[Complications of presumed benign ovarian tumors]

Effects of vitamin B12 on rat ovary with ischemia-reperfusion injury

We investigated the histopathological and biochemical effects of vitamin B12 on ischemia-reperfusion (I-R) injury using a rat ovarian torsion-detorsion model. We used four groups of female Wistar albino rats. Group 1 (sham group): both ovaries were removed. Group 2 (torsion group): ovarian torsion was established. Group 3 (torsion-detorsion group) perfusion was retored after ischemia for 2 h. Group 4 (torsion-detorsion-vitamin B12 group): after 2 h ovarian torsion, perfusion was re-established and 4 mg/kg vitamin B12 was administered for 2 h. Follicular degeneration, vascular congestion, hemorrhage, edema and infiltration were evaluated histologically. Tissue damage was decreased in group 4 compared to groups 2 and 3. Total antioxidant status TAS), total oxidant status (TOS) and malondialdehyde (MDA) level were measured. The values for TOS and MDA for groups 1 and 4 were similar. We found a significant increase in MDA and TOS levels in group 3 compared to group 2. MDA and TAS levels decreased and TOS levels were increased in group 4 compared to groups 2 and 3. MDA, TAS and TOS values were increased in groups 2 and 3 compared to group 1. We found that vitamin B12 reduced I-R damage in the rat ovary.

[Epidemiological, clinical and therapeutic aspects of supposed benign ovarian tumors at the Central Hospital of Yaoundé]

Introduction

Les tumeurs ovariennes présumées bénignes (TOPB) constituent l'un des motifs les plus fréquents de consultation gynécologique, et l'une des indications les plus fréquentes en chirurgie gynécologique.

Méthodes

Nous avons mené une étude descriptive rétrospective dans le service de gynécologie-obstétrique de l'hôpital central de Yaoundé. La durée de l'étude était de 6 mois sur une période 5ans du 1er janvier 2010 au 31 décembre 2014. La population de l'étude était constituée de toutes les patientes opérées pour une tumeur ovarienne présumée bénigne pendant la période de l'étude.

Résultats

L'âge moyen était de 29,33± 6,83 avec un âge minimum de 20 ans et un âge maximum de 48ans. La tranche d'âge la plus représentée est celle de 21à 25 ans. Le motif de consultation était les douleurs pelviennes 93,90% des cas. Onze patientes avaient une grossesse soit 33,3% de notre population d'étude et 72,70% étaient au premier trimestre de la grossesse. Les TOPB répertoriés dans notre série étaient : la rupture de kyste (36,40%), la torsion d'annexe (27,30%), le volumineux kyste ovarien (21,20%), l'hémorragie intrakystique (15,20%). Le traitement était conservateur chez 26 (78,78%) patientes. Cependant, l'annexectomie a été réalisée chez 5 patientes sur 9 qui ont eu une torsion d'annexe.

Conclusion

Les TOPB compliquées sont présentes dans notre milieu surtout chez des patientes en âge de procréer. Le diagnostic tardif particulièrement en cas de torsion d'annexe oblige un traitement radical qui est délétère pour le patient. Le traitement chirurgical par laparoscopie est le plus recommandé si le plateau technique le permet car il diminue les risques de complications.

Pattern of benign ovarian cysts in Qatari women

Objective: To study the age distribution, histopathological types, lateral distribution and surgical interventions performed for benign ovarian cysts in Qatari women undergoing surgical intervention for an ovarian cyst. Design: A retrospective descriptive study. Setting: Obstetrics and Gynecology Department, Al-Ahli Hospital, Doha, Qatar. Patients and methods: Data were collected retrospectively from clinical records of Qatari women who underwent surgical intervention from 1 January 2013 to 31 December 2015 at Al-Ahli Hospital for an ovarian or paraovarian cyst. The age distribution, frequencies and percentages were calculated for each type of ovarian cyst and the side of the ovary involved was recorded. Results were statistically analysed by IBM SPSS, version 23. Results: A total of 81 women had an ovarian or paraovarian cyst. Age ranged from 16 to 58 years. The maximum number of women were in the 21–30-year-old age group. Benign epithelial cysts were found to be most common (32; 39.5%), of which the majority were for endometriotic cysts (15; 18.5%), serous cystadenoma (13; 16%) and mucinous cystadenoma (4; 4.9%). This was followed by physiological cysts (26; 32.1%), which included corpus luteal cysts (15; 18.5%) and simple follicular cysts (11; 13.6%). The other categories of ovarian tumours were for mature cystic teratoma (14; 17.3%), benign sex cord–stromal tumours (1; 1.2%) which included stromal cell tumours (1; 1.2%), borderline ovarian tumour (1; 1.2%) and paraovarian cysts (7; 8.6%). There was bilateral ovarian involvement in 9 cases (11.1%) and unilateral involvement in 72 (88.9%). The right ovary was involved in more cases (39; 48.1%), than for the left ovary (33; 40.7%). Conclusion: Benign epithelial tumours were found to be the most common type of ovarian tumour in Qatari women. Endometriotic cysts followed by serous cystadenomas were the most common types of benign epithelial tumours. The right ovary was found to be involved in more cases than the left ovary.

Ovarian Mature Cystic Teratoma: Challenges of Surgical Management

Although ovarian mature cystic teratomas are the commonest adnexal masses occurring in premenopausal women, there are many challenges faced by gynecologists on deciding upon the best surgical management. There is uncertainty, lack of consensus, and variation in surgical practices. This paper critically analyzes various surgical approaches and techniques used to treat these cysts in an attempt to outline a unified guidance. MEDLINE and EMBASE databases were searched in January 2015 with no date limit using the key words “ovarian teratoma” and “ovarian dermoid.” The search was limited to articles in English language, humans, and female. The two authors conducted the search independently. The laparoscopic approach is generally considered to be the gold standard for the management. Oophorectomy should be the standard operation except in younger women with a single small cyst. The risk of chemical peritonitis after contents spillage is extremely rare and can certainly be overcome with thorough peritoneal lavage using warmed fluid. There is a place for surveillance in some selected cases.

[Recommendations for clinical practice: Presumed benign ovarian tumors--short text]

These guidelines from the French College of Gynecologists and Obstetricians on the diagnosis and treatment of presumed benign ovarian tumors (PBOT) concern physicians whether gynecologists, obstetricians, surgeons, radiologists, pediatricians, and general practitioners. Vaginal pelvic ultrasound is the first-line imaging examination in case of PBOT in adult women (grade A). In case of pure fluid unilocular mass less than 7 cm size, ultrasound is sufficient to characterize the mass (grade A). MRI is recommended as second-line to explore indeterminate masses or masses greater than 7 cm (grade B). Serum CA125 assay is not recommended as first-line diagnostic in adult women (grade C). Among women with a pure unilocular liquid cyst, hormonal therapy is ineffective (LE1) and is not recommended (grade A). Ultrasound-guided puncture is not recommended (grade B). In adult women without history of cancer, abstention is possible in case of asymptomatic pure unilocular cyst less than 10 cm (grade B). If symptoms develop, laparoscopy is the reference approach for PBOT surgical treatment (grade A). A conservative surgical treatment (cystectomy) should be preferred to oophorectomy in non-menopausal women without previous history of cancer (grade C). In cases of suspected adnexal torsion, laparoscopic surgical exploration is recommended (grade B). Conservative treatment, untwisting without oophorectomy, is recommended for non-menopausal women whatever the estimated duration of the twist and the macroscopic appearance of the ovary (grade B). During pregnancy, expectation is recommended for asymptomatic unilocular liquid masses less than 6 cm (grade C).