Management Of Ovarian Masses Research Articles

The role of intraoperative consultation in the management of ovarian masses and endometrial carcinomas: a 7-year experience

The role of intraoperative consultation in the management of ovarian masses and endometrial carcinomas: a 7-year experience

Review of a 25-Year Experience in the Management of Ovarian Masses in Neonates, Children and Adolescents: From Laparoscopy to Robotics and Indocyanine Green Fluorescence Technology.

Background: Ovarian masses in pediatric populations are the most common abdominal masses in young girls. In neonates, the majority of masses are benign while in children and teen-agers the risk of malignancy exists. The aim of this study is to perform a 25-year experience retrospective analysis of clinical and therapeutic aspects of ovarian tumors in girls, in order to show how the development of minimally invasive technology has changed the management of this pathology. Methods: The records of patients under the age of 18 who were operated in three pediatric surgical units due to ovarian mass, in the last 25 years, were reviewed retrospectively. The study group comprised 147 patients operated between 1996 and 2021 with a diagnosis of ovarian masses. Data involved were demographical, surgical, follow-up and final diagnosis. We analyzed the type of surgical technique, intra-operative data (operative time, the use of different technologies), complications, length of stay and long-term follow-up. Based on these data, we assessed how the surgical approach to ovarian masses has changed in the last 25 years in newborns and young girls. Results: The patients ages ranged between 7 days and 15 years (median, 59 days). All the procedures were completed in laparoscopy or robotics without conversion in open surgery. One-hundred and eleven patients were neonates; they all had follicular cysts and they were all managed in laparoscopy using 1 or 3 trocars. In 80/111 patients (72%), a small part of ovarian parenchyma was saved; in 31/111 patients (28%), in which the ovarian parenchyma was not available, an ovariectomy was performed. Patients in which we saved a small part of ovary, at long term follow-up (minimum follow-up of 12 years) (29/80, 36%), developed a normal ovary at US control. Thirty-six were older patients. They had a histological diagnosis of benign (30) or malign (6) tumors. All the patients (8/36) with a pre-operative suspicion of ovarian malignancy received an ovariectomy and an adnexectomy using sealing devices. In the last 10 years in all the children, except neonates, we adopted sealing devices and, in the last 4 years, in 20 cases, we always adopted ICG fluorescence technology to check ovarian vascularization in case of torsion or to check lympho-nodes condition in case of malignancy. Conclusions: In neonatal ovarian cysts, surgical management remained unchanged and an ovarian sparing procedure is always indicated and the long-term follow-ups confirm this hypothesis. The principal innovation in this age period is the use of ICG fluorescence technology to check ovarian vascularization in case of torsion. In teenagers, the decision-making strategy is based on the tumoral markers and on the morphological aspects of the mass. Robotics cystectomy or ovariectomy now-days represents the safer and faster way to perform this. Sealing devices are essential tools for dissection and resection to avoid bleeding. ICG fluorescence technology in all ages is fundamental to check ovary vascularization after detorsion or to check lympho-node status in case of malignancy. All the suspected lesions have to be removed with an endo-bag.

Torsion of ovarian mass-A diagnostic dilemma to tissue diagnosis

A holistic and multidisciplinary approach is required for ovarian cancer diagnosis and management. Ovarian tumor diagnosis is based on clinical symptomatology followed by radiological confirmation. Tumor markers are considered just adjunct. Management of ovarian mass is surgical and intra -op frozen section aids in understanding the nature of the mass but histopathology is definitive. Ovarian torsion affects 2.5 to 7.4% of all ovarian tumors. The present case will highlight the destructive changes brought about by torsion which could ultimately result in missed tissue diagnosis.

Management of ovarian masses in postmenopausal women

Introduction: The discovery of an adnexal mass in the postmenopausal period is a common situation and concerns 15 to 20% of this population. The development of gynecological ultrasound and technical advances in medical imaging as well as advances in laparoscopic surgery have changed the management of these ovarian tumors.

Clinical Spectrum and Management of Ovarian Masses in Children and Adolescent up to 20 Years of Age

Pathological type as well as management of ovarian tumor in the pediatric population are different than adult women. We performed a retrospective analysis of clinical and diagnostic aspects of ovarian tumors and tumor-like lesions in girls in order to identify characteristics associated with malignancy and it’s clinical management which is different from adult women. This is a descriptive type of cross sectional study was condunted among seventy nine female children and adolescent admitted in Bangabandhu Sheikh Mujib Medical University (BSMMU) with ovarian mass from January 2017 to December 2020. Secondary data were collected from hospital record review. The demographic data, diagnostic procedure, management and histopathological analysis of the ovarian tumor were recorded. Mean age of study population was 16.7±3.1 and age range was 8-20 Years. Benign and malignant ovarian tumor was 40.50% and 59.49% respectively. The main symptom and sign were abdominal pain and palpable mass were found in 51% and 50% cases respectively. Malignant lesion appeared as cystic in 22.44%, solid 44.89% and mixed in 32.65% cases. But benign ovarian tumor was found predominantly as cystic in 70% cases preoperatively. More than three fourth (75.51%) of malignant ovarian tumor showed one or more positive tumor marker whereas one third (33.33%) benign tumor had raised tumor marker. Large lesions in both benign and malignant cases were found in almost similar number of cases and these were 80% and 81% respectively. In the group of solid tumors, positive tumor marker results occurred more frequently in patients with malignant tumor (57.14%). Elevated serum alpha feto protein (AFP), Human Chorionic Gonadotrophin (HCG) and high Lactate Dehydrogenage (LDH) value associated more often with malignant tumor. Laparotomy was performed in all cases of study population. Among 49 malignant ovarian tumour 34 (69.3%) underwent ovary preserving surgery. All patient with benign ovarian tumor undergone conservative surgery. Predominantly solid structures noted on imaging studies, large dimension and positive tumor markers are clinical predictors of malignancy. Multicenter prospective studies are needed to improve and unify the ovarian preservation rates across the world.
 Bangladesh Med J. 2021 January; 50(1) : 1-9

How should the management of ovarian masses in children?

Introduction: Prevalence of ovarian masses in children increase due to easy access to imaging techniques. There are conflicting views about evaluation and classification of ovarian masses for neoplasia in such age group in the literature. Material and methods: The patients who were monitored and treated because of ovarian mass in pediatric surgery and obstetrics and gynaecology clinics were reviewed retrospectively. Demographic data, symptoms, dimensions and lateralization of the mass, serum tumour markers, histopathological evaluation results, and treatment outcomes of the patients enrolled in were recorded. Ovarian masses of the participants were divided into two groups as non-neoplastic group (NNG) and neoplastic group (NG) depending on imaging techniques, serum tumour markers and histopathological analysis results. Results were statistically reviewed. Results: There was not any statistical difference between NG and NNG for age, body mass index, mass diameter, initial symptoms, and mass lateralization (p>0.05). Review of ovarian masses reported by imaging techniques revealed that pure cystic appearance was statistically significant for NNG (p=0.012). Duration of the surgery and hospitalization were detected shorter in NNG treated laparoscopically (p=0.023). Conclusion: Surgical treatment of ovarian masses in children should be ovarian protective as much as possible. However, there is not any reliable and proven marker that may differentiate a benign ovarian mass from a malignant ovarian mass in paediatric patients like adult population. A detailed medical history, physical examination, imaging methods, and adequate tumour markers should be used for preoperative evaluation of adnexial masses.

Management of ovarian masses in pregnancy: patient selection for interventional treatment

ObjectiveThe management of pregnant women with an adnexal tumor is still challenging and in the literature few data are available. The aim of this study was to describe the management...

VP66.29: Clinical management of ovarian masses in pregnancy

VP66.29: Clinical management of ovarian masses in pregnancy

OC04.05: Management of ovarian masses during pregnancy in a London university hospital: a cohort study

OC04.05: Management of ovarian masses during pregnancy in a London university hospital: a cohort study

Ovarian masses in pediatric patients: a multicenter study of 98 surgical cases in Tunisia

Ovarian masses requiring surgical intervention are uncommon in the pediatric population. Our aim is to report results of a multicentric Tunisian study concerning the clinical practice and the management of pediatric ovarian masses and to identify the factors that are associated with ovarian preservation. Between January 2000 and December 2015, 98 pediatric patients (<14 years) were surgically treated for ovarian masses at the five pediatric surgery departments in Tunisia. Ninety-eight patients were included in this study. The mean age of the patients at time of surgery was 8.46 ± 4.87 years. Sixty-three ovarian masses (64.3%) were non-neoplastic lesions, 24 (24.5%) were benign tumors, and 11 (11.2%) were malignant neoplasms. Conservative surgery (ovarian-preserving surgery) was successfully performed in 72.4% of the benign lesions, whereas only three patients (27.3%) with malignant tumors underwent ovary-sparing tumor resection (p < .001). The mean diameter of the tumors in the patients who underwent oophorectomy was significantly larger than that in the patients who underwent conservative surgery (7.8 ± 3.9 cm vs. 5.7 ± 2.9 cm, respectively, p = .001). In our study, the risk factors for oophorectomy were a malignant pathology and large tumor size. In accordance with the Gynecologic Cancer Intergroup consensus, we recommend that surgical management of ovarian masses in children should be based on ovarian-preserving surgery.

Laparoscopic cystectomy in pregnancy, a viable solution - A 14 years series.

Study objective:To evaluate the safety and maternal fetal outcome of laparoscopic surgery in the management of ovarian mass in pregnant women and the usage of analgesia in postoperative period.Materials and methods:This is a retrospective cross-sectional study which was carried out at department of O&G, Putrajaya Hospital. A total of 120 cases of ovarian mass in pregnancy between Jan 2000–December 2014 were evaluated. 115 patients had undergone laparoscopy cystectomy/salpingo-oophorectomy. Women’s age, parity, gestational age, surgical technique, operative findings and time, estimated blood loss, postoperative hospital stay, post operative pain score, usage of analgesia, complications of surgery, outcome of the pregnancy and histopathology reports were evaluated.Measurement and main results:Outcome of the pregnancy and post operative pain score and usage of analgesic were evaluated. The mean gestational week at the time of surgery was 14 weeks 1 day (±2 weeks 1 day). The duration of surgery was 87.4 mins (±34.8 mins) with average blood loss of 110.3 ml (±32.0). Median size of ovarian cyst was 6 cm (IQR 2 cm). 2 cases converted to laparotomy. Only 2 cases were reported with second trimester loss which was diagnosed after 4 weeks and 10 weeks respectively. 5 women received tocolytic agent post operatively, all of them delivered at term.The mean length of hospitalization was 1.51 day (±0.597). The average gestational age of delivery was 37.78 (±3.42) mean birth weight 2.97 kg (±0.65 kg). There was one intrauterine growth restriction baby with birth weight of 1.89 kg at 35 weeks of gestation and another baby with bladder exstrophy with ambiguous genitalia which was not related to surgery. The mean of pain score was 1.5 (±1.6) over 10. 87.9% of the women had mild pain which only 64.6% require paracetamol or no analgesia.Conclusion:Majority of women with ovarian masses in pregnancy can be treated with ensured safety and reduced morbidity using the endoscopic approach.

Ovarian needle aspiration in the diagnosis and management of ovarian masses.

ObjectiveOvarian needle aspiration and biopsy (ONAB) may be employed for pretreatment diagnosis of ovarian malignancies or intraoperatively to facilitate removal of ovarian masses. However, there is reluctance to utilize this procedure due to potential cyst rupture or seeding of malignant cells. The objective of this study was to examine the efficacy of ONAB over a 13-year period at our institution.MethodsBetween 2000 and 2013, all ONAB specimens were identified from the Queen's Medical Center Pathology Department database. All cytologic specimens were reviewed and correlated with histopathologic findings. A retrospective chart review was conducted to retrieve data on clinical course and treatment.ResultsThis study identified 144 cases of ovarian masses sampled by aspiration or needle biopsy between 2000 and 2013. Ninety-two (64%) cases had corresponding histopathology, 84 (91%) of which were obtained concomitantly. On histology, 12 (13%) cases were malignant and 80 (87%) benign. Three false negative cases were noted; 2 serous borderline tumors and 1 mucinous cystadenocarcinoma. These were sampling errors; no diagnostic tumor cells were present in the aspirates. Sensitivity and specificity of ONAB in the detection of malignancy were 75% and 100%, respectively. The positive and negative predictive values were 100% and 96%, respectively.ConclusionONAB represents a valuable tool in the diagnosis of malignancy and treatment of ovarian masses. In our study, it was highly specific, with excellent positive and negative predictive value.

Ovarian Torsion in the Third Trimester of Pregnancy Leading to Iatrogenic Preterm Delivery.

Ovarian torsion in the third trimester of pregnancy leading to a midline laparotomy and caesarean section for the delivery of a preterm baby is an uncommon event. As the woman is likely to present with nonspecific symptoms of lower abdominal pain, nausea, and vomiting, ovarian torsion can often be misdiagnosed as appendicitis or preterm labour. Treatment and the opportunity to preserve the tube and ovary may consequently be delayed. We report the case of a multiparous woman who had undergone two previous caesarean sections at term, presenting at 35 weeks of gestation with a presumptive diagnosis of acute appendicitis. Ultrasonography described a cystic lesion 6 × 3 cm in the right adnexa, potentially a degenerating fibroid or a torted right ovary. MRI of the pelvis was unable to provide further clarity. The patient was managed by midline laparotomy and simultaneous detorsion of the ovarian pedicle and ovarian cystectomy together with caesarean section of a preterm infant. This report describes that prompt recognition and ensuring intraoperative access can achieve a successful maternal and fetal outcome in this rare and difficult scenario. Furthermore, we would like to emphasise that the risk for a pregnant woman and her newborn could be reduced by earlier diagnosis and management of ovarian masses (Krishnan et al., 2011).

Role of Intraoperative Frozen Section in Surgical Management of Ovarian Masses

Role of Intraoperative Frozen Section in Surgical Management of Ovarian Masses

Role of frozen section in the intraoperative management of ovarian masses

Abstract Objective To evaluate the performance and limitations of FS in the intraoperative evaluation of ovarian masses. Design Retrospective descriptive study. Methods The case records of patients presenting with ovarian masses who underwent surgery and intraoperative FS assessment between January 2009 and December 2012 were analyzed. Demographic and clinical data were reviewed. Data on FS analysis were compared with the final diagnosis on paraffin section. Results Sixty patients with ovarian masses undergoing surgery and FS were included. Four cases had the diagnosis at the time of FS deferred (6.6%). In the remaining 56 patients, the FS diagnoses were benign in 24 (40%), borderline in 9 (15%), and malignant in 23 (38.4%), whereas the final diagnosis was benign in 23 (38.4%), borderline in 11 (18.3%), and malignant in 26 (43.3%). The overall accuracy of intra-operative FS diagnosis was 95.5%. The sensitivity for FS diagnosis was 100% for benign, 72.7% for borderline and 88.4% for malignant category, whereas the specificity was 97.3%, 97.9%, and 100.0%, respectively. There were 4 cases with discordance between the FS diagnoses and the final diagnoses, all of which were under-diagnosed by FS. Conclusion Frozen section is a good tool for decision making at the time of ovarian surgery but does not always provide an immediate solution. However a large prospective study is recommended.

OC14.02: The additive value of HE4 novel tumor marker to the IOTA simple rules in the management of ovarian masses

<scp>OC</scp>14.02: The additive value of <scp>HE4</scp> novel tumor marker to the <scp>IOTA</scp> simple rules in the management of ovarian masses

Unexpected ovarian malignancy after conservative laparoscopic surgery: five case series in a half decade of experience

To analyse and describe cases of unexpected ovarian malignancy after conservative laparoscopic surgery for an apparent benign ovarian mass at our centre. This retrospective study was performed by collecting data from records of premenopausal women who underwent conservative laparoscopic surgery for benign ovarian mass at Siriraj Hospital over a 5 year period from 2006 to 2010. The rate of unexpected malignancy, histopathological type of the ovarian neoplasm and follow-up after surgery were reviewed. During the study period, 1,161 patients underwent conservative laparoscopic surgery. Of these, five (0.43%) had ovarian malignancy which were diagnosed after reviewing histopathological report postoperatively. The histopathological diagnosis was borderline tumour in two patients, clear cell carcinoma, granulosa cell tumour and mucinous cell adenocarcinoma in the other three patients. All patients are alive after a mean follow-up of 9-60 months with two patients developed recurrence. The main concern for laparoscopic management of ovarian masses is unexpected malignancy. However, with careful patient selection, proper technique and an experienced operator, laparoscopic treatment of ovarian masses is the best approach and should be implemented, with low risk of unexpected malignancy and recurrence.

The management of ovarian pathology in pregnancy

The extensive use of ultrasound in early pregnancy populations has led to more ovarian lesions being diagnosed incidentally in asymptomatic gravid women. The majority of these lesions are physiological in nature and tend to resolve spontaneously as the pregnancy progresses. Expectant management or a "watch and wait" approach is the benchmark standard of care for a woman with an ovarian mass diagnosed during pregnancy. This approach assumes the woman is relatively asymptomatic, and the likelihood of malignancy is negligible. The prevalence of malignancy in pregnancy is rare indeed, i.e. 1 in 15,000-32,000. It is the discriminatory ability of ultrasound, in experienced hands, to distinguish between benign and malignant ovarian lesions that allow appropriate triaging during pregnancy. Discriminating benign from malignant masses is crucial not only to optimize the management of malignancies, but also to avoid unnecessary intervention that may adversely affect maternal or foetal outcomes. This review will focus on the management of ovarian masses in pregnancy.

QS437. Pediatric Surgeon Versus Gynecologist: Does Surgical Training Impact Outcomes in Management of Ovarian Masses?

QS437. Pediatric Surgeon Versus Gynecologist: Does Surgical Training Impact Outcomes in Management of Ovarian Masses?

Management of ovarian masses in pregnancy

AbstractWith the increasing use of prenatal ultrasonography, identification of ovarian masses during pregnancy is becoming more common. The author considers how these can be evaluated and managed, and looks at factors that may help determine the need for surgical intervention. Copyright © 2009 Wiley Interface Ltd