Explore the vast range of titles available.

Background Ovarian cystic lesions are typically slow-growing neoplasms, but giant ovarian tumors with dual histological types are rare, particularly in pediatric populations. They pose significant diagnostic and therapeutic challenges due to the potential for rapid enlargement and surgical complexity. Case presentation A 12-year-old female presented with progressive abdominal pain, early satiety, and a two-month history of abdominal distension. Imaging revealed a 30 × 22 × 12 cm intraperitoneal cystic mass with negative tumor markers. She underwent mini-laparotomy and tumor enucleation, during which 4400 cc of serous fluid was aspirated. Histopathology revealed a serous cystadenoma alongside a hemorrhagic corpus luteal cyst. Fertility was successfully preserved. Discussion Despite their rarity, large benign ovarian cysts with differing histology should be considered in young patients presenting with abdominal symptoms suggestive of malignancy. Early imaging, tumor marker evaluation, and fertility-preserving surgical strategies are crucial for optimal outcomes. Conclusion Benign giant ovarian cysts with concurrent histological types may mimic malignancy. Thorough preoperative evaluation and conservative surgical management are essential to balance oncological safety with fertility preservation in pediatric patients.

Purpose To investigate the clinical characteristics and prognosis of surgically treated ovarian endometrioma (OMA) in pregnant women. Methods This retrospective cohort study analyzed 30 patients with pathologically confirmed ovarian endometrioma during pregnancy and delivery. Clinical characteristics and follow-up data were summarized. Results Among the 30 patients, 21 underwent laparoscopic surgery during pregnancy. A total of 24 OMAs were identified in 21 patients and exhibited various changes during pregnancy: 13 did not show significant changes, 10 increased in size and 1 decreased in size. The indications for surgery included suspicion of malignancy (16/21), large and progressive growth (3/21), and ovarian cyst torsion (2/21). The postoperative pathology results showed that decidualization occurred in 7 cases, while only 1 case was diagnosed with malignancy, and there appears to be a lack of specific clinical characteristics to distinguish between malignant cysts and de ci du a l I zed cysts. Of the 21 patients, 19 underwent successful follow-up. Among them, 2 cases were preterm births, 1 experienced recurrence, and 2 developed adenomyosis during long-term follow-up. Besides, 9 patients underwent cystectomy during the cesarean section. All the ultrasound findings showed regular and smooth-walled unilocular cysts, with diameters smaller than 6 cm and no apparent growth during pregnancy. Postoperative pathology revealed decidualization in 3 cases, and 1 case experienced recurrence during follow-up. Conclusions OMA presents various changes during pregnancy and caution should also be taken for recurrence after delivery. Surgical intervention is prompted mainly by suspected malignancies which is difficult to distinguish with decidualization, and laparoscopic surgery is relatively safe during mid-pregnancy.

Objective This study aimed to investigate the effects of cyst volume and bilaterality on serum Anti-Müllerian Hormone (AMH) and CA-125 levels in patients with benign ovarian cysts. Methods We retrospectively analyzed 139 patients who underwent cystectomy for benign ovarian cysts. Serum AMH and CA-125 levels were measured preoperatively and at the second post-operative month. Results The mean preoperative AMH level was 3.96 ± 3.48 ng/mL, which significantly decreased to 3.59 ± 3.92 ng/mL postoperatively ( p  = 0.026), reflecting an average decline of 9.3%. CA-125 levels significantly decreased from 53.1 ± 157.2 to 21.0 ± 18.4 U/mL ( p  = 0.002). Patients with bilateral cysts had lower AMH levels at the second month (1.67 ± 0.6 vs. 3.80 ± 4.1 ng/mL; p  = 0.003) despite similar baseline values. Conclusion Bilaterality and cyst volume may negatively affect ovarian reserve postoperatively. The decline in AMH levels, particularly following bilateral ovarian cystectomy, has a significant impact on the ovarian reserve and may have implications for future fertility. Early fertility counselling and ovarian preservation strategies should be considered during surgical planning.

We describe a case of bilateral ovarian tumor-like lesions detected during pregnancy. It is important to highlight that these masses were not detected for the first time during pregnancy; the patient had already been aware of them 2 years prior, during pregnancy preparation, when an ultrasound examination revealed bilateral space-occupying ovarian lesions. These lesions did not exhibit any increase in size during regular follow-ups until pregnancy. At 17 weeks of gestation, fetal ultrasound showed significant enlargement of the bilateral ovarian lesions. The patient underwent pelvic magnetic resonance imaging, which revealed cystic masses in both the ovaries with septations and multiple nodular and flocculent projections on the walls and septations, exhibiting features resembling malignant tumors. The cystic fluid within each cyst predominantly showed slightly short T1 and long T2 signal characteristics. The final diagnosis of lesions occupying the ovarian space was endometriotic cysts with a decidual reaction associated with pregnancy, which was confirmed on postoperative pathological examination. Subsequently, at 19 weeks of gestation, the patient underwent a “laparoscopic excision of the left ovarian lesion and right ovarian lesion stripping.” The patient recovered well postoperatively and successfully delivered a baby at 39 weeks of gestation. Endometriosis with decidual reaction during pregnancy is rare and ectopic decidual tissue can easily be confused with neoplastic lesions using imaging results. In addition, clinicians must remain vigilant about the special conditions that ectopic decidual tissue may cause, such as cyst rupture, massive hemorrhage, dystocia, and even fetal death.

Background This study aimed to compare the expression patterns of hypoxia-inducible factor-1α in ovarian cyst capsules and endometrial tissue samples from patients with and without endometriosis to evaluate its potential as a biomarker of hypoxia in endometriosis. Methods This retrospective observational case–control study included 87 women of childbearing age (20–45 years) who underwent ovarian cystectomy at Balıkesir University Hospital between 2015 and 2020. Of these, 40 patients with confirmed endometriosis constituted the study group, while 47 patients with benign ovarian cysts comprised the control group. Immunohistochemical staining was used to assess the expression of hypoxia-inducible factor-1-alpha in ovarian cyst capsules and endometrial tissue samples. The relationship between the expression of hypoxia-inducible factor-1-alpha and clinical parameters, including age, body mass index, and endometriosis stage, was also evaluated. Results The expression of hypoxia-inducible factor-1-alpha was significantly higher in ovarian cyst capsules and endometrial tissues of patients with endometriosis than in those of controls (p < 0.05). No correlation was found between hypoxia-inducible factor-1-alpha expression and age, body mass index, or disease stage. Conclusions In this study, the expression of hypoxia-inducible factor-1-alpha in the ovarian and endometrial tissues was significantly elevated in patients with endometriosis compared with that in controls, independent of clinical parameters. These results support hypoxia-inducible factor-1-alpha as a stable biomarker of hypoxia in endometriosis and provide a basis for future research on hypoxia-targeted therapies for endometriosis management.

PurposeLaparoscopic cystectomy for ovarian endometriomas and benign ovarian cysts is often conducted through hemostatic methods, with bipolar electrocoagulation as a common approach. This study evaluated the impact of electrocoagulation, primarily through bipolar energy, versus nonthermal hemostatic methods on ovarian reserve in patients undergoing laparoscopic cystectomy for ovarian endometriomas and benign ovarian cysts.MethodsA systematic review with meta-analysis was conducted by searching the Cochrane Library, PubMed, EMBASE, and Web of Science databases. Randomized controlled trials (RCTs) comparing the impact of nonthermal hemostatic methods and electrocoagulation on the ovarian reserve during laparoscopic cystectomy were included. The Cochrane Risk of Bias Tool for Randomized Controlled Trials (ROB 2.0) was utilized to assess the quality of the included studies. The meta-analysis included 13 RCTs involving 1043 patients. Postoperative serum anti-Müllerian hormone (AMH) levels and antral follicle counts (AFCs) were analyzed using Review Manager ver. 5.4.ResultsCompared with the bipolar group, patients with endometriomas in the nonthermal hemostatic group exhibited significantly higher postoperative AMH levels at 1, 3, 6, and 12 months. Conversely, no significant differences in AMH levels were observed in patients with benign ovarian cysts. Similarly, AFCs showed no significant differences, except for lower postoperative AFCs in patients with endometrioma in the electrocoagulation group.ConclusionNonthermal hemostatic methods are associated with more effective preservation of the ovarian reserve compared with bipolar electrocoagulation in laparoscopic cystectomy for ovarian endometriomas. However, no significant impact of bipolar electrocoagulation on the ovarian reserve was observed in patients with benign ovarian cysts.Trial registrationRegistered in PROSPERO on April 10, 2023; ID # CRD42023413158.

Background and Objectives: Fetal ovarian cysts (FOCs) are a very rare pathology that can be associated with maternal–fetal and neonatal complications. The aim of this study was to assess the influence of ultrasound characteristics on FOC evolution and therapeutic management. Materials and Methods: We included cases admitted to our perinatal tertiary center between August 2016 and December 2022 with a prenatal or postnatal ultrasound evaluation indicative of FOC. We retrospectively analyzed the pre- and postnatal medical records, sonographic findings, operation protocols, and pathology reports. Results: This study investigated 20 cases of FOCs, of which 17 (85%) were diagnosed prenatally and 3 (15%) postnatally. The mean size of prenatally diagnosed ovarian cysts was 34.64 ± 12.53 mm for simple ovarian cysts and 55.16 ± 21.01 mm for complex ovarian cysts (p = 0.01). The simple FOCs ≤ 4 cm underwent resorption (n = 7, 70%) or size reduction (n = 3, 30%) without complications. Only 1 simple FOC greater than 4 cm reduced its size during follow-up, while 2 cases (66.6%) were complicated with ovarian torsion. Complex ovarian cysts diagnosed prenatally underwent resorption in only 1 case (25%), reduced in size in 1 case (25%), and were complicated with ovarian torsion in 2 cases (50%). Moreover, 2 simple (66.6%) and 1 complex (33.3%) fetal ovarian cysts were postnatally diagnosed. All of these simple ovarian cysts had a maximum diameter of ≤4 cm, and all of them underwent size reduction. The complex ovarian cyst of 4 cm underwent resorption during follow-up. Conclusions: Symptomatic neonatal ovarian cysts, as well as those that grow in size during sonographic follow-up, are in danger of ovarian torsion and should be operated on. Complex cysts and large cysts (with >4 cm diameter) could be followed up unless they become symptomatic or increase in dimensions during serial ultrasounds.

PurposeTo identify markers of previous ovarian torsion and outline the outcomes according to US appearance and operative management.MethodsA retrospective single-centre review of neonatal ovarian cysts from January 2000 to January 2020. Data on postnatal cyst size and sonographic features and operative treatment were co-related with outcomes of ovarian loss and histology.Results77 females were included with 22 simple and 56 complex cysts, one patient had bilateral cysts. 9/22 (41%) simple cysts regressed spontaneously in a median of 13 weeks (8–17). Complex cysts regressed spontaneously less frequently, 7/56(12%, P = 0.01), in 13 weeks (7–39). 38/56 (68%) complex and 12/22 (55%) simple cysts were treated operatively. 21/22 (95%) ovaries with initially simple cyst were salvaged compared to 20/56(36%) with initially complex cyst (P < 0.001). A fluid-debris level in 23/26 complex cysts was most associated with ovarian loss (P = 0.0006). Presence of viable ovarian stromal tissue was seen in 8/20 (40%) excised specimens during ovarian sparing procedures and in 5/30 (17%) oophorectomies for necrotic appearing ovaries.ConclusionsFluid-debris level on US is significantly associated with ovarian loss likely due to previous torsion. Simple cysts are viable and often regress spontaneously. The finding of viable ovarian stromal tissue in resected specimens supports attempting ovarian preservation wherever possible.

PurposeThe management of ovarian torsion in pediatric patients has evolved over time. Ovarian salvage is currently recommended given concerns for fertility preservation and the low likelihood of malignancy. Studies have shown that the incidence of oophorectomy is higher amongst pediatric surgeons in comparison to gynecologists. Using a national database, this study examined how the surgical management of ovarian torsion has evolved.MethodsChildren with a discharge diagnosis of ovarian torsion (ICD-9 code 620.5, ICD-10 code N835X) and procedure codes for oophorectomy (CCS code 119) were identified within the KID database from 2003, 2006, 2009, 2012, 2016, and 2019. Diagnosis of ovarian pathology was based upon ICD-9 and ICD-10 codes at the time of discharge.ResultsA total of 7008 patients, ages 1–20, had a discharge diagnosis of ovarian torsion. Of those patients, 2,597 (37.1%) were diagnosed with an ovarian cyst, 1560 (22.2%) were diagnosed with a benign ovarian neoplasm, and 30 (0.4%) were diagnosed with a malignant neoplasm. There was a decreased risk of oophorectomy in urban-teaching versus rural hospitals (OR: 0.64, p < 0.001). The rate of oophorectomy has decreased overtime. However, patients with benign or malignant neoplasms were more likely to undergo oophorectomy than those without a diagnosis (OR: 2.03, p < 0.001; 4.82, p < 0.001).ConclusionThe rate of oophorectomy amongst children with ovarian torsion has decreased over time. Yet, despite improvements, oophorectomy is common amongst patients with benign ovarian neoplasms and those treated at rural hospitals. Continued education is needed to optimize patient care in all clinical scenarios.Level of evidenceIV.

The aim of this study was to evaluate the rate of and risk factors for recurrence ovarian endometrioma after conservative surgery in patients aged 40–49 years. This retrospective, single-center study included 408 women between January 2008 and November 2018. All patients underwent ovarian cyst enucleation, were pathologically diagnosed with ovarian endometrioma and were followed up for ≥ 6 months. Recurrence was defined as a cystic mass with diameter ≥ 2 cm detected by sonography. Recurrence rate after conservative surgery and risk factor of recurrence were analyzed. The median follow-up duration after surgery was 32.0 ± 25.9 months (range 6–125 months). Ovarian endometrioma recurred in 34 (8.3%) of included women and median time to recurrence was 22.4 ± 18.2 months. The cumulative recurrences rate at 12, 24, 36, and 60 months were 3.7%, 6.7%, 11.1%, and 16.7%, respectively. Recurrence was correlated with multilocular cysts ( p  = 0.038), previous surgical history of ovarian endometrioma ( p  = 0.006) and salpingectomy ( p  = 0.043), but not use or duration of post-operative medication. In multivariate analysis, large cyst size (> 5.5 cm) was only risk factor for recurrence in this age group. Post-operative medication did not reduce disease recurrence rate, and thus may be administered for endometriosis-associated pain rather than to prevent recurrence in patients aged 40–49 years.