Bilateral ovarian cysts of mature cystic teratoma and Endometrioma: Its surgical challenges and review of literature

Teratomas are most frequent germ cell tumors of ovary with an incidence of 15%–20% of all ovarian neoplasm while endometriomas are present in 25.5%–45% of women with pelvic endometriosis. In spite of their increased individual incidence, association of cystic teratomas and ovarian endometriomas is extremely rare. Our case is that of a 33-year-old nulligravida who presented with heavy menstrual flow and pain during periods for last few months, ultrasonography revealed 74 × 57 mm mass in right adnexa-likely ovarian dermoid, enlarged left ovary with two small cysts of size 33 × 29 mm and 25 × 20 mm likely endometrioma, managed by laparoscopy, found to have left ovarian endometrioma of 6 × 6 cm and right ovarian dermoid cyst of 10 × 8 cm size, histopathology confirmed the same. This association of teratoma in one ovary and endometrioma in other ovary of same patient poses a surgical challenge, when it affects young and nulliparous women. Further follow up is mandatory for this simultaneous finding of ovarian endometriosis with coincidental dermoid cyst to assess ovarian reserve, recurrence of either of the cysts, and it also presents a challenge to clinicians to predict the post-operative course of such cases.

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Absorbable Hemostatic Particles to Reduce the Damage on the Follicular Reserve After Ovarian Endometriomas Stripping

Gynecology and Women’s Health Care ◽

10.47485/2766-5879.1017 ◽

2021 ◽

Keyword(s):

Antral Follicle ◽

Antral Follicle Count ◽

Ultrasound Probe ◽

Ovarian Endometriosis ◽

Ovarian Endometrioma ◽

Haemostatic Agents ◽

Microporous Polysaccharide Hemospheres ◽

Follicular Reserve ◽

Ovarian Endometriomas

Objective: to reduce the surgical damage to the ovarian reserve, after stripping of ovarian endometrioma, of the necrotic type given by the electrohaemostasis or ischemic type given by the suture. Design: perform haemostasis on ovarian parenchyma with topical haemostatic agents. Materials and methods: we used Arista AH which is a powder made up of microporous polysaccharide hemospheres that act by osmotic action and accelerate the natural coagulation process. We used Arista AH in 27 women with mono- or bilateral ovarian endometriosis. Results: in all treated cases we obtained a rapid and optimal haemostasis. There were no post-surgical complications related to haemostatic defects. Three months after the surgery, we checked the Antral Follicle Count (AFC) with a trans-vaginal ultrasound probe. AFC in 24 women with full follow-up gave the following results: unilateral endometrioma – AFC between 5 and 8 (MV: 6.3), bilateral endometriomas – the AFC between 5 and 7 (MV: 5.8). Conclusions: The use of Arista AH powder allows highly effective hemostasis and is easy to use, fully respecting the residual ovarian parenchyma after stripping.

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Is CA72-4 a Useful Biomarker in Differential Diagnosis between Ovarian Endometrioma and Epithelial Ovarian Cancer?

Disease Markers ◽

10.1155/2013/984641 ◽

2013 ◽

Vol 35 ◽

pp. 331-335 ◽

Cited By ~ 9

Author(s):

Emanuela Anastasi ◽

Lucia Manganaro ◽

Teresa Granato ◽

Pierluigi Benedetti Panici ◽

Luigi Frati ◽

...

Keyword(s):

Ovarian Cancer ◽

Differential Diagnosis ◽

Epithelial Ovarian Cancer ◽

Ovarian Tissue ◽

Correct Diagnosis ◽

Surgical Excision ◽

Serum Marker ◽

Ovarian Endometriosis ◽

Ovarian Endometrioma ◽

Ovarian Endometriomas

Background. Surgical excision of ovarian endometriomas in patients desiring pregnancy has recently been criticized because of the risk of damage to healthy ovarian tissue and consequent reduction of ovarian reserve. A correct diagnosis in cases not scheduled for surgery is therefore mandatory in order to avoid unexpected ovarian cancer misdiagnosis. Endometriosis is often associated with high levels of CA125. This marker is therefore not useful for discriminating ovarian endometrioma from ovarian malignancy. The aim of this study was to establish if the serum marker CA72-4 could be helpful in the differential diagnosis between ovarian endometriosis and epithelial ovarian cancer.Methods. Serums CA125 and CA72-4 were measured in 72 patients with ovarian endometriomas and 55 patients with ovarian cancer.Results. High CA125 concentrations were observed in patients with ovarian endometriosis and in those with ovarian cancer. A marked difference in CA72-4 values was observed between women with ovarian cancer (71.0%) and patients with endometriosis (13.8%) ().Conclusions. This study suggests that CA72-4 determination can be useful to confirm the benign nature of ovarian endometriomas in women with high CA125 levels.

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Mature Cystic Teratoma of Ovary– a Case Report & Review of Literature

10.21203/rs.3.rs-50261/v1 ◽

2020 ◽

Author(s):

Sunita Nayak ◽

Suren Prasad Dash

Keyword(s):

Case Report ◽

Germ Cell ◽

Ovarian Neoplasms ◽

Germ Cell Tumour ◽

Cystic Teratoma ◽

Good Prognosis ◽

Mature Cystic Teratoma ◽

Review Of Literature ◽

The Right

Abstract Mature cystic teratoma or dermoid cyst is the most common germ cell tumour of the ovary. The incidence ranges from 5 to 25% of all ovarian neoplasms out of which 13.7% are bilateral. Teratomas usually occur in the ovaries but they may be seen in other sites known as extragonadal teratomas the incidence of which is only 0.4%. Teratomas are usually benign but they may turn out to be highly malignant. Torsion is known to be the most frequent complication of ovarian teratomas followed by autoamputation. Teratomas are classified as “Mature” and “Immature” by WHO. Teratomas show good prognosis specially the mature ones. Surgery and follow up remains the standard approach. We report a case of mature cystic teratoma in the right ovary of a 28 years old nulliparous woman.

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Ovarian endometrioma – a possible finding in adolescent girls and young women: a mini-review

Journal of Ovarian Research ◽

10.1186/s13048-019-0582-5 ◽

2019 ◽

Vol 12 (1) ◽

Author(s):

Krzysztof Gałczyński ◽

Maciej Jóźwik ◽

Dorota Lewkowicz ◽

Anna Semczuk-Sikora ◽

Andrzej Semczuk

Keyword(s):

Adolescent Girls ◽

Surgical Intervention ◽

Pelvic Mass ◽

Ovarian Endometriosis ◽

Professional Help ◽

Adolescent Women ◽

Ovarian Endometrioma ◽

Preservation Of Fertility ◽

Ovarian Endometriomas

Abstract Young girls before menarche or menstruating adolescent women may experience long-term drug-resistant chronic pelvic pain, as well as other symptoms associated with pelvic mass. In such cases, it is of great importance to consider ovarian endometrioma in the differential diagnosis. In general, endometrioma is recognized as an ovarian cyst. However, in most cases, the pathology represents pseudocyst with a partial or complete endometrial-like lining with extraovarian adhesions and endometriotic implants which are likely to occur at the sites of ovarian adhesions and at the ceiling of the ovarian fossa. Ovarian endometriomas occur in 17–44% patients with endometriosis and account for 35% of all benign ovarian cysts. The time span from the onset of menarche to the time of endometrioma formation, which requires surgical intervention, has been evaluated to be a minimum of 4 years. The pathogenesis of early-life endometrioma may be different from other types of endometriosis. Diagnosis is often delayed, especially in adolescents, who tend to wait too long before seeking professional help. The three specific aims of treatment in adolescents with endometriosis and endometriomas are control of symptoms, prevention of further progression of the disease as well as preservation of fertility. Increasing evidence demonstrates association between ovarian endometriosis and ovarian cancer. In the present mini-review, we draw the particular attention of clinicians to such a possibility, even if relatively infrequently reported.

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Clinical and sonological features in endometriomas in women of reproductive age

HEALTH OF WOMAN ◽

10.15574/hw.2016.114.85 ◽

2016 ◽

pp. 85-89

Author(s):

О. Shapoval ◽

Keyword(s):

Endometrial Hyperplasia ◽

Benign Tumor ◽

Pain Syndrome ◽

Reproductive Age ◽

Control Group ◽

Women Of Reproductive Age ◽

Ovarian Endometriosis ◽

Gynecological Examination ◽

Different Characteristics ◽

Ovarian Endometriomas

The objective: to study the prevalence of ovarian endometriosis in women of reproductive age, the features of clinical and ultrasound picture of endometriosis. Patients and methods. The study involved 22 patients with endometriomas, the control group – 50 women gynecological and somatically healthy. Results. The incidence of ovarian endometriomas in the structure of benign tumor-like formations of ovaries is 0.62%. In 72.73% of ovarian endometriomas occur on a background of concomitant gynecological pathology. Clinically, in 77.27% of cases there is a pain syndrome, in 59.09% – algomenorrhea, in 13.64% – infertility; 18.18% of cases endometriomas remain «dumb» and proceed with the erased clinical picture. Sonologically in patients with endometriomas adenomyosis, endometrial hyperplasia, changes in the contralateral ovary are determined. Conclusion. Without additional methods of diagnostic gynecological examination may identify the 3 cm tumor-like formation of the ovary with different characteristics, which does not allow to differentiate endometrioma from inflammation, functional and ovarian tumors. Ultrasound can diagnose pathological ovarian formation of 1 cm, detailing the nature of the cyst. Key words: endometriosis, reproductive age, retrospective analysis, ultrasound.

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GCT-28. RECURRENCE PATTERN AND SURVIVAL FOR RELAPSED INTRACRANIAL NON-GERMINOMATOUS GERM CELL TUMORS: A SINGLE-INSTITUTION EXPERIENCE

Neuro-Oncology ◽

10.1093/neuonc/noaa222.248 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii333-iii333

Author(s):

Lei Wen ◽

Zhaoming Zhou ◽

Qingjun Hu ◽

Juan Li ◽

Mingyao Lai ◽

...

Keyword(s):

Germ Cell ◽

Germ Cell Tumors ◽

Late Recurrence ◽

Salvage Chemotherapy ◽

Recurrence Time ◽

First Line ◽

Primary Tumor Site ◽

First Line Therapy ◽

Line Therapy

Abstract PURPOSE Intracranial non-germinomatous germ cell tumors (NGGCTs) have lower overall survival than germinoma because relatively higher recurrence usually occurs after first line therapy. METHODS Between January 2003 and December 2018, 111 consecutive patients diagnosed with NGGCTs reviewed. Those who progressed after first line therapy were included in this study. Data of first line treatment, salvage treatment, clinicopathological features and survival were collected and analyzed. RESULTS Totally, thirty patients (30/111, 27.0%) relapsed in our cohort, including 19 patients with accurate relapse information detail, and 11 patients who died of disease progression during follow up but without exact time and site of relapse. The median OS from diagnosis of the disease was 49.2 months (95% CI: 14.1 to 84.3 months) and 3-year OS was 54.3%. Patients who received both CSI and chemotherapy relapsed less than those who received reduced volume of radiotherapy or only CSI or only chemotherapy (22.5% vs. 45.5%, p=0.034). Of 19 patients who had detail information of recurrence time and site, the median time from diagnosis of disease to relapse was 9.5 months (2.2 to 72.1 months). Regarding to recurrence site, most patients relapsed in primary site (10/19, 52.6%) or distant intracranial (6/19, 31.6%). The recurrence site of other 3 patients were spinal (n=1), ventricular (n=1) and peritoneal (n=1). CONCLUSION Protracted follow-up is recommended because late recurrence is not uncommon. Primary tumor site and distant intracranial are the most prevalent relapsed location. Patients who relapsed could benefited from both CSI and salvage chemotherapy.

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Increased Expression of Retinol-Binding Protein 4 in Ovarian Endometrioma and Its Possible Role in the Pathogenesis of Endometriosis

International Journal of Molecular Sciences ◽

10.3390/ijms22115827 ◽

2021 ◽

Vol 22 (11) ◽

pp. 5827

Author(s):

Jae Chul Lee ◽

Sung Hoon Kim ◽

Young Sang Oh ◽

Ju Hee Kim ◽

Sa Ra Lee ◽

...

Keyword(s):

Retinol Binding Protein ◽

Endometrial Stromal Cells ◽

Endometrial Cells ◽

Retinol Binding Protein 4 ◽

Ovarian Endometrioma ◽

Proliferation And Differentiation ◽

In Vitro Effects ◽

Ovarian Endometriomas

Although endometriosis is a benign disease characterized by the presence of endometrial tissues outside the uterus, ectopic endometrial cells can exhibit malignant biological behaviors. Retinol-binding protein4 (RBP4) is a novel adipocyte-derived cytokine, which has important roles in regulating insulin sensitivity and energy metabolism. RBP4 is a potent modulator of gene transcription, and acts by directly controlling cell growth, invasiveness, proliferation and differentiation. Here, we evaluated the possible role of RBP4 in the pathogenesis of endometriosis. We compared the levels of RBP4 in the tissues and peritoneal fluid (PF) of women with and without endometriosis and evaluated the in vitro effects of RBP4 on the viability, invasiveness, and proliferation of endometrial stromal cells (ESCs). RBP4 levels were significantly higher in the PF of the women in the endometriosis group than in the controls. RBP4 immunoreactivity was significantly higher in the ovarian endometriomas of women with advanced stage endometriosis than those of controls. In vitro treatment with human recombinant-RBP4 significantly increased the viability, bromodeoxyuridine expression, and invasiveness of ESCs. Transfection with RBP4 siRNA significantly reduced ESC viability and invasiveness. These findings suggest that RBP4 partakes in the pathogenesis of endometriosis by increasing the viability, proliferation and invasion of endometrial cells.

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Long term follow-up of inguinal endometriosis

BMC Women s Health ◽

10.1186/s12905-021-01235-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

BoRan Mu ◽

ZhiQiang Zhang ◽

Chongdong Liu ◽

Kunning Zhang ◽

ShuHong Li ◽

...

Keyword(s):

Management Strategies ◽

Uterosacral Ligament ◽

Round Ligament ◽

Pelvic Endometriosis ◽

Ovarian Endometriosis ◽

Hernia Sac ◽

Peritoneal Endometriosis ◽

Long Term Follow Up ◽

The Right

Abstract Background Inguinal endometriosis (IEM) is a rare extra pelvic endometriosis. Here, we study the clinical characteristics, management strategies, and long-term gynecological outcomes of IEM patients at Beijing Chaoyang Hospital. Case presentation Three patients presented with a total of four lesions (one on the left side, one on the right side, and one bilaterally). The diameters of the four lesions were 2 cm, 2 cm, 3.5 cm and 1.5 cm, respectively. Two patients were admitted with inguinal hernias. Two patients were admitted with endometrioses—one with ovarian endometriosis and one with pelvic endometriosis. The hernia sac was repaired concomitantly via excision of the round ligament in two patients. One patient underwent a concomitant laparoscopy for gynecologic evaluations, including an ablation to the peritoneal endometriosis, and resection of the left uterosacral ligament endometriosis and pelvic adhesiolysis. All lesions were located on the extraperitoneal portion of the round ligament and were diagnosed histologically. No recurrence was observed in the inguinal region. All patients diagnosed with adenomyosis were treated with medication alone without any complaints. Conclusions Inguinal endometriosis can occur simultaneously with pelvic endometriosis. In most cases, a concomitant hernia sac appears together with groin endometriosis. Clinical management should be individualized and performed in tandem with general practitioners and obstetrics & gynecology experts. Pelvic disease, in particular, should be followed-up by a gynecologist.

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GCT-27. CLINICAL FEATURES AND PROGNOSTIC FACTORS OF NONGERMINOMATOUS GERM CELL TUMORS IN 111 CONSECUTIVE PATIENTS IN A SINGLE INSTITUTION: IMPACT OF IRRADIATION AND CHEMOTHERAPY CYCLES ON SURVIVAL

Neuro-Oncology ◽

10.1093/neuonc/noaa222.247 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii333-iii333

Author(s):

Lei Wen ◽

Juan Li ◽

Qingjun Hu ◽

Mingyao Lai ◽

Cheng Zhou ◽

...

Keyword(s):

Prognostic Factors ◽

Germ Cell ◽

Chinese Population ◽

Germ Cell Tumors ◽

Tumor Diameter ◽

Limited Data ◽

Single Institution ◽

Large Institution ◽

Significant Difference

Abstract BACKGROUND Limited data is available in intracranial nongerminomatous germ cell tumors (NGGCTs) in Chinese population. Here we aimed to retrospectively assess the clinical-pathological and prognostic factors of NGGCTs in a single large institution in China. METHODS From June 2003 to December 2018, 111 consecutive NGGCTs were treated in Guangdong Sanjiu Brain Hospital, China. RESULTS The median follow-up was 36.2 months (range, 1.2 to 131.2 months). Three-year EFS and OS for 111 NGGCTs patients were 78.5%±4.5% and 82.8%±4.0%, respectively. 98 patients received CSI plus boost yielded better survival than those who received reduced-volume radiotherapy or no radiotherapy (3y OS, 86.7% vs. 51.4%, p=0.007). Patients had at least four cycles of chemotherapy were strongly associated with improved 3-year OS, compared to those received less than 4 cycles (94.1% vs. 63.6%, p＜0.001). There was no significant difference in survival of patients stratified by age, surgery, hydrocephalus, as well as tumor diameter. Multivariate analysis identified chemotherapy cycles less than 4 was the only prognostic factor that conferring a worse OS (p=0.003). Patients both received CSI and at least 4 courses of chemotherapy were correlated with lower incidence of relapse (p=0.044). CONCLUSIONS Multimodal approach including CSI and enough courses of chemotherapy was effective and should be recommended for the treatment of newly diagnosed NGGCTs in Chinese population.

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Adjuvant therapy of ovarian germ cell tumors with cisplatin, etoposide, and bleomycin: a trial of the Gynecologic Oncology Group.

Journal of Clinical Oncology ◽

10.1200/jco.1994.12.4.701 ◽

1994 ◽

Vol 12 (4) ◽

pp. 701-706 ◽

Cited By ~ 224

Author(s):

S Williams ◽

J A Blessing ◽

S Y Liao ◽

H Ball ◽

P Hanjani

Keyword(s):

Germ Cell ◽

Gynecologic Oncology ◽

Cell Cancer ◽

Germ Cell Tumors ◽

Germ Cell Cancer ◽

Gynecologic Oncology Group ◽

Long Term Follow Up ◽

Acute Myelomonocytic Leukemia

PURPOSE This study was performed to determine the effectiveness of postoperative adjuvant chemotherapy in patients with surgically resected ovarian germ cell tumors. PATIENTS AND METHODS After tumor removal and thorough surgical staging, patients were enrolled on this study and treated with three courses of cisplatin, etoposide, and bleomycin (BEP). Reassessment laparotomy was required of consenting, appropriate patients initially, but became an optional procedure in 1989. RESULTS Of 93 patients assessable on this trial, 89 are continuously free of germ cell cancer. At second-look laparotomy, two other patients were found to have small foci of immature teratoma; both remain clinically free of recurrence. One received subsequent alternate chemotherapy and one did not. Thus, 91 of 93 patients are currently free of germ cell cancer. Follow-up duration ranges from 4.0 to 90.3 months, with 67 patients monitored for longer than 2 years. Acute toxicity was moderate. One patient developed acute myelomonocytic leukemia 22 months after diagnosis. Another patient was noted to have a malignant lymphoma 69 months after protocol treatment. CONCLUSION Three courses of BEP will nearly always prevent recurrence in well-staged patients with completely resected ovarian germ cell tumors and should be given to all such patients. The development of acute leukemia as a complication of treatment is disturbing and mandates careful long-term follow-up, but is unusual and does not alter the risk-to-benefit ratio of treatment.

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