Ovarian hemangioma—report of three cases and review of the literature

Introduction Ovarian hemangiomas are rare tumors, with less than 50 reported cases in the English literature. This is a low incidence, considering the rich vascular supply of the ovary.Discussion We have encountered three cases of ovarian hemangiomas found incidentally at the time of surgery. Ovarian hemangioma should be considered when a hemorrhagic ovarian tumor is encountered. Although often an incidental finding at surgery, these lesions may rarely be associated with systemic manifestations.     

Ovarian Mucinous Cystadenoma of Borderline Malignancy in a Premenarchal Girl

Ovarian mucinous cystadenomas are benign epithelial neoplasms that occur most often in the third to sixth decade of life. Ovarian mucinous cystadenoma can be classified into 3 categories (benign, borderline malignancy, malignancy) based on histopathologic evaluation. Premenarchal cases of ovarian mucinous cystadenoma of borderline malignancy are exceedingly rare. To the best of our knowledge, there have been only 4 reported cases of borderline ovarian mucinous cystadenoma prior to 2009. Here we report a 13-year-old premenarchal girl with a giant mass occupying almost the whole of the abdomino-pelvic cavity.     

Management of ovarian cysts during pregnancy

Ovarian cysts are common in pregnancy, more so with the increase in routine antenatal use of ultrasonography. The majority of ovarian cysts in pregnancy are benign and resolve spontaneously. It is rare to diagnose malignant ovarian tumours during pregnancy. Imaging with ultrasonography is the first line investigation of choice and the use of International Ovarian Tumor Analysis (IOTA) group rules of ultrasonographic appearances of ovarian lesions can help identify benign and malignant lesions more accurately. MRI is also safe to use in pregnancy to better delineate ovarian lesions. Simple cysts <6 cm can be safely managed conservatively, with surgery reserved for larger, symptomatic cysts or those suspicious of malignancy. Ovarian cysts can be managed laparoscopically between 14 and 16 weeks gestation but require advanced laparoscopic skills. Image guided aspiration of benign ovarian cysts remains an option but is associated with high recurrence rates and risk of spillage, a disadvantageous outcome in cases subsequently shown to be malignant.     

Ovarian lymphoma

Ovarian lymphomas are rare. We reviewed three cases seen at our hospital to determine any similarities and outcome. The women presented with abdominal discomfort and swelling and were staged as stage I, II and IV. All three cases were B-cell lymphomas confirmed with positive staining with CD45 (LCA), CD20 (L26), CD 45 (4KB) CD45RA (MB1) and MB2 on immunohistochemistry. The two patients with more advanced disease died soon after treatment but the one with stage I (primary ovarian lymphoma) was still alive after 2 years. Ovarian lymphoma when detected late carries a poor prognosis.     

<Emphasis Type="Italic">In vitro</Emphasis> growth and maturation of mouse oocyte-granulosa cell complex from cryopreserved ovaries and achievement of pup birth

Ovarian tissue banking is a feasible strategy for fertility preservation for young women after cancer treatments. Ovarian tissue, after thawing, is used for several options; orthotopic grafting (normal site), autologous heterotopic grafting and collection of ovarian follicles for culture. Recent reports of live birth encouraged clinicians and researchers to apply this technology to premature ovarian failure (POF) resulting from strong cancer therapy. Grafting, however, carries a risk of malignant cell recurrence. For safety, development of a culture method is necessary but optimum culturing conditions for less-developed follicles abundant in the ovary are not well known. In the present article, the current status of ovarian tissue cryopreservation, and in vitro oocyte growth and maturation from the preserved ovaries are reviewed.     

Ovarian hyperstimulation syndrome

Ovarian Hyperstimulation Syndrome (OHSS) is an iatrogenic condition arising from supraphysiological ovarian stimulation for fertility treatment. It is characterized by ovarian enlargement with fluid shift to the third space and intravascular dehydration. Ovarian reserve tests can identify patients at high risk of OHSS, allowing targeted preventative measures. Evidence supports the use of GnRH antagonist regimes in women with a high ovarian reserve. GnRH agonist trigger and elective cryopreservation of all embryos further reduce the risk of OHSS. All women at risk of OHSS should have adequate information and access to 24-hour care. Women presenting with possible OHSS should be assessed and investigated to confirm the diagnosis and classify severity. Mild to moderate cases can be managed on an out-patient basis, whilst more severe cases need admission and monitoring. Principles of management are maintaining intravascular hydration by encouraging “drink to thirst”, close monitoring of fluid balance, prevention of thromboembolic complications, drainage of ascites in selected cases and symptom relief. If conception occurs in OHSS cycle, the recovery is protracted.     

Ovarian vascular accidents: a complication of anticoagulant therapy.

Ovarian vascular accidents are usually more severe when the patient is being kept on anticoagulant therapy following cardiac surgery or for other reasons. 4 cases of massive hemoperitoneum are reported. Rupture of the corpus luteum and corpus luteum cyst and an ovarian ectopic pregnancy were responsible for massive hemoperitoneum. All 4 patients survived and recovered.     

Pelvic tumors in patients under 18 years

Between 1965 and 1985 28 patients aged between 10 and 18 years (average age 16.3 years) were treated for pelvic tumor, with a frequency of 0.13% of gynecological admissions. Ovarian tumor was the most frequent type (21 cases), followed by paraovarian tumor (5 cases), and uterine tumor (2 cases), 21 of pelvic tumor were neoplastic of which 18 benign. Among the ovarian neoplasias the most prevalent was cystadenoma (9 cases), followed by dermoid tumors (7 cases).     

Recent progress in oocyte and ovarian tissue cryopreservation and transplantation

Ovarian tissue cryopreservation and transplantation is an experimental technique that has been developed to sustain the reproductive function of women and children who are faced with sterilizing chemotherapy, radiotherapy, or radical reproductive surgery. Oocyte cryopreservation, on the other hand, is less feasible in the context of cancer because there is usually inadequate time to complete an ovarian stimulation cycle. The main promise of oocyte cryopreservation is that it offers an alternative when embryo freezing is not possible for technical, regulatory, or religious reasons. Oocyte freezing is more suitable for a single woman when the concern is age-related decline in fecundity. There have been significant scientific advances in the field of cryopreservation of ovarian tissue and oocytes, especially within the past few years. Ovarian function has been reported after the first cases of ovarian transplantation, and the number of pregnancies from cryopreserved oocytes has grown. Ovarian tissue and oocyte freezing can now be recommended in a carefully selected group of patients, provided that these options are offered under protocols that are approved by an institutional review board.     

The design of clinical trials in the therapy of ovarian carcinoma

Ovarian carcinoma continues to be a major cause of death in women in spite of the effective use of operation, radiotherapy, and chemotherapy in some patients. Improved survival will depend upon proper definition of prognostic factors, adequate and standardized staging, and upon prospective randomized clinical trials to define optimal existing therapy. With optimal existing therapy as a base line, newer therapeutic and combined modality approaches may be compared to optimal existing therapy in a systematic way. Results of such trials should improve survival of patients with ovarian carcinoma.     

Chemotherapy for early ovarian cancer

PURPOSE OF REVIEW: The treatment of early ovarian cancer has long been based on non-randomized studies and on a small number of randomized studies without sufficient power. Adjuvant chemotherapy is often given to high-risk patients, but the benefit of such an approach has never been proven and the definition of high-risk early ovarian cancer differs widely. Recently, the results of the two largest randomized clinical trials on early ovarian cancer became available. Both trials are discussed, and their results are related to the other relevant literature of the last three years. RECENT FINDINGS: A meta-analysis of over 1500 patients from the year 2001 confirmed tumor grade as a strong prognostic factor but it also demonstrated the adverse effect of capsule rupture before and during surgery. The Adjuvant Chemotherapy in Ovarian Neoplasm trial (European Organization for Research and Treatment of Cancer) randomized 448 patients to either adjuvant chemotherapy following surgery or observation. Adjuvant chemotherapy improved overall survival and disease-free survival in non-optimally staged patients but showed no benefit in optimally staged patients. The Medical Research Council International Collaborative Ovarian Neoplasm 1 trial randomized 477 patients in a similar way. Overall survival and disease-free survival were improved by adjuvant chemotherapy. It was argued that the study population of the International Collaborative Ovarian Neoplasm 1 trial probably represents non-optimally staged patients, and this hypothesis explains why the results of this trial were in accord with those of the Adjuvant Chemotherapy in Ovarian Neoplasm trial. SUMMARY: The implications of these data are that a complete surgical staging is of utmost importance and should be pursued. In cases of non-optimal staging and contraindications for restaging, adjuvant chemotherapy is indicated to deal with unnoticed residual tumor deposits that exist in approximately 25% of cases.     

Embarazo ectópico ovárico

Ovarian pregnancy is an uncommon type of ectopic pregnancy. Preoperative diagnosis is difficult. Some cases are diagnosed during surgery and most need to be confirmed by histopathological study. The treatment of choice is conservative ovarian surgery to preserve fertility such as enucleation of the gestational sac or wedge resection of the ovary, preferably by laparoscopy. In some cases intramuscular methotrexate could be effective. We report two cases of ectopic ovarian pregnancy in our hospital.     

Ovarian tumors in young females. A laparoscopic approach

Ovarian tumors are one of the major preoccupations in the everyday practice of gynecology. During the period January 1997 through December 2000, 54 cases of ovarian tumors in young females aged 14-20 years were diagnosed and managed laparoscopically in our institution. Twenty-two cases of mature cystic teratoma, 12 cases of endometriosis, eight cases of serous cystadenoma, five cases of mucinous cystadenoma, three cases of fibroma-thecoma, two cases of serous low-malignant tumors and one case of mucinous low-malignant tumor were found. The management of ovarian tumors during this age by laparoscopic techniques represents an efficient and safe procedure.     

Ovarian endometriosis associated with ovarian cancer and endometrial-endocervical polyps

AIM: To determine the prevalence of ovarian cancer and endometrial polyps in women with moderate and severe ovarian endometriosis. METHODS: A retrospective analysis of 667 cases of moderate and severe endometriosis laparoscopically and histologically confirmed during the period 1997-2004. RESULTS: One hundred and ninety-three (29%) of cases were American Fertility Society (AFS) stage III (moderate endometriosis) and 473 (71%) were AFS stage IV (severe endometriosis). Ovarian cancer was diagnosed in 13 cases (2.0%), while an endometrial or endocervical polyp was identified in 35 cases (5.3%). The incidence of endometrial polyps in the group with moderate endometriosis tended to be higher (15/193, 7.8%) than in the group with severe endometriosis (20/473, 4.2%), and the same results were obtained in the ovarian cancer group (moderate: 6/193, 3.1%; severe: 7/473, 1.5%). However, neither of the two differences was statistically significant. CONCLUSIONS: Ovarian endometriosis may be associated with an increased incidence of both ovarian cancer and endometrial polyps. Careful evaluation for coexistent pathology should be undertaken in women with symptomatic endometriosis.     

Low-grade immature teratomas with peritoneal gliomatosis; a case report

Immature teratomas with peritoneal gliomatosis are rare. Eight cases have been registered by the Dutch Ovarian Tumor Committee and one patient, presented in this paper, was treated recently. The follow-up in these cases indicates a good prognosis, even in grade 2 teratomas. Peritoneal implants do not influence adversely the prognosis when they are composed of mature glial tissue. A conservative approach seems to be justified.     

Ovarian twin pregnancy.

Ovarian twin pregnancy is quite uncommon. We present a case of an ovarian twin pregnancy associated with pelvic endometriosis. The ultrasonographic findings in our case were similar to those of malignant ovarian tumor. Five cases of ovarian twin pregnancy, including this case, are reviewed.     

Novel insights on the malignant transformation of endometriosis into ovarian carcinoma

The malignant transformation of endometriosis is an uncommon event, which happens in 0.7–2.5% of the cases, and, when occurs, it usually involves the ovary. A 2 to 3-fold higher risk of ovarian endometrioid and clear cell carcinoma has been reported in women with endometriosis. Pathological studies have detected a morphological continuum of sequential steps from normal endometriotic cyst epithelium to atypical endometriosis and finally to invasive carcinoma. Ovarian endometrioid carcinoma harbors mutations of CTNNB1 in 16–53.3%, of PTEN in 14–20% and of ARID1A in 30–55% of the cases. Ovarian clear cell carcinoma harbors mutations of PIK3CA in 20–40% and of ARID1 in 15–75% of the cases. Whereas estrogen receptors and progesterone receptors are quite always absent, HNF-1b is often over-expressed in this histotype. Atypical endometriosis and endometriosis-related ovarian neoplasms share molecular alterations, such as PTEN mutations, ARID1A mutations and up-regulation of HNF-1b. Moreover, ARID1A mutations have been noted in clear cell tumors and contiguous atypical endometriosis, but not in distant endometriotic lesions. The loss of BAF250a protein expression is suggestive for the presence of ARID1A mutations, and represents an useful marker of malignant transformation of endometriosis.     

Retroperitoneal metastatic spread of ovarian cancer

Four patients with ovarian cancer, after chemotherapy or combined immunochemotherapy, were found to have retroperitoneal disease at the time of second-look exploratory laparotomy, even though there was no evidence of intra-abdominal residual cancer. Ovarian cancer can metastasize to both the pelvic and para-aortic lymph nodes, and therefore these areas must be evaluated in order to assess appropriately the true extent of disease in patients with ovarian cancer.     

Accuracy of the preoperative diagnosis in 100 emergency laparoscopies performed due to acute abdomen in nonpregnant women

STUDY OBJECTIVE: To assess the validity of preoperative diagnosis in the emergency room in relation to the surgical diagnosis at laparoscopy. DESIGN: Retrospective study (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: One hundred consecutive nonpregnant women who underwent emergency laparoscopy for acute abdomen between 1997 and 1999. Intervention. Emergency diagnostic laparoscopy. MEASUREMENTS AND MAIN RESULTS: The preoperative diagnosis was confirmed by laparoscopy in 29 (44%) of 66 cases of ovarian torsion, 9 (82%) of 11 cases of ovarian cyst, and 12 (80%) of 15 cases of bleeding corpus luteum. Unsuspected diagnoses among nonconfirmed cases were ovarian cysts (24), adhesions (5), bleeding corpus luteum (3), degenerative myomas (3), pelvic inflammatory disease (2), and appendicitis (1). The preoperative diagnosis was confirmed by emergency laparoscopy in 56% of all patients. Diagnoses most likely to be predicted accurately were ovarian cysts and bleeding corpora lutea. Ovarian torsion was most difficult to diagnose preoperatively, as it was not confirmed during laparoscopy in over half patients. Ovarian cysts and adhesions were the most common unsuspected findings. CONCLUSION: Patients and surgeons alike should be aware of difficulty making accurate preoperative diagnoses of acute gynecologic pathologies in the emergency room. (J Am Assoc Gynecol Laparosc 8(1):92-94, 2001)     

Anti-NMDAR encephalitis with ovarian teratomas: Review of the literature and two case reports

ObjectiveAnti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis is a paraneoplastic syndrome associated with ovarian teratomas. Anti-NMDAR encephalitis patients typically present with prominent psychiatric symptoms, seizures, and involuntary movements; further, they rapidly progress to unresponsiveness with central hypoventilation and dysautonomia.Case reportThis paper presents two anti-NMDAR encephalitis cases with ovarian teratomas and reviews 13 anti-NMDAR encephalitis clinical case reports in Taiwan, of which six involved ovarian tumors, five being mature teratomas. Patients presented with acute onset of psychiatric symptoms and subsequently developed coma within a few days. Anti-NMDAR encephalitis usually occurs in young women and is often associated with ovarian tumors, specifically teratomas. Ovarian cystectomy or oophorectomy was performed, which markedly improved cognitive function.ConclusionParaneoplastic neurological conditions associated with ovarian teratomas represent a fascinating disease process. Identifying the gynecological cause of a neurological condition, particularly in young women, followed by prompt treatment can remarkably improve clinical conditions and, thus, be lifesaving.