Contralateral Ovary Research Articles

Ovarial Torsion in Young Children. Ultrasound Diagnostic

Background. Early adnexal torsion (AT) is extremely rare. It usually involves a torsion of the ovary together with the tube, which cannot be differentiated by transabdominal ultrasound, so the terms "adnexal torsion" and "ovarian torsion" for children are echographically identical.Objective. To study the features of echographic representation of ovarian torsion in infant girls.Materials and Methods. During 2015–2024, adnexal torsion was echographically diagnosed in 6 girls of the first year of life. All patients underwent transabdominal ultrasound in B-mode and color Doppler scanning. All children were operated, and the diagnosis was verified.Results. The frequency of adnexal torsion in children under 1 year of age was 13.3% of all patients (45) with this pathology. The complaints and clinical picture were nonspecific. In all cases, suspicion of adnexal torsion was expressed only when ultrasound was performed. There was an increase in the volume of the affected ovary by 6.91 ± 0.68 times compared to the contralateral ovary and increased echogenicity of the ovarian parenchyma, against which numerous anechogenic follicles were traced. Vascular pattern in the parenchyma of the affected ovary was detected in 2/6 cases (33.33%), uterine appendages were irreversibly changed. Hyperstimulated ovaries were observed in 4 out of 6 cases. The distribution of follicles in the affected ovary was chaotic, there was no "necklace symptom", there was no marked rounding of the ovarian shape, and the amount of stromal component in the tilted ovary was relatively small. In 5/6 (83.3%) girls, no pelvic cavity effusion was noted.ConclusionThere are no specific anamnestic and clinical data suggestive of adnexal torsion in infants, which determines the importance of ultrasound as virtually the only method of emergency diagnosis of this pathology.The peculiarity of ultrasound in the infant should be the maximum expansion of the area of examination with attempts to visualize the pelvic organs regardless of the degree of bladder filling.The basis of echographic diagnosis of adnexal torsion in infants are structural changes of the appendage in B-mode: increase in linear size of 1.5–2 times, volume of 4–10 times and increased echogenicity of the stroma. Rounding of the shape of the affected ovary is insignificant.A feature of twisted appendage in infants is a large number of follicles in the affected ovary (2/3 of observations). The "necklace" symptom is atypical.The presence of abdominal effusion in adnexal torsion in infants is not characteristic.Preservation of the vascular pattern in the ovary does not exclude adnexal torsion, is infrequent (in 1/3 of cases) and does not guarantee preservation of ovarian viability.

8661 A case of post-menopausal female with virilization due to Sertoli-Leydig cell ovarian tumor recurring in contralateral ovary 8 years later

Abstract Disclosure: M.S. Maharaul: None. J.L. Miller: None. Introduction: Sertoli-Leydig cell tumors (SLCTs) are rare androgen-secreting tumors of the ovaries, accounting for less than 0.5% of all ovarian tumors. Their incidence peaks in the second to third decade of life. New onset of severe hyperandrogenism with virilization in postmenopausal women is exceedingly rare, and the three most frequent causes are ovarian tumors, ovarian hyperthecosis and adrenal androgen producing tumors. We report one such case of ovarian androgen producing tumor which was further complicated by recurrence in the contralateral ovary. Case: A 66-year-old woman presented for evaluation of hyperandrogenism. Physical examination revealed evidence of virilization and clitoromegaly. Laboratory workup was remarkable for total serum testosterone level of 367 ng/dL with normal dehydroepiandrosterone sulfate and cortisol levels. A computerized scan of abdomen did not show any adrenal masses. Transvaginal ultrasound revealed uterine myomas but did not show any ovarian pathology. She underwent selective vein catheterization of her adrenal glands as well as ovaries and was noted to have right ovary secreting 3,982 ng/dL of testosterone whereas all other samples had total testosterone levels < 200 ng/dL. She underwent right salpingo-oophorectomy. Histopathologic examination revealed a 2.2 cm well differentiated Sertoli-Leydig cell tumor confined to the ovary; the fallopian tube was negative for tumor. Six weeks later, her serum total testosterone level was 18 ng/dL. 8 years later, she returns with recurrent symptoms of hyperandrogenism. Repeat workup revealed a total testosterone level of 662 ng/dL. A computerized scan of abdomen and transvaginal ultrasound revealed an unremarkable uterus and left ovary. Magnetic resonance imaging of the pelvis was done that showed a 1.2 cm enhancing mass in the left ovary. She then underwent left salpingo-oophorectomy and supracervical hysterectomy. Histopathologic examination revealed a 1.5 cm Sertoli-Leydig-cell tumor of the left ovary, the fallopian tube was negative for tumor. Six weeks later, her serum total testosterone level was 24 ng/dL and she felt significant improvement in her symptoms. Conclusion: We present an interesting case of virilization in a post-menopausal female due to Sertoli-Leydig cell tumor that resolved after unilateral oophorectomy but recurred 8 years later in the contralateral ovary with resolution after completion oophorectomy. Presentation: 6/2/2024

GnRH antagonist protocol with hCG triggering ameliorates fertilization defect caused by failure of cumulus cell pentraxin-3 expression in unilateral endometriomas.

The aim of the study was to determine the expression pattern of long pentraxin 3 (PTX3) mRNA in cumulus cells (CCs) isolated from metaphase II oocytes of women with unilateral endometrioma undergoing controlled ovarian stimulation using a gonadotropin-releasing hormone antagonist (GnRHa) protocol. A total of 60 CC samples, 30 from the affected ovary and 30 from the contralateral ovary, were collected from 12 patients with unilateral endometrioma who underwent flexible GnRHa protocol with recombinant human chorionic gonadotropin (rhCG) trigger. Thirty CC samples collected from the left ovary of 12 women with male factor infertility were used as external controls. Long PTX3 mRNA expression in each group was analyzed by real-time polymerase chain reaction (RT-PCR). Relative gene expression (fold-change) was calculated according to the 2-ΔΔCt equation. Fertilization rates after intracytoplasmic sperm injection (ICSI) were recorded for each group. CC-PTX3 mRNA expression in the unilateral endometrioma group was significantly lower than the mRNA expression of the disease-free ovary (0.90±0.01 vs. 0.25±0.02, p<0.01). CC-PTX3 mRNA expression of MII oocytes of the disease-free ovary was found to be similar to the control group (1.02±0.03 vs. 0.90±0.01, p=0.107). A significant 3.6-fold downregulation was observed in the CC-PTX3 mRNA expression of the endometrioma group compared to the CC-PTX3 mRNA expression in the contralateral ovary. CC-PTX3 mRNA expression in the endometrioma group was downregulated 4.08-fold compared to the CC-PTX3 mRNA expression of the control group (1.02±0.03 vs. 0.25±0.02, p<0.001). The cumulus morphologies of the endometrioma group with low CC-PTX3 expression and the groups with normal CC-PTX3 levels were similar. Fertilization rates of the endometrioma group were similar to the contralateral ovary and control groups. Unilateral endometrioma reduces CC-PTX3 expression but does not affect disease-free ovaries. The GnRHa protocol improved the fertilization rates, suggesting that failed CC-PTX3 expression is an in vivo pathology.

Unusual Scenario: Ipsilateral Pelvic Lymph Node Metastasis in High- Grade Serous Ovarian Carcinoma without Peritoneal Extension - A Case Report

Introduction:: Ovarian cancers are the third most common gynecological cancers worldwide with serous carcinomas being the most common subtype with 90% of them as high-grade carcinomas. Case Presentation:: In the present case report a 60 years postmenopausal, nulliparous woman presented with complaints of bleeding per vaginum for 1-2 months with a left-sided solid-cystic ovarian mass of size 4x5 cm and ipsilateral enlarged external iliac and obturator lymph nodes which were diagnosed on histopathological examination as high-grade serous ovarian carcinoma (HGSOCs) with ipsilateral pelvic lymph node metastasis in presence of intact ovarian capsule and no metastatic deposits over the uterus, contralateral ovary and fallopian tubes, omentum, or any other gross peritoneal deposits. There was coexisting non-atypical endometrial hyperplasia. The patient was managed successfully with staging laparotomy with modified radical hysterectomy, and bilateral pelvic lymphadenectomy followed by six cycles of adjuvant chemotherapy with Paclitaxel and Carboplatin injections. Conclusion:: Patients with HGSOCs can have varied presentations with unusual involvement of lymph nodes in the absence of peritoneal spread. Hence, the clinician must be aware of these unusual presentations for the successful management of such cases.

Combined removal of ovarian teratoma and oocyte retrieval by laparoscopic surgery under regional anesthesia

To describe the simultaneous laparoscopic approach for teratoma removal and oocyte retrieval performed under regional anesthesia in a woman, desiring to preserve fertility. The patient included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites, and other applicable sites. Video case report demonstrating the clinical management and laparoscopicteratoma removal combined with oocyte retrievalaccomplished underregional anesthesia. University tertiary care hospital. We present a case of a 31-year-old woman who referred to our Fertility Center with a previous history of right salpingo-oophorectomy for mucinous ovarian cystadenoma and the presence of a large ovarian teratoma of ten centimeters of the contralateral ovary. The ovarian stimulation started in the early follicular phase. Not being able to visualize follicular growth during the ovarian stimulation, it was decided to adopt fixed protocol with antagonist on the 5th day and to proceed, on 15th day, with a laparoscopic pick-up and simultaneous removal of the cyst. Laparoscopic surgery was performed: the left ovary appeared larger in size for the presence of the suspicious mature dermoid cyst and multiple follicles, previously not identified at ultrasound imaging. The follicles contained oocytes that were aspirated with an aspiration needle of 17 G connected to a craft suction pump. Then, practicing the stripping technique, an enucleation of the ovarian cyst was performed. Surprisingly, the removal of the cyst revealed other follicles that were readily aspirated. The patient remained awake during the entire procedure and a low pressure of 10 mmHg was maintained at 15° of Trendelenburg position. A total of seven follicles were aspirated, seven oocytes were retrieved, and six mature oocytes were cryopreserved. The cyst was totally removed and no intracavitary spillage was caused. Simultaneous laparoscopic approach for teratoma removal and oocyte cryopreservation should be considered an effective fertility preservation strategy in patients in whom the presence of an ovarian neoformation does not allow visualization of growing follicles by ultrasound. Laparoscopic oocyte retrieval under regional anesthesia is a safe and well-tolerated technique and should be considered for patients where the transvaginal approach could not be performed.

Management strategy for children with ovarian immature teratoma: results from a tertiary pediatric oncology center

ObjectivesWe present an Egyptian study on pediatric ovarian immature teratomas (ITs), aiming to clarify our treatment strategy selection.MethodsA retrospective review of all children with pure ovarian ITs who were treated at our institution between 2008 and 2023. The analysis included clinical characteristics, tumor staging according to Children’s Oncology Group (COG), grading based on the Norris system, management, and outcomes.ResultsThirty-two patients were included, with a median age of 9 years. All patients underwent primary surgery. Unilateral salpingo-oophorectomy was performed in 31 patients. Surgical staging was completed in all patients. Based on COG staging, there were 28 patients (87.5%) stage I, 1 (3%) stage II, and 3 (9.5%) stage III. According to Norris classification, 16 patients (50%) were classified as grade I, 9 (28%) grade II, and 7 (22%) grade III. All patients in stage I were treated using surgery-alone approach, whereas the remaining four (12.5%) received adjuvant chemotherapy. Five patients in stage I had gliomatosis peritonei (GP), and none of them underwent extensive surgery. At a median follow-up of 86 months, two patients had events. The first patient (stage III/grade I) developed IT relapse on the operative bed, and the second (stage I/grade I) had a metachronous IT on the contralateral ovary. Both patients were successfully managed with surgery followed by second-line chemotherapy. Five-year overall survival and event-free survival for all patients were 100% and 93.4%, respectively.ConclusionsSurgery-alone strategy with close follow-up achieves excellent outcomes for localized ovarian ITs in children, irrespective of the Norris grading or the presence of GP. However, adjuvant chemotherapy is questionable for patients with incompletely resected or locally advanced tumors, and its role requires further evaluation through prospective multicentric studies with a larger sample size.

P-622 Prospectively randomized study of intraovarian injections of autologous platelet-rich plasma (PRP) into one alternating ovary in Primary Ovarian Insufficiency (POI)

Abstract Study question Does intraovarian injection of autologous PRP affect ovarian function in women with POI? Summary answer Ovaries that were injected with PRP demonstrated a significant increase in follicles &amp;gt;4mm in size compared to the untreated contralateral ovaries. What is known already The injection of PRP into ovaries has been reported to improve subsequent ovarian response to ovulation induction in women with POI and is now widely used in fertility centers in women with POI as well as in women with premature ovarian aging (POA). Prospectively randomized studies are, however, lacking. Study design, size, duration This is a Randomized Controlled Trial with recruitment from July 2018 - November 2023. 40 patients were screened; 34 qualified. POI was defined by amenorrhea among women &amp;lt; 40 years old, with FSH &amp;gt; 30 mIU/mL, undetectable AMH, and no follicles &amp;gt;4mm. For each participant one ovary was randomly selected for treatment ( with the Sealed Envelope Ltd 2022 tool). The study was powered to detect a 20% response in the treated versus untreated ovary. Participants/materials, setting, methods For each patient (n = 34), 10mL of blood was drawn into ReganLab vacutainer and centrifuged. Platelets were re-suspended in 1.5mL of plasma. PRP was injected into the stroma of one randomly selected ovary under iv sedation and ultrasound control. Patients were followed with ultrasounds, estradiol, and FSH q3-4 days for two weeks. Our primary outcome was the development of new follicles &amp;gt;4mm in the treated vs. untreated ovary, using Chi-Square. Main results and the role of chance Study population description: age 33.9±5.5 years (range 21-40.4 years); BMI 23.4±4.2; FSH 96.7±27.6 mIU/mL; AMH 0.019±0.03 ng/mL; length of amenorrhea 2.2 years (3 months-14 years). 10 patients developed no follicles &amp;gt; 4 mm, 21/34 (62%) did develop follicles &amp;gt; 4 mm in treated ovaries; 9/34 (26%) developed a follicle &amp;gt; 4 mm in untreated ovaries (Chi-square = 8.59; P = 0.003). Most follicles developed without significant estradiol production; nine showed sufficient follicle development to initiate ovulation induction with initiation of gonadotropins, four produced eggs and one produced an embryo; one patient had four oocytes banked and resumed menses following PRP treatment for several months. Limitations, reasons for caution N/A Wider implications of the findings This demonstrates the first objective evidence that intraovarian PRP injections into POI ovaries initiate some follicle activation. Though the observed degree of activation was small, findings suggest that remaining follicles in women with POI can be activated through injections into ovaries, suggesting that better agents than PRP may be discovered. Trial registration number N/A

Ovarian torsion due to prenatally diagnosed cystic abdominal mass – case report and literature review

The majority of abdominal cystic formations in newborns are benign and usually originate from the urinary tract, genital system or gastrointestinal system. Fetal ovaries are predisposed to development of cysts due to the maternal hormonal environment of advancing gestational age. Prenatal diagnosis became possible with improvement of ultrasound techniques. Complex pattern of the cysts are at higher risk for complications, the most concerning being ovarian torsion and consequent compromised fertility. Management is controversial, involution of simple cysts few months after birth is possible considering the cease of ovarian stimulation by maternal and fetal hormones but surgical approach is more indicated in symptomatic or complex cysts. We report the case of a prenatally diagnosed cystic abdominal mass at 33 weeks of gestation with antenatal ovarian torsion and need for right oophorectomy in the neonatal period. At two months of age appearance of ovarian cyst was observed on the contralateral ovary by ultrasound, being managed conservatively.

Serum anti-Müllerian hormone is an indirect predictor of ovarian reserve in domestic cats

Anti-Müllerian hormone (AMH) serves as an indirect marker for predicting primordial follicles that are representative of ovarian reserve. In this study the possibility of using AMH and age to predict the ovarian reserve in domestic cats. Ovaries and blood were collected from 30 cats undergoing routine ovariohysterectomy. The animals were divided into three age groups: prepubertal (<4 mo, n = 10), adult (1–5 y, n = 10), and senior (>5 y, n = 10). Blood was collected at surgery for serum AMH measurements using the AMH Gen II ELISA kit. The intra-assay coefficient of variation (CV) and inter-assay CV were 3.56 % and 7.68 %, respectively. One side of the ovary was processed to determine AMH localization using immunohistochemistry and for a histological count of follicles, which is the gold standard. The expression of AMH protein was quantified from the contralateral ovary by Western blot analysis. Primordial follicles exhibited the most pronounced inverse relationship with age (rho = −0.779, P < 0.05), followed by a positive association with serum AMH concentration (rho = 0.490, P < 0.05), indicating that both age and AMH are potential markers indicative of primordial follicles. Furthermore, secondary (rho = 0.651, P < 0.05) and small antral follicles (rho = 0.648, P < 0.05) were identified as the major sources of circulating AMH, as indicated by the stronger correlation with serum AMH concentrations compared with primary follicles. However, there was no significant correlation between the expression of AMH protein and other factors, including age, primordial follicles, primary follicles, secondary follicles, small antral follicles, and serum AMH concentration. A model for predicting primordial follicle number using serum AMH concentration (AIC = 672.66, P < 0.05) and age (AIC = 668.93, P < 0.05) was established. In conclusion, both serum AMH concentration and age may serve as comparable markers of ovarian reserve in domestic cats. Moreover, AMH is particularly useful in situations where age information is not available.

Outcomes after fertility-sparing surgery of early-stage ovarian cancer: A nationwide population-based study.

Fertility-sparing surgery (FSS) is an alternative choice of young patients who have not completed their family planning and still have fertility needs. The aims of this study were to compare the outcomes of early-stage epithelial ovarian cancer (EOC) patients undergoing FSS and radical comprehensive staging surgery (RCS), and the suitability of FSS. A total of 1297 patients aged between 20 and 44 years with newly diagnosed early-stage EOC were recruited from the Taiwan Cancer Registry database between 2009 and 2017. Site-specific surgery codes were used to distinguish patients in FSS group or RCS group. Cancer-specific survival (CSS) was evaluated using Kaplan-Meier method with log-rank test and Cox regression model. There were 401 and 896 patients in FSS and RCS group. Patients in FSS group were with younger age and mostly had Stage I disease. In contrast, patients in RCS group were older. There were more Stage II, high-grade (Grade 3) disease, and adjuvant chemotherapy in RCS group. Stage and tumor grade were two independent factors correlating with CSS and the type of surgery showed no effect on CSS (HR: 1.09, 95% CI: 0.66-1.77, p = 0.73) in multivariable analysis. In multivariable analysis, the clear cell carcinoma group who underwent FSS demonstrated better CSS compared to those in the RCS group (HR: 0.28, 95% CI: 0.06-0.82, p = 0.04). A total of 17 women who underwent FSS developed second malignancies of the uterine corpus or contralateral ovary. FSS can be a safe alternative procedure in selected young patients of Stage I EOC who have fertility desire. Endometrial biopsy before or during FSS and regular surveillance to detect recurrence are mandatory for ovarian cancer patients undergoing FSS.

Клінічний випадок діагностики та лікування тератобластоми яєчника в дитини

Aim: to demonstrate the possibilities of surgical treatment of the child with teratoblastoma at the early stage of detection. Clinical case. The article presents an experience of treatment a child with ovarian teratoblastoma. The anamnesis of the disease was studied. The child has been examined by laboratory (general blood test, biochemical blood test, alpha-fetoprotein, ovarian tumor marker) and instrumental methods (ultrasound diagnostics of internal organs and organs of the lesser pelvis, computer tomography of the organs of lesser pelvis). The patient was consulted by a pediatric gynecologist, urologist and oncologist. Taking into account the results of the study, surgical treatment was prescribed: biopsy of the tumor-like formation and ovaries. Ovarian cystectomy, unilateral operation. A multidisciplinary team was involved in the treatment. The child recovered. Additional treatment is not required. The observation of the pediatric oncologist is recommended. Conclusion. The described clinical case demonstrates the experience of treatment a child with teratoblastoma, which is a rare pathology in childhood and that needs to be remembered. Proper preoperative examination forms the tactic of the treatment. Intraoperative staging is a mandatory component (peritoneal lavage, examination of the contralateral ovary, biopsy of suspicious lesions of the peritoneum and the omentum, revision of the regional lymph nodes). When performing all protocol surveys and confirming the local process only surgical intervention without adjuvant chemotherapy is enough. The research was carried out in accordance with the principles of the Declaration of Helsinki. The informed consent of the child's parents was obtained for conducting the studies. No conflict of interests was declared by the authors.

Effect of GnRH on the day of Insemination on Ovulatory Response in Crossbred Cows

The effect of gonadotropin releasing hormone (GnRH) analogue on the ovulatory response of oestrual follicle during cold and hotter months of the year was studied. A total of 120 crossbred cows brought for insemination with oestrus signs during colder months (December 2022 –January 2023; n=52) and hotter months (April – May 2023; n=68) to the Gynaecology Unit of Veterinary Clinical Complex, Veterinary College and Research Institute, Orathanadu were utilized for the study. Oestrus (Day 0) was confirmed by gynaeco-clinical and ultrasound examination and animals were inseminated with (n =33) or without (n = 87) GnRH (Buserelin acetate 10 mcg; im). The biometry of oestrual follicle (OF) and regressing corpus luteum (RCL) were measured ultrasonographically on Day 0 and the OF was observed every 24 hours until ovulation. The diameter of the OF on Day 0 was non-significantly (P &gt; 0.05) larger during hotter months (12.19 ± 0.21 mm) than colder months (11.58 ± 0.32 mm). There were no significant (P &gt; 0.05) differences in the diameter of RCL between the two periods (9.63 ± 0.21 and 9.56 ± 0.22 mm respectively). OFs were observed majorly in the right ovary during the hotter (60.76%) and colder (54.17%) months. Ovulations occurred on the mean days of 1.00 and 1.37 ± 0.18 in GnRH group during hotter (H-Gn) and colder months (C-Gn) respectively. The respective mean days in non-GnRH group were 1.14 ± 0.05 and 1.33 ± 0.08 during hotter (H-O) and colder months (C-O). In H-Gn group all the animals (100%) ovulated on Day 1, when compared to C-Gn animals (62.50%). On perusing the possible effect of RCL on ovulation, significantly increased percentages of ovulations were observed in OFs on the contralateral ovary to the ovary having the RCL in GnRH group and viceversa in non-GnRH group. It could be assumed that GnRH administration on the day of insemination may be beneficial during the hotter months of the year.

All-cause and cancer-specific mortality after fertility-sparing surgery for stage IA and IC epithelial ovarian cancer

ObjectiveTo compare all-cause and cancer-specific mortality between women who underwent fertility-sparing surgery (FSS) versus standard surgery for stage IA and IC epithelial ovarian cancer. MethodsReproductive aged patients (18–45) with stage IA or IC epithelial ovarian cancer diagnosed between 2000 and 2015 were identified in the California Cancer Registry. FSS was defined as retention of the contralateral ovary and the uterus, and standard surgery included at least removal of both ovaries and the uterus. The primary outcome was all-cause mortality and the secondary outcome was cancer-specific mortality. Inverse probability of treatment weighting (IPTW) was used to create two groups balanced on covariates of interest. The Kaplan-Meier method and Cox proportional hazards analysis were used to model survival outcomes. ResultsAmong 1119 women who met inclusion criteria, 390 (34.9%) underwent FSS. IPTW yielded a balanced cohort of 394 women who underwent FSS and 723 women who underwent standard surgery. Among patients who underwent FSS, there were 45 deaths corresponding to an 85.4% (95% confidence interval [CI] 0.79–0.92) 10-year all-cause survival probability, compared to 81 deaths and 86.4% 10-year all-cause survival probability (95% CI 0.83–0.90) among patients who underwent standard surgery. FSS was not associated with increased all-cause mortality (HR 1.04, 95% CI 0.72–1.49) or cancer-specific mortality (HR 1.50, 95%CI 0.97–2.31). ConclusionsAmong reproductive-aged patients with early-stage epithelial ovarian cancer fertility-sparing surgery was not associated with an increased risk of death compared to standard surgery.

Western-style diet in the presence of elevated circulating testosterone induces adipocyte hypertrophy without proinflammatory responses in rhesus macaques.

Anovulatory infertility is commonly associated with hyperandrogenemia (elevated testosterone, T), insulin resistance, obesity, and white adipose tissue (WAT) dysfunction associated with adipocyte hypertrophy. However, whether hyperandrogenemia and adipocyte hypertrophy per se induce a proinflammatory response is unknown. Young adult female rhesus macaques were exposed to an obesogenic Western-style diet (WSD) in the presence of elevated circulating testosterone (T+WSD) or a low-fat control diet with no exogenous T. Immune cells residing in visceral omental white adipose tissue (OM-WAT), corpus luteum and the contralateral ovary, endometrium, lymph nodes, bone marrow, and peripheral blood mononuclear cells were characterized by flow cytometry during the luteal phase of the reproductive cycle. Following one year of treatment, T+WSD animals became more insulin-resistant and exhibited increased body fat and adipocyte hypertrophy compared to controls. T+WSD treatment did not induce macrophage polarization toward a proinflammatory phenotype in the tissues examined. Additionally, T+WSD treatment did not affect TNFα production by bone marrow macrophages in response to toll-like receptor agonists. While the major lymphoid subsets were not significantly affected by T+WSD treatment, we observed a significant reduction in the frequency of effector memory CD8+ T-cells (Tem) in OM-WAT, but not in other tissues. Notably, OM-WAT Tem frequencies were negatively correlated with insulin resistance as assessed by the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). This study shows that short-term T+WSD treatment induces weight gain, insulin resistance, and adipocyte hypertrophy, but does not have a significant effect on systemic and tissue-resident proinflammatory markers, suggesting that adipocyte hypertrophy and mild hyperandrogenemia alone are not sufficient to induce a proinflammatory response.

Ovarian serous borderline tumors with recurrent or extraovarian lesions: a Japanese, retrospective, multi-institutional, population-based study.

Ovarian serous borderline tumors (SBT) are typically unilateral and are primarily treated using hysterectomy and bilateral salpingooophorectomy (SO). However, most young patients prefer fertility-sparing surgeries (FSS) with tumorectomy or unilateral SO. Micropapillary morphology and invasive implants have been designated as histopathological risk indicators for recurrence or metastasis, but their clinical impact remains controversial because of limitations like diagnostic inconsistency and incomplete surgical staging. A nationwide multi-institutional population-based retrospective surveillance was conducted with a thorough central pathology review to reveal the clinical features of SBT. Of 313 SBT patients enrolled in the Japanese Society of Clinical Oncology's Surveillance of Gynecologic Rare Tumors, 289 patient records were reviewed for clinical outcomes. The glass slides of patients at stage II-IV or with recurrence or death were re-evaluated by three gynecological pathologists. The 10-year overall and progression-free survival (PFS) rates were 98.6% and 92.3%. The median recurrence period was 40months and 77.0% was observed in the contralateral ovary within 60months. Patients aged ≤ 35years underwent FSS more frequently and relapsed more (p < .001). A clinic-pathological analysis revealed diagnosis during pregnancy, FSS, and treatment at non-university institutes as well as advanced stage and large diameter were independent risk factors of recurrence. Among patients having pathologically confirmed SBTs, PFS was not influenced by the presence of micropapillary pattern or invasive implants. The recurrence rate was lower in this cohort than previous reports, but the clinical impacts of incomplete resection and misclassification of the tumor were still significant on the treatment of SBT.

Ovarian Follicular Response Is Altered by Salpingectomy in Assisted Reproductive Technology: A Pre- and Postoperative Case-Control Study.

Objectives: The goal of this study was to assess the effect of unilateral salpingectomy on the number of mature follicles in the ipsilateral ovary during an assisted reproductive technology (ART) stimulation cycle, as compared to the contralateral ovary. Methods: This was a retrospective, single-center, case-control cohort study conducted from 2017 to 2022. Patients from 18 to 43 years old who underwent at least one ART cycle before and after a unilateral salpingectomy were included. The number of recruited follicles, including mature (≥16 mm) and intermediate follicles (13-15.5 mm), on the salpingectomy side (case) were compared to those present on the contralateral ovary (control) during an ART attempt. To take into account the inter-ovarian variability, the comparison was performed on two ART cycles, performed before then after the salpingectomy. Results: Overall, 24 patients were included in our study. While the number of mature follicles was similar in both ovaries before surgery, the mean number of mature follicles was significantly reduced after salpingectomy in the operated side, as compared to the control side, being, respectively 3.00 vs. 5.08 (p = 0.048). There was no significant difference between the intermediate and total recruited follicles. Conclusions: Our study suggests that salpingectomy may impact the follicle recruitment on the ipsilateral side by altering the vascularization during mesosalpinx coagulation. Gynecologists should be mindful of this concept and accurately set surgical indications. Beyond the indication, this emphasizes the critical role of having infertility surgeons sensitive to fertility preservation for optimal management of ART patients. Further studies with larger patient populations are required to confirm these results.

Artemisinin reduces acute ovarian ischemia-reperfusion injury in rats

Artemisinin (ARS) is well known as an effective agent in the treatment of malaria through the rapid elimination of Plasmodium falciparum parasites. This study aims to investigate the effect of ARS in treating adnexal torsion, one of the most common gynecological surgical emergencies. ARS was administered intraperitoneally once 30 min before unilateral ovarian torsion in two different doses (10 mg/kg vs. 50 mg/kg). Torsion was maintained for 3 h and then held in the detorted state for 3 h. Bilateral adnexectomy was performed to measure antioxidant enzyme activities and oxidant levels on the ipsilateral ovary and to make histopathological and immunohistochemical analyses on the contralateral ovary. Ischemia-reperfusion (I/R) injury dramatically upregulated the activities of CAT, GST, and MDA levels in the ipsilateral ovary, which were all downregulated by ARS treatment. A significant increase in follicular cell degeneration, congestion, and edema in the contralateral ovary was seen in the I/R group, which was significantly reduced with ARS treatment. Furthermore, I/R injury resulted in a significant increase in apoptosis as shown by the increased levels of BAX and CASP-3, and decreased levels of BCL-2 whereas ARS significantly reduced the impact of the injury. Our data, based on a rat I/R injury model, show that both ipsilateral and contralateral ovaries are protected with ARS pretreatment, and 50 mg/kg ARS treatment demonstrates to be more effective than the 10 mg/kg ARS.

Abstract #1397957: Papillary Thyroid Carcinoma Arising from Malignant Struma Ovarii

Struma ovarii is a rare ovarian teratoma characterized by the presence of thyroid tissue. It can be functional leading to hyperthyroidism or transform into malignant thyroid cancer. We present a case of a 46-year-old woman without risk factors for thyroid cancer, who was found to have a cystic ovarian lesion suspicious for malignancy. Surgery revealed struma ovarii with papillary thyroid cancer. A 46-year-old woman presented with right lower quadrant abdominal pain associated with urinary incontinence. She was found to have palpable mass in the lower abdomen on physical examination. Abdominal/pelvic computed tomography (CT) scan showed a 12.7 cm right ovarian complex cystic lesion and a 5.9 cm left ovarian complex cyst. She underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, radical pelvic dissection, and omental biopsy. Pathology revealed struma ovarii of the right adnexa, with a 1.8 cm papillary thyroid cancer noted to be well to moderately differentiated without ovarian surface or fallopian tube involvement. It was staged as pT1aNxMx. BRAF mutation was negative. The contralateral ovary, fallopian tubes, and uterus were negative for malignancy. Post-operative labs included thyroglobulin antigen of 20.1 ng/ml, thyroglobulin antibodies were undetectable, thyroid stimulating hormone (TSH) of 3.53 mIU/L (0.4-4.5 mIU/L) and Free T4 of 1.1 ng/dl (0.8-1.8 ng/dl). Thyroid ultrasound (US) showed a 6 mm hypoechoic nodular lesion in the right isthmus. She was started on levothyroxine to suppress her TSH to the low normal level and she is planned to follow up on the small thyroid nodule with US in 3-5 years. The vast majority of struma ovarii are benign in nature and less likely to transform into malignant tissue. Most of the tumor transformation occurs in the form of papillary thyroid carcinoma, and the risk tends to be higher with larger-size ovarian teratomas >5 cm. The presenting symptoms are indistinguishable between benign and malignant tumors, and usually present with lower abdominal pain. Diagnosing papillary thyroid cancer in struma ovarii tumors is often challenging given the lack of distinct imaging characteristics and specific tumor markers. Additionally, cancer antigen 125 (CA-125) has no value. The mainstay for management is surgical resection. Regardless of the surgical strategy used, patients with malignant struma ovarii have an excellent disease-specific survival rate overall. However, staging is key to assessing if thyroidectomy and radioactive iodine are needed. Surveillance with thyroid imaging and biochemical markers is recommended, however, the disease is curable in most cases.

Diagnosis and Clinico-Surgical Management of Secondary Laminitis due to Ovarian Tumour in a Kathiawari Mare

Granulosa cell tumours (GCTs) are the most common ovarian tumours in equine which involves around 2.5% of all tumours of horses and 85% of reproductive tract tumours (McCue et al. 2006). Tumours may originate from tissue present within the equine ovary. GCTs are most often first detected during either routine reproductive examination for breeding or when behavioral changes caused by the presence of the tumour in ovary requiring further investigation (McKinnon and Barker, 2010). Mares with GCTs remain infertile due to atrophy of the contralateral ovary, which has been variably associated with elevated serum inhibin, testosterone or anti-Mullerian hormone concentrations (Ball et al., 2012). Surgical removal is regarded as the treatment of choice for GCTs (McCue et al., 2006). Surgical removal of the affected ovary almost always results in the resumption of normal heat cycles and the ability to carry a normal pregnancy. Lameness in mare which suffered from GCT was also reported earlier by Meagher et al. (1977). Various scientists reported different technique for removal of affected ovary. Standing laparoscopic ovariectomy is associated with a lower complication rate than other surgical methods like colpotomy (Colbern and Reagan 1987), flank, paramedian or ventral midline celiotomy (Lee and Hendrickson, 2008; Azizi et al., 2014). Most of GCTs are benign and affect the left ovary (McCue et al. 2006; Korany et al., 2020). The present document reports clinical diagnosis and surgical management of secondary laminitis due to ovarian tumour in a Kathiawari mare by left flank ovariectomy of the affected ovary.

Ovariectomy in a mare with granulosa cell tumor: Case report

Granulosa cell tumor is the most common type of neoplasm that affects the ovaries of mares. It is usually benign and unilateral, while the contralateral ovary is usually atrophied and without follicular activity. The diagnostic suspicion is based on clinical signs and behavioral changes, such as anestrus and increased libido; however, it is confirmed by hormonal, ultrasound and histopathological examinations. The aim of this study is to report a case of granulosa cell tumor in an 18-year-old female horse, submitted to an ovariectomy procedure and pre- and postoperative care. Surgical intervention proved effective, not only preventing damage that could be caused by the tumor, but also restoring follicular activity in the contralateral ovary.