ABSTRACT
Introduction: Struma ovarii is a rare ovarian teratoma characterised by the unusual presence of thyroid tissue. Even though usually benign, malignant transformation is sometimes detected. We report such a case of malignant struma ovarii in a 29-year-old nulliparous woman who was managed systematically with fertility preservation and followed up to have a successful delivery. Patient Intervention: The patient was diagnosed to have bilateral complex ovarian cyst when evaluated for pain abdomen. She underwent bilateral ovarian cystectomy with frozen section biopsy as initial management. On diagnosing as malignant epithelial ovarian tumour in frozen, definitive treatment was planned after final histopathology report and fertility preservation. Her histopathology showed stage 3 malignant struma ovarii. Multidisciplinary team was convened. After further detailed evaluation, she had embryo freezing by controlled ovarian stimulation with antagonist protocol. Two good quality embryos were vitrified on day 2 post-intra-cytoplasmic sperm insemination (ICSI). She underwent staging laparotomy that included uterus conserving surgery with bilateral oophorectomy, omentectomy, peritonectomy, appendicectomy with total thyroidectomy and iodine ablation. After 1 year of follow-up, embryo transfer was done which resulted in a successful delivery. This is, to our knowledge, the first case of fertility preservation after stimulation with gonadotropins in a case of malignant struma ovarii. Conclusion: Poor ovarian reserve due to bilateral ovarian cystectomy, time constraint as she had to undergo a definitive surgery and residual complex ovarian cystic lesions made this a challenging case.
ABSTRACT
Krukenberg tumour is a rare ovarian metastatic carcinoma arising from a primary malignancy elsewhere, classically the gastrointestinal tract and breast. They are bilateral solid ovarian tumour which most commonly occurs between 40-60 years, and its occurrence in the second decade of life is extremely rare. In this short commentary, we present an unusual case of Krukenberg tumour in a 16-year old in which diagnosis was made intraoperatively and managed systematically, thus emphasising the need to suspect Krukenberg in all age groups.
ABSTRACT
STUDY OBJECTIVE: To study the reproductive outcomes after laparoscopic myomectomy comparing conventional (nonbarbed) suture with barbed suture used for myometrial defect closure. DESIGN: Monocentric retrospective cohort study with prospective follow-up survey for reproductive outcomes conducted in April and May 2020. SETTING: Tertiary care center (center for advanced gynecologic laparoscopy and infertility). PATIENTS: Women who underwent laparoscopic myomectomy for uterine leiomyomas from January 2004 to December 2017. INTERVENTIONS: Laparoscopic myomectomy with closure of the myometrium using either conventional (nonbarbed suture) or barbed suture and follow-up survey regarding reproductive outcomes. MEASUREMENTS AND MAIN RESULTS: The outcomes measured included the rate of conception, pregnancy complications, mode of delivery, and perioperative complications for both kinds of suture materials used. Of the 399 women who underwent laparoscopic myomectomy, 343 satisfied the inclusion criteria and were followed up; 235 patients responded. A total of 120 patients were included in the nonbarbed group (group A), and 115 patients were included in the barbed group (group B). A total of 182 (group A: 97 vs group B: 85; p = .204) women had actively sought pregnancy postoperatively, of whom 93 (51.09%) in total and 51 (54.8%) in group A vs 42 (45.1%) in group B reported at least 1 pregnancy with no significant difference in the incidence rate ratios between the 2 groups. Of the recorded pregnancies84.9% (group A: 88.2% vs group B: 80.9%) live births, 6.4% (group A: 5.8% vs group B: 7.1%) had first-trimester miscarriages, 2.1% (group A: 1.9% vs group B: 2.3%) had an ectopic pregnancy, and 6 were ongoing pregnancies at the time of the study analysis, which were compared statistically between both study groups. Pregnancy-related complications were noted in 12 of the 93 pregnant women (12.9%), which were comparable in both groups. No case of uterine rupture was reported. CONCLUSION: Our study supports good reproductive outcomes in women after laparoscopic myomectomy with barbed sutures. Furthermore, the inclusion of nonbarbed sutures as a control group in our study reinforces that barbed sutures in myomectomy are as safe as, and an easier alternative to, conventional sutures without affecting pregnancy outcomes.
