Mucinous Ovarian Cystadenoma Research Articles

Combined removal of ovarian teratoma and oocyte retrieval by laparoscopic surgery under regional anesthesia

To describe the simultaneous laparoscopic approach for teratoma removal and oocyte retrieval performed under regional anesthesia in a woman, desiring to preserve fertility. The patient included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites, and other applicable sites. Video case report demonstrating the clinical management and laparoscopicteratoma removal combined with oocyte retrievalaccomplished underregional anesthesia. University tertiary care hospital. We present a case of a 31-year-old woman who referred to our Fertility Center with a previous history of right salpingo-oophorectomy for mucinous ovarian cystadenoma and the presence of a large ovarian teratoma of ten centimeters of the contralateral ovary. The ovarian stimulation started in the early follicular phase. Not being able to visualize follicular growth during the ovarian stimulation, it was decided to adopt fixed protocol with antagonist on the 5th day and to proceed, on 15th day, with a laparoscopic pick-up and simultaneous removal of the cyst. Laparoscopic surgery was performed: the left ovary appeared larger in size for the presence of the suspicious mature dermoid cyst and multiple follicles, previously not identified at ultrasound imaging. The follicles contained oocytes that were aspirated with an aspiration needle of 17 G connected to a craft suction pump. Then, practicing the stripping technique, an enucleation of the ovarian cyst was performed. Surprisingly, the removal of the cyst revealed other follicles that were readily aspirated. The patient remained awake during the entire procedure and a low pressure of 10 mmHg was maintained at 15° of Trendelenburg position. A total of seven follicles were aspirated, seven oocytes were retrieved, and six mature oocytes were cryopreserved. The cyst was totally removed and no intracavitary spillage was caused. Simultaneous laparoscopic approach for teratoma removal and oocyte cryopreservation should be considered an effective fertility preservation strategy in patients in whom the presence of an ovarian neoformation does not allow visualization of growing follicles by ultrasound. Laparoscopic oocyte retrieval under regional anesthesia is a safe and well-tolerated technique and should be considered for patients where the transvaginal approach could not be performed.

Extremely high levels of CA199 antigen in borderline mucinous ovarian cystadenoma.

SynopsisA case report on a patient with a mucinous borderline ovarian cystadenoma with extremely elevated CA199 levels.

Massive ovarian mucinous cystadenoma with torsion: A surgical wonder

Mucinous cystadenomas are some of the commonly encountered ovarian tumors, having huge size which causes pain, pressure, distension, genito urinary symptoms etc. Eventually, these tumors are prone to life threatening complications, like hemorrhage or torsion. These cases may remain asymptomatic for a long period of time. For further diagnosis of symptomatic patients clinical examinations and radiological investigations can be used and help the surgeon in deciding management. We hereby report a case involving a very large mucinous cystadenoma, measuring 25 × 24 centimeter with torsion. The data presented here contains details post admission of this patient in casualty to discharge of the patient, such as (a) clinical history (b) physical examination, (c) laboratory reports, (d) radiological investigations, (e) surgical evaluation, (f) histo pathology reports. These Mucinous cystadenomas constitute a comparatively smaller percentage of cases that can present with pain in abdomen due to an ovarian cause. Here, a huge mucinous ovarian cystadenoma had been found pressing on the abdominal contents leading to a variety of symptoms. The aim is to establish the value of detailed diagnosis and timely surgical treatment of these ovarian tumors as well as to signify the potential fatal outcomes.

Receptive status of the endometrium in patients of reproductive age with serous and mucinous ovarian cystadenoma before and after unilateral adnexectomy

BACKGROUND: Currently, the incidence of benign ovarian tumors has increased, and numerous studies have reported its negative effect on womens reproductive health. In modern literature, approximately 30% of patients with ovarian neoplasms have reproductive problems. In the presence of ovarian diseases, changes in the endometrium alter its receptivity, thereby reducing the chances of successful conception and gestation and gaining increasing attention. Patients seeking to preserve their reproductive function prefer organ-preserving surgical interventions; however, in clinical practice, adnexectomy is often necessary because of damaged ovarian tissue.
 AIM: To analyze the morphofunctional state of the endometrium and its receptivity in patients with serous and mucinous ovarian cystadenomas before and after surgical treatment.
 MATERIALS AND METHODS: The prospective study included patients of reproductive age with benign epithelial tumors (serous/mucinous cystadenomas) who had not received hormonal drugs for 6 months before surgical treatment. Group 1 included 32 patients with serous cystadenoma, and group 2 included 30 patients with mucinous cystadenoma. Before and 612 months after unilateral salpingo-oophorectomy, a pipelle biopsy of the endometrium was performed during the implantation window. The qualitative and quantitative parameters of pinopodes were examined, and the expression levels of estrogen (ER) and progesterone (PR) receptors in the glands and stroma of the endometrium were evaluated.
 RESULTS: Preoperatively, the number of pinopodes decreased in patients with serous cystadenoma, and the expression level of ER in the stroma and those of PR in the stroma and glands was reduced. Postoperatively, the number of mature pinopodes increased, and the expression levels of ER in the stroma and PR in the stroma and glands was increasing. Preoperatively, in patients with mucinous cystadenomas, the expression levels of ER in the stroma and glands and PR in the stroma and glands decreased, and the number of pinopodes reduced. Postoperatively, compared with patients with serous cystadenomas in the glandular component of the endometrium, those with mucinous cystadenoma had lower expression levels of both ER and PR, lower PR expression level in the stromal component, and increased number of pinopodes.
 CONCLUSIONS: The results of this study showed that benign ovarian tumors are accompanied by impaired morphofunctional state and receptivity of the endometrium, and timely surgical intervention positively affects these indicators and increases the reproductive potential of women.

Intraoperative predictors of appendiceal abnormalities in patients with mucinous ovarian neoplasms.

To evaluate intraoperative factors predicting appendiceal pathology during gynecologic oncology surgery for suspected mucinous ovarian neoplasms. We conducted a retrospective study on 225 patients with mucinous ovarian neoplasms who underwent surgery for an adnexal mass with concurrent appendectomy between 2000 and 2018. Regression analyses were used to evaluate intraoperative factors, such as frozen section of the ovarian mass and surgeon's impression of the appendix in predicting appendiceal pathology. Most patients (77.8%) had a normal appendix on final pathology. Abnormal appendix cases (n = 26) included: metastasis from high-grade adenocarcinoma of the ovary (n = 1), neuroendocrine tumor of the appendix (n = 4), and low-grade appendiceal mucinous neoplasms (n = 26; 23 associated with a mucinous ovarian adenocarcinoma, 2 with a benign mucinous ovarian cystadenoma, and 1 with a borderline mucinous ovarian tumor). Combining normal intraoperative appearance of the appendix with benign or borderline frozen section yielded a negative predictive value of 85.1%, with 14.9% of patients being misclassified, and 6.0% having a neuroendocrine tumor or low-grade appendiceal neoplasm. Benign or borderline frozen section of an ovarian mucinous neoplasm and normal appearing appendix have limited predictive value for appendiceal pathology. Appendectomy with removal of the mesoappendix should be considered in all cases of mucinous ovarian neoplasm, regardless of intraoperative findings.

Гигантская опухоль яичника у 16-летней девочки

Ovarian tumors are an important and urgent problem of modern gynecology. This is due to the difficulties in diagnosing neoplasms due to the absence of characteristic complaints and frequent asymptomatic course. Pediatric surgeons, pediatric gynecologists should conduct differential diagnostics between ovarian tumors and tumors of the abdominal cavity and retroperitoneal space in order to timely diagnose and treat neoplasms and prevent possible medical error. The article presents an indicative clinical case of the occurrence of giant mucinous ovarian cystadenoma in a teenage girl requiring differential diagnosis with formations of a different localization. Patient F., 16 years old, was admitted to the hospital in the direction of one of the regions of the Russian Federation. The reason for the patient's treatment to a gynecologist at the place of residence was pain in the lower abdomen for a month and an increase in the size of the abdomen. The patient was sent to the hospital to clarify the diagnosis and further treatment. Radical surgical treatment was performed: removal of the cyst of the left ovary using video endoscopic technologies

Giant mucinous cystadenoma of ovary in the pelvic cavity shaped like a turtle shell: case study and literature review

[Method] To summarize the medical history and imaging features of a case of giant pelvic and abdominal mucinous ovarian cystadenoma shaped like a turtle shell outside the abdomen, so as to improve the ability of early diagnosis and differential diagnosis, prevent serious complications during and after operation, and summarize the surgical treatment experience. Combined with relevant literature reports, the diagnosis and treatment process were optimized. [Results]The patient was in stable condition after surgery and was discharged on the 10th day. Follow-up after discharge showed no recurrence.With the importance of early detection, preoperative evaluation, and multidisciplinary collaboration to reduce intraoperative and postoperative complications, surgical resection is the treatment of choice. Regular postoperative follow-up is helpful for early detection of recurrence.

Histopathological discrepancy and variation of surgical management in mucinous ovarian cystadenoma and pseudomyxoma peritonei.

Introduction and importanceMucinous cystadenoma occurs in 10–15% of all ovarian tumors. Diagnosis and treatment should be decided precisely as it has a chance to develop into pseudomyxoma peritonei (PMP). Management of PMP might be challenging especially when repeated surgery is needed.Case presentationThe first case, a 22-year-old lady with recurrent stomach enlargement for seven months. She had history of laparotomy surgery due to an ovarian tumor. Whole abdomen contrast CT scan showed a large cyst with mucinous fluid. We decided to do re-laparotomy and found a left ovarian cyst. Histological examination results confirm ovarian mucinous cystadenoma. The second case was, 55-year-old woman, with abdominal enlargement for six months. She had a history of laparotomy and chemotherapy due to pseudomyxoma peritonei. Post chemotherapy MRI showed persistent pseudomyxoma and two multilocular cysts from both adnexa. Debulking laparotomy was then conducted. We obtained 8 L of mucinous pseudomyxoma along with mucinous cyst from both ovaries. The final diagnosis concluded as a pseudomyxoma and we decide to close the follow-up of the patient.Clinical discussionPseudomyxoma is caused by the production of mucin originating from intra-abdominal organs. Open surgery should be prioritized when the mucinous cystadenoma is detected to do a complete peritoneum evaluation and avoid perioperatively ruptured mucinous neoplasm. Pseudomyxoma often needed repeated surgical treatment and may exhibit different surgical findings and different pathologies.ConclusionRepeated surgery is logical and still no need for adjuvant chemotherapy in both cases. Accurate and precise diagnosis should be prioritized in order to prevent repeated surgery.

Giant Mucinous Ovarian Cystadenoma - A Case Report

Mucinous ovarian cystadenoma is a benign tumor, which accounts for 15% of all ovarian tumors and when diagnosed, 80% are benign, 10% limitrophe, and 10% malignant. It is a cyst that arises from the ovary surface epithelium, presenting multilocular features with a plain surface. It is more common between 30- and 50-years old persons and clinical signs differ from other ovarian pathologies because they present rapid growth, reach large dimensions, and evolve with peritoneal pseudomyxoma, causing a significant increase in abdominal volume. Imaging methods such as ultrasonography and computed tomography, as well as the tumor markers CA-125 and CEA, are fundamental for its elucidation and therapeutic planning. We report a case of giant mucinous cystadenoma of the left ovary in a 61-year-old patient admitted to the emergency room.

Composition of lectin receptors in serous and mucinous ovarian cystadenomas

The most common group of benign cystic ovarian tumors in women of all ages are epithelial tumors (cystadenomas) that make up about a third of ovarian tumors and half of benign lesions. The growth of tumor proliferative activity accompanied by increased number of lectins receptors in cells. Lectins are non-immune origin proteins that have a common property of binding carbohydrates and carbohydrate determinants of biopolymers strictly defined structure and intact their covalent structure. It was established that oncogenesis changes of the structure of glycoconjugates membrane as cancer and immune cells, and mark faster than glycoconjugates variability in tumor cells. This is the basis for the use of labeled lectins to study changes in cell membrane and secretory structures of glycoconjugates during tumor growth. The aim of the study was to determine the composition of the receptors in serous and mucinous cystadenomas. Operating material was studied from 60 women operated on for ovarian serous cystadenomas, and from 60 patients – on for ovarian mucinous cystadenomas. To identify the set of glycoconjugates it were used peroxidaselabeled lectins with different carbohydrate specificity. Characteristic of serous and mucinous cystadenomas was the accumulation of lectins receptors in their cells of wheat germs (WGA), groundnut seed (PNA) and soybean seeds (SBA). Papillary serous cystadenomas differed moderate accumulation in the epithelium papillae throughout the cytoplasm lectins receptors of SBA, mistletoe (VAL) and WGA. The most intense and uniform expression in mucinous cystadenomas was one of lectin receptors of bark elderberry (SNA) and SBA. The authors conclude that changes in the molecular-spatial structure of glycoconjugates of the plasmolemma cells surfaces and increase of the mobility of membrane lectins receptors in serous and mucinous cystadenomas cause lack of contact inhibition of proliferation. In their opinion, further study of lectins can contribute to the elucidation of the pathogenesis of ovarian formations, their differential diagnosis, the development of tumor markers and drugs lectins.

Huge mucinous borderline ovarian cystadenoma in a premenarchal girl

Epithelial ovarian tumors are common in adult women, but rare in children. Especially mucinous ovarian cystadenoma is extremely rare, with only 16 cases in premenarchal girls reported to date. We present a case of 12-year-old premenarchal girl with symptoms of lower abdominal distension. CT showed a large multilocular tumor spreading throughout the entire abdominal cavity from the right upper quadrant to the pelvic cavity. The tumor was brought out little by little with aspiration of the fluid contents with a small incision. The tumor was found to originate from the left ovary, and oophorectomy was performed. The tumor measured 26 × 18 cm and weighed 5860 g. Histological diagnosis was mucinous ovarian cystadenoma with borderline malignancy. No evidence of recurrence had been seen as of 2 years postoperatively. In the review of premenarchal mucinous borderline ovarian cystadenoma, all cases were stage I and underwent salpingo-oophorectomy or oophorectomy. Those patients were alive without recurrence. Al-though mucinous borderline ovarian cystadenoma was characterized as malignancy, premenarchal cases showed favorable outcomes and salpingo-oohprectomy or oophorectomy appears appropriate.

A Woman with Salt-wasting Congenital Adrenal Hyperplasia Presenting with a Mucinous Ovarian Cystadenoma during Pregnancy

Women with congenital adrenal hyperplasia (CAH) caused by steroid 21-hydroxylase deficiency show reduced fertility, especially with the salt-wasting form. A 27-year-old pregnant woman with this disease underwent laparotomy and oophorectomy to remove a multilocular ovarian tumor at 14 weeks of pregnancy. This proved to be a mucinous cystadenoma. Toward the third trimester, she presented with marked elevations of 17α-hydroxyprogesterone and plasma renin activity. Careful management of endocrine and body fluid homeostasis allowed her to give birth to a healthy female infant with normal external genitalia. This case illustrates endocrinological parameters during pregnancy in a woman with classical salt-wasting CAH.

Stage-Specific Embryonic Antigen 4 Expression in Epithelial Ovarian Carcinoma

Stage-specific embryonic antigen 4 (SSEA-4) is a widely used marker to monitor the differentiation of pluripotent embryonic stem cells. Little is known about the expression pattern of SSEA-4 in solid tumors up to now. In this study, we investigated the expression of SSEA-4 in 479 cases of various degrees of ovarian epithelial lesions by immunohistochemistry, consisting of 45 normal ovarian epithelia, 110 benign serous ovarian cystadenomas, 68 borderline serous ovarian cystadenomas, 104 invasive serous ovarian carcinomas, 64 benign serous mucinous cystadenomas, 48 borderline mucinous ovarian cystadenomas, and 40 invasive mucinous carcinomas. Moreover, the association between SSEA-4 expression and clinicopathological parameters was also evaluated. The expression of SSEA-4 was found to be increased from normal epithelium to benign cystadenoma and to borderline cystadenoma and adenocarcinoma in both serous and mucinous group. The loss or reduction of the expression of SSEA-4 was significantly correlated with more advanced tumor stage and poorer tumor cell differentiation. We therefore proposed that SSEA-4 may play a role during the oncogenesis of epithelial ovarian carcinoma and posses a tumor suppressor effect during malignancy promotion. It could be a potential therapy target in patients with epithelial ovarian carcinoma.

Lectin histochemistry in mucinous and serous ovarian neoplasms.

The lectin-binding properties of 44 cases of serous and mucinous ovarian cystadenoma, tumor of low malignant potential (LMP), and invasive carcinoma were examined histochemically. Wheat germ agglutinin (WGA), concanavalin A (con A), Ulex europaeus agglutinin I (UEA-I), peanut agglutinin (PNA), Ricinus communis agglutinin I (RCA-I), soybean agglutinin (SBA), and Robina pseudoaccacia (RPA) were employed. All the lectins examined were bound to neoplastic epithelial cells of benign and malignant tumors, but none bound exclusively to ovarian tumor cells. Different lectin-binding patterns between serous and mucinous neoplasms were observed, with the exception of RPA. UEA-I, con A, RPA, and PNA in serous neoplasms and UEA-I, RPA, and WGA in mucinous neoplasms demonstrated lectin-binding properties of LMP tumors intermediate between those of cystadenoma and invasive carcinoma. These findings indicate that serous and mucinous ovarian neoplasms contain different glycoconjugates, that malignant transformation of the neoplasms is associated with alteration of these glycoconjugates, and especially that LMP tumors have a different composition of cellular glycoconjugates from that of invasive ovarian carcinoma.

Mucosubstances in classification of serous and mucinous ovarian tumors: A morphometrical study

108 serous and 106 mucinous ovarian cystadenomas of varying malignancy were studied with the saliva-periodic acid-Schiff (SPAS) reaction and with the Alcian blue (AB) pH 2.7 method, which stain neutral and acid mucosubstances, respectively. Positively stained mucin was quantitated morphometrically and the measured parameters were tested by discriminant analysis. As expected, the mucinous tumors were more positive for mucin than the serous ones. Also the borderline tumors contained more mucin than their benign or malignant counterparts. The best discriminating capacity for mucin was obtained in serous tumors with the AB stain and in mucinous tumors with the SPAS reaction. The ratio of neutral to acid mucosubstances decreased in mucinous cystadenomas with increasing malignancy.

Pathology of mucinous ovarian cystadenomas. 2. Ultrastructural findings.

Fourteen mucinous ovarian cystadenomas of different grades of malignancy (7 benign, 4 borderline and 3 malignant) were investigated by electron microscopy. The main tumour cell type was a columnar mucous epithelial cell with short microvilli. With increasing grade of malignancy the shape and size of these cells became more irregular and the number of mucous granules in them decreased. Most of the mucous granules had a dense core and a less dense reticular component, which stained well with the periodic acid-silver methenamine (PASM) technique. Goblet cells with the usual ultrastructure were found rather frequently. The tumours in a given group of malignancy were relative similar to each other in their light and electron microscopic appearance. However, a number of tumours contained argyrophil and argentaffin cells in addition to the columnar and goblet cells. The findings of the present study support the view that the mucinous ovarian cystadenomas arise from the ovarian surface epithelium via a metaplastic process.

Pathology of Mucinous Ovarian Cystadenomas

The presence of argyrophil and argentaffin cells and epithelial mucosubstances was studied in 187 mucinous ovarian cystadenomas of varying malignancy. Sixty-two per cent of the benign tumours contained these cells. The corresponding figures for tumours of borderline malignancy and malignant tumours were 60 and 51, respectively. The epithelial cells of the mucinous cystadenomas characteristically contained periodic acid-Schiff reactive and diastase resistant secretory material, mixed with acid mucin which contained both sulphate and carboxyl groups. The amount of mucin diminished with increasing malignancy, as did the ratio of neutral to acid mucins. Mucin histochemistry in tumours with and without argyrophil cells in a given group of malignancy was similar, and the ages of the patients having those tumours did not differ significantly.