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Background: Ovarian cysts represent a common condition among women. Epidemiologic studies are inconsistent in determining if women with cysts are more likely to develop endometrial cancer (EC) regardless of overweight/obesity. We investigated the combined role of cysts and body mass index (BMI) on EC risk., Methods: We pooled data from three case-control studies conducted in Italy and Switzerland on 920 women with EC and 1700 controls. The prevalence of cysts was 5% among both cases and controls, with 63% of cases being overweight/obese. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) using logistic regression models, adjusting for potential confounders. We conducted stratified analyses according to BMI, and estimated the interaction between cysts and BMI; we carried out additional analyses according to age at diagnosis of cysts., Results: Overall, history of cysts was not associated to EC (OR=1.27, 95% CI=0.82-1.97, P = 0.29). Normal weight women reporting cysts had an increased risk of EC (OR=2.49, 95% CI=1.31-4.74), while no such effect was found among overweight/obese women (OR=0.65, 95% CI=0.36-1.18; P for interaction=0.004). The association was limited to women below 65 years of age and was stronger in those who reported cysts at age 48 or older., Conclusions: Cysts appeared to be a risk factor for EC in lean women but not in overweight/obese ones; these results are consistent with an effect of cysts and obesity on EC along common pathways., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Competing Interests: Conflict of Interest None declared.

Research Question: What are ovarian stimulation cycle outcomes and acceptance rates of an oocyte accumulation programme in young women with benign ovarian tumour (BOT)?, Design: Retrospective cohort study conducted at the Academic Assisted Reproductive Technology and Fertility Preservation Centre, Lille University Hospital, between January 2016 and December 2019. The number of metaphase II oocytes per cycle and per patient after accumulation were evaluated. Two groups were identified for the analysis: endometrioma ('endometrioma') and dermoid, mucinous or serous cyst ('other cysts')., Results: A total of 113 fertility-preservation cycles were analysed in 70 women aged 27.9 ± 4.8 years. Almost all women had undergone previous ovarian surgery before fertility preservation (89%). Mean anti-Müllerian hormone levels before ovarian stimulation was 12.5 ± 8.7 pmol/l. A total of 6.4 ± 3.4 oocytes were retrieved, and 4.3 ± 3.4 metaphase II (MII) oocytes were vitrified per cycle. All agreed to the oocyte accumulation programme and all underwent at least one cycle. To date, 36 (51%) patients achieved two or three fertility- preservation cycles. After accumulation, 7.0 ± 5.23 MII oocytes were vitrified per patient. No difference was found in ovarian response and oocyte cohort between the 'endometrioma' and 'other cysts' groups. Questionnaires completed after oocyte retrieval revealed abdominal bloating and pelvic pain in most patients, with no difference according to the type of cyst. No serious adverse events occurred., Conclusions: Oocyte accumulation should be systematically offered to young women with BOT irrespective of histological type, as it seems to be well-tolerated. Long-term follow-up is needed to assess the efficiency of oocyte accumulation to optimize the chances of subsequent pregnancies., (Copyright © 2021 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Adnexal masses are diagnosed in 5% pregnancies and pose diagnostic and management challenges. Ultrasound and magnetic resonance imaging (MRI) are the mainstay as an evaluation procedure; surgery is warranted for persistent masses with a diameter of >5 cm and sonographic signs of possible malignancy. Optimal timing for a planned surgery is the second trimester and does not adversely affect neonatal outcome. Laparoscopy is safe in pregnancy. Management for ovarian cancer during pregnancy should be individualised and formulated by a multidisciplinary team in a specialised centre while also considering the patients' wishes to preserve pregnancy. The following options can be considered: (i) induced abortion followed by standard management of ovarian cancer, (ii) pregnancy-preserving surgery followed by chemotherapy, planned delivery and secondary surgical completion or (iii) neoadjuvant chemotherapy followed by surgery during the postpartum period. Standard chemotherapy administered in non-pregnant population can only be used during the first trimester of pregnancy., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Traditionally, the management of symptomatic ovarian cysts in pregnancy has been limited to laparoscopy or laparotomy with the associated morbidity. However, in select patients requiring intervention, the risks of surgery may be minimized with sclerotherapy. We present the first case report, to our knowledge, of ethanol sclerosis of an ovarian cyst during pregnancy. A description of the surgical technique to complete such a procedure is provided as well as a brief review of the current literature with respect to the use of sclerotherapy for the management of ovarian cysts., (Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.)

Background: To evaluate the clinical significance of serum CA-125 and CA19-9 in women with spontaneous ruptured ovarian endometriomas., Methods: From January 2006 to April 2015, a total of 1653 women were diagnosed with ovarian endometriomas, and 43 women were diagnosed with the spontaneous rupture of their ovarian endometrioma. In addition, 70 women diagnosed with unruptured ovarian endometriomas were chosen to serve as control subjects. Serum CA-125 and CA19-9 levels, together with the clinical materials, were collected., Results: Serum CA-125, CA19-9, and the combined biomarkers were shown to be obviously elevated in the spontaneous ruptured ovarian endometrioma group (p=0.001, p=0.001, p=0.001, respectively). The AUC value for the combined biomarkers was 0.992 (95% CI, 0.981-1.000), with a high sensitivity and specificity of nearly 100% and 93.6%, respectively. Moreover, the maximum diameter of the mass was significantly (p=0.001) increased in the ruptured group., Conclusions: Serum CA-125 and CA19-9 were significantly increased in patients with spontaneous ruptured ovarian endometriomas. Moreover, the combined biomarkers were better than either CA-125 or CA19-9 alone in the diagnosis of a spontaneous rupture of the ovarian endometrioma., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Hyperreactio luteinalis is a rare condition in which there is massive cystic enlargement of the ovaries, mimicking malignancy, during pregnancy. When confronted with this condition, the fear of missing a cancer diagnosis often leads the physician to react with unnecessary surgical intervention, potentially resulting in impaired future fertility. The literature on the subject contains mainly case reports and one small case series. A recent review attempted to summarize what is currently known, but there has not yet been a pervasive change in the approach to the management of this condition. In order to define the natural history of the condition and its maternal and fetal effects, we examined all case reports available in the English literature from 1993 to 2014, in addition to another as yet unpublished case report. Our analysis suggests that, despite its impressive presentation with ovarian enlargement and hyperandrogenism, hyperreactio luteinalis tends to be self-limiting, with spontaneous postpartum resolution and without untoward maternal or fetal sequelae. In particular, fetal virilization is rare, and dependent on the timing of hyperandrogenism. Adverse pregnancy outcomes are likely a consequence of the abnormally high hCG levels observed in many of these gestations, and the subset of women with these abnormal values should be considered for enhanced surveillance. Vaginal delivery is preferred, and strategies to sustain the potential for breastfeeding must be introduced while maternal androgen levels fall, allowing lactation to be established. Considering its benign nature and postpartum resolution, management of HL must be conservative, and continued education of health care professionals who may encounter this entity is vital.

Study Objective: To compare the effects of local anesthetic intraperitoneal nebulization with intraperitoneal instillation during laparoscopic ovarian cystectomy on postoperative morphine consumption and pain., Design: Multicenter, randomized, case-control trial., Design Classification: Canadian Task Force Classification I., Setting: University hospitals in Italy., Patients: One hundred forty patients scheduled for laparoscopic ovarian cystectomy., Interventions: Patients were randomized to receive either nebulization of ropivacaine 150 mg before surgery or instillation of ropivacaine 150 mg before surgery. Nebulization was performed using the Aeroneb Pro device (Aerogen, Galway, Ireland)., Measurements and Main Results: One hundred forty patients were enrolled, and 123 completed the study. There was no difference between the 2 groups in average morphine consumption (7.3 ± 7.5 mg in the nebulization group vs 9.2 ± 7.2 mg in the instillation group; p = .17). Eighty-two percent of patients in the nebulization group required morphine compared with 96% in the instillation group (p < .05). Patients receiving nebulization had a lower dynamic Numeric Ranking Scale compared with those in the instillation group in the postanesthesia care unit postanesthesia care unit and 4 hours after surgery (p < .05). Ten patients (15%) in the nebulization group experienced shivering in the postanesthesia care unit compared with 2 patients (4%) in the instillation group (p = .035)., Conclusion: Nebulization of ropivacaine prevents the use of morphine in a significant proportion of patients, reduced postoperative pain during the first hours after surgery, and was associated with a higher incidence of postoperative shivering when compared with instillation., (Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.)

Objective: The marker for the early diagnosis of endometriotic cyst rupture is unknown. We report a preliminary study designed to evaluate the relationship between plasma D-dimer levels and endometriotic cyst rupture in clinical case series., Materials and Methods: We reviewed the patients' records of endometriotic cyst rupture cases, and the background (i.e., age, body mass index, and parity) and preoperative laboratory assessments (i.e., white blood cell count, levels of serum C-reactive protein, serum CA125, and plasma D-dimer) of the patients were compared with those of unruptured cases., Results: Emergency surgery cases of endometriotic cyst rupture (n = 6) and planned surgery cases of unruptured endometriotic cysts as controls (n = 16) were reviewed. Backgrounds of the patients were not significantly different between the two groups. The plasma D-dimer level was significantly higher in the rupture cases (8.5 μg/mL vs. 0.20 μg/mL, p < 0.001). Differences in white blood cell count and serum C-reactive protein level, but not serum CA125 level, were found to be statistically significant between groups., Conclusion: An elevation of plasma D-dimer level is associated with endometriotic cyst rupture., (Copyright © 2015. Published by Elsevier B.V.)

Nutcracker syndrome (NCS), a rare clinical entity, when refractory to medical management warrants surgical intervention. In the following discussion, we present a case of NCS which was managed successfully by left renal vein transposition using a decompression shunt., (Copyright © 2014 Elsevier Inc. All rights reserved.)

The main risk factor of adnexal torsion is a previous adnexal torsion (LE3). There is no clinical, biological or radiological sign that may exclude the diagnosis of adnexal torsion (LE3). The presence of flow at color Doppler imaging does not allow exclusion of the diagnosis (LE2). An emergent laparoscopy is recommended for adnexal untwisting (Grade B), except in postmenopausal women where oophorectomy is recommended (grade C). A persistent black color of the adnexa after untwisting is not an indication for systematic oophorectomy (grade C), since a functional recovery is possible (LE3). Ovariopexy is not routinely recommended following adnexal untwisting (grade C). The clinical signs of intra-cystic hemorrhage and those of rupture of the corpus luteum are not specific (LE4). MRI is not recommended to confirm the diagnosis of intra-cystic hemorrhage (grade C). Malignant transformation of an ovarian cyst is very rare. The presence of a benign ovarian cyst is not associated with an increased risk of ovarian cancer at long-term follow-up (LE2). For these women, an ultrasound follow-up is not recommended (grade C). Dermoid ovarian cyst containing nerve tissue can trigger the production of pathogenic auto-antibody-anti-NMDA, leading to encephalitis. A high proportion of thyroid tissue in a mature teratoma (struma ovarii) may cause hyperthyroidism., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Ovarian tumors in childhood are rare, often organic with 10% of malignant cases. Functional pathology dominates in adolescence and its management is the same as the adult. The clinical symptoms of PBOT (presumed benign ovarian tumor) are non-specific. The main clinical signs are acute pain, associated with peritoneal irritation syndrome, which can suggest an ovarian torsion, a mass or the development of secondary sexual characters. Hyperestrogenemia suggests a McCune-Albright syndrome or a granulosa tumor. Hyperandrogenism evokes a malignant tumor. Pelvic ultrasound is the main examination. Pure liquid cysts are benign but could be organic if persisting beyond 6 months. MRI and tumor markers are needed for heterogeneous cyst diagnosis. The protected extraction of a cyst is recommended during the laparoscopic cystectomy. If case of doubt of malignancy, laparoscopy allows the peritoneal cavity exploration. In case of torsion, ovarian untwisting must be performed. After untwisting, the ovary must be preserved because macroscopic aspect is not predictive of the ovarian function recovery. No medical treatment is effective. After resection, US follow up is required for five years., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

We reviewed the studies about fertility-sparing in young patient presenting a benign ovarian tumor. It appears that more than the histologic nature of the ovarian cysts, it is the surgical treatment of the cyst which may decrease fertility. Some good practice of surgical procedures must be kept in mind when one manages a benign ovarian tumor in a young patient wishing to preserve her fertility: surgery should be avoided as much as possible; kystectomy is better than oophorectomy; no radical surgery should be done without pathological certitudes; electrocoagulation must be avoided on the cyst walls. In some situations, fertility is specially endangered: bilateral ovarian cysts, recurrence or strong probability of recurrence (endometriomas), poor ovarian reserve (previous chemo- or radiotherapy, age>35, premature ovarian failure). In these situations, a pre-operative assessment of the ovarian reserve could be useful. Beside the surgical 'good procedures', gamete cryopreservation procedures could be used. Cryopreservation of mature oocytes (after ovarian hyperstimulation) or in vitro mature oocytes (after antral follicle retrieval) can be proposed. Ovarian tissue cryopreservation is another option. Oocyte (or embryos) cryopreservation can be proposed before or after the surgery. The global management of benign ovarian tumors in young patients should be decided between surgeons and specialists in reproductive biology., (Copyright © 2013. Published by Elsevier Masson SAS.)

Objective: The aim of our study was to evaluate the practice of Lille in the management of ovarian cyst during pregnancy and to compare our results with data from the literature., Patients and Methods: The study was a retrospective cohort of Lille University Hospital between 1st January 2007 and 31st December 2010. The inclusion was based on the ultrasound diagnosis of an ovarian cyst greater or equal to 30mm during pregnancy. Obstetrical and neonatal data, surgical techniques and indications were analyzed., Results: Seventy-one patients had a diagnosis of ovarian cyst during pregnancy, i.e., 0.35% of pregnancies followed at the University Hospital of Lille during the study period. The diagnosis took place in the first quarter in the majority of cases, at 12.30±6.99 weeks of amenorrhea (WA). Most often, the ovarian cyst is monitored during pregnancy, which has been strictly the case in 63.38% of cysts (45 patients). Fourteen patients had to be operated during pregnancy (19.72%). There were 7 emergency interventions and 7 programmed intrapartum interventions. Five intrapartum laparoscopies were performed at a mean term of 14.75±2.63 WA, and 9 laparotomies were performed at a mean term of 18.88±4.57 WA. Twelve ovarian mass surgeries were performed per caesarean section. Operated cysts are most often organic cysts (74.39%). No malignancies were observed, and 3 cases of borderline tumors were diagnosed. There were no obstetrical or neonatal complications., Discussion and Conclusion: A simple monitoring is possible if the cyst is benign, less than 6cm and does not change. Surgery is required in an emergency or in case of suspicious signs of complications or malignancy. Laparoscopy can be widely used until the 2nd quarter. Lille's attitude respects the recommendations is consistent with the literature., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Ovarian torsion requiring surgical intervention in pregnancy is rare. Herein is reported a case of ovarian torsion that was managed by transvaginal ovarian cystectomy in a 27 week gravid patient., (Copyright © 2012 AAGL. Published by Elsevier Inc. All rights reserved.)

Background: Abdominal pain is one of the most common complaints made by patients visiting emergency departments; however, ovarian torsion is an uncommon cause of abdominal pain, especially in young children. Early diagnosis is essential in order to salvage the ovaries. We performed a retrospective analysis of patients under 18 years of age who visited Changhua Christian Hospital with adnexal torsion between June 2003 and June 2010., Methods: Medical records were reviewed for age, associated symptoms, past and present medical histories, physical findings, diagnostic tests performed, clinical course, pathological findings, and diagnoses., Results: A total of 21 patients were identified and included in the analysis; their mean (SD) age was 13.62 (3.75) years. Abdominal pain was the universal symptom. Vomiting or nausea was the second most common symptom (33.3%). The average period between symptom onset and diagnosis was 3.29 (6.39) days. Right-side adnexal torsion occurred in 14 patients, and left-side torsion in seven patients. Ovarian cysts, most often dermoid cysts (e.g., teratomas), were found in 16 patients (76%). Except for one conservatively treated case and one malignant case (adult granulose cell tumor), the other results of the pathological examination were as follows: eight dermoid cysts, two cystadenomas, one follicular cyst, and eight simple cysts., Conclusion: Although it is uncommon, adnexal torsion should be included in the differential diagnosis of lower abdominal pain in all girls, regardless of age. Sonography is helpful for making such a diagnosis. Time is a critical factor, and early laparoscopy or laparotomy may save a viable ovary., (Copyright © 2012. Published by Elsevier B.V.)

Objective: To assess risk factors, clinical findings and mode of diagnosis and treatment in premenarchal children with surgically verified ovarian torsion (OT)., Study Design: A retrospective case review (Canadian Task Force Classification II-2)., Setting: Teaching and research hospital, a tertiary center., Patients: Premenarchal children with surgically verified OT., Interventions: Patients underwent either laparoscopy or laparotomy., Results: Twenty-two cases of OT in 20 premenarchal girls (median age 12 years) were identified. Three cases involved recurrent torsion after detorsion without cystectomy. The main presenting symptoms were sudden pain and vomiting. Six patients underwent Doppler examinations, and all demonstrated an abnormal flow. Seventeen interventions were by laparoscopy. Conservative management, mainly detorsion with additional cyst drainage or cystectomy, was performed in 19 cases (86.4%). Oophoropexy was performed in 3 cases (13.6%). Pathologic examination demonstrated 5 simple cysts and 1 dermoid cyst., Conclusions: Ovarian torsion in premenarchal girls usually presents with intermittent abdominal pain and abdominal tenderness. Other signs and symptoms are nonspecific. When performed, Doppler imaging may assist in diagnosing ovarian torsion in children. Detorsion followed by cystectomy may prevent recurrence., (Copyright © 2012 AAGL. Published by Elsevier Inc. All rights reserved.)

Multiple cysts ranging from 2-111 mm were noted bilaterally in the ovulation fossa of 11 mature Miranda jennets. These ovulation fossa inclusion cysts (OFICs) were lined by a simple low to columnar epithelium that included many ciliated cells. Although most cases were incidental findings, two of the jennets were presented with reduced fertility. Extensive cyst formation could have been responsible for the reproductive problems because they replaced most of the ovarian parenchyma. Due to their close proximity to the ovulation fossa, the OFICs may have mechanically interfered with passage of eggs into the oviduct. OFICs are histologically common in equids, but are reported uncommonly as gross lesions in either mares or jennets. Ovarian inclusion cysts are associated with neoplasia in women; however, these OFICs showed no evidence of epithelial hyperplasia or cellular atypia and no evidence of independent growth, therefore they were considered to be non-neoplastic. The bilateral occurrence and high incidence of OFICs in Miranda jennets, a breed with limited genetic variability, suggests that the lesion has a genetic causation., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Isolated fallopian tube torsion requiring surgical intervention in pregnancy is rare. Herein is reported a case of fallopian tube torsion that was managed laparoscopically at 35 weeks of gestation., (Copyright © 2011 AAGL. Published by Elsevier Inc. All rights reserved.)

Post-void residual (PVR) determination is an integral part of the evaluation of children presenting with lower urinary tract symptoms. Historically the PVR volume has been obtained by urinary catheterization after the child has voided, however, with the advent of ultrasound technology, PVR was determined in a noninvasive fashion by radiology personnel. Currently, PVR determinations may be obtained by healthcare personnel (without specialized training) using a portable, self calculating ultrasound; the BladderScan. While BladderScan PVR has been shown to be accurate and reproducible, it cannot differentiate between a distended bladder and other cystic pelvic structures. Several case reports have been published illustrating falsely elevated PVRs by bladder scan in adults with cystic pelvic structures. We present two adolescent females with LUTS who had falsely elevated PVRs by bladder scan, who, subsequently, underwent formal imaging to identify ovarian cystic pathology. To our knowledge, this is the first report of falsely elevated bladder scan PVR in children related to cystic pelvic organ pathology., (Copyright © 2010 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

The Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a spectrum of Müllerian anomalies characterized by congenital vaginal aplasia and absent uterus or a rudimentary one in female subjects with normal endocrine status. The ovaries and fallopian tubes are present. The prime feature is a primary amenorrhea in women presenting normally developed secondary sexual characteristics and normal external genitalia. The etiology remains unknown. This syndrome is subdivided in two types. It may be isolated (type I) or associated with other malformations (type II). Type I is less frequent than type II. We report a case of MRKH syndrome in a 21-year-old woman who presented a primary amenorrhea studied with transabdominal and pelvic ultrasonography and pelvic magnetic resonance, which demonstrated a complete agenesis of uterus, a functional cyst in the right ovary, and a left pelvic ectopic kidney. We studied the MRKH syndrome with review of the literature., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Since the first laparoscopic appendectomy was performed by Semm in 1983, laparoscopic surgery has become the criterion standard surgical route for treatment of several pathologic conditions across disciplines. Attempts to minimize access-related injuries and complications resulted in development of laparoendoscopic single-site surgery (LESS), which, because of the decreased number of ports used, may be the next generation of minimally invasive surgery. Laparoscopic single-site surgery has been reported in nephrectomy, pyeloplasty, radical prostatectomy, cholecystectomy, and colorectal, bariatric, and gynecologic surgery. This technique may increase the benefits of traditional minimally invasive surgery such as decreased blood loss and postoperative pain, faster recovery time, fewer complications, and better cosmetic results, without increasing costs. Herein, we present a case report of single-port laparoscopic ovarian cystectomy and concomitant cholecystectomy performed with a multi-instrument access port (TriPort; Olympus America Inc., Center Valley, Pennsylvania). Single-port surgery eliminates the problem of multiple and different site placement for accessory ports, typical of these procedures when performed simultaneously at conventional laparoscopy., (Copyright © 2010 AAGL. Published by Elsevier Inc. All rights reserved.)

Background: Although salivary-type hyperamylasemia is known to occur with ovarian pathologies such as salpingitis and adenocarcinoma, pancreatic-type hyperamylasemia and hyperlipasemia are considered to be highly specific for pancreatitis., Objectives: To discuss the interpretation of hyperamylasemia in the context of acute abdominal pain, implications for management, and to review the literature relating to non-pancreatic causes of hyperamylasemia and hyperlipasemia., Case Report: We present the case of a 25-year-old woman who presented with an acute abdomen and a markedly elevated pancreatic-type amylase and lipase in whom acute pancreatitis was suspected. Further investigations showed that the underlying pathology was actually a ruptured ovarian cyst causing massive intra-abdominal hemorrhage and necessitating emergency laparotomy., Conclusions: This case represents an initial report of pancreatic-type hyperamylasemia and hyperlipasemia occurring with ovarian pathology and hemoperitoneum. Although these derangements may have been secondary to peritoneal irritation, this case raises the possibility that ovarian tissue is able to secrete large amounts of pancreatic-type amylase and lipase in addition to salivary-type amylase. Clinicians should be aware that simultaneous elevations of both enzymes are not necessarily pathognomic of acute pancreatitis., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)

Periurethral masses in females are rarely observed, although they can occur anywhere along the genitourinary tract. They may be detected on physical examination or present with symptoms such as vaginal swelling, bladder outlet obstruction, vaginal bleeding, hematuria, or urinary tract infection. We report a sexually inactive, 27-year-old woman with an exophytic, fimbria-like periurethral mass. The benign nature of the lesion was suspected on the basis of the findings of magnetic resonance imaging. Surgical enucleation was performed. The microscopic examination revealed a urethral leiomyoma. Immunohistochemical study confirmed a leiomyoma with positive staining for smooth muscle actin and negative staining for S-100.

Endometrioma is one of the most frequent pathologies in gynecologic surgery. Laparoscopic cyst excision is considered the best treatment in terms of lower recurrence and improved fertility. However, it was recently questioned whether the excision of the endometrioma could decrease the function of the operated ovary and if it could affect the subsequent fertility. Even if a consistent amount of ovarian tissue is unintentionally removed together with the capsule of the cyst, resulting in does not show the follicular pattern observed in working ovaries. Currently, no definitive data clarify whether the damage to the ovarian reserve, observed in patient with endometrioma, is related to the surgical procedure, to the previous presence of the cyst, or both. Electrosurgial coagulation during hemostasis could play an important role in terms of damage to ovarian stroma and vascularization. Particular attention must be paid in presence of bilateral endometriotic cysts. In fact, an increase in premature ovarian failure rate was reported when both the ovaries are involved in surgery. Incase of assisted reproductive techniques, no clear evidence indicates which is the best approach for concomitant endometriotic cyst. On the base of these considerations endometriomas Should be treated only in case of pain, infertility, and in asymptomatic patients if the cyst diameter is greater than 4 cm.

We report a patient in Automatic Peritoneal Dialysis (APD) with tuberculous peritonitis by possible peritoneal infection due to the proximity between fallopian tube and the left ovary, a peritoneal liquid culture was constantly negative. The patient presented a bad clinic evolution. Her only medical history was hypercalcemia six months before developing a peritonitis and occasionally nausea and vomits To confirm the diagnosis it was needed a peritoneal biopsy by means of a laparoscopy with a removal of the peritoneal catheter and left anexectomy. Now, the patient is asintomatic in daily home hemodialysis.

Dermoid cyst is the most frequent benign ovarian tumor. Its spontaneous or more frequently iatrogenic intraperitoneal rupture may lead to a chemical peritonitis. This is a rare complication but with a potentially dangerous issue. We report a case of a patient who developed chemical peritonitis after laparoscopic management of ovarian dermoid cysts. Three further interventions, associated with systemic anti-inflammatory treatment, were necessary to resolve symptoms completely. On the basis of this case, we aim to re-access the characteristics of dermoid cysts and highlight in particular the potential complication of chemical peritonitis and the following attitude to avoid this.

Objective: Complications during laparoscopic surgery involving the bladder, bowel, and major vessels have been reported extensively. However, uterine manipulator-associated injuries are seldom reported., Case Report: We describe herein the case of a 28-year-old female patient who underwent a laparoscopic cystectomy 5 days after cervical conization, during which the uterine manipulator perforated the anterior cul-de-sac through the cervix. Fortunately, the wound healed with conservative treatment and no adverse consequences were found., Conclusion: This case serves to highlight the potential for complications following seemingly benign maneuvers.

Objectives: To determine the feasibility, safety and limiting factors of laparoscopic management of pelvic mass in pregnancy., Material: and methods. During a 10-year period, 21 laparoscopic procedures were performed in patients with pelvic masses in pregnancy after exclusion of appendicitis and ectopic pregnancy. Laparoscopic surgery was done during the first trimester of pregnancy in 8 cases, the second trimester in 12 cases and the third trimester in one case. All the procedures were performed with general anesthesia and the laparoscopic cystectomies were performed with the intraperitoneal technique., Results: The indications were: persistent or sonographically abnormal ovarian cyst (12 cases), torsion of ovarian cyst (5 cases), and symptomatic pelvic mass (4 cases: 2 painful cysts and 2 infarction of fibroma). One borderline tumor were discovered. The laparoscopic procedure could not be performed in two cases due to difficulty of access to the lesion. No patient encountered complications during the intra- and post-operative periods. The mean hospital stay was 4.5 days. The outcome of the pregnancy was normal in all cases., Conclusion: Laparoscopic management of pelvic masses in pregnancy by an experienced team, is a safe and effective procedure.

Study Objective: To evaluate a prospective series of consecutive patients with unexpected intracystic vegetations detected during operative laparoscopy for adnexal masses., Design: Prospective series of consecutive patients (Canadian Task Force classification: II-2)., Setting: Tertiary care university hospitals., Patients: Consecutive patients found during surgery to have unexpected intracystic vegetations and treated by operative laparoscopy, out of a total series of 667 patients under 40 years of age with ultrasonographic evidence of an adnexal cystic mass without thick septa, internal wall papillarities, or solid components., Interventions: Operative laparoscopy and follow-up., Measurements and Main Results: Thirty-five (5.2%) of 667 patients were found at surgery to have unexpected intracystic vegetations. A frozen section was sent for pathologic analysis in all 35 patients. Frozen section diagnosis was benign in 32 patients and borderline in 3 patients. Final pathology diagnosis was borderline ovarian tumor in five of the 35 patients (14.3%), and benign in 30 patients (85.7%). No case of invasive carcinoma was diagnosed either at frozen section or at final pathology examination. The patients with borderline tumors are alive with no evidence of disease after a mean follow-up of 60 months., Conclusions: In the present series, with accurate preoperative selection, the rate of adnexal cysts with unexpected intracystic vegetations was 5%, of which 14% were borderline tumors. The laparoscopic management of these adnexal masses did not adversely affect the prognosis.

Study Objective: To evaluate damage to ovarian reserve following laparoscopic cystectomy of benign ovarian cysts., Design: Prospective study (Canadian Task Force classification II-3)., Setting: Tertiary gynecologic endoscopic unit at a university-affiliated hospital., Patients: Thirty-one patients who underwent excision of monolateral (n=25) or bilateral (n=6) benign ovarian cysts., Interventions: Serial transvaginal ultrasound examinations during the first and third postsurgical menstrual cycles. The following ovarian echographic variables were evaluated: antral follicle count, ovarian volume, stromal blood flow, and side of ovulation. Two types of statistical analysis were performed: a paired analysis comparing operated and intact ovaries of the same patient and a prospective analysis comparing ecographic characteristics of the operated gonad at first and second evaluation., Measurements and Main Results: Antral follicle count and stromal blood flow were not significantly affected by surgery. While ovarian volume was similar in the operated and in the contralateral intact gonad at the first ultrasound evaluation, the volume of the operated ovary was significantly reduced at the second assessment. The median (interquartile range) of the percentage of this reduction was 33% (18%-81%). This progressive reduction was confirmed by prospectively analyzing the operated ovaries. An increased probability of ovulation in the intact gonad was observed at both assessments., Conclusion: Laparoscopic excision of ovarian cysts is associated with damage to ovarian reserve, at least immediately after surgery. This effect does not appear to be consequent to an injury to ovarian vascularization.

Study Objective: To evaluate the treatment by laparoscopic surgery of adnexal disease occurring in young girls., Design: Retrospective analysis (Canadian Task Force classification II-1)., Setting: Department of gynecology at a general hospital., Patients: Twelve consecutive girls aged 15 years or younger., Interventions: Laparoscopic surgery., Measurements and Main Results: Seven patients had dermoid cysts, and three of these were associated with adnexal torsion. Two patients had ruptured lutein cysts with ovarian bleeding, and one of them was pregnant. Torsion of the tube with paraovarian cyst, torsion of normal ovary, and serous cystadenoma were noted in one patient each. Although the underlying diseases varied, the chief symptom in each of these patients was lower abdominal pain. Because the symptom is nonspecific, the clinical features were confusing, especially in emergency cases; in two patients with adnexal torsion with dermoid cysts and one patient with adnexal torsion of a normal ovary, there was substantial delay in diagnosis, and salpingo-oophorectomy was required as a result., Conclusion: Even in young girls, laparoscopic surgery can be performed in an acceptable manner using regular instruments designed for adults.

We relate the case of a 22-year-old woman, without any particular medical history, apart from a previous full-term pregnancy with no complication, for whom the discovery of prolongated APTT (Activated Partial Thromboplastin Time) postponed an emergency operation in spite of intracystic ovarian haemorrhage. The complementary check-up revealed the existence of an autoantibody antifactor VIII (antithromboplastinogen), showing acquired postpartum haemophilia.

The review included 163 cases of paraneoplastic pemphigus (PNP) reported between 1990 and 2003, including a new unique case of PNP associated with occult breast cancer and an ovarian cyst of borderline malignancy. Hematologic-related neoplasms or disorders were associated with 84% of the cases, with non-Hodgkin lymphoma (38.6%) as the most frequent, followed by chronic lymphocytic leukemia (18.4%) and Castleman's disease (18.4%). The non-hematologic neoplasms comprised 16% of all cases: epithelial origin-carcinoma (8.6%), mesenchymal origin-sarcoma (6.2%), and malignant melanoma (0.6%). Carcinoma cases comprised 58% of the non-hematologic neoplasms. Carcinoma cases (n = 14) consisted of adenocarcinoma (n = 7), squamous cell carcinoma (n = 2), multiple skin tumors probably basal cell carcinoma (n = 1), and bronchogenic carcinoma (n = 1). Of the 10 (6.2%) sarcoma cases, there was one case each of leiomyosarcoma, liposarcoma, malignant nerve sheath tumor, poorly differentiated sarcoma, reticulum cell sarcoma, dendritic cell sarcoma and inflammatory myofibroblastic tumor. The oral mucosa was involved in all of cases. Isolated oral ulcerations were the first sign in 45% of the cases. Diffuse and persistent oral ulcerations with a progressive course could be a sign of malignancy, either recognized or occult. In the absence of a clear diagnosis, malignancy should be suspected and extensive work-up performed. The full spectrum of signs of PNP may not be present initially. Repeated biopsies, direct and indirect immunofluorescence as well as screening indirect immunofluorescence on murine bladder are required for diagnosis. Clinicians should be highly suspicious when signs and symptoms suggestive of PNP are present in cancer patients, of hematologic and non-hematologic origin.

The objective of this observational study was to evaluate the association between lameness, ovarian cysts, and fertility in lactating dairy cows. Data analysis of historical records from a 3000 Holstein farm was conducted. Sixty-five cows that became lame within 30 days postpartum were used as cases, and 130 nonlame cows served as controls. The outcome variables were incidence of ovarian cysts (OC, %), conception rate at first service (CRFS, %), overall pregnancy rate (PR, %), and calving to first service interval (CFSI, day), Incidence of OC and CRFS were analyzed by logistic regression, PR by survival analysis and CFSI by ANOVA. Lame cows had a lower CRFS (17.5% versus 42.6%) and higher incidence of OC (25.0% versus 11.1%) than controls (P0.05). There was a multicollinearity relationship between lameness and ovarian cysts. The results show that cows that became lame within the first 30 days postpartum were associated with a higher incidence of ovarian cysts, a lower likelihood of pregnancy, and lower fertility than control cows. Because this is an observational study it is not possible to conclude a cause-effect relationship.

Endometrioma is one of the most frequent localisations of endometriosis. The diagnosis is based mainly on the intravaginal ultrasonography which has a good predictive value, even if there are a lot of atypical echographic aspects. Endoscopic surgery remains the standard treatment for endometriosis, the goal being the complete removal of the lesions. Three surgical options are possible: intraperitoneal cystectomy, the three-phase "Donnez technique" in three time, and ovariectomy. Treatment of recurrences of endometriosis must be based on a precise diagnosis, and also on the type of patient being treated: patient wishing to be pregnant, patient under medically-assisted reproductive programs, and patients close to menopause. The ultrasound-guided puncture could be an interesting option for multioperated patients or patients under assisted reproductive programs, yet these patients should be informed of the high risk of further episodes of endometriosis after such a puncture.

We report on a 30-year-old female patient with a beta-human chorionic gonadotropin (beta-HCG)-producing lung tumour. Abdominal discomfort and vaginal bleeding were the presenting symptoms and, in conjunction with elevated beta-HCG levels, initially led to the diagnosis of extrauterine pregnancy. Bilateral ovarian cysts were detected on further diagnostic workup. Ultimately, a chest X-ray revealed a lung tumour. The paraneoplastic symptoms were completely reversible after resection of the lung lesion, and the ovarian cysts disappeared.

The efficacy of medical treatment as unique treatment for endometrioma is not demonstrated. Operative laparoscopic management is the gold standard for surgical treatment. There is no indication to prescribe preoperatively medical treatment before cystectomy. Post-operative administration of low-dose cyclic oral contraceptive does not significantly affect long-term recurrence rate of endometriosis after surgical treatment. In cases of infertility, management of endometriomas is controversial. Recurrent ovarian surgery is not recommended.