Contralateral Ovary Research Articles

Role of laparoscopy in the diagnosis and treatment of adnexal masses

Laparoscopy has been accepted for years as a management of benign ovarian tumors. The aim of this study was to estimate the feasibility and safety of laparoscopy in diagnosis and management of adnexal masses. A total of 2083 patients with benign adnexal mass were treated by laparoscopy at Peking Union Medical College Hospital from January 2000 to December 2003. Their clinical data were reviewed retrospectively. All the adnexal masses suspicious of malignancy at the time of laparoscopy were sent for frozen section evaluation intraoperatively. The rates of unexpected intracystic vegetation and low malignant potential (LMP) tumor or malignancy were investigated. The sensitivity, specificity, positive predictive value, and negative predictive value of laparoscopic diagnosis for LMP or ovarian malignancies were calculated. The ratios were compared by Chi-square test and the continuous variables were tested using two-tailed t test. Of the 2083 patients, 16 had LMP or invasive tumors (0.77%), among which 14 were diagnosed histologically intraoperatively and 2 postoperatively. Fifty-five (2.6%) of the 2083 patients had unexpected intracystic vegetations. Their frozen sections showed benign tumors in 41 (74.5%), LMP tumors in 8 (14.5%), and focal invasive ovarian cancers (stage Ic) in 6 (10.9%). The final pathological diagnosis were benign tumors in 41 (74.5%), LMP tumors 7 (12.7%), and focal invasive ovarian cancers (stage Ic) in 7 (12.7%). Laparoscopy achieved a sensitivity of 87.5%, specificity of 98%, positive predictive value of 25.5%, and negative predictive value of 99.9% in the diagnosis of ovarian malignancies. 2067 cases with benign adnexal masses underwent laparoscopy successfully. No conversion to laparotomy, or intra- and postoperative complications in this series. Of the 16 patients with LMP or invasive ovarian cancer, seven underwent laparoscopic surgery including immediate staging laparoscopy in 3. The mean follow-up was 17.3 months for the 16 patients. Among them, 1 developed a recurrent LMP tumor in the contralateral ovary 36 months after laparoscopic salpingo-oophorectomy, and received subsequent laparoscopic cystectomy and pelvic lymph node sampling; the others had no evidence of recurrent tumor during the follow-up. Laparoscopy is feasible for diagnosis of adnexal masses, and the surgery is safe for patients with benign ovarian tumors.

Disruption of Gap Junctional Communication within the Ovarian Follicle Induces Oocyte Maturation

Meiotically arrested mammalian oocytes are stimulated to resume meiosis by LH. This response, which can be reversed by elevation of intraoocyte cAMP levels, is associated with interruption of gap junctional communication (GJC) within the ovarian follicle. In the present study, we examined the hypothesis that disruption of GJC within the ovarian follicle is sufficient for induction of oocyte maturation. For this purpose, we incubated rat follicle-enclosed oocytes with carbenoxolone (CBX), a known blocker of gap junctions. We found that this selective disruptor of GJC promoted maturation of almost all the follicle-enclosed oocytes after 5 h of incubation; this response was also obtained by a transient (2 h) exposure to this agent. CBX-induced oocyte maturation was accompanied by a substantial decrease in intraoocyte concentrations of cAMP that was not associated with elevated activity of type 3A phosphodiesterase (PDE3A). The effect of CBX on reinitiation of meiosis was blocked by isobutylmethylxanthine, a phosphodiesterase inhibitor. Unlike LH, CBX did not activate MAPK in the follicular cells, and inhibition of the MAPK signaling pathway by means of UO126 did not prevent the resumption of meiosis. Injection of CBX into the ovarian bursa of intact animals stimulated maturation in 30% of the oocytes, whereas no maturation was observed in the contralateral ovary injected with PBS. We conclude that, because experimentally induced breakdown of communication within the ovarian follicle is associated with a drop in intraoocyte cAMP concentrations and results in resumption of meiosis, this could be the physiological mechanism employed by LH to stimulate oocyte maturation.

Atypical reactive ovarian surface epithelium, a pitfall in pathologic assessment

A 21-year-old parous woman was operated on due to a torsioned huge hemorrhagic benign ovarian mass. A wedge biopsy of the contralateral ovary revealed endophytic superficial cell clusters with atypical features raising suspicion of malignancy. Detailed pathologic and clinical workup proved these foci as reactive ovarian surface epithelium contrary to various initial interpretations as metastatic, deciduoid, or histiocytic by expert pathologists.

Atypical reactive ovarian surface epithelium, a pitfall in pathologic assessment

A 21-year-old parous woman was operated on due to a torsioned huge hemorrhagic benign ovarian mass. A wedge biopsy of the contralateral ovary revealed endophytic superficial cell clusters with atypical features raising suspicion of malignancy. Detailed pathologic and clinical workup proved these foci as reactive ovarian surface epithelium contrary to various initial interpretations as metastatic, deciduoid, or histiocytic by expert pathologists.

Fertility-Sparing Surgery for Ovarian Low Malignant Potential Tumors

Ovarian tumors with low malignancy potential can be treated with simple surgical excision without removing the uterus and remaining ovary. For this study, the outcomes of women with low-malignant-potential (LMP) ovarian tumors who underwent fertility-sparing surgery were compared with those of women who had more extensive surgery. A review of medical charts at the authors' institution from January 1984 to June 2003 identified 249 women with ovarian LMP tumors, 38 (15%) of whom were treated with fertility-sparing surgery. The remaining 211 patients served as controls for this study. Women who had fertility-sparing surgery were a mean age of 26 years compared to 48 years for women who had complete resection and had lower mean gravidity (0.5 vs 2) and parity (0 vs 2) compared with controls (P <.001 for all). More Hispanic and Asian women were younger than age 40 compared with black and white women (P <.01), and they more commonly underwent fertility-sparing surgery (P =.002). Total estimated blood loss was less among patients who were treated with fertility- sparing procedures than controls (125 mL vs 300 mL; P < 0.001), and surgical staging was less common in the women treated with unilateral oophorectomy than in women who had complete resection (65 vs 184; P =.04). Among patients who were staged, those with stage I disease (34 of 196, 17%) were more likely to receive fertility-sparing treatment than stage II or III patients (4 of 53, 8%). Among the 38 patients who had fertility-sparing surgery, 33 underwent unilateral salpingo-oophorectomy. No evidence of disease was seen in 6 women who had concomitant contralateral ovarian cystectomy or in 3 of 4 women who underwent biopsy of the contralateral ovary with no visible indication of disease. The fourth woman was found to have a serous LMP tumor that mirrored the primary tumor. Five women were treated with ovarian cystectomy (5 of 38; 13%). Four were bilateral procedures and one was unilateral. There were 6 recurrences among the 38 patients treated with fertility-sparing surgery, including 5 serous tumors and one mucinous tumor. Five recurrent lesions were in the contralateral ovary. One woman was diagnosed with positive peritoneal cytology for pelvic pain 5 months after ovarian cystectomy for a serous LMP tumor. She had no other treatment and has not recurred. The remaining 4 patients were disease-free for 62, 122, 117, and 18 months from initial treatment. These 4 patients were treated with surgery alone and all are alive and well.

Damage to ovarian reserve associated with laparoscopic excision of endometriomas: A quantitative rather than a qualitative injury

Retrospective studies suggest that laparoscopic excision of endometriomas is associated with a reduced responsiveness to ovarian hyperstimulation. In this study, we prospectively evaluated ovarian response to hyperstimulation in women selected for in vitro fertilization and intracytoplasmic sperm injection cycles who previously underwent laparoscopic enucleation of a monolateral endometrioma. Operated and contralateral intact ovaries of the same patient were compared in terms of number of follicles, number of oocytes retrieved, fertilization rate, and rate of high-quality embryos. Thirty-eight subjects were included. A reduced number of dominant follicles, oocytes, embryos, and high-quality embryos was observed in the operated gonad. The mean percentage of reduction was 60% (95% confidence interval 38-81%), 53% (95% confidence interval 30-75%), 55% (95% confidence interval 28-81%), and 52% (95% confidence interval 17-87%), respectively. Fertilization rate and rate of good-quality embryos were similar. Laparoscopic excision of endometriomas is associated with a quantitative but not a qualitative damage to ovarian reserve.

Laparoscopic Ovariectomy in Mares Using a Polyamide Tie‐Rap

To describe use of a polyamide tie-rap to ligate the mesovarium during standing laparoscopic ovariectomy in mares. Prospective study. Ten mares. Bilateral ovariectomy was performed in 10 mares. Standing laparoscopic ovariectomy was performed using 3 portals in the paralumbar fossa. A commercial polyamide tie-rap was prepared as a loop and marked with 4 colored lines close to the buckle, to enable us to check whether the loop was tightened securely. The ovary was grasped with forceps and after the mesovarium was minimally transected cranially and caudally, the loop of the tie-rap was inserted in the abdomen and placed around the mesovarium. It was firmly tightened, until at least 3 of the 4 marks were visible, then the end of the tie-rap was cut. The ovary was transected and removed through an enlarged 3rd portal. The contralateral ovary was removed similarly through the opposite paralumbar fossa. Repeat laparoscopy was performed in 8 mares, 2, 3, 4, and 12 weeks later. None of the mares had postoperative discomfort. On repeat laparoscopy, there was complete encapsulation of the stump and tie-rap after 3-4 weeks. In 2 mares, an adhesion between the left stump and the mesentery of the descending colon was observed. Ligation of the mesovarium can be easily and safely performed using a polyamide tie-rap during standing laparoscopic ovariectomy in mares. Standing laparoscopic ovariectomy using a polyamide tie-rap is a safe, technically easy and reliable surgical procedure in the mare.

A clinically relevant orthotopic implantation nude mouse model of human epithelial ovarian cancer-based on consecutive observation

The aim of this study is to establish an orthotopic implantation nude mouse model of epithelial ovarian cancer (EOC) and observe its biologic features. A human ovarian tumor line SKOV3ipl previously grown subcutaneously was implanted orthotopically as intact tissue into the ovarian capsule of 64 nude mice. Every week eight mice were taken randomly, and the tumor growth pattern and extent of metastatic disease were monitored continuously. Those mice that died of disease were necropsied and the end date was recorded. The orthotopic implanted tumors demonstrated a 100% take rate. Three weeks after implantation the tumors grew fast and weighed 1149 +/- 152 mg, and 5 weeks after implantation the tumors reached a flat stage. The tumors metastasized more often to peritoneum (32/56) and diaphragm (18/56), then to pelvic lymph nodes (11/56) and lung (10/56), and then to the seldom invaded organs including the pancreas, the liver, the contralateral ovary, and the para-aortic lymph node. Eight nude mice became exhausted 7 weeks after implantation and died within 68 days after implantation. Our study, utilizing the SKOV3ipl cell, is the first model of consecutive observation of the process of invasion and metastasis of EOC. It should be useful in understanding the molecular biology of EOC and in the development of therapeutic modalities against metastasis.

Asynchronous bilateral adnexal torsion in a 13-year-old adolescent: Our experience of a rare case with review of the literature

Adnexal torsion is a serious condition and delay in surgical intervention may result in loss of the tube and/or ovary. Children and adolescents who have suffered from uterine adnexal torsion may be at risk for asynchronous torsion of the contralateral uterine adnexa. We report the case of sequential bilateral torsion of uterine adnexa in a 13-year-old girl, resulting in right and subsequently left salpingo-oophorectomy because of gross evidence of total necrosis in both uterine adnexa. After the castration the patient was started on hormone replacement therapy. Families of children who suffered from ovarian torsion and unilateral ovarian loss should be educated about the risk of the contralateral ovary for future torsion and should be encouraged to seek immediate medical help with the recurrence of abdominal pain.

Evaluation of ovulation rate and ovarian phenotype in puberal heifers from a cattle population selected for increased ovulation rate1,2

Long-term selection for increased ovulation rate (1984 to 2002) has resulted in a unique ovarian phenotype in the MARC Twinner cattle population. Ovulation rate and frequency of bilateral ovulations were examined by rectal palpation in 29,547 estrous cycles for 3,910 heifers (12 to 18 mo of age) in this population. Bilateral ovulations (one corpus lutuem [CL] on each ovary) were of interest because bilateral twin pregnancies result in decreased dystocia and increased calf survival. Ovulation rate increased linearly at a rate of 0.026 CL per year, and it currently averages 1.48 +/- 0.04 CL per estrous cycle. Concurrent with the increase in ovulation rate, the frequency of triplet ovulations increased from 0% to 2.3 +/- 0.8% (P < 0.001). Ovulation rate of both the right and left ovary increased equally at a rate of 0.013 CL per year, and mean ovulation rate of the right ovary remained greater than mean ovulation rate of the left ovary throughout the study (0.66 vs. 0.55 +/- 0.003 CL per estrous cycle; P < 0.001). Although correlations were low, ovulation rate of one ovary was negatively correlated (P < 0.001; r = -0.07) with ovulation rate of the same ovary in the previous estrous cycle, but positively correlated (P < 0.001; r = 0.13) with the contralateral ovary of the previous estrous cycle. The proportion of bilateral ovulations averaged 55.7 +/- 0.7%, a value greater than the predicted 49.5% (P < 0.001). In addition to dystocia and retained placenta, triplet pregnancies increase the incidence of pregnancies gestating fetuses of opposite sexes and subsequent incidence of freemartins; thus, selection pressure on ovulation rate may need to be adjusted in the MARC Twinner population. The proportion of bilateral ovulations in the population is greater than expected, and this may be an economically important trait, which will respond to selection and be beneficial for improving bovine reproductive efficiency. Understanding factors controlling the increased functional activity of the right ovary and bilateral ovulations may provide further insights into the mechanisms controlling follicle selection and methods to improve reproductive management of cattle.

Different proportions of aneusomic cells in ovarian inclusion cysts associated with serous borderline tumours and serous high‐grade carcinomas support different pathogenetic pathways

Ovarian serous tumours may arise from the ovarian surface epithelium or from ovarian cortical epithelial inclusion cysts. However, little is known about the pathogenetic mechanisms involved in the progression from ovarian surface epithelium or inclusion cysts to neoplastic disease. In the present study, chromosomal aberrations typical of ovarian serous tumours were studied in ovarian surface epithelium and inclusion cysts. Ten ovaries with inclusion cysts obtained from patients without a gynaecological tumour, as well as 15 serous borderline tumours and 16 invasive high-grade serous carcinomas with inclusion cysts either in the ipsi- or in the contralateral ovary, were investigated by fluorescence in situ hybridization (FISH) using centromere enumeration probes directed against chromosomes 1, 6, 7, and X. The proportions of aneusomic cells were assessed. Trisomies 1 and 7 and monosomies 6 and X were present in the surface epithelium, inclusion cysts, and tumours, providing evidence for a link between the surface epithelium, and inclusion cysts, and serous neoplasia. Inclusion cysts generally harboured more aneusomic cells than the associated surface epithelium, suggesting an influence of the ovarian stroma on the development of chromosomal instability. Moreover, inclusion cysts associated with borderline tumours displayed a higher proportion of aneusomic cells than inclusion cysts associated with invasive high-grade carcinoma and than inclusion cysts in ovaries without neoplastic disease. These results suggest a genetic field defect of the inclusion cyst epithelium in serous borderline tumours. Invasive high-grade serous carcinomas, by contrast, may arise from single cell clones subject to a different set of genetic events.

Acute depletion of murine primordial follicle reserve by gonadotropin-releasing hormone antagonists

To examine the effects of GnRH antagonists on preantral follicle survival in vivo and to investigate whether GnRH antagonist use during cyclophosphamide treatment would protect the ovary and preserve primordial follicle survival in a murine model. Prospective basic research study. Research laboratory in an academic medical center. Adult C57Bl/6 mice (5 to 6 weeks old). Mice received either a single injection of GnRH agonist (leuprolide acetate) on study day -10 or injections of the GnRH antagonist (antide or cetrorelix) on study days -3 and 0. Some animals also received the chemotherapeutic agent cyclophosphamide on day 0. All animals were killed by CO2 asphyxiation on day 7. To examine direct vs. indirect effects, some mice received GnRH antagonist under the bursa of one ovary, with the contralateral ovary receiving vehicle. Ovaries were fixed in Kahle's solution; 7-mum tissue sections were stained with Lillie's allochrome, and preantral follicles were counted on every fifth section. Numbers of primordial, primary, and secondary follicles. Systemic administration of both GnRH antagonists caused a significant destruction of primordial follicles compared with control mice. Similar results were obtained whether the antagonists were administered systemically or directly to the ovary. Gonadotropin-releasing hormone agonist had no effect on primordial follicle numbers by itself but reduced the follicular depletion caused by cyclophosphamide. In contrast to the effects of GnRH agonists to reduce chemotherapeutic destruction of primordial follicles, GnRH antagonists do not protect the ovary from the damaging effects of cyclophosphamide. More importantly, GnRH antagonists alone deplete primordial follicles in this murine model, likely through a direct effect on the ovary. Whether these observations apply to other species requires further study.

Effects of Pentoxifylline and Vitamin E on the Bilateral Ovary After Experimental Ovarian Ischemia

Pentoxifylline (PTX) and vitamin E inhibit the release of superoxide and hydroxyl radicals, and PTX improves capillary flow and tissue oxygenation. This experimental study was designed to determine the effects of PTX and vitamin E in the ovary after unilateral ovarian ischemia reperfusion (I-R) in albino Wistar rats. A vascular clamp was placed on the left ovary for 4 hours in all groups except for the control group. Following this, in the ischemia (I) group bilateral ovariectomy was performed. Saline, PTX, vitamin E, and PTX plus vitamin E were infused 30 min before reperfusion in the reperfusion (R), pentoxifylline (P), vitamin E (E), and pentoxifylline plus vitamin E (PE) groups, respectively. After 4 hours of reperfusion, the ovaries were removed for biochemical and histologic examination. MDA levels of bilateral ovaries in the PE group were significantly lower than in the E group (p < 0.0033). NO levels of bilateral ovaries in the PE group were significantly lower than in the P and E groups (p < 0.0033). Massive hemorrhage was determined in the ipsilateral ovaries of the R group. Hemorrhage was minimal or moderate in the ipsilateral ovaries of other groups. The contralateral ovaries showed congestion in different degrees. The contralateral ovaries of the group PE and the bilateral ovaries of the control group showed no pathological changes. PTX and vitamin E given together seems to be more effective in reducing I-R injury in ovarian tissue compared to administration of PTX, or vitamin E alone. However, further studies are required to evaluate the effective dose and duration of PTX and vitamin E on bilateral ovaries.

Long-term results of conservative management of adnexal torsion in children

Background/purpose Adnexal torsion is a condition that may result in serious morbidity including adnexal removal. However, conservative management with preserving the torsed adnexa is not justified, and long-term outcomes remain unclear. Methods The records of 14 girls with ovarian torsion whose adnexal structures were preserved after detorsion were reviewed to evaluate the long-term results of conservative management. Data including age, previous history, duration of complaints, surgical findings and type of intervention, color Doppler ultrasound findings performed in the early and late postoperative periods, and final outcomes were collected. Results Mean age of patients was 11.5 ± 2.8 (range 6 to 15) years. Time interval between the onset of pain to surgery was 46.78 ± 35.5 (range 12 to 126) hours. Seven patients had a benign solitary cyst as an underlying cause for adnexal torsion. The intervention performed by open surgery in 9 and by laparoscopy in 5 patients included detorsion, simple cyst aspiration, unroofing and/or cystectomy in 7 patients with ovarian cysts, and oophoropexy in 9 of 14 patients. Follow-up ranged from 3 to 66 (mean 21.9 ± 20.1) months. Thirteen patients resumed normal size and folliculogenesis, whereas in 1 patient, the involved ovary atrophied. No recurrence or contralateral adnexal torsion was observed on follow-up. Conclusions Conservative management with untwisting the ovary and pexing both retained detorsed and contralateral ovaries especially in idiopathic torsions should be considered in cases of ovarian torsion in children.

Monolateral mature ovarian cystic teratoma

A 41-year-old multipara woman was hospitalized with a 1-month history of pelvic pain. Past medical history revealed no gynecologic or obstetric disease. Abdominal examination gave normal results, and no mass was palpable. Routine laboratory test results were normal. An ultrasound scan showed a right complex solid and cystic ovarian mass, and computed tomography of the pelvis revealed a 3.5-cm right adnexal mass with calcifications suggestive of teeth. The contralateral ovary was normal in appearance.

Fertility-Sparing Surgery for Malignancies in Women

Never before have women with newly diagnosed gynecologic malignancies had more options for preservation of fertility. Girls or women of childbearing age with several ovarian cancer subtypes have a high probability of unilateral ovarian involvement, and, thus, may be candidates for fertility-sparing surgery with preservation of a contralateral normal ovary and uterus. These subtypes include ovarian tumors of low malignant potential, malignant ovarian germ cell tumors, and ovarian sex cord-stromal tumors. For women with invasive epithelial ovarian cancer who have early-stage disease, fertility-sparing surgery may be an option. In some cases, fertility-sparing surgery may be followed by postoperative chemotherapy. For women with invasive cervical cancer, fertility-sparing surgery may be possible. Options include conization alone for stage IA1 or IA2 disease, radical trachelectomy with stage IA2 or IB disease, or ovarian transposition for women undergoing chemoradiation. Non-operative options, such as hormonal therapy, may be considered for women with early-stage, low-grade endometrial cancer. For all women of childbearing age with gynecologic malignancies, in vitro fertilization techniques or cryopreservation of ovarian tissue may be an option prior to definitive treatment.

Ovarian follicular development in the unilateral ovariectomized rat

Background and Aims: Following unilateral ovariectomy, the contralateral ovary underwent hypertrophy and the number of ovulations remained unchanged. The aim of the present study was to elucidate the mechanism, which occurred by this compensation, through examination of ovarian follicular development in operated rats. Methods: Rats were examined 1-8weeks post unilateral operation. The ovaries were serially sectioned. All sections were examined and the size of each follicle was measured. Results: Large follicles soon recovered after surgery, but it took 5weeks for small and medium-sized follicles to recover. The rate of atresia at the 'critical point' was 31.1% in unilateral ovariectomized animals and 73.9% in the sham-operated rats. Conclusions: These findings showed that in operated rats, the recovery of the number of follicles varied depending on the size of the follicle. Compared with the control animals, approximately twice as many large healthy follicles were saved from atresia at the 'critical point', producing a compensatory increase in the ovulation number (P<0.01). (Reprod Med Biol 2005; 4: 89-93).

Ovarian follicular development in the unilateral ovariectomized rat

Background and Aims: Following unilateral ovariectomy, the contralateral ovary underwent hypertrophy and the number of ovulations remained unchanged. The aim of the present study was to elucidate the mechanism, which occurred by this compensation, through examination of ovarian follicular development in operated rats.Methods: Rats were examined 1–8 weeks post unilateral operation. The ovaries were serially sectioned. All sections were examined and the size of each follicle was measured.Results: Large follicles soon recovered after surgery, but it took 5 weeks for small and medium‐sized follicles to recover. The rate of atresia at the ‘critical point’ was 31.1% in unilateral ovariectomized animals and 73.9% in the sham‐operated rats.Conclusions: These findings showed that in operated rats, the recovery of the number of follicles varied depending on the size of the follicle. Compared with the control animals, approximately twice as many large healthy follicles were saved from atresia at the ‘critical point’, producing a compensatory increase in the ovulation number (P &lt; 0.01). (Reprod Med Biol 2005; 4: 89–93)

Local Delivery of Angiopoietin-2 into the Preovulatory Follicle Terminates the Menstrual Cycle in Rhesus Monkeys1

The angiopoietin (ANGPT)-receptor (TEK) system plays a crucial role in blood vessel formation and stability. Because the endogenous agonist ANGPT1, antagonist ANGPT2, and TEK are expressed in the primate ovary, experiments were designed to investigate their role at a critical time during tissue remodeling/ angiogenesis in the menstrual cycle (i.e., at midcycle during maturation, ovulation, and luteinization of the dominant follicle). Either vehicle, 20 microg of ANGPT1, 2 microg of ANGPT2 (low-dose), or 20 microg of ANGPT2 (high-dose) was injected directly into the preovulatory follicle of monkeys around the day (-1 to 0) of the midcycle estradiol (E2)/LH peak. Ovaries were evaluated on Day 3 postinjection for follicle rupture, and serum samples were analyzed for levels of E2 and progesterone. Similar to controls, ANGPT1 treatment was followed by ovulation, and elevated progesterone levels during the luteal phase. In contrast, high-dose ANGPT2 treatment prevented follicle rupture, and progesterone levels never rose above baseline in the subsequent 12 days. However, an E2 peak typically occurred 12 days postinjection. Laparoscopy detected a preovulatory follicle on the contralateral (noninjected) ovary. Progesterone levels subsequently increased above baseline in these animals. Thus, exogenous ANGPT2 disrupted maturation of the preovulatory follicle, preventing its ovulation and conversion into the corpus luteum. ANGPT antagonism eliminated the dominant structure, thereby resetting the ovarian cycle, with selection and maturation of the next preovulatory follicle occurring in a timely manner. The data are consistent with a critical role of the ANGPT-TIE1/TEK system in the ovary, notably at the late stages of follicle maturation during the menstrual cycle.

Monitoring return to cyclicity following removal of a granulosa cell tumor associated with precocious lactation in an 11-month-old Holstein heifer

An 11-month-old Holstein heifer was presented to the Western College of Veterinary Medicine for evaluation of precocious lactation associated with a palpably enlarged right ovary. Ultrasound examination of the ovaries revealed a 6 inch (15 cm) diameter right ovary with a multilobulated appearance, and a small left ovary measuring 0.6 inches (1.6 cm) long by 0.3 inches (0.8 cm) wide. The mammary secretion was consistent with milk: fat-3.07%, protein-4.78%, and lactose-1.07% with a somatic cell count of 4.8?106/mL. Prior to removal of the right ovary by right flank laparotomy, serum hormone levels were measured: testosterone (0.01 ng/mL), estradiol-17? (9.1 pg/mL), progesterone (0.2 ng/mL), prolactin (5.8 ng/mL), luteinizing hormone (0.14 ng/mL) and follicle stimulating hormone (0.32 ng/mL). Gross examination revealed that the right ovary weighed 7.34 oz (208 g) and was composed of numerous cysts (0.2-1.6 inches [0.5-4 cm] in diameter) containing fluid or blood. Microscopically, foci of cells of a follicular or luteal nature were noted. The definitive diagnosis was a right ovarian granulosa cell tumor, and milk secretion declined rapidly following tumor removal. The left ovary was monitored ultrasonographically at weekly intervals to determine onset of cyclicity. Follicular activity resumed between three and four weeks post-surgery, followed by detection of a corpus luteum at day 32. The heifer became pregnant five months post-surgery, and has since delivered a live calf. This case represents only the second reported case of precocious lactation associated with a granulosa cell tumor, and suggests that cyclicity is likely to return to the contralateral ovary less than a month after tumor removal.