Search

We present here the results of developing a complex method for the differential diagnosis of malignant tumors of the uterine adnexa which was used as the basis for the “Risk Ovarian Cancer v.2.2” computer system. Measures of the sensitivity and specificity of this system and the potential for its use are presented.

Currently, differential diagnostics and treatment of uterine adnexal torsion (UAT) in girls is not completely solved and is not an easy one because surgical and gynecological pathologies often intersect with each other. That is why, girls with abdominal pain are to be consulted by a gynecologist. The case discussed in the article demonstrates the problem with differential diagnostics in girls with “acute abdomen”. UAT differential diagnostics is not easy because this pathology has no clear clinical picture what complicates putting a correct diagnosis. UAT in girls is an acute pathology which has to be differentiated from the volume tumor-like formations in the ovaries, a frequent complication of which is an incomplete torsion of tumor leg or ovarian tumor which then leads to complete uterine adnexa torsion. Differential diagnostics should be done with other surgical pathologies such as acute appendicitis, omentum infiltration. Their clinical picture is characterized by a certain complex of symptoms which develops specific changes during the progress of the inflammatory process; this picture also depends on the anatomical peculiarities. Uterine adnexa torsion is met in 15-25% of girls with abdominal pain syndrome. The aim of this work is to demonstrate preventive measures so as to avoid possible diagnostic errors and complications associated with them in girls with abdominal pain syndrome.

Epithelial metastases originating from the gynecologic tract or secondarily involving it frequently display a different morphology when compared to the primary tumor. Furthermore, issues such as modes of metastasis, appropriate nomenclature and prognostic significance remain subjects of discussion and some skepticism. In this review, we will discuss: metastases to uterine adnexa; serous tubal intraepithelial carcinoma (STIC); serous borderline tumors; metastases from the uterine corpus; and “synchronous” endometrial and ovarian tumors. Three additional themes that will run through the discussions are those that are peculiar, although not restricted to the gynecologic tract: metastasis from non-invasive primary tumors, metastases that look benign and metastases that are benign or clinically indolent.

Background Hernia uteri inguinale (HUI), or uterus-containing inguinal hernia, is an extremely rare condition in which the uterus and uterine adnexa are found in the inguinal hernial sac in female infants. The uterus may be free within the sac adherent to the wall by adhesions or a true sliding component. However, in true sliding-type HUI, one of the walls of the hernia sac is formed by the uterus itself. Patients and Methods The medical records for all female children with inguinal hernia who were operated from 1999 through 2010 were reviewed retrospectively (n=3100). Results Among these patients, we identified seven cases of HUI in infants with a normal female karyotype. The incidence of HUI was 0.23%. Patients were discharged on the postoperative 1st day with no complications. Conclusions Surgeons should be aware of the possibility of presence of the uterus or another organ in the hernial sac in phenotypic female children, and sliding components should be replaced carefully into the abdomen to prevent any damage.

Changes in the local expression of IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-15, IL-18, TNF-α, IFN-γ- and TGF-β2 genes in the uterine adnexa and endometrium were studied in women with pyoinflammatory adnexal diseases. Examination of tissue specimens from the uterine adnexa involved in inflammation revealed a direct correlation in the levels of mRNA production between IL-6 and IL-10 (r=0.93, p

A clinical case of ovarian torsion and necrosis in a 4-month infant, admitted to the surgical department with suspected ileocecal intussusception, is described., Приведён клинический случай перекрута и некроза яичника у ребёнка четырех месяцев, который поступал в хирургическое отделение с подозрением на илеоцекальную инвагинацию., Наведено клінічний випадок перекручення та некрозу яєчника в дитини чотирьох місяців, яка поступила в хірургічне відділення з підозрою на ілеоцекальну інвагінацію.

Unilateral uterine adnexa absence with a normal uterus is extremely rare but meaningful in clinical. To date, this rare malformation is still not well understood. Here, we present a new case and systematically summarize 38 historical cases to make this rare anomaly be understood better by clinicians. The Chinese and English language medical literature were searched for all cases reported to date, and 39 were identified. All 39 cases were assessed for age, menstrual history, reproductive history, pelvic adhesions, other organ abnormalities, and mode of diagnosis. Patient age ranged from 6 days to 46 years. Menstrual history included normal (n = 27), irregular (n = 4), or unknown (n = 7). Childbearing history included pregnancy (n = 21), no history of pregnancy (n = 3), and primary infertility (n = 7). The absence of uterine adnexa involved either the left (n = 17) or right (n = 22) structures, showing a right adnexa preferential bias (22/39). The unilateral absence of uterine adnexa may be a congenital anomaly of reproductive organs; it does not significantly affect fertility or childbearing and is usually not diagnosed until adulthood.

A 2-month-old infant girl died suddenly as a result of torsion of the uterine adnexa. The infant was found unresponsive in bed and was pronounced dead shortly after her arrival at a hospital. There were no antecedent signs of illness. At autopsy, the right ovary and right fallopian tube were twisted and were dark purple, swollen, and necrotic. The right ovary was enlarged by a follicle cyst 4 cm in diameter, which likely precipitated the torsion. The mechanism of death was unclear but may have resulted from the release of cytokines produced in response to necrotic adnexal tissue. Fatal uterine adnexal torsion has been reported rarely in infants; in all those cases there were antecedent symptoms. Torsion of the uterine adnexa should be included in the differential diagnosis of sudden death in infancy.

Advances in understanding of the mechanisms involved in oncogenesis have led to the development of targeted therapies such as epidermal growth factor receptor inhibitors (EGFRIs), targeting a variety of molecular structures and able to inhibit aberrantly activated oncogenic pathways. Their use made treatment more tolerable with significant reduction of systemic adverse effects. However, EGFRIs are associated with toxicities affecting the skin and adnexal structures that affect the majority of treated patients. Trichomegaly of eyelashes is a unique side-effect, seen in prolonged treatment with EGFRI. It is essential to be familiar with this adverse effect, its potential complications, long-term sequelae, and available effective treatment strategy in order to appropriately manage these patients.

We herein report two female cases, aged 1 and 1.5 months, of inguinal sliding hernias containing the uterus, fallopian tube, and ovary. The diagnosis of inguinal hernia with uterus and uterine adnexa was highly suspected preoperatively by ultrasonography and was confirmed during surgical correction. Freeing the attachment of fallopian tube and uterus from the sac and with reduction of the uterus, ovary, and fallopian tube back to the peritoneal cavity, high ligation of the hernia sac was performed in these cases. In conclusion, the hernia sac containing fallopian tube, ovary, and uterus in the female is very rare. We present our experience of treatment with these rare cases and suggest that sonography be performed routinely in female infants with an inguinal hernia containing a palpable movable mass.

Torsion of the fallopian tube and ovary has an interesting and extensive history in the gynecologic literature. Frequent occurrence of this malady in children gives the topic added importance. Early diagnosis is made difficult by the symptoms, history, and physical findings that may be confusing and result in delayed initiation of a definitive therapy. Rapid and precise diagnosis of torsion is expected and necessary for early intervention to prevent loss of reproductive organs and function.

Background: We ask patients' doctors and nurses to answer the questionnaires after intervention for self-assessment and mutual assessment. Purpose: We analyze the questionnaires and assess intervention by our team. Patients and Method: The questionnaire included; had their requests been resolved? (Q1), had patients and their family looked changed? (Q2), had doctors looked changed? (Q3), had nurses looked changed? (Q4), and we asked them to write down detail of the change concretely. We analyzed 35 questionnaires of patients with malignant tumors whom we had intervened in from 2012 to 2013. Results: The characteristics of the 35 cases were as follows: male, 20; female, 15; mean age, 66 years; range, 40-82 years; location, digestive organ, 12, hematopoietic organ, 10, urinary tract, 5, head and neck, 4, lung, 3, uterine adnexa, 1. 9 patients were under intensive treatment and 26 were in terminal stage. Aims were as follows: pain control, 27, relief of symptoms except pain, 13, mental support, 21, introduction of hospice or home care, 4, family support, 9. Mean interventional period was 21 days; range, 2-83 days, and mean interventional time was 7; range, 2-17. Doctors and nurses assessed their requests had been resolved in 19 (54%) and 14 (40%) cases, respectively (Q1), and answered yes in 26 (74%) and 29 (82%) (Q2), 22 (62%) and 11 (31%) (Q3), and 10 (28%) and 28 (80%) (Q4), respectively. Almost all changes were favorable. Each answer of doctors and nurses had agreed in 20 (57%) (Q1), 27 (77%) (Q2), 20 (57%) (Q3), and 14 cases (40%) (Q4). Conclusion: Our intervention brought favorable changes for most patients and their families, although requests had resolved in not a lot of cases. We should work on doctors and nurses to hold their information in common to correct the discrepancy in their assessment.

Extraskeletal myxoid chondrosarcoma is a rare soft-tissue sarcoma, mostly occurring in the proximal extremities and limb girdle. Majority of the patients are in fifth and sixth decades of life with male preponderance. We report here a case of primary extraskeletal myxoid chondrosarcoma of the uterine adnexa involving the broad ligament and fallopian tube synchronously without any evidence of uterine/ovarian involvement in a young multiparous female of 27 years. After the histopathological diagnosis, re-excision of the tumor bed with wide local margins was recommended. Since the tumor has an aggressive course, with propensity for late recurrence and metastases to lungs, the patient must be considered for long-term follow-up.

The unilateral absence of uterine adnexa is a rarely described entity. It may be due to developmental failure or auto amputation following adnexal torsion.[1] Such a condition may be discovered during investigation for infertility or primary amenorrhea in asymptomatic cases with or without past history of acute abdomen pain. It may be incidentally detected as a migratory abdominal calcification during radiologic investigation and also during postmortem examination

OBJECTIVE: To evaluate the clinical and pathologic correlates of specimens removed for the diagnosis of adnexal torsion and to evaluate trends in the management of torsion. STUDY DESIGN: Cases of ovarian or adnexal torsion (N = 104) were identified retrospectively over a period extending from January 1987 to March 1998 by the coding of ovarian, fallopian tube or adnexal torsion. Statistical evaluation was by X 2 analysis using the Bonferroni inequality correction when appropriate. RESULTS: Neoplastic and functional tumors of the ovary composed >90% of the diagnoses at microscopic evaluation, with cancer diagnosed in < 1% of cases. Laparoscopy was attempted in 47 (46%) cases, and adnexa-sparing procedures were performed in 20 (19%) patients. Patients treated in the latter half of the study were not less likely to undergo laparotomy than those treated in the first half; however, conversion from laparoscopy to laparotomy was significantly less common in the latter half. Patients in this study were more likely to receive an adnexa-sparing operation than historical controls, but there was no improvement in this rate from the first to the second half of this study. A history of previous abdominal surgery was the most common associated condition, but 47% of patients had no known risk factors. Ovarian hyperstimulation, previously omitted in series reports, was an antecedent factor in 9% of patients. CONCLUSION: Adnexal torsion is most commonly associated with a benign process. A more-conservative approach to the treatment of this process is becoming increasingly common, as seems warranted in light of the low incidence of malignancy. The need for conversion from a laparoscopic to an open approach appears to have been waning over the last decade; that may correlate with an increased comfort level in gynecologists with laparoscopic approaches.

Although uterine adnexal torsion is a rare phenomenon and an infrequent diagnosis, there have been several reported cases. Two cases that occurred in our practice in the past year are presented to illustrate the acute and chronic phases of the disease. This paper discusses the intrinsic and extrinsic concepts of etiologic factors of adnexal torsion and reviews the common presenting symptoms and the physical, laboratory and pathologic findings of this syndrome. An increased index of suspicion of intermittent adnexal torsion may lead to laparoscopic diagnosis and conservative therapy.

50歳, 女性の子宮付属器に発生した悪性腹膜中皮腫を経験したので, 細胞所見, 組織所見について報告する. 患者は卵巣癌を疑われ開腹手術をうけた. 超手拳大の腫瘍が付属器に限局してみられ, 単純子宮全摘術, 両付属器切除, 大網部分切除術が施行された. 腫瘍の捺印細胞診では, 上皮性の結合を示すやや小型の腫瘍細胞と, 散在性に出現する非上皮性形態を示す大型の腫瘍細胞が混在して認められ中胚葉性混合腫瘍を思わせた. 術前の腹水細胞診でも紡錘形の胞体をもつ異型細胞をごく少数認めたが, 確診はできなかった. 組織学的には, 付属器の漿膜面に限局して, 管状, 乳頭状ないし髄様構造をもつ腫瘍が認められたがはっきりした非上皮性部分はなく, 限局性, 上皮型の悪性腹膜申皮腫と診断された. PAS染色陰性, Alcian blue染色で一部陽性となり, これはhyaluronidase処理で消失した. 電顕では細胞の管腔面や細胞間隙腔に細長い微絨毛が多数認められた. 免疫組織化学的に各種腫瘍マーカーの染色を試みたが, ヒトケラチン蛋白, epithelialmembrane antigen, CA125で陽性所見が得られ, carcinoembryonic antigen (CEA) は陰性であった.

A miniature Geiger-Müller probe was inserted into one ovary of 8 women undergoing hysterectomy. A control probe was inserted into the other ovary of 2 of the women. Krypton-85 in 0.15 M-NaCl was infused into the adjacent utero-ovarian vein and the radioactivity was registered for 5--14 min after the infusion. An increase of radioactivity was recorded in the ovary in 5 cases. In one of the women with 2 probes, no increase in radioactivity was observed in the control ovary. The results show a local transfer of gas from the ovarian branch of the uterine vein into the adjacent ovary, which may be due to a countercurrent exchange mechanism between the vessels of the human uterine adnexa.

Torsion of the uterine adnexa is an urgent surgical condition that usually occurs in women of reproductive age. In the present review of 135 women with surgically proved disease, sudden abdominal pain, a tender pelvic mass, and signs of moderate, pelvic, peritoneal irritation were the most specific helps to diagnosis. More than half of the patients recalled having had previous, similar attacks. Most patients with twisted uterine adnexa did not have malignancy. When possible, a conservative surgical approach should be used, and fertility should be preserved.

The purpose of this paper is to consider the twisting of oviducts and ovaries which are otherwise normal without other coexisting pelvic pathology. In order to eliminate all reasonable possibility of inflammation it is deemed advisable not to include those cases in which the condition has occurred beyond the age of sixteen years. It must be realized that coitus introduces the possibility of pelvic infection, and there is no assurance of virginity beyond this age. Perhaps we should have limited our consideration of cases to those who had not reached puberty, because occasionally the state of virginity is terminated soon after. On the maternity services of two Detroit hospitals 94 girls sixteen years of age or under were delivered in one year (1929) and one of the patients was only eleven years old. During this same period of time (one year) the records of the Juvenile Court of Detroit show that of the 1886 girls sixteen years of age or under examined, only 566 or 30 per cent had intact hymens. Schied 1 in 1922 reported having operated upon a fifteen-year-old patient with pyosalpingitis and another, thirteen years old, with chronic active salpingitis. Gonorrheal vulvovaginitis in children and young girls is a common disease. Married women could not be considered, even if there were not the element of pregnancy, because the assurance of normal oviducts in this group is still more remote.

1. 1. Torsion of ovarian tumors is an uncommon occurrence in childhood, as shown by the fact that only 26 cases, including our own, have been reported in the literature since 1900. 2. 2. About 50 per cent occurred between the ages of eight and ten. 3. 3. Sixty per cent of them were dermoids. 4. 4. The tumors varied in size from that of an adult ovary to one reaching above the umbilicus. 5. 5. The symptoms are those of an abdominal crisis similar to that of the same accident in adult life, sudden abdominal pain, vomiting, a variable degree of prostration, tenderness, rigidity, distention, temperature, increased pulse rate, and the presence of an abdominal tumor. 6. 6. The diagnosis is usually difficult, probably due to rarity. Appendicitis is often the preoperative diagnosis. 7. 7. The causes are much the same as in adult life. 8. 8. Fourteen claimed cases of torsion of normal adnexa have been reported to date. 9. 9. Eight of fourteen cases, more than half, occurred before the age of 20; four under 12, and presumably before puberty. 10. 10. The tube alone may be involved, the tube and ovary together, or the ovary may be essentially the offending organ. 11. 11. A large percentage occur in close relation to the menstrual period. 12. 12. Three are reported during pregnancy. 13. 13. Some question still exists as to whether a normal tube can undergo torsion, but it seems to be proved that a normal ovary may do so. 14. 14. Factors such as the length of the mesentery, the size of the ovary, and the length of the tube, must be considered as well as the histologic structure of the organ. 15. 15. Torsion of adnexa in hernial sacs (apart from strangulation) is relatively rare. It occurs only in congenital inguinal hernias and usually in the first year of life.

Sequential bilateral torsion of the uterine adnexa in a young girl led to right and, subsequently, left salpingo-oophorectomy. Acute lower abdominal pain in a young female patient, especially one who has had previous similar episodes, should alert the physician to the possible presence of adnexal torsion. If possible, surgical management of this condition should be conservative--that is, the blood supply should be restored to the adnexa and a viable tube or ovary should be preserved. Contralateral adnexal suspension should always be done, in an effort to prevent bilateral adnexal torsion and to preserve the reproductive potential in these young patients.

An adolescent with pelvic calcification, autoamputation of the right uterine adnexa, and surface endometriosis of the left ovary is presented. The differential diagnosis of pelvic calcifications in adolescent females is discussed.

Two cases are reported of torsion of the normal uterine adnexa in premenarchal girls. In one patient, aged 3 yr, both the ovary and fallopian tube had undergone torsion. The second patient, aged 11 yr, had sustained torsion of the fallopian tube alone. This is the first reported case of torsion of the fallopian tube occurring without torsion of the ovary in a patient in this age group. The mechanisms of torsion of normal uterine adnexa are described and the operative management is discussed.

Received March 26, 1 982; accepted after revision August 1 6, 1982. ‘Department of Radiology, Pennsylvania State University, M. S. Hershey Medical Center, 500 University Dr., Hershey, PA 1 7033. Address reprint requests to D. K. Boal. 2Department of Radiology, Childrens Hospital Medical Center, Harvard Medical School, Boston, MA 021 i 5. 3Department of Surgery, Pennsylvania State University, M. S. Hershey Medical Center, 500 University Dr., Hershey, PA 1 7033. 1223

An antenatal detection of unilateral torsion of uterine adnexa was made by means of ultrasonography on the 32nd gestational week. This presented as an asymptomatic large "pseudo-cystic" mass, and was resected electively at the age of two weeks. A "fluid-fluid" level on ultrasonography is highly suggestive of this rare entity. This is the fourth case in the English literature to have been detected antenatally, and among the first dozen to be reported in the neonatal period.

The marked operative tendency which existed among gynecologists toward the end of the last century was naturally followed by a more conservative era. Signs were not wanting that the pendulum had reached the limit of its swing toward the operative side and that its return movement had begun. At one of the New York medical societies Emmet ridiculed the common occurrence of presenting large jars with uterine adnexa at gynecologic meetings. Ramy, 1 in a warning against operating without indication, ironically called attention to the fact that at some gynecologic meetings the surgeons who reported the most radical operations on the female genital organs received the greatest recognition. After these and similar warnings the question naturally arose whether it was not possible to attain normal conditions or nearly such in the female pelvis with non-operative methods. It is not to be denied that the non-operative treatment often requires weeks to

In recent literature it has been usual to speak of the conservative surgery of the uterine adnexa as though it were one subject. In point of fact, the resection of diseased tubes and the conservation of the ovaries belonging to them is usually brought to our attention in inflammatory cases and the question then hinges mainly on the condition of the tube, i. e., on the possibility of its restoration to functional value, as balanced against the possibility of reinfection of the pelvis from the patent stump. In this class of cases the condition of the ovary is usually a subordinate matter. These cases are etiologically in a different class from those which present normal tubes and neoplastic ovaries. They are also distinct clinically since in the latter class the decision rests wholly on the state of the ovary. I believe that confusion has been wrought, that clearness of thought

n/a

n/a

A case of torsion of a normal right ovary and tube in an 8-year-old child is presented. True infarction of the adnexa can be prevented only by considering this diagnosis early in the course of right lower quadrant pain. It is recommended that a routine exploration of the pelvis be carried out in any patient explored for acute appendicitis in whom that diagnosis cannot be made at the operating table.