Adenexal Mass Research Articles

Correlation of Risk of Malignancy Index to Malignant Nature of Ovarian Tumours

Background: Ovarian tumours are relatively common and account for ~6% of female malignancies. Risk of malignancy index is used to categorize patients into high, intermediate and low risk groups. Aims: To categorize patients into groups according to risk of malignancy in preoperative periods and correlate the risk of malignancy and to histopathologic nature of ovarian tumours. Study design: Descriptive study. Place and duration of study: Department of Obstetrics & Gynaecology, Independent University Hospital, Faisalabad from 1st September 2017 to 31st August, 2018. Methodology: Sixty patients with adenexal masses were enrolled. All patients were investigated by tumour markers and imaging techniques to diagnose ovarian mass and then categorized according to risk of malignancy index. Staging laparotomy was done and specimen was sent for histopathology which was then correlated to risk of malignancy index. Results: There were 33 (55%) benign and 27 (45%) malignant cases. There were more pre-menopausal patients (43/60) 71.6% while (17/60) 28.33% were post-menopausal. Forty patients (66.6%) had complex ovarian masses (multi-locular, solid areas or associated with ascites). Twenty five (41.6%) patients fall in low risk group with RMI <25, in intermediate risk group with RMI 25-200 were 23 patients (38.3%) and high risk group with RMI >200 had 12 cases (20%). Conclusion: The study correlated the risk of malignancy to malignant nature of tumours. Key words: Risk of malignancy index (RMI), CA-125, Ovarian tumour

Radiological evaluation of ovarian mass by contrast-enhanced computed tomography abdomen with clinicopathological correlation in Eastern Indian population

Background: Adenexal masses present diagnostic challenges. After identification of the ovarian mass, the most critical step is to determine the degree of suspicion for malignancy. It is mainly based on imaging modalities and clinicopathological correlation. Aims and Objectives: This radiological study was designed to differentiate benign and malignant ovarian masses by contrast enhanced-computed tomography (CECT) of abdomen and correlation of the radiological findings with histopathological report. Materials and Methods: This was a hospital-based prospective study conducted in Department of Radiodiagnosis, Nilratan Sircar Medical College and Hospital, Kolkata during January 2019–June 2020. The study was done on clinically suspected 50 patients of 15–50 years with ovarian mass having CECT diagnosed solid/complex solid cystic mass. Results: Among 50 cases under study, 37(74.0%) were benign which was significantly higher than that of malignant cases (26.0%). Malignancy was significantly associated with wall irregularity, solid-cystic composition, presence of thick septations, septal enhancement, presence of both septal, and solid enhancement pattern in CECT. Conclusion: Based on the results of the present study, multi-detector contrast-enhanced CT could be a rapid non-invasive and cost-effective step in the evaluation of ovarian masses.

LAPAROSCOPIC MANAGEMENT OF SUSPICIOS ADENEXAL MASS

ABSTRACT Background: Different tools have been used for prediction of malignancy in ovarian masses; such as tumor markers, ultrasound findings, or other malignancy indices combining more than one variable. Cancer antigen 125 (CA-125) is the most frequently used biomarker for ovarian cancer detection. Objective: To investigate whether laparoscopy could replace safe and effective surgical management of adnexal masses. Patients and Methods: This was a prospective study. It was conducted over 2 years in Al-Maadi Military Hospital and Air force General Hospital. The study was conducted on 100 patients from October 2018 till September 2020. Histopathology was done by Histopathology team at Maadi Military hospital. Results: All 93 patients managed laparoscopically had a benign and malignant diagnosis, whereas 7 of the 19 patients who underwent laparotomy were diagnosed with malignancy. The indications for conversion to laparotomy were malignancies, dense adhesions and small bowel enterotomies. Conclusion: Laparoscopic surgery seemed to offer significant advantages such as reduced hospital stay, less adverse effects, and better quality of life, laparoscopic surgery became a corner stone in management of adenexal masses either benign or malignant especially if the facility of Frozen Section Biopsy can be offered.

To study relation between size of ovary and various histomorphological patterns at SRMSIMS

A study which assess the relation between size of ovary and various histomorphological patterns.Gross examination was done carefully examining the outer surface and on-cut surface of ovary, looking for any cyst with its content and type of fluid filled inside, any solid area, papillary projections and growth. Associated tissue piece if received were also carefully examined and grossed.Radiologically, of total 66 non neoplastic cases, 51 are reported as benign ovarian cyst, 05 as complex ovarian cyst, 04 as hemorrhagic cyst, 03 as bulky uterus and 02 as adenexal mass. 03 out of 05 cases of non-specific oophoritis are reported as benign ovarian cyst, all 01 cases of tuberculosis are reported as complex ovarian cyst. Of 07 follicular cysts, 05 are reported as benign ovarian cyst, 01 as complex ovarian cyst and one each as hemorrhagic cyst and bulky uterus. Of 24 cases diagnosed as simple serous cyst histologically, 20 are reported as benign ovarian cyst, 02 as bulky uterus and 02 as adenexal mass. 04 out of 04 cases of endometriosis are reported as benign ovarian cyst. Observational Study. Viable therapeutic administration of ovarian dangerous tumors keeps on being a test to the oncologist. A precise histopathological determination joined with clinical organizing will help in delivering expeditious and fitting treatment to the patient. The ovary is a successive site for essential malignancy. Because of various cell types and its unpredictable design, essential ovarian neoplasms are of different histological types.

Conundrum of chronic pelvic pain and a pelvic journey of unparalleled grit: The good, the bad, and the ugly

Conundrum of chronic pelvic pain and a pelvic journey of unparalleled grit: The good, the bad, and the ugly

Risk of Malignancy Index (RMI-2) in the Evaluation of Adenexal Masses

Risk of Malignancy Index (RMI-2) in the Evaluation of Adenexal Masses

Ultrasound Criteria and CA-125 for Evaluation of Adenexal Masses in Developing Countries

Ultrasound Criteria and CA-125 for Evaluation of Adenexal Masses in Developing Countries

A Study on Adenexal Masses Diagnosed During Surgery in Pregnancy

A Study on Adenexal Masses Diagnosed During Surgery in Pregnancy

Juvenile granulosa cell ovarian tumor- a rare presentation

Juvenile granulosa cell tumor is a rare gynecologic malignancy. A fourteen year old girl was brought to the emergency with acute abdominal pain with distension of abdomen and admitted in surgical unit, clinically suspected perforation of gut. Transabdominal ultrasonography revealed a right adenexal irregular mass with a moderate amount of ascitic fluid. On laparotomy, it was suspected malignant ovarian tumor stage Ic, and then ipsilateral salphingoophorectomy was done considering the age of the patient. It was juvenile Granulosa cell tumor which confirmed by histo-pathologically. The epidemiology, natural history, presentation, histological and imaging appearances, prognosis and treatment of this malignancy were reviewed. DOI: http://dx.doi.org/10.3329/mediscope.v1i1.21636 Mediscope Vol. 1, No. 1: 2014, Pages 36-39

Secondary Abdominal Pregnancy: A Rare Presentation

ABSTRACTBackgroundAbdominal pregnancy has been defined as an implantation in the peritoneal cavity, exclusive of tubal, ovarian or intraligamentary pregnancy which further classified in primary and secondary abdominal pregnancy. Abdominal pregnancy is a rare event but it represents a grave risk to the health of the pregnant woman.CaseA 32 years old multigravida presented at 16 weeks of pregnancy with complaints of pain in right iliac fossa since 4 days. Vaginal examination revealed a 12 weeks size uterus with an right adenexal mass. Sonography showed intrauterine placentation with dead fetus lying outside the uterus in the right fornix. On laparotomy, diagnosis of secondary abdominal pregnancy made and managed accordingly.ConclusionA high suspicion of abdominal pregnancy is to be kept in obstetrician mind because of its various presentation. Early diagnosis and management is required in this lifethreatening condition. A combine approach of clinical as well as diagnostic technique is indicated.How to cite this articleSharma E, Khateja R, Agarwal R, Suneja A, Sharma A. Secondary Abdominal Pregnancy: A Rare Presentation. J South Asian Feder Obst Gynae 2015;7(3): 243-244.

A case of bilateral primary fallopian tube carcinoma

Abstract A 60 years old postmenopausal woman was presented with complaints of intermittent watery discharge from vagina, and of cramping pain at the lower abdomen. On pelvic examination, blood tinged watery discharge was seen coming out of os. But, ultrasonography revealed bilateral adenexal masses and pyometra. The serum CA-125 level in blood was raised. Cervical smear showed inflammatory changes, but endometrial histopathology was negative for malignant cells. Suspecting ovarian malignancy, laparotomy was done that revealed the bilateral tubal growth with normal ovaries; the right adenexal mass was of the size (6.8×4.8) cm while, the left adenexal mass was the size of (4.2×2.6) cm. Histopathology study revealed bilateral serous cyst adenocarcinoma of fallopian tubes. The case of bilateral primary fallopian tube carcinoma was presented here for its rarity.

Acute Presentation of Spontaneous Heterotopic Pregnancy Presenting with Tubal Rupture

Spontaneous heterotopic pregnancy is a rare clinical condition in which intrauterine and extra uterine pregnancies occur at the same time. It can be a life threatening condition and can be easily missed with the diagnosis being overlooked. We are presenting the case of a 24 year old Para 2+1 young female who presented with pain abdomen and vomiting after an induced abortion. Ultrasonography revealed intrauterine embryo of 7- 8 weeks without cardiac activity suggesting missed abortion and, with right adenexal mass about (7 x 6) cm adhered to the uterus with free fluid in pouch of Douglas. The patient presented acutely with a ruptured tubal pregnancy and this was managed by laparotomy. The ectopic pregnancy was not suspected at her initial presentation. A high index of suspicion is needed in women with risk factors for an ectopic pregnancy and in low risk women who have free fluid with or without an adnexal mass with an intrauterine gestation.

Two Cases of Adult Disorders of Sexual Differentiation Presenting as Hematometra and Adenexal Masses

Two Cases of Adult Disorders of Sexual Differentiation Presenting as Hematometra and Adenexal Masses

Evaluation of the Scoring Systems to Differentiate between Benign and Malignant Adnexal Masses in a Tertiary Care Center, Pune

ABSTRACT Objective The aim of this study was to evaluate the scoring systems to differentiate between benign and malignant adnexal masses. Methods It is a prospective study carried on 60 women at a tertiary care center. Transabdominal ultrasonography and color Doppler was done and women were followed till resolution of symptoms. Gold standard for diagnosis of adenexal masses was histopathological examination of specimen or fluid cytology. Results Efficacy of Sassone scoring system for diagnosing malignant tumors sensitivity 75%, specificity 90.91%, positive predictive value 75%, negative predictive value 90.91% and an accuracy of 86.67%. Efficacy of De Priest scoring system sensitivity 66.67%, specificity 100%, positive predictive value 100%, negative predictive value 92.31% and an accuracy of 93.33%. Efficacy of Ferrazzi scoring system sensitivity 75%, specificity 100%, positive predictive value 100%, negative predictive value 91.67%, and an accuracy of 93.33%. Efficacy of alcazar scoring system sensitivity 100%, specificity 100%, Positive predictive value 100%, negative predictive value 100%, and an accuracy of 100%. Conclusion Alcazar scoring system was found to be more sensitive and specific than other available scoring systems. How to cite this article Chaudhari SN, Deshpande PN, Gupta PR, Warty TR, Bhikane DB. Evaluation of the Scoring Systems to Differentiate between Benign and Malignant Adnexal Masses in a Tertiary Care Center, Pune. J South Asian Feder Obst Gynae 2013;5(3):135-138.

Nail Toxicity Associated With Paclitaxel Treatment for Ovarian Cancer

A 57-year-old woman named C. B. began experiencing abdominal pain and bloating. She presented to her primary physician with these symptoms, and her physician palpated an adenexal mass on pelvic examination. That prompted a computed tomography (CT) scan of the abdomen and pelvis, which demonstrated omental thickening as well as a mildly enlarged left ovary. After initial consultation with a gynecologic oncologist, C. B. was taken to surgery and a total abdominal hysterectomy bilateral salpingo-oophorectomy omentectomy partial bowel resection, and pelvic and periaortic lymph node dissection were performed. C. B. was diagnosed with stage IV ovarian cancer involving the omentum, pelvic lymph nodes, and bowel wall and was subsequently referred for postoperative chemotherapy.

Conservative management of interstitial pregnancy.

A 27-year-old second gravid was admitted with history of amenorrhea of 8 weeks’ duration with lower abdominal pain and spotting per-vaginum of 2 days’ duration. Her vitals were stable, and abdominal examination revealed a soft bulky 6 weeks’ size uterus. Cervical motion tenderness was absent. In view of a positive urine pregnancy test, an urgent transvaginal ultrasound was performed, which revealed an empty uterus with endometrial thickness of 12 mm and a complex adenexal mass of 33 9 32 mm size on the right side (Fig. 1). There was no free fluid in the abdomen. Her b-hCG level was 6,460 mIU/ml. With a provisional diagnosis of ectopic pregnancy, the patient underwent diagnostic laparoscopy which showed an unruptured right-sided interstitial ectopic pregnancy (Fig. 2). Since the patient was keen to preserve her fertility and her general condition remained stable, a conservative medical management was planned for her. She was administered with a two-dose regimen, of intramuscular injection Methotrexate, in the dose of 50 mg/sq m of body surface area, on day 1 and day 4. She was closely monitored for any signs of rupture like pain abdomen, tachycardia, or syncope. She remained asymptomatic and repeat b-hCG value on day 7 showed more than 15 % decline (3,009 mIU/ml), as compared with day 4 levels (3,674 mIU/ml). Hence, the patient was discharged, with advice for weekly follow-up. During the follow-up visit, b-hCG and ultrasound examination was conducted. b-hCG value returned to normal on the 8th visit, and thereafter, the patient was reviewed fortnightly. The complex mass in right cornu resolved after 5 months. Patient was planned for a hysterosalpingography 3 months thereafter, to establish tubal patency. However, she was lost to follow-up.

Ovarian strumal carcinoid presenting as severe progressive constipation.

Strumal carcinoid develops in a germ cell tumor characterized by an intimate mixture of thyroid and carcinoid. Unlike other carcinoid tumors, most patients with strumal carcinoid have no symptoms of carcinoid syndrome; few are reported to cause severe constipation.We report a case of a 60-year-old female patient presenting with severe progressive constipation and painful defecation for last few years. A right ovarian tumor was discovered during clinical examination. CT scan revealed a large lobulated solid cystic right adenexal mass suggestive of monomorphic teratoma, which was successfully removed surgically. The histopathology confirmed the diagnosis of strumal carcinoid tumor. Her constipation completely disappeared post surgery. These tumors are known to produce a biologically active substance like peptide YY, which has a pharmacologic inhibitory action on intestinal motility. This was presumably the cause of the constipation in this patient rather than a mechanical effect of the tumor.

0215 Adenexal mass in patients with prior breast carcinoma

0215 Adenexal mass in patients with prior breast carcinoma

Androgen secreting steroid cell tumor of the ovary in a young lactating women with acute onset of severe hyperandrogenism: a case report and review of literature

IntroductionSteroid cell tumors of the ovary account for less than 0.1% of all ovarian tumors [1] and these tumours may present at any age in association with interesting presentations related to the hormonal activity and virilizing properties of tumor. Hayes and Scully [2] reported 63 cases in patients ranging from 2 to 80 years of age. The subtype, not otherwise specified, is associated with androgenic changes in approximately one half of patients with this tumour [1]. In a series of 63 cases from Massachusetts General Hospital, 94% of the tumors were found to be unilateral and 28.6% were malignant [3]. As most of these tumors are diagnosed at an early stage and do not recur or metastasize, little is known about their response to therapies such as chemotherapy or radiation [3].Case PresentationWe present the case of a 22-year old lactating woman who presented with four months of amenorrhea associated with signs of virilization. Clinical and diagnostic evaluation revealed a right adenexal mass and elevated serum levels of testosterone and she was diagnosed as having a stage 1A androgen secreting steroid cell tumor. In view of the early stage of the disease, she underwent right salpingo-oopherectomy. Histopathological examination and immunohistochemistry confirmed the diagnosis. Two months after surgery she regained normal menses and showed regression of the androgenic changes.ConclusionSurgery remains the mainstay of the treatment of gonadotrophin receptor positive steroid cell tumors although medical therapy using Gonadotrophin Releasing Hormone [GnRH analogues has been tried recently in recurrent or inoperable cases. There is no described effective chemotherapy or radiotherapy for this condition.

ECTOPIC PREGNANCY : A MAJOR CAUSE OF MATERNAL MORTALITY?

ABSTRACTSeventyeight cases of ectopic pregnancy were studied retrospectively at Tribhuvan University TeachingHospital during April 1993 - December 1996. The overall incidence of etopic pregnancy was 0.86% livebirths. Grandmultipara were found to be at a low risk for ectopic pregnancy. A history of infertility andprevious pelvic surgery were positive risk factors. The most common presenting symptoms were abdominalpain (90%), history of amenorrhoea (46%), abnormal uterine bleeding (40%). On examination adenexaltenderness (72%), abdominal tenderness (68%), pallor (53%) and cervical excitation (33%) were the mostfrequent findings. Adenexal mass was noted in 22% cases and in 35 % cases the size of the uterus could notbe assessed. Ultrasonography and transvaginal sonography proved to be valuable diagnostic aids. Twomaternal deaths (2.6 %) due to ectopic pregnancy occurred in the hospital during this period.Key Words: Ectopic pregnancy, risk factors, sonography.