Left Ovarian Cystectomy Research Articles

二期的腹腔鏡下手術にて治療をおこなった卵巣島状カルチノイドの1例：最近の腫瘍分類に基づく治療方針

Objective: To report a case of ovarian carcinoid.Design: Case report.Patient: A 31-year-old woman with a mature cystic teratoma.Intervention: Diagnostic and therapeutic laparoscopic surgery.Results: We performed a laparoscopic left ovarian cystectomy as the primary surgery. The pathological diagnosis was insular carcinoid with a mature cystic teratoma. As a secondary surgery, we performed a laparoscopic left salpingo-oophorectomy. No malignant cells were found.Conclusion: Appropriate management of ovarian carcinoid has not been elucidated to date. A review by Gardner GJ, et al. published in Journal of Gynecologic Oncology may be useful for appropriate management of these tumors. This case may contribute to a further understanding of these tumors.

Bilateral ovarian metastasis of non-small cell lung cancer with ALK rearrangement

The discovery of a distinct subtype of non-small cell lung cancer (NSCLC) positive for rearrangement of the anaplastic lymphoma kinase gene (ALK) has had a substantial impact on personalized therapy for this disease. The clinical features associated with metastasis in individuals with ALK rearrangement-positive NSCLC remain to be fully characterized, however. We now describe a case of ovarian metastasis from NSCLC with ALK rearrangement. A 39-year-old woman underwent a right middle lobectomy for acinar-type adenocarcinoma of the lung (pT2aN2M0, stage IIIA). Fluorescence in situ hybridization (FISH) analysis of the resected tumor tissue revealed the presence of an ALK rearrangement. Twenty months later, a large intrapelvic mass was detected in the patient at follow-up. She underwent both left salpingo-oophorectomy and right ovarian cystectomy. Histological examination of the ovarian tumors showed acinar adenocarcinoma, and FISH analysis revealed the presence of ALK rearrangement, confirming a diagnosis of ALK rearrangement-positive NSCLC with ovarian metastasis. Although the ovary is an uncommon site for metastasis from lung cancer, physicians should be aware of the possibility for such metastasis during follow-up for female patients with ALK rearrangement-positive NSCLC. Further investigation is warranted to clarify the incidence of ovarian metastasis in NSCLC patients with ALK rearrangement.

Presentation of a Patient who Underwent Fertility-Sparing Surgeries for Contralateral Recurrence of Ovarian Immature Teratoma with Gliomatosis Peritonei

We report a patient who has maintained a regular menstrual cycle despite undergoing cystectomy and chemotherapy for contralateral recurrence of ovarian immature teratoma with gliomatosis peritonei. We initially performed a fertility-sparing right salpingo-oophorectomy, omentectomy and peritoneal biopsy for immature teratoma with gliomatosis peritonei, with adjuvant chemotherapy; we performed a left ovarian cystectomy and peritoneal biopsy for mature cystic teratoma with gliomatosis peritonei 16 months after the first surgery, a fertility-sparing left ovarian cystectomy and peritoneal biopsy for contralateral recurrence of ovarian immature teratoma with gliomatosis peritonei 60 months after the first surgery, and a left ovarian cystectomy and peritoneal and external iliac lymph node biopsy for endometrial cyst with gliomatosis peritonei 71 months after first surgery. The peritoneal gliomatosis lesions gradually decreased through the 4 surgeries over 8 years. The patient has maintained a regular menstrual cycle and currently shows no evidence of disease.

Benign multicystic peritoneal mesothelioma mimicking recurrence of an ovarian borderline tumor: a case report

IntroductionBenign multicystic peritoneal mesothelioma is an extremely rare tumor that occurs mainly in women in their reproductive age. Its preoperative diagnosis and adequate treatment are quite difficult to attain.Case presentationOur patient was a 23-year-old Japanese woman who had a history of right oophorectomy and left ovarian cystectomy for an ovarian tumor at 20 years of age. The left ovarian tumor had been diagnosed on histology as a mucinous borderline tumor. Two years and nine months after the initial operation, multiple cysts were found in our patient. A laparotomy was performed and her uterus, left ovary, omentum and pelvic lymph nodes were removed due to suspicion of recurrence of the borderline tumor. A histological examination, however, revealed that the cysts were not a recurrence of the borderline tumor but rather benign multicystic peritoneal mesothelioma. There were no residual lesions and our patient was followed up with ultrasonography. She remains free from recurrence nine months after treatment.ConclusionWe report a case of benign multicystic peritoneal mesothelioma mimicking recurrence of an ovarian borderline tumor. Benign multicystic peritoneal mesothelioma should be suspected when a multicystic lesion is present in the pelvis as in the case presented here, especially in patients with previous abdominal surgery.

Ovarian Hernia : A rarity = فتق المبيض : حالة نادرة

Ovarian hernias are extremely rare. The prevalence of ovaries and fallopian tubes in operable inguinal hernias is only about 2.9%. We report here an unusual case of an ovary in a hernia sac in an adult female. She presented with symptoms and signs of an incarcerated left inguinal hernia. The left ovary contained a haemorrhagic cyst and, along with the left fallopian tube and broad ligament, these were found in the sac. She underwent a left ovarian cystectomy and the inguinal hernia was repaired with mesh.

Strumosis peritoneal: estudio de extensión con 99mTc-pertecnectato

We report the case of a 35-year-old nulliparous woman, with a previous history of ovarian cystectomy diagnosed 3 years earlier due a struma ovarii type of monodermal teratoma in the right ovary and a hemorrhagic cyst in the left ovary. Progressive growth of the left adnexal mass was observed in the periodic medical check-ups. Due to this, a second laparoscopy was performed and, based on the findings, a left ovarian cystectomy, right salpingectomy and resection of multiple peritoneal implants were carried out.The pathology diagnosis was left struma ovarii and peritoneal strumosis. A whole body and SPECT/CT scan with 99mTc-pertechnetate was performed to detect possible peritoneal implants. This study helped to make the therapeutic decision.

Violence, malignant catatonia or anti-NMDA receptor encephalitis: a case report

We present the case of a 25-year-old woman who initially presented after committing an assault resulting in serious injury. She exhibited recent onset psychiatric symptoms which were later followed by a rapid deterioration in her physical health. She was treated with electroconvulsive therapy on a medical intensive care unit for a presumptive diagnosis of malignant catatonia. A test for anti-NMDA receptor antibodies returned positive. She was treated with IV immunoglobulin (IVIg) and high dose steroids, then underwent a left ovarian cystectomy. She was subsequently treated on a psychiatric intensive care unit until discharge.

Bilateral Herniation of the Ovaries into the Anterior Compartment of the Pelvis

A 41-year-old woman had a 6-month history of pelvic pain and heavy periods. She had no significant gynecologic or surgical history. Pelvic ultrasonography revealed a large complex cyst measuring 5.1 ! 5.4 ! 5.4 cm within the right adnexa (Fig. 1). CA 125 was minimally increased at 44. During laparoscopy, both ovaries were found to have herniated through the broad ligament into the anterior compartment. The round and ovarian ligaments had their usual attachments to the uterus. Bilateral ovarian cysts were observed, both approximately 5 cm in greatest diameter. The right ovary was densely adherent to the pelvic side wall. No other pelvic or upper abdominal disease was noted. A perioperative diagnosis of bilateral ovarian endometrioma was made. Laparoscopic right salpingo-oophorectomy and left ovarian cystectomy were performed with the ovaries in their abnormal location. Histologic analysis confirmed endometriotic cyst in the right ovary and hemorrhagic corpus luteum in the left ovary. Defects in the broad ligament can be congenital or acquired. Acquired defects can result from pelvic surgery, pregnancy, or pelvic inflammatory disease. Although herniation of bowel through the broad ligament has been described [1–4], to our knowledge, there are no reports of bilateral ovarian herniation through defects of the broad ligament.

Pediatric borderline ovarian tumors: a retrospective analysis

Background/PurposeBorderline ovarian tumors (BOTs) are uncommon in the pediatric population, and there have been limited studies that have included a small number of patients. In present study, we evaluated the clinical outcomes and the rates of recurrence of pediatric BOTs with larger sample size than those in previous studies. MethodsA retrospective chart review was performed on 29 patients who were treated for histopathologically confirmed BOTs at our institution between January 1997 and December 2009. ResultsTwenty-nine patients (median age, 18 years) had a large-sized tumor (median, 19.8 cm). Abdominal pain was the most common symptom, seen in 82.8% of the patients, followed by abdominal distension. The permanent section histology revealed 25 mucinous (86.2%) and 4 serous type tumors (13.8%). There was considerable discordance between the permanent and frozen sections (rate of concordance, 55.1%). Disease stage was IA in 26 patients (89.7%) and stage IC in the other 3 patients (10.3%). All patients underwent fertility-preserving surgery. Overall, 4 patients (13.8%) experienced a clinically suspicious recurrence requiring surgery. In 2 cases, the suspected recurrences were found to be other benign ovarian tumors. In one case that was initially treated with left ovarian cystectomy for a mucinous BOT, subsequent left salpingo-oophorectomy confirmed recurrence of a mucinous BOT at 16-month follow-up. The last case was a newly developed primary ovarian mucinous carcinoma with no evidence of recurrence of a previous mucinous BOT at 26-month follow-up. ConclusionsThis study shows that BOTs in pediatric populations can be successfully treated conservatively to preserve fertility with no apparent increased risk of morbidity or mortality compared with those of more radical surgical options.

A Rare Triple Coexistence Of A Collision Tumor, A Benign Mature Cystic Teratoma And A Hemorrhagic Follicular Cyst Of The Ovaries

Ovarian collision tumors are rare entities and most commonly consist of a benign mature ovarian teratoma and an ovarian cystadenoma or cystadenocarcinoma. Serous cystadenomas are the most common ovarian neoplasms, representing 20% of them. Benign mature ovarian cystic teratomas are often diagnosed in women of child-bearing age (12-15% of ovarian neoplasms). Benign mature ovarian solid teratomas are less common than the cystic ones. Follicular cysts are cysts of unruptured mature ovarian follicles. We present a rare case of a triple coexistence of a large collision tumor (consisting of a serous cystadenoma and a benign mature cystic teratoma) in the right ovary and a benign mature solid teratoma and a hemorrhagic follicular cyst in the left ovary of a young-aged woman, with a palpable mass in the lower abdomen. Right-sided salpingo-oophorectomy and left ovarian cystectomy preserving as much intact ovarian tissue as possible, took place. The possible existence of an ovarian collision tumour should carefully be examined preand postoperatively and histologically, so as to avoid misdiagnosis of a possible malignancy.

Inguinal endometriosis attaching to the round ligament

We report a case of endometriosis in the right inguinal region, attached to the right round ligament in a 28-year-old woman. At the age of 20, laparoscopic left ovarian cystectomy and pelvic adhesiolysis for endometriosis was carried out. She noticed a right tender groin mass 7 months previously, and the tumour size fluctuated with the menstrual cycle. A poorly circumscribed elastic hard mass, measuring 3 cm in diameter, was palpated in her right inguinal region. Magnetic resonance imaging showed a 2.5 cm x 2.5 cm mass in the right inguinal canal and a 5.4 cm x 6.8 cm mass was seen in the left ovary. The mass enlarged during menstruation. The groin mass was removed, in addition to carrying out laparoscopic ovarian cystectomy. At operation, the groin mass was found to be in continuity with the round ligament of extraperitoneal portion. Histological diagnosis of endometriosis was made in both ovarian and inguinal tumours. After surgery, the pain disappeared completely. Worth mentioning is that MRI clearly showed the change of tumour size depending on the menstrual cycle, which aided in arriving at the correct diagnosis of endometriosis in an unusual location.

Haemoperitoneum following coitus with no associated vaginal injury

Postcoital haemoperitoneum resulting in shock rarely occur without evident vaginal injury. A 24 year old Para 0 ±4 women presented to the emergency unit in shock with a history of fainting attack and severe absominal pain of 6 hours duration. Pain was felt immediately after coitus and was so severe that the patient had a blackout. Ultrasound scan revealed a left adnexal mass and fluid in the peritoneal cavity. At laparatomy more than 2 litres of fresh blood was found in the peritoneal cavity. The left ovary was enlarged by a haemorrhagic cyst with 3 bleeding points. The left fallopian tube was slightly oedematous with 2 areas of haemorrhagic spots but no obvious bleedig. Left ovarian cystectomy was done. Haemostasis was secured. Mary Slessor Journal of Medicine Vol. 5(2) 2005: 70-72

A case of ovarian mature cystic teratoma presenting as a pedunculated ileal tumor

We report on a 34-year-old Japanese woman who presented with a pedunculated ileal tumor and who was finally diagnosed as having a right ovarian mature cystic teratoma penetrating and protruding into the ileum. She had undergone laparoscopic left ovarian cystectomy, whose specimen was diagnosed as dermoid cyst when she was 27 years old. The colon fiberscope revealed an ileal polyp, diagnosed as mature teratoma. Because of adhesion to the necrotic nodule between the tumor and the right ovary, ileocecal resection and right ovarian cystectomy were performed. The ileal tumor contained tissues of skin, neuroglia, ganglion, choroid, retina, smooth muscle, as well as fibrous and adipose tissues, cartilage, bone, mucous epithelium, and bronchial structures with bronchial glands. The necrotic nodule showed abscess, granulation tissue, foreign body reaction, hairs, normal ileal epithelium, and the ovary with ovums.

Recurrent laryngeal nerve paralysis after laparoscopic surgery

To present a case of recurrent laryngeal nerve paralysis after laparoscopic surgery.A 26‐year‐old nulligravid woman.The patient underwent laparoscopic left ovarian cystectomy and myomectomy under general anaesthesia. A few hours later, she complained of throat discomfort and hoarseness. Indirect laryngoscopy showed an immobile left vocal cord. The hoarseness continued for 4 weeks.Recurrent laryngeal nerve paralysis might present as a complication of laparoscopic surgery under general anaesthesia.

Gynaecology Case Reports

replacement of the myometrium by adenomyosis. Th e fallopian tubes appeared macroscopically normal. Haematoxylin and eosin (H & E) staining showed classical features of adenomyosis with endometrial glands and myometrial hyperplasia throughout the uterus. Routine histology of the fallopian tubes was normal. Immunohistochemical staining of the uterus of full thickness samples from the endometrium to the serosa with anti-S100 confi rmed widespread absence of nerves at the endometrial – myometrial interface, and, throughout the adenomyosis. Th e isthmus of both fallopian tubes showed complete loss of nerves in the inner layer of longitudinal smooth muscle (Figure 1). Case report 2 A 48-year-old, Chinese woman presented with a 5-year history of painful, irregular periods. Ten years previously, she had a left ovarian cystectomy, myomectomy and sterilisation. Five years previously, she underwent hysteroscopy and curettage for simple endometrial hyperplasia. She had two previous vaginal deliveries and a mid-trimester miscarriage requiring surgical evacuation of the uterus. CA125 was normal; ultrasound examination demonstrated adenomyosis and a small right, ovarian cyst. She underwent laparoscopic subtotal hysterectomy with bilateral salpingectomy and right ovarian cystectomy. Th e postoperative course was uncomplicated. Histology confi rmed a uterus weighing 160 g and extensive adenomyosis. Th ere was evidence of collateral sprouting of nerve bundles and abnormal nerves in the subserosal and subendometrial layers of the uterus. Th e fallopian tubes showed loss of nerves in the inner longitudinal muscle layer (Figure 1). Th e Ethics Committee of the Women ’ s Hospital, University of Zhejiang gave permission for these studies. Discussion Th ese reports confi rm previous observations of absence of nerves at the endometrial – myometrial interface and throughout the proliferating columns of adenomyosis in diff erent clinical presenta

Endometriosis of the liver

A 40-year-old woman with known recurrent endometriosis was referred to us by the gynecologists because of an asymptomatic liver lesion. She was multiparous with four previous pregnancies. Ten years ago she had pelvic endometriosis affecting the left ovary, and a left ovarian cystectomy was performed. Three years ago she presented again with recurrent dysmenorrhea and bleeding per vagina. A sonogram revealed a posterior fundal fibroid and a recurrent hemorrhagic cyst in the left ovary. The diagnoses were recurrent pelvic endometriosis and uterine fibroid.

Vascular pedicle transposition of an ovary with subsequent intrauterine pregnancy

In a patient who underwent both a right salpingectomy because of right tubal pregnancy and left ovarian cystectomy due to an ovarian cyst, we performed an operation whereupon the normal right ovary was shifted toward the position of the left ovary together with the pelvic infundibular ligament. By observation of the ovarian follicle through ultrasonic tomography, the follicle, as seen only from the right preoperatively, was seen only from the left after the operation. The patient delivered a baby by normal pregnancy 3 months after the operation. This method requires no complicated technique and could prove to be a promising therapeutic procedure treating patients with infertility.

Ovarian Pregnancy-A Case Report

This article describes a case of ovarian pregnancy without the presence of an IUD. The patient, a 33-year old Indian woman para 4, presented with right iliac fossa pain and 8 weeks of amenorrhea. There was no history of contraceptive use. The initial diagnosis was twisted ovarian cyst; however, ultrasonography revealed an enlarged uterus with a gestational sac. At laparotomy, a right solid ovarian mass was found anterior to the uterus and adherent to the uterus, bladder, and the rectosigmoid junction. The mass was mobilized and a right salpingo-oophorectomy was performed along with left ovarian cystectomy and tubal ligation. Microscopic examination indicated a developing embryo of 6 weeks gestation. Ovarian pregnancy has been reported in 1/10,000-40,000 pregnancies and represents 0.5-2.0% of all ectopic pregnancies. 12-20% of ectopic pregnancies in the presence of an IUD are ovarian as are 0.5% of all pregnancies occurring in IUD users. It is speculated that, in this case, fertilization took place outside the ovary and reimplantation occurred. Diagnosis of ovarian pregnancy generally requires 4 criteria: 1) the tube on the affected side must be intact; 2) the fetal sac must occupy the normal position of the ovary; 3) the ovary and sac must be connected to the uterus by the utero-ovarian ligament; and 4) definite ovarian tissue must be present in the sac wall.

Utilization of contralateral fallopian tube segments in tubal reanastomosis

A 38-year-old patient who had had a left ovarian cystectomy, partial salpingectomy, and laparoscopic cauterization of the right fallopian tube, underwent reanastomosis to attempt pregnancy. Only 3 cm of the left isthmic tubal segment were attached to the uterus; on the right, 7 cm of the distal fallopian tube was present, with the missing segment being at the uterine cornua; endometriosis was present at the site of cauterization at the right cornual area. After excision of the endometriosis, the surgeon performed anastomosis of the left proximal fallopian tubal segment to the right distal fallopian tubal segment without homotransplantation of the adnexa. The patient conceived in the 2nd cycle after hospital discharge. This new technique of tubal reanastomosis, which utilizes the patient's remaining fallopian tube segments, may give the microsurgeon another surgical option regarding tubal reanastomosis.