Multiple paraovarian cysts requiring emergency surgery: a rare clinical finding

This report presents an unusual case of multiple paraovarian cysts that required emergency surgery due to a paraovarian cyst being entrapped by another paraovarian cyst. Laparoscopic surgery is considered useful for diagnostic and therapeutic purposes and is therefore recommended owing to difficulty in differentiating paraovarian cysts from ovarian cysts.

Giant paraovarian cyst in an adolescent: a challenge of accurate diagnostic

BackgroundParaovarian cysts (POCs) are rarely seen among pediatric female patients. The diagnosis still represents a challenge. Giant POCs are exceedingly rare and only few cases have been reported in the literature.Case presentationA 17-year-old girl from the rural area presented with abdominal pain, pollakiuria and a giant abdomino-pelvic mass. Ultrasound and computed tomography revealed a 14cm x 24cm x 30cm anechoic unilocular cyst which raised the suspicion of a mesenteric or ovarian cyst. The correct diagnosis of left POC was established intraoperatory. Cystectomy was performed. Histopathological diagnosis was serous cystadenoma.DiscussionsPOCs become symptomatic when reach large sizes or complicate, the most feared complication being ovary torsion. Imagistic investigations can establish the diagnosis of cyst, but the cyst’s origin often remains an intraoperatory discovery. Surgical excision is necessary to decrease the risk of complications, and adnexal preservation is essential in pediatric patients. Even for pediatric female patients POC should be considered in the differential diagnosis of cystic abdominal masses.

Isolated fallopian tube torsion with paraovarian cysts: a case report and literature review

Background Isolated fallopian tube torsion (IFTT) is a rare cause of gynecological acute abdomen, is easily misdiagnosed and often has a delay in diagnosis. IFTT with paraovarian cysts is most frequently reported in studies. Here, we reported a patient diagnosed with IFTT associated with a paraovarian cyst, and we conducted a literature review for IFTT, aiming to identify valuable information that will be helpful for diagnosis and treatment for fallopian tube torsions. Case presentation A 13-year-old girl presented with a 10-day history of right lower abdominal pain that worsened 2 days before presentation. On presentation, ultrasound showed a 5.8 * 5.5 cm hypoechoic cyst adjacent to the right ovary, and between the cyst and ovary, a tortuous thickened tube was visualized. Laparoscopy revealed a triple torsion of the right fallopian tube with a 6-cm paraovarian cyst, and tubal conservation surgery was performed. The postoperative course was uneventful. Histopathological diagnosis revealed serous papillary cystadenoma. Conclusion Paraovarian cystic dilatation often occurs in adolescence and can induce fallopian torsion when the size of the cyst reaches 5-cm. In our review, the median age of patients diagnosed with IFTT with paraovarian cysts was 15 years old, and the main clinical manifestation was emergency abdominal pain. The associated symptoms were variable, and vomiting was the most commonly associated symptom. Salpingectomy was the most common procedure performed; however, timely surgical intervention can effectively avoid salpingectomy.

Borderline Serous Papillary Tumor Arising in a Paraovarian Cyst: A Case Report and an Extensive Review of the Literature

Background: Paraovarian cysts are benign cysts that develop near the ovaries and fallopian tubes in the pelvic region. They can cause mass effects requiring excision. In rare cases, tumors may develop inside these cysts. These tumors may be benign, malignant, or borderline. Case Report: A 26-year-old lady presented for excision of a paraovarian cyst. Pre-operative imaging showed the presence of few undulating folds at the periphery of the cyst. The patient underwent laparoscopic pelvic cystectomy without intra-operative drainage. Pathological examination of the specimen revealed a borderline serous papillary tumor protruding from the cyst wall. Conclusion: The occurrence of a borderline tumor, also known as a tumor of low malignant potential, in a pre-existing paraovarian cyst is very rare and has only been reported few times in the literature. A thorough review of these cases showed that the most common imaging finding that raises suspicion for a borderline tumor within a paraovarian cyst is the presence of small intracystic projections within the unilocular adnexal cyst. However, since evaluating the presence of an intracystic tumor is not always possible, performing a fertility-preserving laparoscopic cystectomy without cyst content spillage, is recommended. If properly excised, the prognosis of this tumor is good, and recurrence is rare.

Non-Tender Huge Abdominal Mass in an Adolescent

Paraovarian cysts constitute about 10% of all adnexal masses in females and occur most commonly in the third and fourth decades of life. These cysts are benign and usually uncommon in adolescence. Such cysts pose a diagnostic challenge while distinguishing them from ovarian cysts clinically and during radiological investigations. We report a rare case of a 13-year-old female patient with bilateral paraovarian cysts, including a giant cyst in right mesosalpinx presenting to Sohar hospital, Oman in 2018. The definitive origin of the huge mass on the right side of abdominal cavity could not be established in the current case despite contrast enhanced computerized tomography. It was only on laparoscopic exploration that this mass was identified as a giant paraovarian cyst. Both the giant cyst and a smaller paraovarian cyst on the left side were enucleated with minimally invasive surgery while preserving the fertility of the patient. Only one other similar case of bilateral paraovarian cysts in an adolescent, including a giant cyst managed with laparoscopy, has been documented previously. Keywords: Adolescent; Parovarian Cyst; Laparoscopy; Ultrasonography; Minimally Invasive Surgical Procedures; Case Report; Oman.

Paraovarian cyst as the cause of uterine prolapse

Paraovarian cysts originate from the mesothelium and are presumed to be remnants of M?llerian or Wolffian ducts. In majority of cases they are found to be 10-80 mm in diameter and do not cause any symptoms. Paraovarian cysts can be found unexpectedly during an operation or on ultrasound examination performed for other reasons. They are most freequently discovered on ultrasound examination. However, due to the proximity of the ovary for which cystic formations are not rare, the diagnosis of these lesions can be a challenge. They are mostly asymptomatic and only large lesions (?20 cm in diameter) become symptomatic. Although these are mostly benign tumors, in rare cases they can become borderline or true malignancies. Most paraovarian cysts are found in the third and fourth decade of life. Paraovarian cyst complications include: compression of the surrounding structures of the pelvis minor and abdomen, pelvic pain, cyst torsion and rupture. Except for the already mensioned complications available literature has so far failed to show cases of uterine prolapse caused by an increase of intra-abdominal pressure due to the expansive growth of giant paraovarian cystic formation.

LAPAROSCOPIC MANAGEMENT OF BENIGN ADNEXAL MASSES

Objective: to assess the effectiveness of laparoscopic management of adnexal masses suspected to be benign on pre-operative evaluation. Material and method: all women with 2018 to December 2018 were included in the study. Results: 32 women with adnexal mass presumed to be benign were taken up for laparoscopy. Diagnosis in 34.4% cases was endometriosis, 25% simple ovarian cyst,12.5% hydroslapinx, 9.4% dermoid cyst, 6.3% paraovarian cyst, 3.1% tubo-ovarian abscess, 3.1% TO mass, 3.1% tubal ectopic pregnancy and 3.1% PCOS. Most commonly performed surgery was cystectomy (53.1% cases). Other procedures included deroofing and fulguration(15.6%), cuff salpingostomy (12.5%), aspiration (6.3%), salpingectomy (3.1%), salpingo-oopherectomy (3.1%) and ovariectomy (3.1%). Conclusions: laparoscopy is safe procedure and can be used in managing patients with benign adnexal masses. Proper selection of cases is important and can be achieved by ultrasonography, CA-125, CT scan and MRI.