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Background: The aim was to evaluate whether patients with benign ovarian cysts, functional ovarian cysts, or endometriosis have an increased risk of developing gynecologic cancer., Methods: The Swedish Hospital Discharge Register was used to identify a cohort of women discharged from hospital with the diagnoses of ovarian cyst (n = 42217), functional ovarian cyst (n = 17998), or endometriosis (n = 28163). To each case, three controls were matched. The National Swedish Cancer Register matched all incident cancers diagnosed among cases and controls. From the Fertility Register, the date of birth of children born to the cases and controls were obtained., Results: Women with endometriosis had an increased risk for ovarian cancer (OR 1.34; 95% CI 1.03-1.75), but no association was found between ovarian cysts or functional cysts and ovarian malignancy, including all ages. Young women (15-29 years old) discharged from hospital for ovarian cysts and functional cysts showed an increased risk of developing ovarian cancer later in life (OR 2.2; 95% CI 1.3-3.9 and OR 1.8; 95% CI 1.5-2.0), as well as women with ovarian cysts who had undergone ovarian cyst resection or unilateral oophorectomy (OR 8.8; 95% CI 5.2-15). The risk of developing ovarian cancer was inversely related to parity. Mean age at diagnosis was significantly lower in all three study groups., Conclusion: In this study women with endometriosis and young women who had undergone surgery with removal of an ovarian cyst had an increased risk of developing ovarian cancer.

Lactogenesis II is the onset of copious milk production (i.e., the milk "coming in"), which usually occurs between 30 to 40 hours postpartum. When lactogenesis II fails to occur or is delayed, it may be due to a number of underlying hormonal or non-hormonal conditions. Of the various hormonal etiologies, many can be identified with the aid of a few standard blood tests. Gestational ovarian theca lutein cysts may cause delayed lactogenesis II and are fairly easily detected by ordering testosterone levels. Although this condition can delay lactogenesis II for as long as 31 days, with proper management women affected by these cysts have established breastfeeding. Three of the four women reviewed in this article were eventually able to produce 100% of their infants' caloric requirements.

Background: A number of histologic and epidemiologic studies have suggested an association between endometriosis and ovarian carcinoma. Some reports have described a transition from endometriosis to atypical endometriosis to carcinoma. Using immunohistochemistry, the authors compared staining patterns in benign endometriotic cysts with ovarian tumors and the endometriotic cyst lining from which they arose, in an attempt to identify sequential or etiologic correlations., Methods: One hundred thirteen formalin-fixed, paraffin-embedded sections were studied (30 benign ovarian endometriotic cysts, 24 endometriotic cysts containing endometrioid carcinomas, 19 endometriotic cysts harboring clear cell carcinomas, and 40 ovarian papillary serous cystadenocarcinomas). All sections were immunostained with anti-bcl-2 and anti-p53 antibodies using the streptavidin-biotin method., Results: bcl-2 was reported to stain 23% of benign endometriotic cysts, 67% of endometrioid carcinomas, 73% of clear cell carcinomas, and 50% of papillary serous carcinomas. Approximately 42% of benign endometriotic lesions adjacent to the endometrioid carcinoma and 73% adjacent to clear cell carcinomas were found to stain for bcl-2 (p = 0.274 [not significant (NS)] and P = 0.008, respectively). p53 staining was negative in the benign endometriotic cyst group and was positive in 37-55% of the group with tumors. p53 staining was positive in 25% of the benign endometriotic lesions next to the endometrioid carcinoma and in 9% of the benign endometriotic lesions next to clear cell carcinoma (P = 0.014 and P = 0.239 [NS], respectively)., Conclusions: The results of the current study suggest that alterations in bcl-2 and p53 may be associated with the malignant transformation of endometriotic cysts., (Copyright 2002 American Cancer Society.)

Diagnosis of ectopic pregnancy continues to be an important challenge facing emergency physicians. The authors present a case of bilateral tubal ectopic pregnancy and discuss its clinical features and diagnostic difficulties. A review of the English-language literature on the subject is discussed. Suggestions are made on ways to increase diagnostic accuracy, reduce complications, and preserve future fertility in this group of patients.

Cases of coexisting ovarian hyperstimulation and ectopic pregnancy are rare, and pose a difficult diagnostic problem. The routine attempts at laparoscopic diagnosis and treatment of these pregnancies may prove to be hazardous. Such cases may be better managed nonsurgically either by methotrexate or, in selected cases, by expectant management while monitoring the beta-hCG level and clinical status.

Sebaceous carcinoma in a ovarian dermoid cyst is a rare entity. The present patient has survived 54 months and has no evidence of recurrence after total abdominal hysterectomy, bilateral salpingo-oophorectomy and adjuvant chemotherapy with cisplatin, vinblastine, and bleomycin.

A 28-year old primigravida with massive bilateral theca-lutein cysts associated with a non-molar pregnancy is reported. The pregnancy resulted in a spontaneous premature vaginal birth of a 27-week gestation female infant, with no placental pathology or congenital anomalies. During the same pregnancy and post partum period the patient manifested an associated synchronous endocrinopathy of severe hypothyroidism and virilization. The cysts, except for one 2.5 cm in size still present, completely resolved with non-surgical approach during the 10 months period following delivery.

A case of hyperreactio luteinalis in a patient with normal singleton pregnancy is reported. The course of pregnancy had been normal until the 24th week of gestation, when the mother developed lower abdominal pain and signs of virilization. She delivered of a normal female infant at 39 weeks' gestation. The baby did not show any signs of masculinization. Serum testosterone, delta 4-androstene-dione, and 5 alpha-dihydrotestosterone of the mother were markedly elevated. They remained high after the delivery but returned to the normal ranges soon after the partial resection of the enlarged ovaries. Reported causes of hyperreactio luteinalis are reviewed. Their maternal serum androgen levels were compared with cases of luteoma of pregnancy.

This is a case report of a patient with congenital afibrinogenemia and massive intra-abdominal bleeding from a ruptured corpus luteum cyst. None of the previously reported 100 cases mentioned obstetrical or gynecological complications associated with this rare entity.

The frequency of ovarian cysts in patients with Crohn's disease (CD) or ulcerative colitis (UC) is believed to be higher than in the normal population, but this aspect has not been studied hitherto. The prevalence of ovarian cysts in the normal population is unknown. By ultrasonic scanning, we studied the frequency of ovarian cysts in 61 patients with CD, 64 with UC, and in 100 controls. The findings were positive in 3 out of 61 with CD, 5 of 64 with UC, and in 2 of 100 controls. There is a tendency to a higher frequency of ovarian cysts in patients with inflammatory bowel diseases than in the normal population, but no statistically significant difference.

A patient with persistent ovarian cysts subsequent to clomiphene-induced severe hyperstimulation was found to have borderline ovarian carcinoma. Since several endocrine and epidemiological studies implicate hormonal factors in the genesis of ovarian tumors, a possible association between ovarian hyperstimulation and neoplasia is suggested.

We describe 3 cases of torsion of the Fallopian tube during pregnancy, caused by sactosalpinx, a cyst of the mesosalpinx, and an ovarian cyst. Other causes of torsion of the Fallopian tube are discussed. The difficulty of diagnosing this condition during pregnancy is emphasized.

Non-tubal ectopic pregnancy is very rare. We report a case of spleen pregnancy, difficult to recognize clinically. The tests and investigations which led to the diagnosis and treatment are described briefly.

Four cases of squamous carcinoma arising in benign cystic teratoma of the ovary are presented, with a detailed correlation of clinical, operative and pathological findings with prognosis. Confinement of tumor to the ovary, with an intact ovarian capsule, is the most important prognostic factor since patients wih extracapsular extension succumb to their disease within 2 years. The literature dealing with this subject is reviewed.

Women under 40 years of age rarely develop carcinoma of the endometrium, this age group comprising less than 3% of all cases in most large series. The Registry for Endometrial Carcinoma in Young Women Taking Oral Contraceptive Agents has recorded and studied 30 cases in women under 40 with a history of oral contraceptive administration, and these are compared with 25 cases in the same age group which were accessioned at the Armed Forces Institute of Pathology prior to the era during which these agents have been available, and with series reported in the literature totaling 137 cases with no contraceptive history. In the first group, special attention is paid to the 20 women who received sequential agents exclusively or predominantly, since the association with these agents (primarily Oracon) is much higher than would be expected from the fact that less that 10% of oral contraceptives used in this country are of the sequential type. An analysis of the three groups reveals a similar incidence of the various histologic types (primarily well differentiated tumors with a relatively favorable prognosis), the only difference being the presence of secretory features in 14 of 29 oral contraceptive users vs. only two of 25 women not taking these agents. Clinical and pathologic staging were also predominantly favorable, and comparable in all groups. There were, however, notably higher incidences of nulliparity, obesity, and sclerocystic ovaries--all features traditionally associated with endometrial carcinoma--in the patients not receiving oral contraceptives or receiving combined agents, suggesting that the group receiving sequentials may not represent the same constitutionally predisposed population. Only three of 55 women among our personally reviewed cases have thus far died of cancer (one in the contraceptive group and two in the non-user group) and all three of these had poorly differentiated tumors with myometrial invasion. The excellent prognosis for most patients in this age group is thus confirmed.

A case of a huge right-sided ovarian cyst associated with torsion of the whole internal female genital apparatus around the uterine collum, herniation of the transverse colon into the thoracic cavity and mechanical obstruction of the ileum is described. The symptomatology, pathogenesis and treatment of the condition is discussed.