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Abdelmoaty MA, Taha WS. Pediatric puzzle: Large ovarian dermoid cyst and markedly elevated CA 19-9 in an 8-year-old. Qatar Med J 2024; 2024:47. [PMID: 39319015 PMCID: PMC11420555 DOI: 10.5339/qmj.2024.47] [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: 02/23/2023] [Accepted: 06/23/2024] [Indexed: 09/26/2024] Open
Abstract
Background Mature cystic teratomas, also known as dermoid cysts, are the most prevalent form of ovarian germ cell tumors. While they typically manifest in women of reproductive age, they can also occur in pediatric patients. These tumors are generally benign and comprise a diverse array of tissue types. However, large lesions, particularly those exceeding 10 cm in diameter, are infrequent and can present diagnostic and therapeutic challenges. Notably, elevated tumor markers, such as cancer antigen 19-9 (CA 19-9), are not commonly associated with mature cystic teratomas, rendering this case particularly unusual. Case presentation The clinical case involved an 8-year-old female patient who presented with an exceptionally large ovarian teratoma, measuring 13 × 12 cm. While the prepubertal presentation of such tumors is not uncommon, the remarkable size of the lesion was an extraordinary occurrence. Preoperative evaluation revealed markedly elevated levels of CA 19-9, a tumor marker, at 297 U/mL-an atypical finding for mature cystic teratomas. Imaging studies identified a complex cystic adnexal mass, indicative of a teratoma. Consequently, a laparotomy was performed, revealing an intact, benign lesion that was successfully resected via cystectomy, with preservation of the ovary. Histopathological examination confirmed the diagnosis of a mature cystic teratoma, without any evidence of malignant transformation. Notably, following the surgical intervention, the elevated CA 19-9 levels normalized, suggesting a potential association between the teratoma and the abnormal tumor marker levels. Discussion This report delineates the surgical management and clinical course of an exceptionally large ovarian teratoma in a pediatric patient with abnormal preoperative tumor markers. Despite atypical features, the excellent prognosis following fertility-sparing resection underscores the significance of conservative treatment in young females. Conclusion This case highlights the occurrence of a large mature cystic teratoma with elevated CA-19-9 in a pediatric patient with no complications such as torsion, rupture, or malignancy. The elevation in CA-19-9 likely relates directly to the teratoma itself. A conservative, fertility-sparing surgical approach proved effective, emphasizing the importance of careful preoperative evaluation and management in similar cases.
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Affiliation(s)
- Muhamed Ahmed Abdelmoaty
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt *
| | - Wael Soliman Taha
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt *
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2
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Deeksha HS, Pajai S, Patel DJ, Navalihiremath VU, Jyotsna G. Unraveling the Enigma: A Case Report on Unilateral Ovarian Dermoid Cyst. Cureus 2024; 16:e53700. [PMID: 38455810 PMCID: PMC10919066 DOI: 10.7759/cureus.53700] [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: 11/11/2023] [Accepted: 02/06/2024] [Indexed: 03/09/2024] Open
Abstract
Mature teratomas, also known as ovarian dermoid cysts, are benign embryonal tumors that develop slowly. One of the following imaging techniques is commonly employed to evaluate these cysts: transvaginal ultrasound, pelvic ultrasonography, magnetic resonance imaging, or computed tomography. The two surgical methods most frequently used for removing persistent or very large cysts are laparoscopy and laparotomy. A 42-year-old female, who is P3L1D2 with a history of previous cesarean section, presented with an abdominal mass that had been gradually increasing in size over the past five months. She also reported lower abdominal pain for the last five days. Upon further evaluation, she was diagnosed with a left ovarian dermoid cyst. The patient underwent exploratory laparotomy, during which a total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The cut section of the gross cyst specimen revealed abundant sebaceous fluid and a large tuft of hair, which was confirmed by histopathology. The patient was followed up every three months for a year. Ovarian tumors typically manifest with nonspecific symptoms. The early recognition of dermoid cysts and prompt intervention are crucial to prevent potential complications.
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Affiliation(s)
- H S Deeksha
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sandhya Pajai
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Dharmesh J Patel
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | | | - Garapati Jyotsna
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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3
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Shaikh M, Acharya N. Hospital-based interventional two-arm parallel comparative study on dydrogesterone vs combined oral contraceptive pills for functional ovarian cysts. F1000Res 2024; 13:84. [PMID: 38450050 PMCID: PMC10912786 DOI: 10.12688/f1000research.142012.1] [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] [Accepted: 11/16/2023] [Indexed: 03/08/2024] Open
Abstract
Background Functional ovarian cysts are common among women of reproductive age, often necessitating medical intervention. This hospital-based interventional study compares the efficacy and safety of combined oral contraceptive pills (COC) and dydrogesterone in managing functional ovarian cysts. Methods This randomized controlled trial will be conducted over two years at the Department of Obstetrics & Gynecology, AVBRH, Datta Meghe Institute of Medical Sciences. The study population consists of reproductive-age women seeking care at the outpatient unit of Obstetrics and Gynecology at AVBRH hospital. The sample size of 46 participants per group has been calculated based on a 95% confidence interval and the estimated prevalence of functional ovarian cysts. Group A will receive low-dose COC for three menstrual cycles. At the same time, Group B will be administered dydrogesterone (10 mg twice daily) for ten days during the luteal phase, repeated across three cycles. Expected outcomes The primary outcomes include evaluating the recession of cysts within three months, monitoring alterations in menstrual patterns (frequency, regularity, duration, and volume), assessing the necessary treatment duration, and observing potential side effects (e.g., nausea, vomiting, weight gain, and acne) and complications (e.g., thromboembolism, delayed menstrual cycles post-treatment, and interactions with other drugs). Data analysis will encompass descriptive statistics, comparative tests, and regression models to assess the primary outcomes. The significance level for hypothesis testing will be 0.05 with a two-tailed approach. Registration CTRI/2023/04/051811.
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Affiliation(s)
- Muneeba Shaikh
- Obstetrics and Gynaecology, Datta Meghe Institute of Higher Education & Research, Wardha, Maharashtra, 442001, India
| | - Neema Acharya
- Obstetrics and Gynaecology, Datta Meghe Institute of Higher Education & Research, Wardha, Maharashtra, 442001, India
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4
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Sun HD, Peng FH, Hsiao SM, Wang PH. A small mature cystic ovarian teratoma associated with anti-NMDA receptor encephalitis and acute respiratory failure: A case report. Taiwan J Obstet Gynecol 2023; 62:765-768. [PMID: 37679011 DOI: 10.1016/j.tjog.2023.07.024] [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] [Accepted: 03/06/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE To report a rare case of anti-N-Methyl-d-aspartate receptor encephalitis (anti-NMDARE) presented by mental and behavioral changes and seizures accompanied with respiratory failure. CASE REPORT A 37-year-old multiparous woman was initially presented with abnormal mental behavior and the diagnosis of schizophrenia was made, but the disease progressed rapidly to general convulsion and acute respiratory failure. Although active treatment, including steroids, intravenous immunoglobulins (IVIGs) and plasma exchange was applied, no significant improvement was obtained. Transvaginal ultrasound and pelvic magnetic resonance image (MRI) were arranged and the results showed a suspicious cystic lesion (3 × 2.3 cm) at the right ovary. Laparoscopic unilateral salpingo-oophorectomy was performed and final pathology reported a matured cystic teratoma, suggesting that this patient had anti-NMDARE secondary to ovarian mature teratoma. After surgery, the clinical condition was dramatically improved and she recovered completely without sequelae. CONCLUSION Although it is well-known about the relation between anti-NMDARE and ovarian mature teratoma, this small tumor may result in the missing diagnosis. Remind us to consider the possibility of any small ovarian cystic lesion-related anti-NMDARE in women with autoimmune encephalitis.
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Affiliation(s)
- Hsu-Dong Sun
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Ban Ciao, New Taipei City, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Fu-Hsiang Peng
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Ban Ciao, New Taipei City, Taiwan
| | - Sheng-Mou Hsiao
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Ban Ciao, New Taipei City, Taiwan
| | - Peng-Hui Wang
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Female Cancer Foundation, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
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5
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M SC, Peethambar BA. Mature cystic teratoma without intratumoral fat: A diagnostic dilemma. Radiol Case Rep 2023; 18:3109-3112. [PMID: 37416320 PMCID: PMC10319638 DOI: 10.1016/j.radcr.2023.06.005] [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: 05/07/2023] [Revised: 05/29/2023] [Accepted: 06/02/2023] [Indexed: 07/08/2023] Open
Abstract
Teratomas are the most common benign ovarian neoplasms in young women. Typical computed tomography imaging findings include fat, fat fluid level, tooth or calcification, rokitansky nodule, floating balls sign, and tufts of hair. They can have unusual imaging features leading to diagnostic dilemmas. Studies have shown the presence of intratumoral fat to be specific to ovarian cystic teratoma. However, there are reports in the literature of mature cystic teratoma that do not contain fat in the lumen of the cyst which can hinder an accurate diagnosis. They can be associated with various complications like torsion, rupture, malignant transformation, infection, and autoimmune hemolytic anemias. Presented here is a case of mature cystic teratoma without visible intracystic fat which underwent torsion.
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Affiliation(s)
- Sandra C M
- Department of Radiology, MES Medical College, Palachode Post, Perinthalmanna, Kerala, India
| | - Breman Anil Peethambar
- Madras Medical College and Government General Hospital, Emergency Department, Chennai, Tamil Nadu, India
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6
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Gorginzadeh M, Tajbakhsh B, Mortazi S. Preservation of ovarian tissue embedded in omentum following torsion and auto-amputation of the left ovary and fallopian tube in a 14-year-old girl: A case report. Int J Surg Case Rep 2023; 109:108490. [PMID: 37437323 PMCID: PMC10362290 DOI: 10.1016/j.ijscr.2023.108490] [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: 03/24/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION Autoamputation of the ovary and fallopian tube is a scarce phenomenon particularly in adolescents but could adversely affect fertility by causing ovarian damage and loss of tubal function. CASE PRESENTATION A case of autoamputation of the left adnexa as a result of chronic torsion in the setting of an ovarian dermoid cyst in an adolescent girl is presented. The patient had also a large dermoid cyst in the contralateral ovary which was in danger of another torsion and loss of ovarian reserve and tube. Her left fallopian tube was absent and left ovary was embedded in the omentum. She was successfully managed through laparoscopic surgery. Bilateral cystectomy was performed and the ectopic ovarian tissue was saved. CLINICAL DISCUSSION Chronic torsion sometimes results in ectopic displacement of the affected ovary. While some patients may be asymptomatic, many of these cases express episodes of acute or chronic abdominopelvic pain. Hence, a prolonged pain or discomfort, even of low intensity, should not be overlooked particularly in younger patients with bilateral ovarian cysts. CONCLUSION Ovarian dermoid cysts in adolescents could possibly undergo chronic torsion resulting in autoamputation of the adnexa and ectopic displacement of the ovary. With prompt diagnosis and intervention, ovarian tissue and fertility could be preserved.
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Affiliation(s)
| | - Banafsheh Tajbakhsh
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shahin Mortazi
- Division of Pathology Department, Milad Hospital, Tehran, Iran
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7
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Chang CH, Ding DC. Comparing outcomes of ovarian cystectomy by vaginal natural orifice transluminal endoscopic surgery versus laparoendoscopic single-site surgery: A retrospective cohort study. J Chin Med Assoc 2023; 86:682-687. [PMID: 37185219 DOI: 10.1097/jcma.0000000000000933] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND We aimed to compare the outcomes of ovarian cystectomy (OC) performed by vaginal natural orifice transluminal endoscopic surgery (vNOTES) vs transumbilical laparoendoscopic single-site surgery (LESS). METHODS We retrospectively analyzed the data of patients in our hospital who underwent OC either by vNOTES or LESS between January 2015 and September 2021. Demographic data were collected. The primary outcome was the conversion rate. The secondary outcomes were the duration of surgery, length of hospital stay, estimated blood loss, maximum body temperature within 48 hours after operation, and duration of maximum body temperature (hours), among others. Statistical analysis was done using the SPSS software. RESULTS Exactly 284 patients were screened. The vNOTES and LESS groups consisted of 21 and 47 patients, respectively. There was no significant difference in the conversion rates between the two groups (0 vs 8.5% in vNOTES and LESS, respectively; p = 0.303). Compared with the vNOTES group, the LESS group had a larger cyst diameter (6.00 ± 2.32 vs 4.69 ± 1.29 cm; p = 0.004), more endometriotic cysts (42.6% vs 9.5%; p < 0.001), and more pelvic adhesions requiring adhesiolysis (57.4% vs 19.0%; p = 0.003). At baseline, there were no other differences between the groups. The secondary outcomes included a shorter duration of surgery (70.14 ± 27.30 vs 99.57 ± 36.26 minutes; p = 0.001) and lower estimated blood loss (64.29 ± 39.19 vs 163.43 ± 251.20 mL; p = 0.011) in the vNOTES group. Regression analysis showed the diameter of the ovarian cyst correlated with surgical time. The complication was comparable between the two groups. CONCLUSION Above all, the advantages of vNOTES include an absence of visible scars, shorter surgical duration, and less blood loss when compared with LESS. Further large-scale prospective trials should confirm the results of our study.
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Affiliation(s)
- Chi-Han Chang
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, and Tzu Chi University, Hualien, Taiwan, ROC
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, and Tzu Chi University, Hualien, Taiwan, ROC
- Institute of Medical Sciences, College of Medicine, Tzu Chi University, Hualien, Taiwan, ROC
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8
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Lai PH, Ding DC. Ruptured teratoma mimicking a pelvic inflammatory disease and ovarian malignancy: A case report. World J Clin Cases 2023; 11:3852-3857. [PMID: 37383124 PMCID: PMC10294172 DOI: 10.12998/wjcc.v11.i16.3852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/20/2023] [Accepted: 05/06/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND We report a case of ruptured ovarian teratoma mimicking pelvic inflammatory disease (PID) and ovarian malignancy. The case indicates the need for reviewing the information on ovarian teratomas, as the symptoms are vague, and, therefore, diagnosis and treatment had to be structured accordingly.
CASE SUMMARY A 60-year-old woman was admitted to the emergency department with acute lower abdominal pain. She experienced weight loss and increased abdominal girth. Pelvic ultrasound and computed tomography revealed a 14-cm pelvic tumor. Laboratory examination revealed leukocytosis (white blood cell count: 12620/μL, segment: 87.7%) and high levels of C-reactive protein (18.2 mg/dL). Elevated levels of the tumor marker cancer antigen 19-9 (367.8 U/mL, normal value < 35 U/mL) were also noted. Due to the impression of a ruptured tubo-ovarian abscess or a tumor with malignancy, she immediately underwent an exploratory laparotomy. A ruptured ovarian tumor with fat balls, hair strands, cartilage, and yellowish fluid was observed on the right side. Right salpingo-oophorectomy was performed. A pathological examination revealed a mature cystic teratoma. The patient recovered after surgery and was discharged on post-operative day three. No antibiotics were administered.
CONCLUSION This case illustrates the differential diagnosis of an ovarian tumor. Therefore, surgery is the mainstay for treating a ruptured teratoma.
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Affiliation(s)
- Pei-Hsuan Lai
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Tzu Chi University, Hualien 970, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Tzu Chi University, Hualien 970, Taiwan
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9
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Chen LY, Ding DC. Vaginal Natural Orifice Transluminal Endoscopic Surgery in a Second-trimester Pregnant Woman with an Ovarian Teratoma. Gynecol Minim Invasive Ther 2023; 12:116-119. [PMID: 37416106 PMCID: PMC10321348 DOI: 10.4103/gmit.gmit_107_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 07/08/2023] Open
Abstract
We present the first case of a pregnant woman with teratoma, who underwent vaginal natural orifice transluminal endoscopic surgery (vNOTES). Mature ovarian cystic teratomas compromise 20%-30% of all ovarian tumors. The best surgical management is still unclear, especially during pregnancy. A 21-year-old pregnant woman (gravida 1, para 0) at 14 weeks and 3 days of gestational age was admitted with an intermittent mild sharp and dull pain in her right lower abdomen when walking or moving lower limbs. Pelvic ultrasonography revealed a 5.9 cm × 5.4 cm heterogeneous mass that was suspected as a teratoma in the right adnexa. Initially, laparoendoscopic single-site ovarian cystectomy (OC) was arranged. However, the ovarian tumor was impeded by the enlarged uterus. The OC procedure was changed to vNOTES OC. The vNOTES OC was performed smoothly and the pathology confirmed the mass to be a teratoma. After the operation, she recovered well and was discharged 2 days after the operation without any complication. In conclusion, the application of vNOTES in the second-trimester pregnancy might be considered safe and effective. The vNOTES can be performed safely in selected patients and by an experienced surgeon.
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Affiliation(s)
- Li-Yeh Chen
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, Hualien, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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10
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Petrozza JC, Fitz V, Bhagavath B, Carugno J, Kwal J, Mikhail E, Nash M, Barakzai SK, Roque DR, Bregar AJ, Findley J, Neblett M, Flyckt R, Khan Z, Lindheim SR. Surgical approach to 4 different reproductive pathologies by 3 different gynecologic subspecialties: more similarities or differences? Fertil Steril 2023; 119:377-389. [PMID: 36574916 DOI: 10.1016/j.fertnstert.2022.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Affiliation(s)
- John C Petrozza
- Division of Reproductive Medicine and IVF, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Victoria Fitz
- Division of Reproductive Medicine and IVF, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bala Bhagavath
- Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin
| | - Jose Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department, Minimally Invasive Gynecology Unit, University of Miami, Miller School of Medicine, Miami, Florida
| | - Jaclyn Kwal
- Obstetrics, Gynecology and Reproductive Sciences Department, Minimally Invasive Gynecology Unit, University of Miami, Miller School of Medicine, Miami, Florida
| | - Emad Mikhail
- Division of Gynecologic Subspecialties, Department of Obstetrics and Gynecology, University of South Florida Health Morsani College of Medicine, Tampa, Florida
| | - Moawad Nash
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics & Gynecology, University of Florida College of Medicine, Gainesville, Florida
| | - Syem K Barakzai
- Division of Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dario R Roque
- Division of Gynecologic Oncology, Feinberg School of Medicine, Northwestern University
| | - Amy J Bregar
- Division of Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joseph Findley
- Department of Obstetrics and Gynecology, University Hospitals of Cleveland, Beachwood, Ohio
| | - Michael Neblett
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, Minnesota
| | - Rebecca Flyckt
- Department of Obstetrics and Gynecology, University Hospitals of Cleveland, Beachwood, Ohio
| | - Zaraq Khan
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, Minnesota
| | - Steven R Lindheim
- Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Dayton, Ohio; Department of Obstetrics and Gynecology, University of Central Florida, Orlando, Florida; Center for Reproductive Medicine Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
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11
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Mitchell JR, Siegelman ES, Sundaram KM. MR Imaging of Germ Cell and Sex Cord Stromal Tumors. Magn Reson Imaging Clin N Am 2023; 31:65-78. [DOI: 10.1016/j.mric.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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12
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Federico A, Patel M, Cummings K. Cystic Teratoma Resection With Ovarian Preservation in a Pediatric Transgender Male: A Case Report. Cureus 2022; 14:e29161. [PMID: 36259003 PMCID: PMC9564695 DOI: 10.7759/cureus.29161] [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] [Accepted: 09/14/2022] [Indexed: 12/04/2022] Open
Abstract
Ovarian teratomas are germ cell-derived tumors that are classically reported in the literature to occur in cisgender female patients. While this is statistically the most common patient population that they are diagnosed in, they can also occur in transgender men with ovaries who have not undergone a previous oophorectomy. Because of the lack of research and literature regarding this unique patient population, decisions regarding the treatment of these neoplasms are controversial. Here, we report the case of a pediatric transgender male who developed an ovarian teratoma and discuss specific considerations for treating ovarian neoplasms in the transgender population.
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13
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St. Louis M, Mangal R, Stead TS, Sosa M, Ganti L. Ovarian Dermoid Tumor. Cureus 2022; 14:e27233. [PMID: 36039208 PMCID: PMC9400835 DOI: 10.7759/cureus.27233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/05/2022] Open
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14
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Palomba S, Russo T, Albonico G, Tripodi M. Stage Ia squamous cell carcinoma as the malignant transformation of giant and unusual mature teratoma of the ovary in an elderly patient. J Ovarian Res 2022; 15:68. [PMID: 35659276 PMCID: PMC9166460 DOI: 10.1186/s13048-022-01005-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 05/17/2022] [Indexed: 12/01/2022] Open
Abstract
Background Mature cystic teratomas of the ovary (MCTO) are a type of germ cell tumor that may contain well-differentiated tissues developed from three germ cell layers and constitute about 20% of ovarian germ cell tumors. They are rare ovarian tumors with an annual incidence variable from 1.2 to 14.2 cases per 100,000 that occur mainly in women of reproductive age. They are frequently benign with a slow growth rate, even if they can undergo a malignant transformation in about 1–2% of cases. Case presentation Here, we present the case of an elderly woman referred to gynecological first aid for acute abdominal pain and showing a giant and unusual MCTO at rapid growth with malignant transformation in squamous cell carcinoma (FIGO stage Ia). The patient underwent pelvic mass removal trough emergency longitudinal midline laparotomic incision with intraoperative frozen pathologic examination. A complete surgical staging during the first surgery was performed. After about 9 years of follow-up, she died of non-oncological reasons without recurrence. Conclusions Present case highlights that CMTO with malignant transformation should always be suspected in elderly women in presence of pelvic mass at rapid growth, even if in absence of other clinical and ultrasonographic signs of malignancy. An intraoperative frozen pathologic examination may drive the best treatment.
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Affiliation(s)
- Stefano Palomba
- Gynecology and Obstetrics, University Magna Graecia of Catanzaro, Catanzaro, Italy. .,Casa di Cura "Caminiti", Villa San Giovanni (RC), Italy. .,, Via A. Arabia 14, 87100, Cosenza, Italy.
| | - Tiziana Russo
- Unit of Obstetrics and Gynecology, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Giuseppe Albonico
- Unit of Pathology, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Marcello Tripodi
- Unit of Obstetrics and Gynecology, Grande Ospedale Metropolitano, Reggio Calabria, Italy
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15
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Foley AJ, Ragsdale BD. Unusual teeth in unusual places: Criteria for identifying teratomatous dental elements in archeological contexts. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2022; 37:53-59. [PMID: 35489279 DOI: 10.1016/j.ijpp.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 03/23/2022] [Accepted: 04/12/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This paper describes the dental elements (i.e., teeth and incomplete tooth-like structures) formed by mature cystic teratomas and provide some diagnostic criteria to aid in their paleopathological identification and analysis. MATERIALS Hard tissue structures from 13 clinically-derived mature cystic teratomas excised between 2003 and 2007. All are from female patients (N = 13) between the ages of 17 and 56. METHODS A dental and osteological inventory identified number of teeth and tooth types present in each specimen. RESULTS Of the 13 specimens, nine contained dental elements. The number per teratoma ranged from one to seven. A wide variety of tooth types were present in the teratomas with some teeth independent of, and others embedded within, bony matrices. CONCLUSIONS While some teratoma teeth exhibit distinguishable types and laterality, the majority will exhibit some degree of abnormality in size, form, developmental completion, or association with other irregular bony elements. SIGNIFICANCE Give the modern clinical prevalence and yet relatively few paleopathological cases reported, it is likely that mature teratomas are under-identified in the archeological record. The diagnostic criteria presented in this paper can aid paleopathologists in their identification and analysis of these neoplasms. LIMITATIONS Precise paleopathological identification of teratoma elements can be difficult; particularly when they are no longer constrained or contextualized by unmineralized neoplastic borders. As such, there is a risk that such remnants may be mistaken for fetal parts or disassociated elements. SUGGESTIONS FOR FURTHER RESEARCH Application of these criteria, paired with careful excavation techniques, is advised.
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16
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Delehaye F, Sarnacki S, Orbach D, Cheikhelard A, Rouger J, Parienti JJ, Faure-Conter C, Hameury F, Dijoud F, Aubry E, Wacrenier A, Habonimana E, Duchesne C, Joseph S, Alliot H, Scalabre A, Chaussy Y, Podevin G, Croue A, Haraux E, Guibal MP, Pommepuy I, Ballouhey Q, Lavrand F, Peycelon M, Irtan S, Guerin F, Dariel A, Borionne C, Galmiche L, Rod J. Lessons from a large nationwide cohort of 350 children with ovarian mature teratoma: A study in favor of ovarian-sparing surgery. Pediatr Blood Cancer 2022; 69:e29421. [PMID: 34842332 DOI: 10.1002/pbc.29421] [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: 08/12/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Ovarian mature teratoma (OMT) is a common ovarian tumor found in the pediatric population. In 10%-20% of cases, OMT occurs as multiple synchronous or metachronous lesions on ipsi- or contralateral ovaries. Ovarian-sparing surgery (OSS) is recommended to preserve fertility, but total oophorectomy (TO) is still performed. DESIGN This study reviews the clinical data of patients with OMT, and analyzes risk factors for second events. A national retrospective review of girls under 18 years of age with OMTs was performed. Data on clinical features, imaging, laboratory studies, surgical reports, second events and their management were retrieved. RESULTS Overall, 350 children were included. Eighteen patients (5%) presented with a synchronous bilateral form at diagnosis. Surgery was performed by laparotomy (85%) and laparoscopy (15%). OSS and TO were performed in 59% and 41% of cases, respectively. Perioperative tumor rupture occurred in 23 cases, independently of the surgical approach. Twenty-nine second events occurred (8.3%) in a median time of 30.5 months from diagnosis (ipsilateral: eight cases including one malignant tumor; contralateral: 18 cases; both ovaries: three cases). A large palpable mass, bilateral forms, at diagnosis and perioperative rupture had a statistical impact on the risk of second event, whereas the type of surgery or approach did not. CONCLUSION This study is a plea in favor of OSS as the first-choice treatment of OMT when possible. Close follow-up during the first 5 years is mandatory considering the risk of 8.3% of second events, especially in cases with risk factors.
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Affiliation(s)
- Fanny Delehaye
- Department of Pediatric Haematology and Oncology, University Hospital of Caen, 14000, Caen, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Université de Paris, Hôpital Necker Enfants-Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Daniel Orbach
- SIREDO Oncology Centre (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, PSL University, Paris, France
| | - Alaa Cheikhelard
- Department of Pediatric Surgery, Université de Paris, Hôpital Necker Enfants-Malades, Assistance Publique - Hôpitaux de Paris, Paris, France.,National Reference Centre for Rare Gynecological Diseases (PGR), Paris, France
| | - Jérémie Rouger
- Department of Pediatric Haematology and Oncology, University Hospital of Caen, 14000, Caen, France
| | - Jean-Jacques Parienti
- Department of Biostatistics and Clinical Research, University Hospital of Caen Normandy, Caen, France
| | - Cécile Faure-Conter
- Centre Leon Bernard, Pediatric Hemato-Oncology Institute (IHOPe), Lyon, France
| | - Frédéric Hameury
- Pediatric Surgery Department, Femme-Mère-Enfant University Hospital, 59, boulevard Pinel, 69677, Bron, France
| | - Frédérique Dijoud
- Anatomy-Cytology-Pathology Department, Women-Mother and Child Hospital, Hospices Civils de Lyon, Lyon, France
| | - Estelle Aubry
- CHU Lille, Centre de Référence du Développement Génital DEV GEN, Service de Chirurgie Pédiatrique, Hôpital Jeanne de Flandres, 59000, Lille, France
| | - Agnès Wacrenier
- Anatomy-Cytology-Pathology Department, CHU Lille, Lille, France
| | - Edouard Habonimana
- Department of Pediatric Surgery, Rennes University Hospital, Rennes, France
| | - Camille Duchesne
- Department of Pediatric Surgery, Rennes University Hospital, Rennes, France
| | - Solène Joseph
- Department of Pediatric Surgery, CHU de Nantes, Hôtel-Dieu, 1, Place Alexis-Ricordeau, 44000, Nantes, France
| | - Hortense Alliot
- Department of Pediatric Surgery, CHU de Nantes, Hôtel-Dieu, 1, Place Alexis-Ricordeau, 44000, Nantes, France
| | - Aurélien Scalabre
- Department of Pediatric Surgery, University Hospital of Saint-Etienne, CHU de Saint-Etienne Hôpital Nord, Saint-Etienne Cedex 2, France
| | - Yann Chaussy
- Paediatric Surgery Department, University Hospital of Besancon, Besancon, France
| | - Guillaume Podevin
- Paediatric Surgery Department, Angers University Hospital, Angers, France
| | - Anne Croue
- Anatomy-Cytology-Pathology Department, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Elodie Haraux
- Paediatric Surgery Department, Amiens University Hospital, Amiens, France
| | - Marie Pierre Guibal
- Department of Pediatric Surgery, University Hospital of Montpellier, Montpellier, France
| | - Isabelle Pommepuy
- Service d'anatomie Pathologique, CHU Dupuytren, 2, Avenue Martin-Luther-King, 87042, Limoges Cedex, France
| | - Quentin Ballouhey
- Department of Pediatric Surgery, Hôpital des Enfants, 8 Avenue Dominique Larrey, 87042, Limoges Cedex, France
| | - Frédéric Lavrand
- Department of Pediatric Surgery, Groupe Hospitalier Pellegrin, Hôpital d'enfants, Bordeaux, France
| | - Matthieu Peycelon
- AP-HP, Hôpital Universitaire Robert-Debré, Pediatric Urology Department, Reference Center for Rare Diseases (CRMR), Malformations Rares des Voies Urinaires (MARVU), Université de Paris, Paris, France
| | - Sabine Irtan
- Paediatric Surgery Department, Trousseau Hospital - Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Florent Guerin
- Paediatric Surgery Department, Groupement Hospitalier Paris Sud (GHUPS), Hôpital Bicêtre, Le Kremlin-Bicetre, France
| | - Anne Dariel
- Pediatric Surgery Department, Hôpital d'enfants de la Timone, Marseille, France
| | - Claude Borionne
- Pediatric Surgery Department, Hôpital d'enfants de la Timone, Marseille, France
| | - Louise Galmiche
- Pathology Department, CHU de Nantes, Hôtel-Dieu, 1, Place Alexis-Ricordeau, 44000, Nantes, France
| | - Julien Rod
- Department of Pediatric Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14000, Caen, France.,Laboratory INSERM U1086, ANTICIPE, Centre François Baclesse, Caen, France
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17
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Lata K, Davis AA, Sehrawat V, Panwar A, Kriplani I, Kriplani A. Universal Laparoscopic Approach with Emphasis on Ovarian Preservation and Use of Indigenous Bags for Spillage Free Removal of Dermoid Cysts: Update on Technique. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kusum Lata
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Delhi, New Delhi, India
| | - Amenda Ann Davis
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurgaon, Haryana, India
| | - Vandana Sehrawat
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurgaon, Haryana, India
| | - Akshita Panwar
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurgaon, Haryana, India
| | - Isha Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Delhi, New Delhi, India
| | - Alka Kriplani
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurgaon, Haryana, India
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18
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Bou Zerdan M, Bouferraa Y, Boyrazian R, Skaf R. Fertility in multiple recurrent bilateral ovarian teratomas: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221074471. [PMID: 35127098 PMCID: PMC8808009 DOI: 10.1177/2050313x221074471] [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: 09/14/2021] [Accepted: 12/24/2021] [Indexed: 11/20/2022] Open
Abstract
Very few cases of bilateral and recurrent teratomas have been reported. We present the case of a 21-year-old nulliparous female who presented to an outside facility complaining of left flank pain and was found to have bilateral ovarian teratomas. The physician proceeded with a laparotomy. Five years later, the patient presented to our facility complaining of abdominal pain. Imaging revealed a second incidence of bilateral dermoid cysts for which she underwent a bilateral laparoscopic cystectomy. The patient retained her fertility and was able to deliver a newborn 2 years later. At the age of 31, and during a regular check-up, the patient was found again to have a third incidence of bilateral dermoid cysts for which she underwent bilateral laparoscopic cystectomy with preservation of her ovaries. In conclusion, laparoscopic removal of dermoid cysts is of utmost importance to retain the fertility of young patients. Regular check-up by ultrasound post-operatively is necessary to screen for recurrences and prevent painful presentations.
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Affiliation(s)
- Maroun Bou Zerdan
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Balamand, Beirut, Lebanon
| | - Youssef Bouferraa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Balamand, Beirut, Lebanon
| | - Raffi Boyrazian
- Department of Pathology, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Rana Skaf
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Balamand, Beirut, Lebanon
- Department of Obstetrics and Gynecology, Saint George Hospital University Medical Center, Beirut, Lebanon
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19
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Jha S, Goel G, Sinha HH, Anant M, Agarwal M. Effects of Intraoperatively Ruptured Ovarian Dermoid Cysts. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sangam Jha
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences Patna, Patna, Bihar, India
| | - Garima Goel
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences Patna, Patna, Bihar, India
| | - Hemali Heidi Sinha
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences Patna, Patna, Bihar, India
| | - Monika Anant
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences Patna, Patna, Bihar, India
| | - Mukta Agarwal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences Patna, Patna, Bihar, India
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20
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García-Ríos LE, García-Ávila AK, Luna-Castillo M, Anda-González JGD, Medrano-Guzmán R. Giant liver teratoma with gliosis peritonei treated by right extended hepatectomy: Overview and case report. Ann Hepatobiliary Pancreat Surg 2021; 25:544-550. [PMID: 34845129 PMCID: PMC8639313 DOI: 10.14701/ahbps.2021.25.4.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/03/2021] [Accepted: 05/12/2021] [Indexed: 11/17/2022] Open
Abstract
Germ cell tumors (GCTs) are considered as extragonadal if there is no evidence of a primary tumor in the testes or ovaries. GCTs can be classified as seminomas, non-seminomatous, mature teratomas, and immature teratomas based upon histology. Mature teratomas are generally found in prepuberal children. Less than 1% of them have been reported in the gastrointestinal tract and liver. Liver teratomas are extremely rare. There are only 11 cases reported in adults up to 2018. Isolated liver metastasis of ovarian teratoma is also very rare. We present a case of a late metachronous recurrence of liver cystic teratoma with gliosis peritonei in a female adult treated by a right extended hepatectomy along with a literature review.
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Affiliation(s)
- Luis Enrique García-Ríos
- Department of Surgical Oncology, Soft Tissue, Bone Tumors and Digestive Tract Tumors, Oncology Hospital, XXI Century National Medical Center, Mexican Institute of Social Security, Mexico City, Mexico
| | - Ana K García-Ávila
- Department of Surgical Oncology, Soft Tissue, Bone Tumors and Digestive Tract Tumors, Oncology Hospital, XXI Century National Medical Center, Mexican Institute of Social Security, Mexico City, Mexico
| | - Marisol Luna-Castillo
- Department of Surgical Oncology, Soft Tissue, Bone Tumors and Digestive Tract Tumors, Oncology Hospital, XXI Century National Medical Center, Mexican Institute of Social Security, Mexico City, Mexico
| | - Jazmín G De Anda-González
- Department of Pathology, Oncology Hospital, XXI Century National Medical Center, Mexican Institute of Social Security, Mexico City, Mexico
| | - Rafael Medrano-Guzmán
- Department of Surgical Oncology, Soft Tissue, Bone Tumors and Digestive Tract Tumors, Oncology Hospital, XXI Century National Medical Center, Mexican Institute of Social Security, Mexico City, Mexico
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21
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Tatekawa Y. Surgical approach to three pediatric patients with ovarian tumors: laparoscopic excision using a specimen retrieval bag. J Surg Case Rep 2021; 2021:rjab505. [PMID: 34760219 PMCID: PMC8575496 DOI: 10.1093/jscr/rjab505] [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: 09/28/2021] [Revised: 10/08/2021] [Accepted: 10/20/2021] [Indexed: 11/24/2022] Open
Abstract
We report our experience with three pediatric patients with ovarian tumors who underwent laparoscopic excision using a specimen retrieval bag. Patient 1 was a 12-year-old girl with a left ovarian tumor. The tumor was laparoscopically placed in a specimen retrieval bag and removed through a suprapubic incision without content spillage. Patient 2 was a 14-year-old girl with a left ovarian tumor. The tumor was laparoscopically placed in a specimen retrieval bag. The contents of the tumor were aspirated, and the tumor was removed without content spillage. Patient 3 was a 13-year-old girl with bilateral large ovarian tumors. After releasing torsion of the left-sided mass, each tumor was laparoscopically placed in a specimen retrieval bag and excised. Peritoneal lavage was performed due to content spillage. The pathologic findings confirmed mature teratomas in all patients. All three girls have been doing well without evidence of chemical peritonitis or recurrence.
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Affiliation(s)
- Yukihiro Tatekawa
- Correspondence address. Department of Pediatric Surgery, Saku Central Hospital Advanced Care Center 3400-28, Nakagomi, Saku-shi, Nagano 385-0051, Japan. Tel: +81-267-62-8181; Fax: +81-267-88-7354; E-mail:
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22
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Bacalbasa N, Cretoiu D, Halmaciu I, Diaconu C, Iliescu L, Dima S, Neacsu A, Balalau C, Bratu OG, Balescu I. Squamous Cell Carcinoma from Abscessed, Mature Cystic Ovarian Teratoma - A Case Report and Literature Review. In Vivo 2021; 34:2141-2146. [PMID: 32606195 DOI: 10.21873/invivo.12020] [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] [Received: 03/28/2020] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Malignant transformation of mature cystic ovarian teratoma is a scarce eventuality, only rare cases being reported so far. Furthermore, development of this transformation in the setting of an abscessed tumor is even scarcer. The aim of this study was to report the case of a 47-year-old patient submitted to surgery for such a lesion. CASE REPORT The patient was investigated for diffuse pelvic pain and diagnosed with a 10×7×8 cm mass at the level of the left adnexa with imaging findings suggesting the presence of an ovarian teratoma. The patient was submitted to surgery involving a total hysterectomy with bilateral adnexectomy, lymphadenectomy and peritoneal biopsies. The histopathological examination demonstrated the presence of squamous cell carcinoma areas transformation in association with areas of abscess. Postoperatively the patient was submitted to six cycles of platinum-based chemotherapy and concurrent external radiotherapy. At one-year follow-up she is free of recurrent disease. CONCLUSION Although malignisation of mature cystic ovarian teratoma is a rare event, it should not be omitted when mature ovarian teratoma is suspected; however, association between malignant transformation and abscess is a scarcer eventuality.
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Affiliation(s)
- Nicolae Bacalbasa
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania .,Department of Obstetrics and Gynecology, "I. Cantacuzino" Clinical Hospital, Bucharest, Romania.,Department of Visceral Surgery, Center of Excellence in Translational Medicine "Fundeni" Clinical Institute, Bucharest, Romania
| | - Dragos Cretoiu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"Alessandrescu-Rusescu" National Institute of Mother and Child Health, Fetal Medicine Excellence Research Center, Bucharest, Romania
| | - Ioana Halmaciu
- Department of Anatomy, "George Emil Palade" University of Medicine, Pharmacy, Science and Technology, Târgu Mureş, Romania
| | - Camelia Diaconu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Internal Medicine, University Emergency Hospital Bucharest, Bucharest, Romania
| | - Laura Iliescu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Internal Medicine, "Fundeni" Clinical Institute, Bucharest, Romania
| | - Simona Dima
- Department of Visceral Surgery, Center of Excellence in Translational Medicine "Fundeni" Clinical Institute, Bucharest, Romania
| | - Adrian Neacsu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Obstetrics and Gynecology, "St. John" Emergency Clinical Hospital, Bucharest, Romania
| | - Cristian Balalau
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Surgery, "Pantelimon" Clinical Hospital, Bucharest, Romania
| | - Ovidiu Gabriel Bratu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Urology, Emergency Central Military Hospital, Academy of Romanian Scientists, Bucharest, Romania
| | - Irina Balescu
- Department of Surgery, "Ponderas" Academic Hospital, Bucharest, Romania
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23
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Benedict MA, Adefuye AO. A classic case suggestive of an unruptured ectopic pregnancy with unexpected finding of a unilateral dermoid cyst intraoperatively: A case report. S Afr Fam Pract (2004) 2020; 62:e1-e5. [PMID: 33314946 PMCID: PMC8378139 DOI: 10.4102/safp.v62i1.5164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/19/2020] [Accepted: 09/20/2020] [Indexed: 11/28/2022] Open
Abstract
Acute lower abdominal pain or pelvic pain is a common presenting complaint in women of reproductive age, which can be accounted for by numerous aetiologies. The presentation of lower abdominal pain with associated findings of an adnexal mass on transvaginal ultrasonography and positive beta-human chorionic gonadotropin (β-hCG) (serum and urine) in a sexually active woman of reproductive age is an ectopic pregnancy until proven otherwise. Here, we present a classic case suggestive of an unruptured ectopic pregnancy, with an unexpected finding of a unilateral dermoid cyst intraoperatively in a 33-year-old woman. Findings presented herein suggest that practitioners in our local setting should evaluate patients carefully, and consider neoplasms as a possible source of β-hCG production in sexually active women of reproductive age who present with subacute lower abdominal pain, identified adnexal mass on ultrasonography and positive serum or urine β-hCG readings.
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Affiliation(s)
- Matthew A Benedict
- Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein.
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24
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Rengaraj S, Chaturvedula L, Murugesan K, Aneja T, Toi PC. Catastrophic Cascade of Laparoscopic Management of Dermoid Cyst: A Rare Presentation of Immature Teratoma. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2019.0065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Sasirekha Rengaraj
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Latha Chaturvedula
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Kanmani Murugesan
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Tripti Aneja
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Pampa Ch Toi
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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25
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Spontaneously Ruptured Dermoid Cysts and Their Potential Complications: A Review of the Literature with a Case Report. Case Rep Obstet Gynecol 2020; 2020:6591280. [PMID: 32292616 PMCID: PMC7150697 DOI: 10.1155/2020/6591280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/17/2020] [Accepted: 03/09/2020] [Indexed: 11/24/2022] Open
Abstract
Spontaneous ruptures of dermoid cysts are a rare occurrence due to their thick capsules. This is the first systematic review on spontaneously ruptured dermoid cysts. A comprehensive literature search was performed from PubMed, Google Scholar, and MEDLINE. The cases were analysed for patient demographics, presenting signs and symptoms, imaging modalities used, management methods, and outcomes. The majority of cases report an idiopathic cause with symptoms of abdominal pain, distension, and fever. Computed tomography is the most accurate in detecting ruptured dermoid cysts. We also report a case of a 66-year-old who presented with sudden abdominal pain and a low-grade temperature. Imaging showed a 10 cm well-circumscribed hyperechoic mass consistent with a dermoid cyst with no suggestive signs of rupture. She was planned for a laparoscopic bilateral salpingo-oophorectomy. However, intraoperatively, a ruptured dermoid cyst was found with bowel adhesions and chemical peritonitis as cyst contents covered the entirety of the intra-abdominal cavity. Her operative course was complicated by inadvertent iatrogenic small bowel injury, unsuccessful laparoscopy, needing conversion to laparotomy. Despite their benign nature, complications from ruptured dermoid cysts include peritonitis, bowel obstruction, and abscesses. Surgical management by both laparoscopy and laparotomy is successful, with laparotomies more likely to be performed. Complications have mostly no long-term sequelae.
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26
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Atilgan R, Pala Ş, Bulu G. Purse-string suture technique using a mini-Pfannenstiel incision to treat large dermoid cysts. J OBSTET GYNAECOL 2020; 40:1160-1163. [PMID: 32037929 DOI: 10.1080/01443615.2019.1706161] [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: 10/25/2022]
Abstract
This study describes the purse-string suture technique using a mini-Pfannenstiel incision for the surgical treatment of large ovarian dermoid cysts. We investigated intra and postoperative outcomes in 24 patients who underwent removal of large ovarian dermoid cysts through a mini-Pfannenstiel incision using the purse-string suture technique. The surgical procedure was performed by two experienced surgeons. The mean diameter of the cysts was 11.9 cm. The mean operation time was 46 min and the intraoperative rupture rate was 8.3%. No patient developed chemical peritonitis. The length of hospitalisation was 36 h. The recurrence rate was 8.3% in the same ovary at 1-year follow-up. In conclusion, ovarian dermoid cysts measuring >8 cm in diameter can be effectively treated through a mini-Pfannenstiel incision using the purse-string suture technique.Impact StatementWhat is already known on this subject? Dermoid cysts are the most common ovarian germ cell tumours occurring in the second and third decades of life, and these tumours are usually treated surgically. There is a lack of consensus among gynaecologists regarding the optimal surgical treatment modalities for ovarian dermoid cysts; however, laparoscopic cystectomy is the gold standard for the surgical treatment of dermoid cysts. Notably, aspiration of dense cystic contents may be difficult during laparoscopic cystectomy.What do the results of this study add? Our technique enables easy removal of dense cystic materials including hair and bone fragments. The short operation time, low recurrence rate and the minimal incisional scar serve as advantages of our novel method.What are the implications of these findings for clinical practice and/or further research? This surgical technique can be successfully used in clinical settings with limited facilities for laparoscopic surgery.
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Affiliation(s)
- Remzi Atilgan
- Department of Obstetrics and Gynecology, Firat University School of Medicine, Elazig, Turkey
| | - Şehmus Pala
- Department of Obstetrics and Gynecology, Firat University School of Medicine, Elazig, Turkey
| | - Gülay Bulu
- Department of Obstetrics and Gynecology, Firat University School of Medicine, Elazig, Turkey
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27
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Hassan SA, Akhtar A, Falah NU, Sheikh FN. Malignant Thyroid-type Papillary Neoplasm in Struma Ovarii: A Case Report. Cureus 2019; 11:e6450. [PMID: 32010534 PMCID: PMC6975244 DOI: 10.7759/cureus.6450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Papillary thyroid carcinoma (PTC) arising in a coexistent struma ovarii (SO) is a rare malignancy. It manifests with abdominal symptoms such as palpable mass, pain, distension, and possibly ascites. It is usually diagnosed postoperatively, and its histopathological diagnostic criteria remain identical to that of papillary carcinoma of the thyroid gland. Due to the relative rarity of the disease, definitive guidelines for its overall management are still undefined. We present a case of a 51-year old female with suspicion of a left ovarian tumor due to her presenting symptoms: raised serum CA-125 levels and abnormal abdominopelvic CT scan findings. She underwent complete surgical debulking of the mass (total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO), omentectomy, appendectomy, and pelvic lymphadenectomy). The mass was postoperatively diagnosed by histopathology as PTC in SO (stage IA). Furthermore, our patient did not receive any adjuvant treatment. The patient has been disease-free for 24 months post-surgery and is scheduled for regular biannual follow-ups.
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Affiliation(s)
| | - Ali Akhtar
- Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Noor Ul Falah
- Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Fahad N Sheikh
- Internal Medicine, Sahiwal Medical College, Sahiwal, PAK
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Prodromidou A, Pandraklakis A, Loutradis D, Haidopoulos D. Is There a Role of Elevated CA 19-9 Levels in the Evaluation of Clinical Characteristics of Mature Cystic Ovarian Teratomas? A Systematic Review and Meta-analysis. Cureus 2019; 11:e6342. [PMID: 31938630 PMCID: PMC6952044 DOI: 10.7759/cureus.6342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The role of preoperative CA 19-9 levels in patients with ovarian mature cystic teratoma (MCT) and the association of elevated levels of the biomarker with patients’ and tumor characteristics were evaluated. Four electronic databases were searched for articles published up to September 2019. Trials that evaluated the significance of elevated CA 19-9 in patients with ovarian MCTs and publications with > 20 patients were considered eligible for inclusion. Seven studies that included 995 patients with an ovarian MCT who were evaluated with elevated (n = 364) or normal (n = 631) CA 19-9 levels were included. Mean tumor size was significantly increased in patients with elevated CA 19-9 levels (p = 0.038). The rate of ovarian torsion was significantly increased in the elevated CA 19-9 group (p = 0.04). The present study highlights the importance of CA 19-9 as a marker in the diagnosis of MCT, and a meta-analysis supports that it could raise a high degree of clinical suspicion of early recognition of torsion and early surgical management due to complications related to increased size. Nonetheless, the diagnostic value of CA 19-9 is still limited and CA 19-9 can still serve only as a supplementary diagnostic tool in patients with MCTs.
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Affiliation(s)
- Anastasia Prodromidou
- Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Anastasios Pandraklakis
- Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Dimitrios Loutradis
- Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Dimitrios Haidopoulos
- Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, GRC
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Rodriguez-Purata J, Gonzalez-Foruria I, Montoya-Botero P, Rodriguez I, Hereter L, Polyzos NP, Graupera B, Martínez F, Pascual MA, Coroleu B. Ultrasonographically diagnosed dermoid cysts do not influence ovarian stimulation response in an in vitro fertilization cycle. Gynecol Endocrinol 2019; 35:612-617. [PMID: 30727778 DOI: 10.1080/09513590.2018.1563887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
To determine if patients with a DC respond similarly to ovarian stimulation when compared to patients without a DC. Infertility patients with a DC that underwent IVF between January 2009 and December 2016 were included. A cystic mass with mixed echogenicity, internal echoes similar to thick bands, fatty-fluid level, or an echogenic tubercle with acoustic shadow (Rokitansky nodule) within two years of the cycle characterized the diagnosis. The z-score compared the standard deviations (SDs) in patients with/without a DC and were compared to a nomogram (expected oocytes minus oocytes obtained divided by the SD), adjusted for age and number of oocytes retrieved, built utilizing cycles from noninfertile female patients. Thirty-nine patients with DC and 7839 patients without DC were identified. The mean number of oocytes (8.6 ± 5.8 vs. 8.5 ± 7.7, p = .43) and MIIs (6.7 ± 4.7 vs. 7.0 ± 6.7, p = .74) retrieved were similar. When cycles with and without a DC were compared to the nomogram (z-score of 0), cycles with a DC presented a z-score for ovarian response of 0.1921 SDs from the mean, and patients without DC presented a z-score of -0.2065 SDs from the mean (similar and less than -1.0). After building a population 'normal' response as a template, patients with and without a DC responded similar to COS.
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Gadducci A, Guerrieri ME, Cosio S. Squamous cell carcinoma arising from mature cystic teratoma of the ovary: A challenging question for gynecologic oncologists. Crit Rev Oncol Hematol 2018; 133:92-98. [PMID: 30661663 DOI: 10.1016/j.critrevonc.2018.10.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 10/28/2018] [Indexed: 11/19/2022] Open
Abstract
Mature cystic teratomas of the ovary have an incidence of 1.2-14.2 cases per 100.000 people per year. Malignant transformation occurs in approximately 2% of the cases, and usually consists of squamous cell carcinoma. The preoperative detection is difficult and the diagnostic accuracy of ultrasound, magnetic resonance imaging, and computed tomography is debated. The diagnosis is frequently made in the operating room or on final histological examination. Standard treatment consists of bilateral salpingo-oophorectomy, total hysterectomy and comprehensive surgical staging in early disease and optimal cytoreductive surgery in advanced disease. Paclitaxel/carboplatin- based chemotherapy is the most used adjuvant treatment, whereas more aggressive regimens can be adopted in patients with high tumor burden or recurrent disease. The efficacy of radiotherapy is still unproven. The prognosis is poor when the tumor has spread beyond the ovary. There are few information to provide commonly accepted guidelines for this malignancy.
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Affiliation(s)
- Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy.
| | - Maria Elena Guerrieri
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy
| | - Stefania Cosio
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy
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Oide S, Chikazawa K, Imai K, Yoshida C, Kuwata T, Konno R. Cyst contents aspiration before laparoscopically assisted cystectomy in pregnant women. J OBSTET GYNAECOL 2018; 39:286-287. [PMID: 30370795 DOI: 10.1080/01443615.2018.1498467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Shiho Oide
- a Department of Obstetrics and Gynecology, Saitama Medical Center , The Jichi Medical University , Saitama , Japan
| | - Kenro Chikazawa
- a Department of Obstetrics and Gynecology, Saitama Medical Center , The Jichi Medical University , Saitama , Japan
| | - Ken Imai
- a Department of Obstetrics and Gynecology, Saitama Medical Center , The Jichi Medical University , Saitama , Japan
| | - Chikako Yoshida
- a Department of Obstetrics and Gynecology, Saitama Medical Center , The Jichi Medical University , Saitama , Japan
| | - Tomoyuki Kuwata
- a Department of Obstetrics and Gynecology, Saitama Medical Center , The Jichi Medical University , Saitama , Japan
| | - Ryo Konno
- a Department of Obstetrics and Gynecology, Saitama Medical Center , The Jichi Medical University , Saitama , Japan
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Martellosio JP, Landron C, Milin S, Sarfati R, Arrivé F, Beuvon C, Roblot P. [Surgical treatment of an auto-immune hemolytic anemia]. Rev Med Interne 2018; 39:435-438. [PMID: 29650300 DOI: 10.1016/j.revmed.2018.03.018] [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] [Received: 07/31/2017] [Revised: 02/11/2018] [Accepted: 03/10/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Auto-immune hemolytic anemia (AIHA) is a rare cause of anemia, characterized by autoantibodies directed against self red blood cells. It can be primary or secondary, in particular due to lymphoproliferative diseases. CASE REPORT We report the case of a 24-year-old woman who presented with a severe macrocytic anemia associated with an ovarian teratoma. CONCLUSION Ovarian teratoma is a rare cause of secondary AIHA, with only few cases reported. Its treatment differs from primary AIHA as steroids may be ineffective. Indeed, complete response can only be achieved with surgical excision of the tumor.
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Affiliation(s)
- J-P Martellosio
- Service de médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France.
| | - C Landron
- Service de médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - S Milin
- Service d'anatomie et cytologie pathologique, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - R Sarfati
- Service de gynécologie-obstétrique, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - F Arrivé
- Service de médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - C Beuvon
- Service de médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - P Roblot
- Service de médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
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de la Blanca EP, Fernandez-Perez MF, Martin-Diaz EDM, Lozano M, Garcia-Sanchez M, Monedero C. Ultrasound-guided Ex-vivo Retrieval of Mature Oocytes for Fertility Preservation During Laparoscopic Oophorectomy: A Case Report. J Reprod Infertil 2018; 19:174-181. [PMID: 30167399 PMCID: PMC6104431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Cryopreservation of oocytes is an efficient method of fertility preservation (FP) that can be applied in women suffering from gynecologic conditions that menace their reproductive future. Collection of oocytes becomes challenging in some scenarios, like the possibility of an ovarian cancer, the "ex-vivo" harvest of oocytes for FP, aspirating follicles directly from the ovarian specimen already excised by laparotomy or laparoscopy and it is an option for these cases. CASE PRESENTATION In the present case report, the case of a patient with an adnexal mass suspected to be a recurrent teratoma was described who referred to our Assisted Reproduction Unit in Hospital Quironsalud Malaga for FP counseling. After controlled ovarian hyperstimulation, followed by laparoscopic abdominal examination and oophorectomy, an ex-vivo follicular aspiration for oocyte retrieval was performed on the specimen, using a standard ultrasound-guided procedure to ease and improve the process. All the follicles were aspirated and 5 metaphase II oocytes were obtained. CONCLUSION This is to our knowledge, the first communication describing the ex-vivo ovarian aspiration of mature oocytes for FP using standard ultrasound guidance. Although this ultrasound guidance is not completely necessary, as other authors demonstrated previously, such a procedure permitted an easy and complete harvest of oocytes in a rare tumor with bizarre cystic formations, which made follicle recognition very difficult.
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Affiliation(s)
- Enrique Perez de la Blanca
- Department of Assisted Reproduction, Hospital Quironsalud Malaga, Malaga, Spain,Corresponding Author: Enrique Perez de la Blanca, Department of Assisted Reproduction, Hospital Quironsalud Malaga, Malaga, Spain, ORCID: 0000-0002-2379-0987, E-mail:
| | | | | | - Manuel Lozano
- Department of Gynecology, Hospital Quironsalud Malaga, Malaga, Spain
| | | | - Carolina Monedero
- Department of Assisted Reproduction, Hospital Quironsalud Malaga, Malaga, Spain
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Laparoscopic resection of prenatally detected intra-abdominal testicular teratoma: Report of a neonatal case. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Wang YQ, Xia WT, Wang F, Zhuang XX, Zheng FY, Lin F. Use of cancer antigen 125, cancer antigen 19-9, and the neutrophil-to-lymphocyte ratio to diagnose mature cystic teratoma with torsion. Int J Gynaecol Obstet 2017; 137:332-337. [PMID: 28273351 DOI: 10.1002/ijgo.12139] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 01/11/2017] [Accepted: 03/02/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine the efficacy of serum levels of cancer antigen 125 (CA125) and cancer antigen 19-9 (CA19-9), and the neutrophil-to-lymphocyte ratio (NLR) for diagnosis of mature cystic teratoma (MCT) with torsion. METHODS A retrospective medical record review was conducted of data for women who had undergone surgery for ovarian MCT at the First Affiliated Hospital of Wenzhou Medical University, China, between January 1, 2008, and January 1, 2015. Patients with torsion and a control group who underwent surgery on the same days were identified. Clinical characteristics and the serum levels of CA125, CA19-9, and the NLR were assessed. RESULTS The serum levels of CA125, CA19-9, and the NLR were higher in the torsion group (n=68) than in the control group (n=120; P≤0.001 for all). Receiver operating characteristic analysis indicated that the area under the curve for the combined use of CA125, CA19-9, and NLR was 0.978 (95% confidence interval 0.954-1.000; P<0.001). This combination had a diagnostic sensitivity of 93.9% and a specificity of 98.3%. Moreover, levels of these inflammatory markers were significantly increased among patients with large tumor diameters (P<0.01 for all). CONCLUSION The combined measurement of CA125, CA19-9, and the NLR provided an efficient method for the diagnosis of MCT with torsion.
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Affiliation(s)
- Yuan-Qiu Wang
- Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wei-Ting Xia
- Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Fang Wang
- Department of Pathology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | | | - Fei-Yun Zheng
- Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Feng Lin
- Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Wang WC, Lai YC. Evidence of metachronous development of ovarian teratomas: a case report of bilateral mature cystic teratomas of the ovaries and systematic literature review. J Ovarian Res 2017; 10:17. [PMID: 28288660 PMCID: PMC5348818 DOI: 10.1186/s13048-017-0313-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/07/2017] [Indexed: 12/31/2022] Open
Abstract
Background Mature cystic teratomas are usually found in the ovaries. They are bilateral in 10 to 15% of cases and multiple cystic teratomas may be present in one ovary. The aim of this study is to clarify if development of mature cystic teratomas of the ovaries in a single host is metachronous or due to autoimplant or recurrence. Case presentation We report a woman with bilateral mature cystic teratomas of the ovaries. DNA profiles of these teratomas were investigated via short tandem repeat (STR) analysis and methylation statuses were determined via methylation sensitive multiplex ligation-dependent probe amplification methods. The results showed that the cystic teratomas originated from different stages of oogonia or primary oocyte before germinal vesicle stage failure of meiosis I in female gametogenesis. Potentially relevant literature was searched in PubMed database. Cases of bilateral or multiple mature cystic teratomas of the ovaries were analyzed. To date, there has been no reported case of multiple mature cystic teratomas in which clarification of the origin was achieved using molecular genetic methods. Conclusions The results of this case study provide evidence of metachronous development of mature cystic teratomas of the ovaries and may serve as a reference in the management of patients following laparoscopic cystectomy. Electronic supplementary material The online version of this article (doi:10.1186/s13048-017-0313-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wen-Chung Wang
- Department of Obstetrics and Gynecology, Jen-Ai Hospital, Taichung, Taiwan
| | - Yen-Chein Lai
- Department of Medical Laboratory and Biotechnology, Chung Shan Medical University, No.110, Sec. 1, Chien Kuo N. Road, Taichung, 402, Taiwan, Republic of China.
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