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PubMed2006

Hyperreactio luteinalis presenting with marked hyperglycemia and bilateral multicystic adnexal masses at 21 weeks gestation.

We present an unusual case in which a 23-year-old nulliparous patient was noted to have bilateral multicystic adnexal masses at 21 weeks gestation. Subsequent severe nausea, vomiting, and hyperglycemia with a serum glucose level of 450 mg/dL led to the diagnosis of gestational diabetes. Gradual development of marked maternal virilization ensued and was associated with a serum testosterone level of 4030 ng/mL (free testosterone level of 224 pg/mL), with normal serum dehydroepiandrostendione, estriol, and cortisol levels, leading to the diagnosis of hyperreactio luteinalis. Following vaginal delivery at 38 weeks gestation, gradual and complete spontaneous resolution of signs, symptoms, adnexal masses, diabetes, and testosterone levels were documented.

Adult↗

PubMed1986

[Bacteriologic findings and therapeutic consequences in adnexitis].

After laparoscopic confirmation of adnexitis, a bacteriological examination was made of specimens taken from the small pelvis of 63 patients, with an average age of 26.4 years, at the Rheinischen Landesfrauenklinik (Gynecological Hospital) in Wuppertal. To this end, various aerobic and anaerobic optimal and selective culture media were used. The cultured germs were identified with API systems, other conventional methods, and by using gas chromatography. All bacilli were tested for their sensitivity to mezlocillin and metronidazole. In 40 cases (63.5%), it was possible to determine 1-10 bacilli from the inner genital tract. In most cases there was an aerobic/anaerobic mixed infection, with participation of streptococci, staphylococci, enteric bacteria, as well as peptococci, peptostreptococci and bacteroid types. Neisseria gonorrhoeae was only identified three times. In 23 cases (36.5%), it was not possible to determine bacilli in spite of definite inflammatory symptoms. Since, according to international literature, Chlamydia trachomatis was to be found on the inflamed tubes of roughly one third of cases of adnexitis, the presence of this bacillus is suspected even in the many bacteriologically negative cases in the author's own study. Only in one case of a monoinfection by Staphylococcus aureus did the combination of mezlocillin and metronidazole prove to be unsuitable. In 25% of the cases where the presence of bacilli was proved, metronidazole was even necessary, since bacilli of the Bacteroides fragilis and Bacteroides bivius and disiens groups were involved, all of which are capable of inactivating penicillins and cephalosporins by formation of a beta-lactamase.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2001

Microcystic adnexal carcinoma: First reported case in an African American man.

Microcystic adnexal carcinoma (MAC) is a relatively uncommon adnexal neoplasm that can display aggressive local invasion. MAC occurs most commonly on the central part of the face and can be clinically asymptomatic with a benign appearance. We describe the first reported case of MAC in an African American man who was treated by Mohs micrographic surgery.

Black or African American↗

PubMed2002

Results of radiotherapy for orbital and adnexal lymphoma.

Twenty-five patients presenting with stage I primary orbital and/or ocular adnexal lymphoma from May 1990 through January 1997 were retrospectively reviewed at National Taiwan University Hospital. Staging workups included physical examination, chest radiography, blood analysis, whole-body CT scan, CSF examination and bone marrow biopsy. The histological types, based on the National Cancer Institute working formulation, were 17 cases of low-grade and 8 of intermediate lymphoma. Twenty patients received radiotherapy, while five cases refused. All patients except two received a radiation dose of 40 Gy, the other two received 30 Gy. The mean follow-up period was 4.7 +/- 1.6 years (2-8 years). Local control of disease was achieved in all 20 patients, but one patient with low-grade lymphoma developed disseminated disease with parotid gland, bone marrow and lung involvement 43 months after radiotherapy. Two out of five patients who refused treatment with radiotherapy developed systemic involvement 24 months and 18 months after diagnosis. Dry eye (45%) and cataract formation (35%) were among the most frequent complications in this study. One patient developed a recalcitrant trophic corneal ulcer and ultimately required corneal transplantation. In conclusion, radiotherapy is a safe and effective local treatment in the management of primary orbital or adnexal lymphoma.

Adult↗

PubMed2001

Robotically assisted laparoscopic hysterectomy and adnexal surgery.

BACKGROUND: In this pilot study, we tested the feasibility and safety of using a robotic device to perform complex gynecologic surgery. METHODS: Ten female pigs underwent adnexal surgery (n = 5) or hysterectomy (n = 5) using the "Zeus" robotic device. The surgeon operates while sitting at the console away from the surgical table on which the robotic arms are fixed. Both procedures were performed solely with the robotic arms. After 1 week of observation the animals were sacrificed and the surgical site was explored. RESULTS: The procedure was completed successfully in all cases. No animal required conversion to laparotomy or nonrobotic laparoscopic assistance. The mean operative time (+/- SD) was 170 +/- 44 min for adnexal surgery and 200 +/- 57 min for hysterectomy. No complications occurred. No ureteral injuries were found on necropsy. CONCLUSION: Although designed for laparoscopic microsuturing, this robotic technology has the potential to be used for more complex gynecologic procedures.

Adnexa Uteri↗

PubMed1995

Comparative study of laparoscopy vs. laparotomy for adnexal surgery: efficacy, safety, and cyst rupture.

Operative laparoscopy is becoming routine in gynecologic surgery. This study was designed to compare the safety and efficacy of laparoscopy and laparotomy for ovarian cystectomy and adnexectomy. The medical records of 32 patients who underwent operative laparoscopy for adnexal masses (group L) were reviewed and compared with those of 32 patients who underwent surgical laparotomy (group S) for similar indications. All patients sustained either an ovarian cystectomy or adnexectomy. The group were matched for age, weight, and history of previous laparotomy. Median operating time for group L was 90 min and for group S was 85 min. Blood loss was significantly less in group L (33.4 +/- 22 mL) than in group S (84.6 +/- 22.2 mL), p < 0.0001. There were two intraoperative complications in group L and one in group S. Significantly less patients in group L had postoperative fevers (16%) as compared with those in group S (69%), p < 0.0001. There was a higher incidence of cyst rupture when cystectomy was performed in patients from group L (7 of 21) as compared with patients from group S (2 of 17). No such difference in cyst rupture was noted when an adnexectomy was affected in group L (1 of 11) and group S (1 of 15). Patients in group L remained in the hospital a shorter time period, 1.5 +/- 0.8 days, than patients in group S, 4.7 +/- 0.9 days, p < 0.0001. Patients in group L required a shorter postoperative recovery time before resuming normal activities, 9.1 +/- 6.6 days, than patients in group L, 27.5 +/- 9.2 days, p < 0.0001. Similarly, patients in group L required less time to become pain free, 10.1 +/- 7.4 days, than patients in group L, 17.7 +/- 6.1 days, p < 0.0005. This study demonstrates a statistically significant decrease in postoperative morbidity and faster recovery in patients undergoing laparoscopy for adnexal surgery as compared with patients undergoing laparotomy for the same procedure. When cystectomy is performed via the laparoscope, there is a higher incidence of cyst rupture than with laparotomy.

Adnexa Uteri↗

PubMed2005

Long-term follow-up results of no initial therapy for ocular adnexal MALT lymphoma.

BACKGROUND: The majority of lymphomas in the ocular adnexa are low-grade B-cell lymphomas of mucosa-associated lymphoid tissue (MALT lymphoma). Although radiotherapy is the most frequently applied management, cataract and dry eye are problematic complications. PATIENTS AND METHODS: Between 1973 and 2003, the clinical features of 36 patients with ocular adnexal MALT lymphoma with no symptoms who were managed with no initial therapy after biopsy or surgical resection were retrospectively analyzed. RESULTS: The median patient age was 63 years (range 22-84) and all patients had stage I disease, consisting of 31 unilateral cases and five bilateral cases. With a median follow-up of 7.1 years, 25 (69%) did not require treatment. The median time until the initiation of treatment in the remaining 11 patients (31%) was 4.8 years. Six patients (17%) died, and among them only two (6%) died due to progressive lymphoma. Seventeen patients (47%) progressed, but histologic transformation was recognized in only one (3%). The estimated overall survival rates of the 36 patients after 5, 10 and 15 years were 94%, 94% and 71%, respectively. CONCLUSIONS: In selected patients with ocular adnexal MALT lymphoma, no initial therapy might be an acceptable approach, because 70% of patients remained untreated at a median of 8.6 years, and their survival was comparable to that of reports on immediate therapy.

Adult↗

PubMed1990

Cutaneous adnexal carcinomas with divergent differentiation.

Adnexal carcinomas of the skin are rare lesions that encompass multiple histologic patterns. The authors have identified seven neoplasms in this category that showed combined morphologic features of at least two appendegeal tissues. Two manifested pilar and sebaceous differentiation, three showed pilar, sebaceous, and sudoriferous features, and two had sweat glandular and sebaceous characteristics. All tumors arose in the skin of the head and neck; four patients were men and three were women (age range, 21-84 years). One lesion had been present for 25 years with progressive enlargement over the last 3, and another two had slowly expanded over 1-2 years; the duration of growth for the remaining cases was uncertain. Follow-up revealed that six patients were free of disease for at least 1 year after complete excision. In the seventh case, complete excision was performed, but follow-up was not available. Immunohistochemical analysis showed reactivity for keratin and epithelial membrane antigen in each case. Carcinoembryonic antigen was seen in four tumors, and amylase was present in three; none expressed vimentin, S100 protein, or gross cystic disease fluid protein-15. It is concluded that mixed cutaneous adnexal carcinomas are recognizable entities that appear to have little potential for aggressive growth. Immunohistochemical studies may serve as adjuncts to conventional microscopy in the definition of cellular lineages pursued by such neoplasms.

Adult↗

PubMed1998

Cutaneous lymphadenoma: an adnexal neoplasm with intralobular activated lymphoid cells.

Cutaneous lymphadenoma is an uncommon epithelial neoplasm with a controverted adnexal differentiation. We report a typical case of cutaneous lymphadenoma that developed on the left cheek of a 18-year-old woman. Histologically, the neoplasm consisted of lobules of basaloid cells with a peripheral palisading array and filled with a lymphocyte-predmoninant mixed cellular population. Numerous intralobular cells with ample amphopilic cytoplasm, large vesicular nuclei, and prominent nucleoli also were noticed. Immunohistochemical study showed labeling of these Reed-Sternberg-like large cells by antibodies against CD30 antigen. Our findings suggest that cutaneous lymphadenoma is a poorly differentiated adnexal neoplasm, probably trichoblastoma-related, where a singular interaction with several immune cells is established, including activated large lymphocytes analogous to those malignantly proliferating in Hodgkin's disease.

Adolescent↗

PubMed1987

Microcystic adnexal carcinoma: an unpredictable aggressive neoplasm.

Microcystic adnexal carcinoma is a rare, locally aggressive cutaneous neoplasm that has been recently recognized as a distinct entity. Typically it appears as a papular, flesh-colored mass on the face of women patients. Because of its benign appearance, it is often present for months or years before diagnosis. Histologically, there is a paucity of mitotic figures and other criteria usually associated with aggressive lesions. In this article we discuss 3 cases of microcystic adnexal carcinoma, each presenting as a small, localized lesion but all requiring extensive surgical extirpation with margin control using the Mohs tissue resection technique.

Aged↗

PubMed2005

Microcystic adnexal carcinoma: an often misdiagnosed, locally aggressive growing skin tumor.

Microcystic adnexal carcinoma (MAC) belongs to the spectrum of locally aggressive adnexal carcinomas and most commonly occurs in the head and neck region. Recently it has been proposed that MAC is an apocrine tumor. It is characterized by slow, but locally aggressive growth with infiltration of subcutaneous fat tissue, muscles, perichondrium, periosteum, or perineurium. As a result, surgical treatment often leads to ablation defects, which are many times the size of the clinical lesion. In 1982, Goldstein and colleagues first reported MAC to be a distinct histologic entity characterized by a combination of keratinous cysts in the upper dermis, islands and strands of small basaloid, benign-appearing keratinocytes or squamous cells in the deeper dermis within a dense desmoplastic stroma, and areas of ductular differentiation. The authors report the case of a 78-year-old woman in whom a diagnosis of MAC was made when a tumor on the right cheek recurred for the second time. Previous histopathologic diagnoses were squamous cell carcinoma and desmoplastic trichoepithelioma. Local recurrences of the tumor occurred, despite histographic surgery because in hematoxylin and eosin stains, small islands of the deceptively benign-appearing small basaloid cells of MAC were not recognized as tumor cells. The reported case demonstrates the difficulties in diagnosing MAC and indicates that MAC should always be considered in the differential diagnosis of slowly growing tumors in the head and neck region. If MAC is diagnosed too late, it can be inoperable because of its infiltrative growth.

Aged↗

PubMed2001

The cystic adnexal mass: patient selection, surgical techniques and long-term follow-up.

The continuous change in the treatment and management of ovarian tumours is an excellent example of the changes that have occurred in gynaecological laparoscopic surgery. This paper evaluates the management of the adnexal mass in 2001. Second, it reviews ovarian tumours treated at the Department of Obstetrics and Gynaecology, University of Kiel, between January 1997 and December 1998, and the place of laparoscopy in the management of these lesions. Third, the review attempts to give an insight into the long-term follow-up of patients treated laparoscopically for the removal of ovarian cysts. Finally, a retrospective survey is given of the clinical pathology and prognostic features of adnexal masses operated on during pregnancy. With regard to long-term follow-up, no difference was found between laparoscopic or laparotomic treatment of ovarian tumours.

Adolescent↗

PubMed1993

Adnexal findings in AIDS.

We reviewed the adnexal and orbital findings in a large population with HIV infection followed in one medical center. Around 6% of the series had positive periocular findings. In 1% of the series, the periocular findings were the first manifestation of HIV infection or AIDS. We present the first case of basal cell carcinoma in an HIV-infected individual; the carcinoma involved the eyelid. Orbital findings included lymphoma, cellulitis, Kaposi's sarcoma, and nonspecific inflammatory disease. Adnexal findings included Kaposi's sarcoma, molluscum contagiosum, bacterial folliculitis, madarosis, psoriasis, basal cell carcinoma, and chalazion. Additional opportunistic infections and tumors involving the periocular region are expected to be reported in the future.

AIDS-Related Opportunistic Infections↗

PubMed1994

Microcystic adnexal carcinoma (sclerosing sweat duct carcinoma).

Microcystic adnexal carcinoma is a relatively uncommon tumor first described in 1982. Most commonly presenting as a facial plaque or nodule, this highly invasive tumor is characterized by slow growth and relentless local destruction. We report the presence of microcystic adnexal carcinoma in the neck, a previously unreported site. The patient was a 48-year-old man who had received radiation therapy at age 5 to shrink the thymus gland and subsequent radiation therapy after excision of a thyroid tumor at age 35. The results of immunohistochemical stains were consistent with the hypothesis that this tumor develops from pluripotential cells capable of follicular and eccrine differentiation.

Adult↗

PubMed1995

Orbit and adnexal neoplasia.

This article reviews the major orbital and adnexal tumors and focuses on clinical diagnosis and management. It emphasizes recent reports and reviews. Orbital tumors can be divided into vascular, mesenchymal, neural, epidermal, lymphoid, and metastatic lesions. Although derived from similar elements, the tumors of the lacrimal gland and eyelid form a separate category. Within the realm of vascular tumors, this article reviews recent literature regarding the treatment of capillary hemangiomas. It summarizes important information concerning the treatment of rhabdomyosarcomas published during the preceding year. The article also reviews case reports and studies of orbital tumors derived from neural, epithelial, and lymphoid elements. It provides general information regarding orbital metastatic disease and presents several recent case reports on lacrimal and adnexal tumors.

Eyelid Neoplasms↗

PubMed2006

Microcystic adnexal carcinoma with mandibular bone marrow involvement: a case report with immunohistochemistry.

Microcystic adnexal carcinoma is a rare, locally aggressive cutaneous neoplasm with a high probability of persistence locally but a low probability of metastasis. We report a case of a 69-year-old female patient with an indurated plaque at the mental region. Histologically, the tumor cells invaded the subcutaneous tissue and mandibular bone. The tumor consisted mainly of squamous and basaloid epithelial nests and cords embedded in a desmoplastic stroma. A few keratin-filled microcysts and ductal structures were also observed. Perineural encroachment was also noted but there was no mitosis, cytologic features of malignancy, or metastasis. The epithelial nests were positive to various cytokeratins except for CK20 and the lumina of the ductal structures were positive to carcinoembryonic antigen. Our results indicate that microcystic adnexal carcinoma consists of tumor cells capable of both follicular and eccrine differentiation. It is locally aggressive, extends far beyond its clinical presentation and may involve the bone. It may persist and remain asymptomatic for so many years without metastasis. A lifetime postsurgery monitoring is mandatory to ensure early and proper management.

Aged↗

PubMed2004

Microcystic adnexal carcinoma of the eyebrow.

PURPOSE: To describe a case of the largest reported microcystic adnexal carcinoma of the eyebrow in an 89-year-old woman and to review the literature regarding the periorbital occurrence of this tumor. METHODS: Case report and literature review. RESULTS: This case was treated with primary excision and radiotherapy, with no clinical signs of recurrence in the past 6 months. CONCLUSIONS: Microcystic adnexal carcinoma is a rare tumor; however, because of its aggressive local infiltration, ophthalmologists should consider this diagnosis and complete surgical excision. Long-term data are needed to establish outcomes from the different treatment options.

Aged↗

PubMed1992

Microcystic adnexal carcinoma: a case report with immunohistochemical and electron microscopical examinations.

Microcystic adnexal carcinoma (MAC) is an unusual cutaneous neoplasm comprised of pilar and sweat duct structures. We report here a 66-year-old Japanese woman with MAC on her left nasolabial fold with more prominent calcified keratinous cysts than ductal differentiated structures which stained positively for carcinoembryonic antigen (CEA). The clinical appearance and statistical characteristics of MAC are reported to be different from those of other adnexal tumors. Desmoplastic trichoepithelioma (DTE) is the most difficult tumor to differentiate from MAC, unless positive reactivity for CEA in differentiated ductal structures in MAC can be demonstrated. We compare the differences between the clinical, histological, immunohistochemical, and electron microscopical features of DTE and MAC. It seems probable that these differences could be explained by biological differences in the characteristics of the cells from which these tumors originate, hair follicle cells and eccrine sweat cells, respectively.

Aged↗