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Objective: To diagnostic accuracy of ultrasonongraphy and MRI for characterization of pelvic masses of gynecological origin in reproductive age group, with histopathology acting as the gold standard. Study Design: Crosssectional. Setting: Department of Radiology, PAF Hospital Islamabad. Period: April 25th, 2021, to October 25th, 2021. Methods: In this investigation, non-probability consecutive sampling was utilized to collect data. A total of 220 women with pelvic mass were included in the study. Data regarding characterization of pelvic masses (malignant/benign) form ultrasound/MRI and histopathology was noted as per operational definition. Results: The study included participants aged 18-50, with a mean age of 31.6135.70 years, a mean parity of 3.130+1.37, and a mean duration of complaints of 7.186 +2.10 weeks. Ultrasound has shown sensitivity of 75.5%, specificity 88.8% and diagnostic accuracy by 83.2%, PPV 69% and NPV 88.3%. MRI has shown sensitivity of 83%, specificity 93.7% and diagnostic accuracy by 91%, PPV 83% and NPV 93.7% in characterization of pelvic masses. Conclusion: When sonographic characteristics of a pelvic tumor are inconclusive, MRI should be investigated for pathology investigation. [ABSTRACT FROM AUTHOR]

Meigs syndrome is a classic triad of ascites, pleural effusions, and an ovarian fibroma with resolution following excision. Pseudo‐Meigs syndrome presents similarly but is caused by a pelvic mass other than an ovarian fibroma, such as a fibroid. We present a case report of a 33‐year‐old gravida 2 para 0‐0‐1‐0 woman with a massive, pedunculated fibroid who developed rapid onset of ascites and edema beginning at 5 weeks of gestation. Malignant, cardiac, renal, hepatic, and rheumatologic causes were ruled out. Her symptoms resolved following myomectomy and delivery via cesarean. Pseudo‐Meigs syndrome was suspected. Pseudo‐Meigs syndrome is a diagnosis of exclusion and requires surgical management for resolution. Pregnancy may be an inciting factor. Myomectomy may be done safely at the time of cesarean. Synopsis: Pseudo‐Meigs syndrome consists of ascites, pleural effusions, and a benign pelvic mass and resolves with surgical excision; it may be exacerbated in pregnancy. [ABSTRACT FROM AUTHOR]

INTRODUCTION: A complete consensus has not been achieved in the diagnosis and management of uterovaginal canal obstructions in children and adolescents. In this study, our uterovaginal canal obstruction experiences were evaluated with the literature. METHODS: Data of patients with uterovaginal obstruction were evaluated, between 2015 and 2018. Values were expressed as counts and percentages. RESULTS: Twenty-one female patients with uterovaginal obstruction were detected. The mean age was 13 (Min-max: 3 days-17 years). The most common anomalies detected were labial synechia and imperforate hymen.. DISCUSSION AND CONCLUSION: Most of the uterovaginal obstructions can be treated with simple surgical intervention when differential diagnosis is kept in mind. However, complex cases require a multidisciplinary approach.

Introduction: The congenital vaginal obstructions, which may be associated with labial synechia, imperforate hymen, complete vaginal transverse septum, partial vaginal agenesis or atresia are extremely rare reproductive system anomalies in children and a dolescents. A complete consensus has not been achieved in the diagnosis and management of uterovaginal canal obstructions in children and a dolescents. In this study, our uterovaginal canal obstruction experiences were evaluated with the literature. Materials and Methods: Data of patients with uterovaginal obstruction were evaluated, between 2015 and 2018. Values were expressed as counts and percentages. The files containing age, symptoms, diagnosis, radiological modalities and surgical management of the pa tients diagnosed with reproductive tract obstruction, between 1st April 2015 and 1st August 2018 were evaluated retrospectively. In addition to the general physical examination, a careful urogenital system examination was performed in the initial evaluation of the patients Results: Twenty-one female patients with uterovaginal obstruction were detected. The mean age was. The most common anomalies detected were labial synechia and imperforate hymen. Moreover, the labial synechia was determined in 9 patients, the imperforate hymen in 7 patients, the distal vaginal atresia in 2 patients, the OHVIRA in 2 patients. Conclusion: Most of the uterovaginal obstructions can be treated with simple surgical intervention when differential diagnosis is kept in mind. However, complex cases require a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Abstract Background Telangiectatic osteosarcoma is rare and it rarely affects flat bones, especially the bones of the pelvis. It is uncommon for telangiectatic osteosarcoma to be considered as a differential diagnosis when assessing a large intrabdominal mass. Case report We present our case of a 33-year-old African female who presented with a sizeable telangiectatic osteosarcoma of the left iliac bone. She reported a 3-year duration of a painless, slow-growing mass arising from the left flank. At examination, a large bony hard mass extending from the left ilium to the umbilicus was noted, almost mimicking an intra-abdominal pregnancy. All laboratory tests were within normal limits and an unconventional surgical approach was used for a one-stage excision of the tumor without complications. The definitive histopathological diagnosis postexcision was that of a telangiectatic osteosarcoma only on the second review of the histological specimen. Conclusions Pelvic telangiectatic osteosarcoma is rare, and the ilium is the commonly affected pelvic bone. These tumors can be sizeable at presentation with intra-abdominal or pelvic extension with a high chance of misdiagnosis. Fortunately surrounding soft tissue involvement seems to be a rare and late finding when present.

Boning Li,1,* Tingting Zhu,1,* Fenghua Ma,2 Yuqing Zhao1 1Department of Gynecology, the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, People’s Republic of China; 2Department of Radiology, the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yuqing Zhao, Department of Gynecology, the Obstetrics and Gynecology Hospital of Fudan University, No. 128, Shenyang Road, Yangpu District, Shanghai, 200090, People’s Republic of China, Tel +86-13817678883, Fax +86-021-33189900, Email yyqingzz@126.comAbstract: An ectopic kidney is a rare congenital defect that is often asymptomatic, but can be incidentally discovered during imaging examinations. Moreover, the morphological characteristics and laboratory features of ectopic kidneys are nonspecific, which may lead to misleading diagnostic approaches, particularly when there are additional factors, such as infection, obstruction, or other anomalies. A 43-year-old female presented with a mass in the left adnexal area. She had septate uterus and a history of congenital urinary incontinence. Ultrasound and MRI findings indicated that the mass was a cyst originating from the ovary. However, it is possible that the lump was derived from the urinary system. To confirm the diagnosis, laparoscopy was performed, followed by pathological examination, which confirmed the presence of an ectopic kidney with a single-system ectopic ureter. The patient underwent nephroureterectomy, and her symptoms successfully resolved, leading to a favorable prognosis. This case report highlights a rare case involving an ectopic kidney with a vaginal ectopic ureter that initially presented as an adnexal cyst and caused urinary dribbling. This case emphasizes the importance of early recognition and accurate diagnosis in women with similar symptoms.Keywords: ectopic kidney, ectopic ureter, urinary incontinence, pelvic mass, urogenital malformation

Peripheral nerve sheath tumors are very rare to arise from the obturator nerve. As such, they are usually not considered one of the imaging diagnostic possibilities for a cystic-solid pelvic mass. The present case involves a 32-year-old man with a known pelvic mass who complained of increasing discomfort in his pelvic region along with swelling over his left inguinal area. The tumor was reported to exhibit mixed solid and cystic components after being tracked with serial imaging for 5 years.

Key Clinical Message: We present a rare case of a female pelvic solitary fibrous tumor unsuccessfully resected using single‐port laparoscopy, requiring conversion to laparotomy. Although the resection was successful, the surgical approach could have been improved. For large tumors, minimally invasive results are possible with flexible choices of equipment and incision position. [ABSTRACT FROM AUTHOR]

• Study on mucinous ovarian cancer involving 43 cases and evaluating the impact of gastro-intestinal endoscopy on survival. • No difference in overall survival was noticed between the endoscopy and non-endoscopy groups. • The 5-year overall survival and recurrence rate of our patients is similar to published literature. • Our findings do not support the routine use of endoscopy in every case of mucinous ovarian cancer. • Our findings support the use of endoscopy in cases high-risk for metastatic disease on imaging. Mucinous ovarian cancer (MOC) represents a rare entity of ovarian malignant neoplasms. The true incidence could be as low as 3% of all ovarian cancers. The aim of this study is to compare and understand the clinicopathological characteristics of patients with mucinous ovarian cancer, report on the survival rates and evaluate the role of gastrointestinal (GI) endoscopy as part of the peri -operative investigations and the impact it has on the survival rates. This is a retrospective data collection on patients with MOC operated in Nottingham gynaecological oncology centre over a 10-year period. Data were analysed using SPSS software. 43 cases were included in the final analysis. The median maximal tumour diameter was 180 mm. 32 (74.5 %) and 11 (25.5 %) women presented with unilateral and bilateral tumours respectively. 30 patients (69.7 %) presented with stage 1 disease, 1 (2.3 %) presented with stage 2 disease, 7 women (16.4 %) had stage 3 disease and 1 woman (11.6 %) had stage 4 disease. 41 women had staging surgical procedures and 2 women had limited surgery due to poor performance status. After final histology, 5 cases found to have metastatic disease to the ovary rather than primary MOC. 14 women had GI endoscopy as part of their investigation. The total estimated cost of the endoscopies that have been performed is £5635. Primary GI cancer was diagnosed in 1 case during the endoscopy (1 case of gastric cancer). The 5-year overall survival of the women included in this study is 62.8 %. The 5-year overall survival of the women in the endoscopy and non-endoscopy groups was 60 % and 64.3 % respectively (p-value: 0.767). The findings of this study show that the survival rates of patients treated for mucinous ovarian cancer in our centre are similar to other published studies. Our findings do not support the routine use of GI endoscopy in the peri -operative investigations of every patient with MOC due to the non-statistically significant difference in the overall survival. [ABSTRACT FROM AUTHOR]

Background: Telangiectatic osteosarcoma is rare and it rarely affects flat bones, especially the bones of the pelvis. It is uncommon for telangiectatic osteosarcoma to be considered as a differential diagnosis when assessing a large intrabdominal mass. Case report: We present our case of a 33-year-old African female who presented with a sizeable telangiectatic osteosarcoma of the left iliac bone. She reported a 3-year duration of a painless, slow-growing mass arising from the left flank. At examination, a large bony hard mass extending from the left ilium to the umbilicus was noted, almost mimicking an intra-abdominal pregnancy. All laboratory tests were within normal limits and an unconventional surgical approach was used for a one-stage excision of the tumor without complications. The definitive histopathological diagnosis postexcision was that of a telangiectatic osteosarcoma only on the second review of the histological specimen. Conclusions: Pelvic telangiectatic osteosarcoma is rare, and the ilium is the commonly affected pelvic bone. These tumors can be sizeable at presentation with intra-abdominal or pelvic extension with a high chance of misdiagnosis. Fortunately surrounding soft tissue involvement seems to be a rare and late finding when present. [ABSTRACT FROM AUTHOR]

This article discusses a rare complication of endometriosis called superinfection, which occurs in 1-2% of cases. Superinfection can result from various sources, such as ascending infection from the lower genital tract or direct inoculation from a surgical procedure. The article presents a case study of a 51-year-old woman with a complex pelvic mass, initially suspected to be ovarian cystadenocarcinoma. However, surgical management revealed severe pelvic endometriosis with superimposed ascending infection. The article emphasizes the importance of considering superinfection of endometriosis as a differential diagnosis for complex pelvic masses and highlights the need for multidisciplinary team review in such cases. [Extracted from the article]

Hypervirulent Klebsiella pneumoniae (hvKp) causes invasive infections in the community setting. We report a rare case of uterine abscess due to hvKp, which appeared as a large-sized ovarian tumor-like pelvic mass. A timely laboratory warning of possible hvKp prompted correct diagnosis and helped guide perioperative decision making, contributing to successful treatment.

A 48-year-old man with a medical history of hypertension and no family history of prostate cancer presented with abdominal distension, lower abdominal pain, and lower urinary symptoms. Physical examination revealed a palpable mass in the lower abdomen, and a digital rectal examination detected a firm mass on the anterior side of the rectum. Laboratory tests showed an elevated PSA level (7.9 ng/mL). Imaging studies indicated a solid mass connected to the prostate's posterior and rectum's anterior walls, along with bladder compression. Transperitoneal biopsy and histological analysis led to a diagnosis of a stromal tumor with uncertain potential malignancy. Considering the absence of apparent malignancy signs and the smooth outer wall of the tumor, the patient underwent, for the first time in the literature, a robot-assisted radical extraperitoneal prostatectomy for complete macroscopic resection. The surgery involved excision of the bulky pelvic mass, preservation of the urethra, and anatomical reconstruction. The postoperative course was uneventful, and we discharged the patient with no complications. The pathological examination documented the diagnosis of multilocular prostatic cystadenoma. Post-surgery follow-up examinations, including PSA levels and imaging scans, showed no signs of tumor recurrence. At the 3-, 6-, and 9-month follow-ups, the patient was asymptomatic and had fully recovered, with no urinary or sexual dysfunction reported. [ABSTRACT FROM AUTHOR]

Key Clinical Message We present a rare case of a female pelvic solitary fibrous tumor unsuccessfully resected using single‐port laparoscopy, requiring conversion to laparotomy. Although the resection was successful, the surgical approach could have been improved. For large tumors, minimally invasive results are possible with flexible choices of equipment and incision position.

Key Clinical Message The coexistence of extramedullary hematopoiesis and extramedullary multiple myeloma can occur and present as painful pelvic masses. In such a case, normal hematopoietic cells may outnumber clonal plasma cells, posing a diagnostic challenge.

BackgroundSurgery remains the main treatment option for an adnexal mass suspicious of ovarian cancer. The malignancy rate is, however, only 10–15% in women undergoing surgery. This results in a high number of unnecessary surgeries. A surveillance-based approach is recommended to form the basis for surgical referrals. We have previously reported the clinical performance of MIA3G, a deep neural network-based algorithm, for assessing ovarian cancer risk. In this study, we show that MIA3G markedly improves the surgical selection for women presenting with adnexal masses.MethodsMIA3G employs seven serum biomarkers, patient age, and menopausal status. Serum samples were collected from 785 women (IQR: 39–55 years) across 12 centers that presented with adnexal masses. MIA3G risk scores were calculated for all subjects in this cohort. Physicians had no access to the MIA3G risk score when deciding upon a surgical referral. The performance of MIA3G for surgery referral was compared to clinical and surgical outcomes. MIA3G was also tested in an independent cohort comprising 29 women across 14 study sites, in which the physicians had access to and utilized MIA3G prior to surgical consideration.ResultsWhen compared to the actual number of surgeries (n = 207), referrals based on the MIA3G score would have reduced surgeries by 62% (n = 79). The reduction was higher in premenopausal patients (77%) and in patients ≤55 years old (70%). In addition, a 431% improvement in malignancy prediction would have been observed if physicians had utilized MIA3G scores for surgery selection. The accuracy of MIA3G referral was 90.00% (CI 87.89–92.11), while only 9.18% accuracy was observed when the MIA3G score was not used. These results were corroborated in an independent multi-site study of 29 patients in which the physicians utilized MIA3G in surgical consideration. The surgery reduction was 87% in this cohort. Moreover, the accuracy and concordance of MIA3G in this independent cohort were each 96.55%.ConclusionThese findings demonstrate that MIA3G markedly augments the physician’s decisions for surgical intervention and improves malignancy prediction in women presenting with adnexal masses. MIA3G utilization as a clinical diagnostic tool might help reduce unnecessary surgeries.

The weakened immune system in people living with HIV (PLWH) can lead to infectious diseases occurring more aggressively and mimicking the clinical manifestations of malignancies. Mycobacterium sherrisii, a slow-growing nontuberculous mycobacterium, may cause opportunistic infections among PLWH. We present a case of a 41-year-old woman who initially presented with fever, vaginal spotting, and a bulky pelvic mass, raising suspicion of uterine malignancy. Following a surgical resection, she was pathologically diagnosed with leiomyoma and endometriosis. However, during an event of needlestick injury, she was unexpectedly found to be HIV-infected and the CD4 count was 157 cells/µL at diagnosis, which prompted a diagnostic work-up for opportunistic infections. The diagnosis of disseminated M. sherrisii infection was confirmed through cultures and special staining of specimens obtained from the pelvic tumor and blood. Subsequently, she was treated with a combination of ethambutol, azithromycin, and levofloxacin. Two months after treatment, abdominal and pelvic computed tomography revealed no evidence of recurrent tumor or abscess formation. Given the frequent association of pelvic masses with gynecologic malignancies in women living with HIV, it can be challenging to differentiate between a cancerous lesion and an infectious process, emphasizing the need for meticulous investigations to minimize the potential for misdiagnosis.

Key Clinical Message: The coexistence of extramedullary hematopoiesis and extramedullary multiple myeloma can occur and present as painful pelvic masses. In such a case, normal hematopoietic cells may outnumber clonal plasma cells, posing a diagnostic challenge. [ABSTRACT FROM AUTHOR]

Leiomyosarcoma of the prostate is a rare and aggressive tumor, with a quarter of the patients harboring metastatic disease, commonly in the lung. It usually presents with urinary obstruction in a relatively younger patient group. A 29-year-old male presented with lower urinary tract symptoms to the urologist. Computed tomography scan revealed a large pelvic mass involving the prostate. Biopsy on two occasions yielded leiomyoma. Instead of conventional radical surgery, en-bloc resection of the mass was done while preserving the remaining portion of the prostate, seminal vesicles, and ejaculatory duct. Histopathology revealed a high-grade leiomyosarcoma with negative margins. The patient had excellent recovery of defecation, erectile, and ejaculatory functions within 2 months after adjuvant radiotherapy. At the 24-month follow-up there was no evidence of disease. En-bloc resection of the tumor can be considered in select cases to improve functional outcomes and sustain a higher quality of life in patients. [ABSTRACT FROM AUTHOR]

Aggressive Angiomyxoma (AA) is a rare, benign, and slow-growing mesenchymal tumor that affects the female pelvis and perineum. It appears as an infiltrative tumor with a high likelihood of local recurrence (up to 71%), which is why it is called aggressive. In this case, a 35-year-old female presented with heavy menstrual bleeding for four months and abdominal pain for one month. Clinical examination revealed the presence of a palpable, uniform, non-mobile mass over the uterus. Ultrasonography revealed fibroid with cystic change. Surgical excision of the mass was performed and its histopathological examination established the diagnosis as aggressive angiomyxoma. The diagnosis of AA is difficult due to its nonspecific clinical and radiological findings. This case report reveals the importance of histopathology in the diagnosis of aggressive angiomyxoma.

• A pelvic mass is often considered a gynecologic malignancy among people living with HIV (PLWH). • Opportunistic infections can mimic the manifestations of malignancies in PLWH. • Mycobacterium sherrisii infection may present as mycobacteremia and multi-organ involvement. The weakened immune system in people living with HIV (PLWH) can lead to infectious diseases occurring more aggressively and mimicking the clinical manifestations of malignancies. Mycobacterium sherrisii , a slow-growing nontuberculous mycobacterium, may cause opportunistic infections among PLWH. We present a case of a 41-year-old woman who initially presented with fever, vaginal spotting, and a bulky pelvic mass, raising suspicion of uterine malignancy. Following a surgical resection, she was pathologically diagnosed with leiomyoma and endometriosis. However, during an event of needlestick injury, she was unexpectedly found to be HIV-infected and the CD4 count was 157 cells/µL at diagnosis, which prompted a diagnostic work-up for opportunistic infections. The diagnosis of disseminated M. sherrisii infection was confirmed through cultures and special staining of specimens obtained from the pelvic tumor and blood. Subsequently, she was treated with a combination of ethambutol, azithromycin, and levofloxacin. Two months after treatment, abdominal and pelvic computed tomography revealed no evidence of recurrent tumor or abscess formation. Given the frequent association of pelvic masses with gynecologic malignancies in women living with HIV, it can be challenging to differentiate between a cancerous lesion and an infectious process, emphasizing the need for meticulous investigations to minimize the potential for misdiagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Uterine leiomyomas, solid benign monoclonal tumors, are the most common pelvic tumor in women. Sex steroid hormones are thought to play a role in their pathogenesis, and they are known to increase with age in premenopausal women. Leiomyomas are exceedingly rare in the pediatric and adolescent population and even more so in premenarchal females. Case presentation: An 11-year-old premenarchal patient presented with a large abdominal mass, which had been increasing in size for the previous year. Laboratory studies were normal. Magnetic Resonance Imaging (MRI) confirmed a solid, circumscribed 8.5× 16.5 × 15.9 cm mass. Open biopsy was consistent leiomyoma. Exploratory laparotomy via infraumbilical vertical midline incision was performed. After exteriorizing the uterus, compressing the uterine arteries with a Penrose drain and injecting dilute vasopressin into the serosa of the uterus, the plane beneath the serosa, between the leiomyoma and normal myometrium was identified. The mass was completely resected without entering the endometrium. The uterus was closed transversely, from cornua to cornua in three layers. Menarche occurred 4 months after surgery. Three years post-operatively, the patient remains menstruating normally and free of recurrent leiomyoma. Conclusion: Though rare in premenarchal patients, leiomyoma should be considered in the differential for pelvic and uterine masses. An understanding of the surgical technique for uterine preservation is important. The underlying factors for stimulation of this large benign uterine mass remain unknown.

Cervical adenocarcinoma accounts for 10%-25% of total cases of cervical carcinoma. But in recent years, the incidence of adenocarcinoma has risen both proportionally and absolutely. Clinically, most cervical adenocarcinoma show no symptom or present with abnormal uterine bleeding or vaginal discharge, similar to squamous cell carcinoma. What different about it is that cervical cytological testing demonstrates a high false-negative rate of cervical adenocarcinoma, potentially leading to the failure in detecting in early stage. This report presents two cases both with pelvic masses, and massive ascites served as the initial symptom, which is similar to the clinical symptom of ovarian cancer, but ultimately diagnosed with cervical adenocarcinoma through surgical specimens. There are few literature reports on this situation. Hence, a literature review also has been performed to improve the recognition for cervical adenocarcinoma presenting with pelvic masses and massive ascites, and to avoid misdiagnosis. [ABSTRACT FROM AUTHOR]

Aggressive Angiomyxoma (AA) is a rare, benign, and slow-growing mesenchymal tumor that affects the female pelvis and perineum. It appears as an infiltrative tumor with a high likelihood of local recurrence (up to 71%), which is why it is called aggressive. In this case, a 35-year-old female presented with heavy menstrual bleeding for four months and abdominal pain for one month. Clinical examination revealed the presence of a palpable, uniform, non-mobile mass over the uterus. Ultrasonography revealed fibroid with cystic change. Surgical excision of the mass was performed and its histopathological examination established the diagnosis as aggressive angiomyxoma. The diagnosis of AA is difficult due to its nonspecific clinical and radiological findings. This case report reveals the importance of histopathology in the diagnosis of aggressive angiomyxoma. [ABSTRACT FROM AUTHOR]

Key Clinical Message: The study reports a rare case of pelvic solitary fibrous tumor (SFT) that was initially considered as a peri‐anal gastrointestinal stromal tumor due to similar radiologic/pathologic features. SFT diagnosis can be challenging due to its rarity and wide range of diagnoses that must be ruled out precisely. Solitary fibrous tumors (SFTs) are rare tumors that can occur in any part of the body. Although usually benign, malignant SFTs have been reported, especially outside the lungs. Radiology can help with diagnosis, but immunohistochemistry is necessary to distinguish SFTs from other possible diagnoses such as gastrointestinal stromal tumors (GISTs). This study presents a rare case of pelvic SFT initially considered to be a peri‐anal GIST, highlighting the importance of accurate diagnosis given the rarity of SFTs and the need to rule out other potential diagnoses. [ABSTRACT FROM AUTHOR]

Abstract Background Cesarean scar defect (CSD) presents as a cystic defect that connects the uterine cavity at the site of the previous cesarean section (CS). Endometriosis refers to the discovery of endometrial glands and stroma outside the uterine cavity. Cases of endometriosis cysts at CSD have not been reported. Case presentation In this article, we will present a patient with an endometriosis cyst at CSD with symptoms of a prolonged menstrual cycle, periods without cyclic abdominal pain, and a history of cesarean delivery. The gynecologic ultrasound showed a CSD and a mixed mass in the right front of the uterus. After about 1 month, the tumor grew from a diameter of 4.75 cm to 8.06 × 6.23 × 3.66 cm. The patient eventually had an operation, which revealed a mass protruding from the incision in the anterior uterine wall, which was attached to the anterior uterine wall by a thin tip with a smooth surface. Intraoperative rapid cytopathology suggested that endometrial glands were seen within the smooth muscle tissue, similar to endometriosis. Subsequently, the patient underwent resection of the endometriotic cyst. Final paraffin pathology showed smooth muscle with visible endometrial glands and old hemorrhage, and a one-year follow-up showed no recurrence of endometriosis cysts at CSD. Conclusions Endometriosis cysts at CSD are very rare. The clinical symptoms may be less obvious, and the diagnosis relies mainly on the patient’s previous surgical history and imaging. A finding of a pelvic mass in the location of the CSD, with or without symptoms of menstrual changes and intermittent abdominal pain, should be considered an endometriotic cyst at CSD. Surgical treatment is a good choice for this disease. Further studies are needed regarding the etiological mechanism of this case and why the mass enlarged rapidly in one mouth.

In this article, we present a case of retroperitoneal schwannoma localized in the pelvic cavity mimicking ovarian carcinoma. A 60-year-old woman presented with a feeling of pelvic heaviness and dyspareunia for 3 months. On physical examination, a hardened mass is palpated on the cul-de-sac of Douglas, measuring approximately 10 cm. The sonographic study showed a retro-uterine solid mass, containing cystic areas, measuring 14 cm. Magnetic resonance imaging showed a solid left tumor in the small pelvis, posterior to the uterus, suspicious of an ovarian malign tumor. Surgery revealed a retroperitoneal pelvic tumor and uterus and adnexa without macroscopic changes. Pathology examination of the pelvic mass confirmed the diagnosis of schwannoma. In the present case, it is emphasized that it is easy to misdiagnose a pelvic mass as an ovarian tumor. While prompt recognition of ovarian cancer remains essential, awareness of processes that mimic ovarian tumors can avoid potential misdiagnosis. The pelvis has a complex anatomy and there are some imaging signs that help assessing the origin of a mass, especially in cases of masses abutting the ovary.

FACTORS PREDICTING INACCURACY BETWEEN FROZEN SECTION ANALYSIS AND POSTOPERATIVE PATHOLOGY RESULTS: A TERTIARY CENTER EXPERIENCE ABSTRACT Objective: To evaluate the diagnostic accuracy and to identify the factors determining the inaccuracy between FS analysis and postoperative pathology results in our hospital. Materials and Methods: This study included 1435 patients with pelvic masses who underwent surgical intervention and FS consultation. Results: On univariate analysis, menopausal state, abnormal uterine bleeding, preoperative serum Ca125 level, preoperative leukocyte value, preoperative neutrophil value, tumor size, presence of cystic component, pathological findings in Doppler USG, ascites and cell type were found to have statistical significance for benign / borderline / malign discrimination. Menopausal state (p lt;0.0001), preoperative serum Ca125 level (p lt;0.0001) and tumor size (p lt;0.0001) were identified as independent predictors for determining inaccuracy between intraoperative and postoperative pathological evaluation. Inconsistency increased 2.5 times with a serum Ca125 gt; 35 IU/ml, 3.8 times with tumor size gt; 79 mm and 5 times in postmenopausal patients. For the discrimination of benign / borderline / malign definitions, FS results and final pathology results were compatible in 1250 (87%) patients while it was not in 185 (13%) patients. Conclusions: Increased preoperative serum Ca125 level was a predictor for inaccuracy between FS examination and postoperative pathology results. Also, tumor size ≥80 mm and menopausal state were related to misdiagnosis in FS results. Maximal effort should be done to minimize preventable errors during intraoperative FS analysis. Keywords: Frozen section, Pelvic mass, Inaccuracy, Borderline tumors

We present a rare case of pelvic splenosis, in a 46-year-old man, with a previous history of partial splenectomy, complaining of nonspecific pain in the lower abdominal quadrants. Splenosis is a benign acquired condition, defined as a heterotopic autotransplantation of splenic tissue in other compartments of the body, caused by rupture of the splenic capsule following trauma or splenectomy. Splenosis is often asymptomatic and incidentally found and does not require treatment. Surgery is indicated only in patients presenting with symptoms or complications. In our case, the multimodal imaging study (ultrasound, MRI, CT, and scintigraphy) allowed a correct differential diagnosis without resorting to invasive procedures, susceptible to complications

A pelvic mass in a common condition and a thorough history and examination is important to identify possible causes. A combination of laboratory investigations and radiological imaging is helpful to reach a diagnosis and also to triage cases of malignancy. In this review we consider common presentations, methods to assess the risk of malignancy and treatment strategies of a range of causes. [ABSTRACT FROM AUTHOR]

Key Clinical Message The study reports a rare case of pelvic solitary fibrous tumor (SFT) that was initially considered as a peri‐anal gastrointestinal stromal tumor due to similar radiologic/pathologic features. SFT diagnosis can be challenging due to its rarity and wide range of diagnoses that must be ruled out precisely. Abstract Solitary fibrous tumors (SFTs) are rare tumors that can occur in any part of the body. Although usually benign, malignant SFTs have been reported, especially outside the lungs. Radiology can help with diagnosis, but immunohistochemistry is necessary to distinguish SFTs from other possible diagnoses such as gastrointestinal stromal tumors (GISTs). This study presents a rare case of pelvic SFT initially considered to be a peri‐anal GIST, highlighting the importance of accurate diagnosis given the rarity of SFTs and the need to rule out other potential diagnoses.

Pelvic leiomyoma in male patients is a very rare occurrence and its association with prostate cancer is a unique clinical situation. This study reports a new case of a 9 cm pelvic Leiomyoma associated with intermediate-risk localized prostate cancer in a 68-year-old patient. The leiomyoma was discovered fortuitously after an MRI was performed in the context of prostate cancer work-up. Surgical excision of the pelvic mass along with a radical prostatectomy were performed and the diagnosis of leiomyoma was confirmed by histopathology.

A 37-year-old lady, when being evaluated in gynecology for pain in the abdomen, was found to have a pelvic mass suspicious of ovarian cancer with markers negative. There was an ovarian vein thrombosis extending to the right atrium in the contrast-enhanced computed tomography scan. A fluorodeoxyglucose positron emission tomography-computed tomography ruled out any other lesions. The patient underwent surgery under general anesthesia with transesophageal echocardiography to monitor the atrial thrombus. Intraoperatively, a retroperitoneal mass is seen arising from the right adnexal region of the uterus extending to the lumbar area. After the hysterectomy, bilateral salpingo-oophorectomy, tumor resection, and baring and looping of the retroperitoneal vessels, a sternotomy was done, and she was put on cardiopulmonary bypass. The tumor thrombus had two limbs both arising from the mass, one through the ovarian and the second through the iliac veins and joining together inside the inferior vena cava (IVC). With the excision of the ovarian vein at its junction, atrial incision, and incisions over the iliac veins and IVC, the thrombus was removed completely in a single sitting. Final histopathology revealed intravenous leiomyomatosis and no malignancy. We report this case as a rare disease, with both ovarian and iliac thrombus being a further rarity and a multidepartment joint effort with a successful outcome.

Objective The prognosis for ovarian cancer patients remains poor. A key to maximizing survival rates is early detection and treatment. This requires an accurate prediction of malignancy. Our study seeks to improve the accuracy of prediction by focusing on early subjective assessment of malignancy. We therefore investigated the assessment of patients themselves in comparison to the assessment of physicians. Methods One thousand three hundred and thirty patients participated in a prospective and multicenter study in six hospitals in Berlin. Using univariate analysis and multivariate logistic regression models, we measured the accuracy of the early subjective assessment in comparison to the final histological outcome. Moreover, we investigated factors related to the assessment of patients and physicians. Results The patients’ assessment of malignancy is remarkably accurate. With a positive predictive value of 58%, the majority of patients correctly assessed a pelvic mass as malignant. With more information available, physicians achieved only a slightly more accurate prediction of 63%. Conclusions For the first time, our study considered subjective factors in the diagnostic process of pelvic masses. This paper demonstrates that the patients’ personal assessment should be taken seriously as it can provide a significant contribution to earlier diagnosis and thus improved therapy and overall prognosis.

Background: Sporadic tumors called pelvic schwannomas are typically not diagnosed until they are large enough to squeeze nearby organs. Since the radiological findings are vague, a histopathological examination is necessary for the final diagnosis. The basis of treatment for these tumors is surgical resection, which is difficult due to their large size and retroperitoneal origin. Case Report: In this article, a case study of a 25-year-old male who underwent two-stage management for an incidental 15 cm pelvic mass is given. The lump was first endovascularly embolized in the patient before being completely removed without any complications. The patient did not need a blood transfusion, and the postoperative phase went smoothly. Additionally, at 4 months following surgery, the control CT scan revealed no signs of recurrence. Conclusion: Patients with hypervascular pelvic tumors benefit from preoperative embolization, which enables a less bloody surgical resection. [ABSTRACT FROM AUTHOR]

Introduction: A possible cause for acute abdomen is haemoperitoneum resulting from the rupture of an ovarian tumour. Here we discuss a case of spontaneous haemoperitoneum caused by granulosa cell tumour (GCT) rupture in a postmenopausal woman. Material and methods: We present a systematic review of the current literature to draw attention to this rare gynaecological complication and provide guidance about the most appropriate management. Results: Eight case reports and one retrospective study were identified. A total of 11 patients were analysed in this review including the present case report. The first case was described in 1948, while the last one was in 2019. The mean age of the patients was 60.8 years. All cases were treated with primary surgery. The mean diameter of the masses was 10.1 cm. Discussion: We found endometrial pathology in 45% of the cases, of which 4 (36%) were associated with postmenopausal bleeding. The presentation of GCT is not always in the form of overt endocrine disturbance but can onset (10-15%) with acute abdomen. Conclusions: Granulosa cell tumour should remain in the differential diagnosis of all patients presenting with acute abdomen and imaging suspicious for gynaecological malignancy originating from the ovary. [ABSTRACT FROM AUTHOR]

Background: Cesarean scar defect (CSD) presents as a cystic defect that connects the uterine cavity at the site of the previous cesarean section (CS). Endometriosis refers to the discovery of endometrial glands and stroma outside the uterine cavity. Cases of endometriosis cysts at CSD have not been reported. Case presentation: In this article, we will present a patient with an endometriosis cyst at CSD with symptoms of a prolonged menstrual cycle, periods without cyclic abdominal pain, and a history of cesarean delivery. The gynecologic ultrasound showed a CSD and a mixed mass in the right front of the uterus. After about 1 month, the tumor grew from a diameter of 4.75 cm to 8.06 × 6.23 × 3.66 cm. The patient eventually had an operation, which revealed a mass protruding from the incision in the anterior uterine wall, which was attached to the anterior uterine wall by a thin tip with a smooth surface. Intraoperative rapid cytopathology suggested that endometrial glands were seen within the smooth muscle tissue, similar to endometriosis. Subsequently, the patient underwent resection of the endometriotic cyst. Final paraffin pathology showed smooth muscle with visible endometrial glands and old hemorrhage, and a one-year follow-up showed no recurrence of endometriosis cysts at CSD. Conclusions: Endometriosis cysts at CSD are very rare. The clinical symptoms may be less obvious, and the diagnosis relies mainly on the patient's previous surgical history and imaging. A finding of a pelvic mass in the location of the CSD, with or without symptoms of menstrual changes and intermittent abdominal pain, should be considered an endometriotic cyst at CSD. Surgical treatment is a good choice for this disease. Further studies are needed regarding the etiological mechanism of this case and why the mass enlarged rapidly in one mouth. [ABSTRACT FROM AUTHOR]

Objective: to elaborate a new algorithm, based on serum CA125, HE4 and age, to assess the risk of malignancy in premenopausal patients with pelvic mass, which performs better than Risk of Ovarian Malignancy Algorithm (ROMA).Materials and methods. The training dataset included 284 premenopausal patients operated because of the presence of pelvic mass, out of which there were 249 patients with benign diseases and 35 patients with malignant or borderline tumors. A novel algorithm, based on serum HE4, CA125 and patient’s age as variables, has been developed. This algorithm was named Risk of Ovarian Cancer Kazan Index (ROCK-I). The validating dataset consisted of 227 consecutively operated premenopausal patients with pelvic mass out of which there were 193 cases of benign diseases, 27 cancers and 7 borderline ovarian tumors (BOT).Results. In the validating dataset ROCK-I and ROMA demonstrated 15 and 30 false positive results respectively. Thus the specificities of ROCK-I and ROMA were 92.2 % and 84.5 %, respectively (р = 0.017). The sensitivities of ROCK-I and ROMA for the joint group of Epithelial ovarian cancers (EOC) (all stages) together with BOT stage IC2–III were 96.3 % and 92.6 %, respectively (p = 0.55). For all malignant disease (all stages) together with BOT stage IC2–III the sensitivities were 90 % and 86.7 %, respectively (p = 0.69). The positive predictive values of ROCK-I and ROMA were 65.1 % and 47.4 %, respectively (p = 0.07). When the scenario of discrimination “benign disease vs the joint group of EOC (all stages) together with BOT stage IC2–III” was used, ROC-AUC of ROCK-I, ROMA and CA125 were 0.988, 0.946 and 0.937. The difference in ROC-AUC between ROCK-I and CA125 was statistically significant (p = 0.01) while the difference between ROMA and CA125 was not (p = 0.79).Conclusion. The proposed ROCK-I has demonstrated greater diagnostic performance than both ROMA and CA125 in the analyzed dataset. If an independent validation shows similar or even slightly lower superiority of ROCK-I over ROMA, it may provide a new basis of routine-use of HE4 in premenopausal patients with pelvic mass.

Objective To compare the diagnostic value of contrast-enhanced ultrasound （CEUS） and enhanced magnetic resonance imaging （MRI） in indeterminate pelvic masses. Methods CEUS and MRI were performed on 46 cases of sonographically indeterminate pelvic masses according to International Ovarian Tumor Analysis （IOTA） simple rules. Two independent sonographers and two radiologists reviewed the images before and after combining with medical history and serum tumor markers, respectively. The results of CEUS and MRI were compared with pathologic findings （n = 43） or follow-up data after clinical treatment （n = 3） as gold standard. The diagnostic values of CEUS and MRI before and after combining with medical history and tumor markers were compared. Results The diagnostic accuracy of CEUS in indeterminate pelvic masses was 67.4% without combining with medical history and tumor markers, which was lower than 80.4% of MRI. There was a statistical significance （P < 0.05）. However, there was no statistical significance between them after combining with tumor markers and/or medical history （both P > 0.05）. The accuracy of CEUS combined with medical history and tumor markers in diagnosing pelvic masses was 91.3%, which was statistically different from CEUS without considering any medical histories （P < 0.05）. Conclusion When combining with medical history and tumor markers, CEUS yields an equivalent diagnostic accuracy in differentiating malignant from benign pelvic masses compared with MRI. CEUS has high clinical value for diagnosing indeterminate pelvic masses.

The complex anatomy and similarity of imaging features of various pathologies in the pelvis can make accurate radiology interpretation difficult. While prompt recognition of ovarian cancer remains essential, awareness of processes that mimic ovarian tumors can avoid potential misdiagnosis and unnecessary surgery. This article details the female pelvic anatomy and highlights relevant imaging features that mimic extra-ovarian tumors, to help the radiologists accurately build a differential diagnosis of a lesion occupying the adnexa.

Pelvic metastasis of melanoma is extremely rare and may pose a diagnostic challenge. We present a case report of a female with a history of colon cancer who underwent exploratory surgery for a pelvic mass that was suspicious for ovarian malignancy. Pathology was consistent with both recurrent colon cancer as well as synchronous newly diagnosed metastatic melanoma.

BackgroundConservative management of adnexal mass is warranted when there is imaging-based and clinical evidence of benign characteristics. Malignancy risk is, however, a concern due to the mortality rate of ovarian cancer. Malignancy occurs in 10–15% of adnexal masses that go to surgery, whereas the rate of malignancy is much lower in masses clinically characterized as benign or indeterminate. Additional diagnostic tests could assist conservative management of these patients. Here we report the clinical validation of OvaWatch, a multivariate index assay, with real-world evidence of performance that supports conservative management of adnexal masses.MethodsOvaWatch utilizes a previously characterized neural network-based algorithm combining serum biomarkers and clinical covariates and was used to examine malignancy risk in prospective and retrospective samples of patients with an adnexal mass. Retrospective data sets were assembled from previous studies using patients who had adnexal mass and were scheduled for surgery. The prospective study was a multi-center trial of women with adnexal mass as identified on clinical examination and indeterminate or asymptomatic by imaging. The performance to detect ovarian malignancy was evaluated at a previously validated score threshold.ResultsIn retrospective, low prevalence (N = 1,453, 1.5% malignancy rate) data from patients that received an independent physician assessment of benign, OvaWatch has a sensitivity of 81.8% [95% confidence interval (CI) 65.1–92.7] for identifying a histologically confirmed malignancy, and a negative predictive value (NPV) of 99.7%. OvaWatch identified 18/22 malignancies missed by physician assessment. A prospective data set had 501 patients where 106 patients with adnexal mass went for surgery. The prevalence was 2% (10 malignancies). The sensitivity of OvaWatch for malignancy was 40% (95% CI: 16.8–68.7%), and the specificity was 87% (95% CI: 83.7–89.7) when patients were included in the analysis who did not go to surgery and were evaluated as benign. The NPV remained 98.6% (95% CI: 97.0–99.4%). An independent analysis set with a high prevalence (45.8%) the NPV value was 87.8% (95% CI: 95% CI: 75.8–94.3%).ConclusionOvaWatch demonstrated high NPV across diverse data sets and promises utility as an effective diagnostic test supporting management of suspected benign or indeterminate mass to safely decrease or delay unnecessary surgeries.

Congenital adrenal hyperplasia (CAH) is an inherited disorder of adrenal steroidogenesis often diagnosed in infancy. Gynecologists may encounter adult patients with CAH due to the clinical effects of increased androgens, e.g. hirsutism, clitoromegaly, oligomenorrhea, or, rarely, pelvic masses. This case report reviews the association of para-ovarian adrenal rest tumors with CAH, and the role of gynecologists in their evaluation and treatment. A 23-year-old woman with CAH (21-hydroxyase deficiency) untreated for the past 5 years presented with a pelvic mass and elevated serum testosterone (1433 ng/dL) and plasma ACTH (1117 pg/mL). Intraoperative findings revealed multiple retroperitoneal masses. Final pathology demonstrated adrenal rest tissue. Para-ovarian and ovarian adrenal rest tumors may present as a rare gynecologic manifestation in patients with untreated CAH.

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Lymphovascular malformations (LVMs) uncommonly present outside the head and neck region as slow-growing nontender masses. Given their rarity, LVMs are not regularly on the differential for genitopelvic masses. These anomalies are not usually dangerous due to their slow progression and distance from vital structures. Recognition of benign LVMs is important to appropriately counsel regarding treatment options and follow-up. We describe an occurrence of an extensive pelvic LVM in an adolescent female presenting as a persistent, increasingly uncomfortable growing vulvar mass, highlighting the importance of keeping this diagnosis in mind when dealing with unusual genital masses. A multidisciplinary approach including consultation with an interventional radiologist and pediatric hematologist is paramount in providing timely care when dealing with a rare diagnosis. [ABSTRACT FROM AUTHOR]

Primary seminal vesicle tumors are extremely rare. Several rare pathological types of primary seminal vesicle tumors have been reported, such as adenocarcinoma, but there is no report on adenofibroma. We report the first case of adenofibroma arising from the seminal vesicle. A 50-year-old man, with no history or clinical evidence of any other tumors, accidentally found a pelvic mass during an ultrasound examination. As the mass grew, the patient developed mild constipation, without genitourinary or other symptoms. All laboratory examinations were normal. MRI of the pelvis revealed a mixed density, measuring 11.7×9.9×8.2cm, well circumscribed mass. The rectum, bladder, prostate and lymph nodes were normal. We successfully performed the open surgery and removed the mass. Histopathological results confirmed that the mass was a primary seminal vesicle adenofibroma. In literature, we found that for biphasic differentiated tumors, it is easy to reduce the accuracy of pathological diagnosis because of insufficient puncture. Therefore, preoperative puncture biopsy for seminal vesicle tumors should be investigated further. [ABSTRACT FROM AUTHOR]