Congenital unilateral absence of fallopian tube with ipsilateral ovarian agenesis is a rare occurrence with a suggested incidence of 1:11240. Unilateral ovarian agenesis (UOA) and fallopian descent ...problems are other very rare congenital entity. We presented a case report, detailing one such patient where unilateral partial fallopian tube and ipsilateral ovarian agenesis was seen with neonatal outcome. Our case describes 28 years old G5P2L2A2 un booked case with an obstetric history of 2 spontaneous abortion and two previous full term institutional normal vaginal deliveries (both female child) presented at 37 weeks of gestation with borderline oligo hydramnios (USG suggestive of AFI- 9.1 cm), Posterior placenta, EFW-2003 g, single loop of cord around fetal neck. On repeat scan USG suggestive of AFI-7.7cm, with discrepancy of >2 weeks between POG and LMP IUGR. Elective caesarean section done after patient and relatives counselling and informed consent done. During C- section unilateral partial agenesis of right fallopian tube and complete agenesis of right ovary found incidentally. The left fallopian tube and ovary was normal. A male baby with birth weight 2.2 kg, well cried was born. USG abdomen of baby was performed to rule out any congenital genitourinary abnormalities. USG revealed, a small aplastic left kidney, for which baby was referred to higher center for further renal function workup. This case was unique since the incidental diagnosis of right ovary and right fallopian tube agenesis occurred during C section instead of imaging. Keywords: Fallopian tube agenesis, Ovary agenesis, Unilateral adnexal agenesis
Background: Adnexal mass is a common clinical presentation among women of all age groups and is extremely common among reproductive age groups. It may be gynecological or non- gynecological origin. ...The exact prevalence of adnexal mass could not be determined, as most of them develop and resolve without any clinical symptoms. Adnexal mass poses a special perplexity to the attending gynecologists, because the differential diagnosis is extensive and most masses are benign. Differential diagnosis of adnexal mass is complex and includes benign and malignant ovarian tumors, functional cysts, para ovarian cysts, tubo-ovarian abscess, ectopic pregnancy, hydrosalpinx, fimbrial cyst, tubal malignancies, broad ligament fibroid. Methods: It was a prospective study conducted in the department of gynecology, GGH, Kadapa. It was a tertiary care hospital. Total of hundred cases were included in the study based on selection criteria. Ethical committee approval was taken prior to the study. Results: A total 100 cases of adnexal masses were included in the study. 40% of study subjects had parity 2 and 11% had maximum parity 4. 81% of study subjects had surgical management. 45 patients had CA125 >35 u/ml. Among them 48% have benign lesions and 51% have malignant lesions. 92.72% of patients with CA125 <35 u/ml have benign lesions and 7.27% have malignant lesions. Conclusions: Adnexal mass was found to be more common in middle females (54%) in age group 31-50 years. Serous cystadenoma and simple serous cyst (25%) were common benign lesions and most common malignant lesion was serous cystadenocarcinoma. Keywords: Abdominal mass, Ultrasonography, Tumor marker, RMI, Malignancy index, Treatment given
Zusammenfassung. Die «Pelvic Inflammatory Disease» (PID) beschreibt eine aufsteigende Entzündung des oberen weiblichen Genitaltraktes, beginnend bei einer Zervizitis über eine Endometritis zur ...Adnexitis. Sie ist ein häufiges und in den letzten Jahren wieder zunehmendes klinisches Bild, das sowohl in der gynäkologischen wie auch hausärztlichen Praxis vorkommt. Die Symptome sind unspezifisch, diskret ausgebildet oder ganz fehlend. Eine schnelle Diagnosestellung mit unverzüglicher Therapieeinleitung sowie eine gute interdisziplinäre Zusammenarbeit können das Langzeitrisiko der chronischen Unterbauchschmerzen, Sterilität und/oder Extrauteringravidität mindern. Screeningprogramme auf Chlamydien und Gonokokken, die die häufigsten Erreger der PID darstellen, sind bisher in der Schweiz nicht implementiert.
Background: Adnexal masses can be either be a physiological luteal cyst, a benign tubo-ovarian mass or a malignancy. The signs and symptoms along with tumour markers and imaging modalities are ...considered to differentiate between a benign and a malignant adnexal mass. Adnexal masses in pregnancy can be asymptomatic or can present with acute abdomen in cases of ectopic pregnancy and torsion. The aim was to study the prevalence of various histopathologic types of adnexal masses in different age groups. Methods: This was a retrospective study carried out in the department of obstetrics and gynecology in a tertiary care hospital from May-2019 to April-2022. Women with sonographically diagnosed adnexal mass were evaluated. Data regarding ultrasound findings, tumour markers, RMI score and the management done were recorded from medical record charts. Descriptive statistics was applied and results shown in the form of frequencies and percentages. Results: Among 31 study participants, the most common presentation was pain abdomen. Majority (93.5%) patients had benign adnexal pathology and 6.45% had malignant pathology. The most common ovarian pathology encountered was Benign surface epithelial tumours (48.4%). Early diagnosis of 2 tubal ectopic and 1 ovarian ectopic pregnancy was made and managed conservatively. Conclusions: Early diagnosis and intervention is helpful in adolescent girls to conserve their ovarian function. Early diagnosis of ectopic pregnancy in stable patients can be managed conservatively. A high RMI should raise a suspicion of malignancy. Keywords: Adnexal mass, CA-125, Ectopic pregnancy, Ovarian malignancy, Ovarian tumour, RMI, Tubo-ovarian mass, Tumour markers
Lesions of the Ovary and Fallopian Tube Sisodia, Rachel C.; del Carmen, Marcela G.
The New England journal of medicine,
08/2022, Letnik:
387, Številka:
8
Journal Article
Recenzirano
Lesions of the ovary and fallopian tube are common and may be acute or chronic. Diagnostic assessment is designed to distinguish benign from malignant causes. Referral to a gynecologic oncologist is ...often necessary.
Background: The currently available ovarian malignancy probability scores incorporate biochemical markers such as CA 125 (Carbohydrate Antigen 125), which is not routinely available in peripheral ...centers. There is a need for tumour marker independent prediction model to differentiate malignant ovarian masses from their benign counterparts in order to plan appropriate surgery. To formulate and prospectively validate a new Ovarian Malignancy Suspicion Index (OMSI) independent of serum CA 125 level, in preoperative evaluation of adnexal masses admitted for surgery. Methods: This was a combined retrospective and prospective cohort study conducted in a tertiary referral hospital over a period of one and half years. Retrospective sample included 100 subjects who had undergone surgery for adnexal masses and who had definite histopathological report. Detailed data were obtained with respect to age, menopausal status, sonographic findings including solid areas, ascites, mean diameter, bilateralism, and presence of septa. A logistic multivariate regression analysis was carried out to find the best prediction score (OMSI--Ovarian Malignancy Suspicion Index). This model was further evaluated prospectively in 60 subjects for its diagnostic ability to identity benign and malignant ovarian pathology. Results: OMSI at the cut off value of 3.9 differentiated effectively malignant ovarian mass from benign variety with a good diagnostic performance (Sensitivity 100%, Specificity 90.5%, Positive Predictive Value 81.8% and Negative Predictive Value 100%) as good as currently recoimnended RMI (Risk Malignancy Index) score. It was also found that OMSI > 3.9 was associated with positive ultrasound evidence for ovarian malignancy such as presence of thick septae (90%), solid areas within the tumour (93.8%), papillary projections (100%), bilaterality (90%) and ascites (100%). Conclusions: This study shows that it is possible to derive ovarian malignancy prediction model such as OMSI without including CA 125 with diagnostic ability in par with risk scoring systems such as WHO recoimnended RMI. Using this model, physicians working in peripheral centers without facilities for estimating serum tumour markers can arrive at the possible diagnosis and plan appropriate management strategies. Keywords: Adnexal mass, CA 125, OMSI, RMI
* Context.--Female adnexal tumor of probable Wolffian origin (FATWO) often is a diagnostic challenge given its rarity, histologic heterogeneity, and lack of specific immunoprofile. Objective.--To ...further understand the clinicopathologic and immunohistochemical features of this rare entity. Design.--We studied the clinical, morphologic, and immunohistochemical features of a cohort of 11 FATWO cases from our institute. Results.--Patients' age ranged from 25 to 76 years (mean, 55 years). Tumor size ranged from 0.5 to 18 cm (mean, 2.7 cm). Histopathologically, most tumors presented with low-grade cytologic features with low mitotic activity and lack of necrosis. Three main growth patterns were appreciated: solid, tubular, and sievelike patterns. Higher-grade nuclear atypia, increased mitotic activity, and focal necrosis were seen in 2 cases. These 2 cases were clinically considered malignant FATWO mainly because of their extra-adnexal involvement. Immunohistochemical studies found that tumor cells were positive for CD10 (11 of 11, 100%), AE1/3 (8 of 8, 100%), CAM 5.2 (4 of 5, 80%), and cytokeratin 7 (CK7; 7 of 10, 70%), and focally positive for calretinin (4 of 10, 40%), inhibin (4 of 10, 40%), epithelial membrane antigen (EMA; 3 of 9, 33%), and steroidogenic factor-1 (SF-1; 2 of 8, 25%). Lack of immunoreactivity to PAX8 and GATA3 in almost all cases indicates that FATWO is different from the tumors derived from the Mullerian or mesonephric origins. All patients with available follow-up had favorable prognosis. Conclusion.--The broad spectrum of clinical presentation, various morphologic features, and overlapping immunophenotype suggest that FATWO is a diagnosis of exclusion until it is further defined at the molecular and immunohistochemical levels.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Xanthogranulomatous inflammation, a form of destructive chronic inflammation is a rare occurrence in female genital tract, especially ovary and fallopian tube. Its clinical and radiological ...presentation mimics ovarian malignancy which poses a diagnostic dilemma at times. Histopathology plays a pivotal role in diagnosis of this entity. We described seven cases in total, out of which two cases showed xanthogranulomatous oophoritis and five had both xanthogranulomatous oophoritis and salpingitis, all diagnosed on histopathology. Majority of the patients had abdominal pain, fever and adnexal mass on examination. Most women were treated based on the working diagnosis of malignancy or severe pelvic inflammatory disease. Histopathology remains the gold standard for diagnosis in all these cases, and with the aid of clinical and radiological details helps in ruling out other differential diagnosis.
Zusammenfassung. Unterbauchschmerzen sind ein häufiger Grund für eine weiterführende bildgebende Abklärung mittels Sonografie. Die häufigsten Ursachen sind Appendizitis und Divertikulitis, daneben ...auch Uretersteine, Ovarial- und Tubenpathologie sowie diverse Hernien. Die Appendizitis hat eine charakteristische Klinik und kann mit CT oder Ultraschall diagnostizieret werden, wobei bei Kindern differenzialdiagnostisch an die Lymphadenitis mesenterialis gedacht werden muss. Auch die Divertikulitis, meinst linksseitig, kann sicher mit CT oder Ultraschall nachgewiesen werden. Nicht zu vergessen ist die linksseitige Divertikulitis, die gehäuft bei asiatischen Personen auftreten kann. Die Appendizitis epiploica sollte erkannt werden, damit unnötige Operationen verhindert werden. Oft unerkannt bleibt das Iliopsoas-Syndrom, das mittels der Sonopalpation diagnostiziert wird.
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