Contralateral Ovary Research Articles

Postoperative Ovarian Morphology on Ultrasound after Ovarian Torsion—Effect of Immediate Surgery: A Retrospective Cohort Study

Our objective was to determine if ovarian surgery at the time of ovarian detorsion is associated with impaired short-term ovarian function as indicated by ovarian morphology on ultrasound when compared with detorsion alone. Retrospective cohort study SETTING: The Hospital for Sick Children, Toronto PARTICIPANTS: Patients ≤18 years old with confirmed ovarian torsion from January 1, 2004, to December 31, 2018, with ovarian-sparing surgery. Data were collected on demographics, procedure, intraoperative findings, and postoperative ultrasound. To determine ovarian function, we compared the morphology on the postoperative ultrasound between those with surgery to the ovary and those without surgery to the ovary at the time of detorsion. We also compared the ovarian volume of affected and contralateral ovaries after detorsion and surgery to the affected ovary. One hundred and nineteen patients met the inclusion criteria, of whom 67 (56%) had detorsion with surgery to the ovary and 52 (44%) had detorsion alone. There was no statistically significant difference in appearance on the postoperative ultrasound between these groups (P =.446). There was also no statistically significant difference on the postoperative ultrasound of affected and contralateral ovarian volumes after detorsion and surgery to the affected ovary (P=.69). Patients who underwent surgery to the ovary experienced a lower rate of recurrence; however, this did not reach statistical significance, with a P value of 0.080. Our study demonstrates that surgery, eg cystectomy to the ovary at the time of ovarian detorsion, does not appear to impact ovarian function when compared with detorsion alone, as indicated on postoperative imaging. There was also no difference in volume of the affected and contralateral ovaries in those cases that underwent surgery at the time of initial detorsion. This evidence would support that immediate cystectomy at the time of initial ovarian detorsion is not associated with impaired ovarian function, thus avoiding the need for an interval cystectomy.

Transvaginal Aspiration for Management of Huge Ovarian Endometrioma in Pregnancy

Study Objective To demonstrate a minimally invasive approach of a huge ovarian cyst during pregnancy. Design A step-by-step explanation of the patient's condition, diagnosis, surgical technique, and post-operative results. Setting The patient underwent transvaginal procedure in the lithotomy position and under intravenous sedation and ventilation by face mask. Patients or Participants A 34-year-old woman, gravida 1 at 12 weeks 5 days’ gestation, presented with huge ovarian cyst. A transvaginal ultrasound demonstrated ovarian cyst measuring 10.4 × 8.2 cm with no evidence of malignancy, no free fluid, and a normal-appearing contralateral ovary. The crown-rump length measured 5.92 cm. On non-enhanced magnetic resonance imaging (MRI), 11 × 7 cm sized cystic lesion with high signal intensity in T1-weighted image (WI) and T1-weighted fat suppressed image, low signal intensity in T2 WI suggesting endometrioma, located in cul-de-sac was noted. Because the cyst was huge and deeply located in cul-de-sac, and the uterus was enlarged to 13 weeks size, approach through laparoscopy or even laparotomy was thought to be difficult and the risk of manipulation for uterus was high. So, we decided to aspirate the ovarian cyst through the vaginal route. Interventions Ultrasound-guided transvaginal aspiration was performed using an 18-G needle. Measurements and Main Results The operation time was 4 hours and 35 minutes with 305 mL dark brownish fluid drained. The patient recovered well and was discharged 2days after the procedure. There was no intraoperative or postoperative complication. Postoperative ultrasound revealed neither recurrence nor fetal abnormality. Until delivery, the patient was free of symptom and ultrasound revealed neither recurrence nor fetal abnormality. Conclusion In select pregnant woman with endometrioma requiringintervention, the risks of surgery may be minimized with aspiration. Transvaginal ultrasound-guided aspiration is a safe, feasible, and effective minimally invasive procedure for huge ovarian endometrioma in pregnancy. To demonstrate a minimally invasive approach of a huge ovarian cyst during pregnancy. A step-by-step explanation of the patient's condition, diagnosis, surgical technique, and post-operative results. The patient underwent transvaginal procedure in the lithotomy position and under intravenous sedation and ventilation by face mask. A 34-year-old woman, gravida 1 at 12 weeks 5 days’ gestation, presented with huge ovarian cyst. A transvaginal ultrasound demonstrated ovarian cyst measuring 10.4 × 8.2 cm with no evidence of malignancy, no free fluid, and a normal-appearing contralateral ovary. The crown-rump length measured 5.92 cm. On non-enhanced magnetic resonance imaging (MRI), 11 × 7 cm sized cystic lesion with high signal intensity in T1-weighted image (WI) and T1-weighted fat suppressed image, low signal intensity in T2 WI suggesting endometrioma, located in cul-de-sac was noted. Because the cyst was huge and deeply located in cul-de-sac, and the uterus was enlarged to 13 weeks size, approach through laparoscopy or even laparotomy was thought to be difficult and the risk of manipulation for uterus was high. So, we decided to aspirate the ovarian cyst through the vaginal route. Ultrasound-guided transvaginal aspiration was performed using an 18-G needle. The operation time was 4 hours and 35 minutes with 305 mL dark brownish fluid drained. The patient recovered well and was discharged 2days after the procedure. There was no intraoperative or postoperative complication. Postoperative ultrasound revealed neither recurrence nor fetal abnormality. Until delivery, the patient was free of symptom and ultrasound revealed neither recurrence nor fetal abnormality. In select pregnant woman with endometrioma requiringintervention, the risks of surgery may be minimized with aspiration. Transvaginal ultrasound-guided aspiration is a safe, feasible, and effective minimally invasive procedure for huge ovarian endometrioma in pregnancy.

Clinical Outcomes of Drug-Free in Vitro Activation (IVA) with Modified Surgical Technique in Patients with Diminished Ovarian Reserve

<h3>Study Objective</h3> Patients with critically diminished ovarian reserve have few remaining follicles and using donated eggs becomes the only chance of getting pregnant. Kawamura et al. have invented a method for the activation of dormant follicles using PI3K stimulator and PTEN inhibitors, but later showed that ovarian tissue fragmentation alone with returning to the contralateral ovary could also lead to follicular growth. Our purpose was to optimize infertility treatment in patients with diminished ovarian reserve using a new modified surgical technique with ipsilateral ovarian tissue reimplantation. <h3>Design</h3> Prospective study, Level II. <h3>Setting</h3> National Medical Research Center. <h3>Patients or Participants</h3> 70 patients with diminished ovarian reserve and no successful results from previous treatment, including ART methods. <h3>Interventions</h3> Bilateral ovarian cortex biopsy via laparoscopy, ovarian tissue fragmentation in aliquots of 1 mm², and hysteroscopy with endometrial biopsy were performed in all patients, followed by histological examination. Collected tissue fragments were grafted into a formed space between the ovarian cortex and medulla ipsilaterally. To date 40 patients underwent ovarian stimulation after at least a one-month postoperative period. <h3>Measurements and Main Results</h3> Our study demonstrated at least a triple increase in estradiol level in 5 days after surgery, progressive decrease in gonadotropins levels, increase in the number of growing follicles in all patients after our modified surgical approach. 31 out of 40 patients have responded to ovarian stimulation. Moreover, in 25 out of 31 patients we revealed an increase in the number of oocytes, fertilization rates, and high-quality embryo rates. 10 patients became pregnant after the surgery (3 spontaneous pregnancies, 7 - after ovarian stimulation). <h3>Conclusion</h3> Our data shows that drug-free IVA with our modified surgical technique is associated with favorable clinical outcomes for infertility treatment in patients with diminished ovarian reserve.

In Vitro Maturation of Oocytes Retrieved from Ovarian Tissue: Outcomes from Current Approaches and Future Perspectives.

In vitro maturation (IVM) of transvaginally aspirated immature oocytes is an effective and safe assisted reproductive treatment for predicted or high responder patients. Currently, immature oocytes are also being collected from the contralateral ovary during laparoscopy/laparotomy and even ex vivo from the excised ovary or the spent media during ovarian tissue preparation prior to ovarian cortex cryopreservation. The first live births from in vitro-matured ovarian tissue oocytes (OTO-IVM) were reported after monophasic OTO-IVM, showing the ability to achieve mature OTO-IVM oocytes. However, fertilisations rates and further embryological developmental capacity appeared impaired. The introduction of a biphasic IVM, also called capacitation (CAPA)-IVM, has been a significant improvement of the oocytes maturation protocol. However, evidence on OTO-IVM is still scarce and validation of the first results is of utmost importance to confirm reproducibility, including the follow-up of OTO-IVM children. Differences between IVM and OTO-IVM should be well understood to provide realistic expectations to patients.

Serous Borderline Ovarian Tumor Diagnosis, Management and Fertility Preservation in Young Women.

Borderline ovarian tumors (BOT) represent about 10 to 20 percent of all epithelial tumors of the ovary. They constitute intermediate lesions between benign ovarian cysts and invasive carcinomas. They often occur in young women of reproductive age, and, albeit with a favorable prognosis, it may recur on the ipsilateral or contralateral ovary. Controversies surround the diagnostic criteria used for their assessment, and the optimal management to minimize their risk of recurrence and/or transformation into malignant carcinoma. Fertility preservation (FP) is considered a priority in the management of these patients, and studies aim at finding the safest and most effective way to help women with BOT history conceive with minimal risk. We present the experience of a single institution in managing three cases of serous BOT in young nulliparous women, followed by a thorough review of the existing literature, highlighting controversies and exploring the possible FP techniques for these women.

Fertility-sparing surgery for patients with stage IC2 or IC3 epithelial ovarian carcinoma: any evidence of safety?

<h3>Objectives:</h3> For young patients with epithelial ovarian carcinoma (EOC), stage IC2 or IC3 disease is regarded as a relative contra-indication for fertility-sparing surgery (FSS) due to data suggesting a higher relapse rate compared to patients with stage IA or IC1 disease. The aim of the present study was to investigate the oncologic outcomes of patients with stage IC2/3 EOC who underwent FSS utilizing a large database and perform a systematic review of the literature. <h3>Methods:</h3> Patients aged ≤45 years without a history of another tumor diagnosed between 2004-2015 with EOC, who underwent surgical staging with lymphadenectomy and had tumor involving the ovarian surface (IC2), malignant ascites or positive cytology (IC3) were identified in the National Cancer Database. FSS group included patients who had preservation of the uterus and the contralateral ovary while radical surgery group included patients who had hysterectomy with bilateral salpingo-oophorectomy. Overall survival (OS) was compared following generation of Kaplan-Meier curves with the log-rank test while a Cox model was constructed to control for tumor histology, grade and substage. A systematic review of the literature (Medline and EMBASE databases) was performed and cumulative relapse rate among patients with IC2/3 disease who underwent FSS was calculated. <h3>Results:</h3> A total of 135 patients with stage IC2/3 disease who met the inclusion criteria were identified; 69 (51.1%) and 66 (48.9%) with stage IC2 and IC3 respectively. FSS was performed for 42 patients (31.1%). Patients who underwent FSS were younger (median 29 vs 41 years, p<0.001), and more likely to have non-serous tumors (83.3% vs 58.1%, p=0.006) and stage IC2 disease (66.7% vs 44.1%, p=0.017). Tumor grade (p=0.71), comorbidities (p=0.55) and chemotherapy administration (p=0.18) were comparable between the FSS and radical surgery groups. There was no difference in OS between the FSS and radical surgery groups, p=0.23; 5-year OS rates were 94% and 83.7% respectively. After controlling for tumor histology, and grade performance of FSS was not associated with worse survival (HR: 0.56, 95% CI: 0.19, 1.69). A systematic review identified 144 patients with EOC and stage IC2 or IC3 disease who underwent FSS. Cumulative relapse rate was 20.1% (n=29). A total of 12 (8.3%) deaths were reported, while 3 (2.1%) patients were alive with disease. Median time to recurrence was 19 months. Among patients who experienced a relapse, 10 had serous, 10 mucinous, 4 clear cell, and 4 endometrioid histology while the majority (18/28, 64.3%) had grade 1 or 2 tumors. Based on available data, relapse rate was 20.7% (12/58) and 14% (8/57) for patients with stage IC3 and IC2 disease respectively. <h3>Conclusions:</h3> In a large cohort of young patients with stage IC2/3 EOC, FSS was not associated with worse overall survival. However, based on a systematic review of literature approximately 1 in 5 patients experienced a relapse.

The value of fertility-sparing surgery for young females with epithelial ovarian cancer: a comparative study

Background: Epithelial ovarian cancer is increasingly often diagnosed in young females who wish to preserve their fertility. Fertilitypreserving surgeries, where conservation of the uterus and contralateral ovary was performed, might be beneficial for patients with stage I epithelial ovarian cancer, but their safety is still controversial. In the present study, we aimed to compare radical surgery and fertility-saving surgery in females with stage IA–C epithelial ovarian cancer for recurrence and survival rates, as well as to evaluate reproductive and obstetric outcomes for stage I epithelial ovarian cancer females who were managed with fertility-saving surgery. Materials and methods: We prospectively identified 60 patients aged ≤40 years who were diagnosed with stage I epithelial ovarian cancer. The patients in the fertility-preservation group underwent salpingo-oophorectomy on the side of the affected ovary in addition to incisional biopsy or wedge excision of the ovary on the other side. The patients in the radical surgery group underwent total hysterectomy and bilateral salpingo-oophorectomy. We followed up all patients for 5 years to assess their reproductive and oncological outcomes. Results: Patients in the fertility preservation surgery group were significantly younger (30 ± 4 versus 35 ± 5 years) (p &lt; 0.001), their tumor sizes were smaller (3.4 ± 1.3 versus 6.0 ± 2.6 cm) (p &lt; 0.001), of lower grade (p = 0.011), earlier stage (p &lt; 0.001) and had more mucinous histology than patients in the radical surgery group. There were no statistically significant differences between both groups regarding tumor recurrence or survival rates. Of 25 patients who underwent fertility preservation surgery, 18 (72%) attempted to conceive. A total of 15/18 (83%) pregnancies were recorded, including 13 live births, 1 miscarriage, and 1 intrauterine fetal death. Conclusion: Fertility-sparing surgery could be an adequate alternative to radical surgery for young females with stage I epithelial ovarian cancer.

Magnetic resonance imaging texture analysis for the evaluation of viable ovarian tissue in patients with ovarian endometriosis: a retrospective case-control study.

BackgroundTexture analysis has been used as a method for quantifying image properties based on textural features. The aim of the present study was to evaluate the usefulness of magnetic resonance imaging (MRI) texture analysis for the evaluation of viable ovarian tissue on the perfusion map of ovarian endometriosis.MethodsTo generate a normalized perfusion map, subtracted T1-weighted imaging (T1WI), T1WI and contrast-enhanced T1W1 with sequences were performed using the same parameters in 25 patients with surgically confirmed ovarian endometriosis. Integrated density is defined as the sum of the values of the pixels in the image or selection. We investigated the parameters for texture analysis in ovarian endometriosis, including angular second moment (ASM), contrast, correlation, inverse difference moment (IDM), and entropy, which is equivalent to the product of area and mean gray value.ResultsThe perfusion ratio and integrated density of normal ovary were 0.52±0.05 and 238.72±136.21, respectively. Compared with the normal ovary, the affected ovary showed significant differences in total size (p<0.001), fractional area ratio (p<0.001), and perfusion ratio (p=0.010) but no significant differences in perfused tissue area (p=0.158) and integrated density (p=0.112). In comparison of parameters for texture analysis between the ovary with endometriosis and the contralateral normal ovary, ASM (p=0.004), contrast (p=0.002), IDM (p<0.001), and entropy (p=0.028) showed significant differences. A linear regression analysis revealed that fractional area had significant correlations with ASM (r2=0.211), IDM (r2=0.332), and entropy (r2=0.289).ConclusionMRI texture analysis could be useful for the evaluation of viable ovarian tissues in patients with ovarian endometriosis.

Unplanned adnexectomy for ovarian cystadenoma with undiagnosed autoamputation of the contralateral ovary, lessons learned from medical mistakes.

Autoamputation of the ovary is a rare occurrence of uncertain aetiology with only a few cases reported in literature. It usually develops following ovarian torsion or torsion of a dermoid cyst with subsequent necrosis of the pedicle and autoamputation. We present the case of a 42 year-old woman was admitted for a laparoscopic removal of a right ovarian cyst. The ultrasound showed a right ovarian cystic mass suggestive of a cystadenoma, and another heterogeneous small echogenic cyst of the left ovary. During laparoscopy, excessive bleeding from the ovarian cortex complicated the cyst stripping and, considering the age of the patient and the emerging technical difficulty of the procedure, a total adnexectomy for the right ovary was performed. While exploring the small cyst on the left ovary, a dermoid cyst was found in the Douglas pouch. This finding could be interpreted as an autoamputation of the adnexa due to an asymptomatic torsion of a previous ovarian cyst arising from the left ovary. Medical errors could occur due to lack of knowledge, expertise, as well as lack of training and surgical skills, but also due to an unfortunate association of very rare confounding factors. Even in the hands of experts, following the basic rules of surgery remains a milestone in teaching and preventing surgical complications.

Stage I Sertoli-Leydig cell tumors: An interim report from the International PPB/DICER1 &amp; OTST Registry.

5547 Background: Sertoli-Leydig cell tumors (SLCT) are rare ovarian sex cord-stromal tumors which occur primarily in adolescents and young adults and are associated with DICER1 pathogenic variants. Methods: Informed consent for participation in the International PPB/ DICER1 or OTST Registry was obtained. When available, pathology was centrally reviewed. Staging was evaluated by Registry review using the International Federation of Gynecology and Obstetrics (FIGO) classification system. Results: Eighty-three patients with stage I SLCT were enrolled. Median age at diagnosis was 15 (range 1-60) years. Most (57/83) patients had germline DICER1 testing; 35/57 (61%) had germline pathogenic variants. Fifty-six patients had Ia and 27 had Ic SLCT. The distribution of patients receiving chemo based on histology and stage is displayed in Table. One patient with poorly differentiated stage Ia SLCT with sarcomatous elements and no chemo at diagnosis recurred 6 months after surgery and died of disease. Three patients with local diagnosis of stage Ia SLCT, with data unavailable for Registry confirmation of stage, developed a subsequent SLCT 33 to 74 months after diagnosis; of these, 2 died, and 1 remains in treatment for recurrence. Available records and molecular testing in these 3 cases have not provided a distinction between recurrent and metachronous disease. Excluding the latter 3 patients, 3-year overall survival was 97.3% for stage Ia SLCT. Six patients with stage Ic SLCT recurred (Stage Ic1=5 and Stage Ic2=1) with a median time to recurrence of 25 (range 3-53) months. In stage Ic1, 18% (2/11) recurred after upfront chemo compared to 33% (3/9) after surgery alone. Of the 5 patients with stage Ic1 disease that recurred, 4 had intermediate and 1 had poorly differentiated SLCT. One patient had sarcomatous elements and 2 received upfront chemo. Two of the 5 patients are alive, neither received upfront chemo. One patient with poorly differentiated stage Ic2 SLCT with sarcomatous elements and no upfront chemo recurred and died of disease. Three-year event free and overall survival were 86.9 and 88.6% for stage Ic SLCT. Four patients had metachronous SLCT in the contralateral ovary confirmed by clinical review or somatic testing at a median time from diagnosis of 33 (range 28-104) months. All 4 have germline pathogenic variants and no evidence of disease at last follow-up. Conclusions: Individuals with early stage SLCT generally fare well, however, ongoing surveillance for recurrence and metachronous disease is indicated. Novel therapies are needed to address recurrent SLCT.[Table: see text]

Diffusivity mapping of the ovaries: Variability of apparent diffusion and kurtosis variables over the menstrual cycle and influence of oral contraceptives

PurposeWe aimed to investigate whether quantitative diffusivity variables of healthy ovaries vary during the menstrual cycle and to evaluate alterations in women using oral contraceptives (OC). MethodsThis prospective study (S-339/2016) included 30 healthy female volunteers, with (n = 15) and without (n = 15) intake of OC between 07/2017 and 09/2019. Participants underwent 3T diffusion-weighted MRI (b-values 0–2000 s/mm2) three times during a menstrual cycle (T1 = day 1–5; T2 = day 7–12; T3 = day 19–24). Both ovaries were manually three-dimensionally segmented on b = 1500 s/mm2; apparent diffusion coefficient (ADC) calculation and kurtosis fitting (Dapp, Kapp) were performed. Differences in ADC, Dapp and Kapp between time points and groups were compared using repeated measures ANOVA and t-test after Shapiro-Wilk and Brown-Forsythe test for normality and equal variance. ResultsIn women with a natural menstrual cycle, ADC and kurtosis variables showed significant changes in ovaries with the dominant follicle between T1 vs T2 and T1 vs T3, whilst no differences were observed between T2 vs T3: ADC ± SD for T1 1.524 ± 0.160, T2 1.737 ± 0.160, and T3 1.747 ± 0.241 μm2/ms (p = 0.01 T2 vs T1; p = 1.0 T2 vs T3, p = 0.003 T3 vs T1); Dapp ± SD for T1 2.018 ± 0.140, T2 2.272 ± 0.189, and T3 2.230 ± 0.256 μm2/ms (p = 0.003 T2 vs T1, p = 1.0 T2 vs T3, p = 0.02 T3 vs T1); Kapp ± SD for T1 0.614 ± 0.0339, T2 0.546 ± 0.0637, and T3 0.529 ± 0.0567 (p < 0.001 T2 vs T1, p = 0.86 T2 vs T3, p < 0.001 T3 vs T1). No significant differences were found in the contralateral ovaries or in females taking OC. ConclusionPhysiological cycle-dependent changes in quantitative diffusivity variables of ovaries should be considered especially when interpreting radiomics analyses in reproductive women.

Brenner Borderline Ovarian Tumor: A Case Series and Literature Review.

Most frequent borderline ovarian tumors are serous and mucinous subtypes. Less frequent borderline diseases are endometrioid, clear-cell, and Brenner tumors (BBOT). Very little is known about the latter subtype, and most studies include very short series or case reports. The aim of this study is to determine the prognosis of a continuous series of BBOT and analyze data published in the literature on this rare entity. A retrospective review of patients with BBOT treated or referred to our institutions was conducted. A centralized histological review by a reference pathologist and data on the clinical characteristics, management, and outcomes of patients were required for inclusion. Overall, 17 patients were identified. Median age was 62 (range 42-85) years. Six patients underwent unilateral salpingo-oophorectomy, and 11 bilateral salpingo-oophorectomy +/- hysterectomy and/or staging surgery. In total, 16 patients had unilateral tumor, and all patients had stage I disease. Stromal microinvasion was observed in three cases. Median follow-up was 60 months (range 7-118 months). One patient developed a recurrence in contralateral ovary after unilateral salpingo-oophorectomy. One patient had previous history of urothelial tumor. Peritoneal staging surgery is not required because all patients reported had stage I disease. One recurrence occurred. When reviewing all the 82 cases reported in the literature (including ours), 9% had previous history or synchronous urothelial tumor, suggesting the need to carefully check for urological disease in patients with BBOT.

Sphingosine-1-phosphate and its mimetic FTY720 do not protect against radiation-induced ovarian fibrosis in the nonhuman primate†.

Oocytes are highly radiosensitive, so agents that prevent radiation-induced ovarian follicle destruction are important fertility preservation strategies. A previous study in rhesus macaques demonstrated that ovarian treatment with antiapoptotic agents, sphingosine-1-phosphate (S1P) and FTY720, its long-acting mimetic, preserved follicles following a single dose of 15Gy X-ray radiation, and live offspring were obtained from FTY720-treated animals. However, it is unknown whether these antiapoptotic agents also protected the ovarian stroma from late effects of radiation, including vascular damage and fibrosis. Using ovarian histological sections from this study, we evaluated the vasculature and extracellular matrix in the following cohorts: vehicle + sham irradiation, vehicle + irradiation (OXI), S1P+irradiation (S1P), and FTY720+irradiation (FTY720). One ovary from each animal was harvested prior to radiation whereas the contralateral ovary was harvested 10months post-treatment. We assessed vasculature by immunohistochemistry with a PECAM1 antibody, hyaluronan by a hyaluronan binding protein assay, and collagen by picrosirius red and Masson's trichrome staining. Disorganized vessels were observed in the medulla in the OXI and S1P cohorts relative to the sham, but the vasculature in the FTY720 cohort appeared intact, which may partially explain fertoprotection. There were no differences in the hyaluronan matrix among the cohorts, but there was thickening of the tunica albuginea and fibrosis in the OXI cohort relative to the sham, which was not mitigated by either S1P or FTY720 treatment. Thus, the fertoprotective properties of S1P and FTY720 may be limited given their inability to protect the ovarian stroma against the late effects of radiation-induced fibrosis.

Fertility preserving surgery in carcinoma ovary: a single institution experience

Conventional treatment of ovarian cancer includes removal of the uterus and both ovaries. Use of fertility preservation surgery (FPS) has been steadily rising due to late marriages/ pregnancy combined with an increase in the number of patients diagnosed with early stage ovarian cancer. We present our series of ovarian cancer patients in whom FPS was done. We retrospectively analyzed cases of ovarian cancer in which FPS was carried out between 2011 to 2017 at our hospital. All patients diagnosed with ovarian cancer stage I-III who underwent comprehensive surgical staging and in whom the uterus and contralateral ovary was preserved either at laparoscopy or by open technique were included in the analysis. Thirty one patients (31) underwent FPS . The mean age was 23 years (range 11–33). Twenty three were operated upfront and 8 after neoadjuvant chemotherapy. Germ cell tumors (GCT’s) were the most common histology (17 patients) followed by epithelial ovarian cancers (8- invasive and 4 -borderline) only 2 patients had granulosa cell tumours. Amongst GCT’s, 4 were dysgerminomas and 13 non-dysgerminomatous tumors (6- immature teratomas, 3 yolk sac tumors and 4 mixed germ cell tumors). 24 patients were in stage IA, 2 in stage IC, 1 in stage IIB, 2 in stage IIIB and 2 in stage IIIC. After a median follow up of 40 months, 3 patients (9.6%) were lost to follow up. There were 4 recurrences; 2 patients were FIGO stage IA, one FIGO stage IC and the other was FIGO stage IIIB. None of them had grade 3 tumors. The overall survival was 92.85 % and recurrence free survival was 85%. Fourteen (14), (50%) patients were unmarried at the time of analysis and 7 of the remaining 14 patients already had a child and did not plan for another. Seven(7) patients planned to start their family, 2 patients (28.6%) conceived and both had full term normal pregnancy with live birth. Fertility-preserving surgery should be considered for young ovarian cancer patients who want to preserve their fertility. The decision regarding fertility preservation in higher stage (more than stage 1A) and high grade (grade 3) tumors should be taken only after adequate patient counseling regarding the risks of recurrence and chances of retaining fertility.

Comparison of intraoperative cardiorespiratory and behavioral responses to medetomidine combined with tramadol or butorphanol during standing laparoscopic ovariectomy in horses.

The purpose of this study was to assess the cardiorespiratory and behavioral responses to the combination of medetomidine and tramadol (M-T) or butorphanol (M-B) in standing laparoscopic ovariectomy in horses. One ovary was removed under M-T and the contralateral ovary was removed under M-B with at least 4 weeks between operations at random. Horses were sedated using intravenous medetomidine (5 µg/kg) followed by tramadol (1 mg/kg) or butorphanol (10 µg/kg) after 5 min. Sedation was maintained through the repeated injection of medetomidine (1 µg/kg) and tramadol (0.4 mg/kg) or medetomidine (1 µg/kg) and butorphanol (4 µg/kg) every 15 min. Cardiorespiratory function and behavioral responses, including, sedation, ataxia, and analgesia, were assessed during the surgery. There were no significant differences in cardiorespiratory values and sedation and analgesia scores between M-T and M-B. Ataxia scores were significantly lower in M-T than in M-B. This result suggests that M-T could maintain smooth and stable standing surgery with minimal cardiorespiratory changes in horses.

Case report: The case of a 17 kg ovarian granulosa cell tumor in a Breton draft mare.

ABSTRACTGranulosa cell tumor (GCT) is a benign tumor which affects the mareʼs ovaries. In this report, a case of unilateral GCT in an ovary, which weighed 17.04 kg, of a 9-year-old Breton draft mare is described. A transrectal ultrasonography exam revealed a unilateral multi-cystic enlarged ovary. Laparoscopic ovariectomy was difficult due to enlargement of blood vessels in the ovarian broad ligament. The mare was necropsied, and the pathological changes in the GCT-affected ovary and unaffected ovary were evaluated. The ovarian mass in the GCT-affected ovary had a cribriform pattern and was positive for anti-Müllerian hormone (AMH) and its receptor (AMHR2). The contralateral ovary showed no follicular development and was negative for AMH. AMHR2 was positively expressed in stromal cells. The AMH concentration in plasma was 4,210 ng/ml. This is the first report showing the presence of AMH (2,210 ng/ml) in ascites fluid, and it also shows that laparoscopic ovariectomy might not be suitable for larger ovaries affected by a GCT. Ultrasonographic, endocrine, and histopathological analyses were helpful for making a definitive diagnosis of GCT in this mare.

SRY-negative 46,XX testicular/ovotesticular DSD: Long-term outcomes and early blockade of gonadotropic axis.

SRY-negative 46,XX testicular and ovotesticular disorders/differences of sex development (T/OTDSD) represent a very rare and unique DSD condition where testicular tissue develops in the absence of a Y chromosome. To date, very few studies have described the phenotype, clinical and surgical management and long-term outcomes of these patients. Particularly, early blockade of the gonadotropic axis in patients raised in the female gender to minimize postnatal androgenization has never been reported. Retrospective description of sixteen 46,XX T/OTDSD patients. Sixteen 46,XX SRY-negative T/OTDSD were included. Most (12/16) were diagnosed in the neonatal period. Sex of rearing was male for six patients and female for ten, while the clinical presentation varied, with an external masculinization score from 1 to 10. Five patients raised as girl were successfully treated with GnRH analog to avoid virilization during minipuberty. Ovotestes/testes were found bilaterally for 54% of the patients and unilaterally for the others (with a contralateral ovary). Gonadal surgery preserved appropriate tissue in the majority of cases. Spontaneous puberty occurred in two girls and one boy, while two boys required hormonal induction of puberty. One of the girls conceived spontaneously and had an uneventful pregnancy. DNA analyses (SNP-array, next-generation sequencing and whole-exome sequencing) were performed. A heterozygous frameshit mutation in the NR2F2 gene was identified in one patient. This study presents a population of patients with 46,XX SRY-negative T/OTDSD. Early blockade of gonadotropic axis appears efficient to reduce and avoid further androgenization in patients raised as girls.

Ovarian Carcinosarcoma with Malignant Neuroectodermal Components (Teratoid Carcinosarcoma) - A Rare Entity

Abstract Introduction/Objective Ovarian carcinosarcoma is an aggressive tumor accounting for 2% of all ovarian malignancies. Ovarian carcinosarcoma with malignant neuroectodermal components is exceedingly rare and only four cases have been previously reported. Here we report a series of three cases in 65(case 1), 61 (case 2) and 72 (case 3) year old females. Methods All patients presented with pelvic mass and elevated CA125. They underwent hysterectomy, bilateral salpingo-oophorectomy, omentectomy and tumor-debulking, along with lymph node dissection (2,3) and appendectomy (3). The FIGO stages were IIIC (1,3) or IIA (2). Case #2 experienced pelvic recurrence three months after initiating platinum based chemotherapy and was treated with BEP. She died of metastatic disease ten months after initial surgery. Case #3 is a current case and is being treated with chemotherapy. Case #1 was an outside consult and was lost to follow–up. Results Grossly the dominant ovarian mass measured 25 (left), 20 (left) and 21 (right) cm. The cut surfaces were hetergenous tan, yellow, partially cystic and solid with hemorrhage and necrosis. Microscopically, they showed mixed morphology of carcinomatous, sarcomatous, and undifferentiated neuroectodermal component. The carcinomatous element showed squamous cell carcinoma and adenocarcinoma. The sarcomatous component included rhabdomyosarcoma, chondrosarcoma and liposarcoma. The undifferentiated neuroectodermal component consisted of nested or solid primitive cells. All three cases showed fetal-appearing teratoid squamous cell epithelium with clear cytoplasm. The contralateral ovary and extraovarian metastatic implants were either carcinosarcoma, carcinoma or contained all three components. Conclusion Case #1 and 3 also showed a yolk sac component. All lymph nodes (2,3) were negative for metastatic tumor at the time of initial surgery. Case #2 had first recurrence in retroperitoneal lymph node showing mature neural tissue. Her second recurrence in abdomen was undifferentiated neuroblastoma. Immunohistochemical studies included CK7, CK20, CDX2, NapsinA, S100, GFAP, PAX-8, CK5/6, P63, AE1/AE3, desmin, Myf-4, CD56, glypican3, AFB, CD99, chromogranin, synaptophysin, NF, NeuN, calretinin, and inhibin. The staining pattern was consistent with histologic interpretation. These cases histologically resemble to so-called “teratoid carcinosarcoma” of paranasal sinuses. The histogenesis remains unknown.

Estimated radiation doses to ovarian and uterine organs in breast cancer irradiation using radio-photoluminescent glass dosimeters (RPLDs).

IntroductionThe well‐being of breast cancer patients is essential, especially fertility in patients of reproductive age. The objective of this study was to estimate the radiation doses to the ovaries and uterus for different treatment techniques of breast cancer irradiation using radio‐photoluminescent glass dosimeters (RPLDs).MethodsA Farmer‐type ionisation chamber (IBA FC‐65G) and RPLDs were used to measure in‐ and out‐of‐field radiation doses in a solid water phantom. The field sizes were set to 10 × 10 cm2 and 8 × 17 cm2 with the central axis at out‐of‐field measurement distances of 30 or 50 cm. The Rando phantom’s left breast was planned using four different techniques: two tangential standard fields with and without electronic tissue compensator (E‐comp) techniques, intensity‐modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT). The radiation doses in the ipsilateral ovary, contralateral ovary and uterus were measured using RPLDs.ResultsThe percentage ratio of out of field to in field was affected by distance from the central axis to the point of measurement, in addition to the field sizes associated with collimator scatter. Advanced techniques such as IMRT and VMAT produced higher doses to the ovaries and uterus. The estimated results of the worst‐case scenario for the ipsilateral ovary, contralateral ovary and uterus were 0.84% (42 cGy), 0.62% (31 cGy) and 0.76% (38 cGy), respectively, for a 5000 cGy prescription dose.ConclusionThe lowest to highest out‐of‐field radiation doses to the ovarian and uterine organs from breast irradiation were the two tangential field techniques, VMAT and IMRT. These advanced techniques yielded higher radiation leakage, which potentially contributed to the out‐of‐field radiation dose.

Effects of semen components on ovulation and fertilization

In pigs, transcervical infusion of seminal plasma at the onset of oestrus advances ovulation and thus improves the chance of gametes meeting during their full fertilizing competence. An animal model that allows single uterine horn infusion was used in combination with transcutaneous sonographic monitoring of ovaries. Preparative surgery involved the detachment of one uterine horn from the corpus, leaving the caudal end open to the peritoneal cavity but sealing the corpus wound. Transcervical infusion of 100 ml seminal plasma immediately after the detection of oestrus advanced ovulation by between 8 and 14 h on the ipsilateral ovary adjacent to the infused horn compared with the contralateral ovary. In addition, the seminal plasma infusion did not influence the LH profile compared with uterine infusion of PBS. This finding indicates that the effect is mediated by a local mechanism in the female genital tract. The advancement of ovulation depends on the time of infusion early in oestrus and is more pronounced in gilts exhibiting a long interval between the onset of oestrus and spontaneous ovulation compared with early ovulators. At 24 h after the detection of oestrus, seminal plasma was ineffective. Apparently, seminal plasma does not affect maturation and fertilizing competence of oocytes. The activity resides in a low molecular mass protein fraction and, to a far lesser extent, in seminal oestrogens. Further characterization of the active components may allow a practical application in AI.