Corpus Luteum Cyst Research Articles

Spontaneous ovarian heterotopic pregnancy mimicking ovarian malignant tumor: case report

Spontaneous ovarian heterotopic pregnancy is extremely rare. Ovarian ectopic pregnancy frequently resembles hemorrhagic corpus luteum cyst, but possibly mimics ovarian malignant tumor due to inhomogeneous echogenic appearance in some instances. Emergency laparotomy was performed for a seven-week spontaneous ovarian heterotopic pregnancy, because the ovarian cystic tumor exhibited a solid part on ultrasonography, therefore malignancy could not be ruled out. Postoperative course was uneventful, and the intrauterine fetus grew without complications, resulting in spontaneous vaginal delivery at 39 weeks of gestation. The possibility of an ovarian heterotopic pregnancy should be suspected, when an ovarian tumor is detected during pregnancy. These findings help physicians to diagnose ovarian heterotopic pregnancy or isolated ovarian ectopic pregnancy, to reduce maternal morbidity and mortality, and provide satisfactorily ongoing intrauterine gestation in heterotopic pregnancy.

Hemoperitoneum from Spontaneous Rupture of Corpus Luteal Cyst: A Case Report and Literature Review

Hemoperitoneum resulting from various gynecological emergencies can be life threatening and ruptured corpus luteal cyst is one of the causes Here we are reporting a case of yrs women with history acute pain abdomen on th day of her mentstrual cycle Ultrasound showed collection in pelvic cavity mainly around right adnexa After few hours of observation she was taken for laparotomy because of tense and tender abdomen Intraoperative there was hemoperitoneum of around cc with ruptured corpus luteal cyst of right ovary Ruptured corpus luteum cyst should be kept in differential diagnosis of acute abdomen in women of reproductive age group especially in secretory phase Timely diagnosis and management can save patient life

Clinical and sonographic predictors of adnexal torsion in pediatric and adolescent patients

ObjectiveTo investigate the accuracy of torsion diagnosis in the pediatric and adolescent population. MethodsThis retrospective study included 87 patients <18years who presented with acute pelvic pain and were operated for suspected adnexal torsion from January 2009 to September 2016. ResultsAdnexal torsion was found in 53 of 87 (60.9%) cases operated for suspected torsion. The rate of accurate torsion diagnosis was significantly higher among pre-menarchal (21/21, 100%) compared with post-menarchal girls (32/66, 48.5%) (p<0.001). Patients with torsion were more likely to report nausea or vomiting (73.6% compared with 32.3%, p<0.001) and had higher rates of peritoneal irritation signs on exam (15.1% compared with 0.0%, p=0.02). On the pre-operative ultrasound, patients with torsion were characterized by higher rates of enlarged ovary showing signs of edema (49.1% compared with 8.8%, p<0.001) and free pelvic fluid (45.3% compared with 17.6%, p<0.001). In post-menarchal girls without adnexal torsion, the leading diagnosis was hemorrhagic corpus luteum cyst (found in 18/33, 78.3%) cases. ConclusionsVarious clinical and ultrasound findings may point to the correct diagnosis of torsion in the pediatric and adolescent population. However, none of the clinical and ultrasound characteristics are sufficient to confirm or disprove the pre-operative diagnosis, and young patients with the clinical suspicion of adnexal torsion should undergo laparoscopy. Level of evidenceLevel II. Type of studyClinical retrospective study.

Asynchronus bilateral ovarian torsions in girls-systematic review.

Bilateral ovarian torsions with complete loss of ovaries is devastating. This study analyzed the literature on bilateral ovarian torsions in girls to evaluate surgical options and outcomes. Literature was searched on Pubmed® (1987-2014) using terms "bilateral", "adnexal", "ovary", "torsion" and "children". Data were collected on age, surgical preference, pathology and outcomes. Thirteen articles were identified, and 9 met the inclusion criteria (5 case reports, 4 original articles); and analyzed 17 girls (mean age: 8.75 years, range: 1-16). Bilateral oophorectomies (n=4), ipsilateral oophorectomy of severely affected ovary and contralateral oophoropexy (n=10), and detorsion of bilateral ovaries and bilateral oophoropexy (n=3) were performed. One torsion recurrence occurred after two oophoropexies. Laparoscopy and open surgery was done in 2 and 15 girls, respectively. Considering etiology, there were simple tubo-ovarian torsions (n=8), polycystic ovary (n=1), polycystic ovary associated with Down syndrome (n=1) and corpus luteum cyst (n=1). No tumors were reported. Serial ultrasound follow-ups of ipsilateral oophorectomy and contralateral oophoropexy (n=5) confirmed follicular function (n=4) and viability and position of the ovary (n=1). Though extremely rare, school age girls present bilateral ovarian torsion. Ipsilateral oophorectomy and contralateral detorsion with oophoropexy has been the preferred approach.

In this issue – April 2017

In this issue – April 2017

Radiological appearances of corpus luteum cysts and their imaging mimics.

To review the radiological appearances of corpus luteum cysts and their imaging mimics. Corpus luteum cysts are normal post-ovulatory structures seen in the ovaries through the second half of the menstrual cycle and the first trimester of pregnancy. The typical appearance, across all modalities, is of a 1- to 3-cm cyst with a thick crenulated vascularized wall. Occasionally, similar imaging findings may be seen with endometrioma, ectopic pregnancy, tuboovarian abscess, red degeneration of a fibroid, and ovarian neoplasia. In most cases, imaging findings are distinctive and allow for a confident and accurate diagnosis that provides reassurance for patients and referring physicians and avoids costly unnecessary follow-up.

CLINICAL AND DIAGNOSTIC PARALLELS, THERAPEUTICAL STRATEGIES IN BENIGN OVARIAN TUMOR-LIKE FORMATIONS

This paper deals with study of the characteristics of clinical course of benign ovarian tumor formations in women of reproductive age, depending on the fertility and the choice of treatment strategy. Functional ovarian cysts in 60,45 % of cases were diagnosed in parous patients, in 39,55 % in nulliparous women, in 5,22 % in women with infertility. Corpus luteum cysts in 36,96 % of cases occured in nulliparous patients, whereas follicular cysts were more common for parous women (28,4 %) and infertile patients (28,57 %). The clinical picture of ovarian retention formations to 56,72 % of cases manifested by the pain syndrome in all patients, regardless of parity, whereas cycle disorders were more specific for parous patients (37,04 %). In 14,29 % of patients with infertility ovarian tumor formations were asymptomatic. In nulliparous patients inflammation of the uterine appendages was diagnosed significantly more often than in parous women. Increasing of the frequency of the myometrium pathology in the group of parous patients was significantly more often than in nulliparous women. Lack of individualization of the diagnostic algorithm, low commitment to hormonal, immunomodulatory therapy, use of standard antibiotic regimens led to ineffective treatment measures and to the formation of antibiotic resistance and the development of the process relapse.

Ruptured Ovarian Pregnancy- A Case Report

Ovarian pregnancy accounts for up to 3% of all ectopic pregnancy but is the most common form of non-tubal ectopic pregnancy. Its diagnosis often is difficult to distinguish as it is frequently confused with a ruptured corpus luteum cyst and clinically with a tubal ectopic. Hereby, presenting a case of primary ovarian pregnancy in a 29-year-old patient, referred from District Hospital Thoubal as query ectopic to Regional Institute of Medical Sciences (RIMS) Imphal. She presented with the complaint of severe lower abdominal pain with history of loss of consciousness, severe pallor and per vaginal findings suggestive of ruptured ectopic.The decision for emergency laparotomy was taken and intraoperatively it was found that patient showing intact tube with ruptured ovarian pregnancy, hence proceeded with right oophorectomy. Aetiological, clinical and therapeutic aspects of this rare extrauterine pregnancy are described. Also, the problems of its differential diagnosis are discussed.

A Pathological Study of Ovarian Abnormalities in Slaughtered NonPregnant Cows in Sulaimani Province.

The current study was conducted to address the pathological conditions of ovaries of cows&#x0D; slaughtered at the abattoir in Sulaimani province, Kurdistan Region-Iraq. Among the 404&#x0D; genitalia samples collected from the non-pregnant animals, 206 (51%) were found without&#x0D; gross pathological abnormalities (with cyclic activity) and the remaining&#x0D; 120(29.70%)samples were found with gross pathological abnormalities of ovaries. The&#x0D; ovaries exhibited the highest percentage of lesions 29.70%. Detected ovarian lesions&#x0D; included follicular cyst 10.89%, cystic corpus luteum 5.44%, mild ovariobursal adhesions&#x0D; 4.45 %, sever ovariobursal adhesion 0.25%, paraovarian cysts 3.22%, ovarian hypoplasia&#x0D; 1.98%, ovarian hemorrhage (hemorrhagic cystic corpus luteum) 1.48%, luteal cyst 1.24%,&#x0D; ovarian agenesis 0.50% and ovarian tumor (Gonadoblastoma) 0.25%. Histopathological&#x0D; examinations exhibited that the follicular cysts were lined by several layers of granulosa&#x0D; and theca cell, while the luteal cysts had follicular granulsa and the theca cells with marked&#x0D; luteinization of cytoplasm. Microscopically, the ovarian hypoplasia showed lack of&#x0D; ovarian follicles and oocytes, while the cavities of paraovarian cysts were lined by a single&#x0D; layer of cuboidal epithelial cells, and the hemorrhagic cyst showed scattered hemorrhagic&#x0D; spots close to the lumen and luteinized of granulosa and theca cells layers of cystic wall.&#x0D; Histopathologically, the ovarian gonadoblastoma (Dysgenentic gonadoma) was&#x0D; characterized by dual population of germ cell tumor and sex-cord stromal tumor and this&#x0D; observation has not been recorded in Iraq previously. It was concluded that ovarian&#x0D; abnormalities constitutes an percentage 0f 29.70%. And ovarian gonadoblastoma was&#x0D; firstly recorded in this study in Iraq.

The management of gynecological hemoperitoneum found to be associated with a ruptured corpus luteum cyst

Rupture of a corpus luteum cyst (RCLC) is the major cause of gynecological hemoperitoneum. RCLC is often difficult to diagnose on imaging and a standardized management is not defined. While mild cases of hemoperitoneum associated with RCLC require only observation and support, surgical intervention is necessary for severe cases or if the adnexal cyst in question is concerning for malignancy or torsion. Our study compares the outcomes of patients undergoing conservative and surgical management of gynecological hemoperitoneum found to be associated with RCLC. We performed a retrospective chart review of non-pregnant patients with a diagnosis of hemoperitoneum, corpus luteum cyst rupture, or follicular cyst rupture of the ovary between September 2007 and January 2013. The clinical characteristics, laboratory findings, and radiological findings of the women hospitalized and conservatively monitored or who underwent laparoscopy or laparotomy were reviewed for short-term and long-term adverse outcomes. Data were analyzed using Fisher’s exact test or chi-square test for categorical data and the Mann-Whitney U test for continuous data between the comparison groups. Of 30 women appearing with gynecological hemoperitoneum associated with an adnexal cyst, 5 (17 %) underwent conservative management and 25 (83 %) underwent surgical management including laparotomy (n = 11, 37 %) and laparoscopy (n = 14, 47 %). Patients predominantly presented with pelvic or abdominal pain (93 % of patients). On imaging, RCLC (or ovarian mass) was visualized on the left side in 50 % of the cases. Women younger than 30 years old were more likely to be conservatively managed (p = 0.045) and all cases of radiological concern for malignancy were surgically managed. The correct diagnosis of RCLC was made preoperatively in only 40 % of surgically managed cases. No significant difference was seen in either short-term or long-term outcomes between the two groups. RCLC is a difficult diagnosis that can appear similar to torsion or malignancy on imaging and can prompt surgical management. Though our study size was small, there was no significant difference between conservative and surgical management options in terms of short and long-term adverse outcomes in the management of ruptured corpus luteum cyst-associated hemoperitoneum.

Hemorrhagic Corpus Luteum With Generalized Abdominal Pain in Patients With Idiopathic Thrombocytopenic Purpura

Introduction: Idiopathic thrombocytopenic purpura is a platelet autoimmune hemostatic disorder. In this study, an ITP case with abdominal signs and hemorrhagic corpus luteum is presented.Case Presentation: The patient is a 28-year-old nonpregnant woman admitted to ED for constant acute abdominal pain, accompanied by nausea and vomiting. ITP was the prominent disease in her medical history which had been treated by corticosteroids. On physical examination, the patient had stable vital signs. Important paraclinic results were hemoglobin 8 g/dL and platelet count (7000 per microliter). Free fluid was reported in primary trans-abdominal sonography and CT scan. Finally, hemorrhagic corpus luteum was diagnosed in further radiologic studies.Conclusions: Hemorrhagic corpus luteum is known to simulate a number of medical, surgical and gynecological conditions that cause acute abdomen. Sometimes it may have unusual presentations. Moreover, hemorrhagic corpus luteum (cysts) is not always identified during sonography and their diagnosis is often challenging as a result of variations in their size, the thickness of cyst wall, and internal echo pattern. As such, it is suggested to consider both internal and gynecologic spontaneous hemorrhages even in controlled ITP and more attention is paid to gynecologic disorders in abdominal pain management.

Ovulation Escape in a Gonadotropin-releasing Hormone Antagonist In Vitro Fertilization Cycle is Not an All or None Phenomenon: A Case Report

Case presentation of a healthy G2P2 patient in her late 30s, treated with in vitro fertilization–intracytoplasmic sperm injection for severe male factor infertility. The patient was treated with a gonadotropin-releasing hormone antagonist cycle (GnRH-An). GnRH-An (Cetrorelix) daily injections were started on cycle day 7 and switched to a different GnRH-An preparation (Ganirelix) due to an allergic reaction. Serum hormone levels and ultrasound monitoring were uneventful until day 13, when a corpus luteum cyst was detected, in addition to multiple intact follicles. Serum progesterone increased to 45 nmol/L, while serum luteinizing hormone (LH) remained low. Thirty-six hours following a day 13 human chorionic gonadotropin (HCG) triggering, 18 cumulus-oocyte complexes were successfully retrieved, resulting in the development of two blastocysts. This is an example for an isolated single-follicle ovulation without compromising the rest of the cohort. A possible explanation is an increased concentration of LH receptors on a specific follicle or increased sensitivity to endogenous GnRH in GnRH-An cycles. Clinicians facing a similar scenario should consider not cancelling the cycle in case additional intact follicles are present.

Occurrence of paratubal cysts in childhood: An analysis of 26 cases.

A retrospective analysis was conducted on the case files of patients operated on for adnexal pathology between January 2004 and December 2015 at our institution. The data of the patients with a diagnosis of paratubal cysts (PTCs) was extracted. A total of eighty-seven children were operated on for adnexal pathology. Twenty-six (29.9%) patients had PTCs. The patients were predominantly grouped as adolescents (n=22) and newborns (n=3). One of the patients was a pre-pubertal girl. Of the 26 PTC cases, 18 of them occurred on the contralateral side to ovarian pathology (OP) or physiologic ovarian changes (POC) such as corpus luteum cyst or follicular cyst which their final diagnosis confirmed by histopathology examination; in one case, the PTCs were bilateral; and in three cases, PTCs were ipsilateral with OP or POC. There were only 4 solitary PTC cases identified among the 26 cases. Paratubal cysts can be observed at every age, even in newborns. Their association with OP or POC in childhood cases needs to be clarified to further understand the hormonal mechanisms that are influencing the occurrence of these cysts.

Nutrition, Metabolic Status and Reproductive Efficiency in Dairy Herds

Nutrition of transition period in dairy cows dramatically increases requirements for energy, glucose, amino acids and other nutrients in dairy cows and, parallel to that, feed intake is depressed. An insufficient or imbalanced nutrient intake might lead to the malfunction of organs, causing reproductive failure. To minimize the metabolic/reproductive damage caused by negative energy balance (NEBAL), feeding of a glucogenic and lipogenic diet containing fat-enriched supplements is recommended. In heat-stressed dairy cows, the reduction of dry matter intake causes an energy deficit, thereby accentuating NEBAL. Heat stress may also have a direct impact on oocyte quality due to the high ovarian temperatures. The intrauterine environment is also compromised in heat-stressed cows, with reduced blood flow to the uterus and increased uterine temperature; this may impair embryonic development, increase early embryonic loss and reduce the proportion of successful inseminations. Postpartum NEBAL suppresses immune function and promotes metabolic disorders, potentially explaining relationships between infectious and noninfectious transition disorders. In postpartum dairy cows, pathologic ovarian phenomena including ovulatory (cystic corpora lutea) and non-ovulatory (follicular and luteal cysts) forms frequently occur causing decreased fertility. The main objective of this review was summarizing the most relevant information regarding nutrition and reproduction in dairy cows.

English

English

Pathomorphology of spontaneously occurring female genital tract lesions in buffaloes of North Gujarat

The objective of the present study was to determine the prevalence of female genital tract pathology in buffaloes of North Gujarat. A total of 179 buffalo genitalia collected from the slaughter house were screened for the presence of gross lesions. Out of 179, 57 (37.84%) genitalia were found grossly affected. The lesions observed were paraovarian cyst, 18 (10.06%) followed by bilateral inactive ovaries, 14 (7.82%), uterine serosal inclusion cyst, 6 (3.35%), aneurysms, 6 (3.35%), unilateral ovarian atrophy, 5 (2.79%), unilateral follicular cyst, 4 (2.23%) and one each of unilateral cystic corpus luteum, hematoma in paraovarian tissues, unilateral hydrosalpinx and mucometra.

Diagnostics and treatment improving of functional ovarian cysts

Functional ovarian cysts are benign tumour retention formations formed from the natural structures of the ovary – follicle or yellow body. In 50% of cases cysts are asymptomatic and self-liquidated. In the absence of functional cyst self-destruct in the first menstrual cycle after treatment it should be revealing.Functional cysts are divided into follicular cysts, corpus luteum cyst, paraovarian cysts.Diagnosis consists of analysing history, general examination, gynaecological examination, clinical laboratory tests (including advanced analysis of blood, determination of C-reactive protein, appropriate biochemical if it need, compulsory bacterioscopic and bacteriological examination of vaginal discharge) and special methods of diagnosing ovarian tumors (ultrasound, computed or magnetic resonance tomography, determination of tumor markers, human chorionic gonadotropin, α-fetoprotein, hormones analysis, endoscopy).Clinical management of patients with functional cysts in reproductive and perimenopausal age includes the following options. In asymptomatic disease in three menstrual cycles conducted surveillance of ultrasound control and preventive measures against cyst recurrence. Conservative treatment is used after determining the causes of disease for persistent cysts. Therapeutic measures include anti-inflammation therapy, hormonal and anti-adhesion therapy. While cysts maintaining after conservative treatment for three menstrual cycles the laparoscopy is used for removing formations.Treatment is more successful when combined allopathic, homeopathic and phytotherapy. Most pathogenic provided in the treatment of functional ovarian cysts is an herbal preparation mastodynon. Mastodynon is a complex drug containing standardized herbal ingredients with depressing effect on inflammatory cytokines, helps eliminate hormonal imbalance caused by hyperestrogenia of follicular cysts (endometrial hyperplasia). In addition, the main component of mastodynon – Vitex Agnus Castus – promotes the elimination of the latent hyperprolactinemia, which in turn causes the hyperestrogenia development.After the disappearance of the cyst to prevent recurrence of reproductive age with elevated levels of follicle stimulating hormone and luteinizing hormone the use of combined oral contraceptives for four to six menstrual cycles is needed.Surgery treatment indicated if there is complication (torsion, rupture, suppuration).

A prospective, randomized, pharmacodynamic study of quick-starting a desogestrel progestin-only pill following ulipristal acetate for emergency contraception.

Is there a pharmacodynamic interaction between ulipristal acetate (UPA) 30 mg for emergency contraception and a daily progestin-only contraceptive pill, desogestrel (DSG) 0.75 mg, when initiated the next day? In this study, DSG impaired the ability of UPA to delay ovulation, but UPA had little impact on the onset of contraceptive effects due to DSG. UPA is a progesterone receptor modulator used for emergency contraceptive (EC) at the dose of 30 mg. UPA delays ovulation by at least 5 days when administered in the mid to late follicular phase. In theory, potent progestins could reactivate progesterone signaling that leads to follicle rupture, thereby impacting the effectiveness of UPA as EC. In addition, UPA could alter the onset of the contraceptive effect of progestin-containing contraceptives started immediately after UPA. A single-blind (for observer), placebo-controlled, partial crossover study was conducted in two sites [Dominican Republic (DR) and the Netherlands (NDL)] over 11 months from October 2012 to September 2013. Healthy female volunteers participated in two of the three treatment cycles separated by a washout cycle. Treatment combinations studied were as follows: (i) a single 30 mg dose of UPA followed by 75 µg per day DSG for 20 days, (ii) a single 30 mg dose of UPA followed by 20 days of placebo matching that of DSG (PLB2) or (iii) one tablet of placebo-matching UPA (PLB1) followed by 75 µg per day DSG for 20 days. Participants were randomized to one of the three treatment sequences (UPA + DSG/UPA + PLB2, PLB1 + DSG/UPA + DSG and UPA + PLB2/PLB1 + DSG) when a lead follicle was ≥ 14 to <16 mm diameter on transvaginal ultrasound imaging (TVU). A total of 71 women were included, and 49 were randomized to a first treatment combination of the three period sequences (20 in the DR and 29 in the NDL); 41 of the 49 continued and completed two treatment combinations (20 in the DR and 21 in the NDL). Initiating DSG treatment the day after UPA significantly reduced the ovulation delaying effect of UPA (P = 0.0054). While ovulation occurred in only one of the 29 UPA-only cycles (3%) in the first 5 days, it occurred in 13 of the 29 (45%) UPA + DSG cycles. This was a small, descriptive, pharmacodynamic study in which some findings differed by study site. Distinguishing between a cystic corpus luteum and a luteinized unruptured follicle (LUF) by TVU was difficult in some cases; however, the investigators reached consensus, when the study was still blinded, regarding ovulation based on hormone levels and careful review of daily TVU images. Initiating the use of a DSG progestin-only pill (POP) immediately after UPA reduces the ability of UPA to delay ovulation and thus may decrease its efficacy as EC. If starting a DSG POP after using UPA for EC, and possibly any progestin-only method, consideration should be given to delaying for at least 5 days after UPA intake in order to preserve the ovulation delaying effects of UPA.

Tratamiento quirúrgico de los tumores del ovario no neoplásicos

A propósito de cuales tumores del ovario han de considerarse no neoplásicos hay diferencias de criterio. Así, p. ej. Goodall (7) acepta que los quistes foliculares y los quistes del cuerpo amarillo son neoplasias; otros muchos autores y entre ellos Barzilai (4) y Geist (6) los clasifican entre los tumores no neoplásicos por no haber crecimiento verdadero de sus elementos estructurales, y finalmente, otros autores, como Ahumada y colaboradores (1), consideran que no merecen siquiera el nombre de tumores.

Ovarian Masses You May Encounter in the Emergency Room

Pelvic pain is a common complaint in the emergency room. A physical pelvic exam is part of the evaluation of a female patient with abdominal or pelvic pain. Whether after a finding on pelvic exam or as an adjunct to the clinical evaluation, ultrasound may be helpful in better delineating the cause of the pain. Certainly transabdominal sonography (TAS) is usually the first ultrasound modality used, and although it may give a good global view of the abdomen, is not sensitive enough to make any clear diagnosis. Transvaginal sonography (TVS) is then utilized, with particular attention paid to the ovaries. The clinical and sonographic signs of ovarian torsion will be addressed in another lecture, therefore this section will just highlight several of the most commonly encountered ovarian masses seen in the ER setting. Normal ovaries with different sizes of follicles are the most common findings, and even large follicles may be seen and are known to cause pelvic pain that brings the patient into the ER. Solitary dominant follicles usually don't exceed 3-4 cm but occasionally may be larger. Another common finding is the corpus luteum cyst, and often has the pathognomonic sonographic signs of lacy reticular and low level echoes within the ovary. It is also not uncommon to encounter benign non functional ovarian masses, such as benign cystic teratomas and endometriomas, and less likely more complex benign benign and malignant ovarian masses. Certainly the emergency room is not the place for the full evaluation of these ovarian masses, but often the ER visit is the triage that then can be followed up in the outpatient sonography suite.