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Extrauterine adenomyomas are rare tumors that present as uterus-like masses. Uterine adenomyomas can show interval changes according to hormone status. However, interval changes in imaging studies have not been reported in adenomyomas. We report a rare case of an extrauterine adenomyoma showing unique interval changes in magnetic resonance imaging., (Copyright © 2012 Mosby, Inc. All rights reserved.)

Objective: The aim of this study was to assess the complementary use of ultrasonographic end points with the level of circulating CA 125 antigen by multivariate logistic regression analysis algorithms to distinguish malignant from benign adnexal masses before operation., Study Design: One hundred ninety-one patients aged 18 to 93 years with overt adnexal masses were examined by transvaginal ultrasonography with color Doppler imaging and 31 variables were recorded. The end points were the histologic classification of the tumor and the areas under the receiver-operator characteristic curves of alternative algorithms., Results: One hundred forty patients had benign tumors and 51 (26.7%) had malignant tumors: 31 primary invasive tumors (37% International Federation of Gynecology and Obstetrics stage I), 5 tumors of borderline malignancy (100% International Federation of Gynecology and Obstetrics stage I), and 15 tumors were metastatic and invasive. The most useful variables for the logistic regression analysis were the menopausal status, the serum CA 125 level, the presence of >/=1 papillary growth (>3 mm in length), and a color score indicative of tumor vascularity and blood flow. The optimized procedure had a sensitivity of 95.9% and a specificity of 87.1%. The area under the receiver-operator characteristic curve was significantly higher (P <.01) than the corresponding values from the independent use of serum CA 125 levels or indexes of tumor form or vascularity., Conclusion: Regression analysis of a few complementary variables can be used to accurately discriminate between malignant and benign adnexal masses before operation.

A rare neoplasm was described in young white women in 1983. Its gelatinous appearance, histologic characteristics, locally infiltrative nature, and local recurrence are discussed. Twenty-five cases have been previously reported, our case being the first one in the United Kingdom. The value of a preoperative computed tomographic scan and a systematic anatomic, microscopic, and pathologic identification of all perineal tumors are described.

Objective: To establish a relationship between pelvic pain and the stage and severity of pelvic endometriosis determined according to the revised American Fertility Society classification., Study Design: Retrospective study of 618 cases diagnosed by laparoscopy as endometriosis at the Tohoku University Hospital from 1984 to 1991., Results: Pelvic pain did not appropriately reflect the stage and severity of pelvic endometriosis in 40% of patients. Although the pain in some patients in stage IV showed some correlation with the stage and severity of the disease, others had either no symptoms or paradoxically complained of less pain than those patients with stage I or II endometriosis., Conclusions: With the present revised American Fertility Society classification of endometriosis we cannot evaluate the severity of pelvic pain.

Twelve patients with pelvic "lipolymph nodes" were seen at the Mayo Clinic during a period of 26 years. Most of the patients were perimenopausal or postmenopausal, and all but one were obese. The average size of the nodes was 6.6 cm, with the range being 2 to 14 cm. The most frequently involved nodes were the external iliac and obturator groups. Excretory urography and pelvic ultrasound scan (high-resolution scanner) were helpful in determining the extraperitoneal location and the solid nature of the tumors. Lymphangiography performed in one case was helpful in confirming the nodal origin of the pelvic tumor. Exploratory laparotomy was required to determine the exact nature of the lesion in all patients. The treatment consisted of simple removal of the involved nodes. No recurrences have been observed.

Two small series of cases documenting ultrasound misdiagnoses are presented. The first concerns obstetric ultrasound misdiagnoses originating in the private offices of physicians. The second concerns gynecologic ultrasound misdiagnoses originating in a level II medical center. A dichotomy exists in the use of diagnostic ultrasound examination in the practice of obstetrics and gynecology. The dichotomy is a serious defect in our specialty that needs urgent addressing. The institutional problem can be partially resolved by furnishing the sonographer with the referred patient's history and physical findings. The problem of the ultrasound machine in the office of a private physician is much more complex. It may require government intervention and strict licensing measures for resolution.

The use of danazol (Danocrine) appears to be the most effective medical form of therapy for endometriosis. A double-blind study on 32 patients with laparoscopically proved pelvic endometriosis was designed to evaluate the immediate short-term and long-term effectiveness of daily dosages of danazol (100, 200, 400, and 600 mg) on the amelioration of the disease, with the use of posttreatment surgical findings and symptomatic changes. The American Fertility Society classification based on a point system was used. The clinical and surgical improvement rates varied from 75% to 85% and 50% to 70%, respectively. Ovarian endometriomas of even 1 cm in size generally do not respond to danazol. The pregnancy rate was 45%. We have demonstrated that lower than maximum doses of danazol produce similar beneficial effects in the treatment. With the low dosages, we did not achieve freedom from side-effects. The average symptomatic recurrence rate was 36%, with a mean duration of 19 months of follow-up, and was dose dependent.

Presented is the case of a patient with inguinal endometriosis adjacent to a hernia sac in whom laparoscopy revealed no evidence of pelvic endometriosis.

Because of the recent reports indicating the high incidence of unsuspected diaphragmatic metastases in presumed localized ovarian cancer, we have carried out peritoneoscopy on 14 consecutive patients referred with the diagnosis of Stage I or II ovarian cancer. Of the 14 women none was demonstrated to have diaphragmatic metastases, but 35 per cent were found to have cytologic washings demonstrating malignant cells. The significance of these findings is discussed.

When a 32-year-old woman was first seen, physical findings suggested she had a large levator hernia, but at the time of surgical resection an aggressive angiomyxoma was found.

Thirty-six large cystic masses of pelvic origin were evaluated by means of gray-scale ultrasonography. The goal was to determine which sonographic criteria would help establish whether a lesion was malignant or benign, to further characterize it into ovarian neoplasms (cystadenoma, teratoma), inflammatory lesions (tuboovarian abscess), and blood-containing lesions (hematocolpos, hematoma). Eighty-three percent of the masses were benign, and 72% were of ovarian origin. Fifty-six percent of the masses were found in women 11 to 30 years old. Although no pathognomonic patterns were discovered, the application of certain sonographic criteria may narrow the differential diagnoses considerably.

Endometriosis has heretofore been considered rare in black women. Laparoscopy in 190 black women, in many of whom pelvic inflammatory disease was previously diagnosed clinically and treated, revealed endometriosis to be present in 21 per cent. The importance of this finding for clinical practice is discussed.

Review of the literature revealed 42 patients with uterine hemangiopericytoma (HPC) and nine with extrauterine tumors. Three additional patients with uterine and one with extrauterine are described. The primary treatment should be aggressive surgery, but high doses of irradiation and chemotherapy may be of benefit in extensive disease or recurrences. The prognosis of uterine HPC is better than that of the extrauterine tumors. Cells from the extrauterine tumor were grown in tissue culture. The culture consisted of two cell types resembling pericytes and endothelial cells. The cells in culture retain most of the ultrastructural characteristics of the in vivo tumor.