Management of a Huge Ovarian Cyst in Pregnancy at the Douala General Hospital, Cameroon: A Case Report and Review of the Literature

Background: Ovarian cysts in pregnancy are common and are usually small benign functional cysts (corpus luteum and theca-lutein cysts) that usually resolve spontaneously between 14 and 16 weeks of gestation. However, large ovarian cysts are rare in pregnancy, with an incidence of 0.2% - 2%, and most of them are benign. The first-line diagnostic modality is ultrasonography. Complications of ovarian cysts in pregnancy include miscarriage, ovarian torsion, cyst rupture, etc. Laparotomy is the treatment modality commonly used in our setting, and histopathologic diagnosis is important for the prognosis of the treatment. Case Presentation: MC is a 32-year-old G3P2002 married housewife of the Bakweri tribe who was referred to our department because of progressive abdominal discomfort and shortness of breath for 1 month’s duration. Her medical history is consistent with two normal vaginal deliveries at term and the use of implants (for contraception) until one month prior to the index pregnancy. Her booking visit was at 16 weeks gestation at a primary (missionary) healthcare facility, and she underwent ultrasonography and was diagnosed with a singleton viable intrauterine pregnancy and a simple septate cystic mass measuring 17 cm situated on top of the uterus, appearing to originate from the left ovary. She was referred to seek the expertise of an obstetrician-gynecologist, but she came to our department at 35 weeks gestation and underwent cesarean birth at 37 weeks gestation. In the pathological review, serous cystadenoma was diagnosed, and there were no positive findings in peritoneal cytology. Conclusion: The ultrasonographic diagnosis of the huge ovarian cyst in the index case was after 16 weeks gestation because of her late booking visit at 16 weeks gestation. The index case deferred referral to the obstetrician because of a lack of finances, came to our department at 35 weeks gestation because of abdominal pain that may have resulted from a torsion of the ovarian cyst, and underwent cesarean birth because of malpresentation and fear of cyst rupture during labor. We recommend cesarean section in such cases because of suboptimal antenatal care uptake and histopathology of the specimen to exclude malignancy. .

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.

Research on the modern clinical herbal administration rules in TCM treatment of ovarian cysts based on data mining

Objective:To explore the recent 20 years' herbal administration rules in TCM treatments of ovarian cysts (OCs) based on data mining.Methods:A prescription database for ovarian cysts was established by ACCESS 2007.Importing the database into SPSS17.0 and SPSS Modeler14.1.SPSS17.0 was used for descriptive and cluster analyses,while SPSS Modeler14.1 was used for association rules analysis.Results:After screening,363 prescriptions were obtained.The 10 most frequently-used Chinese herbal medicines are Zedoaria (Rhizoma Curcumae),Poria cocos (Poria),Common buried rubber (Rhizoma Sparganii),Red peony root (Radix Paeoniae Rubra),Peach seed (Semen Persicae),Danggui (Radix Angelicae Sinensis),Chinese angelica (Ramulus Cinnamomi),Liquorice root (Radix Glycyrrhizae),Pangolin scales (Squama Manis) and Moutan cortex (Cortex Moutan Radicis);the 5 most common syndromes of OCs are qi stagnation and blood stasis,phlegm and blood stasis,uterine blood stasis,stagnation of liver qi and retention of phlegm and dampness,nearly to 54.26%;In association rules analysis,5 sets of two-herbs association rules were obtained,17 sets of three-herbs association rules were obtained,22 sets of four-herbs association rules were obtained and 4 sets of five-herbs association rules were obtained;By clustering,13 sets of core couplet medicinals were obtained.Conclusion:Medicinal herbs for promoting blood circulation to remove blood stasis,resolve hard lumps,for strengthening the spleen,eliminating phlegm,and relieving liver qi stagnation were highly used in the treatment of OCs;Herbs attributed to the Liver Meridian,the Spleen Meridian and the Heart Meridian were highly used in OCs;The compatibility of herbs for promoting blood circulation to remove blood stasis and resolve hard lumps were highly used;Guizhi Fuling Wan (GFW) was often used and combined with other herbs in the treatment of OCs.

Benign ovarian cysts in reproductive-age women undergoing assisted reproductive technology treatment

The scope of this review is to focus on the management of benign ovarian cyst in the reproductive-age group of women undergoing ART. Ovarian cysts are a common occurrence in this patient population. The differential diagnosis includes functional cysts, dermoid cysts, endometrioma. The appropriate evaluation includes medical history and physical examination, laboratory tests and imaging. The treatment options include conservative follow-up, medical treatment and surgery. This review will explore the differential diagnosis, appropriate work-up and treatment options to the various cyst types encountered.

Management of Ovarian Cystic Tumor: Diagnosis, Management, and Its Follow-Up-Case Presentation of Three Patients and Literature Review

The diagnosis and management of ovarian cystic tumor is sometimes difficult. In this manuscript, we wish to summarize this issue by showing three cases. Ultrasound and Color Doppler are very useful to diagnose the presence of this tumor but also to distinguish between benign and malignant. Pelvic MRI is also a strong tool and is sometimes mandatory. HE4 and CA125 are often useful as a serum diagnostic marker of malignancy, but not always so. Recently, laparoscopic management has gained popularity;however, great caution should be exercised during laparoscopic operative procedures, as this may lead to intraperitoneal malignant cell spreading/proliferation when the tumor is malignant. During the surgery of malignant tumor, irrespective of laparoscopic or laparotomic, intraperitoneal rupture should be avoided. Since the final diagnosis must be made by histological examination, the patient must always be informed of this possibility.

Evaluation of ovarian cysts in adolescents

The presentation of an adnexal mass in an adolescent is a concerning event for the patient and the family. Patients are most likely to present with abdominal pain or a palpable mass. The diagnostic imaging of choice is pelvic ultrasonography. The majority of these lesions are benign ovarian cysts. These cysts should be followed with ultrasound, as many will spontaneously regress. Further evaluation with laboratory tests may also be warranted, which will aid in diagnosis and treatment. Ovarian cysts that are failed to resolve, severely symptomatic, or concerned with malignancy require surgical intervention. Laparoscopy has shown to be beneficial in the adolescent population and should be the procedure of choice. In addition, ovarian conservation is the ideal treatment in order to continue normal pubertal development and preserve reproductive health.

EVALUATION OF SURGERY IN SIMPLE OVARIAN CYSTS

Objective. To evaluate the surgery in simple ovarian cysts.Methods. From Jan.1994 to Dec.1999, 221 women with simple ovarian cysts were admitted into our hospital. The diameter of cysts was <5 cm in 76 cases, and was>5 cm in 145 cases ultrasonically. One hundred and eighty-four patients underwent laparosocopy, and thirty-seven underwent laparotomy.Results. Histological findings showed no malignancy in this series. Simple cysts, paraovarian cysts and corpus luteum were found histologically in 90.8% of cases with cysts <5 cm, and 60% of those with cysts >1 cm respectively, their difference was significant (x2=37.13, P<0.001). The simple cysts, paraovarian cysts and corpus luteum cysts were found in 81.5% of postmenopausal women and 84.0% of pre-menopausal women.Conclusion. Patients with cysts >1 cm are indicated for surgical procedures, while a period of fol-lowup is acceptable for patients with cysts <7 cm, and surgery is advisable if the cyst is persistent during followup. Postmenopausal women with cysts should have operations.

Clinical study on Chuanxiong Hualiu Mixture in the treatment of blood stasis and phlegm stagnation type of ovarian cyst

Objective:To observe the clinical efficacy of Chuanxiong Hualiu Mixture in the treatment of blood stasis and phlegm stagnation type of ovarian cyst and the effects on physical and chemical indicators.Methods: A total of 80 patients with blood stasis and phlegm stagnation type of ovarian cyst were randomly divided into two groups, research group (n=40) took Chuanxiong Hualiu Mixture, control group (n=40) took Guizhi Fuling Capsule, 3 months was a course of treatment, and the curative effect was compared between two groups.Results:(1) The overall response rate of Chuanxiong Hualiu mixture group after 3 months of treatment was 82.5%, that of Guizhi Fuling Capsule group was 62.5%, the overall response rate of Chuanxiong Hualiu mixture group was higher than that of control group, and the difference was statistically significant;(2) before and after treatment, sex hormone and hemorheology index E2 of both groups decreased significantly, whole blood viscosity, whole blood reduced viscosity and plasma viscosity decreased significantly, the results were statistically significant, but there was no difference between two groups;(3) rank sum test of TCM symptom efficacy between two groups before and after treatment showed that the overall response rate of Chuanxiong Hualiu mixture group was 95%, the overall response rate of Guizhi Fuling Capsule group was 85%, the overall response rate of research group was better than that of control group, and the difference was statistically significant.Conclusion:Chuanxiong Hualiu mixture has good curative effect for the treatment of ovarian cyst, it can effectively improve the patients' blood stasis and phlegm stagnation constitution, and its mechanism of action is associated with lowering estrogen levels and improving hemorrheology.

Takotsubo Cardiomyopathy in a Female Patient After Laparoscopic Oophorocystectomy: a Case Report

TAKOTSUBO cardiomyopathy （TC）, also known as ＂left apical ballooning syndrome＂ and ＂broken heart syndrome＂, has been reported throughout the world occasionally. The major cause of thisdisease is psychological or physical stress, and it has various clinical presentations. In this article, we present a TC case caused by laparoscopic oophorocystectomy.

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.

Management of mucinous cystic neoplasms of the pancreas

The purpose of this study was to investigate the actual management of mucinous cystic neoplasm (MCN) of the pancreas. A systematic review was performed in December 2009 by consulting PubMed MEDLINE for publications and matching the "pancreatic mucinous cystic neoplasm", "pancreatic mucinous cystic tumour", "pancreatic mucinous cystic mass", "pancreatic cyst", and "pancreatic cystic neoplasm" to identify English language articles describing the diagnosis and treatment of the mucinous cystic neoplasm of the pancreas. In total, 16 322 references ranging from January 1969 to December 2009 were analysed and 77 articles were identified. No articles published before 1996 were selected because MCNs were not previously considered to be a completely autonomous disease. Definition, epidemiology, anatomopathological findings, clinical presentation, preoperative evaluation, treatment and prognosis were reviewed. MCNs are pancreatic mucinproducing cysts with a distinctive ovarian-type stroma localized in the body-tail of the gland and occurring in middle-aged females. The majority of MCNs are slow growing and asymptomatic. The prevalence of invasive carcinoma varies between 6% and 55%. Preoperative diagnosis depends on a combination of clinical features, tumor markers, computed tomography (CT), magnetic resonance imaging, endoscopic ultrasound with cyst fluid analysis, and positron emission tomography-CT. Surgery is indicated for all MCNs.

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.

A young women with a large ovarian mass

A dermoid ovarian cyst is the commonest ovarian cystin women of reproductive age. We report a young woman who presented with a large abdominal mass. We discuss the differential diagnosis and surgical management of a large complex ovarian mass in a young woman.

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.

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.

Robotic Removal of a Hypogastric Splenic Cyst. A Case Report and Review of Literature

Background: Splenic cysts are infrequent findings in everyday medical practice. They are usually associated with nonspecific symptoms and the diagnosis is incidental. In most instances they are located in the left subcostal region, except for cases of huge sized cysts which can extend to the whole abdomen or pelvis. Aim: To present a case of a large hypogastric splenic cyst in a nulliparous woman, managed with robotic cystectomy. Review of the literature is included. Case: A 19-year-old woman, presented to the gynecologic department with a painless, palpable mass in the lower abdomen. Ultrasonography revealed a pelvic cystic mass, originally misdiagnosed for an ovarian cyst. Serum biomarkers and?β-hCG were negative. Definite diagnosis was made during explorative laparoscopy where the cyst was found to originate from the spleen. The surgery setup was changed from a lower to upper abdominal procedure. A robotically-assisted cystectomy was performed without concurrent splenectomy, and the splenic cavity was filled with an omental patch. There was no blood loss and the operation time was 163 minutes. Recovery was uneventful and there was no recurrence for a period of 16 months postoperatively. Conclusions: Pelvic splenic cysts are rare, and may be incidental findings during routine abdominal ultrasound scans. Modern minimally invasive approaches such as robotic surgery offer safe and efficient alternatives to standard techniques.

卵巢子宫内膜异位囊肿患者血清及腹腔液中Th1/Th2细胞因子、IL-37、HE4表达及其临床意义

目的:探讨卵巢子宫内膜异位囊肿(OEM)患者血清及腹腔液中辅助性T淋巴细胞(Th1/Th2)细胞因子、白细胞介素-37(IL-37)、人附睾分泌蛋白4(HE4)表达及其临床意义。方法:选择2017年1月-2020年10月行腹腔镜手术治疗的OEM患者102例为OEM组,同期因输卵管阻塞行腹腔镜检查术且盆腔结果正常的患者68例为对照组。检测两组血清与腹腔液中Th1/Th2细胞因子γ干扰素(IFN-γ)、IL-2、IL-4、IL-6、IL-37、HE4水平。结果:OEM组血清IFN-γ、IFN-γ/IL-4低于对照组,IL-4、IL-6、IL-37、HE4高于对照组,腹腔液IFN-γ、IL-2、IFN-γ/IL-4低于对照组,IL-4、IL-6、IL-37、HE4水平高于对照组(均P<0.05)。分期高的OEM患者的血清及腹腔液IFN-γ、IL-2、IFN-γ/IL-4均低于分期早期患者,IL-4、IL-6、IL-37、HE4水平均高于早期患者(均P<0.05)。结论:OEM患者血清及腹腔液中Th1细胞因子低表达而Th2细胞因子、IL-37、HE4高表达,且随OEM疾病分期升高变化增大;Th1/Th2细胞因子失衡及IL-37、HE4过表达可能参与了OEM的发生发展。

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.

Intra-operative consult for cystic struma ovarii—An experience in an academic medical center: A study of 53 cases over 21 years

Struma ovarii often escapes recognition during intraoperative consultation because of its rarity, subtle characteristic gross appearance, and lack of clinical suspicion. An intraoperative diagnosis of benign struma ovarii enables the general gynecologic surgeon to continue the planned surgery. However, a diagnosis of malignnancy in a struma ovarii would alter the course of surgery with the involvement of a gynecologic oncology surgeon. We present here that our experience with intraoperative consultation for preoperatively undiagnosed struma ovarii presenting as an adnexal cystic or solid mass at our teaching hospital. Fifty-three cases of struma ovarii, 5.2% of all cystic teratoma of the same period, were diagnosed between January 1991 and March 2011. All intraoperative consultation reports, gross descriptions and final pathology reports were reviewed. The H&E stained slides and in selected cases, immunohistochemistry stained slides, were reviewed. Of the 53 cases of struma ovarii, intraoperative consultation was requested on 48 cases. Frozen section was done on 24 cases and only gross examination was felt appropriate in remaining 24 cases. 83% cases were diagnosed when a frozen section was done. None of the remaining 24 cases were recognized as struma by gross inspection. Our findings reveal that in a large number of cases the diagnosis of struma ovarii remained unrecognized during intraoperative consultation, indicating its often subtle/deceptive gross morphologic appearance. However, the purpose of the intraoperative consultation was served, as appropriate information was provided to the surgeon to guide the surgical management.

Ovarian torsion—A course for severe abdominal pain in children

Ovarian torsion is a rare, albeit important cause of abdominal pain as it may lead to ovarian necrosis if not resolved. Although it has been described in all ages, it is very rare in young children. The primary symptom is abdominal pain, and due to the abundance hereof in a pediatric setting and the significant overlap in the clinical manifestations between ovarian torsion and more common entities such as appendicitis, a high level of suspicion needs to be maintained. We report the case of a young girl with a history of severe abdominal pain. A primary hospitalization at the age of 1? years resolved quickly and spontaneously without any imaging. At the age of 2 years and 10 months, she was once again hospitalized for severe abdominal pain. A CT scan shoved a large dermoid cyst and possible torsion of the ovary. An exploratory laparotomy confirmed the diagnosis and oophorectomy was performed. Histopathological examination of the cyst demonstrated a 5 × 5 × 6 cm mature cystic teratoma without malignancy. This case illustrates how a high level of suspicion for ovarian torsion needs to be maintained, even in otherwise healthy children.