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Variations in management of adnexal tumours.

Three interesting cases in which unconventional treatment has been very successful are presented. The first was a fibrous histiocytoma of the conjunctiva which recurred twice after apparently complete surgical excision, but which responded to immunotherapy using dinitrochlorobenzene. The second was a squamous cell carcinoma of the lower eyelid treated by total surgical excision of the lid; the wound was allowed to heal by granulation with an excellent cosmetic result. The third was a squamous cell carcinoma of the limbus treated by lamellar excision with the Crock Contact-lens Corneal Cutter; the wound was allowed to granulate, and in so doing, caused negligible astigmatism.

Aged↗

Adnexal surgery in dogs and cats.

Abnormalities in eyelid position and function can lead to chronic irritation of cornea and conjunctiva. Corneal ulceration, vascularization and pigmentation are common consequences. Loss of vision, or loss of the globe may be the end result. The combination of ptosis and entropion of the upper eyelid is commonly seen in breeds with abundant forehead skin folds. Treatment options include surgical reduction of skin folds, suspending the brows, enforced secondary granulation of the upper eyelid, or a combination of procedures. Lid-shortening procedures reduce corneal exposure, improve functional blinking and reduce likelihood of traumatic proptosis. Although a lateral canthoplasty is technically easier to perform, a medial canthoplasty is the preferred method of eyelid shortening. An involuted lateral canthus with entropion is seen in certain dog breeds with a broad skull base and redundant facial skin. Surgical correction is by either applying traction to the lateral canthus, or by resection of the lateral canthal ligament. A combination of entropion, ectropion and macroblepharon may result in the presence of diamond shaped eyelids. Surgical correction involves the combination of several procedures. Upper eyelid agenesis is a congenital absence of part of the upper eyelid in cats. Treatment options include a skin-orbicularis flap from the lower eyelid with a conjunctival pedical graft, the transposition of the lower eyelid to the upper eyelid, cross lid flap and subdermal plexus flap, and subdermal collagen injection. Several techniques for reconstruction of upper and lower eyelid defects are described.

Animals↗

Ovulatory disorders and inflammatory adnexal damage: a neglected cause of the failure of fertility microsurgery.

Failure of reconstructive tubal surgery is usually attributed to pre-existing endosalpingeal damage, recurrent adhesion formation or progressive inflammatory disease. We studied ovarian follicle development and ovulation by ultrasound in 25 infertile patients with laparoscopically proven sequelae of pelvic inflammatory disease. Failure of the follicle to rupture was seen in 13, although luteinization occurred. The mean mid-luteal progesterone concentration in cycles with an unruptured follicle was significantly lower than the concentrations both in ovulatory cycles in the same patients and in a comparison group of 45 normally ovulating women (P less than 0.01). Microsurgical adhesiolysis did not seem to influence the occurrence of the ovulation disorder.

Adult↗

Massive ovarian oedema: a nonneoplastic adnexal mass mistaken for a neoplasm.

Massive ovarian oedema (MOO) is an unusual clinical entity occurring in teenage girls and young women, and is thought to result from periodic and intermittent torsion of the ovarian pedicle. It is usually mistaken for an ovarian neoplasm and treated by oophorectomy. A case that underwent more radical surgery than is necessary is presented.

Adolescent↗

Not all ovarian cysts in young woman are benign: a case series and review of the management of complex adnexal masses in young women.

While ovarian cancer is a disease that predominately affects postmenopausal women, up to 13% of affected patients are indeed less than 45 years of age. The diagnosis is often delayed because of the non-specific nature of symptoms and a lack of specific and accurate diagnostic tests, that is, CA125 and ultrasound. In premenopausal women these issues are compounded, further reducing the likelihood of an accurate and early diagnosis. It is important for gynaecologists to have a high index of suspicion and appropriately investigate symptomatic patients and interpret test results critically. Not all ovarian cysts in young women are benign, and a low threshold for surgical evaluation is warranted.

Adenocarcinoma, Clear Cell↗

Microcystic adnexal carcinoma.

A 71-year-old woman presented with a firm flesh-colored plaque with overlying whitish discoloration that had been present on her left cheek for at least 15 years (Figure 1). The lesion measured 1.6 x 1.1 cm in diameter. The patient had a history of radiation treatment for acne. What is your diagnosis? What should be the course of management?

Aged↗

Adnexal participation in formation of cutaneous tumors following topical application of 9,10-dimethyl-benzanthracene.

The response of the hair follicle apparatus to topical 9, 10-dimethyl-benzanthracene applications was studied in several strains of mice and rats. Early follicular destruction in mice was associated with subsequent formation of large number of epithelial tumors. Preserved follicular structures in rats proliferated with the formation of low incidence of adenomas and trichoepitheliomas. Hair nevi, hairfollicle nevi and trichofolliculomas, unrelated to treatment, were observed in several animal strains.

9,10-Dimethyl-1,2-benzanthracene↗

Adnexal metaplasia in carcinoma in situ of the skin.

Two cases of epidermoid carcinoma in situ of the skin, one with mucinous metaplasia and the other with sebaceous metaplasia, are reported. These unique cases suggest a spectrum of differentiation possible by neoplastic epidermal keratinocytes, which may help in the understanding of the histogenesis of certain skin neoplasms.

Aged↗

Adnexal displacement and regression in association with histiocytoma (dermatofibroma).

The literature about the changes occurring in histiocytomas mentions only the possibility of induction of primitive pilosebaceous structures and basal cell epithelioma-like lesions by the histiofibrocytic growth. We suggest here that the histopathologic findings are indicative of regressive changes of the pre-existing cutaneous adnexa resulting in the formation of basal cell epithelioma-like structures.

Adolescent↗