1
|
Jongjakapun A, Salang L, Aueaungkul A, Kleebkaow P. Chronic interstitial ectopic pregnancy presenting with a negative urine pregnancy test. BMJ Case Rep 2024; 17:e259267. [PMID: 38589241 PMCID: PMC11015295 DOI: 10.1136/bcr-2023-259267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
The ampulla portion of the fallopian tube is the most common site of ectopic pregnancy (70%), with approximately 2% of pregnancies implanted in the interstitial portion. In general, an interstitial ectopic pregnancy (IEP) is difficult to diagnose and is associated with a high rate of complications-most patients with an IEP present with severe abdominal pain and haemorrhagic shock due to an ectopic rupture. Chronic tubal pregnancy (CTP) is an uncommon condition with an incidence of 20%. The CTP has a longer clinical course and a negative or low level of serum beta-human chorionic gonadotropin due to perished chorionic villi. This study presents a case of a woman who was diagnosed with a chronic IEP (CIEP) which was successfully treated by surgery. This case also acts as a cautionary reminder of considering a CIEP in women of reproductive age presenting with amenorrhea, vaginal bleeding and a negative pregnancy test.
Collapse
Affiliation(s)
- Apiwat Jongjakapun
- Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Lingling Salang
- Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Apiwat Aueaungkul
- Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pilaiwan Kleebkaow
- Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| |
Collapse
|
2
|
Bursać D, Zadro M, Haramina S, Bošnjak DC, Tučkar N, Kuna K. Unusual presentation of late-stage ectopic tubal pregnancy (19 weeks' gestation): Case report and literature review. Eur J Obstet Gynecol Reprod Biol 2024; 295:150-152. [PMID: 38359636 DOI: 10.1016/j.ejogrb.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/23/2024] [Accepted: 02/07/2024] [Indexed: 02/17/2024]
Abstract
Ectopic pregnancy is a medical condition in which a fertilized egg takes an unexpected detour away from the uterine cavity and the fallopian tube becomes a popular host, with the ampulla being the prime location. However, it can occur in other areas such as cervix, ovaries, or abdomen. The most common risk factors are pelvic inflammatory disease, previous pelvic or abdominal surgery, abnormal anatomy of genital organs, endometriosis, previous ectopic pregnancies, assisted reproductive technologies, endocrine disorders, and even the subtle influence of low-dose progestins from contraceptives. We will present a rare case of unrecognized late-stage tubal ectopic pregnancy. The following case report is of a 25-year-old Caucasian female patient (G2, P0) who presented to the emergency department with a 24-hour abdominal pain syndrome. The patient did not have a gynecological examination for this reason. During the examination, taking into account the clinical and ultrasound findings, a suspicion of pregnancy in a bicornuate uterus was raised, and an MRI of the pelvis was performed. MRI showed ectopic pregnancy in the left fallopian tube with a properly developed fetus that corresponded to a gestation of 19 weeks. An emergency laparotomy was performed and the left fallopian tube with the fetus was removed. The early and late course of recovery went smoothly. The patient was discharged after adequate clinical development.
Collapse
Affiliation(s)
- Danijel Bursać
- Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia; University of North, University Center Varaždin, Croatia
| | - Matilda Zadro
- Department of Obstetrics and Gynecology, University Hospital Sisters of Charity, Zagreb, Croatia
| | - Suzana Haramina
- Department of Obstetrics and Gynecology, University Hospital Sisters of Charity, Zagreb, Croatia
| | - Diana Culej Bošnjak
- Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia.
| | - Neven Tučkar
- Department of Obstetrics and Gynecology, University Hospital Sisters of Charity, Zagreb, Croatia; Faculty of Kinesiology, University of Zagreb, Croatia
| | - Krunoslav Kuna
- Department of Obstetrics and Gynecology, University Hospital Sisters of Charity, Zagreb, Croatia
| |
Collapse
|
3
|
Geagea V, Echtay L, Salman F, Ghaname W, Ziadeh H. Isolated torsion of the fallopian tube associated with hematosalpinx in a 17-year-old adolescent: A case report. Int J Gynaecol Obstet 2024; 165:382-383. [PMID: 38112290 DOI: 10.1002/ijgo.15289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Vanessa Geagea
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Leen Echtay
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Firas Salman
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Wadih Ghaname
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Hanane Ziadeh
- Department of Obstetrics and Gynecology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| |
Collapse
|
4
|
Rajanbabu M, Ma K, Shuheibar H, Somoye G, Sirkeci F, Bandyopadhyay SK, Sheen AJ. Primary Hepatic Ectopic Pregnancy: Diagnosis and Laparoscopic Management. J Minim Invasive Gynecol 2024; 31:178-179. [PMID: 38030033 DOI: 10.1016/j.jmig.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/11/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE To demonstrate and discuss a case of primary hepatic ectopic pregnancy and laparoscopic management. DESIGN Case presentation with demonstration of surgical hepatic wedge resection. SETTING Tertiary referral center in Manchester, United Kingdom. INTERVENTIONS A 33-year-old women gravida 13 para 2 with a body mass index of 55 kg/m2 and previous 2 cesarean sections and a laparoscopic cholecystectomy presented to the emergency services after a private ultrasound scan showing a pregnancy of unknown location and a serum human chorionic gonadotropin (hCG) of 18 336 IU/mL. A diagnostic laparoscopy was performed but fallopian tubes were normal with no signs of ectopic pregnancy seen. An abdominal ultrasound scan was performed but did not identify the ectopic pregnancy. Owing to worsening symptoms of pain and rising hCG levels, she underwent a further laparoscopy converted to laparotomy and a left salpingo-oophorectomy for suspected left ovarian pregnancy. However, serum hCG levels continued to rise after the surgery, reaching 36 960 IU/mL. An magnetic resonance imaging scan of her abdomen and pelvis was arranged that showed a 4 cm cystic lesion in the segment V of the liver. Further ultrasound correlation showed a hyperechoic lesion with echogenic components suspicious of an ectopic pregnancy with a fetal pole. Fetal heart action was not visualized. A multidisciplinary team approach was adopted with involvement of the hepatobiliary surgical team, and the option of medical management with methotrexate and surgical excision was considered. A decision was made for surgical excision based on the accessible location of the ectopic pregnancy on segment V and the more controlled and predictable outcome with surgical excision. A preoperative computed tomography scan confirmed the lesion in segment V of liver in keeping with liver capsular implantation of ectopic pregnancy (Video still 1). At laparoscopy the ectopic pregnancy was visualized on the inferior surface of liver close to the inferior margin with a band of overlying omental adhesion (Video still 2). The overlying omental adhesions were sealed and cut with advanced bipolar diathermy, keeping a safe margin from the ectopic pregnancy to minimize any bleeding. The liver capsule was then opened with monopolar diathermy, and the small segment of liver with the ectopic pregnancy was excised using a combination of Bowa-Lotus liver blade (Bowa Medical Ltd). Hemostasis was controlled using Floseal hemostatic matrix and applied pressure laparoscopically. Total operating time was 80 minutes with an estimated blood loss of 500 mL. The patient was discharged on day 3 postoperatively, and follow-up serum hCG excluded residual trophoblastic disease. On review of the clinical case, earlier imaging of the upper abdomen when confronted by a persistent pregnancy of unknown location with high levels of serum hCG would have prevented the second laparoscopy, laparotomy, and salpingo-oophorectomy. In similar cases, it would also help exclude poorly differentiated malignancies as a source of serum hCG. CONCLUSION Only 27 cases of ectopic pregnancy on the liver have been identified in English literature since 1952, based on a MEDLINE and Embase enquiry and further review of all case reports by the authors to avoid duplicates. Estimated incidence of hepatic implantation is 1 in 15 000 pregnancies; 4 case reports of laparoscopic liver resection have been identified and another case managed by suction from the liver surface [1,2]. The key principle demonstrated is to resect the ectopic pregnancy with a safe margin of liver tissue and any adhesions to avoid catastrophic bleeding from direct handling of the ectopic pregnancy.
Collapse
Affiliation(s)
- Manojbabu Rajanbabu
- St. Mary's Hospital, Manchester Foundation Trust, Manchester, United Kingdom (all authors)
| | - Kenneth Ma
- St. Mary's Hospital, Manchester Foundation Trust, Manchester, United Kingdom (all authors)..
| | - Hani Shuheibar
- St. Mary's Hospital, Manchester Foundation Trust, Manchester, United Kingdom (all authors)
| | - Gbolahan Somoye
- St. Mary's Hospital, Manchester Foundation Trust, Manchester, United Kingdom (all authors)
| | - Füsun Sirkeci
- St. Mary's Hospital, Manchester Foundation Trust, Manchester, United Kingdom (all authors)
| | | | - Aali J Sheen
- St. Mary's Hospital, Manchester Foundation Trust, Manchester, United Kingdom (all authors)
| |
Collapse
|
5
|
Shah AS, Menias CO, Schmitt A, Chen L, Magtibay PM, Nguyen B, Martinez F. An Unusual Presentation: High-Grade Serous Carcinoma of the Fallopian Tube Manifesting With Altered Mental Status Secondary to a Single Brain Metastasis-A Case Report and Review of the Literature. J Minim Invasive Gynecol 2024; 31:155-160. [PMID: 37984516 DOI: 10.1016/j.jmig.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 11/22/2023]
Abstract
Epithelial ovarian and fallopian cancers are aggressive lesions that rarely metastasize to the central nervous system. Brain metastases usually occur in the setting of known primary disease or widespread metastatic disease. However, in extremely rare cases, an isolated intracranial neoplasm may be the first presentation of fallopian cancer. To the best of our knowledge, only one such case has been reported previously. We present an illustrative case with multimodality imaging and histopathologic correlation of a fallopian tube carcinoma first presenting with altered mental status secondary to an isolated brain metastasis. A 64-year-old female with no pertinent medical history presented with altered mentation. Initial workup identified a 1.6 cm avidly enhancing, solitary brain lesion at the gray-white junction with associated vasogenic edema concerning for either central nervous system lymphoma or metastatic disease. Additional imaging identified a 7.5 × 3 cm left adnexal lesion, initially thought to be a hydrosalpinx with hemorrhage, but magnetic resonance imaging suggested gynecologic malignancy. No lesions elsewhere in the body were identified. Given the lack of locoregional or systemic disease, the intracranial and pelvic lesions were assumed to represent synchronous but distinct processes. The intracranial lesion was biopsied. Preliminary results were suggestive of lymphoma, but further analysis was consistent with high-grade serous carcinoma of müllerian origin. Positron emission tomography/computed tomography was performed to evaluate for other neoplastic lesions, only highlighting the intracranial and pelvic lesions. At this point, a diagnosis of metastatic fallopian cancer was made. The patient was taken for robot-assisted laparoscopy with surgical debulking of the pelvic neoplasm, pathology demonstrating high-grade serous carcinoma of the fallopian tube, matching that of the intracranial lesion. Even though rare, metastatic fallopian cancer should be considered in patients with isolated brain lesions and adnexal lesions, even in the absence of locoregional or systemic disease.
Collapse
Affiliation(s)
- Amar S Shah
- Department of Radiology (Drs. Shah, Menias, Nguyen, and Martinez).
| | | | | | | | - Paul M Magtibay
- Department of Gynecology (Dr. Magtibay), Mayo Clinic in Arizona, Phoenix, AZ
| | - Ba Nguyen
- Department of Radiology (Drs. Shah, Menias, Nguyen, and Martinez)
| | - Felipe Martinez
- Department of Radiology (Drs. Shah, Menias, Nguyen, and Martinez)
| |
Collapse
|
6
|
Li M, Lv J. Effect of salpingectomy versus tubal ligation on postoperative wound infection in patients: A meta-analysis. Int Wound J 2024; 21:e14543. [PMID: 38272821 PMCID: PMC10805532 DOI: 10.1111/iwj.14543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 01/27/2024] Open
Abstract
After several institutions recommended salpingectomy as opposed to tubal ligation, we attempted to perform meta-analysis to compare operative properties and rates of postoperative wound infections. There are no temporal or linguistic limitations to our search in PubMed, Cochrane Library and Embase. The search was carried out in September 2023. The database search identified 401 potential studies and five studies were included in the meta-analysis. Our study involved a comparison of salpingectomy with tube ligating in female patients who wanted to be sterilized. Our trial included at least one result of the wound and haemorrhage. The articles that did not qualify for inclusion or did not submit data, and those who did not answer questions were excluded. Abstracts and full-text articles were assessed independently by two authors using blinding. Conflicting decisions were settled by consensus. The Cochrane-recommended ROBINS-I instrument has been applied to evaluate the risk of bias in clinical trials and to establish the quality of inclusion. Two authors separately evaluated the risk of bias for each trial; differences were settled by consensus. There were no statistically significant differences in the rate of postoperative wound infections among those who had received salpingectomy or tubal ligation (OR, 0.46; 95% CI, 0.18-1.20 p = 0.11). In the three trials, the risk of bleeding following the ligation of the fallopian tubes was lower than that of the salpingectomy group (OR, 1.25; 95% CI, 1.21-1.30 p < 0.0001). From this information we have come to the conclusion that it is possible to give preference to tubal ligation for reduction of bleeding in suitable circumstances, and that the findings currently do not provide sufficient evidence for a reduction in the risk of postoperative wound infection.
Collapse
Affiliation(s)
- Min Li
- Department of Pre‐Pregnancy and Post‐Natal CareJinan Second Maternanl and Child Health HospitalJinanChina
| | - Jian Lv
- Department of ObstetricsJinan Second Maternanl and Child Health HospitalJinanChina
| |
Collapse
|
7
|
Tachi E, Yokota Y, Shiota K, Hirata T. Isolated Fallopian Tube Torsion Associated with Tubal Pregnancy. J Obstet Gynaecol Can 2023; 45:102084. [PMID: 36868353 DOI: 10.1016/j.jogc.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 12/24/2022] [Accepted: 12/29/2022] [Indexed: 03/05/2023]
Affiliation(s)
- Emiri Tachi
- Department of Integrated Women's Health, St. Luke's International Hospital
| | - Yuko Yokota
- Department of Integrated Women's Health, St. Luke's International Hospital
| | - Kyoko Shiota
- Department of Integrated Women's Health, St. Luke's International Hospital
| | - Tetsuya Hirata
- Department of Integrated Women's Health, St. Luke's International Hospital.
| |
Collapse
|
8
|
Sastre J, Mínguez JÁ, Alcázar JL, Chiva L. Microsurgical anastomosis of the fallopian tubes after tubal ligation: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2023; 291:168-177. [PMID: 38353086 DOI: 10.1016/j.ejogrb.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/04/2023] [Accepted: 10/12/2023] [Indexed: 02/16/2024]
Abstract
OBJECTIVE Between 20% and 30% of women who have undergone tubal ligation regret their decision. The alternative to regain fertility for these women is either in vitro fertilization or tubal re-anastomosis. This article presents a systematic review with meta-analysis to assess the current evidence on the efficacy of tubal recanalization surgery in patients who have previously undergone tubal ligation. STUDY DESIGN The search was conducted in the World of Science (WOS) database, The Cochrane Library and ClinicalTrials.gov record using the keywords "tubal reversal", "tubal reanastomosis" and "tubal anastomosis". The review was carried out by two of the authors. Data from 22 studies were evaluated, comprising over 14,113 patients who underwent the studied surgery, following strict inclusion criteria: articles published between January 2012 and June 2022, in English and with a sample size bigger than 10 patients were included. A random-effects meta-analysis was performed. RESULTS The overall pregnancy rate after anastomosis was found to be 65.3 % (95 % CI: 61.0-69.6). The percentage of women who had at least one live birth, known as the birth rate, was 42.6 % (95 % CI: 34.9-51.4). Adverse outcomes after surgery were also examined: the observed abortion rate among women who underwent surgery was 9.4 % (95 % CI: 7.0-11.7), and the overall ectopic pregnancy rate was 6.8 % (95 % CI: 4.6-9.0). No differences were found between the outcomes when differentiating surgical approaches: laparotomy, laparoscopy, or robotic-assisted surgery. The patient's age was identified as the most significant determining factor for fertility restoration. Finally, when comparing the results of tubal reversal with in vitro fertilization, reversal procedures appear more favorable for patients over 35 years old, while the results are similar for patients under 35 years old, but more data is needed to evaluate this finding. CONCLUSION Therefore, the available literature review demonstrates that surgical anastomosis following tubal ligation is a reproducible technique with relevant success rates, performed by multiple expert groups worldwide.
Collapse
Affiliation(s)
- Juan Sastre
- Department of Obstetrics and Gynecology. Clínica Universidad de Navarra, Spain
| | - José Ángel Mínguez
- Department of Obstetrics and Gynecology. Clínica Universidad de Navarra, Spain
| | - Juan Luis Alcázar
- Department of Obstetrics and Gynecology. Clínica Universidad de Navarra, Spain
| | - Luis Chiva
- Department of Obstetrics and Gynecology. Clínica Universidad de Navarra, Spain.
| |
Collapse
|
9
|
Long Y, Lin Y, He J, Zhu R. Treatment outcomes of tubal pregnancy with tubal preservation: A meta-analysis. Medicine (Baltimore) 2023; 102:e36165. [PMID: 38013278 PMCID: PMC10681471 DOI: 10.1097/md.0000000000036165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Ectopic pregnancy is a common gynecological emergency that poses a significant risk of maternal mortality during the first trimester. It also increases the incidence of infertility and repeated ectopic pregnancy. The aim of this study was to evaluate whether there is a difference in the degree of tubal patency between salpingostomy and systemic treatment with methotrexate (MTX), as well as the odds of intrauterine pregnancy and repeat ectopic pregnancy, and the degree of tubal patency in salpingectomy with or without tubal suturing. METHODS We searched PubMed, EMBASE, and the Cochrane Library up to April 2023. Four randomized controlled trials were included in the review. We analyzed the combined data using Review Manager 5.3 software and Stata 12.0 software, utilizing a random effects model. RESULTS When comparing salpingostomy and systemic treatment with MTX, there was no significant difference in the degree of tubal patency (OR = 1.09, 95% CI (0.54-2.38), P = .83). For salpingostomy with or without tubal suturing, there were no significant differences in the rates of intrauterine pregnancy, repeat ectopic pregnancy, and tubal patency degree [(OR = 1.05, 95% CI (0.41-2.68), P = .92), (OR = 0.68, 95% CI (0.19-2.42), P = .92), (OR = 1.68, 95% CI (0.14-20.33), P = .68)]. CONCLUSION This meta-analysis demonstrates that systemic treatment with MTX is an effective treatment for patients who wish to preserve their fallopian tubes without undergoing surgery. This form of treatment can help avoid surgical procedures that may damage the fallopian tubes and improve fertility prospects. If choosing surgery, we believe that opting for salpingostomy without tubal suturing could reduce the operation time and minimize damage.
Collapse
Affiliation(s)
- Yan Long
- Luzhou Maternal and Child Health Hospital (Luzhou Second People’s Hospital), Sichuan Province, China
| | - Yong Lin
- Luzhou Maternal and Child Health Hospital (Luzhou Second People’s Hospital), Sichuan Province, China
| | - Jin He
- Luzhou Maternal and Child Health Hospital (Luzhou Second People’s Hospital), Sichuan Province, China
| | - Rong Zhu
- Luzhou Maternal and Child Health Hospital (Luzhou Second People’s Hospital), Sichuan Province, China
| |
Collapse
|
10
|
Khromchenko K, Aikman N, Sun X, ElSahwi K. Early-stage serous fallopian tube carcinoma. BMJ Case Rep 2023; 16:e255638. [PMID: 37996138 PMCID: PMC10668166 DOI: 10.1136/bcr-2023-255638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
Primary fallopian tube carcinoma (PFTC) is a rare disease. Its location, close association with epithelial ovarian carcinoma, and lack of specific signs and symptoms make diagnosis challenging especially in its early stages. We report a postmenopausal patient who presented with a 2-month history of abdominopelvic pain with watery vaginal discharge. Imaging findings showed a 7 cm complex left adnexal mass. The patient underwent a robotic-assisted total laparoscopic hysterectomy and bilateral salpingo-oophorectomy and surgical staging. Findings were significant for stage IA serous fallopian tube carcinoma. PFTC is sometimes missed preoperatively and intraoperatively. Available literature review has focused on the clinical and imaging characteristics of PFTC to aid in timely disease diagnosis. Minimally invasive surgery is a viable option in the diagnosis and management of early-stage ovarian cancer due to improved visualisation of pelvic structures, decreased length of hospital stay, decreased estimated blood loss and lower postoperative complication rates compared with laparotomy.
Collapse
Affiliation(s)
- Keren Khromchenko
- Department of Obstetrics and Gynecology, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Noelle Aikman
- Department of Obstetrics and Gynecology, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Xiu Sun
- Department of Pathology, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Karim ElSahwi
- Division of Gynecologic Oncology, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ, USA
| |
Collapse
|
11
|
Dujardin M, Timmermans M, Closon F, De Landsheere L, Nisolle M. [Management of tubal ectopic pregnancies with methotrexate : is it an effective treatment ?]. Rev Med Liege 2023; 78:634-640. [PMID: 37955293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Ectopic pregnancy is a gynecological emergency. The hCG level, the clinical presentation and the ultrasound remain the key steps for the diagnosis. The criteria tend to be more and more codified to decide on the optimal treatment, however, there is no consensus. The aim of this study was to evaluate the impact of applying a mathematical formula to predict the failure rate of metho-trexate for tubal ectopic pregnancy. A retrospective, monocentric study was conducted on a cohort of 193 patients for whom the formula could be calculated. Regarding our professional practice, the success rate of first-line metho-trexate is 93 %. It would increase to 96 % if the formula had been applied. The use of the formula would also reduce the rate of first-line surgery by 12 %.
Collapse
Affiliation(s)
| | - Marie Timmermans
- Service de Gynécologie-Obstétrique, CHU Citadelle, Liège, Belgique
| | - François Closon
- Service de Gynécologie-Obstétrique, CHU Citadelle, Liège, Belgique
| | | | - Michelle Nisolle
- Service de Gynécologie-Obstétrique, CHU Citadelle, Liège, Belgique
| |
Collapse
|
12
|
Traisrisilp K, Sethasathien S. Large unruptured tubal pregnancy mimicking abdominal pregnancy. BMJ Case Rep 2023; 16:e256090. [PMID: 37816580 PMCID: PMC10565280 DOI: 10.1136/bcr-2023-256090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
Ectopic pregnancy accounts for 1-2% of all pregnancies. Ultrasound is the primary diagnostic tool to locate pregnancy outside the uterus and identify complications such as haemoperitoneum. In inconclusive cases, MRI is an adjunctive imaging modality offering more precise tissue differentiation and helpful to location identification. Presented is an unusual case of tubal pregnancy. The patient in her 30s, who was 14 weeks into her first pregnancy, had a suspected abdominal pregnancy. Both transabdominal ultrasound and an MRI indicated an ectopic pregnancy, likely originating from the right fallopian tube. A successful laparotomy and right salpingectomy were performed without complications. Rarely, as in this case, large unruptured and advanced tubal pregnancies can mimic an abdominal pregnancy, underscoring the importance of disease recognition and familiarity with uncommon image findings. An accurate diagnosis of pregnancy location is crucial for effective case management.
Collapse
Affiliation(s)
- Kuntharee Traisrisilp
- Obstetric and Gynecology, Chiang Mai University, Faculty of Medicine, Chiang Mai, Thailand
| | - Sethawat Sethasathien
- Obstetric and Gynecology, Chiang Mai University, Faculty of Medicine, Chiang Mai, Thailand
| |
Collapse
|
13
|
Zhan H, Zhang H, Sun J, Wang W, Zhu J, Huang X. Refractory florid cystic endosalpingiosis: A case report with 5 years follow up and literature review. Int J Gynaecol Obstet 2023; 163:44-50. [PMID: 37014527 DOI: 10.1002/ijgo.14764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/13/2023] [Indexed: 04/05/2023]
Abstract
Endosalpingiosis is characterized by the presence of ectopic, benign glands with a fallopian tube-like ciliated epithelium. Florid cystic endosalpingiosis (FCE) is a rare type of endosalpingiosis and presents with tumor-like lesions. In general, FCE has no specific clinical features. In this case, extensive pelvic multiple Müllerian cysts were first observed and removed during the patient's second cesarean section. Lesions relapsed after a year. Therefore, the patient underwent total hysterectomy and bilateral salpingectomy; pathology revealed that the patient had FCE. According to imaging studies during the follow up, recurrent and progressive multiple pelvic and extra-pelvic cysts were observed. The patient had no obvious symptoms, and the results of her laboratory tests were within normal limits. Ultrasound-guided aspiration and lauromacrogol sclerotherapy were performed, and in the past year, the cysts have stabilized without progression. This is the first reported case of recurrent FCE after total hysterectomy and bilateral salpingectomy with a 5-year follow up. A literature review and novel ideas for diagnosing and managing FCE based on this case are also presented.
Collapse
Affiliation(s)
- Hong Zhan
- Zhejiang Provincial Key Laboratory of Precision Diagnosis and Therapy for Major Gynecological Diseases, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Obstetrics and Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongyun Zhang
- Department of Ultrasound, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jin Sun
- Department of Radiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenwen Wang
- Department of Pathology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiang Zhu
- Department of Ultrasound, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiufeng Huang
- Zhejiang Provincial Key Laboratory of Precision Diagnosis and Therapy for Major Gynecological Diseases, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Obstetrics and Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
14
|
Crosier CJ, Ricca RL. Isolated Fallopian Torsion: A Pediatric Case Series. Am Surg 2023; 89:3917-3919. [PMID: 37204787 DOI: 10.1177/00031348231175118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Isolated fallopian tube torsion is a rare cause of acute abdominal pain in adolescent females. It is known to be a surgical emergency as it may lead to ischemia of the fallopian tube which can result in necrosis, infertility or infection. Presenting symptoms and radiographic findings are vague making diagnosis difficult, often requiring direct visualization in the operating room to make the definitive diagnosis. There has been an increase in this diagnosis at our institution in the previous year prompting compilation of cases and a literature review.
Collapse
Affiliation(s)
| | - Robert L Ricca
- Department of Pediatric Surgery, Prisma Health Upstate, Greenville, SC, USA
| |
Collapse
|
15
|
Sokalska A, Rambhatla A, Dudley C, Bhagavath B. Nontubal ectopic pregnancies: overview of diagnosis and treatment. Fertil Steril 2023; 120:553-562. [PMID: 37495011 DOI: 10.1016/j.fertnstert.2023.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 07/28/2023]
Abstract
Nontubal ectopic pregnancies occur as a result of embryo implantation outside the uterine cavity and fallopian tubes. Sites include ovary, cervix, abdominal cavity, interstitial portion of fallopian tube, and cesarean scar. Nontubal pregnancies are uncommon. Nonspecific signs and symptoms of nontubal ectopic pregnancies make diagnosis challenging and, in many cases, significantly delayed, resulting in a high rate of morbidity. Although surgical management remains the mainstay of treatment, there is growing evidence that some of these can be managed medically or with the use of a combination of medical and surgical approaches with good outcome. This review summarizes the current diagnostic modalities, therapeutic options, and outcomes for nontubal ectopic pregnancies. Diagnostic and management options may be limited, especially in resource-restricted settings. Therefore, an understanding of the available options is critical. It needs to be emphasized that the rarity of cases and the difficulties in organizing ethically justified randomized trials result in the lack of well-established management guidelines for nontubal ectopic pregnancies.
Collapse
Affiliation(s)
- Anna Sokalska
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California.
| | - Anupama Rambhatla
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California
| | - Christina Dudley
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin
| | - Bala Bhagavath
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin
| |
Collapse
|
16
|
Murakami H, Fujiwara S, Nishie R, Ueda S, Terada S, Yamada T, Ohmichi M. Hereditary breast and ovarian cancer triggered by occult fallopian tube cancer: a case report. J Med Case Rep 2023; 17:351. [PMID: 37592269 PMCID: PMC10436669 DOI: 10.1186/s13256-023-04095-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/21/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND At the time of benign gynecological surgery, a prophylactic salpingo-oophorectomy or salpingectomy is increasingly being performed concurrently to reduce the risk of future ovarian and fallopian tube cancer. We herein describe a case of hereditary breast and ovarian cancer syndrome in which a hysterectomy and bilateral adnexectomy were performed with a preoperative diagnosis of benign tumor. A detailed pathological examination revealed occult fallopian tube cancer, and additional staging surgery provided an accurate pathology diagnosis. CASE PRESENTATION A 72-year-old Japanese woman with a past history of breast cancer underwent a hysterectomy and bilateral oophoro-salpingectomy for the preoperative diagnosis of uterine myoma and a right para-ovarian cyst. In the detailed pathological examination, high-grade serous carcinoma of the right fallopian tube was detected incidentally, and a subsequent staging laparotomy confirmed single para-aortic lymph node metastasis. Furthermore, a mutation in germline BRCA2 was detected postoperatively, and the patient was finally diagnosed with hereditary breast and ovarian cancer syndrome. She was diagnosed with fallopian tube cancer International Federation of Gynecology and Obstetrics Stage IIIA1(i) and started on adjuvant therapy (six courses of paclitaxel and carboplatin followed by maintenance therapy with olaparib), and 18 months after surgery, she was free of disease. CONCLUSION This is a case of fallopian tube cancer that was diagnosed incidentally and then accurately staged with additional advanced staging surgery. Even in the absence of grossly malignant findings, a detailed pathological search of the fallopian tubes and accurate staging surgery are important to make the necessary treatment decisions for the patient.
Collapse
Affiliation(s)
- Hikaru Murakami
- Department of Obstetrics and Gynecology, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Satoe Fujiwara
- Department of Obstetrics and Gynecology, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
| | - Ruri Nishie
- Department of Obstetrics and Gynecology, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Shoko Ueda
- Department of Obstetrics and Gynecology, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Shinichi Terada
- Department of Obstetrics and Gynecology, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Takashi Yamada
- Department of Pathology, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Masahide Ohmichi
- Department of Obstetrics and Gynecology, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| |
Collapse
|
17
|
Młodawski J, Kardas-Jarząbek A, Młodawska M, Świercz G. Conservative Management of Heterotopic Pregnancy: A Case Report and Review of Literature. Am J Case Rep 2023; 24:e940111. [PMID: 37550961 PMCID: PMC10421752 DOI: 10.12659/ajcr.940111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/06/2023] [Accepted: 06/07/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Tubal heterotopic pregnancy is an extremely rare complication of pregnancy, in which there is a simultaneous presence of a pregnancy in the uterine cavity and in an ectopic location, most commonly in the fallopian tube. The management of such cases is not clearly established. In the case of a desire to maintain an intrauterine pregnancy, the surgical procedure consisting of a salpingectomy or salpingostomy is the most common. Such a procedure is effective, but it involves potential complications typical of surgeries, so, in some cases, it seems reasonable to apply the expectant management. CASE REPORT A 31-year-old woman was admitted to the clinic due to pain in the right lower abdomen. An ultrasound examination revealed a gestational sac in the uterine cavity corresponding to 5 weeks of pregnancy with a yolk sac. A twin sac was found in the right fallopian tube. Due to the patient's mild symptoms, absence of bleeding into the peritoneal cavity, concerns about the safety of the embryo and the pregnant woman in case of surgery, conservative management was decided. On the 20th day, the patient was discharged from the clinic with a viable intrauterine pregnancy and a partially absorbed ectopic pregnancy. CONCLUSIONS In the case of an ectopic tubal pregnancy, if there are no symptoms of bleeding into the peritoneal cavity, it is possible to adopt a safe conservative approach with strict patient observation.
Collapse
Affiliation(s)
- Jakub Młodawski
- Collegium Medicum, Jan Kochanowski University in Kielce, Kielce, Poland
| | | | - Marta Młodawska
- Collegium Medicum, Jan Kochanowski University in Kielce, Kielce, Poland
| | - Grzegorz Świercz
- Collegium Medicum, Jan Kochanowski University in Kielce, Kielce, Poland
| |
Collapse
|
18
|
Wang Y. An isolated left sided fallopian tube with gangrenous necrosis in an adolescent. Arch Gynecol Obstet 2023; 308:639-640. [PMID: 35999404 DOI: 10.1007/s00404-022-06749-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/12/2022] [Indexed: 11/02/2022]
Affiliation(s)
- Ying Wang
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Longshan Road 120, Yubei District, Chongqing, China.
| |
Collapse
|
19
|
Trecourt A, Devouassoux-Shisheboran M, Nohuz E, Cerruto E, Moret S, Hallez D, Miguet-Bensouda C, Chene G. Clinical and histopathological correlations in symptomatic patients with salpingectomy for Essure ® implant removal: a cross-sectional study. EUR J CONTRACEP REPR 2023; 28:227-233. [PMID: 37365993 DOI: 10.1080/13625187.2023.2218953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/18/2023] [Accepted: 05/24/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE Many concerns have been raised about adverse effects related to Essure® device. Several pathophysiological hypotheses have been proposed including allergic reactions, Autoimmune/Autoinflammatory Syndrome Induced by Adjuvants, galvanic corrosion with release of heavy metals and inflammation. In the present study, we aimed to focus on inflammation process by performing a histopathological evaluation of Fallopian tubes in symptomatic patients with Essure® removal. MATERIALS AND METHODS A cross-sectional study with identification of the type of inflammatory response and characterisation of inflammatory cells in the surrounding tubal tissue around the Essure® (STTE) and at distance from the implant. Histopathological and clinical correlations were also investigated. RESULTS In the STTE from 47 cases, acute inflammation was observed in 3/47 (6.4%) cases. Chronic inflammation with lymphocytes (42.5%, 20/47) was associated with a significant higher pre-operative pain score (p = .03). Fibrosis was noted in 43/47 (91.5%) cases. Fibrosis without lymphocytes (51.1%, 24/47) was statistically associated with significant reduced pain (p = .04). At distance from the Essure® implant, only chronic inflammation with lymphocytes was present in 10/47 (21.7%) cases. CONCLUSIONS Inflammation response do not seem to be enough to explain all the Essure-related adverse outcomes, suggesting the involvement of other biological mechanisms. CLINICALTRIALS.GOV IDENTIFIER NCT03281564.
Collapse
Affiliation(s)
- Alexis Trecourt
- Multi-Site Department of Pathology, Lyon Sud University Hospital, Chemin du Grand-Revoyet, University Hospital of Lyon, Pierre-Bénite, France
| | - Mojgan Devouassoux-Shisheboran
- Multi-Site Department of Pathology, Lyon Sud University Hospital, Chemin du Grand-Revoyet, University Hospital of Lyon, Pierre-Bénite, France
| | - Erdogan Nohuz
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, Bron, France
| | - Emanuele Cerruto
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, Bron, France
| | - Stephanie Moret
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, Bron, France
| | - Doriane Hallez
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, Bron, France
| | - Chloe Miguet-Bensouda
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, Bron, France
| | - Gautier Chene
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University Hospital of Lyon, Bron, France
- University Claude Bernard of Lyon 1, EMR 3738 CICLY, Lyon, France
| |
Collapse
|
20
|
Amir W, Zafarullah S, Waheed MR, Anwar J, Asghar MS. Obstructed inguinal hernia containing ovary with an ovarian cyst: a case report. J PAK MED ASSOC 2023; 73:1302-1304. [PMID: 37427636 DOI: 10.47391/jpma.6407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A 27-year-old married woman came to the emergency room (ER) with the chief complaint of severe pain in the abdomen for 3 days, which was more pronounced in the right iliac fossa, along with the complaint of multiple episodes of vomiting for the last 6 hours. She also gave a history of swelling in the right inguinal region for last 9 months with the complaint of mild on and off pain in the swelling. On physical examination, diagnosis of obstructed inguinal hernia was made. Ultrasonography (USG) of abdomen was of no use, as it only commented on hernial defect and not on the contents of the hernial sac. An emergency surgery was planned; marsupialisation of ovarian cyst, repositioning of fallopian tube along with ovary and herniorrhaphy was performed without any difficulty.
Collapse
Affiliation(s)
- Wajahat Amir
- Department of Surgery, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - Sadaf Zafarullah
- Department of Surgery, King Edward Medical University, Mayo Hospital, Lahore,Pakistan
| | | | - Jamal Anwar
- Department of Surgery, King Edward Medical University, Mayo Hospital,Lahore, Pakistan
| | | |
Collapse
|
21
|
Kayastha S, Bharati A, Shrestha A, Shrestha S, Pandey A, Panday P. Mature Cystic Teratoma at Fallopian Tubes: A Case Series. JNMA J Nepal Med Assoc 2023; 61:465-468. [PMID: 37203904 PMCID: PMC10896449 DOI: 10.31729/jnma.8149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Indexed: 05/20/2023] Open
Abstract
Benign tumors of the fallopian tube are uncommon. Teratomas are most frequently found in the ovary and fallopian tube teratoma is extremely rare. To date, around 70 cases have been described, and most of them were discovered by chance. Here we present two cases of fallopian tube dermoid cyst. The first case is of a woman who was unable to conceive for 4 years with a right ovarian dermoid. She was managed with laparoscopic cystectomy when she was found to have a small teratoma-like lesion at the fimbrial end of the left fallopian tube. The second case is of a female who underwent elective caesarian section and was found to have a teratoma-like lesion at the right fallopian tube. Histopathology of both cases were reported as mature cystic teratoma. These cases suggest the need for careful examination of the pelvic organs for other pathology apart from the primary surgical sites. Keywords case reports; dermoid cyst; fallopian tube; infertility.
Collapse
Affiliation(s)
| | - Akrity Bharati
- Vatsalya Natural IVF, Grande City Hospital Pvt. Ltd., Kantipath, Kathmandu, Nepal
| | | | | | - Asmita Pandey
- Vatsalya Natural IVF, Grande City Hospital Pvt. Ltd., Kantipath, Kathmandu, Nepal
| | - Pratikshya Panday
- Vatsalya Natural IVF, Grande City Hospital Pvt. Ltd., Kantipath, Kathmandu, Nepal
| |
Collapse
|
22
|
Stewart JK, Hipolito Canario DA, Daso G, Thapa D, Montgomery S, Kohi M. Use of n-Butyl-2-Cyanoacrylate for Fallopian Tube Embolization via Selective Catheterization in a Rabbit Model: Feasibility Study for Potential Nonsurgical Sterilization. J Vasc Interv Radiol 2023; 34:225-233. [PMID: 36306987 DOI: 10.1016/j.jvir.2022.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 10/08/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To determine whether fallopian tube embolization with n-butyl-2-cyanoacrylate (nBCA) administered via a microcatheter in a rabbit model was technically feasible and resulted in short-term tubal occlusion. MATERIALS AND METHODS In 10 female New Zealand white rabbits, the 2 cervices were cannulated using a 5-F catheter and hydrophilic guide wire transvaginally. Salpingography confirmed tubal patency bilaterally. A 2.4-F microcatheter was advanced to the distal fallopian tube, and nBCA/ethiodized oil was administered as the microcatheter was withdrawn to fill the length of the tube. A metallic coil was deployed prior to nBCA administration in half of the fallopian tubes. Rabbits were evaluated for tubal occlusion with salpingography at 1 month, followed by euthanasia and histopathologic analysis. Inflammation and fibrosis were graded from 0 (normal) to 3 (severe). RESULTS Fallopian tube embolization was technically successful in 17 (85%) of 20 fallopian tubes. Thirteen (76%) of 17 embolized fallopian tubes were occluded at 1 month on salpingography (nBCA only, 7/9; nBCA and coil, 6/8). On histopathologic analysis, direct or indirect evidence of occlusion was observed in 14 (82%) of 17 fallopian tubes. Mild or early fibrosis was observed in 65% of the tubes. The mean inflammation and fibrosis scores for the embolized tubes were 0.62 and 0.94, respectively. CONCLUSIONS This pilot study demonstrated that embolization of rabbit fallopian tubes using nBCA administered via a microcatheter is technically feasible and results in occlusion of most fallopian tubes in the short term with minimal inflammation. Investigation of efficacy in preventing pregnancy over the long term is warranted.
Collapse
Affiliation(s)
- Jessica K Stewart
- Division of Interventional Radiology, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California.
| | - Diego A Hipolito Canario
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Gabrielle Daso
- Division of Interventional Radiology, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Diwash Thapa
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Stephanie Montgomery
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Maureen Kohi
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| |
Collapse
|
23
|
Marchand GJ, Masoud AT, King AK, Brazil GM, Ulibarri HM, Parise JE, Arroyo AL, Coriell CL, Goetz SP, Moir CJ, Govindan ML. Salpingectomy, tubal ligation and hysteroscopic occlusion for sterilization. Minerva Obstet Gynecol 2022; 74:452-461. [PMID: 35912465 DOI: 10.23736/s2724-606x.22.05134-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Sterilization of females is considered one of the most prevalent contraceptive techniques among women in the United States. There are many surgical sterilization procedures including salpingectomy, tubal ligation, and hysteroscopic occlusion of the fallopian tubes. We provide an overview of these methods from the clinical data and latest studies available on this topic. EVIDENCE ACQUISITION In order to review the latest literature on the topic, we searched electronic databases including PubMed, Web of Science, Scopus, and Cochrane library for all eligible studies from May 1st 2018 until May 1st 2022 using the following strategy: ("fallopian tube removal" OR Salpingectomy OR "fallopian tube excision" OR "tubal sterilization") AND ("tubal ligation" OR "bipolar coagulation" OR "tubal clip" OR "tubal ring" OR fimbriectomy). We reviewed every study that met our criteria and subjectively considered their results and methodology into this narrative review. EVIDENCE SYNTHESIS In addition to reviewing major guidelines in the United States, 19 recent studies met our eligibility criteria and were included in this review. We grouped the findings under the following headings: anatomical and physiological considerations, sterilization, salpingectomy, tubal ligation, and hysteroscopic tubal occlusion. CONCLUSIONS Bilateral salpingectomy and techniques of tubal ligation or occlusion continue to be effective procedures with good safety profiles. All techniques have similar surgical outcomes and long-term success rates. As salpingectomy has the advantage of reducing the risk of occurrence of ovarian cancer, this is preferential when feasible. Hysteroscopic occlusion techniques may be more minimally invasive but have the disadvantages of delayed efficacy, the need for a second invasive diagnostic procedure, and limited availability.
Collapse
Affiliation(s)
- Greg J Marchand
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA -
| | - Ahmed T Masoud
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
- Faculty of Medicine, University of Fayoum, Fayoum, Egypt
| | - Alexa K King
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Giovanna M Brazil
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Hollie M Ulibarri
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Julia E Parise
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Amanda L Arroyo
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Catherine L Coriell
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Sydnee P Goetz
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Carmen J Moir
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Malini L Govindan
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| |
Collapse
|
24
|
Ji M, Jin Y, Chen X, Li Y, Rahman J, Dai H. Primary mucosa-associated lymphoid tissue lymphoma in fallopian tubes: A case report and literature review. Medicine (Baltimore) 2022; 101:e30228. [PMID: 36042662 PMCID: PMC9410653 DOI: 10.1097/md.0000000000030228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Mucosa-associated lymphoid tissue (MALT) lymphoma accounts for 7%-8% of newly diagnosed lymphomas. The stomach is the most common organ of origin (nearly 50% of MALT lymphomas). Only 2% of MALT lymphomas arise from the female genital tract, and most originated from uterus. We described a rare case of MALT lymphoma primarily arising from the fallopian tube. PATIENT CONCERNS A 26-year-old woman was brought into our gynecological clinic because of a history of irregular menstruation. The transvaginal ultrasonography revealed cystic masses in bilateral adnexa and both of them showed rich vasculature. Laboratory tests showed a high level (455.3 U/mL) of cancer antigen-125 (CA-125). INTERVENTIONS A laparoscopy was performed. OUTCOMES Frozen section of the removed specimen revealed acute and chronic inflammation with abundant inflammatory cells infiltrating the mesenchyme. The right fallopian tube was removed. However, the final histological results showed inflammation accompanied by hyperplasia of lymphoid tissue. Immunohistochemistry staining were consistent with MALT lymphoma. The patient received the second surgery to remove the left fallopian tube and also confirmed the same pathology. LESSONS Gynecologists should be aware of cystic masses which showed rich vasculature and high level of CA-125.
Collapse
Affiliation(s)
- Mengying Ji
- Department of Gynecology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yichao Jin
- Department of Gynecology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Xing Chen
- Department of Gynecology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yujing Li
- Department of Gynecology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Juveria Rahman
- Department of Gynecology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Huihua Dai
- Department of Gynecology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
- * Correspondence: Huihua Dai, PhD, Department of Gynecology, The First Affiliated Hospital with Nanjing Medical University, 368 Jiangdong North Road, Gulou, Nanjing, China. (e-mail: )
| |
Collapse
|
25
|
Restaino S, De Gennaro E, Floris S, Stabile G, Zinicola G, Sorrentino F, Vizzielli G, Driul L. Surgical Treatment Following Failed Medical Treatment of an Interstitial Pregnancy. Medicina (Kaunas) 2022; 58:medicina58070937. [PMID: 35888656 PMCID: PMC9316431 DOI: 10.3390/medicina58070937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022]
Abstract
Interstitial pregnancy (IP) is a type of ectopic pregnancy in which the embryo implants in the interstitial part of the Fallopian tube. It accounts for 2% of all ectopic pregnancies. Signs and symptoms appear later than the other forms of ectopic pregnancies because of its peculiar location. The gold standard for its diagnosis is transvaginal ultrasound. The treatment can be medical or surgical. Medical treatment is based on the systemic or local injection of methotrexate (MTX); a dose of mifepristone can be added with a reported 85–90% success rate. The surgical option is laparoscopic unilateral cornuostomy or unilateral salpingectomy. The therapeutic choice is based on symptoms, serum β-human chorionic gonadotropin (β-hCG) values, and sonographic features. Furthermore, the patient’s fertility perspectives should be considered. We report a case of IP in a Caucasian woman of 29 years old, with a previous salpingectomy for ectopic pregnancy medically treated by a double dose of intramuscular MTX 50 mg/m2 combined with a single dose of leucovorin 15 mg and a single dose of mifepristone 600 mg orally. Medical therapy failed as suggested by the sudden onset of intense pelvic pain after 10 days. Because of the clinical symptoms and the sonographic suspicious of pregnancy rupture due to the modest amount of fluid in the pouch of Douglas, clinicians decided on an urgent unilateral laparoscopic salpingectomy. The hemoperitoneum was drained. The patient was discharged two days later and β-hCG serum levels became negative after 45 days. The advantages of fertility sparing should be weighted according to the patient’s reproductive perspectives. Appropriate counseling is therefore key in managing the treatment of interstitial pregnancy.
Collapse
Affiliation(s)
- Stefano Restaino
- Obstetrics and Gynecology Unit, Department of Obstetrics, Gynecology and Pediatrics, Department of Medical Area DAME, Udine University Hospital, 33100 Udine, Italy; (S.R.); (S.F.)
| | - Elena De Gennaro
- Clinic of Obstetrics and Gynecology, Department of Medical Area (DAME), Hospital of Udine, University of Udine, 33100 Udine, Italy; (E.D.G.); (G.V.); (L.D.)
| | - Stefano Floris
- Obstetrics and Gynecology Unit, Department of Obstetrics, Gynecology and Pediatrics, Department of Medical Area DAME, Udine University Hospital, 33100 Udine, Italy; (S.R.); (S.F.)
| | - Guglielmo Stabile
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, 34100 Trieste, Italy;
| | - Giulia Zinicola
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy;
| | - Felice Sorrentino
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy
- Correspondence:
| | - Giuseppe Vizzielli
- Clinic of Obstetrics and Gynecology, Department of Medical Area (DAME), Hospital of Udine, University of Udine, 33100 Udine, Italy; (E.D.G.); (G.V.); (L.D.)
| | - Lorenza Driul
- Clinic of Obstetrics and Gynecology, Department of Medical Area (DAME), Hospital of Udine, University of Udine, 33100 Udine, Italy; (E.D.G.); (G.V.); (L.D.)
| |
Collapse
|
26
|
Abstract
Ectopic pregnancy is a pregnancy outside the uterine cavity and is, in majority of cases, a non-viable pregnancy. There are multiple methods of managing patients with ectopic pregnancy including expectant, medical and surgical management. Live tubal ectopic pregnancies, also known as ectopic pregnancies present in the fallopian tube with fetal heartbeat still present, are most commonly treated via surgical route. This case outlines the presentation and an unusual method of management of a patient diagnosed with a live tubal ectopic pregnancy with extensive medical and surgical history.
Collapse
Affiliation(s)
| | - Jane Ding
- Department of Obstetrics and Gynaecology, Royal London Hospital, London, UK
| | - Joe Aquilina
- Department of Obstetrics and Gynaecology, Royal London Hospital, London, UK
| | - Mary Gbegbaje
- Department of Obstetrics and Gynaecology, Royal London Hospital, London, UK
| |
Collapse
|
27
|
Cheng P, Yang XH. Preservation of the fallopian tube in ectopic tubal pregnancy. An analysis of the outcome of two laparoscopic surgical approaches. Ann Ital Chir 2022; 93:241-247. [PMID: 35166230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The application of laparoscopic partial tubal resection with end-to-end anastomosis can reduce the incidence of persistent ectopic pregnancy. AIM We aim to compare the therapeutic effects of laparoscopic fenestration and laparoscopic partial tubal resection with end-to-end anastomosis in the treatment of tubal ectopic pregnancy. MATERIAL AND METHODS The patients were randomly divided into the observation group (the group treated with laparoscopic partial tubal resection with end-to-end anastomosis, n=238) and the control group (the group treated with laparoscopic fenestration, n=213). The average operation time, intraoperative blood loss, postoperative exhaust time and hospital stay were observed to evaluate the clinical effect. In addition, the time required for the β-HCG to drop to normal level, the patency of the fallopian tubes and the ovarian function were observed in the two groups after the operation. RESULTS There was no significant difference between observation group operation time, intraoperative hemorrhagic amount, blood β-HCG recovery time and hospital time and control group (P > 0.05). The postoperative fallopian tube patency rate in the observation group was 67.58%, significantly higher than the control group (P < 0.05). In addition, there was no significant difference in ovarian function between the two groups. CONCLUSIONS The method of laparoscopic partial tubal resection with end-to-end anastomosis is more effective in the treatment of tubal ectopic pregnancy, and has less impact on ovarian function, which can effectively improve the probability of normal pregnancy after the operation. KEY WORD Fallopian tube, Ectopic pregnancy, Laparoscopic fenestration, Laparoscopic partial tubal resection with end-to-end anastomosis.
Collapse
|
28
|
Dibbern CB, Bergstrand-Poulsen E, Farooqui W, Penninga L. Internal bowel herniation through a peritoneal defect between the right fallopian tube and right ovarian vessels. BMJ Case Rep 2021; 14:e246171. [PMID: 34620639 PMCID: PMC8499314 DOI: 10.1136/bcr-2021-246171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
| | | | - Waqas Farooqui
- Surgery and Transplantation, Rigshospitalet, Copenhagen, Denmark
| | - Luit Penninga
- Surgery and Transplantation, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
29
|
Sato K, Nishijima Y, Tabe K, Sagara Y, Kashiwagi H, Izumi SI, Ishimoto H. Tips and Techniques for Laparoscopic Tubal Reanastomosis: A Case Report. Tokai J Exp Clin Med 2021; 46:137-141. [PMID: 34498250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/11/2021] [Indexed: 06/13/2023]
Abstract
Tubal reanastomosis or tubal reversal, a surgical method used to reverse tubal sterilization, may be an option for women who for various reasons wish to reestablish their fertility. A 38-year-old Chinese woman, gravida 2, para 2 (both delivered through cesarean section) presented to our outpatient gynecology clinic requesting bilateral tubal recanalization. After other causes of infertility were excluded, laparoscopic tubal reanastomosis was performed. Here, we present our tips and techniques for laparoscopic tubal reanastomosis that rapidly resulted in an intrauterine pregnancy, which delivered at term. Laparoscopic tubal reanastomosis is a well-established procedure with good prognosis, as reported in the literature. For women who wish to become pregnant after tubal sterilization, it is necessary to present the option of surgery as well as in vitro fertilization.
Collapse
Affiliation(s)
- Kenji Sato
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
| | | | | | | | | | | | | |
Collapse
|
30
|
de Matos VL, Pessanha I, David DA, Gante I. Isolated torsion of a fallopian tube: an uncommon cause of abdominal pain in an 11-year-old. BMJ Case Rep 2021; 14:e243947. [PMID: 34433530 PMCID: PMC8388290 DOI: 10.1136/bcr-2021-243947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 11/04/2022] Open
Abstract
This report describes a rare case of isolated fallopian tube torsion (IFTT) in a premenarchal 11-year-old girl. The patient presented with subacute abdominal pain, associated with nausea and vomiting. Sonographic findings revealed left tube enlargement with free intraperitoneal fluid. Doppler mapping was not unequivocal. During exploratory laparoscopy, a large pelvic necrotic mass was found to be a twisted left fallopian tube. After detorsion, salpingectomy was performed and the patient recovered promptly, showing no complications 3 months post operation. IFTT should be considered as a differential diagnosis of lower abdominal pain in adolescent girls with normal-appearing ovaries on ultrasound. Conservative management for fertility preservation is the ideal approach. Therefore, avoiding delay in laparoscopy is crucial.
Collapse
Affiliation(s)
- Victória Leones de Matos
- Department of Pediatric Surgery, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Inês Pessanha
- Department of Pediatric Surgery, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Daniela Agostinho David
- Department of gynecology and obstetrics, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Inês Gante
- Department of gynecology and obstetrics, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| |
Collapse
|
31
|
São Pedro V, Pires R, Santos F, Tovim Rodrigues C, Santos Silva I, Almeida MC, Águas F. [Opportunistic Salpingectomy for Permanent Contraception: A Cross Sectional Study in Portugal]. ACTA MEDICA PORT 2021; 34:258-265. [PMID: 34214417 DOI: 10.20344/amp.14033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/01/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Opportunistic bilateral salpingectomy has been proposed as an ovarian cancer risk-reducing strategy namely as a means of tubal sterilization. We aimed to assess what were the procedures for interval and peripartum sterilization carried out nationwide, related motivational aspects and influential demographic or professional factors. MATERIAL AND METHODS Cross-sectional study based on an original survey sent to Obstetrics and Gynecology specialists and residents from across the country in 2019. RESULTS Two hundred and twenty-five answers were obtained from 42 institutions (37 from the public sector). Laparoscopic tubal electrocoagulation (61%) was the most common procedure for interval sterilization followed by salpingectomy (28%). Major reasons pointed out for not performing salpingectomy were increased operative time (48.5%) and procedure not considered (45.5%). In some hospitals, the choice of salpingectomy depended on specific criteria namely surgical team decision. During cesarean-section, sterilization was most frequently performed using the modified Pomeroy technique (54%), followed by salpingectomy (32.5%), with a statistically significant prevalence in the north of the country. Sixty-nine percent of Portuguese Obstetrics and Gynecology residents and specialists consider that salpingectomy should be the procedure offered to women asking for definitive contraception. DISCUSSION Although data are limited, salpingectomy at the time of cesarean delivery appears feasible and safe and this context might represent the best opportunity for intervention. CONCLUSION Opportunistic salpingectomy is not the most common sterilization procedure performed in Portugal, but it was considered the best choice to offer. Its benefits and risks should be discussed with women.
Collapse
Affiliation(s)
- Verónica São Pedro
- Serviço de Ginecologia e Obstetrícia B. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Rafaela Pires
- Serviço de Ginecologia e Obstetrícia B. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Fernanda Santos
- Serviço de Ginecologia e Obstetrícia B. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Carla Tovim Rodrigues
- Serviço de Ginecologia e Obstetrícia B. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Isabel Santos Silva
- Serviço de Ginecologia e Obstetrícia B. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Maria Céu Almeida
- Serviço de Ginecologia e Obstetrícia B. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Fernanda Águas
- Serviço de Ginecologia e Obstetrícia B. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| |
Collapse
|
32
|
Abstract
RATIONALE In this article, we report interesting clinical manifestation of spontaneous bilateral fallopian tube pregnancies in a patient with a didelphic uterus. PATIENT CONCERNS A 26-year-old female patient, gravida 2, para 0 + 1, suffered from progressive abdominal pain and vaginal bleeding. A laboratory exam revealed a human chorionic gonadotropin level of 1091 IU/L. Transvaginal ultrasound detected no embryo sacs in the uterus but revealed a didelphic uterus, and a mass measuring 39 mm x 32 mm in the left adnexa region with another mass measuring 42 x 28 mm in the right adnexa region. DIAGNOSES An ectopic pregnancy in the left adnexa region and a corpus hemorrhagicum in the right adnexa region were suspected. INTERVENTIONS Laparoscopic exploration operation confirmed a didelphic uterus, and pathological biopsy revealed bilateral fallopian tube pregnancies. OUTCOMES The patient made a good recovery and the human chorionic gonadotropin became normal within the following 2 months. LESSONS To the best of our knowledge, clinical manifestation of spontaneous bilateral fallopian tube pregnancies in a patient with a didelphic uterus has never been reported before. Based on the experience with this case, we suggest that if a gestational sac is found in 1 fallopian tube, the contralateral fallopian tube needs to be examined for an ectopic pregnancy during surgery.
Collapse
|
33
|
Melo P, Georgiou EX, Johnson N, van Voorst SF, Strandell A, Mol BWJ, Becker C, Granne IE. Surgical treatment for tubal disease in women due to undergo in vitro fertilisation. Cochrane Database Syst Rev 2020; 10:CD002125. [PMID: 33091963 PMCID: PMC8094448 DOI: 10.1002/14651858.cd002125.pub4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Tubal disease accounts for 20% of infertility cases. Hydrosalpinx, caused by distal tubal occlusion leading to fluid accumulation in the tube(s), is a particularly severe form of tubal disease negatively affecting the outcomes of assisted reproductive technology (ART). It is thought that tubal surgery may improve the outcome of ART in women with hydrosalpinges. OBJECTIVES To assess the effectiveness and safety of tubal surgery in women with hydrosalpinges prior to undergoing conventional in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). SEARCH METHODS We searched the Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, DARE, and two trial registers on 8 January 2020, together with reference checking and contact with study authors and experts in the field to identify additional trials. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing surgical treatment versus no surgical treatment, or comparing surgical interventions head-to-head, in women with tubal disease prior to undergoing IVF. DATA COLLECTION AND ANALYSIS We used Cochrane's standard methodological procedures. The primary outcomes were live birth rate (LBR) and surgical complication rate per woman randomised. Secondary outcomes included clinical, multiple and ectopic pregnancy rates, miscarriage rates and mean numbers of oocytes retrieved and of embryos obtained. MAIN RESULTS We included 11 parallel-design RCTs, involving a total of 1386 participants. The included trials compared different types of tubal surgery (salpingectomy, tubal occlusion or transvaginal aspiration of hydrosalpingeal fluid) to no tubal surgery, or individual interventions to one another. We assessed no studies as being at low risk of bias across all domains, with the main limitations being lack of blinding, wide confidence intervals and low event and sample sizes. We used GRADE methodology to rate the quality of the evidence. Apart from one moderate-quality result in one review comparison, the evidence provided by these 11 trials ranged between very low- to low-quality. Salpingectomy versus no tubal surgery No included study reported on LBR for this comparison. We are uncertain of the effect of salpingectomy on surgical complications such as the rate of conversion to laparotomy (Peto odds ratio (OR) 5.80, 95% confidence interval (CI) 0.11 to 303.69; one RCT; n = 204; very low-quality evidence) and pelvic infection (Peto OR 5.80, 95% CI 0.11 to 303.69; one RCT; n = 204; very low-quality evidence). Salpingectomy probably increases clinical pregnancy rate (CPR) versus no surgery (risk ratio (RR) 2.02, 95% CI 1.44 to 2.82; four RCTs; n = 455; I2 = 42.5%; moderate-quality evidence). This suggests that in women with a CPR of approximately 19% without tubal surgery, the rate with salpingectomy lies between 27% and 52%. Proximal tubal occlusion versus no surgery No study reported on LBR and surgical complication rate for this comparison. Tubal occlusion may increase CPR compared to no tubal surgery (RR 3.21, 95% CI 1.72 to 5.99; two RCTs; n = 209; I2 = 0%; low-quality evidence). This suggests that with a CPR of approximately 12% without tubal surgery, the rate with tubal occlusion lies between 21% and 74%. Transvaginal aspiration of hydrosalpingeal fluid versus no surgery No study reported on LBR for this comparison, and there was insufficient evidence to identify a difference in surgical complication rate between groups (Peto OR not estimable; one RCT; n = 176). We are uncertain whether transvaginal aspiration of hydrosalpingeal fluid increases CPR compared to no tubal surgery (RR 1.67, 95% CI 1.10 to 2.55; three RCTs; n = 311; I2 = 0%; very low-quality evidence). Laparoscopic proximal tubal occlusion versus laparoscopic salpingectomy We are uncertain of the effect of laparoscopic proximal tubal occlusion versus laparoscopic salpingectomy on LBR (RR 1.21, 95% CI 0.76 to 1.95; one RCT; n = 165; very low-quality evidence) and CPR (RR 0.81, 95% CI 0.62 to 1.07; three RCTs; n = 347; I2 = 77%; very low-quality evidence). No study reported on surgical complication rate for this comparison. Transvaginal aspiration of hydrosalpingeal fluid versus laparoscopic salpingectomy No study reported on LBR for this comparison, and there was insufficient evidence to identify a difference in surgical complication rate between groups (Peto OR not estimable; one RCT; n = 160). We are uncertain of the effect of transvaginal aspiration of hydrosalpingeal fluid versus laparoscopic salpingectomy on CPR (RR 0.69, 95% CI 0.44 to 1.07; one RCT; n = 160; very low-quality evidence). AUTHORS' CONCLUSIONS We found moderate-quality evidence that salpingectomy prior to ART probably increases the CPR compared to no surgery in women with hydrosalpinges. When comparing tubal occlusion to no intervention, we found that tubal occlusion may increase CPR, although the evidence was of low quality. We found insufficient evidence of any effect on procedure- or pregnancy-related adverse events when comparing tubal surgery to no intervention. Importantly, none of the studies reported on long term fertility outcomes. Further high-quality trials are required to definitely determine the impact of tubal surgery on IVF and pregnancy outcomes of women with hydrosalpinges, particularly for LBR and surgical complications; and to investigate the relative efficacy and safety of the different surgical modalities in the treatment of hydrosalpinges prior to ART.
Collapse
Affiliation(s)
- Pedro Melo
- Buckinghamshire Hospitals NHS Trust, Aylesbury, UK
| | | | - Neil Johnson
- Discipline of Obstetrics and Gynaecology, School of Medicine, Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | | | - Annika Strandell
- Obstetrics and Gynecology, University of Gothenburg, Gothenburg, Sweden
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Christian Becker
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Ingrid E Granne
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| |
Collapse
|
34
|
McQueen BE, Kiatthanapaiboon A, Fulcher ML, Lam M, Patton K, Powell E, Kollipara A, Madden V, Suchland RJ, Wyrick P, O'Connell CM, Reidel B, Kesimer M, Randell SH, Darville T, Nagarajan UM. Human Fallopian Tube Epithelial Cell Culture Model To Study Host Responses to Chlamydia trachomatis Infection. Infect Immun 2020; 88:e00105-20. [PMID: 32601108 PMCID: PMC7440757 DOI: 10.1128/iai.00105-20] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/23/2020] [Indexed: 12/20/2022] Open
Abstract
Chlamydia trachomatis infection of the human fallopian tubes can lead to damaging inflammation and scarring, ultimately resulting in infertility. To study the human cellular responses to chlamydial infection, researchers have frequently used transformed cell lines that can have limited translational relevance. We developed a primary human fallopian tube epithelial cell model based on a method previously established for culture of primary human bronchial epithelial cells. After protease digestion and physical dissociation of excised fallopian tubes, epithelial cell precursors were expanded in growth factor-containing medium. Expanded cells were cryopreserved to generate a biobank of cells from multiple donors and cultured at an air-liquid interface. Culture conditions stimulated cellular differentiation into polarized mucin-secreting and multiciliated cells, recapitulating the architecture of human fallopian tube epithelium. The polarized and differentiated cells were infected with a clinical isolate of C. trachomatis, and inclusions containing chlamydial developmental forms were visualized by fluorescence and electron microscopy. Apical secretions from infected cells contained increased amounts of proteins associated with chlamydial growth and replication, including transferrin receptor protein 1, the amino acid transporters SLC3A2 and SLC1A5, and the T-cell chemoattractants CXCL10, CXCL11, and RANTES. Flow cytometry revealed that chlamydial infection induced cell surface expression of T-cell homing and activation proteins, including ICAM-1, VCAM-1, HLA class I and II, and interferon gamma receptor. This human fallopian tube epithelial cell culture model is an important tool with translational potential for studying cellular responses to Chlamydia and other sexually transmitted pathogens.
Collapse
Affiliation(s)
- Bryan E McQueen
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Amy Kiatthanapaiboon
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - M Leslie Fulcher
- Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Mariam Lam
- Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kate Patton
- Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Emily Powell
- Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Avinash Kollipara
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Victoria Madden
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Robert J Suchland
- University of Washington, Division of Allergy and Infectious Diseases, Department of Medicine, Seattle, Washington, USA
| | - Priscilla Wyrick
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Catherine M O'Connell
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Boris Reidel
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Mehmet Kesimer
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Scott H Randell
- Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Toni Darville
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Uma M Nagarajan
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina, USA
| |
Collapse
|
35
|
Černiauskaitė M, Vaigauskaitė B, Ramašauskaitė D, Šilkūnas M. Spontaneous Heterotopic Pregnancy: Case Report and Literature Review. ACTA ACUST UNITED AC 2020; 56:medicina56080365. [PMID: 32707853 PMCID: PMC7466362 DOI: 10.3390/medicina56080365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 11/16/2022]
Abstract
Heterotopic pregnancy is defined as a condition when intrauterine and extrauterine pregnancy occur simultaneously. It is a life-threatening condition that requires immediate and accurate diagnostics and treatment. We present a case of a 28-year-old primigravida female who conceived spontaneously and at her seventh week of gestation and was presented to the emergency department with weakness and acute pain in lower abdomen. Laboratory tests and transvaginal ultrasonography revealed the diagnosis of heterotopic pregnancy. Urgent laparoscopic salpingotomy was chosen as a treatment option. The ectopic pregnancy was successfully removed with the preservation of the intrauterine embryo and fallopian tubes. The course of pregnancy after the surgery was without complications, and a healthy baby was delivered at the 39th week of gestation. When treated properly and on time, a heterotopic pregnancy can result in live childbirth with favorable outcomes for both the child and the mother.
Collapse
Affiliation(s)
- Miglė Černiauskaitė
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania
- Correspondence: ; Tel.: +370-622-36-570
| | - Brigita Vaigauskaitė
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University Clinic of Obstetrics and Gynaecology, Vilnius University Hospital Santaros Clinics, Santariškių g. 2, 08661 Vilnius, Lithuania; (B.V.); (D.R.); (M.Š.)
| | - Diana Ramašauskaitė
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University Clinic of Obstetrics and Gynaecology, Vilnius University Hospital Santaros Clinics, Santariškių g. 2, 08661 Vilnius, Lithuania; (B.V.); (D.R.); (M.Š.)
| | - Mindaugas Šilkūnas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University Clinic of Obstetrics and Gynaecology, Vilnius University Hospital Santaros Clinics, Santariškių g. 2, 08661 Vilnius, Lithuania; (B.V.); (D.R.); (M.Š.)
| |
Collapse
|
36
|
Bárta J, Klát J. Bilateral simultaneous tubal pregnancy. Ceska Gynekol 2020; 85:15-17. [PMID: 32414280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE We present a rare case of peroperatively diagnosed bilateral tubular pregnancy. DESIGN Case report. SETTING Department of Obstetrics and Gynekology, Novy Jicin Hospital. CONCLUSION In the case of ectopic pregnancy always think about the possibility of contralateral pathology and during the surgical revision remember a thorough inspection of both fallopian tubes.
Collapse
|
37
|
Zhang Q, Xing X, Liu S, Xie X, Liu X, Qian F, Liu Y. Intramural ectopic pregnancy following pelvic adhesion: case report and literature review. Arch Gynecol Obstet 2019; 300:1507-1520. [PMID: 31729562 DOI: 10.1007/s00404-019-05379-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 11/06/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Intramural pregnancy is an uncommon type of ectopic pregnancy, where the gestational sac is completely encircled by myometrium and unconnected with endometrial cavity, fallopian tubes or round ligament. Owing to its potentially life-threatening hemorrhage and uterine rupture, early diagnosis and management are urgently required. We present a case of a woman undergoing zigzag medical procedures, which featured non-consensus preoperative diagnosis of intramural and interstitial pregnancy and an intramural ectopic pregnancy ultimately confirmed and successfully removed by emergency laparoscopy. Additionally, we present a review of the related literature and discuss its varied clinical features, imageological characters, diagnosis, differential diagnosis and multiple treatments. METHODS A comprehensive bibliographic search through PubMed, using keywords: intramural ectopic pregnancy. Relevant literatures published from January 2013 to April 2019 were reviewed. RESULTS Twenty-four cases in total for intramural ectopic pregnancy including this report were reviewed. Diagnoses were mainly made by ultrasound images. Most patients had a history of uterine surgery or intrauterine operation and had been surgically resected. None of the mothers were in danger, but only one case had live birth at 37 weeks of gestation. CONCLUSION Non-specific clinical presentation and non-uniform ultrasound criteria pose a challenge for us to make timely and accurate management. Integrated radiological examinations and communication and cooperation between sonographers and gynecologists play a vital role in diagnostic accuracy and selecting the optimal therapeutic method of an intramural pregnancy.
Collapse
Affiliation(s)
- Qi Zhang
- Department of Medical Ultrasound, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xiaoxiao Xing
- Department of Medical Ultrasound, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Shuiqing Liu
- Department of Medical Ultrasound, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xiao Xie
- Department of Medical Ultrasound, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xia Liu
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Feng Qian
- Department of Medical Ultrasound, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Yanping Liu
- Department of Medical Ultrasound, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.
| |
Collapse
|
38
|
Shevach Alon A, Kerner R, Ginath S, Barda G, Bar J, Sagiv R. Clinical Characteristics of Women with Isolated Fallopian Tube Torsion Compared with Adnexal Torsion. Isr Med Assoc J 2019; 21:575-579. [PMID: 31542899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Isolated fallopian tube torsion (IFTT) is a rare gynecological entity and its diagnosis is challenging. OBJECTIVES To compare clinical characteristics, sonographic findings, surgical management, and outcomes of women with surgically verified IFTT compared to those diagnosed with adnexal torsion. METHODS A retrospective case-control study in a university hospital was conducted. Thirty-four women with surgically verified IFTT between March 1991 and June 2017 were compared to 333 women diagnosed with adnexal torsion within the same time period. RESULTS Both groups presented primarily with abdominal pain, which lasted longer prior to admission among the IFTT group (46.8 ± 39.0 vs. 30.0 ± 39.4 hours, P < 0.001). Higher rates of abdominal tenderness with or without peritoneal signs were found in the adnexal torsion group (90.3% vs. 70.6%, P < 0.001). Sonographic findings were similar; however, an increased rate of hydrosalpinx was found among the IFTT group (5.9% vs. 0.0%, P = 0.008). Suspected adnexal torsion was the main surgical indication in only 61.8% of IFTT cases compared with 79.0% in the adnexal torsion group (P = 0.02). Salpingectomy with or without cystectomy was more commonly performed in the IFTT group (35.3% vs. 1.5%, P < 0.001). The leading pathological findings among the IFTT group were hydrosalpinx and paraovarian cysts. CONCLUSIONS The clinical signs and symptoms of IFTT and adnexal torsion are similar. Although sonographic imaging demonstrating a paraovarian cyst or hydrosalpinx may be helpful in diagnosing IFTT, it is rarely done preoperatively.
Collapse
Affiliation(s)
- Ayala Shevach Alon
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ram Kerner
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shimon Ginath
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Giulia Barda
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Sagiv
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
39
|
Alur-Gupta S, Cooney LG, Senapati S, Sammel MD, Barnhart KT. Two-dose versus single-dose methotrexate for treatment of ectopic pregnancy: a meta-analysis. Am J Obstet Gynecol 2019; 221:95-108.e2. [PMID: 30629908 DOI: 10.1016/j.ajog.2019.01.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/18/2018] [Accepted: 01/02/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare the treatment success and failure rates, as well as side effects and surgery rates, between methotrexate protocols. DATA SOURCES PubMed, Embase, and the Cochrane library searched up to July 2018. STUDY ELIGIBILITY CRITERIA Randomized controlled trials that compared women with ectopic pregnancies receiving the single-dose, two-dose, or multi-dose methotrexate protocols. STUDY APPRAISAL AND SYNTHESIS METHODS Odds of treatment success, treatment failure, side effects, and surgery for tubal rupture, as well as length of follow-up until treatment success, were compared using random and fixed effects meta-analysis. Sensitivity analyses compared treatment success in the groups with high human chorionic gonadatropin (hCG) values and a large adnexal mass, as defined by individual studies. The Cochrane Collaboration tool was used to assess risk of bias. RESULTS The 2-dose protocol was associated with higher treatment success compared to the single-dose protocol (odds ratio [OR], 1.84; 95% CI, 1.13, 3.00). The 2-dose protocol was more successful in women with high hCG (OR, 3.23; 95% CI, 1.53, 6.84) and in women with a large adnexal mass (OR, 2.93; 95% CI, 1.23, 6.9). The odds of surgery for tubal rupture were lower in the 2-dose protocol (OR, 0.65; 95% CI, 0.26, 1.63), but this was not statistically significant. The length of follow-up was 7.9 days shorter for the 2-dose protocol (95% CI, -12.2, -3.5). The odds of side effects were higher in the 2-dose protocol (OR, 1.53; 95% CI, 1.01, 2.30). Compared to the single-dose protocol, the multi-dose protocol was associated with a nonsignificant reduction in treatment failure (OR, 0.56; 95% CI, 0.28, 1.13) and a higher chance of side effects (OR, 2.10; 95% CI, 1.24, 3.54). The odds of surgery for tubal rupture (OR, 1.62; 95% CI, 0.41, 6.49) and time to follow-up (OR, -1.3; 95% CI, -5.4, 2.7) were similar. CONCLUSION The 2-dose methotrexate protocol is superior to the single-dose protocol for the treatment of ectopic pregnancy in terms of treatment success and time to success. Importantly, these findings hold true in patients thought to be at a lower likelihood of responding to medical management, such as those with higher hCGs and a large adnexal mass.
Collapse
Affiliation(s)
- Snigdha Alur-Gupta
- Division of Reproductive Endocrinology and Infertility, University of Pennsylvania, Philadelphia, PA.
| | - Laura G Cooney
- Division of Reproductive Endocrinology and Infertility, University of Pennsylvania, Philadelphia, PA
| | - Suneeta Senapati
- Division of Reproductive Endocrinology and Infertility, University of Pennsylvania, Philadelphia, PA
| | - Mary D Sammel
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA
| | - Kurt T Barnhart
- Division of Reproductive Endocrinology and Infertility, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
40
|
Yuan L, Jingying H, Xiujuan C, Chengying L, Xiaochen H, Xiumei X, Yulong Z, Zihua C. Predictive value of a modified classification of fallopian tube status on prognosis of tubal factor infertility after laparoscopic surgery. Medicine (Baltimore) 2019; 98:e14952. [PMID: 30921195 PMCID: PMC6455906 DOI: 10.1097/md.0000000000014952] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Built on 2 existing classification systems, this study was to develop a new classification system to better predict the pregnancy prognosis after laparoscopic surgery in patients with tubal factor infertility and accordingly propose a management strategy.We followed up 423 patients suffering from tubal factor infertility who had undergone hysteroscopic-laparoscopic surgery for 2 years without in vitro fertilization and embryo transfer (IVF/ET). Based on the operative reports, a new, modified classification of fallopian tube status (hereafter referred to as the modified classification) was developed with reference to the 2 existing classification systems (the r-AFS classification of pelvic adhesions and the scoring system of distal tubal obstruction). A score of 0 to 3 was assigned to each of the 4 factors (tubal wall consistency, hydrosalpinx, pelvic adhesions, and tubal patency) for each of the tubes with a total bilateral score of 0 to 24. The patients were classified for the abnormalities of the fallopian tubes into 3 groups: mild (<8), moderate (8-15) and severe (>15). By utilizing SPSS 20.0 Statistic Analysis Software, the data were analyzed with t test, Chi-Square test, ANOVA or ROC as appropriate.Each of the 4 factors of the modified classification was independently and closely associated with post-surgical prognosis (P < .05). There was a statistically significant difference in postoperative pregnancy prognosis among the 3 groups of patients (P < .05). Patients with a score of <8 (mild) had the highest intrauterine pregnancy rate, reaching 60.1%. In contrast, patients with a score of 8 to 15 (moderate) had a significant increase in ectopic pregnancy (21.5%), while patients with a score of >15 (severe) had a significantly increased infertility rate of 89.5%. When the pregnancy outcomes were divided into intrauterine pregnancy and other outcomes, the modified classification had the largest area under the ROC curve (0.569) (P < .05). With the optimum cutoff of 4.5, the sensitivity was 88.6%, specificity was 74.5% and accuracy was 63.1%.The modified classification of fallopian tube status is a simple and practical scoring system which can comprehensively and effectively evaluate the function of the fallopian tube and thus is more accurate than the other 2 systems in predicting the postoperative pregnancy outcomes.
Collapse
Affiliation(s)
- Lin Yuan
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian
| | - Huang Jingying
- Department of Obstetrics and Gynecology, First Hosipital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, China
| | - Chen Xiujuan
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian
| | - Lian Chengying
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian
| | - Huang Xiaochen
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian
| | - Xiong Xiumei
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian
| | - Zhang Yulong
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian
| | - Chen Zihua
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian
| |
Collapse
|
41
|
Abstract
"To understand the actual world as it is, not as we should wish it to be, is the beginning of wisdom." - Bertrand Russell.
Collapse
Affiliation(s)
- Eve C Feinberg
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
42
|
Verkuyl DAA, van Beekhuizen HJ. [New opportunities for preventing ovarian carcinoma]. Ned Tijdschr Geneeskd 2019; 163:D3562. [PMID: 30730681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A large majority of patients with ovarian carcinoma does not carry a BRCA1/2 mutation, nor another known mutation that increases the risk of ovarian carcinoma. Screening for early ovarian carcinoma in this low-risk group is not efficient. It is, however, a known fact the risk for ovarian carcinoma decreases slightly, but to a statistically significant extent, following sterilisation via tubal occlusion. It has recently become apparent that this risk declines further after complete removal of both fallopian tubes, because many cases of ovarian carcinoma start in or on the tubes. In many countries this knowledge has led to the recommendation to give preference to bilateral total salpingectomy in routine female sterilisation. Additionally, it is often thought advisable that women with completed families who will be undergoing an abdominal intervention should be given timely counselling about an opportunistic bilateral total salpingectomy, even if they are postmenopausal, so that they can make an informed choice. This intervention will probably reduce the risk of ovarian carcinoma by approximately 50%.
Collapse
|
43
|
Abstract
RATIONALE Persistent Müllerian duct syndrome (PMDS) is rare form of male pseudohermaphroditism characterized by the presence of uterus and fallopian tubes with normal external genitalia and secondary sexual characteristics. Transverse testicular ectopia (TTE) is also a rare form of testicular ectopia that may be associated with PMDS. PATIENT CONCERNS We present a 2-year-old boy who presented with bilateral non-palpable testes with left inguinal mass. DIAGNOSIS TTE with PMDS. INTERVENTIONS On exploration, both testes were present in the left inguinal region. Uterus and fallopian tubes were located between the testes. A hysterectomy was perfomed with resection of the underdeveloped fallopian tubes. Bilateral orchiopexy was performed by placing both gonads into subdartos pouches in each scrotum with transseptal approach. OUTCOMES Both testes were palpable in both the scrotum at 1-year postoperative follow-up and we are planning a regular follow-up. LESSONS In case of TTE with PMDS, optimal surgical approach with orchiopexy and excision of Müllerian duct should be needed. A long-term postoperative follow-up is necessary for assessment of malignant transformation and infertility.
Collapse
Affiliation(s)
| | | | | | - Sung-Sun Kim
- Pathology, Chonnam National University Medical School, Gwangju, Korea
| | | |
Collapse
|
44
|
Camus MF, Chauvet P, Hordonneau C, Lafaye AL, Canis M, Bourdel N. Laparoscopic Management of an Intrauterine Fallopian Tube Incarceration After Curettage for a Non-progressing Pregnancy. J Minim Invasive Gynecol 2018; 26:805. [PMID: 30243687 DOI: 10.1016/j.jmig.2018.09.770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 09/12/2018] [Accepted: 09/14/2018] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To report and demonstrate a case of a laparoscopic repair of an intrauterine fallopian tube incarceration as complication of curettage. DESIGN A step-by-step explanation of the surgery using video (instructive video) (Canadian Task Force classification III). SETTING University Hospital Estaing, Clermont-Ferrand, France. PATIENT A 29-year-old woman experiencing a nonevolving pregnancy at 8 weeks underwent curettage. After 9 months, she complained of abnormal vaginal discharge. Ultrasound evaluation showed a right parauterine mass. She reported a maternal medical history of ovarian cancer in a context of Lynch syndrome. Magnetic resonance imaging revealed a right hydrosalpinx 12 mm in diameter, with a suspect fimbriae lesion of the tube and a 7-mm endometriosis nodule of the uterine torus. INTERVENTION We decided to explore the fallopian tube by laparoscopy and to perform hysteroscopy. A fallopian tube incarceration was suspected during hysteroscopy: a defect of the uterine wall was observed, through which there was protrusion of a tubal fimbriae. The laparoscopic view of the pelvis confirmed incarceration of the right fallopian tube through the uterine wall. It was carefully extracted out of the uterine defect, and the uterine wall defect was repaired with an X-point using Monocryl 1. MEASUREMENTS AND MAIN RESULTS A tubal patency test was performed, which was positive on both sides. Because phimosis responsible for the hydrosalpinx had been treated, salpingectomy was not performed. CONCLUSION Curettage for miscarriage or undesired pregnancy is not exempt from complications, such as hemorrhage, simple perforation, and infection. Intrauterine fallopian tube incarceration is uncommon but can affect fertility. This diagnosis is important to avoid destruction of the fimbriae and necrosis of the tube and also to reduce the risk of ectopic pregnancy.
Collapse
Affiliation(s)
- Margaux F Camus
- Departments of Gynecologic Surgery (Drs. Camus, Chauvet, Canis, and Bourdel), Radiology (Dr. Hordonneau) and Anesthesiology (Dr. Lafaye), University Hospital Estaing, Clermont-Ferrand, France..
| | - Pauline Chauvet
- Departments of Gynecologic Surgery (Drs. Camus, Chauvet, Canis, and Bourdel), Radiology (Dr. Hordonneau) and Anesthesiology (Dr. Lafaye), University Hospital Estaing, Clermont-Ferrand, France
| | - Constance Hordonneau
- Departments of Gynecologic Surgery (Drs. Camus, Chauvet, Canis, and Bourdel), Radiology (Dr. Hordonneau) and Anesthesiology (Dr. Lafaye), University Hospital Estaing, Clermont-Ferrand, France
| | - Anne-Laure Lafaye
- Departments of Gynecologic Surgery (Drs. Camus, Chauvet, Canis, and Bourdel), Radiology (Dr. Hordonneau) and Anesthesiology (Dr. Lafaye), University Hospital Estaing, Clermont-Ferrand, France
| | - Michel Canis
- Departments of Gynecologic Surgery (Drs. Camus, Chauvet, Canis, and Bourdel), Radiology (Dr. Hordonneau) and Anesthesiology (Dr. Lafaye), University Hospital Estaing, Clermont-Ferrand, France
| | - Nicolas Bourdel
- Departments of Gynecologic Surgery (Drs. Camus, Chauvet, Canis, and Bourdel), Radiology (Dr. Hordonneau) and Anesthesiology (Dr. Lafaye), University Hospital Estaing, Clermont-Ferrand, France
| |
Collapse
|
45
|
Guan Z, Liu J, Blazek K, Guan X. Robotic Single-Site Tubal Reanastomosis: The Robotic Factor. J Minim Invasive Gynecol 2018; 26:607. [PMID: 30176362 DOI: 10.1016/j.jmig.2018.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/23/2018] [Accepted: 08/25/2018] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE To investigate the advantages of using robotic assistance in tubal reanastomosis surgery. DESIGN A narrated instructional video. SETTING University Hospital, Baylor College of Medicine, Houston, Texas (Canadian Task Force Classification III). PATIENT A 33-year-old woman, G2P2003, who regretted her prior tubal ligation; she continued to request for a tubal reversal with a desire to conceive in the near future. A single-site approach was decided on when she expressed concern for the cosmetic aftermath of multiport surgery. INTERVENTIONS Robotic single-site tubal reanastomosis. MEASUREMENTS AND MAIN RESULTS We performed robotic single-site tubal reanastomosis on the patient. We used the energy instruments of the monopolar hook and the bipolar slotted grasper. Entry was performed in the umbilicus, after which an abdominal survey was conducted to determine and locate the blocked fallopian tubes. A cold scissor, to avoid additional damage to the tubes, was used to resect the portion of the right blocked tube, and a neonatal feeding tube was inserted though both sections of the tube to ensure proper alignment during the repair. Additionally, a figure of eight suture was placed in the mesosalpinx to reduce the amount of tension during the tubal reanastomosis. We used 4 interrupted 5-0 PDS sutures, with 2 wristed needle drivers, to establish and precisely align the 2 sections of tube, first in the mucosal layer and then in the serosal layer, to achieve proper retention. Upon successful chromopertubation with methylene blue dye, the process was repeated on the left side. A successful tubal reanastomosis was completed and chromopertubation clearly demonstrated that the tubes were patent. Total operation time was approximately 100 minutes, resulting in a successful surgery. Estimated blood loss was only 20 mL. At 2 months after surgery a fluoroscopic hysterosalpingogram was conducted to verify the patency of the tubes. We concluded that both tubes were patent. CONCLUSIONS The single-site robotic approach provides a potent and valuable method for tubal reanastomosis, rendering difficult surgical techniques more accessible.
Collapse
Affiliation(s)
| | - Juan Liu
- Guangzhou Medical University, Guangzhou, China
| | - Kelly Blazek
- Minimally Invasive Gynecology Surgery, Baylor College of Medicine, Houston, Texas
| | - Xiaoming Guan
- Guangzhou Medical University, Guangzhou, China; Minimally Invasive Gynecology Surgery, Baylor College of Medicine, Houston, Texas..
| |
Collapse
|
46
|
Rosič M, Žegura B, Vadnjal Đonlagić S. Use of Hysterosalpingo-Foam Sonography for Assessment of the Efficacy of Essure Hysteroscopic Sterilization. J Ultrasound Med 2018; 37:1929-1935. [PMID: 29344973 DOI: 10.1002/jum.14539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/18/2017] [Accepted: 10/19/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Hysterosalpingo-foam sonography (HyFoSy) has been suggested to be a possible less invasive alternative to hysterosalpingography (HSG), which is the reference standard for confirmation of tubal occlusion after Essure (Bayer AG, Leverkusen, Germany) hysteroscopic sterilization. The purpose of our study was to evaluate the accuracy of HyFoSy compared to HSG for confirmation of tubal occlusion after Essure hysteroscopic sterilization. METHODS A prospective study included 90 patients who underwent Essure hysteroscopic sterilization. Twelve weeks after the sterilization, 2-dimensional transvaginal ultrasonography was performed to assess the microinsert position and was followed by HyFoSy and HSG for evaluation of tubal occlusion. Patients with patent fallopian tubes on HSG were scheduled for additional HSG procedures at 3-month intervals until tubal occlusion was documented. RESULTS Of 90 enrolled patients, 86 patients with 170 fallopian tubes underwent the complete imaging protocol. Tubal occlusion was evaluated by HyFoSy as an index test and HSG as a reference standard. The accuracy of HyFoSy was 97.1% (95% confidence interval [CI], 93%-99%). The sensitivity and specificity were 100% (95% CI, 97%-100%) and 54.6% (95% CI, 23%-83%), whereas the positive and negative predictive values were 97.0% (95% CI, 93%-99%) and 100% (95% CI, 42%-100%), respectively. No long-term complications were reported for HyFoSy or HSG. CONCLUSIONS Given that the concordance rate for tubal occlusion between HyFoSy and HSG was not 100%, an occluded fallopian tube on HyFoSy should be confirmed by HSG, which remains the reference standard for confirmation of tubal occlusion after Essure hysteroscopic sterilization.
Collapse
Affiliation(s)
- Maja Rosič
- Departments of General Gynecology and Gynecologic Urology, University Medical Center Maribor, Maribor, Slovenia
| | - Branka Žegura
- Departments of General Gynecology and Gynecologic Urology, University Medical Center Maribor, Maribor, Slovenia
| | | |
Collapse
|
47
|
Subramaniam A, Blanchard CT, Erickson BK, Szychowski J, Leath CA, Biggio JR, Huh WK. Feasibility of Complete Salpingectomy Compared With Standard Postpartum Tubal Ligation at Cesarean Delivery: A Randomized Controlled Trial. Obstet Gynecol 2018; 132:20-27. [PMID: 29889762 PMCID: PMC6019146 DOI: 10.1097/aog.0000000000002646] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the feasibility of salpingectomy compared with standard bilateral tubal ligation at the time of cesarean delivery in women with undesired fertility. METHODS We included women at 35 weeks of gestation or greater desiring permanent sterilization at the time of cesarean delivery. Patients were randomized after skin incision to bilateral salpingectomy or bilateral tubal ligation by a computer-generated scheme. If salpingectomy could not be completed on one or both sides, bilateral tubal ligation was attempted. Primary feasibility outcomes were total operative time and bilateral completion of the randomized procedure. Secondary outcomes included clinically estimated blood loss and surgical complications up to 6 weeks postpartum. We estimated that 80 patients (40 per group) would provide greater than 80% power to identify a 10-minute difference in the primary outcome (time) with a SD of 15 minutes and a two-sided α of 0.05. Analysis was by intent to treat. RESULTS Of 221 women screened from June 2015 to April 2017, 115 (52%) consented to the study; 80 were randomized-40 to salpingectomy and 40 to bilateral tubal ligation. Groups were similar at baseline. A total of 27 bilateral salpingectomies were successfully completed compared with 38 bilateral tubal ligations (68% compared with 95%, P=.002). Total operative time was on average 15 minutes longer for salpingectomies (75.4±29.1 compared with 60.0±23.3 minutes, P=.004). No adverse outcomes directly related to the sterilization procedure were noted in either group. Although estimated blood loss of only the sterilization procedure (surgeon estimate) was greater for the salpingectomy group (median 10 [interquartile range 5-25] compared with 5 [interquartile range 5-10] cc, P<.001), total estimated blood loss and safety outcomes were similar for both groups. CONCLUSION Adding 15 minutes to total operative times, salpingectomy can be successfully completed in approximately two thirds of women desiring permanent contraception with cesarean delivery. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov, NCT02374827.
Collapse
Affiliation(s)
- Akila Subramaniam
- University of Alabama at Birmingham, Center for Women’s Reproductive Health, Department of Obstetrics and Gynecology, Birmingham, AL
| | - Christina T Blanchard
- University of Alabama at Birmingham, Center for Women’s Reproductive Health, Department of Obstetrics and Gynecology, Birmingham, AL
| | - Britt K Erickson
- University of Minnesota, Division of Gynecologic Oncology, Minneapolis, MN
| | - Jeff Szychowski
- University of Alabama at Birmingham, Center for Women’s Reproductive Health, Department of Obstetrics and Gynecology, Birmingham, AL
| | - Charles A Leath
- University of Alabama at Birmingham, Division of Gynecologic Oncology, Birmingham, AL
| | - Joseph R Biggio
- University of Alabama at Birmingham, Center for Women’s Reproductive Health, Department of Obstetrics and Gynecology, Birmingham, AL
- Ochsner Health System, New Orleans, Louisiana
| | - Warner K Huh
- University of Alabama at Birmingham, Division of Gynecologic Oncology, Birmingham, AL
| |
Collapse
|
48
|
Michael Straughn J, Boitano T, Smith HJ, Dilley SE, Liang MI, Novak L. Treatment of low-grade endometrial stromal sarcoma in a nulligravid woman. Gynecol Oncol 2018; 151:6-9. [PMID: 29887484 DOI: 10.1016/j.ygyno.2018.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 32 year-old nulligravid woman with a uterine mass underwent exploratory laparotomy with myomectomy. Final pathology revealed a low-grade endometrial stromal sarcoma (ESS) with positive margins. She subsequently underwent definitive robotic hysterectomy and bilateral salpingectomy with ovarian preservation. She was diagnosed with a stage IB low-grade ESS. She is currently undergoing observation. Discussion of classification, surgical options, and adjuvant therapy is presented.
Collapse
Affiliation(s)
- J Michael Straughn
- University of Alabama at Birmingham, Division of Gynecologic Oncology, United States.
| | - Teresa Boitano
- University of Alabama at Birmingham, Division of Gynecologic Oncology, United States
| | - Haller J Smith
- University of Alabama at Birmingham, Division of Gynecologic Oncology, United States
| | - Sarah E Dilley
- University of Alabama at Birmingham, Division of Gynecologic Oncology, United States
| | - Margaret I Liang
- University of Alabama at Birmingham, Division of Gynecologic Oncology, United States
| | - Lea Novak
- University of Alabama at Birmingham, Department of Pathology, United States
| |
Collapse
|
49
|
Abstract
RATIONALE Fallopian tube carcinoma is a rare female genital cancer with no specific clinical and surgical features. It is hardly diagnosed on imaging due to non-specific presentation. Laparoscopy has been recommended as the diagnostic procedure for the assessment of suspicious ovarian and adnexal masses. However, it has brought new complications like tumor recurrences at the trocar insertion sites, called port-site metastasis (PSM). PATIENT CONCERNS A 65-year-old, postmenopausal woman presented to hospital with loss of appetite, Ultrasound showed ill-defined pelvic mass. The patient was diagnosed with fallopian tube carcinoma by a diagnostic laparoscopy. DIAGNOSES The PSM as a primary complication following diagnostic laparoscopy of fallopian tube carcinoma, which is presumed by positron emission tomography/computed tomography and confirmed by Nodule resection and further pathological assessment. INTERVENTIONS As port-site metastasis was suspected, the patient was advised to undergo umbilical mass resection. OUTCOMES the patient has no signs of recurrence was detected 20 months after the last surgery during follow-up. LESSIONS Laparoscopy plays a significant role in the diagnose and treatment of fallopian tubal and ovarian malignancies but has a risk of PSM occurrence. When isolated PSM occurs the management should be local resection.
Collapse
Affiliation(s)
- Yan Chen
- Department of Gynecology and Obstetrics, Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University
- Department of Gynecology and Obstetrics, Chengdu First People's Hospital, Chengdu, P. R. China
| | - Chen Ling
- Department of Gynecology and Obstetrics, Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University
| | - Ce Bian
- Department of Gynecology and Obstetrics, Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University
| |
Collapse
|
50
|
De Palo G, Spatti GB, Bandieramonte G, Luciani L. Pilot Study with Adjuvant Hormone Therapy in Figo Stage I Endometrial Carcinoma with Myometrial Invasion. Tumori 2018; 69:65-7. [PMID: 6836750 DOI: 10.1177/030089168306900111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A pilot study with adjuvant hormone therapy in FIGO stage I endometrial carcinoma with myometrial invasion was carried out. All patients received total abdominal hysterectomy and bilateral salpingo-oophorectomy plus complementary radium therapy on the vaginal stump. After the conventional treatment, patients were randomly allocated to adjuvant hormone therapy or no further treatment. Hormone therapy consisted of gestonorone caproate (17α-hydroxy-19-norpregn-4-en 3,20 dione caproate) administered i.m. at the dose of 200 mg/week for 1 year. Of the 62 patients who entered the study, 51 were considered evaluable (24 with adjuvant hormone therapy and 27 with no further treatment). Five patients had a relapse: four of these were in the group with no further treatment. Actuarial relapse-free survival analysis at 5 years was 95.7% in the group of adjuvant-treated patients and 82.8% in the control group. Although there is no statistical significance, adjuvant therapy appears to result in an increase in relapse-free survival in the group of patients with deep myometrial invasion and undifferentiated carcinoma. Further studies are necessary to assess the effectiveness of hormone adjuvant treatment in FIGO stage I endometrial carcinoma with myometrial invasion.
Collapse
|