Common Benign Disorder Research Articles

A Rare Case of a Large Composite Endometrioma–Mature Cystic Teratoma: The Importance of Surgical Treatment and Pathologic Diagnosis

Endometriosis is a common benign gynecologic disorder associated with infertility and pelvic pain, affecting 6–11% of reproductive-age females, and can frequently lead to the formation of ovarian endometriomas. Mature cystic teratomas are benign ovarian tumors comprising 10–25% of ovarian tumors. Both pathologies are common individually but rarely coexist. The case presented here describes a 49-year-old female presenting with a large composite endometrioma–mature cystic teratoma, a rare occurrence with few documented cases. The patient had a 24 cm × 17 cm × 15 cm adnexal mass identified via imaging, which was surgically removed. Pathology confirmed a composite tumor, with the teratoma encased within the endometrioma. This case underscores the importance of surgical management in complex adnexal masses to obtain tissue for definitive diagnosis and to exclude malignancy. Given the rarity of such coexistence and the challenges in preoperative diagnosis, surgical intervention is crucial for accurate diagnosis and effective management.

Imaging of Benign Biliary Tract Disease.

This review article discusses the most common benign biliary disorders and the various radiological findings on multiple modalities. A broad spectrum of diseases including various congenital disorders, infective and parasitic etiologies, immunological pathologies such as primary sclerosing cholangitis, and immunoglobulin G4-related sclerosing cholangitis are discussed along with obstructive diseases and ischemic cholangitis. The article emphasized the imaging differential diagnosis of the above lesions as well as clinical correlates those that are most relevant to radiologists. The article briefly touched upon management and intervention where relevant.

Impact of Endometriotic Cyst Position on Infertility

Endometriosis is one of the most common benign gynecologic disorders affecting reproductive health. There are many theories regarding how endometriosis affects fertility, but the exact mechanisms are still uncertain. We evaluated 100 patients with unilateral ovarian endometriosis and infertility who underwent ovarian cystectomy. The women had at least one patent tube after surgery and were observed for spontaneous pregnancy for up to one year. Patients were divided into two groups according to the endometrioma position. The first group included 67 women with an endometriotic cyst in the left ovary, and the second group included 33 with an endometrioma in the right ovary. Groups were similar according to age, type of infertility, BMI, and size of the endometrioma. The number of patients was significantly higher in the first group. Spontaneous pregnancy after cystectomy occurred in 28.4% of the patients with an endometrioma in left ovary, and in 9.1% with a right endometriotic cyst. The better results regarding spontaneous conception with a left-sided endometrioma in our study are most likely related to the permeability of the fallopian tubes and adhesions in the Douglas pouch as a result of endometriosis. Further investigations are necessary to assess the influence of the laterality of endometriosis on infertility.

Clinical spectrum study of female patients with benign breast diseases in surgery department of tertiary care centre

Background: Benign breast disorders are classified as congenital disorders, injury related inflammatory conditions infective conditions, aberration of normal differentiation and involution, duct ecstasies and congenital breast conditions such as inverted nipple etc. Aberration of normal differentiation and involution of breast consist of cystic nodularity, mastalgia, cysts and fibroadenoma. Methods: Aim of the study is to study the co-relation of clinical, pathological and radiological parameters in benign breast diseases and study detail the different modes of presentations of benign breast disease respect to age, marital status, religion, clinical features, menstruation, presentation of lump, diagnostic modalities used. Results: The 200 patients diagnosed with benign breast disease. Most of the cases belong to the age group of 20-29 years, fibroadenoma is the most common benign disorder in that age group followed by fibroadenosis. The presentation is breast lump without pain in most of the time. Conclusions: Benign breast disease occupy majority of the total breast diseases. Majority of the benign breast diseases occur in the reproductive age group with fibroadenoma as the most common lesion. Lump is the most common presentation of all of the benign breast diseases.

Metabolic profile of follicular fluid in patients with ovarian endometriosis undergoing IVF: a pilot study

Research QuestionEndometriosis is a common benign gynaecological disorder. A number of studies have confirmed that the occurrence of disease in endometriosis patients is associated with metabolic changes in biological fluids and tissues. We set out to investigate the metabolic characteristics of follicular fluid in patients with ovarian endometriosis undergoing in vitro fertilization (IVF). DesignThe current research project is an exploratory cohort study on endometriosis. A total of 19 infertile patients with ovarian endometriosis diagnosed by laparoscopy were enrolled in this study and 23 age- and BMI-matched controls (women with infertility due to male or tubal factors). All the patients underwent IVF treatment with a gonadotropin-releasing hormone antagonist protocol and completed follicular fluid (FF) collection at oocyte retrieval. The metabolomics of FF samples was analyzed by Ultra high performance liquid chromatography-orbitrap exploris-mass spectrometer (UHPLC-OE-MS). The best combination of biomarkers was then selected by performing stepwise logistic regression analysis with backward elimination. ResultsFifteen metabolites were identified as biomarkers associated with endometriosis. A final model containing 8-hydroxy-2-deoxyguanosine, biotin, n-acetyl-L-methionine and n-methylnicotinamide was constructed. Receiver operating characteristic analysis confirmed the value of these parameters in diagnosing endometriosis, with a sensitivity of 94.7% and a specificity of 95.7%. Analysis of fortification via the Kyoto Encyclopedia of Genes and Genome showed that 15 metabolites were enriched in 8 metabolic pathways. ConclusionMetabolomics based on UHPLC-OE-MS effectively characterized the metabolomics analysis of FF in patients with ovarian endometriosis. These findings may provide a new basis for a better understanding of how diseases progress and for the discovery of new biomarkers.

Role of Adipose Tissue Hormones in Pathogenesis of Cryptoglandular Anal Fistula.

The cryptoglandular perianal fistula is a common benign anorectal disorder that is managed mainly with surgery and in some cases may be an extremely challenging condition. Perianal fistulas are often characterized by significantly decreased patient quality of life. Lack of fully recognized pathogenesis of this disease makes it difficult to treat it properly. Recently, adipose tissue hormones have been proposed to play a role in the genesis of cryptoglandular anal fistulas. The expression of adipose tissue hormones and epithelial-to-mesenchymal transition (EMT) factors were characterized based on 30 samples from simple fistulas and 30 samples from complex cryptoglandular perianal fistulas harvested during surgery. Tissue levels of leptin, resistin, MMP2, and MMP9 were significantly elevated in patients who underwent operations due to complex cryptoglandular perianal fistulas compared to patients with simple fistulas. Adiponectin and E-cadherin were significantly lowered in samples from complex perianal fistulas in comparison to simple fistulas. A negative correlation between leptin and E-cadherin levels was observed. Resistin and MMP2 levels, as well as adiponectin and E-cadherin levels, were positively correlated. Complex perianal cryptoglandular fistulas have a reduced level of the anti-inflammatory adipokine adiponectin and have an increase in the levels of proinflammatory resistin and leptin. Abnormal secretion of these adipokines may affect the integrity of the EMT in the fistula tract. E-cadherin, MMP2, and MMP9 expression levels were shifted in patients with more advanced and complex perianal fistulas. Our results supporting the idea of using mesenchymal stem cells in the treatment of cryptoglandular perianal fistulas seem reasonable, but further studies are warranted.

A cross-disorder study to identify causal relationships, shared genetic variants, and genes across 21 digestive disorders

Digestive disorders are a significant contributor to the global burden of disease and seriously affect human quality of life. Research has already confirmed the presence of pleiotropic genetic loci among digestive disorders, and studies have explored shared genetic factors among pan-cancers, including various malignant digestive disorders. However, most cross-phenotype studies within the digestive tract system have been limited to a few traits, with no systematic coverage of common benign and malignant digestive disorders. Here, we analyzed data from the UK Biobank to investigate 21 digestive disorders, exploring the genetic correlations and causal relationships between diseases, as well as the common genetic factors and potential biological pathways driving these relationships. Our findings confirmed the extensive genetic correlation and causal relationship between digestive disorders, providing important insights into the genetic etiology, causality, disease prevention, and clinical treatment of diseases.

Exosomes: potential diagnostic markers and drug carriers for adenomyosis.

Adenomyosis is a common benign gynecological disorder and an important factor leading to infertility in fertile women. Adenomyosis can cause deep lesions and is persistent and refractory in nature due to its tumor-like biological characteristics, such as the ability to implant, adhere, and invade. The pathogenesis of adenomyosis is currently unclear. Therefore, new therapeutic approaches are urgently required. Exosomes are nanoscale vesicles secreted by cells that carry proteins, genetic materials and other biologically active components. Exosomes play an important role in maintaining tissue homeostasis and regulating immune responses and metabolism. A growing body of work has shown that exosomes and their contents are key to the development and progression of adenomyosis. This review discusses the current research progress, future prospects and challenges in this emerging therapeutic tool by providing an overview of the changes in the adenomyosis uterine microenvironment and the biogenesis and functions of exosomes, with particular emphasis on the role of exosomes and their contents in the regulation of cell migration, proliferation, fibrosis formation, neovascularization, and inflammatory responses in adenomyosis.

Recalcitrant Grover’s Disease Successfully Managed with Dupilumab and Naltrexone in a Middle-Aged Woman: A Case Study

Introduction: Grover’s disease, or transient acantholytic dermatosis, is a common benign papulovesicular disorder that often affects elderly men. It is typically managed with topical therapeutics in this population. We present here an uncommon case of Grover’s disease, occurring in a relatively younger patient, that was recalcitrant to typical therapeutics modalities. Case Report: A 45-year-old woman presented to our clinic with a several month history of discrete, pink, ill-defined pruritic papules on her torso with sparing of her extremities. Grover’s disease was diagnosed based on her clinical presentation and subsequently biopsy-confirmed. She failed multiple topical medications, oral acitretin, and only experience minimal relief when transitioned to Naltrexone. Dupilumab was added to her regimen, with rapid improvement. She was eventually transitioned down to dupilumab monotherapy, and has remained clear since. Conclusion: Grover’s disease is not common among middle-aged women. Novel therapies, such as biologics, have been efficacious in elderly (especially male) populations with this condition. Our case demonstrates the importance of attempting new treatment modalities such as dupilumab for patients with recalcitrant disease. Novel application of these biologic treatments may be needed in particular for atypical cases, such as when patients do not fit the known epidemiologic profile.

Management of chronic fissure in ano-lateral internal sphincterotomy versus 2% diltiazem gel local application: a prospective comparative study

Background: Fissure-in-ano is one of the most common benign anorectal disorders often encountered in surgical outpatient department. Various pharmacological agents and surgical interventions have been tried in the management of fissure in ano. In this study we have compared medical management by topical diltiazem gel with established surgical procedure of lateral internal sphincterotomy (LIS) in the management of chronic anal fissure. Methods: A total of 50 patients with chronic fissure in ano involved in this prospective comparative study, between December 2020 to May 2022, at Rajarajeswari Medical College and Hospital, Bengaluru. Selected patients were put under two groups of 25 participants each, A (2% diltiazem group) and B (lateral internal sphincterotomy - LIS group) using simple randomization technique and were to receive treatment accordingly. Fissure healing and pain relief were recorded on presentation and during follow up visits. Results: The results were compared weekly for 4 weeks and monthly for 2 consecutive months. Fissure healing and pain relief were recorded. Conclusions: Both 2% diltiazem group and LIS group are equally effective and did not show any difference in pain relief or fissure healing with p value not significant (>0.05).

Research advances in drug therapy of endometriosis.

Endometriosis is one of the most common benign gynecological disorders in reproductive-aged women. The major symptoms are chronic pelvic pain and infertility. Despite its profound impact on women's health and quality of life, its pathogenesis has not been fully elucidated, it cannot be cured and the long-term use of drugs yields severe side effects and hinders fertility. This review aims to present the advances in pathogenesis and the newly reported lead compounds and drugs managing endometriosis. This paper investigated Genetic changes, estrogen-dependent inflammation induction, progesterone resistance, imbalance in proliferation and apoptosis, angiogenesis, lymphangiogenesis and neurogenesis, and tissue remodeling in its pathogenesis; and explored the pharmacological mechanisms, constitutive relationships, and application prospects of each compound in the text. To date, Resveratrol, Bay1316957, and bardoxifene were effective against lesions and pain in controlled animal studies. In clinical trials, Quinagolide showed no statistical difference with the placebo group; the results of phase II clinical trial of the IL-33 antibody have not been announced yet; clinical trial stage III of vilaprisan was suspended due to drug toxicity. Elagolix was approved for the treatment of endometriosis-related pain, but clinical studies of Elagolix for the pretreatment of patients with endometriosis to before In vitro fertilization treatment have not been fulfilled. The results of a clinical study of Linzagolix in patients with moderate to severe endometriosis-related pain have not been disclosed yet. Letrozole improved the fertility of patients with mild endometriosis. For endometriosis patients with infertility, oral GnRH antagonists and aromatase inhibitors are promising drugs, especially Elagolix and Letrozole.

The efficacy of GnRH-a followed by SanJieZhenTong capsules in long-term management of endometriosis: Study protocol for a multicenter, double-blinded, double-dummy randomized clinical trial

BackgroundEndometriosis is a common benign gynecological disorder with high risk of recurrence and adverse impact on fertility-sparing. This study aims to evaluate the effectiveness and safety of SanJieZhenTong Capsules, a traditional Chinese medicine, in the long-term management of endometriosis postoperatively. Methodsand analysis: A prospective, double-blinded, double-dummy parallel-group randomized controlled trial will be conducted at three university-based medical centers in China. A total of 600 patients with rAFS III-IV endometriosis diagnosed by laparoscopy will be enrolled. After fundamental treatment (gonadotropin-releasing hormone agonists injection starts on the first day of menstruation postoperatively, and repeats 3 times every 28 days), participants will be randomly allocated to the oral contraceptive group (oral contraceptive + dummy A) or SanJieZhenTong Capsules group (SanJieZhenTong Capsules + dummy B) in a 1:1 ratio. All participants will be treated and followed up for 52 weeks. The primary outcome is a recurrence rate based on endometriosis-related symptoms, physical examination, and/or ultrasound/MRI findings. The secondary outcome includes changes in quality of life and organic function outcome via the 36-item Short-Form scores and gastrointestinal function score. ConclusionThe current trial could provide rigorous evidence on SanJieZhenTong Capsules application in the long-term management of advanced-stage endometriosis.

Benign Esophageal Disorders: The Thing About Race and Ethnicity

The aim of this review is to highlight the racial and ethnic differences in the prevalence, presentation, management, and outcomes of benign foregut disorders. Gastroesophageal reflux disease and achalasia make up the most common benign esophageal disorders. There are limited data in the literature regarding racial and ethnic disparities in the care and management of these disorders. However, studies have shown that racial and ethnic disparities play a role in the management of these disorders. To minimize the impact of these disparities, more effort is needed in identifying the interplay between race, insurance status, socioeconomic status and their underlying mechanism.

Single-Cell Profiling Uncovers the Roles of Endometrial Fibrosis and Microenvironmental Changes in Adenomyosis.

Adenomyosis (AM) is a common benign uterine disorder that has deleterious effects on women's health. However, the pathogenesis of AM is not clearly understood. We aimed to investigate the pathophysiological changes and molecular mechanism in AM. Single-cell RNA sequencing (scRNA-seq) was employed to construct a transcriptomic atlas of various cell subsets from the ectopic endometrium (EC) and eutopic endometrium (EM) of one AM patient and evaluate differential expression. The Cell Ranger software pipeline (version 4.0.0) was applied to conduct sample demultiplexing, barcode processing and mapping reads to the reference genome (human GRCh38). Different cell types were classified with markers with the "FindAllMarkers" function, and differential gene expression analysis was performed with Seurat software in R. The findings were confirmed by Reverse Transcription Real-Time PCR using samples from three AM patients. We identified nine cell types: endothelial cells, epithelial cells, myoepithelial cells, smooth muscle cells, fibroblasts, lymphocytes, mast cells, macrophages and unknown cells. A number of differentially expressed genes, including CLO4A1, MMP1, TPM2 and CXCL8, were identified from all cell types. Functional enrichment showed that aberrant gene expression in fibroblasts and immune cells was related to fibrosis-associated terms, such as extracellular matrix dysregulation, focal adhesion and the PI3K-Akt signaling pathway. We also identified fibroblast subtypes and determined a potential developmental trajectory related to AM. In addition, we identified increased cell-cell communication patterns in EC, highlighting the imbalanced microenvironment in AM progression. Our results support the theory of endometrial-myometrial interface disruption for AM, and repeated tissue injury and repair could lead to increased fibrosis in the endometrium. Therefore, the present study reveals the association between fibrosis, the microenvironment, and AM pathogenesis. This study provides insight into the molecular mechanisms regulating AM progression.

The role of laparoscopic IPOM in the treatment of abdominal hernias: lesson learned after 400 surgeries using single mesh.

Abdominal wall hernias and incisional hernias are a common benign disorder affecting quality of life, potentially leading to life-threatening complications. Laparoscopic IPOM (intraperitoneal onlay mesh) approach can offer good results in selected cases. Patients who underwent laparoscopic incisional/ventral abdominal hernia repair operated with standardized technique and the same mesh, from January 2011 to December 2022, were retrospectively considered. Four hundred consecutive patients underwent laparoscopic abdominal wall repair. There were 255 ventral hernia (63%) and 145 (37%) primitive hernia (epigastric and umbilical). Mean size of the defect was 4.2 cm, W3 were 19 (4%). After a mean follow-up of 1906 days (range 45-4109), no mesh-related complications have been detected. There were 10 (2.5%) recurrences and 20 (5%) bulging. In this study we emphasized the role of patient selection and standardized technique which represents "the lesson" learned over a period of 15 years of activity. In this setting, we believe that laparoscopic approach can achieve very good results in abdominal wall repair.

Monozygotic twins with endometriosis in matching locations at time of laparoscopy: A case report

Endometriosis is a common benign gynaecological disorder, which has an increased prevalence amongst twins and first degree relatives of affected individuals. Here we describe a case of remarkable resemblance in the distribution of deep infiltrating endometriosis related to the bowel in a monozygotic twin pair. We provide a literature review of studies of endometriosis in twins. We propose that genetic factors influence the nature and distribution of the disease, while environmental factors may affect the severity.

Clinical impact of a new method using a clear proctoscope to evaluate the therapeutic effect of sclerotherapy with aluminum potassium sulfate and tannic acid (ALTA) for internal hemorrhoids: a prospective cohort study

Hemorrhoids are a common benign disorder that can require surgery for treatment. Aluminum potassium sulfate and tannic acid (ALTA) have been used as a sclerotherapy agent that induces noninvasive sclerosis and regression of hemorrhoids without surgery. However, there is no objective index for determining its effectiveness. In this study, we prospectively investigated the usefulness of our method as an objective indicator of the effectiveness of ALTA sclerotherapy. From April 2015 to April 2019, 241 patients underwent ALTA sclerotherapy. We standardized a simple evaluation method using the lumen of the lower rectum as observed through a clear plastic proctoscope. Patients' hemorrhoids were evaluated preoperatively and their subjective satisfaction with treatment by our new method was evaluated on postoperative day 7. Our method showed that among patients who lost the rectal lumen before treatment, the lumen was reacquired after ALTA sclerotherapy in 96.1% (224/233). McNemar test showed the effect of ALTA sclerotherapy to be significantly associated with lumen gain [κ value, 0.0027; 95% confidence interval (CI): 0.0001-0.0052], P<0.001]. Patients' subjective satisfaction with the treatment was significantly higher in the group reacquiring the lumen (Fisher's exact test, P=0.0186). Among those patients needing re-treatment, 59.4% (19/32) had lost their lumen during follow-up [mean difference, 0.578; standard deviation (SD): 0.502, P<0.001]. Our simple method using a clear plastic proctoscope could objectively indicate the effect of ALTA sclerotherapy and patients who needed re-treatment on losing their lumen during follow-up. We believe this method is highly advantageous for patients, can advocate the concept of the hemorrhoid shrinking sign, and will contribute to the development of new indication criteria for ALTA sclerotherapy.

Aktuelni hirurški modaliteti lečenja polipa glasnica - mini-pregled

Vocal fold polyps represent one of the most common benign organic disorders affecting the larynx in the general population, and a relatively frequent cause of long-standing hoarseness. The exact etiology is unclear, but poor vocal behavior has been suggested as the principal etiologic factor. Histopathologically they are characterized by various structural alterations in the vocal fold superficial lamina propria, and typical clinical finding is of a solitary, unilateral and well-defined vocal fold lesion. Vocal fold polyps usually require surgical removal using microlaryngoscopy with cold steel excision in general anesthesia, which has been the practice standard for the last 60 years. Microlaryngoscopy offers the surgeon an unparalleled magnified view of the vocal folds and very precise work on a still operative field without a specific time limit. The introduction and technological development of ambulatory endoscopy and various laser systems provided the surgeon with ample therapeutic opportunities, including operating some of the patients in the office setting in local anesthesia. These outpatient procedures are technically simple and cost-effective, require fewer medical personnel, exclude general anesthesia-related risks, and are less time-consuming both for the patient and the physician. Nevertheless, the contemporary laryngologist should be able to perform both conventional microlaryngoscopy and office-based surgery for vocal fold polyps, depending on the clinical situation.

Magnetic sphincter augmentation: laparoscopic or robotic approach?

Gastroesophageal reflux disease (GERD)-the pathologic reflux of gastric contents into the distal esophagus-is the most common benign disorder of the esophagus. Its incidence is at 10-20% of the Western population and it yearly cost of treatment in the USA in 9.3 billion dollars. Although first line treatment for the disorder is medical therapy with proton pump inhibitors, an estimated 30-40% of patients will continue to experience medically refractory GERD. In this population anti-reflux surgery can be offered. Traditional anti-reflux surgery is done via the Nissen fundoplication, a technically difficult surgery with uncomfortable side effects of bloating and inability to belch. Magnetic sphincter augmentation (MSA) of the lower esophagus via the LINX device was introduced a less technically challenging alternative to the Nissen. The LINX provides fewer side effects of bloating and inability to belch and has been adapted widely to the practice of anti-reflux surgery. In this paper we discuss the progression of surgical practices with the LINX, including an analysis of the laparoscopic and robotic approaches to MSA device implantation.

AYURVEDIC PERSPECTIVE AND MANAGEMENT OF SCAR ENDOMETRIOSIS: A REVIEW

Endometriosis is a common benign disorder associated with chronic pelvic pain, infertility, and other symptoms which affect women of reproductive age. Nowadays, the increase in cases of caesarean section increases the cases of abdominal wall scar endometriosis. The curative treatment in modern medical science excises the mass, showing a high recurrence rate. Ayurveda gives knowledge of various gynaecological disorders and various approaches to treating them. Causative factors and symptoms of scar endometriosis give identical signs and symptoms of vataja vrana and various types of yonivyapad. This review aims to understand scar endometriosis from an Ayurveda perspective better, decrease the reoccurrence rate and surgical intervention, and improve the quality of life.