Total Abdominal Hysterectomy Bilateral Salpingo-oophorectomy Research Articles

Analysis of the Relationship Between Body Perception and Self-Esteem of Women with Total Abdominal Hysterectomy Bilateral Salpingo-Oophorectomy Surgery – A Secondary Publication

Objective: To determine the relationship between body image and self-esteem of women who underwent total abdominal hysterectomy bilateral salpingo-oophorectomy (TAH-BSO). Method: The sample of the descriptive study consisted of 118 women who underwent TAH-BSO in the obstetrics and gynecology service of a university hospital in Mersin. Data was collected using a self-made questionnaire, the Body Perception Scale (BAS), and the Rosenberg Self-Esteem Scale (RBSS). Descriptive statistics included median, mean, standard deviation, number, and percentage values. Data evaluation methods included Mann-Whitney U Test and t-test to compare the means of two groups; Kruskal Wallis test and one-way ANOVA were used to compare the means of more than two groups; and Spearman correlation coefficient was used to determine the relationship between two continuous variables. Results: The mean age of the women was 50.13 ± 9.57, and the mean duration of marriage was 26.53 ± 11.97 years. It was found that 86.4% of the women were married, 40.7% were primary school graduates, and 55.1% had at least three children. Besides, 47.5% of the women applied to the hospital with the complaint of bleeding and according to 39% of them, the uterus meant nothing to them. Furthermore, the mean score of the women in BAI was 151.05 ± 26.64, and the mean score from RBSS was 5.02 ± 1.08. In the study, it was found that there was no statistically significant relationship between BAI and RBRS (r = -0.113; P = 0.224). Conclusion: In this study, it was determined that TAH-BSO surgery did not have a negative effect on women’s body perceptions and self-esteem. This result shows that women’s perspectives on common gynecological surgeries such as TAH-BSO have changed.

Psychological experience of women post total abdominal hysterectomy bilateral salpingo-oophorectomy

Introduction: Total abdominal hysterectomy bilateral salpingo-oophorectomy (TAH BSO) is still a severe problem for women, especially in psychology. Women will feel inferior because their existence does not have several vital reproductive organs. This study explores women’s psychological experiences after TAH BSO surgery.

Endometrial Cancer in 40 Years Old or Younger: A Single Center Experience

Purpose: The purpose of this study was to identify prognostic factors associated with the successful outcome of endometrial cancer (EC) in women aged ≤40 years. Methods: This was a retrospective cohort study. The medical records of all women aged ≤ 40 years with EC diagnosed on endometrial curettage between 1995 and 2020 were reviewed. Patients who underwent hysterectomy and whose final histopathological evaluation was made in our hospital, or who were evaluated by the members of the tumor board and followed up in our hospital, were included in the study. Results: Median follow-up was 79 months (range 9-192). 42 of 44 patients underwent surgical intervention. 33,4%(n: 14) underwent total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO), and pelvic paraaortic lymph node dissection (PPLND). 61.9% (n:26) underwent TAH BSO, and PLND. In one patient (2,4 %) only TAH and in the other patient (2,4%) TAH BSO was performed. Medical treatment was administered to 2 patients who desired to preserve their fertility and had grade 1 endometrioid adenocarcinoma without any evidence of myometrial invasion and a comprehensive evaluation showed no evidence of extra-uterine disease. 26 (59,1%) patients had grade 1, 15(34,1%) had grade 2, and 3(6,8%) had grade 3 adenocarcinoma. CA 125 ≥35 IU/ml was statistically associated with lymph node metastasis (p=0,004), ˃ 50% myometrial invasion (p=0,044), and advanced-stage disease (p=0,048). Conclusions: CA 125 ≥35 IU/ml was statistically associated with lymph node metastasis, deep myometrial invasion, and advanced-stage disease in EC patients ≤ 40 years of age.

Frequency of Total Abdominal Hysterectomy-Bilateral Salpingo-Oophorectomy (TAH-BSO) History in Women with Parkinson's Disease

Frequency of Total Abdominal Hysterectomy-Bilateral Salpingo-Oophorectomy (TAH-BSO) History in Women with Parkinson's Disease

The Importance of Lymphovascular Invasion in Uterine Adenosarcomas: Analysis of Clinical, Prognostic, and Treatment Outcomes.

This retrospective study examined the clinicopathologic features of adenosarcoma patients to determine potential prognostic factors and retrospectively evaluated overall survival (OS), disease-free survival (DFS), and local recurrence-free survival (LRFS) after primary treatment of adenosarcoma including surgery, radiation, and chemotherapy. One hundred sixty-five patients with adenosarcoma were identified from the MD Anderson Cancer Center tumor registry between 1982 and 2014. Clinical data were collected retrospectively. Pathologic characteristics were examined by sarcoma pathologists. We used the Kaplan-Meier method to estimate OS, DFS, and LRFS. The log-rank test was performed to test the difference in survival between groups. Multivariate regression analyses of survival data were conducted using the Cox proportional hazards model. Median OS and DFS for all patients were 8.5 and 4.7 years, respectively. Pathologic characteristics that influence OS and DFS were sarcomatous overgrowth (SO), myometrial invasion (MI), lymphovascular invasion (LVI), tumor size, number of mitosis, estrogen receptor, progesterone receptor, International Federation of Gynecology and Obstetrics (FIGO) stage, age, and resection status. Median OS for adenosarcoma patients with SO was 5.2 versus 14.5 years for patients without SO (P < 0.0001). Median OS for adenosarcoma patients with MI was 5.8 years versus not reached for patients without MI (P = 0.0005). Median OS for adenosarcoma patients with LVI was 1.0 versus 8.9 years for patients without LVI (P = 0.0021). On Cox analysis for OS and DFS and LRFS, only SO, MI, LVI, age, resection status, and FIGO stage remained significant. There was no difference in OS or LRFS for adjuvant radiation versus no adjuvant radiation (P = 0.17, P = 0.076). This study highlights the importance of LVI as a prognostic factor and confirms the prognostic significance of SO, MI, age, resection status, and FIGO stage for adenosarcoma. Furthermore, this study suggests that there is no additional benefit to adjuvant radiation. The standard-of-care treatment for adenosarcoma should remain total abdominal hysterectomy bilateral salpingo-oophorectomy +/- lymphadenectomy and no adjuvant radiation.

Isolated Splenic Parenchymal Recurrence in a Case of Carcinoma Ovary

Ovarian cancer has emerged as one of the most common malignancies in women in India. Majority of the ovarian cancers present at advanced stage, and, unfortunately, most of them are known to relapse after primary treatment. The pattern of recurrence is usually as disseminated disease. Although metastatic involvement of spleen is common in disseminated recurrences, isolated metastasis in spleen parenchyma is uncommon. We hereby report this rare case of isolated parenchymal splenic recurrence of epithelial ovarian cancer which developed 48 months after the initial treatment. The patient, a 40-year-old woman, with a preoperative diagnosis of Stage IIIB carcinoma ovary, underwent total abdominal hysterectomy bilateral salpingo-oophorectomy (TAH & BSO), omentectomy and pelvic lymph node sampling for a papillary serous carcinoma of the ovaries. She subsequently received six cycles of adjuvant chemotherapy. During follow-up, she was detected to have splenomegaly, along with rising levels of serum CA 125. CT scan revealed the 6 × 7 cm parenchymal splenic lesion. She was taken up for surgery and was detected to have isolated splenic mass. She underwent splenectomy. Histopathological evaluation revealed metastatic parenchymal disease consistent with recurrent ovarian cancer. She remains alive and disease free for 14 months since the last operation. Isolated parenchymal splenic lesions are very rare and may occur as a late recurrence in epithelial ovarian cancer. Splenectomy can be performed with acceptable morbidity and confers a substantial survival benefit to the patients.

Frontotemporal Dimentia (FTD), Late Onset Secondary to Total Abdominal Hysterectomy-Bilateral Salpingo-Oophorectomy: A Case Report in Malaysia

The relationship between cognitive impairment and depression were established. However, the exact mechanism is virtually unknown. Frontotemporal dementia (FTD) is second most common type of dementia after Alzheimer’s disease. To date, there is no proposed specific treatment for FTD, the mainstay of treatment is a combination of symptomatic pharmacological and psychosocial or behavioural intervention. The connection between FTD and level of estrogen was poorly understood. Interestingly recent findings reflect that there is association between estrogen use and development of FTD. Primary function of estrogen is in the development of sexual characteristics. Apart from that, it plays a vital role in the metabolism and mental health. Abrupt reduction of estrogen level in the blood and internal sustained low level of estrogen correlate with significant mood and cognitive changes. Estrogen replacement therapy (ERT) introduced to as a treatment for menopause, but it has linked with increased risk for breast cancer and thromboembolism phenomenon. We describe the case of post-menopausal women secondary to TAHBSO with underlying treatment-resistant major depressive disorder presented with cognitive disturbance. This case illustrates a challenge in the determination of correct diagnosis and decision of appropriate management that subsequently can affect the prognosis.

Palliative Chemotherapy: Does It Only Provide False Hope? The Role of Palliative Care in a Young Patient With Newly Diagnosed Metastatic Adenocarcinoma

Palliative Chemotherapy: Does It Only Provide False Hope? The Role of Palliative Care in a Young Patient With Newly Diagnosed Metastatic Adenocarcinoma

A 54-Year-Old Woman with Progressive Ataxia

Paraneoplastic cerebellar degeneration (PCD) is a rare but devastating syndrome associated with autoantibodies targeting cerebellar antigens expressed by tumours outside of nervous system. PCD is most often associated with breast and gynecological cancers and can precede clinical manifestations of the cancer. Of the dozen autoantibodies associated with PCD, anti-Yo is the most commonly identified. In this report, we present a case of a woman with progressive cerebellar ataxia and anti-Yo antibody, who has microscopic high-grade serous carcinoma found with empiric total abdominal hysterectomy bilateral salpingo-oophorectomy (TAH-BSO). This case highlights the challenges in diagnosis, difficulty in identifying the occult malignancy, and the need for multidisciplinary collaboration between Internal Medicine, Neurology, Gynecology and Pathology. The literature relating to diagnosis, prognosis and treatment of PCD is also reviewed.

Chronic postsurgical pain and neuropathic symptoms after abdominal hysterectomy: A silent epidemic.

Chronic postsurgical pain (CPSP) is an important clinic problem. It is assessed that prevalence of chronic pain extends to 30% but it is contended that there are various risk factors. We aimed to evaluate the prevalence of chronic pain after hysterectomy, risk factors of chronicity, neuropathic features of pain, and sensorial alterations at surgery area.Between years 2012 and 2015, 16 to 65 ages old patients that electively undergone total abdominal hysterectomy bilateral salpingo-oophorectomy and passed minimum 3 months after surgery were included to study. Visual analog scale (VAS) and Douleur Neuropathique 4-questionnaire (DN-4) surveys were used to evaluate pain symptoms, algometry device was used for evaluating abdominal pressure threshold and Von Frey Filament was used for sensorial alterations.Ninety-three of 165 eligible patients were included to study. As the groups were compared by demographic data, no difference was obtained (P > 0.05). There was no difference between groups regarding patient and surgery attributes (P > 0.05). Most frequently performed incision type was Pfannenstiel. Neuropathic symptoms were observed in 90 patients (96.8%). Sensorial alterations as hypoesthesia and hyperesthesia were detected around abdominal scar in 18 patients (19.4%) with pinprick test.Neuropathic symptoms should not be ignored in studies evaluating CPSP and a standard methodology should be designed for studies in this topic.

Timing of prophylactic hysterectomy-oophorectomy, mastectomy, and microsurgical breast reconstruction in BRCA1 and BRCA2 carriers

BRCA (breast cancer susceptibility gene) carriers are at high risk for breast and ovarian malignancies, and often undergo prophylactic total abdominal hysterectomy-bilateral salpingo-oophorectomy (TAH-BSO), bilateral mastectomy, and microsurgical breast reconstruction. Our goal was to determine whether abdominal wall complications and flap choice are affected by the order of those procedures. All BRCA carriers who underwent microsurgical breast reconstruction between 2007 and 2012 were studied. Abdominal wall complications and changes in the reconstructive plan were analyzed depending on the order of breast reconstruction and TAH-BSO. 442 patients underwent 612 microsurgical breast reconstructions, 47 of whom were BRCA carriers. TAH-BSO was not a predictor of requiring mesh for fascial closure (OR 1.1, P = 0.8), or of hernia/bulge (OR = 1.6, P = 0.65). In five patients, a DIEP flap was altered to another flap as a direct result of prior TAH-BSO. Robotic TAH-BSO after breast reconstruction took longer to perform than before breast reconstruction (4.48 ± 1.00 hours vs. 3.23 ± 0.70 hours, respectively, P = 0.023), due to abdominal wall tightness. However, none were converted to open. Full-muscle free TRAM flaps (compared to other flaps) and bilateral reconstructions (compared to unilateral) were the only predictors of mesh (OR = 9.85, P < 0.001 and 4.01, P < 0.001), and hernia/bulge (OR = 6.18, P < 0.001 and 2.13, P = 0.07). The order of TAH-BSO and breast reconstruction did not affect complications. In BRCA carriers, the order of TAH-BSO and microsurgical breast reconstruction does not affect complication rates. However, prior TAH-BSO may make DIEP flaps unfeasible, and robotic TAH-BSO after breast reconstruction takes longer, but can still be performed safely.

Delayed Menopause Due to Ovarian Granulosa Cell Tumour

A patient presented to us with complaints of inability to attain menopause even at the age of 64. She has been having irregular cycles of bleeding for 5 days every 2-3 months from the age of 54. On evaluation, she was found to have endometrial hyperplasia and ultrasonography showed a homogenous solid ovarian mass of size of the 4 cm x 3.5 cm. She underwent staging laparotomy with total abdominal hysterectomy bilateral salpingo-oophorectomy and infra colic omentectomy. Histopathology confirmed granulosa cell tumour of the ovary. Most commonly granulosa cell tumour presented with post-menopausal bleeding and abnormal uterine bleeding, however, women with delayed menopause also have to be evaluated thoroughly for estrogen secreting ovarian tumours. There should be an element of suspicion if patient doesn't attain menopause as specified and they need to be evaluated in detail.

Nail Toxicity Associated With Paclitaxel Treatment for Ovarian Cancer

A 57-year-old woman named C. B. began experiencing abdominal pain and bloating. She presented to her primary physician with these symptoms, and her physician palpated an adenexal mass on pelvic examination. That prompted a computed tomography (CT) scan of the abdomen and pelvis, which demonstrated omental thickening as well as a mildly enlarged left ovary. After initial consultation with a gynecologic oncologist, C. B. was taken to surgery and a total abdominal hysterectomy bilateral salpingo-oophorectomy omentectomy partial bowel resection, and pelvic and periaortic lymph node dissection were performed. C. B. was diagnosed with stage IV ovarian cancer involving the omentum, pelvic lymph nodes, and bowel wall and was subsequently referred for postoperative chemotherapy.

Interval changes of an extrauterine adenomyoma on magnetic resonance imaging

Extrauterine adenomyomas are rare tumors that present as uterus-like masses. Uterine adenomyomas can show interval changes according to hormone status. However, interval changes in imaging studies have not been reported in adenomyomas. We report a rare case of an extrauterine adenomyoma showing unique interval changes in magnetic resonance imaging.

Retropective analysis of 25 cases with borderline ovarian tumors

SUMMARY Objective: To determine the borderline ovarian tumors according to clinical features, treatment methods, recurrence and survival rates. Material and methods: Twenty-five cases were included to this study. Demographic and clinical findings, surgical methods, stage of disease, recurrences and survivals were revealed from hospital records. Data were analyzed with SPSS 13.0. Results: Mean age were 42.7±17.9. Most of the patients were in premenopausal (n=19, 76%). Mean tumor size were 13.44±9.37 cm (range 4-30 cm) and 16 of the patients had serous and 9 of them had musinous histologic type. Mean tumor size of serous and mucinous tumors were 9.44±6.78 cm, 20.56±9.4 cm, respectively and the difference was statisticallly significant (p=0.007). Tumor markers were elevated in 17 of the patients (68%) before the surgery. Twenty-two patients had frozen section (88%), accuracy rate of the frozen section was 90%. during surgery. Most of the patients were treated with total abdominal hysterectomy bilateral salpingo-oophorectomy (TAH-BSO) (n=12), 6 of the patients were treated with cystectomy and the others were treated with unilateral oophorectomy (USO) (n=7). Most of the cases were stage I (n=23, 92%). Recurrence of the disease was detected in 4 patients (16%) and 2 of them were treated with cystectomy and the others were treated with USO. No recurrence was detected in TAH-BSO group. Conclusions: Borderline tumors have perfect prognosis and most of the cases are premenopausal. The suggested treatment is surgical staging with TAH-BSO. Cystectomy might be chosen in young patients with fertilty desire, however, patients should be warned for high recurrence rates.

Uterine-like Mass With Features of an Extrauterine Adenomyoma Presenting 22 Years After Total Abdominal Hysterectomy–Bilateral Salpingo-oophorectomy: A Case Report and Review of the Literature

Adenomyoma is a benign tumor composed of smooth muscle and benign endometrium. These tumors typically originate within the uterus. An extrauterine adenomyoma is a rare entity. We report a uterine-like mass consistent with an extrauterine adenomyoma presenting 22 years following a total abdominal hysterectomy and bilateral salpingo-oophorectomy. The mass was pear-shaped with uterine-type smooth muscle and a cavity lined by functional endometrial glands and stroma. To our knowledge, only 4 other cases of an extrauterine uterine-like mass are reported in the literature. Three involved the ovary, while one was located adjacent to the broad ligament with normal pelvic organs. Although none of these other uterus-like masses were described as adenomyomas with uterine-like features, the histologic findings are strikingly similar. An understanding of the müllerian system suggests that either an embryologic malformation or a differential multipotentiality existing in the subcoelomic tissues in response to hormonal stimulation results in a supernumerary müllerian structure like a uterus, as observed in this case. The presence of endometrial glands and stroma in the mass confirms that the tissues in this mass are hormonally responsive. It is most likely that this uterine-like mass arose from the tissues of the secondary müllerian system in response to estrogenic stimulation.

Hysterectomy and bilateral oophorectomy for severe premenstrual syndrome.

Premenstrual syndrome (PMS) is a chronic, poorly understood psycho-endocrine disorder severely affecting 5%; of women. Hormonal therapy which suppresses ovulation is the mainstay of medical treatment, but these interventions are rarely permanent. We evaluated the effectiveness and patient satisfaction with total abdominal hysterectomy/bilateral salpingo-oophorectomy (TAH/BSO) in PMS sufferers, and assessed the post-operative HRT continuation. All women undergoing TAH/BSO for severe PMS between January 1994 and April 2000 were interviewed and responses recorded by structured questionnaire. Forty-seven women were interviewed. Median age was 42 years (interquartile range 39.8-46.6) at the time of surgery. They had suffered with PMS for a mean of 9.68 years (SD 6.8) and received treatment for a mean of 3.57 years (SD 2.0) prior to referral to a gynaecologist. Fifty-two percent were treated with estradiol patches and 48% with estradiol implants prior to TAH/BSO. Ninety-six percent of women were 'satisfied' or 'very satisfied' with TAH/BSO, and 93.6% declared complete resolution of their cyclical symptoms; 93.6% were continuing with HRT usually by implants of estradiol and testosterone for a mean duration of 3.8 years (SD 1.86) post-operatively. Despite few reports of TAH/BSO as a treatment for severe PMS, we have found surgery, coupled with appropriate HRT, to be an extremely effective and well-accepted permanent cure for PMS.

The value of pelvic and para-aortic lymphadenectomy in endometrial cancer to avoid unnecessary radiotherapy.

The case histories of 95 patients with endometrial carcinoma treated between July 1998 and December 2002 were reviewed. These patients were staged according to FIGO classification and included peritoneal cytology, total abdominal hysterectomy/bilateral salpingo-oophorectomy (TAHBSO), and pelvic with or without para-aortic lymphadenectomy. The FIGO surgical stages were as follow: IA, 9 (9.5%); IB, 35 (36.8%); IC, 16 (16.8%); IIB, 10 (10.5%); IIIA, 5 (5.3%); IIIB, 1 (1.1%); IIIC, 19 (20.0%). In addition to TAHBSO, 47 (49.5%) patients had pelvic lymphadenectomy whereas 48 (50.5%) had both pelvic and para-aortic lymphadenectomy. Nineteen (20.0%) of 95 patients had nodal metastases. Positive pelvic and para-aortic lymph nodes were found in 15 (15.8%) of 95 and 12 (25.0%) of 48 patients, respectively. According to the result of the lymphadenectomy, 19 (20.0%) patients had their surgical stage upgraded to stage IIIC and 61 (64.2%) patients had a change in their management plan. Twelve (12.6%) patients required extended field irradiation due to para-aortic nodal metastases and 49 (51.6%) patients with negative nodes avoided postoperative external radiotherapy. By defining the lymphatic spread via surgical staging, postoperative radiotherapy can be recommended to patients with nodal metastases, while it can be withheld from those patients with negative nodes, irrespective of the presence of risk factors.

The value of pelvic and para-aortic lymphadenectomy in endometrial cancer to avoid unnecessary radiotherapy

The case histories of 95 patients with endometrial carcinoma treated between July 1998 and December 2002 were reviewed. These patients were staged according to FIGO classification and included peritoneal cytology, total abdominal hysterectomy/bilateral salpingo-oophorectomy (TAHBSO), and pelvic with or without para-aortic lymphadenectomy. The FIGO surgical stages were as follow: IA, 9 (9.5%); IB, 35 (36.8%); IC, 16 (16.8%); IIB, 10 (10.5%); IIIA, 5 (5.3%); IIIB, 1 (1.1%); IIIC, 19 (20.0%). In addition to TAHBSO, 47 (49.5%) patients had pelvic lymphadenectomy whereas 48 (50.5%) had both pelvic and para-aortic lymphadenectomy. Nineteen (20.0%) of 95 patients had nodal metastases. Positive pelvic and para-aortic lymph nodes were found in 15 (15.8%) of 95 and 12 (25.0%) of 48 patients, respectively. According to the result of the lymphadenectomy, 19 (20.0%) patients had their surgical stage upgraded to stage IIIC and 61 (64.2%) patients had a change in their management plan. Twelve (12.6%) patients required extended field irradiation due to para-aortic nodal metastases and 49 (51.6%) patients with negative nodes avoided postoperative external radiotherapy. By defining the lymphatic spread via surgical staging, postoperative radiotherapy can be recommended to patients with nodal metastases, while it can be withheld from those patients with negative nodes, irrespective of the presence of risk factors.

Immature teratoma of the ovary

Twenty-five cases of patients with pure immature teratoma of the ovary, accrued from the Connecticut Tumor Registry from 1969 to 1984, were reviewed. Two patients had grade 1 tumors, twelve had grade 2 tumors, and eleven had grade 3 tumors. The majority of patients (23) were stage I at the time of initial surgery. Twenty-one of the twenty-three patients were treated with some form of unilateral adnexal surgery with or without adjuvant combination chemotherapy (VAC). Two of the twenty-three patients were treated with total abdominal hysterectomy/bilateral salpingooophorectomy (TAH/BSO) with the addition of either VAC chemotherapy or radiation therapy. Recurrence occurred in two patients, both of whom had grade 3 tumors and were subsequently treated with surgical resection plus VAC chemotherapy. One patient, who recurred after initial therapy with unilateral salpingo-oophorectomy (USO) plus VAC chemotherapy, was successfully treated with surgical resection and further chemotherapy. Two patients were stage III at the time of initial surgery, one of whom was treated with USO plus adjuvant combination chemotherapy and radiotherapy. The other patient was treated with TAH/BSO plus VAC chemotherapy. In our series, no patient died from immature teratoma (one patient died from advanced breast carcinoma). It is reasonable to withhold chemotherapy from patients with stage I, grade 1 and 2, immature teratoma which may be treated initially with conservative surgery. The risk of recurrence in patients with grade 3 tumors warrants the addition of further chemotherapy.