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Abdominal cystic masses are diagnosed during the intrauterine period and have a relatively low incidence. Fetal ovarian cysts are the most common form diagnosed prenatally or immediately after birth. The pathophysiology of the development of these types of tumors is not fully elucidated, with ovarian hyperstimulation caused by maternal and placental hormones being the most accepted hypotheses. We conducted a scoping review with the aim to map the current knowledge regarding the treatment of fetal ovarian cysts diagnosed in the intrauterine period. Focusing on the articles published in the last 10 years in the specialized literature, we tried to identify a conceptualization regarding the surveillance and treatment of these anomalies. We describe the case of a 38-year-old patient, in her second pregnancy, with a physiological course of pregnancy until 29 weeks of gestation, when a cystic mass of 52/48 mm was detected in the abdomen during the routine ultrasound examination. The most likely origin was established to be the right ovary. Applying the diagnostic criteria described by Nussbaum, the detected cystic mass was of a simple type, with a thin wall, transonic content, without the presence of septa, vegetations or the appearance of intracystic hemorrhage. We observed a linear growth trend from the time of diagnosis when the diameter measured 52 mm, until 38 weeks of gestation when it reached 76 mm. A female fetus was born, weighing 3570 g, with an Apgar score of 10, with a good postnatal adaptation. On the eighth day of life, the newborn was transferred to the pediatric surgery unit where ovarian cystectomy was performed. Intraoperatively, a cystic mass was found belonging to the right ovary, with a size of 80/70/70 mm. Ovarian cystectomy was performed, with the successful preservation of ovarian tissue. The postoperative recovery had a favorable outcome. [ABSTRACT FROM AUTHOR]

Introduction/objectives. Romania ranks first regarding the incidence and mortality of cervical cancer (CC) in the European Union. The persistent infection with high-risk HPV subtypes is a confirmed precursor in the development of almost all invasive cervical cancers, with HPV 16 and HPV 18 being classically considered the most common oncogenic subtypes. The prevalence of various HPV strains varies widely across the globe. The objectives of this study were to determine the presence of HPV infection and the infectious viral subtype in patients with normal cervix, CIN and with cervical cancer hospitalized in our institution, as well as to evaluate the particularities of this infection according to certain clinical parameters, in order to prioritize the screening services for patients with high-risk characteristics for HPVinduced disease in our geographic region. Materials and method. A total of 77 patients admitted to the “Dominic Stanca” Clinic of Obstetrics and Gynecology, Cluj-Napoca, were enrolled in the study, grouped in three categories: Group 1 – Control (n=38), Group 2 – CIN (n=30), Group 3 – CC (n=9). For all patients, the diagnosis of the cervical condition was confirmed by histopathological examination. A complex clinical database was developed, followed by the detection of high-risk HPV strains by the HPV Genotypes 14 Real-TM Quant kit. The number of previous cyto-tumoral examinations, as well as the macroscopic appearance of the cervix at the gynecologic examination were also recorded. The SPSS v. 24.0 program was used for data analysis, considering the statistical significance at the standard level of 5%. Results. HPV infection was detected in 88.3% of the subjects and a large number of patients were coinfected with several HPV strains. The most prevalent HR strains were HPV 16, 58, 56, 52, 33 and 31. Considering a single examination, 42% of patients in the control group had abnormal cytological results (PAP III, PAP IV), probably in association with the presence of the HPV infection; however, all patients (100%) in CIN and CC groups had abnormal cytology. At the clinical examination, 26.3% of patients without neoplastic cellular changes had a cervix presenting a macroscopic lesion. When analyzing the appearance of the cervix according to the HPV status, it was found that almost half (44.11%) of the patients with microscopically normal cervix had HPV infection, in 96.8% of cases the detected strain being HPV 16. Conclusions. This study highlighted HPV 16, 58, 56 and 52 as the most prevalent strains in the analyzed population. Given the wide variability in the prevalence of HPV-HR strains by geographical area, it is important to include the most common genotypes in the test kits for each region. The appearance of a cervical lesion is associated in half of the cases with HPV 16 infection, in case of normal cytology. HPV testing could bring additional benefits in guiding the subsequent management for these patients. [ABSTRACT FROM AUTHOR]

Introduction. Herlyn-Werner-Wunderlich syndrome (HWW) is a rare congenital anomaly of the urogenital tract characterized by the triad: uterus didelphys, obstructed hemivagina and unilateral renal agenesis, which is two times more common on the right side than on the left side. The incidence of this syndrome is 0.1-3.8% and, so far, in less than 10 cases the association of this pathology with acute urinary retention has been reported. Materials and method. We present the case of a 13-year-old girl who came to our emergency room accusing pain of increased intensity in the lower abdominal floor, started insidiously a week before, accompanied by nausea, pallor, sweating, anxiety and moderate vaginal bleeding (menstrual status). The anamnesis revealed absent diuresis for about 6 hours, menarche at 12 years old, regular menstruation, oligomenorrhea and dysmenorrhea. The clinical examination revealed respiratory movements of the abdomen, distension caused by a pseudotumoral mass located subumbilically, reluctant, painful; normal external genitalia. The paraclinical examination (ultrasound and MRI) revealed: voluminous cystic mass of 155/100/100 mm located between the bladder and the rectum, suggestive of hematometrocolpos; lower it protruded into the vagina, the image being suggestive of the transverse vaginal septum; uterus didelphys; normal ovaries and fallopian tubes. Unseen left kidney – left renal agenesis. Results. Surgery was performed with urinary bladder catheterisation, incision of the septum and continuous aspiration – about 1000 ml of chocolate-like fluid, suggestive of old blood, followed by resection of the vaginal septum. Conclusions. A high rate of awareness and clinical suspicion of HWW syndrome among adolescents is necessary for both the diagnosis and the prompt surgical treatment, leading to remission of symptoms, prevention of complications and to preservation of fertility. [ABSTRACT FROM AUTHOR]

Introduction. The aim of the study is to analyze the utility of real-time elastography (RTE) in diagnosing cervical cancer (CC) and cervical intraepithelial neoplasia (CIN), using an experimental device (ED) made from a synthetic material as benchmark of rigidity. Methodology. Seventy-nine patients were involved in the study, being divided into three groups: Group 1 – benign cervix (n=39); Group 2 – CIN (n=32); Group 3 – CC (n=8). Seventy-nine identical silicone DEs were created. RTE was performed and the strain ratio (SR) method was used to quantify stiffness, representing the ratio of stiffness between the analyzed cervical tissue and ED. The average SR values corresponding to each group were compared. The diagnostic performance of the method was evaluated by generating the ROC curve and analyzing the area under the curve (AUC). Cut-off values were set. The histopathological results were the benchmark for data interpretation. Results. The average value of SR for Group 1 was significantly different from that of Groups 2 and 3 (p=0.001). After the exclusion of two aberrant values from Group 3, attributed to complicated cases with hemorrhagic necrosis, significant differences of the average SR between Groups 2 and 3 were observed (p=0.02). For Groups 1 and 3, the AUC was 0.966, with 95% CI (0.914-1.000); the cut-off value of the SR was 1.42, with a sensitivity of 100% and a specificity of 94.9%. The AUC was 0.752, with 95% CI (0.629-0876) for Groups 1 and 2; the sensitivity and specificity were 75%, respectively 74% for the cut-off value of 1.03. Conclusions. RTE, quantified by SR, using a synthetic reference material, seems a reliable method of differentiating the benign cervix from the malignant one; the technique proves promising results as a complementary method in CIN evaluation and diagnosis. Nevertheless, SR becomes inoperative in cases of cancer complicated by extensive hemorrhagic necrosis. [ABSTRACT FROM AUTHOR]

Introducere. Elastografia este o tehnică imagistică ce apreciază rigiditatea structurilor şi care este complementară ultrasonografiei convenţionale. Metoda elastografică are în prezent o largă utilizare în evaluarea leziunilor mamare, tiroidiene şi prostatice. Scopul acestui studiu este de a evalua utilitatea elastografiei în timp real în analiza ţesutului cervical normal, precum şi a leziunilor preneoplazice şi neoplazice ale colului uterin. Materiale şi metodă. Au fost incluse în studiu 28 de paciente, repartizate în trei grupuri, după cum urmează: grupul A - fără leziuni ale colului uterin (n=10), grupul B - displazie col uterin (n=10), grupul C - neoplasm de col uterin (n=8), confirmate prin biopsie şi analiză anatomopatologică. Au fost realizate 28 de dispozitive identice din silicon de adiţie, cu dimensiuni de 35/10/10 mm, care au fost considerate reper al ridigităţii în evaluarea colului uterin. S-a realizat ecografie bidimensională cu sondă endovaginală pentru identificarea şi reperarea colului uterin şi a dispozitivului din silicon, poziţionat în proximitatea colului, urmată de elastografie în timp real. S-a calculat raportul de dislocare (Strain Ratio; SR) între colul uterin şi dispozitivul din silicon. Analiza datelor a fost realizată utilizând programul SPSS 16.0. Au fost comparate rezultatele SR din cele trei grupuri. Pentru fiecare pacientă, s-a considerat media a 10 determinări consecutive ale SR. Rezultate şi concluzii. Analiza datelor a indicat diferenţe semnificative (p<0,05) ale SR între toate cele trei grupuri, cu cele mai mici valori ale SR în grupul A şi cele mai mari valori pentru grupul C. În concluzie, elastografia în timp real, realizată cu sonda endovaginală, utilizând un dispozitiv din silicon ca reper, este o tehnică utilă în evaluarea rigidităţii colului uterin. Rezultatele acestui studiu sugerează capacitatea elastografiei de a diferenţia, neinvaziv, între leziunile preneoplazice şi neoplazice ale colului uterin. [ABSTRACT FROM AUTHOR]