Ovarian fibroma thecoma with serous cystadenoma-an unusual combination in young patient: a case report

The article is a case report of a 16-year-old patient who came to tertiary care centre in western part of India with a case of ovarian tumor with torsion. The ovarian mass was a composite tumor of ovarian thecoma fibroma and serous cystadenoma. The detection of ovarian mass was made with ultrasonography and CT scan. Her tumor markers were not raised. The patient was managed surgically with ovarian mass removal along with removal of non-salvageable ovary. The present literature has very few cases of ovarian thecoma fibroma with serous cystadenoma and there is no such case occurring at a young age of 16 years. Such a case needs to be kept in mind when dealing with ovarian masses in young age as a solid mass with a cystic tumor may raise a suspicion of malignancy in preliminary evaluation. Also, further evaluation is necessary as to occurrence of such composite tumors and that too in younger age groups.

Key clinical predictors in the diagnosis of ovarian torsion in children

Abstract Objective: Ovarian torsion (OT) represents a severe gynecological emergency in female pediatric patients, necessitating immediate surgical intervention to prevent ovarian ischemia and preserve fertility. Prompt diagnosis is, therefore, paramount. This retrospective study set out to assess the utility of combined clinical, ultrasound, and laboratory features in diagnosing OT. Methods: The authors included 326 female pediatric patients aged under 14 years who underwent surgical confirmation of OT over a five-year period. Logistic regression analysis was employed to pinpoint factors linked with OT, and the authors compared clinical presentation, laboratory results, and ultrasound characteristics between patients with OT (OT group) and without OT (N-OT group). The authors conducted receiver operating characteristic (ROC) curve analysis to gauge the predictive capacity of the combined features. Results: Among 326, OTwas confirmed in 24.23 % (79 cases) of the patients. The OT group had a higher incidence of prenatal ovarian masses than the N-OT (22 cases versus 7 cases) (p < 0.0001). Similarly, the authors observed significant differences in the presence of lower abdominal pain, suspected torsion on transabdominal ultrasound, and a high neutrophil-lymphocyte ratio (NLR > 3) between the OTand non-OT groups (p < 0.05). Furthermore, when these parameters were combined, the resulting area under the curve (AUC) was 0.868, demonstrating their potential utility in OT diagnosis. Conclusion: This study demonstrates a prediction model integrating clinical, laboratory, and ultrasound findings that can support the preoperative diagnosis of ovarian torsion, thereby enhancing diagnostic precision and improving patient management. Future prospective studies should concentrate on developing clinical predictive models for OTin pediatric patients.

Dysgerminoma: a case report on rare malignant tumor

Dysgerminoma is a malignant germ cell tumour (GCT) accounting for less than 1% of ovarian neoplasm. It is analogous to seminoma in males. It is a tumour of young age, affecting women of reproductive age group. In most of the cases, due to its clinical features of it is often, misdiagnosed as abdominal tuberculosis. It is one of the rare tumours, which have excellent response to chemotherapy and radiotherapy. It is tumour in whom, surgery followed by radiotherapy and chemotherapy gives excellent prognosis even in advanced stage. This is a rare case report of 16-year-old girl with primary amenorrhoea, abdominal mass and pleural effusion, when undergone staging laparotomy � had ovarian tumour with torsion which histopathologically came out to be, dysgerminoma.

Ovarian torsion in second trimester of pregnancy: a case report

Torsion of the ovary is the total or partial rotation of the adnexa around its vascular axis or pedicle. Although the exact etiology is unknown, common predisposing factors include moderate size cyst, free mobility and long pedicle. Torsion of ovarian tumors occurred predominantly in the reproductive age group. The majority of the cases presented in pregnant (22.7%) than in non-pregnant (6.1%) women. Here, we report a case of ovarian torsion in second trimester of pregnancy. Ovarian torsion is an urgent gynecological surgery and can occur during pregnancy. Surgical techniques should be considered in the development of the adnexal torsion regardless of the gestational age.

Surgical management of torsion of ovarian fibroma: a case report

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.

Case of ovarian torsion-detorsion-ovarian and round ligament plication to save the ovary

Adnexal torsion is defined as twisting of the ovary and/or tube around usually the utero-ovarian ligament and in case of the ovary the infundibulopelvic ligament. Ovarian torsion is seen in reproductive age group, mainly due to enlongated ovarian ligament. Recurrence is more uncommon. This article presents a case of young 23-year-old women presenting with acute pain abdomen, with scan showing ovarian torsion, an emergency laparoscopy was performed, 1 turn of left infundibulopelvic ligament was noted and detorsion performed along with plication of round and ovarian ligament and utero-ovarian ligament plication. This helps in preventing recurrent ovarian torsion, though there is no standard management to prevent recurrent ovarian torsion, plications to some extent prevents recurrent torsion and thus also preserving fertility of women.

Torsion of ovary and acute abdomen

Ovarian torsion refers to partial or complete rotation of ovarian vascular pedicle. This study explored the presenting symptoms and management of ovarian torsion in a newly established ESIC Medical College and Hospital, Bihta, Patna. This report presents two cases of ovarian torsion, the presenting symptoms and management. This underscores the need of prompt diagnosis and management to improve postoperative outcomes.

An interesting case of right ovarian cyst torsion: case report

Ovarian torsion is a comparatively rare gynecological emergency. It commonly presents with complaints of acute abdominal pain, nausea, and vomiting. It occurs due to twisting of the ovarian pedicle leading to ischemic changes in the ovary. It can even result in complete loss of blood supply, eventually necrosis of the ovary. It is diagnosed clinically and can be confirmed on ultrasound color doppler. The management of ovarian torsion depends on the age of the patient, size of the mass, ovary condition, and USG findings. Early diagnosis and treatment of torsion are necessary to preserve the viability of the ovary. We are reporting a case of a 30-year-old female with right ovarian cyst torsion of size 6.3×6.8×6 cm. Once torsion is diagnosed surgery is the mainstay of treatment, either detorsion and ovariopexy or oophorectomy if the ovary cannot be salvaged.

Clinical and imaging features of extralobar pulmonary sequestration with torsion in children / 实用放射学杂志

Objective To investigate the clinical and imaging features of extralobar pulmonary sequestration(ELS)with torsion.Methods The clinical and imaging data,surgical records and pathological results of four ELS children with torsion were analyzed ret-rospectively.Results All four children presented with abdominal pain,and all CT scans showed soft tissue masses on the medial side of the lower lobe,and there were 2 masses with long fusculine-shaped in the right pleural cavity,2 round masses in the left pleural cavity,all of which were accompanied by pleural effusion and poor ventilation of adjacent lung lobes.There were 1 case without enhance-ment,1 case with mild enhancement,and 2 cases with simple marginal linear enhancement.There were no patients with definitive supplying artery and 3 cases with peripheral post-intercostal dilated veins.Intraoperative ELS combined with torsion was shown,and the nutrient artery were derived from the thoracic aorta.All ELS showed bleeding and necrosis according to the pathological results,and 1 case was complicated with congenital pulmonary airway malformation(type 2).Conclusion ELS combined with torsion is mostly abdominal pain as the first symptom,and there are soft tissue mass adjacent to the lower lobe with pleural effusion on the affected side as the imaging features with no,mild or marginal linear enhancement,with no supplying artery,and with intracostal posterior venous expansion.

CT findings and clinical value analysis of ovarian torsion in children / 实用放射学杂志

Objective To investigate the characteristics of CT findings in pediatric ovarian torsion and improve the understanding of pediatric ovarian torsion.Methods The clinical and CT data of 20 cases of ovarian torsion confirmed by pathology and/or surgery were analyzed retrospectively,based on the timing of ovarian torsion,they were divided into fetal and non-fetal groups.All 20 cases underwent plain CT scan and 11 cases underwent CT enhancement.Results All of the 20 cases were unilateral duplication,including 12 cases right and 8 cases left.There were 8 cases of ovarian torsion in the fetal group,all of them were visited with the finding of abdominal mass.The eggshell calcification on CT manifestations was found in 8 cases,and 2 cases of pelvic effusion.There were 12 cases of ovarian torsion in the non-fetal group,all of them presented with abdominal pain,CT showed the disc sign in 7 cases,peduncular protrusion sign in 6 cases,adnexal bleeding sign in 2 cases,subcapsular effusion sign in 2 cases,the uterus displaced to the ipsilateral ovary in 6 cases and pelvic effusion in 10 cases.The disc sign and peduncular protrusion sign were direct signs for the diagnosis of ovarian torsion,and the adnexal bleeding sign and subcapsular effusion sign suggested the possibility of necrosis.Conclusion Pediatric ovarian torsion CT findings with typical signs such as disc sign,peduncular protrusion sign,adnexal bleeding sign and subcapsular effusion sign,combined with clinical history,a more accurate diagnosis can be given,providing assistance in clinical treatment.

Massive hydrosalpinx with torsion in second trimester of pregnancy: a case report

Acute abdominal pain in pregnancy can be due to obstetrical (preterm labour), gastrointestinal, urinary causes etc. Pregnancy with large adnexal masses are rare presentations. This is a case report about a woman presenting to emergency with 16 weeks and 5 days of gestation with acute pain abdomen. Diagnosis of coexisting huge adnexal mass was made with ultrasound. No response to conservative therapy forced us to do laparotomy which showed huge hydrosalpinx with 4 twists around its pedicle. This case report emphasizes the need to keep hydrosalpinx with torsion in a differential diagnosis for acute pain abdomen in second or third trimester, especially if pain is not relieved on conservative management.

The pain is not from the uterus: a rare complication of ovarian cyst during term labour

A case of primigravida with an ovarian torsion at 39 weeks of gestation is reported here. A Malay lady in her late 20s with a known case of ovarian cyst complained of sudden onset of severe pain during labour. Diagnosis of ovarian torsion was made and she underwent laparotomy cystectomy with emergency lower segment caesarean section in the same setting. Post-operative recovery was unremarkable. Histopathological examination confirmed mucinous cystadenoma.

The role of carbohydrate antigen 19-9 in the clinical evaluation of mature cystic teratomas: an observational study at a tertiary care centre

Background: Carbohydrate antigen (CA) 19-9 is a tumour marker mainly used in the evaluation of gastrointestinal tract malignancies including pancreas, colon and biliary tract. Cases of ovarian tumours such as mucinous neoplasms have been reported to have high levels of CA 19-9. However, its role in the management of cystic teratomas (MCT) which are the most common benign ovarian tumours encountered in gynaecology, is not studied in depth in literature.Methods: In our study, we observed the levels of CA 19-9 in 40 patients presenting with MCT. Its association to the cyst size, contents, laterality and torsion or rupture were documented.Results: The various clinical parameters evaluated in our study such as larger cyst size, presence of torsion and tooth as a content had a positive association with elevated CA 19-9 levels (p<0.05). However, CA 19-9 had no significant relationship with the laterality of the cyst. Thus, CA 19-9 may serve as an important adjunct tool to ultrasonography in the management of dermoid cysts (MCT), particularly in those with larger sizes and at risk of torsion.Conclusions: High levels of CA 19-9 can be observed in benign ovarian tumors like mature cystic teratoma (MCT) and it need not always be associated with malignancy or malignant transformation of benign tumors. Levels more than 100 IU may warrant further imaging studies to rule out gastro-intestinal pathologies. Unnecessary medical investigations or patient anxiety can be avoided in cases of moderate elevation in CA 19-9 levels.

Donación de óvulos posterior a detorsión de ovario isquémico por pedículo torcido debido a quiste paratubárico / Oocyte donation following ischemic ovarian detorsion for twisted pedicle due to paratubal cyst

RESUMEN La torsión anexial es secundaria a quistes ováricos generalmente benignos. La cirugía habitual es la salpingooferectomía. Sin embargo, para mantener la función ovárica se recomienda una cirugía mínimamente invasiva con detorsión y conservación del ovario independientemente de su apariencia. Presentamos el caso de una mujer de 19 años con diagnóstico de quiste a pedículo torcido, a quien se realizó detorsión laparoscópica del pedículo torcido y exéresis del quiste paratubárico con preservación de ovario, a pesar del aspecto isquémico. La paciente presentó evolución favorable y participó en un programa de ovodonación, obteniéndose ovocitos del ovario antes afectado en cantidad y calidad similar al ovario no afectado. La detorsión ovárica laparoscópica y conservación del ovario comprometido independientemente de su apariencia es un procedimiento seguro y eficaz para preservar la fertilidad.

Acute pain abdomen in adolescents: a gynecologist’s dilemma

Background: Ovarian torsion is 5th most common emergency in gynecology. Benign functional ovarian cysts and benign teratomas are most common among ovarian torsion. Aims and objectives were to study the outcome and HPE of all adolescent girls presenting with acute pain abdomen at BGS GIMS, Bangalore.Methods: A study was conducted at BGS GIMS from 2020 to 2022 of all children and adolescents presenting with acute pain abdomen. Study included data consisting of age, complaints, investigations, intervention and HPE was collected and analysed.Results: There were 21 cases between 12- and 21-years age group who presented with acute pain abdomen in the study period. Majority of them were of 16-19 years age group. Out of 21 cases, 100% of them presented with acute pain abdomen. Operative procedures included 15 (71%) exploratory laparotomy and 6 (29%) operative laparoscopies. Ovarian torsion was seen in 11 cases of which 2 cases had bilateral ovarian torsion and 9 cases had unilateral torsion. Ovarian cystectomy was done in 7 patients, unilateral oophorectomy in 3 patients and unilateral salpingo-oophorectomy in 6 patients. Histopathology reports showed 5 cases of serous cystadenoma, 1 case of teratoma and others were mostly simple cyst or corpus luteal cysts.Conclusions: Acute pain abdomen in adoloscents should be diagnosed early to prevent from risk of ovarian torsions. Operative procedures should aim at fertility preservation.

Acute pain abdomen in adolescents: a gynecologist’s dilemma

Background: Ovarian torsion is 5th most common emergency in gynecology. Benign functional ovarian cysts and benign teratomas are most common among ovarian torsion. Aims and objectives were to study the outcome and HPE of all adolescent girls presenting with acute pain abdomen at BGS GIMS, Bangalore.Methods: A study was conducted at BGS GIMS from 2020 to 2022 of all children and adolescents presenting with acute pain abdomen. Study included data consisting of age, complaints, investigations, intervention and HPE was collected and analysed.Results: There were 21 cases between 12- and 21-years age group who presented with acute pain abdomen in the study period. Majority of them were of 16-19 years age group. Out of 21 cases, 100% of them presented with acute pain abdomen. Operative procedures included 15 (71%) exploratory laparotomy and 6 (29%) operative laparoscopies. Ovarian torsion was seen in 11 cases of which 2 cases had bilateral ovarian torsion and 9 cases had unilateral torsion. Ovarian cystectomy was done in 7 patients, unilateral oophorectomy in 3 patients and unilateral salpingo-oophorectomy in 6 patients. Histopathology reports showed 5 cases of serous cystadenoma, 1 case of teratoma and others were mostly simple cyst or corpus luteal cysts.Conclusions: Acute pain abdomen in adoloscents should be diagnosed early to prevent from risk of ovarian torsions. Operative procedures should aim at fertility preservation.

Acute abdomen in pregnancy, not to forget twisted ovarian cyst: a case report

Aim of the study was to present a case of acute abdomen in pregnancy with twisted ovarian cyst which is a rare entity. A primigravida with period of gestation 25 weeks presented to casualty with acute abdomen. Her USG Doppler revealed findings of ovarian mass of around 9 by 6 cm which underwent torsion. Patient was taken up for emergency laparatomy. Per operatively right sided tubo-ovarian mass-9×8×5 cm, dumbell shaped, fleshy, hemorrhagic and necrosed with one twist over the pedicle seen separate from the uterus. Left side tubes and ovaries seen normal, uterus-26-week size. Frozen section revealed benign pathology. Postoperatively patient was done well and delivered a healthy baby at term via cesarean section. High index of suspicion, regular antenatal follow up and analysis of related risk factors, early and prompt diagnosis and timely intervention in cases of ovarian torsion in pregnancy can change feto-maternal outcome. Meticulous planning and timely intervention under multidisciplinary care team at a tertiary care centre reduces feto-maternal morbidity and mortality.

Acute abdomen in pregnancy, not to forget twisted ovarian cyst: a case report

Aim of the study was to present a case of acute abdomen in pregnancy with twisted ovarian cyst which is a rare entity. A primigravida with period of gestation 25 weeks presented to casualty with acute abdomen. Her USG Doppler revealed findings of ovarian mass of around 9 by 6 cm which underwent torsion. Patient was taken up for emergency laparatomy. Per operatively right sided tubo-ovarian mass-9×8×5 cm, dumbell shaped, fleshy, hemorrhagic and necrosed with one twist over the pedicle seen separate from the uterus. Left side tubes and ovaries seen normal, uterus-26-week size. Frozen section revealed benign pathology. Postoperatively patient was done well and delivered a healthy baby at term via cesarean section. High index of suspicion, regular antenatal follow up and analysis of related risk factors, early and prompt diagnosis and timely intervention in cases of ovarian torsion in pregnancy can change feto-maternal outcome. Meticulous planning and timely intervention under multidisciplinary care team at a tertiary care centre reduces feto-maternal morbidity and mortality.

Incidental finding of dysgerminoma in a full-term pregnancy: a case report

Ovarian tumors are reported in 1 of every 200 pregnancies. Dysgerminoma with pregnancy is extremely rare, with a reported incidence of about 0.2-1 per 100,000 pregnancies. They are generally discovered due to their large size related complications like torsion, infarction, and obstruction of vaginal delivery. These rapidly growing tumors can have a heterogeneous presentation and lead to peripartum complications and morbidity. We present a unique case where a dysgerminoma went undiagnosed until labor in a patient who otherwise had an uncomplicated prenatal course. The purpose is to report and discuss our case, as further studies are needed to confirm the best management especially in the management of the incidentally diagnosed tumor.

Effect of protection of enoxaparin against experimental ischemia/reperfusion injury in the rat ovary on in vitro fertilization outcomes

SUMMARY OBJECTIVE: The study aimed to investigate the protection of enoxaparin (E) against experimental ischemic (I) and ischemic-reperfusion (I/R) injury in rat ovaries on in vitro fertilization outcomes. METHODS: In total, 56 adult female Sprague-Dawley albino rats were randomly assigned to 6 groups of 8 animals each: Sham, Ischemia, I/R, Sham+E, I+E, and I/R+E. Ischemia groups were subjected to bilateral adnexal torsion for 3 h. In contrast, I/R and I/R+E groups received subsequent detorsion for 3 h. Enoxaparin (0.5 mg/kg s.c.) was administered 30 min prior to ischemia (I+platelet-rich plasma) or reperfusion (I/R+I+platelet-rich plasma). Ovaries were stimulated through intraperitoneal injection of 150-300 internal units IU/kg pregnant mare serum gonadotropin. Anti-Müllerian hormone levels were measured before and after surgery in all groups. RESULTS: When the number of metaphase II oocytes was evaluated, statistically significant differences were observed between the I and I+E (p=0.001) and I/R and I/R+E (p=0.000) groups. When both I and I+E groups and I/R and I/R+E groups were compared, it was found that E application increased the number of fertilized oocytes. The number of embryos on the second day was higher in the I/R+E group than that in the I/R group. Statistically significant differences were found in the number of grade 1 embryos between the I/R and I/R+E groups (p=0.003). In comparing anti-Müllerian hormone values within the group, the highest decrease was observed in the I and I/R groups. CONCLUSION: Enoxaparin effectively minimizes ovarian damage and preserves ovarian reserve following ovarian torsion.