Ovarian Dermoid Research Articles

Magnetic resonance imaging evaluation of gynecological mass lesions: A comprehensive analysis with histopathological correlation.

Evaluating gynecological mass lesions and reviewing their morphological characteristics based on their imaging appearance on magnetic resonance imaging (MRI), and correlating the MRI findings with histopathological findings, was the central theme of our study. This observational cross-sectional study was conducted on 60 female patients with clinically suspected gynecological mass lesions upon physical examination and/or ultrasonography, referred for MRI at a tertiary care hospital over a 1-year period between June 2022 and July 2023. A broad spectrum of differential diagnoses of gynecological masses was observed. In our study, the ratio of benign versus malignant disease was 1.6:1, with 37 benign and 23 malignant masses identified. The most common benign masses were uterine fibroids (n = 14; 23.3%), followed by endometriosis (n = 8; 13.3%), and ovarian dermoid cysts (n = 4; 6.6%). Among the malignant lesions, cervical cancer was the most common (n = 11; 18.3%), followed by endometrial carcinoma (n = 7; 11.6%), ovarian carcinoma (n = 3; 5%), and vaginal carcinoma (n = 2; 3%). Benign lesions mostly appeared hypo- to isointense on T1-weighted imaging and iso- to hyperintense on T2-weighted imaging, while malignant lesions appeared isointense on T1-weighted and hyperintense on T2-weighted imaging. Hemorrhage and fat were well appreciated on MRI and aided in diagnosis. T2 shading was present in 7 out of 8 endometriotic cysts, demonstrating a specificity of 100% and a sensitivity of 83%. For determining parametrial invasion in cervical carcinoma, MRI showed an accuracy of 91%, specificity of 100%, and positive predictive value, negative predictive value, and sensitivity of 100%, 75%, and 88%, respectively. In cases of endometrial carcinoma, MRI demonstrated a sensitivity and specificity of 87% and 91%, respectively, with a positive predictive value of 87% and a negative predictive value of 91% for identifying myometrial invasion greater than 50%. Compared to other modalities, MRI provided substantial information regarding uterine and adnexal masses and surrounding structures, facilitating accurate staging of lesions.

Ovarian Dermoid Cyst Trajectory in Premenarchal Girls

Study ObjectiveMature ovarian dermoid cysts (ODCs) are the most common benign ovarian tumors diagnosed in children. However, there is minimal data on management of ODCs in premenarchal patients. This study assesses characteristics associated with expectant (EM) vs surgical (SM) management in premenarchal patients and the growth rate of ODCs in EM patients at a single institution. MethodsForty-four premenarchal patients, either post-surgical with pathologically-confirmed ODC or having radiologic findings consistent with ODCs, were included. Data collected included demographics, cyst characteristics, imaging findings, presence of symptoms, surgical procedure performed, and ovarian torsion occurrence. ResultsPatient age at diagnosis was similar between groups (SM: 8.8 vs EM: 8.0, P = .55). At presentation, 36 patients (82%) underwent SM and 8 (18%) underwent EM. There was a significant difference in cyst size between groups (SM: 8.9 cm vs EM: 3.6 cm, P = .004). Of SM patients, 30% underwent oophorectomy vs cystectomy, with a significant difference in ODC size between procedures (11.8 cm vs 7.7 cm, P = .016). Of EM patients, 75% had at least one and 60% had three follow-up ultrasounds, with average follow-up timeframes of 3.7 and 27 months respectively. Average yearly ODC growth rate for the latter group was 0.8 cm. ConclusionThe average yearly growth rate of ODCs in premenarchal patients within our institution was slower than in older cohorts, and both age and cyst size played significant roles in determining surgical procedure. Continued study on EM in premenarchal ODCs will help define parameters for recommending SM vs EM in this population.

A Review and Case Series of Uterine Lipoleiomyomata

Purpose: The purpose of this case series is to understand the prevalence, clinical significance, pathophysiology, pathology findings, and workup of uterine lipoleiomyomas. Methods: This case series, with cases in February and March of 2023, includes the presentation, clinical management, and pathologic diagnosis of two separate uterine lipoleiomyomas. Separate chart reviews were performed on each patient, including frozen and permanent section pathologic findings. Micropictographs were obtained from hematoxylin and eosin-stained slides. This project was acknowledged as “IRB-exempt” by the MU Institutional Review board. Results: Case 1: A 51-year-old G3P2 woman presented with six months of severe postmenopausal bleeding, severe left-lower quadrant pelvic pain, and lightheadedness. A transvaginal ultrasound revealed a heterogeneous, thickened endometrial echo of 3.9 centimeters and a probable left ovarian dermoid cyst. CT showed distension of endometrial cavity due to polyps and/or submucosal masses, as well as a fat-containing mass in the uterine corpus. Hysteroscopy with dilation and curettage was performed with pathology of high-grade malignancy. Differential diagnosis at this time included high-grade stromal sarcoma, undifferentiated carcinoma, adenosarcoma, or malignant mixed Mullerian tumor. Patient underwent MRI due to concern for malignancy, which showed FDG-avid endometrial thickening with no other FDG-avid areas of concern. Histopathologic diagnosis found carcinosarcoma of the uterus, two positive lymph nodes, and an incidental finding of lipoleiomyoma. Plan for medical management with gynecologic oncology will include chemotherapy and vaginal cuff brachytherapy for uterine carcinosarcoma. Case 2: A 50-year-old G5P5 woman presented with increasing vaginal spotting and worsening urge incontinence. CT showed increased size of heterogeneous mass in right lateral uterine wall, consistent with previously identified fibroid/leiomyoma. An adjacent fat-containing lesion was identified within the uterine wall. Patient underwent MRI which revealed large uterine mass at the fundus, with an associated fatty component. Due to the abnormal rate of fibroid growth, and the fat component, there was concern for uterine sarcoma and/or malignant transformation of leiomyoma. Histopathologic diagnosis found lipoleiomyoma with benign atrophic endometrium, paratubal cysts of bilateral fallopian tubes, and follicular cyst of the right ovary. Follow-up in one year was recommended. Conclusion: Lipoleiomyomas are uncommon benign entities, occurring most commonly in postmenopausal women, similarly to uterine fibroids. While asymptomatic patients can be managed conservatively, these tumors can cause vaginal bleeding, pain, and urinary or fecal incontinence and can be definitively treated with hysterectomy. While imaging is necessary to initially characterize the lesion and determine concern for malignancy, histopathologic diagnosis remains the gold standard for diagnosis. Lipoleiomyomas are associated with other gynecologic malignancies, metabolic disorders, and rarely tumor-to-tumor metastasis. For this reason, careful clinical evaluation and surgical management are required for complete evaluation of the patient.

Twisted Fate: Third Trimester Ovarian Dermoid Cyst Torsion

Twisted Fate: Third Trimester Ovarian Dermoid Cyst Torsion

Case Series and Review of Uterine Lipoleiomyomata

Introduction Uterine lipoleiomyomas are benign neoplasms that are not often seen in clinical practice. First described in 1965, these entities were recognized by a composition of intermixed smooth muscle, mature adipocytes, and fibrous tissue [2,4]. The incidence of lipoleiomyoma has always been accepted as 0.03-0.2% by Willen et al. in 1978 [1,4]. However, recent studies propose a higher incidence at 2.9%, such as Akbulut et al. in 2014. Most commonly found in the uterus, these neoplasms can rarely be associated with the cervix, broad ligament, peritoneum, ovary, as well as other extrapelvic locations. These benign tumors present similarly to uterine leiomyomas in peri- and post-menopausal women with obesity, with symptoms of pelvic/abdominal pain, mild abnormal vaginal bleeding, constipation, increased urinary frequency, and possibly a palpable mass. Methods This case series, diagnosed in February and March of 2023, includes the presentation, clinical management, and ultimately pathologic diagnosis of two separate uterine lipoleiomyomas. Results A 51-year-old, G3P2, female presented with six months of severe post-menopausal bleeding, severe left-lower quadrant pelvic pain, and lightheadedness. A transvaginal ultrasound revealed a heterogeneous, thickened endometrium of 3.9 centimeters and a probable left ovarian dermoid cyst. CT showed distension of endometrial cavity due to polyps and/or submucosal masses, as well as a fat-containing mass in the uterine corpus. Hysteroscopy with dilation and curettage was performed with pathology of high-grade malignancy. Differential diagnosis at this time included high-grade stromal sarcoma, undifferentiated carcinoma, adenosarcoma, or malignant mixed Mullerian tumor. Patient underwent MRI due to concern for malignancy, which showed FDG-avid endometrial thickening with no other FDG-avid areas of concern. Histopathologic diagnosis found carcinosarcoma of the uterus, two positive lymph nodes, and an incidental finding of lipoleiomyoma. Further medical management will include chemotherapy and vaginal cuff brachytherapy for uterine carcinosarcoma. A 50-year-old, G5P5, female presented with increasing vaginal spotting and worsening urge incontinence. CT showed increased size of heterogeneous mass in right lateral uterine wall, consistent with previously identified fibroid/leiomyoma. An adjacent fat-containing lesion was identified within the uterine wall. Patient underwent MRI which revealed large uterine mass at fundus with associated fatty component. Due to abnormal rate of growth of fibroid and fat component, there was concern for uterine sarcoma and/or malignant transformation of leiomyoma. Histopathologic diagnosis found lipoleiomyoma with benign atrophic endometrium, paratubal cysts of bilateral fallopian tubes, and follicular cyst of the right ovary. Follow-up in one year was recommended. Conclusion Lipoleiomyomas are uncommon benign entities, occurring most commonly in post-menopausal women, similarly to uterine fibroids. While asymptomatic patients can be managed conservatively, these tumors can cause vaginal bleeding, pain, and urinary or fecal incontinence and can be definitively treated with hysterectomy. While imaging is necessary to initially characterize the lesion and determine malignancy concern, histopathologic diagnosis remains the gold standard for diagnosis. Lipoleiomyomas are associated with other gynecologic malignancies, metabolic disorders, and rarely tumor-to-tumor metastasis. For this reason, careful clinical evaluation and surgical management are required for complete evaluation of the patient.

6275602 Anesthetic management of a pregnant patient with congenital long QT syndrome type 2 undergoing ovarian dermoid cyst excision: A Case Report

6275602 Anesthetic management of a pregnant patient with congenital long QT syndrome type 2 undergoing ovarian dermoid cyst excision: A Case Report

Diagnostic dilemma – Ovarian dermoid cysts presenting with uncommon complications and a rare association

Mature cystic teratomas, also known as dermoid cysts, are commonly encountered ovarian tumors accounting for up to 10–25% of all ovarian neoplasms. Mostly asymptomatic and incidentally detected, they may present with associated complications such as torsion, rupture, malignant transformation, and infection. Fistulization of ovarian cysts into the bowel is a rare complication and occurs in cases of infection or malignant transformation. We present a rare case of an infected dermoid cyst with co-existing endometriosis and fistulization into the rectum in a 35-year-old female. The patient presented with fever, pain, and history of infertility. This article highlights the important differential diagnosis to be considered in a multiloculated ovarian cyst containing fat and pockets of air.

Ultrasound radiomics-based artificial intelligence model to assist in the differential diagnosis of ovarian endometrioma and ovarian dermoid cyst.

Accurately differentiating between ovarian endometrioma and ovarian dermoid cyst is of clinical significance. However, the ultrasound appearance of these two diseases is variable, occasionally causing confusion and overlap with each other. This study aimed to develop a diagnostic classification model based on ultrasound radiomics to intelligently distinguish and diagnose the two diseases. We collected ovarian ultrasound images from participants diagnosed as patients with ovarian endometrioma or ovarian dermoid cyst. Feature extraction and selection were performed using the Mann-Whitney U-test, Spearman correlation analysis, and the least absolute shrinkage and selection operator (LASSO) regression. We then input the final features into the machine learning classifiers for model construction. A nomogram was established by combining the radiomic signature and clinical signature. A total of 407 participants with 407 lesions were included and categorized into the ovarian endometriomas group (n = 200) and the dermoid cyst group (n = 207). In the test cohort, Logistic Regression (LR) achieved the highest area under curve (AUC) value (0.981, 95% CI: 0.963-1.000), the highest accuracy (94.8%), and the highest sensitivity (95.5%), while LightGBM achieved the highest specificity (97.1%). A nomogram incorporating both clinical features and radiomic features achieved the highest level of performance (AUC: 0.987, 95% CI: 0.967-1.000, accuracy: 95.1%, sensitivity: 88.0%, specificity: 100.0%, PPV: 100.0%, NPV: 88.0%, precision: 93.6%). No statistical difference in diagnostic performance was observed between the radiomic model and the nomogram (P > 0.05). The diagnostic indexes of radiomic model were comparable to that of senior radiologists and superior to that of junior radiologist. The diagnostic performance of junior radiologists significantly improved with the assistance of the model. This ultrasound radiomics-based model demonstrated superior diagnostic performance compared to those of junior radiologists and comparable diagnostic performance to those of senior radiologists, and it has the potential to enhance the diagnostic performance of junior radiologists.

Torsion of a Large Ovarian Dermoid Cyst in Third Trimester Pregnancy: A Case Report

Dermoid cysts are the most frequent ovarian tumours among women of reproductive age, constituting a notable 20% of all adult ovarian tumours. They are typically lined by stratified squamous epithelium and contain dermal and epidermal elements. During pregnancy, dermoid cysts are more likely to lead to infection, rupture and torsion. A 23-year-old multigravida (G2P1L1) female at 36 weeks of gestation presented with complaints of left lumbar pain persisting for one day, unrelieved by medication. Ultrasound (USG)revealed a multiloculated septated cystic lesion in the left lumbar region adjacent to the gravid uterus, just anteroinferior to the left kidney. Magnetic Resonance Imaging (MRI) showed a predominantly fat-density multiloculated cystic lesion with twisting of the pedicle. An emergency laparotomy was performed, and the left ovarian cyst was removed, revealing patchy discolored areas of gangrene, and a live healthy foetus was delivered. While torsion of an ovarian cyst is a well-known complication, its presentation during pregnancy is rare. Due to the variable symptoms of ovarian torsion, the clinical presentation can be quite confusing. Therefore, both the obstetrician and radiologist should have a lower threshold for clinical suspicion of torsion in pregnancy, enabling prompt diagnosis and management of such cases to prevent both maternal and foetal mortality.

Torsion of a Large Ovarian Dermoid Cyst in Third Trimester Pregnancy: A Case Report

Dermoid cysts are the most frequent ovarian tumours among women of reproductive age, constituting a notable 20% of all adult ovarian tumours. They are typically lined by stratified squamous epithelium and contain dermal and epidermal elements. During pregnancy, dermoid cysts are more likely to lead to infection, rupture and torsion. A 23-year-old multigravida (G2P1L1) female at 36 weeks of gestation presented with complaints of left lumbar pain persisting for one day, unrelieved by medication. Ultrasound (USG)revealed a multiloculated septated cystic lesion in the left lumbar region adjacent to the gravid uterus, just anteroinferior to the left kidney. Magnetic Resonance Imaging (MRI) showed a predominantly fat-density multiloculated cystic lesion with twisting of the pedicle. An emergency laparotomy was performed, and the left ovarian cyst was removed, revealing patchy discolored areas of gangrene, and a live healthy foetus was delivered. While torsion of an ovarian cyst is a well-known complication, its presentation during pregnancy is rare. Due to the variable symptoms of ovarian torsion, the clinical presentation can be quite confusing. Therefore, both the obstetrician and radiologist should have a lower threshold for clinical suspicion of torsion in pregnancy, enabling prompt diagnosis and management of such cases to prevent both maternal and foetal mortality.

The Possibility of Laparoscopic Cystectomy for Large Ovarian Dermoid Cyst in Young Age

Study Object: To evaluate the possibility of laparoscopic cystectomy for large ovarian dermoid cyst in young age. Laparotomy usually has been performed for it due to small abdomen and spillage. Materials and Methods: The patients below 15 years-old were 33 of 71 patients. Large cyst (above 6 cm) were 15 of 33 patients. Intervention: The cysts classified to type A and type B according to contents. Type A has more fluid content than thick non-fluid content, and type B is opposite. In type A, cystectomy was modified to minimize the spillage of content by aspiration and suture before dissection of cyst and by immediate suction with suture for rupture. In below 15 years-old, Type A was 27 of 33 patients (81.8%) compared to 5 of 38 (13.2%) in older age (p<0.01). Results: In type A cysts during the operation, no rupture was 28 of 32 patients (87.5%) and ruptures but no spillage to abdomen were 4 (12.5%) and spillage case was none. However, in type B (p<0.05), no rupture was 23 of 39 (58.2%) and rupture but no spillage was 13 of 34.2 (34.2%) and the spillage was 3 of 39 (7.6%). In patients below 15 years-old, all 15 patients with cysts above 6 cm were type A compared to 12 of 18 (66.7%) with the smaller cysts (p<0.01). The spillage rates in below 16 years-old were no rupture 1 of 33 (3.0%), ruptures but no spillage 3 of 33 (88%) compared to in 38 older age patients (12.6%, 34.4% and 53%; p<0.05). Conclusions: Large dermoid cysts in young age has more fluid contents and modified operation to minimize spillage can be possible. Therefore, even in large dermoid cyst of young age, laparoscopic cystectomy is possible and sometimes easier than old age.

Detection of Maternal Malignancy after Abnormal Noninvasive Prenatal Testing (NIPT)

Introduction: Noninvasive prenatal testing (NIPT) is routinely used to screen for fetal aneuploidies in chromosomes 13, 18 and 21. NIPT uses NGS based methods to detect fetal cfDNA in maternal circulation. In 2016, the American College of Obstetricians and Gynecologists recommended offering NIPT testing for all pregnant patients regardless of maternal age. Reports of maternal malignancy detected by NIPT have been increasing since its wide adoption into clinical practice, but subsequent management has not been standardized. We therefore report the outcomes of patients with abnormal NIPT evaluated and managed at a single institution. Methods: A case series ofpatients referred to Dana-Farber Cancer Institute between 2014 and 2022 for evaluation following an abnormal NIPT or for treatment of a cancer identified through NIPT. Results: Fourteen cases were included in this series. The median age at NIPT was 34 (range 29-42). Most patients (79%) had multiple chromosomal aneuploidy while 3 patients had ≤2 chromosomal abnormalities reported on their NIPT. Twelve patients (86%) underwent subsequent invasive prenatal testing: results were normal in all but one whose trisomy 12 finding led to early termination. Eleven patients (79%) underwent a whole-body MRI (WBMRI), 6 (55%) of which identified a suspicious finding that required biopsy. Of the 6 patients biopsied for a finding on WBMRI, 5 (83%) were found to have a malignancy. All patients who had a negative WBMRI did not have an identified malignancy. Of the total 14 cases, 10 (71%) underwent biopsies for abnormal findings and 8 (80%) of biopsies led to diagnosis of malignancy (or 57% of overall cohort). This was found to be Hodgkin lymphoma in 4 (29%), primary mediastinal large B cell lymphoma in 2 (14%) and triple negative breast cancer in 2 (14%) of the patients. Other causes of abnormal NIPT were uterine fibroids in 3 (21%), hepatic adenoma in 1 (7%), ovarian dermoid cyst in 1 (7%) and no abnormal findings in 1 (7%). Half of the patients received cancer treatment during pregnancy and the other half after pregnancy. Treatment included chemotherapy 6 (75%), chemotherapy/radiation 1 (12.5%) and surgery/chemotherapy 1 (12.5%). Post treatment, 6/8 (75%) patients achieved a complete metabolic response (CMR), one patient is still undergoing treatment and one patient (breast cancer) is deceased. Overall, there were 12 (86%) live births, one pregnancy termination and one patient with missing data. The median birthweight was 7.2 lbs (6.1-8.5 lbs). Two patients had NIPT with previous pregnancies. One patient had a normal NIPT and the other had an abnormal NIPT that was similar in two pregnancies, but she had a hepatic adenoma. Two patients with PMBCL had subsequent pregnancies and repeat NIPT after treatment were both normal . Conclusions: Specific abnormal NIPT results may be caused by maternal malignancy, especially where there is discordance with the fetal karyotype. A WBMRI without contrast is a safe and feasible initial approach for diagnosis and staging in these patients. Most tumors are lymphomas, for which treatment during and soon after pregnancy is possible with favorable maternal and fetal outcomes.

Severe postmenopausal hirsutism and virilization caused by a virilizing ovarian dermoid cyst

Severe postmenopausal hirsutism and virilization caused by a virilizing ovarian dermoid cyst

Ovarian Dermoid Tumor Masquerading as Rectal Tumor

Ovarian Dermoid Tumor Masquerading as Rectal Tumor

Co-Existence of Endometriosis with Ovarian Dermoid Cysts: A Retrospective Cohort Study.

Both endometriosis and ovarian dermoid cysts are benign conditions characterized by the presence of well-differentiated tissues in ectopic locations. The presence and surgical excision of these entities can potentially impact ovarian reserves, contributing to reduced chances of future pregnancy. The objective of our study is to investigate the bidirectional association between endometriosis and ovarian dermoid cysts, as well as to analyze the clinical characteristics of patients diagnosed with both conditions. A retrospective cohort study was conducted, including women who underwent laparoscopy and received histological diagnoses of endometriosis and/or dermoid cysts between 2011 and 2019 at the Cantonal Hospital of Schaffhausen. We identified 985 women with endometriosis and 83 women with ovarian dermoid cysts. Among these groups, 22 women presented with both endometriosis and ovarian dermoid cysts. The majority of the above patients had endometriosis stage rASRM I-II (72.7%), with peritoneal endometriosis being the most common phenotype of endometriosis (77.2%). Out of the 14 patients with a desire for future pregnancy, the majority (11/14, 78.5%) had an EFI score of 7-8. The prevalence of bilateral ovarian dermoid cysts was higher in women with both ovarian dermoid cysts and endometriosis in comparison to women with ovarian dermoid cysts without endometriosis (18% vs. 6.5%). Our study revealed that 26.5% of women with ovarian dermoid cysts also had endometriosis, a notably higher prevalence than observed in the general population. Clinicians should be aware of this co-existence, and preoperative counseling should be an integral part of the care plan for affected individuals, where the potential risks and the available options for fertility preservation should be discussed in detail.

Role of Kanchnar Guggulu in Ovarian Dermoid Cyst

Today we see the age of menarche has dropped to as 10 years of age. In fast growing world, over workload, pesticides rich food, hormone-based fruits and vegetables, stress, over ambition, avoiding pregnancy all are the major causes of these new diseases in modern woman. Premenstrual syndrome, irregular menses, ovarian cyst, uterine fibroids are commonly seen now a days. Due to defective lifestyle of women in modern era, ovarian cyst has become a burning problem in current scenario affecting all age group of women. There is no such effective treatment in modern science rather hormonal therapy and laparoscopy and hormonal therapy has its own harms, regardless of the presence of this disease laparoscopy or surgical management is certainly a treatment option; it is not necessarily the only option. Hormonal therapy is not a ‘cure’. Due to limitation of Modern science, Ayurveda has a great scope in this filed. This is the high time to develop an effective Ayurvedic treatment protocol for its prevention & cure.

The Role of CA19-9 and CA125 in Differentiation of Ovarian Dermoid Cyst and Ovarian Malignancy: A Case-Control Study

Background: An ovarian dermoid cyst is one of the most prevalent benign tumors in women of reproductive age. They can get complicated or be mistaken for malignant tumors. Most of the time, their pathology will not be discovered until after surgery. Objectives: Finding the role of CA19-9 and CA125 tumor markers in diagnosing the dermoid cyst before surgery and distinguishing it from the malignant type. Methods: A case-control study was conducted on all cases of dermoid cysts and malignant tumors (both diagnosed by pathology) from 2019 to 2021. Required information such as age, level of tumor markers, size, and whether it is unilateral or bilateral were extracted, and the tumor marker levels were analyzed in benign and malignant groups. Results: In this study, 95 cases of ovarian cysts and 85 control of malignant ovarian tumors were included. The mean level of CA19-9 and CA125 in the patients with dermoid cysts was 32.26 ± 5.45 units/mL and 31.37 ± 4.77 units/mL, respectively. In the malignant ovarian tumor group, the average level of CA19-9 and CA125 was equal to 9.56 ± 3.54 units/mL and 233.79 ± 54.57 units/mL, respectively. CA19-9 level was significantly higher in the dermoid cyst group (P-value < 0.001). CA125 level was significantly elevated among the malignant group (P-value < 0.001). It was observed that there was a significant relationship between the level of CA19-9 with the size of the cyst and the level of CA125 with the age of the patients. No significant relationship was found between the level of tumor markers and whether they were unilateral or bilateral. Conclusions: Regarding the correlation between the cyst size and CA19-9 in the comparison of the two groups, this tumor marker may be a suitable diagnostic marker in benign ovarian cysts along with ultrasound.

Successful use of single-port laparoscopic surgery for ovarian cyst removal during pregnancy: a case series of three cases

Abstract Pregnant patients have an increased risk of torsion compared to that seen in nonpregnant patients, and those with larger cysts undergo torsion more frequently, which can cause obstructions during labor. The risks associated with emergent surgery are higher than those with elective surgery. Laparoscopic surgery can be safely performed during pregnancy. Single-port laparoscopic surgery is reported to be a minimally invasive laparoscopic technique. We report three cases of ovarian dermoid cysts, which were successfully removed during pregnancy through elective single-port laparoscopic surgery. In all cases, imaging showed a dermoid cyst and the cyst size was greater than 6 cm. All patients requested the surgery. The ovarian cysts were successfully removed by single-port laparoscopy without additional ports and without intra- or postoperative complications. All pregnancies progressed well and delivered vaginally at full term. The single-port laparoscopic approach is useful for removing ovarian cysts during pregnancy.

Mature Cystic Teratoma at Fallopian Tubes: A Case Series.

case reports; dermoid cyst; fallopian tube; infertility.

Abstract #1412915: Malignant Struma Ovarii - A Rare Disease with Unpredictable Nature and Treatment Option Controversies

Struma ovarii is a rare kind of ovarian teratoma which consists of >50% of thyroid tissue. It contributes to 2-5% of all ovarian teratomas. 5-10% of ovarian teratomas undergo malignant transformation. To date, due to its rarity, unpredictable nature and high recurrence rate no consensus have been reached regarding the optimal treatment strategy. Therefore, it is prudent to highlight this rare disease and its management as sharing experiences will further expand the accruing data and helps in reaching consensus regarding its optimal treatment strategy. 42-year-old lady presented in clinic with missed periods. She had no weight loss and hyper or hypo thyroidism related symptoms. Her ultrasound pelvis revealed left ovarian cyst and MRI showed left ovarian dermoid cyst. She underwent left oophorectomy whose biopsy showed malignant struma ovarii having papillary thyroid carcinoma, FIGO stage 1a and BRAF V600 mutation was present. Her thyroid function test, thyroid scan, CT chest and abdomen were normal. She underwent staging laprotomy, right salphingo-oophorectomy, left salphingectomy and total hystrectomy whose biospy was normal. Subsequently total thyroidectomy was done which showed <1cm low grade papillary thyroid carcinoma involving left lobe of thyroid gland, stage pT1a, Nx, Mx. Her stimulated thyroglobulin and antithyroglobulin antibody were normal. Her 6 weeks postop ultrasound neck was normal. She was kept on replacement thyroxine doses. Malignant struma ovarii presents with abdominal pain, menstrual irregularity, bloating, abdominal mass and ascites. At times it may be asymptomatic. Thyroid symptoms are not frequent. Studies demonstrated good survival with malignant struma ovarii. However, its clinical course remains unpredictable with relatively high frequency of recurrences and metastasis irrespective of its morphology which poses difficulty in optimal treatment selection. Mostly aggressive approach including total hystrectomy, bilateral salphingo-oophorectomy, total thyroidectomy followed by radioactive iodine therapy and thyroxine in TSH suppressive doses have been adapted. Though some prefer less aggressive approach. Due to its uncertain nature and scanty data on its management, its optimal treatment is still a matter of debate. Tumor size, molecular profiling and histopathology have been proposed to consider while stratifying risk and selecting treatment approach. Moreover, vigilant followups should be done to detect early recurrence or metastasis so that timely intervention could be done.