Ovarian Cysts Research Articles

Association of candidate gene (INSR & THADA) polymorphism with polycystic ovary syndrome: meta-analysis and statistical power analysis.

Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder that impacts women before reaching menopause. In addition to notable features (irregular ovulation, elevated androgen levels, and the existence of numerous ovarian cysts), individuals with PCOS frequently encounter diverse metabolic, cardiovascular, and psychological conditions. The onset of PCOS is influenced by a combination of factors, and various genetic variations are believed to play a significant role in its progression. The objective of the current study was to explore the link between genetic variations in the candidate genes thyroid-adenoma-associated (THADA) gene and insulin receptor (INSR) and susceptibility to developing PCOS. We conducted an extensive search across various databases, including Google Scholar, PubMed, Science Direct, Scopus, and EMBASE, to compile relevant case-control studies and literature reviews for subsequent statistical analysis. In the present study, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was followed, a guideline for Systematic Reviews and Meta-Analysis. While a previous meta-analysis explored the correlation between INSR rs1799817 and THADA rs13429458 and their association with susceptibility to PCOS, our current study did not integrate any findings from these prior investigations. Our research encompassed articles published between 2017 and 2023, and we employed MetaGenyo software to assess the collected data. Statistical power analysis was performed using G*Power 3.1 software. Odds ratios and their corresponding 95% confidence intervals were calculated for each genetic model. Fifteen studies that met the criteria were analyzed. Out of these, ten studies, involving 1,189 cases and 1,005 controls, examined the INSR rs1799817 gene polymorphism, while five studies, including 783 cases and 553 controls, investigated the THADA rs13429458 gene polymorphism. The meta-analysis results indicated that there was no statistically significant association between the INSR rs1799817 gene polymorphism and the risk of PCOS (p>0.05). In contrast, the THADA rs13429458 gene polymorphism showed a significant association with PCOS risk under the over-dominant model (p<0.05). The present meta-analysis demonstrated a notable association between the THADA rs13429458 gene polymorphism and the likelihood of developing PCOS. Further rigorous studies with expanded sample sizes and diverse ethnic representation will be important to comprehensively evaluate and validate these findings.

Safety profile of levonorgestrel intrauterine system: Analysis of spontaneous reports submitted to FAERS

The levonorgestrel-releasing intrauterine system (LNG-IUS) is an established, long-acting contraceptive option. With the widespread use of the LNG-IUS, drug-reported adverse events (AEs) have also garnered significant attention. In this study, we conducted a real-world analysis using the FDA's Adverse Event Reporting System (FAERS) database to assess the incidence of AEs associated with LNG-IUS use. Data from FAERS spanning from 2004Q1 to 2024Q1 were reviewed, with a focus on reports in which LNG-IUS was the primary suspected and secondary suspect drug. Signal detection was carried out utilizing Standardized MedDRA Queries (SMQ) and Preferred Terms (PT), with reporting odds ratio (ROR), proportional reporting ratio (PRR), and information component (IC) employed to identify Signals of Disproportionate Reporting (SDR) for AEs. A positive SDR was defined when all three methods indicated significance. Analysis of 13 SMQs revealed notable SDRs in ear and eye disorders, cardiac arrhythmias, and lipodystrophy. Of the 61 suspected SDRs identified at the PT level, nearly half were not previously documented in labeling. Key potential signals of AEs associated with LNG-IUS use included increased heart rate, papilledema, idiopathic intracranial hypertension, cervical dysplasia, ruptured ovarian cyst, and uterine embedment and perforation. The findings underscore the importance of signal detection using FAERS data for identifying safety concerns related to LNG-IUS. Long-term observational studies are warranted to confirm and further elucidate these potential safety signals.

The effect of silver nanoparticles prepared from the aqueous extract of the fenugreek plant on some of the hormones associated with polycystic ovary syndrome in female laboratory rats

Background: This study dealt with an assessment of the effect of the nanoparticles of the fenugreek plant and the metformin of 50 mg/kg on female laboratory rats infected with the updated ovarian cyst syndrome using the letrazole with a concentration of 1 mg/kg of body weight (except for the healthy group), as ovarian affiliation is a common endocrine disorder that affects 3-13% of women at the age of pregnancy and childbearing. Objective: to assess the effectiveness of medicinal plants represented by the Fenugreek extract with nanoparticles and its ability to treat female rats infected with ovarian cyst syndrome. Materials and Methods: Twenty-four animals of white laboratory rats were tested, and the groups were randomly divided into the following ways: 1- The control group. 2- A group of animals infected with ovaries. 3- A group of animals with cysts, was given orally the nano-fenugreek extract 2 mg/ kg. 4- A group of animals infected with cysts and treated by adding metformin 50 mg/ kg of body weight. After the end of the experiment period (30 days), the blood was withdrawn using a dispensed infection with cardiovis to conduct laboratory tests for hormones that are affected by the new disease, such as Lutein hormone, Follicle-stimulating hormone, Prolactin, Progesterone, and Estrogen. Results showed the following: 1- The injection of litrazole 1 mg/ kg led to an ovarian cyst and negative effects on the animal represented in a moral increase in levels, of lutein hormone and prolactin, while the injury led to a moral decrease in the hormone concentration that stimulates follicles, progesterone, and estrogen. 2- The treatment of an oral dosage of 2 mg/ kg of body weight with the nanoparticle fenugreek extract led to positive effects in the body's hormones represented in a moral increase in FSH, progesterone, estrogen while the same treatment led to a moral decrease in the lutein hormone and prolactin in the body at a level (P&gt; 0.05). For follicles and decrease in prolactin and lutein hormone in the body at the probability level (P&gt; 0.05). Conclusion: The current study has found that the Nano - extract fenugreek can be prepared with the Green synthesis by the use of Nanoscopic silver particles, which is an effective treatment to reduce the strikes in the hormones of the body with ovarian stinging syndrome, as a result of the small surface area to the size of the nanoparticles, so the absorption of cells has more efficient and faster than The normal size of the plant.

A Study On Clinical Outcome Of Ovarian Cyst In A Tertiary Care Hospital‐ESIC Medical College And Hospital Kalaburagi

A Study On Clinical Outcome Of Ovarian Cyst In A Tertiary Care Hospital‐ESIC Medical College And Hospital Kalaburagi

Mucinous Carcinoma of Ovary in a 15-Year-Old Girl, A Rare Case Report and Literature Review.

Ovarian epithelial tumors are common in adults, and the median patient age at presentation is 55 years. In children, epithelial tumors are rare and mostly benign. Mucinous cystadenocarcinoma is reported in only 11 cases less than 15 years old. This report describes the case of a 15-year-old postmenarchal Omani girl with ovarian mucinous carcinoma. She was admitted with severe epigastric pain and abdomen distension. CT scan showed a huge cystic lesion arising from the left adnexa filling the entire abdominal and pelvic cavity. The patient underwent laparotomy with left ovarian cystectomy and omental biopsy which revealed a 35 x 30 cm left ovarian cyst filled with turbid straw color fluid. Histopathology was reported as mucinous carcinoma. The patient later underwent cytoreductive surgery with left salpingo-oophorectomy, omentectomy, appendicectomy, and lymph node dissection that were negative for malignancy or metastatic disease. During follow-up, she developed a lymphocele in the pelvic cavity that was drained. There were no other significant issues during follow-up, as well as no evidence of recurrence or metastasis. Epithelial tumors of the ovary are rare in young girls, with malignant tumors being exceedingly rare. Fertility-sparing surgery is adopted over radical surgery in these patients, even though the recurrence rates with this treatment protocol are high. All cases should be under follow-up to look for recurrence and timely management.

SFRP4 contributes to insulin resistance-induced polycystic ovary syndrome by triggering ovarian granulosa cell hyperandrogenism and apoptosis through the nuclear β-catenin/IL-6 signaling axis

Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by chronic ovulation dysfunction and overproduction of androgens. Women with PCOS are commonly accompanied by insulin resistance (IR), which can impair insulin sensitivity and elevate blood glucose levels. IR promotes ovarian cysts, ovulatory dysfunction, and menstrual irregularities in women patients, leading to the pathogenesis of PCOS. Secreted frizzled-related protein 4 (SFRP4), a secreted glycoprotein, exhibits significantly elevated expression levels in obese individuals with IR and PCOS. Whereas, whether it plays a role in regulating IR-induced PCOS still has yet to be understood. In this study, we respectively established in vitro IR-induced hyperandrogenism in human ovarian granular cells and in vivo IR-induced PCOS models in mice to investigate the action mechanisms of SFRP4 in modulating IR-induced PCOS. Here, we revealed that SFRP4 expression levels in both mRNA and protein were remarkably upregulated in the IR-induced hyperandrogenism with elevated testosterone in the human ovarian granulosa cell line KGN. Under normal conditions without hyperandrogenism, overexpressing SFRP4 triggered the remarkable elevation of testosterone along with the increased nuclear translocation of β-catenin, cell apoptosis and proinflammatory cytokine IL-6. Furthermore, we found that phytopharmaceutical disruption of SFRP4 by genistein ameliorated IR-induced increase in testosterone in ovarian granular cells, and IR-induced PCOS in high-fat diet obese mice. Our study reveals that SFRP4 contributes to IR-induced PCOS by triggering ovarian granulosa cell hyperandrogenism and apoptosis through the nuclear β-catenin/IL-6 signaling axis. Elucidating the role of SFRP4 in PCOS may provide a novel therapeutic strategy for IR-related PCOS therapy.

Unintentionally retained lap sponge mimicking an ovarian cyst two years after Caesarean section in a 37-year old patient: case report of a rare “never event” in Sudan

IntroductionThis case report reports an unusual occurrence of gossypiboma, which refers to the accidental retention of surgical materials like sponges in the peritoneal cavity. The term is derived from “gossypium” (cotton) and “boma” (place of concealment). Its incidence varies with surgical type, posing diagnostic challenges due to nonspecific symptoms and equivocal imaging. Despite its rarity, gossypiboma poses significant risks, including intestinal obstruction and abscess formation.Case presentationA 37-year-old woman with ten previous pregnancies and an emergent caesarean section presented with abdominal pain. Examination and ultrasound suggested an ovarian cyst. During surgery, a 10 × 10 cm gauze-filled mass adherent to the ovary and jejunum was found. Postoperatively, she recovered well with no complications. The patient was treated with intravenous fluids and antibiotics for five days post-surgery and recovered without any complications. She was discharged from the hospital five days after the procedure.ConclusionTo the best of our knowledge, this is the first reported case of gossypiboma in Sudan in 2024, highlighting diagnostic challenges and the need for preventive protocols. Root cause analysis of accidents, enhanced training, application of advanced technologies and a collaborative culture in the operating room can prevent the occurrence of such incidents. This case underscores the importance of meticulous surgical protocols and continuous improvement in safety measures to prevent retained surgical items, ensuring patient safety and optimal outcomes.

Potential damage to ovarian reserve from laparoscopic electrocoagulation in endometriomas and benign ovarian cysts: a systematic review and meta-analysis.

Laparoscopic cystectomy for ovarian endometriomas and benign ovarian cysts is often conducted through hemostatic methods, with bipolar electrocoagulation as a common approach. This study evaluated the impact of electrocoagulation, primarily through bipolar energy, versus nonthermal hemostatic methods on ovarian reserve in patients undergoing laparoscopic cystectomy for ovarian endometriomas and benign ovarian cysts. A systematic review with meta-analysis was conducted by searching the Cochrane Library, PubMed, EMBASE, and Web of Science databases. Randomized controlled trials (RCTs) comparing the impact of nonthermal hemostatic methods and electrocoagulation on the ovarian reserve during laparoscopic cystectomy were included. The Cochrane Risk of Bias Tool for Randomized Controlled Trials (ROB 2.0) was utilized to assess the quality of the included studies. The meta-analysis included 13 RCTs involving 1043 patients. Postoperative serum anti-Müllerian hormone (AMH) levels and antral follicle counts (AFCs) were analyzed using Review Manager ver. 5.4. Compared with the bipolar group, patients with endometriomas in the nonthermal hemostatic group exhibited significantly higher postoperative AMH levels at 1, 3, 6, and 12months. Conversely, no significant differences in AMH levels were observed in patients with benign ovarian cysts. Similarly, AFCs showed no significant differences, except for lower postoperative AFCs in patients with endometrioma in the electrocoagulation group. Nonthermal hemostatic methods are associated with more effective preservation of the ovarian reserve compared with bipolar electrocoagulation in laparoscopic cystectomy for ovarian endometriomas. However, no significant impact of bipolar electrocoagulation on the ovarian reserve was observed in patients with benign ovarian cysts. Registered in PROSPERO on April 10, 2023; ID # CRD42023413158.

Herlyn-Werner-Wunderlich Syndrome Accompanying Hemosalpinx and Endometriotic Ovarian Cyst suspected as Tubo-Ovarian Abscess: A Rare Congenital Anomaly of Genitourinary System in a 12-year-old Female Patient

Herlyn-Werner-Wunderlich Syndrome Accompanying Hemosalpinx and Endometriotic Ovarian Cyst suspected as Tubo-Ovarian Abscess: A Rare Congenital Anomaly of Genitourinary System in a 12-year-old Female Patient

Segmentation of ovarian cyst in ultrasound images using AdaResU-net with optimization algorithm and deep learning model

Ovarian cysts pose significant health risks including torsion, infertility, and cancer, necessitating rapid and accurate diagnosis. Ultrasonography is commonly employed for screening, yet its effectiveness is hindered by challenges like weak contrast, speckle noise, and hazy boundaries in images. This study proposes an adaptive deep learning-based segmentation technique using a database of ovarian ultrasound cyst images. A Guided Trilateral Filter (GTF) is applied for noise reduction in pre-processing. Segmentation utilizes an Adaptive Convolutional Neural Network (AdaResU-net) for precise cyst size identification and benign/malignant classification, optimized via the Wild Horse Optimization (WHO) algorithm. Objective functions Dice Loss Coefficient and Weighted Cross-Entropy are optimized to enhance segmentation accuracy. Classification of cyst types is performed using a Pyramidal Dilated Convolutional (PDC) network. The method achieves a segmentation accuracy of 98.87%, surpassing existing techniques, thereby promising improved diagnostic accuracy and patient care outcomes.

Surgical approach for a refractory enterocutaneous fistula by combining laparoscopic surgery and a planned open conversion: a case report

BackgroundAn enterocutaneous fistula (ECF) is defined as an abnormal communication between the gastrointestinal tract and skin. ECFs are rarely encountered in clinical practice, yet are frequently difficult to treat. Few reports exist regarding the surgical techniques for the treatment of an ECF. Therefore, we report a case of refractory ECF with concomitant severe adhesions, in which we performed combined laparoscopic adhesiolysis and planned open conversion.Case presentationA 57-year-old female patient underwent a laparotomy for an ovarian cyst in her 20s. At 46 years, adhesiolysis without bowel resection was performed for adhesive small bowel obstruction (SBO). However, her symptoms did not improve. Eighteen days postoperatively, she underwent a reoperation and jejunostomy. An ECF developed post-reoperation; therefore, stoma closure and radical surgery for the ECF were planned. Due to the severe adhesions, only stoma closure was performed, based on intraoperative assessments. The patient was subsequently referred to our hospital. First, skin care around the fistula was provided during an outpatient visit. Appropriate sizing of the stoma pouch was performed, to improve erosions and ulcers. Thereafter, debridement of the perifistula skin and simple closure of the ECF outlet were attempted; however, the ECF recurred shortly thereafter. After 8 years of regular skin care, with the ECF remaining stable, however, manifesting as symptomatic SBO, she underwent laparoscopic adhesiolysis. This procedure was initiated in the epigastric region, where relatively fewer adhesions were anticipated. Post-open conversion, partial resection of the small intestine at four locations, including the fistula site, was performed. Postoperatively, jejunal edema and peristaltic dysfunction, due to narrowing of the superior mesenteric artery occurred. Regular drainage by percutaneous endoscopic gastrostomy was required. However, she improved and was discharged 3 months post-operatively. Three years post-operatively, the ECF and SBO did not recur.ConclusionsWe reported a case of refractory ECF in which we were able to safely perform surgery, by combining laparoscopic adhesiolysis and a planned open conversion. Therefore, the surgical approach used in this case may be an option for securing a safe surgical field, while avoiding collateral damage.

Intrauterine torsion of an ovarian cyst with a fallopian tube followed by self-amputation of the appendages

Intrauterine torsion of an ovarian cyst with a fallopian tube followed by self-amputation of the appendages

Magnetic resonance imaging and clinical features of Mayer-Rokitansky-Küster-Hauser syndrome: A 10-year review from a dedicated specialist centre.

To correlate the clinical history with imaging findings of women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Retrospective cohort study. A UK IOTA and ESGO-certified tertiary referral centre for disorders of reproductive development. All patients with a diagnosis of MRKH and who had undergone an MRI pelvis between 1 January 2011 and 31 April 2021 were included. MRI images were analysed by specialist gynaecological radiologists. Clinical data was extracted from an electronic patient record system. Statistical analysis was computed in R (version 4.1.2), R base stats package and ggstatsplot (v0.5.0). Clinical history and predefined imaging features. One hundred and thirty-four patients were included. Median age at MRI was 18 years (10-64 years). Half (48.2%) of women presenting had a history of pain, most often abdominal (84.6%) or vaginal (9.2%). Remnants were identified in 91.8% of women (n = 123). 4.5% of women had imaging features of endometriosis (n = 6). Women with a functional remnants were significantly more likely to experience pain (p < 0.001). Pain history was not strongly associated with ectopic ovarian position. Common gynaecological pathology such as endometriosis, ovarian cysts and fibroids were also identified. We identify that majority of women with MRKH will have uterine remnants with a connecting fibrous band, and an ectopic ovarian position 44.0% of cases. Abdominal pain was significantly associated with functional remnants on MRI. Further work is required to identify how other gynaecological pathology impacts women with MRKH.

Mesenteric Cyst Masquerading as an Ovarian Cyst

Abstract Mesenteric cysts are rare benign abdominal lesions that possess the risk of malignant transformation in 3% of reported cases. Most cysts are asymptomatic and can affect practically any abdominal quadrant. They are diagnosed incidentally or during the management of their complications. Ultrasonography, computed tomography scan, magnetic resonance imaging and histopathology are needed for the diagnosis. They can mimic multiple other cysts; hence, their timely diagnosis is of utmost importance. The mainstay of treatment is surgical excision of the cyst, which is essential to prevent the recurrence of malignant transformation. We present a rare case of a 40-year-old female patient with no known comorbidities who started feeling weakness with gradual onset and was increasing. We successfully removed a mesenteric cyst of size approximately 10 cm × 6 cm × 5 cm. This article aims to educate the readers and to make fellow surgeons well aware of this condition for better diagnosis and treatment.

Magnetic resonance imaging evaluation of gynecological mass lesions: A comprehensive analysis with histopathological correlation.

Evaluating gynecological mass lesions and reviewing their morphological characteristics based on their imaging appearance on magnetic resonance imaging (MRI), and correlating the MRI findings with histopathological findings, was the central theme of our study. This observational cross-sectional study was conducted on 60 female patients with clinically suspected gynecological mass lesions upon physical examination and/or ultrasonography, referred for MRI at a tertiary care hospital over a 1-year period between June 2022 and July 2023. A broad spectrum of differential diagnoses of gynecological masses was observed. In our study, the ratio of benign versus malignant disease was 1.6:1, with 37 benign and 23 malignant masses identified. The most common benign masses were uterine fibroids (n = 14; 23.3%), followed by endometriosis (n = 8; 13.3%), and ovarian dermoid cysts (n = 4; 6.6%). Among the malignant lesions, cervical cancer was the most common (n = 11; 18.3%), followed by endometrial carcinoma (n = 7; 11.6%), ovarian carcinoma (n = 3; 5%), and vaginal carcinoma (n = 2; 3%). Benign lesions mostly appeared hypo- to isointense on T1-weighted imaging and iso- to hyperintense on T2-weighted imaging, while malignant lesions appeared isointense on T1-weighted and hyperintense on T2-weighted imaging. Hemorrhage and fat were well appreciated on MRI and aided in diagnosis. T2 shading was present in 7 out of 8 endometriotic cysts, demonstrating a specificity of 100% and a sensitivity of 83%. For determining parametrial invasion in cervical carcinoma, MRI showed an accuracy of 91%, specificity of 100%, and positive predictive value, negative predictive value, and sensitivity of 100%, 75%, and 88%, respectively. In cases of endometrial carcinoma, MRI demonstrated a sensitivity and specificity of 87% and 91%, respectively, with a positive predictive value of 87% and a negative predictive value of 91% for identifying myometrial invasion greater than 50%. Compared to other modalities, MRI provided substantial information regarding uterine and adnexal masses and surrounding structures, facilitating accurate staging of lesions.

CLINICAL FEATURES AND LABORATORY CHARACTERISTICS OF PATIENTS WITH OVARIAN ENDOMETRIOMA AND INFERTILITY DEPENDING ON THE TYPE OF PRECONCEPTION PREPARATION

Approximately 30-40% of all forms of endometriosis consist of endometriotic ovarian cysts, which directly affect the ovarian reserve of women by mechanical impact on healthy tissues and foci of local inflammatory processes and oxidative stress.The aim of the study was to evaluate the impact of preconception antioxidant and vitamin therapy in combination with sclerotherapy of ovarian endometrioma on hormonal profile indicators and serum tumor markers in women with endometriosis-associated infertility.Materials and Methods. In a prospective clinical study, changes in hormonal profile indicators and serum tumor markers depending on the type of preconception preparation of women with endometriosis-associated infertility before IVF cycle were evaluated. 110 women were divided into 3 clinical groups.Results and Discussion. Significant differences between groups were found depending on the preparation for the IVF cycle. In both the first clinical group, where only sclerotherapy was performed, and the second group, where women received preconception preparation in combination with sclerotherapy, a decrease in basal FSH levels by 1.2 and 1.5 times, respectively, was established. This decrease in FSH levels contributed to the normalization of the LH to FSH ratio, whereas in the comparison group, the FSH level remained almost unchanged and the LH/FSH ratio remained low. There was a tendency towards relatively stable levels of anti-Müllerian hormone in serum, indicating the safety of the sclerotherapy method and its gentle impact on ovarian reserve. A more pronounced decrease in serum CA 125 tumor rmarker levels was observed in the second clinical group (by 1.95 times), somewhat less in the first group (by 1.6 times), while in the comparison group, the indicator remained relatively stable.Conclusions. The use of sclerotherapy of ovarian endometrioma in combination with preconception antioxidant and vitamin therapy before the IVF cycle positively affects the main parameters of hormonal profile and serum tumor markers in patients with endometriosis-associated infertility.

POLYCYSTIC OVARY SYNDROME AND ENDOMETRIOSIS: IMPACT ON FERTILITY AND QUALITY OF LIFE AND SURGICAL OPTIONS.

Polycystic Ovary Syndrome (PCOS) and endometriosis are gynecological disorders that affect a significant number of women of reproductive age, severely impacting their fertility and quality of life. PCOS is characterized by ovarian dysfunction, hyperandrogenism, and the presence of multiple ovarian cysts, while endometriosis involves the growth of endometrial tissue outside the uterus, causing chronic pelvic pain and infertility. Both conditions are complex, with multifactorial etiologies that include genetic, hormonal, and environmental components. Additionally, the intersection of these conditions can exacerbate symptoms and complicate clinical management. Surgical options, such as laparoscopy for the removal of ovarian cysts or endometrial lesions, play a crucial role in treatment, improving fertility and relieving pain. Objective: to analyze the impact of Polycystic Ovary Syndrome and endometriosis on fertility and quality of life, as well as to evaluate the available surgical options. Methodology: based on the PRISMA checklist, encompassing a detailed search in the PubMed, Scielo, and Web of Science databases. Five main descriptors were used: "Polycystic Ovary Syndrome," "Endometriosis," "Fertility," "Quality of Life," and "Surgical Options." Three inclusion criteria were: articles published in the last 10 years, studies involving women of reproductive age, and research addressing both PCOS and endometriosis. Three exclusion criteria were: studies in languages other than English and Portuguese, articles not addressing surgical aspects, and publications focused exclusively on medicinal treatment. Results: indicated that the coexistence of PCOS and endometriosis is associated with a significant negative impact on fertility, with reduced rates of natural conception. Surgical options, particularly laparoscopy, were effective in removing ovarian cysts and endometrial lesions, resulting in improved fertility and reduced chronic pelvic pain. Additionally, surgical intervention contributed to an overall improvement in the quality of life of patients, although the risks and benefits must be carefully considered in each individual case. Conclusion: the interaction between Polycystic Ovary Syndrome and endometriosis presents considerable challenges for the fertility and quality of life of affected women. Surgical options, especially laparoscopy, offer significant benefits but should be weighed according to the specific circumstances of each patient. The review highlighted the importance of a multidisciplinary approach to managing these conditions, aiming to optimize reproductive outcomes and overall patient well-being.

Preterm Vaginal Delivery and Postpartum Laparotomy for a Giant Ovarian Serous Cyst: A Case Report

Preterm Vaginal Delivery and Postpartum Laparotomy for a Giant Ovarian Serous Cyst: A Case Report

Patient with Herlyn–Werner–Wunderlich syndrome and endometriosis achieves successful full-term pregnancy (40 weeks and 6 days): a case report

IntroductionHerlyn–Werner–Wunderlich syndrome , a rare Müllerian ducts congenital disease, is characterized by a diphtheritic uterus, blind hemivagina, and ipsilateral renal agenesis. Diagnosis is at young age by ultrasound and magnetic resonance imaging, and the prognosis is good. Usually, complications evolve endometriosis and secondary pelvic inflammation.Case reportA 40-year-old female patient, Brazilian, white, primigravida, diagnosed at 30 years with a didelphic uterus on ultrasound, and 4 years later, with a left ovarian endometrioma, multiple ovarian cysts, and left renal agenesis on magnetic resonance imaging. Subsequently, due to dyspareunia and a feeling of swelling, the patient underwent transvaginal ultrasound with bowel preparation, and a hematocolpos was found and Herlyn–Werner–Wunderlich syndrome was suspected; 10 years after the diagnosis she had a planned pregnancy. She presented frequent contractions following the 15th week of pregnancy and fortunately there were no complications or premature labor. Labor was inducted at 40 weeks and 6 days without progress and a cesarean section was indicated and performed without complications. Herlyn–Werner–Wunderlich syndrome often goes unnoticed, leading to inadequate treatment. Individuals with Herlyn–Werner–Wunderlich syndrome commonly face fertility issues, such as high miscarriage rate (21–33%), and obstetric complications, such as spontaneous abortions (40% risk), intrauterine growth restriction, postpartum hemorrhage, increased fetal mortality, preterm delivery (21–29%), and elevated rates of cesarean sections. In addition, there is higher susceptibility of developing endometriosis, especially with hemivaginal obstruction, and pelvic adhesions.ConclusionEarly diagnosis enables timely treatment and, consequently, fewer complications. Still, when these factors are absent, vaginal birth may still be possible. The true prevalence and incidence of complications related to Herlyn–Werner–Wunderlich syndrome are still unknown.

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.