Ovarian Follicular Cysts Research Articles

ADAPTING THE TREATMENT OF OVARIAN CYSTS ACCORDING TO THEIR TYPE IN DAIRY CATTLE

Ovarian cysts, estimated as the most frequent ovarian disorder in dairy cattle, can impact the economic aspect and trigger serious loss by affecting the reproductive performance. However, treatment strategies for ovarian cysts in dairy cattle are disputed, as some researchers favour the use of gonadotropin-releasing hormone (GnRH) for all cysts, whereas others recommend this treatment only for follicular cysts, with prostaglandin F2α (PGF2α) for luteal cysts, but not all of the dairy cattle responded to these regimes. Other studies mention a spontaneous recovery for some of the dairy cattle that present this disorder. However, the Ovsynch protocol appears to be the most used for treating ovarian follicular cysts, despite low pregnancy rates. Thus, this study’s main purpose is to assess by analogy the reproductive efficiency of multiparous dairy cattle with follicular cysts after treatment with a recommended dose of GnRH or a further Ovsynch protocol, and of cattle with luteal cysts after PGF2α or a further 12-day Presynch protocol, by comparing the reproductive responses between treated and non-treated cattle. It is remarkable that ten of the dairy cattle diagnosed with ovarian cysts recovered spontaneously without any hormonal intervention, but the reproductive performance indicates that treatment should be started as soon as the condition is diagnosed. Compared with other studies, our approach improved the conception (82.4% and 64.3%, respectively) and pregnancy rates (53.8% and 50%, respectively) in both follicular and luteal cysts.

6-Year-Old Girl With a Luteinized Follicular Ovarian Cyst and an Estradiol Level > 1,000 PG/ML

Background: Precocious puberty in girls is defined as onset of secondary sexual characteristics, such as breast development, before 8 years of age. To differentiate between central and peripheral precocious puberty, laboratory and imaging evaluation is helpful. When gonadotropins are low but estradiol is elevated, results may suggest a primary ovarian source of estrogen production. Small ovarian cysts are not uncommon, are benign and self-resolve. However, large ovarian cysts are rare, let alone ones requiring surgical removal. Clinical Case: A 6 year 7 month old girl presented with several days of breast tenderness and palpable bilateral breast tissue noted by her mother. There was no history of vaginal bleeding. There were no reported exposures to estrogen-containing products. Her mother reached menarche at age 14 years. The patient was born full term and was otherwise healthy. On exam, her height was at the 90-95th %ile (mid-parental height at the 95th %ile) and her growth velocity was 10.9 cm/yr. She had Tanner 2 breasts (1 cm breast bud on the left and 1.5 cm on the right), Tanner 1 pubic hair and no axillary hair, body odor, acne or café-au-lait macules. A bone age was read as 6 years at a chronological age of 6 years 7 months. A laboratory evaluation revealed an estradiol of 1,029 pg/mL (<15 pg/mL), LH <0.02 mIU/mL, FSH <0.09 mIU/mL, 17-hydroxyprogesterone (17-OHP) 410 ng/dL (<91 ng/dL), AFP 2.3 ng/mL (<6.1 ng/mL), beta-hCG <2 mIU/mL, TSH 2.41 mIU/L (0.5-3.2 mIU/L), and free T4 0.9 ng/dL (0.9-1.4 ng/dL). Pelvic ultrasound revealed a large unilocular cystic structure measuring 6.5 x 4.1 x 6.1 cm in the left adnexal region with no left ovary visualized. The right ovary appeared prepubertal. The uterus was prepubertal in appearance with endometrial thickness of 2 mm. Abdominal ultrasound showed no evidence of a suprarenal mass. A laparoscopic cyst resection was completed, given the risk of left ovarian torsion. Cytology was negative; pathology revealed a luteinized follicular cyst. Repeat labs in one month showed a prepubertal estradiol level of 6.7 pg/mL with LH 0.02 mIU/mL and FSH 0.38 mIU/mL. 17-OHP normalized to 29 ng/dL. Breast tissue had regressed. Conclusion: This case describes the rare finding of a large luteinized follicular ovarian cyst that required surgical removal in a 6-year-old girl in the setting of a significantly elevated estradiol level. Luteinized follicular cysts have been described in newborns, though rare. To our knowledge, this is the first described case of a luteinized follicular cyst in this patient’s age group. Laboratory and imaging evaluation should be considered in girls presenting with precocious puberty, despite the extent of thelarche, as the clinical examination does not always correlate with degree of estradiol elevation. This is especially important if clinical changes are acute and other features are consistent with puberty, such as rapid linear growth.

A Case of Preterm Ovarian Hyperstimulation Syndrome Presenting With Vaginal Bleeding

Abstract Background: Preterm ovarian hyperstimulation syndrome (POHS) is a rare syndrome described in preterm female infants. This is associated with high serum estradiol and gonadotropin levels, multiple follicular ovarian cysts, and edema of the hypogastric, labial and upper leg regions. This usually occurs at 30 to 39 weeks post-conceptional age (PCA). Vaginal bleeding may or may not be present. We present an unusual case of POHS that had a delayed presentation at 5 months of age (45 weeks PCA) with vaginal bleeding. Case presentation: An extremely premature female infant presented with vaginal bleeding at 5 months of age. Workup revealed pubertal gonadotropins indicating ovarian hyperstimulation. She had mild swelling in the hypogastric region. No breast buds were palpable and there was no clitoromegaly. At the time LH (22.2 mu/ml), FSH (8.3 mu/ml), Estradiol (502.2 pg/mL), and Testosterone (111 ng/dL) were all highly elevated. Multiple ovarian follicles were visualized on her pelvic ultrasound, with generous ovarian dimensions: right ovary (3.6 x 1.6 x 1.9 cm, volume 5.7 cc) and left ovary (2.5 x 2.4 x 1.5 cm, volume 4.7 cc). The largest follicle measured 8.8 mm. The uterus was 3.3 x 1.3 x 1.7 cm, with endometrial stripe thickness of 3 mm. There was no endometrial or adnexal mass. Cosyntropin test showed adequate peak cortisol (32.6 mcg/dL). Her newborn screen had been normal. Serial monitoring of her lab work showed a decrease in her gonadotropin and estradiol levels. She had a recurrence of vaginal bleeding about 3 weeks after initial presentation. By 50 weeks PCA the bleeding had resolved and the LH (1.2 mu/ml), FSH (1.5 mu/ml), estradiol (36 pg/ml) had reduced considerably. Complete normalization of LH (1.2 mu/ml), FSH (1.5 mu/ml), E (36 pg/ml), and testosterone (&amp;lt;7 ng/dl) was demonstrated by 55 weeks PCA. Conclusion: POHS has been attributed to the immaturity of the hypothalamic-pituitary-gonadal axis in preterm infants. Vaginal bleeding has been described in one case [1] several weeks after breast enlargement and swelling of clitoral hood, labia majora, hypogastrium and upper legs. In our case the baby presented with vaginal bleeding at 45 weeks that recurred about 3 weeks later and resolved by 50 weeks, with only minimal swelling. This case underlines the need to be aware of this etiology and its varied presentation. [1] Preterm ovarian hyperstimulation syndrome presented with vaginal bleeding: a case report. Altuntas et al. J Pediatr Endocr Met; 273(3-4):355-358.

Role of adjuvant hormonal therapy in restoring reproductive function in women after endosurgical treatment of ovarian follicular cysts

In the structure of the causes of female infertility, follicular ovarian cysts make up 710% of cases. Despite the studies on the reproductive health of women undergoing endosurgical treatment of follicular ovarian cysts, the problem of restoring reproductive function has not yet been resolved.&#x0D; Aim. To assess the effectiveness of a preparation containing 0.03 mg of ethinyl estradiol and 2 mg of chlormadinone acetate in the restoration of reproductive function in women after endosurgical treatment of follicular ovarian cysts.&#x0D; Materials and methods. The study group included 100 women, of whom 70 patients (the main group) received adjuvant therapy with a drug containing 0.03 mg of ethinyl estradiol and 2 mg of chlormadinone acetate after endosurgery, and a comparison group of 30 patients who did not receive adjuvant therapy. The diagnosis of follicular ovarian cysts was established on the basis of hormonal, ultrasound, endoscopic and immunohistochemical studies. The levels of gonadotropic hormones (LH, FSH), steroid hormones estradiol and progesterone were determined twice at the beginning of the follicular (35 day) and secretory phase (2022 day) of the menstrual cycle. An ovarian ultrasound was performed at the beginning of the follicular phase and on days 2022 of the menstrual cycle. Immunohistochemical studies of estrogen and progesterone receptors in the ovaries were carried out using a Bond-max immunostimulator from Leica (Germany) using monoclonal antibodies: clone 1D5 and clone 1A6 Dako (USA).&#x0D; Results. Menstrual irregularities were detected in 36 (51.4%) patients, of which: irregular menstruation in 18.0%, algomenorrhea in 15.1%, polymenorrhea in 11.0%, and menorrhea in 7.3% of patients, infertility was observed in 34 (48.6%) patients. Endosurgical treatment of follicular ovarian cysts was performed for all examined patients. Adjuvant hormone therapy with a drug containing 0.03 mg of ethinyl estradiol and 2 mg of chlormadinone acetate was received by 70 patients. Menstrual function was restored in 70 (100%) patients. Pregnancy occurred in 60 (86.0%) of them.&#x0D; Conclusion. Adjuvant hormone therapy with a drug containing 0.03 mg of ethinyl estradiol and 2 mg of chlormadinone acetate allowed to restore menstrual function (100% of cases), pregnancy at 4.3 times (86.0% of cases), which confirms its high efficiency in the restoration of reproductive function in women after endosurgical treatment of follicular ovarian cysts.

Ovarian responses and FSH profiles at superovulation with a single epidural administration of gonadotropin in the Thai-Holstein crossbreed.

The conventional method of ovarian superstimulation requires multiple injections of gonadotropins which is time-consuming and may be stressful for the cows. This study was designed to determine whether a single epidural injection of FSH (EI group) would induce the superovulatory response in the Thai-Holstein crossbreed and evaluate FSH plasma hormone concentrations. Eight cows (replication = 3; n=24) were assigned to one of 2 treatments in switch back design. Control group (n=12): cows were received 400 mg FSH twice daily by intramuscularly for 4 days (80, 80, 60, 60, 40, 40, 20 and 20 mg), EI group (n=12): cows were received 400 mg FSH by single epidural injection. Data were collected in term of ovarian follicle responses, superovulatory responses, ova/embryo collection. FSH concentrations were examined using ELISA. The total follicular responses during oestrus were not different between treatments; however, the large follicles were less frequent (P < 0.01) while the medium follicle sizes were higher (P < 0.05) in the EI group. The plasma concentration of FSH in EI was dramatically increased within 2 hours before decreasing sharply thereafter (P < 0.01) and did not remain above baseline after 10 hours of administration. The embryo quality was better in the control than the EI groups (P < 0.05). Interestingly, the number of ovulation cysts in the EI group was 50%. The ovarian responses and embryo quality in the cows with cysts were worse compared with the non-cyst groups (P < 0.05). In conclusion, alternative protocols decreased the superovulatory response and increased poor embryo quality in Thai-Holstein crossbred. Also, the incidence of ovarian follicular cysts is higher in the EI group.

Association of endometritis and ovarian follicular cyst with mastitis in dairy cows.

The occurrence of multiple metabolic and inflammatory diseases in dairy cows is higher during the periparturient period, which may be triggered by bacterial components, but not a viable bacterium. This study aimed to determine the association of endometritis and ovarian follicular cyst (OFC) with mastitis in dairy cows. Ninety-eight Holstein dairy cows were clinically examined for endometritis and OFC approximately 30–50 days after calving. Blood and milk samples were collected for the determination of milk somatic cell count (SCC); milk interleukin-1β (IL-1β), tumor necrosis factor-α (TNFα), and interleukin-8 (IL-8) concentrations; and plasma haptoglobin (Hp) and lipopolysaccharide-binding protein (LBP) concentrations. Of the 98 dairy cows included in this study, 12 were diagnosed with endometritis and 37 cows were identified as OFC-positive, whereas the remaining 49 cows were healthy (without endometritis or OFC). The average and maximum SCCs and plasma Hp and LBP concentrations were not significantly different between the healthy cows and those with endometritis or OFC. However, when the maximum SCC was classified as <300, 300–1,000, or >1,000 × 103 cells/ml, the percentage of cows with the maximum SCC <300 × 103 cells/ml was significantly lower in the endometritis and OFC-positive groups than in the healthy group. These results suggested that cows with endometritis and OFC during the postpartum period exhibit high SCC, indicating that some bacterial components can be transferred between organs.

Application of cattle placental stem cells for treating ovarian follicular cyst.

BACKGROUNDHigh humidity and temperature in Taiwan have significant effects on the reproductivity of Holstein cattle, resulting in the occurrence of bovine ovarian follicular cyst (OFC). Because of economic loss from OFC, manual rupture and hormone injection have been advocated for the management of OFC. However, these incomplete treatments increase hormone resistance in cattle. Mesenchymal stem cells (MSCs) derived from placental stem cells (PSCs) demonstrate potential properties for the treatment of several diseases via promoting angiogenesis and immune modulation. AIMTo establish the possibility of cattle placental stem cells (CPSCs) as a treatment modality for OFC of cows in Taiwan. METHODSThe cows with OFC were divided into three groups: control (BC1 and BC2), hormone (H1 and H2), and CPSC (PS1 and PS2) treatment groups. In the hormone treatment group, the cows were given gonadotrophin-releasing hormone (GnRH)-prostaglandin-GnRH intramuscular injection with or without drainage of follicular fluid. In the CPSC treatment group, CPSCs were isolated from the placenta after labor. With the identification of surface antigen on stem cells, the cows were administered ovarian injection of 1 × 106 or 6 × 106 CPSCs with drainage. In all groups, OFC was scanned by ultrasound once a week for a total of seven times. The concentrations of estradiol and progesterone in serum were tested in the same period. The estrus cycle was analyzed by food intake and activity. If estrus was detected, artificial insemination was conducted. Then the cow was monitored by ultrasound for confirmation of pregnancy.RESULTSAfter 7 d of culture, CPSCs were successfully isolated from placental pieces. CPSCs significantly proliferated every 24 h and had high expression of MSC markers such as cluster of differentiation 44, as determined by flow cytometry. Ultrasound showed lower numbers of OFCs with drainage of follicular fluid. We achieved recovery rates of 0%, 50%, 50%, 75%, 75% and 75% in BC1, BC2, H1, H2, PS1, and PS2, respectively. Higher concentrations of progesterone were detected in the CPSC treatment groups. However, both hormone and CPSC treatment groups had no significant difference in the concentration of estradiol. The estrus rate was 0%, 100%, 25%, 75%, 75% and 75% in BC1, BC2, H1, H2, PS1, and PS2, respectively. The two fetuses were born in H2 and PS1. In brief, cows with CPSC injection achieved higher recovery, estrus, and inseminated conception rates.CONCLUSIONCPSCs have efficacy in treating cows with OFC, and thus, may serve as an alternative treatment for reproductive disorders.

Impact of lipopolysaccharide administration on luteinizing hormone/choriogonadotropin receptor (Lhcgr) expression in mouse ovaries

Lipopolysaccharide (LPS) is isolated from the genital tract of animals suffering from uterine damage and ovarian dysfunction. This study provides direct molecular evidence about the mechanism through which endotoxins cause reproductive disorders. Granulosa cells and ovaries were collected from immature mice treated with eCG or with eCG and LPS injection intraperitoneally. Normal large antral follicles were observed in ovaries obtained from eCG and LPS coinjected mice, and the morphology of the ovaries was similar to that observed in the control group. These antral follicles were not deemed atretic because few TUNEL-positive cells were observed. However, the granulosa cells of large antral follicles did not acquire the ability to respond to hCG stimulation. The number of ovulated oocytes was significantly lower in LPS-injected mice after superovulation compared to mice that were not exposed to LPS. The low reactivity was caused by the limited expression of the Lhcgr gene, which encodes the LH receptor in granulosa cells as well as an LPS-induced increase in the level of Dnmt1 expression. The methylation rate of the Lhcgr promoter region was significantly higher in granulosa cells obtained from the LPS treatment group compared with the control group. Together, these findings demonstrated that the decrease in the expression of Lhcgr due to LPS was a result of the epigenetic regulatory action of LPS. Our studies suggest that ovarian follicular cysts that is characterized by bacterial infection in humans and animals, is closely connected to the level of methylation of the Lhcgr promoter region.

Ovarian Dynamics, Plasma Endocrine Profile and Fertility Response Following Synchronization Protocols in Crossbred Cows with Cystic Ovaries

Background: Cystic ovarian degeneration (COD) with prevalence of 10-13% is a common and economically important condition in dairy cattle affecting fertility. Predisposing factors and aetiology of ovarian cysts are multifaceted. The most widely accepted cause is either absent, insufficient or wrong time occurrence of pre-ovulatory LH-surge. The accuracy of differential diagnosis of cyst per rectum can be increased by simultaneous use of USG and/or plasma progesterone assay and therapeutic success depends on type and duration of cystic condition. The literature on these aspects in crossbred cows is meagre, hence was planned to differentially diagnose the ovarian follicular and luteal cysts based on clinical, sonographic and endocrine findings and to study the estrus response and conception rates following different treatment modalities of COD in crossbred cattle. Methods: This study was conducted on greater than 90 days postpartum HF crossbred cows with cystic ovaries (n=58) confirmed by per rectal palpation and ultrasonography. The animals with follicular cysts were randomly treated with either conventional Ovsynch or Ovsynch + CIDR protocol (n=10 each) and those with luteal cysts with either Double PG injections 11 days apart or modified Ovsynch protocol (n=16 each) with fixed time AI. A group of six cystic cows was kept as untreated control. Blood samples were collected in heparinized vacutainers, together with trans-rectal ultrasonography, on day 0 (just before initiation of treatment), on day of last PGF2á injection, on day of induced estrus/FTAI and on day 12 post-AI for determination of plasma progesterone and estradiol-17â by RIA technique. Results: The mean diameters and wall thickness of ovarian cysts regressed significantly (p less than 0.01) among responded cows of all four protocols. The estrus induction response within 48-96 hrs of last PG injection with Ovsynch, Ovsynch + CIDR, Modified Ovsynch and Double PG protocols was 90.00, 100.00, 87.50 and 81.25 %, respectively. The conception rates at induced estrus with FTAI for these protocols were 50.00, 40.00, 50.00 and 43.75 %, respectively and the corresponding overall conception rates for 3 cycles’ post-treatment were 60.00, 70.00, 68.75 and 56.25 %, respectively, compared to zero result of control group. The mean plasma progesterone concentration varied highly significantly (p less than 0.01) between periods of treatment in all protocols, the values were lower (p less than 0.01) on day 0 and on day of FTAI than on the day of last PG injection and on day 12 post-AI. The values on day 12 post-AI were significantly higher in conceived than non-conceived cows. The trend of estradiol-17â profile on day of last PG injection was reversed than on day 0. The higher levels of estradiol-17â on day of FTAI were associated with regression of cystic structures and development of new dominant follicles with estrogenic activity concomitant to induced estrus and ovulatory LH surge in most of the animals as evident from USG monitoring, behavioural signs and conception rates.

The role of relative hyperprolactinemia in the genesis of the оvarian follicular cysts development

Follicular ovarian cysts (FOC) today occur in 25–30% in the structure of all tumors and tumor-like formations in gynecological practice and tend to increase. The study presents the results of using four different treatment regimens for FOC treatment in patients aged 18 to 42 years. Group I (n = 46) consisted of women with uncomplicated course of FOC who received complex hormonal therapy for 3 months. Group II (n = 49) patients who received monotherapy with a special extract of the Vitex Agnus Castus BNO 1095 (Cyclodynon®) for 6 months. Group III (n = 47) – patients who received a combination of hormone therapy (3 months) and BNO 1095 (6 months). Group IV (n = 35) – patients who did not receive drug therapy (expectant tactics + lifestyle modification).The highest efficacy in relation to the elimination of FOC and the stability of the result during the year was observed in patients of group III who received complex hormone therapy + BNO 1095 extract. Elimination of FOC in 100% of patients within 3 months with a result of more than 95% of patients during the year. Complex hormonal therapy without the use of BNO 1095 (group I) also showed a rather high efficiency with respect to the regression of FOC, but the result was not stable. During the year, relapses in the formation of FOC were observed in 37% of patients. Monotherapy BNO 1095 (group II) demonstrated the efficacy of resorption of the cyst for 6 months in 87% of cases, with the result being preserved for over a year in almost 80% of patients. Active observation (group IV) showed fairly low efficacy: after a year of observation FOC had more of 63% of patients.The average prolactin level in the study groups was higher than the reference values. During the observation period, prolactin levels in all groups except the control group decreased statistically. After 12 months of follow-up, in the group of women who received a combination of hormone therapy with Cyclodynon®, steady normalization of steroid hormones, estradiol and progesterone, was observed, which is explained by the restoration of the biphasic menstrual cycle in most women of this group.The study confirms the role of functional hyperprolactinemia in the development of FOC and the advisability of prescribing Cyclodynon® in their treatment regimen both in combination with hormone therapy and monotherapy (if there are have contraindications to hormone therapy or reproductive plans).

Influence of ovarian follicular cysts on reproductive performance in the cattle of new Ukrainian red dairy breed

Influence of ovarian follicular cysts on reproductive performance in the cattle of new Ukrainian red dairy breed

Hormonal and biochemical studies on female dromedary camels affected with multiple ovarian cysts

Abstract The purpose of the present study was to investigate the hormonal and biochemical profile of dromedary she-camels with multiple ovarian cysts (MOC). Seventeen she-camels suffering from MOC and 10 control animals were enrolled in this study. Blood samples were collected from all animals. Progesterone (P4), estradiol 17-β (E2), Testosterone, tri-iodothyronine (T3), Thyroxine (T4), glucose, total protein, albumin, total cholesterol, triglycerides, HDL, nitric oxide (NO), malondialdehyde (MDA) and glutathione peroxidase (GPX) levels were estimated in blood serum. Results revealed the presence of three or more large follicular ovarian cysts either on one (n = 6) or both ovaries (n = 11) of MOC cases with absence of any luteal structure. She-camels with multiple MOC had significantly (P ≤ 0.001) lower levels of P4 (0.24 ± 0.02 vs. 0.40 ± 0.03 ng/mL, respectively) and significantly higher levels of E2 and T3 (19.62 ± 0.62 vs. 13.74 ± 0.67 pg/mL, P ≤ 0.001 and 1.85 ± 0.09 vs. 1.44 ± 0.10 ng/mL, P ≤ 0.012, respectively) as compared with control. There were no significant differences between the two groups regarding testosterone and T4 levels (0.031 ± 0.002 vs. 0.026 ± 0.001 and 10.93 ± 0.24 vs. 10.17 ± 0.28 ng/mL, respectively). She-camels having MOC had significantly higher levels of glucose, cholesterol, triglycerides, HDL, total lipids and MDA and lower levels of GPX and NO as compared with control group. There were no significant differences between the two groups in levels of total proteins, albumin and globulin. In conclusion, the hormonal imbalances, metabolic disorders and oxidative stress are involved in the formation and/or persistence of multiple ovarian cysts in dromedary camels.

Histopathological study of ovarian lesions at a tertiary rural hospital

Background:Ovaries are the third leading site of cancer among women trailing behind cervical and breast cancer according to the Indian cancer registries. The spectrum of ovarian lesions is wide with harmless simple cystic lesions at one end and the fatal aggressive malignant lesions at the other end. Thus, ovarian neoplasm offers a good field for research. The present study is aimed to observe the frequency of neoplastic and non-neoplastic lesions in a tertiary care centre of rural India. Methods: This was a prospective two years observational study and was conducted at the Department of Pathology SRTR GMC, Ambajogai, including 185 ovarian lesions. Result: Total 185 ovarian lesions were studied, 101 cases were non-neoplastic while 84 cases were neoplastic. The most common non-neoplastic lesion was corpus luteal cyst (27.7%) followed by simple ovarian cyst (24.7%) and follicular cyst (21.8%). Among 84 neoplastic cases, 74 cases (88.1%) were benign,02 cases (2.4%) were borderline tumours and 08 cases (9.5%) were diagnosed malignant. Surface epithelial tumours contributed 75% cases, while germ cell tumours and sex-cord stromal tumourcontributed 20.8% and 4.8% respectively. Conclusions: Both non-neoplastic as well as neoplastic lesions of ovary often present with similar clinical and radiological features. So histopathological study is essential to diagnose ovarian tumours and predict their prognosis.

Ovarian Granulosa Cell Tumors: Cystic Presentation of Six Cases

The World Health Organization classifies ovarian granulosa cell tumors as sex cord stromal tumors pure sex cord and both, adult granulosa and juvenile granulosa cell tumors are described. Usually, they appear as solid or cystic solid tumors and less commonly the tumors are entirely cystic, which results in scarce literature published on this presentation. Juvenile type presents histologically a lobulated appearance Call-Exner bodies are infrequent, luteinization is common, and it is usual to observe follicles containing eosinophilic or basophilic secretions. Adult type typically shows a proliferation of uniform cells with vesicular nuclei that show typical grooves. It is important to take into account the entirely cystic presentation to avoid wrong diagnoses such as ovarian follicular cyst. From the pathological point of view there are no overwhelming data that could clearly differentiate a cystic granulosa cell tumor from a follicular cyst. However, some authors have described macroscopic and microscopic findings that should be taken into account to perform the differential diagnostic between these entities. Six cystic granulosa cell tumor cases from the period 1973–2017 from our Pathology Department were studied, and they included three adult granulosa cell tumors and three juvenile granulosa cell tumors. We analyzed clinical presentation and histological features like patterns, nuclear atypia, epithelium-stroma relationship, mitotic index, and presence of necrosis in order to establish whether there is a correlation among these parameters and clinical behavior.

Hydroxysafflor yellow A exerts beneficial effects by restoring hormone secretion and alleviating oxidative stress in polycystic ovary syndrome mice.

What is the central question of this study? What are the potential therapeutic roles of ginsenoside Rb1 and hydroxysafflor yellow A (HSYA) in polycystic ovary syndrome (PCOS). What is the main finding and its importance? HSYA restored the oestrous cycles of PCOS mice, reduced follicular cysts in ovaries and rescued abnormal hormone secretion; ginsenoside Rb1 did not ameliorate the main symptoms of PCOS mice. HSYA alleviated oxidative stress along with an enhancement of antioxidant enzyme activity. This highlights a potential role of HSYA in PCOS therapy. Polycystic ovary syndrome (PCOS) is the most common endocrine disease resulting in female infertility. Hydroxysafflor yellow A (HSYA) and ginsenoside Rb1 have been shown to have antioxidant properties, but little is known about their impact in PCOS. Here dehydroepiandrosterone was used to induce PCOS in a mouse model that was characterized by an irregular oestrous cycle, cystic follicles and an elevated serum testosterone level. Supplementation of HSYA restored the oestrous cycle of PCOS mice, reduced follicular cysts in PCOS mouse ovaries and brought about a decline in serum testosterone level, while ginsenoside Rb1 did not ameliorate the above symptoms of PCOS mice. After HSYA treatment, there was elevation of serum oestradiol, progesterone, luteinizing hormone and anti-Müllerian hormone levels and a reduction of follicle-stimulating hormone level, but ginsenoside Rb1 only rescued the levels of follicle-stimulating hormone and anti-Müllerian hormone. Further analysis evidenced that HSYA reversed the expression of steroid hormone secretion-related genes Star, Hsd3b1, Cyp11a1 and Cyp19a1. In PCOS mice HSYA weakened the elevation of ovarian malondialdehyde, which is regarded as a biomarker for oxidative stress. Moreover, HSYA improved reduced glutathione content accompanied by a simultaneous increase in reduced to oxidized glutathione ratio, and enhanced the activities of the antioxidant enzymes superoxide dismutase, glutathione peroxidase and catalase. Collectively, HSYA exerted beneficial effects on PCOS mice by restoring hormone secretion and alleviating oxidative stress.

Intraoral and extraoral hyperpigmentation and an expansile mandibular lesion

A 19-year-old woman was referred to the Oral and Maxillofacial Pathology Resident Clinic at Northwell Health Long Island Jewish Medical Center with a primary symptom of “dark spots on my tongue and lips.” She initially reported a noncontributory medical and social history and was not taking any medication at that time nor had any allergies to report. On further questioning, the patient revealed a prior diagnosis of a condition involving multiple bones, including her femur, humerus, maxilla, and mandible. This condition caused expansion of these bones and created a greater risk of developing a fracture. Previous radiographs of the humerus and femur were reviewed (Figure 1). At 10 years of age, she underwent mandibular recontouring for mandibular expansion and obvious facial asymmetry. The tissue was submitted for histologic examination, which revealed a benign fibro-osseous lesion consisting of irregularly shaped, lamellar trabeculae with minimal osteoblastic rimming in a fibrous stroma exhibiting clefting around the trabeculae (Figure 2). She also reported multiple pigmented cutaneous macules on her right shoulder, right buttock, and right inner thigh that had not changed in size and were of unknown duration. She reported an incident of vaginal bleeding at the age of 7, which on further evaluation was revealed to be a sequela from an ovarian cyst. A search of our institution’s archives revealed that the histologic examination of the tissue showed an ovarian follicular cyst with luteinization, which is not an age-appropriate finding in a prepubescent 7-year-old girl. No other family member had exhibited these signs or symptoms. Figure 2Histologic presentation of tissue submitted after recontouring of expansile mandibular lesion. A. A low-power (hematoxylin-eosin, original magnification ×40) image of the tissue specimen shows irregular trabeculae of woven bone in a somewhat parallel arrangement within a fibrous connective tissue stroma. There is a marked clefting artifact separating the connective tissue stroma from the bony trabeculae. B. A higher power (hematoxylin-eosin, original magnification ×100) view of the tissue shows the minimal osteoblastic rimming around the trabeculae in scattered areas but absent entirely in others. The fibrous tissue stroma, parallel trabeculae arrangement, and cleft artifact can also be seen at this power. View Large Image Figure Viewer Download Hi-res image Dr Roth is an oral and maxillofacial pathology resident, Department of Dental Medicine, Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, New Hyde Park, NY. Dr Kelsch is an associate professor, Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, New Hyde Park, NY.

A giant ovarian follicular cyst - a rare case report

Background: Benign cystic ovarian mass is a very common incidentally detected mass lesion in the reproductive age group female. A giant ovarian follicular cyst is a very rare entity described in the literature. Imaging modalities including ultrasonography (USG) and magnetic resonance imaging (MRI) play a pivotal role in the differential diagnosis of cystic ovarian mass lesions. Case Presentation: A young adult female presented to surgery outpatient department with the complaints of abdominal pain with normal vital parameters. Subsequent USG and MRI study showed a large abdominopelvic cystic mass lesion with right mild hydroureteronephrosis. Furthermore, the histopathological investigation confirms the diagnosis of a simple follicular cyst. Conclusion: Imaging modality collaboration with the histopathological findings may lead to accurate diagnosis of cystic ovarian mass. USG and MRI play a vital role in narrow down the differential diagnosis, which can be further confirmed on histopathological investigations.

MRI image features and differential diagnoses of Herlyn–Werner–Wunderlich syndrome

This study aims to explore how Herlyn–Werner–Wunderlich Syndrome (HWWS) manifests in diagnostic images and analyze the imaging specifications and differential diagnoses thus improving the understanding of the disease. The preoperative magnetic resonance imaging (MRI) findings and clinical data of 19 patients with HWWS were retrospectively analyzed, taking the intraoperative findings and postoperative pathological results of laparoscopic or hysteroscopy surgery as the diagnostic criteria. In this study, all the 19 patients underwent laparoscopic or hysteroscopic excision of vaginal oblique septum, and the preoperative MRI diagnosis of HWSS was consistent with the clinical postoperative diagnosis, with a diagnosis coincidence rate of 19/19 (100%). According to the classification of vaginal oblique septum syndrome, 16 cases were vaginal oblique septum type I and 3 cases were vaginal oblique septum type II. MRI showed a double uterus and double cervix, blood accumulation and dilatation of the vagina connected with the cervix of the affected side, T1WI showed high signal intensity and T2WI showed low or mixed signal intensity. MRI coronal view of 19 patients clearly showed ipsilateral renal absence with obstruction, including 5 cases on the left and 14 cases on the right. Other pelvic complications included: 1 patient with cervical dysplasia and the absence of right kidney and ureter, 3 patients with right ovarian endometriosis cyst, 1 patient with complicated with adenomyosis, 1 patient with right ovarian follicular cyst, 1 patient with right ovarian fallopian tube and pelvic abscess, and 1 patient with right ovarian hematoma. The MRI image of HWWS has its own features and MRI can more accurately evaluate type and related complications of HWWS, therefore it can be used as the best and effective examination method for preoperative imaging evaluation, thus better providing help for clinical comprehensive preoperative evaluation and guidance of surgery.

Laparoscopy decision for precocious pseudopuberty of ovarian origin

Development of autonomous functional ovarian follicular cysts results in precocious pseudopuberty. Conservative approach is the first choice for these patients, and the authors present two cases of precocious pseudopuberty due to autonomous ovarian cysts to discuss the decision of surgery.

SAT-292 Superimposed Peripheral Precocious Puberty Caused by Autonomous Ovarian Follicular Cyst in Being Treated Central Precocious Puberty Patient: Underlying Condition of Herlyn-Werner-Wunderlich Syndrome

Autonomous ovarian follicular cysts are known as the most common cause of peripheral precocious puberty(PPP) in prepubertal girls, and relapses of autonomous ovarian cysts resulting in prolonged estrogen exposure can precipitate early maturation of the hypothalamic-pituitary-gonadal axis, resulting in progression from PPP to central precocious puberty(CPP), which is called “combined precocious puberty”, an evolution which may require GnRH therapy. In present case, PPP caused by autonomous ovarian follicular cyst was developed concomitantly during the treatment course of CPP, with suppressed status of hypothalamic-hypophyseal-axis. In addition, a rare congenital Müllerian anomaly known as Herlyn-Werner-Wunderlich syndrome(HWWS), consisting of uterus didelphys, obstructed hemivagina and unilateral renal agenesis was incidentally diagnosed as an underlying condition. A 7-year-old girl was presented to our clinic with the development of breast buds which was examined as Tanner stage 2-3. Right renal agenesis was diagnosed in infancy. Her bone age was advanced as 10 years of age, and Luteinizing hormone(LH) showed pubertal response in LHRH stimulation test. The pelvic US revealed absence of right kidney and uterine enlargement. Brain MRI showed no specific abnormalities. Based on these results, We diagnosed idiopathic central precocious puberty. Thereafter, we commenced the treatment with Leuprolide acetate 3.75mg every 4 weeks. After the 11th injection of Leuprolide acetate, however, the patient complained of sudden breast engorgement and vagnal bleeding. Being considered as unsuccessful suppression of HPG axis, Leuprolide acetate was boosted. Hormonal analysis results revealed an extremely elevated level of estradiol and suppressed baseline gonadotropin levels. The pelvic US revealed double uterus, which had not been detected to that point. Abdominopelvic MRI demonstrated right renal agenesis and uterus didelphys with clearly separated uterine body, cervix and vagina. About 3cm sized cystic lesion with several internal daughter cysts is also discovered in left adnexa area. Based on all examinations, we concluded that PPP caused by autonomous ovarian cyst was superimposed on treatment course of CPP and HWWS was incidentally found as underlying disease. Maintaining GnRH agonist treatment, the progression of secondary sexual characteristics was halted and left ovarian cyst disappeared. In couclusion, clinician should be aware of possibility of autonomous ovarian follicular cyst when sudden progression of secondary sexual characteristics is shown in being treated CPP patients, and discriminate PPP from unsuccessfully treated CPP. Additionally, careful suspicion for HWWS that is tied to indications of renal agenesis in children may be the key for successful early diagnosis and immediate treatment intervention, which could prevent long-term complications.