Non-invasive Resolution of Pathological Ovarian Masses with Homeopathic Treatment—A Case Series

Background Ovarian masses may be either physiological or pathological. Physiological ovarian masses are non-neoplastic. Pathological masses grow more than 7 cm and persist beyond 3 months; they do not resolve spontaneously, and invasive surgery with removal of reproductive organs is the conventional treatment. It usually results in further co-morbidities and hampers the quality of life of the patient. Objectives This case series of pathological left ovarian masses demonstrates the role of homeopathic treatment in each of two multiparous women where the right ovary was surgically removed previously for similar pathology and in an adolescent girl with increased tumor marker CA-125. Methods Three cases of women with pathological ovarian masses in the left ovary, and advised invasive surgery by attending gynecologists, were treated with homeopathic medicines at the outpatient department of the National Homeopathy Research Institute in Mental Health, Kottayam, Kerala, from 2017 to 2020. Each case was followed up with clinical and ultrasonographic evidence and reported according to the criteria set out in the HOM-CASE guidelines. Result Complete resolution of the ovarian masses was observed in all three cases, evidenced by ultrasonography, with normalizing CA-125 values also observed in the case of endometrial cyst. The patients improved within 4 to 15 months of treatment using Thuja and other individualized homeopathic medicines. The MONARCH score was calculated as +7/13, +9/13, and +9/13 for the three cases, respectively, indicating a positive causal attribution of homeopathy in the resolution of these pathological ovarian masses. Conclusion This case series suggests that individualized homeopathy, and notably Thuja, can be useful in the treatment of pathological ovarian masses.

Comparison of conventional, doppler and contrast-enhanced ultrasonography in differential diagnosis of ovarian masses: a systematic review and meta-analysis

ObjectivesTo assess the value of conventional, Doppler and contrast-enhanced ultrasonography (CEUS) (conventional ultrasonography (US), Doppler US and CEUS) for diagnosing ovarian cancer.DesignSystematic review and meta-analysis.Data sourcesPubMed, Embase and the Cochrane Library were conducted for studies published until October 2021.Eligibility criteriaStudies assessed the diagnostic value of conventional US, Doppler US or CEUS for detecting ovarian cancer, with no restrictions placed on published language and status.Data extraction and synthesisThe study selection and data extraction were performed by two independent authors. The sensitivity, specificity, positive and negative likelihood ratio (PLR and NLR), diagnostic OR (DOR) and area under the receiver operating characteristic curve (AUC) were pooled using the bivariate generalised linear mixed model and random effects model.ResultsThe meta-analysis included 72 studies and involved 9296 women who presented with ovarian masses. The pooled sensitivity, specificity, PLR, NLR, DOR and AUC for conventional US were 0.91 (95% CI: 0.87 to 0.94) and 0.87 (95% CI: 0.82 to 0.91), 6.87 (95% CI: 4.98 to 9.49) and 0.10 (95% CI: 0.07 to 0.15), 57.52 (95% CI: 36.64 to 90.28) and 0.95 (95% CI: 0.93 to 0.97), respectively. The sensitivity, specificity, PLR, NLR, DOR and AUC for Doppler US were 0.93 (95% CI: 0.91 to 0.95) and 0.85 (95% CI: 0.80 to 0.89), 6.10 (95% CI: 4.59 to 8.11) and 0.08 (95% CI: 0.06 to 0.11), 61.76 (95% CI: 39.99 to 95.37) and 0.96 (95% CI: 0.94 to 0.97), respectively. The pooled sensitivity, specificity, PLR, NLR, DOR and AUC for CEUS were 0.97 (95% CI: 0.92 to 0.99) and 0.92 (95% CI: 0.85 to 0.95), 11.47 (95% CI: 6.52 to 20.17) and 0.03 (95% CI: 0.01 to 0.09), 152.11 (95% CI: 77.77 to 297.51) and 0.99 (95% CI: 0.97 to 0.99), respectively. Moreover, the AUC values for conventional US (p=0.002) and Doppler US (p=0.005) were inferior to those of CEUS.ConclusionsConventional US, Doppler US and CEUS have a relatively high differential diagnostic value for differentiating between benign and malignant ovarian masses. The diagnostic performance of CEUS was superior to that of conventional US and Doppler US.

Evaluation of a step-by-step approach to frozen section diagnosis in ovarian masses

Background: Ovarian cancer forms a significant proportion of cancer-related mortality in females. It is often detected late due to non-specific clinical presentation. Radiology and tumor markers may indicate an ovarian mass. However, exact diagnosis requires pathological evaluation, which may not be possible before surgery. Intraoperative frozen section (FS) is, therefore, an important modality for the diagnosis of ovarian masses. Aims and Objectives: This study was conducted to study step-by-step approach along with diagnostic utility and accuracy of intraoperative FS in diagnosis of ovarian masses. Materials and Methods: Retrospective comparative analysis was done to determine the diagnostic accuracy of FS as compared to routine histopathology in the pathology department of a tertiary care hospital. Diagnostic categorization was done into benign, borderline, and malignant. Overall accuracy, sensitivity, and specificity of FS technique were calculated. Results: Out of 51 cases, FS analysis yielded accurate diagnosis in 94.1% of ovarian masses. Intraoperative FS had a sensitivity of 94.7%, specificity of 96.9%, 3.1% false-positive rate, and 5.3% false-negative rate in malignant tumors. In benign lesions, FS had 91.7% sensitivity and 100% specificity. FS had 75% sensitivity and 96.4% specificity in cases of borderline tumors. Conclusion: FS is a fairly accurate technique for intraoperative evaluation of ovarian masses. It can help in deciding the extent of surgery. It distinguishes benign and malignant tumors in most cases with high sensitivity and specificity. A methodical approach is useful in determining accurate diagnosis on FS diagnosis.

Histopathologic pattern of ovarian masses in Usmanu Danfodiyo university teaching hospital, Sokoto, Nigeria

Diseases of the ovary are diversely arising from the different parenchymal tissue components. This span between reactive functional cysts to more debilitating ovarian carcinoma. Ovarian carcinoma is the sixth most common cancer and one of the leading cause of cancer death among female. This study aims to determine the epidemiological and histopathological patterns of ovarian masses in our setting.The study material was all the ovarian tissues biopsy specimen submitted to the Department of Histopathology, Usmanu Danfodiyo University Teaching Hospital, Sokoto over five years. These were fixed in 10% formal saline embedded in paraffin wax, tissue blocks formed and were sections and stained with hematoxylin and eosin on the glass slides. Request cards and case folders were used to extract clinical information. These were reviewed, analysed and presented as frequency distribution figures.There were 112 ovarian biopsies during the study period. Their ages ranged between 13 and 67 years and peaked in the fourth decade of life. Fifty per cent of all the cases were seen between the ages of 21 and 40 years. Benign neoplastic diseases formed 50% of the ovarian masses and matured cystic teratoma was the most common. Others were reactive and functional ovarian cysts (24.1%), malignant neoplastic conditions (14.3%) and inflammatory / infectious diseases (11.6%). Overall mature cystic teratoma constitutes 27% of the entire ovarian masses. Matured cystic teratoma was the most common disease of the ovary in our setting, afflicting young female, while malignant tumours dominated by serous cystadenocarcinoma affect the older age group. The fourth decade of life was the most common age of affectation. We advocate for proper histopathologic evaluation of all ovarian masses to arrive at a definitive diagnosis to offer an appropriate treatment modality.

Ovarian Masses-Applicable IOTA ADNEX Model versus Morphological Findings for Accurate Diagnosis and Treatment

A common problem in gynecological practice is the differential diagnosis of the ovarian masses. The clinician must apply the IOTA (International Ovarian Tumor Analysis) ADNEX (Assessment of Different Neoplasia in the Adnexa) model criteria to evaluate the risk of benign, borderline or malignant tumors. The aim of this study was to verify if the IOTA ADNEX model is a practical tool to be used before surgery and if there is a significant difference between IOTA ADNEX criteria and histological findings. A prospective single center study was performed between January 2017 and December 2019 in Obstetrics and Gynecology Hospital “Cuza-Voda”, Iasi, Romania. The study included 230 patients between 17 and 74 years old diagnosed with persistent adnexal masses. We applied the IOTA ADNEX model protocol predicting the risk of benign, borderline or malignant masses. The golden standard remains the histological diagnosis of the surgically removed mass. The patients that had been diagnosed using ultrasonography with persistent adnexal masses between 30 and 291 mm were operated on in our clinic. In our study. the majority of patients had benign ovarian tumor mass, these being 223 (96.96%) patients, from whom, according to IOTA ADNEX protocol, the correspondence was: 91.8–99.7% at risk of benign tumors, 0.3–4.5% at risk of borderline tumors and 0.3–8.2% at risk of malignant masses. Unexpected findings were obtained from the malignant group that included five patients (2.17%) with the following correspondence: 96.1–99% at risk of benign tumors, 0.6–2.4% at risk of borderline tumors and 1–3.9% at risk of malignant masses. After applying the IOTA ADNEX model criteria, the patients with a suspicion of malignant disease were correctly guided towards surgical treatment in an oncological center. In our hospital, surgical treatment was only proposed to those patients with high suspicion of benign masses.

Breast Carcinomatous Lymphangitis as an Unusual Presentation of Ovarian Cancer

We describe the case of a 45-year-old woman with an unusual presentation of metastatic ovarian cancer. The patient presented to the oncological clinic with a three-week history of skin rash on the right breast. She underwent a chest and abdomen CT scan, which showed skin thickening of the right breast, right pleural effusion and bilateral cystic ovarian masses. Biopsy of a left ovarian lesion by diagnostic laparoscopy revealed the presence of ovarian serous carcinoma. Biopsy of the breast skin lesion revealed the presence of carcinomatous lymphangitis and immunohistochemistry documented the ovarian origin.

A prospective study of clinical and diagnostic methods of ovarian tumors admitted in a tertiary care hospital and its correlation with histopathology

Background: Aim of the study was to study demographic profile and diagnostic modalities of ovarian tumors and their correlation with histopathological report (HPR).Methods: Prospective observational study conducted in NSCB medical college, Jabalpur from February 2019 to July 2020 on subjects with ultrasonographically diagnosed ovarian tumors. Relevant history obtained, gynecologic examination, investigations recorded. Subjects followed up to collection of HPR and correlation with histopathology done.Results: Out of 120 cases of ovarian tumors, 39.16% were malignant and 60.83% were benign ovarian tumors. Out of 80 premenopausal females, majority (78.75%) had benign ovarian masses. Amongst 40 postmenopausal females, 75% of ovarian masses were malignant. CA125 had sensitivity 76.59%, specificity 76.71% and accuracy 76.66% in diagnosing ovarian malignancy. Amongst 4 RMI scores, RMI 1 has the highest sensitivity and specificity 85.10%, 86.30% respectively. Sensitivity, specificity, and accuracy of ultrasound score was 65.21%, 86.30% and 77.5% respectively. Sensitivity and specificity of clinical diagnosis was 83% and 95.89% respectively and ROC analysis showed clinical diagnosis can accurately predict benign and malignant ovarian tumors in 89% cases.Conclusions: RMI 1 score has the highest sensitivity and specificity in our study. When all 4 methods of diagnosis i.e., RMI Score, ultrasound score, CA125 and clinical diagnosis were compared, clinical diagnosis has highest prediction of malignancy.