Paratubal Cyst Recurrence in Children and Adolescents

Study ObjectiveTo examine the association between patient characteristics and risk for recurrence risk of paratubal cysts (PTC) in children and adolescents.DesignRetrospective chart review at a single institution.SettingSingle academic children's hospital.ParticipantsPediatric patients presenting to Texas Children's Hospital between July 2007 and March 2019. Patients were identified for the study by reviewing pathology reports and were included if they met inclusion criteria of a pathologic diagnosis of a paratubal or paraovarian cyst removed during any surgical procedure between July 2007 and March 2019.InterventionsSubjects with pathologic diagnoses of a paratubal cyst during the study period underwent chart review for the following data points: age at presentation, ethnicity, pathologic recurrence of paratubal cysts, pubertal status, body mass index (BMI), diagnosis of polycystic ovary syndrome (PCOS), size of cyst, laterality of cysts, and number of cysts.Main Outcome Measure(s)Recurrence, Pathology types.ResultsOf the 627 patients that met inclusion criteria, the incidence of recurrence was 11.3%. Group 1 included those with recurrence of PTC (N = 70). Group 2 was identified as those without recurrence of PTC (N = 557). There were no differences related to age, BMI, ethnicity, history of PCOS, cyst size, laterality or number of cysts present. PTC NOS and serous PTC occurred most frequently. Of the unique cases involving recurrence, 70.1% recurred on the ipsilateral side. There were no cases of paratubal cyst malignancies in this cohort. The range of pathology diagnoses included pathologies that may occur in ovarian cysts. This is particularly interesting, given the known origins of ovarian cancer from fallopian tube transformations. Rare pathology diagnoses likely did not occur with frequency to determine definitive risks of recurrence in these cases.ConclusionsThere appears to be a baseline recurrence risk for PTC, for which patients can be counseled. Recurrence does not appear to be associated with any particular pathology type, cyst size, number of cysts, BMI, PCOS, or puberty stage. Recurrence, should it occur, appears to occur more commonly on the ipsilateral side.     

Paratubal Borderline Malignancy: A Case of a 17-Year-Old Adolescent Female Treated with Laparo-Endoscopic Single-Site Surgery and a Review of the Literature

BackgroundAlthough paratubal cysts are common, borderline paratubal cysts are extremely rare. We describe the case of a large borderline paratubal cyst in a 17-year-old adolescent female treated with laparo-endoscopic single-site surgery (LESS), and review the literature.CaseA 17-year-old female was referred due to a large right adnexal cyst on pelvic sonogram. A CT scan showed a 19-cm cystic lesion with enhancing papillary projection along the wall. Laparo-endoscopic single-site surgery confirmed a large cystic mass that originated from the right salpinx. Right salpingectomy and right ovarian wedge resection were performed, and intraoperative frozen section analysis was conducted. The result of the frozen section analysis and final pathologic review indicated that the cyst was a serous papillary-type borderline tumor in a paratubal cyst.Summary and ConclusionTo the best of our knowledge, this is the first case report of a BPC treated with LESS. We suggest that minimally invasive, fertility-preserving surgery should be considered as a standard treatment of borderline paratubal cysts if patients desire future fertility.     

Giant Paratubal Serous Cystadenoma in an Adolescent Female: Case Report and Literature Review

BackgroundParaovarian/paratubal cysts constitute 5-20% of all adnexal lesions and typically originate from the paramesonephric or Müllerian duct. The primary epithelial tumors arising from paraovarian cysts account for 25% of the cases, but giant cystadenomas of paraovarian origin are extremely uncommon during childhood and adolescence with very few cases reported in the literature.CaseWe present the case of a 15-year-old female that presented with a bulky mass in the abdomen and pelvis. An initial clinical and radiological examination indicated an ovarian cyst measuring ∼25 × 20 cm. However, explorative laparotomy revealed a giant paratubal cyst that was successfully treated with complete excision using fertility-sparing surgery. Histopathological examination was consistent with a serous cystadenoma. The postoperative course was uneventful and the girl was discharged on the seventh postoperative day. At the follow-up of 6 months, the patient was doing well.     

A voluminous twisted paraovarian cyst in a 74-year-old patient: case report and review of the literature

Although paraovarian cysts rarely cause symptoms, they may be complicated due to massive size, torsion or internal haemorrhage from rupture. Moreover, benign or malignant neoplasms may occasionally develop in paraovarian cysts. The risks from voluminous ovarian or paraovarian cysts are due to severe cardiovascular, pulmonary, and circulatory problems including surgical and postoperative complications. We present a case of a 74-year-old patient who suffered from a twisted voluminous right paraovarian cyst. Her preoperative respiratory function required attention. The patient was treated surgically with good results and she showed notable improvement of her respiratory function, postoperatively. The maximum diameter of the mass was 26 cm and its total weight was 5,100 g. In addition, a simple cyst was found in the left ovary with a maximum diameter of 9.5 cm and total weight of 300 g. In conclusion, paraovarian cysts, even in elderly patients, can reach large sizes requiring awareness of the problems that these large masses may cause.     

Torsion of para-ovarian cyst

Torsion of uterine adnexa is an important cause of acute abdominal pain. Torsion of ovarian masses is quite common and isolated torsion of the fallopian tube has also been reported in the literature. However, torsion of para ovarian cyst is rare. We report a rare case of twisted paraovarian cyst. Torsion of the fallopian tube and paraovarian cyst is usually seen in the reproductive age group. Physicians need to maintain a high index of suspicion for this uncommon and often difficult to diagnose cause of abdominal pain.     

Unilateral Ovarian Dermoid Cyst Accompanied by an Ipsilateral Paratubal Cyst in a Girl with Proteus Syndrome Discovered by Laparoscopic Surgery

BackgroundProteus syndrome is a rare hamartomatous disorder characterized by the overgrowth of multiple tissues in a mosaic pattern. Tumors of genitourinary tract in Proteus syndrome are uncommon.CaseWe here report a 5-year-old girl with Proteus syndrome who developed a cystic mass in the pelvic cavity. The cyst was discovered by ultrasonographic examination and finally proved to be a unilateral ovarian dermoid cyst accompanied by an ipsilateral paratubal cyst by laparoscopic surgery.Summary and ConclusionProteus syndrome accompanied by an ovarian cyst is rare in girls. The possibilities of underlying ovarian cyst required for surgical intervention should be considered in Proteus syndrome.     

Isolated Fallopian Tube Torsion in Pediatric and Adolescent Females: A Retrospective Review of 15 cases at a Single Institution

Study ObjectiveTo identify and review cases of isolated fallopian tube torsion (FTT) at our institution to further characterize diagnosis and management.DesignRetrospective review.SettingTertiary care medical center.ParticipantsCase series of pediatric and adolescent females, <21 years old, with operatively diagnosed isolated fallopian tube torsion from our institution.InterventionNone.Main Outcome MeasureIsolated fallopian tube torsion.ResultsFifteen cases of isolated fallopian tube torsion were identified based on intraoperative diagnosis. Patient ages ranged from 8-15 years old, mean age of 12. Fourteen patients (93%) presented with abdominal pain, 8 (53%) localized to the side of associated torsion. Ultrasonography reports described a tubular structure in 4 patients and an associated ovarian or paraovarian cyst in eleven patients. Suspicion of fallopian tube torsion was only described for those patients with a tubular structure described on ultrasonography report. Intraoperatively, 7 patients (47%) were found to have no associated pathology and 8 (53%) were found to have associated cyst or hydrosalpinx. Eight (53%) patients underwent salipingectomy and 7 (47%) underwent reversal of torsion with drainage of associated cyst or cystectomy.ConclusionsIsolated fallopian tube torsion is a rare condition that seems to occur in younger adolescents. Vague clinical presentation contributes to low preoperative suspicion. Preoperative suspicion may be increased based on radiographic findings of an enlarged tubular structure or an adjacent normal ovary. Management may be considered nonemergent and salpingectomy is controversial. Long-term fertility outcomes must be further assessed for more definitive decisions regarding surgical management.     

Torsion of Fallopian Tube Remnant Associated with Noncommunicating Rudimentary Horn in Adolescent Girl with Unicornuate Uterus

BackgroundThe prevalence of müllerian anomalies may be as high as 7% in the general population, yet there is scant published literature on adnexal torsion occurring in these patients.CaseA 14-year-old female presented with right lower quadrant pain. Pelvic ultrasonography demonstrated a 2-cm simple right adnexal cyst. Diagnostic laparoscopy revealed a unicornuate uterus with a normal left uterine horn and fallopian tube but atretic and cordlike müllerian structures on the right side. Torsion of the right tubal remnant and two paratubal cysts were noted and the structures were then excised.Summary and ConclusionAgenesis, hypoplasia, or maldevelopment of müllerian structures may predispose patients to an increased risk of adnexal torsion secondary to looser ligamentous attachments and consequent lack of fixation to the pelvic sidewall.     

Controversies in the management of endometriomas in patients undergoing assisted reproduction

Introduction

Paraovarian or paratubal cysts (PTCs) constitute about 10?% of adnexial masses. Although they are not uncommon; they rarely cause symptoms and are usually incidentally found. Actual incidence is not known. The symptoms occur when they grow excessively, or in case of hemorrhage, rupture or torsion.

Methods

Here, literature review reporting the incidence, presentation and complications of PTCs is performed. Uncommon presentations of PTCs in three different cases, a giant PTC, torsion of PTC and borderline paratubal tumor, are also reported and discussed.

Results

Ultrasonography, CT or MRI may be performed in preoperative evaluation; but none of these imaging techniques have specific criteria for diagnosis. So, in most cases misdiagnosis as an ovarian mass remains to be a problem.

Conclusion

Paratubal cysts can become extremely big before causing symptoms. Torsion is another urgent issue regarding PTCs, necessiating urgent surgery for preservation of the ovary and the tube. Although malignancy is rare, borderline paratubal tumors have been reported in the literature.     

Uteroovarian ligament torsion of the due to a paratubal cyst

Paratubal cysts rarely undergo torsion. When they do, typically they involve the infundibulopelvic ligament and affect the ovary and fallopian tube. We present a case and discussion of torsion of the uteroovarian ligament secondary to a large paratubal cyst with preservation of the ovary and fallopian tube.     

Management of antenatally diagnosed fetal ovarian cysts

1. Fetal ovarian cysts are usually unilateral, diagnosed in the third trimester and are uncommon. 2. Average ovarian cyst size is 5 x 5 cm at diagnosis and size does not change throughout the pregnancy. 3. Most cysts are functional in origin and histologically benign, simple cysts. 4. Polyhydramnios is a common finding but associated anomalies are rare. 5. Although large cysts can compress other viscera and torsion or rupture can occur, in utero aspiration has limited value in prenatal management. 6. Vaginal delivery with confirmed fetal pulmonary maturity or at term is appropriate. 7. Soft tissue dystocia is rare. Cesarean delivery should be reserved for obstetrical indications only. 8. The best predictor of neonatal cyst torsion risk is length of the cyst pedicle rather than cyst size. 9. When surgery is indicated a cystectomy, with preservation of maximal ovarian tissue is to be preferred over oophorectomy. 10. Ultrasound-guided aspiration of neonatal ovarian cysts may be an alternative to surgical management.     

Risk factors, symptoms, and treatment of ovarian torsion in children: the twelve-year experience of one center

ObjectiveTo assess risk factors, clinical findings and mode of diagnosis and treatment in premenarchal children with surgically verified ovarian torsion (OT).Study DesignA retrospective case review (Canadian Task Force Classification II-2).SettingTeaching and research hospital, a tertiary center.PatientsPremenarchal children with surgically verified OT.InterventionsPatients underwent either laparoscopy or laparotomy.ResultsTwenty-two cases of OT in 20 premenarchal girls (median age 12 years) were identified. Three cases involved recurrent torsion after detorsion without cystectomy. The main presenting symptoms were sudden pain and vomiting. Six patients underwent Doppler examinations, and all demonstrated an abnormal flow. Seventeen interventions were by laparoscopy. Conservative management, mainly detorsion with additional cyst drainage or cystectomy, was performed in 19 cases (86.4%). Oophoropexy was performed in 3 cases (13.6%). Pathologic examination demonstrated 5 simple cysts and 1 dermoid cyst.ConclusionsOvarian torsion in premenarchal girls usually presents with intermittent abdominal pain and abdominal tenderness. Other signs and symptoms are nonspecific. When performed, Doppler imaging may assist in diagnosing ovarian torsion in children. Detorsion followed by cystectomy may prevent recurrence.     

Laparoscopic Cystectomy for the Treatment of Benign Ovarian Cysts in Children: An Analysis of 21 Cases

Study ObjectiveTo evaluate the outcomes of treatment with minimal invasive surgery in children with benign ovarian cysts.DesignRetrospective chart review.SettingsMaternity and children hospital.PatientsBetween May 2007 and May 2011, 21 children were treated by laparoscopic method for ovarian cysts at our clinic. The age, symptoms, ultrasonographic findings, operation records and follow-up times were retrospectively evaluated.ResultsThe mean age was 13.2 years. One patient presented with findings of torsion and another presented with findings of rupture; both were urgently operated on. The other patients presented with intermittent abdominal pain and were operated on under elective basis. The mean cyst size was 8.4 cm (5-13 cm). One patient with necrotic ovary and salpinx due to torsion underwent salpingo-oophorectomy while the others were administered ovary-preserving cystectomy. Only 4 patients required iv paracetamol as an analgesic in the postoperative period. Two patients were discharged on the second postoperative day while the remaining 19 patients were discharged on the first postoperative day. During a mean follow-up of 14 months, no recurrence was seen in this period. Cosmetic appearance was good in all patients.ConclusionThe authors demonstrated that laparoscopic cystectomy was a technically feasible and safe method in the treatment of benign ovarian cysts, associated with short hospitalization, minimal analgesic requirement, and a good cosmetic appearance.     

Leak-proof puncture of ovarian cysts: instant mounting of plastic bag using cyanoacrylate adhesive

BACKGROUND: Reliable leak-proof aspiration of cyst contents is required for treatment of large ovarian cysts by minilaparotomy. TECHNIQUE: Through a small abdominal wound a transparent plastic bag was instantly mounted onto the cyst surface using an ethyl-2-cyanoacrylate adhesive. A 1-2-cm-wide cut was made in the consolidated cyst wall through the inside of the bag and the contents directly aspirated. The fluid was trapped inside the bag without leaking into the abdominal cavity. This method can also be applied to relatively small cysts by holding the cyst just beneath the wound. EXPERIENCE: We used this method in 30 patients with unilateral ovarian cysts and in one patient with an ovarian cyst associated with an ipsilateral paraovarian cyst. All patients were successfully treated without spillage, although in one case a large mucinous ovarian cyst ruptured before surgery. CONCLUSION: Minilaparotomy using the instant adhesive is cost-effective, safe, reliable, and easily implemented. This procedure is also applicable to relatively small cysts and is a viable alternative to laparoscopic surgery for treatment of dermoid cysts showing considerable calcification.     

Recurrent Bilateral Serous Cystadenomas in a Premenarchal Girl: A Case Report and Literature Review

BackgroundOvarian serous cystadenomas are rare in children. No case of recurrence after surgical resection in a premenarchal girl has been published.CaseAn 8-year-old presented with abdominal pain and ultrasound showed bilateral ovarian cystic masses with normal clinical and laboratory exam. Cystectomies were performed revealing serous cystadenomas. Ten months later, her pain returned and ultrasound showed new cysts. Persistence of cysts and symptoms required repeat surgery with the same pathology.Summary and conclusionPremenarchal girls with ovarian cystic masses require surgical intervention in cases of persistent symptoms, uncertain diagnosis, or concern for ovarian torsion. With reassuring imaging and tumor markers, conservation of the ovary can be achieved with cystectomy alone. Ultrasound follow-up is recommended after surgical resection until bimanual exam can be performed.     

卵巢囊肿患者手术指征的探讨

目的 :探讨卵巢囊肿患者的手术指征。方法 :诊治单纯囊肿患者 2 2 1例 ,其中最大径 <5cm 76例、≥ 5cm 14 5例。 184例施行了腹腔镜手术 ,37例施行了剖腹手术。结果 :病理学分析无 1例恶性。单纯囊肿、卵巢冠囊肿和黄体囊肿最大径在 <5cm和≥7cm者中的发生率分别为 90 .8%和 6 0 % ,二者差异有显著性 (P <0 .0 1)。单纯囊肿 ,卵巢冠囊肿和黄体囊肿在绝经前和绝经后者中的发生率为 81.5 %和 84 .0 %。结论 :最大径≥7cm的卵巢囊肿应及时手术 ,<7cm者可短时间观察 ,如囊肿持续存在 ,则应手术。绝经后者的卵巢囊肿应及时手术     

Contribution of laparoscopy in young women with abdominal pain

This study retrospectively evaluates the laparoscopic treatment of acute abdominal pain in 120 young girls aged 13 to 25 years from 1990 to 1995. Seventy-two (60%) of all operations were emergency procedures. Of these, 55 had functional ovarian cysts, eight patients were operated on for adnexal torsion and nine patients had other adnexal conditions. Ovarian cyst resection was performed in 46 patients and ovarian cyst coagulation in 17 patients. In the rest of the 48 patients (40%), 31 (26.67%) cases had pelvic inflammatory disease, three (2.5%) benign ovarian tumors, two (1.6%) ectopic pregnancies, one (0.8%) a paraovarian cyst and 11 (5%) endometriosis. Laparoscopy appeared to be a safe and effective surgical procedure.     

The cell of origin of ovarian epithelial tumors and the ovarian surface epithelium dogma: does the emperor have no clothes?

The widely favored hypothesis that ovarian epithelial tumors arise from the mesothelial cell layer lining the ovarian surface fails to explain the resemblance of these tumors to those arising in organs that are embryologically derived from the Müllerian ducts such as fallopian tubes, endometrium, and endocervix. In addition, this theory cannot account for the fact that tumors that are morphologically identical to ovarian carcinomas can sometimes be found outside the ovary. A suggestion is made that components of the secondary Müllerian system, which include paraovarian/paratubal cysts, rete ovarii, endosalpingiosis, endometriosis, and endomucinosis, merit some consideration as to their possible role in ovarian tumorigenesis.     

One-Trocar,Video-Assisted Stripping Technique for Use in the Treatment of Large Ovarian Cysts in Infants

BackgroundManagement of ovarian cysts in infants is controversial; it can be conservative or surgical, and the management is determined by the cyst's size and sonographic features.MethodsA surgical approach using a 10-mm umbilically placed operative laparoscope was taken in 3 female infants with antenatally diagnosed large, simple ovarian cysts. The contents of the cysts were partially aspirated and the cyst walls were stripped off the remaining ovarian parenchyma. No intraoperative or postoperative complications were recorded.ConclusionsThe one-trocar video-assisted stripping technique for large ovarian cysts in infants appears to be an ovarian-tissue-preserving procedure, and it sidesteps the disadvantages of large scars and formation of adhesions.     

Paratubal borderline tumor diagnosed in the adolescent period: a case report and review of the literature

Background

Borderline paratubal cysts are rare entities. These tumors are identified as epithelial proliferation without stromal invasion.

Case

A 19-year-old virgin patient was admitted to our clinic with abdominal pain and nausea. The sonographic evaluation showed a left adnexal mass 89 × 80 mm in diameter with solid tissue projections. Doppler examination revealed no significant blood supply. At surgery, a torsed left paratubal cyst 10 cm in diameter and normal bilateral ovaries were encountered. Cystectomy was performed and of frozen section revealed a borderline Fallopian tube neoplasm. Final pathology review was reported as a serous borderline paratubal tumor.

Conclusion

The evaluation of the structure of cyst by ultrasound and the performance of intraoperative frozen section analysis are two important issues to diagnose the nature of a cyst. Fertility-sparing surgery is the main point of management.