Unilateral Salpingo-oophorectomy Research Articles

Fertility outcomes in stage I ovarian immature teratomas

ObjectiveTo evaluate the impact of adjuvant chemotherapy, type of ovarian surgery, and the surgical approach on fertility in patients with stage I immature teratoma of the ovary.MethodsClinicopathologic data were retrospectively...

Management strategy for children with ovarian immature teratoma: results from a tertiary pediatric oncology center

ObjectivesWe present an Egyptian study on pediatric ovarian immature teratomas (ITs), aiming to clarify our treatment strategy selection.MethodsA retrospective review of all children with pure ovarian ITs who were treated at our institution between 2008 and 2023. The analysis included clinical characteristics, tumor staging according to Children’s Oncology Group (COG), grading based on the Norris system, management, and outcomes.ResultsThirty-two patients were included, with a median age of 9 years. All patients underwent primary surgery. Unilateral salpingo-oophorectomy was performed in 31 patients. Surgical staging was completed in all patients. Based on COG staging, there were 28 patients (87.5%) stage I, 1 (3%) stage II, and 3 (9.5%) stage III. According to Norris classification, 16 patients (50%) were classified as grade I, 9 (28%) grade II, and 7 (22%) grade III. All patients in stage I were treated using surgery-alone approach, whereas the remaining four (12.5%) received adjuvant chemotherapy. Five patients in stage I had gliomatosis peritonei (GP), and none of them underwent extensive surgery. At a median follow-up of 86 months, two patients had events. The first patient (stage III/grade I) developed IT relapse on the operative bed, and the second (stage I/grade I) had a metachronous IT on the contralateral ovary. Both patients were successfully managed with surgery followed by second-line chemotherapy. Five-year overall survival and event-free survival for all patients were 100% and 93.4%, respectively.ConclusionsSurgery-alone strategy with close follow-up achieves excellent outcomes for localized ovarian ITs in children, irrespective of the Norris grading or the presence of GP. However, adjuvant chemotherapy is questionable for patients with incompletely resected or locally advanced tumors, and its role requires further evaluation through prospective multicentric studies with a larger sample size.

Fertility-sparing surgery in children and adolescents with borderline ovarian tumors: a retrospective study

ObjectiveTo describe the characteristics of children and adolescents with borderline ovarian tumors (BOTs) and evaluate the efficacy and safety of fertility-sparing surgery (FSS) in these patients.MethodsPatients with BOTs younger than 20 years who underwent FSS were included in this study.ResultsA total of 34 patients were included, with a median patient age of 17 (range, 3–19) years; 97.1% (33/34) of cases occurred after menarche. Of the patients, 82.4% had mucinous borderline tumors (MBOTs), 14.7% had serous borderline tumors (SBOTs), and 2.9% had seromucinous borderline tumor (SMBOT). The median tumor size was 20.4 (range, 8–40)cm. All patients were at International Federation of Gynecology and Obstetrics stage I and all underwent FSS: cystectomy (unilateral ovarian cystectomy, UC, 14/34, 41.2% and bilateral ovarian cystectomy, BC, 1/34, 2.9%), unilateral salpingo-oophorectomy (USO; 18/34; 52.9%), or USO + contralateral ovarian cystectomy (1/34; 2.9%). The median follow-up time was 65 (range, 10–148) months. Recurrence was experienced by 10 of the 34 patients (29.4%). One patient with SBOT experienced progression to low-grade serous carcinoma after the third relapse. Two patients had a total of four pregnancies, resulting in three live births. The recurrence rate of UC was significantly higher in MBOTs than in USO (p = 0.005). The 5-year disease-free survival rate was 67.1%, and the 5-year overall survival rate was 100%.ConclusionsFertility-sparing surgery is feasible and safe for children and adolescents with BOTs. For patients with MBOTs, USO is recommended to lower the risk of recurrence.

The Effects of a Laparoscopy by Single-Port Endoscopic Access in Benign Adnexal Surgery: A Randomized Controlled Trial

To evaluate whether laparoendoscopic single-site surgery (LESS) offers advantages over conventional laparoscopy (CL) in benign adnexal surgery. Randomized controlled study. Gynecology-Obstetrics Unit of the University Hospital of the Conception in Marseille, France. Patients older than 18 years requiring ovarian cystectomy or salpingo-oophorectomy by laparoscopy for symptomatic ovarian cysts requiring benign or prophylactic surgery. In the case of ovarian cysts, premenopausal patients typically undergo a unilateral cystectomy, whereas postmenopausal patients undergo a unilateral or bilateral salpingo-oophorectomy upon a patient's request. In cases requiring prophylactic surgery, a bilateral salpingo-oophorectomy was performed. All participants were randomly assigned to either the LESS or the CL group. Patients in both groups reported similar levels of pain at 24 hours: Simple Numerical Scale was 1.3 (standard deviation, 1.5) in the LESS group vs 1.7 (standard deviation, 1.5) in the CL group (p = .12), and there were no significant differences in postoperative pain at 2 hours, 4 hours, 6 hours, and 7 days. Furthermore, there was no difference in analgesic consumption. Regarding intraoperative criteria, the only difference was the longer operating time in the LESS group than the CL group. We also found that patients' satisfaction with their scar at 1 month may be higher with LESS than with CL. There was no significant difference between the 2 techniques in postoperative pain, although the LESS technique necessitated a longer operative time than the CL technique, while providing better aesthetic result patients.

Clear cell carcinoma arising in an ovarian remnant 19 years after oophoerctomy: case report

BackgroundOvarian remnant syndrome (ORS) is a rare complication that occurs after oophorectomy, characterized by residual ovarian tissue causing pelvic pain, masses, and various symptoms. The clinical manifestations of ORS are nonspecific, and its diagnosis relies on histological examination. Since ORS typically represents a benign ovarian lesion, there have been few reported cases of malignant transformation. In this report, we presented a unique case of ovarian clear cell carcinoma (OCCC) arising from an ovarian remnant following salpingo-oophorectomy.Case presentationOur patient was a 47-year-old female initially diagnosed with uterine myoma. She had previously undergone cesarean section and unilateral salpingo-oophorectomy. Transvaginal ultrasound and computed tomography (CT) scans revealed a soft tissue mass adjacent to the right lateral wall of the myometrium. The patient opted for transabdominal hysterectomy, left adnexal resection, laparoscopic omentectomy, appendectomy, and pelvic and abdominal lymphadenectomy. The final pathology results confirmed the diagnosis of OCCC, consistent with ORS. The patient subsequently received six cycles of intravenous chemotherapy using the carboplatin/paclitaxel (TC) regimen (paclitaxel liposomes 175 mg/m², carboplatin AUC 5). After 3 years of follow-up, the patient’s condition remained normal.ConclusionORS can significantly impact patients’ quality of life and pose challenges for clinicians. Complete excision of ovarian tissue during the initial surgery is crucial in preventing ORS recurrence and potential malignant transformation of ovarian remnants.

When Thyroid Meets Ovary: A Case Report of Struma Ovarii

Struma Ovarii is not a common tumor. It is a mature ovarian teratoma, completely or predominantly composed of thyroid tissue. It belongs to a specialised monodermal variety. Struma ovarii may have an association with hyperthyroidism; however, it is a rare association and just in about 8% of cases. Its diagnosis is mostly delayed because most of the patients do not present any symptoms. Some patients may develop symptoms of specific conditions like ovarian torsion, hyperthyroidism, and ascites. Ultrasound, MRI, CT scan, and scintigraphic evaluation are necessary to differentiate benign from malignant variety. The first line treatment option is surgical removal. There are lesser chances that the tumor will recur and the quality of life is improved significantly. In this case report, we have discussed a unique case of struma ovarii. It was duly diagnosed and appropriate management was done. The tumor was different from malignant ovarian tumor on the basis of ascites and tumor marker assessments. Thyroid function investigations were also normal. The tumor is incidentally found on imaging in most cases. The definitive diagnosis is established by a histopathological study. The first line of treatment is surgical removal and it usually leads to a successful prognosis. We will determine the challenges that are faced to reach the diagnosis and management of this rare tumor. Misdiagnosis is common. The treatment options are debatable because it is a rare tumor. In fertile and young age groups, fertility conserving surgeries like ovarian cystectomy or unilateral salpingo-oophorectomy are advised. For the purpose of treatment, in postmenopausal cases, total abdominal hysterectomy with bilateral salpingo-oophorectomy may sometimes be indicated. The quality of life will improve if investigations are done early and appropriate management is done.

Receptive status of the endometrium in patients of reproductive age with serous and mucinous ovarian cystadenoma before and after unilateral adnexectomy

BACKGROUND: Currently, the incidence of benign ovarian tumors has increased, and numerous studies have reported its negative effect on womens reproductive health. In modern literature, approximately 30% of patients with ovarian neoplasms have reproductive problems. In the presence of ovarian diseases, changes in the endometrium alter its receptivity, thereby reducing the chances of successful conception and gestation and gaining increasing attention. Patients seeking to preserve their reproductive function prefer organ-preserving surgical interventions; however, in clinical practice, adnexectomy is often necessary because of damaged ovarian tissue.
 AIM: To analyze the morphofunctional state of the endometrium and its receptivity in patients with serous and mucinous ovarian cystadenomas before and after surgical treatment.
 MATERIALS AND METHODS: The prospective study included patients of reproductive age with benign epithelial tumors (serous/mucinous cystadenomas) who had not received hormonal drugs for 6 months before surgical treatment. Group 1 included 32 patients with serous cystadenoma, and group 2 included 30 patients with mucinous cystadenoma. Before and 612 months after unilateral salpingo-oophorectomy, a pipelle biopsy of the endometrium was performed during the implantation window. The qualitative and quantitative parameters of pinopodes were examined, and the expression levels of estrogen (ER) and progesterone (PR) receptors in the glands and stroma of the endometrium were evaluated.
 RESULTS: Preoperatively, the number of pinopodes decreased in patients with serous cystadenoma, and the expression level of ER in the stroma and those of PR in the stroma and glands was reduced. Postoperatively, the number of mature pinopodes increased, and the expression levels of ER in the stroma and PR in the stroma and glands was increasing. Preoperatively, in patients with mucinous cystadenomas, the expression levels of ER in the stroma and glands and PR in the stroma and glands decreased, and the number of pinopodes reduced. Postoperatively, compared with patients with serous cystadenomas in the glandular component of the endometrium, those with mucinous cystadenoma had lower expression levels of both ER and PR, lower PR expression level in the stromal component, and increased number of pinopodes.
 CONCLUSIONS: The results of this study showed that benign ovarian tumors are accompanied by impaired morphofunctional state and receptivity of the endometrium, and timely surgical intervention positively affects these indicators and increases the reproductive potential of women.

5-year review of hysterectomy at the Delta State University Teaching Hospital, Oghara, south-south Nigeria

Context: Hysterectomy is a major surgical procedure that is performed worldwide for several indications ranging from benign to malignant conditions. It may be life-saving especially in certain obstetric situations.
 Objective: The aim was to determine the incidence, indications and complications of hysterectomy in Delta State University Teaching Hospital (DELSUTH), Oghara.
 Materials and methods: This was a retrospective descriptive study of hysterectomy performed in DELSUTH, Oghara from January 1st, 2012 to December 31st 2016. Every patient that had hysterectomy was included.
 Results: During the period, there were there 468 major gynaecological surgeries. Eighty-five patients had hysterectomy accounting for 18.2%. The mean age of the patients was 47.9±10.6 years. Majority (46.6%) of the patients were para 5 and above. The mean parity was 3.2±0.83. Uterine fibroid accounted for majority (30.0%) of the cases. Total abdominal hysterectomy accounted for 78.75% while 8.75% had sub-total abdominal hysterectomy and 12.5% had vaginal hysterectomy. Fifty-two percent of the patients had bilateral salpingo-oophorectomy while 6.25% had unilateral salpingo-oophorectomy. Anaemia and wound sepsis were the most common complications. One patient (1.25%) ended as a mortality during the period under review.
 Conclusion: The indications for, and surgical outcome following hysterectomy are comparable to that from other public hospitals across the country.

Study of significance of p53 expression in primary ovarian tumour

The purpose of the study was to understand the molecular changes that happen in human cancer, P53 gene mutation. Here, with respect to P53 immunohistochemical staining were taken into consideration as the surrogate for the mutational analysis. This was used for the diagnosis of ovarian cancer. The main aim of the study was to evaluate the immunohistochemical frequency of the P53 and to correlate its expression with the prognosis. In the current study 107 cases associated with ovarian cancer were studied. The samples received were hysterectomy as well as unilateral and bilateral salpingo-oophorectomy specimens, which were fixed in 10% neutral buffer formalin and processed routinely. 68.7% of the patients showed P53 malignant ovarian tumours. In the benign, it was considered as negative or in the position of borderline tumour. No statistically significant correlation was shown between the age and P53 expression. There was statistically significant difference between borderline, benign and the malignant tumors. It was also assessed that there was a statistically significant difference between P53 expression and serous carcinoma in the current study. The present study concludes that P53 tumor gene was found to be mutated in more than the 50% of the human cancer and was expressed as the aberrant form of protein. The study also concludes that in borderline tumor, P53 rarely mutates and is results in poor prognosis.

An analysis of clinical characteristics and prognosis of endometrioid ovarian cancer based on the SEER database and two centers in China

PurposeTo assess the clinical characteristics and the risk factors related to the unfavorable prognosis of endometrioid ovarian carcinoma (EOVC) based on data from the Surveillance, Epidemiology, and End Results (SEER) database and two clinical centers in China.MethodsData were extracted from the SEER database and two clinical centers in China (2010 ~ 2021), 884 cases and 87 patients with EOVC were selected, respectively. Overall survival (OS) and progression-free survival (PFS) were compared among the different groups using Kaplan–Meier analysis. The Cox proportional-hazards model was used to identify independent prognostic factors related to EOVC. A nomogram was constructed based on the risk factors of the SEER database affecting prognosis and the discrimination and calibration of the nomogram were evaluated by C-index and calibration curves.ResultsThe average age at diagnosis of patients with EOVC in the SEER database and two centers in China was 55.77 ± 12.40 years and 47.14 ± 11.50 years, 84.7% and 66.6% of them were diagnosed at FIGO stage I ~ II, respectively. In the SEER database, age over 70 years, advanced FIGO stage, tumor grade 3, only unilateral salpingo-oophorectomy were independent risk factors of unfavorable prognosis. In two clinical centers in China, 27.6% of EOVC patients were diagnosed with synchronous endometriosis. Advanced FIGO stage, HE4 > 179 pmol/L and bilateral ovarian involvement significantly correlated with poor OS and PFS in Kaplan–Meier analysis. Body mass index (BMI) < 19.34 kg/m2 was an independent risk factor relating to OS and PFS. Additionally, C-index of internal and external verification for the nomogram were 0.812 and 0.754 respectively, revealing good accuracy and clinical applicability.ConclusionsMost patients were diagnosed at early stage, low grade and had better prognosis. Asian/Pacific Islander and Chinese diagnosed with EOVC were more likely to be younger than whites and blacks. Age, tumor grade and FIGO stage (SEER database) and BMI (two centers) are independent prognostic factors. HE4 appears to be more valuable in prognostic assessment compared with CA125. The nomogram had good discrimination and calibration for predicting prognosis, providing a convenient and reliable tool for clinical decision-making for patients with EOVC.

Safety of fertility sparing management in invasive mucinous ovarian carcinoma

BackgroundThe aim of the study was to evaluate the safety of fertility-sparing surgery in invasive mucinous ovarian carcinomas (MOC). MethodsRetrospective review was performed of MOCs diagnosed between 1999 and 2019 at two tertiary cancer centers. Pathology was reviewed to rule out metastasis from gastrointestinal tract. The demographics and survival outcomes were compared between women who underwent fertility-sparing surgery and those who underwent radical surgery (at least hysterectomy, bilateral salpingo-oophorectomy +/− staging). Cox proportional hazard models were constructed to evaluate the effect of fertility sparing surgery on survival. ResultsOf 134 with stage I disease, 42 (31%) underwent fertility-sparing surgery with unilateral salpingo-oophorectomy. Compared to women who underwent radical surgery, these women were younger with low grade, early-stage disease. Two patients (5%) in the fertility-sparing cohort experienced a recurrence and 1 of these 2 patients died due to disease progression. There was no difference in either OS or RFS between those that underwent fertility-sparing surgery and radical surgery. In a multivariable analysis adjusting for age and use of adjuvant chemotherapy, fertility-sparing surgery was not significantly associated with OS (HR 0.18; 95% CI 0.01–2.78) or RFS (HR 0.19; 95% CI 0.03–1.45). There were 4 patients (9%) with documented full-term delivery with median interval to conception of 11 months. ConclusionsFertility-sparing surgery in stage I MOC is not associated with worse outcomes compared to radical surgery and is reasonable to offer to those with early stage disease who wish to retain fertility.

Clinicopathological Features and Outcomes of Granulosa Cell Tumor of the Ovaries - A Retrospective Study.

Background Granulosa cell tumor (GCT) is rare among all ovarian cancers. Its overall prognosis is favorable; however, the presence of extra-ovarian disease is associated with worse clinical outcomes. We report a retrospective analysis of granulosa cell tumors to evaluate the clinicopathological features and their outcomes. Methods This retrospective study included 54 adult patients aged 13 years and older. After data extraction and scrutiny, only those patients who were treated and followed up later at our institute were included in this study. Results Fifty-four patients were evaluated in this study, with a median age of 38.5 years. Most of the patients had dysfunctional uterine bleeding and abdominal pain (40.7%, n=22). The majority (n=26, 48%) underwent completion surgery as per ovarian protocol; however, 16.7% (n=09) patients underwent simple total abdominal hysterectomy with a bilateral salpingo-oophorectomy (TAH+BSO), debulking surgery in 3.7% (n=2), unilateral salpingo-oophorectomy in 20.4% (n=11) and fertility-sparing surgery in 11.1% (n=06) of the patients. Pathological stage I-A was found in 59.3%(n=32), I-C in 25.9% (n=14), II-A in 1.9% (n=1), III-A in 1.9% (n=1), III-C in 9.3% (n=5) and IV-B in 1.9% (n=1) of the population. Eleven (20.3%) patients relapsed during their course of treatment. Out of these 11 patients, threewent into remission, twostill have active disease, and six patients died. Conclusion Post-menopausal patients, more advanced disease at presentation, capsular rupture, presence of ascites, omental involvement, peritoneal spread, and residual disease after surgical resection were the main contributing factors towards poorer outcomes affecting disease-free survival. Overall median disease-free survival was 60 months for all the stage groups, while the overall survival was 62 months.

Clinical characteristics and survival outcomes in patients with primary ovarian carcinoid: A historical cohort study.

Primary ovarian carcinoids are extremely rare ovarian tumors, and there is limited data available on their clinical characteristics and survival outcomes. We conducted a historical cohort study of 56 patients to investigate their clinical characteristics. The overall survival, disease-specific survival, recurrence-free survival, and potential prognostic factors of these patients were also evaluated. The median age of these patients was 42.0 years (range: 20-71). The average mass and carcinoid size was 7.3 and 0.4 cm, respectively. Elevated tumor marker levels and ascites were observed in 15 and 10 patients, respectively. In 98.2% of the patients, tumors were confined to the ovary, while only one had metastatic disease. Surgery was the mainstay therapy: 37.5% of the patients underwent unilateral salpingo-oophorectomy, 25.0% underwent hysterectomy with bilateral salpingo-oophorectomy, 21.4% underwent ovarian cystectomy, 10.7% underwent comprehensive staging surgery, and 5.4% underwent bilateral salpingo-oophorectomy. Appendectomy and lymphadenectomy were performed in eight and five patients, respectively, but none showed tumor involvement. Chemotherapy was the only adjuvant treatment utilized, and was administered in four patients. Pathological analysis showed that strumal carcinoid was the most predominant subtype, occurring in 66.1% of the patients. The Ki-67 index was reported in 39 patients, 30 of which had an index of no more than 3%, with a maximum of only 5%. Only one relapse occurred after the initial treatment, and that patient experienced recurrences on two occasions, maintaining stable disease after surgery and octreotide therapy. After a median follow-up of 3.6 years, 96.4% of the patients achieved no evidence of disease, while 3.6% were alive with the disease. The 5-year recurrence-free survival rate was 97.9% and no death occurred. No risk factors for recurrence-free survival, overall survival, or disease-specific survival were identified. The Ki-67 indices were extremely low and prognoses were excellent in patients with primary ovarian carcinoids. Conservative surgery, especially unilateral salpingo-oophorectomy, is preferred. Individualized adjuvant therapy may be considered for patients with metastatic diseases.

A Retrospective Study Comparing Operative Time Between Single-Glove Port Laparoscopic Hysterectomy and Conventional Multiport Laparoscopic Hysterectomy for Benign Gynecology Diseases: Hospital-Based Study in Thailand

Background: Laparoscopic hysterectomy is popular today. Using a 3- to 4-port for laparoscopic hysterectomy. But laparoscopic hysterectomy can be done by using a single-modified glove port. It was found to have good performance and low price. Objective: To compare operative time and other surgical outcomes between single-glove port laparoscopic hysterectomy (SGPLH) and conventional multiport laparoscopic hysterectomy (MPLH). Methods: A retrospective study, data were extracted from medical records of patients diagnosed with benign gynecologic diseases and underwent laparoscopic hysterectomy at Prapokklao Hospital, Chanthaburi, Thailand from February 2016 to April 2021. Results: A total of 125 patients were divided into 2 groups 65 (52%) in the SGPLH group and 60 (48%) in the MPLH group. The operative time of SGPLH was significantly shorter than conventional MPLH (mean [SD], 96 [31.35] vs 161.4 [57.37] minutes; P &lt; .001). There was significant difference between 2 groups in terms of previous abdominal surgery (P = .01). In multivariate regression analysis, independent factors correlated with operative time were type of laparoscopic operation (P &lt; .001), additional procedure of bilateral salpingo-oophorectomy (P = .02), unilateral salpingo-oophorectomy (P = .01), and complication with bladder injury (P = .03). Conclusions: The operative time of SGPLH is shorter than the conventional MPLH. SGPLH is also feasible and economical for patients with symptomatic benign gynecologic diseases.

Oncologic and obstetric outcomes of early-stage epithelial ovarian cancer patients who underwent fertility-sparing surgery: A retrospective study.

This study aimed to assess the long-term oncologic and obstetric outcomes of women with epithelial ovarian cancer who underwent fertility-sparing surgery. A total of 68 patients observed between March 2007 and July 2021 were included in this retrospective study. Unilateral salpingo-oophorectomy and uterine preservation with staging surgery were the main procedures for fertility-sparing surgery. Disease-free, overall survival, and obstetric outcomes were measured as primary outcomes. The median age of the patients was 30.5 years. The median follow-up time was 60.5months. Disease recurrence occurred in 15 (22.1%) of the patients. Five-year disease-free survival and overall survival (OS) percentages were 75.6% and 83.3%, respectively, for all stages. The FIGO (International Federation of Gynecology & Obstetrics) stage was the only significant factor that affected OS (P= 0.001). Twenty-three patients tried to conceive, and 15 (65.2%) patients became pregnant. Twelve (80%) pregnancies reached term and resulted in 15 live births. Chemotherapy administration and surgical intervention (cystectomy or unilateral salpingo-oophorectomy) showed no difference in pregnancy results (P= 0.806 and P= 0.066, respectively). Fertility preservation is safe for invasive epithelial ovarian cancer at early stages for women in the reproductive era. Disease recurrence and OS results are similar to standard treatment at early stages with decent obstetric outcomes.

Non-Electrical Ligation of Vessels Using Hem-o-lok Clips Ensures No Electrical Ureteral Injury during Total Laparoscopic Hysterectomy

Background: Ureteral injury is one of the most common anatomical complications during total laparoscopic hysterectomy (TLH). And most ureteral injuries resulted from electrosurgery and were recognized postoperatively. To avoid thermal damage to the ureter during TLH, we evaluated the feasibility and safety of vessel ligation using the Hem-o-lok clip. Methods: A retrospective analysis of 480 patients who underwent TLH. Hem-o-lok clips were used to ligate both uterine vessels. If the patient underwent unilateral or bilateral salpingo-oophorectomy, the gonadal vessels were also ligated by using Hem-o-lok clips. Clinical outcomes including perioperative and postoperative complications were evaluated. Results: Perioperative complications were reported in six patients, with four cases of stump dehiscence and two cases of bladder injury. All bladder injuries were found during the operation and repaired. None of the patients experienced ureter injury or vessel rebleeding. Conclusions: Vessel ligation by Hem-o-lok clips in TLH is a safe method for ligating vessels and avoiding unexpected ureteral injury. Prospective studies are needed to confirm the real clinical benefit of this surgical approach.

Primary Ovarian Lipoleiomyoma with Chondroid Metaplasia: an Original Case Report with Literature Review

Primary ovarian lipoleiomyoma is a rare benign tumor of the ovary predominantly consisting of smooth muscles and adipocytes. Clinically, they are asymptomatic and are diagnosed accidentally during the histopathological examination after the surgery. Herein, we report a case of unilateral, primary ovarian lipoleiomyoma in a 20-year-old primigravida who presented with complaints of abdominal distension for 4 months. The abdominal contrast-enhanced computed tomography (CECT) revealed a large, well-defined, heterogeneously enhancing mass in the right adnexa measuring 35.9 × 26.1 × 12.9 cm. A primary clinical diagnosis of teratoma was raised. Unilateral salpingo-oophorectomy was performed, and histomorphology revealed a benign smooth muscle tumor admixed with mature adipocyte and cartilage arising primarily in the ovary. The diagnosis was confirmed by immunohistochemistry. The tumor may be asymptomatic or manifest with abdominal pain or distension, like in our index case. As there are no pathognomonic clinical symptoms, tumor markers, or characteristic imaging findings, definitive diagnosis is difficult prior to surgical removal. Histomorphology and immunohistochemistry confirm the smooth muscle nature of the tumor. This common and benign solid tumor at an unusual location should be kept in the differential diagnosis of solid ovarian masses.

Laparoscopic surgery of large adnexal masses (>12 cm): Single port or conventional?

We aimed to compare single-port laparoscopic surgery (SPLS) and conventional multiport laparoscopic surgery (CMLS) for large adnexal mass (AM). Patients undergoing laparoscopy (LS) due to huge AMs (≥12 cm) between 2016 and 2021 were evaluated retrospectively. The SPLS procedure was applied in 25 cases, and CMLS was performed in 32 cases. The premier result was the grade of the postoperative improvement according to the Quality of Recovery (QoR)-40 questionnaire score (24 h after the surgical procedure; postoperative day 1). Observer Scar Assessment Scale (OSAS) and Patient Observer Scar Assessment Scale (PSAS) were also evaluated. A total of 57 cases undergoing SPLS (n=25) or CMLS (n=32) due to a large AM (≥12 cm) were analyzed. No meaningful distinctions in age, menopausal status, body mass index, or mass size were observed between the two cohorts. The operation time was shorter in the SPLS than CPLS cohort (42.2 ± 3.3 vs. 47.6 ± 6.2; p < 0.001). Unilateral salpingo-oophorectomy was performed in 84.0% of cases in the SPLS cohort and 90.6% of patients in the CMLS cohort (p=0.360). The QoR-40 points were significantly higher in the SPLS than the CMLS group (154.9 ± 12.0 vs. 146.2 ± 17.1; p=0.035). The OSAS and PSAS scores were lower in the SPLS than the CMLS group. LS can be used for large cysts that are not considered to be at risk of malignancy. The postoperative recovery time was shorter in patients undergoing SPLS compared to CMLS.

Clinical characteristics and survival outcomes in patients with ovarian strumal carcinoid

BackgroundOvarian strumal carcinoid is an extremely rare ovarian malignant tumor with limited data on clinical characteristics and survival outcomes.MethodsA retrospective study of 119 patients was conducted, including 98 cases identified from literature review, and their clinical characteristics were investigated. The overall survival (OS), disease-specific survival (DSS), recurrence-free survival (RFS), and potential prognostic factors of these patients were also evaluated.ResultsLesions of 115 cases were confined to the ovarian while four patients presented with extra-ovarian disease upon initial diagnosis. Surgical treatment options performed in this cohort varied, 5.0% received ovarian cystectomy, 36.1% received unilateral salpingo-oophorectomy (USO), 7.6% received bilateral salpingo-oophorectomy (BSO), 42.0% received hysterectomy with BSO, and 8.4% underwent debulking surgery. Moreover, one patient did not undergo any surgery. No postoperative adjuvant therapy was administered in 89.9% patients, while 7.6% and 2.5% received adjuvant radiotherapy and chemotherapy, of which two patients received combined radiation and chemotherapy. At the final follow-up, 89.1% patients showed no evidence of the disease, and 5.0% were alive with the disease. Only seven deaths occurred, with two attributed to the tumor. The 5-year, 10-year, and 20-year OS rates were 96.0%, 85.0%, and 85.0%, respectively, with a 15-year recurrence rate of 4.4%. The 5-year and 20-year DSS rate were 98.5% and 95.9%. Multivariate Cox regression showed age ≥ 55 years was the only risk factor associated with the OS (P = 0.014, OR 7.988; 95% CI 1.519 – 42.004). However, the univariate and multivariate Cox regression showed no potential risk factor for RFS and DSS.ConclusionPatients with ovarian strumal carcinoid have an excellent prognosis irrespective of the surgical option. Conservative surgery especially USO with individualized adjuvant therapy is recommended.

Gonadotropin-releasing hormone agonist protects ovarian function in young patients with ovarian malignancy undergoing platinum-based chemotherapy: A prospective study.

We aimed to ascertain the effectiveness of gonadotropin-releasing hormone (GnRH) agonist co-therapy for the preservation of ovarian function in patients with ovarian malignancy who underwent unilateral salpingo-oophorectomy and platinum-based chemotherapy. We enrolled 158 patients with ovarian malignancy who underwent fertility preservation surgery and postoperative platinum-based chemotherapy between January 2018 and December 2020. Patients were divided into two groups based on the use of GnRH agonist (GnRHa) during chemotherapy. Two patients withdrew from the study. Laboratory tests (serum follicle-stimulating hormone [FSH], serum luteinizing hormone [LH], and serum anti-Müllerian hormone [AMH]) were performed pre-chemotherapy and one year post-chemotherapy. Data on menstruation resumption, perimenopausal symptoms (modified Kupperman Menopausal Index [KMI]), health-related quality of life (Medical Outcomes Study Short Form-36 [MOS SF-36]), and obstetric outcomes were collected. One year post-chemotherapy, the serum AMH level in the GnRHa group was higher than that in the control group (P<0.001), while the serum FSH and FSH/LH levels in the GnRHa group were lower than those in the control group (P<0.001). The mean period from last chemotherapy to menstrual resumption was 3.86 and 5.78 months in the GnRHa and control groups (P<0.001), respectively. The rate of menstrual resumption post-chemotherapy was 93.5% and 82.3% in the GnRHa and control groups (P<0.05), respectively. GnRHa co-administration during chemotherapy reduced the likelihood of low AMH levels post-chemotherapy and was significant in the multivariate analysis (P<0.05). The modified KMI scores and MOS SF-36 scores were better in the GnRHa group than in the control group (both P<0.001). GnRHa protects ovarian function during platinum-based adjuvant chemotherapy in young patients with ovarian malignancy. This study provides a therapeutic reference for gynecologists, especially for those in economically and medically underdeveloped areas. Chinese Clinical Trial Registry (chiCTR1800019114; October 26, 2018; http://www.chictr.org.cn/index.aspx).