Fibroid Uterus Research Articles

Limitations in Total Laparoscopic Hysterectomy in Bangladesh

Laparoscopic Hysterectomy is achieving great popularity nowadays. Our people are becoming increasingly interested in new advances in this field of surgery. Highly skilled surgical technique, longer operative time and expensive technology are observed to be the factors that impede the advancements in laparoscopic surgery1.Objective: The aim of our study is to analyze the limitations of laparoscopic hysterectomy in our country.Methods: This is a retrospective observational study where we have reviewed demographic data, compliance of the patients, quality of anaesthesia, efficiency of supportive staffs, adequacy of appropriate instruments, continuous training of surgeons and surgical risk factors. Total 80 Total Laparoscopic Hysterectomy (TLH) were done between January’ 2016 to December’2017 in Shaheed Suhrawardy Medical College Hospital (ShSMCH), Dhaka.Result: In this study, we analyzed eighty patients who underwent total laparoscopic hysterectomy for fibroid uterus, adenomyosis, recurrent post-menopausal bleeding, abnormal Uterine bleeding(AUB) etc. We tried to analyze some limitations and challenges which we can overcome. In spite of lack of appropriate instruments, adequate ICU support and repeated training in specialized centre at home and abroad, 87.5% patients recovered well. The aim of our study was to identify the surgical risk factors of the patients and limitations in our theatre environmentJ Shaheed Suhrawardy Med Coll, June 2018, Vol.10(1); 3-5

An atypical presentation of an ovarian lymphoma: a case report

BackgroundOvarian lymphoma has a varied clinical presentation and rarely presents with heavy menstrual bleeding. It may occur de novo or secondary to systemic disease and macroscopically appear as solid ovarian tumors.Case presentationA 32-year-old Tamil woman presented with heavy menstrual bleeding of 4 months’ duration. On examination she was anemic with no lymphadenopathy. A large immobile pelvic mass and three firm nodules were found involving her vaginal walls. Ultrasonography suggested a fibroid uterus with two large pedunculated fibroids. Following preoperative optimization an endometrial sampling and biopsy of the nodules were done. Subsequently, histology revealed proliferative phase endometrium. The vaginal nodules showed lymphoid tissue.She presented a week later with an undulating fever and features of acute abdomen with clinical evidence of ascites. During an emergency laparotomy two large solid ovarian masses, gross ascites, pelvic lymph nodes, para-aortic lymph nodes, mesenteric lymph nodes, omental deposits, and a 24-week-size uterus were found. Bilateral oophorectomy was done. Laboratory investigations revealed raised lactate dehydrogenase with normal serum β-human chorionic gonadotropin, alpha-fetoprotein, and cancer antigen-125 levels. Histology of ovarian specimens revealed a diffuse large B cell lymphoma.A bone marrow biopsy revealed more than 80% infiltration with lymphoid cells. Two weeks after the laparotomy a computed tomography of her chest, abdomen, and pelvis revealed a pelvic mass, gross ascites, omental deposits, hepatosplenomegaly, and enlarged lymph nodes above and below her diaphragm. Immunohistochemistry confirmed the diagnosis of B cell lymphoblastic lymphoma. She was classified as stage IV E non-Hodgkin’s lymphoma on the Ann Arbor staging system.ConclusionThis is an atypical presentation of an ovarian lymphoma. The atypical presentations of ovarian lymphomas can lead to diagnostic dilemmas.

Minimally Invasive Surgery at Paropakar Maternity and Women’s Hospital

Aims: The purpose of this study is to review the reintroduced minimally invasive surgical practice in the hospital after a couple of decades long gap. Methods: It is a two years (2015 to 2017) retrospective cross-sectional study carried out in Paropakar Maternity and Women’s Hospital. The patients with pre-operative diagnosis of benign condition underwent laparoscopic surgery; hysteroscopy was diagnostic and operative both. Data were collected by demographics, indication of surgery, nature of surgery, complications, hospital stay and histo-pathological reports. Data were entered in the SPSS and MS-excel. Results were presented as tables and graphs.Results: Sixty five and 39 women underwent laparoscopic surgery and hysteroscopy respectively. None of them had major complications and hospital stay was1-3 days in majority. The most common age group was 31-35 years. Preoperative diagnoses of them were adnexal tumor in 47 women, fibroid uterus in six, AUB in two, ectopic pregnancies in four, PCOD in two and one women each with primary sub-fertility and POP Q II with elongated cervix. Laparoscopic cystectomy was performed on 25 women for the adnexal masses while 13 women underwent laparoscopic oophorectomy for the ovarian masses. Total laparoscopic hysterectomy was the second commonest surgery (n=12). On histopathological examination of the ovarian tissues, mature cystic teratoma was the commonest finding (n=18) followed by the endometriotic cysts (n=9), benign serous cystadenoma (n=7) and mucinous cystadenoma (n=4). Conclusions: Laparoscopy and hysteroscopy procedures have become the alternative in surgical modality at this hospital.

Surgical Techniques for Retroperitoneal Dissection and Uterine Artery Ligation

Objective: To demonstrate the techniques of laparoscopic retroperitoneal dissection with large fibroid uterus.

Contained Vaginal Morcellation for Fibroid Uterus

Contained Vaginal Morcellation for Fibroid Uterus

727 - Vaginal Hysterectomy for a Large Fibroid Uterus: Contemporary Techniques and Tips for Success

Objective: The objective of this video is to review principles and techniques for vaginal hysterectomy of an enlarged, fibroid uterus at three key steps: entry into the peritoneal cavity, securing the uterine blood supply, and vaginal morcellation of the uterus using contemporary surgical instrumentation and techniques.

672 - TLH: 2 kg Uterus with Broad Ligament Fibroid – Tips and Technique

Objective: This video will review techniques for successful total laparoscopic hysterectomy for a large 2 kg fibroid uterus.

The Enlarged Fibroid Uterus: Aberrant Arterial Supply via the Omental Artery.

Uterine artery embolization is considered a first-line therapy for symptomatic fibroids and is occasionally required to mitigate operative risk prior to total abdominal hysterectomy or myomectomy. We present a pictorial review of parasitized omental artery supply to the enlarged fibroid uterus in three patients undergoing preoperative uterine artery embolization. A detailed understanding of variant uterine blood supplies is crucial when performing fibroid embolization. Although omental artery supply to the fibroid uterus is an unusual finding, aortography to include mesenteric arteries may be necessary when anomalous blood supply to the enlarged fibroid uterus is suspected.

Socio-demographic Characteristics of Pelvic Inflammatory Diseases Women attended at a Tertiary Care Hospital in Dhaka

Background: Women with pelvic inflammatory diseases can occur in different socio-demographic characteristics.Objectives: The purpose o f the present study was to see the socio-demographic characteristics of women presented with pelvic inflammatory diseases women.Methodology: The cross-sectional study has been carried out at the outpatient units of Obstetrics and Gynaecology Department of Dhaka Medical College Hospital from January 2007 to June 2007 for a period of six (6) months. Women with the age group of 15 to 45 years presented with lower abdominal pain, tenderness, per vaginal discharge and cervical motion tenderness were included in this study. Women with fibroid uterus, uterovaginal prolapsed or cystocele was excluded from this study. The details of socio-demographic characteristics like the age, religion, social status, occupation, marital status and their husband information were taken.Result: The study was performed on 50 cases of which majority (50%) belonged to the age group of 26 to 35 years. Majority of the patients were housewife (82.0%). Among them 30% of the husbands occupation was driver. Maximum were from low socio-economic status (70.0%), illiterate (50.0%) and married single (80.0%).Conclusion: In conclusion majority of the women presented pelvic inflammatory diseases are in reproductive age group illiterate housewife.Journal of Science Foundation 2017;15(2):31-35

Primary Biphasic Peritoneal Mesothelioma Encountered During Myomectomy for Symptomatic Fibroid Uterus

Abstract Background: Malignant mesothelioma (MM) is an aggressive neoplasm whose pathogenesis is conventionally associated with occupational and environmental respiratory exposure to asbestos. MM a...

Safety and feasibility of myomectomy during caesarean section in case of pregnancy associated with fibroid uterus

Routine myomectomy during pregnancy is not recommended because of excessive bleeding during myomectomy and the difficulty in securing hemostasis may need hysterectomy. This prospective observational study was carried out in Obstetrics & Gynecology department of Ad-din Akij Medical College, Khulna from June 2016 to August 2017 to evaluate safety and feasibility of performing myomectomy at the time of caesarean delivery. Nineteen patients with fibroid uterus with pregnancy whom needed cesarean section for various indications were the target population for this study. Main outcome measures were difficulty of myomectomy & cesarean section, time needed for operation, per-operative complications, need for blood transfusion, postoperative complications and duration of hospital stay. Caesarean myomectomy operation was successful in all cases. No patient was required hysterectomy. The duration of operation was 45-60 minutes. Only one patient had one unit of whole blood transfusion during postoperative period. Mean (SD) duration of hospital stay and post-operative Hb concentration were 6.9 (0.6) days and 8.6 (1.4) g/dl, respectively. Two patients developed post-operative fever which delayed their hospital stay. Myomectomy during cesarean section in selected cases with proper indication is safe and feasible.Mediscope Vol. 5, No. 1: Jan 2018, Page 5-9

Neutrophils to lymphocytes ratio and platelets to lymphocytes ratio in pregnancy: A population study.

BackgroundNeutrophils to lymphocytes ratio (NLR) and platelets to lymphocytes ratio (PLR) are both inflammatory ratios that can be easily calculated from a simple blood count. They are frequently reported and tested as prognostic factors in several medical disciplines. Pregnancy involves special reference values for laboratory assays.ObjectiveThe aim of this study was to define pregnancy-related reference values for NLR and PLR according to trimester, background morbidity and according to the patient's age.Study designA retrospective analysis of a large cohort undergoing community-based pregnancy surveillance between the years 2011–2016. Data were analyzed according to high-risk patient versus normal-risk patient.ResultsA total of 11,415 patients were included. Mean PLR and NLR values were 136.3±44.3, 2.6±1, respectively during the first trimester, 144.6±47.1, 4.0±1.4 respectively during the second trimester and 118.1±42.0, 3.5±1.2 respectively during the third trimester. No difference was detected between the high-risk and the normal population (P-values 0.3, 0.5 and 0.4 for PLR in each trimester respectively and 0.3, 0.4, 0.6 for NLR in each trimester, respectively). No differences were detected among parity categories. The correlation between patient’s age and either PLR and NLR was a weak positive correlation (though statistically significant). Both PLR and NLR reached a maximum value during the second trimester. The differences between mean NLR and PLR between trimesters were significant (P <0.01 for all differences tested). PLR rises in the presence of anemia, reaching statistical significance (P-value for PLR in each trimester was <0.01). NLR showed an opposite trend (P-values for NLR were 0.4, 0.005 and 0.06 in each trimester, respectively).ConclusionsIn our cohort, there were generally no differences between the high-risk and the normal population, excluding patients with a fibroid uterus or inflammatory bowel disease who presented a significantly elevated PLR through all trimesters. Both PLR and NLR reached a maximum value during the second trimester and were positively correlated with age. We anticipate that the population-based data will assist in providing accurate reference values for future research testing NLR and PLR measures during pregnancy.

Thirteen Years of Experience with Opportunistic Bilateral Salpingectomy During TLH in Low-Risk Premenopausal Women

Opportunistic bilateral salpingectomy (OBS), also called as prophylactic salpingectomy or risk-reducing salpingectomy is the concurrent removal of the fallopian tubes in premenopausal women. Though there are some studies comparing the intraoperative complications and effect of salpingectomy on ovarian reserve, limited data are available on long-term follow-up after OBS. To evaluate the surgical outcome of routine bilateral salpingectomy during total laparoscopic hysterectomy (TLH) in terms of intraoperative and postoperative complications. We also evaluated the incidence and reoperation rate for adnexal pathology after TLH. A retrospective study of 1470 patients undergoing total laparoscopic hysterectomy (TLH) with opportunistic bilateral salpingectomy (OBS) over 13years was carried out at Paul's Hospital. The mean age of the subjects was 43.6 ± 4.2years, mean body mass index was 27 ± 5.4kg/m2, and median parity was 2 (range 0-7). 43% of women had at least one previous surgery. The most common indication for surgery was fibroid uterus (67%, n = 985). The total complication rate was 4.4% (n = 65). One specimen showed paratubal borderline serous malignancy. The follow-up period ranged from 6months to 13years during which 17 (1.1%) women had adnexal pathology, and eight women (1.1%) needed resurgery for it. No ovarian malignancies were reported on follow-up. OBS is a simple and short surgical step during TLH without increasing morbidity. OBS eliminates the risk of future diseases of tubal origin, and there might be a possible reduction in incidence and reoperation rate for future ovarian pathologies.

Evaluation of etiological factors and management of puberty menorrhagia

Objectives: To evaluate the causes of puberty menorrhagia and effect of hormonal (Progestogens, estrogens and Combined Oral Contraceptive pills) and non-hormonal methods in the management of puberty menorrhagia.Methods: This prospective study included 51 subjects, who presented with puberty menorrhagia to Department of Obstetrics and Gynaecology, King George Medical University, Lucknow from August 2014 to August 2015. Assessment of each case with thorough history, physical examination and laboratory investigations was done. The underlying cause was diagnosed and the relevant treatment started and subjects kept under regular follow up.Results: In 26 (50.98%) subjects, immaturity of hypothalamic pituitary ovarian axis was the main cause of pubertymenorrhagia, 6 (11.76%) subjects had hypothroidism,5 (9.80%) subjects had polycystic ovarian syndrome, 4 (7.8%) subjects had idiopathic thrombocytopenic purpura, 2 (3.9%) subjects had disseminated intravascular coagulopathy, 3 (5.88%) subjects had hyperprolactinemia, 3 (5.88%) subjects had both hypothyroidism and hyperprolactinemia, 2(3.92%) subjects had fibroid uterus. All patients responded to medical management.Conclusion: Puberty menorrhagia is a distressing condition both for the subject as well as her parents. Most of thecases are due to anovulatory cycles which is a self-limiting condition at perimenarchal age group. Counseling and reassurance ofthe subjects is an important part of management. Long term medical treatment is successful in the majority of cases and rarely surgical intervention is required. Blood transfusion is required in a few cases.

Impact of Parity on Early Cesarean Scar Healing

Background: with increasing cesarean delivery rate the cesarean scar defects and related consequences should be evaluated. Aim of the work: this study aimed to assess impact of parity on cesarean scar wound healing. Methods: a prospective observational study was conducted on 51 females with singleton term pregnancy that underwent uncomplicated prelabor primary cesarean section. 6 weeks later they underwent saline hystrosalpingography. Females with medical diseases that can affect the healing process or received medications can affect wound healing as corticosteroids or anticoagulant were excluded. Women used intrauterine device as a contraceptive method inserted during CS, women with any structural uterine abnormality as cervical stenosis or fibroid uterus or with pelvic infection at the time of saline hystrosalpingography were excluded from this study. Results: 75% of the primiparous had CS niche, while, 82.9% of the multiparous group had CS defect (p=0.512). The most prevalent shape of CS defect in the participants was the triangular shape (45.1%) followed by irregular defect (31.4%). The anterior myometrial thickness and the residual myometrial thickness were significantly higher among primiparous women with negative correlation between parity, anterior and residual myometrial thickness (rho = - 0.917 and -0.753 respectively). Conclusion: parity was associated with significant reduction of both the anterior and residual myometrial thickness.

Histopathological analysis of hysterectomy specimens in tertiary care center: two year study

Background: The uterus is a major female hormone-responsive reproductive pear-shaped organ located within the pelvic region. The gross morphology of uterus quite dramatically changed throughout life by changing levels of ovarian hormones. A hysterectomy is done for many reasons including the ridding of tumours both benign and malignant. It is the most commonly performed gynecological surgical procedure throughout the world. Materials and Methods: This study was undertaken to identify the different types of pathologies in hysterectomy specimens and to correlate the findings with the different age group and clinical indications.In the present study, 303 cases were studied over a period of two years from January 2016 to December 2017. Surgical specimens were formalin fixed and the tissue was adequately processed for histopathological examination. The sections were stained routinely with hematoxylin and eosin stain. Results: Of the 303 cases, half of the cases (50.8%) were encountered in the age group of 40 - 49 years which was the most common age group. Fibroid uterus (38.6%) and uterine prolapse (32.6%) were the most common clinical indications for hysterectomy. The most common pathology identified was leiomyoma (42.2%) in myometrium. In cervix most common finding was chronic cervicitis (28.1%). Histopathological examination confirmed the clinical and gross diagnosis in majority of the cases. Conclusions: The present study provides a fair insight into the histological patterns of lesions in hysterectomy specimens in our institution. A wide range of lesions are encountered when hysterectomy specimens are subjected to histopathological examination. Few lesions were encountered as incidental findings. Hence, it is important that every hysterectomy specimen should be subjected to detailed gross and histopathological examination for better postoperative management.

Prospective Study on Low-Dose Mifepristone for the Treatment of Leiomyoma: A Hospital Based Study

Background: Fibroid or myoma is the commonest reported tumor of uterus, and is one of the important reasons for hysterectomy in our setting. Medical Management of fibroid uterus can be done by Mifepristone, a progesterone antagonist. This study was commenced to study the effect of mifepristone on the symptoms and size of fibroids, especially using a low-dose regimen for 6 months. In addition, any symptomatic improvement of menorrhagia and dysmenorrhea was also studied. Materials & Methods: The study was designed as an observational prospective study done on women diagnosed with uterine fibroids attending OPD of Dept. of Obstetrics & Gynaecology, Pataliputra Medical College, Jharkhand. A total of 48 patients were enrolled in the study. Out pf 48, only 36 patients completed our study. 50 mg of mifepristone weekly used, and patient assessed at 1 and 6 month. They were a follow up period of 3 months after stopping the drug to observe the changes in menstrual pattern, fibroid volume, hemoglobin and liver function tests. Results: Majority of the study population comprised of perimenopausal women, i.e., 36–45 years (48 %). Fifty percent of the patients were Para 2 and belonged to the perimenopausal age-group (18 out of 36). The dominant presenting symptom was menorrhagia associated with dysmenorrhea and pelvic pain. After 6 months of treatment with mifepristone, the mean fibroid volume reduced from 204.33 to 113.16 cm3 (n = 33), and the percentage mean volume reduction of the fibroid in the study population was 44.57 %. Immediate reduction in bleeding PV was observed in 100 %, and 88.89 % (32/36) patients attained amenorrhea. The mean hemoglobin increased from 9.18 to 10.82 g/dl. Conclusion: To conclude, 6 months therapy with 50 mg of mifepristone given weekly is efficacious and acceptable for the treatment of symptomatic leiomyoma, especially in a select group of patients.

FEMALE INFERTILITY

Objectives: To find the prevalence and etiology of female infertility as well asto study the associated biochemical abnormalities. Place and Duration of Study: Departmentof Gynecology, Frontier Medical &amp; Dental College, Abbottabad, from July 2016 to June 2017.Study Design: Case-control study. Materials &amp; Methods: All married patients between theages of 18-35 years were included in the study. Sixty patients who met eligibility criteria wereincluded in one group while sixty normal healthy individuals were included in the second groupas controls. Detailed history was taken focusing specifically on age and duration of marriage,menstrual and sexual history and drug history especially use of contraceptives. A thoroughclinical examination was performed by an experienced clinician and body mass index wascalculated. Laboratory investigations included complete blood examination, hormonal assays,ultrasonography in female patients and semen analysis in male partners. Tubal patency wasassessed by hysterosalpingography and laparoscopy was performed, if required. Results: Themean age of infertile patients was 27.4±4.9 years and mean duration of their marriage was6.6±2.9 years. Majority of patients in our study belonged to lower socio-economic status inboth groups. About 50% belonged to lower and 16.67% to poor socio-economic group amonginfertile subjects while 60% belonged to lower and 10% to poor socio-economic group amongcontrols. The chief presenting complaint was oligomenorrhea followed by galactorrhea anddyspareunia. The chiefunderlying condition was luteal phase deficiency, 60%, followed byhyperprolactinemia, 16.66%, and polycystic ovarian disease, 10%, fibroid uterus, 6.7%, andendometriosis, 6.7%. The serum estradiol levels were 114.6±48.7pg/ml and 233.2±70.8 pg/ml in follicular and luteal phase among infertile couples. Similarly, serum progesterone, serumprolactin, serum FSH and LH levels were 3.6±4.2 ng/ml, 18.1±12 ng/ml, 6.7±2.7 mIU/ml, and7±6.6 mIU/ml among infertile patients respectively. Serum estradiol and prolactin levels weresignificantly higher among infertile patients. Conclusion: Infertility is not a very uncommoncondition in our country. It is the need of time to increase awareness and educate massesabout infertility as well as establish infertility clinics for early detection and treatment of infertilecouples. Large scale multi-centric studies should also be conducted to accurately estimate theprevalence and etiology of infertility in our region.

A STUDY OF SOCIO-DEMOGRAPHIC AND ETIOLOGICAL PROFILE IN ABBOTTABAD

Objectives: To find the prevalence and etiology of female infertility as well asto study the associated biochemical abnormalities. Place and Duration of Study: Departmentof Gynecology, Frontier Medical &amp; Dental College, Abbottabad, from July 2016 to June 2017.Study Design: Case-control study. Materials &amp; Methods: All married patients between theages of 18-35 years were included in the study. Sixty patients who met eligibility criteria wereincluded in one group while sixty normal healthy individuals were included in the second groupas controls. Detailed history was taken focusing specifically on age and duration of marriage,menstrual and sexual history and drug history especially use of contraceptives. A thoroughclinical examination was performed by an experienced clinician and body mass index wascalculated. Laboratory investigations included complete blood examination, hormonal assays,ultrasonography in female patients and semen analysis in male partners. Tubal patency wasassessed by hysterosalpingography and laparoscopy was performed, if required. Results: Themean age of infertile patients was 27.4±4.9 years and mean duration of their marriage was6.6±2.9 years. Majority of patients in our study belonged to lower socio-economic status inboth groups. About 50% belonged to lower and 16.67% to poor socio-economic group amonginfertile subjects while 60% belonged to lower and 10% to poor socio-economic group amongcontrols. The chief presenting complaint was oligomenorrhea followed by galactorrhea anddyspareunia. The chiefunderlying condition was luteal phase deficiency, 60%, followed byhyperprolactinemia, 16.66%, and polycystic ovarian disease, 10%, fibroid uterus, 6.7%, andendometriosis, 6.7%. The serum estradiol levels were 114.6±48.7pg/ml and 233.2±70.8 pg/ml in follicular and luteal phase among infertile couples. Similarly, serum progesterone, serumprolactin, serum FSH and LH levels were 3.6±4.2 ng/ml, 18.1±12 ng/ml, 6.7±2.7 mIU/ml, and7±6.6 mIU/ml among infertile patients respectively. Serum estradiol and prolactin levels weresignificantly higher among infertile patients. Conclusion: Infertility is not a very uncommoncondition in our country. It is the need of time to increase awareness and educate massesabout infertility as well as establish infertility clinics for early detection and treatment of infertilecouples. Large scale multi-centric studies should also be conducted to accurately estimate theprevalence and etiology of infertility in our region.

Disseminated Peritoneal Leiomyomatosis and Metastatic GIST: Differential Diagnosis Dilemma Regarding Multiple Nodular Serosal Lesions and Management

We aim to discuss cases with gastrointestinal stromal tumor and leiomatosis peritoneal dissemeniata LPD regarding their diagnosis and surgical management with pitfalls related. We also aim to focus on management of multiple nodular serosal lesions. Two cases are presented. Both were diagnosed as advanced ovarian cancer on CT and ultrasound imaging by multiple nodular peritoneal lesions, omental cake and adnexal masses. Tumor markers were normal in both cases. Both were scheduled for exploratory laparotomy. One patient diagnosed with neurofibromatosis type I. Midline laparotomy was done for one case revealing normal adnexa with multiple fibroid uterus, peritoneal solid masses with large mesenteric and omental masses related to the small intestine. Total hysterectomy with bilateral salpingo-oophorectomy, total omentectomy and resection anastomosis for the small intestine with removal of macroscopic lesions were done. Midline line laparotomy was done for the second case revealing free adnexa with subserous vascular fibroids and omental fibroid solid masses. Total hysterectomy with bilateral salpingo-oophorectomy and total omentectomy and removal of macroscopic peritoneal lesions seen were done. The second case was diagnosed as Disseminated Peritoneal Leiomyomatosis, and the other case was diagnosed with multiple uterine fibroid and metastatic GIST on histopathology. Disseminated Peritoneal Leiomyomatosis and metastatic GIST can be similar on imaging and operative findings. Also they are similar to other lesions especially peritoneal carcinomatosis as in advanced ovarian cancer. These pathologies should be kept on mind when encountering multiple solid nodular masses in the visceral and parietal wall peritoneum and the omentum on imaging and intra-operative especially with normal associated tumor markers of ovarian cancer as serum CA125. Surgical and postoperative management differ according to the pathology. These pathologies should be confirmed by histopathology and immunohistochemistry. Frozen section is highly needed in these cases to optimize management.