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PubMed1996

[Microcystic adnexal carcinoma of the skin. An underestimated tumor].

Microcystic adnexal carcinoma is a rare semimalignant cutaneous neoplasm characterised by slow but locally aggressive growth. Its histogenesis and nomenclature are still a subject of controversy. Under-recognition and the tumor's bland cytologic features lead to frequent misdiagnoses. In addition, subclinical tumour invasion explains the high incidence of local recurrence. Thus, the tumour makes great demands on the planning of its surgical removal. We report the case of an 81-year-old woman with a microcystic adnexal carcinoma of the lower lip, which was treated by micrographic surgery. On the basis of this case, differential diagnoses, histogenesis and micrographic surgery as the treatment of choice are discussed.

Aged↗
PubMed2002

Adnexal torsion after gonadotrophin ovulation induction for IVF or ICSI and its conservative treatment.

This study was designed to find out the incidence of ovarian torsion in the patients who were in ovulation induction treatment for either In vitro fertilization (IVF) or Intracytoplasmic sperm injection (ICSI). Also operative laparoscopic conservative treatment (detorsion or unwinding the twisted adnex) was tried to perform to all the patients. Among 10,583 cycles 9 ovarian torsion cases had been diagnosed laparoscopically between January 1994 and October 1998. 104 ovarian hyperstimulation syndrome (OHSS) patients were evaluated during that time. From 104 hyperstimulated cases three had torsion of the adnex and two of them were pregnant. Five of the patients were clinically and one was chemically pregnant. First, laparoscopy was done to all the patients and 8 of them could be detorsioned, in one case unwinding performed by laparotomy because of the large size of the ovary. No complications were observed after conservative surgery. These results demonstrate that, in the IVF or ICSI clinics ovarian torsion has to be regarded as one of the major complications especially if the patients are hyperstimulated or pregnant or both. Immediate manipulation is needed conservatively, preserving the ovaries which were very important for those infertile patients.

Adult↗
PubMed2005

Ocular adnexal marginal zone B cell lymphoma: a clinical and pathologic study of 23 cases.

To better characterize ocular adnexal marginal zone lymphoma of mucosa-associated lymphoid tissue (MZL-MALT), we analyzed the clinical and pathologic features of 23 patients (11 men, 12 women, median age 66 years). The tumor was confined to one ocular structure in 18 cases (conjunctiva, n=8; orbit, n=8; or lacrimal gland, n=2). Concurrent extraorbital disease was detected by the staging procedure in five patients, and preferentially involved other MALT sites. Histogenetic B cell marker studies, available in 13 cases, showed an early post-germinal center (GC) phenotype (BCL-6(-)/IRF4(+)/CD138(-)) (n=5) or a late post-GC phenotype (BCL-6(-)/IRF4(+)/CD138(+)) (n=8), which could be helpful for discrimination from other types of small-B cell lymphoma. BCL10 was positive in 12 of 13 patients tested, with nuclear (n=4) or cytoplasmic (n=8) immunoreactivity. These staining patterns ruled out t(1;14)(p22;q32) translocation. T(11;18)(q21;q21), another MZL-MALT-specific translocation, was detected by reverse transcriptase polymerase chain reaction in four of 15 patients tested. Clinical outcome was excellent but the overall relapse rate was 26.1% with a median follow-up of 39 months (range 6-132 months). Regardless of the disease stage at diagnosis, combined chemotherapy and radiotherapy seemed to be more effective than chemotherapy alone in ocular adnexal MZL-MALT, as persistent complete remission was achieved in nine patients receiving combination therapy, while six of 14 patients treated with chemotherapy alone relapsed.

Adult↗
PubMedDate not supplied

Primary ocular adnexal lymphoma in pediatric patients: report of two cases and review of the literature.

Primary ocular adnexal lymphoma (POAL) is a rare extranodal lymphoma. The mucosa-associated lymphoid tissue (MALT) subtype predominates and primarily occurs after the sixth decade of life. Most studies of ocular adnexal lymphoma are from the adult population. The data and experience in pediatric patients with POAL are limited to a few cases reported in the literature. Here we describe two pediatric cases of POAL and review the literature to further help characterize the clinical features and histopathologic appearance of this uncommon lymphoma.

Adolescent↗
PubMedDate not supplied

Adnexal-centered giant congenital melanocyte nevus with extensive ganglioneuromatous component and trisomy 7.

Adequate interpretation of clinical and histopathologic features of giant congenital melanocytic nevus (GCMN) in newborns is a continued challenge. A GCMN with three large nodules and three polypoid exophytic tumors presented in the dorsum of a female full-term newborn, the borders exhibiting a spotted grouped pattern. Microscopic examination revealed a peculiar adnexal-centered (eccrine sweat gland ducts, acrosiringia, and hair infundibula) compound nevus expressing pagetoid intraepidermal spreading of epithelioid melanocytes. The nodules represented an extensive ganglioneuromatous component. The neurons and their neuropil were positive for neuron-specific enolase, S-100, synaptophysin, tyrosine hydroxilase, and PGP 9.5. In addition to these components, a poorly differentiated, fusiform, low-mitotic rate population of cells undergoing epithelioid differentiation (and probably neuronal differentiation) with nodular arrangement was also present in the polypoid tumors and deeper parts of the nevus, in part intermixed with the neurons. These cells were vimentin positive but S-100 negative. FISH studies revealed these cells to express three signals for the centromeric probe for chromosome 7 whereas the neuronal component showed just two. Adnexal-centered arrangement of melanocytes has not been emphasized in GCMN. Ganglioneuromatous differentiation has been rarely reported in this condition. Trisomy 7 in GCMN has been reported only once previously.

Chromosomes, Human, Pair 7↗
PubMed2004

Serious eye and adnexal injuries from fireworks in Northern Ireland before and after lifting of the firework ban--an ophthalmology unit's experience.

BACKGROUND/AIMS: To report serious fireworks-related eye and adnexal injuries presenting to the Department of Ophthalmology in the Royal Victoria Hospital, Belfast. To assess the effect of lifting of the legislative ban on fireworks in Northern Ireland in 1996. METHOD: Twelve year retrospective review from 1990 to 2001 inclusive of all ocular and adnexal injuries from fireworks requiring hospitalisation to the ophthalmology department. RESULTS: Twenty three patients with 23 injured eyes were reported. Six were female. The mean age was 18 years (+/- 13 SD). Six patients presented between the years 1990 and 1995. The remaining 17 patients presented between 1996 and 2001. Nearly half of the patients required ophthalmic surgical procedures. Thirty-six percent of patients had a final visual acuity of 6/60 or less. Superficial trauma not requiring hospitalisation was not included. CONCLUSION: Removal of the legislative ban on fireworks in 1996 has had a significant effect on the incidence of eye injuries. These injuries are potentially preventable with stricter control on the availability of fireworks and a greater awareness of the ocular risks they pose.

Adolescent↗
PubMed1978

Adnexal malignancy detected by cervical cytology.

These case presentations are submitted to focus attention on positive (Class V) cervicovaginal cytologic results compatible with adenocarcinoma in the face of benign endocervical and endometrial tissue and in the absence of clinically detectable adnexal disease. Two patients were found to have primary ovarian malignancy, and one patient had adenocarcinoma of the distal end of the right Fallopian tube. Provided that there is confidence in the cytologic diagnosis and that primary disease has been ruled out elsewhere, the clinician is encouraged to utilize additional diagnostic methods, such as laparoscopic visualization of the pelvis and peritoneal fluid studies, in an attempt to facilitate early diagnosis of nonpalpable adnexal disease.

Adenocarcinoma↗
PubMed1988

The value of adnexal sonographic findings in the diagnosis of ectopic pregnancy.

A prospective study of 383 patients with suspected ectopic pregnancy was carried out at Yale-New Haven Hospital to determine the value of adnexal sonographic findings in the diagnosis of ectopic pregnancy. In patients with adnexal sonographic results and human chorionic gonadotropin titers less than 6000 mIU/ml (n = 220), the presence of a noncystic mass had a positive predictive value of 83%, and the presence of a cystic mass had a positive predictive value of 35%. The combination of a noncystic mass and fluid in the cul-de-sac (found in 22% of all patients with ectopic gestations) was the best predictor of an ectopic pregnancy with a 94% positive predictive value. It is suggested that the demonstration of a non-cystic mass, alone or in the presence of fluid in the cul-de-sac, be used as an indication for diagnostic laparoscopy.

Abortion, Spontaneous↗
PubMed1979

Immunologic characterization of ocular adnexal lymphoid neoplasms.

We correlated the light microscopic features of ten ocular adnexal lymphoid neoplasms with the results of selected immunologic and histochemical lymphocyte marker studies. The lesions were divided into three histomorphologic patterns: inflammatory pseudotumor, reactive follicular hyperplasia, and malignant lymphoma. The six inflammatory pseudotumors, and reactive follicular hyperplasia, despite diverse histomorphology, were immunologically polyclonal and consisted of from 45 to 73% T cells and 27 to 60% B cells, the B cells being polyclonal with respect to light chain determinants. The four malignant lymphomas were immunologically monoclonal. Each consisted of a predominant B-cell proliferation, greater than 50% of the cells, which were monoclonal with respect to surface light chain determinants. No T-cell proliferations were observed. Our preliminary data indicate that, as in systemic lymphoid neoplasms, benign reactive lymphoid hyperplasias are immunologically polyclonal whereas malignant lymphomas are immunologically monoclonal. The systematic application of immunologic and histochemical techniques to the study of ocular adnexal lymphoid neoplasms may elucidate the natural history of these lesions.

Adult↗
PubMed1990

C-reactive protein is a marker for the diagnosis of adnexitis.

The study reports the C-reactive protein (CRP) plasma concentrations in 115 women with a presumed diagnosis of acute adnexitis. In addition to CRP, blood sedimentation rate, white blood cell count and the body temperature were evaluated and compared with the clinical findings. Diagnosis was confirmed or excluded by laparoscopy (n = 69) or laparotomy (n = 9). Clinical examinations and conventional laboratory examinations were of limited value in the diagnosis of acute adnexitis. In contrast, CRP was a highly sensitive indicator of inflammatory pelvic disease. Furthermore, the CRP determination was superior in assessing the efficacy of an antibiotic treatment.

Anti-Bacterial Agents↗
PubMed1996

Dural ectasia presenting as an adnexal mass.

BACKGROUND: Dural ectasia associated with the sacrum is uncommon, even more so in presenting as an adnexal mass. CASE: A 49-year-old, postmenopausal women presented with the ultrasonographic finding of a complex left adnexal mass. Diagnostic laparoscopy revealed a 2-cm left ovarian cystic lesion and a 6-cm retroperitoneal mass. Subsequent laparotomy revealed bilateral, retroperitoneal, cystic masses attached to the anterior sacrum. Postoperative pelvic magnetic resonance imaging revealed multilevel dural ectasia involving the ventral foramina of the sacrum, with extension into the pelvis most prominent on the left at the S1-S2 level. CONCLUSION: Dural ectasia, as well as other growths of neurologic origin, should be considered in the differential diagnosis of the pelvic mass.

Diagnosis, Differential↗
PubMed2005

Prevalence and histologic diagnosis of adnexal cysts in postmenopausal women: an autopsy study.

OBJECTIVE: The purpose of this autopsy study was to examine the prevalence and histologic condition of adnexal cysts in postmenopausal women. STUDY DESIGN: Adnexa of 234 postmenopausal women who had died from nongynecologic diseases were examined by the team pathologist. RESULTS: Ovarian cysts were found in 36 of the women (15.4%). Nine women (3.8%) had ovarian cysts with a diameter between 20 and < or =50 mm; 4 women (1.7%) had cysts that were >50 mm in diameter. Four women had bilateral ovarian cysts. Paraovarian cysts were found in 11 women (4.7%). All cysts were benign, except for 1 woman, who had bilateral serous cystadenoma of borderline type. Macroscopically, the borderline cysts were multilocular with mean diameters of 60 mm and 15 mm, respectively. CONCLUSION: Because of the high prevalence of benign adnexal cysts, the identification of small unilocular cysts in postmenopausal women should be regarded as a normal finding.

Aged↗
PubMed2004

Treatment results of endometrial carcinoma with positive peritoneal washing, adnexal involvement and serosal involvement.

AIMS: To review the treatment results of patients with endometrial carcinoma having positive peritoneal washing (PPW), adnexal involvement, uterine serosal involvement, or all three. MATERIALS AND METHODS: The treatment records of patients who had undergone primary surgery for endometrial cancer without distant metastasis during 1990--2001 at the Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, were reviewed. Thirty-five patients were found to have involvement of positive PPW, adnexal involvement, uterine serosal involvement, or all three. Seven (20%) of them had gross or microscopic lymph-node metastasis. Thirty-three (94.3%) patients received adjuvant radiotherapy (28 whole-pelvic irradiation [WPI]; five abdominal radiotherapy [WART]). Two patients with solitary ovarian metastasis received chemotherapy, and one with isolated PPW also received adjuvant hormonal therapy. The median follow-up was 50.4 months (range 2.4-151.2 months). Multivariate analysis was carried out using the Cox regression proportional hazards model. RESULTS: Among the 28 patients with clinical or pathological node-negative disease (International Federation of Gynecology and Obstetrics [FIGO] stage IIIA), only two patients with solitary ovarian metastases developed recurrence. The 5-year actuarial disease-free survival (DFS) rates for the whole group and patients without lymph-node involvement were 77.9% and 91.7%, respectively. Five out of the seven patients with lymph-node involvement developed recurrences. Univariate analysis showed that lymph-node involvement (P < 0.0001) and high-grade disease (P = 0.011) were the significant poor prognostic factors. Multivariate analysis showed that lymph-node involvement was the only significant poor prognostic factor to predict poor 5-year DFS (P = 0.0001). Only one patient (3.7%) who had received WART developed grade 4 toxicity. CONCLUSIONS: This study showed that good treatment results could be obtained from patients with stage IIIA endometrial carcinoma without clinical or pathological lymph-node involvement after adjuvant radiotherapy, with acceptable late side-effects. The relative prognostic importance of individual IIIA involvement and the optimal adjuvant treatment remain to be determined.

Adult↗
PubMed2006

Chlamydia psittaci in ocular adnexal lymphoma: Japanese experience.

We searched for the Chlamydia psittaci DNA the touchdown enzyme time release PCR (TETR-PCR) in 23 specimens from 21 patients with ocular adnexal lymphoproliferative disorders, including 12 patients with MALT lymphoma to identify C. psittaci infection. Southern hybridization of the PCR product using the C. psittaci-specific probe failed to detect C. psittaci, although three samples appeared to be positive by ethidium bromide staining. This indicates that technical approach for detecting C. psittaci infection in ocular adnexal lymphoma might be an essential in disclosing this association.

Adult↗
PubMed2004

Selective incorporation of total laparoscopic hysterectomy for adnexal pathology and body mass index.

OBJECTIVES: We studied patients undergoing adnexectomy with total laparoscopic hysterectomy (TLH) for ovarian pathology, over a 6-year period. METHODS: Chart abstraction, analyzed by ANOVA, Fisher's Exact Test with significance at P < 0.05, stratifying by body mass index (BMI, kg/m(2): ideal < 25; overweight 25-29.9; obese 30+). RESULTS: Of 354 patients undergoing TLH, 90 cases had adnexal pathology: 69 complex masses, 16 BRCA1/2 mutations, 5 unstaged ovarian carcinomas; 48 having ideal BMI, 26 overweight, and 16 obese. Mean age (51 years) and parity (1.2 children) were similar between BMI groups. Thirty-four percent were nulliparous. All 90 underwent TLH, adnexectomy, washings; with 14 appendectomies, 5 lymphadenectomies, 3 node samplings, 6 omentectomies, 8 ureterolyses, and 1 Burch. Mean surgery duration (156 min), blood loss (152cc), and hospital stay (1.9 days) were similar across BMI groups. Mean nodal yield from each lymphadenectomy was 14, and 2.6 from sampling. Mean size of pelvic masses was 8 cm (range 3-19 cm). There were seven cases of ovarian carcinoma: 2 Stage IA, 1 IB, 2 IC, 1 IIC, 1 IIIB; 1 recurrent breast cancer, 16 adenofibromas, 15 endometriomas, 10 dermoids, and 41 serous/mucinous cystadenomas. Mean complication rate was 6.6% (ns): 1 seroma, 1 hematoma, 1 obstructive adhesions, and 3 urological injuries. All urological injuries were within the first third of patients. CONCLUSIONS: TLH appears feasible for women with adnexal pathology regardless of BMI, in an oncological practice. This pilot data can facilitate guidelines for a randomized controlled trial of TLH with TAH and LAVH, and help surgeons avoid our early complications.

Adnexa Uteri↗
PubMed2004

Malignant female adnexal tumor of probable wolffian origin relapsing after pregnancy.

BACKGROUND: Female adnexal tumors of probable wolffian origin (FATWO) represent a rare gynecologic tumor and display in the majority of cases a benign behavior. CASE: A 27-year-old woman underwent a laparotomy for a left adnexal mass. Pathologic examination showed a FATWO. Three years later, 1 month after a vaginal delivery, a recurrence of the disease was observed. Immunohistochemistry revealed the presence of progesterone receptors that may explain recurrence after pregnancy. CONCLUSION: In light of this case, hormone dependency of FATWO may be suggested.

Adnexa Uteri↗
PubMed2005

Adnexal fascioliasis masquerading as ovarian cancer.

BACKGROUND: Preoperative diagnosis of ovarian cancer is still problematic as multiple disease processes may present with pelvic mass. Fascioliasis is a parasitic disease producing unique clinical manifestations. CASE REPORT: A 49-year-old female patient admitted to our hospital with the complaint of occasional abdominal pain. Pelvic examination revealed a right adnexal mass. Serum CA-125 level was elevated. Explorative laparotomy was performed with the initial diagnosis of ovarian tumor. Final diagnosis was adnexal fascioliasis. CONCLUSION: In the setting of a newly diagnosed pelvic mass, care should be taken when interpreting an elevated CA-125 level. While ovarian cancer is high on the list of differential diagnoses, atypical clinical presentation of fasciola may give rise to a misdiagnosis of malignancy.

Animals↗
PubMed1976

Response of adnexal glands to testosterone stimulation in the normal adult male.

Normal male volunteers were studied in order to set up a functional exploration test based on administration of testosterone propionate for use on the adnexal glands of the male genital tract. Seminal acid phosphatase and citric acid levels showed no significant variations compared with spontaneous physiologic oscillations. Concentration and total quantity of fructose were considerably reduced. Alkaline phosphatase showed an intermediate pattern with constant values of concentration and decrease of total quantity. The hypothesis is advanced that adnexal glands possess a secretory metabolism with a maximal basal response to androgen stimulation, but with a different mechanism of action: partly adaptable at the level of the prostate and of the "all or nothing" type at the level of the vesicles.

Acid Phosphatase↗