scholarly journals Ovarian hyperstimulation syndrome following surgical removal of a complete hydatidiform mole: a case report

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Hiroaki Tsubokura ◽  
Yohei Ikoma ◽  
Takuya Yokoe ◽  
Tomoo Yoshimura ◽  
Katsuhiko Yasuda
Keyword(s):  
Ovarian Cyst ◽  
Ovarian Hyperstimulation Syndrome ◽  
Histopathological Examination ◽  
Hydatidiform Mole ◽  
Ovarian Cysts ◽  
Surgical Removal ◽  
Ovarian Hyperstimulation ◽  
Complete Hydatidiform Mole ◽  
Multilocular Cyst ◽  
The Right

Abstract Background Generally, ovarian hyperstimulation syndrome develops after superovulation caused by ovulation-inducing drugs in infertile patients. However, ovarian hyperstimulation syndrome associated with natural pregnancy is rare, and most cases of ovarian hyperstimulation syndrome have been associated with a hydatidiform mole. Case presentation We describe a case of a 16-year-old Japanese girl with a complete hydatidiform mole. The patient was referred for intensive examination and treatment of the hydatidiform mole and underwent surgical removal of the hydatidiform mole at 9 weeks, 5 days of gestation. Histopathological examination revealed a complete hydatidiform mole. The patient’s blood human chorionic gonadotropin level decreased from 980,823 IU/L to 44,815 IU/L on postoperative day 4, and it was below the cutoff level on postoperative day 64. Transvaginal ultrasonography on postoperative day 7 revealed a multilocular cyst measuring 82 × 43 mm in the right ovary and a multilocular cyst measuring 66 × 50 mm in the left ovary. Both ovarian cysts enlarged further. Magnetic resonance imaging on postoperative day 24 revealed that the right multilocular ovarian cyst had enlarged to 10 × 12 cm and that the left multilocular ovarian cyst had enlarged to 25 × 11 cm. Blood examination showed an elevated estradiol level as high as 3482 pg/ml. We diagnosed the patient with bilateral giant multilocular cysts accompanied by ovarian hyperstimulation syndrome because of the rapid increase in the size of the cysts. The patient complained of mild abdominal bloating; however, symptoms such as nausea, vomiting, dyspnea, and abdominal pain were not observed. Therefore, we chose spontaneous observation in the outpatient clinic. The cysts gradually decreased and disappeared on postoperative day 242. Conclusion Physicians should be aware that ovarian cysts can occur and can increase rapidly after abortion of a hydatidiform mole. However, the ovarian cyst can return to its original size spontaneously even if it becomes huge.

scholarly journals 6-Year-Old Girl With a Luteinized Follicular Ovarian Cyst and an Estradiol Level > 1,000 PG/ML

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A690-A690
Author(s):  
Marianne Jacob ◽  
Dix Poppas ◽  
Oksana Lekarev
Keyword(s):  
Precocious Puberty ◽  
Ovarian Cyst ◽  
Breast Tissue ◽  
Estradiol Level ◽  
Laboratory Evaluation ◽  
Ovarian Cysts ◽  
Surgical Removal ◽  
Imaging Evaluation ◽  
Follicular Cyst ◽  
The Right

Abstract Background: Precocious puberty in girls is defined as onset of secondary sexual characteristics, such as breast development, before 8 years of age. To differentiate between central and peripheral precocious puberty, laboratory and imaging evaluation is helpful. When gonadotropins are low but estradiol is elevated, results may suggest a primary ovarian source of estrogen production. Small ovarian cysts are not uncommon, are benign and self-resolve. However, large ovarian cysts are rare, let alone ones requiring surgical removal. Clinical Case: A 6 year 7 month old girl presented with several days of breast tenderness and palpable bilateral breast tissue noted by her mother. There was no history of vaginal bleeding. There were no reported exposures to estrogen-containing products. Her mother reached menarche at age 14 years. The patient was born full term and was otherwise healthy. On exam, her height was at the 90-95th %ile (mid-parental height at the 95th %ile) and her growth velocity was 10.9 cm/yr. She had Tanner 2 breasts (1 cm breast bud on the left and 1.5 cm on the right), Tanner 1 pubic hair and no axillary hair, body odor, acne or café-au-lait macules. A bone age was read as 6 years at a chronological age of 6 years 7 months. A laboratory evaluation revealed an estradiol of 1,029 pg/mL (<15 pg/mL), LH <0.02 mIU/mL, FSH <0.09 mIU/mL, 17-hydroxyprogesterone (17-OHP) 410 ng/dL (<91 ng/dL), AFP 2.3 ng/mL (<6.1 ng/mL), beta-hCG <2 mIU/mL, TSH 2.41 mIU/L (0.5-3.2 mIU/L), and free T4 0.9 ng/dL (0.9-1.4 ng/dL). Pelvic ultrasound revealed a large unilocular cystic structure measuring 6.5 x 4.1 x 6.1 cm in the left adnexal region with no left ovary visualized. The right ovary appeared prepubertal. The uterus was prepubertal in appearance with endometrial thickness of 2 mm. Abdominal ultrasound showed no evidence of a suprarenal mass. A laparoscopic cyst resection was completed, given the risk of left ovarian torsion. Cytology was negative; pathology revealed a luteinized follicular cyst. Repeat labs in one month showed a prepubertal estradiol level of 6.7 pg/mL with LH 0.02 mIU/mL and FSH 0.38 mIU/mL. 17-OHP normalized to 29 ng/dL. Breast tissue had regressed. Conclusion: This case describes the rare finding of a large luteinized follicular ovarian cyst that required surgical removal in a 6-year-old girl in the setting of a significantly elevated estradiol level. Luteinized follicular cysts have been described in newborns, though rare. To our knowledge, this is the first described case of a luteinized follicular cyst in this patient’s age group. Laboratory and imaging evaluation should be considered in girls presenting with precocious puberty, despite the extent of thelarche, as the clinical examination does not always correlate with degree of estradiol elevation. This is especially important if clinical changes are acute and other features are consistent with puberty, such as rapid linear growth.

scholarly journals A Case with Severe Endometriosis, Ovarian Hyperstimulation Syndrome, and Isolated Unilateral Pleural Effusion after IVF

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Negjyp Sopa ◽  
Elisabeth Clare Larsen ◽  
Anders Nyboe Andersen
Keyword(s):  
Pleural Effusion ◽  
Ovarian Hyperstimulation Syndrome ◽  
Common Finding ◽  
Ovarian Hyperstimulation ◽  
Pleural Effusions ◽  
Luteal Support ◽  
Vitro Fertilization ◽  
Fluid Production ◽  
The Right

We present a very rare case of right-sided isolated pleural effusion in a patient with severe endometriosis who, in relation to in vitro fertilization (IVF), developed ovarian hyperstimulation syndrome (OHSS). Earlier laparotomy showed grade IV endometriosis including endometriotic implants of the diaphragm. The patient had no known risk factors for OHSS and only a moderate number of oocytes aspirated. She received, however, repeated hCG injections for luteal support. The patient did not achieve pregnancy but was hospitalized due to pain in the right side of the chest and dyspnoea. A chest computed tomography (CT) showed a pleural effusion on the right side. Total of 1000 ml of pleural fluid was drained after a single thoracentesis. After three days, the symptoms and fluid production ceased. Ascites is a common finding in OHSS, but pleural effusions are rare. Further, isolated pleural effusions have not previously been described in a patient with endometriosis. We suggest that the repeated hCG injections induced effusions from the endometriotic lesions at the diaphragm and as a consequence this patient developed isolated hydrothorax.

scholarly journals Surgical aspects of the treatment of neonatal ovarian cysts in girls

2021 ◽  
Vol 25 (4) ◽  
pp. 278-283
Author(s):  
D. A. Malysheva ◽  
A. A. Sukhotskaya ◽  
V. G. Bairov ◽  
I. M. Kagantsov ◽  
N. A. Kokhreidze ◽  
...  
Keyword(s):  
Ovarian Cyst ◽  
Postnatal Period ◽  
Premature Delivery ◽  
Ovarian Cysts ◽  
Joint Control ◽  
National Medical ◽  
Laparoscopic Fenestration ◽  
Dynamic Ultrasound ◽  
The Right

Introduction. Neonatal ovarian cysts develop in case of hormonal imbalance in the mother-placenta-fetus system. Cystic transformation in the ovary may cause appendage torsion which leads to follicular necrosis and loss of ovarian reserve. Most often, torsion occurs in the utero, but in premature girls- due to the specific hormonal status - the risk of cyst growth and its torsion remains in the postnatal period. Currently, a unified approach to the surgical treatment of neonatal ovarian cysts is absent.Material and methods. In the department of pediatric surgery for malformations in the Perinatal Center of the Amazov National Medical Research Center, 34 girls with ovarian cysts were examined during 2012-2020; 9 of them (27%) were premature. In the presented observation, we faced an ovarian cyst in the fetus of 30 week gestation.Results. The cyst looked uncomplicated, but had the enormous size, so we discussed a possibility to perform an intrauterine puncture. However, due to severe hemolytic disease of the fetus and premature delivery, the intervention was not carried out. By the third week of life, torsion of the cystic-transformed ovary developed; necrosis and self-amputation of the right uterine appendage were revealed intraoperatively. By the age of three months, cystic transformation of the only ovary developed. Timely performed laparoscopic fenestration was organ-sparing. Further follow-up revealed preserved and normally growing single ovary what confirmed the right choice of surgical tactics.Conclusion. Dynamic ultrasound examination of the pelvic organs is indicated to all premature girls, at least once every two weeks (in case of revealed ovarian cyst - weekly). We consider it reasonable to make the laparoscopic fenestration of uncomplicated cysts that have size of 3 cm and more. Newborn girls with ovarian cysts should be under the joint control of pediatrician and pediatric gynecologist for developing an individual follow-up plan.

scholarly journals Diagnostic Mystery — a Rare Right Ventricular Cardiac Hemangioma: a Case Report

2021 ◽  
Author(s):  
Jingya Fan ◽  
Lei Guo ◽  
Peng Teng ◽  
Xiaoyi Dai ◽  
Qi Zheng ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Histopathological Examination ◽  
Surgical Removal ◽  
Cardiac Tumors ◽  
Term Survival ◽  
Cardiac Hemangioma ◽  
First Choice ◽  
The Right ◽  
Choice Of Therapy

Abstract Background: Cardiac hemangiomas are rare in all kinds of benign cardiac tumors. Although cardiac hemangiomas affect all ages and may occur anywhere within the heart, right ventricular hemangiomas are extremely uncommon.Case presentation: We report a 56-year-old woman presented with chest tightness and breath shortness for 3 months. Transthoracic echocardiography and coronary computed tomography angiography showed a mass located adjacent to the apex of the right ventricle but both failed to figure out where the mass originated from, remaining a diagnostic mystery preoperatively. The mass was removed successfully and the histopathological examination confirmed it was hemangioma.Conclusions: Cardiac magnetic resonance should be the ultimate diagnostic tool of cardiac tumors. Surgical removal, associated with a low recurrence rate and long-term survival benefits, should be the first choice of therapy for cardiac hemangiomas.

scholarly journals Tubercular Ascites Simulating Ovarian Hyperstimulation Syndrome following In Vitro Fertilization and Embryo Transfer Pregnancy

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Amar Ramachandran ◽  
Pratap Kumar ◽  
Naveen Manohar ◽  
Raviraj Acharya ◽  
Anita Eipe ◽  
...  
Keyword(s):  
Ovarian Hyperstimulation Syndrome ◽  
Care Center ◽  
Tertiary Care ◽  
Third Space ◽  
Common Disease ◽  
Ovarian Hyperstimulation ◽  
Vitro Fertilization ◽  
Reproductive Techniques ◽  
The Right

Ovarian hyperstimulation syndrome (OHSS) is a known complication of using ovulation induction drugs in assisted reproductive techniques. Its incidence and severity vary. Tuberculosis is a very common disease in the developing world, and ascites is one of its sequelae. The newer aids in diagnosing tuberculosis include measuring levels of Adenosine DeAminase (ADA) in the third-space fluids or serum. This case report is from a tertiary care center, reflecting how tubercular ascites simulated OHSS, and the right diagnosis was made and managed. This is being presented due to its rarity.

scholarly journals Legal Implication of Ovarian Cysts in Prepuberal Girl

2020 ◽  
Vol 5 (7) ◽  
Keyword(s):  
Ovarian Cyst ◽  
Ovarian Function ◽  
Clinical Course ◽  
Lower Abdominal Pain ◽  
Ovarian Torsion ◽  
Ovarian Cysts ◽  
Legal Implications ◽  
Extra Weight ◽  
The Right ◽  
Legal Implication

Ovarian torsion is a condition that can occur in a normal ovary, but it is more likely to happen when the presence of a cyst or other tissues (tumor) in the ovary can displace it. The extra weight or mass on the ovary can cause it to start to twist and rotate around its supporting ligaments. Ovarian torsion can cause severe pain, more frequently on the right-hand side. However, in some cases, the clinical course is prolonged, as the torsion can be intermittent. Early diagnosis and surgery are essential to protect ovarian and tubal function and prevent severe morbidity ending with annessiectomy. The ovarian cyst is an insidious risk factor for ovarian torsion and can cause sudden lower abdominal pain and loss of ovarian function with possible legal implications and malpractice. A timely diagnosis of ovarian cyst is of paramount importance to prevent necrosis and preserve ovarian viability. To avoid such a dangerous complication, it is essential the preventive management of the cyst. A cyst becomes a problem when it does not go away or gets bigger. The treatment of ovarian cysts depends on several factors but the size of the cyst and its appearance need to be monitored.

scholarly journals Ovarian cyst regression with levothyroxine in ovarian hyperstimulation syndrome associated with hypothyroidism

2013 ◽  
Vol 2013 ◽  
Author(s):  
Roghieh Molaei Langroudi ◽  
Fatemeh Ghazanfari Amlashi ◽  
Mohammad Hassan Hedayati Emami
Keyword(s):  
Ovarian Hyperstimulation Syndrome ◽  
Abdominal Ultrasound ◽  
Ovarian Cysts ◽  
Complete Regression ◽  
Hypothyroid Patient ◽  
List Type ◽  
Ovarian Hyperstimulation ◽  
Ovarian Size ◽  
Significant Regression

Summary Background: Spontaneous ovarian hyperstimulation syndrome (sOHSS) can occur following hypothyroidism. Ultrasonography facilitates diagnosis and monitoring of this syndrome. We describe ovarian sonographic changes in a hypothyroid patient with sOHSS after treatment with levothyroxine (l-T4). Case presentation: A 15-year-old girl presented with abdominal pain and distension for a few months. On examination, she had classical features of hypothyroidism. Abdominal and pelvic ultrasound revealed enlarged ovaries with multiple thin-walled cysts and mild ascitic fluid. On follow-up, abdominal ultrasound showed significant reduction of ovary size after 6 weeks of initiation of l-T4. Normal ovary size with complete regression of ovarian cysts was seen after 4 months. Conclusion: Serial ultrasound in sOHSS associated with hypothyroidism showed regression of ovarian cysts and ovarian volume after 4 months whereas in other studies, it is reported to happen in various durations, presumably according to its etiology. Learning points OHSS can rarely occur due to hypothyroidism. This type of OHSS can be simply treated by l-T4 replacement, rather than conservative management or surgery in severe cases. Ultrasound follow-up shows significant regression of ovarian size and cysts within 6 weeks of initiation of l-T4. Ultrasound follow-up shows normal ovarian size with complete resolution of ovarian cysts 4 months after treatment.

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