Contralateral Ovary Research Articles

Abstract 1835: Mechanisms of psychological stress on the adaptive immune system and disease progression in a novel double transgenic ovarian cancer mouse model

Abstract It is estimated that 21,880 women will be diagnosed with ovarian cancer in 2010 with 13,850 patients dying of this disease. In addition, gynecologic cancer is one of the most stressful diseases because patients need to receive repeated chemotherapy treatments, and young patients in particular fear their impending loss of fertility. It is becoming increasingly apparent that the immune system plays a global role in cancer initiation and progression. We have previously defined a novel mechanism through which stress, via release of glucocorticoids and catecholamines, impacts the cellular actin cytoskeleton; a dynamic structure intimately involved in cell activation and migration in healthy mice. However, studies using disease-specific preclinical models are sorely needed to unravel molecular mechanisms underlying the stress response and cancer in disease pathogenesis. We hypothesize that psychological stress and stress hormones significantly impact T cell activation and trafficking which directly contribute to disease outcome. To determine if stress influences tumor initiation and progression we used a LSLS-KrasG12D/+PtenloxP/loxp conditional transgenic mouse model for endometrioid ovarian cancer. Four weeks post tumor induction via intrabursal Adcre injection, a group (n = 6) of mice were restrained for 1h, 3 times per week for four weeks. Non-restrained (control, n = 5) mice remained in their home cages in a noise-free environment for 1 h. Following the 4 week restraint stress protocol, mice were monitored for weight loss and for signs of tumor formation and ascites accumulation. All mice were sacrificed at 8 weeks and all primary (ovarian) and metastatic (peritoneal) tumors, regional (para-aortic) lymph nodes and spleens were harvested at necropsy. All tumors were histologically confirmed by H & E staining of injected ovaries. Contralateral (non-injected) ovaries were kept as controls. The spleens and regional lymph nodes were immune phenotyped using T cells markers for activation. We found that stress decreased overall mouse weight (control median 24.1g vs. stress median 22.5g) and observed that stressed mice demonstrated early onset and more confined to the ovary than non stressed mice. We also demonstrated that restraint stress resulted in decreased activation of CD3+cells isolated from the spleen and para-aortic lymph nodes. More specifically, there was a significant decrease in CD3+CD69+ (p = 0.006) in stressed mice and these changes were independent of the mouse tumor burden. These findings link the effect of stress on T cell immunity in mice with orthotopic de novo ovarian tumors and substantiate the use of the KrasPten mice as a suitable model for in vivo studying the stress-induced immune regulation in ovarian cancer. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1835. doi:10.1158/1538-7445.AM2011-1835

Effects of salpingectomy on ovarian response in controlled ovarian hyperstimulation for in vitro fertilization: a reappraisal

To evaluate the effects of salpingectomy on ovarian response in controlled ovarian hyperstimulation (COH), 36 women who underwent controlled ovarian stimulation cycles for IVF before and after salpingectomy were studied. The overall number of dominant follicles and the number of oocytes aspirated before and after salpingectomy were comparable (7.2 ± 3.8 vs. 7.3 ± 3.7 and 10.2 ± 6.6 vs. 10.3 ± 7.4, respectively) as well as maximal E(2) levels, daily doses of gonadotropins, and the number of dominant follicles before and after surgery on the operated side, demonstrating that salpingectomy does not influence ovarian response in COH.

Effects of ovarian endometrioma on embryo quality

The proportions of good, fair, and poor embryos in 13 women with bilateral endometriomas were compared with those of 39 women without endometriomas and were found to be similar (47.2% vs. 41.1%, 28.3% vs. 32.8%, and 24.3% vs. 26.0%, respectively). Therefore, it appears that the presence of bilateral endometriomas during IVF treatment is not associated with reduced embryo quality.

V1713 PEDIATRIC ROBOT-ASSISTED LAPAROSCOPIC RESECTION OF A FUNCTIONAL NON-COMMUNICATING UTERINE HORN

You have accessJournal of UrologyPediatrics & Reconstruction1 Apr 2011V1713 PEDIATRIC ROBOT-ASSISTED LAPAROSCOPIC RESECTION OF A FUNCTIONAL NON-COMMUNICATING UTERINE HORN Manoj Rao, Andrew Marks, and Bruce Lindgren Manoj RaoManoj Rao Chicago, IL More articles by this author , Andrew MarksAndrew Marks Chicago, IL More articles by this author , and Bruce LindgrenBruce Lindgren Chicago, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2038AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We present robot assisted laparoscopic resection of a non-communicating functional uterine horn in a pediatric patient. To our knowledge, this is the first reported robot assisted procedure for this indication in a pediatric patient. METHODS A 13-year-old female presented from an outside hospital with left abdominal pain. She was found to have a cystic pelvic mass and underwent open resection via a pfannensteil incision with pathology showing hematosalpinx and encased ovary. Post operatively, she returned with recurrent left abdominal pains and left leg numbness and tingling. MRI showed a right unicornuate uterus and a non-communicating, functional left uterine horn with hematometros as well as left sided renal agenesis. She was transferred to our facility for further care. A robotic resection of the non communicating uterine horn was performed. RESULTS After positioning in dorsal lithotomy, we performed examination under anesthesia, cystoscopy and vaginoscopy, identifying a single right-sided cervix and a mass effect on the left pushing on the bladder. We proceeded with robot assisted laparoscopic resection. We used an 8.5 mm camera port 2 cm superior to the umbilicus. We identified the left uterine horn and the normal contralateral uterine horn, ovary and fallopian tube. Two 8 mm robotic ports were placed in the right and left lower quadrants and a 10 mm assistant port was placed through the right lateral aspect of her prior pfannensteil incision. The distended uterine horn was punctured and 60 ml of hemolyzed blood aspirated for decompression. The sigmoid colon was aherent to the lateral aspect of the uterine horn due to previous salpingo-oophorectomy, and was dissected away. The vascular pedicle to the left uterine horn was ligated with a harmonic scalpel. The fibrotic attachment of the uterine horn to the vagina was identified and divided, with guidance from an assistant's finger to delineate the lateral wall of the vagina and the rectum. The specimen was placed into an endocatch bag inserted via the assistant port, and the incision extended along her prior Pfanensteil incision specimen retrieval. Estimated blood loss was 100 ml. She was discharged home post operative day three. On follow up she had no abdominal pain and lower extremity numbness had resolved. CONCLUSIONS Robot-assisted laparoscopic resection of a functional uterine horn can be performed successfully, safely, and with good outcome. This technique offers a minimally invasive approach to a complicated internal genital anomaly and is another robot assisted procedure for the urologist's armamentarium. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e688 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Manoj Rao Chicago, IL More articles by this author Andrew Marks Chicago, IL More articles by this author Bruce Lindgren Chicago, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Ovarian‐sparing surgery for ovarian teratoma in children

Ovarian teratoma (OT) is the most common ovarian neoplasm in children. Oophorectomy has been the standard treatment but may impair fertility. The aim of this study was to investigate the feasibility and outcome of ovarian-sparing surgery (OSS) for OT. We retrospectively studied all children treated for OT at a pediatric teaching hospital in Paris, France, between March 1992 and July 2006. OSS was performed when deemed technically feasible in patients who had no lymphadenopathy by preoperative imaging or surgical exploration, normal tumor marker levels, and calcifications on radiographs. We identified 30 patients, including 29 with unilateral OT and 1 with synchronous bilateral OT. Emergent surgery was performed in five patients, among whom four had ovarian torsion requiring oophorectomy and one underwent OSS. Of the 26 OTs in the 25 remaining patients, 10 were managed with OSS and 16 with oophorectomy. Subsequently, ultrasound monitoring detected OT development in the contralateral ovary in 4 (14%) patients, after a median of 3 years (range, 1-14 years); OSS was performed in all four cases. The patient with bilateral synchronous OT, managed by OSS initially, underwent unilateral oophorectomy 3 years later for a recurrence. Overall OSS was performed for 15 (42%) OTs. Our results suggest recommendations for preserving fertility whenever possible without compromising the oncological prognosis. In particular, OSS should be reserved for patients who meet all criteria for localized mature teratoma. Long-term follow-up is crucial.

A borderline ovarian Brenner tumor mimicks uterine fibroids

Brenner tumors are uncommon tumors that are a part of the surface epithelialestromal tumor group of ovarian neoplasms. Most of these tumors are benign. However, they can be malignant. They are most frequently detected as incidental findings on pelvic examination or at laparotomy. Besides, they can occur in other locations very rarely, including the testes. We report on this rare, gynecological, borderline adnexal tumor because it mimicks the common, benign uterine fibroids we see in our daily practice. A 47-year-old woman had a 3-year history of profuse menstrual bleeding. The gynecological ultrasound showed an enlarged uterus with a right-wall tumor mass measuring about 50 mm in size. We suggested conservative treatment and regular ultrasound follow-up. Unfortunately, the tumor was accompanied by several microcalcifications and grew to 80 mm within 6 months (Fig. 1), when surgical intervention was indicated. During the operation, the uterus appeared to be in normal size, but an enlarged right ovarian solid tumor, about 8 cm in size, was adhered to the uterus and the peritoneum. This solid tumor’s surface was smooth, and the content was yellowish in color (Fig. 2). Unfortunately, the frozen section showed malignant cells of fibrous composition in the tumor, and the metastatic tumor was first impressed. Complete staging surgery, including a total hysterectomy, a bilateral salpingo-oophorectomy, an infracolic omentectomy; a pelvic and para-aortic lymph node sampling; and an appendectomy were done. The gross tumor (about 8 cm in size) was in the right ovary, with the outer surface lobulated, intact, and without adhesions. The sectioned surface of the main tumor contained 100% solid components that were yellow-white in color with a firm consistency. The contralateral ovary was mildly enlarged with focal, whitish nodule formation (18 mm). The other specimens were unremarkable. The microscopic findings indicated a right ovarian tumor exhibiting irregular epithelioid tumor nests infiltrating a dense

Ovarian serous surface papillary borderline tumors form sea anemone‐like masses

To clarify the imaging characteristics of ovarian serous surface papillary borderline tumor (SSPBT), whose prognosis is far better than that of serous surface papillary adenocarcinoma (SSPC). We retrospectively reviewed the clinical and imaging findings of six cases (age range, 26-58 years; mean, 43 years) with SSPBT encountered at our institute from 1996 to 2008. Serum levels of CA125 were elevated, and they were clinically suspected to have ovarian cancer. All masses were almost entirely solid and showed hyperintense papillary architecture with hypointense internal branching on T2-weighted MRI. Five patients had peritoneal implants, and two had lymph node enlargement, and all tumors were accompanied by ascites. In all cases, contralateral ovaries had cystic masses with mural nodules or mixed solid and cystic masses, of which the solid part was similar to the contralateral mass. No evidence of recurrence was noted at a follow-up of >12 months postoperatively. SSPBT, which has more favorable prognosis than those of flank ovarian carcinoma, is characterized by a solid mass with papillary architecture and internal branching resembling a sea anemone on MR.

Role of Polycomb Group Protein Cbx2/M33 in Meiosis Onset and Maintenance of Chromosome Stability in the Mammalian Germline

Polycomb group proteins (PcG) are major epigenetic regulators, essential for establishing heritable expression patterns of developmental control genes. The mouse PcG family member M33/Cbx2 (Chromobox homolog protein 2) is a component of the Polycomb-Repressive Complex 1 (PRC1). Targeted deletion of Cbx2/M33 in mice results in homeotic transformations of the axial skeleton, growth retardation and male-to-female sex reversal. In this study, we tested whether Cbx2 is involved in the control of chromatin remodeling processes during meiosis. Our analysis revealed sex reversal in 28.6% of XY−/− embryos, in which a hypoplastic testis and a contralateral ovary were observed in close proximity to the kidney, while the remaining male mutant fetuses exhibited bilateral testicular hypoplasia. Notably, germ cells recovered from Cbx2(XY−/−) testes on day 18.5 of fetal development exhibited premature meiosis onset with synaptonemal complex formation suggesting a role for Cbx2 in the control of meiotic entry in male germ cells. Mutant females exhibited small ovaries with significant germ cell loss and a high proportion of oocytes with abnormal synapsis and non-homologous interactions at the pachytene stage as well as formation of univalents at diplotene. These defects were associated with failure to resolve DNA double strand breaks marked by persistent γH2AX and Rad51 foci at the late pachytene stage. Importantly, two factors required for meiotic silencing of asynapsed chromatin, ubiquitinated histone H2A (ubH2A) and the chromatin remodeling protein BRCA1, co-localized with fully synapsed chromosome axes in the majority of Cbx2(−/−) oocytes. These results provide novel evidence that Cbx2 plays a critical and previously unrecognized role in germ cell viability, meiosis onset and homologous chromosome synapsis in the mammalian germline.

Unilateral ovarian absence in two capuchin monkeys

Ovarian absence is a rare condition with congenital or traumatic origin. Gross and microscopic examination of two capuchin monkeys were performed. Case 1 had absence of the right ovary and distal uterine tube, bilateral absence of fimbriae, and a rudimentary uterus. Case 2 had unilateral ovarian absence, but a functional contralateral ovary, and a normal uterus. Unilateral ovarian absence was confirmed in two capuchin monkeys for the first time.

Comparison of Fertility on Intrauterine Insemination between Cryopreserved Ejaculated and Cauda Epididymal Sperm in Dogs

The fertility was compared between ejaculated and cauda epididymal sperm sensitized with prostatic fluid in dog after freeze-thawing using the fertility of ova from the contralateral ovary after injection (2 × 10(8) sperm) into dog uterus on the unilateral ovariectomized side, on the basis of the presence or absence of conception. No significant difference was observed in sperm quality after freeze-thawing between the two groups and conception rates were equivalent and low. Therefore, to achieve a high fertility by intrauterine insemination of canine frozen-thawed ejaculated and cauda epididymal sperm, intrauterine insemination on both sides is recommended, rather than insemination with a lot of sperm of the uterine horn on one side.

Ovarian Lymphangioma

Lymphangiomas have been reported in various sites in literature. We present a rare case of ovarian lymphangioma detected incidentally in a 47 ndash years old post ndash menopausal woman. She underwent total abdominal hysterectomy with bilateral salpingo-oopharectomy for menorrhagia and a coexistent benign cystic teratoma of the contralateral ovary

Ovarian Choriocarcinoma as the First Manifestation of 46,XY Pure Gonadal Dysgenesis

We report a case of 46,XY pure gonadal dysgenesis (Swyer syndrome) in a phenotypically normal 12-year-old girl with a history of vaginal bleeding and early breast development, with ovarian choriocarcinoma as the first manifestation. The clues leading to the diagnosis included the failure to establish any relationship between normal menstrual cycles postoperatively and a small remaining contralateral ovary. The correct diagnosis is important for cancer prophylaxis and hormonal replacement therapy. Prepubertal and peripubertal girls presenting with gonadal germ cell tumors should be carefully evaluated for the possibility of underlying gonadal dysgenesis. A history of vaginal bleeding or early signs of puberty does not exclude the diagnosis.

Ovarian cysts and laparoscopy in children: Importance of late postoperative ultrasound examination in follow-up

Objective: The ultrasonography (USG) as a non-invasive method plays very important role in diagnosis and treatment of childhood ovarian cysts. In this prospective study, results of early and late postoperative USG follow-ups were evaluated in patients who had laparoscopic cystectomy for ovarian cyst. Method: Forty patients having laparoscopy (45 operation) due to ovarian cysts were included into the study for a 5-year period. Preoperative clinical and USG findings and operation videos recorded during laparoscopic intervention were reviewed. The patients were invited to USG controls at postoperative 1, 3, 9-month, and 1-year and thereafter. Results: The age range of patients was from 13 days to 18 years old. Postoperative USG controls showed that reoccurred cysts on the operated side were small and there was no indication for reoperation, but a second intervention was needed for the contralateral ovary in 5 patients. All these re-operated cases were determined in the late (a‰¥1 year) USG control. Conclusion: Laparoscopy is an effective treatment method for ovarian cysts. The reoperation may be needed depending on physical examination and USG findings. There is a risk of symptomatic and large cyst occurrence on the contralateral side. A long term postoperative USG follow up helps to determine these cysts.

Vaporization of ovarian endometrioma using plasma energy: histologic findings of a pilot study

In ten ovarian endometriomas of diameter exceeding 30 mm, managed by complete vaporization of the inner surface using plasma energy followed by cystectomy, we performed histologic evaluation of the depth of necrosis and the effectiveness of endometrial tissue ablation. We observed that plasma energy allows the ablation of endometrial tissue with minimal damage to the ovarian parenchyma, which suggests that this technique might be of particular interest for women with risk factors of postoperative ovarian reserve impairment, such as recurrent and bilateral endometriomas.

Comparing Ovarian Reserves After Laparoscopic Excision of Ovarian Endometriotic Cysts and Ovarian Nonendometriotic Cysts

Abstract Objective: This study compared ovarian response to controlled ovarian hyperstimulation between women who previously underwent laparoscopic excision of an ovarian endometriotic monolateral cyst with women who had surgery for ovarian nonendometritoic monolateral cysts. Materials and methods: This was a retrospective review of women who underwent controlled ovarian hyperstimulation for in vitro fertilization or intracytoplasmicsperm injection after laparoscopic excision of an ovarian endometriotic monolateral cyst (group A) after surgery for ovarian nonendometritoic monolateral cysts (group B). The contralateral intact ovary and the operated ovary of each patient were compared in terms of the number of follicles with a mean diameter gt;15 mm at the time of human chorionic gonadotropin administration between groups A and B. An unpaired Student's t-test was used to investigate differences between groups A and B. Results: Thirteen (13) and 7 women were recruited for groups A and B. Although the mean (±...

Mucinous carcinoid of the ovary: report of a case with metastasis in the contralateral ovary after ten years

Monodermal teratomas of the ovary can take the form of carcinoid tumors of which there are several types, mucinous carcinoid being the least common. Very few cases of primary mucinous carcinoid of the ovary have been reported in the literature and the behavior of these tumors over the long term is unclear. We describe a case of primary mucinous carcinoid of the ovary in a 39-year-old woman treated with unilateral salpingo-oophorectomy, where a metastasis occurred in the contralateral ovary ten years later. This case demonstrates that mucinous carcinoid of the ovary can metastasize even after a long interval, and careful follow-up of patients, particularly those treated conservatively, is appropriate.

Lethal, Malignant, Metastatic Struma Ovarii

Struma ovarii (SO) is extremely rare, with less than 200 reported cases in the medical literature. SO is defined by the presence of an ovarian tumor containing thyroid tissue as the predominant cell type. Malignant transformation is rare and lethal cases of SO are even rarer. We report on a patient presenting with left ovarian cystic SO and lethal outcome. A 45-year-old woman was diagnosed with a follicular variant of papillary carcinoma on laparotomy and left salpingo-oophorectomy. She had persistently elevated serum thyroglobulin following total thyroidectomy + radioiodine and second-look surgery. Imaging scan analysis showed pelvic tumor recurrence and hypervascular liver metastases during follow-up as well as peritoneal carcinomatosis in the pelvis, right abdominal wall, and malignant ascites. The patient died from cachexia at 37 months after diagnosis. Such an aggressive malignant disease and lethal course of SO is rare. Total thyroidectomy is mandatory to exclude a primary thyroid neoplasm and for radioiodine therapy and follow-up. SO may spread to contralateral ovary, pelvic nodes, peritoneum, liver, lungs, and bones through hematogeneous spread, which is different from the dissemination pattern of papillary thyroid carcinomas. Imaging highlights the mixed behavior of this ovarian tumor.

True Hermaphroditism: First Evidence of an Ovotestis in a Cetacean Species

An immature unilateral hermaphrodite common dolphin (Delphinus delphis) was found stranded on the southwest coast of the UK. The external phenotype was that of a female, but internally there was one ovotestis, containing both ovarian follicles and testicular tubular elements, and a contralateral ovary. Ovarian portions of the ovotestis appeared normal and demonstrated follicular development, whereas the testicular tissue exhibited hypoplasia and degeneration. This is the first reported case of an ovotestis in a cetacean species.

Efficacy and safety of ovarian stimulation before chemotherapy in 205 cases

Ovarian stimulation and cryopreservation of fertilized oocytes before cancer therapy is the best established and efficient fertility preservation technique and should still be considered before chemotherapy. Within a short time frame of 2 weeks, between 8.6 (18-25 y) and 5.1 (36-40 y) fertilized oocytes can be cryopreserved.

Risk of malignancy in sonographically confirmed septated cystic ovarian tumors

Objective To determine the risk of malignancy in septated cystic ovarian tumors. Materials 1319 (4.4%) of 29,829 women were identified by transvaginal sonography (TVS) as having a complex cystic ovarian tumor with septations without solid areas or papillary projections and were placed on long-term ultrasound surveillance for ovarian malignancy. Results These 1319 patients had a total of 2870 septated cystic ovarian tumors. 2288 tumors (79.7%) had a septal width < 2 mm and 582 (20.3%) had a septal width ≥ 2 mm. 2286 tumors (79.6%) were < 5 cm in diameter and 584 (20.4%) were ≥ 5 cm in diameter. 1114 septated cystic tumors (38.8%) resolved spontaneously (mean duration to resolution—12 months) and 1756 (61.2%) tumors persisted. 128 patients underwent surgical tumor removal within 3 months of ultrasound. Most common histopathology was: serous cystadenoma (75), mucinous cystadenoma (13), and endometrioma (10). One patient had an ovarian tumor of borderline malignancy (Stage IB). There were no cases of ovarian cancer. Patients were followed from 4 to 252 months (mean—77 months). One patient developed papillary morphology in the contralateral ovary 3.2 years after detection of a septated ovarian cyst and had epithelial ovarian cancer in that ovary and in the omentum (Stage IIIC disease). The remaining patients are all free of ovarian neoplasia after a total of 7642 follow-up years. Conclusions Septated cystic ovarian tumors without solid areas or papillary projections have a low risk of malignancy and can be followed sonographically without surgery.