Laparoscopic evaluation of pelvic organ in case of subfertility

Background: Globally subfertility affects 10-15% of couple. All these people need proper evaluation and treatment. Now a days laparoscopy considered as a gold standard procedure for evaluation of pelvic organ. The aim of this study was to find out the different causes of female factor infertility with the help of laparoscopy.Methods: This retrospective study was conducted in infertility clinic of BIRDEM hospital, Dhaka, Bangladesh during the period of May, 2007 to October 2007. The study group comprised 100 cases of infertile patients.Results: In this study, among 100 patients 68% had primary and 32% had secondary infertility. In laparoscopy majority (55.0%) had normal ovary, 20.0% had cystic change with thick capsule in right ovary and 22% had in left ovary, 7.0% had endometriosis, 8.0% had adhesion, 10.0% had simple cyst in right ovary and 8% had in left ovary and rest could not be visualized. 79.4% right and 77.9% left fallopian tube patent in primary subfertility cases and 56.3% right and 59.4% left tube normal in secondary subfertility cases. Both fallopian tube patent in 62%, unilateral block 21% and bilateral block in 17% cases in this study peritoneum was normal in 78% cases, 8% cases there was endometriosis and 14% cases there was adhesion of fallopian tube with the ovary, adhesion of uterus with intestine and also with bladder.Conclusions: Laparoscopy is an important tool for diagnosing anatomical and pathological abnormalities of pelvic organ which has a major role in subfertility management.

Cystic Variation of Schwannoma in the Neck: A Rare Presentation

It is uncommon for schwannomas to present as neck swellings. This case presented as painless, cystic and slow growing neck swelling which was excised. Histopathology proved it to be cystic schwannoma. Cystic change occurs in only 4% of all schwannomas. The cystic change renders the schwannoma to mimic second branchial cyst on clinical and radiological examination. Although modality of treatment remains the same which is extracapsular excision, the follow up differs in terms of recurrence.

Ultrasonographic characteristics of medullary thyroid carcinoma according to nodule size: application of the Korean Thyroid Imaging Reporting and Data System and American Thyroid Association guidelines

Background Few studies have categorized ultrasound (US) findings of various sized medullary thyroid carcinomas (MTCs) according to updated guidelines. Purpose To evaluate and compare the differences in US findings of MTC according to nodule size, using the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and American Thyroid Association (ATA) guidelines. Material and Methods The study included 119 patients with 129 MTC nodules, which were surgically confirmed at our institution between March 1999 and September 2017. Nodules were divided into large (≥1.0 cm) and small (<1.0 cm) groups. US images were analyzed according to the K-TIRADS and ATA guidelines. The differences in US characteristics between small and large nodules were compared using Fisher’s exact or Chi-square tests. Results Of 129 MTC nodules, 84 (65.1%) were large nodules and 45 (34.9%) were small nodules. According to the nodule size, small MTC nodules were classified more commonly as high suspicion by K-TIRADS and ATA (95.6% and 93.3%, respectively) ( P < 0.001), but presented neither cystic change, isoechogenicity, nor low suspicion category by K-TIRADS and ATA. In contrast, large MTC nodules showed more frequently cystic change (15.5%), isoechogenicity (16.7%), smooth margins (50%), or low or intermediate suspicion US features by K-TIRADS and ATA (59.6% and 36.0%, respectively) (all P values < 0.001). Conclusion Most small MTC nodules are classified as high suspicion on US, whereas large MTC nodules are diagnosed more frequently as low or intermediate suspicion by K-TIRADS and ATA.

Intra-parotid lymph node metastasis in patients with non-cutaneous head and neck cancers: clinical and imaging features for differentiation from simultaneous parotid primary tumor

Background Although uncommon, intra-parotid lymph node (IPLN) metastasis should be considered in the differential diagnosis of parotid masses in patients with head and neck cancers. Purpose To compare the clinical and imaging features of IPLN metastases from head and neck cancers and simultaneous parotid primary tumors. Material and Methods A retrospective review of 2199 patients with non-parotid head and neck cancers revealed 63 patients who also underwent parotidectomy during curative resection of head and neck cancer. After exclusion of direct extension to the parotid gland from adjacent primary tumors (n = 12) and IPLN metastases from skin cancer (n = 5), the final study group was composed of 46 patients, including 26 (1.2%) with 33 IPLN metastases and 20 (0.9%) with 24 simultaneous parotid primary tumors. We compared clinical features of patients (sex, age, site of primary tumor, histologic type, history of prior treatment for malignancy, TNM stages, side of parotid lesion, multiplicity, and metastasis in ipsilateral cervical LNs) and the CT (location in parotid gland, maximum dimension, margins, and central necrosis or cystic change) and 18F-FDG PET/CT (maximum standardized uptake value) findings. Results Ipsilateral level II LN metastasis was more frequent in the IPLN metastasis group than in the simultaneous parotid primary tumor group (73.1% vs. 35.0%, P < 0.05). Imaging features such as location in parotid gland, maximum dimension, margins, central necrosis or cystic change, and maximum standardized uptake value showed no significant differences between the two groups. Conclusion CT and PET/CT findings of IPLN metastasis are indistinguishable from simultaneous parotid primary tumor in patients with head and neck cancers.

A case report of fibroadenoma of the breast with characteristic cystic change on a cut surface

Fibroadenoma with remarkable cystic change is very unusual. Opinions differ as to the interpretation of this lesion. Furthermore, there have been few reports focusing on its macroscopic view. We herein report a case of fibroadenoma in a 43-year-old woman. The patient presented herself to a medical doctor’s office due to a rapidly growing breast tumor. Based on a core needle biopsy, a benign lesion was suspected, and the tumor was surgically resected. On a macroscopic study, the cut surface of the tumor revealed a remarkably cystic and well-circumscribed lesion with an intracystic polypoid component. Microscopically, a variety of findings of epithelial and stromal proliferation were observed. This is an interesting case not only because a fibroadenoma with prominent cystic change is unusual but also because the breast tumor showed a characteristically cystic appearance on its macroscopic view.