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PubMedDate not supplied

Laparoscopic management of benign adnexal mass in obese women.

STUDY OBJECTIVE: To compare complications and rate of conversion to laparotomy between normal-weight, preobese, and obese women who underwent laparoscopic management of benign adnexal mass. DESIGN: Retrospective chart review (Canadian Task Force classification II-3). SETTING: Tertiary care teaching hospital. PATIENTS: One hundred seventy women who underwent laparoscopic surgery because of benign adnexal mass were placed in three groups on the basis of their body mass index (BMI) using the World Health Organization's classification (normal-weight [BMI 18.5-24.9 kg/m2], preobese [BMI 25-29.9 kg/m2], and obese [BMI > or = 30 kg/m2]). INTERVENTION: Retrospective comparison of conversions from laparoscopy to laparotomy, operative time, estimated blood loss, complications, history of pelvic inflammatory disease, endometriosis, and length of hospital stay was carried out among the different groups. MEASUREMENTS AND MAIN RESULTS: Overall, 170 laparoscopic cases were evaluated (64 with normal-weight, 67 preobese, and 39 obese women). The rate of conversion to laparotomy was significantly higher in the obese and preobese groups compared with the normal-weight women (17.9%, 17.9% vs 1.5%, p < .01). Obese women were 13 times more likely to undergo conversion than normal-weight women (OR 13.78; 95% CI 1.76-29.1). In addition, obese women had significantly longer surgeries (143 +/- 87 minutes vs 114 +/- 41 minutes [p = .04]) and longer hospital stay (1.07 +/- 1.83 days vs 0.51 +/- 1.06 days [p = .04]) when compared with normal-weight women. There was no significant difference in history of pelvic inflammatory disease, endometriosis, and adhesions at the time of laparoscopy between obese, preobese, and normal-weight women. The rate of complications was similar among the groups. CONCLUSION: Obese and preobese women undergoing laparoscopic management of benign adnexal mass were found to be at an increased risk for conversion to laparotomy, longer surgery and longer hospital stay. Obese and preobese women should be counseled extensively on morbidity associated with laparoscopy.

Adnexal Diseases↗
PubMedDate not supplied

A minimally invasive technique for management of the large adnexal mass.

STUDY OBJECTIVE: To describe our experience managing large pelvic masses through a minilaparotomy incision using a flexible, self-retaining wound retractor and exteriorized drainage by application of 2-octyl cyanoacrylate and a thin polyurethane membrane. DESIGN: Prospective nonrandomized trial (Canadian Task Force classification II-1). SETTING: Academic university hospital. PATIENTS: Ten women undergoing minilaparotomy for adnexal masses. INTERVENTIONS: After obtaining institutional review board approval, we identified 10 patients who underwent minilaparotomy for treatment of adnexal masses not thought to be amenable to laparoscopic surgical management and with clinical, radiographic, and laboratory evaluation consistent with a low probability of malignancy. Charts were reviewed and data collected. MEASUREMENTS AND MAIN RESULTS: The median mass size was 17.5 cm (range 9-30 cm), median incision length was 4.0 cm (range 3-5.5 cm), median patient age was 29.5 years (range 19-41 years), median body mass index was 24.7 (range 19.4-30.7), median duration of surgery was 85 minutes (range 53-141 minutes). Blood loss was minimal in all cases and all patients were discharged on the day of surgery. There were no diagnoses of ovarian malignancy. Pathologic diagnoses included mature cystic teratomas, cystadenomas, and cystadenofibromas. There were no instances of intraabdominal leakage of cyst fluid. One patient required readmission for a postoperative ileus. CONCLUSION: Minimally invasive management is a reasonable alternative to traditional laparotomy in the setting of a large adnexal mass with low probability of malignancy. This technique allows adequate access and exposure while minimizing the risk of intraabdominal contamination, speeding patient recovery, and optimizing cosmetic results. Further, this approach can be converted to a laparoscopic staging procedure if a patient is found to have ovarian cancer.

Adnexal Diseases↗
PubMed2006

No evidence for an association of ocular adnexal lymphoma with Chlamydia psittaci in a cohort of patients from the Netherlands.

Extra-nodal marginal zone B cell lymphomas (MZBCLs) of the mucosa-associated lymphoid tissues (MALT) arise at sites of chronic antigenic stimulation due to organ-specific autoimmunity or infections, like Helicobacter pylori-associated chronic gastritis and Borrelia burgdorferi dermatitis. Recently, conflicting data have been published regarding a possible association between Chlamydia psittaci and ocular adnexal MZBCL. In the present study, we analyzed a cohort of ocular adnexal MZBLs from the Netherlands for the presence of C. psittaci DNA. We found no evidence for the presence of C. psittaci DNA in any of the tumor samples studied. Our data do not support a role for C. psittaci in the pathogenesis of ocular adnexal lymphomas in patients from the Netherlands.

Chlamydia Infections↗
PubMed2004

Adnexal mass with pelvic pain.

In a pregnant woman who presents with acute pelvic pain and an adnexal mass, pregnancy-related etiologies, such as ectopic pregnancy or ovarian torsion, are typically the first diagnoses to be considered. Many other causes of pelvic pain associated with an adnexal mass can occur in pregnant patients, however. Some causes are benign and others require urgent management and treatment. Clinical presentation and physical examination can be misleading in pregnancy. The location of pain may be atypical for the pathologic entity, the pain may be muted, and in the case of infection, fever and leukocytosis can be absent. US examination is a safe and effective method for evaluating these patients. Sonographic characterization of adnexal masses may make a definitive diagnosis or focus the differential, which allows for prompt and appropriate treatment of patients.

Acute Disease↗
PubMed1993

Preservation of ovarian tissue in adnexal torsion with fluorescein.

OBJECTIVE: Our purpose was to assess the ability of fluorescein to intraoperatively detect viable fallopian and ovarian tissues involved in adnexal torsion. STUDY DESIGN: This prospective study was performed at Los Angeles County+University of Southern California Women's Hospital. Participants were female patients 18 to 45 years old with adnexal torsion confirmed at exploratory celiotomy. Five milliliters of 10% fluorescein were injected intravenously, and the involved untwisted adnexa was observed under ultraviolet light. Nonfluorescent tissue was resected and histologically evaluated. RESULTS: Eleven patients were entered into the study. Mean age was 25 years (range 15 to 42). Eight patients (72%) had preservation of involved ovarian tissue. No complications were associated with this procedure. Only three patients (28%) underwent oophorectomy. CONCLUSION: The use of intravenous fluorescein appears to be a valuable adjunct in the management of adnexal torsion. Application of this technique in reproductive-aged patients resulted in a three-quarter reduction in oophorectomy procedures.

Adnexal Diseases↗
PubMed1992

Four ovarian cancers diagnosed during laparoscopic management of 1011 women with adnexal masses.

OBJECTIVES: This study was conducted to assess the value of laparoscopic management of adnexal masses. Two concerns we wish to address are the failure to diagnose early ovarian cancer at laparoscopy and worsening the prognosis of stage I cancer by spilling fluid during surgery. STUDY DESIGN: The setting is a predominantly referral-based, private subspecialty practice. All operations were preformed in the outpatient surgical suite of a large suburban hospital. After extensive patient screenings, which included history and physical examination, preoperative serum CA 125 levels (since 1988), and pelvic ultrasonography, 1209 adnexal masses were managed laparoscopically. RESULTS: Of 1011 patients with surgical management, ovarian cancer was discovered intraoperatively in four. CONCLUSIONS: Our findings indicate that with consistent use of frozen sections of all cyst walls and suspicious tissue, laparoscopic management did not alter the prognosis. Neither CA 125 level, pelvic ultrasonography, nor peritoneal cytologic testing had sufficient diagnostic specificity to predict malignancy. Experienced surgeons using intraoperative histologic sampling may safely evaluate adnexal mass laparoscopically.

Adnexal Diseases↗
PubMed1999

Adnexal masses in pregnancy: a review of 130 cases undergoing surgical management.

OBJECTIVE: Our purpose was to determine maternal and fetal outcome in patients undergoing surgery for pelvic mass in pregnancy. STUDY DESIGN: Maternal and fetal records of 130 cases of adnexal masses associated with intrauterine pregnancy that required laparotomy or aspiration or that were diagnosed incidentally at the time of cesarean section were reviewed. The chi(2) and Fisher's exact tests were used for statistical analysis. A P value of </=.05 was considered significant. RESULTS: The incidence of adnexal masses in pregnant women who required surgical management was 1 in 1312 live births. A malignant tumor or a tumor of low malignant potential was found in 6.1% of cases. In 10 patients the only finding at the time of laparotomy was leiomyomas. Ultrasonography was not helpful in distinguishing tumors of low malignant potential from benign neoplasms or in identifying the source of the pelvic mass in patients found to have only leiomyomas. There were 2 intrauterine fetal deaths and 1 neonatal death in this cohort of patients. Patients who underwent laparotomy after 23 weeks' gestation had a significantly higher adverse pregnancy outcome compared with those who underwent laparotomy earlier in pregnancy (P =.005). CONCLUSION: The incidence of an adnexal mass during pregnancy in our population was consistent with what has been reported in the literature. However, the percentage of malignant tumors or tumors of low malignant potential was 2-fold greater than previously reported. Preoperative ultrasonography was not helpful in differentiating tumors of low malignant potential from benign neoplasms.

Adnexal Diseases↗
PubMed1999

A comparison of methods for preoperative discrimination between malignant and benign adnexal masses: the development of a new logistic regression model.

OBJECTIVE: The aim of this study was to assess the complementary use of ultrasonographic end points with the level of circulating CA 125 antigen by multivariate logistic regression analysis algorithms to distinguish malignant from benign adnexal masses before operation. STUDY DESIGN: One hundred ninety-one patients aged 18 to 93 years with overt adnexal masses were examined by transvaginal ultrasonography with color Doppler imaging and 31 variables were recorded. The end points were the histologic classification of the tumor and the areas under the receiver-operator characteristic curves of alternative algorithms. RESULTS: One hundred forty patients had benign tumors and 51 (26.7%) had malignant tumors: 31 primary invasive tumors (37% International Federation of Gynecology and Obstetrics stage I), 5 tumors of borderline malignancy (100% International Federation of Gynecology and Obstetrics stage I), and 15 tumors were metastatic and invasive. The most useful variables for the logistic regression analysis were the menopausal status, the serum CA 125 level, the presence of >/=1 papillary growth (>3 mm in length), and a color score indicative of tumor vascularity and blood flow. The optimized procedure had a sensitivity of 95.9% and a specificity of 87.1%. The area under the receiver-operator characteristic curve was significantly higher (P <.01) than the corresponding values from the independent use of serum CA 125 levels or indexes of tumor form or vascularity. CONCLUSION: Regression analysis of a few complementary variables can be used to accurately discriminate between malignant and benign adnexal masses before operation.

Adnexal Diseases↗
PubMed1995

Correlation between the American Fertility Society classifications of adnexal adhesions and distal tubal occlusion, salpingoscopy, and reproductive outcome in tubal surgery.

OBJECTIVE: To compare the prognostic value of salpingoscopy with a current classification system of adnexal adhesions and distal tubal occlusion in patients with tubal infertility undergoing reconstructive tubal surgery. DESIGN: Prospective clinical study. SETTING: Department of Obstetrics and Gynecology of the Catholic University, a tertiary care University Center in Rome, Italy. PATIENTS: Fifty-five infertile patients with either adnexal adhesions (29 patients) or hydrosalpinx (26 patients) undergoing reconstructive tubal surgery. INTERVENTIONS: Salpingoscopy performed concomitantly to salpingo-ovariolysis or salpingoneostomy at the time of either operative laparoscopy or laparotomy using microsurgical techniques. MAIN OUTCOME MEASURES: Salpingoscopic findings were compared with a current classification system of adnexal adhesions and distal tubal occlusion. The patients were followed for a mean follow-up of 49 months; the pregnancy rates achieved were correlated with the salpingoscopic findings and the classification system used. RESULTS: There was a significant correlation between the salpingoscopic grade and the occurrence of a term pregnancy for both the salpingo-ovariolysis and salpingoneostomy groups of patients. There was no significant correlation between the classification system used and the occurrence of a term pregnancy for both groups of patients. CONCLUSION: Salpingoscopy plays an important role in selecting the patients who may benefit the most from reconstructive tubal surgery.

Adnexal Diseases↗
PubMed1996

The laparoscopic approach to uterine adnexal torsion in childhood.

Seven girls with adnexal torsion (of varying degrees) were treated laparoscopically during a 6-month period. All had associated adnexal pathology. Six had simple follicular cysts (> 4 cm in diameter), and one had a 10-cm dermoid cyst. Detorsion with resection of the cyst and preservation of ovarian tissue was performed in all cases. No intraoperative or postoperative complications were encountered. Video-assisted minimally invasive surgery is suitable for the treatment of adnexal pathology in children; the hospitalization period is short, the cosmetic results are excellent, and the return to normal activity is rapid.

Adnexal Diseases↗
PubMed2001

Adnexal torsion: a report on forty-five cases.

OBJECTIVES: To evaluate the clinical findings, evolution of treatment and ovarian function following conservative therapy. STUDY DESIGN: A case series of 45 patients presenting with adnexal torsion between January 1989 and June 1999. All patients were surgically treated, either conservatively or radically. Patients who had received conservative treatment, interviewed by phone and underwent ovarian sonographic examination. RESULTS: Adnexal torsion is more frequent in young women with adnexal pathology. Conservative therapy by laparoscopy has gained increasing preference as a surgical procedure. It is safe and preserves ovarian function. CONCLUSIONS: Conservative therapy by laparoscopy is recommended to preserve ovarian function in young women.

Adnexal Diseases↗
PubMed2002

Ultrasound guided aspiration in pathological adnexal processes.

OBJECTIVE: To establish the efficiency of ultrasonographically guided transvaginal adnexal cyst aspiration as a treatment and diagnostic method. STUDY DESIGN: In 72 patients with an adnexal cystic mass, transvaginal ultrasound guided cyst aspiration was performed. Before the procedure, presence of primary malignant disease was excluded by gynecologic and ultrasound examination. Cyst content was sent for cytological analysis. Cytological findings were staged according to Papanicolaou. Patients were re-examined 3 and 6 months after the ultrasound intervention. Cysts measuring 3 cm or more in diameter were considered to be recurrence of the disease. RESULTS: Recurrence of the disease appeared in 32 cases (44%) and was more common with larger cysts. Malignant cells were found in one case (1.5%), a recurrent ovarian cancer, previously treated by surgery and chemotherapy. CONCLUSION: In our study, ultrasound guided aspiration of adnexal cysts was not shown to be an efficient method of treatment because of the high recurrence rate. It may be used in selected patients at high anaesthesiologic risk for surgery as a therapeutic or a diagnostic procedure.

Adnexal Diseases↗
PubMed2003

Laparoscopic management of adnexal masses in pregnancy: a case series.

OBJECTIVE: To determine the feasibility, safety, limiting factors, and advantages of laparoscopic management of adnexal masses in pregnancy. STUDY DESIGN: During a 12-year period, 48 laparoscopic procedures were performed in 47 patients with adnexal masses in pregnancy. Laparoscopic surgery was done during the first trimester of pregnancy in 17 cases, the second trimester in 27 cases and the third trimester in four cases. All the procedures were performed with general anesthesia and curarization. The laparoscopic cystectomies were performed either with the intra-peritoneal or the trans-peritoneal technique. RESULTS: The indications were: persistant or sonographically abnormal ovarian cyst (36 cases), torsion or rupture of ovarian cyst (8 cases), and symptomatic pelvic mass (3 cases). Two borderline tumors were discovered. The laproscopic procedure could not be performed in two cases due to dense adhesions and difficulty of hemostasis. No patient encountered complications during the intra- and post-operative periods. The mean hospital stay was 3.8 days. The outcome of the pregnancy was normal in all cases except one fetal loss 4 days after the laparoscopy. CONCLUSION: Laparoscopic management of adnexal masses in pregnancy by an experienced team, is a safe and effective procedure that allows, compared to the traditional surgery, a shorter hospital stay, a reduced rate of post-operative complications and a decreased maternal and fetal morbidity.

Adnexal Diseases↗
PubMed1997

Salpingo-oophorectomy for adnexal masses. Place and results for operative laparoscopy.

OBJECTIVES: The aim of the study is to specify the place, modalities and results of operative laparoscopy when adnexectomy is indicated in a patient presenting with an adnexal mass. STUDY DESIGN: A retrospective analysis of the 186 patients who underwent adnexectomy for an adnexal mass between January 1, 1989 and December 31, 1994. RESULTS: The operation took place via laparotomy in 34.9% of cases (65 patients) and by laparoscopic surgery in 65.1% of cases (121 patients). All the patients presenting a malignant ovarian lesion (15 cases) were operated by laparotomy. For these patients the laparotomy was decided from the outset in 7 cases and there was a conversion to laparotomy decided during the diagnostic phase of laparoscopy in 8 cases. The preoperative workup (clinical examination, study of past history, trans vaginal ultrasonography, doppler, tumoral markers etc.) together with the diagnostic phase of laparoscopy provide 100% sensitivity, a positive predictive value of 50% and a negative predictive value of 100% for diagnosis of malignancy. CONCLUSION: These results demonstrate that provided a strict selection system is used, it is possible to carry out adnexectomy using laparoscopic surgery in 70.8% of cases (121/171) for patients with benign adnexal mass.

Adnexa Uteri↗
PubMed2004

Laparoscopic excision of adnexal masses.

STUDY OBJECTIVE: The purpose of the present study was to evaluate a prospective series of consecutive patients with adnexal masses selected with strict preoperative clinical and ultrasonographic criteria. DESIGN: Prospective series of consecutive patients (Canadian Task Force classification II-2). SETTING: Tertiary care university hospitals. PATIENTS: Six hundred and eighty-three consecutive patients under 40 years of age with ultrasonographic evidence of an adnexal cystic mass without thick septa, internal wall papillation, or solid components, except for sonographic pattern suggestive of dermoid. INTERVENTIONS: Operative laparoscopy and follow-up. MEASUREMENTS AND MAIN RESULTS: After initial diagnostic laparoscopy in 13 patients with stage 4 endometriosis and extensive bowel adhesions, in 2 patients with large-volume dermoids, and in 1 patient with suspect ovarian and peritoneal implants, the procedure was converted to laparotomy. Therefore, 667 patients were completely managed by laparoscopy. There were 1069 cysts excised. Histologic diagnosis was endometrioma in 57% of the excised cysts, serous cyst in 13%, dermoid in 12%, paratubal in 8%, mucinous cysts in 5.3%, functional cyst in 2.8%, other benign histotypes in 1.1%, and ovarian malignancies (seven borderline tumors and one endometrioma with a microfocus of G1 endometrioid carcinoma) in 0.7% of the cysts and 1.2% of the patients. These last patients are alive with no evidence of disease after a mean follow-up of 62 months. CONCLUSIONS: In the present series, with accurate preoperative and intraoperative selection, the rate of unexpected borderline or focally invasive malignancies was 1.2% of the patients, and the laparoscopic management of these adnexal masses did not adversely impact on prognosis.

Adnexal Diseases↗
PubMed1998

CYFRA 21-1 serum levels in women with adnexal masses and inflammatory diseases.

The aim of the present study was to evaluate the clinical usefulness of the cytokeratin marker CYFRA 21-1 as a screening marker for ovarian cancer, as a predictive marker in patients with adnexal masses and as a prognostic marker in women suffering from ovarian cancer. In order to determine the specificity of the CYFRA 21-1 test, we have investigated CYFRA 21-1 serum levels in several benign conditions. This retrospective study comprises 37 patients suffering from ovarian cancer FIGO stages Ia-III. Sera from patients with benign ovarian cysts, endometriosis, pelvic inflammatory disease, inflammatory bowel disease and liver cirrhosis were evaluated in 90, 10, 38, 10 and 20 cases respectively. With a sensitivity of 41% and a specificity of 95%, CYFRA 21-1 was not suitable as a screening marker for ovarian cancer. Although CYFRA 21-1 was able to discriminate between ovarian cancer and benign adnexal tumours (univariate regression model, P = 0.0001), CYFRA 21-1 did not reveal additional information to CA 125 in a multivariate regression analysis (P = 0.06). CYFRA 21-1 serum levels were elevated in benign conditions such as liver cirrhosis, but not in endometriosis and inflammatory diseases. In ovarian cancer patients, elevated CYFRA 21-1 serum levels before therapy were associated with a poor overall and disease-free survival (log-rank test, P = 0.02 and log-rank test, P = 0.005 respectively). CYFRA 21-1, while obviously not suitable for screening or differential diagnosis of adnexal masses, could be useful as an additional prognostic factor in ovarian cancer patients.

Adnexal Diseases↗
PubMed1999

Subjective assessment of adnexal masses with the use of ultrasonography: an analysis of interobserver variability and experience.

OBJECTIVE: The aim of the study was to evaluate the subjective assessment of ultrasonographic images for discriminating between malignant and benign adnexal masses. STUDY DESIGN: The study was prospective. Initially, one ultrasonographer preoperatively assessed 300 consecutive patients with adnexal masses. Subsequently, the recorded transparent photographic prints were independently assessed by five investigators, with different qualifications and level of experience, who were also given a brief clinical history of the patients (i.e. the age, menstrual status, family history of ovarian cancer, previous pelvic surgery and the presenting symptoms). The diagnostic performance of the observers was compared with the histopathology classification of malignant or benign tumors. The end-points were accuracy, interobserver agreement and the possible effect of experience. RESULTS: The first ultrasonographer and the most experienced investigator both obtained an accuracy of 92%. There was very good agreement between these two investigators in the classification of the adnexal masses (Cohen's kappa 0.85). The less experienced observers obtained a significantly lower accuracy, which varied between 82% and 87%. Their interobserver agreement was moderate to good (Cohen's kappa 0.52 to 0.76). CONCLUSION: Experienced ultrasonographers using some clinical information and their subjective assessment of ultrasonographic images can differentiate malignant from benign masses in most cases. The accuracy and the level of interobserver agreement are both correlated with experience. About 10% of masses were extremely difficult to classify (only < 50% of assessors were correct).

Adnexal Diseases↗
PubMed1999

Artificial neural network models for the preoperative discrimination between malignant and benign adnexal masses.

OBJECTIVE: The aim of this study was to generate and evaluate artificial neural network (ANN) models from simple clinical and ultrasound-derived criteria to predict whether or not an adnexal mass will have histological evidence of malignancy. DESIGN: The data were collected prospectively from 173 consecutive patients who were scheduled to undergo surgical investigations at the University Hospitals, Leuven, between August 1994 and August 1996. The outcome measure was the histological classification of excised tissues as malignant (including borderline) or benign. METHODS: Age, menopausal status and serum CA 125 levels and sonographic features of the adnexal mass were encoded as variables. The ANNs were trained on a randomly selected set of 116 patient records and tested on the remainder (n = 57). The performance of each model was evaluated using receiver operating characteristic (ROC) curves and compared with corresponding data from an established risk of malignancy index (RMI) and a logistic regression model. RESULTS: There were 124 benign masses, five of borderline malignancy and 44 invasive cancers (of which 29% were metastatic); 37% of patients with a malignant or borderline tumor had stage I disease. The best ANN gave an area under the ROC curve of 0.979 for the whole dataset, a sensitivity of 95.9% and specificity of 93.5%. The corresponding values for the RMI were 0.882, 67.3% and 91.1%, and for the logistic regression model 0.956, 95.9% and 85.5%, respectively. CONCLUSION: An ANN can be trained to provide clinically accurate information, on whether or not an adnexal mass is malignant, from the patient's menopausal status, serum CA 125 levels, and some simple ultrasonographic criteria.

Adnexal Diseases↗