Ascites, high CA-125 and chronic pelvic pain in an unusual clinical manifestation of Enterobius vermicularis ovarian and sigmoid colon granuloma.

We present a case of a 36-year-old Caucasian woman with ascites, elevated CA-125, an enlarged left ovary and chronic pelvic pain who underwent an unnecessary surgical intervention because of suspected malignant disease. During the operation ovarian and sigmoid colon granulomatous tumors caused by Enterobius vermicularis infestation were revealed. In this case, the presence of Enterobius vermicularis ova in the abdominal cavity appears to have caused a sufficient reaction to produce symptoms and signs of malignancy leading to surgical intervention. Moreover, awareness that such lesions may occur is important since the lesions and clinical signs may be misinterpreted as being malignant with subsequent unnecessary surgical intervention.

[Transvaginal sclerosing therapy of cystic ovarian lesions with alcohol]. / Die transvaginale Behandlung von Ovarialzysten mittels Alkoholsklerosierung.

AIM: Description of puncture technique for conservative treatment of cystic ovarian lesions. METHOD: The cyst should be unilocular, sonolucent, with a smooth inner wall of the capsule, without septa and neovascularisation on transvaginal colour Doppler. Serum CA-125 levels must be lower than 35 U/ml. The capsule of the cyst was punctured with a 18 gauge needle, sonographically guided with a 5 MHz transvaginal probe. After complete emptying of the cyst, (cytological examination of the cystic fluid was negative), we injected an amount of sterile 96 % alcohol equalling 50 % of the volume of the cyst. The alcohol remained in the cyst for 5 minutes and was then aspirated completely. RESULTS: 152 patients aged 18 to 60 with an ovarian cyst volume between 40 and 140 ml were treated. Five of the patients (3.3 %) had intensive pelvic pain and therefore received intravenous analgesics. After three months, relapse appeared in 8 patients (5.3 %), in most of whom the volume of the cyst had been more than 100 ml. CONCLUSION: The proposed puncture technique is simple and easily performed. Treatment with 96 % alcohol showed good results. In cases where the cyst volume exceeds 100 ml, we advise surgical treatment by laparoscopy or laparotomy.

Serum CA-125 tumor marker in endometrial adenocarcinoma.

One hundred and seventy-four patients, mean age 61.23 +/- 9.41 years old, with irregular perimenopausal haemorrhage were included in the study. Fractional curettage was performed in all patients. When the pathohistologic findings were adenocarcinoma the concentration of CA-125 tumor marker was determined. Hysterectomy with bilateral salpingo-oophorectomy was determined. In 142 cases carcinoma was restricted to the uterus and in 32 patients extrauterine metastatic disease was found. In the former group CA-125 was positive in 130 patients with a mean value of 64.12 +/- 22.41 U/ml serum. In the latter group the cancer antigen was positive in 29 patients with a mean value of 244.82 +/- 68.11 U/ml. High production is associated with increased metastatic potential.

Adnexal masses in pregnancy: a review of eight cases undergoing surgical management.

OBJECTIVE: Our purpose was to determine maternal and foetal outcome in patients undergoing surgery for a pelvic mass in pregnancy. STUDY DESIGN: Maternal and foetal records (outcomes) of eight cases of adnexal masses associated with intrauterine pregnancy that required laparotomy or aspiration or that were diagnosed incidentally at the time of caesarean section were reviewed. The review was performed on patients who were seen with an adnexal mass in pregnancy from January 1994 to February 2001. We included patients with simple or complex masses > or = 6 cm that were persistent on ultrasonographic evaluation and patients with adnexal masses with complications (torsion, haemorrhage). We excluded cysts that spontaneously resolved by 16 weeks' gestation. RESULTS: Eight patients of 16,472 deliveries were identified with adnexal masses that satisfied the above criteria. Six patients underwent laparotomy in the first and/or the second trimester of pregnancy. In two of them emergency laparotomy were done due to torsion or haemorrhage as a complication of the adnexal masses. In all patients benign ovarian tumors were found. Two patients underwent transvaginal aspiration of simplex cysts due to subtorsion in the first trimester of gestation (negative results on cytological study). All of these eight patients had term deliveries. Two patients, due to obstetrical reasons, underwent caesarean section. CONCLUSION: The incidence of an adnexal mass during pregnancy in our population is consistent with what has been reported in the literature. We emphasize that transvaginal aspiration and drainage of symptomatic simplex cysts in the first trimester and percutaneous cysts in the second trimester can avert laparotomy. Our data support a randomised clinical study to determine optimal management of an adnexal mass in pregnancy.

Ultrasonic fetal and placental tissue characterization and lung maturity.

OBJECTIVE: To determine a relationship between gestational age and the quantitative assessment of ultrasonic signs of placental tissue, fetal lung and liver tissue for determining fetal lung maturity in normal pregnancies and pregnancies with preeclampsia. METHODS: Placental, fetal lung and fetal liver tissue was examined by ultrasound in 240 normal and 60 preeclamptic pregnancies at 30-41 weeks' gestation. All patients underwent ultrasonically guided amniocentesis to obtain the lecithin-sphingomyelin ratio. The placentas of 160 patients after delivery were placed in water at body temperature for ultrasonic echo amplitude analysis. The coefficients of variation (the standard deviation divided by the mean value) of gray levels of the pixels in the region of interest obtained from images of the placenta, fetal liver and lung, were used to characterize the tissue in different groups during pregnancy. RESULTS: The coefficients of variation in mature fetuses were > 29% for placentas in vivo, > 34% for placentas in vitro, > 28% for liver tissue and > 30% for lung tissue. In mature fetuses the ratio of coefficients of variation of placental tissue in vivo against placental tissue in vitro was > 0.80, placental tissue in vivo against lung tissue > 0.90, lung tissue against liver tissue > 1.10 and placental tissue in vivo against liver tissue > 1.00. CONCLUSION: The placental and fetal lung tissue of preeclamptic patients tended to have higher coefficients of variation throughout pregnancy. These results were significantly higher when associated with low-birth-weight babies. There were no significant differences in fetal liver tissue between normotensive and preeclamptic groups.