1
|
Tjokroprawiro BA, Novitasari K, Ulhaq RA, Sulistya HA. Clinicopathological analysis of giant ovarian tumors. Eur J Obstet Gynecol Reprod Biol X 2024; 22:100318. [PMID: 38881672 PMCID: PMC11176949 DOI: 10.1016/j.eurox.2024.100318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/15/2024] [Accepted: 05/22/2024] [Indexed: 06/18/2024] Open
Abstract
Objective This study aims to analyze giant ovarian tumors' clinical and pathological characteristics. Material and Methods This was an analytical observational study. Medical records of all patients with giant ovarian tumors who underwent surgery between January 2020 and June 2022 at Dr. Soetomo Academic Hospital, Surabaya, Indonesia, were analyzed. Results We analyzed 63 patients with ovarian tumors measuring > 20 cm who underwent surgery at Dr. Soetomo Academic Hospital, Surabaya, Indonesia. The mean tumor size was 25.9 cm (largest size was 41 cm). There was no significant difference in tumor size between benign and malignant giant ovarian tumors (p = 0.261). Based on histopathological results, 66.67 % of giant ovarian tumors were malignant, 26.98 % were benign, and 6.35 % were borderline. Among the malignant tumors, the epithelial type accounted for 69 % of cases. Most giant ovarian tumors originated in the left adnexa (68.25 %). There was no significant difference in patient age (p = 0.511), tumor size (p = 0.168), malignancy (p = 0.303), and histopathological type (p = 0.232) regardless of adnexal side. CA125 levels did not differ significantly between malignant and benign giant ovarian tumors (p = 0.604). There was no correlation between malignant ovarian tumor size and CA125 levels, while there was a significant difference between CA125 levels and the adnexal side (p = 0.010). Conclusions Most giant ovarian tumors were malignant, diagnosed at an early stage, and predominantly epithelial type. CA125 levels did not correlate with the size of malignant ovarian tumors. Most giant ovarian tumors originate in the left adnexa.
Collapse
Affiliation(s)
- Brahmana Askandar Tjokroprawiro
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Khoirunnisa Novitasari
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Renata Alya Ulhaq
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Hanif Ardiansyah Sulistya
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| |
Collapse
|
2
|
Sengupta RK, Pareek C, Badge A, Nikhade PW. Successful Management of a Giant Mucinous Cystadenocarcinoma of the Ovary Through Laparotomy: A Case Report. Cureus 2024; 16:e60474. [PMID: 38883143 PMCID: PMC11180533 DOI: 10.7759/cureus.60474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 05/16/2024] [Indexed: 06/18/2024] Open
Abstract
Giant mucinous cystadenocarcinoma of the ovary is rarely described. Huge ovarian masses are mostly benign, but malignancy should be ruled out by investigations and clinical assessment. Here, we present a case of a large mucinous cystadenocarcinoma of the ovary in a 48-year-old postmenopausal woman. Imaging examinations revealed a large cystic tumor that filled the whole abdominal cavity. Despite the difficulties presented by the size of the tumor and its malignant potential, laparotomy was carried out, which included bilateral salpingo-oophorectomy, total abdominal hysterectomy, exploration of other intra-abdominal organs, and pelvic lymphadenectomy. Histopathology indicated the presence of mucinous cystadenocarcinomas. Adjuvant chemotherapy was given post-operatively, and the patient maintained remission during follow-up. This case emphasizes the need for early detection by simple imaging modalities such as ultrasonography in cases of ovarian masses. Most adnexal masses, if detected early, are amenable to surgical management with a good prognosis. Large masses underline the need for a multidisciplinary approach to improve patient outcomes.
Collapse
Affiliation(s)
- Rajasi K Sengupta
- Gynecology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to Be University), Nagpur, IND
| | - Charu Pareek
- Clinical Embryology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to Be University), Nagpur, IND
| | - Ankit Badge
- Microbiology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to Be University), Nagpur, IND
| | - Pravin W Nikhade
- Surgery, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to Be University), Nagpur, IND
| |
Collapse
|
3
|
Tzortzopoulou A, Kordasz M, Häcker FM, Krebs T. The Alexis Laparoscopic System as Minimally Invasive Surgical Technique in Operative Management of Huge Cystic Ovarian Tumors in Children and Young Adolescents: A Case Report. J Pediatr Adolesc Gynecol 2023; 36:560-562. [PMID: 37354989 DOI: 10.1016/j.jpag.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/11/2023] [Accepted: 06/16/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND The use of the Alexis wound protector-retractor (AWPR) could further improve the laparoscopic techniques for safely removing huge ovarian tumors in children. CASE A 15-year-old patient presented to our emergency department with a history of weeks of persistent abdominal pain. Clinical examination and magnetic resonance imaging demonstrated a 25 × 21 × 21 cm cystic mass arising from the left ovary. An en block unilateral oophorectomy and salpingectomy with the use of a medium-sized AWPR was performed without complications. The patient was discharged on the second postoperative day. CONCLUSION The AWPR is a safe and effective tool in treating such children and adolescents with huge ovarian tumors, preserving fertility, minimizing the postoperative pain and hospital stay, and providing an excellent cosmetic outcome.
Collapse
Affiliation(s)
| | - Marcin Kordasz
- Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Frank-Martin Häcker
- Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Thomas Krebs
- Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland; Departmentof General, Visceral, Thoracic, Transplant and Pediatric Surgery, UKSH University Hospital of Schleswig-Holstein Kiel Campus, Kiel, Germany.
| |
Collapse
|
4
|
Gharbia N, Halouani A, Tekaya F, Slama SB, Triki A, Amor AB. Infected, giant borderline ovarian tumor: A case report. Int J Surg Case Rep 2023; 111:108873. [PMID: 37801963 PMCID: PMC10558306 DOI: 10.1016/j.ijscr.2023.108873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/08/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Gigantic borderline ovarian cancer, also known as giant borderline ovarian tumor, is a rare subtype of borderline ovarian cancer. This type of ovarian cyst can be associated to various complication, including superinfection. CASE PRESENTATION We present the case of a 30-year-old woman who sought medical attention due to chronic abdominal pain and a rapid increase in abdominal girth over the past four months. Pelvic ultrasound and pelvic magnetic resonance imaging (MRI) revealed an abdominal-pelvic mass of 27 ∗ 12 cm. The tumoral markers were elevated. During her hospitalization, she developed a fever along with abdominal pain and biological inflammatory syndrome. Surgical intervention a 30-cm-long solid cystic mass located on the right ovary, accompanied by moderate ascites. The surgical procedure included a right adnexectomy, omentectomy, and appendicectomy, with cytology performed. Postoperative antibiotics were administered, and the patient showed favorable clinical and biological progress. The anatomopathological examination confirmed a 35-cm borderline mucinous tumor with signs of infection. CLINICAL DISCUSSION Giant borderline ovarian tumor is characterized by the presence of an ovarian mass measuring at least 10 cm in diameter. Infectious complications are rare, and their clinical features usually mimic those of a peritonitis. Treatment is based on antibiotics and chirurgical removal of the tumor based on the FIGO classification along with peritoneal biopsies and cytology. CONCLUSION This study explores the diagnosis, treatment, and prognosis of infected giant borderline ovarian tumors.
Collapse
Affiliation(s)
- Nourallah Gharbia
- Department of Gynecology and Obstetrics, University Hospital Center Mongi Slim, Tunis, Tunisia; Research laboratory LR18SP05, Tunis, Tunisia.
| | - Ahmed Halouani
- Department of Gynecology and Obstetrics, University Hospital Center Mongi Slim, Tunis, Tunisia; Research laboratory LR18SP05, Tunis, Tunisia
| | - Fatma Tekaya
- Department of Gynecology and Obstetrics, University Hospital Center Mongi Slim, Tunis, Tunisia
| | - Sana Ben Slama
- Department of Anatomical Pathology, University Hospital Center Mongi Slim, Tunis, Tunisia
| | - Amel Triki
- Department of Gynecology and Obstetrics, University Hospital Center Mongi Slim, Tunis, Tunisia
| | - Anissa Ben Amor
- Department of Gynecology and Obstetrics, University Hospital Center Mongi Slim, Tunis, Tunisia; Research laboratory LR18SP05, Tunis, Tunisia
| |
Collapse
|
5
|
Birbas E, Kanavos T, Gkrozou F, Skentou C, Daniilidis A, Vatopoulou A. Ovarian Masses in Children and Adolescents: A Review of the Literature with Emphasis on the Diagnostic Approach. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1114. [PMID: 37508611 PMCID: PMC10377960 DOI: 10.3390/children10071114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023]
Abstract
Most abdominal masses in the pediatric population derive from the ovaries. Ovarian masses can occur in all ages, although their incidence, clinical presentation and histological distribution vary among different age groups. Children and adolescents may develop non-neoplastic ovarian lesions, such as functional cysts, endometrioma, torsion, abscess and lymphangioma as well as neoplasms, which are divided into germ cell, epithelial, sex-cord stromal and miscellaneous tumors. Germ cell tumors account for the majority of ovarian neoplasms in the pediatric population, while adults most frequently present with epithelial tumors. Mature teratoma is the most common ovarian neoplasm in children and adolescents, whereas dysgerminoma constitutes the most frequent ovarian malignancy. Clinical manifestations generally include abdominal pain, palpable mass, nausea/vomiting and endocrine alterations, such as menstrual abnormalities, precocious puberty and virilization. During the investigation of pediatric ovarian masses, the most important objective is to evaluate the likelihood of malignancy since the management of benign and malignant lesions is fundamentally different. The presence of solid components, large size and heterogenous appearance on transabdominal ultrasonography, magnetic resonance imaging and computed tomography indicate an increased risk of malignancy. Useful tumor markers that raise concern for ovarian cancer in children and adolescents include alpha-fetoprotein, lactate dehydrogenase, beta subunit of human chorionic gonadotropin, cancer antigen 125 and inhibin. However, their serum levels can neither confirm nor exclude malignancy. Management of pediatric ovarian masses needs to be curative and, when feasible, function-preserving and minimally invasive. Children and adolescents with an ovarian mass should be treated in specialized centers to avoid unnecessary oophorectomies and ensure the best possible outcome.
Collapse
Affiliation(s)
- Effrosyni Birbas
- Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Theofilos Kanavos
- Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Fani Gkrozou
- Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece
| | - Chara Skentou
- Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece
| | - Angelos Daniilidis
- 1st Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece
| | - Anastasia Vatopoulou
- Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece
| |
Collapse
|
6
|
Therapeutic Management and Prognostic Factors for Ovarian Malignant Tumours in Adolescents: A Comprehensive Review of Current Guidelines. Diagnostics (Basel) 2023; 13:diagnostics13061080. [PMID: 36980387 PMCID: PMC10047001 DOI: 10.3390/diagnostics13061080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/14/2023] Open
Abstract
Background: Ovarian malignant tumours are rarely diagnosed in adolescents but may have a significant impact on their survival, future fertility and quality of life. The management of such cases is rather complex and requires expertise and careful planning according to scarce existing evidence and recommendations. Objective: The aim of this study was to review and compare recommendations from published guidelines regarding the diagnosis, prognosis and treatment of malignant ovarian tumours in adolescents. Evidence acquisition: A comparative descriptive/narrative review of guidelines issued by L’Observatoire des Tumeurs Malignes Rares Gynécologiques, the British Society for Paediatric & Adolescent Gynaecology, the European Society for Medical Oncology, the European Society of Gynecological Oncology-European Society for Paediatric Oncology and the European Cooperative Study Group for Pediatric Rare Tumors was conducted. Results: All guidelines recommend a thorough diagnostic work-up, consisting of both imaging tests and serum tumour marker measurement, as well as the use of immunohistochemical methods to confirm the diagnosis and complete surgical staging prior to constructing the treatment plan. There is a lack of recommendations regarding the assessment of prognostic factors, with only one guideline providing detailed information. Treatment strategies, as suggested by the majority of guidelines and with only a few discrepancies between them, should include both surgery and adjuvant therapies, mainly chemotherapy, with great emphasis on fertility preservation when it is considered oncologically safe and on the significance of regular and long-term follow-up. Conclusions: There is a significant degree of agreement among recommendations of existing guidelines. The reported differences, although limited, highlight the need for the adoption of an international consensus in order to further improve the management of adolescent ovarian cancer.
Collapse
|
7
|
Pramana C, Almarjan L, Mahaputera P, Wicaksono SA, Respati G, Wahyudi F, Hadi C. A Giant Ovarian Cystadenoma in A 20-Year-Old Nulliparous Woman: A Case Report. Front Surg 2022; 9:895025. [PMID: 35599793 PMCID: PMC9117763 DOI: 10.3389/fsurg.2022.895025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
Giant ovarian cyst itself is defined as a cyst >10 cm in diameter from radiological- examination or the size of the cyst exceeds the umbilicus. Extra-large benign and malignant cysts of the ovary are uncommon and involve diagnostic and management challenges. We present the case of a 20-year-old nulliparous woman who was referred to our center with complaints of abdominal pain and heavy breathing. She benefited from a salphingo-oophorectomy laparotomy procedure. Benign and malignant gynecologic and non-gynecologic etiologies are included in the differential diagnosis of an abdominal mass. Because of the infrequent occurrence or absence of distinctive clinical presentation of the giant ovarian cyst, accurate preoperative diagnosis is challenging.
Collapse
Affiliation(s)
- Cipta Pramana
- Faculty of Medicine Wahid Hasyim University, Semarang, Indonesia
- Obstetrics and Gynecology Department Medical Faculty Tarumanagara University, Jakarta, Indonesia
- Correspondence: Cipta Pramana
| | - Lulu Almarjan
- Department of Obstetrics and Gynecology, Tarumanagara University, Jakarta, Indonesia
| | - Pramadio Mahaputera
- Department of Obstetrics and Gynecology, Tarumanagara University, Jakarta, Indonesia
| | - Satrio Adi Wicaksono
- Department of Anesthesiology and Intensive Therapy, Medical Faculty, Diponegoro University, Semarang, Indonesia
| | - Giri Respati
- Department of Obstetrics and Gynecology,Pondok Indah Hospital, Jakarta, Indonesia
| | - Firdaus Wahyudi
- Department of Public Health, Medical Faculty, Diponegoro University,Semarang, Indonesia
| | - Cahyono Hadi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia
- Dr. Moewardi Hospital, Surakarta, Indonesia
| |
Collapse
|
8
|
Liu CH, Liu WM, Wang PH. Laparoscopic-aid procedure for complicated gynecologic surgery. Taiwan J Obstet Gynecol 2022; 61:195-196. [DOI: 10.1016/j.tjog.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 12/21/2022] Open
|
9
|
Rashmi MV, Bhaskar A. Mucinous cystadenoma in a 15-year-old girl: An incidental finding. JOURNAL OF CURRENT RESEARCH IN SCIENTIFIC MEDICINE 2022. [DOI: 10.4103/jcrsm.jcrsm_37_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
|
10
|
Tumasyan EA, Biryukov AE, Gracheva NA, Gashimova AI, Ismaiilova PD, Solomatina AA, Mikhaleva LM. [Receptive status of the endometrium in patients with benign ovarian tumors before and after organ-preserving operations]. Arkh Patol 2022; 84:29-37. [PMID: 35880597 DOI: 10.17116/patol20228404129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
UNLABELLED Background. Benign ovarian tumors (BOT) occupy the 2nd place in the structure of diseases of the female genital organs. In 20% of women of reproductive age, BOT are associated with infertility. One of the causes of infertility caused by ovarian tumors is morphofunctional inferiority with impaired endometrial receptivity. OBJECTIVE To reveal the morphological and functional features of the endometrium and the level of receptivity to sex hormones in patients with BOT before and after organ-preserving operations. MATERIAL AND METHODS The study included 77 patients with epithelial ovarian tumors (EOT) - I group, 52 with mature teratomas (MT) - II group. Before and 6-12 months after laparoscopic cystectomy aspiration biopsy of endometrium was performed in the middle stage of secretory phase. The percentage and degree of maturity of pinopodes were determined, and the level of expression of estrogen (ER) and progesterone (PR) receptors in the glands and stroma of the endometrium was assessed. RESULTS At the preoperative stage, a decrease in the number of mature pinopodes in patients with EOT was revealed. Normal levels of ER were determined in glands and stroma of endometrium, PR was reduced both in stroma and glands of uterine mucosa. In patients with MT all markers corresponded to those of healthy women. In the postoperative period an increase in the number of developed pinopodes on the apical surface of endometrium in patients of I group was found. The ER level did not differ from control values, PR remained reduced in stroma. In II group a persistent decrease in quantity of mature pinopodes, ER in stroma, PR in glands and stroma of uterine mucosa was recorded. CONCLUSION The presence of BOT and unintentional intraoperative removal of healthy ovarian tissue lead to indirect disorders of the morphofunctional state and endometrial receptivity.
Collapse
Affiliation(s)
- E A Tumasyan
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A E Biryukov
- Avtsyn Research Institute of Human Morphology, Moscow, Russia
- City Clinical Hospital No. 31, Moscow, Russia
| | | | - A I Gashimova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - P D Ismaiilova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A A Solomatina
- Pirogov Russian National Research Medical University, Moscow, Russia
- City Clinical Hospital No. 31, Moscow, Russia
| | - L M Mikhaleva
- Avtsyn Research Institute of Human Morphology, Moscow, Russia
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
| |
Collapse
|