Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “ADNEXITIS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 37 records · Page 2Linked to original sources
PubMed2000

Microcystic adnexal carcinoma: forty-eight cases, their treatment, and their outcome.

BACKGROUND: Microcystic adnexal carcinoma, or sclerosing sweat duct carcinoma, is an uncommon cutaneous neoplasm associated with extensive local invasion. The standard of care with regard to the best excisional method in treating microcystic adnexal carcinoma has not been established. OBJECTIVES: To perform a retrospective study comparing patients treated by Mohs micrographic surgery with those treated by wide excision and to elucidate the epidemiological features of microcystic adnexal carcinoma. PATIENTS AND METHODS: A retrospective analysis of a case series involving 48 primary and referral patients diagnosed as having microcystic adnexal carcinoma using standardized criteria. All cases were reviewed by the same dermatopathologists. RESULTS: Microcystic adnexal carcinoma predominantly affects the left side of the face of middle-aged women. Microcystic adnexal carcinoma is misdiagnosed 30% of the time. The recurrence rate is 1.98% per patient-year. Mohs micrographic surgery and simple excision show comparable complication rates. Clear margins were obtained in fewer procedures and, therefore, fewer office visits when the lesions were treated with micrographic surgery. The defect surface area after full extirpation following Mohs micrographic surgery was a mean of 4 times that of the clinically apparent size. The wide range of difference between the pre- and the post-Mohs micrographic surgery surface area noted in our data indicates that a margin cannot be safely predicted. CONCLUSIONS: Microcystic adnexal carcinoma is a predominantly left-sided, locally aggressive facial tumor, which results in significant morbidity. Our data do not support the use of standardized predictable margins. Mohs micrographic surgery is a reasonable initial treatment, as it accomplishes cure in fewer office visits and does not rely on predicted margins.

Adult↗
PubMed2005

Ovarian malignancy in breast cancer patients with an adnexal mass.

OBJECTIVE: The objectives of this study were to estimate ovarian malignancy rate in breast cancer patients with an adnexal mass and to identify variables predictive of malignancy. METHODS: This was a review from 1990-2002 including women with breast cancer diagnosed with an adnexal mass who subsequently underwent oophorectomy. Ovarian pathology was classified as benign, primary malignancy, or metastatic breast cancer. Women with preoperative evidence of malignancy were excluded. RESULTS: Of 129 cases reviewed, benign ovarian cysts were found in 113 cases (88%) and malignant ovarian neoplasms were found in 16 cases (12%). Univariate logistic regression analyses were performed to determine predictors of malignancy. Complex masses were 29 times more likely to be malignant (P < .001). Women with estrogen-receptor-negative breast cancer had an increased risk for malignant adnexal masses (44%; OR 12.4, 95% confidence interval 2.4-65.1; P = .003). Patients with an elevated CA 125 had a 6.3-fold increased risk of malignancy, P = .02. Adnexal mass size greater than 5 cm also increased the risk of malignancy (18.8%; OR 4.6, 95% confidence interval 1.2-17.3; P = .02). Malignant adnexal masses had a greater likelihood of being primary ovarian cancer than metastatic breast cancer by 7:1. CONCLUSION: An isolated adnexal mass in the breast cancer patient is most commonly a benign ovarian cyst. Adnexal masses associated with an increased CA 125, complex architecture by ultrasonography, or size greater than 5 cm are significant predictors of malignancy and are indications for referral to a gynecologic oncologist.

Adult↗
PubMed2002

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

OBJECTIVE: Our purpose was to determine maternal and foetal outcome in patients undergoing surgery for a pelvic mass in pregnancy. STUDY DESIGN: Maternal and foetal records (outcomes) of eight cases of adnexal masses associated with intrauterine pregnancy that required laparotomy or aspiration or that were diagnosed incidentally at the time of caesarean section were reviewed. The review was performed on patients who were seen with an adnexal mass in pregnancy from January 1994 to February 2001. We included patients with simple or complex masses > or = 6 cm that were persistent on ultrasonographic evaluation and patients with adnexal masses with complications (torsion, haemorrhage). We excluded cysts that spontaneously resolved by 16 weeks' gestation. RESULTS: Eight patients of 16,472 deliveries were identified with adnexal masses that satisfied the above criteria. Six patients underwent laparotomy in the first and/or the second trimester of pregnancy. In two of them emergency laparotomy were done due to torsion or haemorrhage as a complication of the adnexal masses. In all patients benign ovarian tumors were found. Two patients underwent transvaginal aspiration of simplex cysts due to subtorsion in the first trimester of gestation (negative results on cytological study). All of these eight patients had term deliveries. Two patients, due to obstetrical reasons, underwent caesarean section. CONCLUSION: The incidence of an adnexal mass during pregnancy in our population is consistent with what has been reported in the literature. We emphasize that transvaginal aspiration and drainage of symptomatic simplex cysts in the first trimester and percutaneous cysts in the second trimester can avert laparotomy. Our data support a randomised clinical study to determine optimal management of an adnexal mass in pregnancy.

Adnexa Uteri↗
PubMed1987

Immunoglobulin and T cell receptor beta chain gene rearrangement analysis of ocular adnexal lymphoid neoplasms: clinical and biologic implications.

We investigated the organization of the immunoglobulin heavy chain (IgH) and the T cell receptor beta chain (T beta) gene loci in 20 ocular adnexal and four extraocular lymphoid neoplasms obtained from 18 patients presenting with an ocular adnexal lymphoid neoplasm. Fifteen ocular adnexal and four extraocular lymphoid neoplasms occurring in 13 patients were classified by morphological examination and immunophenotypic analysis as monoclonal B cell lymphomas. Each one of these 19 lymphoid neoplasms exhibited clonal IgH gene rearrangements upon hybridization of EcoRI- or HindIII-digested DNA to a heavy-chain joining region (JH)-specific DNA probe. The bilateral ocular adnexal monoclonal B cell neoplasms occurring simultaneously in two individuals exhibited identical clonal IgH gene rearrangements, which indicated their derivation from an identical B cell clone. The ocular adnexal and the extraocular monoclonal B cell neoplasms occurring in two of three patients also exhibited identical clonal IgH gene rearrangements, which suggested that they too were derived from an identical B cell clone. Five ocular adnexal lymphoid neoplasms were classified by morphological examination and immunophenotypic analysis as benign, polyclonal pseudolymphomas. Three of these five ocular adnexal lymphoid neoplasms exhibited clonal IgH gene rearrangements, which suggested the presence of monoclonal B cell populations that escaped detection by morphological and immunophenotypic examination. None of the 24 pathological samples exhibited clonal T beta gene rearrangements upon hybridization of EcoRI- or BamHI-digested DNA to a T beta gene DNA probe. The results of these studies demonstrate the value of Southern blot hybridization analysis for clonal IgH and T beta gene rearrangements in the diagnosis, classification, and investigation of extranodal lymphoid neoplasms originating and/or presenting in the ocular adnexa.

Aged↗
PubMed1997

Sequential bilateral adnexal torsion after a single cycle of gonadotropin ovulation induction with intrauterine insemination.

OBJECTIVE: To report a rare case of sequential bilateral adnexal torsion in a pregnant woman after a single cycle of gonadotropin ovulation induction with IUI. To review the literature with regards to the causation and aspects of the management of adnexal torsion, particularly after assisted conception. DESIGN: Case report. SETTING: Fertility department within a teaching hospital. PATIENT(S): A 35-year-old woman with a twin pregnancy after a cycle of gonadotropin ovulation induction and IUI. INTERVENTION(S): Gonadotropin ovulation induction with IUI; two laparotomies, salpingo-oophorectomy, stabilization of adnexa with stay suture. RESULT(S): Continuation of pregnancy until 37 weeks gestation with the abdominal delivery of healthy twins. CONCLUSION(S): The case of a woman with a multiple pregnancy and ovarian hyperstimulation syndrome after ovulation induction and IUI who developed sequential bilateral adnexal torsion is used to illustrate the risk factors and management options for adnexal torsion. Physicians should be aware of the increased incidence of adnexal torsion in the rising number of women undergoing ovulation induction in order to effect early surgical intervention and adnexal salvage. Consideration should be given to the anchoring of bulky adnexae to prevent torsion recurrence.

Adnexal Diseases↗
PubMed2003

Predictors of clinical outcomes in the laparoscopic management of adnexal masses.

OBJECTIVE: Laparoscopy has become an accepted approach in the management of adnexal masses. We evaluated clinical outcomes of laparoscopic management of adnexal masses thought to be benign preoperatively. METHODS: We performed a retrospective study of patients undergoing laparoscopic evaluation of adnexal masses over a 7-year period. Regression models evaluated predictors of blood loss, length of stay, complications, mass rupture, conversion to laparotomy, and operating time. Preoperative predictors of malignant and borderline disease were evaluated using a separate model. RESULTS: Complications occurred in 8% of 396 patients undergoing laparoscopic evaluation of adnexal masses and were associated with concurrent hysterectomy (P =.01) and smaller mass (P =.01). Conversion to laparotomy occurred in 25% and was associated with larger mass (P =.001), prior hysterectomy (P =.002), and younger age (P =.002). Mass rupture occurred in 25% and was associated with prior (P <.001) or concurrent (P =.003) hysterectomy and younger age (P =.001). Blood loss greater than 500 mL was associated with concurrent hysterectomy (P <.001). Length of stay was associated with concurrent (P <.001) and prior (P <.001) hysterectomy, larger mass (P =.01), prior abdominal surgery (P =.009), and medical comorbidities (P =.007). Malignancy occurred in 2%, and laparoscopic management was not associated with adverse outcomes. CONCLUSION: Adnexal masses thought to be benign preoperatively were successfully managed laparoscopically in three fourths of cases and clinical outcomes were acceptable. To a great extent, adverse events were attributable to concurrent hysterectomy rather than removal of the adnexal mass.

Adnexal Diseases↗
PubMed1999

Predictors of persistence of adnexal masses in pregnancy.

OBJECTIVE: To determine factors predicting the persistence of sonographically identified adnexal masses in pregnancy. METHODS: All patients from March 1988 to April 1993 diagnosed with an adnexal mass by obstetric sonography were reviewed. Examinations had been entered prospectively into our sonography database. Follow-up data were collected from the database, from hospital and pathology department records, and from interviews with referring obstetricians. Adnexal masses were characterized by size, sonographic appearance, and anatomic site. Persistence of the masses was determined by subsequent sonography, operative findings, or postpartum physical examinations. RESULTS: The rate of adnexal masses during pregnancy was 2.3% (432 of 18,391). Complete follow-up was available for 422 of 432. Most of the adnexal masses (76%; 320 of 422) were simple cysts with a mean diameter less than 5 cm. The remainder of the masses were simple or complex, measuring 5 cm or more in diameter. Seventy of 102 large or complex masses resolved. By multivariate analysis, the best predictors for persistence of these masses were complex appearance on sonography and size of the mass (P < .05 for both categories). CONCLUSION: Most adnexal masses identified by sonography during pregnancy were small, simple cysts that did not pose a risk to the pregnancy. Even the majority of large or sonographically complex masses resolved. The best predictors of persistence of the masses were sonographic appearance and size.

Adnexal Diseases↗
PubMed2001

Australasian orbital and adnexal Wegener's granulomatosis.

OBJECTIVE: To report a retrospective case series of 29 Australian and New Zealand patients with orbital and adnexal Wegener's granulomatosis (WG). DESIGN: Retrospective case series. PARTICIPANTS: Twenty-nine cases of orbital and adnexal WG were identified. METHODS: A number of oculoplastic surgeons and other clinicians in Australia and New Zealand was asked about their experience with orbital and adnexal WG. Clinical data regarding these cases were conveyed by means of a questionnaire. Cases of ophthalmic WG without features of orbital or adnexal disease were excluded. MAIN OUTCOME MEASURES: Data obtained from the questionnaire includes age, gender, limited or generalized disease, antineutrophil cytoplasmic antibody (ANCA) status, symptoms and signs: nasolacrimal obstruction, sinusitis, fistula/orbital bone erosion, orbital mass/proptosis, extraocular muscle/diplopia, visual acuity reduction caused by optic nerve compression, orbital pain, lid edema/erythema, biopsy status, and treatment status. RESULTS: Twenty-nine patients with orbital and adnexal WG were identified and described. Symptoms included awareness of an orbital mass, epiphora, orbital pain and diplopia. Signs included an orbital mass or proptosis (69%), nasolacrimal duct obstruction (52%), limited ocular rotations (52%), lid erythema and edema (31%), bony destruction (21%), and reduced visual acuity (17%). Two patients had a persistent nasolacrimocanthal fistula. Cytoplasmic pattern antineutrophil cytoplasmic antibodies (c-ANCA) were present in 52% of patients, and in 9 of 10 patients with generalized disease. However, c-ANCA was positive in only 32% (6 of 19) of patients with limited WG. Perinuclear pattern antineutrophil cytoplasmic antibodies (p-ANCA) was positive in 10% of cases. CONCLUSIONS: To diagnose and treat ophthalmic WG effectively, the clinician must be aware of its protean orbital and adnexal manifestations. WG may occur with or without systemic involvement, and c-ANCA was negative in approximately half our cases. Our cases also demonstrated two orbital fistulae, an observation previously believed to be rare.

Adolescent↗
PubMed2000

The use of laparoscopy in the management of adnexal pathologies in children.

BACKGROUND: The authors' experience of using laparoscopy in the management of 23 girls (mean age: 8.9 years; range: 3 months-15 years) with various adnexal pathologies over a 3-year period is reviewed. METHODS: Of the 23 patients, seven were evaluated for congenital gonadal pathologies, 15 presented with abdominal pain and one patient had an antenatally diagnosed adnexal mass. Detailed laparoscopic examination of the pelvic cavity and laparoscopic gonadectomy were successfully performed in all seven patients with congenital gonadal pathologies: mosaic Turner's syndrome (n = 2), gonadal dysgenesis (n = 3) and testicular feminization syndrome (n = 2). Of 15 patients presenting with abdominal pain, 11 had an adnexal mass, two had acute appendicitis and two had pelvic inflammatory disease. RESULTS: Laparoscopic excision of the adnexal masses were successfully performed in 10 of 11 patients. Conversion to open surgery was required in one patient with a huge teratoma. Laparoscopic appendicectomy was successfully performed in both patients with acute appendicitis while diagnostic laparoscopy was the only procedure required in the two patients with pelvic inflammatory disease. Laparoscopy in the infant with an antenatally diagnosed adnexal mass confirmed this to be an omental cyst, which was successfully excised. All patients recovered without complications and good cosmetic result was universally achieved. CONCLUSION: Laparoscopy is safe and effective in both diagnosis and treatment of adnexal pathologies in children.

Adnexa Uteri↗
PubMed2006

Expression of Bcl-x in normal skin and benign cutaneous adnexal tumors.

BACKGROUND: Bcl-x appears to have an antiapoptotic role in the epidermis. Little is known about the expression of Bcl-x in cutaneous adnexal structures and benign cutaneous adnexal tumors. METHODS: Tissues from 31 cases of benign cutaneous adnexal tumors (five trichofolliculomas, five trichoepitheliomas, two sebaceous adenomas, five apocrine hidradenomas, five eccrine poromas, five eccrine spiradenomas, and four syringomas) were immunostained for Bcl-x. RESULTS: Strong staining for Bcl-x was seen in cells of the epidermal granular layer and inner root sheath of hair follicles. Sebaceous gland cells showed strong staining. Apocrine gland cells showed weak to moderate staining. No staining was seen in eccrine gland cells. The basaloid cells of trichofolliculomas and trichoepitheliomas showed no staining. In sebaceous adenomas, the sebaceous cells showed strong staining while the basaloid cells were negative. The cells of apocrine hidradenomas showed patchy weak staining. No staining was seen in eccrine poromas, eccrine spiradenomas, and syringomas. CONCLUSIONS: The degree of Bcl-x expression in cutaneous adnexal glandular structures appears to be related to their mode of secretion, being strongest in cells with apoptotic degradation of the entire cell (sebocytes). This pattern is recapitulated in the corresponding benign cutaneous adnexal tumors. Bcl-x may be useful in identifying cells with sebaceous differentiation in poorly differentiated adnexal tumors.

Biomarkers, Tumor↗
PubMed1994

Doppler sonography of adnexal masses: the predictive value of the pulsatility index in benign and malignant disease.

OBJECTIVE: The purpose of this study was to determine whether pulsed Doppler sonography can be used to distinguish between benign and malignant adnexal masses on the basis of pulsatility index. SUBJECTS AND METHODS: In an 18-month period, all patients in whom an adnexal mass was detected at sonography had further evaluation of the mass by color and pulsed Doppler sonography. Ninety-nine patients with 102 masses that were surgically removed were included in the study. The pulsatility indexes were calculated from the reproducible spectral waveforms generated from flow centrally or peripherally within or immediately adjacent to the mass. Each lesion was categorized on the basis of its gray scale morphologic features as typically benign or indeterminate/malignant in appearance. RESULTS: Of the 102 adnexal masses, 89 were benign and 13 were malignant. In seven of the 89 benign lesions, no flow could be detected, and these were excluded from analysis. Of the remaining 82 benign lesions, 65 showed pulsatility indexes consistently equal to or greater than 1.0, and 17 showed pulsatility indexes of less than 1.0. Ten of the 13 malignant lesions had pulsatility indexes consistently less than 1.0, and three primary malignant tumors had their lowest pulsatility indexes ranging between 1.1 and 1.8. Sixty-five of the 68 masses with pulsatility indexes equal to or greater than 1.0 were benign, for a positive predictive value of 96% for benign disease. Ten of the 27 masses with pulsatility indexes of less than 1.0 were malignant, for a positive predictive value of 37% for malignant disease. Forty-five masses were detected in perimenopausal and postmenopausal patients. In this group, the pulsatility index had a positive predictive value of 88% for benign disease and 47% for malignant disease. In this study, 45 of 49 masses that had a typically benign sonographic appearance had pulsatility indexes equal to or greater than 1.0. All 49 masses had benign histology. In the remaining 46 masses with an indeterminate/malignant sonographic appearance, 20 of 23 with pulsatility indexes equal to or greater than 1.0 were benign, and 10 of 23 with pulsatility indexes of less than 1.0 were malignant. CONCLUSION: Our results show a high positive predictive value of high-impedance flow in benign adnexal disease and a predominance of low-impedance flow in malignant adnexal disease. However, the pulsatility indexes showed considerable overlap between benign and malignant lesions, indicating that Doppler sonography has severe limitations in the differentiation of benign from malignant adnexal disease on the basis of low-impedance flow (pulsatility index < 1.0).

Adenofibroma↗
PubMed1996

Management of benign adnexal masses by vaginal route.

Until recently, surgical treatment of a benign adnexal mass implied a laparotomy. In recent years, the development of laparoscopic surgery, as well as ultrasound-guided aspiration techniques, have significantly modified the treatment options for these patients. These procedures have shown considerable advantages. They have reduced surgical trauma and have shortened the hospital stay. We present the results of our experience on the feasibility of a trans-vaginal surgical approach for the removal of benign adnexal masses. This technique, using traditional and cheap surgical instruments, allows the surgeon to excise benign adnexal masses, by entering the peritoneum through the posterior vaginal fornix and thus avoids the trauma of laparotomy. Fifty-four patients were operated on by this technique at our Department. The mean age was 39 years (range 21-66). In all cases, the operation was completed by the trans-vaginal approach. The median operative time was 30 minutes (range 20-45), and no blood transfusion was needed. The pathological diagnoses were as follows: functional ovarian cyst; 19, endometriotic cyst; 18, dermoid cyst; 11, parovarian cyst; 4 and peduncolated fibroid of the uterine fundus; 2 cases. The diameter of the adnexal masses ranged from 3 to 10 cm (median of 6 cm). In 30 cases, a conservative surgery was done (including 2 myomectomies), whereas in 24 cases, the adnexectomy was needed. Median post-operative stay in hospital was 4 days (range 1-14). This study shows the feasibility of trans-vaginal surgical approach for benign adnexal masses. The advantages and limitations of this technique, as well as of the traditional and laparoscopic surgery are considered and discussed. We believe that the transvaginal approach could be useful and cost-effective for the treatment of selected cases of adnexal masses.

Adnexal Diseases↗
PubMed2003

[Adnexal torsion: a report of 135 cases].

OBJECTIVES: To evaluate the clinical findings and therapeutic options following adnexal torsion. STUDY DESIGN: A retrospective series of 135 patients presenting with adnexal torsion between January 1992 and December 2001 in Sousse- Tunisia- a university teaching hospital. RESULTS: Adnexal torsion accounted for 14.8% of surgically treated adnexal tumors. Pregnancy was associated in 17% of cases and diagnosis was accurate at first clinical examination in only 57.8% of cases. Ultrasound allowed visualisation of Adnexal Diseases in all cases. Operative laparoscopy was successfully achieved in 34% of patients. Conservative management was used in 57% of the premenopausal patients. No major postoperative complication was noted. CONCLUSION: Clinicians must be aware of a possible adnexal torsion in women with acute pelvic pain. Ultrasound is a useful tool in these situations. Laparoscopy allows diagnosis and surgical management even during pregnancy.

Abdominal Pain↗
PubMed1994

[The significance of color [Collor] flowmetry in the differential diagnosis of adnexal tumors].

OBJECTIVE: to specify the diagnostic importance of arteria ovarica flowmetry, in relation to morphological ultrasonic criteria in the diagnosis adnexal masses. SETTING: The authors measured arteria ovarica flow in women suffering from adnexal masses, and compared flowmetry with the morphological ultrasound score for extrauterine mass evaluation acord Sassone. SUBJECTS: Open group of 25 women with diagnosis of adnexal mass in a prospective non-comparative study, underwent laparotomy for this diagnosis. INTERVENTION: The SSD-680 Aloka scanner with Collor Doppler facility, using transvaginal 5.5 MHz probe. MAIN OUTCOME MEASURES: Arteria ovarica flow on the side of adnexal mass is significantly higher in solid and mixed ovarian tumours (Sassone index > 7). Cystic tumours and functional ovarian cysts (Sassone index < 7) were responsible for lower than average flow in the a. ovarica. RESULTS: an indirect relation of the arteria ovarica flow on the side of the adnexal mass and the grade of morphological changes evaluated acording Sassone scoring system was found. Significantly lower value of Pulzatility index, Rezistence index and S/D ratio related with higher haemoperfusion of adnexal region, was found in solid and mixed ovarian tumours.

Adnexal Diseases↗
PubMed2006

Chlamydia psittaci is variably associated with ocular adnexal MALT lymphoma in different geographical regions.

Infectious agents play a critical role in MALT lymphoma development. Studies from Italy showed Chlamydia psittaci infection in 87% of ocular adnexal MALT lymphomas and complete or partial regression of the lymphoma after C. psittaci eradication in four of nine cases. However, C. psittaci was not demonstrated in ocular adnexal MALT lymphomas from the USA. This study was thus designed to investigate further the role of C. psittaci, and other infectious agents commonly associated with chronic eye disease, in the development of ocular adnexal MALT lymphoma. The presence of C. psittaci, C. trachomatis, C. pneumoniae, herpes simplex virus 1 and 2 (HSV1, HSV2), and adenovirus 8 and 19 (ADV8, ADV19) was assessed separately by polymerase chain reaction in 142 ocular adnexal MALT lymphomas, 53 non-marginal zone lymphomas, and 51 ocular adnexal biopsies without a lymphoproliferative disorder (LPD), from six geographical regions. C. psittaci was detected at similar low frequencies in non-LPD and non-marginal zone lymphoma groups from different geographical regions (0-14%). Overall, the prevalence of C. psittaci was significantly higher in MALT lymphomas (22%) than in non-LPD (10%, p=0.042) and non-marginal zone lymphoma cases (9%, p=0.033). However, the prevalence of C. psittaci infection in MALT lymphoma showed marked variation among the six geographical regions examined, being most frequent in Germany (47%), followed by the East Coast of the USA (35%) and the Netherlands (29%), but relatively low in Italy (13%), the UK (12%), and Southern China (11%). No significant differences in the detection of C. pneumoniae, C. trachomatis, HSV1, HSV2, ADV8, and ADV19 were found between lymphomas and controls from different geographical regions. In conclusion, our results show that C. psittaci, but not C. pneumoniae, C. trachomatis, HSV1, HSV2, ADV8 or ADV19, is associated with ocular adnexal MALT lymphoma and that this association is variable in different geographical areas.

Adenoviridae↗
PubMed1994

Adnexal torsion: can the adnexa be saved?

OBJECTIVE: Our purpose was to identify which cases of adnexal torsion may be managed with adnexal conservation. STUDY DESIGN: A retrospective chart review was conducted on all patients diagnosed with adnexal torsion between February 1983 and February 1993 at four hospitals in the Emory University system. RESULTS: Fifty-nine patients ranging in age from 23 months to 73 years (mean 31.9 years) were reviewed. Almost half of the patients were nulliparous. Lower abdominal pain (83%) and an adnexal mass (72%) were the most common presenting findings, but in general clinical findings were nonspecific. Most patients were treated with extirpative therapy of the affected adnexa. Untwisting of the adnexa was performed in 10 patients; however, adnexal conservation was accomplished in only one patient. There were no thromboembolic complications in any of the patients. CONCLUSIONS: Adnexal torsion is a diagnostic challenge, often with nonspecific symptoms. There is growing evidence that untwisting the involved adnexa to observe for tissue reperfusion and viability is safe. However, significant delay in surgical intervention may result in irreversible tissue necrosis, rendering the adnexa unsalvageable.

Adnexa Uteri↗
PubMed2000

Contrast-enhanced, three-dimensional power Doppler sonography for differentiation of adnexal masses.

OBJECTIVE: To investigate the potential usefulness of contrast-enhanced, three-dimensional power Doppler sonography in the differentiation of benign and malignant adnexal lesions. METHODS: A total of 45 patients with complex adnexal lesions of uncertain malignancy at transvaginal B mode and/or color Doppler sonography were prospectively evaluated with three-dimensional power Doppler sonography before and after injection of contrast agent. Presence of a penetrating pattern and a mixed penetrating and peripheral pattern suggested adnexal malignancy. All the results were compared with histopathology. RESULTS: There were 12 cases of ovarian malignancy and 33 benign adnexal lesions. Of the 12 ovarian cancers, seven (58. 3%) showed vascular distribution suggestive of malignancy at nonenhanced three-dimensional power Doppler sonography. After injection of contrast agent, a penetrating vascular pattern and/or a mixed penetrating and peripheral pattern were detected in all cases of ovarian malignancy. One cystadenofibroma demonstrated penetrating vessels at initial scan, whereas two benign lesions (fibroma and cystadenofibroma) were misdiagnosed as malignant at contrast-enhanced, three-dimensional power Doppler sonography. The use of a contrast agent with three-dimensional power Doppler sonography showed diagnostic efficiency (95.6%) that was superior to that of nonenhanced three-dimensional power Doppler sonography (86. 7%). CONCLUSION: Contrast-enhanced, three-dimensional power Doppler sonography provides better visualization of tumor vascularity in complex adnexal masses. If used together with three-dimensional morphologic ultrasound assessment, enhanced three-dimensional power Doppler imaging might precisely discriminate benign from malignant adnexal lesions.

Adult↗
PubMedDate not supplied

Ocular adnexal lymphomas: five case presentations and a review of the literature.

The ocular adnexal lymphomas represent the malignant end of the spectrum of lymphoproliferative lesions that occur in these locations. The Revised European and American Lymphoma (REAL) Classification and the new World Health Organization Classification of Tumors of Hemopoietic and Lymphoid Tissues are the most suitable for subdividing the ocular adnexal lymphomas, whereby the extranodal marginal zone B-cell lymphoma represents the most common lymphoma subtype. This review is based on five cases subtyped according to the above classifications-three "typical" lymphomas (an extranodal marginal zone B-cell lymphoma, a diffuse large cell B-cell lymphoma arising from an extranodal marginal zone B-cell lymphoma, and a follicular lymphoma) and two "atypical" lymphomas (a non-endemic Burkitt lymphoma in an immune competent elderly patient, and a primary Hodgkin lymphoma of the eyelid) of the ocular adnexa. Management of patients with ocular adnexal lymphomas includes a thorough systemic medical examination to establish the clinical stage of the disease. The majority of patients with ocular adnexal lymphoma have stage IE disease. Current recommended therapy in stage IE tumors is radiotherapy, while disseminated disease is treated with chemotherapy. Despite usually demonstrating an indolent course, extranodal marginal zone B-cell lymphomas are renowned for recurrence in extranodal sites, including other ocular adnexal sites. Long-term follow-up with 6-month examinations are therefore recommended. Major prognostic criteria for the ocular adnexal lymphomas include anatomic location of the tumor; stage of disease at first presentation; lymphoma subtype as determined using the REAL classification; immunohistochemical markers determining factors such as tumor growth rate; and the serum lactate dehydrogenase level.

Adult↗