Differential Diagnosis Of Pelvic Mass Research Articles

Image features and clinical analysis of retroperitoneal pelvic schwannoma: a case report

BackgroundSchwannomas are benign usually encapsulated nerve sheath tumors derived from the Schwann cells, and affecting single or multiple nerves. The tumors commonly arise from the cranial nerves as acoustic neurinomas but they are extremely rare in the pelvis and the retroperitoneal area. Retroperitoneal pelvic schwannomas often present with non-specific symptoms leading to misdiagnosis and prolonged morbidity.Case presentationWe report the case of a 59-year-old woman presenting with a feeling of heaviness in the lower abdomen who was found to have a retroperitoneal pelvic schwannoma originating from the right femoral nerve. She had a history of two resections of peripheral schwannomas at four different sites of limbs. After conducting magnetic resonance imaging, this pelvic schwannoma was misdiagnosed as a gynecological malignancy. The tumor was successfully removed by laparoscopic surgery. Pathological analysis of the mass revealed a benign schwannoma of the femoral nerve sheath with demonstrating strong, diffuse positivity for S-100 protein.ConclusionsAlthough retroperitoneal pelvic schwannoma is rare, it should be considered in the differential diagnosis of pelvic masses, especially in patients with a history of neurogenic mass or the presence of neurogenic mass elsewhere.

Pelvic splenosis in a patient with a 20-year history of splenectomy

Pelvic splenosis, also called ectopic pelvic spleen, is a rarely reported clinical condition. Pelvic splenosis refers to autotransplantation of splenic tissue resulting from seeding into the pelvic space that typically occurs after trauma. This report presents the case of a 39-year-old male with a rectal lesion. After a laparoscopic low anterior resection of rectosigmoid colon with colorectal anastomosis, the lesion was resected and diagnosed as an ectopic pelvic spleen. Pelvic splenosis requires no treatment in most cases. Surgery is considered only if it is accompanied with acute complications. When the diagnosis remains unclear, further biopsy or laparoscopy is recommended. If pelvic splenosis is confirmed, careful follow-up is beneficial. Finally, pelvic splenosis should be considered in the differential diagnosis of pelvic masses in patients with a history of splenectomy.

Primary left ovarian hydatid cyst presenting as an abdominal mass - Case report.

IntroductionHydatid disease, which is most often caused by Echinococcus granulosus, can occur in virtually all parts of the body. The disease most frequently occurs in the liver followed by the lungs, muscles, and bones respectively. Primary ovarian hydatid cyst is a rare case.Case presentationA 28-year-old woman presented to the emergency department with vague abdominal discomfort of 8-month duration which was located to the left side of lower abdomen and pelvis associated with episodes of low-grade fever. Her past medical and surgical histories were unremarkable with no surgical operation. She had 3 vaginal deliveries and did not smoke.DiscussionHydatid disease is commonly caused by Echinococcus granulosus. The parasite can colonize virtually in every organ or in several organs at one time in the body. Pelvic hydatid cyst most often presents with vague abdominal pain. The diagnosis of the disease is not straightforward most of the time and requires investigations. The gold standard surgical treatment for ovarian hydatid cyst is cystectomy.ConclusionOvarian hydatid cyst should always be considered in the differential diagnosis of pelvic masses, especially in endemic areas. Surgical treatment in the form of radical cystectomy is the treatment of choice and it is necessary to take all precautions not to spill hydatid fluid and daughter cysts inside the abdomen. Anthelmintics adjuvant chemotherapy postoperatively may decrease the recurrence rate of the disease.

Exploratory Analysis of CA125-MGL and -STn Glycoforms in the Differential Diagnostics of Pelvic Masses.

The cancer antigen 125 (CA125) immunoassay (IA) does not distinguish epithelial ovarian cancer (EOC) from benign disease with the sensitivity needed in clinical practice. In recent studies, glycoforms of CA125 have shown potential as biomarkers in EOC. Here, we assessed the diagnostic abilities of two recently developed CA125 glycoform assays for patients with a pelvic mass. Detailed analysis was further conducted for postmenopausal patients with marginally elevated conventionally measured CA125 levels, as this subgroup presents a diagnostic challenge in the clinical setting. Our study population contained 549 patients diagnosed with EOC, benign ovarian tumors, and endometriosis. Of these, 288 patients were postmenopausal, and 98 of them presented with marginally elevated serum levels of conventionally measured CA125 at diagnosis. Preoperative serum levels of conventionally measured CA125 and its glycoforms (CA125-MGL and CA125-STn) were determined. The CA125-STn assay identified EOC significantly better than the conventional CA125-IA in postmenopausal patients (85% vs. 74% sensitivity at a fixed specificity of 90%, P = 0.0009). Further, both glycoform assays had superior AUCs compared to the conventional CA125-IA in postmenopausal patients with marginally elevated CA125. Importantly, the glycoform assays reduced the false positive rate of the conventional CA125-IA. The results indicate that the CA125 glycoform assays markedly improve the performance of the conventional CA125-IA in the differential diagnosis of pelvic masses. This result is especially valuable when CA125 is marginally elevated.

Evaluation of female pelvic mass - correlation of clinical and histopathological findings in female patients attending at Birat Medical College and Teaching Hospital, Morang, Nepal

Introduction: The female pelvis is a quite complex anatomical region consisting of uro-genital system as its main part and other structures like blood vessels, gastrointestinal tracts, lymphatics, nerves and a part of musculoskeletal system. Thus, the differential diagnosis of pelvic masses may be of gynecological or non gynecological origin. Gynecological pelvic masses are uterine, ovarian or adnexal masses which may be benign or malignant.
 Objective: The objective of this study was to evaluate the type of various gynecological pelvic masses and to correlate the preoperative diagnosis with histopathological diagnosis.
 Methodology: This was a hospital based cross sectional study conducted on 107 patients from September 2018 to September 2019 at Birat Medical College and Teaching Hospital (BMCTH) with presenting complian of lump in the abdomen. These patients underwent clinical examination, routine and specific investigations along with ultrasonographic evaluation and tumour markers to reach a preoperative clinical diagnosis. Patients were admitted and preanesthetic consultation was done. Patients were taken for therapeutic or diagnostic laparoscopy or exploratory laparotomy and diagnosis were confirmed with histopathological diagnosis.
 Results: Total 107 patients were enrolled in the study with age ranging from 21 to ≥70 years and among them majority (42.1%) were in the age group of 41-50 years. The most common presenting complain of patients were lower abdominopelvic pain (58.87%). The most common clinical diagnosis was leiomyoma in 39.25% patients followed by adenomyosis in 24.29% patients. The most common histopathological diagnosis was fibroid uterus seen in 42.05% patients. There were 2 (1.86%) patients of ovarian malignancies and 1 (0.93%) patient of uterine malignancy.

Appendiceal mucinous neoplasm mimics ovarian tumors: Challenges for preoperative and intraoperative diagnosis and clinical implication

ObjectiveThe aim of this study was to investigate the clinicopathological characteristics of appendiceal mucinous neoplasm that had been preoperatively misdiagnosed as a mucinous ovarian tumor and to discuss the clinical impacts of misdiagnosis. MethodsSeventy-eight patients with a final pathologic diagnosis of appendiceal mucinous neoplasm during a 10-year period were retrospectively reviewed. All patients were diagnosed with ovarian tumor before treatment. A univariate analysis was performed to evaluate predictors of the diagnostic accuracy of a frozen section. ResultsThe patients’ median age was 61 years (range, 21–82 years), and most were diagnosed as low-grade appendiceal mucinous neoplasm (LAMN) (84.62%). The diagnostic concordance between the frozen section and the final pathology was 56.92%. The most consistent diagnosis was LAMN (64.14%). Univariate analysis indicated that maximal diameter of the ovarian tumor (unilateral), laterality of the ovarian tumors (unilateral or bilateral), and frozen section site (appendix or extra-appendix) significantly correlated with the accuracy of frozen section diagnosis (all p < 0.05). Although the diagnostic discordance between the frozen section and the final pathology was 43.08%, only one patient was clinically impacted because of suboptimal surgery. ConclusionAppendiceal mucinous neoplasm should be considered as a differential diagnosis of pelvic mass in women. For patients who do not require fertility-sparing surgery, excision and frozen section of the bilateral ovaries and appendix regardless of the appearance of the appendix might improve the diagnosis. For older patients with peritoneal dissemination, appropriate cytoreductive surgery is recommended to reduce the clinical impact of misdiagnosis.

Discriminative value of CA-125, HE4, Risk of Malignancy Index II (RMI-II) and Risk of Malignancy Algorithm (ROMA) in the differential diagnosis of pelvic masses: conclusions from a referral Centre in Portugal

The major purpose of this article was to compare the discriminative value of different algorithms and serum biomarkers in the differential diagnosis of adnexal masses. We performed a retrospective study with 247 women with adnexal neoplasia, submitted to surgical treatment and with a histological diagnosis. The evaluation of the area under the curve (AUC) for isolated CA-125 and HE4, and for ROMA and RMI-II, showed a better specificity of HE4 and RMI-II in premenopausal women. In the postmenopausal group, ROMA and RMI-II were the algorithms with a better performance.Impact StatementWhat is already known on this subject? CA-125 remains the most commonly used biomarker used to predict the behaviour of an adnexal mass, but it has a low sensitivity for stage I tumours. Other isolated serum markers have emerged more recently, such as HE4, as well as more complex algorithms, such as RMI or ROMA. It remains unclear which is the best marker/algorithm to predict the behaviour of an adnexal mass.What do the results of this study add? Our findings showed that ROMA is a suitable marker for postmenopausal women, with no advantage found in the premenopausal women when compared with an isolated HE4.What are the implications of these findings for clinical practice and/or further research? The different algorithms of the preoperative discrimination of ovarian neoplasia appear to have different AUC, SN and SP in the pre- or the postmenopausal patients. For the premenopausal women, the use of ROMA does not seem to have any advantage over the isolated use of HE4, which does not lose specificity even when the borderline tumours are considered for discrimination. In the postmenopausal women, ROMA is a valid algorithm with a good sensitivity. The RMI-II showed a good performance in both groups, although it depends on the ultrasound findings and has an important interobserver variability. This information allows a more targeted selection of markers and algorithms to be requested prior to surgery of ovarian neoplasms regarding the menopausal status of each patient.

Primary Transitional Cell Carcinoma of Fallopian Tube Mimicking Radiologically as Extrauterine Leiomyoma: A Case Report

Introduction: Primary carcinoma of the fallopian tube is very rare among primary genital tract malignancies. Transitional cell carcinoma is among the rarest tumor subtypes that can involve the fallopian tube. Case Presentation: Here, we reported a 42-year-old premenopausal lady presenting with spotting, dysmenorrhea, and abdominal pain. She was found to have a pelvic mass in the right posterior cul-de-sac suspicious to be an eccentrically located leiomyoma. Histopathology examination of the resected mass revealed transitional cell carcinoma arising from the fallopian tube. Conclusions: Primary fallopian tube tumors could be considered in differential diagnosis of pelvic mass and intraoperative frozen consultation is useful for correct diagnosis.

Giant ovarian teratoma: an important differential diagnosis of pelvic masses in children.

Giant ovarian teratoma: an important differential diagnosis of pelvic masses in children.

Retroperitoneal endometriosis in postmenopausal woman causing deep vein thrombosis: case report and review of the literature

Endometriosis is an uncommon disease in postmenopausal women (PMW), ranging from 2% to 5% of cases, and it is very important to exclude neoplastic transformation of the endometrium. The authors would like to introduce the case of a 63-year-old overweight patient with abdominal pain associated to pain and swelling of the left inferior limb occurring for approximately six weeks. The CT X-ray of the abdomen revealed the presence of a retroperitoneal mass causing deep vein thrombosis because of extrinsic compression of the left iliac vein. Following removal of the pelvic masses with laparotomy, the histological exam revealed an endometriosis. The CT X-ray carried out after a month postoperatively revealed the root canal treatment of the left femoral vein with a considerable decrease of the thrombosis of homolateral external iliac veins. Despite the endometriosis, it is uncommon in women who have reached menopause and must be considered in the differential diagnosis of pelvic masses.

Castleman's Disease Presenting in the Pelvis

Castleman's disease (CD) is a rare benign lymphoid disorder with unknown etiology. There are 2 major forms of this disease, unicentric (ie, localized CD) and multicentric, which play a major role in determining therapy. The mediastinum is the most common localization for the localized CD, whereas its occurrence in the pelvis is even rarer. We report the case of a 22-year-old woman who had a pelvic mass located in the region of the left iliac fossa. The patient subsequently underwent a robotic-assisted laparoscopic tumorectomy. Pathological examination revealed pelvic localized CD of the hyaline-vascular type. CD should be included in the differential diagnosis of pelvic masses that are noted in the pelvic cavity.

Abstract B25: Preclinical evaluation of radiolabeled MUC16 antibodies for PET imaging of epithelial ovarian carcinoma.

Abstract The CA-125 antigen is the most widely used serum biomarker to monitor epithelial ovarian carcinoma (EOC) and for the differential diagnosis of pelvic masses. A repeating glycopeptide, CA-125 is an epitope of the larger transmembrane mucin protein, MUC16, which is overexpressed in EOC. MUC16 has an average molecular weight of 3-5 million Da and includes a putative cleavage site proximal to a tandem repeat region. To date, the majority of antibodies against MUC16 have targeted the tandem repeat region of the protein, which is shed into circulation following cleavage. Using synthetic MUC16 peptides, high affinity antibodies (9C9, 19C11, 7B12) were raised against the portion of MUC16 retained by the cell. Imaging modalities currently used for EOC are generally viewed as inadequate and as such, the goal of this study is to evaluate these three antibodies to determine the best candidate to be used as a PET imaging agent for EOC. These antibodies were conjugated with desferrioxamine-isothiocyanate and radiolabelled with 89Zr. Using a MUC16-positive cell line (SKOV3-MUC16c114), in vitro studies were performed to confirm immunoreactivity and binding affinities of the radiolabeled antibodies. In addition, in vitro internalization studies were conducted which demonstrated similar uptake among the tracers. Subcutaneous EOC tumors were established in athymic, nude mice for the in vivo characterization of the MUC16 antibodies. Firstly, biodistribution data for 89Zr-9C9 revealed an accumulation of the tracer in the tumor tissue at 24 hours post-injection of 9.41 ± 1.98 %ID/g. Kidney uptake of this tracer, although washing out over time, was extremely high at 24 hours (37.02 ± 1.35 %ID/g). The liver and spleen uptake of the tracer at 24 hours post-injection were 9.74 ± 0.76 and 4.76 ± 0.55 %ID/g, respectively. For 89Zr-19C11, despite in vitro data that demonstrated active internalization, biodistribution data for 89Zr-19C11 revealed minimal tumor uptake in vivo 24 hours post-injection (3.12 ± 0.68 %ID/g). Kidney uptake of this tracer was 4.84 ± 0.98 %ID/g and liver and spleen uptake were high 24 hours post-injection (34.73 ± 4.39 and 9.25 ± 0.90 %ID/g, respectively) indicating potential aggregation or stability issues in vivo. Unlike the other tracers, serum stability data of 89Zr-19C11 demonstrated a purity of 74.43 ± 1.51% after 7 days, an uncharacteristically low stability for a 89Zr-labeled antibody (typically greater than 90%). For 89Zr-7B12, biodistribution data revealed modest tumor uptake 24 hours post-injection (8.54 ± 0.95 %ID/g), kidney uptake of 7.19 ± 0.75 %ID/g, and liver and spleen uptake of 6.24 ± 0.83 and 7.22 ± 1.26 %ID/g, respectively. These in vitro and in vivo studies point to 89Zr-7B12 as the leading candidate thus far. Further studies, including imaging, will be conducted at longer time points to evaluate in vivo tumor uptake of 89Zr-7B12 in addition to blocking studies to demonstrate the specificity of the tracer. Research funded, in part, by the Center to Reduce Cancer Health Disparities of the National Cancer Institute (3R01CA176671-02S1). Citation Format: Brandon E. Nemieboka, Dharmarao Thapi, Ariana Bitton, Jason S. Lewis. Preclinical evaluation of radiolabeled MUC16 antibodies for PET imaging of epithelial ovarian carcinoma. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research: Exploiting Vulnerabilities; Oct 17-20, 2015; Orlando, FL. Philadelphia (PA): AACR; Clin Cancer Res 2016;22(2 Suppl):Abstract nr B25.

Clinical Use of Cancer Biomarkers in Epithelial Ovarian Cancer: Updated Guidelines From the European Group on Tumor Markers.

ObjectiveTo present an update of the European Group on Tumor Markers guidelines for serum markers in epithelial ovarian cancer.MethodsSystematic literature survey from 2008 to 2013. The articles were evaluated by level of evidence and strength of recommendation.ResultsBecause of its low sensitivity (50–62% for early stage epithelial ovarian cancer) and limited specificity (94–98.5%), cancer antigen (CA) 125 (CA125) is not recommended as a screening test in asymptomatic women. The Risk of Malignancy Index, which includes CA125, transvaginal ultrasound, and menopausal status, is recommended for the differential diagnosis of a pelvic mass. Because human epididymis protein 4 has been reported to have superior specificity to CA125, especially in premenopausal women, it may be considered either alone or as part of the risk of ovarian malignancy algorithm, in the differential diagnosis of pelvic masses, especially in such women. CA125 should be used to monitor response to first-line chemotherapy using the previously published criteria of the Gynecological Cancer Intergroup, that is, at least a 50% reduction of a pretreatment sample of 70 kU/L or greater. The value of CA125 in posttherapy surveillance is less clear. Although a prospective randomized trial concluded that early administration of chemotherapy based on increasing CA125 levels had no effect on survival, European Group on Tumor Markers state that monitoring with CA125 in this situation should occur, especially if the patient is a candidate for secondary cytoreductive surgery.ConclusionsAt present, CA125 remains the most important biomarker for epithelial ovarian cancer, excluding tumors of mucinous origin.

Endoscopic Ultrasonography-Guided Biopsy for Differentiation of Benign and Malignant Pelvic Lesions: A Systematic Review and Meta-Analysis.

Preoperative diagnosis of pelvic lesions remains challenging despite advances in imaging technologies. Endoscopic ultrasonography (EUS)-guided biopsy is an effective diagnostic modality for sampling the digestive tract and surrounding areas. However, a meta-analysis summarizing the diagnostic efficacy of EUS-guided biopsy for pelvic lesions has not been published. We aimed to evaluate the utility of EUS-guided biopsy in the diagnosis of pelvic lesions. Articles were identified via structured database search; only studies where pelvic lesions were confirmed by surgery or clinical follow-up were included. Data extracted were selected with strict criteria. A fixed-effects model was used to estimate the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). A summary receiver operating characteristic curve (SROC) was also constructed. Ten studies containing a total of 246 patients were included. The pooled sensitivity of EUS-guided biopsy for differential diagnosis of pelvic masses was 0.89 (95% CI 0.83-0.94), and the specificity was 0.93 (95% CI 0.86-0.97). The area under the SROC was 0.9631. The combined PLR, NLR, and DOR were 11.75 (95% CI 5.90-23.43), 0.12 (95% CI 0.07-0.20), and 100.06 (95% CI 37.48-267.10) respectively. There is potential presence of publication bias in this meta-analysis. Our meta-analysis shows that EUS-guided biopsy is a powerful tool for differentiating pelvic masses with a high sensitivity and specificity. Furthermore, it is a safe procedure with low rate of complication, although more high-quality prospective studies are required to be done.

Presentation and treatment of uterine leiomyoma in adolescence: a systematic review.

BackgroundUterine leiomyoma is the most common gynecological tumor in the reproductive years. However, it is extremely rare in adolescence (<1%), with few reports found in the literature. The biological behavior of such tumors in this age group is unknown, as well as the best possible treatment for this population. We aimed to analyze all available reports of uterine leiomyoma in adolescence.MethodsA systematic review was performed at PubMed/MEDLINE and EMBASE. Between 1965 and 2014, 19 reports were found on uterine leiomyoma in patients under 18 years. The following parameters were discussed: age, tumor diameter, symptoms, clinical treatments, surgical treatments, hemodynamic changes.ResultsMean age was 15.35 (14–17) years. Mean tumor diameter was 12.28 cm (3–30) and median diameter was 10 cm. Most patients presented with symptoms (87.5%), including abnormal uterine bleeding (10/18) and pelvic/abdominal pain (6/18). A pelvic mass was the most common finding. Two patients required transfusion due to anemia. One patient underwent abdominal hysterectomy, and the others underwent myomectomy. Mean follow-up was 1 year and 8 months, and only case recurred, after 6 months.ConclusionLeiomyomas’ biologic behavior in adolescents may be different from that of older women, but their molecular characteristics still haven’t been analyzed. Optimal treatment is still not defined, but myomectomy has several advantages in this population. Leiomyomas must be remembered as an important differential diagnosis of pelvic mass in adolescents.

Comment on case report entitled: adenomyosis of uterus with adenomyoma of fallopian tube.

To the Editor I read an interesting case report titled “adenomyosis of uterus with adenomyoma of fallopian tube” by Ganitha et al that appears in the recent issue of your journal. While reading this, I was pondering that it is adenomyoma in rudimentary horn of uterus instead of adenomyoma of fallopian tube. It may be due to wrong interpretation by pathologist as sample sent might be labeled as uterus with fallopian tube and rudimentary horn may not be mentioned. Although the development of leiomyomas from uterine remnant is a rare finding, it is still possible and it should be considered in the list of differential diagnosis of pelvic masses with mullerian dysgenesis [1].

Primary Extranodal Hodgkin's Lymphoma presenting with a Single Pelvic Mass

ABSTRACTIntroductionAlthough lymphomas can arise from a wide variety of tissues, primary extranodal presentation is predominantly a feature of non-Hodgkin's lymphomas. Primary pelvic extranodal Hodgkin's lymphoma is a rare malignancy. We presented a case of primer retroperitoneal Hodgkin's lymphoma initially presumed gynecologic malignancy. We discussed its rarity, staging and management.Case ReportA 75-year-old woman was referred to our hospital with persisting pelvic mass. Pelvic examination revealed an ill-defined immobile mass with hard in consistency. The mass 100 × 75 mm in diameter, invading right parametrium, perivesical space and bladder wall was detected in CT and there were no signs of metastases or enlarged lymph nodes. Diagnostic laparoscopy was suggested but the patient refused the surgery due to her advanced age. One year later, she presented with the symptoms of fever, sweats and fatigue. Hodgkin's lymphoma was diagnosed via laparoscopic biopsy of the mass located at retroperitoneal space anteriorly to the uterus. CT examination revealed multiple swollen lymph nodes and a pulmonary nodule; thus, stage 4 disease was established. International prognostic score was 2, indicating 67% progression free survival; however, patient died due to respiratory failure after the first course of ABVD chemotherapy.ConclusionAlthough gynecologists rarely experience primary extranodal lymphomas particularly Hodgkin's disease, lymphoid malignancies should be kept in mind in differential diagnosis of pelvic masses. This disease can rarely arise adjacent to gynecologic organs in retroperitoneal space, and this presentation can be misinterpreted as a gynecological malignancy.How to cite this articleKiran G, Canaz E, Sayar H, Serin S, Balakan O. Primary Extranodal Hodgkin's Lymphoma presenting with a Single Pelvic Mass. J South Asian Feder Obst Gynae 2014;6(3):183-186.

Leiomyoma of the round ligament presenting as an adnexal mass in a patient with a history of hysterectomy

A 52 year old woman complaining of vaginal vault eversion applied to our outpatient clinic. In her medical history, she had underwent total abdominal hysterectomy for uterin leiomyoma 15 years ago. Physical examination revealed a firm, left sided pelvic mass and uterine vault prolapse. Laparotomy and frozen section were performed for the suspected mass. A solid mass arising from the left round ligament was observed. This mass was completely removed and diagnosed as leiomyoma on frozen section. Although adnexal masses are more common causes of pelvic masses in women, leiomyomas should be kept in mind in the differential diagnosis of pelvic masses even in patients with the history of hysterectomy.

Mucocele appendix: A rare differential diagnosis of pelvic mass

Mucocele of the appendix is a descriptive term that implies a dilated appendiceal lumen caused by abnormal accumulation of mucus. Mucocele is found in 0.2-0.3% of all appendectomy specimens. The male to female ratio is 1:4 and the average age at the time of diagnosis is over 50 years. Ultrasonography and computed tomography are useful tools for the diagnosis of appendiceal mucocele. Pre-operative diagnosis is a major component for minimizing intra operative and post-operative complications. We herein report a case of 40-year-old female presented as pelvic mass and this pose a diagnostic challenge

Tubo-ovarian abscesses: A retrospective analysis of risk factors, clinical features, and treatments

Tubo-ovarian abscess (TOA) is a serious inflammatory disease of the female reproductive system including the ovary, fallopian tube, and the surrounding tissues. In this study, we aimed to present risk factors, clinical features and treatment approaches in TOA. The files of 31 patients with a diagnosis of TOA were analyzed retrospectively from January 2007 to June 2012. The patients' risk factors, clinical details, treatment modalities, laboratory results, and complications were recorded. The medically treated patients were divided into two groups: successful and unsuccessful treatment groups. Groups were compared according to the demographic data, risk factors, and mass characteristics. The mean age of patients was 33.12±10.43. Twenty-eight patients (90.3%) were married and 27 of them (87%) were multiparous. Intrauterine device (IUD) were used as contraceptive method in 11 of married patients (35.5%). Nine patients (29%) had history of prior intrauterine or intraabdominal intervention within 6 months. Pelvic inflammatory disease (PID) were in 15 patients (48.4%). At admission, pelvic pain in 31 (100%), vaginal discharge in 24 (77.4%), fever in 17 (54.8%), irregular menstrual bleeding in 14 (45.2%) of patients were recorded. Laboratory findings were elevated erythrocyte sedimentation rate (71%), and increased C-reactive protein level (71%), leukocytosis (61.3%) respectively. The initial diagnosis of hospitalized patients were observed TOA in 14 (45.2%), ruptured TOA in 5, IUD translocation and TOA in 7, the suspicion of a complication of perforated appendicitis in 1 and pelvic mass (teratoma, fibroid degeneration, ovarian cancer, endometrioma) in 4 of patients, respectively. Medical treatment was applied in 13 patients and reached 46.2% success rate. There was no significant difference in between successful and unsuccessful treatment groups with respect of demographic data, risk factors, and the mass characteristics. Surgical procedures were laparoscopic abscess drainage (22.6%), laparotomy and drainage of abscess (32.3%), unilateral salpingooopherectomy (12.9%), and total abdominal hysterectomy and bilateral salpingo-ooferectomy (12.9%), respectively. The bowel injury and sepsis (6.5%), dehiscence (6.5%), and wound infection (3.25%) were observed as postoperative complications. The pelvic masses may be a risk factor in addition to PID and the use of IUD for TOA. The patients with TOA may present with the pelvic mass and pelvic pain without the classic symptoms of infection. Therefore, TOA should be considered in the differential diagnosis of pelvic masses. Although the medical treatment should be the first choice in patients with TOA, suspected cases and ruptured abscesses should be treated by surgery.