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We describe a female adnexal tumor of probable wolffian origin with stage 2B disease. The presence of peritoneal implants suggests a more aggressive clinical course than is usually expected. We present the findings of light microscopic and ultrastructural evaluation as well as those of immunohistochemical and DNA ploidy analysis, which, to our knowledge, have not been previously described for this type of tumor.
An adnexal tumour of probable Wolffian origin occurring in a 36 year old woman is reported. The lesion was asymptomatic and incidentally discovered during laparotomy. No recurrences have been demonstrated to date. Its origin from Wolffian remnants is briefly.
From histogenetic, morphologic and immunohistochemical point of view the authors try to make possible algorithms that can be employed in a routine diagnosis of adnexal skin tumours. They stress the importance of knowledge of clinical data necessary for orientation classification of tumour skin lesions after biopsies. The authors translated their obtained data into survey tables to be used as guidelines in a routine bioptic practice.
The term female adnexal tumor of probable Wolffian origin "FATWO" designs this tumor wich arises by the rare persisting remnants of the mesonephric duct (Wolffian duct). About 40 cases have been reported in literature. Few cases of recurrence have been reported, FATWO usually shows no signs of hormonal activity. We report a case of the youngest patient affected by FATWO in October 2002. At laparotomy the left adnexa were deformed by a well-capsulated mass, totally removed and sent to the pathologist with a specimen of peritoneal fluid and of the omentum. The histological examination showed a prevalent tubular structure with focal retiform area, without intraluminal mucines. Immunohistochemical findings of the case reported are similar to those described by other authors, except for inhibin which has not been detected by us. The cytofluorimetry showed the low presence of aneuploid cells, with a very low prolifing component (< 1%).
Adnexal skin tumors are rare neoplasms that develop from hair follicles, sebaceous glands and sweat glands. In the majority of cases these tumors are benign, although metastases have been reported in rare occasion. The diagnosis in always histologic and often it is sufficient to report the lesion simply as benign or malignant. Radical surgery is the treatment of choice. When the tumor is large, the Mohs technique can be used. Local recurrence is frequent in case of incomplete surgical removal. Etastatic disease, although rare, has a poor prognosis. Chemotherapy and radiotherapy experience is very limited. Overall, combination chemotherapy seems to be superior to single agent treatment.
Seventy patients with palpable adnexal masses were subjected to ultrasonographic examination. Three patients with negative ultrasound and no disease were excluded from the final analysis. Correct diagnosis was obtained in 58.2% patients; contributory information in 16.4%. Ultrasonography is valuable in diagnosing functional and benign ovarian neoplasms. It is also useful in suspecting malignant ovarian neoplasms and confirming diagnosis of ectopic pregnancy, if correlated with the clinical findings.
A series of 101 patients with adnexal torsion during a 12 year period are reviewed. Twenty patients were pregnant at the time of diagnosis and underwent surgical treatment. Preoperatively, the correct diagnosis was not established in four pregnant patients and in 30 nonpregnant patients. An operation was usually delayed for more than 24 hours. Unwinding of the twisted adnexa, regardless of its appearance, was the main surgical procedure in both groups. The outcome of the pregnancies was favorable. The main histopathologic findings in both groups were cysts of the follicular or corpora lutea.
Arriving at a system for staging adnexal disease is a scientific, clinical and political process which has already begun. Gynecologic oncologists started this process in 1967, and are still arriving at refinements and adjustments in the staging of cancer after 22 years. To rigorously evaluate new medical and surgical technologies in the treatment of adhesions it is important for infertility surgeons to continue the process of working towards a classification system, keeping in mind that it will take a long time.
Two hundred twenty-eight adnexal masses during pregnancy were discovered among 37,159 deliveries occurring between January 1, 1983 and October 31, 1988 at Kapiolani Medical Center for Women and Children in Honolulu. Hydatid cysts of morgagni (45.6%) occurred most frequently, followed by benign cystic teratomas (15.8%), epithelial cystadenomas (15.4%), and paraovarian cysts (13.6%). There were no malignant or borderline tumors. The patients were categorized as 22.1% part Hawaiian, 18.5% white, 17% Filipino, and 16% Japanese. We demonstrated an increased incidence of benign cystic teratomas in Filipinas (P less than .01). There was no significant predisposition for the occurrence of non-neoplastic or other neoplastic lesions among any of the other ethnic groups studied.
Laparoscopic management was used for 35 cases of adnexal torsion. Since early diagnosis and treatment are necessary to preserve the adnexa, laparoscopy is the best procedure for diagnosing this rare condition. In 27 cases (77%) conservative treatment was carried out, with only 1 recurrence. Complete laparoscopic treatment was achieved in 27 cases (77%), including 3 of endoscopic salpingectomy. Laparotomy was indicated in cases of gangrenous adnexa, organic ovarian cyst and unusual ovarian attachment.
Adnexal torsion due to an ovarian cyst was treated laparoscopically by fenestration of the cyst and shortening of the ovarian ligament. Serial ultrasound examinations three months later demonstrated recovery of follicular growth.
Ten cases of adnexal torsion were analyzed to review the spectrum of clinical and pathologic problems that may be encountered. Included were two cases representing the earliest changes to be seen and a case of ovarian fibrosis thought to be secondary to intermittent or incomplete torsion with prolonged stromal edema.
Adnexal masses in postmenopausal women were reviewed according to size, pathology, age of the patient, and accuracy of ultrasound versus pelvic examination. Only one of 32 masses less than 5 cm in diameter was malignant. Of 55 masses 5-10 cm in size, six were malignant, including one lymphoma and two borderline tumors. Forty of 63 tumors larger than 10 cm were malignant. The proportion of malignancies increased with age. Pelvic examination missed 10% of tumors less than 10 cm in diameter. Of those palpated, the examination predicted the size of the mass to within 2 cm in 68% of cases. Ultrasonic prediction of size was accurate in 87% of cases scanned. Our findings cast doubt on the concept that all postmenopausal women with minimally enlarged ovaries should undergo laparotomy.
13 uterine adnexal torsions were diagnosed by means of laparoscopy between June 1978 and October 1982. Laparoscopy is an opportunity for the adnexae to be untwisted, and gives precision to estimate the severity of the damage of the adnexae and to elucidate the aetiology. In ten patients, the treatment was performed by means of laparoscopy Three patients underwent immediate laparotomy: two for necrosis of the adnexae, one for a mucinous cystadenoma. The post-operative course was always uneventful. A second look laparoscopy was performed to check the anatomical recovery of primary severe ischaemic lesions (4 cases). The usefulness of laparoscopy in diagnosing torsion of the uterine adnexae is now well established. We can also treat by means of laparoscopy. Contra-indications to this management are necrosis of the adnexae and organic tumours.
A postmenopausal patient was referred to us because of an adnexal mass that turned out to be calcific pelvic lymph-adenopathy thought to be caused by healed pelvic tuberculosis. This entity has not been described before.
Patients wearing the intrauterine contraceptive device (IUD) and presenting with an unilateral adnexal mass may have a pelvic abscess in the absence of the typical dramatic stigmata that usually accompany an acute pelvic infection. Three such patients are presented, each receiving a different surgical management. An elevated erythrocyte sedimentation rate helps make the diagnosis in these relatively asymptomatic patients. IUD removal and prompt hospitalization for intravenous antibiotics are the appropriate management.
Uterine adnexal torsion and infarction is described in a 12-year-old girl who, six weeks later, suffered a contralateral recurrence, rendering her sterile. This is on the second known and reported case of this unusual sequence of events. The question of performing a prophylactic oophoropexy is addressed. A high index of suspicion and early diagnosis are mandatory in this condition to preserve reproductive function.
A case of a pelvic kidney diagnosed as an adnexal mass, resulting in surgery, is reported. The employment of ultrasonography in the evaluation of suspected pelvic masses is well established. A number of pathologic conditions can be responsible for a pelvic mass in female patients and consideration of the differential diagnosis of such masses has been well documented. The discrimination of a pathologic pelvic mass from an anatomic variation or unusual location of a normal structure can be, however, a potential source of confusion and erroneous interpretation. This report concerns the unfortunate result of not considering a renal anomaly, i.e. ectopic pelvic kidney, in the differential consideration of a "pelvic mass".