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PubMed1995

Differentiation of benign and malignant adnexal masses: relative value of gray-scale, color Doppler, and spectral Doppler sonography.

OBJECTIVE: The purpose of this study was to evaluate prospectively the relative usefulness of color Doppler, spectral Doppler, and gray-scale sonography in differentiating benign from malignant adnexal masses. SUBJECTS AND METHODS: A total of 170 adnexal masses in 161 patients were classified prospectively as suggestive of or not suggestive of malignant tumor on the basis of gray-scale morphology, internal flow versus peripheral or no flow, and spectral Doppler pulsatility, as measured by a pulsatility index (PI) threshold of 1.0 and a resistive index (RI) threshold of 0.4. RESULTS: Surgical pathology revealed 123 benign masses and 46 malignant masses. One malignant mass was confirmed by cytologic evaluation of ascitic fluid. On gray-scale analysis, 46 of the 47 malignant masses were classified as suggestive of tumor, and 76 of the 123 benign masses were classified as not suggestive of tumor (sensitivity, 98%; specificity, 62%; negative predictive value [NPV], 99%; and positive predictive value [PPV], 50%). The use of internal color flow as a predictor of malignant tumor yielded a sensitivity of 77%, a specificity of 69%, an NPV of 89%, and a PPV of 49%. The PI and RI values were significantly lower (p < .0001) in malignant masses than in benign masses, although the values overlapped considerably. For a PI of less than 1.0, sensitivity was 67%, specificity was 66%, NPV was 83%, and PPV was 46%. For an RI of less than 0.4, sensitivity was 24%, specificity was 90%, NPV was 73%, and PPV was 50%. CONCLUSION: In our series, a gray-scale prediction of benignity was reliable (NPV = 99%), and a prediction of malignancy was unreliable (PPV = 50%). Internal color flow was not useful as a predictor of malignancy (PPV = 49%). Although the absence of internal or peripheral color flow suggested benignity (NPV = 94%), only 17 (16 benign) of the masses (about 10%) had no flow. Spectral Doppler analysis with RI and PI was not useful, as no reliable discriminatory value with both high sensitivity and high specificity could be found for either parameter because of the overlap in values obtained for benign and malignant masses.

Adnexal Diseases↗
PubMed1996

Characterization of adnexal masses: combination of color Doppler and conventional sonography compared with spectral Doppler analysis alone and conventional sonography alone.

OBJECTIVE: To evaluate the importance of color Doppler combined with conventional sonography in characterizing adnexal masses and to compare the results with those of spectral Doppler analysis alone and conventional sonography alone. MATERIALS AND METHODS: One hundred and fifteen women with 132 adnexal masses (98 benign, three borderline, and 31 malignant) were prospectively studied with conventional and Doppler sonography (transabdominal in all patients and transvaginal in 111). Three methods differentiated benign from borderline and malignant masses. In the first, conventional sonography was used. In the second, conventional sonography was combined with color Doppler. In this method, the presence of color flow in an echogenic portion classified as indeterminate or malignant by conventional sonography indicated malignancy; the absence of color flow in an echogenic portion classified as indeterminant or malignant at conventional sonography indicated benignancy; the presence or absence of color flow in a regular wall or septum indicated benignancy. The third method used spectral Doppler analysis. Malignancy was indicated by a resistive index (RI) less than or equal to 0.4, a pulsatility index (PI) less than or equal to 1, or a peak systolic velocity (PSV) greater than or equal to 15 cm/sec. RESULTS: Using conventional sonography alone, accuracy was 83%, sensitivity was 88%, and specificity was 82%. Using conventional sonography and color Doppler, accuracy was 95%, sensitivity was 88%, and specificity was 97%. Using spectral Doppler analysis and an RI less than or equal to 0.4, accuracy was 77%, sensitivity was 18%, and specificity was 98%. For a PI less than or equal to 1, accuracy was 68%, sensitivity was 71%, and specificity was 67%. For a PSV greater than or equal to 15 cm/sec, accuracy was 72%, sensitivity was 47%, and and specificity was 81%. CONCLUSION: Adding color Doppler to conventional sonography produced a specificity and positive predictive value higher than those of conventional sonography alone. Specificity increased from 82% to 97% (p < .001), and positive predictive value increased from 63% to 91%. RI, PI, and PSV were of limited value.

Adnexal Diseases↗
PubMed1993

Accessory spleen presenting as adnexal mass.

Pelvic splenic ectopia is a very rare entity, often unsuspected preoperatively. We report a case of an ectopic spleen presenting as an adnexal mass in a middle-aged woman. Diagnosis was achieved intraoperatively, and confirmed pathologically. Pelvic ectopic spleen should be considered in the differential diagnosis of adnexal masses.

Adnexal Diseases↗
PubMed1999

Multiple pregnancy with adnexal torsion after in vitro fertilization: case report.

Assisted reproductive techniques (ART) are widely accepted procedures for infertile couples. Rare complications, like heterotopic pregnancy, bilateral tubal pregnancy, and adnexal torsion during pregnancy, have been diagnosed with increasing frequency after ART. We present a case of an early triplet pregnancy complicated with adnexal torsion. The patient was pregnant through in vitro fertilization. Early ultrasound examination revealed a triplet pregnancy within the uterine cavity. At 7 weeks' gestational age, an acute onset of lower abdominal pain, progressive abdominal distension, and massive internal bleeding prompted emergency laparotomy. The right ovary was enlarged, twisted, necrotic and hemorrhagic. Attempts to preserve the ovary failed because of the friable nature of the affected ovary, and an oophorectomy had to be performed. Although the removed ovary contained a corpus luteum, the pregnancy continued smoothly after only short luteal support. A precise pre-surgery diagnosis in our case was difficult based on the patient's initial clinical presentation. However, with high clinical suspicion in addition to color Doppler ultrasound, the physician should be able to make an early decision for an exploratory laparotomy or laparoscopy, gaining the benefit of more conservative treatment.

Adnexal Diseases↗
PubMed1999

Gasless laparoscopy under epidural anesthesia for adnexal cysts during pregnancy.

OBJECTIVE: To evaluate laparoscopic adnexal cystectomy during pregnancy using an open technique with a whole abdominal wall-lift method under epidural anesthesia. STUDY DESIGN: Seven cases of adnexal cysts during pregnancy were resected using a gasless laparoscopic (extracorporeal) method with a whole abdominal wall-lift. We performed this procedure without using general anesthesia or CO2 pneumoperitoneum. RESULTS: All operations were performed successfully without complications. All patients resumed normal activity within one week. The subsequent antenatal courses of the patients were uneventful. There were no severe complications during the operations or postoperative courses. Six patients had vaginal deliveries of normal infants at term. No abnormal findings were found in the antenatal course of patient 7 until 30 weeks of gestation. CONCLUSION: Based on our limited experience, this procedure may be safe.

Adnexal Diseases↗
PubMed1999

Adnexal torsion. A clinicopathologic review of 31 cases.

OBJECTIVE: To evaluate the correlation between clinical parameters, intraoperative assessment of tissue viability and histopathology in adnexal torsion. STUDY DESIGN: A retrospective study of 31 patients undergoing surgical intervention for adnexal torsion was performed, and clinical and pathologic parameters were compared. RESULTS: Intraoperative evaluation of viability was confirmed in 10/12 cases. Impression of necrosis was confirmed in 18/19 cases. Fever was seen in 2/12 patients with viable adnexa and in 7/19 patients with necrosis. CONCLUSION: Intraoperative impression of tissue viability correlated well with histopathology. Fever was significantly associated with tissue necrosis.

Adnexa Uteri↗
PubMed2001

Large pelvic accessory spleen mimicking an adnexal malignancy in a teenage girl.

A large pelvic accessory spleen in a teenage female is rare and may be misdiagnosed as an adnexal tumor. A 17-year-old girl, gravida 0, had suffered from intermittent and dull pain in the lower abdomen for 1 month. Laboratory evaluation showed a low platelet count (136,000/microL). Abdominal sonography showed a large solid mass situated at the right pelvis, containing abundant vascular supply with low resistant blood flow. At laparotomy, an accessory spleen fed by a tortuous vascular pedicle from the omentum was found and then excised. Histopathologic examination revealed congestive accessory splenomegaly. Follow-up platelet count returned to normal levels (374,000/microL). The importance of including accessory spleen in the differential diagnosis of a solid adnexal tumor with thrombocytopenia is emphasized.

Adnexal Diseases↗
PubMed1992

Management of adnexal masses by operative laparoscopy. Selection criteria.

The management of adnexal masses by operative laparoscopy is controversial. The application of strict criteria for preoperative patient selection and careful intraoperative assessment and management are critical to the appropriate use of this approach. Clinical examination, ultrasound imaging of the pelvis and the addition of the CA-125 tumor marker in postmenopausal women can aid in the selection of a population at low risk for malignancy that may be appropriate for operative laparoscopic adnexal surgery. Recommended procedures include careful intraoperative inspection of the pelvis and abdomen, liberal use of frozen sections, and conversion to immediate-staging laparotomy when malignancy is found.

Adnexal Diseases↗
PubMed2003

[Female adnexal tumor of probable Wolffian origin (Wolffian adenoma)--2 case reports and literature review].

Presented are two cases of unusual adnexal tumor described under the term "female adnexal tumor of probable wolffian origin (FATWO)" in the bibliography. One lesion was 18 cm large tumor located in the ovary in 85-year-old woman, the second one was a 5 cm large pedunculated mass arising from broad ligament in 40-year-old female. Three main structural patterns often coexisted and comprised solid or diffuse, sieve-like and tubular arrangement of spindle or epithelial cells. Cellular atypia and mitotic figures were practically absent. Clinical follow up confirmed benign behavior in both cases. Discussed is differential diagnosis and review of the literature.

Adenoma↗
PubMed2003

[Management of adnexal torsion].

Adnexal torsion is a current emergency in gynecology because it may compromises young women fertility. We have conducted a retrospective study about 26 adnexal torsion cases managed in B service of C.M.N.T during 4 years (1997-2001). Objective of our study is to improve patient fertility prognosis; we propose a diagnosis and therapeutic attitude which respect the time between diagnosis and treatment. Laparoscopy authorizes diagnosis, treatment and prognosis of this situation. It must usually be done in young woman who declare acute pelvic pain.

Abdominal Pain↗
PubMed2003

Clinical profile of patients operated for benign adnexal tumors and the histopathological types.

OBJECTIVE: To study the clinical presentation of patients with benign adnexal tumors who had surgical management and the histopathological types of the tumors. METHODS: Retrospective data were collected on 110 patients who underwent surgery for benign adnexal tumor from January 1999 through to April 2002, in Sultan Qaboos University Hospital, Sultanate of Oman. The histopathological types of the tumors were also studied. RESULTS: Abdominal pain was the commonest presenting symptom in 65% of the patients followed by abnormalities of vaginal bleeding. Most of the patients were managed by laparotomy and ovarian cystectomy. The commonest histopathological type was benign mature teratoma in 28% of the patients. CONCLUSION: Benign mature teratoma was the commonest histopathological type. Most of the patients had laparotomy; ovarian cystectomy and recurrences were few.

Abdominal Pain↗
PubMedDate not supplied

The adnexal mass in pregnancy.

The management of the adnexal mass in pregnancy can place the patient and/or fetus at risk. Adnexal masses occur in approximately one in 600 pregnancies, of which the risk of malignancy is up to 5%. The decision to proceed with conservative versus operative intervention is discussed in this article.

Adnexal Diseases↗
PubMed2004

Laparoscopic cystectomy of an ovarian mucinous cystadenoma in a 12-year-old girl: a possible role of operative laparoscopy for a huge benign adnexal mass.

The case of an obese 12-year-old girl with a huge and mobile pelvic cystic mass is presented. After ultrasonography and determination of tumor markers, a right huge benign adnexal mass was suspected. In order to avoid exploratory laparotomy because severe pain and a large operative scar were expected, an operative laparoscopy was performed. No intra-operative and post-operative complications were observed. With the uneventful recovery, only a one-day hospital stay was needed. Neither residual nor recurrent evidence was suspected after 2-, 6-, 12-, 18- and 24-months follow-up. With proper case selection, good pre-operative counseling and the operation performed under familiarity and good training in laparoscopy, laparoscopic management of a huge suspected benign adnexal mass is technically feasible. The benefits are reducing hospital stay, lowering morbidity, especially less pain and cosmetic acceptance of the operative scar.

Adnexal Diseases↗
PubMed1992

[Bilateral adnexal torsion].

A case of non-simultaneous bilateral adnexal torsion is described. Adnexal torsion is uncommon, rarely diagnosed preoperatively, and is most often treated by removal of the adnexa. However, if prompt diagnosis is made and viable tissue found (laparoscopy may be helpful), the opportunity of untwisting the adnexa and salvaging of ovarian function and fertility should be taken. In this situation, some authors recommend ovariopexy to prevent recurrence. Prophylactic suspension of the contralateral adnexa may, in some instances prevent subsequent recurrence on the contralateral side.

Adnexal Diseases↗
PubMed1992

Diagnostic imaging of adnexal masses. A review.

The application of diagnostic imaging modalities in the management of adnexal masses is reviewed. Nonionizing radiation techniques (ultrasound and magnetic resonance) are particularly important in pregnant and pediatric patients. Special consideration is given to imaging adnexal masses during reproductive development and senescence.

Adnexal Diseases↗
PubMed2006

[Present occurrence of benign teratoma of ovary and fallopian tube in a patient with adnexal torsion].

OBJECTIVE: The authors demonstrate the case of left adnexal torsion caused by 2 benign teratomas in its ovarian and tubal location. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, 1st Faculty of Medicine and General Teaching Hospital, Charles University, Prague. CASE: 24-years old woman underwent laparoscopy for several days lasting pain in lower abdomen and ultrasound finding of semicystic mass in the left adnexal region with suspicion of teratoma. The benign teratoma of the left ovary together with a torsion of the left Fallopian tube distended by teratoma was revealed during surgery. Left side salpingectomy and enucleation of the ovarian teratoma has been performed. This surprising finding was confirmed by histopathological examination. CONCLUSION: The acute gynaecological torsion event may be caused not only by torsion of uterine fibroid or enlarged tumorous ovary but rarely also by a teratoma of the Fallopian tube.

Adnexal Diseases↗
PubMedDate not supplied

Sonographic morphology scores (SMS) for differentiation between benign and malignant adnexal masses.

OBJECTIVE: To determine the sensitivity and specificity of a scoring system for distinguishing between benign and malignant adnexal masses and to detect threshold scores for prediction of malignant ovarian tumors. STUDY DESIGN: Cross-sectional diagnostic testing. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University. SUBJECTS: A total 158 patients scheduled for elective surgery due to ovarian tumors at Maharaj Nakorn Chiang Mai Hospital between June 16, 2002 and August 8, 2004 were recruited into the study. METHODS: All patients were sonographically examed within 72 hours before surgery by the same sonographer to evaluate the morphology including wall structure, shadowing, septum, echogenicity and score the tumors. The final diagnosis was based on either pathological or operative findings. MAIN OUTCOME MEASURE: Sensitivity and specificity of the best cut-off score. RESULTS: A score of 5 from the receiver operating characteristic curve was found to be the best cut-off score, giving a sensitivity and a specificity of 85% and 70%, respectively. CONCLUSION: Sonographic morphology scores are useful in distinguishing adnexal malignancies from benign lesions in some selected cases.

Adenocarcinoma, Clear Cell↗
PubMed1990

Adnexal torsion in menotropin-induced pregnancies.

Adnexal torsion of enlarged ovaries during early pregnancy is an infrequent but serious complication of menotropin therapy. Over 4 years, we encountered four cases of adnexal torsion among 648 menotropin-induced pregnancies. Multiple gestation may be a predisposing factor. The history of exogenous gonadotropin use, the acute clinical presentation, and the use of pelvic sonography facilitate the diagnosis. Although adnexectomy is well tolerated and pregnancy outcome is acceptable, future efforts should involve identifying preventive measures and more conservative means of therapy in these women.

Adnexal Diseases↗