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PubMed1982

The expression of surface antigen Leu 1 by ocular adnexal lymphoid neoplasms.

Leu 1 is a surface membrane antigen expressed by benign systemic T cells, most cases of B-cell-derived chronic lymphocytic leukemia, and approximately one half of the systemic B-cell lymphomas. Benign systemic B cells are Leu 1-. Our studies showed that the percentage of Leu 1+ cells was essentially the same as the percentage of OKT3+E+ (T) cells in six ocular adnexal pseudolymphomas, strongly suggesting that the benign B cells in these lesions were similarly Leu 1-. These studies also showed that malignant B cells in six of 15 (40%) ocular B-cell lymphomas were Leu 1+. Thus, the expression of Leu 1 by some malignant ocular adnexal B cells but not by benign ocular adnexal B cells appears to be analogous to the situation for lymph nodal and other systemic B cells. Although the explanation for the existence of this shared determinant is unknown, Leu 1 expression may possess clinical and diagnostic significance as a marker of neoplastic B cells.

Antigens, Neoplasm↗
PubMed1995

Treatment of nonendometriotic benign adnexal cysts: a randomized comparison of laparoscopy and laparotomy.

OBJECTIVE: To compare laparoscopy and laparotomy in the management of benign adnexal cysts, with particular attention to postoperative convalescence. METHODS: Forty premenopausal, nonpregnant women, 18-40 years of age and without acute pelvic symptoms, were scheduled to undergo surgical management of anechoic, unilateral, unilocular, persistent adnexal cysts from January 1993 through June 1994 at the Department of Obstetrics and Gynecology of the University of Cagliari, Cagliari, Italy. After ultrasonographic examination, followed by the completion of 6 months' expectant management with repeat ultrasonographic evaluations, subjects were randomized to undergo operative laparoscopy (n = 20) or laparotomy (n = 20). The patients were reviewed postoperatively at the out-patient clinic at 15, 30, 90, and 180 days. The intensity of pain was assessed by completion of a visual analogue scale on the results of the two groups were compared. We also compared the proportions of patients who were analgesic-free on day 2, discharged from hospital within 3 days, and feeling fully recuperated on day 15. RESULTS: The intensity of postoperative pain was significantly lower (P < .05) in the operative laparoscopy group than in the laparotomy group. A significantly higher (P < .05) proportion of the laparoscopy patients was analgesic-free on day 2, discharged from the hospital within 3 days, and feeling fully recuperated on postoperative day 15. CONCLUSION: After careful patient evaluation, management of anechoic, unilocular adnexal cysts by operative laparoscopy significantly reduces both the intensity of postoperative pain and the length of convalescence compared with laparotomy.

Adolescent↗
PubMed1993

Microcystic adnexal carcinoma of the skin. A reappraisal of the differentiation and differential diagnosis of an underrecognized neoplasm.

BACKGROUND: Microcystic adnexal carcinoma (MAC) is a locally aggressive adnexal neoplasm whose histogenesis is disputed. Many cases referred to us had been misdiagnosed. OBJECTIVE: Our purpose was to clarify the differential diagnosis and differentiation of MAC. METHODS: We sought follow-up data and examined routinely stained sections from 17 cases. We performed immunoperoxidase stains for carcinoembryonic antigen, pilar keratin (AE13), proliferating cell nuclear antigen (PCNA), type IV collagen, p53, and CD34 on selected cases. RESULTS: Nine biopsy specimens had initially been misinterpreted. Cysts containing compact keratin or shadow cells were present in 11 cases, which we interpret as evidence of follicular differentiation. Sebaceous gland and duct as well as inner root sheath structures were seen in one case each. CD34 did not mark the clear cells as it does those of the outer root sheath. Staining for PCNA, type IV collagen, and p53 did not distinguish MAC from benign adnexal neoplasms. CONCLUSION: MAC can be distinguished from its simulants in adequate biopsy specimens. Incompletely excised lesions usually recur. Both follicular and sudoriforous differentiation is present. Type IV collagen, PCNA, and p53 antisera were not useful in differential diagnosis.

Adult↗
PubMed1993

Microcystic adnexal carcinoma.

Microcystic adnexal carcinoma is a rare cutaneous neoplasm characterized by invasive, relentless, and destructive local growth. The incidence of perineural invasion and tumor recurrence is high. We report two cases of microcystic adnexal carcinoma with typical clinical features. The use of formalin-fixed, paraffin-embedded horizontal Mohs sections is described in one case. We also review the current concepts and management of microcystic adnexal carcinoma.

Aged↗
PubMed2005

B-Cells in ocular adnexal lymphoproliferative lesions express B-cell attracting chemokine 1 (CXCL13).

PURPOSE: The homeostatic chemokine, B cell attracting chemokine 1 (CXCL13), has been implicated in the pathogenesis of lymphocyte-mediated diseases. We investigated the cellular expression of this chemokine in the spectrum of ocular adnexal lymphoproliferative lesions. DESIGN: Laboratory investigation. METHODS: CXCL13 expression in paraffin-embedded adnexal biopsy specimens was determined by indirect immunohistochemistry with antigen retrieval. RESULTS: In 15 of 16 biopsy specimens, including reactive lymphoid hyperplasia (n = 7), atypical lymphoid hyperplasia (n = 3), and B cell lymphoma (n = 6), CXCL13 was detected. CD20-positive B-cells, as well as dendritic cells and endothelial cells, expressed the chemokine. CONCLUSIONS: B-cells in ocular adnexal lymphoproliferative lesions demonstrate expression of CXCL13, a chemokine that may participate in tumor pathogenesis and is a potential target for novel therapies.

Antibodies, Monoclonal↗
PubMed2005

Mantle cell lymphoma in the ocular adnexal region.

PURPOSE: To study the clinicopathologic features of mantle cell lymphoma (MCL) in the ocular adnexal region. DESIGN: Retrospective review. METHODS: The slides of 23 suspect patients were reevaluated with a panel of monoclonal antibodies, including anti-CD20, cyclin-D1, CD5, CD3, and p53 immunostains. Patients confirmed to have MCL were examined retrospectively on the basis of chart review. RESULTS: Ten patients with periocular MCL were included in the study on the basis of characteristic histopathologic features and coexpression of nuclear cyclin-D1. This included 1 female and 9 male patients, with an age range of 32 to 84 years (median, 73.5 years). Median follow-up was 20 months (range, 5-172 months). Six of the 10 patients died, all of lymphoma. The orbit (90%) was most commonly involved followed by the lacrimal gland (50%) and lid (50%), with 90% of cases having lymphoma present at 2 or more periocular sites. Most had a primary periocular presentation (80%) that was associated with stage III/IV disease (80%), including atypical cells in the peripheral blood smear (60%) and bone marrow involvement (70%) at presentation. Three cases were CD5-negative, and 2 other cases showed composite histologic findings (MCL and follicular lymphoma and MCL and a plasma cell neoplasm). Fluorescent in situ hybridization performed in these 2 cases demonstrated t(11;14) in the MCL component. Actuarial survivals were median progression-free (PFS) survival, 12 months; median overall survival (OS), 57 months; 5-year PFS, 0; 5-year OS, 39%. CONCLUSIONS: Mantle cell lymphoma presenting in the ocular adnexal region has a male predominance and tends to affect an elderly age group, as is typical of MCL involving nodal sites. A higher frequency of these tumors fail to co-express CD5, and composite lymphomas were observed in 20% of patients. Mantle cell lymphoma presenting in the ocular adnexal region is associated with advanced-stage disease and short PFS but an OS similar to MCL at other sites.

Adult↗
PubMed2004

Cultures of ovarian surface epithelium from women with and without a hereditary predisposition to develop female adnexal carcinoma.

AIM: Conflicting evidence exists on whether in vivo morphological characteristics can distinguish Ovarian Surface Epithelium (OSE) of ovaries obtained from women with and without a predisposition to develop female adnexal (ovarian and fallopian tube) carcinoma. This study aims to detect differences in growth potential and morphology that are maintained or specifically expressed in vitro. STUDY DESIGN: Ovarian surfaces were scraped to retrieve OSE cells from 56 women at hereditary high risk for female adnexal carcinoma, of whom 33 are BRCA1 and four are BRCA2 mutation carriers (Predisposed OSE, POSE) and from 26 women without such risk (Non Predisposed OSE, NPOSE). Number of passages and total cell yield until last passage, as well as morphology was compared between both groups. To confirm morphology, the expression of epithelial, mesothelial, and fibroblast markers was assessed. RESULTS: Both POSE and NPOSE cultures displayed similar growth potential and morphology. The expression of epithelial markers cyto-keratins 7 and 8 was similar between both groups. Only in cultures in which cells did not uniformly exhibit these markers, the percentage of cells expressing these markers was significantly lower at last passage when compared to the initial culture. In these latter cultures, cells that were morphologically indistinguishable from fibroblasts were observed. Mesothelial marker calretinin was expressed in 75% of cells of both POSE and NPOSE cultures and correlates with cyto-keratins 7 and 8 expression. CA 125 expression was equally low in POSE and NPOSE cultures (4.3%). Fibroblast markers FSM and vimentin were expressed in 100% and collagen IV was expressed in 16% of cells in all cultures. CONCLUSION: OSE cells derived from women with a hereditary predisposition to develop female adnexal cancer possess similar in vitro characteristics as OSE from women without this predisposition. On basis of our results, it seems advisable to study only 100% cyto-keratins 7 and 8 positive OSE cultures, since contamination of fibroblasts in some primary OSE cultures cannot be ruled out.

Adnexa Uteri↗
PubMed2004

Laparoscopic restaging of early stage invasive adnexal tumors: a 10-year experience.

UNLABELLED: Surgical staging of apparent early stage adnexal carcinoma provides indispensable information. A significant number of patients are referred to tertiary centers with inadequate staging information. We report on our experience with late results of laparoscopic restaging procedure in uncompletely managed early adnexal carcinomas. MATERIALS AND METHODS: From 1991 to 2001, 53 laparoscopic restaging operations were performed: 42 patients were restaged early after initial surgery for an ovarian carcinoma (OC) in 35 of them, and for fallopian tube carcinomas (FTCs) in 7 others. Eleven patients were assessed as a second-look procedure, after six courses of platinum-based chemotherapy indicated for a high-risk tumor. The procedure systematically followed the guidelines of laparotomy. RESULTS: All except one (adhesions) procedures were successfully completed. Operative room time averaged 238 min and hospital stay 3.1 days. Only one major complication required laparotomy (1.8%). In the primary restaging group, eight patients were upstaged (19%) and were given chemotherapy. After a 54-month median follow-up, 3 out of the 34 remaining patients diagnosed as stage IA grades 1-2 (6.4%) recurred and died. In the group of 11 second-look operations, 4 were found positive after chemotherapy. One of the positive patient recurred and died. CONCLUSIONS: Laparoscopy seems to be an acceptable technical option to perform restaging of apparently early adnexal carcinomas. It spares the patients the discomfort of repeat laparotomy. Long-term outcome results suggest that laparoscopic staging, provided it meets the standards, accurately detects the patients who need chemotherapy and safely select the patients who can be proposed surgery only.

Adolescent↗
PubMed2005

Laparoscopic findings during adnexal surgery in women with a history of nongynecologic malignancy.

OBJECTIVES: To describe the results of laparoscopic management of adnexal masses in women with a history of nongynecologic malignancy. METHODS: We conducted a retrospective review of 262 patients with history of prior nongynecologic malignancy who underwent laparoscopy for management of an adnexal mass between 1/1992 and 6/2004. RESULTS: Median patient age at laparoscopy was 55 years (range, 20-91 years), and median BMI was 25 kg/m2 (range, 14-41 kg/m2). Of the 262 patients, 145 (55.3%) had prior abdominal/pelvic surgery. Prior cancer history included breast (202, 77.1%), lymphoma/leukemia (16, 6.1%), colorectal (8, 3.0%), lung (7, 2.7%), multiple myeloma (5, 1.9%), head/neck (5, 1.9%), genitourinary (5, 1.9%), upper gastrointestinal (4, 1.5%), and other (10, 3.8%). Median ovarian mass diameter measured on radiologic imaging was 3.8 cm (range, 0.2-13.5 cm); median CA-125 was 17.0 U/mL (range, 1-7000 U/mL). In all, 49 (18.7%) patients had malignancy identified at laparoscopy, with 30/49 (61.2%) diagnosed with metastatic malignancy to the ovary and 19/49 (38.8%) having a new primary ovarian malignancy. Median tumor diameter and CA-125 were significantly higher in women found to have a malignancy (4.7 vs. 3.7 cm, and 35 vs. 14 U/mL, respectively). Overall, conversion to laparotomy occurred in 34 (12.9%) cases. Twenty-one of 49 (42.9%) patients with malignancy were converted to laparotomy compared with 13/213 (6.1%) when benign disease was noted (P < 0.001). CONCLUSIONS: Approximately 1 in 5 patients with a history of nongynecologic malignancy who were selected for laparoscopic management of an adnexal mass was found to have malignancy, with 60% being metastatic from other primaries. The majority of cases were managed laparoscopically even if malignancy was identified.

Adnexa Uteri↗
PubMed2003

Benign ocular adnexal tumours of apocrine, eccrine or hair follicle origin.

BACKGROUND: The differential diagnosis of malignant eyelid tumours, particularly basal cell carcinoma (BCC), includes tumours of skin appendages. The incidence of these adnexal tumours has not been well established. This study aimed to determine the incidence and review the main clinicopathological features of benign tumours arising from skin appendages of the eyelid with apocrine, eccrine or hair follicle differentiation. METHODS: The histopathological diagnoses of 7751 ophthalmic specimens retrieved from 6967 patients between September 1993 and March 2002 at the Henry C. Witelson Ophthalmic Pathology Laboratory and Registry, McGill University, Montreal, were retrospectively reviewed. Clinical data and histopathological diagnoses were obtained for 228 benign adnexal tumours of apocrine, eccrine or hair follicle origin. New histopathological slides were made from the paraffin-embedded specimens and stained with hematoxylin-eosin and periodic acid-Schiffs reagent. RESULTS: Of the 228 benign adnexal tumours, 182 were diagnosed as apocrine or eccrine hydrocystoma (79.8%), 12 pilomatrixoma (5.3%), 12 syringoma (5.3%), 11 trichilemmoma (4.8%), 5 syringocystadenoma papilliferum (2.2%), 3 trichoepithelioma (1.3%) and 3 trichofolliculoma (1.3%). Discrepancies between clinical and histopathological diagnoses were noted in 22 cases (9.6%). INTERPRETATION: Benign tumours originating from skin appendages of the eyelid are rare and frequently have apocrine or eccrine differentiation. These tumours, particularly those originating from the hair follicle, should be considered in the differential diagnosis of BCC of the eyelid.

Adolescent↗
PubMed1999

Laparoscopy versus laparotomy in the management of adnexal masses during pregnancy.

OBJECTIVE: To compare the outcome of pregnancy after operative laparoscopy or laparotomy for the management of adnexal pathology during pregnancy. DESIGN: Retrospective comparative study. SETTING: University tertiary care referral center for endoscopic surgery. PATIENT(S): Eighty-eight pregnant women who underwent 93 operations for suspected adnexal pathology at our institute. Laparoscopy was performed during the first trimester in 39 patients. The remaining 54 patients underwent laparotomy, 25 during the first trimester and 29 during the second trimester. INTERVENTION(S): Laparoscopy or laparotomy for the management of adnexal masses during pregnancy. MAIN OUTCOME MEASURE(S): Operative and postoperative maternal complications, miscarriage, congenital malformations, and newborn long-term outcome. RESULT(S): No operative or postoperative maternal complications occurred in the pregnant women who underwent laparoscopic surgery. In this group of 39 women, 5 women had a first-trimester miscarriage and 2 newborns had congenital malformations (hypospadias and cleft lip and palate). Two miscarriages occurred in the first-trimester laparotomy group, and 1 congenital malformation (transposition of the great vessels) was diagnosed in the second-trimester laparotomy group. CONCLUSION(S): Laparoscopic gynecologic surgery appears to be safe during pregnancy, although prospective controlled studies and national registries encompassing larger numbers of cases are needed.

Abortion, Spontaneous↗
PubMedDate not supplied

Immunohistochemical and immunogenetic analyses of ocular adnexal lymphoid proliferation.

PURPOSE: To compare polymerase chain reaction (PCR) results with histological, immunohistochemical, and clinical findings to understand the nature of ocular adnexal lymphoid proliferation. METHODS: We examined 20 cases (21 specimens) of ocular adnexal lymphoid proliferation, using histological, immunohistochemical, and molecular genetic methods. The latter two types of experiments were performed to examine the light chain restriction of immunoglobulin using the peroxidase-antiperoxidase method, and the clonality of immunoglobulin heavy chains using the PCR method. RESULTS: Although in 8 cases it could not be determined morphologically whether the tumors were neoplastic or not, clonality was revealed in 1 case by immunohistochemistry and in 4 cases by PCR. Two cases showed disparate results between immunohistochemistry and PCR, probably due to somatic mutation of the framework region of the immunoglobulin heavy chain gene. CONCLUSION: Examination using these methods contributes to a better understanding of the nature of the ocular adnexal lymphoid proliferation. Furthermore, the immunoglobulin gene PCR method is very useful in practice for examination of specimens, as it can be used with formalin-fixed and paraffin-embedded specimens.

Adult↗
PubMed2003

Ocular adnexal lymphoid proliferations: clinical, histologic, flow cytometric, and molecular analysis of forty-three cases.

PURPOSE: To describe the clinical features, histologic findings, flow cytometric immunophenotypes, and molecular profiles of ocular adnexal lymphoid proliferations. STUDY DESIGN: Prospective noncomparative case series. PARTICIPANTS: Forty-three patients suspected of having ocular adnexal lymphoid proliferations were biopsied and prospectively evaluated. METHODS: Provisional diagnoses were made on the basis of routine histology and immunohistochemistry for B and T cells. Results of flow cytometric immunophenotyping (FCI) and molecular assessment using polymerase chain reaction for immunoglobulin heavy chain (IgH) and TCR gamma chain gene rearrangement and bcl-2/IgH translocation were then incorporated into a final diagnosis. Demographic and clinical outcome data were collected. MAIN OUTCOME MEASURES: Final diagnosis based on histology, flow cytometry, and polymerase chain reaction. RESULTS: Forty-three cases were studied. Final diagnoses included 17 lymphomas, 18 chronic inflammations, 4 reactive lymphoid hyperplasias, and 4 atypical lymphoid infiltrates. Preliminary evaluation accurately categorized all 43 cases as either lymphoma or nonlymphoma. FCI permitted more precise subclassification of the lymphomas according to the Revised European American Lymphoma (REAL) system of nomenclature as follows: eight marginal zone B cell (mucosa-associated lymphoid tissue type), three mantle cell, two follicular, three large cell, and one lymphoplasmacytoid lymphoma. FCI showed a clonal B cell proliferation in 94% (16 of 17) of the lymphomas; FCI identified a clonal B cell population in 4% (1 of 25) of cases of nonlymphomas. Molecular evidence of clonality was identified in 88% (15 of 17) of lymphomas, 39% (7 of 18) of chronic inflammations, and 50% (4 of 8) of reactive lymphoid hyperplasias and atypical lymphoid infiltrates. CONCLUSIONS: The histologic diagnosis of ocular adnexal lymphoid lesions is highly accurate when determined by an experienced pathologist. FCI refines the histologic diagnosis and classification. Results of molecular studies should be interpreted in conjunction with clinical, histologic, and immunophenotyping findings.

Adolescent↗
PubMed1992

Treatment of ocular adnexal Kaposi's sarcoma in acquired immune deficiency syndrome.

PURPOSE: To determine the most effective, safe, and cost-efficient treatment for ocular adnexal Kaposi's sarcoma in the acquired immune deficiency syndrome. METHODS: Eighty-two patients with ocular adnexal Kaposi's sarcoma related to the acquired immune deficiency syndrome were examined, and 25 were selected to participate in a 3-year study that treated the ocular lesions based on stage of development and location. RESULTS: Of 14 patients with bulbar conjunctival Kaposi's sarcoma treated with surgical excision, 2 stage III lesions recurred during a follow-up that ranged from 8 to 31 months; no stage I or stage II lesion recurred. Of 7 patients with eyelid Kaposi's sarcoma treated with cryotherapy, 2 stage III lesions recurred during a follow-up that ranged from 9 to 24 months; no stage I or stage II lesion recurred. Four patients with stage III Kaposi's sarcoma of the bulbar conjunctiva were treated with fluorescein angiography-based surgical excision. None of these lesions recurred during a follow-up that ranged from 4 to 8 months. CONCLUSION: A treatment regimen for ocular adnexal Kaposi's sarcoma related to the acquired immune deficiency syndrome based on tumor stage and location, using cryotherapy and surgical excision with or without fluorescein angiography, is effective, safe, and cost-efficient.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Ocular and adnexal findings in patients with facial microsomias.

The authors reviewed the ocular findings in 49 patients with facial microsomias not considered part of a known syndrome. Five patients had bifacial microsomia, and 44 patients had hemifacial microsomia. These patients were evaluated in the Craniofacial Clinic in the Division of Pediatric Ophthalmology at Children's Hospital of Philadelphia between the years 1979 and 1989. Ocular or adnexal abnormalities were present in 67% of patients. Visual loss was present in 8% of eyes. Amblyopia was present in 16% of patients. Significant refractive errors were present in 27% of patients, and anisometropia was documented in 8%. Strabismus was present in 22% of patients, and significant lid and adnexal abnormalities were seen in 41%. Because ocular or adnexal findings present in a significant percentage of patients with more mild forms of facial microsomias, regular examinations to uncover and treat these abnormalities are recommended.

Adolescent↗
PubMed1999

Limitations of the evaluation of adnexal masses by its macroscopic aspects, cytology and biopsy.

To investigate the relevance of intraoperative macroscopic evaluation of adnexal masses a prospective study was conducted from June 1st, 1993 to May 31st, 1994, which included 57 premenopausal and 60 postmenopausal women, who underwent laparotomy because of a cystic adnexal mass. The surgeons were asked to classify the tumor intraoperatively as benign or malignant and to assign to histologic groups. In addition cytology of the cyst fluid and a biopsy from the cystic wall were evaluated. Comparison of these items with the results of permanent section diagnosis revealed the tendency of the surgeons to underestimate adnexal masses depending on patients' age and the complexity of the tumor, despite of the knowledge of preoperative ultrasonographic findings. Sufficient cytolologic examination was possible in only one third of aspirates and only 21% of the examined postmenopausal malignant neoplasms have correctly been diagnosed by cytology. Evaluation of the biopsy specimens demonstrates a marked percentage of false negatives with respect to benign tumors (30% of non-functional benign neoplasms in the premenopause were assessed as functional cysts) as well as malignant neoplasms (only 72% were diagnosed correctly in the postmenopause group). In conclusion intraoperative subjective assessment, cytology and representative biopsies do not necessarily concur with the definitive histological diagnosis.

Biopsy↗
PubMed2003

Ocular adnexal lymphoma: clinical behavior of distinct World Health Organization classification subtypes.

PURPOSE: To evaluate the clinical behavior and treatment outcome of ocular adnexal lymphomas classified by the World Health Organization system, with emphasis on marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT). MATERIALS AND METHODS: The clinicopathologic materials from 98 consecutive patients treated for ocular adnexal lymphoma were reviewed. Fourteen patients had prior lymphoma and 84 patients had primary disease (75% Stage I, 6% Stage III, and 19% Stage IV). Radiation (photons/electrons) was administered to 102 eyes to a median dose of 30.6 Gy. The mean follow-up was 82 months. RESULTS: The most common subtypes among the primary patients were MALT (57%) and follicular (18%) lymphoma. The 5-year actuarial local control rate in 102 irradiated eyes was 98%. Among the low-grade lymphomas, the 5-year local control rate correlated with the radiation dose in the MALT lymphoma subgroup (n = 53): 81% for <30 Gy and 100% for > or =30 Gy (p <0.01). For the non-MALT low-grade lymphomas such as follicular lymphoma (n = 30), the local control rate was 100% regardless of dose. For 39 Stage I MALT lymphoma patients treated with radiation alone, the distant relapse-free survival rate was 75% at 5 years and 45% at 10 years. Distant relapses were generally isolated and successfully salvaged by local therapy. The overall survival for this subgroup was 81% at 10 years, with no deaths from lymphoma. CONCLUSIONS: Dose-response data suggest that the optimal radiation dose for MALT lymphoma of the ocular adnexa is 30.6-32.4 Gy in 1.8-Gy fractions and follicular lymphoma is adequately controlled with doses in the mid-20 Gy range. The substantial risk of distant relapse in Stage I ocular adnexal MALT lymphoma underscores the importance of long-term follow-up for this disease and the need for additional comparative studies of MALT lymphoma of different anatomic sites.

Adolescent↗
PubMed1994

Comparison of minimally invasive surgery and laparotomy in the treatment of adnexal masses.

STUDY OBJECTIVE: To compare the outcome of laparoscopic treatment of adnexal masses with treatment by laparotomy. The procedures, their duration, and associated complications also were evaluated. DESIGN: Women were randomized to undergo either procedure based on the ward to which they were admitted. SETTING: A university teaching hospital. PATIENTS: The 192 patients were admitted with a preoperative diagnosis of adnexal mass. INTERVENTIONS: Surgical procedures were cystectomy, salpingectomy, oophorectomy, and unilateral or bilateral salpingo-oophorectomy. Organ-preserving techniques were used wherever possible. All tissue specimens were examined histologically. MEASUREMENTS AND MAIN RESULTS: The mean duration of surgery was statistically not significantly different between the groups, 96.8 minutes for minimally invasive surgery, and 116 minutes for laparotomy. Organ preservation did reach statistical significance at 65.7% and 17.2% respectively (p <0.001). Postoperative morbidity was statistically lower in patients undergoing minimally invasive procedures. Preoperative tumor marker levels did not correlate well with postoperative histology. One woman in the laparotomy group had histologically proved ovarian cancer. Minimally invasive surgery was converted to laparotomy in three patients in whom malignancy was suspected at the start of operation. CONCLUSIONS: Laparoscopic management of adnexal masses has definite advantages over laparotomy, for example, lower postoperative morbidity. In addition, intraoperative endoscopic diagnosis is highly accurate, and the frequency of unnecessary procedures is lower.

Adolescent↗