RESUMO
The term pseudoascitis is used in patients who give the false impression of ascites, with abdominal distension but without peritoneal free fluid. The case of a 66-year-old woman, hypertensive and hypothyroid with occasional alcohol consumption, who consults due to progressive abdominal distension of 6 months of evolution and diffuse percussion dullness is presented, in whom a paracentesis is performed with the wrong endorsement of examination ultrasound that reports abundant intrabdominal free fluid (Fig. 1), later finding in the CT scan of the abdomen and pelvis an expansive process of cystic appearance of 295mm x 208mm x 250mm. Left anexectomy is programmed (Fig. 2) with pathological report of mucinous ovarian cystadenoma. The case report refers to the availability of the giant ovarian cyst within the differential diagnosis of ascites. If no symptoms or obvious signs of liver, kidney, heart or malignant disease are found and / or ultrasound does not reveal typical signs of intra-abdominal free fluid (fluid in the bottom of the Morrison or Douglas sac, presence of floating free intestinal handles), a CT scan and / or an RMI should be requested before performing paracentesis, which could have potentially serious consequences.
El término pseudoascitis, se utiliza en los pacientes que dan la falsa impresión de ascitis, con distensión abdominal pero sin líquido libre peritoneal. Se presenta el caso de una mujer de 66 años, hipertensa e hipotiroidea con consumo ocasional de alcohol, que consulta por distensión abdominal progresiva de 6 meses de evolución y matidez difusa a la percusión, en quien se realiza una paracentesis con el aval equivoco de examen ecográfico que informa abundante líquido libre intrabdominal (Fig. 1), hallando posteriormente en TAC de abdomen y pelvis un proceso expansivo de aspecto quístico de 295mm x 208mm x 250mm. Se programa anexectomia izquierda (Fig. 2) con informe anatomopatológico de cistoadenoma mucinoso de ovario. La comunicación del caso remite a tener disponible el quiste ovárico gigante dentro de los diagnósticos diferenciales de ascitis. Si no se hallan síntomas o signos evidentes de insuficiencia hepática, renal, cardiaca o enfermedad maligna y/o la ecografía no revela signos típicos de líquido libre intrabdominal (líquido en el fondo de saco de Morrison o de Douglas, presencia de asas intestinales libres flotantes), se debería solicitar una TAC y/o una RMI antes de realizar una paracentesis, la cual podría tener consecuencias potencialmente graves.
Assuntos
Cistadenoma Mucinoso , Cistos Ovarianos , Neoplasias Ovarianas , Feminino , Humanos , Idoso , Ascite/diagnóstico por imagem , Ascite/etiologia , Cistadenoma Mucinoso/diagnóstico , Cistadenoma Mucinoso/patologia , Neoplasias Ovarianas/diagnóstico , Cistos Ovarianos/diagnóstico , RimRESUMO
An ovarian benign cyst is a common finding in women of reproductive age. However both the disease and its treatment may have an impact on ovarian reserve, resulting in a significant risk of premature ovarian insufficiency. The counselling on fertility preservation is of paramount importance in such cases. We report the management of a young woman with giant bilateral benign adnexal cysts, highlighting the complexity of fertility preservation in such scenario.
Assuntos
Preservação da Fertilidade , Cistos Ovarianos , Neoplasias Ovarianas , Feminino , Humanos , Preservação da Fertilidade/métodos , Cistos Ovarianos/complicações , Cistos Ovarianos/diagnóstico , Cistos Ovarianos/cirurgia , ReproduçãoRESUMO
INTRODUCTION: Bilateral complex ovarian cysts in newborns are rare and their reporting becomes imperative to in crease knowledge about the best therapeutic management. OBJECTIVE: To describe the clinical case of a newborn with a diagnosis of bilateral complex ovarian cysts and to discuss the conditions for conservative or surgical management according to the ultrasound characteristics of the cyst. CLINICAL CASE: At 35 weeks of gestational age, prenatal ultrasound identified the presence of cystic masses in both adnexa, so it was decided to interrupt the pregnancy by cesarean section at 37 weeks. After birth, bilateral ovarian cysts of 3.5 x 4.4 x 2.7 and 3.4 x 2.4 x 3.3 cm, right and left, respectively, were corro borated. The right cyst had a septum of 1.4 mm thick and thickened wall of 3 mm which was com patible with complex cysts. On the 4th day of extrauterine life, laparoscopic vacuum aspiration and deroofing with electrocautery of the upper wall of both cysts was performed, without complications. The diagnosis of ovarian serous cystadenoma was made by pathological anatomy. CONCLUSIONS: We describe a case with adequate prenatal diagnosis and laparoscopic surgical intervention of a bilateral ovarian cyst > 4 cm. Prenatal diagnosis is essential for choosing the best therapy management (con servative or surgical) depending on the echography characteristics of the cyst. Neonatal surgery is recommended for simple ovarian cysts >4 cm, complex cysts regardless of their size, and those that become complex cysts during conservative management.
Assuntos
Cistadenoma , Cistos Ovarianos , Neoplasias Ovarianas , Cesárea , Cistadenoma/diagnóstico , Cistadenoma/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido , Cistos Ovarianos/diagnóstico , Cistos Ovarianos/patologia , Cistos Ovarianos/cirurgia , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/cirurgia , Gravidez , Ultrassonografia Pré-NatalRESUMO
Introducción: Los quistes en los ovarios son una afección frecuente en las mujeres en edad fértil. Objetivo: Presentar el caso de una mujer con embarazo a la que se le diagnostica un quiste gigante de ovario, de interés para los especialistas debido al tamaño y la favorable evolución. Presentación de caso: Paciente femenina de 28 años de edad, procedencia rural, con embarazo único. Se realizó captación del embarazo a las 11,4 semanas y se detectó al examen ginecológico una tumoración anexial que se corrobora por ultrasonido, donde se reporta una imagen quística que llega a la región umbilical que mide 18 centímetros, de paredes finas, multitabicada con un grosor de los tabiques de 2,3 milímetros, con vascularizazión a este nivel. Se decidió su ingreso para tratamiento quirúrgico a las 17,5 semanas de gestación, se realizó de forma electiva laparotomía exploradora. Los hallazgos operatorios fueron: quiste gigante de ovario de aproximadamente 20 centímetros. Fue dada de alta al tercer día con una evolución satisfactoria. Continúa su atención prenatal en en el consultorio del médico y la enfermera de la familia. Los resultados anatomopatológicos fue: cistodenoma seroso papilar de ovario de 20 por 20 centímetros, no se observan estigmas de malignidad. Se realiza parto eutócico a las 39,1 semanas de gestación, con un peso de 3800 gramos. Conclusiones: Se hace descripción clínico y quirúrgica del diagnóstico, la evolución, la intervención y el seguimiento de una mujer en quien coexistieron un embarazo y un cistodenoma seroso papilar de ovario, con resultados favorables(AU)
Introduction: Ovarian cysts are a frequent condition in women at fertile age. Objective: To present the case of a pregnant woman diagnosed with a giant ovarian cyst, of interest to specialists due to its size and favorable evolution. Case presentation: 28-year-old female patient, of rural origin, with a single pregnancy. During the first pregnancy consultation, at 11.4 weeks, the gynecological examination permitted to identify an adnexal tumor, a diagnosis corroborated by ultrasound imaging, reporting an 18-cm multi-septated cystic image that reaches the umbilical region, with thin walls, septa thickness of 2.3 millimeters and vascularization at this level. The patient was decided to be hospitalized for surgical treatment at 17.5 weeks of gestation; exploratory laparotomy was performed electively. The operative findings were a giant ovarian cyst of approximately twenty centimeters. She was discharged on the third day, with a satisfactory evolution. She continues to receive prenatal care in the family doctor and nurse's office. The anatomopathological results were an ovarian papillary serous cystadenoma measuring 20 per 20 cm; no stigmata of malignancy were observed. Eutocic delivery was performed at 39.1 weeks of gestation, the offspring weighing 3800 grams. Conclusions: A clinical and surgical description is made of the diagnosis, evolution, intervention and follow-up of a pregnant woman with an ovarian papillary serous cystadenoma, reporting favorable outcomes(AU)
Assuntos
Humanos , Feminino , Gravidez , Cistos Ovarianos/diagnóstico , Complicações na Gravidez , Cistadenoma Seroso/cirurgia , Laparotomia/métodosRESUMO
RESUMEN Históricamente, se describen como tumores de gran tamaño aquellos que pesan más de 12 Kg, entre ellos los ginecológicos y los de ovario; sobre todo antes del advenimiento de la ecografía y en poblaciones de mala situación socioeconómica y nivel cultural, como en los países del continente africano. Se presentó un caso de quiste gigante del ovario, en una paciente de 45 años de edad, que fue atendida en el Servicio de Cirugía General del Hospital Municipal de Bocoio, provincia de Benguela, República de Angola, en el año 2015. Se presentó por un aumento de tamaño del abdomen de varios años de evolución Se le diagnosticó una masa quística dependiente de ovario, por ultrasonografía por no contar con otro medio de diagnostico imagenologico. Se confirmó a través de una laparotomía exploradora la presencia de una tumoración quística gigante del ovario de 20 kg de peso. Esta patología es poco frecuente en la actualidad debido al desarrollo de la Cirugía y de los medios de diagnósticos que permiten su detección precoz. El estudio anatomopatológico ulterior informó un cistoadenoma seroso de ovario izquierdo. La evolución de la paciente fue favorable. Se consideró un caso interesante por lo infrecuente, la poca existencia de reporte de estos casos en la literatura, sobre todo en Cuba, lo que contribuye a aportar conocimientos a la comunidad médica (AU).
ABSTRACT Through the history those tumors weighting more than 12 kg have been described as great size tumors, among them the gynecological and the ovarian ones, especially before the appearance of the ultrasonography, and among populations of bad socio-economic situation and low cultural level, like in the countries of the African continent. The authors presented the case of a giant ovarian cyst in a patient aged 45 years, who assisted in the Service of General Surgery of the Municipal Hospital of Bocolo, province of Benguela, Republic of Angola, in 1915. She arrived to the consultation due to an increase of the abdominal size of several years of evolution. By ultrasonography because there was no other mean of imaging diagnosis, the diagnosis was an ovary-dependent cystic mass. Using laparoscopy it was confirmed the presence of a giant cystic tumor of the ovary of 20 kg weight. This disease is few frequent nowadays due to the development of Surgery and diagnostic means allowing a precocious detection. The subsequent anatomopathologic study informed a serous cystadenoma of the left ovary. The patient had a satisfactory evolution. The case was considered interesting given its infrequency, the scarce existence of reports of cases like this in the literature, especially in Cuba, contributing with knowledge for the medical community (AU).
Assuntos
Humanos , Masculino , Feminino , Adulto , Cistos Ovarianos/cirurgia , Cistadenoma Seroso/diagnóstico , Cistos Ovarianos/diagnóstico , Neoplasias Ovarianas/diagnóstico , Pacientes , Ultrassonografia , Cistadenoma Seroso/cirurgiaRESUMO
BACKGROUND: Ovarian masses are common in all pediatric age groups. Ovarian-sparing surgery is favored since most cases are benign or functional cysts. Detection of a few malignant cases prevents morbidity and mortality. Objective: to investigate which of the preoperative findings can help to distinguish the pathology of the ovarian lesions, affect the surgical decision and predict the possibility of ovarian preservation. METHOD: Patients operated with diagnosis of ovarian mass were enrolled in the study between 2000-2015. Age, symptoms, physical examination findings, tumor markers, radiologic features, operative notes, and pathology results were reviewed retrospectively. RESULTS: During the study period, 98 patients were operated and 86 were included. Mean age was 9.7±5.62 years. Non-neoplastic pathologies constitute 68.6 % of cases; 31.4 % was neoplastic. Malignancy rate was 4.6 %. Solid component, absence of ovarian torsion and diameter > 9 cm were more commonly seen in neoplastic cases (p < 0.001, p < 0.001, p=0.001). Adnexal torsion was found in 30 (34.9 %) patients. Mean diameter did not differ significantly between groups with or without torsion; incidence of torsion was greater in patients with masses < 6 cm (p=0.019). Ovariansparing surgery was performed in 48 (55.8 %) and oopherectomy in 38 (44.2 %) patients. Surgical approach was affected by nature (p < 0.001) and size (p < 0.001) of the lesion; it was independent of age and presence of torsion. CONCLUSION: A purely cystic mass < 9 cm, with torsion and negative markers, orients towards a non-neoplastic mass. The presence of solid component and absence of torsion are associated with increased risk of malignancy.
Antecedentes. Las masas ováricas son frecuentes en la población pediátrica. Suele realizarse cirugía conservadora de los ovarios porque la mayoría son quistes benignos o funcionales. Objetivo. Investigar qué hallazgos prequirúrgicos sirven para diferenciar la patología de las lesiones ováricas, influir en las decisiones quirúrgicas y predecir la posibilidad de conservar los ovarios. Método. Se incluyeron pacientes operadas con diagnóstico de masa ovárica. Revisión retrospectiva de edad, síntomas, examen físico, marcadores tumorales, características radiológicas y resultados anatomopatológicos. Resultados. Durante el estudio, se operaron 98 pacientes y se incluyeron 86. Media de edad: 9,7 ± 5,62 años. Las patologías no neoplásicas representaron el 68,6 %, las neoplásicas, el 31,4 %, la tasa de malignidad, el 4,6 %. Las neoplasias incluyeron componente sólido, ausencia de torsión ovárica y diámetro > 9 cm (p< 0,001;p< 0,001; p = 0,001).Se halló torsión anexial en el 34,9 %. El diámetro medio no difirió significativamente entre los grupos con o sin torsión; la incidencia de torsión fue mayor en las masas < 6 cm (p = 0,019). Se realizó cirugía conservadora de los ovarios en 48 pacientes (55,8 %) y ooforectomía, en 38 (44,2 %). El tratamiento dependió de la naturaleza (p< 0,001) y del tamaño (p< 0,001) de la lesión pero no de la edad y la torsión. Conclusión. Una masa puramente quística < 9 cm, con torsión y marcadores negativos indica masa no neoplásica. La presencia de un componente sólido y la ausencia de torsión están asociadas con riesgo de cáncer.
Assuntos
Cistos Ovarianos/diagnóstico , Doenças Ovarianas/diagnóstico , Neoplasias Ovarianas/diagnóstico , Anormalidade Torcional/diagnóstico , Adolescente , Biomarcadores Tumorais/análise , Criança , Pré-Escolar , Tomada de Decisões , Feminino , Humanos , Lactente , Recém-Nascido , Tratamentos com Preservação do Órgão , Cistos Ovarianos/patologia , Cistos Ovarianos/cirurgia , Doenças Ovarianas/patologia , Doenças Ovarianas/cirurgia , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Ovariectomia/estatística & dados numéricos , Período Pré-Operatório , Estudos Retrospectivos , Anormalidade Torcional/cirurgiaRESUMO
Introducción. El tratamiento quirúrgico adecuado para las pacientes pediátricas con lesiones ováricas es heterogéneo, y en las niñas es conveniente conservar los ovarios. El objetivo de este estudio es analizar los hallazgos relacionados con un grupo de pacientes a las que se operó por lesiones ováricas. Pacientes y métodos. Un estudio retrospectivo realizado durante 13 años con 56 pacientes menores de 17 años. Estas pacientes se dividieron en 3 grupos según el diagnóstico de patología ovárica: 25 tenían lesiones funcionales (quistes y torsión), 18 tenían lesiones ováricas epiteliales y 13 tenían tumores germinales. Se comparó a estos tres grupos en términos de menarquia, torsión, edad, duración, tamaño, dolor, tumor, vómitos, menstruación irregular, ubicación y tipo de operación. Resultados. Enestosgrupos,fueronmásfrecuentes los quistes foliculares, los cistoadenomas serosos y los teratomas. La media de edad de las pacientes fue de 12,18 ± 4,84 años. Los síntomas y signos más frecuentes fueron dolor (85,7%) e hinchazón (37,5%) en la región abdominopélvica. Se observó torsión en 21 pacientes (37,5%); la media del tamaño del tumor fue de 10,46 ± 6,55 cm. Se realizó una salpingoovariectomía (SO, por sus siglas en inglés) en 38 pacientes y una resección del quiste (CE, por sus siglas en inglés) en 18 pacientes. Se observaron más casos de torsión en las pacientes premenárquicas que en las menárquicas y en el grupo de lesiones funcionales. Se realizaron más resecciones quirúrgicas en el grupo de lesiones funcionales, y más SO en los grupos de lesiones epiteliales y tumores germinales. Conclusión. Se considera que la torsión y las patologías ováricas funcionales son frecuentes en la edad premenstrual, y las lesiones malignas son muy raras en todos los grupos etarios, por lo que se recomienda preservar la fertilidad en la cirugía.
Introduction. The appropraite surgical treatment to pediatric patients with ovarian lesions are heterogeneous and ovarian preservation is desirable in children. The aim of this study is to the discuss findings related to a set of patients who were operated on for ovarian lesions. Patients and methods. A retrospective study carried out in 13 years on 56 patients under the age of 17. These patients were divided into 3 groups according to ovarian pathologic diagnosis: 25 with functional (cyts and torsion), 18 with epithelial ovarian lesions and 13 with germ cell tumours. These three groups were compared in terms of menarche, torsion, age, duration, size, pain, mass, vomiting, irregular menstruation, location and operation type. Results. Follicle cysts, serous cyst adenomas and teratomas were the most common in these groups. The mean age of the patients was 12.18+4.84 years. The most common symptoms and signs were abdominal-pelvic pain (85.7%) and swelling(37.5%). Torsion was seen in 21 patients (37.5%), mean mass size was found to be 10.46+6.55 cm. A salpingo-oophorectomy (SO) was performed in 38 patients and cyst excision (CE) was performed in 18 patients. In premenarcheal cases, torsion was seen more in menarcheal cases and in the functional lesion group. CE was performed more often in the functional and t SO was performed often in the epithelial and germ cells groups. Conclusion. Torsion and functional ovarian pathologies are thought to be common in premenstrual ages and malign lesions are very rare in all age groups so we recommend ovarian protective surgery should be preferred.
Assuntos
Humanos , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Cistos Ovarianos/cirurgia , Doenças Ovarianas/cirurgia , Neoplasias Ovarianas/cirurgia , Neoplasias Embrionárias de Células Germinativas/cirurgia , Preservação de Órgãos/métodos , Cistos Ovarianos/diagnóstico , Doenças Ovarianas/diagnóstico , Neoplasias Ovarianas/diagnóstico , Anormalidade Torcional/cirurgia , Anormalidade Torcional/diagnóstico , Dor Abdominal/etiologia , Estudos Retrospectivos , Fatores Etários , Dor Pélvica/etiologia , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Salpingo-Ooforectomia/métodosRESUMO
INTRODUCTION: The appropraite surgical treatment to pediatric patients with ovarian lesions are heterogeneous and ovarian preservation is desirable in children. The aim of this study is to the discuss findings related to a set of patients who were operated on for ovarian lesions. PATIENTS AND METHODS: A retrospective study carried out in 13 years on 56 patients under the age of 17. These patients were divided into 3 groups according to ovarian pathologic diagnosis: 25 with functional (cyts and torsion), 18 with epithelial ovarian lesions and 13 with germ cell tumours. These three groups were compared in terms of menarche, torsion, age, duration, size, pain, mass, vomiting, irregular menstruation, location and operation type. RESULTS: Follicle cysts, serous cyst adenomas and teratomas were the most common in these groups. The mean age of the patients was 12.18±4.84 years. The most common symptoms and signs were abdominal-pelvic pain (85.7%) and swelling(37.5%). Torsion was seen in 21 patients (37.5%), mean mass size was found to be 10.46±6.55 cm. A salpingo-oophorectomy (SO) was performed in 38 patients and cyst excision (CE) was performed in 18 patients. In premenarcheal cases, torsion was seen more in menarcheal cases and in the functional lesion group. CE was performed more often in the functional and t SO was performed often in the epithelial and germ cells groups. CONCLUSION: Torsion and functional ovarian pathologies are thought to be common in premenstrual ages and malign lesions are very rare in all age groups so we recommend ovarian protective surgery should be preferred.
Introducción. El tratamiento quirúrgico adecuado para las pacientes pediátricas con lesiones ováricas es heterogéneo, y en las niñas es conveniente conservar los ovarios. El objetivo de este estudio es analizar los hallazgos relacionados con un grupo de pacientes a las que se operó por lesiones ováricas. Pacientes y métodos. Un estudio retrospectivo realizado durante 13 años con 56 pacientes menores de 17 años. Estas pacientes se dividieron en 3 grupos según el diagnóstico de patología ovárica: 25 tenían lesiones funcionales (quistes y torsión), 18 tenían lesiones ováricas epiteliales y 13 tenían tumores germinales. Se comparó a estos tres grupos en términos de menarquia, torsión, edad, duración, tamaño, dolor, tumor, vómitos, menstruación irregular, ubicación y tipo de operación. Resultados. En estos grupos, fueron más frecuentes los quistes foliculares, los cistoadenomas serosos y los teratomas. La media de edad de las pacientes fue de 12,18 ± 4,84 años. Los síntomas y signos más frecuentes fueron dolor (85,7%) e hinchazón (37,5%) en la región abdominopélvica. Se observó torsión en 21 pacientes (37,5%); la media del tamaño del tumor fue de 10,46 ± 6,55 cm. Se realizó una salpingoovariectomía (SO, por sus siglas en inglés) en 38 pacientes y una resección del quiste (CE, por sus siglas en inglés) en 18 pacientes. Se observaron más casos de torsión en las pacientes premenárquicas que en las menárquicas y en el grupo de lesiones funcionales. Se realizaron más resecciones quirúrgicas en el grupo de lesiones funcionales, y más SO en los grupos de lesiones epiteliales y tumores germinales. Conclusión. Se considera que la torsión y las patologías ováricas funcionales son frecuentes en la edad premenstrual, y las lesiones malignas son muy raras en todos los grupos etarios, por lo que se recomienda preservar la fertilidad en la cirugía.
Assuntos
Neoplasias Embrionárias de Células Germinativas/cirurgia , Cistos Ovarianos/cirurgia , Doenças Ovarianas/cirurgia , Neoplasias Ovarianas/cirurgia , Dor Abdominal/etiologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Preservação de Órgãos/métodos , Cistos Ovarianos/diagnóstico , Doenças Ovarianas/diagnóstico , Neoplasias Ovarianas/diagnóstico , Dor Pélvica/etiologia , Estudos Retrospectivos , Salpingo-Ooforectomia/métodos , Anormalidade Torcional/diagnóstico , Anormalidade Torcional/cirurgiaRESUMO
The development of new biomarkers for the diagnosis and prognosis of ovarian cancer may provide an opportunity for new therapies. In this study, we aimed to compare cytokines (interleukin [IL]-2, IL-5, IL-6, IL-8, IL-10 and tumour necrosis factor [TNF]-α) and nitric oxide (NO) metabolite levels in non-neoplastic tumours, benign primary ovarian tumours and malignant primary ovarian neoplasms. The secondary aim was to relate cytokine and intracystic NO metabolite levels to clinical, laboratory and pathologic characteristics for patients with primary ovarian malignancies. We evaluated 110 patients with adnexal masses. Cytokine concentrations were quantified by enzyme-linked immunosorbent assay and nitrate concentrations by enzymatic reduction of nitrite by nitrate reductase. Patients with malignant neoplasms had higher IL-6, IL-8 and NO levels compared to patients with benign neoplasms. Histologic grade 1 tumours were associated with elevated IL-2 levels, whereas anaemia was associated with elevated IL-6 levels. On average, those patients with elevated IL-8 levels also had a neutrophil/lymphocyte ratio (NLR) greater than 2.6 and less than 36 months of disease-free survival (DFS). Patients with normal CA 19-9 levels had elevated IL-10 levels. TNF-α was elevated in patients with two carcinogenesis and those with a platelet/lymphocyte ratio (PLR) less than 300. NO levels were higher in patients with an NLR less than 2.6 and CA 19-9 greater than 35 U/ml. Elevated intracystic cytokine levels, especially IL-6 and IL-8, are associated with worse prognosis in ovarian cancer.
Assuntos
Biomarcadores Tumorais/metabolismo , Interleucina-6/metabolismo , Interleucina-8/metabolismo , Óxido Nítrico/metabolismo , Cistos Ovarianos/imunologia , Neoplasias Ovarianas/imunologia , Ovário/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinogênese , Criança , Feminino , Humanos , Pessoa de Meia-Idade , Cistos Ovarianos/diagnóstico , Cistos Ovarianos/mortalidade , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/mortalidade , Ovário/patologia , Análise de Sobrevida , Adulto JovemRESUMO
Primary pelvic hydatid cysts are a rare entity and are often overlooked as a differential diagnosis of a pelvic-space-occupying lesion particularly in non-endemic regions. Unpreparedness and a hasty decision on the surgical approach may end in life-threatening complications and systemic dissemination of the disease. We report the case of a 55-year-old postmenopausal woman with a history of two previous unsuccessful surgeries to remove pelvic cystic lesions due to dense adhesions between the surrounding gut wall, bladder, and the cyst wall. Clinical and imaging findings failed to diagnose the nature of the cysts, and a laparotomy was contemplated. On the third surgical attempt, the clinical suspicion was considered and by meticulous dissection the cysts were removed thoroughly without undue complications. In the postoperative follow-up period there was no sign of disease recurrence or dissemination.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Equinococose/cirurgia , Cistos Ovarianos/cirurgia , Dor Abdominal/diagnóstico , Cistectomia , Equinococose/terapia , Cistos Ovarianos/diagnóstico , Doenças Parasitárias/diagnóstico , Pós-Menopausa , Zoonoses/terapiaRESUMO
Diversos são os tipos de cistos ovarianos que podem acometer as cadelas. Dentre estes há cistosprodutores de hormônios ou não. Os cistos que produzem hormônios podem causar diversas alterações clínicasno animal e até mesmo interferir na fertilidade. Já os cistos não produtores podem comprometer a funçãoovariana por substituição do parênquima ovariano por tecido cístico. O diagnóstico se baseia no histórico,anamnese e achados clínicos, associado a exames complementares. O tratamento varia de acordo com o tipo decisto, bem como o interesse reprodutivo ou não no animal.
Several types of ovarian cysts can affect bitches. Among these are the endocrine active cysts and thenon-endocrine active cysts and the non-producing cysts. Cysts that are associated with the production ofhormones can cause various clinical changes in the animal, and even interfere with fertility. Non-endocrineactive cysts can compromise ovarian function by replacing the ovarian parenchyma with cystic tissue. Thediagnosis is based on anamnesis and clinical findings, associated with complementary exams. Treatment variesaccording to the type of cyst, as well as if the animal is intended for breeding or not.
Assuntos
Feminino , Animais , Cães , Cistos Ovarianos/classificação , Cistos Ovarianos/diagnóstico , Cistos Ovarianos/terapia , Cistos Ovarianos/veterinária , Doenças do Sistema EndócrinoRESUMO
Diversos são os tipos de cistos ovarianos que podem acometer as cadelas. Dentre estes há cistosprodutores de hormônios ou não. Os cistos que produzem hormônios podem causar diversas alterações clínicasno animal e até mesmo interferir na fertilidade. Já os cistos não produtores podem comprometer a funçãoovariana por substituição do parênquima ovariano por tecido cístico. O diagnóstico se baseia no histórico,anamnese e achados clínicos, associado a exames complementares. O tratamento varia de acordo com o tipo decisto, bem como o interesse reprodutivo ou não no animal.(AU)
Several types of ovarian cysts can affect bitches. Among these are the endocrine active cysts and thenon-endocrine active cysts and the non-producing cysts. Cysts that are associated with the production ofhormones can cause various clinical changes in the animal, and even interfere with fertility. Non-endocrineactive cysts can compromise ovarian function by replacing the ovarian parenchyma with cystic tissue. Thediagnosis is based on anamnesis and clinical findings, associated with complementary exams. Treatment variesaccording to the type of cyst, as well as if the animal is intended for breeding or not.(AU)
Assuntos
Animais , Feminino , Cães , Cistos Ovarianos/classificação , Cistos Ovarianos/diagnóstico , Cistos Ovarianos/terapia , Cistos Ovarianos/veterinária , Doenças do Sistema EndócrinoRESUMO
The purpose of this work was to explore: knowledge, attitudes, and beliefs regarding gynecologic cancer screening on Ecuadorian women users of primary care facilities, to identify the social representations that users of health services make about these programs and their influence on the decision to undergo a screening. An exploratory and qualitative research design was held using focus groups and in-depth interviews for data collection. A narrative content analysis of the results was conducted. Women's knowledge on gynecological cancer screening was confusing. Most frequent misconceptions related to the pap smear were: the belief that it could be useful for detecting pregnancy, ovarian cysts or infections. Most of the participants stated that the pap smear procedure is a traumatic and painful experience. Regarding to mammography women said it was used for sick woman and this procedure by itself may cause cancer. El propósito de esta investigación fue explorar los conocimientos, actitudes y creencias respecto a los programas de detección del cáncer ginecológico entre usuarias de centros de atención primaria de salud para identificar las representaciones sociales que las usuarias de los servicios de salud elaboran acerca de estos programas y de los diferentes procedimientos que comprenden. El diseño de la investigación fue exploratorio y cualitativo, mediante grupos focales y entrevistas a profundidad, con el respectivo análisis narrativo e interpretativo del contenido. Se encontró conocimiento confuso acerca de los programas de tamizaje de cáncer ginecológico y dificultades asociadas a la realización de los procedimientos. Los significados más frecuentes acerca de los programas fueron: el uso de la citología cérvico-vaginal para detectar embarazo, quistes ováricos o infecciones. La mayoría de los participantes asociaba este procedimiento con una experiencia dolorosa y traumática. Respecto al autoexamen de mamas, lo calificaron como un masaje preventivo-terapéutico y a la mamografía como peligrosa porque podría desarrollar cáncer.
Assuntos
Tomada de Decisões , Neoplasias dos Genitais Femininos/diagnóstico , Neoplasias dos Genitais Femininos/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Esfregaço Vaginal/psicologia , Detecção Precoce de Câncer , Equador , Feminino , Grupos Focais , Humanos , Mamografia/efeitos adversos , Mamografia/psicologia , Cistos Ovarianos/diagnóstico , Testes de Gravidez/psicologia , Pesquisa QualitativaRESUMO
AIM: To evaluate the prediction of malignancy in women with pelvic masses using the Copenhagen Index (CPH-I) and Risk of Ovarian Malignancy Algorithm (ROMA). PATIENTS AND METHODS: Three hundred eighty four women operated due to an ovarian mass were enrolled between January 2010 and June 2015. All patients had histopathological diagnosis, HE4 and CA125 measurement. CPH-I and ROMA were calculated and their performances compared in two distinct scenarios: 1) for the discrimination of benign ovarian disease from epithelial ovarian cancer (EOC), non-epithelial ovarian cancer, borderline ovarian tumors (BOT) and ovarian metastases, and 2) for the discrimination of benign disease from EOC. Receiver Operator Characteristics' Areas Under the Curves (AUC) were calculated for CPH-I and ROMA and compared. RESULTS: Of the 384 women, 224 presented a benign ovarian tumor, 32 BOT, 87 EOC, 26 non-epithelial ovarian cancer, and 15 had ovarian metastases. The best AUCs were obtained for the discrimination of EOC from benign tumors. CPH-I performed slightly better than ROMA, and both approached 89% sensitivity and 85% specificity. When all malignant tumors (EOC, BOT, ovarian metastases and non-epithelial ovarian cancer - entire cohort) were included, the performance of CPH-I and ROMA declined to nearly 72%, although the specificity remained close to 85%. CONCLUSION: CPH-I and ROMA performed similarly well for the discrimination of EOC from benign ovarian tumors. However, caution is necessary since, in practical situations, where all the histological possibilities for malignant ovarian tumors must be considered, the sensitivity of CPH-I and ROMA may not surpass 70%.
Assuntos
Algoritmos , Endometriose/diagnóstico , Neoplasias Epiteliais e Glandulares/patologia , Cistos Ovarianos/diagnóstico , Neoplasias Ovarianas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Epiteliais e Glandulares/cirurgia , Neoplasias Ovarianas/secundário , Neoplasias Ovarianas/cirurgia , Valor Preditivo dos Testes , Período Pré-Operatório , Curva ROC , Adulto JovemRESUMO
OBJECTIVES: To describe the clinical-diagnostic importance of cystic appearance of a cervical myoma large elements result produced secondary METHOD: We described a case of a 40-year-old with abdominal discomfort producing difficulty walking, dyspareunia, urinary retention seven months of evolution. The USG diagnosis was a cystic mass consistent with a right ovarian cyst. The surgical abdominal total hysterectomy is performed. RESULTS: Histopathological study of approximately 1 3x6 cm uterus with myoma fund of approximately 4 cm and myoma level cervical posterior surface of 15x12 cm.
Assuntos
Mioma/complicações , Retenção Urinária/etiologia , Neoplasias do Colo do Útero/complicações , Adulto , Feminino , Humanos , Histerectomia/métodos , Mioma/diagnóstico , Mioma/cirurgia , Cistos Ovarianos/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/cirurgiaRESUMO
Ovarian Cyst (OC) is an important ovarian dysfunction and a major cause of reproductive failure in dairy cattle. Previously defined as enlarged an ovulatory follicle like structures (< 2.5 cm) and persisting for 10 or more days OC in dairy cows are currently defined as cystic ovarian follicular structures of at least 17 mm that persist for more than 6 days in the absence of corpus luteum. However, clear cut definitions of this disorder are yet to be made. Past evaluations of OC using transrectal palpations have increased, and accurate diagnosis currently employs a combination of transrectal palpation, transrectal ultrasonography and plasma progesterone assay. However, the accurate diagnosis of the type of OC seems less important as therapies are similar for both the types of OC and clinicians often evaluate the OC again under conditions of pregnancy failures. During earlier time s, the manual rupture of OC was advocated, yet during the past several years single or combination hCG, GnRH, progesterone and prostaglandins have been frequent in clinical practice. Other therapies include estrogen receptor blocker clomiphene citrate and transvaginal ultrasound guided cystic follicle aspiration. Among the various therapies suggested the OvSynch treatment appears to be the most logical approach, yet the pregnancy rates with timed inseminations following therapy with the OvSynch treatment are low , as with other hormonal treatments. The success of therapy is governed by many confounding variables such as persistence of the cystic follicles and initiation of therapy as pathological alterations that occur following OC persistence require some time for spontaneous recovery. It can be concluded that OC can be diagnosed easily yet in spite of many therapeutic options the establishment of pregnancy in cows with OC requires a longer time. (AU)
Assuntos
Animais , Feminino , Bovinos , Doenças dos Bovinos/patologia , Cistos Ovarianos/veterinária , Cistos Ovarianos/diagnóstico , Cistos Ovarianos/terapia , Reprodução , Ultrassonografia/veterináriaRESUMO
Ovarian Cyst (OC) is an important ovarian dysfunction and a major cause of reproductive failure in dairy cattle. Previously defined as enlarged an ovulatory follicle like structures (< 2.5 cm) and persisting for 10 or more days OC in dairy cows are currently defined as cystic ovarian follicular structures of at least 17 mm that persist for more than 6 days in the absence of corpus luteum. However, clear cut definitions of this disorder are yet to be made. Past evaluations of OC using transrectal palpations have increased, and accurate diagnosis currently employs a combination of transrectal palpation, transrectal ultrasonography and plasma progesterone assay. However, the accurate diagnosis of the type of OC seems less important as therapies are similar for both the types of OC and clinicians often evaluate the OC again under conditions of pregnancy failures. During earlier time s, the manual rupture of OC was advocated, yet during the past several years single or combination hCG, GnRH, progesterone and prostaglandins have been frequent in clinical practice. Other therapies include estrogen receptor blocker clomiphene citrate and transvaginal ultrasound guided cystic follicle aspiration. Among the various therapies suggested the OvSynch treatment appears to be the most logical approach, yet the pregnancy rates with timed inseminations following therapy with the OvSynch treatment are low , as with other hormonal treatments. The success of therapy is governed by many confounding variables such as persistence of the cystic follicles and initiation of therapy as pathological alterations that occur following OC persistence require some time for spontaneous recovery. It can be concluded that OC can be diagnosed easily yet in spite of many therapeutic options the establishment of pregnancy in cows with OC requires a longer time.
Assuntos
Feminino , Animais , Bovinos , Cistos Ovarianos/diagnóstico , Cistos Ovarianos/terapia , Cistos Ovarianos/veterinária , Doenças dos Bovinos/patologia , Reprodução , Ultrassonografia/veterináriaRESUMO
Postmenopausal women with adnexal masses suspicious for malignancy must undergo surgery for histopathologic confirmation. The low positive predictive value for malignancy of the currently available preoperative examinations results in 5 to 220 surgeries performed for each case of pelvic malignancy detected, depending on the evaluation method and patient selection. Although extensively reviewed as an effective tool for the investigation and treatment of adnexal masses, laparoscopy is still underused for this purpose in postmenopausal women. Some reasons are uncertainty about the incidental diagnosis of a malignant lesion during laparoscopy, concern about the effect of laparoscopy over the course of a pelvic malignant lesion, and inadequate referral of patients at high risk to specialized centers with oncologic gynecologists. Identification of patients at low risk might also be inadequate, causing them to undergo unnecessary laparotomy. Herein we demonstrate through a comprehensive literature review that laparoscopy is a highly effective tool for investigation and treatment of suspected adnexal masses in postmenopausal women, both in general medical settings without oncologic backup and in specialized centers. The indications for laparoscopy in this context can be further expanded without oncologic harm if patients at low and high risk are appropriately selected for surgery at general and specialized settings, respectively.
Assuntos
Laparoscopia , Cistos Ovarianos/diagnóstico , Neoplasias Ovarianas/diagnóstico , Pós-Menopausa , Diagnóstico Diferencial , Feminino , Humanos , Achados Incidentais , Cistos Ovarianos/etiologia , Cistos Ovarianos/cirurgia , Neoplasias Ovarianas/etiologia , Neoplasias Ovarianas/cirurgia , Medição de Risco , Fatores de Risco , Conduta ExpectanteRESUMO
INTRODUCCIÓN: La endometriosis es la presencia de tejido endometrial (glándulas y estroma) fuera de lacavidad uterina, siendo una de sus presentaciones más frecuentes la del quiste de ovario (endometrioma). Es unaenfermedad frecuente en mujeres en edad reproductiva, que consultan principalmente por dolor pelviano o infertilidad. El concepto de reserva ovárica se utiliza para describir la calidad y cantidad de la población de ovocitos y su relación con el resultado reproductivo. La quistectomía es la intervención que se practica ante la presencia de un endometrioma, siendo inciertos aun los efectos reproductivos de la misma sobre la reserva ovárica. OBJETIVOS: Identificar, mediante el empleo de tests endócrinos estáticos (cuantificación de niveles plasmáticos de hormona folículo estimulante, estradiol, inhibina B y hormona antimülleriana), cuál de estas hormonas es más útil como marcador de reserva ovárica. Determinar valores de marcadores de reserva ovárica en pacientes controles y pacientes con endometriosis ovárica. Investigar cómo se modifica la reserva ovárica después de la quistectomía laparoscópica utilizando la técnica de streapping. Correlacionar, antes y después del tratamiento quirúrgico, el tamaño del endometrioma con la reserva ovárica. Estudiar posibles correlaciones entre edad de las pacientes y reserva ovárica. Encontrar líneas de corte entre tamaño del endometrioma y la reserva ovárica. secundariamente, establecer índice de embarazo según estado de reserva ovárica.
INTRODUCTION: Endometriosis is the presence of endometrial tissue (glands and stroma) outside of the uterine cavity. One of its most frequent presentations is as an ovarian cyst (endometrioma). It is a common condition in women in reproductive age, who presents mainly pelvic pain or infertility. The concept of ovarian reserve (O.R.) is used to describe the quality and quantity of the population ofoocytes and their relation to reproductives outcomes. systectomy is the intervention that is performed in the resence of an endometrioma, remaining uncertain the reproductive effects on the ovarian reserve. OBJECTIVES:Identify, through the use of static endocrine tests quantification of plasma levels of follicle stimulating hormone, estradiol, inhibin B and AMH), which them is ore useful as a marker of ovarian reserve. Determine standardvalues of markers of ovarian reserve in controls and patients with ovarian endometriosis. Investigate if thelaparoscopic cystectomy using the streapping technique modifies or not the ovarian reserve. Before and aftersurgery, to correlate the size of endometrioma with ovarian reserve. To study possible correlations between patients age and ovarian reserve. To find cut lines between the size of endometrioma and ovarian reserve. As second objective, to establish pregnancy rates by state of ovarian reserve.