Ovarian Enlargement Research Articles

Ovarian Strumal Carcinoid Tumour: Case Report

BACKGROUND:Ovarian strumal carcinoid is a germ cell tumour characterised by a mixture of thyroid tissue and carcinoid. Ovarian struma is a very rare occurrence with 0.3-1% incidence of all ovarian tumours and 3% of mature teratomas. Primary carcinoid ovarian tumours are still uncommon as a part of mature teratoma or mucinous cystadenoma. There are four major variants of a carcinoid tumour: insular, trabecular, strumal and mucinous. A strumal carcinoid is an unusual form of ovarian teratoma composed of an intimate admixture of thyroid/carcinoid tissues.CASE REPORT:This is a case report of a 59-year old woman with a 5-year clinical history of perimenopausal uterine bleeding and three explorative curettages. Gynaecological and ultrasound examinations revealed ovarian enlargement with a diameter of 50 mm with hypoechoic zones suspected of benign teratoma. The diagnostic test such as Ca-125, AFP, free-T4 and TSH was in normal range. A smooth, solid right ovarian 50 an mm-size tumour, as well as small amount of fluid in the Douglas pouch, was found during the total abdominal hysterectomy, bilateral salpingo-oophorectomy and staging biopsy. The histopathology revealed teratoma with strumal carcinoid tumour IA stage according to AJCC 2010 of the right ovary and negative cytopathology of the fluid from the Douglas pouch. On the postoperative 2-year control, the patient was tumour free, and Ca-125, free-T4 and TSH were in normal range.CONCLUSION:We would like to point out those specific diagnostic tools, such as ultrasound and Ca-125 have low specificity and sensitivity in detection of this rare ovarian malignancy.

New possibilities of correction of metabolic disorders in women with PCOS

The aim of the study, the results of which are described in the article, was to study the possibilities of using a polycomponent drug containing D-kiro-inositol in the polycystic ovarian syndrome.A comparative prospective study was conducted with the participation of 60 patients of reproductive age suffering from polycystic ovarian syndrome (phenotype A). The criteria for participation in the study were: a confirmed diagnosis of polycystic ovarian syndrome with ovarian enlargement and oligo/anovulation and a raised level of ovarian androgens; body mass index from 26 to 30 kg/m2. Patients with severe endocrine and somatic pathology were excluded from the study.Women aged 18–35 years were on out-patient treatment in the Endocrine gynecology department of the SI “Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”. By random sampling, the patients were divided into 2 groups of 30 people each. For 6 months, the patients of the main group received twice a day 1 Protalis complex drug containing D-kiroinositol, which is recommended for normalization of ovarian function and stimulation of spontaneous ovulation in polycystic ovarian syndrome, improvement of oocyte state, and also to promote reduction of oxidative and inflammatory stress, reducing the level of total testosterone and increasing fertility. Patients of the control group received recommendations on dietary nutrition and exercise.Analysis of the results of therapy showed a recovery in the main group of regular ovulatory menstrual cycles in 53.33% of cases, a decrease in the frequency of androgen-dependent dermatopathy by 50%, normalization of body weight and a reliable decrease in androgen levels. In addition, a positive effect on metabolic parameters such as HOMA index and homocysteine level was noted.The results of the study allow us to recommend the use of Protalis course therapy (D-kiro-inositol and synergists) to restore ovulatory menstrual cycles, and as a means of preventing metabolic disorders in women with polycystic ovarian syndrome and overweight.

Preoperative Magnetic Resonance Imaging Diagnosis of Ovarian Torsion

Background: Magnetic resonance (MR) imaging, have become more frequently used in the diagnosis of ovarian torsion, particularly in subacute cases. Objectives: To assess the characteristic findings and diagnostic performance of preoperative MR imaging for ovarian torsion. Patients and Methods: Twenty-three patients (age range, 10 - 58 years; mean age, 28.4 ± 12.5 years) with suspected ovarian torsion underwent preoperative MR imaging. Fifteen patients exhibited ovarian torsion, whereas the remaining eight did not. Two radiologists evaluated the MR imaging data in relation to six previously-described characteristics associated with ovarian torsion, and the sensitivity, specificity, and accuracy of this approach was determined. Results: Ovarian enlargement (maximum ovarian diameter > 4.0 cm) and a twisted pedicle were significantly more common findings in patients with ovarian torsion compared with those without (regarding ovarian enlargement, P = 0.032 for both readers and considering twisted pedicle, P = 0.0094 for first reader and P = 0.0013 for second reader). The respective sensitivity, specificity, and accuracy of a twisted pedicle for the diagnosis of ovarian torsion were 73%, 88%, and 78%, respectively for reader 1 and 73%, 100%, and 83%, respectively for reader 2. Conclusion: Identifying a twisted pedicle in a patient is therefore, suggestive of ovarian torsion.

Prognostic significance of normal-sized ovary in advanced serous epithelial ovarian cancer.

ObjectiveWe compared survival outcomes of advanced serous type epithelial ovarian cancer (EOC) patients with normal-sized ovaries and enlarged-ovarian tumors by propensity score matching analysis.MethodsThe medical records of EOC patients treated at Samsung Medical Center between 2002 and 2015 were reviewed retrospectively. We investigated EOC patients with high grade serous type histology and International Federation of Gynecology and Obstetrics (FIGO) stage IIIB, IIIC, or IV who underwent primary debulking surgery (PDS) and adjuvant chemotherapy to identify patients with normal-sized ovaries. Propensity score matching was performed to compare patients with normal-sized ovaries to patients with enlarged-ovarian tumors (ratio, 1:3) according to age, FIGO stage, initial cancer antigen (CA)-125 level, and residual disease status after PDS.ResultsOf the 419 EOC patients, 48 patients had normal-sized ovary. Patients with enlarged-ovarian tumor were younger (54.0±10.3 vs. 58.4±9.2 years, p=0.005) than those with normal-sized ovary, and there was a statistically significant difference in residual disease status between the 2 groups. In total cohort with a median follow-up period of 43 months (range, 3–164 months), inferior overall survival (OS) was shown in the normal-sized ovary group (median OS, 71.2 vs. 41.4 months; p=0.003). After propensity score matching, the group with normal-sized ovary showed inferior OS compared to the group with enlarged-ovarian tumor (median OS, 72.1 vs. 41.4 months; p=0.031). In multivariate analysis for OS, normal-sized ovary remained a significant factor.ConclusionNormal-sized ovary was associated with poor OS compared with the common presentation of enlarged ovaries in EOC, independent of CA-125 level or residual disease.

A case report on severe ovarian hyperstimulation syndrome in a pregnancy with torsion of bilateral enlarged ovaries with acute abdomen

Ovarian hyperstimulation syndrome is a complication of fertility treatment, which uses pharmacological ovarian stimulation to increase the number of oocytes and therefore embryos available during assisted reproductive technology. Ovarian hyperstimulation syndrome is invariably associated with increased volume of ovaries which is itself a threat to undergo torsion, and it may cause an additional threat requiring prompt surgical intervention in many situations. Simple release of torsion, sacrificing the devitalized ovarian tissue in part and complete can have effect in continuation of pregnancy; and something like this happened in our case. The patient, 29-year-old, a known case of polycystic ovary syndrome (PCOS), conceived through ovulation induction; came with an episode of acute pain abdomen with abdominal distension toward the later part of her first trimester. Ultrasonography was done. Bilateral enlarged ovaries of around 23 cm × 11.8 cm each were seen meeting at the pouch of Douglas with ascites. It was a case of ovarian hyperstimulation syndrome, more specifically, a case of late ovarian hyperstimulation syndrome. Serum E2 level was 3263 pg/ml. Laparotomy was then done. Intraperitoneally bilateral ovarian torsion was seen with areas of necrosis. The right oophorectomy was done, while on the left side some portion of normal ovarian tissue was preserved. Following the operation, her symptoms were improved. The pregnancy continued uneventfully. Exposure of ovaries to human chorionic gonadotropin or luteinizing hormone following controlled ovarian stimulation by follicle-stimulating hormone underlies most cases of ovarian hyperstimulation syndrome. The risk of ovarian hyperstimulation syndrome is smaller when using gonadotropin-releasing hormone antagonist (GnRH) antagonist protocol instead of GnRH agonist protocol for suppression of ovulation during ovarian hyperstimulation. To avoid ovarian hyperstimulation syndrome, the best trigger is GnRH agonists. In PCOS patients, metformin is an important aid in reducing ovarian hyperstimulation syndrome.

Spectrum of magnetic resonance imaging findings in ovarian torsion.

PurposeOvarian torsion is the twisting of the ovary on its vascular pedicle resulting in vascular compromise. Diagnosis of ovarian torsion is challenging in patients who have atypical clinical or ultrasound (US) findings. The objective of our study was to demonstrate the magnetic resonance imaging (MRI) features of ovarian torsion to help radiologists make a conclusive diagnosis when the clinical and US findings are unclear.Material and methodsWe retrospectively reviewed the clinical and MRI features in 10 females with surgically proven ovarian torsion, who had inconclusive clinical, US, or computed tomography findings.ResultsAll patients showed a significantly enlarged ovary with size ranging from 5 to 18 cm. ‘Twisted ovarian pedicle’ sign was seen in seven patients. Eight cases showed areas of haemorrhage within the ovarian stroma. Non-enhancement of ovarian stroma was observed in six patients. Seven patients showed an ipsilateral deviation of the uterus.ConclusionsMRI features of ovarian torsion include ovarian enlargement, twisted ovarian pedicle, ovarian haemorrhage, abnormal ovarian enhancement, and ipsilateral deviation of the uterus. Awareness of these imaging features will enable the radiologist to recognise ovarian torsion and differentiate it reliably from other benign or malignant ovarian lesions.

UMBILICAL DISCHARGE - AN EXTREMELY RARE PRESENTATION

Umbilical discharge and dermoid cyst of ovary are quiet commonly encountered problems in the outpatient departments. However, dermoid cyst presenting as a cause of umbilical discharge is extremely rare, and we could find only one case reported in literature so far. A 20-year-old lady presented with painful umbilical swelling and purulent discharge from umbilicus for the last 2 months. A 1 cm×2 cm sprouting granulation tissue with purulent discharge was found at the umbilicus with surrounding erythema. The dilemma in diagnosis was not resolved with routine investigations and imaging studies. On surgical exploration, a fistulous tract was found extending from the umbilicus to the enlarged right ovary. The diagnosis of benign teratoma of ovary with sinus tract up to umbilicus was made on histopathology. The rarity of this case makes its reporting further relevant, considering the differential diagnosis of umbilical discharge or presentations of dermoid cyst of ovary. Key words : Dermoid cyst of ovary, Fistulation, Infected teratoma of ovary, Umbilectomy, Umbilical discharge, Oophorectomy

Genome-Wide Profiling of Small RNAs and Degradome Revealed Conserved Regulations of miRNAs on Auxin-Responsive Genes during Fruit Enlargement in Peaches.

Auxin has long been known as a critical phytohormone that regulates fruit development in plants. However, due to the lack of an enlarged ovary wall in the model plants Arabidopsis and rice, the molecular regulatory mechanisms of fruit division and enlargement remain unclear. In this study, we performed small RNA sequencing and degradome sequencing analyses to systematically explore post-transcriptional regulation in the mesocarp at the hard core stage following treatment of the peach (Prunus persica L.) fruit with the synthetic auxin α-naphthylacetic acid (NAA). Our analyses identified 24 evolutionarily conserved miRNA genes as well as 16 predicted genes. Experimental verification showed that the expression levels of miR398 and miR408b were significantly upregulated after NAA treatment, whereas those of miR156, miR160, miR166, miR167, miR390, miR393, miR482, miR535 and miR2118 were significantly downregulated. Degradome sequencing coupled with miRNA target prediction analyses detected 119 significant cleavage sites on several mRNA targets, including SQUAMOSA promoter binding protein–like (SPL), ARF, (NAM, ATAF1/2 and CUC2) NAC, Arabidopsis thaliana homeobox protein (ATHB), the homeodomain-leucine zipper transcription factor revoluta(REV), (teosinte-like1, cycloidea and proliferating cell factor1) TCP and auxin signaling F-box protein (AFB) family genes. Our systematic profiling of miRNAs and the degradome in peach fruit suggests the existence of a post-transcriptional regulation network of miRNAs that target auxin pathway genes in fruit development.

Non-visualization of the ovary on CT or ultrasound in the ED setting: utility of immediate follow-up imaging

In the setting of female patients in the ED receiving both a CT scan and ultrasound of the pelvis, we compared the studies to assess the diagnostic value of non-visualization of the ovary in predicting the absence of ovarian disease. A retrospective review of the electronic medical record identified adult female non-pregnant patients who received both a CT abdomen and pelvis and a transabdominal and transvaginal pelvic ultrasound within a 48-h period through the emergency department. The imaging studies were blindly reviewed to evaluate the ovaries on each CT and US independently. Ovaries were characterized as normal, non-visualized, or abnormal requiring follow-up. All cases of non-visualized ovaries were compared to the appearance on the corresponding exam for each patient, and assessed for agreement (normal or non-visualized) or disagreement (abnormal). Subsequently, the electronic medical record was used as a reference standard to assess the presence or absence of ovarian pathology over the subsequent ninety days. Statistical analysis was performed utilizing a McNemar test with a 95% confidence interval. A total of 181 patients were included in the study (age range 18-75). Of these, 36 patients had non-visualization of one ovary (21 patients) or both ovaries (15 patients) on either study. On CT, 18 ovaries were non-visualized, with no cases of disagreement on ultrasound or subsequent short-term follow-up (NPV 100%). On ultrasound, 39 ovaries were non-visualized, with three of these adnexae appearing abnormal on CT (NPV 92%): one with an enlarged ovary and two with hydrosalpinx. No ovarian abnormalities were evident on chart follow-up. Significant correlation of agreement between normal and non-visualized pairs on CT and US was observed (p=0.025, McNemar). There was a combined NPV of 94% regardless of modality for the absence of ovarian pathology in the case of non-visualization. The most common abnormal imaging findings associated with non-visualized ovaries were uterine fibroids and hemoperitoneum. The absence of detection of the ovary on pelvic US or CT is highly predictive of the lack of ovarian abnormality on short-term follow-up, and does not typically require additional imaging to exclude ovarian disease.

Marked hyperandrogenicity in a 60-year-old woman.

Markedly elevated androgen levels can lead to clinical virilization in females. Clinical features of virilization in a female patient, in association with biochemical hyperandrogenism, should prompt a search for an androgen-producing tumor, especially of ovarian or adrenal origin. We herein report the case of a 60-year-old woman of Pakistani origin who presented with the incidental finding of male pattern baldness and hirsutism. Her serum testosterone level was markedly elevated at 21 nmol/L (normal range: 0.4–1.7 nmol/L), while her DHEAS level was normal, indicating a likely ovarian source of her elevated testosterone. Subsequently, a CT abdomen-pelvis was performed, which revealed a bulky right ovary, confirmed on MRI of the pelvis as an enlarged right ovary, measuring 2.9 × 2.2 cm transaxially. A laparoscopic bilateral salpingo-oophorectomy was performed, and histopathological examination and immunohistochemistry confirmed the diagnosis of a Leydig cell tumor, a rare tumor accounting for 0.1% of ovarian tumors. Surgical resection led to normalization of testosterone levels.Learning points:Hirsutism in postmenopausal women should trigger suspicion of androgen-secreting tumorExtremely elevated testosterone level plus normal DHEAS level point toward ovarian sourceLeydig cell tumor is extremely rare cause of hyperandrogenicity

EP25.13: Theca lutein cysts in the setting of primary hypothyroidism

Theca lutein cysts, or hyperreactio luteinalis, are luteinised ovarian follicle cysts due to overstimulation from high levels of human chorionic gonadotropin (hCG) or hypersensitivity to hCG. This is a rare condition of bilateral ovarian cysts, which are characteristically benign, multilocular, functional cysts with thin walls and clear, straw-coloured fluid. They cause ovarian enlargement and often pelvic pain due to fullness and compression. Another etiology of theca lutein cysts is ovarian hyperstimulation syndrome (OHSS). This entity appears as a complication of ovulation induction therapy, or rarely, mutations in the FSH receptor. In the absence of ovulation induction therapy, theca lutein cysts are typically managed conservatively and do not have significant long-term sequelae. They can be mistaken for ovarian malignancy with resultant unnecessary surgical and reproductive morbidities. This case involves a non-pregnant 30-year old female patient with chronic pelvic pain, and a 2-year and seven month history of secondary amenorrhea, weight gain and no history of ovarian stimulation therapy. Ultrasound revealed bilaterally enlarged ovaries measuring 10 cm with multiple thin walled cysts. Laboratory investigations revealed primary hypothyroidism. Initiation of daily levothyroxine led to the gradual resolution of both her symptoms and the cysts.

Polycystic Ovary Syndrome among Obese Adolescents

Background and aims: In adolescence and obesity, the pathophysiology of polycystic ovary syndrome (PCOS) is very difficult to distinguish. We aimed to assess the diagnosis of PCOS in the population of obese adolescent.Methods: Cross-sectional study. Setting: Pediatric Endocrinology Weight and Management Clinic from Children's Institute, São Paulo, Brazil. Participants: Forty-nine post-menarcheal obese adolescents with mean age of 14.7 years. Interventions: Anthropometric assessment and review of medical records were done. Clinical and laboratory hyperandrogenism were quantified using Ferriman–Gallwey index and androgenic dosages, respectively. Ovarian morphology was evaluated through suprapubic ultrasonography.Results: By the 2015 Witchel et al. guideline for PCOS in adolescence, 18.4% were diagnosed as having PCOS. When assessed by Rotterdam, Androgen Excess and PCOS Society, and American National Institute of Health criteria's, 26.4%, 22.4%, and 20.4% had PCOS, respectively. Irregular menstrual cycles were found in 65.3% of patients. Clinical hyperandrogenism was observed in 16.3% of girls and 18.4% had elevated serum androgen values. Suprapubic ultrasonography revealed enlarged ovaries in 18.4% of the adolescents.Conclusions: PCOS in all-comers obese adolescents from a Weight and Management Clinic in a quaternary hospital is more frequent when compared to adult women showed in the literature.

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.

Kisspeptin-10 inhibits OHSS by suppressing VEGF secretion

The aim of the present study was to elucidate the effects of kisspeptin-10 (Kp-10) on ovarian hyperstimulation syndrome (OHSS) and its related mechanism in OHSS rat models, human umbilical vein endothelial cells (HUVECs) and human luteinized granulosa cells. OHSS is a systemic disorder with high vascular permeability (VP) and ovarian enlargement. KISS1R (KISS1 receptor) is the specific receptor of kisspeptin. The kisspeptin/KISS1R system inhibits the expression of vascular endothelial growth factor (VEGF), which is the main regulator of VP. In our study, decreased expression of Kiss1r was observed in both ovaries and lung tissue of OHSS rats. Injection of exogenous Kp-10 inhibited the increase of VP and VEGF while promoting the expression of Kiss1r in both the ovarian and lung tissue of OHSS rats. Using HUVECs, we revealed that a high level of 17-β estradiol (E2), a feature of OHSS, suppressed the expression of KISS1R and increased VEGF and nitric oxide (NO) through estrogen receptors (ESR2). Furthermore, KISS1R mRNA also decreased in the luteinized human granulosa cells of high-risk OHSS patients, and was consistent with the results in rat models and HUVECs. In conclusion, Kp-10 prevents the increased VP of OHSS by the activation of KISS1R and the inhibition of VEGF.

Hyperreactio Luteinalis in the Third Trimester Complicating Fetal Hydrops and Mirror Syndrome

Hyperreactio luteinalis (HL) is a benign condition marked by bilateral ovarian cystic enlargement. It is rare and understanding its presentation will prevent unnecessary surgical intervention. A 21-year-old G1P0 with a spontaneous singleton pregnancy complicated by non-immune fetal hydrops and mirror syndrome developed abdominal pain and dyspnea. She underwent therapeutic amnioreduction at 31 3/7 weeks gestation due to presumed symptomatic polyhydramnios. An obstetric ultrasound showed large bilateral ovarian masses, maternal ascites, and a left pleural effusion. Due to abnormal fetal Dopplers, she underwent a cesarean section and ovarian biopsies at 31 4/7 weeks gestation. Pathology revealed bilateral corpus luteal cysts. New onset bilateral ovarian masses associated with HL can be seen in spontaneous pregnancies complicated by fetal hydrops and mirror syndrome, and are best treated conservatively. J Clin Gynecol Obstet. 2017;6(2):41-44 doi: https://doi.org/10.14740/jcgo439w

Hyperreactio Luteinalis: Possible Cause of Intrahepatic Cholestasis and Disseminated Intravascular Coagulation [22B

INTRODUCTION: Hyperreactio luteinalis (HL) is a rare finding in pregnancy consisting of enlarged multicystic ovaries capable of producing excess human chorionic gonadotropin (hCG) and androgens. We present a patient with HL and twin gestation complicated by intrahepatic cholestasis of pregnancy (ICP) who presented to our institution with disseminated intravascular coagulation (DIC). METHODS: Case Report. RESULTS: A 31-year-old gravida 1 para 0 at 35 weeks 5 days gestation with dichorionic/diamniotic twins, presented to our institution for evaluation due to elevated liver enzymes. On presentation, the patient was jaundiced but asymptomatic with normal vital signs. Fetal assessment revealed category three fetal heart tracing for both fetuses. The patient underwent emergent cesarean delivery. During surgery, bilateral enlarged multicystic ovaries were noted and lab values were consistent with disseminated intravascular coagulation. The patient was treated with fresh frozen plasma and cryoprecipitate then transferred to the intensive care unit. Postoperatively, the patient was noted to have elevated bile acids, bilirubin, androstenedione and aldosterone. CONCLUSION: Studies demonstrate that estrogens play a role in development of ICP and can impair bile acid secretion. HL produces high levels of androgens that are converted to estrogens by precursors from the fetal adrenal gland and placental aromatase. We propose estrogens produced by HL lead to the development of ICP. Excess estrogen production throughout pregnancy may lead to chronic bile acid accumulation and contribute to development of DIC.

Multimodality imaging findings of massive ovarian edema in children.

Massive ovarian edema is a rare benign condition that predominantly affects childbearing women as well as preadolescent girls. It is thought to result from intermittent or partial torsion of the ovary compromising the venous and lymphatic drainage but with preserved arterial supply. The clinical features of massive ovarian edema are nonspecific and can simulate tumors, leading to unnecessary oophorectomy. To demonstrate imaging features that should alert radiologists to consider the diagnosis of massive ovarian edema preoperatively so that fertility-sparing surgery may be considered. We identified five girls diagnosed with massive ovarian edema at pathology. Presenting symptoms, sidedness, imaging appearance, preoperative diagnosis, and operative and histopathological findings were reviewed. Age range was 9.6-14.3years (mean age: 12.5years). Common imaging findings included ovarian enlargement with edema of the stroma, peripherally placed follicles, isointense signal on T1-W MRI and markedly hyperintense signal on T2-W MRI, preservation of color Doppler flow by US, and CT Hounsfield units below 40. The uterus was deviated to the affected side in all patients. Two of the five patients had small to moderate amounts of free pelvic fluid. Mean ovarian volume on imaging was 560mL (range: 108-1,361mL). While the clinical presentation of massive ovarian edema is nonspecific, an enlarged ovary with stromal edema, peripherally placed follicles and preservation of blood flow may be suggestive and wedge biopsy should be considered intraoperatively to avoid unnecessary removal of the ovary.

An unusual case of asymptomatic hyperreactio luteinalis present at cesarean section of a spontaneous singleton pregnancy

Abstract Hyperreactio Luteinalis (HL) is a benign self-limited pregnancy-related condition characterized by bilateral ovarian enlargement with multiple theca lutein cysts. It is commonly associated with gestational trophoblastic diseases and multiple pregnancy. We report a rare case of HL discovered accidentally during cesarean section (CS) of a spontaneously conceived normal singleton pregnancy. CS was performed due to fetal malpresentation and previously scarred uterus, and delivered a healthy male neonate. Expectant management was performed to permit conservation of both ovaries without unnecessary surgical intervention. The condition resolved within 6 weeks postpartum without adding morbidity to the patient.

ADNEXAL TORSION IN 7-8 WEEKS PREGNANCY

Aim. Evaluation of clinico-laboratorial and sonographic signs of adnexal torsion. Materials and methods. Follow-up of the patient in the Perinatal Center of the Regional Clinical Hospital No. 2; ultrasound performed on Medison and Voluson E6; laparoscopy performed with the use of endoscopic devices KARL STORZ. Results. Left adnexal torsion was seen on ultrasound while the patient with a gestation period of 7-8 weeks was in the hospital. The main sonographic criteria for dynamic examination were: ovarian displacement and enlargement, changes in its echostructure, paraovarian cyst adherent to it, lack of blood flow in the ovary, and increasing hydroperitoneum. The 192 diagnosis was verified with laparoscopy and histological examination. Laparoscopic adnexectomy was performed. The postoperative period was unremarkable. Pregnancy progresses without complications. Conclusion . In the absence of convincing clinico-laboratorial, instrumental data indicative of adnexal torsion and an absolute indication for laparoscopy, ultrasound is necessary in dynamics. The above signs make possible to diagnose the adnexal torsion. Laparoscopy carried out in early pregnancy does not cause any complications in carrying of a pregnancy now.

Primary hypothyroidism presenting as a pituitary macroadenoma and precocious puberty

The association in young females of long-standing primary hypothyroidism, isosexual precocious pseudopuberty, and multicystic enlarged ovaries was first described in 1960 by Van Wyk and Grumbach. In this case study, we report a girl with precocious puberty, poor linear growth, decreased vision, and a large pituitary pseudotumor due to long-standing hypothyroidism with regression of all components following thyroxine (T4) supplementation. This girl aged 12 years and 3 months presented in Endocrinology Department with complaints of early menarche starting at the age of 8 years with normal cycles along with early progressive breast development starting almost simultaneously. On examination, she had a reduced growth for age ( 150 μIU/ml (0.35–5.5) and a free T4 (FT4) and free triiodothyronine below normal limits suggestive of primary hypothyroidism. Furthermore, serum prolactin levels were elevated along with an elevated serum follicle-stimulating hormone, luteinizing hormone, and estradiol. Multicystic ovaries and a bulky uterus on ultrasound were suggestive of precocious puberty. Magnetic resonance imaging scan of the sella turcica was suggestive of a pituitary macroadenoma. Posttreatment with gluten-free diet, iron supplements, and T4 replacement, her thyroid function, hemoglobin, and prolactin normalized along with a regression in the size of the ovary. Therefore, in patients of this age presenting with a pituitary macroadenoma, anemia, precocious puberty, and primary hypothyroidism, medical management was preferred over neurosurgical intervention so as to avoid permanent hypopituitarism and lifelong hormone replacement therapy.