Excision Of Ovarian Cysts Research Articles

Correlation study of NF-κB, IER3, and Recurrence of Ovarian Endometrioid Cysts.

The study aimed to investigate the expression of nuclear actor-k-gene binding(NF-κB) and immediate early response 3(IER3) in ovarian endometrioid cysts and its correlation with the recurrence of the ovarian endometrioid cyst. From January 2018 to March 2019, a total of 88 patients who underwent laparoscopic ovarian cyst excision due to ovarian endometrioid cyst in Changzhou Maternity and Child Health Care Hospital were selected. Clinical data of the patients were collected. The patient's Revised American Fertility Society (R-AFS) score, least function(LF) score, and endometriosis fertility index (EFI) were calculated. Immunohistochemistry was performed to detect the expression of IER3 and NF-κB. The receiver-operating characteristic (ROC) curve was used to evaluate the predictive value of IER3 and NF-κB expression on postoperative recurrence. Cox regression was fitted to analyze the influencing factors of ovarian endometrioid cyst recurrence. The expression of NF-κB was positively correlated with IER3 (P < 0.001). ROC curve showed that NF-κB combined with IER3 had higher predictive value for disease recurrence. Multivariate Cox regression showed that the IER3 expression intensity > 4.5 (HR = 3.418,95%CI: 1.227 ~ 9.523, P = 0.019) and the NF-κB expression intensity > 4.5 (HR = 5.491,95%CI: 1.600 ~ 18.838, P = 0.007) were independent risk factors for recurrence, and EFI score (HR = 0.791,95%CI: 0.637 ~ 0.983, P = 0.035) was a protective factor for recurrence. Our results suggested that EFI score is a protective factor for recurrence. The expression levels of NF-κB and IER3 > 4.5 are correlated with the recurrence of ovarian endometrioid cysts and independent risk factors for recurrence.

A rare case of concomitant endometrioid adenocarcinoma arising from uterine adenomyosis and clear cell carcinoma arising from parametrial deep endometriosis

BackgroundCarcinomatous changes from the ectopic endometrial glands in endometriosis have been reported in many studies, but malignant transformation from uterine adenomyosis/adenomyoma is rare. And clear cell-like adenocarcinoma represents a seldom-encountered malignant pathological variant of ectopic endometrium.Case presentationThis case report presents a case of a 44-year-old nulliparous woman begun with abdominal pain and intestinal obstruction. Past medical history showed laparoscopic ovarian endometriotic cyst excision. Ultrasound indicated adenomyoma and a parametrial hypoechoic nodule with abundant blood flow signals and unclear boundaries. Deep invasive endometriosis was considered preoperatively. The patient underwent laparoscopic subtotal hysterectomy and bilateral adnexa resection. Chocolate cyst-like lesion was observed in the parametral lesion. Postoperative pathological examinations suggested endometrioid adenocarcinoma arising from eutopic endometrium and adenomyoma. Ectopic endometrium in the myometrium combined with atypical hyperplasia and formation of endometrioid adenocarcinoma. Left parametrial lesions suggested poorly differentiated endometrioid adenocarcinoma combined with clear cell carcinoma. CD10 + endometrial stromal cells were observed surrounding tumor cell masses. Combined with surgical founding and pathological characters of the left parametrial adenocarcinoma, the parametrial lesions were more likely to be carcinomatous changes of the original deep endometriosis.The patient underwent subsequent transabdominal tumor cell reduction surgery and chemotherapy.ConclusionWe herein present a rare case of combined endometrioid adenocarcinoma arising from uterine adenomyosis and clear cell carcinoma arising from parametrial deep endometriosis that may help inspire additional studies in the future. The patient underwent robot-assisted laparoscopic subtotal hysterectomy, bilateral adnexa resection, deep endometriosis lesion resection and bilateral ureteral stent placement. Following surgery, a chemotherapy regimen of Taxol and Carboplatin was administered.

6275602 Anesthetic management of a pregnant patient with congenital long QT syndrome type 2 undergoing ovarian dermoid cyst excision: A Case Report

6275602 Anesthetic management of a pregnant patient with congenital long QT syndrome type 2 undergoing ovarian dermoid cyst excision: A Case Report

Malignant germ cell tumor of fallopian tube with rhabdomyosarcoma: a case report and literature review

BackgroundMixed germ cell tumors originating from the fallopian tubes are rarely reported, and high-grade rhabdomyosarcoma with differentiated components is even less common. The non-specific clinical manifestations of this tumor are prone to misdiagnosis, and there is still controversy over the treatment plan for this rare differentiated type, and there are limited reports on the prognosis of related diseases.Case presentationHere, we report a 34-year-old woman who presented to our hospital with abdominal pain for two weeks and aggravated for two days. After completing relevant examinations, she underwent transabdominal resection of large tubal masses on the left side of the tube + pelvic lymph node dissection + abdominal paraaortic lymph node dissection + right ovarian cyst excision + greater omentectomy + multipoint peritoneal biopsy. hematoxylin–eosin (H&E) and immunohistochemical (IHC) staining were performed on the surgically resected specimens to further determine the type and nature of the tumor, and 3 cycles of Bleomycin + Etoposide + Cisplatonum (BEP) chemotherapy and 1 cycle of EP(Etoposide + Cisplatonum) chemotherapy were given after surgery.ConclusionUp to now, regular follow-up of the patient's tumor markers and imaging showed no abnormalities, the general condition is good, and the tumor free survival time has reached 24 months.

A Case of Laparoscopic Excision of a Large Ovarian Cyst with Controlled Drainage

<h3>Study Objective</h3> Video presentation showing laparoscopic excision of a large ovarian cyst with controlled drainage. <h3>Design</h3> Case presentation. <h3>Setting</h3> This case was performed in an academic tertiary medical center. The patient was in dorsal lithotomy position with arms tucked. We used 4 total ports; the umbilical port for the camera, a supra-pubic port and right and left lateral lower abdominal port. A balloon trocar was used for controlled cyst content drainage. Potassium Titanium Phosphate laser was used for fine dissection. <h3>Patients or Participants</h3> 21-year-old Gravida 0 presented with pelvic pressure and palpable mass for months. Ultrasound showed an 11 cm simple ovarian cyst and 5cm adjacent complex cyst with peripheral echogenic foci without internal vascularity consistent with dermoid cyst. She had mildly elevated alpha fetoprotein and otherwise negative tumor markers. <h3>Interventions</h3> Laparoscopic excision of right ovarian cyst. <h3>Measurements and Main Results</h3> The case was completed uncomplicated. The patient showed significant improvement in her symptoms on follow-up with resolution of pelvic pressure. <h3>Conclusion</h3> Maintaining clear planes between the cyst wall and the ovarian cortex as well as excellent hemostasis is key in ovarian cystectomies. Care must be taken to preserve as much ovarian cortex as possible for future fertility.

Approach to Ovarian Dermoid Cysts in Context of Anti-NMDA Receptor Encephalitis: A Case Series

<h3>Study Objective</h3> Anti-<i>N</i>-methyl D-aspartate receptor (NMDA-R) encephalitis is a rare paraneoplastic syndrome associated with ovarian teratomas that carries significant morbidity and mortality. Treatment is via a multidisciplinary approach that must include ovarian cyst excision. <h3>Design</h3> Case series. <h3>Setting</h3> Hospital. <h3>Patients or Participants</h3> 1: A nulliparous 22-year-old woman, who was undergoing treatment for NMDA encephalitis, was referred to the gynaecology department with new diagnosis of right 7 cm ovarian dermoid cyst discovered with ultrasound screening. She had a BMI of 77 and type II respiratory failure with normal tumor markers. She underwent laparoscopic right oophorectomy and currently has ongoing surveillance of her left ovary. She remains independent in the community. 2: A 25-year-old nulliparous woman was admitted for anti-NMDA-R encephalitis. A CT abdo-pelvis demonstrated bilateral bulky ovaries and a 5 cm right ovarian dermoid cyst. A laparoscopic right salpingo-oophorectomy was performed. Intra-operatively, the left ovary was bulky but nil overt macroscopic lesions identified. Unfortunately, her neurological condition worsened. A pelvic MRI demonstrated normal left ovarian tissue, and a PET scan and tumour markers were unremarkable. Due to concerns of a microscopic ovarian teratoma contributing to her neurological deterioration, a laparoscopic left salpingo-oophorectomy was performed 14 months later. She gradually improved thereafter but requires ongoing care for neuropsychiatric deficits. <h3>Interventions</h3> Surgery. <h3>Measurements and Main Results</h3> Anti-NMDAR encephalitis syndrome develops when teratoma neural tissue stimulates the production of anti-NMDA-R antibodies [1]. These antibodies cause limbic neurone dysfunction and loss by altering cell-surface NMDA receptors, resulting in neuropsychiatric and autonomic symptoms [1]. Early immunotherapy and tumour resection improve the prognosis [1]. When deciding between cystectomy and oophorectomy, the gynaecologist must consider the ipsilateral recurrence rate after ovarian cystectomy (approximately 3-4 percent), the risk of incomplete removal of neural tissue, and intra-operative spillage [2]. <h3>Conclusion</h3> Ovarian teratoma associated with Anti-NMDA-R encephalitis requires urgent surgical intervention leading to favourable outcomes in this otherwise potentially devastating condition.

Ovarian reserve in women with endometriosis under total cystectomy compared to partial cystectomy: A randomized clinical trial.

Background The standard procedure for ovarian endometriosis is laparoscopic excision of ovarian cysts and complete removal of the cyst capsule using the striping technique. Owing to the possibility of reducing ovarian reserve, and in some cases, the premature ovarian failure, the safety remains to be known.Objective To compare the ovarian reserve in women with endometriosis who underwent total cystectomy with partial cystectomy.Materials and Methods In this randomized clinical trial, 56 women with endometriosis who were referred to the Research and Clinical Center for Infertility and Shahid Sadoughi Hospital, Yazd, Iran between January and February 2020 were randomly assigned into two groups (n = 25/each); group I (total cystectomy) and group II (partial cystectomy). To assess the ovarian reserves, the anti-Müllerian hormone (AMH) level before and three months after surgery was measured and compared between the two groups.ResultsNo significant difference was observed in the AMH levels before and after surgery (p = 0.52, p = 0.32, respectively). However, the mean reduction of AMH in total cystectomy group was significantly higher than the partial cystectomy (p = 0.001).ConclusionCystectomy in women with endometriosis reduces ovarian reserve and can help maintain some ovarian reserve by performing partial instead of total cystectomy.

The ideal approach of ovarian dermoid cyst excision; the predicament of laparoscopy versus laparotomy

Purpose: The aim of the current retrospective study for reviewing the cases of dermoid cyst managed at our hospital during the study period, to find out the best and safest management approach after taking in consideration the related factors. Setting: This analysis took place at the department of Gynecology and Obstetrics at Jordan University Hospital. Material and methods: The retrospective records were reviewed for over 6 years (from January 2015 to January 2021). The sample of study included a total number of 87 patients operated with ovarian dermoid. Thirty-five patients (40.22%) presented with abdominal mass, 16 patients (18.39%) were accidently found to have this kind of ovarian cysts, 12 patients (13.79%) presented with pressure symptoms, 11 patients (12.64%) presented with dyspareunia and dysmenorrhea, 8 patients (09.19%) with abdominal pain, and 5 patients (05.74%) with recurrent attacks of nausea. Thirty-nine patients (44.83%) treated by laparotomy, another 39 patients (44.83%), the management procedure completed laparoscopically, and 9 patients (10.34%), the procedure started laparoscopically, then converted to laparotomy. Sixty-one patients (70.11%) were found to have right sided ovarian dermoid, while 19 patients (21.84%) were found to have bilateral, and 7 patients (08.05%) were found to have left sided one. The size of the cyst was more than 11 cm in 40 patients (45.98%), while less than 5 cm in 5 patients (5.75%). Results: ovarian cystectomy performed in 70 patients (80.46%), and salpingo-oophorectomy on 17 patients (19.54%) on both reproductive and postmenopausal group. The average blood loss and operative time were more on the laparoscopic group; 298.7 ml, 98.8 minutes respectively. Conclusion: Laparotomy and ovarian cystectomy seems to be superior to other methods of management for ovarian dermoid, particularly when the size of the cyst is more than 5 cm, and predominantly the cysts presentation bilaterally.

Mean Platelet Volume Increase in Endometriomas and Benign Ovarian Cysts: A Prospective Case-Controlled Study

Objective: The aim of this research is to compare mean platelet volumes (MPV) among women with ovarian endometriomas, women with benign ovarian cysts and infertile women who were otherwise healthy. &#x0D; Material and Methods: Women were selected for the ovarian endometrioma and benign ovarian cyst group after laparoscopic ovarian cyst excision and confirmed histopathologic evaluation. The control group was assigned from women with male partner infertility or unexplained infertility but who were otherwise healthy. Mean platelet volume calculated as a part of complete blood count, which collected in potassium ethylenediaminetetraacetic acid tubes&#x0D; Results: There were 98 women in the endometrioma group, 94 in the benign cyst group and 99 in the control group. Mean platelet volume was different among the groups (p&lt;0.01). The mean platelet volume in the infertile group was statistically different than in the endometrioma and benign cyst groups and was similar between the endometrioma and benign cyst groups. When compared with the infertile group, the area under the curve and predictive value of the mean platelet volume for the endometrioma and the benign cyst group were 0.73 ±0.03 fl (p&lt;0.01, CI 0.65-0.80) and 0.72±0.06 fl (p&lt;0.01; CI 0.64-0.79), respectively. Mean platelet volume had a sensitivity of 74% and specificity of 63% for endometrioma and sensitivity of 72%, and specificity of 63% for benign cysts at a cut-off point of 9.05 fl.&#x0D; Conclusion: The present study demonstrated that mean platelet volume was increased in women with ovarian endometriomas and benign cysts and showed predictive values for endometriomas and benign ovarian cysts.

Value of Laparoscopic Ovarian Cyst Excision in the Treatment of Ovarian Cysts

Value of Laparoscopic Ovarian Cyst Excision in the Treatment of Ovarian Cysts

A randomized controlled trial of ovarian reserve preservation and hemostasis during ovarian cystectomy

The preservation of ovarian reserve during laparoendoscopic single-site (LESS) ovarian cystectomy is crucial for reproductive-age women. This study was a single-blinded, single-center, and randomized controlled trial to evaluate the effect of hemostatic agents on the preservation of ovarian reserve and hemostasis during LESS ovarian cystectomy. Patients with unilateral ovarian cyst were randomized to the hemostatic agent and coagulation groups according to the hemostasis method. Afterwards, the patients underwent LESS ovarian cystectomy, and hemostasis was performed after ovarian cyst excision according to the assigned hemostasis method. If hemostasis was not completed within 10 min. After discharge, the patients were followed until 3 months after surgery. We compared the hemoglobin, anti-Müllerian hormone (AMH) levels, and ovarian volumes before surgery, and 2 days, 1 week, and 3 months after surgery (3 M-POST), and the decline ratio between the two groups. The decline ratio of serum AMH levels was greater at 3 M-POST in the coagulation than in the hemostatic agent group (median intention-to-treat [ITT], − 36.7 vs. − 13.3%; per-protocol [PP], − 36.8 vs. − 13.3%; P < 0.05). Notably, the difference of the decline ratio of serum AMH levels was only shown in endometriosis patients (median; ITT, − 50.7 vs. − 14.4%; PP, − 50.7% vs. − 14.4%; P < 0.05), while there was no difference in non-endometriosis patients. In conclusion, Hemostatic agents may be non-inferior to bipolar coagulation for preserving ovarian reserve and hemostasis during LESS ovarian cystectomy, in particular, for endometriosis patients. (Trial registry: ClinicalTrials.gov Identifier NCT03374397).

In-vitro AMH production of ovarian tissue samples in culture correlates with their primordial follicle pool

ObjectiveWe aimed to investigate if there is a correlation between in-vitro AMH production and primordial follicle reserve of the ovarian cortical samples in culture. MethodsSeven patients undergoing laparoscopic excision of ovarian dermoid cysts were included in the study. 0.5 × 0.5 cm of ovarian cortical samples embedded within the cyst wall were removed and cultured for one day. Then, the cultured cortical pieces were fixed, paraffin-embedded and serially sectioned for histormorphometric analysis. AMH and estradiol (E2) production of the samples after one-day culture period were measured in the spent culture media. Primordial follicle density was expressed as the number of primordial follicles per mm2. Pearson correlation and linear regression analyses were applied. ResultsThe mean age of the patients was 29.2 ± 6.8 (ranging from 18 to 36). There was a negative correlation between age and PF density (r=-0.92, %95CI: -0.99 to -0.76, p < 0.001). In-vitro AMH level of the cortical samples was significantly associated with age (R2 = 0.67, p = 0.023), primordial follicle density (R2 = 0.71, p = 0.015). There was a borderline significance between in-vitro levels of AMH and E2 level (R2 = 0.55, p = 0.058). A similar comparison could not be made for secondary follicles (preantral and small antral follicles) because of their rarity in the histological sections analyzed. ConclusionsThis histomorphometric study provides evidence that in-vitro AMH production of the ovarian cortical samples reflects primordial follicle pool of the samples.

The Long-Term Impact of Excision of Benign Non-Endometriotic Ovarian Cysts on Ovarian Reserve and Reproductive Performance: A Cohort Study Long-Term Ovarian Reserve Status After Ovarian Cystectomy

The Long-Term Impact of Excision of Benign Non-Endometriotic Ovarian Cysts on Ovarian Reserve and Reproductive Performance: A Cohort Study Long-Term Ovarian Reserve Status After Ovarian Cystectomy

Analysis of the effect of laparoscopic excision in the treatment of 53 patients ovarian cyst

Objective To study the clinical effect of laparoscopic excision of ovarian cyst in the treatment of patients with ovarian cyst. Methods From August 2016 to August 2018, 106 patients with ovarian cyst were selected in the Second People's Hospital of Yuyao.According to the different operation methods, 106 patients were divided into two groups, with 53 cases in each group.The control group was treated with open excision of ovarian cyst.The observation group was treated by laparoscopic excision of ovarian cyst.The clinical effect was observed and compared between the two groups. Results In the observation group, the time of operation, the amount of blood lost during operation, the time of anal exhaust, the time of getting out of bed and the time of hospitalization were (38.95±3.64)min, (45.12±4.48)mL, (1.01±0.08)d, (30.58±3.07)h, (4.97±0.46)d, respectively, which in the control group were (59.72±5.33)min, (86.62±8.52)mL, (2.07±0.20)d, (44.20±4.28)h, (7.14±0.72)d, respectively, the differences between the two groups were statistically significant(t=23.242, 31.386, 35.825, 18.825, 18.490, all P<0.05). The pregnancy rate in the observation group was 79.25%(42/53), which in the control group was 49.06%(26/53), the difference was statistically significant(χ2=10.502, P<0.01). Conclusion Laparoscopic excision of ovarian cyst can shorten the operation time, anal exhaust time, the time of getting out of bed after operation, hospital stay, reduce the amount of bleeding and improve the pregnancy rate of the patients. Key words: Ovarian cysts; Gynecologic surgical procedures; Laparoscopy; Ovarian cystectomy; Pregnancy rate; Treatment outcome; Controlled clinical trial

Iatrogenic ureter cutaneous fistula and incisional hernia following laparotomy - case report

Ureteric injuries are known and preventable complications that may follow pelvic surgeries. These injuries are commonly ligation of the distal ureters and are frequently missed intraoperatively. Symptoms typically comprise of post-operative flank pain, fever, and flank swelling from urinary tract obstruction or urinoma. We hereby present a rare case of iatrogenic ureteric injury, ureterocutaneous fistula, and an associated incisional hernia in a middle-aged woman who had ovarian cyst excision.

Strangulated small-bowel loop herniation at the 5 mm trocar entry site after laparoscopic ovarian cyst excision operation

Strangulated small-bowel loop herniation at the 5 mm trocar entry site after laparoscopic ovarian cyst excision operation

Conservative treatment versus surgical excision of ovarian dermoid cysts: Impact on ovarian stimulation and IVF cycle success

To analyze outcomes of IVF treatment among women diagnosed with an ovarian dermoid cyst (DC). Retrospective analysis of women with an ovarian DC who underwent IVF with fresh blastocyst transfer at a single center in New York from January 2010 to March 2018. Outcomes were compared between women with conservative treatment and those with surgical excision of the DC. Multivariate logistic regression was used to assess associations between variables and the presence of a DC during treatment. Overall, 119 women with a DC were included. No differences were found in demographic characteristics, controlled ovarian hyperstimulation parameters, and IVF outcomes between women with an intact DC (n=65, 54.6%) and those who underwent cystectomy (n=54, 45.4%) (all P<0.05). Similarly, there was no difference in anti-Mϋllerian hormone and basal antral follicle count among women with a DC (respectively, β=-0.1, P=0.8, and β=-1.0, P=0.28) or resected DC (respectively, β=0.9, P=0.07, and β=1.5, P=0.08) as compared with control women with no DC (n=352). Ovarian reserve, embryo implantation and IVF success rates were not lower in the presence of an ovarian DC. Surgical therapy, if indicated, can be safely postponed until family planning goals have been achieved.

Management of Endometriomas.

Endometriomas are a unique and complex representation of the classic phenotypes of endometriosis. Associated symptoms, high recurrence rate, and multimodal approach represent ongoing challenges in the management of this chronic disease. To review current literature regarding medical and surgical management of endometriomas. An extensive literature search including PubMed and Cochrane Library was performed. Review was performed using the following key words: "endometrioma," "cystectomy," "chronic pain," "infertility," "IVF," "menopause," "recurrence." All pertinent articles were assessed. The references of those articles were then reviewed, and additional publications were evaluated. Eligibility of the studies was first assessed on titles and abstracts. Full articles were then reviewed for all selected studies, and decision for final inclusion was made at that time. Cystectomy of ovarian endometriomas has been the first-line treatment for management for many years because it provides improved pain relief, reduces recurrence rates, and was thought to be favorable in in vitro fertilization. However, a growing body of evidence is demonstrating benefit, or at least no harm, in expectant management for asymptomatic patients with small, stable endometriomas. Medical management is often very effective and appropriate first line. When surgical intervention is appropriate, careful ovarian cyst excision with goal of ovarian tissue preservation and treatment of additional endometriosis by a trained surgeon can provide the patient the best long-term outcome and preservation of ovarian tissue and function.

Sphingosine-1-phosphate reduces atresia of primordial follicles occurring during slow-freezing and thawing of human ovarian cortical strips.

We aimed in this study to explore if sphingosine-1-phosphate (S1P) reduces apoptosis of primordial follicles during cryopreservation of human ovarian cortical samples. Ovarian cortical tissue fragments obtained from young patients who underwent laparoscopic excision of benign ovarian cysts were used for the experiments. The samples were slow-frozen and thawed with and without S1P at 200 and 400 μM, cultured for 1 day, and then were fixed and processed for both histomorphological assessment and detection of apoptosis with immunohistochemistry using apoptosis marker cleaved caspase-3. Follicle counts were expressed as the mean number of follicles per mm2 . The mean number of primordial follicles and in vitro estradiol (E2) and anti-mullerian hormone (AMH) production of the slow-frozen and thawed samples were significantly reduced compared with fresh unfrozen samples. S1P treatment at 400 μM but not 200 μM concentration resulted in a significant increase in the number of surviving primordial follicles and in vitro E2 and AMH productions of the samples compared with their counterparts slow-frozen without S1P. We found that that there was a significant decrease in the number of primordial follicles with their oocytes stained positive for cleaved caspase-3 in the slow-frozen samples S1P 400 μM in comparison with the samples slow-frozen without S1P. These results suggest that S1P may ameliorate follicle atresia occurring in human ovarian cortical samples during cryopreservation.

Robot-assisted laparoscopic transplant-to-native ureteroureterostomy of an intraperitoneal renal allograft

The objective is to describe our experience with robot-assisted laparoscopic transplant-to-native ureteroureterostomy (UU) in a pediatric patient with an intraperitoneal renal allograft. We have previously demonstrated this technique for an extraperitoneal allograft. The patient is a 17-year-old female who had undergone a deceased donor renal transplant at 5 years of age. She developed acute kidney injury and hydronephrosis because of a ureteral stricture that developed after a right ovarian cyst excision. A retrograde pyelogram of her native ureter showed normal morphology. Her options were discussed and she proceeded with a robotic transplant-to-native UU. Robot-assisted laparoscopic transplant-to-native UU was performed via an intraperitoneal approach. The procedure time was 217min with an estimated blood loss of 10mL. Her postoperative course was unremarkable. After ureteral stent removal, her serum creatinine remained stable and follow-up imaging showed an improvement in hydronephrosis. Pediatric robot-assisted laparoscopic transplant-to-native UU for an intraperitoneal allograft is a technically feasible approach for the treatment of transplant ureteral strictures that combines the durability of open revision with the minimal invasiveness of endourologic management.