Tubo-ovarian Mass Research Articles

Role of Magnetic Resonance Imaging in evaluation of tuberculous tubo ovarian mass

ObjectiveRole of Magnetic Resonance Imaging (MRI) in diagnosis of tuberculous tubo-ovarian (TO) mass. MethodsMRI was performed on 33 patients of tuberculous TO mass of female genital tuberculosis (FGTB). ResultsMean age, BMI, and parity was 27.5 ± 4.2 years, 22.7 ± 3.6 kg/m2, and 0.27 ± 0.13. All patients (100%) had infertility; primary infertility (72.72%) and secondary infertility (27.23%) with mean 5.8 years. Abdominal/pelvic pain 33 (100%) cases, abdominal lump 4 (12.12%), adnexal mass 33 (100%). MRI findings showed pelvic masses 33 (100%), bilateral TO masses 11 (33.33%), cystic lesion 4 (12.12%), solid cystic lesion 3 (9.09%) with bilateral pyosalpinx 1 (3.3%), homogeneous content with ascites 1 (3.03%), rim enhancing lesion abutting pelvic wall in 1 (3.03%). Right adnexal mass 11 (33.33%), right adnexal cyst 2 (6.06%), right adnexal cystic mass in 1 (3.03%), right sided complex TO mass 1 (3.03%), right sided hydrosalpinx in 1 (3.03%) case, right sided TO mass in 4 (12.12%) cases and right sided para-ovarian cyst in 2 (6.06%). Left sided adnexal mass was seen in 11 (33.33%), cystic lesion in 1 (3.03%), ovarian cyst in 3 (9.09%) cases, left sided hydrosalpinx in 2 (6.06%), left ovarian cyst 2 (6.06%) cases, left sided ovarian cyst with encysted ascites 1 (3.03%) case and with left sided paraovarian cyst 2 (6.06%) case. Miscellaneous finding were generalised ascites (6.06%), encysted ascites (3.03%), pelvic (1; 3.03%) and mesenteric lymphadenopathy 1 (3.03%). Incidental finding were fibroid 3 (9.09%) and adenomyosis 1 (3.03%) case. ConclusionMRI appears to be useful diagnostic modality for tuberculous TO masses where differential diagnosis is malignancy but molecular diagnosis remains the gold standard.

A clinicopathological study of ovarian endometriotic cysts

Endometriosis is an important gynecologic disorder with multifactorial causes, primarily affecting women during their reproductive years. Pathologically, it is the result of functional endometrium located outside the uterus which may vary from microscopic endometriotic implants to large cysts. Endometriotic cysts and infertility is a well-known association. Some patients are asymptomatic while others present with disabling pelvic pain, infertility, or adnexal masses. Cyst aspiration, fenestration and ablation of cyst wall are commonly performed surgical procedures. Excision of the cyst wall is an accepted surgical treatment owing to the low recurrence rates. A total of 35 patients who underwent ovarian cystectomy for endometriotic cysts between January 2019 and December 2020 were retrospectively identified. The clinical findings, gross and histopathological features were noted in each case. Microscopically, the presence or absence of ovarian tissue adjacent to the cyst wall was evaluated. If ovarian tissue was present, the morphologic characteristics were graded on a semi-quantitative scale of 0-4 as described by Muzii et al. The age group of patients ranged between 22-28yrs. Right side cysts accounted for the majority, however 6 cases had bilateral endometriotic cysts. Majority of patients presented with primary infertility (46.2%). The maximum weight recorded for these cysts was 35gm, size ranging between 4.5 to 18cm and median thickness of the cyst wall being 0.7cm. 68% of the cysts showed a lining epithelium, few showing atypia and oncocytic change. Fibrosis and hemosiderin laden macrophages were present in more than 70% of cases and endometrial glands and stroma in more than 50%. Inflammation when present was predominantly lymphocytic. On evaluation of the ovarian tissue, 42.8% of cases showed no follicles and the rest showing grades ranging from 1 to 4, with grade 1 accounting for majority. The present study further emphasizes endometriosis to be an important cause of primary infertility which needs to be recognized and treated appropriately. Recognition of these cysts on histopathological examination can be challenging at times when endometrial stroma is scant and in cases of tubo-ovarian masses where these lesions could mimic malignancy. The excision of endometriotic cyst wall may cause loss of functional ovarian tissue in patients with primary infertility and thus could effect the response to ovarian stimulation, ocyte recovery, implantation and fertilization rates in these patients.

Coexistence of Stump Appendicitis and Ovarian Fibro-Thecoma in a Young Women with Recurrent Right Iliac Fossa Pain During Pregnancy; A Rare Case Report

Ovarian Fibro-thecoma is a rare, benign, sex cord-stromal neoplasm, with a typically unilateral location in the ovary, characterized by mixed features of both fibroma and thecoma. Ovarian Fibro-thecoma is Uncommon tumor of gonadal stromal cell origin accounting for 3-4% of all ovarian tumors. We describe a rare case of Fibro-thecoma in a 27- year women with a history of recurrent right iliac fossa pain during pregnancy associated with fever and vomiting with previous history of laparotomy for appendicular abscess 10 years back. She presented to us during pregnancy with this complain for which she was managed conservatively. She did not maintain her follow up regularly at our hospital and visited again after delivery of her baby with a still birth outcome with a newly diagnosed complex bilateral ovarian cyst demonstrated on ultrasound and computed tomography showed inflammatory Right sided tubo-ovarian mass along with inflammatory thickening of ileum in right lower quadrant adjacent to right ovarian mass lesion. The patient underwent laparotomy for this with the removal of mass along with the removal of appendicular stump for appendicular stump appendicitis which was diagnosed intraoperatively. The finding from histopathological examination of the mass was consistent with the diagnosis of Fibro-thecoma.

Pre treatment and post treatment positron emission tomography–computed tomography (PET–CT) to evaluate treatment response in tuberculous Tubo-Ovarian masses

PurposeFemale genital Tuberculosis (FGTB) causes infertility and formation of Tubo-ovarian (TO) masses. The study showed treatment response of PET-CT in evaluation of anti-tubercular treatment response in patients of infertility with tuberculous TO masses. MethodIt’s a Prospective study on 47 confirmed cases of FGTB with infertility having TO masses. All patients were subjected to 18F-FDGPET/CT to see the glucose uptake by the TO mass and extent of the disease. Category I treatment under DOTS was given for 6 months. All underwent follow-up of PET/CT to see the response to ATT. Results of pre ATT PET/CT were compared with post ATT PET/CT. ResultsTO masses was in 42 (89.36%); bilateral in 18 (38.29%) FDG uptake in 14 (29.78%) and without FDG uptake in 4 (8.51%) cases. Right sided mass in 13 (27.65%) FDG uptake in 9 (19.14%) and without FDG uptake in 4 (8.51%) cases. Left sided mass in 11 (23.40%) FDG uptake in 7 (14.89%) and without FDG uptake in 4 (8.51%) cases. Post ATT, there was significant decrease in most parameters. Repeat PET-CT done in 44 cases showed TO mass in 9 (20.45%); bilateral in 4 (9.09%) (FDG uptake in 2.27%) (p < 0.001), right sided in 3 (6.85%) (FDG uptake in 2.27%) (p < 0.002) and left side in 2 (2.27%) FDG uptake in 1 case (p < 0.004). Pelvic and mesenteric lymphadenopathy without FDG uptake was in 1 case (p value = 0.03) while omental and peritoneal deposits without FDG uptake in 1 and 2 cases, respectively. ConclusionPET-CT is useful in treatment response evaluation of tubercular TO masses.

Recurrent liver metastasis in ovarian cancer

The most common sites of metastasis in ovarian cancer is liver, peritoneum, and lymph nodes resulting from hematogenous spread or secondary to liver parenchymal invasion from perihepatic peritoneal metastases. The case was retrieved from routine reporting at our hospital. A 34-year-old female presented with lump in left side of abdomen for six months. Ultrasonography showed Left complex tubo-ovarian mass. Serum level of CA125 was 19.8U/mL. Upfront surgery was done. Histopathology showed malignant lesion, positive for WT1, P53 & CK7 and negative for CK 20. Retroperitoneal lymph nodes and omentum were involved. The cases was diagnosed as epithelial ovarian cancer, high grade papillary serous cyst adenocarcinoma stage III. Three months after surgery repeat contrast enhanced computed tomography showed lung and liver metastasis lymphadenopathy. Patient was given 6 cycles of paclitaxel + carboplatin to achieve complete clinical response (CR). Lesions of lung, liver & lymph node subsided. She spent 33 months of treatment free interval, after which lymph node enlargement was noticed and its fine needle aspiration cytology showed metastasis. Patient was put on to oral metronomic therapy with etoposide, cyclophosphamide, and celecoxib (COX-2 inhibitor) for 8 months, which showed CR. Again after 4 months, lesion in liver reappeared with raised CA 125, suggesting second relapse. The patient is on oral metronomic therapy till date with improved clinical condition. This study highlights the need of early diagnosis, adjuvant chemotherapy with frequent follow up in this case. Liver is an early site for metastasis. Second relapse in also not uncommon.

Clinicopathological study of Tubo ovarian masses- A study of 110 cases

An adnexal mass is a common clinical presentation in gynecological practice. Differential diagnosis of an adnexal mass can vary from a life threatening emergency like ectopic gestation to a malignant lesion with a high mortality rate, so it poses diagnostic challenge for treating gynecologist.To study the histopathological nature of adnexal masses.110 cases of adnexal masses who underwent surgical intervention during the study period of one year were included in the study. Specimen received in the department of Pathology and was subjected to histopathological examination.A total of 110 cases formed the study group. In our study 79% of cases of adnexal masses had an ovarian origin, 15.45% cases were of tubal origin and 5.45% cases had combined pathology i.e due to tubovarian abscess and endometriosis. Among Ovarian lesions 9.1% had non neoplastic cyst like corpus luteal cyst or endometriosis whereas 50% cases had a surface epithelial lesion. 77 cases out of a total of 110 were ovarian in origin, out of which 57(74%) were benign, 05(6.5%) were borderline and 15(19.5%) were malignant.To conclude, adnexal mass often poses a diagnostic dilemma to the treating physician. Ectopic gestation is often a cause of adnexal mass among patients of reproductive age group. Ovarian neoplasm constitute another major cause of adnexal mass, serous cyst adenoma is the commonest benign lesion seen while serous cyst adenocarcinoma is the commonest malignant ovarian lesion.

Computed tomographic findings in female genital tuberculosis tubo-ovarian masses

Female genital tuberculosis (FGTB) is a common cause of infertility in developing countries. It can manifest as menstrual disturbances, infertility and pelvic masses. ObjectiveTo evaluate the role of computed tomography in diagnosis of female genital tuberculosis with tubo-ovarian (adnexal) masses. MethodsIt was a prospective study over a four year period (July 2015 to August 2019) in a tertiary referral centre over 33 patients presenting with tuberculosis and tubo ovarian masses only. 75 total cases of FGTB diagnosed on composite reference standard (evaluation of AFB bacilli in microscopy or culture or endometrial biopsy, gene expert, epitheloid granulomas on endometrial biopsy or definitive or possible findings of FGTB on laparoscopy). Detailed history taken, clinical examination, baseline investigations and endometrial biopsy were done in all cases. Computed tomography was performed in women presenting with infertility, tubo ovarian masses on clinical examination and laboratory investigations. A total of 33 cases were evaluated. ResultsMean age, body mass index, parity and history of TB contact were 27.5 ± 4.2 year, 22.7 ± 3.6 kg/m2, 0.27 ± 0.13 and 44.4% respectively. Infertility was primary in 72.72% and secondary in 27.23%. Case wise mean duration being 5.8 years, menstrual dysfunction was seen in 45.45% cases. Abdominal discomfort with pain and lump were seen in all 33 (100%) cases. Abdominal lumps were felt in 4 (12.12%) cases while adnexal mass was seen in all 33 (100%) cases being unilateral in 18 (54.54%) and bilateral in 15 (45.45%). Mean ESR was 33.4mm in first hour while mean leucocyte count was 6128 ± 2854 per cubic mm. Infectious mantoux test (>10mm) was seen in 14 (42.82%) cases while abnormal X ray chest was seen in 9 (27.27%) cases.Diagnosis of FGTB was made by positive AFB n microscopy or culture of endometrial biopsy in 5 (15.15%) cases, positive gene expert in 6 (18.18%) cases, positive polymerase chain reaction in 32 (96.96%) cases, epitheloid granulomas on histopathology of endometrial biopsy in 7 (21.21%) cases, definitive findings of tuberculosis in 15 (45.45%) cases and a possible findings of tuberculosis inn 18 (54.54%) cases. Various CT findings were pelvic mass (100%), unilateral pelvic mass in 18 (54.54%), bilateral pelvic mass in 15 (45.45%), cystic mass (24.2%), solid mass (21.2%), mixed mass (54.54%), mass showing multilocular caseous necrotic enhancements (12.12%), ascites (42.4%), thickening and enhancement of peritoneum in 14 (42.42%), nodules in 24.2%, smooth in 18.8%, pelvic adhesion in 6 (18.18%), lymphadenopathy in 8 (24.3%) with calcifications (9.09%) and central necrosis (52.5%). Other CT findings were thickening and enhancement of bowel wall (12.12%), hepatic TB (3.03%), splenic TB (3.03%), omental thickening (9.09%) and omental calcification (3.03%) cases. ConclusionComputed tomography appears to be a useful diagnostic modality in diagnosis of tuberculosis tubo ovarian masses and may help avoid unnecessary surgery.

Evaluation of Role of Transabdominal and Transvaginal Ultrasound in Diagnosis of Female Genital Tuberculosis.

Background:Female genital tuberculosis (FGTB) is a common problem in developing countries causing significant morbidity, especially infertility. Radiological imaging, especially ultrasound, can help in diagnosis of FGTB with tubo-ovarian masses.Aims:The present study was performed to evaluate the role of ultrasound in diagnosis of FGTB and to see various findings of FGTB on ultrasound.Study Setting and Design:It was a prospective cross-sectional study over 4-year period between August 2015 and August 2019 in a tertiary referral center.Subjects and Methods:One hundred and seventy-five patients of infertility diagnosed to have FGTB on composite reference standard (CRS) of positive acid-fast bacilli on microscopy or culture of endometrial biopsy, positive polymerase chain reaction, positive GeneXpert, epithelioid granuloma on histology of endometrial biopsy, or definite or probable finding of FGTB on laparoscopy were subjected to transvaginal ultrasound by an experienced sonographer for various findings of FGTB.Statistical Analysis:Data analysis was carried out using STATA software 12.0. Comparison of categorical values was tested using Chi-square Fisher's exact test, with P < 0.05 being taken as significant.Results:Mean age, body mass index, parity, and duration of infertility were 28.9 years, 22.9 kg/m2, 0.26, and 6.06 years, respectively. Menstrual dysfunction was common (44%). Diagnosis of FGTB was made by CRS. Ultrasound was normal in 112 (64%) cases and was abnormal in 63 (36%) cases. Various ultrasound findings were ovarian cyst (23.42%), tubo-ovarian masses (15.42%), unilateral or bilateral hydrosalpinx (13.71%), pyosalpinx (0.57%), adhesion (1.14%), adnexal fixity (6.28%), thin endometrium (24.57%), endometrial fluid (12.57%), endometrial calcification (1.7%), endometrial synechiae (4.57%), cornual synechiae (2.28%), impaired endometrial vascularity (21.71%), ascites (6.85%), and peritoneal or omental thickening (1.75%).Conclusion:Carefully performed ultrasound is a useful modality in diagnosis of FGTB, especially in adnexal masses.

Тубоовариальные абсцессы в репродуктивном периоде. Методологическое обоснование органосберегающего лечения

The issues of complex treatment of patients with tubo-ovarian abscesses (TOA) in the reproductive period were considered, the main component of which is ultrasound minimally invasive surgery – drainage of purulent inflammatory tubo-ovarian mass using transvaginal ultrasound. The technique, indications and contraindications for such treatment were presented. The immune homeostasis of patients with TOA was also studied, and it was shown that they had the expansive nature of proinflammatory changes in cytokine production, as well as activation of the Th1-type lymphocytes with a simultaneous decrease in the Th2-type lymphocytes activity. Therefore, it is appropriate to include immunostimulating agents in the complex of therapeutic measures, particularly inosine pranobex. Conclusion. Drainage of TOA under the control of transvaginal ultrasound can be considered as the choice of treatment of patients of reproductive age. Sixty days after the complex treatment, the proinflammatory nature of cytokine production in these patients changed to mild proinflammatory. Key words: tubo-ovarian abscesses, ultrasound mini-surgery, drainage, inosine pranobex

Comparative Study of Ultrasound and Magnetic Resonance Imaging of Adnexal Masses

Background: Current study aimed to assess the role of ultrasound and MRI in the evaluation of adnexal mass lesions and comparison with clinical outcomes. Subjects &amp; Methods: A total of 30 suspected adnexal mass detected on ultrasonography was performed MRI, and accuracy of both USG and MRI were compared with histopathology. Results: Abdominal pain was predominantly confined to the lower abdomen in13 of 30 cases (43.3%). On USG total number of benign lesions was 19, and the total number of malignancies was 11. However, on MRI, 21 cases were mild, and 9 cases were malignant. six cases were diagnosed as malignant in ultrasound. In these six cases, two cases were serous cystadenocarcinoma, two were mucinous cystadenocarcinoma, one was serious papillary cystadenocarcinoma of the fallopian tube, and one was a malignant tubo-ovarian mass. MRI accurately diagnosed 4 indeterminate cases that correlated with the histopathology report. 9 malignant lesions were diagnosed as malignant by MRI were 3 cases of serous cystadenocarcinoma, 2 cases of mucinous cystadenocarcinoma, 1 case of malignant tubo-ovarian mass, 1 case of endometrioid carcinoma, 1 case of serous papillary cystadenocarcinoma of the fallopian tube and 2 cases of malignant sex cord-stromal neoplasms. Both the cases of serous cystadenomas were correctly diagnosed as benign lesions on both ultrasound and MRI. There were 2 cases of mucinous cystadenocarcinoma, which were accurately diagnosed as malignant on both USG and MRI due to the presence of solid components, mural thickening. The sensitivity, specificity, and accuracy of USG were 36.6%, 94% and 55% respectively. The sensitivity, specificity, and accuracy of MRI were 81.80%, 94.7%, and 65.7%, respectively. Conclusion: The best agreement was observed between MR findings and diagnosis in origin, tissue content, and tissue characteristics. Sonography had a weak correlation in context to the definitive diagnosis for the origin and tissue content of a mass.

CLINICOPATHOLOGICAL STUDY OF SURFACE EPITHELIAL OVARIAN TUMORS- A TERTIARY CARE CENTER STUDY.

Background: Ovarian tumors are one of the most common tumors, which occur in female genital tract. Despite the newer techniques in imaging and molecular biology, the diagnosis of ovarian tumors primarily depends on histopathological examination. Ovarian tumors manifests a wide spectrum of clinical, morphological and histological features. The aim of the study was to find the incidence of surface epithelial ovarian tumors in a tertiary referral centre. Materials and methods: A retrospective data of 3 years were collected for surface epithelial ovarian tumors submitted to the pathology department of the tertiary care hospital and analysed. The correlation of these surface epithelial ovarian tumors was done with age, clinical presentation and histomorphological patterns. Non-neoplastic lesions like simple ovarian cysts, tubo-ovarian mass and polycystic ovaries were excluded. Results: A total number of 56 cases were studied. Out of which 44 cases were benign and 12 cases were malignant. Maximum cases were observed between 21 to 30 years. Mass per abdomen was the most common presentation(36%) followed by mass and pain in abdomen(27%).Serous cystadenoma formed maximum 28 cases(50%) followed by Mucinous cystadenoma(16 cases) 28 % , Serous cysadenocarcinoma formed 5cases (9%), followed by Mucinous cystadenocarcinoma 3 cases(5%) &amp; 2 cases each(4%) of clear cell carcinoma and endometrioid carcinoma were noted. The most common histopathological type of benign and malignant tumor was serous cystadenoma (50.2%) and serous cystadenocarcinoma(9%) respectively. Conclusion: In the study majority (78.6%) of the surface epithelial ovarian tumors were benign. Malignancy was seen in (21.4)% of the cases. Surface epithelial tumours present a great challenge to the gynecologic oncologist because non-neoplastic ovarian lesions can form a pelvic mass and potentially mimic a neoplasm. Correct histopathological diagnosis of surface epithelial ovarian tumors is of prime importance in view of their behavioral predictability and clinical correlation for proper management of the patient.

Evaluation of Gene Xpert as compared to conventional methods in diagnosis of Female Genital Tuberculosis

To evaluate Gene Xpert for diagnosis of Female Genital Tuberculosis (FGTB) as compared to conventional methods. Study DesignIt was a prospective study conducted over 167 cases of infertile female genital tuberculosis (FGTB) diagnosed on composite reference standard (CRS) (smear for AFB, histopathological evidence of epithelioid granuloma or definite or possible findings of tuberculosis on laparoscopy). All women underwent endometrial biopsy for AFB microscopy, culture, gene Xpert, PCR and histopathology) and laparoscopy and hysteroscopy for diagnosis and prognostication of disease. The results of Gene Xpert were compared with conventional methods in detection of FGTB. All patients were treated with 6 months course of rifampicin (R), isoniazid (H), pyrazinamide (Z) and ethambutol (E) (RHZE for 2 months, RHE for 4 months) using directly observed treatment short course strategy. ResultsMean age, parity, body mass index and history of contact was 28.3 years, 0.28, 22.9 Kg/m2 and 38.92% respectively. Primary infertility was seen in 87.42% cases with mean duration of 2.42 years. Menstrual dysfunctions, abdominal or pelvic pain and lump were seen in 38.92%, 14.37% and 10.77% cases. Abnormal vaginal discharge and adnexal mass were seen in 28.14% and 13.17 % cases. On diagnostic laparoscopy, definite findings of tuberculosis (beaded tubes, tuebrcles and caseous nodules) were seen in 96 (57.48%) women while probable findings of tuberculosis (pelvic or abdominal adhesions, hydrosaplinx, tubo-ovarian mass, pyosalpinx) were seen in 81 (48.50%) women.On laboratory investigations, positive AFB on microscopy or culture was seen in 2.99% casess, PCR was positive in 47.90% gene Xpert was positive in 18.56% cases while epitheloid granuloma was seen on histopathology in 16 (9.58%) cases. Gene Xpert had sensitivity of 35.63%, specificity of 100%, positive predictive value of 100% and negative predictive value of 58.82% and diagnostic accuracy of 66.47% in the present study. ConclusionGene Xpert is a very useful test to rule in tuberculosis whereas when it is negative it is not a good test to rule out tuberculosis.

Elusive Presentations of Female Genital Tuberculosis: A Case Series

The Ministry of Health and Family Welfare has made a target of eliminating tuberculosis by 2025 under the National Tuberculosis Elimination Plan (NTEP). For this, it is important to identify cases, notify and treat them effectively. This case series is on women with unique presentations of the Female Genital Tract TB (FGTB). It further explores the diagnostic and treatment modalities of such cases. The cases include four women with atypical presentations- a young nulliparous woman with repeated episodes of pyometra, a woman with tubo-ovarian mass and chronic fever and two women with adnexal masses mimicking dermoid and endometriosis, respectively. The diagnosis was based on the unique presentations, exclusion of other diseases and on the operative findings. One should target to get a tissue based diagnosis. Now the government has advised Cartridge-Based Nucleic Acid Amplification Test (CBNAAT), for all samples of FGTB, to get an accurate estimation of drug resistance. It can be used in very interior areas, gives a result within the same day and also gives sensitivity results to the antitubercular drugs. CBNAAT may give incorrect results with small specimens. That makes clinical judgement by specialists very important. The antitubercular regime has changed and there are no separate regimes for relapses or treatment failures. It is now therapy with daily intake of rifampicin, isoniazid, pyrazinamide and ethambutol for two months and rifampicin, isoniazid and ethambutol for four months. For all cases of FGTB, a working definition should be given and notification should be done by the Nikshay online portal. Future structured studies are required to investigate the sensitivity and specificity of different tissues for CBNAAT in different clinical scenarios of genital Tuberculosis (TB).

Evaluation of cell blocks from effusion specimens in Gynecologic Oncopathology: An experience of 220 cases, diagnosed at a Tertiary Cancer Referral Center.

One of the common indications of ascitic fluid examination in gynecological oncopathology is the detection and classification of malignant cells, especially in cases of clinically suspicious tubo-ovarian masses. The present study was undertaken to assess and validate the diagnostic utility of cell blocks (CBs) and compare its results with the corresponding conventional smears, prepared from effusion samples. CBs were prepared by thromboplastin technique in 220 cases. In 208 cases, diagnostic concordance between results obtained from smears and corresponding CBs was evaluated. Various antibody markers were tested, as per individual case. The average age of patients was 52.2 years. Positive immunohistochemical (IHC) staining for various markers was observed in 182 cases (82.7%) The most frequently positive antibody marker was PAX8 (101/134), followed by p53 (85/92) [mutation type (either diffusely positive or completely negative)], WT1 (tumor cells) (80/112), calretinin (2/87) (diffuse), BerEP4 (21/49), CA125 (21/24), CK7 (31/39) and CK20 and CDX2, together (5/16). Various other IHC markers utilized, including their positive expression, were TTF1 (1/10), p40 (3/3), p63 (2/4), ER (21/29), HBME1 (1/7), GATA3 (1/4), and MIC2 (1/1). Complete diagnostic concordance between CBs and smears was observed in 170/208 cases (81.7%). There were 20 major discordances, 10 minor and 8 cases with sampling errors. IHC was useful in classifying 158/182 (86.8%) cases, including serous or Müllerian adenocarcinoma (n = 123), mostly high-grade (121); metastatic squamous carcinoma (3); gastrointestinal-type adenocarcinoma (8); pulmonary adenocarcinoma (1); breast adenocarcinoma (1); Ewing sarcoma (1); and mesothelioma (2). CBs are complementary to smears in the detection of gynecological malignancies, mostly high-grade serous adenocarcinomas. These provide an opportunity for testing several IHC markers, for a precise diagnosis, including in various uncommon case scenarios, associated with significant therapeutic implications.

Communication and management of incidental pathology in 1,214 consecutive appendicectomies; a cohort study.

Important incidental pathology requiring further action is commonly found during appendicectomy, macro- and microscopically. We aimed to determine whether the acute surgical unit (ASU) model improved the management and disclosure of these findings. An ASU model was introduced at our institution on 01/08/2012. In this retrospective cohort study, all patients undergoing appendicectomy 2.5 years before (Traditional group) or after (ASU group) this date were compared. The primary outcomes were rates of appropriate management of the incidental findings, and communication of the findings to the patient and to their general practitioner (GP). 1,214 patients underwent emergency appendicectomy; 465 in the Traditional group and 749 in the ASU group. 80 (6.6%) patients (25 and 55 in each respective period) had important incidental findings. There were 24 patients with benign polyps, 15 with neuro-endocrine tumour, 11 with endometriosis, 8 with pelvic inflammatory disease, 8 Enterobius vermicularis infection, 7 with low grade mucinous cystadenoma, 3 with inflammatory bowel disease, 2 with diverticulitis, 2 with tubo-ovarian mass, 1 with secondary appendiceal malignancy and none with primary appendiceal adenocarcinoma. One patient had dual pathologies. There was no difference between the Traditional and ASU group with regards to communication of the findings to the patient (p = 0.44) and their GP (p = 0.27), and there was no difference in the rates of appropriate management (p = 0.21). The introduction of an ASU model did not change rates of surgeon-to-patient and surgeon-to-GP communication nor affect rates of appropriate management of important incidental pathology during appendectomy.

2469 Perforated Copper-T Causing an Ovarian Abscess: The First Reported Case

Video Objective To demonstrate laparoscopic retrieval of a rare case of Copper-T migration causing ovarian abscess. Setting A 34 year old Para4 Living4, who underwent a seemingly uneventful Copper-T insertion. She presented at follow up with lower abdominal pain for two months, and fever. Ultrasound showed an empty uterine cavity with Copper-T seen in the right adnexal region. Interventions She underwent laparoscopy proceed. At laparoscopy, the Copper-T was found to be embedded in a right tubo-ovarian mass which was adherent to the pelvic side wall. Ovary was friable, with abscess draining ∼5cc of purulent fluid. The Copper-T was dissected free of the T-O mass. Ureter was dissected free, and integrity ensured. Bilateral salpingectomy and thorough lavage was done. Patient was covered with broad spectrum antibiotics. Post-operative period was uneventful. Conclusion Perforation and migration of IUD can rarely lead to ovarian abscess. Diagnosis and retrieval should be prompt, with appropriate antibiotic cover. Laparoscopic retrieval is a feasible method for IUD retrieval. In-depth knowledge of laparoscopic surgical anatomy is essential in such cases.

Transvaginal sonography of tubo-ovarian masses with clinical correlation

Transvaginal sonography of tubo-ovarian masses with clinical correlation

Ovarian Tuberculosis masquerading as malignancy - Case report of 2 cases with review of literature

Background: Tuberculosis is an unsolved problem and a disease with myriad presentations and manifestations. Isolated ovarian tuberculosis is very rare and always a diagnostic dilemma. Case details: We report here two cases that presented with abdominal pain and after all investigations surgery was done with suspected tuboovarian mass/tumor. Finally after the histopathological examination, special stain and polymerase chain reaction diagnosis of ovarian tuberculosis was made. Conclusion: Genital tuber-culosis should always be considered in a female with tuboovarian mass and has to be evaluated accordingly to prevent complications. Key words: Tuberculosis, Ovary. Granuloma of Ovary

Transvaginal Ultrasound Findings Among the Women Presenting with Infertility

Introduction: Infertility is a difficult conditions for the obstetricians to dealwith. Transvaginal ultrasound (TVS) is a investigation that is primarily done to evaluate the cases of infertility cases. The objective of the present study was to document the Transvaginal Scan (TVS) findings in women presenting with infertility in a teaching hospital of Bangladesh.Methods: Subjects were women of reproductive age presenting at the teaching hospital with infertility over a one year period. As part of their management, transvaginal scans was done. TVS was done by the researcher herself and was checked by a second observer. Data was complied and analyzed by SPSS 20.Results: Among the 100 cases regarding anthropometric variables where mean ± SD of age was found 28 ± 6.7 years, weight was 56 ± 12.5 kg, height 1.57 ± 0.76 m and BMI was 24.5 ± 3.6 Kg/m2. Type of infertility revealed 75% cases were primarily infertile and 25% having secondary infertility. Comorbid diseases revealed 6% cases had DM, 4% cases had HTN, 11% cases had PID, 14% patients had thyroid problems. All the 100 cases undergone TVS study where PCO was found among 69(69%) cases, chronic pelvic inflammatory disease 14(14%) fibroids 6(6%) anatomical problems 19(19%) endometrial/cervical polyp 18(18%) free fluid in pelvic/abdominal cavity 7(7%) endometritis 5(5%) endometriosis 4(4%) adenomyosis 5(5%) chocolate cyst 8(8%) tubo-ovarian mass 2(2%) intrauterine and intra pelvic adhesions 2(2%) septate uterus 292%) pelvic abscess 1(1%) and ectopic pregnancy 1(1%).Conclusions: Polycystic Ovaries (PCO) is the major finding in women with infertility in our study. This hitherto poorly recorded pathology should be actively investigated in women representing with these symptoms by the use of TVS.Chatt Maa Shi Hosp Med Coll J; Vol.16 (2); July 2017; Page 31-34

Diagnose and management of ectopic complete molar pregnancy

We present a rare case of ectopic molar gestation presenting excessive vomiting, lower abdominal pain, and 15 weeks amenorrhea corresponding to her last menstrual period. The ultrasonography showed a right tubo-ovarian mass containing a sac with vesicules, cyst in the left ovary and an empty uterus. The quantitative β-human chorionic gonadotrophin (β-<hCGa) was 93,854 UI/L. The management was surgical. Right salpingectomy was done, and the specimen was sent for histopathological examination which later confirmed on the microscopy the presence of chorionic villi of variable sizes, some cystically dilated and focal trophoblastic proliferation. She was followed up with weekly then a monthly serum β-hCG measurements (1 year after negativation).