A rare ovarian hilus cell tumour accompanying bilateral serous cystadenomas: report of a case

Background Hilus cell tumours is considered an uncommon branch of androgen producing neoplasms that accounts for < 5% of all ovarian tumours. They are mostly benign and have characteristic gross and microscopic features. Here we present the first case of a hilus cell tumour in association with bilateral serous cystadenomas. Case presentation A 65-year-old lady with no symptoms of virilization, presented with postmenopausal dysfunctional uterine bleeding and radiological investigations revealing bilateral ovarian cysts that required a total abdominal hysterectomy with bilateral salpingo-oophorectomy. Gross and microscopic evaluation confirmed the diagnosis of hilus cell tumour associated with bilateral serous cystadenomas. Conclusions This was the first case of hilus cell tumour in association with bilateral serous cystadenomas of the ovaries. Although, majority of hilus cell tumours that have been reported in the literature were benign, further studies are required to determine the behavior of the disease.

CT-Based Radiomics Analysis for Preoperative Diagnosis of Pancreatic Mucinous Cystic Neoplasm and Atypical Serous Cystadenomas

ObjectivesTo investigate the value of CT-based radiomics analysis in preoperatively discriminating pancreatic mucinous cystic neoplasms (MCN) and atypical serous cystadenomas (ASCN).MethodsA total of 103 MCN and 113 ASCN patients who underwent surgery were retrospectively enrolled. A total of 764 radiomics features were extracted from preoperative CT images. The optimal features were selected by Mann-Whitney U test and minimum redundancy and maximum relevance method. The radiomics score (Rad-score) was then built using random forest algorithm. Radiological/clinical features were also assessed for each patient. Multivariable logistic regression was used to construct a radiological model. The performance of the Rad-score and the radiological model was evaluated using 10-fold cross-validation for area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy.ResultsTen screened optimal features were identified and the Rad-score was then built based on them. The radiological model was built based on four radiological/clinical factors. In the 10-fold cross-validation, the Rad-score was proved to be robust and reliable (average AUC: 0.784, sensitivity: 0.847, specificity: 0.745, PPV: 0.767, NPV: 0.849, accuracy: 0.793). The radiological model performed slightly less well in classification (average AUC: average AUC: 0.734 sensitivity: 0.748, specificity: 0.705, PPV: 0.732, NPV: 0.798, accuracy: 0.728.ConclusionsThe CT-based radiomics analysis provided promising performance for preoperatively discriminating MCN from ASCN and showed good potential in improving diagnostic power, which may serve as a novel tool for guiding clinical decision-making for these patients.

Ovarian cysts in Pregnancy: Obstetric Outcome and Management

Objective: To study the pregnancy outcome and management of ovarian cysts during pregnancy. Methods : A prospective observational study was conducted in Prathima Institute of Medical Sciences, Karimnagar from June 2018 to June 2020. A total of 32 cases with ovarian cysts 5cm with benign features as suggested by ultrasound were included in the study. The pregnancy outcome and management were studied. Results : Out of 32 pregnant women with ovarian cysts, 25(78.12%) were asymptomatic and were managed conservatively. Of the 25, spontaneous resolution was seen in 18(56.25%) patients while 7(21.87%) patients in whom ovarian cyst persisted or was incidentally detected during cesarean section were managed by cystectomy at the same time. Surgery was needed in the antenatal period in 7(21.87%) patients due to complications such as increase in size of the cyst seen in 4(12.5%) and torsion seen in 3(9.37%). All the 32 patients had good perinatal outcome. There were no miscarriages. All patients continued to term except one, who presented at 36 weeks with torsion, andunderwent emergency cesarean section with oophorectomy. Histopathological examination of the excised cysts showed 5 as simple cyst, 5 as serous cystadenomas, 3 as mucinous cystadenomas and 1 as dermoid. Conclusion: Management of the ovarian cysts during pregnancy is conservative. Most of them undergo spontaneous resolution. Surgical management is reserved for only symptomatic patients. Pregnancy outcome as such is not affected by ovarian cysts during pregnancy.

A retrospective study on histomorphological spectrum of ovarian lesions in a tertiary care hospital

Introduction: Gynecological morbidity is defined as any condition, disease, or dysfunction of thereproductive system which is not related to pregnancy, abortion, or childbirth. A significant numberof ovarian lesions have been known to cause Gynecological morbidity among most females. With theincreased use of screening modalities, ovarian lesions have increasingly been encountered forpathological analysis. It is important to evaluate the pattern of clinical presentation, corroboratingwith histological diagnosis. Purpose: The present study was carried out to evaluate thehistomorphological spectrum of various ovarian lesions among women in Puducherry. Material andMethods: This retrospective study was conducted on 350 ovarian samples received for five years inthe Department of Pathology, of our tertiary teaching hospital. Clinicopathological data wereretrieved from the hospital records. The histomorphological analysis was reviewed and neoplasticand non-neoplastic ovarian lesions were segregated according to the World Health Organizationclassification. Results: Based on histology, the predominant ovarian lesions diagnosed were non-neoplastic conditions including simple and follicular cyst, corpus luteal cyst, corpus hemorrhagiccyst, and cystic follicles constituting 40.6% on the right side and 34% on the left side. Malignancywas predominant on the right side (1.7%) while the same was 0.6% on the left side. Conclusion:The present study has identified that non-neoplastic lesions are more common in ovaries thanneoplastic lesions and it has identified that serous cystadenomas are the most common ovarianneoplastic lesions.

Primary Retroperitoneal Serous Cystadenoma Mimicking Rectal Duplication Cyst: A Case Report

Background: Primary retroperitoneal serous cystadenomas (PRSCs) are extremely rare, and their pathogenesis is not well understood. Differentiating these tumors from other cystic or tumorigenic lesions can be challenging given the unusual retroperitoneal location and varied symptomatology. Case Presentation: An 83-year-old female was evaluated for vaginal prolapse symptoms, fecal incontinence, and intermittent mixed urinary incontinence symptoms. Magnetic resonance imaging showed a large space-occupying cystic structure closely associated with the rectum. After exploratory laparotomy with excision of the retroperitoneal mass, biopsy showed a simple cyst filled with serous fluid and lined by a single layer of cuboidal epithelial cells consistent with serous cystadenoma. On follow up visit, she reported improvement in stress urinary incontinence, but continued to have difficulty with urinary and bowel urge incontinence. Conclusion: PRSCs should be considered during evaluation of retroperitoneal space-occupying lesions despite the rarity of serous cystadenomas being found in this location. The pathophysiology of how PRSCs arise is still not well understood but establishing better techniques to distinguish these lesions from other cystic and tumorigenic lesions should be investigated.

Cystic Pancreatic Lesions: A Review of Diagnosis and Management

Pancreatic cysts are commonly seen with increasing use of cross-sectional imaging. They range from a benign inflammatory process that can produce pseudocysts to malignant lesions such as mucinous cystadenocarcinoma. Other common pancreatic cysts include intraductal pancreatic mucinous neoplasms and serous cystadenomas. Optimized imaging protocol dedicated to imaging the pancreas is required, such as multiphasic computed tomography, magnetic resonance imaging/magnetic resonance cholangiopancreatography, or endoscopic ultrasound, to fully detect and characterize the lesions. A confident diagnosis can be made on imaging when features such as calcifications, pancreatic duct diameter, main duct communication, and mural nodules are assessed. Additionally, pathologic evaluation from fluid/tissue sampling aid in diagnosis. Optimal management of pancreatic cysts is achieved based on the imaging features, conveying key findings in the radiology report, pathologic evaluation, and clinical factors.