Diagnosis Of Ovarian Masses Research Articles

GD2 and GD3 gangliosides as prognostic biomarkers in high grade serous ovarian cancer

ObjectiveGangliosides GD2 and GD3 have been proposed to be of significance in diagnosis of ovarian masses. We aim to study serum GD2 and GD3 gangliosides as predictors of oncological outcomes among high grade serous (HGS) ovarian cancer (OC). Materials and methodsA retrospective study including biobanked serum samples of HGS OC treated between 2005 and 2016. Serum GD2 and GD3 concentrations were quantified using indirect ELISA and analyzed with respect to survival. ResultsSixty patients were included. Patients with GD3>12.8 ng/mL had shorter PFS when compared to patients with lower level; median 31 vs. 67 months, p = 0.005. Patients with GD2> 7.1 ng/mL had shorter median PFS than those with lower level of (23 vs. 52 months, p = 0.024.) Patients with GD3>14.5 ng/mL had shorter OS vs. patients with lower level (median 31 vs. 70 months, p = 0.002). In a Cox regression, following adjustment for age, CA-125, disease stage and age, serum elevated GD3 was independently associated with short PFS (adjusted hazard ratio 2.0, 95 % CI 1.1–3.8, p=.024). In a separate Cox regression, elevated GD2 was independently associated with PFS (adjusted hazard ratio3.0 (1.2–7.7). p=.019. High serum GD3 and GD2 were independently associated with short OS as well. ConclusionsHigh levels of serum GD2 and GD3 in HGS OC were associated with shorter PFS and OS. GD3 is superior to GD2 as a biomarker for prognosis.

Doppler Ultrasound versus Pelvic Magnetic Resonance Imaging in diagnosis of ovarian mass in teenagers: A Prospective study

Doppler Ultrasound versus Pelvic Magnetic Resonance Imaging in diagnosis of ovarian mass in teenagers: A Prospective study

TO STUDY AND ASSESS THE VALIDITY OF THE RISK OF MALIGNANCY INDEX(RMI-4) IN DISCRIMINATING BETWEEN BENIGN AND MALIGNANT OVARIAN MASSES

Introduction:The most fatal of all gynecological cancers is ovarian cancer. Of all gynecological cancers, it has the greatest fatality-to-case ratio. It is the 4th most prevalent cancer among women. The lifetime risk of being diagnosed with ovarian carcinoma is 1% to 1.5 %, with a nearly 0.5% chance of dying from it. Suboptimal primary cytoreductive surgery has great prognostic significance. The reason was because of inappropriate preoperative evaluation, which decides the kind of surgery being performed and the surgeons expertise of the surgeon in performing staging laparotomy if indicated. Hence, a gynecologist must be able to differentiate benign from the malignant ovarian mass. Several studies have revealed that the diagnosis of ovarian mass by investigations like Ultrasonogram, Doppler, MRI, CT has been proved to be uncertain despite the need for expertise. The goal of this study was to assess the ability of the Risk of Malignancy Index Scoring System (RMI- 4) in differentiating benign from malignant ovarian masses and to compare the scoring patterns to histopathological findings. Objectives: To validate the efficiency of the Risk of Malignancy Index(RMI-4) in discriminating benign and malignant ovarian tumors.To correlate the calculated value of the Risk of Malignancy Index(RMI-4) to the histopathological report.To evaluate the performance of individual parameters and the Risk of Malignancy Index(RMI-4) in differentiating benign and malignant ovarian tumors. Materials and methods: A prospective observational study in one year from date of approval from institutional ethical committee i. e from 2019 to 2021on women attending Gynecology outpatient and inpatient department diagnosed with an ovarian mass at Government Maternity Hospital, Tirupati. Results : 50 women with ovarian mass were selected for the study. Patients with endometriosis, fibroid uterus, Pelvic inflammatory disease, menstruation, pregnancy, ectopic pregnancy, and other non-gynecological conditions like peritonitis, diverticulitis, inflammatory bowel disease, tuberculosis, liver disease, recent surgery, are excluded. General and gynecological examinations were done for all cases. Ultrasound pelvis was done for all the patients and the presence of bilateral ovarian mass, multiloculated tumor, presence of solid areas, ascites, and extra ovarian metastasis was noted. An ultrasound score (U) of 1 was given if none or one of the features are found, and a score of 4 was given if two or more of these features were noted. Size of the tumor measured. A score of 1 was given for a tumor less than 7 cm and a score of 2 for a tumor size more than or equal to 7 cm size. Postmenopausal status was defined as more than one year of amenorrhea or age older than 50 years for women who had undergone hysterectomy they were scored as M=4. All other patients who did not meet these criteria were defined in a premenopausal status which scored M=1. The Risk of Malignancy Index (RMI-4) was calculated by using the formula: RMI-4 = U x M x S x CA 125. Laparotomy was done for all cases and the specimen was sent for histopathological examination which is the gold standard.90% of the tumors were benign and 10% were malignant.Prediction of malignancy by CA 125, ultrasound, and RMI-4 was analyzed.The optimal cut-off value of RMI-4 was 450 with a sensitivity of 95.56%, specificity of 100%, PPV of 100%, and NPV of 71.43%.Though the Specificity and PPV of CA125 were high, Sensitivity was less (86.67%).This study showed that RMI-4 had better performance than CA 125, USG score, and menopausal score in predicting malignancy. Conclusion:RMI-4 is a multimodal approach that is simple and easily applicable in the preoperative evaluation of a patient with an ovarian mass.Risk of Malignancy Index -4 (RMI-4) is a reliable method in discriminating benign and malignant ovarian mass preoperatively.Risk of Malignancy Index -4 (RMI-4) is a better scoring index in differentiating benign and malignant ovarian mass when compared to individual tests of ultrasonogram or CA125 level.The optimal cut-off point of Risk of Malignancy Index -4 (RMI-4) at which benign and malignant tumors can be discriminated was 450 in the present study.RMI-4 is the most useful scoring system in the proper selection of patient.Since the specificity of Risk of Malignancy Index -4 (RMI-4) was high, there is a potential role for this index in the selection of cases for conservative management or minimally invasive surgery in case of benign ovarian masses.

American college of radiology ovarian-adnexal reporting and data system ultrasound (O-RADS): Diagnostic performance and inter-reviewer agreement for ovarian masses in children.

To evaluate the diagnostic performance and inter-observer agreement of the American College of Radiology Ovarian-Adnexal Reporting and Data System Ultrasound (O-RADS) in the diagnosis of ovarian masses in children. From June 2012 to December 2021, 163 ovarian masses in 159 patients with pathologic results were retrospectively analyzed. Each mass was classified into an O-RADS category according to the criteria. The diagnostic performance of O-RADS for detecting malignant ovarian masses was assessed using histopathology as the reference standard. Kappa (k) statistic was used to assess inter-observer agreement between a less-experienced and a well-experienced radiologist. Out of 163 ovarian masses, 18 (11.0%) were malignant and 145 (89.0%) were benign. The malignancy rates of O-RADS 5, O-RADS 4, and O-RADS 3 masses were 72.7%, 34.6%, and 4.8%, respectively. The area under the receiver operating characteristic curve was 0.944 (95% CI, 0.908-0.981). The optimal cutoff value for predicting malignant ovarian masses was > O-RADS 3 with a sensitivity, specificity, and accuracy of 94.4%, 86.2% and 86.2% respectively. The inter-observer agreement of the O-RADS category was good (k = 0.777). O-RADS has a high diagnostic performance for children with ovarian masses. It provides an effective malignant risk classification for ovarian masses in children, which shows high consistency between radiologists with different levels of experience.

Review of a 25-Year Experience in the Management of Ovarian Masses in Neonates, Children and Adolescents: From Laparoscopy to Robotics and Indocyanine Green Fluorescence Technology.

Background: Ovarian masses in pediatric populations are the most common abdominal masses in young girls. In neonates, the majority of masses are benign while in children and teen-agers the risk of malignancy exists. The aim of this study is to perform a 25-year experience retrospective analysis of clinical and therapeutic aspects of ovarian tumors in girls, in order to show how the development of minimally invasive technology has changed the management of this pathology. Methods: The records of patients under the age of 18 who were operated in three pediatric surgical units due to ovarian mass, in the last 25 years, were reviewed retrospectively. The study group comprised 147 patients operated between 1996 and 2021 with a diagnosis of ovarian masses. Data involved were demographical, surgical, follow-up and final diagnosis. We analyzed the type of surgical technique, intra-operative data (operative time, the use of different technologies), complications, length of stay and long-term follow-up. Based on these data, we assessed how the surgical approach to ovarian masses has changed in the last 25 years in newborns and young girls. Results: The patients ages ranged between 7 days and 15 years (median, 59 days). All the procedures were completed in laparoscopy or robotics without conversion in open surgery. One-hundred and eleven patients were neonates; they all had follicular cysts and they were all managed in laparoscopy using 1 or 3 trocars. In 80/111 patients (72%), a small part of ovarian parenchyma was saved; in 31/111 patients (28%), in which the ovarian parenchyma was not available, an ovariectomy was performed. Patients in which we saved a small part of ovary, at long term follow-up (minimum follow-up of 12 years) (29/80, 36%), developed a normal ovary at US control. Thirty-six were older patients. They had a histological diagnosis of benign (30) or malign (6) tumors. All the patients (8/36) with a pre-operative suspicion of ovarian malignancy received an ovariectomy and an adnexectomy using sealing devices. In the last 10 years in all the children, except neonates, we adopted sealing devices and, in the last 4 years, in 20 cases, we always adopted ICG fluorescence technology to check ovarian vascularization in case of torsion or to check lympho-nodes condition in case of malignancy. Conclusions: In neonatal ovarian cysts, surgical management remained unchanged and an ovarian sparing procedure is always indicated and the long-term follow-ups confirm this hypothesis. The principal innovation in this age period is the use of ICG fluorescence technology to check ovarian vascularization in case of torsion. In teenagers, the decision-making strategy is based on the tumoral markers and on the morphological aspects of the mass. Robotics cystectomy or ovariectomy now-days represents the safer and faster way to perform this. Sealing devices are essential tools for dissection and resection to avoid bleeding. ICG fluorescence technology in all ages is fundamental to check ovary vascularization after detorsion or to check lympho-node status in case of malignancy. All the suspected lesions have to be removed with an endo-bag.

Giant luteinized follicular cyst of pregnancy

Functional cysts usually do not cause symptoms or require surgical intervention. We reported a 17-year-old primigravida, gestational age of 10 weeks and 2 days, and ultrasound showing anechoic cyst in the right parauterine region without septa, with a larger diameter of 13.5cm, 632ml, and Doppler color without peripheral vascularization. The patient was oligosymptomatic during gestation. At 37 weeks and 6 days, gestation was interrupted, when the cyst had 2600 ml by ultrasonography. Fetal extraction was performed by cesarean delivery, and a large adnexal cyst visualized on the right was removed. The histopathological analysis of the surgical specimen revealed a cystic lesion coated by luteinized cells with discrete hyperchromatic and slightly pleomorphic nuclei, with underlying fibrous stroma with sparse luteinized cells, characterizing a giant luteinized follicular cyst of pregnancy. The prevalence of ovarian masses in pregnancy is rare, usually not exceeding 5 cm in diameter, and disappearing spontaneously in the second trimester. The patient in the case report had a cyst of 632 ml, increasing in volume to 2600 ml at the time of delivery. Definitive preoperative diagnosis of ovarian masses is still difficult, and predictive criteria for malignancy include the use of tumor markers, ultrasound, and Doppler. The association of these tests should guide the clinician to define the best time for surgical intervention. The association of these tests should guide the clinician to define the best time for surgical intervention.

Clinical Correlation of Ovarian Cyst Malignant or Benign with Ultrasound Reports

Objective: To investigate clinical correlation of ovarian cyst malignant or benign with ultrasound reports. Study Design: Prospective observational study Place and Duration of Study: Department of Radiology, Ghulam Muhammad Mahar Medical College, Sukkur from 1st November 2019 to 31st July 2021 Methodology: Ninety five patients with accidental diagnosis of ovarian mass were enrolled as patients and had symptoms of abdominal pain, palpable-mass as well as irregularities in the menstrual cycles. Diagnosis of each patient was based on ultrasound which was assisted with TVS or Doppler depending upon the cases under consideration. The ultrasonographical reports were correlated with the clinical examination and diagnosis findings for better assessment of the ovarian mass. Results: Mean age was 42 years with 62.3% those women who were in reproductive age while rest were having menopause. 70% were presenting abdominal pain and 2% were asymptomatic. Doppler scan reports showed that all cases of malignancy were having high vascularity with R1< 0.4 in 100% of cases while R1>0.4 was highest in benign cases. The ultrasonographical imaging showed an obvious variance in the imaging reports of benign verses malignant cases where an irregular margin mass was prominently noticeable in cases of malignant ovarian tumor. Conclusion: High sensitivity and specificity was also seen among clinical cases correlated with ultrasound having Doppler scanning. Keywords: Ultrasonography, Ovarian cyst, Tumors, Adnexal masses

Clinical Characterization of Patients with Ovarian Mass Combined with Dysplasia of Secondary Sexual Characteristics

Objective To investigate the clinical characteristics of preadolescent and adolescent female patients with ovarian mass combined with dysplasia of secondary sexual characteristics. Methods This study retrospectively analyzed 18 cases of ovarian mass combined with dysplasia of secondary sexual characteristics aged 0-19 years admitted to Peking Union Medical College Hospital from January 2012 to November 2019.By analyzing the clinical manifestations,surgical methods,postoperative pathology,therapies and prognosis of the cases,we summarized the diagnosis and treatment ideas. Results Among the 18 cases,7(7/18,38.9%)developed secondary sex signs before puberty,including 5 cases showing precocity(including 2 cases of juvenile granulosa cell tumor,1 case of gonadoblastoma,1 case of ovarian follicular cyst,and 1 case of 46,XY simple gonadal dysplasia combined with dysgerminoma)and 2 cases presenting masculine manifestations(1 case of steroid cell tumor and 1 case of sclerosing stromal tumor).The rest 11(11/18,61.1%)cases showed abnormal development of secondary sexual characteristics during puberty,including 8 cases with masculine manifestations or abnormal menstruation after menarche(7 cases with sex cord stromal cell tumor and 1 case with cystic granulosa cell tumor),2 cases with primary amenorrhea(1 case with androgen insensitivity syndrome combined with testicular sertoli cell tumor and 1 case with endometriosis cyst combined with reproductive tract malformation),and 1 case diagnosed as 46,XX gonadal dysplasia with serous cystadenoma and no secondary sexual development during puberty. Conclusions Sex hormone levels should be actively tested in the case of prepubertal secondary sexual characteristics appearing early,pubertal secondary sexual characteristics being abnormal(underdevelopment),and/or menstrual abnormalities.Imaging examination should be performed to exclude ovarian organic lesions,and chromosome karyotype analysis should be performed if necessary.The diagnosis of ovarian mass in preadolescent and adolescent females with related symptoms should first be alerted to cord stromal cell tumor.It is recommended to rule out the possibility of combined reproductive tract malformation in the adolescent patients with primary amenorrhea.Chromosome examination should be conducted to rule out the possibility of gonadal dysplasia in the adolescent patients with primary amenorrhea and/or no development of secondary sexual characteristics.

Sonographic Advancements in Characterization of Benign and Malignant Ovarian Masses

Background: Characterization of ovarian masses is essentially required and inevitable for optimization of clinical decision making, patient care and management. The diagnosis of ovarian masses is a frequent dilemma in clinical work. Ultrasonography remains the modality of choice in the early investigation of suspected adnexal masses because of its availability and being a safe modality. Aim: To review the current literature on different patterns of manifestation of ovarian masses on ultrasound and its various modes, helping in differential diagnosis on the basis of morphologic, vascular and other characteristics as seen on ultrasound. Methods: Electronic database was searched (PubMed, Google Scholar, Science direct) with data ranging from year 2000 to 2021. Most relevant studies, relating to sonographic appearances of ovarian masses were selected. Results: Twenty five most relevant articles were found: 8 articles were regarding gray-scale ultrasound, 3 articles regarding three dimensional ultrasonography, 2 articles regarding contrast enhanced ultrasonography, 2 regarding elastography and rest were regarding combined use of gray-scale and Doppler ultrasound including color and power Doppler ultrasonography for the assessment of ovarian masses. Our results show that conventional 2D sonography, in conjunction with latest advancements helps improving the diagnosis based on typical sonographic appearances of masses. Screening for ovarian cancer also proves to be helpful for early diagnosis and improvement in survival rate. Conclusion: Ultrasonoraphy and its different modalities such as 3DUS, CEUS, elastography along with conventional 2D and Doppler studies accurately identifies morphologic, structural and vascular featuresof the adnexal masses and differential diagnosis by escapingunnecessary surgeries and improving the survival rate. Keywords: Ultrasonography, Ovarian masses, malignant ovarian masses, contrast enhanced ultrasound,

Assess the Role of Sonography and MRI in Diagnosing Ovarian Masses

Background: In order to conduct appropriate surgical treatments, the characterization of ovarian lesions is of considerable significance and can affect patient care. A multidisciplinary approach based on physical assessment, laboratory tests and imaging techniques includes adequate measurement of the adnexal masses. The aim is to assess the role of Sonography and MR in diagnosing ovarian masses, to study imaging characteristics of ovarian masses on USG and Doppler in correlating these findings with MR features. Subjects and Methods: The present study was carried out in the department of radiodiagnosis to determine the efficacy of sonography and MRI in the diagnosis of ovarian masses. The study group comprised 50 patients with clinically suspected ovarian masses and imaging was carried out on all patients with ovarian masses and imaging was carried out on all patients with ovarian masses. All the masses were evaluated on sonography based on the Sassone scoring system. Morphological analysis was performed for each mass based on wall thickness, inner wall structure, septal structure and echogenicity of mass. The color flow was carried out, subsequently; MRI was carried out for each patient. Radiological diagnosis was confirmed after surgery on histopathological examination. Results: The majority of the patients were in the age group of 31-40 years. The most common symptoms noted were pain in the abdomen. The most common clinical finding was a palpable mass. The application of Sassone sonomorphologic score >9 was identified in 8 masses, out of which 7 were malignant and 1 was a benign lesion. The colour flow was detected in 38 out of 50 masses. The presence of flow, type of flow, vessel arrangement, morphology and location were noted and on pulsed Doppler the RI and PI values were calculated. Out of 8 malignant cases, 5 were diagnosed as malignant according to the Caruso score. The overall sensitivity 100 %, specificity is 97.6% and diagnostic accuracy is 98% of MRI which is higher than that of ultrasound and CDS. Conclusion: We conclude that MRI is a superior diagnostic modality in establishing the diagnosis of ovarian masses.

Krukenberg Tumor of Ovary During Pregnancy: Learning From A Mistake.

Sertoli-Leydig cell tumor of the ovary with heterologous differentiation is a relatively uncommon tumor that occurs in females of variable age range. Krukenberg tumor (KT) is a relatively more common tumor of the ovary although only a few cases of KT occur during pregnancy making it an equally uncommon tumor in this setting. We received a unilateral ovarian mass in a 25-yr-old primigravida which we reported as Sertoli-Leydig cell tumor with heterologous (intestinal) differentiation based on its clinical and histomorphologic features. However, on further investigation, a gastric mass was found which was a signet-ring cell adenocarcinoma. We rectified our diagnosis of ovarian mass as KT. We retrospectively analyzed the reasons for our mistake and concluded that the rarity coupled with the nonclassic clinical features and histomorphology of KT during pregnancy pose challenges to the correct diagnosis. This report highlights the diagnostic challenges faced by us along with the ways to circumvent them in the future.

The Role of Diffusion Weighted Imaging in suspected cases of ovarian cancer

BackgroundOvarian cancer is a common gynecological malignancy and often diagnosed late with extensive peritoneal and nodal metastasis. Diffusion-weighted imaging (DWI) provides valuable information about the structural properties of the tissue and has shown great value in cancer imaging. Recently developed post-processing three-dimensional apparent diffusion coefficient (3D ADC) map has a significant value in variable tumors yet its role in ovarian cancer is not well established. We aim to evaluate the added value of DWI and 3D ADC maps in the diagnosis of ovarian masses, detection of nodal and peritoneal deposits, and so appropriate management planning.ResultsConventional MRI and DWI were performed to fifty-one patients with complex cystic or solid adnexal lesions depicted by gynecological ultrasonography. Results were compared with surgical and histopathologic findings revealing 23/51 (45%) had malignant ovarian tumors and 28/51 (55%) had benign ovarian pathologies. The mean 3D ADC values were 0.977 ± 0.32, 0.934 ± 0.27, and 0.956 ± 0.25 × 10−3 mm2/s for ovarian, nodal, and peritoneal malignancy respectively which were significantly lower than the mean 3D ADC values of benign ovarian lesions, non-metastatic lymph nodes and benign peritoneal lesions/fat which were measured 1.516 ± 0.6, 1.208 ± 0.25, and 1.46 ± 0.43 × 10−3 mm2/s respectively.ConclusionAdding DWI and 3D ADC maps to routine MRI improves the sensitivity, specificity, and accuracy for detecting ovarian malignancy, nodal, and peritoneal metastasis. They also provide qualitative data helping in the differentiation of malignant and non-malignant entities.

Can preoperative findings help to interpret neoplastic and non-neoplastic lesions of ovary and affect surgical decisions in children and adolescents?

Ovarian masses are common in all pediatric age groups. Ovarian-sparing surgery is favored since most cases are benign or functional cysts. Detection of a few malignant cases prevents morbidity and mortality. Objective: to investigate which of the preoperative findings can help to distinguish the pathology of the ovarian lesions, affect the surgical decision and predict the possibility of ovarian preservation. Patients operated with diagnosis of ovarian mass were enrolled in the study between 2000-2015. Age, symptoms, physical examination findings, tumor markers, radiologic features, operative notes, and pathology results were reviewed retrospectively. During the study period, 98 patients were operated and 86 were included. Mean age was 9.7±5.62 years. Non-neoplastic pathologies constitute 68.6 % of cases; 31.4 % was neoplastic. Malignancy rate was 4.6 %. Solid component, absence of ovarian torsion and diameter > 9 cm were more commonly seen in neoplastic cases (p < 0.001, p < 0.001, p=0.001). Adnexal torsion was found in 30 (34.9 %) patients. Mean diameter did not differ significantly between groups with or without torsion; incidence of torsion was greater in patients with masses < 6 cm (p=0.019). Ovariansparing surgery was performed in 48 (55.8 %) and oopherectomy in 38 (44.2 %) patients. Surgical approach was affected by nature (p < 0.001) and size (p < 0.001) of the lesion; it was independent of age and presence of torsion. A purely cystic mass < 9 cm, with torsion and negative markers, orients towards a non-neoplastic mass. The presence of solid component and absence of torsion are associated with increased risk of malignancy.

MR imaging in discriminating between benign and malignant paediatric ovarian masses: a systematic review

ObjectivesThe use of magnetic resonance (MR) imaging in differentiation between benign and malignant adnexal masses in children and adolescents might be of great value in the diagnostic workup of sonographically indeterminate masses, since preserving fertility is of particular importance in this population. This systematic review evaluates the diagnostic value of MR imaging in children with an ovarian mass.MethodsThe review was made according to the PRISMA Statement. PubMed and EMBASE were systematically searched for studies on the use of MR imaging in differential diagnosis of ovarian masses in both adult women and children from 2008 to 2018.ResultsSixteen paediatric and 18 adult studies were included. In the included studies, MR imaging has shown good diagnostic performance in differentiating between benign and malignant ovarian masses. MR imaging techniques including diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) imaging seem to further improve the diagnostic performance.ConclusionThe addition of DWI with apparent diffusion coefficient (ADC) values measured in enhancing components of solid lesions and DCE imaging may further increase the good diagnostic performance of MR imaging in the pre-operative differentiation between benign and malignant ovarian masses by increasing specificity. Prospective age-specific studies are needed to confirm the high diagnostic performance of MR imaging in children and adolescents with a sonographically indeterminate ovarian mass.Key Points• MR imaging, based on several morphological features, is of good diagnostic performance in differentiating between benign and malignant ovarian masses. Sensitivity and specificity varied between 84.8 to 100% and 20.0 to 98.4%, respectively.• MR imaging techniques like diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) imaging seem to improve the diagnostic performance.• Specific studies in children and adolescents with ovarian masses are required to confirm the suggested increased diagnostic performance of DWI and DCE in this population.

Struma Ovarii, A Rare Ovarian Tumor: Case Report

Struma ovarii represents a rare type of teratoma that is formed entirely of thyroid tissue. In most cases, these tumors are benign; however, malignant ones have also been reported. It is usually seen between 40 and 60 years and accounts for about 5 % of all cases of ovarian teratomas. Our case was a female patient, 40 years old, who was presented with vaginal bleeding, abdominal swelling and left sided pelvic mass for six months. Clinical examination and imaging techniques showed left ovarian neoplastic lesion and small amount of fluid in Douglas pouch. After laparoscopic excision, Histopathological examination was performed, it showed ovarian tissue, predominantly formed of mature thyroid tissue which are the key features of struma ovarii. In Conclusion: Struma ovarii is a rare ovarian tumor with variable clinical presentations, even can be malignant. Pre-operative diagnosis is usually difficult and confusing, so, it should be put in consideration in differential diagnosis of ovarian masses.

A Giant Ovarian Serous Cystadenoma in Pregnancy: A Case Report

Background:Diagnosis of ovarian mass during pregnancy may be postponed because they may mimic physiological signs of pregnancy. Ovarian masses can lead to complications such as overgrowth, torsion or cyst rupture. Therefore, to inform health providers concerning symptoms, safe diagnostic methods and proper management seem appropriate. Case report: A 19-year-old primigravida was presented to our clinic in the 16th week of gestation with an ultrasound document revealing a giant solid-cystic mass extending from pelvis to diaphragm, which was probably an ovarian cyst. During the ultrasound assessment of pregnancy, the mass was discovered incidentally. The only complaint of patient was insignificant abdominal bloating attributed to dyspepsia. Vital signs and laboratory tests, including tumor markers, were within normal limits. During laparotomy, an ovarian multilocular cyst extending beneath the diaphragm and measuring about 50 cm and 10 kg using was removed using a different technique. The volume of the cyst was decreased before the removal by inserting an angio catheter and withdrawing some fluid. Through this procedure, we prevented spillage of cystic fluid into the abdomen and pressed pregnant uterus during mass extraction. Ovarian serous cystadenoma was confirmed by pathology evaluation. Pregnancy passed normally until the delivery of a 3100-gm baby in the 38th week of gestation. Conclusion: Proper diagnosis of masses during pregnancy can save maternal and fetal health through preventing adverse outcomes, such as abortion or preterm labor. Therefore, pregnant women’s complaints and precise physical examination should be taken into account in prenatal care centers. Also, surgical intervention with the least uterine manipulation is recommended in these cases.

Epidemiology and Characteristics of Extra-ovarian Conditions Mimicking Ovarian Cancer: A 4-Year Assay Among Iranian Women

Introduction: Involving approximately 4% of malignancies in women, ovarian cancer remains one of the most fatal cancers. However, it is important to consider conditions which are not primary ovarian diseases, but mimic their behaviors. In the present study, the epidemiological characteristics of extra-ovarian conditions mimicking ovarian masses are evaluated. Methods: This cross-sectional study was conducted on patients with a primary diagnosis of ovarian mass who underwent surgery by gynecologists between January 2012 and March 2016. The surgeon’s primary diagnosis and the final histopathology assessment report were evaluated for each patient. In cases where the final histopathology report was not in the spectrum of gynecologic pathology, possible reasons for incompatibility were investigated. Results: Ultimately, 1876 patients with a mean age of 48.26±15.4 years underwent analysis. Among these patients, 27 (1.4%) had masses of a non-gynecologic origin. The final diagnoses were divided into four main categories: masses with a gastrointestinal origin (55.5%), infectious (18.5%), those with a retroperitoneal origin (18.5%), and embryologic-origin masses (7.4%). Conclusion: The results suggest that extra-ovarian diseases should be considered in differential diagnoses of patients with a primary diagnosis of ovarian cancer. Furthermore, it was found that metastases from gastrointestinal tract tumors and infectious diseases are the most common pathologies among extra-ovarian conditions.

3. Routine MRI Examination for the Contribution of the Suitable Treatment 3-3. MRI Diagnosis of Ovarian Masses

3. Routine MRI Examination for the Contribution of the Suitable Treatment 3-3. MRI Diagnosis of Ovarian Masses

Role of Frozen Section in the Diagnosis of Ovarian Masses: An Institutional Experience

Role of Frozen Section in the Diagnosis of Ovarian Masses: An Institutional Experience

Магнитно-резонансная томография в дифференциальной диагностике образований яичника. Возможности количественной мультипараметрической оценки

Магнитно-резонансная томография в дифференциальной диагностике образований яичника. Возможности количественной мультипараметрической оценки