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We present the case of a 26-year-old multiparous woman who experienced rupture of a tubo-ovarian abscess during the second trimester of pregnancy. She presented with epigastric and right lower quadrant pain at 12 + 0 weeks' gestation. There were no other specific findings on the magnetic resonance imaging images. We recommended hospitalization to observe the changes in pain, but she refused confinement. About 3 weeks later, she revisited our emergency room at 15 + 4 weeks' gestation. She complained of worsening abdominal pain with fever. She underwent right salpingo-oophorectomy and appendectomy due to uncontrollable, severe abdominal pain without any obstetric abnormal condition. There was a rupture site in the right adnexa, which was covered with pus. The rupture of tubo-ovarian abscess during pregnancy is very rare. Therefore, obstetricians should carefully monitor the adnexal masses observed during pregnancy, which should be treated with caution, whether or not the patient is symptomatic.

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.

Study Objective To present a technique to correct the misplacement of tape during laparoscopic cervical cerclage. Catching and introducing the wrong needle resulted in a knot formed around the right adnexa. Design Step-by-step demonstration of the mistake and the technique to correct it. Setting A patient para 0+V (V corresponds to 5) with cervical insufficiency was managed with laparoscopic interval cerclage 1 , 2 , 3 . The patient's 2 most recent pregnancies had been managed with emergency transvaginal cerclage, which failed to prolong her gestation beyond 24 weeks. Interventions Before the cerclage procedure a 2.0 × 0.8-cm deep endometriotic nodule was excised. Both curved needles were straightened extracorporeally, and the tape was dropped inside the peritoneal cavity. The first needle was introduced successfully through the right side. After insertion of—what was believed to be—the same needle through the left side following the opposite direction, it was discovered that a tight knot had been formed around the right adnexa ( Fig. 1 ). To avoid complete removal, the needleless tape was pulled back completely from the right side (Supplemental Fig. 1), and this end was stitched to a straight needle 2-0 polyglactin suture. The much thinner needle passed easily through the already created path, along with the tape (Supplemental Fig. 2), and the procedure was completed as planned (Supplemental Fig. 3). Conclusion When performing laparoscopic cervical cerclage with the tape and needles inside the abdomen, it is important to keep both under constant view. In the event of misplacement, no need to completely remove the tape. The tape's cut end can still be reintroduced successfully, stitched to a straight needle suture.

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.

To investigate the effect of adnexal torsion on the plasma heat shock protein 70 level and to determine whether plasma heat shock protein 70 can be used in the adnexal torsion diagnosis. Twenty-one nulligravid 3-month-old female Wistar albino rats were randomly and equally allocated into three groups: study group (ovarian torsion) (n = 7), laparotomy group (sham operation) (n = 7) and control group (received no special treatment) (n = 7). Ovarian torsion model was created by twisting the right adnexa two times around its pedicle and fixing over the lateral pelvis with 6.0 polyglactin absorbable surgical suture. Blood was sampled before and 12 h after operation to assess plasma heat shock protein 70 level. In the study group, the mean plasma heat shock protein 70 level was significantly higher than that in the laparotomy and control groups (1.75 ± 0.25), (1.16 ± 0.99), (1.19 ± 0.11) ng/ml, respectively, P = 0.001), following 12 h of ovarian torsion. A significant increase in plasma heat shock protein 70 level in the study group indicates that plasma heat shock protein 70 level could be used as a serum marker in the early detection of adnexal torsion. However, further clinical and experimental studies of a larger size are required.

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.

Serous borderline tumor of the fallopian tube is extremely rare. Eleven cases are found in the English-language literature. A 19-year-old woman was admitted to our hospital with lower abdominal pain. Ultrasonography and computed tomography indicated a pelvic cystic mass approximately 10 cm in diameter arising from the right adnexa. A clinical impression of right ovarian cyst with suspicion of torsion was made, and the patient was admitted for an exploratory laparotomy. During the operation the right fallopian tube was found to be enlarged to 10 × 10 × 11 cm. A right salpingo-oophorectomy was performed. The pathological diagnosis was serous adenofibroma of borderline malignancy in the fallopian tube. She was given no further treatment, and at the current time, 6 years after surgery, she has no evidence of the disease. After our review of the literature, we conclude that because of their young age and usual unilaterality, patients should be treated conservatively to preserve their fertility potential whenever possible.

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.

A 34-year-old woman, gravida 1, para 1, consulted our department because of secondary infertility of 1-year duration. On transvaginal ultrasound, a unilocular hypoechoic cystic mass was observed in the left adnexa measuring 6.70 ! 5.56 cm, suggestive of a paratubal cyst (Fig. 1). She menstruated regularly with dysmenorrhea at a numeric rating scale of 5. She delivered her child vaginally with no other previous operations and pelvic inflammatory disease. Laboratory examination showed her cancer antigen-125 level at 29.6 U/mL. On laparoscopy, there was torsion of the left fallopian tube, twisting around itself 4 times, with its distal end engorged (Fig. 2) containing chocolatelike fluid and adhered to the peritoneum and cul-de-sac. The uterus, right adnexa, and left ovary were grossly normal. Adhesiolysis and left partial salpingectomy were performed. Histopathologic findings revealed tubal endometrioma with hemosiderinladen macrophages, fibrosis, and chronic inflammation.

Correspondence: Dr. Florin Savulescu e-mail: savfl@yahoo.com Nowadays giant ovarian tumors are rare neoplasms and represent a great diagnosis and therapeutic challenge. We present the case of a 68-year-old woman admitted to our department with a history of progressive abdominal distension, constipation and polakiuria. Based on clinical findings, laboratory evaluation and imaging investigations our suspicion of diagnosis was: giant abdominopelvic mass. Exploratory laparotomy revealed a large cystic mass arising from the right adnexa. Bilateral salpingo-oophorectomy was performed. Histologically, the specimen was a 26 kg benign ovarian cystadenoma measuring 40/30/20 cm, the largest ovarian tumor operated in our surgical department. The main goals of optimal surgical management were: carefully organizing all the procedure steps, anticipating any possible complications and being able to deal with them.

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 report here the case of a young woman who presented with pain, fever and apparent cutaneous sub ischaemia following embolisation of the uterine arteries for postpartum haemorrhagia. This embolisation was carried out by bilateral selective catheterism of the uterine arteries using 45 to 150 micron polyvinyl alcohol particles. Investigative laparotomy was decided in view of the persistence of the symptoms, and the patient underwent hysterectomy with ablation of the right adnexa to treat uterine necrosis and adnexal atrophy. Because of the information that we have actually, we can explain that this complication is linked with the use of polyvinyl alcohol small size particles. The migration of those embolisation agents might be responsible for obliteration of a large number of distal vessels. Those embolisation agents must, because of recommendation for good practice published in 2004, be reserved to exceptional cases to minimize the complication of embolisation.

Surgery for suspected ovarian torsion sometimes reveals unexpected sources of pelvic pain, such as internal hernias, adhesions, or anatomic defects. A 23-year-old nulligravida with Alagille syndrome was taken to the operating room with suspected ovarian torsion. Intraoperatively, the right adnexa bulged out of a right-sided, posterior peritoneal cleft that incarcerated most of the enlarged ovary. No ovarian torsion was identified. The left adnexa appeared to be normal; however, it dwelled within a left-sided posterior peritoneal cleft. The bilateral posterior peritoneal defects that housed the adnexa were likely of congenital etiology. Although adnexal incarceration is a rare finding at surgery for suspected ovarian torsion, it should be part of the differential diagnosis when evaluating acute pelvic pain.

Triple-X female characterized by primary amenorrhea and pure gonadal dysgenesis is extremely rare. We present a patient of triple-X syndrome who has not had menarche or the development of the secondary sexual characteristics. She had a hypoplastic uterus and streaked gonads on both sides with a twisted mucinous cystadenoma in the right adnexa.

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

Background Laparoscopy is the most common procedure for minimally invasive intraabdominal surveys. Patients with pulmonary hypertension (PHTN) may need an alternate approach because the systemic absorption of carbon dioxide may lead to hypercapnia, acidemia, and increases in systemic and pulmonary pressures. We report a case of intraabdominal survey using a microcatheter trocar (Check-Flo Introducer) in a patient with a large adnexal mass and PHTN. Case An adolescent girl with severe PHTN and multiple cardiac anomalies presented with oligomenorrhea. During the course of workup, an ultrasound revealed an 8-cm simple cyst in the right adnexa, which required removal. The decision was made to proceed with cystectomy. The patient was not a candidate for laparoscopy, and an alternative method was used. The Check-Flo Introducer, a microcatheter trocar; crystalloid fluid infusion; and a 3-mm laparoscopic camera were used to survey the abdominal cavity, revealing a 10-cm simple paratubal cyst that could be safely drained and removed via a minilaparotomy incision. Conclusion The microcatheter trocar is a useful and novel alternative in patients who cannot tolerate increases in intraabdominal pressure.

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.

Ultrasonography in a 73-year-old woman revealed two cystic structures in the region of the right adnexa. Magnetic resonance imaging suggested two morphologically distinct, space-occupying lesions, findings confirmed at operation and histological examination of the surgical specimen, which demonstrated a serous cystadenoma of the right ovary and a mucocele of the appendix.

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.

Spontaneous dizygotic unilateral twin tubal pregnancy is an extremely rare occurrence with a high risk for pregnancy-related mortality, and a diagnostic challenge for obstetricians. We present a case of a 27-year-old woman with spontaneous twin tubal pregnancy. Transvaginal color Doppler sonography revealed 2 separate gestational sacs within the right adnexa, each containing an embryo. Cytogenetic examination of the trophoblastic tissues confirmed the diagnosis of dizygotic twin ectopic pregnancy. Clinical signs and symptoms together with imaging studies help in the diagnosis of this rare variant of ectopic pregnancies. © 2008 Wiley Periodicals, Inc. J Clin Ultrasound, 2009

Female adnexal tumors of probable Wolffian origin are rare. Although the histological features of the benign tumors are recognized, features of malignancy are not well defined in published work because these tumors are particularly rare. In this study, we report an 81-year-old woman presenting with a 6-month history of postmenopausal bleeding. A pelvic transvaginal ultrasound scan demonstrated a midline, highly vascular, predominantly solid pelvic mass, approximately 14 cm, posterior to the uterus. CA-125 was moderately raised. She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and infracolic omentectomy. Immunohistochemical staining and electron microscopy supported the diagnosis of female adnexal tumor of probable Wolffian origin. There was significant and widespread nuclear pleomorphism with increased mitotic activity endorsing the diagnosis of a malignant tumor. Seven months after initial surgery, follow-up magnetic resonance imaging showed a mass with a maximum diameter of 7 cm in the region of the right adnexa consistent with a recurrence. The patient declined further treatment.

Torsion of the adnexa has traditionally been treated by adnexectomy because of the fear of emboli departing from thrombosed ovarian veins. Several recent reports have described successful conservative management with unwinding of the twisted adnexa. As the trend toward conservative management progresses, the incidence of recurrent adnexal torsion may increase. We present a case of a 33 year old gravida 3, para 2 Caucasian female who presented at 7 weeks gestation complaining of symptoms similar to those experienced during an episode of right ovarian torsion treated by laparoscopic unwinding 6 years earlier. Colour Doppler sonography revealed absent flow in the right adnexa. The twisted right adnexa containing the presumed corpus luteum of pregnancy was laparoscopically unwound. Using an extracorporeal suturing technique, a laparoscopic oophoropexy was performed to prevent any further rotatory movement. This appears to be the first reported case of laparoscopic oophoropexy for a recurrent ovarian torsion ; we encourage the use of this simple, minimally invasive procedure in cases of recurrent adnexal torsion.

Transabdominal ultrasonography in a female patient hospitalized for acute right lower quadrant pain revealed a nonspecific tubular structure in the region of the right adnexa. Endovaginal ultrasonography clearly showed this structure to be an abnormal loop of small bowel with its “target lesion” appearance and thickened wall. A tentative diagnosis of Crohn's disease was made. This was later confirmed by barium studies and histology.

Gestational trophoblastic disease rarely presents in patients beyond the reproductive years. To our knowledge, this is the first case of mixed trophoblastic disease in a postmenopausal woman. We present here a case of a 60-year-old woman with evidence of a pelvic mass and pulmonary metastasis. Surgery revealed an 8 x 6 x 6 cm multinodular uterine tumor involving the right adnexa. Histologic review was consistent with choriocarcinoma with intermediate trophoblastic features. Postoperative beta-hCG was 381 561 mIU/ml. We conclude that maintaining a high index of suspicion facilitates the identification of postmenopausal patients with metastatic gestational trophoblastic disease. This case reconfirms the deceptive presentation of the "great masquerader".

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.

Our objective was to evaluate the preoperative clinical, laboratory, and sonographic characteristics of struma ovarii in comparison to ovarian dermoid cysts. A retrospective review of gynecologic patients operated on for mature cystic teratoma over a 10 year period identified 12 cases of struma ovarii. These cases, combined with 4 additional cases from an earlier report, were the subject of this study. Results were compared to 32 cases of ovarian dermoid cysts. Ovarian struma ovarii occurred in 12 (4.8%) of 251 cases of ovarian dermoid cysts. Most patients were premenopausal, and the mean lesion diameter was 57.3 mm (range, 30-95 mm). Struma ovarii occurred more frequently (68.8%) in the right adnexa and was seen with a normal CA-125 level. Blood flow, assessed by Doppler ultrasonography, was located in the center of the lesion in all cases of struma ovarii. Rare cases were seen with elevated tumor markers and low resistance blood flow. With regard to dermoid cysts, blood flow had a higher resistive index. In addition, no blood flow could be detected from the center of the echoic lesion in dermoid cysts (P < 0.0001). In summary, it is difficult to distinguish between struma ovarii and dermoid cysts on the basis of their sonographic appearance. Nevertheless, Doppler flow may aid in the preoperative diagnosis of struma ovarii. Blood flow signals, detected from the center of the echoic lesion, and low resistance to flow may be more common in struma ovarii.

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

Torsion of the adnexa is rare, and diagnosis is difficult because of the sparse clinical findings. I describe a patient with recurrent torsion of the right adnexa, involving a cystadenoma of aberrant ovarian tissue. Her only symptom was recurrent right-sided pelvic pain.

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.

1. 1. A brief embryologic discussion is presented as to the origin of hydatids of Morgagni. 2. 2. A review of the literature has shown that torsion of such hydatids has been reported in thirty-nine instances. 3. 3. Torsion of hydatids of Morgagni occur more commonly in the male, the ratio being two to one. 4. 4. A brief discussion of the symptomatology and physical findings is presented. 5. 5. A case of torsion of a right hydatid of Morgagni in a girl fourteen years of age, treated by ligation and excision, together with an appendectomy is reported. 6. 6. It is suggested that in all cases of right lower quadrant pain, if a normal appendix is found at operation, the right adnexa be inspected for torsion of such hydatids.

Case 1.1 —History.—Mrs. I., aged 48, came to see me in December, 1929. Her family history was unimportant. About twenty years before, she had had the last of two miscarriages, which passed off without complication. She had borne no children. A number of years before, Dr. H. C. Cowles of New York had extirpated a bartholinian gland for gonorrheal infection, and in 1927 he removed the right adnexa, which were similarly diseased. The patient said that in 1927 there was a period when her legs became swollen without known cause. When I saw her, the swelling had completely disappeared. In June, 1929, Dr. Charles Gordon Heyd operated on her for cystic disease of the left ovary, removing a degenerated multilocular intraligamentous ovarian cyst. The operation had been difficult because of many adhesions to the hollow viscera, but the remainder of the abdomen had revealed no abnormality. Pathologic examination failed

Pneumoperitoneum as a diagnostic measure has passed the stage of experiment and research and is now a method commonly utilized in gynecology. Similarly, the use of opaque mediums for uterine and tubal diagnosis has met with a measure of success in the hands of Heuser, Forestier, Kennedy and others. As far as we are aware, the two methods have not been combined before. We first considered this combination as to its practicability in December, 1925, and have adopted it for some time past as a means of roentgenray diagnosis in our gynecologic clinic. The following case may well illustrate this use: REPORT OF CASE Mrs. R. E., aged 25, who had been married three years, and whose last menses occurred, May 21, 1926, was sterile. Examination revealed a mass in the right adnexa almost fist sized, which was adherent and tender. In the absence of any inflammatory history