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Ovarian fibromas are solid tumors that belong to sex-cord stromal cell tumors of the ovary and are composed of fibrous tissue. They are the most common benign solid tumors of the ovary. The clinical presentation is variable and can include abdominal pain, bloating and menstrual irregularities. In some cases, the first presentation can be that of torsion. This case report presents a case of a 28-year-old who presented with features suggestive of ovarian torsion. Diagnostic difficulty was faced due to the complex appearance of the mass and presenting age of the patient. However, the Computed Tomography (CT) reported a large 12cm multiloculated cystic lesion likely ovarian in origin. Our patient underwent a laparotomy successfully. The diagnosis was confirmed by histopathology.
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Background: Approximately 22% of gynaecologic cancers are of ovarian origin, but 47% of all gynaecologic cancer deaths occur in women who have ovarian cancer. Ovarian cancer is usually diagnosed at an advanced stage because most of the symptoms are nonspecific, hence, the difficulty in diagnosis at early stages. In general, there is no effective screening test for ovarian cancer. Aim was to evaluate the ability of risk of malignancy index 4 (ROMI 4) to differentiate benign from malignant ovarian tumors.Methods: A prospective observational study was conducted in April 2019 to march 2020.Results: In the present study the ROMI 4 score at cut-off ? 450 had sensitivity, specificity, PPV and NPV of 74.3%, 65.3%, 42.6% and 88% respectively for malignant ovarian tumor.Conclusions: Preoperative ROMI 4 score ?450 will lead to rational basis for further referral to higher centre or gynaecology oncologist timely for appropriate surgical intervention/ management.
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Background: This study aimed to determine the utility of RMI 2 in distinguishing benign and malignant adnexal masses in low-income countries. Methods: For the purpose of this retrospective observational study, relevant data from patients who attended a tertiary care institution in central Gujarat between June 2020 and June 2022 were obtained from the Medical Records Department (MRD). Ultrasound and biochemical parameters along with epidemiological factors were identified and an RMI 2 score was calculated followed by statistical analysis. Results: Twenty-five (37.87%) of the sixty-six instances that were investigated were benign, two (3.03%) were borderline, and thirty-nine (59.09%), were malignant. Using RMI 2 at the traditional cut-off value of 250, results showed a sensitivity of 85.2% (95?%; CI=68.9-95.05), a specificity of 66.6% (95?%; CI=47.1-82.7 %), a positive predictive value of 74.36%, and a negative predictive value of 80.0 %. The ROC showed an AUC of 0.68 (CI=0.5-0.7) with a standard error of 0.07 (p=0.009). Conclusions: With a cut-off point of 250, RMI 2 was able to identify malignant masses with an 85.2% sensitivity and 66.6% specificity to enable timely referral to more advanced institutions for improved management in resource-constrained settings where its affordability and user-friendliness are favourable.
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Endometriosis is a disease that most of the times is diagnosed by its common presenting sign and symptoms, but can have varied presentations and may come as a surprise during surgery. We here present a case series of unusual presentations of endometriosis, which created diagnostic dilemma and challenges in the management of the cases at this tertiary center and share our experience. Endometriosis must be kept as a differential diagnosis whenever patient presents with acute pelvic or abdominal pain with adnexal masses and things are not fitting into straight forward diagnosis.
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@#Detection of an adnexal mass during pregnancy has increased during the last decade due to liberal use of sonographic examination during the first trimester. While most are benign or physiologic, the probability of a malignant tumor should always be considered. Deciduosis, a phenomenon related to pregnancy, refers to the presence of decidua outside the uterine cavity, most commonly seen within the pelvis. It is a benign condition, which usually regresses during the postpartum period. However, during pregnancy, this ectopic decidua may enlarge and mimic malignancy.
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Gravidez , EndometrioseRESUMO
Background: Prevalence of symptomatic adnexal masses is 1:1000 in premenopausal women and 3:1000 in post 杕enopausal women. Benign diseases of ovaries and fallopian tube are commonest etiology. However, as risk of neoplastic lesions increases with age and further after menopause The primary goal of diagnostic evaluation of adnexal masses is to exclude malignancy.Methods: This one-year prospective observational study was carried out on 100 female patients attending gynaecology OPD with the clinical diagnosis of adnexal mass. Female patients presenting with symptoms like lower abdominal pain, menstrual irregularity and palpable mass or asymptomatic patients with incidental finding of adnexal mass were included in the study. The aim of the study was to compare the sensitivity, specificity and predictive value of clinical examination, ultrasonography and to compare it with the histopathology.Results: Ultrasound of pelvis was done for all patients. Laparotomy was done for all cases and the specimen was sent for histopathological examination. 70% tumours were benign and 30% tumours were malignant. As per our study, ultrasonography has the highest diagnostic accuracy (93%) followed by pelvic examination (86%) and RMI score (86%). Clinical examination has highest sensitivity of 93.33% followed by CA-125 (86.66%) and ultrasonography (83.33%).Conclusions: Thus, ultrasound is the primary modality used for detection and delineation of pelvic masses. The study also showed that RMI has better performance than CA 125 in the prediction of malignancy. Thus, with such simple methods we can diagnose precisely without advanced radiological imaging.
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Background: Adnexal masses can be either be a physiological luteal cyst, a benign tubo-ovarian mass or a malignancy. The signs and symptoms along with tumour markers and imaging modalities are considered to differentiate between a benign and a malignant adnexal mass. Adnexal masses in pregnancy can be asymptomatic or can present with acute abdomen in cases of ectopic pregnancy and torsion. The aim was to study the prevalence of various histopathologic types of adnexal masses in different age groups.Methods: This was a retrospective study carried out in the department of obstetrics and gynecology in a tertiary care hospital from May-2019 to April-2022. Women with sonographically diagnosed adnexal mass were evaluated. Data regarding ultrasound findings, tumour markers, RMI score and the management done were recorded from medical record charts. Descriptive statistics was applied and results shown in the form of frequencies and percentages.Results: Among 31 study participants, the most common presentation was pain abdomen. Majority (93.5%) patients had benign adnexal pathology and 6.45% had malignant pathology. The most common ovarian pathology encountered was Benign surface epithelial tumours (48.4%). Early diagnosis of 2 tubal ectopic and 1 ovarian ectopic pregnancy was made and managed conservatively.Conclusions: Early diagnosis and intervention is helpful in adolescent girls to conserve their ovarian function. Early diagnosis of ectopic pregnancy in stable patients can be managed conservatively. A high RMI should raise a suspicion of malignancy.
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Background: Adnexal masses can be either be a physiological luteal cyst, a benign tubo-ovarian mass or a malignancy. The signs and symptoms along with tumour markers and imaging modalities are considered to differentiate between a benign and a malignant adnexal mass. Adnexal masses in pregnancy can be asymptomatic or can present with acute abdomen in cases of ectopic pregnancy and torsion. The aim was to study the prevalence of various histopathologic types of adnexal masses in different age groups.Methods: This was a retrospective study carried out in the department of obstetrics and gynecology in a tertiary care hospital from May-2019 to April-2022. Women with sonographically diagnosed adnexal mass were evaluated. Data regarding ultrasound findings, tumour markers, RMI score and the management done were recorded from medical record charts. Descriptive statistics was applied and results shown in the form of frequencies and percentages.Results: Among 31 study participants, the most common presentation was pain abdomen. Majority (93.5%) patients had benign adnexal pathology and 6.45% had malignant pathology. The most common ovarian pathology encountered was Benign surface epithelial tumours (48.4%). Early diagnosis of 2 tubal ectopic and 1 ovarian ectopic pregnancy was made and managed conservatively.Conclusions: Early diagnosis and intervention is helpful in adolescent girls to conserve their ovarian function. Early diagnosis of ectopic pregnancy in stable patients can be managed conservatively. A high RMI should raise a suspicion of malignancy.
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BACKGROUND: Adnexal masses is a significant condition commonly seen in women’sreproductive age. Most common masses arise from ovaries due to their complexembryologic & histologic origin. For diagnosis, ultrasonography is the gold standard.Laproscopy is the gold standard surgical intervention.METHODS: This study was a prospective study that was conducted at a tertiary carehospital in the obstetrics and gynecology department from October 2021 to December2021.RESULTS: In this study, No. 31% of the patients were between the ages of 26 and 35.Of the patients, 12.90% came from the upper socioeconomic class, 72.58% from themiddle, and 14.51% from the lower socioeconomic class. The most common complaintwas abdominal pain (41.93%) followed by menstrual irregularities (25.80%). 46.77% ofpatients were managed medically. In 32.25% of patients, laparoscopy was performed andin 20.96% of patients, laparotomy was performed.CONCLUSION: Adnexal masses are a very common gynecological problem, Presentwith abdominal pain / other symptoms /an incidental finding on ultrasonography done forother purposes. So, the basic approach should be early diagnosis and appropriate medicalor surgical treatment, to minimize morbidity and avoid mortality.
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Background: Adnexal masses are of increasing distress among women because of high fatality related to ovarian malignancy. Finding masses at the primary stage is of crucial significance and in these cases, adnexal masses could be dangerous. Laparoscopy has seemed as one of the most feasible surgical procedures and is now recommended as the “gold standard” method for the management of a wide range of gynecological complaints. The study aimed to determine the evaluation of laparoscopic management of adnexal mass. Material & Methods: A prospective observational study was carried out in the Department of Gynecology & Obstetrics, Ibn Sina Medical College and Hospital, Kallyanpur, Dhaka from 1st January 2020 to July 2022. A total of 146 patients (N=146) were enrolled in this study. Data were collected using the predesigned semi-structured questionnaire. Verbal consent was taken before recruiting the study population. Completed data forms were reviewed, edited, and processed for computer data entry. The data analysis was performed using Statistical Package for the Social Sciences (SPSS) Version 25.0. Results: Among the study population (N=146), the majority of the patients (70,48.0%) belonged to 21-30 years old. Most of the patients (124, 85.0%) were of the reproductive age group & only five patients (5, 3.4%) were of postmenstrual age. Most of the patients (38,26.0%) had ectopic mass, and around one-fourth of the patients (35,24.0%) had a simple cyst. around two-fifths of the patients (63,43.1%) underwent ovarian cystectomy, one-fourth of the patients (37,25.3%) underwent salpingectomy, twenty patients (20,13.7%) underwent excision of chocolate cyst, fourteen patients (14,9.6%) underwent salpingo-oophorectomy and two patients (2,1.4%) underwent conversion to laparotomy. Postoperative fever was seen in only three patients (3,2.0%), and minor port-site infection was seen in three patients (3,2.0%). Conclusion: The diagnosis of adnexal masses is indispensable which may upset all age groups of women. The laparoscopic method is an operative and innocuous procedure for managing patients with adnexal masses. An adequate selection of cases, a laparoscopic surgery-based hospital, and a proficient laparoscopic surgical team are vigorous for good patient consequences.
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Objective:To explore the value of contrast-enhanced ultrasound (CEUS) combined with Ovarian-Adnexal Reporting and Data System (O-RADS US) risk stratification and management system in differential diagnosis of ovarian-adnexal mass.Methods:Fifty-six patients with ovarian-adnexal mass who received transabdominal transvaginal ultrasound and CEUS in the Third People′s Hospital of Longgang District from September 2018 to January 2021 were enrolled. The images were classified by O-RADS US and diagnosed by CEUS by experienced and senior radiologist. On the basis of O-RADS US classification, the enhancement time, enhancement level and enhancement mode of CEUS were combined to upgrade or degrade the classification results of O-RADS US. The diagnostic accuracy was assessed using ROC curve analysis, the area under the ROC curve (AUC) was calculated. The reproducibility of O-RADS US was assessed by another senior radiologist.Results:The AUC of O-RADS US for diagnosing benign and malignant ovarian-adnexal masses was 0.844(0.722, 0.927), the AUC of CEUS was 0.833(0.710, 0.920), the AUC of O-RADS US combined with CEUS was 0.940(0.842, 0.986) (compared with O-RADS US, P=0.020; compared with CEUS, P=0.031). The intra-class correlation coefficient (ICC) was 0.897(0.824, 0.940) for O-RADS US. Conclusions:CEUS combined with O-RADS US classification can effectively improve the diagnostic efficiency for benign and malignant ovarian-adnexal masses.
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Resumen El manejo del tumor anexial en embarazadas sigue siendo un desafío. El objetivo del siguiente trabajo es realizar una revisión bibliográfica, en la que se abordarán las diferentes alternativas en cuanto a diagnóstico y manejo del tumor anexial en embarazadas, así como también indicaciones de abordaje quirúrgico y recomendaciones para una cirugía segura. Los tumores anexiales en embarazadas son poco frecuentes, y la mayoría son benignos y tipo funcionales. La ecografía ha sido fundamental para lograr diferenciar su carácter benigno o maligno. El manejo puede ser expectante o quirúrgico. El manejo quirúrgico se reserva para ciertas características de las lesiones anexiales. En cuanto a la vía operatoria, la literatura apoya la laparoscopia mostrando que existen múltiples beneficios al compararla con la laparotomía. Para el abordaje quirúrgico existen opciones en cuanto a la técnica, siendo estas anexectomía o quistectomía. Resulta fundamental tener consideraciones especiales en la técnica debido a los cambios fisiológicos de las embarazadas, como por ejemplo la altura uterina y el tamaño del tumor anexial. A modo de conclusión, el manejo de los tumores anexiales en el embarazo sigue siendo controversial y se extrapola principalmente basándose en la literatura de pacientes no gestantes u otros procedimientos quirúrgicos en embarazadas.
Abstract Nowadays the management of the adnexal tumors in pregnant women is still a challenge. The purpose of this article is to perform a bibliographic review and present the differential diagnosis, management, and surgical approaches for the women in this condition. Adnexal tumors in pregnant women are rare, most of them are benign corresponding to functional cysts. In order to differentiate benign from malignant tumors, Ultrasonography has been one of the most important imaging advances. The management can be either expectant or surgical. Surgical management is referred for tumors with certain specific characteristics. In relation to surgical management, the literature supports laparoscopy, showing greater benefits in comparison to laparotomy. There are different options for this kind of approach. Its mandatory to have special considerations in the technique due to the physiological changes in pregnant women, some examples are the uterine and the tumor size. The management of the adnexal tumors in pregnancy is still controversial, its based on studies of non-pregnant patients or other kinds of surgeries in pregnant women.
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Humanos , Feminino , Gravidez , Complicações Neoplásicas na Gravidez/cirurgia , Doenças dos Anexos/cirurgia , Laparoscopia/métodos , Complicações Neoplásicas na Gravidez/diagnóstico por imagem , Doenças dos Anexos/complicações , Doenças dos Anexos/diagnóstico por imagem , UltrassonografiaRESUMO
Authors received a case in our casualty, 26 years old, G2P1L1, with full term pregnancy, spontaneous conception, previous normal vaginal delivery, with labour pain. On evaluation, she was having uterine contraction, fetal heart rate normal, vitally stable, with no cervix on per speculum and per vaginal examination, with solid globular mass per rectum. She was shifted to emergency operation theatre with provisional diagnosis of uterine rupture or rectal perforation or pelvic mass. After delivering a live baby, uterus was intact, but there was an impacted mass in pouch of Douglas, it was a twisted ovarian mass, sent for histopathology examination. Post-operative period was uneventful, and patient was discharged with healthy baby with corrected pelvic anatomy.
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Background: The discrimination between benign and malignant adnexal masses is important for clinical management and surgical planning in such patients. Various combined methods of evaluation adnexal mass have also been proposed. Risk of malignancy index (RMI) is a combined parameter which is simple, preclinical and highly sensitive, and more specific. Risk of malignancy index 4 (RMI 4) is calculated as a product of ultrasound score (U)×menopausal score (M)×CA 125×tumor size. Objective of this study was to determine if the RMI (RMI 4) can distinguish between benign and malignant adnexal masses.Methods: A prospective study was conducted on 30 women with an adnexal mass presenting in the OPD and emergency and RMI-4 calculated. Cut off level of 450 was set to differentiate between benign and malignant mass.Results: In this study, the value of RMI-4 is less than 450 in 17 patients with benign disease and 3 patients with malignant disease. The value is more than 450 in 2 patients with benign disease and 8 patients with malignant disease. RMI-4 >450 had a sensitivity of 72.73% and specificity is 89.47%. The positive predictive value is 80% and negative predictive value is 85%. The p-value for RMI-4 in this study is 0.001 which is highly significant.Conclusions: RMI is a reliable, simple, easy to use and cost-effective method in differentiating benign from malignant adnexal masses.
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Background: Risk of malignancy index (RMI) is widely employed in the developed world in predicting malignant pelvic masses. The present study designed to confirm the effectiveness of the RMI to identify cases with high potential of ovarian malignancy, among patients with an adnexal mass.Methods: This was a cross-sectional study was conducted over a period of two years in a government run tertiary healthcare centre of Srinagar, Kashmir, Jammu and Kashmir, India. Study included 72 patients who underwent surgery due to adnexal mass and were evaluated for ovarian malignancy by comparing RMI with histopathological diagnosis. Data collected included demographic characteristics, ultrasound findings, menopausal status, CA125 levels, and histopathological diagnosis. For each patient, RMI was calculated as per the standard formula.Results: Analysis revealed ultrasound score had the highest sensitivity of 72.7%, while an RMI score ≥250 had the highest specificity of 88.5%. The latter also had the highest positive predictive value of 50%, while negative predictive value was highest for an ultrasound score of 3 (94%). The cut off points based on ROC analysis demonstrates significant predictive ability for ovarian cancer for both RMI and CA125 with AUC to the tune of 82.9% and 80.1% respectively.Conclusions: RMI is a simple score system which can be applied directly into clinical practice and might be of value in pre-operative assessment, and hence selecting patients who need surgical team including gynecologic oncologists.
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Endosalpingiosis is a rare gynecological disorder of müllerian origin, characterized by the presence of tubal epithelium outside the fallopian tube, which involves structures of the female genital tract, peritoneum, and sub-peritoneal tissues. Endosalpingiosis can be associated with endometriosis or endocervicosis, although it often appears alone. Authors report a case of endosalpingiosis with concurrent endometriosis in a 42-year-old P2L1 patient. The patient presented to us with complaints of heaviness in lower abdomen, a feeling a lump in the lower abdomen and low-grade fever for 15 days. On per abdominal examination, a large solid cystic mass up to 20 weeks size was felt, which was more on the left side. Cervix was normal on speculum examination, the same mass was felt on per vaginal examination, separate from the uterus, the right fornix appeared free. Patient was asked to get a set of investigations done and to review as early as possible. An exploratory laparotomy with peritoneal wash cytology, total abdominal hysterectomy, bilateral salpingo-ophorectomy with supracolic and infracolic omentectomy and bilateral pelvic lymph nodes dissection was done on 18/07/18. Per operatively, there was a large cystic mass occupying the abdominal cavity adhered to the bowel and to posterior wall of the uterus, adhesiolysis followed by staging laparotomy was done.Patient’s postoperative course was uneventful and she was discharged on the 5th day of surgery in stable condition. The final histopathology report was suggestive of endosalpingiosis with concurrent endometriosis.
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To report the successful conservative surgical management of Ovarian mucinous cystadenoma with silent torsion in a 24 years old pregnant woman in a tertiary care center in Delhi. An antenatal woman came for a routine visit to the OPD of the hospital at 13 weeks gestation. She had a vague, mild pain in lower abdomen since the last four weeks. A cystic mass was discovered during an abdominal examination. Further on sonography, a multisepatated cystic mass was seen, likely to be mucinous cystadenoma. Routine tumor markers came out to be negative. A laparotomy was planned at 15 weeks. On laparotomy a 20 × 15 cm multiloculated cyst with one and half turns of torsion was found. Detorsion, cystectomy of the intact cyst followed by ovarian reconstruction was done after due consent. On histopathological examination the cyst was found to be Benign mucinous cystadenoma. The pregnancy continued without any adverse effects. The woman delivered vaginally at 38 weeks without any feto-maternal complications. She was able to conceive again spontaneously at 18 months post-delivery. After 16 weeks of gestation in the second pregnancy she went to her home town and no further follow-up was possible. This case emphasizes the importance of a thorough examination in all pregnant woman to rule out any adnexal mass separate from the gravid uterus. Big ovarian masses in pregnancy, if not diagnosed can cause growth retardation, preterm deliveries, acute abdomen due to infection, rupture or torsion. Sonography, MRI and tumor markers can facilitate diagnosis before surgery. Torsion and rupture of mucinous cystadenoma need prompt surgery. Wherever possible conservative surgery (detorsion and cystectomy) should be done especially in young women.
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Background: Adnexal masses originating from gynaecologic and nongynecologic sources may be benign or malignant. The objective of this study was to describe multi-detector computed tomography features of benign adnexal masses for diagnostic accuracy and disease understanding.Methods: Study retrospectively evaluates the multidetector computed tomography features of benign adnexal mass lesions, which were referred for MDCT examination with a primary diagnosis of adnexal masses on clinical or USG. Patients who underwent MDCT and subsequently underwent surgery and proved to benign adnexal mass lesion on histopathological examination were included in this study.Results: Forty five percent benign adnexal mass were in the age group of 36-50 years followed by 32.7% in the age group of 21-35 years. Common presenting symptoms of benign adnexal masses were pain abdomen or pelvic pain (65.5%) followed by mass abdomen (42%) while in one fourth of the patients it was asymptomatic and detected as incidental finding. Pathologic diagnosis of most common benign adnexal mass detected were serous cyst adenoma (54.5%), followed by mature cystic teratoma (18.2%), mucinous cyst adenoma (14.5%) and par ovarian cyst (9.1%). Benign ovarian mass had a characteristic CT appearance of cystic lesion (83.6%), unilocular (65.5%) with regular/well defined and thin wall (83.6%) with occasional septations (21.8%) and papillary projections (14.5%). Ascitis (5.5%) was an uncommon finding of a benign adnexal mass lesion. Computed tomography was most accurate to characterize mature cystic teratoma with a typical cystic lesion having fat deposition and calcifications. Serous cyst adenoma had a CT appearance of thin walled cyst mass with no septations or solid component. Mucinous cyst adenoma ovary had a characteristic multilocular cystic lesion with different fluid attenuation and thin septations. Endometrioma had a variable CT appearance with uni or multilocular cystic lesion and hyperdense lesion with focal calcifications.Conclusions: Multi detector computed tomography may provide accurate and valuable diagnostic information about benign nature of an adnexal mass lesion.
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Authors report the case of a 55-year-old patient who presented with postmenopausal bleeding. On clinical evaluation uterus was 12 weeks size with a left sided adnexal cystic mass of 8 × 6 cm size. Further imaging studies revealed uterus size of 11.5 × 6.7 × 6.3 cm, left ovarian mass of size 8.4 × 6.7 × 6 cm and endometrial thickness of 17 mm on ultrasonography. She underwent endometrial biopsy to exclude endometrial cancer. The report of which came to be endometrial hyperplasia without atypia. Further MRI study confirmed the findings of USG of a complex cystic lesion of left adnexa 75 × 57 × 60 mm. Tumor marker for ovarian tumors were sent and inhibin B was found to be markedly raised. A provisional diagnosis of GCT (Granulosa cell tumour) was made and staging laparotomy was done. The uterus was found to be 12 × 8 cm size and a left sided ovarian cyst of 8-9 cm size with smooth wall and intact capsule was found. Patient had an uneventful postoperative recovery.
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Background: Adnexal masses are one of the most common pathologies among women of all age groups. Objective of this study was to assess efficacy of ultrasonography in diagnosing adnexal pathology, rule out malignancy and its comparison with laparoscopy and pathology results.Methods: A total 32 women with benign adnexal mass were evaluated by clinical examination, ultrasonography and laparoscopy. Findings of ultrasound were compared with laparoscopy and histopathology reports and diagnostic accuracy was calculated.Results: Sensitivity of USG in diagnosing simple ovarian cyst is 20% and specificity is 88.9% while laparoscopy has sensitivity of 100% and specificity of 94.4%. USG versus laparoscopy has sensitivity of 50% versus 100% and specificity of 94.1% versus 100% in diagnosing endometrioma. Sensitivity of USG in diagnosing dermoid cyst is 66.7% and specificity is 95% while laparoscopy has both sensitivity and specificity of 100%. USG and laparoscopy, both have 100% sensitivity and specificity in diagnosing ectopic pregnancy, para-ovarian cyst and TO abscess. Benign serous cystadenoma is a histopathological diagnosis and is missed by both laparoscopy and ultrasonography.Conclusions: Ultrasonography should be the primary imaging modality used to identify and characterize adnexal masses, as it is readily available, and noninvasive.