A Rare Cause of Precocious Puberty and Massive Ovarian Cysts Associated with Hypothyroidism

Van Wyk-Grumbach syndrome (VWGS) is characterized by juvenile hypothyroidism, delayed bone age, isosexual precocious puberty and massive ovarian cysts. We report such a case in a 7-year-old girl who presented with a bilateral pelvic pain, abdominal distension and signs of hypothyroidism. Physical examination showed a breast development and lack of pubic and axillary hair. There was no clitoromegaly. Pelvic ultrasonography and CT scan showed enlarged bilateral multiloculared multicystics ovarian masses. The pituitary MRI was recommended before an elevated prolactin, revealed a large sellar and suprasellar mass. The patient was started on thyroid replacement using L-Thyroxine. Clinically, the patient’s fatigue, pelvic pain, and abdominal distension are resolved. During the follow-up, her thyroid functions and serum prolactin normalized within 8 months. Ultrasonography revealed regression of ovarian cysts in 2 months measuring, with normal sized ovaries in 14 months.

Enlarging ovarian cysts mimicking malignant or borderline tumors during pregnancy

Background:Ovarian cysts are uncommon gestational complications.Because of high-level progesterone,ovarian endometriomas may undergo decidualization during pregnancy,manifesting as enlarging cysts with papillae and rich blood flow.Such cases can mimic malignant or borderline tumors,causing dilemmas in clinical management.Here,we present two cases of enlarging ovarian cysts during pregnancy with evidence suggesting decidualized endometrioma.The diagnosis and treatment are further discussed,which add to our limited knowledge and might help future clinical practice.Case summary:In the first case,a right ovarian cyst was detected by ultrasound in a 32-year-old pregnant woman.The cyst measured 4.2 cm in diameter at 7t6 weeks of gestation,and gradually increased to 9.6 cm7.6 cm5.6 cm at 37t5 weeks,with multiple solid papillae lining the inner wall.During cesarean section,an ovarian mass of approximately 9 cm in diameter was surgically removed,which was later identified by pathological review as an endometrioma with decidualization.The second case also presented as an enlarging ovarian mass during the first and second trimester.The size of the cyst peaked at 24t5 weeks of gestation,measuring 6.9 cm5.6 cm4.1 cm.But in the third trimester,the tumor slightly regressed.Careful follow-up was adopted after successful vaginal delivery,and the cyst was found to have undergone quick regression shortly after pregnancy.Both patients recovered well after delivery with no further complications.Conclusion:Endometriomas with decidualization during gestation may resemble borderline or malignant tumors.Close monitoring and proper management are essential for guiding clinical management.

Abdominal Mass Revealing a Right Ovarian Cyst in a 2-Year-Old Infant: A Case Report

Introduction: Ovarian cysts are rare pathologies in infants. They represent 1% to 2% of all abdominal tumors in children. Abdominal pain is the most frequent initial sign. Sometimes the discovery is fortuitous, revealed by an abdominal ultrasound. We report here the case of an ovarian cyst in an infant in order to clarify the diagnostic and therapeutic particularities. Patient and observation: 2-year-old infant, female, weighing 12 kg and with no particular pathological history, was admitted to our department for pain plus abdominal mass evolving for 2 months. The clinical examination had noted: a mass ranging from FID to hypogastrium, painless, of firm consistency, with regular contour, with a smooth and mobile surface in relation to the deep plane. The abdominal ultrasound performed had concluded to a mesenteric cyst. The treatment consisted of a monobloc total cystectomy with preservation of the healthy ovarian tissue by a transverse laparotomy under the umbilical. The postoperative course was simple;the histological study of the surgical specimen had concluded to a serous cystadenoma. Conclusion: Ovarian cysts are benign tumors in most cases. Abdominal pain is the most common initial symptom at any age. Sometimes they can be incidentally discovered by ultrasound. The preservation of healthy ovarian tissue in the rules of oncological surgery allows the preservation of subsequent fertility.

Endocrine-Disrupting Chemicals: Possible Genesis of Ovarian Tumors

Background: Prolonged exposure to environmental toxicants like endocrine-disrupting chemicals has been linked to several ovarian pathologies. Exposure to endocrine-disrupting chemicals may start at any time of life from the fetal stage to adulthood resulting in various health complications The purpose of our study is to compare the concentration levels and association of benzopyrene, bisphenol A and genistein in patients with ovarian tumors and normal control group. We also sort to evaluate the predictive performance of benzopyrene, bisphenol A and genistein in patients with ovarian tumors. Methods: A case-control study was conducted for randomly selected participants involving 30 patients and 30 controls. 30 patients with radiologically diagnosed and histopathological confirmed ovarian tumors were included in the study between January 2022 and December 2022. Urine samples from each group were analyzed using liquid chromatography-mass spectrometry. Descriptive analysis for normally distributed continuous variables was done accordingly. Concentration levels of endocrine-disrupting chemicals were assessed using the Mann-Whitney test. The association of endocrine-disrupting chemicals with pathological ovarian tumors was analyzed using binary logistic regression. Evaluation of the diagnostic performance of endocrine-disrupting chemicals was analyzed using the ROC curve. Results: Overall, patients were significantly (P = 0.000) older than the healthy controls. Mean years (SD) were 36.7 (7.90) and 28.8 years (4.89) for patients and normal women respectively. Endometriomas had the highest incidence of 50%. The level of benzopyrene and bisphenol A in patients was significantly higher than those in the control group, while the level of genistein was significantly higher in normal controls. Benzopyrene and bisphenol A were significantly associated with ovarian cysts, and the incidence of pathological ovarian cysts was positively correlated to these EDCs, with OR value 64.79 (P = 0.005) for benzopyrene and 9.609 (P = 0.001) for bisphenol A. Genistein was significantly negatively correlated with the incidence of pathological ovarian tumors, with OR value of 0.153 (P = 0.007). Diagnostic performance on the AUC for benzopyrene, bisphenol A and genistein&l.

Laparoscopic management of a giant mucinous benign ovarian mass weighing 10150 grams:A case report

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.

Application of cattle placental stem cells for treating ovarian follicular cyst

BACKGROUND High humidity and temperature in Taiwan have significant effects on the reproductivity of Holstein cattle,resulting in the occurrence of bovine ovarian follicular cyst(OFC).Because of economic loss from OFC,manual rupture and hormone injection have been advocated for the management of OFC.However,these incomplete treatments increase hormone resistance in cattle.Mesenchymal stem cells(MSCs)derived from placental stem cells(PSCs)demonstrate potential properties for the treatment of several diseases via promoting angiogenesis and immune modulation.AIM To establish the possibility of cattle placental stem cells(CPSCs)as a treatment modality for OFC of cows in Taiwan.METHODS The cows with OFC were divided into three groups:control(BC1 and BC2),hormone(H1 and H2),and CPSC(PS1 and PS2)treatment groups.In the hormone treatment group,the cows were given gonadotrophin-releasing hormone(GnRH)-prostaglandin-GnRH intramuscular injection with or without drainage of follicular fluid.In the CPSC treatment group,CPSCs were isolated from the placenta after labor.With the identification of surface antigen on stem cells,the cows were administered ovarian injection of 1×106 or 6×106 CPSCs with drainage.In all groups,OFC was scanned by ultrasound once a week for a total of seven times.The concentrations of estradiol and progesterone in serum were tested in the same period.The estrus cycle was analyzed by food intake and activity.If estrus was detected,artificial insemination was conducted.Then the cow was monitored by ultrasound for confirmation of pregnancy.RESULTS After 7 d of culture,CPSCs were successfully isolated from placental pieces.CPSCs significantly proliferated every 24 h and had high expression of MSC markers such as cluster of differentiation 44,as determined by flow cytometry.Ultrasound showed lower numbers of OFCs with drainage of follicular fluid.We achieved recovery rates of 0%,50%,50%,75%,75%and 75%in BC1,BC2,H1,H2,PS1,and PS2,respectively.Higher concentrations of progesterone were detected in the CPSC treatment groups.However,both hormone and CPSC treatment groups had no significant difference in the concentration of estradiol.The estrus rate was 0%,100%,25%,75%,75%and 75%in BC1,BC2,H1,H2,PS1,and PS2,respectively.The two fetuses were born in H2 and PS1.In brief,cows with CPSC injection achieved higher recovery,estrus,and inseminated conception rates.CONCLUSION CPSCs have efficacy in treating cows with OFC,and thus,may serve as an alternative treatment for reproductive disorders.

Laparoscopic Management of a Large Ovarian Cyst Twist in a 14-Year Old Young Girl in Emergency: A Case Report

The diagnosis and the treatment of twisted ovarian tumors are still challenging, especially in adolescent girls. We describe an adolescent girl with a twisted ovarian cyst, in whom emergent laparoscopic surgery was successful. She visited us due to severe abdominal pain. Ultrasound revealed a large cystic mass, indicative of an ovarian cyst. Laparoscopy revealed a large left ovarian cyst twisted on its axis. We punctured the cyst and detorsed it. The lessons learned here are: sudden-onset abdominal pain of adolescent associated with nausea and vomiting is strongly suggestive of a ovarian cyst torsion;ultrasound should be performed immediately, if ovarian cyst torsion is suspected, timely intervention with diagnostic laparoscopy is indicated, a minimally invasive surgical approach is recommended to preserve the adnexal structures and ovarian function.

Giant cyst in heterotopic pregnancy:A case report

BACKGROUND The coexistence of a heterotopic pregnancy with a giant ovarian cyst is an incredibly rare abnormal pregnancy in cases of natural conception.The incidence of this condition has increased significantly as a result of the continuous development of assisted reproductive technologies.When this type of pregnancy occurs,both the continuation of intrauterine pregnancy and the life of the pregnant woman are severely threatened.Early diagnosis and treatment using safe and effective methods are paramount in this situation.CASE SUMMARY A 30-year-old primigravida at a gestation age determined as 8 wk 4 d by scan was admitted to the hospital with heterotopic pregnancy and a right ovarian cyst.Laparoscopic resection of the ectopic pregnancy was performed,but the intrauterine pregnancy and ovarian cyst were preserved.CONCLUSION The approach to a patient with heterotopic pregnancy and a giant ovarian cyst is individualized base on the fertility requirements.We recommend the following:(1)If the patient satisfies parity and has no fertility requirement,a laparoscopic salpingectomy should be performed and the giant ovarian cyst and intrauterine pregnancy removed;(2)If the patient has fertility requirements wishes to have more children in the future,laparoscopic salpingectomy or salpingostomy should be performed and the intrauterine pregnancy preserved.Serial ovarian cyst aspiration can be performed under ultrasound and resection can be done after delivery;and(3)Heterotopic pregnancy should be diagnosed early by active surveillance during antenatal visits using ultra sound as this is important for the avoidance of catastrophic complications.

The Safety of Sino-implant——3-year Clinical Observation

A total of 315 women who had Sino implant Ⅱ implantation and 302 healthy women were recruited and followed up for 3 years in order to observe the effect of Sino implant Ⅱ on myoma of uterus and ovarian cysts. The blood pressure, body weight, vaginal ultrasonic examination and smear of cervix were measured once a year. The results show that Sino implant Ⅱ does not influence the blood pressure and body weight obviously. There are more ovarian cysts in Sino implant group than in the control group, but they are all found to disappear when reexamined after menstruation. These ovarian cysts may be follicular cysts. There are fewer myomas of uterus in Sino implant group than in the control group, and these myomas develop slowly. The results suggest that Sino implant is a safe contraceptive method.

Ovarian Fibrosis： A Phenomenon of Concern

Objective： Ovarian fibrosis is characterized by excessive proliferation of ovarian fibroblasts and deposition ofextracellular matrix （ECM） and it is one of the principal reasons for ovarian dysfunction. This review aimed to investigate the pathogenetic mechanism of ovarian fibrosis and to clarify the relationship between ovarian diseases and fibrosis. Data Sources： We searched PubMed for English language articles published up to November 2016. The search terms included ovarian fibrosis OR fibrosis, ovarian chocolate cyst OR ovarian endometrioma, polycystic ovarian syndrome （PCOS）, premature ovarian failure, ECM, matrix rnetalloproteinases （MMPs）, tissue inhibitors of matrix metalloproteinases （TIMPs）, transforming growth factor-beta 1 （TGF-[31）, connective tissue growth factor （CTGF）, peroxisome proliferator-activated receptor gamma （PPAR-T）, vascular endothelial growth factor （VEGF）, endothelin-1 （ET-1）, and combinations of these terms. Study Selection： Articles were obtained and reviewed to analyze the pathogenic mechanism of ovarian fibrosis and related ovarian diseases. Results： Many cytokines, such as MMPs, TIMPs, TGF-β1, CTGF, PPAR-γ, VEGK and ET- 1, are involved in ovarian fibrogenesis. Ovarian fibrogenesis is associated with various ovarian diseases, including ovarian chocolate cyst PCOS, and premature ovarian failure. One finding of particular interest is that fibrogenesis in peripheral tissues around an ovarian chocolate cyst commonly causes ovarian function diminution, and therefore, this medical problem should arouse widespread concern in clinicians worldwide. Conclusions： Patients with ovarian fibrosis are susceptible to infertility and tend to have decreased responses to assisted fertility treatment. Thus, protection of ovarian function should be a priority for women who wish to reproduce when making therapeutic decisions about ovarian fibrosis-related diseases.

Clinical Study on Endometrial Ovarian Cyst Treated by Combined Laparoscopy and Chinese Herbal Medicine

Objective: To investigate a new method of combined laparoscopy with Chinese herbal medicine (CHM) in treating endometrial ovarian cyst. Methods: One hundred and fifty two patients with endometrial ovarian cyst were randomly divided into 3 groups treated with three therapies: combined laparoscopy with CHM (combination group), CHM (TCM group) and danazol (WM group). To compare the clinical efficacy and side effects shown by the three groups and to elucidate the therapeutic mechanism by detecting the serum CA 125 reproductive endocrine hormone, plasma prostaglandin F 2α , prostaglandin E 2 etc. Results: The shrinking rate, disappearance rate of the cysts and markedly effective rate in the combination group were obviously higher than those in the TCM group and WM group ( P <0.05, P <0.01). The pregnancy rate of combination group was also higher than that of the WM group ( P <0.05). Few side effects constituted the most prominent advantage for the combination group and TCM group. After treatment, the plasma prostaglandin F 1α lowered remarkably, serum progesterone increased and CA 125 reduced obviously ( P <0.01, P <0.05). Conclusion: The laparoscopy and CHM combination therapy is a new method in treating endometrial ovarian cyst which has significant efficacy, minimal adverse effect and maximal preservation of reproductive function.

Hemorrhagic ovarian cyst without peritoneal bleeding in a patient with ovarian hyperstimulation syndrome: case report

Gynecologic and obstetric disorders presenting with abdominal pain are ectopic pregnancy,rupture of endometrial cysts, mature cystic teratoma and torsion of the adnexae. Hemorrhagic ovarian cysts, which included among the functional cysts, are often involved in acute abdomen leading to laparotomy intervention.

A Case of Benign Mature Cystic Teratoma of Left Fallopian Tube Along with Right Endometrial Ovarian Cyst

Objective To report a case of benign mature cystic teratoma of fallopian tube along with endometrial ovarian cyst, occasionally found during the operation. Methods A 30-year-old patient complained of mild dysmenorrhea and gradual enlargement of bilateral adnexal cysts in the past one year. At the age of 27 she had undergone a laparoscopic right ovarian endometrial cyst ablation. Before the second operation, pelvic ultrasound revealed recurrence of bilateral cysts in the adnexal regions, as well as serum concentrations of CA19-9 and CA125 above normal limits. Laparotomy revealed a 7 cm cystic mass of the right ovary, tightly adhesive to the lateral pelvic; a 10 cm-large mass on the left adnexal region embedded among intestines. The left adnexal mass appeared to be attached to the fimbriated end of the left fallopian tube with the ipsi-lateral ovary. However the left fallopian tube was obscure because of severe synechia. After separating the adhesion, we found the left hydrosalpinx. Results During laparotomy, both the cyst on the right ovary and the left fallopian tube were removed. Grossly, it revealed enlargement of the left fallopian tube in diameter 1.3 cm, with 2 neoplasms, in diameter 0.6 cm and off-white and smooth appearance. This mass was considered to be a mature solid teratoma arising in the left fallopian tube. At the same time it indicated left hydrosalpinx. Conclusion Although mature cystic teratomas are derived from ovarian germ cells （in proportion of 16%-20%）, mature teratoma of the fallopian tube is very rare. Once diagnosis, the operation will be recommended. This case was revealed during the laparotomy accidentally. The prognosis was good.