Quiste de ovario gigante y embarazo / Giant Ovarian Cyst and Pregnancy

Introducción: Los quistes en los ovarios son una afección frecuente en las mujeres en edad fértil. Objetivo: Presentar el caso de una mujer con embarazo a la que se le diagnostica un quiste gigante de ovario, de interés para los especialistas debido al tamaño y la favorable evolución. Presentación de caso: Paciente femenina de 28 años de edad, procedencia rural, con embarazo único. Se realizó captación del embarazo a las 11,4 semanas y se detectó al examen ginecológico una tumoración anexial que se corrobora por ultrasonido, donde se reporta una imagen quística que llega a la región umbilical que mide 18 centímetros, de paredes finas, multitabicada con un grosor de los tabiques de 2,3 milímetros, con vascularizazión a este nivel. Se decidió su ingreso para tratamiento quirúrgico a las 17,5 semanas de gestación, se realizó de forma electiva laparotomía exploradora. Los hallazgos operatorios fueron: quiste gigante de ovario de aproximadamente 20 centímetros. Fue dada de alta al tercer día con una evolución satisfactoria. Continúa su atención prenatal en en el consultorio del médico y la enfermera de la familia. Los resultados anatomopatológicos fue: cistodenoma seroso papilar de ovario de 20 por 20 centímetros, no se observan estigmas de malignidad. Se realiza parto eutócico a las 39,1 semanas de gestación, con un peso de 3800 gramos. Conclusiones: Se hace descripción clínico y quirúrgica del diagnóstico, la evolución, la intervención y el seguimiento de una mujer en quien coexistieron un embarazo y un cistodenoma seroso papilar de ovario, con resultados favorables(AU)

Introduction: Ovarian cysts are a frequent condition in women at fertile age. Objective: To present the case of a pregnant woman diagnosed with a giant ovarian cyst, of interest to specialists due to its size and favorable evolution. Case presentation: 28-year-old female patient, of rural origin, with a single pregnancy. During the first pregnancy consultation, at 11.4 weeks, the gynecological examination permitted to identify an adnexal tumor, a diagnosis corroborated by ultrasound imaging, reporting an 18-cm multi-septated cystic image that reaches the umbilical region, with thin walls, septa thickness of 2.3 millimeters and vascularization at this level. The patient was decided to be hospitalized for surgical treatment at 17.5 weeks of gestation; exploratory laparotomy was performed electively. The operative findings were a giant ovarian cyst of approximately twenty centimeters. She was discharged on the third day, with a satisfactory evolution. She continues to receive prenatal care in the family doctor and nurse's office. The anatomopathological results were an ovarian papillary serous cystadenoma measuring 20 per 20 cm; no stigmata of malignancy were observed. Eutocic delivery was performed at 39.1 weeks of gestation, the offspring weighing 3800 grams. Conclusions: A clinical and surgical description is made of the diagnosis, evolution, intervention and follow-up of a pregnant woman with an ovarian papillary serous cystadenoma, reporting favorable outcomes(AU)

Quiste gigante de ovario / Giant cyst of ovary

RESUMEN Históricamente, se describen como tumores de gran tamaño aquellos que pesan más de 12 Kg, entre ellos los ginecológicos y los de ovario; sobre todo antes del advenimiento de la ecografía y en poblaciones de mala situación socioeconómica y nivel cultural, como en los países del continente africano. Se presentó un caso de quiste gigante del ovario, en una paciente de 45 años de edad, que fue atendida en el Servicio de Cirugía General del Hospital Municipal de Bocoio, provincia de Benguela, República de Angola, en el año 2015. Se presentó por un aumento de tamaño del abdomen de varios años de evolución Se le diagnosticó una masa quística dependiente de ovario, por ultrasonografía por no contar con otro medio de diagnostico imagenologico. Se confirmó a través de una laparotomía exploradora la presencia de una tumoración quística gigante del ovario de 20 kg de peso. Esta patología es poco frecuente en la actualidad debido al desarrollo de la Cirugía y de los medios de diagnósticos que permiten su detección precoz. El estudio anatomopatológico ulterior informó un cistoadenoma seroso de ovario izquierdo. La evolución de la paciente fue favorable. Se consideró un caso interesante por lo infrecuente, la poca existencia de reporte de estos casos en la literatura, sobre todo en Cuba, lo que contribuye a aportar conocimientos a la comunidad médica (AU).

ABSTRACT Through the history those tumors weighting more than 12 kg have been described as great size tumors, among them the gynecological and the ovarian ones, especially before the appearance of the ultrasonography, and among populations of bad socio-economic situation and low cultural level, like in the countries of the African continent. The authors presented the case of a giant ovarian cyst in a patient aged 45 years, who assisted in the Service of General Surgery of the Municipal Hospital of Bocolo, province of Benguela, Republic of Angola, in 1915. She arrived to the consultation due to an increase of the abdominal size of several years of evolution. By ultrasonography because there was no other mean of imaging diagnosis, the diagnosis was an ovary-dependent cystic mass. Using laparoscopy it was confirmed the presence of a giant cystic tumor of the ovary of 20 kg weight. This disease is few frequent nowadays due to the development of Surgery and diagnostic means allowing a precocious detection. The subsequent anatomopathologic study informed a serous cystadenoma of the left ovary. The patient had a satisfactory evolution. The case was considered interesting given its infrequency, the scarce existence of reports of cases like this in the literature, especially in Cuba, contributing with knowledge for the medical community (AU).

Tumores ováricos en niñas y adolescentes / Ovarían masses in infant-juvenile age

Introducción. El tratamiento quirúrgico adecuado para las pacientes pediátricas con lesiones ováricas es heterogéneo, y en las niñas es conveniente conservar los ovarios. El objetivo de este estudio es analizar los hallazgos relacionados con un grupo de pacientes a las que se operó por lesiones ováricas. Pacientes y métodos. Un estudio retrospectivo realizado durante 13 años con 56 pacientes menores de 17 años. Estas pacientes se dividieron en 3 grupos según el diagnóstico de patología ovárica: 25 tenían lesiones funcionales (quistes y torsión), 18 tenían lesiones ováricas epiteliales y 13 tenían tumores germinales. Se comparó a estos tres grupos en términos de menarquia, torsión, edad, duración, tamaño, dolor, tumor, vómitos, menstruación irregular, ubicación y tipo de operación. Resultados. Enestosgrupos,fueronmásfrecuentes los quistes foliculares, los cistoadenomas serosos y los teratomas. La media de edad de las pacientes fue de 12,18 ± 4,84 años. Los síntomas y signos más frecuentes fueron dolor (85,7%) e hinchazón (37,5%) en la región abdominopélvica. Se observó torsión en 21 pacientes (37,5%); la media del tamaño del tumor fue de 10,46 ± 6,55 cm. Se realizó una salpingoovariectomía (SO, por sus siglas en inglés) en 38 pacientes y una resección del quiste (CE, por sus siglas en inglés) en 18 pacientes. Se observaron más casos de torsión en las pacientes premenárquicas que en las menárquicas y en el grupo de lesiones funcionales. Se realizaron más resecciones quirúrgicas en el grupo de lesiones funcionales, y más SO en los grupos de lesiones epiteliales y tumores germinales. Conclusión. Se considera que la torsión y las patologías ováricas funcionales son frecuentes en la edad premenstrual, y las lesiones malignas son muy raras en todos los grupos etarios, por lo que se recomienda preservar la fertilidad en la cirugía.

Introduction. The appropraite surgical treatment to pediatric patients with ovarian lesions are heterogeneous and ovarian preservation is desirable in children. The aim of this study is to the discuss findings related to a set of patients who were operated on for ovarian lesions. Patients and methods. A retrospective study carried out in 13 years on 56 patients under the age of 17. These patients were divided into 3 groups according to ovarian pathologic diagnosis: 25 with functional (cyts and torsion), 18 with epithelial ovarian lesions and 13 with germ cell tumours. These three groups were compared in terms of menarche, torsion, age, duration, size, pain, mass, vomiting, irregular menstruation, location and operation type. Results. Follicle cysts, serous cyst adenomas and teratomas were the most common in these groups. The mean age of the patients was 12.18+4.84 years. The most common symptoms and signs were abdominal-pelvic pain (85.7%) and swelling(37.5%). Torsion was seen in 21 patients (37.5%), mean mass size was found to be 10.46+6.55 cm. A salpingo-oophorectomy (SO) was performed in 38 patients and cyst excision (CE) was performed in 18 patients. In premenarcheal cases, torsion was seen more in menarcheal cases and in the functional lesion group. CE was performed more often in the functional and t SO was performed often in the epithelial and germ cells groups. Conclusion. Torsion and functional ovarian pathologies are thought to be common in premenstrual ages and malign lesions are very rare in all age groups so we recommend ovarian protective surgery should be preferred.

Primary pelvic hydatid cyst in a postmenopausal female: a surgical challenge

Primary pelvic hydatid cysts are a rare entity and are often overlooked as a differential diagnosis of a pelvic-space-occupying lesion particularly in non-endemic regions. Unpreparedness and a hasty decision on the surgical approach may end in life-threatening complications and systemic dissemination of the disease. We report the case of a 55-year-old postmenopausal woman with a history of two previous unsuccessful surgeries to remove pelvic cystic lesions due to dense adhesions between the surrounding gut wall, bladder, and the cyst wall. Clinical and imaging findings failed to diagnose the nature of the cysts, and a laparotomy was contemplated. On the third surgical attempt, the clinical suspicion was considered and by meticulous dissection the cysts were removed thoroughly without undue complications. In the postoperative follow-up period there was no sign of disease recurrence or dissemination.

Impacto de la quistectomía laparoscópica en la reserva ovárica de pacientes con endometrioma / Impact of laparoscopic cystectomy on ovarian reserve in patients with endometrioma

INTRODUCCIÓN: La endometriosis es la presencia de tejido endometrial (glándulas y estroma) fuera de lacavidad uterina, siendo una de sus presentaciones más frecuentes la del quiste de ovario (endometrioma). Es unaenfermedad frecuente en mujeres en edad reproductiva, que consultan principalmente por dolor pelviano o infertilidad. El concepto de reserva ovárica se utiliza para describir la calidad y cantidad de la población de ovocitos y su relación con el resultado reproductivo. La quistectomía es la intervención que se practica ante la presencia de un endometrioma, siendo inciertos aun los efectos reproductivos de la misma sobre la reserva ovárica. OBJETIVOS: Identificar, mediante el empleo de tests endócrinos estáticos (cuantificación de niveles plasmáticos de hormona folículo estimulante, estradiol, inhibina B y hormona antimülleriana), cuál de estas hormonas es más útil como marcador de reserva ovárica. Determinar valores de marcadores de reserva ovárica en pacientes controles y pacientes con endometriosis ovárica. Investigar cómo se modifica la reserva ovárica después de la quistectomía laparoscópica utilizando la técnica de streapping. Correlacionar, antes y después del tratamiento quirúrgico, el tamaño del endometrioma con la reserva ovárica. Estudiar posibles correlaciones entre edad de las pacientes y reserva ovárica. Encontrar líneas de corte entre tamaño del endometrioma y la reserva ovárica. secundariamente, establecer índice de embarazo según estado de reserva ovárica.

INTRODUCTION: Endometriosis is the presence of endometrial tissue (glands and stroma) outside of the uterine cavity. One of its most frequent presentations is as an ovarian cyst (endometrioma). It is a common condition in women in reproductive age, who presents mainly pelvic pain or infertility. The concept of ovarian reserve (O.R.) is used to describe the quality and quantity of the population ofoocytes and their relation to reproductives outcomes. systectomy is the intervention that is performed in the resence of an endometrioma, remaining uncertain the reproductive effects on the ovarian reserve. OBJECTIVES:Identify, through the use of static endocrine tests quantification of plasma levels of follicle stimulating hormone, estradiol, inhibin B and AMH), which them is ore useful as a marker of ovarian reserve. Determine standardvalues of markers of ovarian reserve in controls and patients with ovarian endometriosis. Investigate if thelaparoscopic cystectomy using the streapping technique modifies or not the ovarian reserve. Before and aftersurgery, to correlate the size of endometrioma with ovarian reserve. To study possible correlations between patients age and ovarian reserve. To find cut lines between the size of endometrioma and ovarian reserve. As second objective, to establish pregnancy rates by state of ovarian reserve.

Hydrosalpinx with adnexal torsion in a virgin patient

We present a case of 28-years-old female, presenting with acute right lower abdominal pain. She wasn't sexually active and in the absence of infection and hormonal treatment, with right side adnexal torsion due to hydrosalpinx

Abordagem das massas anexiais com suspeita de câncer de ovário / Management of the adnexal mass with suspect of ovarian cancer

O presente estudo visou realizar uma revisão da literatura em relação à abordagem das mulheres com massas anexiais suspeitas de malignidade. Na existência de uma massa anexial, o diagnóstico do câncer de ovário sempre deve ser cogitado e fatores como características aos exames de imagem, idade, história familiar, presença de sinais e sintomas e níveis de marcadores tumorais são fundamentais para a escolha da melhor abordagem terapêutica. A videolaparoscopia constitui uma via bem estabelecida na propedêutica e no tratamento das massas anexiais benignas e vem apresentando um aumento progressivo de indicações em oncologia. No entanto, a cirurgia convencional, por meio de laparotomia mediana, realizada por profissional especializado, ainda constitui o padrão-ouro para confirmação do diagnóstico, estadiamento e tratamento do câncer de ovário.

This paper presents a literature review in the management of women with adnexal mass suspicious of ovarian cancer. In the existence of adnexal mass, the diagnosis of ovarian cancer should always be on mind and factors like features of the image screening, age, family history, presence of signals and symptoms and serum tumor markers levels are essential in the choice of the best management. The videolaparoscopic approach is a well established route in propaedeutic and treatment of benign adnexal masses and has been progressively indicated in oncology. However, the conventional surgery by midline laparotomy, made by a specialist, is still the gold standard for diagnosis confirmation, staging and treatment of ovarian cancer.

Cáncer del ángulo esplénico del colon: presentación de un caso / Cancer of the colon spleen angle: presentation of a case

El cáncer de colon es actualmente un importante problema de salud pública en los países desarrollados. Es el cuarto cáncer más frecuente en el mundo. Reportamos un caso de una paciente femenina, de 65 años de edad, raza negra, que acude a la consulta por presentar trastornos dispépticos como único síntoma, sin factores de riesgo conocido. Se le indicó un colon por enema, en el que se observó un estrechamiento distal al ángulo esplénico del colon en la misma zona de la estrechez fisiológica a ese nivel. Se le realizó colonoscopia que diagnostica: tumor de colon izquierdo próximo al ángulo esplénico. Se operó y se le realizó la resección segmentaria de ángulo esplénico, así como biopsia. Anatomía patológica informa adenocarcinoma del colon bien diferenciado.

The colon cancer is currently an important public health problem in developed countries. It is the fourth most common cancer in the world. We report the case of a 65-years-old, black, female patient, assisting our consultation with dyspeptic disturbances as the unique symptom, without known risk factors. We indicated a colon by enema and a distal narrowing was observed at the colon spleen angle, at the same zone of the physiologic narrowing at that level. A colonoscopy was carried out diagnosing a left colon tumor near the spleen angle. It was operated with segmental resection of the spleen angle and a biopsy was made. Pathologic anatomy informed a well-differentiated colon adenocarcinoma.

Pelvic Hydatidosis Mimicking a Malignant Multicystic Ovarian Tumor

Echinococcosis is a multisystem disease and has propensity to involve any organ, an unusual anatomical site, and can mimic any disease process. Primary peritoneal echinococcosis is known to occur secondary to hepatic involvement but occasional cases of primary peritoneal hydatid disease including pelvic involvement have also been reported. We report here 1 such case of primary pelvic hydatidosis mimicking a malignant multicystic ovarian tumor where there was no evidence of involvement of the liver or spleen. Our patient, a 27-year-old female, was detected to have a large right cystic adnexal mass on per vaginal examination which was confirmed by ultrasonography. Her biochemical parameters were normal and CA-125 levels, though mildly raised, were below the cut off point. She underwent surgery and on exploratory laparotomy, another cystic mass was found attached to the mesentery of the small gut. The resected cysts were processed histopathologically. On cut sections both large cysts revealed numerous daughter cysts. Microscopic examination of fluid from the cysts revealed free scolices with hooklets and the cyst wall had a typical laminated membrane with inner germinal layer containing degenerated protoplasmic mass. The diagnosis of pelvic hydatid disease was confirmed and patient was managed accordingly. Hydatid disease must be considered while making the differential diagnosis of pelvic cystic masses, especially in endemic areas.

Ovarian dermoid cyst

Mature teratoma is the most common germ cell tumor [and the most common tumor] of the ovary, composing more than 20% of all ovarian neoplasms. Super infection of dermoid ovarian cyst is very rare. A 72 years-old woman admitted to the gynecological outpatient clinic because of lower abdominal pain and fever. Gynecological examination and ultrasonography revealed a heterogeneous cystic mass in the right ovary. Abdominopelvic CT scan revealed a right ovarian mass [15 x 15cm] thought to be a dermoid cyst. Right adnexectomy was performed. The pathological evaluation suggested infected benign ovarian dermoid. Infection of a mature teratoma is a relatively uncommon event. However, based on our case and others, superinfection with abscess formation should be considered in the differential diagnosis whenever a patient with a documented pelvic mass and fever

Conduta no cisto simples de ovário na pós-menopausa / Management of simple ovarian cysts in postmenopausal women

Os cistos simples ovarianos são ocorrências relativamente comuns em mulheres após a menopausa, com uma incidência que varia entre 2,5 a 17%. O percentual de remissão espontânea do cisto simples de ovário é muito alto na literatura mundial (49 a 74%) e o potencial de malignidade muito baixo (0,6 a 1%), o que permite conduta conservadora na maioria dos casos. O acompanhamento deve ser realizado com ultrassonografia e dosagem sérica de CA125. São desnecessários o Doppler colorido e a tomografia computadorizada ou ressonância magnética pélvica para este seguimento.(AU)

Simple ovarian cysts are common in postmenopausal women, with an incidence of 2.5 to 17%. The spontaneous remission of simple ovarian cysts percentage is high (49 to 74%) and the malignant potential is low (0.6 to 1%), which allows a conservative management in most cases. The follow-up is with ultrasonography and serum CA 125 levels. The color Doppler and magnetic resonance or computed tomography of the pelvis is not necessary.(AU)

Massas anexiais na gestação / Adnexal masses in pregnancy

O advento da ultrassonografia (US) durante o pré-natal tem contribuído para o aumento da detecção de massas anexiais na gestação. A maior parte dos tumores tem resolução espontânea por volta da 16ª semana de gestação, sendo associada a cistos funcionais. Massas que persistem após esse período podem acarretar riscos de torção, ruptura e obstrução do canal de parto, necessitando, muitas vezes, de uma intervenção cirúrgica de emergência. A ocorrência de tumores malignos é rara. Além da US, que é utilizada como primeira modalidade para o diagnóstico, o estudo do CA-125 e do B-hCG deve ser realizado. Esses marcadores estão normalmente aumentados durante a gestação. No entanto, na presença de massas tumorais, os níveis são bem mais alterados. O manejo dessa patologia na gravidez é desafiante para o médico e acarreta ansiedade para a paciente. A cirurgia, quando indicada, deverá ser realizada entre o segundo e terceiro trimestres da gestação, levando-se em conta os riscos de complicações para a mãe e o feto. Estudos mostram que, havendo indicações precisas de tratamento adjuvante na gravidez, seu uso não deve ser adiado, pois, em longo prazo, o prognóstico para fetos expostos à quimioterapia intra-útero parece ser bom.

The advent of routine prenatal ultrasonography (US) has increased the detection of adnexal masses during pregnancy. The majority of tumors spontaneously resolve around the 16ª week of gestation, usually being associated with functional cysts. Masses that last after this period can complicate on risks of torsion, rupture of obstruction of labor, requiring emergent surgical intervention. The prevalence of malignant tumor is rare. Besides the use of US, which is the primary diagnostic modality, the study of tumor markers, such as CA-125 and B-hCG, must be done. Their levels are already elevated during pregnancy. However, in the presence of certain types of tumors, these levels are much more altered. The management of this pathology during pregnancy is quite challenging to the medical team and involves psychological issues to the patient. When indicated, the surgery must be taken place between the second and third trimester, always considering the risks of complications to the mother and the fetus. Several studies report that if there are strong indications for adjuvant therapy, it should not be delayed, because the longterm fetal outcomes appear to be good for those fetuses exposed to chemotherapy in utero.

Pode a ecografia fornecer o diagnostico de teratoma ovariano de maneira similar ao diagnóstico histopatológico? / Can echography provide a diagnosis of ovarian teratomas similar to the histopatolhogicl diagnosis?

Os teratomas ovarianos são tumores geralmente benignos e relativamente comuns. Adquirem maior importância por acometerem principalmente mulheres em idade reprodutiva e por serem a neoplasia ovariana mais comumente excisada. O objetivo foi analisar se ecografia bidimensional, Doppler e 3-D têm valor em predizer adequadamente o diagnóstico e os achados histopatológicos de teratoma ovariano. O assunto foi revisado em bases de dados eletrônicas, com a seleção de artigos com bom nível de evidência científica publicados de janeiro de 1994 a janeiro de 2008. Os achados ecográficos bidimensionais no teratoma ovariano são variáveis como imagem heterogênea com diversos tipos de conteúdos. A sensibilidade, a especificidade e os valores preditivos positivo e negativo variam nas diversas séries, com evidente melhora da acurácia nos trabalhos mais recentes. Alguns trabalhos apresentam dados que avaliam se o Doppler poderia melhorar o diagnóstico quando associado à ultrassonografia. Em relação à ecografia tridimensional, poucos dados estão disponíveis. A ecografia bidimensional é um método com boa acurácia diagnóstica para teratoma ovariano, e os achados ecográficos têm alta correlação com a histopatologia dos tumores avaliados após ressecção cirúrgica.

Ovarian teratomas are usually benign and relatively common tumors. They are important because they affect mainly women of reproductive age and because they are the most commonly ovarian neoplasia excised. The objective was to determine whether two-dimensional, Doppler and three-dimensional echography methods are of reasonable predictive methods for the diagnosis and for the histopathological findings of ovarian teratomas. A review of electronic data bases with the selection of good level articles of scientific evidence published from January 1994 to January 2008. The two-dimensional echographic findings regarding ovarian teratomas are variable, with heterogeneous images having diverse types of content. Sensitivity, specificity and positive and negative predictive values vary in the different series, with a clear improvement of accuracy in more recent studies. Some studies present data that evaluate whether Doppler could improve the diagnosis in association with ultrasonography. Few data are available about three-dimensional echography. Two-dimensional echography is a method of good diagnotic accuracy regarding ovarian teratomas and the echographic findings are highly correlated with the histopathology of the tumors examined after surgical resection.

Ecografía ginecológica en recién nacidas y en infanto juveniles: masas ováricas / Newborn and prepuberal infant gynecologic ultrasound: ovarian masses

Niña de 8 meses de edad, con sangrado vaginal, telarca y masa abdominal. Por ultrasonido se diagnostica masa quística en anexo izquierdo. Se efectúa cirugía exploradora. El estudio histopatológico identificó un tumor de las células de la teca granulosa del ovario izquierdo.

comparison of pelvic examination, pelvic ultrasound and operative findings in ovarian masses

To compare and correlate the pelvic examination in adnexal masses with pelvic ultrasound and peroperative findings. June 2006 to May 2007. Descriptive observational study. A sample set of 22 patients with adnexal masses have been included in the study to do a comparative study of the pelvic examination with pelvic ultrasound and peroperative findings. Our analysis show a wide range of diversity among the age groups of our sample set. The majority of the patients [81.8%] belong to the reproductive age group between 20-40 years and only 13% of patients are menopausal. Another important observation is that 87% of all patients visited out patient department with subacute symptoms and remaining 13% presented with acute symptoms in the Emergency Department. Moreover, 54.54% have right-sided adnexal masses and the remaining 45.45% have left-sided adnexal masses. We have seen only in the 9% of cases that the operative findings are different from that of the ultrasound examination. The final outcome of our research is that the ultrasound examination - an important noninvasive investigation - can only be used as a complementary method to the pelvic examination because the findings can be accurately confirmed only on laparoscopy

Primary hypothyroidism with precocious puberty and bilateral cystic ovaries.

It is a general observation that children with hypothyroidism have delayed sexual maturation and delayed puberty. However, longstanding untreated hypothyroidism could be associated with isosexual precocious puberty. Here we report a nine year old girl with longstanding untreated hypothyroidism presenting with precocious puberty and bilateral multicystic ovaries, which promptly responded to thyroid hormone replacement.