RESUMO
Objective To investigate the experience of laparoscopic surgery for pedicle torsion of ovarian cyst with pregnancy. Methods A retrospective analysis was made on 26 cases of pregnancy complicated with pedicle torsion of ovarian cyst receiving emergency laparoscopic surgery from January 2009 to December 2016 in our hospital. After the establishment of pneumoperitoneum, laparoscopic cyst dissection or accessory resection of the affected side was performed according to intraoperative conditions. Patients with early pregnancy were given progesterone 20-40 mg intramuscular injection, once a day for 3 days. Patients with late pregnancy were given intravenous drip of magnesium sulfate, 5 g daily for 3 days. The pregnancy outcome was recorded by readmission records, outpatient visits, or telephone follow-ups. Results Laparoscopic surgery was performed in all the 26 patients. During operation, 11 patients with ovarian necrosis underwent affected side resection, and the remaining 15 patients underwent enucleation of the affected ovary. The operation time was 20-60 min (average, 47. 8 min). The intraoperative bleeding was 10-400 ml (average, 88. 8 ml). The hospitalization time was 2-16 d (average, 5. 8 d). There were 21 cases of postoperative tocolytic therapy (80. 8%). All the 26 patients had no symptoms of miscarriage or premature delivery. They continued to term delivery, including 13 cases of spontaneous labor and 13 cases of caesarean section. The newborns were healthy, with 1-and 5-min Apgar scores of 8-10 points. Conclusions It is safe to treat the pregnancy complicated with pedicle torsion of ovarian cyst by laparoscopic surgery. Surgery is difficult for large cysts and late pregnancy.
RESUMO
Ovarian tumor composed only of Brenner tumor and struma ovarii is very rare; only 6 cases have been reported in the English literature, to the best of the author's knowledge. A 66-year-old woman underwent right oophorectomy because of torsion of right ovarian cyst. Macroscopically, the ovarian cyst was hemorrhagic and red. Cystic content was hemorrhagic fluid. Microscopically, the cyst walls were composed only of Brenner tumor (50% in area) and struma ovarii (50% in area). Hemorrhage and ischemic changes were seen. Other elements were not recognized. No malignant transformation was noted. These two elements were separately present, and no mergers between them were recognized. Immunohistochemically, the Brenner tumor element was positive for cytokeratins (AE1/3 and CAM5.2) and Ki67 (labeling=3%), but negative for thyroglobulin, TTF-1, p53, CA125, and vimentin. The struma ovarii element was positive for cytokeratins (AE1/3 and CAM5.2), thyroglobulin, TTF-1 and Ki67 (labeling=5%), but negative for p53, CA125 and vimentin. The findings suggests that there were cases of ovarian cyst composed only of Brenner tumor and struma ovarii, that such a case may be monodermal mature cystic teratoma or the Brenner tumor element was derived from surface epithelium in the preexisting struma ovarii, and that such a tumor manifest as cystic torsion.