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Schwartz B, Weerasooriya N, Mercier R, Gould S, Saul D, Berman L. Factors Associated With Isolated Fallopian Tube Torsion in Pediatric Patients. J Pediatr Surg 2024:S0022-3468(24)00237-9. [PMID: 38649311 DOI: 10.1016/j.jpedsurg.2024.03.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 03/13/2024] [Accepted: 03/26/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Isolated fallopian tube torsion (IFTT) is a rare form of adnexal torsion that is more difficult to diagnose, which may lead to delays in treatment. Our objectives were to identify clinical and radiologic factors associated with surgically-confirmed IFTT and compare them with those of patients without torsion and with adnexal torsion (AT) in a large pediatric population. METHODS We conducted a retrospective chart review of all patients who underwent surgery for suspected adnexal torsion from 2016 to 2019. Torsion was determined intraoperatively, with IFFT defined as those with only tubal but no ovarian torsion and AT defined as those with ovarian torsion, with or without involvement of the ipsilateral fallopian tube. Clinical and radiologic variables were compared between patients with IFTT and those without torsion and with AT using descriptive statistics. A previously-described composite score to predict torsion based on the presence of vomiting and adnexal volume (VVCS) was calculated for each patient. RESULTS Of 291 patients who underwent surgery for suspected torsion, 168 had confirmed torsion: 33 (19.6%) IFTT and 135 (80.4%) AT. Patients with IFTT were more likely to be younger (12.8 vs. 14.2 years, P = 0.02), premenarchal (29.0% vs. 10.7%, P = 0.009), experience nausea (90.6% vs. 70.9%, P = 0.02) and vomiting (81.3% vs. 32.8%, P < 0.001), have a paratubal cyst on imaging (18.8% vs. 2.5%, P = 0.003), and have larger adnexal volume (143.3 vs. 64.9 ml, P < 0.001) than those without torsion. Higher BMI (26.6 vs. 22.9 kg/m2, P = 0.03), a paratubal cyst on imaging (18.8% vs. 1.5%, P < 0.001), presence of arterial (65.5% vs. 44.1%, P = 0.04) and venous Doppler flow (79.3% vs. 55.9%, P = 0.02), and radiologic impression indicating lack of torsion (37.9% vs. 16.8%, P = 0.04) were more common in IFTT than AT. The accuracy of the VVCS in predicting torsion for the IFFT group was 83.9%. CONCLUSIONS IFTT has a similar clinical presentation to AT but with a higher likelihood of a paratubal cyst and preserved Doppler flow on imaging. IFTT should be strongly considered in patients who present with pain, nausea, and vomiting and have an adnexal mass separate from the ovary on imaging, regardless of Doppler flow. LEVEL OF EVIDENCE Level II. TYPE OF STUDY Prognosis study.
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Affiliation(s)
- Beth Schwartz
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA; Division of Adolescent Medicine and Pediatric Gynecology, Nemours Children's Health, Wilmington, DE, USA.
| | - Nimali Weerasooriya
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rebecca Mercier
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sharon Gould
- Division of Radiology, Nemours Children's Health, Wilmington, DE, USA
| | - David Saul
- Division of Radiology, Nemours Children's Health, Wilmington, DE, USA
| | - Loren Berman
- Department of Surgery, Nemours Children's Health, Wilmington, DE, USA
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Cizek SM, Tyson N. Pediatric and Adolescent Gynecologic Emergencies. Obstet Gynecol Clin North Am 2022; 49:521-536. [PMID: 36122983 DOI: 10.1016/j.ogc.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Diagnosis of gynecologic emergencies in the pediatric and adolescent population requires a high index of suspicion to avoid delayed or incorrect diagnoses. This article aims to dispel common misunderstandings and aid with diagnosis and management of 3 common pediatric and adolescent gynecologic emergencies: adnexal torsion, vulvovaginal lacerations, and nonsexually acquired genital ulcers.
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Affiliation(s)
- Stephanie M Cizek
- Pediatric and Adolescent Gynecology, Department of OB/GYN, Stanford University School of Medicine, Center for Academic Medicine, MC 5317, 453 Quarry Road, Palo Alto, CA 94304, USA.
| | - Nichole Tyson
- Pediatric and Adolescent Gynecology, Department of OB/GYN, Stanford University School of Medicine, Center for Academic Medicine, MC 5317, 453 Quarry Road, Palo Alto, CA 94304, USA
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Qian L, Wang X, Li D, Li S, Ding J. Isolated fallopian tube torsion with paraovarian cysts: a case report and literature review. BMC WOMENS HEALTH 2021; 21:345. [PMID: 34583677 PMCID: PMC8479896 DOI: 10.1186/s12905-021-01483-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 09/17/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Isolated fallopian tube torsion (IFTT) is a rare cause of gynecological acute abdomen, is easily misdiagnosed and often has a delay in diagnosis. IFTT with paraovarian cysts is most frequently reported in studies. Here, we reported a patient diagnosed with IFTT associated with a paraovarian cyst, and we conducted a literature review for IFTT, aiming to identify valuable information that will be helpful for diagnosis and treatment for fallopian tube torsions. CASE PRESENTATION A 13-year-old girl presented with a 10-day history of right lower abdominal pain that worsened 2 days before presentation. On presentation, ultrasound showed a 5.8 * 5.5 cm hypoechoic cyst adjacent to the right ovary, and between the cyst and ovary, a tortuous thickened tube was visualized. Laparoscopy revealed a triple torsion of the right fallopian tube with a 6-cm paraovarian cyst, and tubal conservation surgery was performed. The postoperative course was uneventful. Histopathological diagnosis revealed serous papillary cystadenoma. CONCLUSION Paraovarian cystic dilatation often occurs in adolescence and can induce fallopian torsion when the size of the cyst reaches 5-cm. In our review, the median age of patients diagnosed with IFTT with paraovarian cysts was 15 years old, and the main clinical manifestation was emergency abdominal pain. The associated symptoms were variable, and vomiting was the most commonly associated symptom. Salpingectomy was the most common procedure performed; however, timely surgical intervention can effectively avoid salpingectomy.
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Affiliation(s)
- Liang Qian
- Department of Gynecology, Hangzhou Women's Hospital, Hangzhou, 310008, Zhejiang, China
| | - Xue Wang
- Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Dingheng Li
- Department of Gynecology, Hangzhou Women's Hospital, Hangzhou, 310008, Zhejiang, China.
| | - Songyi Li
- Department of Gynecology, Hangzhou Women's Hospital, Hangzhou, 310008, Zhejiang, China
| | - Jiashan Ding
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
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Kuwabara J, Akita S, Sato M, Watanabe K, Tanigawa K, Matsuno Y, Abe Y, Kikuchi S, Yoshida M, Koga S, Ishimaru K, Watanabe Y. Paraovarian Cyst Torsion in a Patient with Rubinstein-Taybi Syndrome: A Case Report. J NIPPON MED SCH 2020; 88:248-252. [PMID: 32863342 DOI: 10.1272/jnms.jnms.2021_88-311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Rubinstein-Taybi syndrome is an extremely rare autosomal dominant genetic disorder that occurs in 1/125,000 and is characterized by distinctive facial appearance, short stature, mild to severe mental retardation, and higher risk for cancer. In addition, variable organ anomalies had been reported. Paraovarian cyst causing torsion of the ipsilateral fallopian tube is less common, with an estimated incidence of 1/1,500,000, but it can adversely affect tubal function. It occurs mainly in women in the reproductive age and is very rare in prepubescent girls. Here, we described the successful treatment of an extremely rare case of paraovarian cyst causing torsion of the ipsilateral fallopian tube in a patient with Rubinstein-Taybi syndrome. A 14-year-old girl with Rubinstein-Taybi syndrome was referred to our hospital for abdominal pain. Her medical history was unremarkable, except for moderate hirsutism and keloid scar. Physical examination revealed tenderness in the lower abdominal midline. The preoperative diagnosis was torsion of a left ovarian cyst. An exploratory laparoscopy was performed because of acute abdominal pain and revealed a left fallopian tube that was twisted twice due to an ipsilateral paraovarian cyst. The huge paraovarian cyst required laparotomy cystectomy, and the left ovary was preserved. Her postoperative course was uncomplicated. Preoperative diagnosis of paraovarian cysts can be difficult. The moderate hirsutism seen in our patient suggested the presence of a large paraovarian cyst due to androgen receptor-mediated effects. Therefore, Rubinstein-Taybi syndrome patients with hirsutism should be screened and assessed by pediatric surgeons for the presence of paraovarian cysts.
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Affiliation(s)
- Jun Kuwabara
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Satoshi Akita
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Mitsunori Sato
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Katsuya Watanabe
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Kazufumi Tanigawa
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | | | - Yousuke Abe
- Department of Surgery, Saijo Central Hospital
| | - Satoshi Kikuchi
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Motohira Yoshida
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Shigehiro Koga
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Kei Ishimaru
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Yuji Watanabe
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
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Sunde J, Wasickanin M, Katz TA, Wickersham EL, Steed DOE, Simper N. Prevalence of endosalpingiosis and other benign gynecologic lesions. PLoS One 2020; 15:e0232487. [PMID: 32401810 PMCID: PMC7219775 DOI: 10.1371/journal.pone.0232487] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 04/15/2020] [Indexed: 02/06/2023] Open
Abstract
Endosalpingiosis, traditionally regarded as an incidental pathological finding, was recently reported to have an association with gynecologic malignancies. To determine the prevalence of endosalpingiosis, we evaluated all benign appearing adnexal lesions using the Sectioning and Extensively Examining-Fimbria (SEE-Fim) protocol, and queried the pathology database for the presence of endosalpingiosis, gynecologic malignancy, endometriosis, Walthard nests, and paratubal cysts. Using the SEE-Fim protocol, the prevalence of endosalpingiosis, endometriosis, Walthard nests, and paratubal cysts were 22%, 45%, 33%, and 42% respectively, substantially higher than previously reported. All lesions were observed to increase with age except endometriosis which increased until menopause then decreased dramatically. Among specimens including ovarian tissue, the prevalence of implantation of at least one lesion type was ubiquitous in patients age 51 and older (93%). The clinical significance of endosalpingiosis should be a continued area of research with larger trials assessing prevalence, factors affecting incidence, and association with malignancy. Our findings contribute to elucidating the origin of ectopic lesions and gynecologic disease risk.
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Affiliation(s)
- Jan Sunde
- Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA, United States of America
- Division of Gynecologic Oncology, Baylor College of Medicine, Houston, TX, United States of America
- * E-mail:
| | - Morgan Wasickanin
- Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA, United States of America
| | - Tiffany A. Katz
- Division of Gynecologic Oncology, Baylor College of Medicine, Houston, TX, United States of America
| | - Emily L. Wickersham
- Department of Pathology Madigan Army Medical Center, Tacoma, WA, United States of America
| | - D. O. Emilie Steed
- Department of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, United States of America
| | - Novae Simper
- Department of Pathology Madigan Army Medical Center, Tacoma, WA, United States of America
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Schallert EK, Abbas PI, Mehollin-Ray AR, Price MC, Dietrich JE, Orth RC. Physiologic Ovarian Cysts versus Other Ovarian and Adnexal Pathologic Changes in the Preadolescent and Adolescent Population: US and Surgical Follow-up. Radiology 2019; 292:172-178. [PMID: 31112089 DOI: 10.1148/radiol.2019182563] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Ovarian and adnexal cysts are frequently encountered at US examinations performed in preadolescent and adolescent patients, yet there are few published studies regarding the outcomes of cysts in this population. Purpose To identify characteristics at US that help to distinguish physiologic ovarian cysts from nonphysiologic entities. Materials and Methods Female patients who underwent pelvic US with or without Doppler from January 2009 through December 2013 were identified by using a centralized imaging database. Patients older than 7 years and younger than 18 years with ovarian or adnexal cysts at least 2.5 cm were included. Demographic characteristics, date of surgery, surgical notes, and pathologic reports were extracted from the electronic medical record. Initial and follow-up dates of US, cyst size and complexity, imaging diagnosis, and change on subsequent US images were recorded. Statistical analysis was performed with the Wilcoxon rank sum and Kruskal-Wallis tests for continuous variables and the Fisher exact test for categorical variables. Results Of 754 patients who met inclusion criteria (age, 8-18 years; mean age, 14.6 years ± 1.9 [standard deviation]; mean cyst size, 5 cm ± 3.3), 409 patients underwent complete follow-up that included resolution at imaging (n = 250) or surgery (n = 159). In the patients with complete imaging follow-up, mean time to US documentation of resolution was 194 days ± 321; 59.6% (149 of 250) patients had nonsimple cyst characteristics. One-hundred fifty-nine patients underwent surgical intervention (mean cyst size, 8.5 cm ± 5.3), and 69.8% (111 of 159) of the cysts had simple characteristics. Of the 159 cysts, 100 (62.8%) were defined in the pathologic report as paratubal cysts. Of 409 patients, no malignancies were encountered in this study population with surgical or imaging resolution. Conclusion No malignancies were encountered in the study population and the majority of cysts resolved at follow-up imaging. Large size, persistence, and separability from the ovary were most helpful for identification of nonphysiologic paratubal cysts. © RSNA, 2019.
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Affiliation(s)
- Erica K Schallert
- From the Department of Radiology, Texas Children's Hospital, 6701 Fannin St, Suite 470, Houston, TX 77030 (E.K.S., A.R.M.R., R.C.O.); Department of Surgery, Children's Hospital of Michigan, Detroit, Mich (P.I.A.); Department of Radiology, Geisinger Wyoming Valley Medical Center, Wilkes Barre, Pa (M.C.P.); and Department of Pediatric and Adolescent Gynecology, Texas Children's Hospital, Houston, Tex (J.E.D.)
| | - Paulette I Abbas
- From the Department of Radiology, Texas Children's Hospital, 6701 Fannin St, Suite 470, Houston, TX 77030 (E.K.S., A.R.M.R., R.C.O.); Department of Surgery, Children's Hospital of Michigan, Detroit, Mich (P.I.A.); Department of Radiology, Geisinger Wyoming Valley Medical Center, Wilkes Barre, Pa (M.C.P.); and Department of Pediatric and Adolescent Gynecology, Texas Children's Hospital, Houston, Tex (J.E.D.)
| | - Amy R Mehollin-Ray
- From the Department of Radiology, Texas Children's Hospital, 6701 Fannin St, Suite 470, Houston, TX 77030 (E.K.S., A.R.M.R., R.C.O.); Department of Surgery, Children's Hospital of Michigan, Detroit, Mich (P.I.A.); Department of Radiology, Geisinger Wyoming Valley Medical Center, Wilkes Barre, Pa (M.C.P.); and Department of Pediatric and Adolescent Gynecology, Texas Children's Hospital, Houston, Tex (J.E.D.)
| | - Martin C Price
- From the Department of Radiology, Texas Children's Hospital, 6701 Fannin St, Suite 470, Houston, TX 77030 (E.K.S., A.R.M.R., R.C.O.); Department of Surgery, Children's Hospital of Michigan, Detroit, Mich (P.I.A.); Department of Radiology, Geisinger Wyoming Valley Medical Center, Wilkes Barre, Pa (M.C.P.); and Department of Pediatric and Adolescent Gynecology, Texas Children's Hospital, Houston, Tex (J.E.D.)
| | - Jennifer E Dietrich
- From the Department of Radiology, Texas Children's Hospital, 6701 Fannin St, Suite 470, Houston, TX 77030 (E.K.S., A.R.M.R., R.C.O.); Department of Surgery, Children's Hospital of Michigan, Detroit, Mich (P.I.A.); Department of Radiology, Geisinger Wyoming Valley Medical Center, Wilkes Barre, Pa (M.C.P.); and Department of Pediatric and Adolescent Gynecology, Texas Children's Hospital, Houston, Tex (J.E.D.)
| | - Robert C Orth
- From the Department of Radiology, Texas Children's Hospital, 6701 Fannin St, Suite 470, Houston, TX 77030 (E.K.S., A.R.M.R., R.C.O.); Department of Surgery, Children's Hospital of Michigan, Detroit, Mich (P.I.A.); Department of Radiology, Geisinger Wyoming Valley Medical Center, Wilkes Barre, Pa (M.C.P.); and Department of Pediatric and Adolescent Gynecology, Texas Children's Hospital, Houston, Tex (J.E.D.)
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Durairaj A, Gandhiraman K. Complications and Management of Paraovarian Cyst: A Retrospective Analysis. J Obstet Gynaecol India 2018; 69:180-184. [PMID: 30956474 DOI: 10.1007/s13224-018-1152-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 06/19/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction Despite their relative frequency, paraovarian cyst received only scant attention. Clinician should be aware of the complications of paraovarian cyst. Objective To analyse the clinical profile, complications and management of paraovarian cyst. Materials and Methods Retrospective analysis of 51 patients with operative diagnosis of paraovarian cyst was carried out at our institution over a 5-year period. Results Majority (60.78%) of paraovarian cysts were found in the third and fourth decades, and the mean age of the patients was 31.8 years. 62.74% patients with paraovarian cyst presented with abdominal pain, and the rest were an incidental finding. Ultrasound made a correct diagnosis in 47.05% of patients. Mean size of paraovarian cyst was 7.51 cm. Complications of paraovarian cyst noted in our study are cyst enlargement (79.62%), adnexal torsion (18.51%), haemorrhage (7.4%), rupture (1.85%) and benign tumour (12.96%). 84.31% paraovarian cysts were managed by laparoscopy. Fertility-sparing surgery was done in 57.39% of paraovarian cysts. Conclusion Paraovarian cyst should be considered in the differential diagnosis of adnexal mass. The importance of differentiating it from ovarian cyst cannot be overemphasized. Laparoscopic approach and preferably a fertility-sparing surgery should be considered in the management of complications of paraovarian cyst.
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Affiliation(s)
- Anitha Durairaj
- Department of Obstetrics and Gynaecology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu 625014 India
| | - Kavitha Gandhiraman
- Department of Obstetrics and Gynaecology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu 625014 India
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