Combination of GI-RADS and 3D-CEUS for differential diagnosis of ovarian masses

SUMMARY OBJECTIVE The purpose of this study is to evaluate the efficacy of the combination of gynecologic imaging reporting and data system (GI-RADS) ultrasonographic stratification and three-dimensional contrast-enhanced ultrasonography (3D-CEUS) in order to distinguish malignant from benign ovarian masses. METHODS In this study, 102 patients with ovarian masses were examined by both two-dimensional ultrasound(2D-US) and 3D-CEUS. Sonographic features of ovarian masses obtained from 3D-CEUS were analyzed and compared with 2D-US. All patients with ovarian masses were confirmed by operational pathology or long-term follow-up results. RESULTS (1)The Chi-square test and multiple Logistic regression analysis confirmed that there were only eight independent predictors of malignant masses, including thick septa (≥3mm), thick papillary projections(≥7mm), solid areas, presence of ascites, central vascularization, contrast enhancement, distribution of contrast agent, and vascular characteristics of the solid part and their odds ratios which were 5.52, 5.39, 4.94, 4.34, 5.92, 7.44, 6.09, and 7.67, respectively (P<0.05). (2)These eight signs were used to combine the GI-RADS with 3D-CEUS scoring system in which the corresponding value of the area under the curve (AUC) was 0.969, which was superior to using GI-RADS lonely (Z-value=1.64, P<0.025). Using 4 points as the cut-off, the scoring system showed the performance was clearly better than using GI-RADS alone (P<0.05). (3) The Kappa value was 0.872 for two different clinicians with equal experience. CONCLUSIONS The combination of GI-RADS and 3D-CEUS scoring system would be a more effective method to distinguish malignant from benign ovarian masses.

RESUMO OBJETIVO O objetivo deste estudo é avaliar a eficácia da combinação da estratificação por ultrassonografia usando o Sistema de Relatórios e Dados de Imagem Ginecológica (GI-RADS) e ultrassonografia 3D com contraste (3D-CEUS) para diferenciar massas ovarianas benignas de malignas. METODOLOGIA Neste estudo, 102 pacientes com massas ovarianas foram examinadas usando ultrassonografia bidimensional (2D-US) e 3D-CEUS. As características ultrassonográficas das massas ovarianas obtidas com 3D-CEUS foram analisadas e comparadas com de 2D-US. Todos os pacientes com massas ovarianas tiveram o diagnóstico confirmado pelos resultados de patologia cirúrgica ou acompanhamento de longo prazo. RESULTADOS (1) O teste qui-quadrado e a regressão logística múltipla confirmaram a existência de apenas oito preditores independentes de massas malignas, incluindo septos espessos (≥3mm), projeções papilares espessas (≥7mm), áreas sólidas, presença de ascite, vascularização central, aumento de contraste, distribuição do agente de contraste e características vasculares da parte sólida e suas razões de possibilidades (OR), que foram 5,52, 5,39, 4,94, 4,34, 5,92, 7,44, 6,09 e 7.67, respectivamente (P< 0,05). (2) Esses oito preditores foram utilizados para combinar o GI-RADS com o sistema de escores da 3D-CEUS, para o qual o valor correspondente da área sob a curva (AUC) foi de 0,969, superior ao uso exclusivo do GI-RADS (valor de Z = 1,64, P < 0,025). Usando 4 pontos como corte, o sistema de escores mostrou que o desempenho foi muito melhor do que com o uso exclusivo do GI-RADS (P < 0,05). (3) O valor de Kappa foi 0,872, obtido por dois médicos diferentes com igual experiência. CONCLUSÃO A combinação do GI-RADS e do sistema de pontuação da 3D-CEUS é um método mais eficaz para distinguir massas ovarianas benignas de malignas.

Ruptura de endometrioma ovárico durante el tercer trimestre del embarazo / Ruptured of ovarian endometrioma during the third trimester of pregnancy

Presentar un caso de ruptura de endometrioma de ovario durante el tercer trimestre del embarazo. Paciente de 35 años con embarazo activo de 34 semanas, acudió por presentar dolor abdominal y aumento súbito de volumen del abdomen. La ecografía demostró la presencia de un embarazo intrauterino, abundante cantidad de líquido libre en cavidad abdominal y del lado izquierdo del útero una tumoración compatible con endometrioma. Durante la laparotomía, el ovario izquierdo estaba adherido a la pared posterior del ligamento ancho y epiplón con la presencia del endometrioma roto. Tres días después de cirugía, el trabajo de parto se inicio en forma espontánea, por lo que se realizó la cesárea. La paciente presentó un posoperatorio sin complicaciones

A 35 years-old patient with an active pregnancy of 34 weeks assisted for presenting abdominal pain and sudden increased of abdominal volume. Ultrasonography showed presence of intrauterine pregnancy, great amount of free fluid in abdominal cavity and in left side of uterus a tumor compatible with endometrioma. During laparotomy, left ovary was adhere to posterior wall of broad ligament and omentum with a ruptured endometrioma. Three days after surgery, labor began spontaneously so a cesarean section was done. Patients had a postoperative course without complications

Associação entre endometrioma ovariano e endometriose profunda infiltrativa / Association between ovarian endometrioma and deep infiltrating endometriosis

OBJETIVO: Avaliar a associação do endometrioma ovariano e a presença de lesões de endometriose profunda infiltrativa (EPI) em uma amostra de mulheres do Sul do Brasil. MÉTODOS: Foi conduzida uma análise retrospectiva com informações dos prontuários de mulheres submetidas a tratamento cirúrgico de endometriose durante o período de janeiro de 2010 e junho de 2012. As pacientes foram divididas em dois grupos de acordo com a presença ou não de endometrioma ovariano. As pacientes portadoras de endometrioma ovariano foram subdivididas em dois grupos de acordo com o diâmetro do endometrioma (<40 e >40 mm). Os parâmetros comparados entre os grupos incluíram: dosagem sérica de cancer antigen (CA) 125, tamanho do endometrioma, presença e número de lesões profundas. A análise estatística foi conduzida com o programa Statistica versão 8.0, utilizando-se o teste exato de Fisher, o teste t de Student e o teste de Mann-Whitney, quando necessário. Os valores p<0,05 foram considerados estatisticamente significativos. RESULTADOS: Durante o período de estudo, um total de 201 mulheres foram submetidas a tratamento cirúrgico laparoscópico de endometriose. Cinquenta e seis pacientes (27,9%) eram portadoras de endometrioma ovariano e 180 pacientes (89,5%) apresentaram EPI confirmada histologicamente. As mulheres com endometrioma ovariano apresentaram um CA 125 sérico mais alto (39,5 versus 24,1 U/mL; p<0,01) e uma maior associação com a presença de lesões de EPI (98,2 versus 86,2%; p=0,01) e de EPI intestinal (57,1 versus 37,9%; p=0,01). Não houve diferença significativa quando se comparou os grupos com endometriomas <40 e >40 mm. CONCLUSÕES: O endometrioma ovariano é um marcador para a presença de lesões de EPI, incluindo EPI com comprometimento intestinal.

PURPOSE: To evaluate the association between ovarian endometrioma and the presence of deep infiltrating endometriosis (DIE) lesions in a sample of women of the South of Brazil. METHODS: A retrospective study was conducted in all women undergoing surgical treatment of endometriosis from January 2010 to June 2012. Patients were divided into 2 groups according to the presence or not of ovarian endometrioma. Patients presenting an ovarian endometrioma were subsequently divided into 2 groups according to the diameter of the endometrioma (<40 and >40 mm). The following parameters were compared between the groups: cancer antigen (CA) 125 level, size of the endometrioma, presence and number of deep lesions. The statistical analysis was performed with Statistica version 8.0 using Fisher's exact test, Student's t-test and Mann-Whitney test, when needed. The p values of <0.05 were considered statistically significant. RESULTS: During the study period, a total of 201 women underwent laparoscopic surgical treatment of endometriosis. Fifty-five patients (27.9%) presented ovarian endometrioma and 180 patients (89.5%) presented DIE confirmed by pathologic examination. Women presenting an ovarian endometrioma had higher CA 125 levels (39.5 versus 24.1 U/mL; p<0.01) and stronger association with the presence of DIE lesions (98.2 versus 86.2%; p=0.01) and intestinal DIE (57.1 versus 37.9%; p=0.01). There was no difference between the groups with endometriomas <40 and >40 mm. CONCLUSIONS: Ovarian endometrioma is a marker for the presence of DIE lesions, including intestinal DIE.

Recidivas de endometriomas ováricos tras cirugía laparoscópica / Ovarian endometrioma: recurrence after laparoscopic surgery

Objetivo: Analizar las variables que influyen en la recurrencia tras la extirpación laparoscópica de endometriomas ováricos. Métodos: Se estudiaron retrospectivamente 214 pacientes, intervenidas por laparoscopia entre los años 2005 y 2006 en el Hospital La Paz y seguidas por 5 años. Como criterios de recurrencia se consideraron: dolor, hallazgo ecográfico y elevación de Ca 125. Resultados: El 30,8 por ciento (66/214) presentaron recurrencia del dolor, el 28 por ciento (60/214) recidiva ecográfica y el 16,8 por ciento (36/214) Ca 125 elevado. Las pacientes con recidiva sintomática presentaron mayor dismenorrea y dispareunia previas a la cirugía (6,8 +/- 2,5 y 1,3 +/- 2,5 frente a 3,8 +/- 3,4 y 0,2 +/- 1,0 en las no recurrencias (p=0,0001; p=0,0001). La puntuación de dis-menorrea y dispareunia previas también fue superior en recidiva ecográfica (5,9 +/- 3,3 y 1,2 +/- 2,5 frente a 4,3 +/- 3,4 y 0,2 +/- 1,1 en ausencia de recidiva) (p=0,003; p=0,002). La recurrencia de dismenorrea fue mayor en jóvenes (31,3 +/- 5,4 años versus 34,3 +/- 7,8; p=0,02), con quistectomía (35 por ciento versus 16,7 por ciento en anexectomía; p=0,02) y adherensiolisis (46,4 por ciento versus 23,4 por ciento; p=0,001) y con tratamiento médico posquirúrgico (41,5 por ciento frente 22,5 por ciento; p=0,004). El tiempo medio de no recurrencia sintomática fue 44 meses (IC95 por ciento: 41-47) y el de no recidiva ecográfica de 47 meses (IC95 por ciento:45-50). Conclusión: El grado de dismenorrea y dispareunia previas a la cirugía fue el factor más claramente asociado a la recidiva.

Objective: To analyze the variables influencing recurrence after laparoscopic excision of ovarian endome-trioma. Methods: We retrospectively studied 214 cases who underwent laparoscopic surgery between 2005 and 2006 in the Hospital La Paz and followed for 5 years. As recurrence criteria were considered: pain, ultrasound finding and Ca125 elevation. Results: 30.8 percent (66/214) of patients presented pain recurrence, 28 percent (60/214) ultrasound recurrence and 16.8 percent (36/214) Ca 125 elevation. Patients with symptomatic recurrence had a bigger degree of dysmenorrhea and dyspareunia before surgery (6.8 +/- 2.5 and 1.3 +/- 2.5 against 3.8 +/- 3.4 and 0.2 +/- 1.0 in no recurrence ones (p=0.0001; p=0.0001). Previous dysmenorrheal and dyspareunia punctuation was also greater in ultrasound recurrences (5.9 +/- 3.3 and 1.2 +/- 2.5 against 4.3 +/- 3.4 and 0.2 +/- 1.1 of those with no recurrence) (p=0.003; p=0.002). Dysmenorrhea recurrence was greater in young (31.3 +/- 5.4 years old versus 34.3 +/- 7.8; p=0.02), with cystectomy (35 percent versus 16.7 percent in adnexectomy; p=0.02), adhesiolysis (46.4 percent versus 23.4 percent; p=0.001) and with medical treatment after surgery (41.5 percent against 22.5 percent; p=0.004). The mean time of no symptomatic recurrence was 44 months (CI95 percent:41-47) and the no ultrasound recurrence was 47 months (CI95 percent:45-50). Conclusion: The degree of dysmenorrhea and dyspareunia before surgery was the factor most clearly associated with recurrence.

Genomic alterations detected by comparative genomic hybridization in ovarian endometriomas

Endometriosis is a complex and multifactorial disease. Chromosomal imbalance screening in endometriotic tissue can be used to detect hot-spot regions in the search for a possible genetic marker for endometriosis. The objective of the present study was to detect chromosomal imbalances by comparative genomic hybridization (CGH) in ectopic tissue samples from ovarian endometriomas and eutopic tissue from the same patients. We evaluated 10 ovarian endometriotic tissues and 10 eutopic endometrial tissues by metaphase CGH. CGH was prepared with normal and test DNA enzymatically digested, ligated to adaptors and amplified by PCR. A second PCR was performed for DNA labeling. Equal amounts of both normal and test-labeled DNA were hybridized in human normal metaphases. The Isis FISH Imaging System V 5.0 software was used for chromosome analysis. In both eutopic and ectopic groups, 4/10 samples presented chromosomal alterations, mainly chromosomal gains. CGH identified 11q12.3-q13.1, 17p11.1-p12, 17q25.3-qter, and 19p as critical regions. Genomic imbalances in 11q, 17p, 17q, and 19p were detected in normal eutopic and/or ectopic endometrium from women with ovarian endometriosis. These regions contain genes such as POLR2G, MXRA7 and UBA52 involved in biological processes that may lead to the establishment and maintenance of endometriotic implants. This genomic imbalance may affect genes in which dysregulation impacts both eutopic and ectopic endometrium.

Cáncer de ovario en el Hospital Central de Maracay: revisión de 1999 a 2007 / Ovarian cancer at the

To identify the incidence and risk factors of the ovarian cancer, clinical aspects and diagnosis related with staging. A retrospective, epidemiological, descriptive study of 52 patients with ovarian cancer from 1999 to 2007. Department of Surgery and Gynecology, Hospital Central de Maracay. The incidence was 0.4 percent of all cases and 13.19 percent of all gynecologic malignancies. The mean age was 49,46 years. In parity 38.5 percent had from one to three pregnancies. Menarche in 17. percent was 12 years. 50.1 percent patients were in postmenopausal. Clinical diagnosis was ovarian tumor (57,6 percent). Patients were evaluated in 69.2 percent with ultrasonography. Staging classification (FIGO 1985) in 23 percent was stage III. In 71.1 percent ovarian cancer was epithelial. In 71.1 percent treatment used was hysterectomy and bilateral salpingo-oophorectomy. In 2 percent there was neoplasm associated. Ovarian cancer is sporadic, and developing after 35 years. The diagnosis is late

Identificar la incidencia y factores de riesgo del cáncer de ovario, los aspectos clínicos y diagnósticos relacionados con su estadificación. Estudio retrospectivo, epidemiológico, descriptivo de 52 pacientes con cáncer de ovario de 1999 a 2007. En el Servicio de Cirugía y Ginecología, Hospital Central de Maracay. La incidencia es del 0,4 por ciento del total de casos y 13,19 por ciento del total de patología ginecológica maligna. La edad promedio fue de 49,46 años. En paridad 38,5 por ciento tenían de uno a tres embarazos. El de la menarquía 17 por ciento fue menor de doce años. Hubo 50,1 por ciento pacientes posmenopáusica. El motivo de consulta fue tumor de ovario (57,6 por ciento). El diagnóstico instrumental en 69,2 por ciento se realizó con ecografía. En 23 por ciento el estadio clínico (FIGO 1985) fue el III. Según el tipo histológico fueron neoplásicas asociadas. El cáncer de ovario es esparádico después de los 35 años. Su diagnóstico es tardío

Edema maciço de ovário / Massive ovarian edema

O edema maciço de ovário é uma condição benigna rara caracterizada pelo aumento tumoral símile do ovário comprometido. As doenças ovarianas de importância cirúrgica da infância não são frequentes e podem ser divididas em lesões neoplásicas, em cistos não neoplásicos e em alterações inflamatórias. Os autores descrevem um caso de edema maciço de ovário em uma paciente de treze anos que referia dor abdominal associada a uma lesão sólido-cística do ovário direito, avaliada como neoplasia pela ultrassonografia. Ao exame macroscópico, o ovário era bocelado e estava aumentado de volume, medindo 9,5×6,0×5,0 cm e apresentando uma lesão sólida com áreas císticas à superfície de corte. O aspecto microscópico fundamental desse processo era a presença de edema acentuado e difuso do estroma, envolvendo folículos, e associado a uma camada cortical com espessamento fibroso superficial. O conhecimento dessa entidade é fundamental para auxiliar no diagnóstico durante a avaliação ultrassonográfica de tumores ovarianos e prevenir tratamentos incorretos.

Massive ovarian edema is a rare benign condition characterized by similar tumor growth of the affected ovary. The ovarian disorders of surgical importance of childhood are not frequent and can be divided into neoplastic lesions, non-neoplastic cysts, and inflammatory alterations. Here the authors describe the case of a massive ovarian edema in a 13-year-old female patient who reported abdominal pain associated with a solid-cystic lesion of the right ovary evaluated as a neoplasm by ultrasonography. The macroscopic examination showed ovary with increased volume, measuring 9.5×6.0×5.0 cm, and presenting a solid lesion with cystic areas at the cutting surface. The key microscopic feature of this process was the presence of pronounced diffuse edema of the stroma, involving follicles and associated with a cortical layer with superficial fibrous thickening. Knowledge of this entity is key in aiding the diagnosis during the ultrasonographic evaluation of ovarian tumors and preventing improper treatments.

Ectopic schistosomiasis: description of five cases involving skin, one ovarian case and one adrenal case / Esquistossomose ectópica: descrição de cinco casos de envolvimento da pele, um do ovário e um da glândula supra-renal

Seven cases of patients with ectopic schistosomiasis from the State of Sergipe, Brazil, are presented (five involving skin, one ovarian and one adrenal). Data were collected from surveying the clinical records and anatomopathological reports in the files of the dermatology and pathology clinics of the University Hospital of the Federal University of Sergipe, from 1995 to 2005. The patients' mean age at diagnosis was 21.1 years. In the dermatological cases, full cures were achieved after treatment with oxamniquine. In the ovarian case, there was an association with embryonic carcinoma: this patient underwent surgery with adjuvant chemotherapy and praziquantel treatment, with satisfactory evolution. The adrenal case was associated with adenoma.

São apresentados sete casos de esquistossomose ectópica (cinco de pele, um de ovário e um de supra-renal) procedentes do Estado de Sergipe, coletados a partir de pesquisa de prontuários e laudos anátomo-patológicos nos arquivos dos Serviços de Dermatologia e de Patologia do Hospital Universitário da Universidade Federal de Sergipe, entre os anos de 1995 e 2005. A média de idade dos pacientes ao diagnóstico foi de 21,1 anos. Nos casos dermatológicos, houve melhora total das lesões após tratamento com oxamniquine. No caso de ovário houve associação com carcinoma embrionário; a paciente foi submetida à cirurgia com quimioterapia adjuvante e praziquantel, evoluindo satisfatoriamente. O caso de supra-renal estava associado a adenoma.

Manejo laparoscópico de masas anexiales: experiencia local / Laparoscopic handling of anexial masses: local experience

Se analizaron 132 pacientes evaluando características epidemiológicas y clínicas, la correlación entre ecografía y anatomía patológica, la evolución y el uso laparoscópico en el tratamiento de masas anexiales. El diagnóstico se basó en la identificación ecográfica de una masa anexial. El rango de edad fue 16-66 años. El dolor abdominal y pélvico estuvo presente en 34 por ciento de los casos; en 45 por ciento se diagnosticó la masa anexial por examen ecográfico de rutina. En 53 por ciento de las pacientes se realizó quistectomía y en 16 por ciento ooforectomía completa. En 78 por ciento la masa correspondió a ovario y en 22 por ciento a trompa. Para las masas de origen ovárico la frecuencia mayor correspondió a tumores epiteliales (22 por ciento), seguido por quistes endometriósicos con 18 por ciento. Hubo 3 complicaciones vasculares y cambio a vía abierta en 5 casos. Solo hubo 1 tumor borderline y como hallazgo un cáncer de cuello uterino. El objetivo de este trabajo es presentar la experiencia quirúrgica en el manejo laparoscópico de los tumores anexiales.

Diagnostico, patologia, tratamento e evolucao de tumores ovarianos em criancas e adolescentes / Diagnosis, pathology, treatment and evolution of ovarian tumor in children and adolescents

Os tumores de ovario representam 1,2 a 1,5 por cento das doencas malignas , na infancia e ate 20 por cento deles, ocorrem antes da menarca. Neste trabalho e apresentada a experiencia do setor de oncologia genital feminina do Hospital das Clinicas de Porto Alegre, no tratamento...

Transvaginal ultrasonography combined with pelvic examination in the diagnosis of ovarian endometrioma.

The aim of this retrospective study was to evaluate the efficacy of TVS and TVS combined with pelvic examination for the diagnosis of ovarian endometrioma. Three hundred and five ovarian masses of 244 patients with either pre-operative or post-operative diagnosis of ovarian tumor and received TVS between January 1, 1996 and December 31, 1998 were included in the study. Of 305 masses, 221 endometriomas of 164 patients were diagnosed histologically. The efficacy of TVS was 84.9 per cent with a sensitivity of 92.3 per cent and specificity of 70.2 per cent. LR+ and LR- were 3.1 and 0.1 respectively. The combination of TVS and pelvic examination with either positive test had a higher sensitivity (98.8%) but lower specificity (26.6%). This combination dramatically improved NPV (97.5%) and LR- (0.05), whereas, the combination with both positive tests had a sensitivity of 78.1 per cent, and specificity of 81.5 per cent. LR+ and LR- were not different from those using TVS alone. In conclusion, the study has shown the role of TVS in the diagnosis of ovarian endometrioma. The combination of TVS and pelvic examination may be useful in ruling out the disease. However, a further prospective study should be performed to confirm the efficacy of the combination.

Tubo-ovarite xanthogranulomateuse a propos d'un cas

Xanthogranulomatous inflammation in the female genital tract is rare and characterized by a massive infiltration of the tissue by lipid containing histiocytic cells, together with lymphocytes and plasma cells. We report a new case of Xanthogranulomatous inflammation of the female genital tract

Fibroma ovárico. Informe de dos casos; ¿Incidencia familiar? / Ovarian fibroma. Two case presentation

Los tumores ováricos representan 23 por ciento del total de las neoplasias ginecológicas. De éstas 4 por ciento son fibromas de ovario. Esta informado en la literatura mundial prevalencia familiar de fibroma de ovario (FO). Un tercio de las pacientes con FO cursan asintomáticos y en la mitad de ellas no se palpa tumor. La información brindada por exámenes radiológicos no es suficiente para diagnosticar al FO. El diagnóstico definitivo se hace mediante el estudio anatomopatológico de la lesión. Se presentan los casos clínicos de dos hermanas con FO calcificado bilateral, quienes presentaron cuadro clínico similar. Se detectaron tumores pélvicos mediante imágenes por Rayos X (Rx) y resonancia magnética (RM). Se realiza laparotomía exploradora extirpando las lesiones e identificándolas mediante examen anatomopatológico como fibroma ovárico calcificado bilateral

Cáncer de ovario / Ovarian cancer

En Costa Rica, el cáncer ovárico ocupa el séptimo lugar en la frecuencia entre los tumores malignos que afectan a la población femenina, con una incidencia que se ha mantenido estable a lo largo de los últimos años, siendo el tercer cáncer gincecológico más frecuente, precedido por el cáncer de mama y el cáncer de cérvix. Probablemente la extirpación profiláctica de anexos durante procedimientos de histerectomía abdominal realizadas por causas no oncológicas, así como el uso creciente de marcadores tumorales, y el progreso en el diagnóstico por imágenes (ultrasonografía vaginal y técnicas de Doppler-Color), harán que la captación en estadíos tempranos...

Edema masivo del ovario / Masive ovarian edema

El edema ovárico masivo es una rara condición que se ha asociado a la torsión anexial. Revisamos cuatro casos de edema ovárico masivo tratados en el Servicio de Ginecología de nuestro Hospital. Uno de los casos se manejó en forma conservadora mediante destorsión y ooforopexia. Se concluye que esta condición es secundaria a un grupo heterogéneo de enfermedades y potencialmente curable

Ooforectomia concomitante a histerectomia no ciclo gravídico-puerperal: quando indicar? / Ovariectomy concomitant with hysterectomy in the pregnancy-puerperium cycle: when to indicate?

Revisaram-se 85 histerectomias realizadas durante o ciclo gravídico-puerperal no Hospital das Clínicas da Faculdade de Medicina de Ribeiräo Preto (USP), no período de janeiro de 1978 a agosto de 1989, com o objetivo de avaliar o número de ooforectomias concomitantes a esta cirurgia. Foram realizadas 25 ooforectomiass com estudo histológico, sendo que 11 (44%) apresentaram-se normais; seis (24%), embora normais histologicamente, continham hematoma periovariano, verificado no ato operatório, e as oito (32%) restantes, comprometimento infeccioso. A idade média das pacientes foi de 32,8 anos. Conclui-se que houve um alto número desnecessário de ooforectomias