identified with adnexal masses that required surgical management. The incidence was 1 in 986 deliveries. One hundred and three cases had complete data for analysis. A malignant tumor or a tumor of low malignant potential was found in 3 cases (2.9%). In 4 patients, the only finding at the time of operation were leiomyomas. Eighty-four of 103 cases (81.6%) had an elective operation and 19 cases (18.4%) had an emergency operation. There were 3 spontaneous abortions, 3 preterm deliveries, and 1 intrauterine growth restriction in all patients. Patients who underwent elective and emergency operation had the same adverse pregnancy outcome. CONCLUSION: The incidence of an adnexal mass during pregnancy in our population was consistent with what has been reported in the literature. The percentage of malignant tumors or tumors of low malignant potential was 2.9%. Patients who underwent elective operation had the same adverse pregnancy outcome compared with those who underwent emergency operation.

Tumores anexiales y embarazo / Adnexal tumors and pregnancy

Objetivo: Evaluar la frecuencia de tumores anexiales en el embarazo, la histología tumoral y los resultados perinatales. Pacientes y método: Análisis retrospectivo de 33 pacientes con diagnóstico de tumor anexial y embarazo atendidas en el Servicio de Obstetricia del Hospital San Juan de Dios entre febrero de 2001 a julio de 2004. Resultados: La asociación tumor anexial y embarazo fue 1 en 424 embarazos. El tipo histológico más frecuente fue el cistoadenoma seroso (19,2 por ciento no alteró el pronóstico perinatal. Conclusión: Recomendamos la resolución quirúrgica de las masas anexiales complejas durante el embarazo sobre las 12 semanas, período que da un margen de seguridad bastante amplio sin afectar la evolución del embarazo o los resultados perinatales.

Incidência de formações anexiais em mulheres na pós-menopausa / Frequency of adnexal abnormalities in menopause women

O objetivo deste estudo é avaliar a presença de formações anexiais em mulheres na pós-menopausa em usao ou não de terapia hormonal (TH). Pacientes e métodos: foram estudadas 1250 mulheres na pós-menopausa com média etária de 60,2 anos usuárias ou não de TH em baixas doses. Todasas mulheres foram avaliadas pela ultra-sonografia transvaginal...

Distribución de la patología anexial en mujer chilena: experiencia de la Universidad Católica de Chile / Distribution of adnexal pathology in chilean women: Universidad Católica de Chile experience

Se presenta la distribución de los hallazgos anátomo-patológicos anexiales en pacientes operadas por patología ginecológica durante el período comprendido entre los años 1991 y 2002. Se analiza su frecuencia según edad, localización anatómica y malignidad. El riesgo de cáncer en pacientes operadas con diagnóstico de tumor anexial es 9,5 por ciento. El hallazgo incidental de cáncer en pacientes operadas por patología ginecológica benigna es aproximadamente 1 en 3000 casos (0,3 por ciento).

Incidencia de formacoes anexiais em mulheres na menopausa / Frequency of abnormal adnexal mass in climateric women

O objetivo deste estudo e avaliar a presenca de formacoes anexiais em mulheres na menopausa em uso ou nao de terapia de reposicao hormonal (TRH). Foram estudadas 5300 mulheres menopausadas, com media etaria de 49,2 anos, as quais foram divididas em 2 grupos: A-composto de 3280 mulheres (61,9 por cento) usuarias de TRH e grupo B-constituido de 2020 (38,1 por cento) mulheres nao usuarias de TRH. Todas as mulheres foram...

Mortalidad fetal tardía: Chile 1990-1996 / Fetal mortality rate: Chile 1990-1996

Se analiza la tasa de mortalidad fetal tardía (TMFT) en Chile entre los años 1990-1996. Hay un significativo descenso de ella y de los nacimientos. La TMFT del período fue de 5,2/1.000 nacidos vivos. Las TMFT fueron significativamente más altas en las madres mayores de 34 años (7,9/1.000), en el bajo peso al nacer (57,2/1.000) y en la prematurez (58,2/1.000). el 42,3 por ciento y el 44,7 por ciento de los mortinatos pesaban más de 2.500 g y eran mayores de 36 semanas, lo que se interpreta como un subdiagnóstico de retardo del crecimiento intrauterino. Las causas más importantes de mortalidad fetal tardía corresponden a patología placentaria y de los anexos ovulares, hipoxia intrauterina, patología materna pregestacional y malformaciones congénitas