Ovarian Cysts Research Articles

Endometriosis: A Narrative Review

Although much progress has been made since endometriosis was first scientifically described centuries ago, numerous unanswered questions still surround this chronic, inflammatory condition. For instance, one theory on the pathogenesis of endometriosis suggests that the condition begins from retrograde menstrual flow implanting on surfaces in the abdomen and pelvis (Samson’s theory), which is a logical mechanism given the high rates of endometriosis in patients with obstructive anomalies of the lower genital tract and significant retrograde flow. This explanation has many shortcomings however, as retrograde menstruation occurs more commonly than the reported 10% prevalence of endometriosis. Additionally, endometriosis lesions can be found in areas quite remote from the pelvis, such as the thoracic cavity. As such, research has been increasingly focused on identifying immune, genetic, and local environmental factors that likely play critical roles in the development of endometriosis. This growth of benign endometrial-like tissue outside of the uterus can sometimes be asymptomatic, but it can also cause debilitating pain, infertility, ovarian cysts (endometriomas), and can invade surrounding organs such as the bowel or bladder. There are three main phenotypes of endometriosis: superficial lesions, deeply infiltrating endometriosis (including nodules), and ovarian endometriomas. While the exact etiology may be obscure, the societal and economic impacts of this condition are undeniable. Patients diagnosed with endometriosis are at a significantly higher risk of absenteeism from work or school, lower quality of life, chronic pelvic pain, and are more likely to receive a mental health diagnosis such as depression or anxiety. Apart from direct and indirect incurred costs to patients (estimated at approximately $5000 per patient annually), at a national level the economic burden of endometriosis exceeds $2 billion annually in Canada, and approaches $80 billion in the USA.

Prospects for Using 3D Modeling and Biomarkers in Differential Diagnosis of Endometrioid Ovarian Cysts

Background. Ovarian heterotopias are quite successfully diagnosed with ultrasound examinations. Considering the high risk of spread of the disease, as well as reproductive consequences (infertility, pelvic adhesive processes, chronic pelvic pain syndrome, dysmenorrhea), early differential diagnosis of endometrioid cysts and, accordingly, early initiation of treatment are of particular importance.Objective: to combine ultrasound criteria using 3D visualization and the content of biomarkers to verify stage 1–2 endometrioid ovarian cysts.Material and methods. In 59 infertile women with endometrioid ovarian cysts, in the dynamics of the menstrual cycle, ultrasound examinations were performed using Acuson S2000 (Siemens, Germany) and Voluson E8 (General Electric, USA) with the possibility of Doppler measurements and three-dimensional reconstruction of tissue images. Also, in laboratories “Invitro”, “Hemotest”, “Nauka” (Samara, Russia) the biomarkers were determined: interleukins IL-1β, IL-6, cancer antigen 125 (CA-125), human epididymis protein 4 (HE4) and the index by Risk of Ovarian Malignancy Algorithm (ROMA). The control group included 195 fertile women of reproductive age. In patients with endometrioid cysts, the diagnosis was subsequently confirmed morphologically.Results. Small unilateral and bilateral ovarian cysts corresponding to stage 1–2 endometriosis by revised American Fertility Society classification (rAFS) were clearly differentiated in 56 (94.9%) patients, in 3 (5.4%) of them the ultrasound result was questionable. In 48 (81.4%) women the lesion was unilateral and in 11 (18.6%) it was bilateral. The structure of cystic formations in all cases was hypoechoic, heterogeneous, in 36 (61.0%) cases it was finely cellular, without blood flow.Conclusion. Ovarian endometriomas in “gray scale” are round formations of reduced echogenicity and fine suspension, with an even, clear contour, not fused with the surrounding tissues, avascular, changing size depending on menstrual cycle phase. An ovarian mass may have a capsule with locus signals on Doppler. The sensitivity of ultrasound examination in “gray scale” in the presence of an endometrioid cyst is 94.6%.

PREVENTION OF HYSTERECTOMY BY AYURVEDIC MANAGEMENT OF ASRUGDARA WITH CYSTIC GLANDULAR HYPERPLASIA: A CASE REPORT

Asrugdara is a condition where there is an occurrence of heavy menstrual bleeding. Excess intake of food, which are excessive Lavana(salty), Amla(sour), Guru(heavy), Katu(hot), Vidahi (producing a burning sensation) and Snigdha (unctuous) etc. leads to this condition. This condition can be correlated with abnormal uterine bleeding (AUB). Abnormal uterine bleeding is defined as any uterine bleeding outside the normal volume, dura-tion, regularity or frequency is considered as abnormal uterine bleeding (AUB). This is a case report of a 41-year-old female patient having complaint of heavy menstrual bleeding with passing of clots for 11 days and ir-regular and early menses for three months. Her ultrasonography report was suggestive of thickened endometrial thickness with chronic cervicitis and a left ovarian simple cyst. She underwent conventional treatment of heavy bleeding, including Dilatation and Curettage (D&C), but was unsuccessful. The histopathology report suggested glandular cystic hyperplasia without atypia. In the allopathic system of medicine, hysterectomy is advised. The patient is diagnosed with Kapha Vataja Asrugadara as per the symptoms. The objective of the present treatment included Ayurvedic management of Asrugadara, ensuring a decrease in the menstrual blood flow and regulariza-tion of the cycle, thereby improving the patient's general condition. The treatment plan included Shamana Chikitsa along with Basti Chikitsa. The treatment outcome was completely relieved of the symptoms with a reg-ular ultrasonography report.

(106) OVARIAN RESERVE AFTER LAPAROSCOPIC CYSTECTOMY OF ENDOMETRIOTIC CYSTS AND OTHER BENIGN CYSTS: 36-MONTHS FOLLOW-UP STUDY

Abstract Introduction There is a growing body of evidence that ovarian cystectomy may negatively impact ovarian reserve. It is unclear whether there are any differences in the long-term effect of ovarian reserve after ovarian cystectomy between women with endometrioma and those with other benign ovarian cysts. Although several studies have shown that AMH reduction is milder in nonendometriotic benign ovarian cysts compared with endometriomas, further studies are necessary because long-term studies are lacking. Objective The aim of this study was to compare the long-term effects of laparoscopic cystectomy for endometriotic cysts and other benign cysts on ovarian reserve. Methods A total of 165 women aged 20-40 years who underwent laparoscopic cystectomy for endometriotic cysts (Endometrioma group, n=96) and other benign cysts (Non-endometrioma group, n=69) were included in this retrospective study. Ovarian reserve was measured by serum anti-Müllerian hormone (AMH) and compared before surgery and at 6, 12, 24 and 36 months after surgery. Results Baseline AMH levels were lower in the endometrioma group compared with the non-endometrioma group without statistical significance (4.43±3.52 ng/mL vs. 4.95±3.59 ng/mL; p =0.378). AMH levels of 6, 12, 24, and 36 months after surgery was significantly decreased when compared with preoperative levels in the endometrioma group. Decline of the AMH levels was statistically significant at 6 months and 24 months but not at 12 and 36 months in the non-endometrioma group. There was no further significant decrease in the AMH levels after 6 months of surgery in both groups. Decline of AMH levels at 6, 12, 24, and 36 months after surgery from preoperative levels was significantly larger in the endometrioma group compared with the non-endometrioma group. Conclusions Laparoscopic ovarian cystectomy reduced ovarian reserve irrespective of the type of cysts. Surgical excision of endometriotic cysts has a more detrimental and persistent damage on ovarian reserve compared with other benign ovarian cysts. After 6 months of surgery, no further significant fall in AMH levels was observed in the 36-month follow-up. Disclosure No.

Prevalence and Impact of Poly cystic Ovary Syndrome and Its Associated Irritable Bowel Syndrome among the Students: A Cross Sectional Study

To determine the prevalence and impact of poly cystic ovary syndrome (PCOS) and its associated irritable bowel syndrome (IBS) among college students. Materials and Methods: A cross-sectional study involving 280 female college students aged 17 to 28 years was conducted. Data collection was carried out using a structured questionnaire administered through Google Forms. The questionnaire gathered information on the following aspects: Demographic characteristics: Age at menarche. PCOS status: Presence or absence of PCOS diagnosis, family history of PCOS or infertility. Menstrual cycle characteristics: Duration of Menstrual bleeding, flow of menstrual bleeding, severity of menstrual pain. Hyper androgenic symptoms : Acne score, hirsutism score. IBS symptoms: Abdominal pain, cramping, diarrhoea, constipation, and psychological distress. Statistical analysis: The collected data was analyzed using descriptive statistics, including frequencies and percentages. Chi-square tests were used to assess the association between PCOS and IBSsymptoms.

An Ayurvedic methodology for managing PCOD - A Case Report

Polycystic ovarian disease (PCOD) is a heterogenous endocrine disorder characterized by ovarian cysts, anovulation, and hormonal fluctuations, impacting women’s health in various ways. PCOD has transformed into a lifestyle disorder due to sedentary habits, excessive consumption of fast food, and an unhealthy lifestyle. Predisposing risk factors such as genetics, neuroendocrine factors, lifestyle and environmental influences, as well as obesity, play significant roles in the development of PCOD. In Ayurveda, PCOD cannot be correlated to any one particular disease; it can be related to certain diseases like Vandhya, Nasthartava, Aratava Kshaya, Pushpaghni Jataharini, etc. and must be controlled according to the Dosha Dushya vitiation. In this present case study, a 21 year old female patient came with symptoms of scanty menses, acne over face and weight gain in the OPD of Kayachikitsa. The USG report reveals PCOD changes in both ovaries as both ovaries are bulky in size right ovary, vol = 18cc and left ovary, vol = 13.2cc with multiple peripherally arranged follicles with central echogenic stroma. The result was determined based on the relief of clinical symptoms and the findings from the ultrasound report. Therefore, in this case study, drugs such as Dashmool Kwath, Narikanti, Cystogrit diamond etc. was given which have Lekhaniya properties results into reducing the size of ovary and effectively alleviate Kapha Dosha and Ama, facilitating the treatment of Sroto-Dusti and removing obstructions caused by Apana Vayu, ultimately enhancing menstrual flow.

Omental Implantation, Mesenteric Defect, and Bilateral Ovarian Cysts Post Salpingectomy for Ruptured Tubal Ectopic Pregnancy

Omental Implantation, Mesenteric Defect, and Bilateral Ovarian Cysts Post Salpingectomy for Ruptured Tubal Ectopic Pregnancy

Uterine hydatidosis: casuistry is possible

Introduction. Hydatidosis is a severe parasitic disease caused by tapeworm Echinococcus granulosus widely spread in some endemic areas all over the world that primarily targets liver, lung, bones, muscles well as pelvis in casuistic cases. Due to the lack of pathognomonic signs as well as low prevalence rate of hydatid cysts in such anatomic sites, a differential diagnosis for relevant gynecological pathologies may be substantially complicated. Compared with common gynecological disease such as uterine fibroids, ovarian cyst and malignancies uterine hydatidosis may be identified only in 0.16 % cases.Aim: to present a clinical case of uterine hydatid cyst in order to optimize algorithms for differential diagnosis of primary pelvic echinococcosis and gynecological pathology, which is necessary for successfully conducted timely surgical treatment.Clinical case. In 2023, patient K. complained of dysuric phenomena and a feeling of heaviness in the pelvic area. Based on the anamnesis, clinical picture, laboratory and instrumental research methods, it was decided to perform surgical treatment. The patient underwent laparoscopic hysterectomy and removal of ¾ hydatid cyst. The obtained material was used for histological examination to verify the diagnosis.Results. Differential diagnosis of uterine echinococcosis is most often carried out with cystic or dysembryogenetic tumors, purulent or tuberculous abscesses, ovarian cysts, ovarian tumors, and uterine fibroids. Features of the MR picture, such as a thick compacted wall, the lack of internal septa, parietal and papillary outgrowths, as well as a solid component, allowed to suspect parasitic genesis of the neoplasm.Conclusion. While treating patients with cystic neoplasms of the pelvic area referred from endemic areas, echinococcosis should be included in the list of differential diagnostic searches.

Comparison of Clinical Effects Between Minimally Invasive Laparoscopic Surgery and Laparotomy in Treating Ovarian Endometriosis Cysts

Objective: To compare the clinical effects of laparoscopic minimally invasive surgery and laparotomy in the treatment of ovarian endometriosis cysts. Methods: 66 patients with endometriosis cysts admitted to our hospital from December 2022 to December 2023 were selected as the study subjects and randomly divided into a control group (n = 33) and an observation group (n = 33). The control group was treated with laparotomy, and the observation group was treated with minimally invasive laparoscopic surgery. The surgical indexes, ovarian function indexes, and complications were observed. Results: All surgical indexes of the observation group (surgical time, intraoperative blood volume, hospital stay, postoperative antibiotic use time) were significantly better than the control group, (Pmean < 0.001). After surgery, the E2 score of ovarian function indexes in the observation group was higher than that in the control group, while the luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels were lower than those in the control (t = 5.246, t = 5.173, t = 3.535, Pmean < 0.001). Lastly, the overall incidence of complications in the observation group (1/3.03%) was lower than that in the control group (8/24.24%), (χ2 = 4.632, P < 0.05). Conclusion: Minimally invasive laparoscopic surgery is more effective than laparotomy in treating ovarian endometriosis.

Deep Learning Based Polycystic Ovary Syndrome (PCOS) Identification

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting reproductive-aged women, characterized by hormonal imbalance and ovarian cysts. Timely and accurate diagnosis of PCOS is crucial for effective management and prevention of associated complications. In this paper, we propose an automated diagnostic system for PCOS using deep learning and convolutional neural networks (CNNs). The dataset comprises ultrasound images of ovaries categorized into infected (PCOS) and not infected (non-PCOS) classes. Two CNN architectures, a deep CNN model and a CNN model with a last layer replaced by a support vector machine (SVM), are implemented and evaluated. Evaluation metrics include accuracy, precision, recall, and F1-score, demonstrating promising performance in accurately distinguishing between PCOS and non-PCOS cases. This automated diagnostic system offers a reliable and efficient approach for PCOS diagnosis, potentially reducing dependence on manual interpretation of ultrasound scans and improving healthcare outcomes for affected individuals. Key Words: Polycystic ovary syndrome (PCOS) , Deep learning, Convolutional neural networks (CNNs), Data augmentation, Ultrasound Scans

An Open Randomised Clinical Study to Evaluate the Combined Effect of Krishna Tila Kashayam and Shatapuspa Choornam in PCOS

PCOS has ovarian dysfunction along with hyperandrogenism and polycystic ovarian morphology. PCOS is a condition where involvement of Kapha dosha is present along with Vata dosha along with Rasa Dhatu, Medo dhatu and Arthava- the Upadhatu of Rasa is affected. Because of having the properties of Ushna virya, Kashaya Tiktha rasa, Arthava janana properties, Krishna Tila Kashayam and Shatapuspa choornam has been mentioned for the treatment of Arthava kshaya (anovulation and oligomenorrhea) in PCOS. The treatment is fully focused on Vata Kapha hara chikitsa and Arthava vardhaka. The drugs selected for the present study can be easily prepared and administered, cost effective. In this study, Tila kashayam along with Anupanam Gudam and Shatapuspa choornam along with Anupanam Madhu has been given and the results have been noted. In the present study, a total of 40 patients suffering from PCOS were selected from OPD and IPD of SJSACH. The thesis is widely focused on increasing the quantity of flow in amenorrhoea or oligomenorrhea cases, to check the size of the ovarian follicle before and after treatment and to check if there is any reduction in hair growth in hirsutism patients. There was a notable change seen in mild to moderate PCOS cases regarding the interval between 2 cycles, duration of flow between 2 cycles and quantity of flow between 2 cycles. There was a notable change seen in reduction of ovarian cyst volume before and after treatment. Hirsutism, BMI and waist circumference - there was no significant changes noted during these 3-month period.

Exploring the role of Chinese herbal medicine in the long-term management of postoperative ovarian endometriotic cysts: a systematic review and meta-analysis.

Ovarian endometriotic cysts (OEC) represent the primary manifestation of endometriosis, constituting a hormonally dependent inflammatory disorder in gynecology. It significantly affects the quality of life and reproductive health of women. It is worth noting that traditional Chinese medicine (TCM), especially Chinese herbal medicine (CHM), has been widely applied in mainland China due to its unique therapeutic system and commendable clinical efficacy, bringing new hope for preventing and managing OEC. This study aims to evaluate the efficacy and safety of CHM in the management of postoperative OEC. Simultaneously, it seeks to explore the medication laws, therapeutic principles, and specific treatment mechanisms of CHM. Eight electronic databases were searched from their inception to 01 November 2023. Randomized controlled trials (RCTs) assessing the therapeutic effects and safety of CHM for postoperative OEC were included. The risk of bias for each trial was assessed using the Cochrane Collaboration's tool. The certainty of the evidence was evaluated using the GRADE profiler 3.2. Additionally, we extracted formulation from the included studies, conducting a thorough analysis. (ⅰ) Twenty-two RCTs involving 1938 patients were included. In terms of the primary efficacy outcome, the CHM group demonstrated a potentially lower recurrence rate compared to both control (odds ratio (OR) = 0.25; 95% confidence intervals (CI): 0.10-0.64) and conventional western medicine (CWM) (OR = 0.26; 95% CI: 0.11-0.65) groups. Furthermore, the joint application of CHM and CWM resulted in a significant reduction in the recurrence rate (OR = 0.26; 95% CI: 0.17-0.40). (ⅱ) Regarding secondary efficacy outcomes, (a) Total clinical efficacy rate: CHM showcased an augmentation in clinical effectiveness compared to both the control (OR = 4.23; 95% CI: 1.12-15.99) and CWM (OR = 2.94; 95% CI: 1.34-6.43) groups. The combined administration of CHM and CWM substantially enhanced overall clinical effectiveness (OR = 3.44; 95% CI: 2.37-5.00). (b) VAS Score: CHM exhibited the capacity to diminish the VAS score in comparison to surgery alone (Mean difference (MD) = -0.86; 95% CI: -1.01 to -0.71). Nevertheless, no substantial advantage was observed compared to CWM alone (MD = -0.16; 95% CI: -0.49 to 0.17). The integration of CHM with CWM effectively ameliorated pain symptoms (MD = -0.87; 95% CI: -1.10 to -0.65). (c) Serum Level of Cancer antigen 125 (CA125): the CHM group potentially exhibited lower CA125 levels in comparison to CWM alone (MD = -11.08; 95% CI: -21.75 to -0.42). The combined intervention of CHM and CWM significantly decreased CA125 levels (MD = -5.31; 95% CI: -7.27 to -3.36). (d) Pregnancy Rate: CHM exhibited superiority in enhancing the pregnancy rate compared to surgery (OR = 3.95; 95% CI: 1.60-9.74) or CWM alone (OR = 3.31; 95% CI: 1.40-7.83). The combined utilization of CHM and CWM demonstrated the potential to enhance pregnancy rates compared to CWM (OR = 2.99; 95% CI: 1.28-6.98). Concerning safety outcome indicators, CHM effectively decreased the overall incidence of adverse events and, to a certain extent, alleviated perimenopausal symptoms as well as liver function impairment. (ⅲ) Most of CHMs were originated from classical Chinese herbal formulas. Prunus persica (L.) Batsch (Taoren), Angelica sinensis (Oliv.) Diels (Danggui), Salvia miltiorrhiza Bunge (Danshen), Paeonia lactiflora Pall. (Chishao), and Corydalis yanhusuo W.T.Wang (Yanhusuo) were most frequently used CHM. CHM may be a viable choice in the long-term management of postoperative OEC, with the potential to enhance clinical efficacy while decreasing recurrence and adverse effects.

Chronic Caffeine Consumption, Alone or Combined with Agomelatine or Quetiapine, Reduces the Maximum EEG Peak, As Linked to Cortical Neurodegeneration, Ovarian Estrogen Receptor Alpha, and Melatonin Receptor 2

RationaleEvidence of the effects of chronic caffeine (CAFF)-containing beverages, alone or in combination with agomelatine (AGO) or quetiapine (QUET), on electroencephalography (EEG), which is relevant to cognition, epileptogenesis, and ovarian function, remains lacking. Estrogenic, adenosinergic, and melatonergic signaling is possibly linked to the dynamics of these substances.ObjectivesThe brain and ovarian effects of CAFF were compared with those of AGO + CAFF and QUET + CAFF. The implications of estrogenic, adenosinergic, and melatonergic signaling and the brain-ovarian crosstalk were investigated.MethodsAdult female rats were administered AGO (10 mg/kg), QUET (10 mg/kg), CAFF, AGO + CAFF, or QUET + CAFF, once daily for 8 weeks. EEG, estrous cycle progression, and microstructure of the brain and ovaries were examined. Brain and ovarian 17β-estradiol (E2), antimullerian hormone (AMH), estrogen receptor alpha (E2Rα), adenosine receptor 2A (A2AR), and melatonin receptor 2 (MT2R) were assessed.ResultsCAFF, alone or combined with AGO or QUET, reduced the maximum EEG peak, which was positively linked to ovarian E2Rα, negatively correlated to cortical neurodegeneration and ovarian MT2R, and associated with cystic ovaries. A large corpus luteum emerged with AGO + CAFF and QUET + CAFF, antagonizing the CAFF-mediated increased ovarian A2AR and reduced cortical E2Rα. AGO + CAFF provoked TTP delay and increased ovarian AMH, while QUET + CAFF slowed source EEG frequency to δ range and increased brain E2.ConclusionsCAFF treatment triggered brain and ovarian derangements partially antagonized with concurrent AGO or QUET administration but with no overt affection of estrus cycle progression. Estrogenic, adenosinergic, and melatonergic signaling and brain-ovarian crosstalk may explain these effects.

Enhancing angiogenesis and inhibiting apoptosis: evaluating the therapeutic efficacy of bone marrow mesenchymal stem cell-derived exosomes in a DHEA-induced PCOS mouse model

BackgroundPolycystic Ovary Syndrome (PCOS) is a widespread endocrine disorder among women, characterized by symptoms like ovarian cysts, hormonal imbalance, and metabolic issues. This research evaluates the therapeutic potential of Bone Marrow Mesenchymal Stem Cell-derived exosomes (BMSC-Exo) in treating PCOS symptoms within a mouse model.MethodsBMSC-Exo were isolated from NMRI mice, characterized using Transmission Electron Microscopy (TEM) and Nanoparticle Tracking Analysis (NTA), and administered to a PCOS mouse model induced by dehydroepiandrosterone (DHEA). The efficacy of BMSC-Exo was assessed in three groups of mice: a control group, a PCOS group, and a PCOS group treated with intravenous BMSC-Exo. Morphological changes in ovarian tissue were examined by Hematoxylin and Eosin (H&E) staining, apoptosis was determined using the TUNEL assay, and CD31 expression was analyzed through immunofluorescent staining to assess angiogenic activity.ResultsThe existence of BMSCs-Exo was confirmed via TEM and NTA, revealing their distinct cup-shaped morphology and a size range of 30 to 150 nanometers. H&E staining revealed that BMSCs-Exo treatment improved ovarian morphology in PCOS models, increasing corpora lutea and revitalizing granulosa cell layers, suggesting a reversal of PCOS-induced damage. TUNEL assays showed that BMSCs-Exo treatment significantly reduced apoptosis in PCOS-affected ovarian cells to levels comparable with the control group, highlighting its role in mitigating PCOS-induced cellular apoptosis. Immunofluorescence for CD31 indicated that BMSCs-Exo treatment normalized endothelial marker expression and angiogenic activity in PCOS models, suggesting its effectiveness in modulating the vascular irregularities of PCOS. Collectively, these findings demonstrate the therapeutic potential of BMSCs-Exo in addressing ovarian dysfunction, cellular apoptosis, and aberrant angiogenesis associated with PCOS.ConclusionThe study substantiates the role of BMSC-Exo in mitigating the deleterious effects of PCOS on ovarian tissue, with implications for enhanced follicular development and reduced cellular stress. The modulation of CD31 by BMSC-Exo further highlights their potential in normalizing PCOS-induced vascular anomalies. These findings propel the need for clinical investigations to explore BMSC-Exo as a promising therapeutic avenue for PCOS management.

Multimodality imaging of acute gynecological emergencies-a pictorial essay.

Gynecological emergencies can often present with a myriad of non-specific signs and symptoms, posing a diagnostic challenge to the clinician. They can be grossly divided into uterine or adnexal pathologies. Uterine pathologies can be secondary to intracavitary accumulation of blood [like in patients with transverse vaginal septum, Robert's uterus, accessory and cavitated uterine mass, unicornuate uterus with contralateral non-communicating functional horn], bleeding per vaginum [like in patients with retained products of conception, enhanced myometrial vascularity], pyometra [secondary to pelvic inflammatory disease, cervical obstruction secondary to benign and malignant causes] or complications of fibroids [like red degeneration, torsion of subserosal fibroid]. The adnexal pathologies can range from ectopic pregnancy in a urine pregnancy test (UPT) positive patient to haemorrhagic ovarian cyst, ovarian torsion, ruptured dermoid cyst and tubo-ovarian abscess in a UPT negative patient. Multimodality imaging including ultrasound (USG), computed tomography (CT) scan and magnetic resonance imaging (MRI) can narrow down the differentials and help in formulating an accurate diagnosis. The objective of this article is to familiarize the readers with multimodality imaging findings in common as well as uncommon acute gynecological emergencies and provide an algorithmic imaging approach for acute gynecological emergencies. USG is typically used as the first line diagnostic modality in diagnosis of acute gynecological emergencies. CT scan & MRI are helpful as a problem-solving tool in acute gynecological emergencies when USG findings are indeterminate.

A Rare Case of Ovarian Hydatid Cyst: A Must Consider Differential in Cystic Ovarian Masses Category: Case Report

A Rare Case of Ovarian Hydatid Cyst: A Must Consider Differential in Cystic Ovarian Masses Category: Case Report

Association of a polygenic risk score with risk of abnormal ultrasound findings and ovarian cancer in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial.

10542 Background: Several susceptibility loci have been identified in genome-wide association studies (GWAS) of single nucleotide polymorphisms (SNPs) that are associated with ovarian cancers. Polygenic risk scores (PRS) combining certain loci have shown limited performance at predicting ovarian cancer risk. However, the utilization of PRS with ovarian cancer screening tests, like transvaginal ultrasound (TVU), warrants further evaluation. This study investigated the association between a polygenic risk score and ovarian cancer risk and abnormal TVU screening in a large-scale randomized controlled ovarian cancer screening trial. Methods: A polygenic risk score was constructed using weighted sums of risk alleles of 15 ovarian cancer SNPs identified in previous GWAS to evaluate the association with abnormal TVU screening results and ovarian cancer outcomes in female participants of the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. Complete genotyping information, TVU results, and ovarian cancer outcomes were available for 15722 females (mean age 62.2 years +/- 5.3) with European ancestry, including 116 ovarian cancer cases. Abnormal TVU was defined as ovarian volume or cyst volume > 10 cm3, any solid/cystic component within a cystic ovarian tumor, or any solid area or papillary projection extending into the cavity of a cystic ovarian tumor. Polygenic risk scores were categorized as quartiles and odds ratios (OR) were calculated to assess risk of ovarian cancer or abnormal TVU result using the lowest PRS quartile as reference category. Results: TVU screening results were abnormal for 732 (732/15722, 4.66%) participants and normal for 14990 (14990/15722, 95.3%) participants at trial baseline. PRS within the fourth quartile demonstrated increased risk of ovarian cancer with reference to the lowest quartile (OR 1.77, 95% confidence interval: 1.04-3.08). Similarly, women in the highest quartile of the PRS had increased odds of an abnormal TVU screening result (OR 1.46, 95% confidence interval: 1.17-1.83) compared to women in the lowest PRS quartile. Conclusions: A polygenic risk score including 15 loci previously shown to be associated with ovarian cancer risk showed an association with increased ovarian cancer risk in the PLCO trial. Furthermore, the PRS was also associated with abnormal ultrasound results. Our findings support further evaluation of polygenic risk scores and transvaginal ultrasound for ovarian cancer risk stratification and screening approaches.

Therapeutic potential of endometrial stem cells encapsulated in alginate/gelatin hydrogel to treat of polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder in women, often leading to infertility due to anovulation. Recent advances suggest that endometrial stem cells (EnSCs) hold considerable promise for tissue regeneration, which could be pivotal in treating PCOS. To enhance the survival and stabilization of EnSCs within the ovary, the EnSCs were encapsulated in an injectable alginate/gelatin hydrogel (SC–H), which has excellent biocompatibility to support the survival of EnSCs. Polycystic ovary syndrome was induced in female Wistar rats using intraperitoneal injection of letrozole over 21 days. Then the rats were treated with SC, SC-H and clomiphene citrate for one-month post-PCOS induction. The effects of these treatments were evaluated based on changes in body and ovarian weights, inflammatory markers, endocrine profiles, and ovarian histology. The Induction of PCOS led to a significant increase in body and ovarian cyst weight, elevated serum levels of testosterone, luteinizing hormone (LH), and anti-Müllerian hormone (AMH), alongside reduced follicle-stimulating hormone (FSH) and progesterone levels. Histologically, there was a decrease in granulosa cells, immature follicles, and corpus luteum numbers. Treatment with SC and SC-H significantly mitigated these alterations, indicating improved PCOS conditions. Our findings demonstrate that SC and SC-H treatments can effectively ameliorate the symptoms of letrozole-induced PCOS in rats, primarily through their anti-inflammatory effects. This study lays the groundwork for potential clinical applications of EnSCs encapsulated in alginate/gelatin hydrogel as a novel therapeutic strategy for PCOS, highlighting the importance of biomaterials in stem cell-based therapies.

Retrospective Review of Management of Antenatally Diagnosed Ovarian Cysts at the Hospital for Sick Children

IntroductionPostnatal management of antenatally diagnosed ovarian cysts is not well-defined. The clinical course, management, and outcomes of patients with antenatally diagnosed ovarian cysts were reviewed. MethodsInfants <1 year of age with antenatally diagnosed ovarian cyst managed at The Hospital for Sick Children between January 2017 and December 2021 were included. Patient charts were reviewed for postnatal ultrasound (US) images, management, clinical course and complications. Mixed linear regression analysis was used to model the change in cyst size over time. ResultsIn total, 52 patients were included and 10 patients had no cyst identified at their first postnatal US. Of the remaining cases, 36% were simple/physiologic and 64% had complex features. Two underwent percutaneous aspiration while 40 patients were managed expectantly with most cysts (62%) resolving. The rate of resolution was significantly higher and faster for simple compared to complex cysts (84% versus 52%, p < 0.05). Cysts that persisted at the end of the study period (n = 14) had all decreased in size, with a rate of resolution similar to resolved cysts. Only one patient managed expectantly required urgent laparoscopy for salpingoophorectomy. ConclusionAntenatally diagnosed ovarian cysts exhibit high rates of resolution with expectant management, supporting the safety and efficacy for expectant management for these patients. Level of EvidenceIII.

Struma Ovarii during Pregnancy.

Struma ovarii is a rare type of ovarian teratoma primarily composed of over 50% thyroid tissue. Its occurrence is reported in 2-5% of all ovarian teratomas, with approximately 0.5% to 10% showing malignant transformation. Managing it during pregnancy poses significant challenges as pregnancy can promote the growth of malignant struma ovarii due to elevated levels of ovarian and pregnancy-related hormones, including estrogen, progesterone, and human chorionic gonadotrophin (hCG). Most ovarian tumors, including struma ovarii, are detected during routine ultrasonography in the first and second trimesters, often as acute emergencies. Diagnosis during pregnancy is rare, with some cases incidentally discovered during cesarean section when inspecting the adnexa for ovarian cysts. This review explores the diagnostic, management, and therapeutic approaches to struma ovarii during pregnancy.