Removal Of Ovarian Tissue Research Articles

Ovarian cyst torsion coexisting with acute pyelonephritis in an eight‐year‐old premenarchal girl

We report the case of a premenarchal eight-year-old girl with an adnexal torsion accompanied by acute pyelonephritis with vague, non-specific symptoms. In young girls, symptoms may be vague, with patients complaining of non-specific gastro-intestinal problems. Combination with other complications such as pyelonephritis makes the diagnosis of adnexal torsion even more difficult as in the present case. To preserve future reproductive function, early surgical intervention is required. Although the impact on menarchal development of oophorectomy or partial removal of ovarian tissue before menarche remains to be evaluated, timely recognition and treatment of adnexal torsion clearly increases the possibility of retaining the ovary. Therefore, to decrease the time between the onset of symptoms and the identification of patients at risk, sonography should be considered as a first imaging modality for evaluating children with any degree of abdominal pain accompanied by non-specific symptoms.

Detection of Hodgkin lymphoma within ovarian tissue

To describe the detection of Hodgkin lymphoma within ovarian tissue taken at the time of harvest for cryopreservation. Case report. University-affiliated women's hospital. A 19-year-old woman diagnosed with Hodgkin lymphoma. Laparoscopic removal of ovarian tissue for cryopreservation. Histologic and immunohistochemical evaluation of ovarian tissue harvested for fertility preservation. Histologic and immunohistochemical identification of Hodgkin lymphoma within ovarian tissue harvested for cryopreservation. Ovarian cryopreservation and subsequent autografting is a procedure still in an experimental phase that has yielded promising findings. This option is frequently offered to young women with neoplasms such as Hodgkin lymphoma. Although the risk of Hodgkin lymphoma infiltration into the ovary may be low, the identification of lymphoma in this case emphasizes the importance of histologic examination of ovarian tissue before freezing and indicates that there is a possibility of reintroducing tumor.

Improving fertility preservation in cancer: ovarian tissue cryobanking followed by ovarian stimulation can be efficiently combined

This pilot study evaluated whether combination of partial removal of ovarian tissue for cryobanking followed by ovarian stimulation and cryopreservation of oocytes can improve the efficacy of fertility preservation without further delaying cancer treatment. Initial partial removal of ovarian tissue did not substantially affect the average number and quality of retrieved oocytes after ovarian stimulation in this study.

Efficacy and safety of ovarian stimulation before chemotherapy in 205 cases

Ovarian stimulation and cryopreservation of fertilized oocytes before cancer therapy is the best established and efficient fertility preservation technique and should still be considered before chemotherapy. Within a short time frame of 2 weeks, between 8.6 (18-25 y) and 5.1 (36-40 y) fertilized oocytes can be cryopreserved.

Direct proportional relationship between endometrioma size and ovarian parenchyma inadvertently removed during cystectomy, and its implication on the management of enlarged endometriomas

The aim of this study was to estimate whether or not the size of an endometrioma is related to the thickness of the ovarian parenchyma inadvertently excised along with the cyst wall. We performed a retrospective study including 35 women who had undergone endometrioma cystectomy, using an ovarian tissue sparing procedure. In total 38 specimens were studied by three pathologists as three women presented bilateral localizations, and all cyst diameters measured at least 30 mm. For each endometrioma, serial sections were performed, and on each section four different sites were randomly chosen to measure the thickness of glandular epithelium and stroma, of subjacent fibrosis, depending on the cyst, and of the ovarian parenchyma removed with the cyst. The diameter of the ovary was measured preoperatively either by MRI or ultrasound, and the area of the internal wall was then calculated. The relationships between the mean thickness of ovarian parenchyma removed and the variables were estimated and a multiple regression model identified independent predictors for ovarian parenchyma thickness. Adjacent ovarian tissue was found in 37 cases (97%). The mean thickness of ovarian tissue removed was 1173 +/- 711 microm and that of the cyst wall was 851 +/- 499 microm. The thickness of the ovarian parenchyma removed presented a direct proportional relationship with cyst diameter (P = 0.015), and consequently with cyst wall area (P = 0.032). This relationship with cyst diameter was independent after adjustment on other variables (P = 0.032). Endometrioma cystectomy even though performed with an accurate surgical technique leads to significant ovarian tissue removal, the thickness of which increases proportionally with cyst diameter.

Ovarian Function After Removal of an Entire Ovary for Cryopreservation of Pieces of Cortex Before Gonadotoxic Treatment: A Follow-Up Study

Cryopreservation of ovarian cortex tissue before gonadotoxic treatment may preserve fertility in premenopausal women with certain types of cancer. The effect of removal of ovarian tissue and gonadotoxic treatment on residual ovarian function is poorly understood. This study assessed residual ovarian function in premenopausal women who had an ovary removed for cryopreservation of cortex tissue before gonadotoxic therapy, and evaluated patient experience with the procedure. The study subjects were 92 Danish women who had 1 ovary removed for cryopreservation 18 to 75 months before administration of chemo and/or radiation therapy. Patients were grouped into 4 categories: (1) breast cancer (n = 31, 34%), (2) Hodgkin lymphoma (n = 23, 25%), (3) bone marrow transplantation (BMT) (n = 19, 21%), and (4) others (n = 19, 21%). Mean age of the patients at time of diagnosis and follow-up was 25.4 years (range, 9–37) and 28.7 years (range, 18–41), respectively. Thirty-eight age-matched women with cancer (n = 38) served as the reference group. Patients completed a questionnaire that provided opinions about the cryopreservation procedure and complications. The serum levels of 2 markers of ovarian reserve, follicle stimulating hormone, and antiMüllerian hormone, were determined in 73 women. The antral follicle count, also a marker of ovarian reserve, was measured by transvaginal ultrasonography. After cryopreservation and treatment, only 11% of the BMT patients reported regular monthly bleeding, whereas 60% of breast cancer and Hodgkin disease patients (who had received regimens more gonadotoxic than ABVD) (doxorubicin, bleomycin, vinblastine, and dacarbazine) reported regular monthly bleeding. Regular menstruation after cryopreservation of ovarian tissue was a good indicator of residual ovarian function. The patients’ report on bleeding regularity correlated well with the serum levels of follicle stimulating hormone, antiMüllerian hormone, and with antral follicle counts. The vast majority of patients was pleased with the procedure, had few complications, and was comforted during treatment by the potential to preserve their fertility. The cryopreservation procedure rarely interfered with cancer treatment. The investigators believe that patients receiving BMT with expected long-term survival and young women with Hodgkin lymphoma receiving more aggressive treatment than ABVD should be considered for ovarian cryopreservation. They suggest that asking a patient whether she has regular bleeding without hormone replacement therapy is a noninvasive, inexpensive and rapid way to assess residual ovarian function after treatment.

Analysis of risk factors for normal ovarian tissue removal during laparoscopic cystectomy for ovarian endometriosis

OBJECTIVE: It has been suggested that the technique of ovarian endometrioma capsule excision may lead to removal of normal ovarian tissue, causing loss of follicles. The objective of the present study was to identify risk factors for removal of normal ovarian tissue during laparoscopic cystectomy for endometriosis. As controls, we included patients who underwent laparoscopic cystectomy for other benign cysts.

VNTR I/I genotype of insulin gene is associated with the increase of follicle number independent from polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is accompanied by selective insulin resistance and enhanced ovarian steroidogenic effects of insulin. We analysed the minisatellite variations of the insulin gene (INS VNTR) with regard to the clinical features of PCOS. Retrospective, adjusted association study. Infertile patients with PCOS (n=30) and tubal factor (n=75) were screened for anthropometrical, clinical and ovarian morphology parameters, as well as hormonal values. INS VNTR was genotyped by its surrogate marker at -23 HphI locus. INS VNTR genotype distribution was similar in PCOS and tubal infertility group. The mean ovarian follicle number was higher in VNTR I/I individuals compared to VNTR I/III and III/III individuals (adjusted OR=1.28, p=0.03), independent from the cause of infertility, the age, the follicle stimulating hormone level on day 3-5 of menstrual cycle, BMI and the previous surgical ovarian tissue removal. In addition, higher level of the luteinising hormone in VNTR I/I individuals was associated with the increase in follicle number. We suggest that INS VNTR genotypes are not associated with PCOS in general, but could have a certain influence on the phenotypic spectrum of the syndrome.

Long-term outcomes following conservative surgery for borderline tumor of the ovary: A large population-based study

Objectives. To examine outcomes in women treated with conservative surgery for borderline ovarian tumor in a large population-based cohort with long-term follow-up. Methods. Women treated by conservative surgery for borderline tumor of the ovary from 1982–2004 within a large HMO setting were identified using electronic and tumor registry data. Chart review was performed when electronic data were incomplete. The indications for and outcomes from any subsequent gynecologic surgery and the risk of recurrent ovarian borderline and malignant tumor were determined. Risk factors for recurrence were analyzed using multivariate regression. Results. Among one hundred and ninety-three patients identified, the average age was 33 (12–95), with 97% having apparent Stage I disease. Patients were followed with remaining ovarian tissue in situ for a mean of 6.9 years, with 59 women having 10 or more years of such observation. There were 21 recurrences with borderline tumor (11%) with a median time to first recurrence of 4.7 years; women treated by cystectomy recurred three times more often compared to women treated by oophorectomy (23% versus 7%). Two patients (1%) recurred with malignant disease involving remaining ovarian tissue, both within the first 3 years after surgery, with one death due to recurrence. During long-term follow-up, 19% of patients eventually underwent complete removal of ovarian tissue: in 8%, the surgery was prophylactic, in 5%, surgery was done for benign pathology, and in 6% for recurrent disease. Conclusions. In this population-based HMO setting, 11% of women treated with conservative surgery for borderline tumor recurred; however, half of these recurrences were successfully managed by repeat conservative surgery, with only 6% of women overall needing eventual complete removal of ovaries for recurrent disease. Patients treated by cystectomy were three times more likely to recur than those treated by oophorectomy. Malignant recurrences were rare, and while borderline recurrences often occurred more than 3 years after initial surgery, late malignant recurrences were not observed. These favorable long-term outcomes provide support for conservative surgery for these women.

Laparoscopic removal of endometriomas: Sonographic evaluation of residual functioning ovarian tissue

Objective. The use of the laparoscopic approach, in particular the technique, has been questioned because it could involve excessive removal of ovarian tissue with loss of follicles. The aim of this study was to determine how and if the laparoscopic removal of ovarian endometriotic cysts is a tissue-sparing procedure. Setting. University Hospital. Patients. Fifty-two patients in fertile age with an ovarian endometrioma, correctly diagnosed by sonography, undergoing laparoscopic removal by stripping. Interventions. Laparoscopic removal of ovarian endometriomas by stripping and transvaginal sonographic (TVS) evaluation of residual ovarian tissue. Measurements and Main Results. Within one week before surgery all recruited patients underwent TVS evaluation of ovarian volume, size and morphology of the endometriotic cyst and measurement of the surrounding ovarian cortex. Within 6-12 months after laparoscopic excision, TVS measurements of residual ovarian tissues were obtained. Mean cyst diameter was 4.7+2.2 cm (range 2.1-9.2 cm). Ovarian residual cortex surrounding the cyst was ultrasonographically lower than the previous evaluation. Conclusion. Although laparoscopic approach is still the less invasive technique in treating ovarian endometriosis, it appears aggressive in terms of injuring the residual ovarian tissue.

Ureteral Obstruction Secondary to Retained Ovarian Remnants: A Case Report and Review of the Literature

A case is reported of ureteral obstruction from retained retroperitoneal corpus luteum. Previously, the patient had undergone a hysterectomy and salpingo-oophorectomy with incomplete removal of ovarian tissue on the affected side. The ureteral obstruction was treated by excision of the mass and ureterolysis.

Pelvic endometriosis and its treatment

There are still many practitioners who have only a vague idea of the nature and significance of endometriosis, which is fairly common, especially in the form of pelvic endometriosis. In this condition aberrant endometrium is found in various locations within the pelvic cavity and especially in the ovaries. The theories concerning the origin of this ectopic uterine mucosa are discussed in the paper. The symptomatology and the findings on pelvic examination are often quite like those of chronic pelvic inflammatory disease and in the majority of cases the diagnosis is not made until the time of operation. In some, however, a strongly presumptive diagnosis can be made, as where the patient suffers with menstrual pain referred to the rectum, lower sacral or coccygeal region, or where one or more small nodules are palpable in the region of the uterosacral ligaments. All grades of the lesion are encountered, varying from very mild cases in which the endometriosis appears to be only of scientific interest rather than clinical importance, to those in which the aberrant endometrial growth is widespread and extensive, with perhaps bilateral endometrial cysts, numerous “implants” throughout the pelvis and perhaps extensive rectal infiltration, with even obstruction of the bowel as a possibility. The management of pelvic endometriosis must take cognizance of these variations and must be individualized on the basis not only of the extent of the lesion but also of such factors as the age of the patient and the importance of conserving the possibility of reproductiveness. In the majority of cases conservative operations are indicated, even though one can not be sure that further extension of the condition will not occur, with perhaps the necessity of secondary operation. Where the disease is very widespread and the patient approaching middle life, it is advisable that the operation include complete removal of ovarian tissue, as abolition of ovarian function is the only effective means of inhibiting further growth of the aberrant endometrium. As discussed in the paper, radiotherapy is only occasionally indicated in the treatment of pelvic endometriosis.

OVARIAN THERAPY

The known facts as to the function of the ovary are sufficient to supply a rational basis for ovarian therapy in certain indications. Especially important in this connection is the study of the phenomena produced by complete removal of ovarian tissue, such as the cessation of menstruation, the frequent appearance of troublesome subjective symptoms similar to those of the natural menopause, and the occurrence of certain metabolic changes. The obvious suggestion derived from such observations is that clinical symptoms thought to be due to ovarian deficiency might be cured or relieved by administering some form of ovarian substance. This fundamental idea has been subjected to some refinement as a result of studies aiming to stress some one or other of the ovarian constituents as the source of the active principle. Based on such investigations, several forms of ovarian therapy have developed, including the administration of whole ovary substance, of corpus