Left Ovarian Cystectomy Research Articles

Case 330: Ovarian Torsion in the Setting of Ovarian Hyperstimulation Syndrome.

A 30-year-old female patient with a history of infertility and no pregnancy presented to the gynecologic endometriosis clinic for follow-up 1 month after oocyte retrieval, to be evaluated for pelvic optimization before potential embryo transfer, with worsening dysmenorrhea, dyspareunia, and overall pelvic pain. Eleven years prior, the patient had undergone left ovarian cystectomy for treatment of endometrioma, as well as excision of deep infiltrating endometriosis. The oocyte retrieval procedure, where more than 30 eggs were retrieved, was complicated by ovarian hyperstimulation syndrome and intraperitoneal bleeding, which necessitated admission to the intensive care unit (ICU) for 3 days. Following discharge from the ICU, the patient experienced occasional on-and-off pressure of the urinary bladder and persistent aching pelvic pain.

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.

Juvenile granulosa cell tumor in a 35-year-old pregnant woman: A rare case report

Juvenile granulosa cell tumors (JGCTs) account for 5% of GCT and 3% are diagnosed after 30 years of age. JGCT is an uncommon neoplasm in pregnancy. About 90% are stage I at diagnosis but advanced-stage tumors are aggressive often resulting in recurrence or death within 3 years of diagnosis. We present a case of JGCT in a pregnant woman of 35 years old. The patient complained of sudden onset pain in her second trimester. Ultrasound whole abdomen was done and a malignant lesion was detected. Subsequently, the left ovarian cystectomy was performed and a diagnosis of JGCT was given which was confirmed by histopathology and immunohistochemistry.

AMH producing purely cystic virilizing adult granulosa cell tumor in 17 years old girl: a case report and review of literatures

BackgroundAndrogen-producing granulosa cell tumor in adolescent girl is rare condition and clinical characteristics are not fully elucidated.Case presentationSeventeen years old girl complained of secondary amenorrhea was referred to our out-patient consultation. Markedly elevated serum testosterone, LH, and AMH levels were noted. Mild hirsutism and clitoromegaly were presented. Transabdominal ultrasonography and MRI revealed cystic mass occupied pelvic cavity probably originated from left ovary. Right ovary showed polycystic appearance. Laparoscopic left ovarian cystectomy was performed. After the surgery, her menstruation resumed along with normalized hormonal parameters, and clinical hyperandrogenism were improved. Since the scarcity of cellular lining of inner cyst wall, definitive pathological diagnosis was difficult. After the consultation with gynecological pathologist, the tumor was diagnosed as sex cord stromal tumor, highly suspicious for adult granulosa cell tumor. Residual left salpingo-oophorectomy was performed by additional laparoscopic surgery. Her serum testosterone and AMH levels were remained low with regular menstrual cycles and no evidence of recurrence.ConclusionsAndrogen-producing cystic granulosa cell tumor is rare gynecological disorders, which need both gynecologic oncological and endocrinological approach. Its clinical manifestations may bring some clues to the pathogenesis of ovulatory dysfunctions, such as polycystic ovary syndrome.

Diagnosis and management of a giant ovarian cyst during pregnancy and puerperium: Case series

In the pregnancy and puerperium phase, giant ovarian cysts are highly uncommon. It raises the risk of fetal and maternal morbidity. We describe three cases of large benign ovarian cysts diagnosed and treated at a rural medical college and hospital with limited facilities during the pregnancy and puerperium phase.Data were obtained by history analysis, clinical assessment, laboratory examination, radiological imaging, and histopathological analysis of the culled surgical specimen. Our first case was a 23-year-old primigravida who presented with pain in abdomen. Antenatal sonography confirmed a huge intact left ovarian cyst. She was managed at term by cesarean for obstetrical indication along with left ovarian cystectomy. Our second case, a 25-year-old woman, reported abdominal distention following uncomplicated vaginal delivery. After a complete workup, she was diagnosed with a benign serous ovarian cystadenoma. Laparotomy with left ovarian cystectomy was done. In our third scenario, a 20-year-old primigravida with a giant ovarian cyst at 34 weeks gestation who also delivered vaginally and underwent laparotomy with left ovarian cystectomy. Histopathological examination revealed benign ovarian serous adenoma in all three cases.When a large ovarian cyst is present during pregnancy, it is unearthed that vaginal delivery is possible. In the postpartum period, surgical cyst treatment can be performed with satisfaction.

Intraoperative Ultrasound Elastography Guided Rectal Shaving for Endometriosis

<h3>Study Objective</h3> Rectal surface endometriosis is more common in cases of cul-de-sac obstruction, and it is preferable in endometriosis surgery to remove as much of the deep endometriosis region as possible. The degree of rectal shaving may be confusing because the depth of the rectal superficial lesion cannot be assumed from the outside during surgery. For safe and appropriate resection, we attempted to confirm the location of the endometriosis lesion with intraoperative ultrasonography and elastography. <h3>Design</h3> Case report. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> A 23-years-old woman with dysmenorrhea diagnosed with left endometrioma and cul-de-sac obstruction by magnetic resonance imaging (MRI). <h3>Interventions</h3> Nerve-sparing endometriosis surgery including left ovarian cystectomy, cul-de-sac adhesiolysis, and deep endometriosis resection was planned. To evaluate the rectal surface endometriosis, a sterilized small ultrasound probe was inserted into the abdominal cavity through an abdominal trocar or small incision in the posterior vaginal fornix. Rectal surface fibrosis and the distance from the rectal muscularis were tried to be visualized with ultrasound elastography. <h3>Measurements and Main Results</h3> Intraoperative ultrasonography clearly indicated the safety distance from the rectal muscularis, and elastography showed hard fibrotic region on rectal surface with color visualization. There was no intra/post-operative complication. The pathological examination revealed the presence of endometriosis in the resected tissue. The visual analog scale (VAS) for dysmenorrhea was reduced from 70 to 10, and the VAS for dyspareunia was reduced from 50 to 0. <h3>Conclusion</h3> Intraoperative ultrasound elastography is considered to be a useful auxiliary means for safe rectal shaving by visualizing the fibrosis caused by endometriosis.

Well-differentiated cerebellum in an ovarian mature cystic teratoma: a case report and review of the literature

BackgroundMature teratoma is the most common germ cell tumor as it represents 95% of germ cell tumors. Although common in children and young adults, ovarian teratoma can occur at any age. Mature teratomas are composed of mature tissues representing elements derived from more than one embryonic germ layer (ectoderm, mesoderm, and endoderm), with ectodermal derivatives being the usual predominant component; however, the finding of a well-differentiated cerebellum is extremely rare.Case presentationA 20-year-old Saudi female presented to the emergency department with severe abdominal pain of 1-day duration. Pelvic ultrasound showed a large ovoid- to bilobed-shaped cystic pelvic structure extending to the lower abdomen. The patient underwent left ovarian cystectomy. Microscopic examination showed a cyst wall with skin tissue, including adnexal structures (sebaceous glands), a well-differentiated cerebellum, and mature glial tissue. After extensive sampling, no immature component was identified. Thus, the final diagnosis of a mature cystic teratoma with well-differentiated cerebellum was established. The patient was well postoperatively and was discharged in a stable condition.ConclusionWe report this case of well-differentiated cerebellum within ovarian teratoma to expand the pool of cases reported in literature of this extremely rare entity, as only 22 cases with such findings have been reported in literature to the best of our knowledge. This finding poses a diagnostic challenge to the pathologist due to its rarity and its similarity to immature teratoma. We thus emphasize that thorough sampling of ovarian teratoma is of paramount importance and to keep the aforementioned diagnosis in mind and not confuse it with immature elements, especially in intraoperative consultation and frozen sections.

A Case of Anti-NDMA Receptor Encephalitis with Bilateral Ovarian Teratomas

Anti-NMDA receptor encephalitis is an autoimmune encephalitis precipitated by antibodies generated against NMDA receptors, resulting in abnormalities in behavior, cognition, memory, and movement. Anti-NMDA receptor encephalitis most commonly occurs as a paraneoplastic disorder associated with an ovarian teratoma. While the symptomatic presentation of NMDA receptor encephalitis can be severe, removal of an associated ovarian teratoma generally causes significant improvement and the resolution of symptoms. Thus, accurate detection and early treatment are crucial for superior outcomes in these rare cases. We present a case of a 19-year-old African American female with a strong family history of epilepsy who was brought to the ED after having two weeks of headaches, multiple seizures over the course of the previous two days, and behavioral changes. An MRI of the brain was normal, but she had an elevated opening pressure. The constellation of symptoms and elevated lumbar pressure raised the suspicion of a paraneoplastic syndrome, and a subsequent CT of the abdomen and pelvis revealed a 5 x 4.2 cm ovarian cyst. Further examination of the features of the cyst with ultrasound revealed areas of calcification. IVIG treatment was started for treatment of a suspected paraneoplastic related encephalitis. After a discussion with neuroradiology about the differential, repeat MRI brain and an MRI abdomen revealed minimal hyperintensities within the temporal lobes bilaterally in the former and evidence of previously unidentified bilateral dermoid cysts in the latter. The patient tested positive for NMDA CSF and underwent left salpingoophorectomy and right ovarian cystectomy. After treatment, she returned to her baseline but still experiences spontaneous jerking movements. This case report discusses the early use of IVIG, communication with radiology, and the importance of maintaining a broad differential. After a thorough review of the literature, there are very few cases in which NMDA receptor encephalitis has presented with bilateral ovarian teratomas.

Primary strumal carcinoid tumor of the ovary arising from a heterochronous struma ovarii in young female patient

Primary ovarian carcinoid tumors are extremely rare. Ovarian strumal carcinoid is usually derived from mature cystic teratoma, an ovarian germ cell tumor composed of two distinctive components characteristic thyroid tissue intermixed with a carcinoid tumor. The incidence of stromal carcinoid tumor is accounting for 0.3-1% of all ovarian tumors and 3% of all mature teratomas. Herein, we report a 25-year-old female presented with severe abdominal pain. She had right struma ovarii after Laparoscopic-Assisted Ovarian Cystectomy (LAOC) procedure one year ago. The sonography of abdomen images study demonstrated a well capsulated cystic mass measured up to 11 cm in dimension. The mature cystic teratoma was the first diagnostic possibility. She underwent the laparoscopy-assisted left ovarian cystectomy. Histopathological and immunohistochemical examinations confirmed strumal Carcinoid Tumor of the Ovary (SCTO) arising from strum ovarii in the left ovary. She was recovered well and was still asymptomatic after two years follow-up. In conclusion, we first describe the primary SCTO arising from a heterochronous struma ovarii. The symptoms of SCTO are usually non-specific and misleading. Therefore, it is important to fully understand the characteristics, diagnosis and management of SCTO. Diagnosis should be confirmed by pathology and immunohistochemistry, and clinically metastatic carcinoid should be excluded.

Primary and recurrent serous borderline tumors during pregnancy: a case report and literature review.

The diagnosis and management of borderline ovarian tumors during pregnancy are still not standardized, because these tumors are rarely encountered. We report the case of a 27-year-old pregnant woman who presented with an ovarian mass in her first trimester. Magnetic resonance imaging revealed a multilocular cystic component with papillary lesions in the background of endometriosis, suggesting a seromucinous borderline tumor or ovarian cancer. A right salpingo-oophorectomy and partial omentectomy were performed at 7weeks of gestation. Pathological examination demonstrated a serous borderline tumor. The subsequent pregnancy course was uneventful, and she gave birth to a healthy baby at 39weeks of gestation. She wanted to retain fertility, and close follow-up was performed. Four years later, she became pregnant, and a lesion suggesting recurrence in the left ovary was detected. An abdominal left ovarian cystectomy was performed at 13weeks of gestation, which demonstrated recurrence of the serous borderline tumor. She gave birth to a healthy baby at 39weeks of gestation. Two months after delivery, she underwent total abdominal hysterectomy with left salpingo-oophorectomy, which revealed no malignant findings. We also reviewed 10 reports that included 58 cases of borderline ovarian tumors diagnosed during pregnancy. The borderline ovarian tumors diagnosed during pregnancy exhibited different characteristics according to each subtype, suggesting the importance of diagnosing borderline ovarian tumor subtypes preoperatively.

Nerve Evaluation during Laparoscopic Endometriosis Resection

Study Objective This video demonstrates a targeted nervous system evaluation in the setting of a uterine and ovarian conserving surgery Design N/A Setting A single surgical center within a large integrated healthcare system. Patients or Participants The patient is a 49-year-old perimenopausal woman with dysmenorrhea and a left ovarian cyst who presented for evaluation of new onset left hip and leg pain. The left ovarian cyst was first noted 4 years ago and the patient declined surgery at that time, instead opting for surveillance with repeat imaging which now demonstrated an interval increase in the cyst size. The patient had an extensive evaluation for her leg pain including MRI and nerve conduction studies which were all unremarkable. The patient declined medical management or definitive surgical treatment of the suspected endometriosis. She opted for a diagnostic laparoscopy and left ovarian cystectomy. Interventions The patient underwent an uncomplicated diagnostic laparoscopy and left ovarian cystectomy. Given the characteristics of her symptoms, care was taken intra-operatively to examine specific nerves within the lumbosacral plexus. Measurements and Main Results No overt pathology was noted along the sacral, genitofemoral, or obturator nerves. Conclusion In summary, this video demonstrates steps for performing a targeted evaluation of the pelvic nervous system based on patient's symptoms.

MON-440 Unusual Case of Metastatic Struma Ovarii Diagnosed at the Time of Hysterectomy

Introduction: Struma ovarii is rare ovarian teratoma composed of more than 50% mature thyroid tissue, which can rarely transform to malignancy. There are fewer than 200 cases reported and no established treatment approach. We present a case of metastatic malignant struma ovarii. Case Presentation: A 41 year old female was diagnosed with metastatic papillary thyroid carcinoma (PTC) after it was found on uterine histopathology. History was notable for remote left ovarian cystectomy of a mature teratoma with prominent thyroid component. She had no personal or family history of craniocervical radiation or thyroid cancer. Eight years later, she had a total hysterectomy for menorrhagia. Pathology showed subcentimeter serosal deposits of follicular variant PTC, staining positive for thyroglobulin, CK19, and HBME1. Endometrial and cervical pathology were normal; the myometrium had many leiomyomata. Post-hysterectomy TSH was 2.3 (0.34 - 5.66 µIU/mL), and thyroglobulin 44.3 (<=33.0 ng/mL). Thyroid ultrasound showed a 7 mm isoechoic nodule without lymphadenopathy. Whole body PET/CT showed multiple hypermetabolic masses in the pelvic peritoneum and liver. The right ovary had many cystic lesions and was enlarged to 5.3 x 4.5 cm. She underwent partial hepatectomy, oophorectomy, salpingectomy, and omental resection with no residual disease. Pathology showed follicular variant PTC in both ovaries, peritoneum, colonic mesentery, and omentum. Thyroglobulin fell to 6.9 ng/mL 3 weeks later. A 0.2 cm focus of follicular variant PTC with capsular invasion was found on pathology after total thyroidectomy. She underwent radioiodine ablation with 150 mCi. Postablative scan showed residual activity in the thyroid bed and right hemipelvis, but no new foci of activity. CT abdomen showed resolution of perihepatic lesions and thyroglobulin declined further to 0.5 ng/mL. Discussion: A low risk of recurrence (7.5%) has been reported in patients with malignant struma ovarii, with survival rates of 96.7% at 5 years and 84.9% at 20 years, despite a variety of surgical and adjuvant management strategies. Unilateral cystectomy, unilateral salpingo-oophorectomy, or total abdominal hysterectomy and bilateral salpingo-oophorectomy may be sufficient for patients with well differentiated thyroid cancer arising in struma ovarii without metastases. Thyroid ultrasound should be performed to exclude primary thyroid malignancy. Patients with distant metastases may benefit from aggressive treatment including resection of gross abdominal and pelvic disease and total thyroidectomy to facilitate radioactive iodine ablation and surveillance for recurrence. Conclusion: Due to its rarity, there is no consensus on optimal treatment of malignant struma ovarii. More research in this field is warranted.

Unicornuate uterus with a rudimentary non-communicating cavitary horn in association with VACTERL association: case report

BackgroundThe unicornuate uterus is caused by abnormal or failed development of one Müllerian duct. Unicornuate uteri with functioning non-communicating rudimentary horns are susceptible to many gynaecologic and obstetric complications such as hematometra, endometriosis and ectopic pregnancy and thus surgical resection is usually recommended..Case presentationWe report a rare case of a unicornuate right uterus with rudimentary non-communicating (functional) cavitary left horn (class U4a) in a 17-year-old girl who was diagnosed with VACTERL association. She was presented to our centre with 3 years history of secondary sever dysmenorrhea. Pelvic magnetic resonance imaging revealed a normal uterus on the right side, a 7 × 8 cm left endometrioma, a tortuous dilated fluid-filled structure in the left hemipelvis, mostly represented left-sided hematosalpinx, and a well-defined lesion with thick enhancing wall in the left hemipelvis measuring 6.7 × 5.7 × 5.6 cm with a similar enhancement to the uterus in the right. She underwent laparotomy that showed a right unicornuate uterus with a normal cervix and a rudimentary non-communicating distended left horn. In addition, there was a left endometrioma and left hematosalpinx. Resection of the left communicating horn, left salpingectomy and left ovarian cystectomy were performed. The right tube and both ovaries were preserved. At 9-months follow up, the patient had a regular period and the pain subsided completely.ConclusionWe report yet the second case of VACTERL association and unicornuate uterus with non-communicating functional rudimentary horn, in hope of expanding the knowledge of a rare occurrence. This case also highlights the importance of considering the diagnosis of Müllerian duct anomalies in patients with a history of other anomalies, and/or history of early-age secondary dysmenorrhea.

Follicular variant of papillary carcinoma thyroid occurring in struma ovarii

We present the case of a 35-year-old female who presented with abdominal pain and irregular menstrual bleeding. The patient was found to have a left adnexal lesion on ultrasonography and contrast-enhanced computed tomography. Based on the preoperative imaging and biochemical workup, a left ovarian cystectomy was done. Histopathology (HPE) revealed follicular variant of papillary carcinoma thyroid in a background of struma ovarii. The patient then underwent total thyroidectomy. HPE showed no malignancy in the thyroid gland. After achieving the desired level of thyroid-stimulating hormone, postoperatively, the patient underwent a diagnostic I-131 whole-body scan (WBS) which revealed remnant thyroid tissue in the neck only. The patient's remnant thyroid tissue was ablated with I-131. Follow-up at 6-month interval revealed normal ultrasound pelvis, no abnormal uptake in diagnostic I-131 WBS and serum thyroglobulin (Tg), and anti-Tg antibody levels within normal range.

Port site recurrence and unusual diffuse subcutaneous metastases of unexpected early stage ovarian cancer after laparoscopic surgery: a case report.

Port site recurrence is a rare but well-documented adverse event peculiar to laparoscopic surgery. We report an unusual outcome of unexpected early stage ovarian cancer in which port site recurrence occurred after laparoscopic surgery and was followed by diffuse subcutaneous metastases. A 31-year-old Japanese woman with a large tumor in her abdomen visited our hospital. Because no intratumoral solid component was detected on diagnostic imaging, the tumor was diagnosed as a benign ovarian tumor and the patient underwent left ovarian laparoscopic cystectomy. Contrary to our expectations, however, the ovarian tumor was a mucinous carcinoma. We performed additional surgery, but the tumor recurred in the umbilical area, and multiple subcutaneous metastases later appeared. The curative effect of chemotherapy and radiation was limited. This atypical metastatic distribution of an extremely small amount of cancer might have been caused by the laparoscopic procedure. Protection against tumor cell dissemination is necessary during all forms of laparoscopic surgery.

Round Ligament Adenomyoma

A 45-year-old woman presented with a history of dull aching right lower quadrant pain on and off for 6 months. In 1996 she had undergone laparoscopic left ovarian endometriotic cystectomy after which she conceived. She then had 2 normal vaginal deliveries, but in 2005 during her second delivery she had a subtotal hysterectomy for severe postpartum hemorrhage. In 2013 she underwent a laparoscopic right adnexectomy with left salpingectomy for endometriosis.

Laparoscopic Minimally Invasive Approach to Sentinel Lymph Node Mapping of the Ovary Using the Near-infrared Fluorescent S1 HD Pinpoint System with Indocyanine Green Dye

Study ObjectiveTo show a novel minimally invasive approach to sentinel lymph node (SLN) detection of the ovary with near-infrared–guided surgery using indocyanine green (ICG). DesignA step by step description of the technique with video and figures (educational video). SettingThe standard surgical staging of early-stage I-II ovarian cancer includes systematic pelvic and aortic lymphadenectomy even in the absence of clear evidence regarding the survival benefits associated with comprehensive retroperitoneal staging. The ideal candidates are all women undergoing a surgical approach with frozen section analysis for highly suspicious ovarian masses or patients in whom an adnexal mass has been removed that appeared to be malignant and an open or laparoscopic surgical staging procedure is planned. PatientA 31-year-old woman with occult ovarian cancer after simple left ovarian cystectomy. InterventionsLaparoscopic surgical staging including simple hysterectomy, bilateral salpingo-oophorectomy, omentectomy, pelvic and aortic bilateral lymphadenectomy, and sentinel node biopsy from the left ovary. Measurements and Main ResultsThe surgical intervention was performed with the PinPoint 0 degree HD S1 SPY fluorescence camera (PinPoint Endoscopic Fluorescence Imaging System; NOVADAQ, Mississauga, ON, Canada). After the induction of the pneumoperitoneum, ICG was injected with 2 separate injections in the proper ovarian ligament and the infundibulopelvic ligament, just below the peritoneum, at a concentration of 1.25 mg/mL. A total amount of 0.4 mL ICG solution was injected using a percutaneous abdominal approach with a 12-cm-long 22-G spinal needle. SLN mapping should be preceded by the exposure of the aortic region with a gentle dissection on both sides along the Toldt fascia up to the left renal vein. Two SLNs were identified in the left inframesenteric para-aortic and superficial left common areas. Both SLNs were negative. ConclusionThe minimally invasive approach in combination with the ICG near-infrared fluorescence S1 PinPoint fluorescence system seems feasible, and, in our opinion, even if preliminary, this approach can further extend the range of indications of SLN mapping. In the future, this combined approach can prospectively involve ovarian SLN detection.

Synchronous occurrence of mature cystic teratoma of the fallopian tube and ovary: A case report.

Primary carcinoma of the fallopian tube represents <1% of all gynecological tumors, and benign tumors of the fallopian tube are encountered even less frequently. Mature teratomas of the fallopian tube and ovary are extremely rare, and to date, only a few cases have been reported. A 31-year-old woman presented with a left adnexal mass that was identified by pelvic ultrasonography during a regular checkup. The patient underwent laparoscopic left salpingectomy and left ovarian cystectomy. Histopathological examination of the removed tissue revealed features compatible with mature cystic teratomas of both the left fallopian tube and ovary. At 26 months post-surgery, the patient underwent a cesarean section at 39+2 weeks of gestation. A right ovarian cystic mass was incidentally identified during the procedure. Right ovarian cystectomy was performed, and histopathological analysis revealed the mass to be a teratoma. The patient continued to receive annual follow-up after surgical intervention and demonstrated no evidence of disease at a routine 2-year follow-up examination. The discussion of the present case is followed by a brief review of the literature.

Ovarian Teratoma With Concurrent Ectopic Pregnancy at Diagnostic Laparoscopy [4

BACKGROUND: Benign mature cystic teratomas account for approximately 33% of all benign ovarian neoplasms, with the majority occurring between the ages of 10 and 30 years. Studies have shown that approximately 60% are asymptomatic at diagnosis, and approximately 10% of cases are found during pregnancy. However, there have been few documented cases of a concurrent ectopic pregnancy with an ovarian teratoma. CASE: A 24-year-old multiparous woman presented with persistent pelvic pressure and pain over the course of a month. She had a plateauing β-hCG level without evidence of an intrauterine pregnancy. She underwent diagnostic laparoscopy, with findings of a ruptured right ectopic pregnancy and bilateral ovarian masses. The left ovarian mass measured 6 cm; as a result, both a right salpingo-oophorectomy and a left ovarian cystectomy were performed. Pathology confirmed a ruptured right ectopic pregnancy and bilateral benign mature cystic teratomas. CONCLUSION: The presence of enlarged ovarian teratomas can predispose patients to many complications such as ovarian torsion. Therefore, it may be beneficial to perform interventions such as an ovarian cystectomy at the time of surgery for other pathologies such as a ruptured ectopic pregnancy.

Case Report: A Laparoscopic Treated Case of Deep Infiltrating Endometriosis with Vaginal Invasion Diagnosed by Vaginal Cytology

A recently observed case of deep infiltrating endometriosis with its vaginal invasion diagnosed by vaginal cytology is reported. A 28-year-old Japanese woman complained of a severe dysmenorrhea. Left ovarian endometriotic cyst and deep infiltrating endometriosis were suspected. Two red-spots were also present in the posterior fornix of vagina. Vaginal cytology with cytokeratin (CK) 7-immunocytochemistry suggested the presence of infiltrating endometriosis. She underwent left ovarian cystectomy and resection of thickened uterosacral ligaments with vaginal endometriotic spots, under a laparoscope, based on the diagnosis of endometriotic cyst. Histopathology revealed DIE with vaginal invasion. Immunostaining for CK7 was positive for endometriotic cyst, while CK20 was negative. The stromal cells in endometriosis were immunohistochemically positive for CD10. The vaginal fornix was well-healed one month later the surgery. Postoperatively, she got pregnant with her natural intercourse and delivered a healthy 2138 g girl at 36 weeks of gestation.