Quiste enterogénico y agenesia renal en la edad adulta / Enterogenic cyst and renal agenesis in adulthood

Introducción: Los quistes enterogénicos son malformaciones producidas durante el período de diferenciación y desarrollo embriológico del intestino primitivo. Objetivo: Presentar una malformación digestiva infrecuente en la edad adulta. Caso clínico: Paciente de 58 años que acude por dolor abdominal y aumento de volumen en hipogastrio. Al examen físico se palpa masa en hipogastrio de 15 cm de diámetro. La tomografía axial computarizada simple y contrastada mostró una masa tumoral en la excavación pélvica hipodensa con densidad de 18 UH, pared gruesa, de 2 cm, que realza con el contraste y agenesia renal derecha. El estudio anatomo-patológico informa quiste enterogénico. Discusión: La clínica de las duplicaciones intestinales es inespecífica, el dolor abdominal recurrente y la presencia de masa abdominal, son frecuentes. El diagnóstico preoperatorio de las duplicaciones intestinales es infrecuente, depende de la disponibilidad de estudios de imagen y la sospecha clínica. Es infrecuente la asociación de quiste enterogénico y agenesia renal. Conclusión: Se presenta una paciente masculino con una masa pélvica de etiología dudosa y agenesia renal derecha, en el que se diagnosticó un quiste enterogénico. La asociación de quiste enterogénico y agenesia renal es una malformación rara en el adulto(AU)

Introduction: Enterogenic cysts are malformations produced during the period of differentiation and embryological development of the primitive intestine. Objective: To report an rare digestive malformation in adulthood. Clinical case report: A 58-year-old patient came for abdominal pain and increased volume in the hypogastrium. On physical examination, a 15-cm diameter mass was palpated in the hypogastrium. Simple and contrast computerized axial tomography showed a tumor mass in the hypodense pelvic excavation with a density of 18 HU, a thick wall of 2 cm, which was enhanced with contrast and right renal agenesis. The anatomo-pathological study reports an enterogenic cyst. Discussion: The symptoms of intestinal duplications are nonspecific, recurrent abdominal pain and the presence of an abdominal mass are frequent. The preoperative diagnosis of intestinal duplications is occasional, it depends on the availability of imaging studies and clinical suspicion. The association of enterogenic cyst and renal agenesis is uncommon. Conclusion: A male patient is reported, with a pelvic mass of doubtful etiology and right renal agenesis, in whom an enterogenic cyst was diagnosed. The association of enterogenic cyst and renal agenesis is a rare malformation in adults(AU)

Diagnóstico prenatal y manejo quirúrgico posnatal exitoso de quiste ovárico fetal / Prenatal diagnosis and successful postnatal surgical management of fetal ovarian cyst

Los quistes ováricos fetales son el tumor abdominal más frecuente en las recién nacidas. Es la tercera causa de quistes intrabdominales, después de los de sistemas renal y gastrointestinal. Se puede sospechar su presencia en la ecografía cuando se observa una tumoración de aspecto quístico de estructura regular localizado en la parte inferior y lateral del abdomen, del tracto intestinal o urinario en un feto femenino sin anomalías. Presentan complicaciones agudas y a largo plazo. La más frecuente es la torsión anexial que presenta dificultades diagnósticas en la etapa neonatal. El diagnóstico prenatal es fundamental para el manejo oportuno de las pacientes. Existen diferentes alternativas terapéuticas donde la cirugía mínimamente invasiva y conservadora juega un importante rol. El objetivo del trabajo es demostrar que el diagnóstico temprano de los tumores fetales interviene en el resultado exitoso. Se presenta el caso de una paciente de 37 años primigesta, a la que durante la evaluación ecográfica; se observó la presencia de una tumoración de apariencia blanda en la parte inferior derecha del abdomen correspondiente a un quiste ovárico fetal claramente identificado y separado de la vejiga fetal. La paciente fue sometida a cesárea en la que se obtuvo una recién nacida femenina. Dos días después, la neonata fue intervenida quirúrgicamente por mínimo acceso y se resolvió exitosamente gracias a un manejo multidisciplinario(AU)

Fetal ovarian cysts are the most frequent abdominal tumor in newborns. It is the third cause of intra-abdominal cysts, after those of renal and gastrointestinal systems. Its presence can be suspected on ultrasound when a cystic-like tumor of regular structure located in the lower and lateral part of the abdomen, intestinal tract or urinary tract is observed in a female fetus with no anomalies. They present acute and long-term complications. The most frequent is adnexal torsion that presents diagnostic difficulties in the neonatal stage. Prenatal diagnosis is essential for the timely management. There are different therapeutic alternatives where minimally invasive and conservative surgery are important. The objective of the work is to demonstrate that the early diagnosis of fetal tumors intervenes in the successful outcome. We present the case of a 37-year-old primiparous patient, who had a soft-appearing tumor in the lower right part of the abdomen observed by ultrasound. This corresponded to a clearly identified fetal ovarian cyst and it was separated from the fetal bladder. The patient underwent cesarean section in which a female newborn was obtained. Two days later, the neonatal was minimal-access surgically treated successfully thanks to multidisciplinary management(AU)

Quiste de ovario intraligamentario gigante y miomatosis uterina / Giant intraligamentary ovary cyst and uterine myomatosis

Se presenta el caso de una paciente de 55 años de edad con quiste gigante de ovario. Fue atendida por integrantes de la Brigada Médica Cubana en la consulta de Ginecología del Hospital Regional de New Ámsterdam de la República de Guyana en el mes agosto de 2016 por presentar aumento de tamaño del abdomen, de aproximadamente dos años de evolución. El diagnóstico fue sospechado por ultrasonografía y tomografía axial computarizada. Se confirmó una tumoración quística gigante del ovario derecho a través de una laparotomía exploradora con dimensiones extraordinarias 48 cm de diámetro y peso 12,5 kg; además, miomatosis uterina. Se le realizó histerectomía total con doble anexectomía. El estudio histológico concluyó ser un cistoadenoma seroso de ovario y miomatosis uterina(AU)

We present the case of a 55-year-old female with giant ovarian cyst. She was attended in the gynecology consultation by members of the Cuban Medical Brigade, at the Regional Hospital of New Amsterdam in the Republic of Guyana during August, 2016. She presented a size increase abdomen, of approximately two years of evolution. The diagnosis was suspected by ultrasonography and computerized axial tomography. An exploratory laparotomy confirmed a giant cystic tumor in the right ovary of extraordinary dimensions (48 cm in diameter and 12.5 kg in weight), beside uterine myomatosis. A total hysterectomy was performed with double annexectomy. The histological study concluded that it was a serous cystadenoma of ovary and uterine myomatosis(AU)

CT Imaging Findings of Ruptured Ovarian Endometriotic Cysts: Emphasis on the Differential Diagnosis with Ruptured Ovarian Functional Cysts

OBJECTIVE: The purpose of this study is to assess the prevalence of abnormal CT findings in patients with surgically proven ruptured endometriotic cysts, as compared with those abnormal CT findings of ruptured ovarian functional cysts. MATERIALS AND METHODS: This study included 13 retrospectively identified patients with surgically confirmed ruptured ovarian endometriotic cysts and who had also undergone preoperative CT scanning during the previous seven years. As a comparative group, 25 cases of surgically confirmed ruptured ovarian functional cysts were included. We assessed the morphologic features of the cysts and the ancillary findings based on CT. RESULTS: For the endometriotic cysts, the mean maximum cyst diameter was significantly larger than that of the functional cysts (70.1 mm versus 36.4 mm, respectively, p < 0.05). The endometriotic cysts frequently had a multilocular shape and a thicker cyst wall, as compared to that of functional cysts, and these differences were statistically significant. Among the ancillary findings, endometriotic cysts showed a significantly higher prevalence of loculated ascites, ascites confined to the pelvic cavity without extension to the upper abdomen, and peritoneal strandings and infiltrations (p < 0.05). Although 11 of the 25 cases of functional cysts showed active extravasation of contrast material at the ovarian bleeding site, only one of 13 cases of endometriotic cysts showed active extravasation. CONCLUSION: The diagnosis of ruptured endometriotic cyst should be suspected for a woman in whom CT reveals the presence of multilocular or bilateral ovarian cysts with a thick wall and loculated ascites confined to the pelvic cavity with pelvic fat infiltrations.

Quiste de ovario errante / Erratic ovarian cyst

Se presenta el caso de un paciente de 52 años de edad, que ingresó en el Centro Nacional de Cirugía Endoscópica a causa de un dolor constante y sensación de pesadez en el bajo vientre, además de trastornos dispépticos. Después de los estudios de laboratorio e imaginológicos se diagnosticó un quiste de ovario derecho de 5-8 cm y varios cálculos menores de 10 mm en la vesícula biliar. Durante la intervención quirúrgica se encontró un quiste (ecolúcido), necrosado, adherido al mesocolon e independiente del ovario. Se practicó su exéresis y una colecistectomía. Por resultar una localización infrecuente de un quiste de ovario, se decide exponer las características clínicas y los resultados quirúrgicos y anatomopatológicos de este caso a la comunidad científica nacional e internacional. Se hace referencia además a la posibilidad que brindó el acceso por cirugía laparoscópica de realizar procedimientos asociados en un mismo paciente: colecistectomía y exéresis del quiste de ovario errante(AU)

The case of a female patient aged 52 is presented, admitted in the National Endoscopy Surgery Center due to a persistent pain and heaviness sensation in the lower stomach as well as dyspeptic disorders. After laboratory and imaging studies a cyst in right ovary of 5-8 mm diameter (echolucid), necrotic and adhered to mesocolon was diagnosed. A exeresis and a cholecystectomy were performed. Due to its infrequent location of a ovarian cyst the clinical features and the surgical and anatomical and pathological results are presented to national and international scientific community. Authors also make reference to the possibility allowed by the laparoscopic surgery approach to carry out procedures associated in a same patient: cholecystectomy and exeresis of erratic ovarian cyst(AU)

Management of ovarian cysts in postmenopausal women

Ovarian cysts in postmenopausal women are not uncommon and the majorities are asymptomatic. The primary goal in case of an ovarian cyst in a postmenopausal woman is to exclude malignant disease. Evidence is emerging that most of these ovarian cysts in postmenopausal women are benign, and many of these cysts resolved spontaneously. Therefore, surgical exploration of these cysts in postmenopausal women, who might have multiple co-morbidities, can be avoided in a large proportion of these patients. The aim of this review was to provide an evidence-based guideline about the management of ovarian cysts in postmeopausal women according to clinical, ultrasonographic, and biochemical features. Articles concerning ovarian cysts in postmenopausal women from a Medline literature search for the past 10 years were included. Using different imaging tools and serum marker CA125 are used. Size and consistency of the cyst found on benign appearing criteria on ultrasound and Doppler in addition to normal CA125, can be managed conservatively by repeated ultrasound and CA125, majority of cyst in postmenopausal women are benign and disappear spontaneously. Operative laparoscopy can be safely used to remove persistent cyst with normal CA125. Suspicious cyst by imaging and elevated CA125 should be manage in the traditional way as ovarian cancer. Discrimination between benign and malignant ovarian cyst is challenging. No single test can achieve this, for this reason multiple diagnostic modalities can be used together to optimize the accuracy of prediction of malignancy in a cyst. More work is needed on Doppler and three-dimensional ultrasound hoping to improve the sensitivity to discriminate between benign and malignant cysts in the future

Successful Intrauterine aspiration of a large Fetal ovarian cyst

A 32-year-old Bahraini lady with a large fetal intra-abdominal cyst detected antenatally on ultrasound examination at 16 weeks of gestation. The cyst was simple anechoic, increasing in size and causing progressive displacement of the fetal thoracic organs. A successful intrauterine needle aspiration was carried out under ultrasound guidance at 30 weeks gestation without maternal or fetal morbidity. Cytology of the cyst fluid showed luteinized granulosa cells and biochemistry demonstrated high concentrations of estradiol, progesterone, and testosterone that confirmed the etiology of the cyst as ovarian. There was no evidence of recurrence following aspiration and no further need for postnatal surgery

Operative laparoscopy in treating benign ovarian cysts

This study was undertaken to evaluate the clinical usefulness of operative laparoscopy in treatment of benign ovarian cysts. A retrospective study was carried on 468 operative laparoscopy cases performed from September 1995 to September 1998 at Yonsei University College of Medicine, Department of Obstetrics and Gynecology. Patient characteristics, specimen pathology, perioperative morbidity, and perioperative complications were reviewed. The percentage of operative laparoscopy increased steadily from 20.7% in 1996, 33.9% in 1997, to 49.7% in 1998. The mean age of patients was 33.66.5 (mean +/- SD) years and the mean hospital stay was less than 2 days. Types of surgery performed were cystectomy (n = 234), salpingo-oophorectomy (n = 126), oophorectomy (n = 63), and fulguration (n = 45), in decreasing order. Depending on the pathology of the ovarian cyst, the mean operation time was in the range of 80 to 110 minutes. Perioperative complications included 5 cases of subcutaneous emphysema, 10 cases of abdominal wall hematoma, 7 cases of trocar site bleeding, 3 cases of bowel injury, and 1 case of bladder injury. In conclusion, operative laparoscopy in treating benign ovarian cysts provides advantages such as less need to perform laparotomy, smaller skin incision, less perioperative discomfort, minimal tissue handling and trauma, and shorter hospital stay. Nevertheless, the risk of unrecognized ovarian malignancy cannot be absolutely excluded, therefore careful patient selection is mandated.

Apport de l'echographie endovaginale en gynecologie obstetrique

Echography imposes itself as a reliable, harmless and repectitive technique in the exploration of female pelvis. Endovaginal echography is a new technique that should be used complementarily with classical over the pubis echography. Authors insist on the contribution of endovaginal echography: In gynecology in the diagnosis of extra utrine pregnancies. itI completes the echography of over the pubis in the study of uterine and ovarian pathology - In obstetrics in the precocions diagnosis of the pregnancy and the study of low-inserted placentas And in interventional echography in the embryonary reduction and the punction of ovocys in the techniques of procreation that are medically aided

value of transvaginal ultraonography in the diagnosis of polycystic ovary disease

Transvaginal ultrasonic examination [TVS] was done to 45 women with the clinical, as well as laboratory, diagnosis of PCOD attending the Infertility Clinic of Sohag University Hospitals and to 30 healthy fertile women attending the Family Planning Clinic who accepted to serve as controls. The idea was to test the ability of TVS to discriminate between normal and polycystic ovaries by putting cut off values to ovarian volume, follicular number and size, as well as stromal echogenicity, and to find the pattern of follicular arrangement in such condition. The mean values [mean +/- SD] for the ovarian volume [ml], follicular number and size [ml] were 12.4 +/- 2.5, 12.3 +/- 2.6 and 3.3 +/- 0.5 for PCOD and 8.9 +/- 1.2, 5.3 +/- 2.2 and 4.9 +/- 0.6 for the controls, respectively, the differences were highly significant [p < 0.001]. Ovarian stromal echogenicity was increased in 91% of PCOD and in 6.7% of controls and the follicles were predominantly subcapsular in 71% of PCOD. TVS is an accurate, simple and safe method for diagnosis of PCOD with adequate precision particularly when more than one parameter is considered together

Ultrasound-guided Ovarian cyst puncture in diagnosis of unexpected malignancy

This study was conducted on 50 women with benign looking ovarian cysts as detected by clinical and ultrasonographic examination. Every woman was subjected to full clinical examination trans-abdominal pelvic ultrasound scanning. Selected benign looking ovarian cysts by ultrasound were submitted to fine needle aspiration under guidance of ultrasound. The aspirated fluid was examined cytologically and histopathological examination was done for all cases after laparotomy and surgical managements. Cytological and histopathological results were as follows: Serous cystadenoma: 19 cases diagnosed cytologically and 30 cases histopathological. Mucinous cyst-adenoma: 8 cases diagnosed cytologically and 4 cases by histopathology. Benign cystic teratoma [dermoid cyst]: 4 cases diagnosed by both cytology and histopathology after laparotomy. Chocolate cyst: only one case diagnosed cytologically and confirmed histologically. Benign unclassified cysts: 17 cases diagnosed cytologically to be benign ovarian cysts and were found histologically to be, 13 cases of serous cystadenoma, two cases of mucinous cystadenoma and two cases of granulosa lutein cyst. One case of clear cell cystic ovarian tumour was detected histologically, but cytologically it was considered as serous cystadenoma. Papillary serous cystadenoma, one case was diagnosed cytologically and confirmed by histopathological examination. From the above results, acceptable correlation between cytological and histological results was found in cases of malignant, benign cystic teratoma, chocolate cysts and to some extent in cases of mucinous cystadenoma. More discrepancy was found as regards serous cystadenoma as most of the cytologically not classifiable cases were found to belong to this category

Clinical and endocrine features of ultrasound diagnosed polycystic ovary patients the correlation between ovarian volume and androgen activity

125 cases with PCO on ultrasound, under went detailed clinical and endocrine evaluation the age matched control group comprised volunteers with normal ovaris on ultrasound and regular ovulatory cycles. Both group were subjected to ultrasound examination and radioimmunassay for E2, FSH, LH testosterone, and androstenedion and DHEAS. 32.8 percent of PCO patient were found to have ovarian volume within normal range while 67.2 percent had enlargement overasis, and there was a significant positive correlation between ovaries volume and serum LH [P=0.56, P<0.05] testosterone R=0.46 P<0.05] and androstenedion R=0.42, P<0.05] and DHEAs levels R=0.48, P<0.05

Mesenteric dermoid cyst: case report similar to ovarian dermoid cyst

Mesenteric cysts are rare. Ultrasonography may help the diagnosis of dermoid nature, but it often misdiagnose the mesenteric localization, especially, pre-operatively. We report a case of 26 years old woman, hospitalized in gynecologic department, for a mesenteric dermoid cyst simulating pre-operatively ovarian dermoid cyst

The value of ultrasonography in the diagnosis of adnexal masses.

Seventy patients with palpable adnexal masses were subjected to ultrasonographic examination. Three patients with negative ultrasound and no disease were excluded from the final analysis. Correct diagnosis was obtained in 58.2% patients; contributory information in 16.4%. Ultrasonography is valuable in diagnosing functional and benign ovarian neoplasms. It is also useful in suspecting malignant ovarian neoplasms and confirming diagnosis of ectopic pregnancy, if correlated with the clinical findings.