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Automatic amputation of the ovary represents a rather uncommon condition. Especially asymptomatic auto amputation is an even more unusual laparoscopic finding. We hereby present a case of a 2-days´-old infant with a prenatal ultrasound (US) diagnosis of a cystic mass, laparoscopically proved as an amputated right adnexa. The female infant was asymptomatic and had normal laboratory exams, including hormone levels, according to her age. The infant was managed surgically, as the size of the cystic lesion, both prenatally and postnatally was indicative of surgical intervention. Careful monitoring is critical for the management of cystic lesions diagnosed prenatally. Although rare, the suspicion of an auto-amputated ovary has to be risen during diagnostic approach of infants with adnexal cysts, especially when these lesions are supposed to “wander” during imaging examinations, and also taking into account the size of the lesion in order for a final approach and management to be established.

A woman in her sixth decade presented with several months of abdominal cramping, decreased appetite, bloating, and increased constipation. Radiologic imaging revealed a 28 cm, multilocular, heterogeneous cystic neoplasm involving the right adnexa. An intraoperative frozen section showed mucinous glandular epithelium, with and without foci of goblet cells, embedded in apparent ovarian stroma. The findings were concerning at least borderline mucinous cystadenoma with possible invasion. Subsequent surgical management and staging were performed. Permanent sections showed a moderately to poorly differentiated Sertoli-Leydig cell tumor (SLCT) with retiform foci and heterologous elements. The discrepancy between frozen and permanent sections was attributable to solely sampling a focus of heterologous elements during intraoperative consultation. The rarity of SLCT and even rarer presence of both heterologous and retiform elements make this concerning frozen section diagnostic pitfall.

A 70-year-old multiparous woman was diagnosed with an ovarian tumour at a local obstetrics and gynaecology clinic with abdominal pain that started 2 weeks prior and was transferred to our hospital. A movable mass as large as the woman’s fist was palpated in the right adnexa on pelvic examination

Objective: To create awareness about this rare tumour and the way it can mislead the clinician into believing it to be of an ovarian origin. Case report: A 50 years old postmenopausal female presented with a partly solid-partly cystic mass noted arising from the mesentery of sigmoid colon, obliterating the pouch of douglas and adhered to the posterior surface of uterus and right adnexa. The histopa thological features were suggestive of Adenocarcinoma of Mullerian origin. Conclusion: Great caution and precision are needed to ascertain the origin and management of these tumours as they carry a bad prognosis.

Round ligament fibroids are rare tumors and can present as inguinal, adnexal, or vulvar masses. Preoperative diagnosis can be made by ultrasonography or magnetic resonance imaging (MRI). A 28-year-old virgin female presented with pelvic pain that persisted for a few days. Her sonographic evaluation detected a well-defined hyperechoic 45 × 40 mm right adnexal mass interfering endometrioma. A contrast-enhanced pelvic MRI showed a 43 × 39 × 32 mm solid mass located in the right adnexa. Laparoscopic exploration revealed a well-defined double torsion around the peduncle pinky solid mass arising from the right round ligament. The mass was resected with the final histopathological diagnosis being leiomyoma. The diagnosis of round ligament fibroids can be challenging, and laparoscopy is one of the first options where surgical facilities are available.

Rationale: Hepatoid adenocarcinoma (HAC) of the fallopian tubes is a rare malignant tumor in the female reproductive system. Patient concerns: An 81-year-old Chinese woman presented with an elevated serum alpha-fetoprotein (AFP) level. Diagnosis: Positron emission tomography-computed tomography (PET-CT) scan revealed a mass of approximately 47 × 27 mm located in the right adnexa. The tumor was diagnosed as a HAC arising from fallopian tube by immunohistochemical and histochemical technique. Interventions: This patient underwent surgical treatment including a bilateral adnexectomy and appendectomy. In addition, the patient underwent 5 cycles of postoperative chemotherapy. Outcomes: The disease has recurred approximately six months after surgery and therefore, this patient will continue to be observed. Lessons: Up to this point, only 4 known cases of HAC originating in fallopian tube have been published in the English literature. Further studies are needed to better understand the clinical characteristics, the prognosis, and the pathological mechanism of HAC development in the fallopian tubes.

Adrenal rest tumors (ART) are extra-adrenal findings of adrenal tissue. Testicular adrenal rest tumors (TART) are widespread in males with congenital adrenal hyperplasia (CAH). Ovarian adrenal rest tumours (OART), which form in females with CAH, are less commonly seen. Reports in literature of OART are extemely rare. The case is here presented of a 43-year-old female who was diagnosed at the age of 15 years with CAH and underwent bilateral adrenalectomy at the age of 37. On presentation at our clinic, 4×2 cm mass was determined on the right adnexa in the advanced tests and a right-side salpingo-oopherectomy was performed. The pathology examination reported heterotopic adrenal cortical tissue. Routine ovarian imaging in females with CAH is not indicated. Although OART are rarely seen, they should be kept in mind and these patients should be evaluated radiologically together with laboratory tests.

Autoamputation of the appendix has rarely been described in the literature. We present a case of a pelvic mass, thought to be a dermoid cyst based on preoperative imaging. After surgical removal and pathological examination, the mass was found to be a chronic pelvic abscess containing the right adnexa as well as an autoamputated vermiform appendix. Differentiating between gynecologic and gastrointestinal disease preoperatively can be difficult and often a definitive diagnosis cannot be made until surgical exploration and pathological review. However, to our knowledge, this is the first described case of a chronic pelvic abscess containing an autoamputated vermiform appendix.

SUMMARY Objective: To report the effects of the torsion attacks on the ovarian reserve, and to present the surgical approach in cases of ovary torsion that develop after preventive surgery. Design: The presentation of the case. Setting: University hospital. The patient: The sixteen-years-old girl, who had lost her right adnexa because of torsion, suffered successive torsion in the left adnexa after preventive surgery. Intervention: Through the laparoscopic method, the utero-ovarian ligament was shortened and ovariopexy was applied to the back of the uterus. The ovarian reserve between the attacks was monitored. Main Outcome Measure: The prevention of recurring torsions through the surgical method and thereby the preservation of the ovarian reserve. Result: The ovary must be protected under all circumstances during the treatment of torsion. More than one method of adnexa fixation may prove necessary to prevent further attacks. Conclusion: The case we present here is the unique in which the two sides were successively affected, despite the surgical intervention to prevent any recurrence, and also the unique in which the ovarian reserve between the attacks was monitored. Apparently, the ovarian reserve is affected badly by recurrent torsion attacks. The ovarian reserve tests indicate some improvement in the months following the last attack.

Massive ovarian edema (MOE) was first described by Kalstone et al. in 1969 as a“massive, solid enlargement of the ovary associated with interstitial edema, without neoplastic change.”A literature review revealed>100 reported cases, and although most of the patients were young, they usually underwent removal of the affected ovaries. We report a case involving a 23-year-old woman admitted to our department with sudden right lower abdominal pain. The ultrasonographic study showed an enlarged right ovary, approximately 6 cm in diameter, with multiple small low echoic lesions. A CT scan showed no malignant features of this mass. With a preoperative diagnosis as MOE with right adnexal torsion, we performed a laparoscopy. As we had expected, the right adnexa was twisted and the right ovary was gray and swollen. Within 10 minutes of detorsion, we noted that the color of the ovary had improved. Postoperatively, she was pain-free and began taking oral contraceptives to diminish the size of the ovary. Eight months after the surgery, the ovary was near-normal in appearance by an ultrasonographic study and there has been no recurrence of pain. Since there are very few cases of young women with neoplasms, to avoid the unnecessary removal of the ovary, we should suspect MOE when we care for young women with abdominal pain and a solid, enlarged ovary. Although there is no established treatment for MOE, laparoscopy is a powerful diagnostic tool. Moreover, oral contraceptives postoperatively may be effective in preventing the recurrence of MOE.

We present an unusual case of recurrent ectopic pregnancy in the tubal stump of a previous partial salpingectomy. The patient presented with the classic triad of amenorrhoea, per vaginal bleeding and abdominal pain paired with a void uterus on ultrasonography. Her history was notable for a previous ectopic pregnancy resulting in a laparotomy and salpingectomy-oophrectomy. A positive B-hCG and echogeneic areas in the right adnexa led to a diagnosis of recurrent ectopic pregnancy. On laparotomy, an ectopic pregnancy was found in the right tubal stump. Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 1 / Issue 13 / Jan- June, 2012 / 50-52 DOI: http://dx.doi.org/10.3126/njog.v7i1.8837

Coexistence of a mucinous cystadenoma arising in a mature cystic teratoma is infrequently reported. Herein a case of a 25-year-old woman diagnosed with a right ovarian mucinous cystadenoma arising in a mature cystic teratoma is reported. She presented with lower right abdominal discomfort. Ultrasound showed a14.8×7.9×12.5 cm structure on the right adnexa. She underwent a diagnostic laparoscopy, which was converted to exploratory laparotomy, during which a right salpingo-oophorectomy was performed.

Ovarian-type mucinous tumours occur very rarely in the retroperitoneum. We present a case of primary retroperitoneal mucinous tumour of borderline malignancy in a 58-year-old woman, detected as an incidental finding. The patient presented with acute renal failure, investigation for which revealed a complex pelvic mass initially thought to be in the right adnexa and consistent with an ovarian neoplasm. Surgical findings revealed a 130-mm, right-sided non-communicating retroperitoneal pelvic mass, posterior to the appendix, which was completely resected. Both ovaries were normal. Macroscopically, it was a multi-loculated cystic structure with a smooth external surface containing clear and mucinous fluid. Microscopic examination showed a mucinous tumour of borderline malignancy. The literature contains approximately nine other cases of primary mucinous retroperitoneal tumour of borderline malignancy. These cases have occurred in women aged 36–60 years. Most patients were asymptomatic and the mass was detected as an incidental finding. The patients have been followed up for up to 6 to 18 months and, to date, none have recurred. There are limitations to pre-operative radiological imaging. A definitive diagnosis can only be made after complete surgical excision and histological examination, having excluded retroperitoneal involvement by mucinous tumours from sites such the ovaries, bowel, appendix and pancreas.

Hepatocellular carcinoma (HCC) is one of the most common malignancies in the world, with high frequency rates in Asia. Many of the patients have unresectable disease at the time of diagnosis, and early detection and surgical resection is the best hope for survival. But, if HCC is presenting as an extrahepatic mass, the diagnosis is difficult. Herein, we report a case of primary HCC masquerading as a pelvic mass. A 74-year-old woman was admitted to our hospital due to a palpable mass in the lower abdomen. CT scan detected an approximately 15.0×13.4×11.4 cm-sized multilobulated homogeneous enhancing mass in the right adnexa. Operative findings showed that the pelvic mass originated from the liver. We performed hepatic wedge resection. Permanent histopathologic report revealed primary HCC. Exophytic-growing hepatocellular carcinoma should be carefully diagnosed.

Purpose: We wanted to examine the usefulness of multi-detector CT (MDCT) with multiplanar reformations for evaluating the location, thickness and the presence or absence of intraluminal gas in the normal appendix of adults. Materials and Methods: From December 2004 to June 2005, we evaluated normal appendices in 427 consecutive adult patients who were scanned with 16-slice MDCT. All these patients had no clinical findings of appendicitis. There were 251 men and 176 women. The age range was 19-84 years (mean age: 55 years). The contrast-enhanced MDCT scans during the portal phase were obtained with 0.75 mm detector collimation and they were reviewed with using the multiplanar reconstruction images (3 mm section thickness). The MDCT images of normal appendices on a PACS monitor were retrospectively analyzed. We analyzed the location, thickness and the presence or absence of intraluminal gas by consensus of two abdominal radiologists. The positions of normal appendices were classified as type I (postileal and medial paracecal), type II (subcecal), type III (retrocecal and retrocolic or laterocolic), type IV (preileal and medial colic) and type V (lower pelvic cavity). Results: The five types of appendiceal locations were as follows; type I (n=187; 44%), type II (n=78; 18 %), type III (n=92; 22%), type IV (n=39; 9%) and type V (n=31; 7%). The appendiceal tips in 29 cases (7%) were unusually located in the right subhepatic space, the small bowel mesentery and the right adnexa. The mean thickness of 427 appendices was 5.8±0.9 mm (range: 3.8-9.2 mm). The appendiceal mean thickness was 5.90.9 mm in men and 5.70.9 mm in women (p

Background To evaluate the preoperative clinical, laboratory and sonographic characteristics of struma ovarii. Method A retrospective review of gynecologic patients operated for mature cystic teratoma over a 10-year period, identified 16 cases of struma ovarii. These cases were the subject of this study and were compared to 32 cases of ovarian dermoid cysts. Results The incidence of struma ovarii among all cases of dermoid cysts was 4.8%. Most patients were menopausal, the mean lesion diameter was 57.3 mm, occurred more frequently (68.8%) in the right adnexa and presented with normal CA-125 level. Blood flow signals were detected from the center of the lesions in all cases. Rare cases presented with elevated tumor marker and low-resistance blood flow. In dermoid cycsts, blood flow had a higher resistive index. In addition, no blood flow could be detected from the center of the echogenic lesion in dermoid (P

Asymmetric enlargement of the right adnexa in a prepubertal, asymptomatic, 7-year-old girl with acute lymphocytic leukemia (ALL) was detected by pelvic sonography as part of examinations after the discontinuation of therapy. The case is the first where asymptomatic ovarian relapse has been detected prospectively by sonography. The technique should be considered for the follow-up female patients with ALL in remission, although more extensive studies are needed to establish its effectiveness.