Sistema IOTA ADNEX: ¿Confiable como predictor en pacientes con blastoma anexial? / ADNEX IOTA SYSTEM: Reliable as a predictor in patients with adnexal blastoma?

Objetivos: Evaluar el valor predictivo del sistema IOTA ADNEX®, en pacientes con diagnóstico de blastoma anexial. Objetivo secundario: Evaluar otras características sugestivas de malignidad no incluidas en el sistema IOTA ADNEX®. Materiales y métodos: Estudio observacional, retrospectivo, descriptivo. Se incluyeron 42 pacientes con diagnóstico ecográfico inicial de blastoma anexial que se atendieron y fueron operadas en nuestro servicio en el periodo 2013 - 2018, divididas en 2 grupos: Grupo A (21 pacientes con diagnóstico posterior de cáncer de ovario) y Grupo B (Pacientes con diagnóstico benigno postoperatorio). Se evaluó el valor predictivo del sistema IOTA ADNEX®, para dichas pacientes y se comparó los resultados del Grupo A vs Grupo B. Resultados: El aumento de Ca125, se encontró fuertemente asociado al cáncer de ovario. La diferencia entre Grupo A y B fue estadísticamente significativo p<0,0001. Encontramos una asociación entre el GRUPO A, con la predicción de cáncer de ovario, siendo esta diferencia estadísticamente significativa p<0,0001. Conclusión: De acuerdo a nuestros resultados el sistema ADNEX®, podría predecir tanto el riesgo de malignidad como de benignidad de un blastoma anexial de manera fidedigna. Dicho sistema presenta como ventaja el objetivar la interpretación de los estudios y su fácil implementación en todos los ámbitos. La adecuada caracterización e intervención pre quirúrgica permite la planificación del tratamiento mejorando el pronóstico de las pacientes (AU)

ABSTRACT: AIM: To assess the predictive value of the IOTA ADNEX® system, in patients diagnosed with adnexal blastoma. Secondary aim: To evaluate other characteristics suggestive of malignancy not included in the IOTA ADNEX® system. Materials and methods: Observational, retrospective, descriptive study. We included 42 patients with initial ultrasound diagnosis of adnexal blastoma, who were treated and operated in our service 2013-2018 period, divided into 2 groups: Group A (21 patients with subsequent diagnosis of ovarían cancer) and Group B (Patients with benign postoperative diagnosis). The predictive value of the IOTA ADNEX® system was evaluated for these patients and the results of Group A vs Group B were compared. Results: Ca125 was found to be strongly associated with ovarian cancer. The difference between Group A and B was statistically significant p <0.0001. We found an association between GROUP A, with the prediction of ovarian cancer, this difference being statistically significant p <0.0001. Conclusion: According to our results, the ADNEX® system could predict both the risk of malignancy and benignity of an adnexal blastoma reliably. This system has the advantage of objectifying the interpretation of the studies and their easy implementation in all areas. Proper characterization and presurgical intervention allows treatment planning to improve the prognosis of patients (AU)

Eye cancers at the guinness eye center Onitsha, Nigeria

Objectives: To describe the hospital incidence and pattern of ocular and adnexal cancers at the Guinness Eye Center, Onitsha. Materials and Methods: The case files of all new patients seen with ocular and adnexal tumors at the Guinness Eye Center, Onitsha, between 2005 and 2017 were reviewed. Those with histological diagnosis of malignancy were selected and analyzed. Information obtained included age, sex, disease duration, diagnosis and co-morbidity. Results: There were 85 patients (0.1% of all the new patients), made up of 42 males and 43 females. The median age was 5 years; range: 5 months­70 years. The commonest cancers were retinoblastoma, 45 patients (52.9%) and conjunctival squamous cell carcinoma, 30 (35.3%). Twenty eight (93.3%) squamous cell carcinoma patients were HIV-positive. No child had squamous cell carcinoma. All retinoblastoma patients were aged ≤6 years. Conclusions: The incidence of ocular and adnexal cancers at the Guinness Eye Center, Onitsha, was low with retinoblastoma and conjunctival squamous cell carcinoma accounting for most of the cancers. While retinoblastoma would most likely be suspected in a child with ocular tumor, young adults with squamous cell carcinoma should be evaluated for HIV infection. Since these lesions threaten sight and life, the public should be educated on the early signs of the diseases and the need to report to hospital early

Clinicopathological characteristics, treatment and outcomes in uterine carcinosarcoma and grade 3 endometrial cancer patients: a comparative study / 부인종양

OBJECTIVE: Uterine carcinosarcoma (UCS) shared the same staging system with endometrial carcinoma in the International Federation of Gynecology and Obstetrics 2009. The aim of the present study was to compare the clinicopathological and prognostic characteristics between UCS and grade 3 endometrioid endometrial carcinoma (G3EC). METHODS: A retrospective analysis of 60 UCS and 115 G3EC patients with initial treatment at the Department of Gynecology in the Fudan University Shanghai Cancer Center between February 2006 and August 2013. Chi-square analysis was used to compare differences between variables. Prognostic factors were determined using univariate/multivariate analysis, and the survival rates were assessed using the Kaplan-Meier method. The Cox regression model was used to assess the independent prognostic factor. RESULTS: UCS had significantly worse overall survival (OS) compared with G3EC. Carcinosarcoma subtype was an independent factor (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.0 to 5.8; p=0.039), stratified based on stage. Compared with G3EC, UCS patients had a greater incidence of ascites fluid (55.0% vs. 15.7%, p<0.001) and adnexal involvement (20.0% vs. 8.7%, p=0.048) and larger median tumor volume (4.6 cm vs. 4.0 cm, p=0.046). Subgroup analysis of the prognostic factors revealed that UCS patients exhibited worse OS than G3EC patients in such specific subgroups as patients at younger ages, with postmenopausal status, without ascites fluid, with early stage diseases, without vagina invasion, without lymph node metastases and receiving adjuvant chemo/radiotherapy. Adjuvant radiotherapy with chemotherapy was predictive of better survival in UCS patients compared with chemotherapy or radiotherapy alone (5-year OS, 71.0% vs. 35.8%, p=0.028). Multivariate Cox regression revealed that tumor mesenchymal component (HR, 4.6; 95% CI, 1.4 to 15.8; p=0.014) was an independent prognostic factor for UCS, whereas advanced stages (HR, 5.9; 95% CI, 1.0 to 33.9; p=0.046) and ascites fluid (HR, 5.1; 95% CI, 1.1 to 22.7; p=0.032) were independently correlated with poor prognosis for G3EC patients. CONCLUSION: The distinctions in both clinicopathological and prognostic characteristics between UCS and G3EC suggest that this subtype should be treated separately from high-risk epithelial endometrial carcinoma.

Adnexal torsion in children: the role of family practice physicians and paediatricians

Objectives: Ovarian torsion [OT] is uncommon and is initially presented to paediatricians and family medicine physicians. The aim of this study is to assess the presentation, reasons for delayed diagnoses, outcomes, and recommended modalities for the early diagnosis of OT

Methods: A retrospective study was carried out in children

Results: Although the data of 15 patients were collected, only 11 medical records of patients with adnexal torsion were available for complete review. The average age of the participants in this study was 9.9 +/- 3.5 years. All patients complained of abdominal pain; whereas 8 [72.7%] patients presented with vomiting. The average duration of symptoms was 39.7 +/- 66 h. Each discipline of general practitioners and paediatricians attended four [36.3%] children. The average delay of presentation to the hospital was 52 +/- 68.78 h, and the average delay in diagnosis and final surgery after admission to the hospital was 9.1 +/- 2.7 h. Ultrasound and Doppler imaging were the only diagnostic tools used for pre-operative diagnoses

Conclusions: We believe that paediatricians and general practitioners are the first line of physicians to initially assess patients with OT, and they should have a high index of suspicion while managing patients with OT. They should perform early ultrasound and Doppler and refer patients to tertiary care centres where early intervention could save the patients' ovaries and future fertility

Tubercular Pyosalpinx Mimicking Ovarian Torsion.

Ovarian torsion is a gynecological emergency that requires prompt recognition and treatment. It may present with nonspecific signs and symptoms, and should be considered in any female with acute abdominal pain. The diagnosis is based on an awareness of the relevant risk factors, the clinical presentation, and a high index of suspicion. Timely investigation and management can make the difference between ovarian loss and salvage — an outcome of great importance in the population of reproductive age females. Whereas Tuberculosis is a chronic infectious disease, and the morbidity associated with it has major health implications. When tuberculosis affects the genital organs of young females, it has the devastating effect of causing irreversible damage to their fallopian tubes, resulting in a possible tubercular pyosalpinx and infertility. However, the disease often remains silent . In this case study, suspecting the diagnosis of genital tuberculosis and of establishing the differential diagnosis with ovarian tumors in the presence of large pyosalpinges is highlighted.

Ultrasonography of adnexal causes of acute pelvic pain in pre-menopausal non-pregnant women

Acute-onset pelvic pain is an extremely common symptom in premenopausal women presenting to the emergency department. After excluding pregnancy in reproductive-age women, ultrasonography plays a major role in the prompt and accurate diagnosis of adnexal causes of acute pelvic pain, such as hemorrhagic ovarian cysts, endometriosis, ovarian torsion, and tubo-ovarian abscess. Its availability, relatively low cost, and lack of ionizing radiation make ultrasonography an ideal imaging modality in women of reproductive age. The primary goal of imaging in these patients is to distinguish between adnexal causes of acute pelvic pain that may be managed conservatively or medically, and those requiring emergency/urgent surgical or percutaneous intervention.

Added Value of Using a CT Coronal Reformation to Diagnose Adnexal Torsion

OBJECTIVE: To evaluate the increased value of using coronal reformation of a transverse computed tomography (CT) scan for detecting adnexal torsion. MATERIALS AND METHODS: This study included 106 woman suspected of having adnexal torsion who underwent CT with coronal reformations and subsequent surgical exploration. Two readers independently recorded the CT findings, such as the thickening of a fallopian tube, twisting of the adnexal pedicle, eccentric smooth wall thickening of the torsed adnexal mass, eccentric septal thickening of the torsed adnexal mass, eccentric poor enhancement of the torsed adnexal mass, uterine deviation to the twisted side, ascites or infiltration of pelvic fat, and the overall impression of adnexal torsion with a transverse scan alone or combined with coronal reformation and a transverse scan. The areas under the receiver operating characteristic curves (AUCs), sensitivity, specificity, and positive predictive value were used to compare diagnostic performance. RESULTS: Fifty-two patients were confirmed to have adnexal torsion. The addition of coronal reformations to the transverse scan improved AUCs for readers 1 and 2 from 0.74 and 0.75 to 0.92 and 0.87, respectively, for detecting adnexal torsion (p < 0.001 and p = 0.004, respectively). Sensitivity of CT for detecting twisting of the adnexal pedicle increased significantly for readers 1 and 2 from 0.27 and 0.29 with a transverse scan alone to 0.79 and 0.77 with a combined coronal reformation and a transverse scan, respectively (p < 0.001 and p < 0.001, respectively). CONCLUSION: Use of a coronal reformation with transverse CT images improves detection of adnexal torsion.

Clinical and histological profile of surgically managed benign adnexal masses

To study the clinical and histological nature of benign adnexal masses managed surgically. A retrospective descriptive study in a teaching hospital in Oman of all the women who had surgical management of benign adnexal masses from January 2008 to May 2012. Data pertaining to age, parity, presenting symptoms, imaging and tumor markers performed and the surgical intervention done on those women with benign adnexal masses was collected from the electronic health records of the patients. There were 198 women during this period operated for benign adnexal masses. The most common benign neoplasm was mature teratoma of the ovary followed by endometriosis. Conservative surgery in the form of ovarian cystectomy was necessary in three fourths of women and in about just less than 50% of women, the procedure was completed laparoscopically. The most common benign tumor was teratoma but laparoscopic approach, which is the standard of care in these women, was possible only in just about 50% of the women

Accuracy of risk of malignancy index in preoperative evaluation of adnexal masses

To evaluate the diagnostic accuracy of risk of malignancy index [RMI] in discriminating between benign and malignant adnexal masses taking histopathology as the gold standard. Validation study. The study was done at the department of Obstetrics and Gynaecology, Government Lady Aitchison Hospital, Lahore from January 2009 to July 2009. Total 60 patients were included in this study. Risk-of-malignancy Index level [RMI] <200 was taken as benign and RMI >200 was taken as malignant. Histopathology report was followed after surgery. Mean age of the patients was found to be 41.03 +/- 8.59 years. The results of RMI were compared with the histopathology with report at histopathology, 91.7% patients had benign masses and 8.3% patients had malignant masses. At RMI, 88.3% patients had benign masses and 11.7% patients had malignant masses. While RMI findings were confirmed with diagnosis made on histopathology the sensitivity, specificity and diagnostic accuracy were found to be 100%, 96.3%, 96.6%, respectively. Positive and negative predictive values of RMI were 71.4%, and 100%, respectively. RMI is an appropriate tool for diagnosing adnexal masses with high risk of malignancy and referring to specialist gynecological centers for suitable surgical operations

Valor del ultrasonido en el diagnóstico de las masas anexiales / Value of ultrasound in the diagnosis of adnexal masses

Introducción: el empleo de técnicas de diagnóstico por imágenes ha cambiado el enfoque sobre el manejo de muchas afecciones en Medicina. Objetivo: determinar el valor del ultrasonido en el diagnóstico de las masas anexiales y correlacionarlo con los hallazgos anatomopatológicos. Métodos: estudio descriptivo longitudinal a 92 mujeres realizado entre el 1ro. de enero de 2008 al 1ro. de enero de 2010, con el diagnóstico de masa anexial por ultrasonido. Se seleccionaron las pacientes atendidas en consulta con el objetivo de obtener información de diferentes variables: tamaño de las masas anexiales, ecogenicidad, grosor de la pared y contornos, vascularización con técnica de Doppler y correlación entre el diagnóstico ultrasonográfico e histopatológico. Las muestras histológicas fueron procesadas a partir de las piezas quirúrgicas en las pacientes operadas. Resultados: los tumores benignos y malignos por lo general medían más de 5 cm para el 13,04 porciento y el 23,9 porciento respectivamente, predominó el aspecto complejo de las masas anexiales, fueron los tumores malignos de ovario, con 20 pacientes (74,4 porciento), los que aportaron el mayor porcentaje, los contornos regulares predominaron en los tumores de ovario benignos y en las lesiones pseudotumorales y en los tumores malignos los contornos se mostraron irregulares (25 porciento)los tumores malignos se mostraron con vascularización central aumentada en 24 pacientes (88,8 porciento de los casos). Conclusiones: los estudios ultrasonográficos de las masas anexiales permiten precisar el diagnóstico de su naturaleza benigna o maligna. Existe una alta concordancia entre el diagnóstico ultrasonográfico e histológico

Introduction: the use of imaging techniques has shifted the focus on the management of many conditions in medicine. Objective: to determine the value of ultrasound in the diagnosis of adnexal masses and to correlate it with pathologic findings. Methods: a descriptive longitudinal study was performed to 92 women between 1 January 1st, 2008 to January 1st, 2010 with the diagnosis of adnexal masses by ultrasound. Patients were selected in consultation with the objective of getting information of different variables: size of adnexal masses, echogenicity, wall and contour thickness, vascularization with Doppler technique and correlation between sonographic and histopathologic diagnosis. The histological samples were processed from surgical specimens in the patients treated. Results: benign and malignant tumors usually were more than 5 cm, 13.04 percent and 23.9 percent respectively, the complex appearance of adnexal masses dominated and there were malignant ovarian tumors in 20 patients (74.4 percent), which contributed the largest percentage; regular contours predominated in benign ovarian tumors and pseudotumoral lesions whereas malignant tumors showed irregular contours (25 percent). Malignant tumors showed increased center vascularization in 24 patients (88.8 percent of cases). Conclusions: the ultrasound studies of adnexal masses allow specifying the benign or malignant diagnosis. There is a high correlation between ultrasound and histological diagnosis

Diagnóstico ecográfico de la disfunción del eje hipotálamo-hipófisis-ovario-útero: propuesta de estudio / Dysfunction of the hypothalamic-pituitary-ovarian-uterus axis: ultrasound diagnosis

Transvaginal ultrasound is the gold standard for the evaluation of the structural gynecological pathology both benign and malignant, with optimal performance. Currently the functional gynecological pathology is, usually not considered in the routine ultrasound study. This leads to a sub diagnosis of frequent pathologies, for example metrorrhagia or amenorrhea. It is feasible, after discarding the organic possibilities, and relating sonographic markers specific to the clinical status, to achieve an orientation about the origin of the dysfunction of the hypothalamic-pituitary-ovarian-uterus axis.

La ecografía transvaginal es el gold standard para la evaluación de la patología ginecológica estructural tanto benigna como maligna con óptimo rendimiento. Actualmente, la patología ginecológica funcional habitualmente no forma parte del estudio ultrasonográfico de rutina lo que lleva a un subdiagnóstico de patologías frecuentes como por ejemplo metrorragias o amenorreas. Es factible, descartando los cuadros orgánicos y relacionando marcadores ecográficos específicos con el cuadro clínico, lograr una orientación sobre el origen de la disfunción del eje hipotálamo-hipófisis-ovario-útero.

Role of combining colour doppler and grey scale ultrasound in characterizing adnexal masses

To evaluate the adnexal masses with conventional gray scale and color Doppler flow imaging and to assess their diagnostic reliability to differentiate benign and malignant adnexal masses. We evaluated 30 patients with adnexal mass. Morphological characterization of the mass was done using Sassone score. Color Doppler parameters noted down in each patient and Caruso vascular score was also used. The results were compared with surgical/ pathological and/or follow up scans. Using sonomorphological score [Sassone] overall reliability of differentiating adnexal masses had sensitivity of 91.7% and specificity of 77.7%. Using Caruso score alone we had sensitivity of 83.3% and specificity of 88.9%. Using Sassone and Caruso score together we had sensitivity of 90.9% and specificity of 93.3%. In evaluation of adnexal masses combining both sonomorphological and color Doppler scores which gave higher specificity and positive predictive value [PPV] than using individual score alone

Utilidad de la ultrasonografía en el diagnóstico de la torsión anexial (TA): revisión / Usefulness of ultrasonography in the diagnosis of adnexal torsion: review

Adnexal torsion is a gynecological emergency caused by the twisting of the ovary on its pedicle, causing lymphatic and venous stasis later in the evolution ischemia and necrosis when left untreated. There is no specific clinical sign or manifestation, nor any sensitive biochemical marker available for diagnosing adnexal torsion or ischemia. The best imaging tool in the diagnosis of torsion is the gynecologic ultrasound. The purpose of this review is to gather the ultrasound signs (coiling, whirlpool, ovary size, Doppler, etc.) found to make the diagnosis of this pathology easier.

La torsión anexial es una emergencia ginecológica causada por la torsión del ovario sobre el pedículo, lo que lleva a estasia linfática y venosa, más tarde en la evolución isquemia y necrosis, cuando no es tradada. No hay signos ni manifestaciones específicas, no hay marcadores bioquímicos para el diagnóstico de torsión anexial o isquemia. La mejor herramienta, en cuanto a exámenes de imágenes, es la ecografía ginecológica. El propósito de esta revisión es recolectar los hallazgos ecográficos (enbobinado, remolino, tamaño ovárico, Doppler, etc.) encontrados en la torsión para hacer más fácil el diagnóstico de esta patología.

Ecografía y angiografía power Doppler tridimensional en el diagnóstico diferencial de las masas anexiales: estado actual / Ultrasound and three-dimensional power Doppler angiography in the differential diagnosis of adnexal masses: current status

Differential diagnosis of ovarian tumors still remains as an important challenge for gynecologists. An accurate diagnosis is vital for a proper planning of adequate courses of action. This differential diagnosis is based on patient's clinical records, symptomatology, medical examination, and fundamentally on bidimensional ultrasonography. Three-dimensional ultrasonography (3D) has recently been incorporated as a new technique allowing an improved morphological assessment as well as a more detailed analysis of tumor vascularization. The article reviews the indications 3-dimensional ultrasonography may have in assessing ovarian tumors.

El diagnóstico diferencial de los tumores de ovario sigue siendo un reto importante para el ginecólogo. Un diagnóstico preciso es de suma importancia para una correcta planificación de la conducta a seguir. Dicho diagnóstico diferencial se basa en los datos clínicos de la paciente, la sintomatología que presenta, la exploración física y, fundamentalmente, en la ecografía bidimensional. Recientemente se ha incorporado una nueva tecnología: la ecografía tridimensional. Esta técnica permite una mejor evaluación morfológica y un análisis más detallado de la vascularización tumoral. En el presente artículo se revisan las indicaciones que puede tener la ecografía tridimensional en la evaluación de los tumores de ovario.

Untwisting and fixation of ovarian torsion in early pregnancy

Adnexal torsion is a common gynecological emergency with an incidence of around 2-3%. Torsion may present as acute or chronic lower abdominal pain, which can be intermittent or constant. Risks of prolonged torsion include atrophy, necrosis, loss of ovarian functions and even premature menopause. [2] Traditionally, adnexal torsion has been treated in a radical manner without prior detorsion, due to fear of embolus migration from the twisted pedicle[3]. As there 1909, ovrian conservation was proposed to avoid castration in young women[4]. The concern of miscarriage due to removal of corpus luteum in early pregnancy encourages conservative surgery for ovarian torsion during pregnancy. We report two cases of ovarian torsion happened in the first trimester of pregnancy which successfully treated by untwisting and fixation of the affected adnexa

[ adnexal torsion in children]

Adnexal torsion is the most frequent gynaecological emergency in children. It requires an early diagnosis and an urgent surgical treatment. To study the clinical, paraclinical and therapeutic aspect of adnexal torsion in paediatric population this is a retrospective review of nine girls with the diagnosis of ovarian torsion observed over a 7 years period [January 1999 to December 2005]. The average age is 9 years [extreme 6 to 13 years]. This pathology was located in 5 cases on the right side and in 3 cases on the left side; a case of bilateral torsion of poly-cystic ovary was encountered in a girl with Down's syndrome. Clinical presentation is made in all the cases by abdominal pains and vomiting. The disorders of the transit and the urinary signs are associated in 3 and 2 cases respectively, the clinical examination objectified a pelvic defense in all the cases and an abdominal mass in 2 cases. Pelvic ultra-sonography was made in 6 observations and give the diagnosis of torsion of the ovary in 4 cases, whereas it was doubtful in the 2 remaining cases when an ovarian mass was observed. In the 3 remaining cases, this examination was not performed since one the diagnosis of acute appendicitis was retained and the patient operated in emergency. All the children of our series were operated; in 1/3 of the cases we found a necrosis of the ovary. 4 cases out of 9 present a torsion on pathologic ovary [cyst, dysplasia], whereas in the 5 remaining cases. We noted a torsion on healthy ovary 4 young girls have undergoes a annexectomy, of which one was bilateral. The evolution was favorable in all the cases. Adnexal torsion is a surgical emergency that need an early diagnosis and management to preserve ovarian function in girls and Doppler sonography every must be done every time there is a pelvic pain without fever in girls

Villoglandular papillary adenocarcinoma of cervix associated with cervical intraepithelial neoplasia: a case report and review of literature.

Well differentiated villoglandular adenocarcinoma of uterine cervix is a rare tumour which usually occurs in young women. It is considered to be an indolent tumour with favorable prognosis and most of them were treated by conservative procedures. We report a 35 year old lady who came with complaints of 3 months amenorrhoea and an episode of spontaneous bleeding. Urine pregnancy test was negative. Physical examination revealed a cervical polyp. Histopathological findings were consistent with villoglandular papillary adenocarcinoma associated with high grade cervical intraepithelial neoplasia (CIN-3). Left parametrial and left ureteral involvement, proved by biopsy, causing left hydroureteronephrosis was detected. The patient was thus found to be in an advanced stage, stage- III b (FIGO). The patient is currently undergoing radiotherapy. A review of literature showed that only occasional cases showing disease spread have been reported, suggesting caution in the management and regular follow up of the patient.