Cystic Pelvic Mass Research Articles

Exploring the Diagnostic Challenges of Pseudotumoral Peritoneal Tuberculosis That Mimics Advanced Ovarian Cancer in Women: The Role of Laparoscopy in a Case Study

This case involves a 63-year-old multiparous woman with no significant medical history and no known exposure to tuberculosis. She presented with chronic abdominal pain and weight loss, anorexia, and subjective fevers. During the clinical examination, the patient was found to have ascites, bilateral pleural effusion, fever, and a general deterioration in her condition. Blood tests revealed normochromic normocytic anemia. The C-reactive protein was elevated, and the erythrocyte sedimentation rate was accelerated. Ferritin levels were raised. Her blood sugar, hepatic and renal functions were normals. The electrolyte panel showed no abnormalities. Serologies for hepatitis B, C, and HIV were negative, and the immunological profile was normal. The ascitic tap yielded a citrine-yellow fluid, and the cytochemical analysis indicated that the ascites were exudative. Analysis of the ascitic fluid revealed that the DNA test for Mycobacterium tuberculosis was negative, but the adenosine deaminase (ADA) level was elevated. Additionally, the CA125 level was significantly elevated, exceeding 600 UI/ml. A pelvic ultrasound identified a cystic pelvic mass with thick septations but without any solid tissue component, measuring 92x69 mm. The complementary CT (Computed Tomography) scan revealed enlarged ovaries, heterogeneous on the left, associated with a moderately abundant peritoneal effusion. The laparoscopic exploration revealed inflammatory peritoneal nodules, parietal adhesions, and serous ascites. Anatomopathology confirmed peritoneal tuberculosis. The peritoneal form, particularly in its pseudotumoral manifestation, can mimic ovarian cancer. Definitive diagnosis often requires invasive procedures.

Tubal mesosalpinx cysts combined with adnexal torsion in adolescents: a report of two cases and review of the literature

BackgroundTubal mesosalpinx cysts are paratubal cysts, that account for approximately 10% of adnexal masses, and the presence of these cysts combined with adnexal torsion is a rare acute abdominal condition, with few cases reported in the literature. We reported two cases of adolescent tubal mesosalpinx cysts combined with adnexal torsion and reviewed the literature to help improve the diagnosis of the disease.Case reportsThe first patient was an 11-year-old girl with left lower abdominal pain for 5 days and fever with nausea and vomiting for 3 days, who was found to have a cystic pelvic mass on preoperative imaging and was diagnosed intraoperatively and postoperatively on pathology as having a left tubal mesosalpinx cyst combined with adnexal torsion. The second patient was a 13-year-old girl with right lower abdominal pain for 16 h and a palpable mass in the lower and middle abdomen on examination, which was hard and tender to palpate. Preoperative imaging revealed a large cystic mass in the right adnexal region, and intraoperative and postoperative pathology revealed a right tubal mesosalpinx cyst combined with adnexal torsion.ConclusionsTubal mesosalpinx cysts combined with adnexal torsion are rare causes of acute lower abdominal pain. Early diagnosis and timely surgery are necessary to ensure ovarian and tubal function. Accurate preoperative imaging diagnosis is challenging, and MRI is a beneficial supplement to ultrasound and CT examinations, providing more objective imaging information and reducing the incidence of adverse outcomes.

Non-gynecological cystic pelvic masses

Non-gynecological cystic pelvic masses

Anatomical Variations of the External Genitalia in Posterior Cloaca: Clinical Consequences of Misdiagnosis-A Systematic Review of the Literature and the ARM-Net Consortium Experience.

All types of cloacal malformations may be associated with anatomic variations of the external genitalia, including hypoplasia of the labia minora and enlarged clitoris; these variations could be even higher in posterior cloacas (PCs). If a careful physical examination is not performed, patients may be misdiagnosed with ambiguous genitalia (AG), leading to subsequent unnecessary testing, surgeries, or even wrong gender assignment. The aim was to analyze data of patients with PC within the ARM-Net registry, focusing on the description of the genitalia, gender assignment, and its consequences. Additionally, we investigated the presence of AG diagnosis in utero or at birth in patients with PC in the literature. The ARM-Net registry was scanned for PC cases and data on diagnosis were collected. A systematic literature search was conducted using the PubMed, EMbase, and Web-of-Science databases. Descriptive statistics was used to report data. Nine patients with PC were identified in the ARM-Net registry. Five patients (55%) were diagnosed with AG, two (22%) were assigned as males and only two patients were correctly assigned as females and diagnosed with PC with respective variations of external genitalia. All patients diagnosed with AG had extensive blood testing including karyotype and hormonal studies. One of the patients who was diagnosed as a male, had surgery for pelvic cystic mass removal, which ultimately led to unaware salpingo-oophorectomy, hysterectomy, and vaginectomy. In the literature we identified 60 patients, 14 (23%) with AG, 1 with clitorolabial transposition and 1 with undeveloped vulva and vagina; 4 patients had normal anatomy. In 40 (67%) patients the anatomy of genitalia was not mentioned. Patients with PC are at high risk of being diagnosed with AG or even assigned the wrong gender at birth. In our series two patients were assigned as males, and consequently one of them underwent a highly mutilating surgery. A thorough physical examination together with a high index of suspicion and laboratory workup are mandatory to identify these variations, avoiding further investigations, unnecessary surgeries, and parental stress.

Zinner syndrome in pediatric patients: rare disease leading to challenging management.

Zinner syndrome (ZS) is the association of seminal vesicle cysts, ipsilateral ejaculatory duct obstruction, and ipsilateral renal agenesis. This condition is very rare in children and both diagnosis and treatment may be challenging. We reviewed the clinical presentation and treatment describing our experience with a series of three patients. From January 2016 to January 2021, three patients (patients 1, 2, and 3) with symptomatic ZS, aged 2, 15, and 17 years, respectively, were diagnosed and treated. All three patients were symptomatic, manifesting pelvic pain and dysuria. The diagnosis was made by physical examination, ultrasonography, and abdominopelvic MRI. Patient 1 underwent open surgery, while for patients 2 and 3, laparoscopic excision was performed. The renal agenesis regarded the left side in patients 1 and 3, and the right side in patient 2. In all cases, the cystic complex was excised. The mean operating time was 4 h and the mean hospitalization time was 5 days (range 4-6 days). The mean follow-up period was 5 years (range 2-5 years). Patients 1 and 3 showed a complete resolution of the symptoms during postoperative follow-up. In patient 2, clinical symptoms relapsed because of the persistence of a 9 mm cyst requiring a redo laparoscopic excision. Seminal vesicle cyst with ipsilateral renal agenesis, even if rare in pediatric age, should be suspected in young male patients presenting with pelvic cystic masses, pelvic pain, dysuria, and ipsilateral renal absence. Conservative management should be reversed to asymptomatic patients. Surgical treatment is mandatory in symptomatic cases and the preferred approach is minimally invasive surgery to magnify the operating field to spare anatomical structures, primarily the contralateral vas deferens. Radicality is crucial to avoid the persistence of symptoms and the need for reintervention.

A A retrospective observational study in assesment of role of sonography in adnexal masses and its histopathological correlation in tertiary care centre.

Background- Adnexal masses (masses of the ovary, fallopian tube, or surrounding tissues) commonly are encountered by obstetrician–gynaecologist and often present diagnostic and management dilemmas. Types of adnexal mass ranges from benign ovarian and non-ovarian to primary and secondary malignant ovarian masses. Although most adnexal masses are benign, the main goal of the diagnostic evaluation is to exclude malignancy. Transvaginal ultrasonography remains the gold standard for evaluation of adnexal masses. The management of the adnexal masses varies according to age at presentation, whether benign or malignant, acute emergency or chronic presentation. Aim- The study aimed to determine the causes of adnexal masses and correlation of ultrasonographic and histopathologic findings of the adnexal masses. Methods- This is a retrospective observational study, performed in the Department of Obstetrics and Gynaecology, in tertiary care hospital. Operative and demographic details of patients operated for adnexal masses over a period of one year was obtained from case records of patient. Results- Among 90 cases studied, 86.66%(78) cases of adnexal masses was of ovarian origin followed by 11.66%(7) was of tubal origin. Among 90 cases of adnexal masses, 91.11%(82) cases were benign , 4.44%(4) were of borderline and malignant. Most common ovarian cause of adnexal mass was endometriotic cyst(22.22%) followed by serous cyst adenoma(20%) The highest sensitivity was found for follicular cyst (87.5%) followed by dermoid and serous cyst adenoma (83.33%). Malignancy was found in 8 cases among which 6 were correctly reported by USG resulting in sensitivity of 75%. Conclusion- It was concluded from the current study findings that sonography was primary modality and best screening tool for evaluation of pelvic masses. Ultrasound has high sensitivity for correctly diagnosing benign versus malignant pelvic lesions. Sonography was observed to be best modality to differentiate between solid and cystic pelvic masses.

Cystic echinococcosis, a rare differential diagnosis of cystic pelvic masses.

Cystic echinococcosis, a rare differential diagnosis of cystic pelvic masses.

A case of ectopic prostatic tissue presenting as a cystic pelvic mass

A 74-year-old man initially presenting with fall had an incidental finding on CT of a heterogeneous, partly cystic lesion in the pelvis that was moderately glucose avid on FDG-PET. The pelvic mass and adherent right seminal vesicle were excised.

Antenatal ultrasound diagnosis of huge fetal hydrometrocolpos secondary to imperforate hymen and successful postnatal treatment: a case report

Abstract Objectives Hydrometrocolpos is a pelvic cystic mass representing the distension of the vagina and uterus due to obstructive congenital anomalies of the female causing accumulation of fluid secretions in the vagina and endometrial cavity. Prenatal diagnosis is uncommon and usually noticed during the adolescent period for failure to see menses with cyclic abdominal pain, abdominal mass, and local compressive symptoms. Late diagnosis after delivery of newborns with this condition results in poor outcomes from local compressive symptoms. Case presentation Here, we present a case diagnosed with congenital hydrometrocolpos at 39 weeks of gestation during routine third-trimester ultrasound scanning. The newborn was delivered vaginally and huge hydrometrocolpos secondary to imperforate hymen was diagnosed postnatally, and a hymenectomy was done and the newborn was discharged and improved from the hospital. Conclusions Although congenital hydrometrocolpos occurs rarely, it is also better to suspect prenatally in a female fetus with a cystic pelvic mass. Antenatal ultrasound diagnosis of this condition will help to make decisions early and to prevent further complications which might occur both intrauterine and after birth.

Contribution of Outpatient Ultrasound Transvaginal Biopsy and Puncture in the Diagnosis and Treatment of Pelvic Lesions: A Bicenter Study.

The use of transvaginal ultrasound guided biopsy and puncture of pelvic lesions is a minimally invasive technique that allows for accurate diagnosis. It has many advantages compared to other more invasive (lower complication rate) or non-invasive techniques (accurate diagnosis). Furthermore, it offers greater availability, it does not radiate, enables the study of pelvic masses accessible vaginally with ultrasound control in real time, and it is possible to use the colour Doppler avoiding puncturing large vessels among others. The main aim of the work is to describe a standardized ambulatory technique and to determine its usefulness. This is a retrospective study of ultrasound transvaginal punctures (core needle biopsies and cytologies) and drainages of pelvic lesions performed on an outpatient basis during the last two years. The punctures were made with local anesthesia, under transvaginal ultrasound guidance with an automatic or semi-automatic 18G biopsy needle with a length of 20-25 cm and a penetration depth of 12 or 22 mm. The material obtained was sent for anatomopathological, cytological and/or microbiological study if necessary. A total of 42 women were recruited in two centers. Fifty procedures (nine punctures, seven drains, and 34 biopsies) were performed. In five cases the punction and drain provided clinical relief in benign pelvic masses. Regarding material of the biopsies performed, 15 were vaginal in women previously histerectomized, finding 10 carcinomas, eight were ovarian tumours in advanced stages or peritoneal carcinomatosis obtaining the appropriate histology in each case, seven were suspicious cervical biopsies finding carcinomas in five of them, three were myometrial biopsies including one breast carcinoma metastasis in the miometrium and a benign placental nodule, and a periurethral biopsy was performed on a woman with a history of endometrial cancer confirming recurrence. The pathological diagnosis was satisfactory in all cases, confirming the nature of the lesion (25 malignant-ten vaginal recurrences of previous gynaecological cancers, eight cases of primary ovarian/peritoneal carcinoma, four new diagnosis of cervical malignant masses, one cervical metastasis of lymphoma, one periurethral recurrence of endometrial carcinoma and one recurrence of breast cancer in the myometrium-and 23 benign). The tolerance was excellent and no complications were detected. The ambulatory ultrasound transvaginal puncture and drainage technique is useful for obtaining a sample for pathological and microbiological diagnosis with excellent tolerance that can be used to rule out the recurrence of malignant lesions or progression of the disease, diagnose masses not accessible to gynecological exploration (vaginal vault, myometrium or cervix) and for early histologic diagnosis in cases of advanced peritoneal carcinomatosis or ovarian carcinoma as well as drainage and cytological study of cystic pelvic masses.

A Woman With a Complex Cystic Pelvic Mass.

A Woman With a Complex Cystic Pelvic Mass.

MULLERIAN CYST PRESENTING AS A LARGE ABDOMINOPELVIC CYST CAUSING OBSTRUCTIVE UROPATHY IN MALE: A RARE CASE.

Introduction: Mullerian duct cyst presenting as a large abdominopelvic cyst is a rare entity. A Mullerian duct cyst represents an incomplete focal regression of the embryological Mullerian duct in a male. Case Report: This is a case of a 55 year old gentleman presenting with a pelvic mass of chronic duration with a recent onset of pain abdomen and obstructive urinary symptoms. Radiological imaging revealed a large centrally located cystic pelvic mass and Left Hydroureteronephrosis. The patient underwent Left DJ stenting followed by an Explorative laprotomy and Marsupialization of the cyst. It is prerogative to understand the development of the male urinary tract and the Conclusion: reproductive system to diagnose rare midline pelvic pathologies and decide on surgical options for treatment of the same. In addition, the nal diagnosis being dependent on the histology of such pelvic masses makes it an additional diagnostic challenge for the surgeons.

Fetal and Newborn Management of Cloacal Malformations.

Cloaca is a rare, complex malformation encompassing the genitourinary and anorectal tract of the female in which these tracts fail to separate in utero, resulting in a single perineal orifice. Prenatal sonography detects a few cases with findings such as renal and urinary tract malformations, intraluminal calcifications, dilated bowel, ambiguous genitalia, a cystic pelvic mass, or identification of other associated anomalies prompting further imaging. Multi-disciplinary collaboration between neonatology, pediatric surgery, urology, and gynecology is paramount to achieving safe outcomes. Perinatal evaluation and management may include treatment of cardiopulmonary and renal anomalies, administration of prophylactic antibiotics, ensuring egress of urine and evaluation of hydronephrosis, drainage of a hydrocolpos, and creation of a colostomy for stool diversion. Additional imaging of the spinal cord and sacrum are obtained to plan possible neurosurgical intervention as well as prognostication of future bladder and bowel control. Endoscopic evaluation and cloacagram, followed by primary reconstruction, are performed by a multidisciplinary team outside of the neonatal period. Long-term multidisciplinary follow-up is essential given the increased rates of renal disease, neuropathic bladder, tethered cord syndrome, and stooling issues. Patients and families will also require support through the functional and psychosocial changes in puberty, adolescence, and young adulthood.

Characteristics of fetal physiological and pathological uterine effusion observed on prenatal ultrasonography: a case report

BackgroundThe prenatal detection rate of fetal uterine effusion is very low, and current case reports mainly focus on pathological hydrometrocolpos. We presented two cases of fetal physiological uterine effusion with different ultrasonic characteristics and compared them with one case of hydrometrocolpos with the hope of identifying strategies to reduce misdiagnosis of fetal uterine effusion.Case presentationThis paper reports the cases of two female fetuses with abnormal pelvic echoes in the third trimester, referred to a tertiary center to be screened for suspected pelvic teratoma and cystic mass, respectively. Ultrasound consultation revealed fetal uterine effusion. The two fetuses were delivered at our hospital after a full term. Re-examining the uterus and adnexa of the neonates revealed that the uterine effusion had subsided naturally. Another female fetus had a large cystic mass in the pelvic cavity in the third trimester, and prenatal examination indicated fetal hydrometrocolpos. The fetus was delivered at our hospital after a full term. The hydrometrocolpos existed even after birth. After consultation with a neonatal surgeon and gynecologist, the newborn was diagnosed with congenital imperforate hymen with hydrometrocolpos. Hymen puncture and open drainage led to a good prognosis.ConclusionsPrenatal ultrasonography plays an important role in diagnosing and differentiating between physiological and pathological fetal uterine effusion. It can help reduce misdiagnoses that can lead to incorrect clinical decisions.

Zinner syndrome – a rare radiological diagnosis in a young male presenting with recurrent dysuria

Zinner syndrome is a rare congenital abnormality of the mesonephric (Wolffian) duct consisting of unilateral renal agenesis, ipsilateral seminal vesicle cyst, and ipsilateral ejaculatory duct obstruction. The syndrome usually presents in the second or third decade of life mainly after the beginning of sexual activity and usually in the form of voiding manifestations. The main imaging modality is magnetic resonance imaging (MRI); however, usually suspected in transabdominal sonography, which may give initial clue to the diagnosis. Herein, we report a rare case of a 24 - year male with right renal agenesis with cystic pelvic mass diagnosed as Zinner syndrome via multimodality imaging.

Mesenteric cystic lymphangioma – A rare case report; National Center for Pediatric Surgery, Gezira State, Sudan; 2021

Cystic lymphangioma is a benign congenital malformation of the lymphatic vessels. At the National Center for Pediatric Surgery, Gezira State, Sudan; 2021; a female baby of 15 months old age presented complaining of abdominal distention of 10 days duration. Patient Looks unwell, not febrile, and not pale or jaundice; abdomen was distended with full flanks, there was a palpable mass in the epigastric region, no area of tenderness and no palpable organs. Abdomino-pelvic U/S showed very huge abdomino –pelvic cystic mass with multiple thick septa. CT abdomen showed huge abdomino-pelvic mass with multiple cysts that having variable sizes measuring up to 6*7 cm. An elective explorative laparotomy was done. Intra operative findings: Multiple cystic masses arise from the root of the small bowel mesentery matted together with multiple enlarged mesenteric lymph nodes involving segment of distal jejunum with multiple adhesions. Release of adhesion, resection of the masses along with 57 cm of the involving jejunum, anastomosis was done, and homeostasis was secured. Histopathology result showed dilated cystic spaces; lined by flat endothelial cells and multiple reactive lymph nodes, no evidence of malignancy. Features are in line with lymphangioma and associated mesenteric lymphadenitis. Discussion and Conclusion: Our case was 15 months old which is the age of presentation as mentioned internationally. Mesenteric cystic Lymphangiomas are more common among male unlike our case. Ultrasonography and CT abdomen were highly recommended to achieve early diagnosis and treatment of such cases.

Appropriate Preoperative Planning Leads to Successful Removal of the Small Volume Ovarian Remnant

<h3>Study Objective</h3> To review the ovarian remnant syndrome characteristics and risk factors. To describe the correct surgical technique to prevent this condition. To demonstrate the appropriate preoperative evaluation and surgical resolution of the small volume ovarian remnant. <h3>Design</h3> Educational video. <h3>Setting</h3> Robotic assisted laparoscopic procedure. Patient in dorsal lithotomy position. Bilateral double ended tiger tail prophylactic ureteral stents used. <h3>Patients or Participants</h3> We describe a case of a 40-year-old patient who presented with a pelvic cystic mass and pelvic pain. She had a history of multiple laparotomies including an abdominal hysterectomy and bilateral salpingo-oophorectomy. She had a known BRCA 1 mutation and a strong family history of ovarian cancer. Her estradiol and follicle-stimulating hormone (FSH) levels were in the premenopausal range. Ovarian remnant syndrome was suspected. <h3>Interventions</h3> Robotic assisted removal of bilateral small volume ovarian remnants. <h3>Measurements and Main Results</h3> An overview of the preoperative evaluation and management of small volume ovarian remnant syndrome is described. The surgical technique to prevent ovarian remnant syndrome is discussed. The preoperative evaluation including hormone levels, ovarian stimulation, and imaging studies are discussed. Surgical planning including discussion with radiology and pathology are reviewed. Relying on anatomical landmarks, ureterolysis, proximal ligation of the infundibulopelvic ligament, and other surgical tips for the successful removal of the small volume ovarian remnant are presented. <h3>Conclusion</h3> Appropriate surgical technique prevents ovarian remnant syndrome. Serial MRIs may help identify cyclic changes of the ovarian remnant. Ovarian stimulation and hormone levels may assist with diagnosis and treatment planning. Preoperative discussion with Radiology to look for anatomical landmarks is important to successfully excise small volume lesions.

Ovarian cysts

Ovarian cysts

Development of an auxiliary device for ultrasound-guided aspiration of pelvic cystic masses: a simulation study.

Pelvic cystic masses are a common gynecological condition. Ultrasound-guided aspiration is a minimally invasive surgical technique for the treatment of pelvic cystic masses. However, further developments to improve its stability and safety are wanting. This study evaluated the application and safety of a self-developed auxiliary device for pelvic cystic masses' ultrasound-guided aspiration through phantom testing. Saline and coupling agents were used at different viscosity levels to simulate simple cysts, medium viscosity cysts (such as pelvic effusions), and ovarian, endometrial cysts. An auxiliary device consisting of a three-way valve, a negative pressure aspirator, and a pressurized infusion bag was developed. Phantom testing was performed to evaluate the application of this device in ultrasound-guided aspiration of pelvic cystic masses. The indicators, including the time of aspiration, time of injection, and the incidence of complications, were compared to cases in which ultrasound-guided aspiration was performed manually with a syringe. The incidence of complications in the auxiliary device group was significantly lower compared to the manual operation group (P<0.05). The ovarian cystic aspiration times and operation times were significantly shorter in the auxiliary device group compared to the traditional manual puncture group (P<0.05). Ultrasound-guided aspiration is repeatable and minimally invasive for the treatment of pelvic cystic masses. Using the auxiliary device designed in this report resulted in shorter operation times, definite needle fixation, and fewer complications, which may allow for a more stable and safer aspiration procedure for the treatment of pelvic cystic masses.

Inferior Vena Caval Malformation with Deep Venous Thrombosis Incidentally Diagnosed as a Cystic Pelvic Mass in a Young Female Patient: A Case Report

Inferior Vena Caval Malformation with Deep Venous Thrombosis Incidentally Diagnosed as a Cystic Pelvic Mass in a Young Female Patient: A Case Report