BACKGROUND Giant ovarian cysts(≥15 cm in diameter)are rare.The size limit of cysts and the methodology for a safe and successful minimally invasive surgery has not been established.Here we report a case of a large 10...BACKGROUND Giant ovarian cysts(≥15 cm in diameter)are rare.The size limit of cysts and the methodology for a safe and successful minimally invasive surgery has not been established.Here we report a case of a large 10-kg multi-locular ovarian mass,which was successfully laparoscopically removed:Our aim was to innovate the surgical practice in this field by providing a safe,effective,and minimally invasive management method for such complex and rare cases.CASE SUMMARY A 49-year-old nulliparous woman presented with abdominal distension,lasting from six Mo prior to admission;she reported worsening abdominal pain,abdominal swelling,and mild dyspnea.Imaging showed a presumed benign multi-locular(>10 locules)left ovarian cyst that measured about 30 cm in diameter.Based on the IOTA-ADNEX model the mass had a 27.5%risk of being a borderline or malignant tumor.The patient was successfully treated via a direct laparoscopic approach with salpingo-oophorectomy,followed by the external drainage of the cyst.Tumor spillage was successfully avoided during this procedure.The final volume of the drained mucinous content was 8950 L;the cyst wall,extracted through the minilaparotomy,weighed about 1200 g.The pathologic gross examination revealed a 24 cm×15 cm×10 cm mass;the histologic examination diagnosed a mucinous cystoadenoma.To our knowledge,this is the first case of a giant multi-locular ovarian cyst treated with a direct laparoscopy with salpingo-oophorectomy followed by external decompression.CONCLUSION Choosing the appropriate technique and surgeon skill are necessary for a safe and effective minimally-invasive approach of unique cases involving giant ovarian cysts.展开更多
目的探讨基于简化流程图的O-RADS联合ADNEX模型评估中老年女性附件肿瘤良恶性的临床应用。方法选取2018年11月—2022年11月在桂林医学院附属医院行妇科超声检查发现附件肿瘤且行手术治疗的中老年患者95例。根据O-RADS及ADNEX模型对附件...目的探讨基于简化流程图的O-RADS联合ADNEX模型评估中老年女性附件肿瘤良恶性的临床应用。方法选取2018年11月—2022年11月在桂林医学院附属医院行妇科超声检查发现附件肿瘤且行手术治疗的中老年患者95例。根据O-RADS及ADNEX模型对附件肿瘤进行分类,以病理组织学作为金标准,计算出O-RADS、ADNEX模型及两者联合的诊断效能,绘制受试者工作特征(ROC)曲线。结果95例患者中,病理结果恶性46例、良性49例。O-RADS 4、5类诊断附件恶性肿瘤的敏感性、特异性、阳性预测值、阴性预测值分别为93.48%(95%CI:0.811,0.983)、69.39%(95%CI:0.544,0.813)、74.14%、91.89%,ADNEX模型诊断附件肿瘤良恶性的敏感性、特异性、阳性预测值、阴性预测值分别为89.13%(95%CI:0.756,0.959)、79.59%(95%CI:0.652,0.893)、80.39%、88.63%,两者联合诊断附件肿瘤良恶性的敏感性、特异性、阳性预测值、阴性预测值分别为93.48%(95%CI:0.811,0.983)、83.67%(95%CI:0.698,0.922)、84.31%和93.18%。O-RADS、ADNEX模型及其联合诊断附件肿瘤良恶性的曲线下面积分别0.814、0.844、0.871。由2位超声医师运用O-RADS分类诊断的一致性好(κ=0.847,P=0.000),运用O-RADS简化流程图者较颜色编码计分表格者用时更短,分别为42 min 39 s和51 min 3 s。结论O-RADS联合ADNEX模型诊断中老年女性附件肿瘤良恶性的价值较单独使用O-RADS高,不同超声医师使用O-RADS有较高的一致性,且使用简化流程图者可更快速进行分类,值得推广。展开更多
Although ectopic hormone-production is uncommon complication, certain tumors can produce symptoms due to the secretion of various bioactive substances accompanied by the aberrantly located tumors. Because of the poten...Although ectopic hormone-production is uncommon complication, certain tumors can produce symptoms due to the secretion of various bioactive substances accompanied by the aberrantly located tumors. Because of the potential for the ovary to act as a source of aberrant hormone secretion, in the literature, ectopic hormone production from ovarian tumor includes granulocyte-colony stimulating factor (G-CSF), parathyroid hormone-related protein (PTHrP), adrenocorticotropic hormone (ACTH), peptide-YY, gastrin and insulin. All patients may present with syndromes of hormone excess. Failure to localize the ovarian tumor preoperatively may be associated with a significantly higher risk of subsequent unnecessary ablative procedures. Better characterization of hormonal forms relatively specific for neoplasia may enhance the clinical value of ectopic hormones as tumor markers, especially in malignancies that are commonly associated with ectopic hormone production. These circumstances may recommend complete preoperative evaluation of the pelvis in female patients presenting with nonlocalizable endocrine tumors.展开更多
文摘BACKGROUND Giant ovarian cysts(≥15 cm in diameter)are rare.The size limit of cysts and the methodology for a safe and successful minimally invasive surgery has not been established.Here we report a case of a large 10-kg multi-locular ovarian mass,which was successfully laparoscopically removed:Our aim was to innovate the surgical practice in this field by providing a safe,effective,and minimally invasive management method for such complex and rare cases.CASE SUMMARY A 49-year-old nulliparous woman presented with abdominal distension,lasting from six Mo prior to admission;she reported worsening abdominal pain,abdominal swelling,and mild dyspnea.Imaging showed a presumed benign multi-locular(>10 locules)left ovarian cyst that measured about 30 cm in diameter.Based on the IOTA-ADNEX model the mass had a 27.5%risk of being a borderline or malignant tumor.The patient was successfully treated via a direct laparoscopic approach with salpingo-oophorectomy,followed by the external drainage of the cyst.Tumor spillage was successfully avoided during this procedure.The final volume of the drained mucinous content was 8950 L;the cyst wall,extracted through the minilaparotomy,weighed about 1200 g.The pathologic gross examination revealed a 24 cm×15 cm×10 cm mass;the histologic examination diagnosed a mucinous cystoadenoma.To our knowledge,this is the first case of a giant multi-locular ovarian cyst treated with a direct laparoscopy with salpingo-oophorectomy followed by external decompression.CONCLUSION Choosing the appropriate technique and surgeon skill are necessary for a safe and effective minimally-invasive approach of unique cases involving giant ovarian cysts.
文摘目的探讨基于简化流程图的O-RADS联合ADNEX模型评估中老年女性附件肿瘤良恶性的临床应用。方法选取2018年11月—2022年11月在桂林医学院附属医院行妇科超声检查发现附件肿瘤且行手术治疗的中老年患者95例。根据O-RADS及ADNEX模型对附件肿瘤进行分类,以病理组织学作为金标准,计算出O-RADS、ADNEX模型及两者联合的诊断效能,绘制受试者工作特征(ROC)曲线。结果95例患者中,病理结果恶性46例、良性49例。O-RADS 4、5类诊断附件恶性肿瘤的敏感性、特异性、阳性预测值、阴性预测值分别为93.48%(95%CI:0.811,0.983)、69.39%(95%CI:0.544,0.813)、74.14%、91.89%,ADNEX模型诊断附件肿瘤良恶性的敏感性、特异性、阳性预测值、阴性预测值分别为89.13%(95%CI:0.756,0.959)、79.59%(95%CI:0.652,0.893)、80.39%、88.63%,两者联合诊断附件肿瘤良恶性的敏感性、特异性、阳性预测值、阴性预测值分别为93.48%(95%CI:0.811,0.983)、83.67%(95%CI:0.698,0.922)、84.31%和93.18%。O-RADS、ADNEX模型及其联合诊断附件肿瘤良恶性的曲线下面积分别0.814、0.844、0.871。由2位超声医师运用O-RADS分类诊断的一致性好(κ=0.847,P=0.000),运用O-RADS简化流程图者较颜色编码计分表格者用时更短,分别为42 min 39 s和51 min 3 s。结论O-RADS联合ADNEX模型诊断中老年女性附件肿瘤良恶性的价值较单独使用O-RADS高,不同超声医师使用O-RADS有较高的一致性,且使用简化流程图者可更快速进行分类,值得推广。
文摘Although ectopic hormone-production is uncommon complication, certain tumors can produce symptoms due to the secretion of various bioactive substances accompanied by the aberrantly located tumors. Because of the potential for the ovary to act as a source of aberrant hormone secretion, in the literature, ectopic hormone production from ovarian tumor includes granulocyte-colony stimulating factor (G-CSF), parathyroid hormone-related protein (PTHrP), adrenocorticotropic hormone (ACTH), peptide-YY, gastrin and insulin. All patients may present with syndromes of hormone excess. Failure to localize the ovarian tumor preoperatively may be associated with a significantly higher risk of subsequent unnecessary ablative procedures. Better characterization of hormonal forms relatively specific for neoplasia may enhance the clinical value of ectopic hormones as tumor markers, especially in malignancies that are commonly associated with ectopic hormone production. These circumstances may recommend complete preoperative evaluation of the pelvis in female patients presenting with nonlocalizable endocrine tumors.
