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PubMed2005

Expression of p63 in primary cutaneous adnexal neoplasms and adenocarcinoma metastatic to the skin.

p63, a recently identified homologue of the p53 gene, has been reported to be essential in the development of epithelia and is mainly expressed by basal and myoepithelial cells. The purpose of this study was to investigate the pattern of p63 expression in cutaneous adnexal neoplasms and to assess its possible value in the differential diagnosis of primary cutaneous neoplasms vs adenocarcinomas metastatic to the skin. Immunohistochemical analysis for p63 was performed on formalin-fixed, paraffin-embedded archival tissue from 20 benign adnexal tumors, 10 malignant adnexal tumors and 14 adenocarcinomas metastatic to the skin. The expression of p63 was evaluated in epidermal cells, skin appendages and metastatic tumor cells. p63 was consistently expressed in the basal and suprabasal cells of epidermis and cutaneous appendages, including the basal/myoepithelial cells of sweat glands. Out of 20 benign adnexal tumors, 13 (65%) showed strong (score 3) p63 expression; the remaining seven (35%) cases had score 2. All primary cutaneous carcinomas, including adenocarcinomas, expressed p63. In contrast, none of the metastatic adenocarcinomas to the skin was positive for p63 (P<0.001). Based on our findings, analysis of p63 expression may help in the differential diagnosis of primary vs metastatic cutaneous adenocarcinomas.

Adenocarcinoma↗
PubMed2003

Expression of differentiation and proliferation related proteins in epithelium of prophylactically removed ovaries from women with a hereditary female adnexal cancer predisposition.

AIMS: To investigate the occurrence of preinvasive neoplastic lesions in ovarian surface epithelium and ovarian inclusion cyst epithelium of women with a hereditary predisposition to the development of female adnexal (ovarian and fallopian tube) carcinoma and to assess the expression of differentiation and proliferation related proteins within putative sites of origin of serous ovarian carcinoma, the ovarian surface epithelium and ovarian inclusion cyst epithelium. METHODS: Twenty-one ovaries, prophylactically removed from 11 women predisposed to the development of female adnexal cancer (cases) were compared with 22 ovaries from 11 women without such predisposition (controls). Archival histological specimens were screened for hyperplastic and dysplastic epithelial lesions. In both the ovarian surface and inclusion cyst epithelia, the percentage of cells was determined that stained positively for Ki67, p21, p27, p53, cyclin A, cyclin D1, bcl-2 and the presence of HER-2/neu, oestrogen (ER-alpha) and progesterone receptors (PR). RESULTS: No preinvasive neoplastic lesions were detected. However, hyperplastic areas were found in three cases and in four controls (NS). ER-alpha (P = 0.013), PR (P < 0.001), bcl-2 (P = 0.008), p21 (P = 0.046) and p27 (P = 0.008) were expressed in a significantly higher percentage of cells in inclusion cyst epithelium than in ovarian surface epithelium (both groups). The latter showed higher bcl-2 expression in cases (P = 0.05) compared with controls. The inclusion cyst epithelium of cases showed higher expression of bcl-2 (P = 0.006) and PR (P = 0.039) compared with controls. Proliferation was low in both cases and controls as reflected by low Ki67 expression. Over-expression of p53, cyclin D1 and HER-2/neu was not detected. CONCLUSIONS: Premalignant changes are not a common feature of ovaries removed prophylactically from women predisposed to the development of female adnexal carcinoma. Increased expression of p21, p27, and ER-alpha is seen in inclusion cyst compared with ovarian surface epithelium of women with and without an inherited risk of adnexal carcinoma. This is most probably caused by the different intraovarian hormonal milieu of inclusion cyst epithelium. However, the increased expression of bcl-2 and PR in the inclusion cyst epithelium of patients with a hereditary predisposition may reflect early disruption of hormonal balance and growth control.

Adnexal Diseases↗
PubMed2003

Adnexal masses and pregnancy: a 12-year experience.

OBJECTIVE: Our purpose was to describe pregnancy-associated adnexal masses in eastern North Carolina. STUDY DESIGN: A retrospective study was performed of 60 adnexal masses resected during pregnancy at a regional referral hospital from January 1990 to March 2002. RESULTS: Adnexal masses occurred in 0.15% of pregnancies. Average gestational age at diagnosis and surgery was 12 and 20 weeks, respectively. Fifty percent of ovarian tumors were mature cystic teratomas, 20% were cystadenomas, and 13% were functional ovarian cysts. Malignancy occurred in 13%. Tumors with low malignant potential comprised 63% of malignancies. Average cyst size was 11.5 cm for malignancies and 7.6 cm for benign lesions (P value <.05). The preterm birth rate was 9%, the miscarriage rate was 4.7% after elective cases, and average Apgar scores were 7.5 and 8.7 at 1 and 5 minutes. CONCLUSION: The incidence of malignancy in pregnancy-associated adnexal masses was high. Ultrasonography detected internal excrescences in the majority of tumors with low malignant potential. Fetal outcomes were not affected.

Abortion, Spontaneous↗
PubMed2004

Laparoscopic removal of a large adnexal mass.

BACKGROUND: Laparoscopic removal of adnexal masses has been facilitated by the use of commercially available retrieval bags. Masses up to 18 cm can be removed using zipper storage bags. Masses with greater diameters have required laparotomy or techniques that do not isolate the mass from the peritoneal cavity. By using larger bags available in the operative suite, even the very large adnexal mass can be isolated from the peritoneal cavity and extracted via laparoscopy. CASE: A 46-year-old nulligravida presented with a 20.9-cm adnexal mass. She underwent laparoscopy and extraction of a dermoid with an improvised retrieval bag without intraperitoneal spillage. CONCLUSION: Very large adnexal masses can be removed laparoscopically without intraperitoneal spillage despite the lack of commercially available bags for this purpose.

Adnexal Diseases↗
PubMed2005

Adnexal masses in pregnancy: surgery compared with observation.

OBJECTIVE: To estimate whether the delay of surgery impacts the risk of adverse maternal and fetal outcomes in patients diagnosed with an adnexal mass during pregnancy. METHODS: A review was performed of pregnant patients diagnosed with an adnexal mass 5 cm or greater in diameter. Data collected included age, gravity/parity, gestational age at diagnosis, and presenting symptoms. Ultrasound examinations were evaluated for mass size and complexity. Pregnancy outcome, complications, and surgical pathology were reviewed. RESULTS: Between 1990 and 2003, 127,177 deliveries were performed at our institution. An adnexal mass 5 cm in diameter or greater was diagnosed in 63 (0.05%) patients. Pathologic diagnosis was available for 59 (94%) patients. The remaining 4 patients were lost to follow-up and excluded from the analysis. Antepartum surgery was performed in 17 patients (29%): 13 because of ultrasound findings that suggested malignancy and 4 secondary to ovarian torsion. The remaining patients were observed, with surgery performed in the postpartum period or at time of cesarean delivery. The majority of masses were dermoid cysts (42%). Four patients were diagnosed with ovarian cancer (6.8% of masses, 0.0032% of deliveries), and one patient (1.7%) had a tumor of low malignant potential. Antepartum surgery due to ultrasound findings that caused concern was performed on all 5 women diagnosed with a malignancy or borderline tumor, compared with 12 (22%) of the patients with benign tumors (P < .01). CONCLUSION: In select cases, close observation is a reasonable alternative to antepartum surgery in patients with an adnexal mass during pregnancy.

Adnexal Diseases↗
PubMed2006

Evaluation of adnexal masses with three-dimensional ultrasonography.

OBJECTIVE: To estimate whether three-dimensional ultrasonography and three-dimensional power Doppler investigation can contribute to the differentiation between benign and malignant ovarian masses. METHODS: Women scheduled for surgical treatment of an adnexal mass were included in a multicenter prospective study. All women underwent two-dimensional and three-dimensional ultrasonographic examination in the week before surgery. All parameters were compared in women with benign tumors, borderline tumors, and malignant tumors using receiver operating characteristic analysis and likelihood ratios. RESULTS: We included 181 women; 144 had a benign mass, 26 had a malignancy, and 11 had a borderline tumor. At three-dimensional ultrasonography, the most striking difference was found in the presence of central vessels in an adnexal mass. Central vessels assessed by three-dimensional ultrasonography were present in 15% (21 of 144) of the benign masses, 69% (18 of 26) of the malignant masses, and 27% (3 of 11) of the masses of borderline malignancy. The likelihood ratios for presence of central vessels for a mass being malignant and/or borderline was 4.9 (95% confidence interval 2.1-12). Mean gray index and flow index were also significantly different between the groups, but other features were not. CONCLUSION: The central localization of vessels in an adnexal mass, as observed by three-dimensional ultrasonography, the mean gray index, and the flow index are potentially important parameters for distinguishing benign from malignant adnexal masses. LEVEL OF EVIDENCE: II-2.

Adnexal Diseases↗
PubMed2006

Skin adnexal neoplasms--part 1: an approach to tumours of the pilosebaceous unit.

Skin adnexal neoplasms comprise a wide spectrum of benign and malignant tumours that exhibit morphological differentiation towards one or more types of adnexal structures found in normal skin. Most adnexal neoplasms are relatively uncommonly encountered in routine practice, and pathologists can recognise a limited number of frequently encountered tumours. In this review, the first of two, the normal histology of the skin adnexal structures is reviewed, and the histological features of selected but important benign and malignant tumours and tumour-like lesions of pilosebaceous origin discussed, with emphasis on the diagnostic approach and pitfalls in histological diagnosis.

Humans↗
PubMed1987

Adnexal masses: MR imaging observations at 1.5 T, with US and CT correlation.

To assess the role of 1.5-T magnetic resonance (MR) imaging in evaluation of the adnexa, 43 consecutive examinations that revealed 61 adnexal masses were retrospectively reviewed. T1- and T2-weighted images in coronal, axial, and/or sagittal planes were included. Available ultrasound (US) (n = 30) and/or computed tomographic (CT) (n = 9) scans were then correlated with the MR images. On T2-weighted images at least part of all adnexal masses was of higher signal intensity than surrounding muscle and adipose tissue, and therefore the adnexal masses were best seen with these sequences. T1-weighted imaging improved tissue characterization by revealing signal characteristics of fat in teratomas and characteristics of blood in endometriomas or hemorrhagic cysts, pelvic inflammatory disease, ovarian carcinomas, serous cystadenomas, and teratomas. MR imaging provided additional information or increased diagnostic confidence in 25 of 30 patients who underwent US or CT. MR imaging is a promising problem-solving modality after US in the study of adnexal abnormalities.

Adenoma↗
PubMed2006

Mean of CA 125 in making therapy decision in adnexal inflammatory tumors.

UNLABELLED: LABORATORY FINDINGS such are white blood count and sedimentation rate are of relative value in inflammations of the upper genital tract and adnexal inflammatory tumors. Antibiotics are administrated in all cases according to the protocol but some of them need operative treatment also. Inflammatory tumors can develop in endometriotic and even in cancer adnexal masses. CA 125 is elevated in great number of patients with advanced ovarian cancer. It can also be elevated in endometriosis, inflammations and in non-gynecological malignancies. Adnexal inflammatory tumor was confirmed in 57 patients. LABORATORY FINDINGS: white blood count and sedimentation rate were in normal levels in 17 patients. CA 125 was elevated in 27 patients. 49 patients were operated and CA 125 decreased in the first 5 days after the operation. Only 8 patients without CA 125 elevation were successfully treated by mean of antibiotics. Even there is no need for routine examining of serum CA 125 in adnexal inflammatory tumors it can be examined in cases with suspected Doppler ultrasonographic findings or unclear clinical findings. Endometriosis brings some risk of malignancy. Inflammatory tumor can develop in endometriotic tumor as well as in necrotic malignant ovary tissue. These could be reasons for making decision to do the operation in cases with inflammatory tumor followed with increased CA 125, hystological assessment and serious interpretation of final results.

Adnexal Diseases↗
PubMed2006

Likelihood ratio of sonographic findings in discriminating hydrosalpinx from other adnexal masses.

OBJECTIVE: The objective of our study was to describe the "waist" sign as a feature of hydrosalpinx and to calculate the likelihood ratio of sonographic findings for predicting that a cystic adnexal mass is a hydrosalpinx. MATERIALS AND METHODS: Consecutive institutional records were reviewed to identify patients with surgically excised cystic adnexal masses and preoperative sonograms that had been used to identify the mass. Two radiologists blinded to outcome reviewed the sonograms and recorded the presence of five specific sonographic findings: incomplete septation, short linear projection, small round projection, tubular shape, and presence of a waist. The likelihood ratios of these signs and combinations of signs for the diagnosis of hydrosalpinx were calculated. RESULTS: There were 55 patients with 67 cystic adnexal masses. Of the 67 cystic adnexal masses, there were 26 hydrosalpinges (39%), 36 cystic ovarian neoplasms (54%), and five paraovarian masses (7%). The likelihood ratios for the sonographic findings were as follows: incomplete septation, 2.1; short linear projection, 3.5; small round projection, 2.7; tubular shape, 10.5; and waist sign, 20.5. The waist sign in combination with tubular shape was found in 12 hydrosalpinges and no other masses (likelihood ratio of between 18.9 and infinity). Small round projection combined with tubular shape was found in 14 hydrosalpinges and one other mass (likelihood ratio of 22.1). CONCLUSION: Hydrosalpinx can be diagnosed with the highest likelihood when a tubular mass with the waist sign or a tubular mass with small round projections is encountered. Incomplete septations and short linear projections are less discriminating findings of hydrosalpinx.

Adnexal Diseases↗
PubMed2003

Characterization of adnexal mass lesions on MR imaging.

OBJECTIVE: The aim of our study was to evaluate the accuracy of MR imaging in the detection and characterization of adnexal mass lesions and to determine which imaging features are predictive of malignancy. SUBJECTS AND METHODS: We prospectively performed MR imaging in 104 patients (age range, 19-87 years; mean age, 50 years) with clinically or sonographically detected complex adnexal masses. We used a 1.5-T unit to perform T1-, T2-, and fat-suppressed T1-weighted sequences before and after IV injection of gadolinium. The adnexal lesions were examined for several features including size, shape, character (solid-cystic), vegetation, signal intensity, and enhancement. Secondary signs such as ascites, peritoneal disease, and lymphadenopathy were noted. We compared the imaging features with the surgical and pathologic findings. Multiple logistic regression analysis was performed on all MR imaging features. RESULTS: A total of 163 lesions--94 benign and 69 malignant lesions--were examined. On MR imaging, 95% (155/163) of the lesions were detected. The overall accuracy for the diagnosis of malignancy was 91%. On univariate analysis, the imaging features associated with malignancy were a solid-cystic lesion, irregularity, and vegetation on the wall and septum in a cystic lesion, the large size of the lesion, an early enhancement on dynamic contrast-enhanced MR images, and the presence of ascites, peritoneal disease, or adenopathy. On multiple logistic regression analysis, ascites and vegetation in a cystic lesion were the factors most significantly indicative of malignancy. CONCLUSION: MR imaging is highly accurate in the characterization of adnexal mass lesions, and the best predictors of malignancy are vegetation in a cystic lesion and ascites.

Adnexal Diseases↗
PubMed2002

Adnexal masses caused by pelvic inflammatory disease: MR appearance.

PURPOSE: To describe the morphologic and signal intensity characteristics of inflammatory adnexal masses in magnetic resonance (MR) images. MATERIALS AND METHODS: MR images of 15 patients with a total of 20 confirmed inflammatory adnexal masses were analyzed retrospectively. RESULTS: The findings obtained from MR imaging were as follows: lesions have ill-defined borders; ill-defined areas of high intensity signals surround the masses on T(2)-weighted images; a "rim" at the innermost layer of the cyst wall exhibits high signal intensity on T(1)-weighted images and low intensity on T(2)-weighted images; secondary changes in the surrounding fat plane and bowel loops are extensive; and adhesions are dense. These findings reflect the basic characteristics of the inflammatory process, which are edema caused by increased permeability and highly vascularized granulation tissue caused by the strong tendency to repair. CONCLUSION: MR imaging findings well reflect the basic pathological process of inflammation, and inflammatory adnexal masses are associated with relatively specific appearances in MR images. MR imaging can be a problem-solving alternative in the diagnosis of inflammatory adnexal masses.

Adnexal Diseases↗
PubMed2005

Selected adnexal cystic masses in postmenopausal women can be safely managed by laparoscopy.

The aim of this study was to assess the efficacy and safety of laparoscopic treatment for adnexal cystic masses that were predicted to be benign in postmenopausal women. Postmenopausal women found to have an adnexal cystic mass were retrospectively evaluated with transvaginal ultrasonography, and serum CA-125 levels. The selection criteria were adnexal cystic masses greater than 3 cm but less than 10 cm, the masses were in the benign range (4-8) of Sassone's scoring system for transvaginal ultrasonography, and the patients had serum CA-125 levels less than 65 IU/mL. Two hundred nineteen women fulfilled the criteria and underwent operative laparoscopy. Almost all the masses (99.5%) were accurately predicted to be benign except for one borderline ovarian tumor. Two hundreds thirteen (97.3%) women were successfully managed by operative laparoscopy and six (2.7%) required laparotomy. For the patients managed by laparoscopy, the mean operative time was 51.3 min; the mean hospital stay was 2.5 days. There was no significant morbidity and surgery-related mortality. The combination of the Sassone's scoring system for transvaginal ultrasonography and serum CA-125 level can accurately predict benign cystic masses, and operative laparoscopy is technically feasible and safe for the management of adnexal mass in postmenopausal women.

Adnexal Diseases↗
PubMed1999

Prospective evaluation of a logistic model based on sonographic morphologic and color Doppler findings developed to predict adnexal malignancy.

To assess prospectively a logistic model based on sonographic morphologic and color Doppler findings, which had been developed to predict adnexal malignancy, 167 consecutive and unselected patients (mean age, 45.7 yr; range, 17 to 81 yr; 113 [67.7%] premenopausal and 54 [32.3%] postmenopausal) diagnosed as having an adnexal mass and scheduled for surgery were prospectively included in this study. All patients were evaluated by transvaginal color Doppler ultrasonography. The probability of adnexal malignancy was estimated prior to surgery, applying a logistic model developed previously. A probability of malignancy greater than 75% was considered to assess model performance. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for the model. In all cases definitive histopathologic diagnosis was obtained. One hundred and twenty-five (74.9%) benign and 42 (25.1%) malignant tumors were found. The sensitivity, specificity, positive predictive value, and negative predictive value of the model were 85.7% (95% confidence intervals, 71.4% to 94.6%), 100% (95% confidence intervals, 97.1% to 100%), 100% (95% confidence intervals, 90.3% to 100%), and 95.4% (95% confidence intervals, 90.3% to 98.3%), respectively. Overall accuracy was 96.4% (95% confidence intervals, 91.3% to 98.7%). Our results confirm the validity of the proposed logistic model in predicting adnexal malignancy.

Adnexal Diseases↗
PubMed2000

Contrast-enhanced sonography in the examination of benign and malignant adnexal masses.

Our objective was to characterize the properties of an intravascular ultrasonographic contrast agent in examination of adnexal masses and to compare contrast agent properties between benign and malignant adnexal tumors. Fifty-eight consecutively examined women with suspected ovarian tumors were examined preoperatively by power Doppler ultrasonography, first without and then with contrast agent enhancement (Levovist). Fourteen women had ovarian cancer, 3 had borderline ovarian tumors, 18 had benign ovarian neoplasms, and 23 had functional adnexal cystic masses or endometriomas. The effect of the contrast agent was evaluated visually and by using computerized power Doppler signal intensity measurements. In visual evaluation, the brightness of the power Doppler signal and the amount of recognizable vascular areas increased in each tumor after contrast agent administration. The number of vessels in power Doppler ultrasonograms, both before and after contrast agent enhancement, was significantly higher in malignant than in benign adnexal masses, as also was the increase in the number of recognizable vessels after contrast agent administration. Contrast agent uptake time was significantly shorter in malignant than in benign tumors. No significant differences were found in the power Doppler signal intensities or their changes between benign and malignant tumors. In conclusion, use of sonographic contrast agent facilitates imaging of tumor vessels. For differentiation of benign and malignant tumors, the kinetic properties of the contrast agent, such as uptake and washout times, may have more potential than the use of the contrast agent in anatomic imaging of the tumor vessels.

Abscess↗
PubMed2001

Assessment of a new logistic model in the preoperative evaluation of adnexal masses.

OBJECTIVE: To assess a new logistic regression model developed to predict malignancy in adnexal masses. METHODS: In the first part of this study, we developed a logistic model by applying logistic regression analysis in a series of 268 adnexal masses (203 benign and 65 malignant lesions) in 248 patients (mean age, 43.6 years; SD, 14.2 years) evaluated and treated at our institution. Eleven parameters were entered in the logistic regression analysis in a forward stepwise way. In the second part of the study, we evaluated the model's diagnostic performance in a further set of 135 adnexal masses (103 benign and 32 malignant tumors) in 129 patients (mean age, 44.4 years; SD, 14.6 years). This diagnostic performance was compared with that of age, tumor volume, Sassone's and Ferrazzi's B-mode ultrasonographic morphologic scoring systems, serum cancer antigen 125 level, and the tumor's lowest resistive index. Comparison was done by calculating the area under the receiver operating characteristic curve. RESULTS: In logistic analysis, only menopausal status, the presence of papillary projections, the logarithm of the cancer antigen 125 value, tumor blood flow location, and the lowest resistive index were retained in the model. The model had the best area under the curve (0.97), significantly higher than patient age (area under the curve, 0.78; P = .001), tumor volume (area under the curve, 0.68; P < .0001), cancer antigen 125 (area under the curve, 0.88; P = .008), lowest resistive index (area under the curve, 0.85; P = .011), Ferrazzi's scoring system (area under the curve, 0.89; P = .01), and maximal peak systolic velocity (area under the curve, 0.71; P< .0001). Comparison with Sassone's scoring system (area under the curve, 0.91) did not reach statistical significance, but a clear trend was found (P = .116). CONCLUSIONS: The model had the best diagnostic performance for discriminating between benign and malignant adnexal masses. A clinical prospective evaluation is needed to confirm its actual value.

Adnexal Diseases↗
PubMed1999

[Preoperative assessment of asymptomatic adnexal tumors by positron emission tomography and F 18 fluorodeoxyglucose].

AIM: To evaluate use of F-18-FDG-PET in assessment of dignity of asymptomatic adnexal masses. METHODS: 85 asymptomatic patients with suspicious, asymptomatic adnexal masses were evaluated. Static FDG-PET (Exact HR+ or ECAT 931) imaging of the abdomen was performed following application of 222-555 MBq F-18-FDG. Iterative reconstruction was applied. PET data were analysed visually, at first without and second together with MRT images. Final diagnosis was made by histopathology. RESULTS: FDG-PET allowed correct identification of 4 of 8 malignant adnexal tumors. False negative results were obtained in 2 adenocarcinomas stage pT1a and 2 borderline-tumors. In 60 out of 77 benign adnexal masses malignancy could be excluded. False positive FDG-uptake, partly because of misinterpretation of gastrointestinal activity, was found in 3 inflammatory processes, 1 teratoma, 1 benign schwannoma, 1 dermoid cyst, 1 benign thecoma, 1 serous cyst, 1 serous cystadenoma, 2 mucinous cystadenomas, 2 corpus luteum cysts, 3 endometriosic cysts and 1 sactosalpinx. The overall sensitivity and specificity of FDG-PET alone were 50% and 78%. Evaluation together with MRT images showed a sensitivity of 50% and a specificity of 86%. CONCLUSION: Sensitivity of FDG-PET in detection of borderline-tumors and early stage ovarian cancer seems to be limited. Low incidence of malignant ovarian tumors requires for assessment of dignity a procedure of high specificity, that is not reached by FDG-PET neither without nor together with MRT images for topographic orientation. Therefore use of FDG-PET for assessment of dignity in suspicious, asymptomatic ovarian tumors is limited.

Adolescent↗
PubMed1999

Laparoscopic management of adnexal masses in pregnant women.

OBJECTIVE: To report on 14 cases of adnexal masses in the second trimester of pregnancy that were managed with laparoscopic surgery. STUDY DESIGN: A retrospective study. During the period between January 1994 and January 1998, 14 women presented with adnexal masses in pregnancy and were surgically managed with laparoscopy. A retrospective chart review of these patients was used to determine factors, including gestational age, operating time, length of hospital stay, pathology results, pregnancy outcomes and complications. RESULTS: Fourteen patients had laparoscopic removal of adnexal masses in their second trimester of pregnancy. Average gestational age was 16 weeks (range, 11.5-21), average operating time was 84 minutes (range, 32-145), and average hospital stay was 2.0 days (range, 1-5). Pathology revealed 4 serous cystadenomas, 3 mucinous cystadenomas, 3 mature teratomas, 3 functional cysts and 1 bilateral endometrioma. There were no postoperative complications except for one case of mild peritonitis, which resolved with expectant management. There were no cases of preterm labor associated with the surgery. Ten pregnancies continued to term without complications and delivered average-sized infants. Three pregnancies were in the third trimester without complications at this writing. There was one intrauterine fetal death at 31 weeks; it was found to be secondary to an acute cord accident on autopsy remote from surgery. CONCLUSION: Significant ovarian masses are diagnosed relatively frequently in the pregnant woman. The risk of malignancy is low, but complications resulting from distention, rupture and/or torsion of the adnexa can be a significant concern. As laparoscopic procedures improve and our experience with laparoscopy in the pregnant woman increases, most of these patients can forego laparotomy and be managed safely by laparoscopic removal of the mass. This series outlines laparoscopic technique and outcomes after removal of significant adnexal masses in pregnancy.

Adenoma↗