Bilateral Salphingoophorectomy Research Articles

LBMON231 Virilization Secondary To Androgen Producing Ovarian Serous Cystadenoma

Abstract Background Ovarian cystadenomas are classically considered as 'non-functional' tumors and among the most common benign ovarian neoplasms. Most of these tumors are asymptomatic and found incidentally on pelvic examination or with ultrasound. In rare circumstances these tumors may present as functional with secretions of excess androgens that subsequently produce virilizing features. Clinical Case A 59 year old Hispanic female G3P3(3003) presented to the clinic for receding hairline and facial hair for a duration of almost 2 years. Her medical history included total abdominal hysterectomy, due to fibroids, syphilis treated in Dominican Republic, Obesity, Vitamin D deficiency. On examination patient had hirsutism and significant hair growth on the abdomen, axilla, chest and extremities. The clitoris was enlarged, had frontal blading and increased abdominal circumference. Initial laboratory studies showed total testosterone was elevated [264 ng/mL] and free testosterone was high normal [4.2 pg/mL], DHEA-Sulfate normal [29.2 ug/mL], CA 125 unremarkable [5 U/mL]. Repeat labs were done showed elevated total testosterone and free testosterone [276 ng/mL and 4.7 pg/mL respectively] Normal levels of DHEA [87ng/dL] and DHEA-sulfate [ug/mL], 17-Hydroxyprogesterone [64 ng/mL], FSH normal [41.7 IU/L], LH normal [26.6 IU/L], morning cortisol level was normal [ 7.1 ug/mL] and a normal response to 1 mg dexamethasone suppression test. Transvaginal/Transabdominal ultrasound showed a left adnexa of 11.7×5.5×8.3 cm and simple cystic mass with no internal septations or nodularity and unremarkable right adnexa. Imaging by CAT scan showed a 9 cm left adnexal mass likely cystadenoma with unremarkable liver, spleen, pancreas and adrenals. Considering the laboratory, imaging findings and onset of symptoms the androgen production favors left adnexal cyst as the origin and not from the adrenals. Patient then underwent bilateral salphingoophorectomy without any complications and pathology reports revealed left serous cystadenoma. During her 2 week and 3 month post op follow up, patient reports no improvement of her hirsutism and virilization while repeat labs postoperatively showed normalization of total [15 ng/mL] and free testosterone [1.5 ng/mL]. Conclusion In conclusion, we report a rare case of androgen producing ovarian serous cystadenoma with virilizing features.

Giant Ovarian Cyst Adenoma in a Postmenopausal Woman: A Case Report with Literature review

Giant ovarian cysts are benign in most cases and histopathologically they are either serous or mucinous. A case of large ovarian cyst (20 × 18 × 10cm) is reported here. She presented at our OPD clinic with complaints of gradual distension of abdomen and a palpable mass for 6 months. At laparotomy a giant, cystic, smooth, vascularized mass adherent with fallopian tube was encountered. Considering age and premenopausal status we performed Total Abdominal Hysterectomy with Bilateral Salphingo-ophorectomy. Histopathology revealed serous cystadenoma of ovary. Post-operative recovery was excellent and patient was discharged at 5th post-operative day in a good health status.

Comparison of bone mineral density in perimenopausal women with surgical menopausal women: Analytical cross sectional study

Aim: Comparison of bone mineral density (BMD) in perimenopausal women with surgical menopausal women. Methods: The present analytical cross sectional study was conducted on patients (out patients and in patients) in Department of Obstetrics and Gynecology, Kamla Nehru Hospital, attached to IGMC Shimla. Group 1 (N=60): Perimenopausal women aged 40-45years as control. Group 2 (N=60): Women who had undergone hysterectomy with bilateral salphingoophorectomy at least 6 month ago. BMD measurements were measured by whole body dual energy X-ray absorptiometery (DEXA), with the help of Hologic Discovery QDR machine available in department of radiology. Results: In the present study the mean age of post-surgical menopausal group was 46.0 years and in the perimenopausal group the mean age was 42.4 years. Mean parity in post-surgical menopausal group was 3.03 and 2.5 in the perimenopausal group. Conclusions: The prevalence of osteoporosis is very high in this part of India. Both perimenopausal and post-surgical menopausal women have lower levels of BMD. Bone mineral density (BMD) can be taken as a useful marker to assess and treat osteoporosis and also to prevent complications in post-menopausal women.

A rare case report on a concomitant papillary serous carcinoma of the uterine cervix and fallopian tube in a tertiary care centre

Cervical adenocarcinoma accounts to about 10–20% of invasive cervical cancers and has poor radiosensitivity and chemosensitivity. Papillary serous carcinoma of the uterine cervix (PSCC) is a very rare variant of cervical adenocarcinoma. It is unique, as it histologically resembles the same tumour occurring more commonly in the ovary, fallopian tube, endometrium, and peritoneum. The recognition that serous carcinomas of ovarian type frequently involved the fallopian tube fimbria has recently led to a new concept that, the fallopian tube epithelium was the origin of most high grade ovarian serous carcinomas.A 58 years old woman, was apparently normal 2 months back, when she started to notice pain abdomen which was dull aching, intermittent in the beginning and then gradually became continuous type of pain. No aggravating or relieving factors, no radiating pain as well. She gave h/o white discharge per vagina since 15 days, on and off, moderate in amount, serous in consistency, not associated with itching and non foul smelling, changing one cloth per day. History of post-menopausal spotting Per vagina – 2 episodes in a span of 15 days was present. History of burning micturition, increased frequency of micturition and urge incontinence since 15 days. After routine investigations and preoperative work up, patient was taken up for Total Abdominal Hysterectomy with Bilateral Salphingoophorectomy with an indication of CIN II on 14/5/19. On table, there was no complications, uterus was 6 weeks size, bilateral tubes and ovaries appeared normal. Post operative period was uneventful. Patient has now been started with radiotherapy and chemotherapy with weekly Carboplatin 150mg.

SERUM MAGNESIUM LEVELS IN WOMEN’S WHO ATTAINED MENOPAUSE NATURALLY AND SURGICALLY: ANALYTICAL CROSS SECTIONAL STUDY

Aim: Serum magnesium levels in women’s who attained menopause naturally and surgically.
 Methods: The present analytical cross sectional study was conducted on patients (out patients and in patients) in Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India. Group 1 (N=60): Women who had undergone hysterectomy with bilateral salphingoophorectomy at least 6 month ago. Group 2 (N=60): Women who have attained natural menopause at least 1 year ago. Serum magnesium was estimated by magnesium by Xylidyl blue colorimetric assay.
 Results: In the present study maximum number of the patients 26 (43.3%) were in the age group of 46-50 years for the post surgical menopausal group and in the natural menopausal group maximum number of the patients were in the age group of 51-55 years 23 (38.3%). Maximum numbers of patients are multiparous in both groups. Hypomagnesemia was observed in 29 (48.3%) natural menopausal group and 17 (28.3%) were postsurgical menopausal. Hypermagnesemia was observed in 1 (1.7%) postsurgical menopausal group.
 Conclusions: The prevalence of osteoporosis is very high in this part of India. Both natural and post- surgical menopausal women have lower levels of serum magnesium.
 Keywords: Osteoporosis, Serum Magnesium

Cervical intraepitheial neoplasm with ichthyosis uteri- A case report

A rare condition in which the entire surface of the endometrium is replaced by stratified squamous epithelium is called Ichthyosis uteri. Originally described as an endometrial response to iatrogenically-introduced caustic substances, similar changes have since been described in association with a variety of inflammatory conditions of the endometrium.Here we report a case of intraepithelial neoplasm III, with ichthyosis uteri. A 75-years-old female with hypetension, underwent total abdominal hysterectomy with bilateral salphingo-ophorectomy for watery discharge per vaginal since four months.

Synchronous Primary Ovarian Mucinous Carcinoma and Endometrioid Endometrial Carcinoma : A rare case report.

Introduction: Synchronous tumours of female genital tract are a rare . The most common organs involved are ovary and endometrium. Endometrioid carcinoma is the most common malignancy detected in majority of cases . Synchronous cancers with dissimilar histology are a very rare phenomenon . We report a case of 51 year old lady with synchronous primary mucinous carcinoma of ovary and primary endometrioid endometrial carcinoma . Case report: a 51 year old lady presented with post menopausal bleeding and foul smelling vaginal discharge of 1 month duration . Her CA125 was elevated. Magnetic resonance imaging showed increased endometrial thickness and a12.5x10x9.3cm mass in the fundus of uterus suggestive of a leiomyoma along with and a 13.8x11.5x11cm mass in the left adnexa. Endometrial aspiration done showed Complex Hyperplasia with Atypia. Total abdominal hysterctomy and bilateral salphingoophorectomy along with lymphnode sampling was performed . The adnexal mass was pT1a pN0 cM0 grade 2 invasive mucinous carcinoma. The endometrial lesion was pT1b pN0 cM0 FIGO grade 2 endometrioid endometrial adenocarcinoma. Conclusion : Synchronous ovarian tumours of dissimilar histology is extremely rare and there are only a few reports of ovarian mucinous carcinoma with endometrioid endometrial carcinoma. DOI: 10.21276/APALM.1295

Uterine Myxoid Leiomyosarcoma with Paraneoplastic Syndrome: A Rare Combination

Myxoid leiomyosarcoma of uterus is a very rare malignancy with only 36 cases documented worldwide and no cases reported in the Indian subcontinent. The present case is of uterine myxoid leiomyosarcoma with associated pancytopenia that has not been described previously in the south-east asia and only one such case reported in world literature. A 32 year old woman who is a known case of uterine fibromyoma discovered in her previous pregnancy , presented to the opd with heavy bleeding per vagina. On examination, she had a large abdominal mass. Her hemoglobin was 6.3 g/dl and platelet count was 80,000/cu.mm and also developed leucopenia(4500/cu.mm).She had received five units of blood transfusion, but her haemoglobin and platelet counts remained low. Her bone marrow biopsy report came out to be inconclusive. She underwent laparotomy followed by total hysterectomy with bilateral salphingoophorectomy, omentectomy and appendicectomy. Histopathology reports showed uterine myxoid leiomyosarcoma ( FIGO stage IIIA). Her haematological profile improved considerably following the surgery and recurred with the recurrence of the disease. Hence, this is considered to be a case of pancytopenia due to paraneoplastic syndrome as a result of the myxoid leiomyosarcoma of the uterus.

Spectrum of Morphological Changes and Prevalence of “P53 Signatures” In Tubal Fimbrial Epithelium in General Population and In Patients with Pelvic Serous Carcinomas

Aim: Pelvic serous carcinomas (PSCs) are very aggressive malignancies and present at advanced stage. A paradigm shift in the origin and pathogenesis of PSCs occurred when precursor lesions were found in the Fallopian tube fimbria in the prophylactic bilateral salphingo-ophorectomy (PBSO) specimens from BRCA positive patients. The knowledge of various benign and reactive alterations in the Fallopian tube is mandatory to distinguish these lesions from the true neoplastic changes. The study therefore aims to see the spectrum of morphological changes in the Fallopian tube epithelium (FTE) and to know the incidence of the various precursor lesions and p53 signatures in the tubal fimbria. Method: The study included 102 Fallopian tubes from patients undergoing salphingo – oophorectomies for gynaecological indications. The fimbrial end along with one cross section was embedded and examined for stromal and architectural changes, epithelial features and inflammatory infiltrates. IHC for p53 and Ki67 was done to assess the presence of precursor lesions. Results: The mean age of patients’ was 49.9yrs. Family history of breast/ovarian cancer was present in 5 cases. Histopathology showed fibrosis (30%), Walthard nest (36%) , Wolfian duct remnants(14.7%), pigmentosis tubae(1%) , infiltration by metastatic carcinoma(7%),reactive atypia(6%), metaplasia(16%), tufting(46%),lymphocytes (9%) and plasma cells (2%). SCOUTS were seen in 12%, p53 signature and STIC in 6% and 4% respectively. Tuboperitoneal junction was identified in 15 cases and showed transitional metaplasia. Conclusion: The study describes the different morphological changes in the Fallopian tube in our population. The prevalence of cytological and molecular alterations leading to malignancy was low in general population.

Staging laparotomy for endometrial cancer in a patient with situs inversus totalis: A case report.

Situs inversus is a rare congenital anomaly in which the organs are transposed from their normal site to the opposite side of the body. To the best of our knowledge, this is the first study of staging laparotomy performed in a patient with endometrial carcinoma and situs inversus totalis (SIT). This study presents a patient with early endometrial carcinoma with SIT who underwent staging laparotomy. Total abdominal hysterectomy with bilateral salphingoophorectomy, omentectomy and pelvic para-aortic lymph node dissection was successfully performed without additional blood loss and time. The number of retrieved lymph nodes was 47. No abnormal course of blood vessels except for the right/left inversion was found. The postoperative course was favorable and the patient was discharged eight days after surgery.

Unusual and Late Recurrence in Ovarian Adult Granulosa Cell Tumour: A Case Report

Granulosa cell tumour of ovary are rare hormonally active neoplasm characterized by indolent course, local spread with a preponderance for extremely late recurrence and high survival rate. We report a 60 year old lady presented in 2009 with aggressive looking growth in vulva 16 years after her total abdominal hysterectomy with Bilateral salphingo-ophorectomy with infracolic omentectomy for suspected stage granulosa cell tumour of ovary , confirmed by histopathology. She remained disease free for 13 years and in 2005 underwent resection of retroperitoneal mass with multiple peritoneal implant, confirmed to be a granulosa cell tumour after biopsy. Despite six course adjuvent combination therapy with complete response she presented after 4 years in 2009 with a second recurrence in vulva. She had tumour reductive surgery followed by chemotherapy and hormonal therapy but the disease was progressive. In conclusion late recurrence and repeat recurrence is a hallmark for granulosa cell tumour of ovary, so we emphasis the need for long term follow up and consider the possibility of recurrence when presented with acute abdomen after initial surgery for granulose cell tumour. But there is no standard management protocol and we review this patients treatment in the context of current literature.
 JCMCTA 2012 ; 23 (2): 42-46

The Assessment of Quality-of-Life after Total Laparoscopic Sacrocolpopexy with Two Separate Meshes

Study Objective: To assess the change of the quality-of-life after total laparoscopic sacrocolpopexy with two separate meshes by using the questionnaires: PFDI-SF20, P-QOL, and ICIQ-SF. Design: Retrospective study. Setting: Hospital in affiliation with Nippon Medical School. Patients: Women (ages 45-73yrs) presenting pelvic organ prolapse. Intervention: Total laparoscopic sacrocolpopexy with two separate meshes along the anterior and posterior vaginal walls with/without supercervical hysterectomy and bilateral salphingoophorectomy. Measurements and Main Results: 30 cases of this surgery were performed in our hospital. The mean operation time and total blood loss for the latest ten cases is 211mins and 99g. To assess the change of the QOL after surgery, 11 out of the 30 patients completed the following questionnaire: PFDI-SF20, P-QOL, ICIQ-SF before operation and three months afte surgery. The results are that PFDI-SF20 score is 76.1 vs 31.6 at before and after surgery (POPDI-6: 35.2 vs 5.6, CARDI-8: 13.0 vs 7.9, UDI-6: 27.8 vs 17.9). P-QOL is composed of nine domains. The results of each domain are that general health perceptions 25.0 vs 26.5, prolapsed impact: 66.7 vs 18.1, role limitations:45.4 vs 22.6, physical limitations 49.9 vs 22.6, social limitations: 33.3 vs 15.1, personal relationships: 38.7 vs 23.5, emotions 47.4 vs 32.2, sleep/energy: 27.2 vs 18.1, and severity measures: 46.1 vs 18.9. The score of ICIQ-SF is 5.1 vs 5.7. Conclusion: Total laparoscopic sacrocolpopexy improves the QOL of POP patients on PFDI-SF and P-QOL, but did not on ICIQ-SF. In other words, this surgery can turn the structure of pelvic organ back to normal, but does not seem to affect the voiding mechanism. Total laparoscopic sacrocolpopexy is less invasive surgry and provide the improved QOL on the POP patients.

Laparoscopic-assisted vaginal hysterectomy for endometrial cancer in high body mass index (BMI) patients: a report of six cases

In this case series, six women with high and very high body mass index (BMI; range, 30–65) underwent LAVH + bilateral salphingo-ophorectomy and removal of vaginal cuff under general anaesthesia for endometrial cancer. Initial Verres needle entry and insufflation was through the left upper quadrant at sub-coastal margin. With good surgical outcome, shorter hospitalisation and improved quality of life, we found that laparoscopic surgery was feasible in high and very high BMI patients with early stage endometrial cancer.

FIGO stage IB clear cell carcinoma and adenocarcinoma of uterine cervix

Objective: To compare the clinical features and prognosis of patients with clear cell carcinoma (CCA) and adenocarcinoma (ACA)of the uterine cervix. Methods: We have performed retrospective clinical study on 5 patients diagnosed as CCA and 55 patients diagnosed as ACA from November 2000 to December 2004. Demographic data, pathologic findings, treatments and survival time were reviewed. Results: The mean age of patients with CCA and ACA was 31.5 or 30.4 years respectively and all patients were FIGO stage IB. Among the 5 patients of CCA, 4 patients have underwent radical hysterectomy (RH) and one patient have treated with radiotherapy only. Among the 55 patients of ACA, 50 patients have underwent RH and pelvic lymph node dissection (PLND), paraaortic lymph node sampling (PALNS) and the other have underwent only bilateral salphingoophorectomy (BSO) and PLND. There are no significant difference on age, tumor size, depth of invasion, parametrial involvement, vaginal involvement and pelvic lymph node metastasis (p>0.05). The mean survival time of CCA and ACA was 42.5 and 43.2 months respectively (p=0.32). The recurrent rate of CCA and ACA are 25% and 5.45% (p=0.30) and the disease free survival of CCA and ACA are 18.7 months and 43.6 months respectively (p=0.054). Conclusion: There were no significant difference on clinical features and prognosis of FIGO stage Ib CCA and ACA. Large scaled prospective multicenter trials will be able to provide a decision for prognosis and proper therapy.

A CASE OF PERFORATED PYOMETRA ASSOCIATED WITH DIFFUSE PERITONITIS

A case of perforated pyometra associating with diffuse peritonitis is reported. An 88-year-old woman was referred to the hospital by a phisician because of a suspicion of acute appendicitis. Simple abdominal X-ray film revealed no free air. Abdominal enhanced CT revealed collection of fluid in the Douglas' pouch and uterine. White blood cell count increased and CRP level was high. The patient was diagnosed as having diffuse peritonitis caused by intestinal perforation and immediately operated on. On lapalotomy, it ws found that the anterior wall of the uterine body perforated and pus flowed out from the site. With a diagnosis of perforated pyometra associated with diffuse peritonitis, histerectomy and bilateral salphingoophorectomy with abdominal drainage were performed. Postoperative course was uneventful. Histological examination of the surgical specimen revealed no findings of malignancy. In a case of acute abdomen in aged woman, this disease should be considered and appropriate examination would permit to make the diagnosis of the disease preoperatively.