Pelvic Cavity Research Articles (Page 1)

Previous female pelvic organ models have predominantly been solid models, which do not accurately reflect the true anatomical structure of the human body. To construct anatomically accurate cavity three-dimensional reconstruction models of female pelvic cavity organs based on in vivo human magnetic resonance imaging (MRI). Based on pelvic MRI from 120 patients, we measured organ wall thickness and anatomical variation to obtain population-averaged wall-thickness parameters (mean ± SD). Using these parameters, we constructed a single representative cavity model through segmentation, Non-Uniform Rational B-Spline surface reconstruction, and Boolean operations. This model represents an instance informed by population metrics rather than a voxel-by-voxel composite of all 120 scans. The present study focuses on visceral organ cavities (uterus, vagina, bladder, and rectum) and does not include pelvic body-wall musculature or bony structures. This was combined with Non-Uniform Rational B-Spline surface reconstruction in Ge-omagic Wrap and Boolean operations in SolidWorks to construct 4 major cavity entities: an irregular wall-thickened myometrial cavity with endometrial resection, a cervically enveloped upper semi-closed (lower open vaginal cavity, a semi-closed bladder cavity with an open urethral end, and an open-ended rectal cavity). A standardized wall thickness parameter table (accuracy 0.01 mm) was established through double measurements by 2 independent operators, with final values derived from the mean of measurements. Anatomically characteristic cavity models were generated, forming an assembly that reflects the adjacency relationships of multiple organs. Measurement results of organ wall thickness, bladder wall 1.52 ± 0.28 mm (intraclass correlation coefficient [ICC] = 0.781), vaginal wall 3.97 ± 0.56 mm (ICC = 0.876), rectal wall 1.38 ± 0.19 mm (ICC = 0.824). This study used MRI-derived, population-averaged wall thickness to construct representative cavity models of female pelvic organs. The inputs showed good reproducibility (ICC), but external validation, such as cadaveric comparison or independent imaging, is still needed. These models provide a basis for teaching, preliminary simulations, and future finite-element analyses.

To determine whether high complexity pelvic exenterations alter perineal wound morbidity and to assess risk factors for perineal flap complications following complex rectal cancer surgery. A retrospective analysis of consecutive adults undergoing complex rectal cancer resections with immediate gluteal flap perineal reconstruction between January 2013-July 2021 at a tertiary referral centre. Conventional complex cancer resections were compared with "high complexity" exenterations, including en bloc sacrectomy and extended lateral pelvic side wall excision. Primary outcomes were short-term (wound infection, necrosis, dehiscence) and long-term (sinus, fistula, hernia) perineal flap complications. We identified 194 patients (median 56 years, 60% male) with gluteal flap reconstructions; 163 (84%) for advanced or recurrent rectal cancer. Gluteal artery perforator flaps were predominantly used (176, 92%). Wound infections were more common in the conventional group (23.2% vs. 6.3%, p = 0.001), but no other differences in complications were observed between groups. Obesity (HR 2.70, 95% CI 1.22-5.97, p = 0.014) and total pelvic exenteration (HR 2.13, 95% CI 1.07-4.23, p = 0.031) were associated with short-term complications. Age over 65 years predicted readmission/reoperation (HR 2.66, 95%CI 1.07-6.6, p = 0.040). Ureteric/ileal conduit leaks were associated with long-term complications (HR 3.37, 95% CI 1.21-9.34, p = 0.024). No flap losses occurred. Gluteal fasciocutaneous perforator flaps provide reliable perineal reconstruction after complex rectal cancer surgery. The extent of surgery and resulting defect size did not significantly influence perineal wound complication rates.

The video includes intraoperative exploration of the abdominal and pelvic cavity, complete surgical anatomical dissection, lymph node dissection, digestive tract reconstruction, and the auxiliary use of ICG fluorescence.

Feline colorectal adenocarcinoma is a malignant tumor with a poor prognosis due to its locally invasive and metastatic nature. Surgical resection remains the mainstay of treatment, but accessing distal colorectal lesions is often challenging due to pelvic anatomy. This study aimed to evaluate the feasibility, postoperative outcomes, and prognosis associated with Swenson's pull-through procedure in feline patients with distal colorectal adenocarcinoma. Six cats with colorectal adenocarcinoma underwent tumor resection using Swenson's pull-through technique were included. Clinical records were retrospectively reviewed to assess perioperative complications, completeness of resection, disease-free survival (DFS), and overall survival (OS). All tumors, with a resection margin of 2 cm, were involved the pelvic cavity, and the median tumor size was 2.0 cm. In all cases, the horizontal resection margins were histologically clear, and metastasis was histologically confirmed in the left colonic lymph nodes. Five cats experienced diarrhea as a short-term postoperative complication during hospitalization, which resolved within approximately 1 month. One cat developed colonic stenosis that was managed with balloon dilation. The median DFS and OS were 150 and 225 days, respectively. These findings suggest that Swenson's pull-through is a feasible and effective surgical option for achieving local tumor control and symptom improvement in cats with distal colorectal adenocarcinoma.

Integrative microbiome-metabolomics identifies Pseudomonas as a potential pathogenic factor in endometriosis.

Retroperitoneal liposarcomas represent an uncommon subset of soft tissue sarcomas, typically exhibiting an indolent growth pattern and remaining clinically silent until attaining a size sufficient to exert mass effect on adjacent organs. Lesions measuring 30 cm or more in maximal diameter are exceedingly rare, with only a limited number of such cases documented in the literature. This report presents a 32-year-old woman from Zambia presented with a history of progressive abdominal distension over the past eight years. She had been diagnosed with a retroperitoneal liposarcoma and was referred to our centre for further management. Contrast-enhanced computed tomography (CT) of the abdomen and pelvis revealed a large, predominantly fat-density lesion arising from the right retroperitoneum, measuring approximately 194×274×301 mm. The mass occupied most of the abdominal and pelvic cavities, encasing and displacing the right kidney, proximal ureter, and renal vessels. The right adrenal gland was also encased, and the bowel loops were displaced toward the left side. The duodenum, ascending colon, pancreas, and inferior vena cava (IVC) were displaced superiorly and to the left, with the lesion abutting the inferior surface of the liver. Complete surgical excision of the retroperitoneal tumour was achieved, including an en bloc right nephrectomy. Massive retroperitoneal liposarcoma is an extremely rare neoplasm with a high risk of recurrence, influenced by factors such as histological subtype, tumour grade, presence of metastases, and completeness of surgical excision. In the present case, a complete resection was achieved, including an en bloc right nephrectomy. The patient will be monitored closely with periodic clinical and radiological follow-up to enable early detection of any recurrence.

Uterine leiomyomas are a heterogenous group of benign mesenchymal tumours. While diagnosis is usually achieved through clinical assessment and pelvic ultrasound (PU), atypical subtypes are not as easily recognisable and can be mistaken for malignant tumours such as leiomyosarcoma or ovarian carcinoma. We describe the case of a 41-year-old patient who presented with increasing bulk symptoms, urinary frequency and growth of a hydropic leiomyoma (HLM) of the left lateral and posterior uterine wall that had been known for 10 years, confirmed with previous biopsy. The tumour filled the entire pelvic cavity in PU and was increasingly difficult to delineate; therefore an abdominal hysterectomy without oophorectomy was performed. Gross tissue examination showed an irregularly enlarged, asymmetric uterus with an intrauterine subserosal mass and an extrauterine papillary tumour arising from the right and posterior uterine wall. The tumour measured 20 × 17 × 10 cm in size. Numerous smooth muscle nodules were observed within the uterus and extending into the extrauterine component in a continuous transition, exhibiting a benign, bland appearance. The nodules were separated by abundant edematous connective tissue with increased vascularization. Histopathological analysis revealed low mitotic activity with no evidence of nuclear atypia, pleomorphism, or necrosis. Immunohistochemical staining confirmed the diagnosis of a benign smooth muscle tumour. Our findings confirm a rare, benign smooth muscle neoplasm with both intrauterine and extrauterine involvement, and add to the existing literature regarding presentation, diagnostic and therapeutic challenges associated with HLM.

Disclosure: D.R. Ávila Salcedo: None. J.A. Ayala San Pedro: None. L.M. Martínez Borja: None. P.A. Montes Hernández: None. R.S. Sánchez García: None.Background: Paraneoplastic hypoglycemia or Doege-Potter syndrome was first described in 1930. It is the clinical manifestation of mesenchymal tumors that produce IGF-II. The most frequent localization is thorax, pelvis, liver and retroperitoneum. The clinical data in addition to hypoglycemia are; hypertrophic osteoarthropathy, seborrheic hyperkeratosis, acanthosis nigricans. The IGF-I/IGF-II molar index in 79% of cases is >10 and in the rest between 3 and 10. Case: 31-year-old female with a history of uterine myomatosis. She started suffering with alterations in mental status, periodic confusion and disorientation, and was diagnosed with psychiatric disease. As the symptoms persisted, hypoglycemia was documented, which was more frequent during fasting. Physical examination showed pachyonychia, gray dyschromia, longitudinal striae and distal lysis of the 1st and 2nd fingers. Paraclinical: TSH1.68 mU/ml, T4t 6.28 µg/dl, T4l 2.7pg/ml, T3t 1.2ng/ml, T3l 2.7pg/ml, Anti-thyroglobulin and anti-TPO antibodies negative. HbA1c 4.9%, glucose 51 mg/dl, creatinine 0.28 mg/dl, total cholesterol 215 mg/dl, triglycerides 102 mg/dl, c-LDL 136 mg/dl, total bilirubin 0.50 mg/dl, albumin 3.6 mg/dl , AST 32 UI/L, ALT 27 U/L. Fasting test was performed, presenting hypoglycemia of 22 mg/dl showing diaphoresis, hunger, dysarthria and somnolence. C-peptide levels 0.01 ng/ml, insulin 0.20µUI/ml, proinsulin <0.5 pmol/L, serum cortisol >18 µg/dl and serum sulfonylureas were negative. Negative anti-insulin and anti-insulin receptor antibodies, GH 0.066 ng/ml, IGF-I 18 ng/ml, IGF-II 184 (267-616 ng/ml). Ratio IGF-I/IGF-II 1:9 (<3), suspecting aberrant IGF-II production, without having that reagent in our country. CT: Heterogeneous right-sided pelvic cavity tumor measuring 133x91x132mm compressing the uterus, bladder and rectum, causing mild ectasia of the right ureter. Treatment was partial resection due to its high vascularity and surgical bleeding. Histology: brown and smooth tissue of pelvic fibrothecoma, proliferation index <10%, Ki67 <10%, Wt-1+, negative for: alpha-inhibin, progesterone receptor, STAT-6, CD56, estrogen receptor, CD10 and CD34. After 24 hours the hypoglycemia subsided and 3 months later the nail changes reversed. Clinical lessons: Despite its low prevalence worldwide, it should be considered as a differential diagnosis of non-insulin-mediated hypoglycemia. The review of the medical literature has not described the nail manifestations presented in this case. In addition, she presented normal serum IGF-II levels and IGF I/IGF II molar index between 3 and 10 contrary to most cases. The patient is being followed up for a second intervention or radiotherapy.

SMARCA4-deficient cervical adenocarcinoma is an exceedingly rare and aggressive subtype of cervical malignancy that presents with clinicopathological features mimicking other types of cervical cancer, leaving no established treatment protocols available. This report describes a case of a 50-year-old woman in perimenopause who presented with an increase in vaginal discharge, discomfort in the external genitalia, and bleeding after intercourse. The imaging examination revealed a cervical mass accompanied by enlarged lymph nodes in the pelvic cavity. A cervical biopsy confirmed adenocarcinoma, with an initial clinical stage classified as International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IIA1. The patient underwent a radical hysterectomy and pelvic lymph node dissection (PLND), during which it was found that the tumor had involved pelvic lymph nodes. The revised staging was Stage IIIC1. According to the postoperative pathologic analysis, the woman was diagnosed as adenocarcinoma with a poorly differentiated grade and with myoepithelial differentiation features. Immunohistochemical analysis supported the diagnosis of the SMARCA4-deficient adenocarcinoma that was accompanied by high-grade squamous intraepithelial lesion (HSIL) in its surroundings, indicating the presence of two distinct types of lesions. Postoperative review after one month revealed multiple lymph node metastases in the left neck. Pathological examination confirmed it as distant metastasis from cervical adenocarcinoma, ultimately leading to a diagnosis of pT1N1M1 (IVB stage) cervical cancer. Following a six-cycle treatment regimen with cadonilimab, paclitaxel, and cisplatin, the lymph nodes in the neck demonstrated a significant reduction, indicating a preliminary positive response. In this case, SMARCA4-deficient cervical adenocarcinoma was characterized by significantly high invasive potential, early metastasis, and heterogeneity, indicating the significance of early detection and molecular pathological diagnosis in guiding personalized treatment strategies. Immunotherapy combined with chemotherapy may offer a new therapeutic approach for this rare type of cancer.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12957-025-04030-7.

BACKGROUNDColorectal cancer (CRC) frequently metastasizes to the lungs, and image-guided thermal ablation (IGTA) has emerged as a promising treatment for oligometastatic colorectal lung metastases (CRLM). However, high-quality multicenter data remain limited, and the prognostic impact of site-specific extrapulmonary metastases is not well defined.AIMTo assess IGTA efficacy in potentially curable oligometastatic CRLM and determine prognostic impacts of extrapulmonary metastatic patterns.METHODSThis multicenter real-world study analyzed 336 CRLM patients treated with IGTA from 2014 to 2022. Inclusion criteria included pathologically or clinically confirmed oligometastatic CRC, tumor diameter < 50 mm, fewer than 5 metastatic lesions, and ≤ 2 organs involved. Kaplan-Meier and Cox regression methods assessed survival outcomes, including local tumor progression-free survival, progression-free survival (PFS), and overall survival (OS).RESULTSThe 3-year cumulative local tumor progression rate was 14.0%. Median PFS and OS were 15.6 and 51 months, respectively, with 3- and 5-year OS rates of 59.5% and 41.0%. Poor survival outcomes were associated with a higher tumor burden (larger size and greater number), carcinoembryonic antigen > 20 ng/mL, carbohydrate antigen 19-9 > 37 U/mL, and extrapulmonary metastases. Patients without extrapulmonary metastasis had 1-, 3-, and 5-year PFS rates of 65.4%, 31.0%, and 27.3%, respectively, which were longer than those of CRLM patients with liver metastasis [hazard ratio (HR) = 1.449, P = 0.019] and abdominal cavity metastasis (HR = 1.864, P = 0.010). The 1-, 3-, and 5-year OS rates for patients without extrapulmonary metastasis were 96.4%, 71.0%, and 53.0%, respectively, which were significantly longer than those for patients with bone metastasis (HR = 4.538, P < 0.001), abdominal cavity metastasis (HR = 4.813, P < 0.001), and pelvic cavity metastasis (HR = 3.105, P < 0.001).CONCLUSIONMetastatic patterns significantly influence PFS and OS, emphasizing the need for careful patient selection. Notably, patients with liver-only extrapulmonary metastasis demonstrate comparatively favorable outcomes, suggesting a distinct biological behavior and better prognosis within this subgroup.

Rhabdomyosarcoma represents a prevalent type of soft tissue sarcoma encountered in pediatric patients. Despite multimodal intensified therapies encompassing surgical intervention, chemotherapy, and radiotherapy, the prognosis for patients with high-risk rhabdomyosarcoma remains notably unfavorable. To date, no definitive and efficacious molecularly targeted therapies have been established. This report describes the first documented case of a rhabdomyosarcoma patient harboring a positive BCR-ABL1 fusion gene. At the time of initial diagnosis, the patient presented with a primary tumor in the right thigh and extensive metastatic involvement affecting both lungs, pleura, mediastinum, pelvic cavity, and the right inguinal region, resulting in the classification of the case as high-risk. In addition to conventional multimodal therapy, early intervention using tyrosine kinase inhibitors was implemented, leading to the achievement of an early complete response.

Laparoscopic ventral rectopexy (LVR) is a widely used technique in the treatment of rectal prolapse but faces limitations due to restricted working space within the narrow confines of the pelvic cavity and suboptimal ergonomics. The advent of robotic platforms, particularly the da Vinci Xi system, has offered solutions by enhancing visualization and precision. This study retrospectively compares outcomes between LVR and robotic ventral rectopexy (RVR), and between the da Vinci Si and Xi robotic systems. This retrospective cohort study analyzed 315 a consecutive series of patients who underwent minimally invasive ventral mesh rectopexy between March 2019 and October 2024 by a single operator at a single institution. Patients were divided into laparoscopic (n = 72) and robotic (n = 243) groups, with the robotic cohort further categorized into Si (n = 159) and Xi (n = 84) subgroups. The outcomes measures included operative time, console time, hospital stay and perioperative complications. The robotic group demonstrated a shorter median length of stay (1vs.2days, p < 0.01) with similar operative times. Prior hysterectomy was associated with increased operative time, while age and redo surgery were not. The Xi platform significantly reduced operative and console times compared to the Si (80vs.100min, p < 0.01; 55vs.68min, p < 0.01). This is the first study to demonstrate that the robotic-assisted technique has shorter operative times as compared to laparoscopic technique. Among robotic platforms, the da Vinci Xi system further enhances these benefits, surpassing the Si platform in efficiency. These findings establish robotic rectopexy, particularly with the Xi system, as the preferred method for optimizing surgical outcomes in the surgical treatment of rectal prolapse syndromes.

Desmoplastic small round cell tumor in children: Report of six cases.

Combined operative and radiotherapeutic treatment for locally recurrent gynaecologic cancer with pelvic wall invasion: A monocentric retrospective study.

Cysticercosis in Pelvic Cavity Mimicking Tubercular Abscess: A Rare Clinical Presentation

Hepatic pseudolipoma is a rare, benign lesion composed of degenerating fat encapsulated beneath the liver capsule. Although typically believed to originate from detached epiploic appendages, its precise pathogenesis remains unclear. We report a case of histologically confirmed hepatic pseudolipoma that migrated from the pelvic cavity to the liver. A 64-year-old woman with no history of liver disease underwent follow-up imaging after treatment for colonic diverticulitis and urinary lithiasis. A non-contrast computed tomography (CT) scan performed 1.5 years earlier showed no hepatic mass but, retrospectively, revealed two fat-attenuating masses with small calcifications in the pelvic cavity. At admission, contrast-enhanced CT demonstrated a newly emerged, well-defined, fat-containing lesion on the hepatic dome. Magnetic resonance imaging suggested a benign fatty lesion without diffusion restriction. Laparoscopy revealed a white, mobile mass emerging from a depression on the liver surface. Histopathological examination confirmed the diagnosis of a typical pseudolipoma. One of the previously identified pelvic lesions was presumed to have migrated transperitoneally to the liver surface. This is the first reported case of a histologically confirmed hepatic pseudolipoma that migrated from the pelvic cavity. Hepatic pseudolipomas may not be confined to the subcapsular space but can migrate freely within the abdominal cavity.

Persistent Mullerian duct syndrome is a rare disorder of sex differentiation characterized by the presence of a uterus, fallopian tubes, and a vaginal outgrowth of the urogenital sinus in boys with a 46,XY karyotype. One variant of persistence of Mullerian duct derivatives in a child with male external genitalia is the mosaic chromosomal anomaly 45,X/46,XY, which clinically manifests as an inguinal hernia or cryptorchidism. This article presents a rare clinical case of failure of Mullerian duct regression in a phenotypically male child with a unilateral nonpalpable testis. A 17-month-old boy was admitted electively to the surgical department of Children’s City Clinical Hospital No. 9 in Yekaterinburg with left-sided nonpalpable testis syndrome. Diagnostic laparoscopy revealed a rudimentary uterus and left fallopian tube with a structure resembling an ovary. Postoperatively, the child underwent further evaluation (histopathological examination, hormonal status assessment, karyotyping, molecular genetic testing, and urethrocystoscopy). The clinical diagnosis was established as “disorder of sex development caused by chromosomal abnormality 45,X/46,XY, mixed gonadal dysgenesis.” In cases where persistent Mullerian ducts are detected intraoperatively, current practice is limited to biopsy of the abnormal gonad, urethrocystoscopy for visualization of the urogenital sinus, and, when possible, catheterization of the rudimentary uterus with a ureteral catheter to visualize its location in the pelvic cavity. For diagnostic confirmation, karyotype analysis, molecular genetic testing, hormonal profiling, and evaluation by a geneticist and endocrinologist are performed. The final decision regarding the child’s sex assignment, after all additional examinations, is made by a medical board in consultation with the parents.

Deep infiltrating endometriosis is a subtype of endometriosis. A case of retroperitoneal endometriosis surrounding the ureter and forming a pelvic mass is relatively rare. A 26-year-old woman was admitted to our department because of unbearable dysmenorrhea and dizziness. CT scan revealed a pelvic mass on the right side of the pelvic cavity. The pain did not alleviate even she received symptomatic treatments. She finally underwent a emergency laparoscopic exploration and a pelvic mass surrounding the right ureter was found during the surgery. We removed the mass successfully with the help of a urologist by inserting a right ureteral stent at last. A retroperitoneal endometriosis was diagnosed by postoperative pathology and GnRh was administered afterwards to prevent reoccurrence. We herein present a rare case of DIE-a retroperitoneal endometriosis and describe the process of the laparoscopic management. For retroperitoneal masses closely adherent to the pelvic wall, clarifying the course of the ureter is of great importance, and collaboration with urologic surgeons may be necessary when needed. Because there is no-specific imaging features, the benign or malignant nature of the mass might be suspected before surgery.

Introduction: Penile fibro-ligaments have been extensively studied for many centuries; however, there is, unfortunately, a lack of thorough understanding. We aimed to bridge the research gap between anatomy and surgical reconstruction. Methods: We excluded cadaveric penises, already dissected and disassembled by medical students, that had damaged the corpora cavernosa (CC) or corpus spongiosum (CS). However, penises were included if both the ischiocavernosus and bulbospongiosus muscles were undamaged. A total of 8 out of 52 penises were meticulously examined. Our dissection findings were supplemented with 101 cadaveric photos, 255 penile vascular surgeries, 11 CT imaging scans, and 8 MRI imaging scans. The combined understanding was reprocessed with radiographic imaging, and patients underwent penile surgeries, notably eight hypospadias surgeries, and eight penile elongation surgeries were performed elsewhere. Results: Bilaterally, the penile CC is primarily anchored to the pelvic wall through the cavernosal ligament (CL = 2), while the CS is connected to the urinary sphincter. The suspensory, fundiform, and arcuate pubic ligament (two anatomically and one functionally) assist in stabilizing and holding the penile shaft to the pelvic wall. Distally, a distal ligament (DL = 1) and spongiosal ligament (SL = 1) extend the CC and CS to the glans penis and frenulum, ensuring urethral patency when necessary. The CC is encircled by a bi-layered tunica consisting of a 360° inner circular and a 300° outer longitudinal tunica. The ischiocavernosus muscle wraps around the penile crus and envelops the CL, connecting to the ischial tuberosity. The CS is partially surrounded by the bulbospongiosus muscle proximally and receives the SL distally. The entire penis interconnects with the skeletal muscle of the urogenital diaphragm. Conclusion: The physiological integrity of the human penis relies on ten anatomically and six functionally fibro-muscular ligaments.

Endometriosis is a typical disorder affecting the female reproductive system and is characterized by the presence of tissue resembling the endometrium both within and beyond the pelvic cavity. Unfortunately, the etiology of endometriosis is not well understood. The purpose of this document is to create a summary of the factors contributing to endometriosis, especially the dysregulation of cellular and molecular pathways. Key biological processes implicated include enzyme dysregulation, exosome dysfunction, hormonal imbalances, apoptosis, angiogenesis, oxidative stress, epigenetic dysregulation, and the involvement of cytokines and chemokines. Many of these factors have overlapping pathways that can enhance the survival of endometrial debris and facilitate the implantation of endometrial tissue in extrauterine sites. This knowledge can provide a broader perspective on the onset and progression of endometriosis. Additionally, this study paves the way for the discovery of new therapeutic targets to improve the efficacy of endometriosis treatments and reduce the side effects associated with current treatments. Further research is needed to better understand the underlying mechanisms that lead to the dysregulation of diseaserelated pathways, which could ultimately be useful in early diagnosis and disease staging.