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Introduction: Adenomatoid tumours are the most common benign mesothelial neoplasms of the fallopian tube. They are usually diagnosed incidentally in specimens submitted for bilateral tubal ligation and can be mistake for vascular or epithelial lesions. Materials and methods: A retrospective analysis of cases with adenomatoid tumour of the fallopian submitted for tubal ligation from 2012 to 2020. The clinicopathological characteristic data was retrieved from the laboratory information system. Results: A total of 11 cases with adenomatoid tumour of the fallopian tubes submitted for tubal ligation were identified in women with average age of 30.9 years. In all the cases, only 1 fallopian tube was affected. Grossly, the fallopian tubes did not show any discernible tumour. Immunohistochemical stains confirmed the diagnosis of adenomatoid tumours in all the cases. Conclusion: Adenomatoid tumours in fallopian tubes are infrequent, and pathologists shouldn't overlook them especially in unsuspicious instances. As frequent as adenomatoid tumour of the fallopian tubes are uncommon, pathologists show be aware of as their misdiagnosis could lead mismanagement of patient with far reaching complication. [ABSTRACT FROM AUTHOR]

This review is intended to serve as an aid in decision-making and patient counseling for the reproductive urologist when female factor infertility is found concurrently with male factor infertility. This review pairs the pathophysiology of female infertility with its implications for the treatment of male infertility, which most commonly includes ovulatory disorders, tubal abnormalities, and uterine abnormalities. By gaining a deeper understanding of these factors, reproductive urologists can employ a tailored approach to managing male factor infertility, taking into account the female partner's specific medical history. [ABSTRACT FROM AUTHOR]

Primary fallopian tube carcinoma is an uncommon female genital tract malignancy that resembles epithelial ovarian neoplasm clinically and radiologically. We present a case of 49-year-old woman with postmenopausal intermittent vaginal bleeding, lower abdominal pain, and pelvic mass for 3 months. On physical examination, lower abdominal tenderness was found. Ultrasound examination revealed bilateral hydrosalpinx with hematometra. Her serum cancer antigen-125 was raised (190.0 U/ml). With the clinical diagnosis of endometrial cancer, patient underwent total abdominal hysterectomy with bilateral salpingo-oopherectomy, infracolic omentectomy and rectal deposit biopsy. Microscopic examination showed features of serous adenocarcinoma of the fallopian tube. Histologically, it is indistinguishable from primary ovarian malignancy. On post-surgical follow up at one year the patient is disease free. Here we report this rare entity and review the literature to highlight the preoperative clinical diagnostic difficulties. [ABSTRACT FROM AUTHOR]

Background: Hao-Fountain syndrome is a neurodevelopmental disorder characterized by global developmental delay, variably impaired intellectual development with significant speech delay and, in some males patients, it has been reported an association with hypogonadism. At present less than 50 cases are reported in literature. Case presentation: We report a case of this rare syndrome in a young female with isolated tubal torsion; our patients had different hospitalizations without treatment but during the last episode we decide to perform an abdominal surgical explortion. This is the first case in Literature with a new USP7 mutation. Conclusions: This case opens new perspective in this rare syndrome and a review approach to isolated tubal torsion. These symptoms should be always well checked. [ABSTRACT FROM AUTHOR]

Simple Summary: Diagnosis and treatment of ovarian cancers has changed significantly over the last years. However, the role of primary surgery and chemotherapy remain important parts of the multimodal treatment. Furthermore, real life data are often lacking but are very important for improving quality indicators and for hypothesis generation for future trials. The present work represents the first major analysis of federal cancer registry data of OC patients in Germany. Overall, 2771 primary OC cases were included. The results clearly elucidate quality measurements and treatment results and show good treatment outcomes in patients with primary OC compared to other internationally reported outcomes. Background: The current therapy of ovarian cancer is based on the so-called "Three-Pillar-Model", consisting of surgery, chemotherapy and maintenance therapy. This study represents the first major analysis of a federal cancer database of OC patients from the states Berlin/Brandenburg in Germany. The primary objective was to evaluate the prevailing established quality indicators surgical outcome, adjuvant chemotherapy and integrity of surgical staging in early stages. Methods: Data from the Clinical Cancer Registry for Brandenburg and Berlin of the years 2009–2019 were analyzed. Objectives were defined by a working group of selected physicians. Descriptive statistics were performed, as well as survival analysis. Results: A total of 2771 primary OC cases were included. Results regarding histological subtype met the suspected allocation with predominantly high-grade serous OC in advanced stage. The rate of complete surgical staging in FIGO stages I–IIA was 57%, and the rate of macroscopic complete resection in >FIGO III was 53%. Five-year survival rate varied from 79% (FIGO I) to 40% (FIGO III). Rate of adjuvant chemotherapy was above 50%. Conclusion: The results elucidate quality measurements and treatment results and show good treatment outcomes in patients with primary diagnosis. However, they also indicate deficits and can help to establish new quality indicators to further improve the treatment. [ABSTRACT FROM AUTHOR]

Yolk sac tumors (YSTs) of the ovary are rare neoplasms, accounting for less than 0.2% of all ovarian tumors. Although this malignancy is much rarer in children, pediatric cases are attributed to a poorer prognosis. Diagnosis of YST is often made by post-operative pathologic examination. The prevalent clinical presentations include fever, distended abdomen or asymptomatic abdominal mass. YST rarely coexists with involvement of fallopian tube and this entity is rare in children. The present research was conducted to present a rare case of ovarian YST in an 8-month-old female infant with involvement of fallopian tube. This report, presents a rare case of YST in terms of its clinical presentation, histopathology findings, imaging findings, diagnosis, and treatment. The patient underwent surgical resection of the mass, followed by pathological examination, which confirmed an ovarian YST. To the best of our knowledge, this case is the youngest case of ovarian YST with the involvement of the fallopian tube reported in literature. [ABSTRACT FROM AUTHOR]

Simple Summary: The mainstay of therapy for primary advanced ovarian, fallopian tube, and primary peritoneal carcinoma is cytoreductive surgery (CRS) and platinum-containing chemotherapy. Since the primary and recurrent disease is mainly confined to the peritoneal cavity, intraperitoneal chemotherapy with or without hyperthermia has been evolved in order to improve survival. However, the studies to date are mainly retrospective, nonrandomized, and heterogeneous in terms of patient selection. There are currently only a limited number of reliable data on the role of hyperthermic intraperitoneal chemotherapy (HIPEC), its ideal timing of application, and duration. The aim of this study was to report our single-center experience with CRS + HIPEC involving patients with primary FIGO stage ≥ III B epithelial carcinoma. Hereby, multimodal therapy was feasible with acceptable morbidity and mortality, with no difference in overall survival between interval and upfront surgery. However, prolongation of HIPEC was shown to provide survival benefits regardless of previous administration of chemotherapy. Background: The usage of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for advanced gynecological cancers is increasing. Methods: Prospectively collected data of 85 advanced primary ovarian/fallopian tube cancer and peritoneal carcinoma patients of a single center were investigated. Results: A total 48, 37, 62, and 25 patients were enrolled into the HIPEC with/without neoadjuvant chemotherapy (upfront vs. interval) and into the 60 min and 90 min long HIPEC groups, respectively. Better overall survival (OS) was observed in the 90 min HIPEC group (p = 0.0330), compared to the 60 min HIPEC group. Neither OS (p = 0. 2410), disease-specific (p = 0. 3670), nor recurrence-free survival (p = 0.8240) differed between upfront and interval HIPEC. Higher peritoneal carcinomatosis index (PCI) values were associated with worse disease-specific survival (p = 0.0724). Age (p = 0.0416), body mass index (p = 0.0044), PCI (p < 0.0001), the type (p = 0.0016) and duration (p = 0.0012) of HIPEC, and increased perioperative morbidity (p < 0.0041) had the greatest impact on OS. Conclusions: Increasing data support the value of HIPEC in the treatment of advanced ovarian cancer. Ongoing prospective studies will definitively clarify the role and timing of this additional therapeutic approach. [ABSTRACT FROM AUTHOR]

Background: This study aims to provide guidance for the use of neoadjuvant and adjuvant systemic therapy in women with newly diagnosed stage II–IV epithelial ovary, fallopian tube, or primary peritoneal carcinoma. Methods: EMBASE, MEDLINE, and Cochrane Library were investigated for relevant systematic reviews and phase III trials. Articles focusing on consolidation and maintenance therapies were excluded. Results: For women with potentially resectable disease, primary cytoreductive surgery, followed by six to eight cycles of intravenous three-weekly paclitaxel and carboplatin is recommended. For those with a high-risk profile for primary cytoreductive surgery, neoadjuvant chemotherapy can be an option. Adjuvant chemotherapy with six cycles of dose-dense weekly paclitaxel plus three-weekly carboplatin can be considered for women of Japanese descent. In women with stage III or IV disease, the incorporation of bevacizumab concurrent with paclitaxel and carboplatin is not recommended for use as adjuvant therapy unless bevacizumab is continued as maintenance therapy. Intravenous paclitaxel plus intraperitoneal cisplatin and paclitaxel can be considered for stage III optimally debulked women who did not receive neoadjuvant chemotherapy. However, intraperitoneal administration of chemotherapy with bevacizumab should not be considered as an option for stage II–IV optimally debulked women. Discussion: The recommendations represent a current standard of care that is feasible to implement and valued by both clinicians and patients. [ABSTRACT FROM AUTHOR]

Introduction: The World Health Organization estimated that approximately 48 million couples and 186 million people are infertile worldwide. Although the problem of infertility is increasing worldwide, as well as in Ethiopia, there are limited studies done. Therefore, this study aims to determine the magnitude of infertility and the major risk factors in three governmental hospitals in Addis Ababa, Ethiopia.Method: An institutional-based cross-sectional study design was used to conduct the study. The participants were selected by using a systematic random sampling technique. Data were collected through an interview using a structured questionnaire. The data were entered into Epi Data version 3.1 and exported to SPSS version 25 for analysis. Logistic regression was used to identify the predictor variables. Statistical significance was considered at a P < 0.05 with an adjusted odds ratio calculated at 95% CI.Result: The overall prevalence of infertility was 27.6% (95%CI = 23.2, 32.0). Of these, 14.4% had primary infertility, and 13.2% had secondary infertility. Those whose duration of marriage was less than 60 months [AOR = 3.85; 95%CI 1.39, 10.64], had a history of fallopian tube obstructions [AOR = 8.27; 95%CI 2.36, 28.91], had irregular frequency of coitus [AOR = 37.4; 95%CI 11.29, 124.114], had more than one sex partner [AOR = 3.51; 95%CI 1.64, 7.54], had an abortion greater than 3 times [AOR = 6.89; 95%CI 1.28, 37.09], and had partners who currently consumed alcohol [AOR = 1.31; 95%CI 1.11, 1.86] were more likely to be infertile than their counterparts.Conclusion: According to the results of this study, the prevalence of infertility was high compared to the global estimate of the World Health Organization. The government, health care providers, and researchers should emphasize developing appropriate strategies, research, education, and awareness creation of infertility and its potential causes. [ABSTRACT FROM AUTHOR]

Background: Isolated fallopian tube torsion (IFTT) is a rare cause of gynecological acute abdomen, is easily misdiagnosed and often has a delay in diagnosis. IFTT with paraovarian cysts is most frequently reported in studies. Here, we reported a patient diagnosed with IFTT associated with a paraovarian cyst, and we conducted a literature review for IFTT, aiming to identify valuable information that will be helpful for diagnosis and treatment for fallopian tube torsions.Case Presentation: A 13-year-old girl presented with a 10-day history of right lower abdominal pain that worsened 2 days before presentation. On presentation, ultrasound showed a 5.8 * 5.5 cm hypoechoic cyst adjacent to the right ovary, and between the cyst and ovary, a tortuous thickened tube was visualized. Laparoscopy revealed a triple torsion of the right fallopian tube with a 6-cm paraovarian cyst, and tubal conservation surgery was performed. The postoperative course was uneventful. Histopathological diagnosis revealed serous papillary cystadenoma.Conclusion: Paraovarian cystic dilatation often occurs in adolescence and can induce fallopian torsion when the size of the cyst reaches 5-cm. In our review, the median age of patients diagnosed with IFTT with paraovarian cysts was 15 years old, and the main clinical manifestation was emergency abdominal pain. The associated symptoms were variable, and vomiting was the most commonly associated symptom. Salpingectomy was the most common procedure performed; however, timely surgical intervention can effectively avoid salpingectomy. [ABSTRACT FROM AUTHOR]

Background: Sactosalpinx means a collection of fluid (serum, blood or pus) in the fallopian tube. CAH (Congenital Adrenal Hyperplasia) is a typical 46XX DSD (Disorder of Sex Development) due to a steroidogenic enzymatic defect. Both conditions are rare and can lead to reduced fertility rate. Case presentation: We describe two post-menarche virgin girls with CAH who were hospitalized for acute abdomen due to laparoscopically confirmed sactosalpinx. Case 1 recovered after conservative management, case 2 after a second-look and bilateral salpingectomy. The first case consisted of right sactosalpinx and previous peritonitis reported; the second one of bilateral symptomatic pyosalpinx and previous vaginal stenosis. Recurrent abdominal pain persisted at follow-up in Case 1: post-operative MRI (Magnetic Resonance Imaging) showed bilateral hydrosapinx that disappeared at a following ultrasound scan control. Follow-up was uneventful 36 months after surgery in Case 2, except for the surgical revision of the vaginal introitus. Conclusions: CAH-sactosalpinx association is a very rare but not negligible event. We suggest a conservative approach for sactosalpinx if tubal and/or ovary torsion can be excluded. Pyosalpinx is more challenging to treat, but during pediatric age we suggest starting with a conservative approach, especially in patients with CAH who have a potential low fertility rate. Careful gynecological follow-up after menarche is recommended to rule out any further causes of infertility. [ABSTRACT FROM AUTHOR]

This document reviews surgical options for reparative tubal surgery and the factors that must be considered when deciding between surgical repair and in vitro fertilization. This document replaces the document of the same name, last published in 2012 (Fertil Steril 2015;103:e37-43). This document reviews surgical options for reparative tubal surgery and the factors that must be considered when deciding between surgical repair and in vitro fertilization. [ABSTRACT FROM AUTHOR]

Study Question: What is the effect of salpingectomy for ectopic pregnancy or hydrosalpinx at a young age on ovarian cancer risk compared to no salpingectomy for any reason?Summary Answer: We found no significant reduction in ovarian cancer risk after salpingectomy for ectopic pregnancy or hydrosalpinx.What Is Known Already: Salpingectomy may reduce ovarian cancer incidence, although the lag-time between intervention and therapeutic effect remains to be elucidated.Study Design, Size, Duration: This nationwide population-based database study uses the Dutch pathology database to identify all women who underwent salpingectomy for ectopic pregnancy or hydrosalpinx between January 1990 and December 2012 and compared ovarian cancer incidence to a control group of women who had a benign dermal nevus removed, matched for age at the time and year of procedure.Participants/materials, Setting, Methods: After selection and manual control of intervention and control group, ovarian cancer incidence was recorded. Hazard ratios (HRs) with 95% CI for the development of ovarian cancer were calculated with Cox regression analyses, both unadjusted and adjusted for age. Subgroup analyses were performed to investigate lag-time between intervention and protective effect.Main Results and the Role Of Chance: In all, 18 961 women were included in the intervention group; 17 106 women had a unilateral salpingectomy and 1855 had a bilateral salpingectomy. The control group consisted of 23 686 women. With 14 ovarian cancer cases in the intervention group, the incidence rate (IR) of ovarian cancer was 5.4 (95% CI 3.1-8.9) per 100 000 person-years. In the control group, there were 24 ovarian cancer cases, resulting in an IR of 7.1 (95% CI 4.7-10.5) per 100 000 person-years (P = 0.34). The age-adjusted HR for ovarian cancer was 0.76 (95% CI 0.39-1.47) after salpingectomy. Unilateral salpingectomy resulted in an age-adjusted HR of 0.81 (95% CI 0.41-1.59) and bilateral salpingectomy resulted in an age-adjusted HR of 0.43 (95% CI 0.06-3.16) based on one case. None of our subgroup analysis for lag-time resulted in a significant difference in ovarian cancer incidence between intervention and control group. The difference in ovarian cancer incidence appeared largest in women with at least 8 years of follow-up (P = 0.08).Limitations, Reasons For Caution: Due to the young population, ovarian cancer incidence is low, even at the end of follow-up. Furthermore, due to the anonymous nature of the pathology registry, we were unable to adjust for confounding factors.Wider Implications Of the Findings: Although results did not reach statistical significance, they add to the available data on ovarian cancer incidence after salpingectomy. Our subgroup analysis suggests there may be no benefit in the first years following salpingectomy.Study Funding/competing Interest(s): None.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]

Background: Primary fallopian tube carcinoma (PFTC) is a malignant tumor of the female genital tract that mostly presents intraperitoneal dissemination in clinical practice. The incidence of upper anterior mediastinal metastasis in PFTCs is extremely rare. We herein report a rare case of PFTC mediastinal metastasis after radical resection. When anterior mediastinal metastasis of an unknown origin is encountered, the possibility of PFTC should be considered.Case Presentation: A 68-year-old female who was previously diagnosed with PFTC after radical resection of a primary tumor in the fallopian tube was admitted to our department with a right anterior mediastinum mass. Radical resection of the mediastinal mass was performed, and poorly differentiated metastatic adenocarcinoma of the fallopian tube was confirmed. There was no recurrence in the 24 months after the curative operation.Conclusion: To our knowledge, no mediastinal metastasis of PFTC has been reported yet. Thus, we presented this rare case indicating the heterogeneity of this malignant disease and to draw attention to the occasional distant metastasis of PFTC in clinical practice. [ABSTRACT FROM AUTHOR]

An interstitial pregnancy that continues beyond the second trimester is a rare phenomenon. We report a patient with an interstitial pregnancy undiagnosed until the third trimester. A multiparous woman was referred to us because of preeclampsia at 26 weeks of gestation. The placental position was the right fundus, and color Doppler ultrasound revealed myometrial thinning and subplacental hypervascularity, leading to a suspicion of placenta accreta spectrum (PAS). Emergency cesarean section was performed at 281/7 weeks of gestation due to severe preeclampsia. The right tubal horn to the isthmus of the fallopian tube bulged with placental adhesion and a part of the tube had ruptured, with the omentum adhering to the ruptured part. Interstitial and tubal isthmic pregnancy with uterine rupture was diagnosed. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of a history of previous naturally conceived tubal ectopic pregnancy (TEP) on subsequent IVF/intracytoplasmic sperm injection (ICSI) pregnancy and perinatal outcomes.Design: Retrospective cohort study.Setting: Reproductive medicine center in a tertiary hospital.Patient(s): A total of 2,892 women with tubal infertility undergoing the first fresh IVF/ICSI cycle.Intervention(s): Women were stratified into three groups according to the type of previous naturally conceived pregnancy: TEP, intrauterine pregnancy (IUP), and no pregnancy.Main Outcomes Measure(s): Pregnancy and neonatal outcomes were analyzed for each cohort and stratified into the following categories based on female age: <30 years, 30-35 years, and ≥35 years.Result(s): Of the 2,892 patients with tubal factor infertility, 511 (17.7%) women had a history of TEP, 1,044 (36.1%) had prior IUP, and 1,337 (46.2%) had never been pregnant. Couples with an initial TEP tended to be younger and had experienced a shorter duration of infertility. Across the whole cohort, the optimal live birth rate decreased in older age groups. Live birth rates stratified by maternal age (<30, 30-35, ≥35 years) did not differ between the TEP group (59.9%, 53.7%, 45.5%) and the IUP (62.0%, 53.8%, 40.6%) and no pregnancy group (56.7%, 54.4%, 45.6%). This did not change after adjusting for confounders such as age and years of infertility. Previous treatment of TEP with salpingectomy, salpingostomy, or medical treatment did not significantly affect subsequent fertility outcomes. The rates of preterm and low birth weight after TEP were also not significantly higher than in women with a previous IUP.Conclusion(s): Fertility history, including previous TEP, does not influence the probability of live birth after IVF/ICSI in women with tubal factor infertility. [ABSTRACT FROM AUTHOR]

Study Question: Does a previous Caesarean section affect reproductive outcomes, including live birth, in women after IVF or ICSI?Summary Answer: A previous Caesarean section impairs live birth rates after IVF or ICSI compared to a previous vaginal delivery.What Is Known Already: Rates of Caesarean sections are rising worldwide. Late sequelae of a Caesarean section related to a niche (Caesarean scar defect) include gynaecological symptoms and obstetric complications. A systematic review reported a lower pregnancy rate after a previous Caesarean section (RR 0.91 CI 0.87-0.95) compared to a previous vaginal delivery. So far, studies have been unable to causally differentiate between problems with fertilisation, and the transportation or implantation of an embryo. Studying an IVF population allows us to identify the effect of a previous Caesarean section on the implantation of embryos in relation to a previous vaginal delivery.Study Design, Size, Duration: We retrospectively studied the live birth rate in women who had an IVF or ICSI treatment at the IVF Centre, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands, between 2006 and 2016 with one previous delivery. In total, 1317 women were included, of whom 334 had a previous caesarean section and 983 had previously delivered vaginally.Participants/materials, Setting, Methods: All secondary infertile women, with only one previous delivery either by caesarean section or vaginal delivery, were included. If applicable, only the first fresh embryo transfer was included in the analyses. Patients who did not intend to undergo embryo transfer were excluded. The primary outcome was live birth. Multivariate logistic regression analyses were used with adjustment for possible confounders ((i) age; (ii) pre-pregnancy BMI; (iii) pre-pregnancy smoking; (iv) previous fertility treatment; (v) indication for current fertility treatment: (a) tubal, (b) male factor and (c) endometriosis; (vi) embryo quality; and (vii) endometrial thickness), if applicable. Analysis was by intention to treat (ITT).Main Results and the Role Of Chance: Baseline characteristics of both groups were comparable. Live birth rates were significantly lower in women with a previous caesarean section than in women with a previous vaginal delivery, 15.9% (51/320) versus 23.3% (219/941) (OR 0.63 95% CI 0.45-0.87) in the ITT analyses. The rates were also lower for ongoing pregnancy (20.1 versus 28.1% (OR 0.64 95% CI 0.48-0.87)), clinical pregnancy (25.7 versus 33.8% (OR 0.68 95% CI 0.52-0.90)) and biochemical test (36.2 versus 45.5% (OR 0.68 95% CI 0.53-0.88)). The per protocol analyses showed the same differences (live birth rate OR 0.66 95% CI 0.47-0.93 and clinical pregnancy rate OR 0.72 95% CI 0.54-0.96).Limitations, Reasons For Caution: This study is limited by its retrospective design. Furthermore, 56 (16.3%) cases lacked data regarding delivery outcomes, but these were equally distributed between the two groups.Wider Implications Of the Findings: The lower clinical pregnancy rates per embryo transfer indicate that implantation is hampered after a caesarean section. Its relation with a possible niche (caesarean scar defect) in the uterine caesarean scar needs further study. Our results should be discussed with clinicians and patients who consider an elective caesarean section.Study Funding/competing Interest(s): Not applicable.Trial Registration Number: This study has been registered in the Dutch Trial Register (Ref. No. NL7631 http://www.trialregister.nl). [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic precision of hysterosalpingography in the diagnosis of fallopian tube pathology among infertile females using laparoscopy as yardstick. Study Design: Cross sectional validation study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Pak Emirates Military Hospital Rawalpindi, from Feb 2015 to Aug 2015. Methodology: Two hundred thirty patients who presented with infertility in Armed Forces Institute of Radiology and Imaging and satisfying the inclusion and exclusion criteria, were included. Informed consent was obtained before undergoing investigations, hysterosalpingography was performed at Armed Forces Institute of Radiology and Imaging and Laparoscopy by Gynecologist at Pak Emirates Military Hospital Rawalpindi. Results: Total 230 patients were enrolled, ages were 32.39 ± 6.30 years. Frequency of tubal pathology in infertile women (on yardstick test) was recorded in 61 (26.52%). Diagnostic precision of hysterosalpingography for diagnosis of tubal pathology in infertile females taking laparoscopic findings as yardstick was recorded, true positive cases were 50 (21.74%), 11 (4.78%) were false negative, 20 (8.70%) were false positive and 149 (64.78%) were true negative. Sensitivity, specificity, positive predictive value and negative predictive value were calculated as 81.97%, 88.17%, 71.43% and 88.17% respectively. Conclusion: There was higher diagnostic precision of hysterosalpingography in the diagnosis of fallopian tube pathology. [ABSTRACT FROM AUTHOR]

Aim To present diagnostic and therapeutic possibilities for genital and peritoneal tuberculosis, mimicking to other pathological conditions, mainly, ovarian cancer. Methods Transabdominal and transvaginal ultrasound, computerized tomography, Ca125 and HE 4, ROMA- index (Risk of Ovarian Maligancy Algorithm index) and diagnostic laparoscopy were performed in order to diagnose genital tuberculosis in a female patient. Results: A 23-year-old woman from Morocco presented with intermitting abdominal pain, unintentional weight loss and primary infertility. There was no positive family history for breast or ovarian cancer and no history of previous tuberculosis (TB). Elevated CA-125 level, HE 4 normal, ROMA-Index of 13.2% suggested high risk for epithelial ovarian cancer (EOC). Ultrasound revealed free fluid, dilated fallopian tubes and a cystic mass near the right ovary. Suspecting fallopian tube or ovarian cancer, we performed exploratory laparoscopy, revealing adhesions, multiple miliary nodes and dilated fallopian tubes. Histological investigation revealed granulomatous abscessing salpingitis with suspicion of genital TB, so antituberculous therapy was administered with success. Conclusion Female genital tuberculosis is very rare but important in differential diagnosis and should be kept in mind regarding suspected fallopian tube or ovarian carcinoma to prevent women from extensive surgery. An algorithm for possible differentiation between peritoneal/female genital TB and EOC may be helpful in clinical setting. [ABSTRACT FROM AUTHOR]

Introduction: To assess the clinical impact of preoperative fludeoxyglucose (FDG) with positron emission tomography (PET) and computed tomography (CT) in women with ovarian, fallopian tube, or peritoneal cancer with focus on consequences of added findings (AFs).Material and Methods: FDG-PET/CT was implemented as a standard imaging modality for women with newly diagnosed ovarian, fallopian tube, or peritoneal cancer at our institution in 2008. After full implementation, all preoperative scans were reviewed and AFs were evaluated from January 2011 to December 2012. Decisions regarding further examination made at the first multidisciplinary team conference were recorded. Subsequent procedures were tracked via medical records, and the impact of AFs on additional examinations, delay, and change in treatment plans was evaluated.Results: Forty-four (21.1%) of 209 women presented with AFs. Further examination was performed in 35/44 (79.5%). Malignancy was identified in 15/35 (42.9%), revealing metastases from ovarian, fallopian tube, or peritoneal cancer in 11, a synchronous primary cancer in 3, and recurrence of a previous cancer in 1 woman. The ovarian, fallopian tube, or peritoneal cancer metastases were localized in the lungs, uterus, colon, vagina, and breasts. The remaining 20 AFs revealed 2 benign lesions and 1 pre-malignant lesion, whereas no abnormality was found in 17. Further examination of AFs resulted in a significant time delay until treatment start of median 4 days (range 1-83 days, P < 0.004).Conclusions: Further examinations of AFs by FDG-PET/CT delayed time to start of treatment by median 4 days in women with newly diagnosed ovarian, fallopian tube, or peritoneal cancer in a contemporary institution with fast-track access to additional diagnostics. The clinical implications of this must be balanced against the gain of detecting unrecognized malignancy in 15 of 209 women (7.2%). [ABSTRACT FROM AUTHOR]

Myeloid sarcoma (MS) is a rare, extramedullary tumor consisting of immature white blood cells of myeloid lineage. MS is usually associated with the concurrent diagnosis of acute myeloid leukemia (AML) but can also present in the absence of bone marrow disease or at relapse of AML. MS of the gynecologic tract is exceedingly rare; however, it is hypothesized that it is likely more prevalent than previously understood given postmortem findings and persistence in preserved ovarian tissue. There is minimal literature surrounding MS and extramedullary relapse with no clear guidelines. This is a case report of a 48-year-old woman with MS involving the uterine corpus, fallopian tubes, and left ovary followed by a literature review. The overall aim is to review data regarding leukemic immune evasion and sanctuary sites in order to raise awareness as this represents an important and underrecognized hematologic malignancy in an often misdiagnosed, underrecognized site. [ABSTRACT FROM AUTHOR]

Study Question: Does pain or volume of used contrast medium impact the effectiveness of oil-based contrast during hysterosalpingography (HSG)?Summary Answer: In women who report moderate to severe pain during HSG, the use of oil-based contrast resulted in more ongoing pregnancies compared to the use of water-based contrast, whereas in women who reported mild or no pain, no difference in ongoing pregnancies was found.What Is Known Already: We recently showed that in infertile women undergoing HSG, the use of oil-based contrast results in more ongoing pregnancies within 6 months as compared to the use of water-based contrast. However, the underlying mechanism of this fertility-enhancing effect remains unclear.Study Design, Size, Duration: We performed a post-hoc analysis of the H2Oil study, a multicentre randomised controlled trial (RCT) evaluating the therapeutic effect of oil- and water-based contrast at HSG. Here, we evaluated the impact of pain experienced at HSG and volume of used contrast media during HSG on ongoing pregnancy.Participants/materials, Setting, Methods: In a subset of 400 participating women, pain during HSG by means of the Visual Analogue Scale (VAS) (range: 0.0-10.0 cm) was reported, while in 512 women, we registered the volume of used contrast (in millilitres). We used logistic regression analyses to assess whether pain and volume of used contrast media modified the effect of oil-based contrast on ongoing pregnancy rates. Data were analysed according to intention-to-treat principle.Main Results and the Role Of Chance: In 400 women in whom pain scores were reported, the overall median pain score was 5.0 (Interquartile range (IQR) 3.0-6.8) (oil group (n = 199) 4.8 (IQR 3.0-6.4); water group (n = 201) 5.0 (IQR 3.0-6.7); P-value 0.28). There was a significant interaction between pain (VAS ≤5 versus VAS ≥6) and the primary outcome ongoing pregnancy (P-value 0.047). In women experiencing pain (VAS ≥6), HSG with oil-based contrast resulted in better 6-month ongoing pregnancy rates compared to HSG with water-based contrast (49.4% versus 29.6%; RR 1.7; 95% CI, 1.1-2.5), while in women with a pain score ≤5, 6-month ongoing pregnancy rates were not significantly different between the use of oil- (28.8%) versus water-based contrast (29.2%) (RR 0.99; 95% CI, 0.66-1.5). In the 512 women in whom we recorded contrast, median volume was 9.0 ml (IQR 5.7-15.0) in the oil group versus 8.0 ml (IQR 5.9-13.0) in the water group, respectively (P-value 0.72). Volume of used contrast was not found to modify the effect of oil-based contrast on ongoing pregnancy (P-value for interaction 0.23).Limitations, Reasons For Caution: This was a post-hoc analysis that should be considered as hypothesis generating. The RCT was restricted to infertile ovulatory women, younger than 39 years of age and with a low risk for tubal pathology. Therefore, our results should not be generalised to infertile women who do not share these features.Wider Implications Of the Findings: The underlying mechanism of the fertility-enhancing effect induced by HSG with the use of oil-based contrast remains unclear. However, these findings suggest a possible mechanistic pathway, that is increasing intrauterine pressure occurring prior to dislodging pregnancy hindering debris or mucus plugs from the proximal part of otherwise normal fallopian tubes. This information might help in the search of the underlying fertility-enhancing mechanism found by using oil-based contrast during HSG.Study Funding/competing Interest(s): The original H2Oil RCT was an investigator-initiated study that was funded by the two academic institutions (AMC and VUmc) of the Amsterdam UMC. The funders had no role in study design, collection, analysis and interpretation of the data. K.D. reports consultancy for Guerbet. H.V. reports consultancy fees from Ferring. C.B.L. reports speakers' fees from Ferring and research grants from Ferring, Merck and Guerbet. V.M. reports receiving travel and speakers fees as well as research grants from Guerbet. B.W.M. is supported by an NHMRC Practitioner Fellowship (GNT1082548). B.W.M. reports consultancy for ObsEva, Merck KGaA and Guerbet and travel and research grants from Merck KGaA and Guerbet. The other authors do not report conflict of interests.Trial Registration Number: The H2Oil study was registered at the Netherlands Trial Registry (NTR 3270).Trial Registration Date: 1 February 2012.Date Of First Patient’s Enrolment: 3 February 2012. [ABSTRACT FROM AUTHOR]

Background: Although detecting ovarian cancer at early stage is a highly meaningful clinical goal, no studies have evaluated early stage disease presentation in a large community‐based population and how it differs from that of late stage disease. Methods: Electronic medical records were evaluated for women diagnosed with ovarian or fallopian tube cancer in 2016 and 2017 to identify the first imaging study to detect disease. Women being followed prior to diagnosis for known genetic risk from BRCA or other mutation were excluded. The visit in which the imaging test was ordered and related encounters were reviewed to determine the indication for imaging. Patient characteristics, presenting symptoms and duration, and modality of first abnormal imaging were compared for early vs late stage ovarian cancer and by provider specialty. Results: Of 540 women with ovarian cancer, 190 (35%) were diagnosed with early stage disease, of whom 141 (74%) were symptomatic, with 45% of women presenting to internists, 33% to gynecologists, and 20% to emergency medicine physicians. Pelvic ultrasonography detected only 23% of late stage cases whereas pelvic ultrasonography and abdominal pelvic computed tomography (CT) each detected 47% of early stage cases. While abdominal pain and bloating were common to both women with early and late stage cancer, women with early stage disease were younger (58 vs 64 years, P < .0001), more likely to present to gynecologists (33% vs 15%, P < .001) and complained more often of a palpable mass (17% vs 6%, P < .0001) or postmenopausal bleeding (11% vs 5%, P < .001). Conclusions: Excluding women with genetic predisposition to ovarian cancer known prior to diagnosis, approximately three out of four cases of early stage ovarian cancer are detected as the result of evaluation of symptoms and one in four cases are detected incidentally. Abdominal pelvic CT and pelvic ultrasonography each detect an equal proportion of early stage cases. In contrast to late stage presentation, women diagnosed with early stage disease present more often with complaints of a palpable mass or postmenopausal bleeding, particularly to gynecologists. [ABSTRACT FROM AUTHOR]

Introduction. Unilateral ovarian and Fallopian tube agenesis is an extremely rare anomaly that is usually associated with uterine and renal anomalies. This anomaly is usually incidentally detected during laparoscopy or laparotomy performed for other indications. We have reported a rare case of unilateral ovarian and Fallopian tube agenesis in an infertile patient with a normal uterus. Case report. A 34-yearold infertile patient was admitted to our clinic for laparoscopy and hysteroscopy, indicated for the right Fallopian tube occlusion and an endometrial polyp. The patient underwent laparoscopy and hysteroscopy. Unilateral right ovarian and Fallopian tube agenesis was diagnosed during laparoscopy. Upon exploration of peritoneal surfaces, omentum and intestinal serosa, neither ectopic nor remnant tissues of the ovary or Fallopian tube were found. Renal anomalies were not identified on the ultrasound examination. The hormone panel and karyotype were normal. Her partner's semen analysis was normal. The patient conceived spontaneously one year later. Serial ultrasound examinations showed normal fetal intrauterine growth and development. The patient vaginally delivered a live, female newborn at 40 weeks' gestation, weighing 3,350 grams, 53 cm long, with 9/10 Apgar scores at birth. The patient and her newborn were discharged home on the third postpartum day. Conclusion. Unilateral ovarian and Fallopian tube agenesis is rarely associated with a normal uterus. Laparoscopy is the gold standard in the diagnosis of ovarian and Fallopian tube agenesis. Unless other obstetric indications are present, this anomaly is not specific and it is not an indication for a Caesarean section, and vaginal delivery is a possibility at term pregnancy. [ABSTRACT FROM AUTHOR]

Patients feel uncomfortable with cervical manipulation, uterine distension and stimulation of peritoneum during hysterosalpingography (HSG) and experience lower abdominal pain during and after the procedure. Pain during the procedure has a negative effect on the adaptation of patients to treatment and physicians are trying to overcome this unpleasant situation. Therefore, the aim of this study was to compare the effect of midazolam and dexmedetomidine on reducing pain and spasm of fallopian tubes during and after HSG procedure in women with infertility. In a double-blind randomized controlled trial, 102 patients were randomly divided into two groups, midazolam and dexmedetomidine. The pain was recorded during injection and immediately after injection and 30 minutes after HSG, and then the complications of injection were recorded. Finally, the data were analyzed using SPSS version 20. Based on the results presented herein, no significant difference was found between the two groups in terms of vasovagal reaction, spasticity of the tube and the side of the spastic tube and uterine cavity anomalies (p <0.05). However, the pain showed a significant difference between the two groups during the injection, immediately or at 30 minutes after the procedure (p = 0.0001). The pain in the midazolam group was less than that of dexmedetomidine. Furthermore, there was no significant difference between the two groups regarding spasticity (p <0.05). There is a benefit in terms of pain reduction with the use of dexmedetomidine when comparing with midazolam injection. However, dexmedetomidine does not cause side effects in patients and can be used to reduce pain during injection. [ABSTRACT FROM AUTHOR]

Background: Recent studies have hypothesized that distal end of fallopian tube is a possible origin of ovarian serous carcinoma. This study investigated histopathological changes in fallopian tube epithelium (FTE) of the patients with ovarian serous tumors compared with control group. Materials and Methods: In a prospective cross-sectional study, fallopian tubes (right and left) of 34 cases with ovarian serous tumors were collected from patients who underwent surgery in two major gynecological centers affiliated to Shiraz University of Medical Sciences, Shiraz, Iran (2012–2015). They are composed of 21 (61.8%) high-grade serous carcinomas (HGSCs), 5 (14.7%) borderline ones, and 8 (23.5%) benign serous tumors. As control group, fallopian tubes of 72 hystrectomy cases without ovarian tumor were added to the study. Both tubes of all of the cases were submitted entirely, according to the protocol of sectioning and extensively examining the fimbriated end. The results were statistically analyzed using SPSS-PC windows and Chi-square tests. Results: Significant differences were found between the cases and control group in tubal epithelial cell stratification (especially >3 cell layers thickness), atypia, mitosis, glandular complexity, tufting, and detached epithelial cells (P < 0.05). These findings particularly atypia and mitosis were more frequently seen in the ampulla and fimbriated end of high-grade ovarian serous carcinomas. Conclusion: Our results showed that premalignant epithelial changes of the ampulla and the distal end of FTE were seen in some of the patients with ovarian HGSCs. Therefore, FTE could be one of the sources of ovarian serous carcinoma. [ABSTRACT FROM AUTHOR]

Objective: To determine the cost effectiveness of the use of oil-based versus water-based contrast in infertile women undergoing hysterosalpingography (HSG).Design: Economic evaluation alongside a multicenter randomized trial.Setting: Hospitals.Patient(s): Infertile women with an ovulatory cycle, 18-39 years of age, low risk of tubal pathology.Intervention(s): Use of oil-based versus water-based contrast during HSG.Main Outcome Measure(s): Costs per additional ongoing pregnancy and per live birth within 6 months of randomization, incremental cost-effective ratios (ICERs).Result(s): A total of 1,119 women were randomized to HSG (oil-based contrast, n = 557; water-based contrast, n = 562). After HSG, most women had no additional treatment; a minority had IUI or IVF. In the oil group, 39.7% women had an ongoing pregnancy within 6 months of randomization versus 29.1% women in the water group. There was a 10.7% increase in the live birth rate in the oil group. For ongoing pregnancy, the mean costs per couple were US$2,014 in the oil group and US$1,144 in the water group, with a corresponding ICER of US$8,198 per additional ongoing pregnancy. For live birth, the mean costs per couple were US$11,532 in the oil group and US$8,310 in the water group, with a corresponding ICER of US$30,112 per additional live birth.Conclusion(s): Hysterosalpingography with oil-based contrast results in higher 6-month ongoing pregnancy and live birth rate. If society is willing to pay US$8,198 for an additional ongoing pregnancy, HSG with oil-based contrast is a cost-effective strategy compared with HSG with water-based contrast for infertile, ovulatory women at low risk for tubal pathology.Clinical Trial Registration Number: Dutch Trial Register, NTR 6577 (www.trialregister.nl). [ABSTRACT FROM AUTHOR]

The treatment of the acute phase of complicated tubo-ovarian abscesses relies on antibiotics associated with surgical management in case of visible abscess, poor clinical tolerance and resistance to medical treatment. Transvaginal, ultrasound-guided, puncture drainage can be considered as an alternative to initial laparoscopy and has multiple advantages over the latter: same success rate, less invasive nature, simple and fast to perform, easy to access, better tolerated by the patient, decreased hospitalization time and less cost. This video article describes and standardizes the essential steps to perform a transvaginal adnexal abscess drainage with a step-by-step explanation of the technique in logical sequences, making the procedure ergonomic and easy to learn. Thus, as part of minimally invasive approach, this technique is henceforth suggested as an effective alternative and signifies a first-line procedure that can promote a therapeutic de-escalation strategy. [ABSTRACT FROM AUTHOR]

Background: Isolated tubal torsion is a rare condition that its management remains a challenge. Case Presentation: In this case report, an isolated torsion of the right fallopian tube was described in a virgin girl who was treated laparoscopically. The patient presented to the University Hospital of Larisa, in Greece (January 2017) after 5 days of sharp pain in right iliac fossa. Through this period, she looked for medical care in her home country, in Albania. However, further treatment was not available there. Conclusion: This case manifested that laparoscopy plays an important role in the accurate diagnosis of isolated torsion of the fallopian tube. It thwarts unnecessary delay in treatment and it requires an endoscopy unit. Unfortunately, endoscopy is not commonly the main diagnostic procedure in many countries, including Greece. [ABSTRACT FROM AUTHOR]

Objective: To demonstrate the laparoscopic excision technique of a juvenile cystic adenomyoma and show how the decidualization of ectopic endometrial tissue can lead to the misdiagnosis of a focus of ectopic pregnancy.Design: Description and step-by-step demonstration of the surgical procedure using a video recording (Canadian Task Force Classification 3).Setting: Teaching and research hospital.Patient(s): A 27-year-old gravida 2 parity 1 patient with one previous caesarean delivery presented to the emergency department with symptoms of pelvic pain and delayed menses. Her beta-human chorionic gonadotropin level was 2,161 mIU/mL. On transvaginal ultrasonography the uterine cavity appeared empty without any signs of a gestational sac, and a 42×45 mm heterogeneous mass was observed on the right cornual area. An 18×21 mm cystic area was observed within the mass. A diagnosis of cornual pregnancy was made and two doses of systemic methotrexate treatment were administered. On the 12th day following medical treatment, the patient reported increasing abdominal pain and free fluid was observed in the pouch of Douglas on ultrasonography. The decision to perform laparoscopic cornual excision was made.Main Outcomes and Measure(s): On laparoscopic exploration a tubal ectopic pregnancy was observed within the left fallopian tube. The presence of two simultaneous ectopic pregnancies, located in the left fallopian tube and the right cornual area, was suspected. However, upon careful inspection, the right fallopian tube appeared normal and the mass initially thought to be a right cornual pregnancy appeared more like a degenerated fibroid. A left salpingectomy was performed and the excision of the mass in the right cornual area was planned. An incision was made over the mass and the cystic inner area containing chocolate-brown colored fluid was drained. As there was no pseudo capsule surrounding the mass, the diagnosis of focal adenomyosis instead of degenerated fibroid was made. No endometriotic foci were observed within the pelvis. Different from the enucleation of a fibroid, the mass was dissected from the middle into two halves until healthy myometrium was reached on the floor of the mass. The two halves of the mass were resected totally by dissecting the adenomyotic tissue from the myometrium starting from the caudal end towards the cranial end. The first layer of the remaining myometrial defect was sutured extracorporeally with No.1 polyglactan sutures. The second and third layers were sutured intracorporeally with V-loc sutures. The resected left fallopian tube containing the ectopic pregnancy and the adenomyotic mass were externalized through a posterior colpotomy incision.Result(s): The patient was discharged 24 hours postoperatively without any complications. A diagnosis of juvenile cystic adenoma was made upon histopathological examination. The patient reported subsiding of her dysmenorrhea on the postoperative third month.Conclusion(s): Juvenile cystic adenomyosis (JCA), is a rare form of focal adenomyosis which is usually located in close proximity to the uterine insertion of the round ligament, contains a cystic inner area larger than 1 cm and is encountered before the age of 30 years. Some authors reported JCA to be an accessory and cavitated uterine mass (ACUM) anomaly developing as a result of gubernaculum dysfunction. The only difference between the two conditions is reported to be the presence of a denser area of adenomyosis surrounding the cystic area lined with endometrium in JCA than in ACUM. This case has shown that decidual changes observed in ectopic endometrial tissue within an adenomyotic area may be misdiagnosed as a focus of ectopic pregnancy. Atypical endometriomas demonstrating decidual changes may also be misdiagnosed as ovarian malignancies. In non-emergency situations, waiting for the decidualization effect of ectopic endometrium to subside can help in the definitive diagnosis of such cases. Our technique for JCA excision is different from enucleation of a fibroid and may aid in the total resection and dissection of the adenomyotic tissue from healthy myometrium. [ABSTRACT FROM AUTHOR]

Primary fallopian tube carcinomas (PFTC) are rare tumors with non-specific clinical presentations. The current case was unique since the tumor was first detected on endometrial curettage and clinicoradiologically was misdiagnosed as endometrial carcinoma. A 48-year-old, post-menopausal female presented with one episode of vaginal bleeding. Endometrial curettage showed poorly differentiated carcinoma, while cervicovaginal Papanicolaou (Pap) smear was negative for malignant cells. Right sided fallopian tube carcinoma in-situ was diagnosed on histopathological examination of surgical hysterectomy with B/L salpingo-oophorectomy specimen. As observed in the current case, unusual tumor histology with broad papillary fronds lined by pleomorphic cells showing nuclear stratification and focal involvement of endometrial curettage specimen may be considered a useful pointer for tubal malignancy. [ABSTRACT FROM AUTHOR]

Germline BRCA1 or BRCA2 mutations (mtBRCA1 and mtBRCA2) increase risk for high-grade serous ovarian cancer (HGSOC), the most commonly diagnosed epithelial ovarian cancer histotype. Other identified risk factors for this cancer, which originates primarily in the distal fallopian tube epithelium (FTE), implicate ovulation, during which the FTE cells become transiently exposed to follicular fluid (FF). To test whether mtBRCA1 or mtBRCA2 nonmalignant FTE cells respond differently to periovulatory FF exposure than control patient FTE cells, gene expression profiles from primary FTE cultures derived from BRCA1 or BRCA2 mutation carriers or control patients were compared at baseline, 24 hours after FF exposure, and 24 hours after FF replacement with culture medium. Hierarchical clustering revealed both FF exposure and BRCA mutation status affect gene expression, with BRCA1 mutation having the greatest impact. Gene set enrichment analysis revealed increased NFκB and EGFR signaling at baseline in mtBRCA1 samples, with increased interferon target gene expression, including members of the ISGylation pathway, observed after recovery from FF exposure. Gene set enrichment analysis did not identify altered pathway signaling in mtBRCA2 samples. An inverse relationship between EGFR signaling and ISGylation with BRCA1 protein levels was verified in an immortalized FTE cell line, OE-E6/E7, stably transfected with BRCA1 cDNA. Suppression of ISG15 and ISGylated protein levels by increased BRCA1 expression was found to be mediated by decreased NFκB signaling. These studies indicate that increased NFκB signaling associated with decreased BRCA1 expression results in increased ISG15 and protein ISGylation following FF exposure, which may be involved in predisposition to HGSOC. [ABSTRACT FROM AUTHOR]

Background :To find out ovulation rates, in Clomiphene citrate (CC) resistance anovulatory infertility, after administration of human menopausal gonadotrophin. Methods: In this cross sectional study 400 infertile patients of anovulation, bilateral patent fallopian tubes evidenced by HSG, normal husband semen analysis and resistant to Clomiphene citrate therapy and take at least three months consecutive unsuccessful treatment in dose >150 mg/day were incorporated. Patients were divided randomly via lottery technique into two groups. Group-A, included those subjects who received Clomiphene citrate (CC) daily from day 2 to 6 of menstrual cycle and Human Menopausal Gonadotrophin 75 IU begun from day 7 onward for 3 days intramuscularly. Group B comprised of those who received Human Menopausal Gonadotrophin alone 75 IU intramuscularly begun from day 2 of menstrual cycle, 5 injections were given on alternate day till 10th day of cycle. Follow up was done by ultrasound for follicle tracking and serum progesterone level on day 21 of the treatment cycle. Results: Mean age was 30.12±4.8 years and 30.27±4.48 years in both groups respectively without significant difference. Out of 400 patients, ovulation induction was observed in 386 patients of both groups. Among these 386, 15 patients got pregnant, 9(2.25%) from group A and 6(1.5%) from group B. Mild OHSS was seen in 12 (3%) and moderate OHSS was seen 4 (1%). Conclusion: Clomiphene Citrate with Human Menopausal Gonadotropins have a likely supportive consequences on ovulation rate contrasted to that of Human Menopausal Gonadotropin alone. [ABSTRACT FROM AUTHOR]

Chlamydia trachomatis is the most commonly diagnosed bacterial sexually transmitted infection and can lead to tubal factor infertility, a disease characterised by fibrosis of the fallopian tubes. Genetic polymorphisms in molecular pathways involving G protein-coupled receptor signalling, the Akt/PI3K cascade, the mitotic cell cycle, and immune response have been identified in association with the development of trachomatous scarring, an ocular form of chlamydia-related fibrotic pathology. In this case-control study, we performed genome-wide association and pathways-based analysis in a sample of 71 Dutch women who attended an STI clinic who were seropositive for Chlamydia trachomatis antibodies and 169 high-risk Dutch women who sought similar health services but who were seronegative. We identified two regions of within-gene SNP association with Chlamydia trachomatis serological response and found that GPCR signalling and cell cycle pathways were also associated with the trait. These pathway-level associations appear to be common to immunological sequelae of chlamydial infections in both ocular and urogenital tropisms. These pathways may be central mediators of human refractoriness to chlamydial diseases. [ABSTRACT FROM AUTHOR]

Fallopian tube disease is one of the most common causes of infertility in women that results from tubal damage or obstruction. The American Society for Reproductive Medicine classification, based on scoring system of tubal changes verified by laparoscopy, is most widely used in practice. The aim of the paper is to determine the involvement and stage of hydrosalpinx and surgical therapy options in patients treated for marital infertility due to tubal factors during the preparation for in vitro fertilization after laparoscopy. In the two-year period, at the Clinic for Gyneacology and Obstetrics, Clinical Center Niš, 75 patients underwent videolaparoscopy to confirm previously established diagnosis of hydrosalpinx. Surgical treatment performed depended on the severity stage of hydrosalpinx. Removed Fallopian tubes were submitted for a histopathological analysis to the Institute of Pathology, Clinical Center Niš. An early stage hydrosalpinx was diagnosed by laparoscopy in 32 tubes. Out of them, tubal removal was performed in 9 tubes, and reconstructive surgery in 21. The most conspicuous changes were present in 46 Fallopian tubes. Surgical removal was performed in 41 tubes, occlusion of the isthmic portion of the tube was present in 5 tubes, and no reconstructive surgery was performed (significant correlation p <0.001 between the stage of hydrosalpinx and type of surgery). HP analysis of the removed Fallopian tubes revealed chronic inflammation in 84.27%. It is necessary to employ always the same, clear criteria in the diagnosis and to select properly the patients who will benefit from hydrosalpinx surgery, either tubal removal or reconstructive surgery. [ABSTRACT FROM AUTHOR]

Rationale: Hysterosalpingography is still the main method to begin with when studying the causes of female impossibility to conceive a baby. Objective: The aim of this study is to correlate and evaluate the wide range of tubal pathology discovered by routine hysterosalpingography in a university hospital in Romania with the successful pregnancy rate. Methods and Results: A total of 95 consecutive patients explored by routine hysterosalpingography in a university hospital during 2015 and 2016 were included. Out of 173 fallopian tubes studied, 28.9% were occluded, 13.29% were almost occluded, and only 57.8% were patent. Of these patients, 11 successful pregnancies occurred in 95 women (11.57%) until September 2017. A number of 7 patients delivered a normal baby in our hospital (7.36%). One patient was admitted at 36 weeks of gestation, and another one at 26 weeks of gestation, for risk of premature delivery. None of these two patients delivered in our hospital. Two patients were admitted for miscarriage at 8 weeks and 5 weeks of pregnancy. In all the 7 patients who delivered a normal baby, the fallopian tubes were entirely visible (100%), whether they were patent or not. Discussion: To our knowledge, this is the largest study about hysterosalpingography and the successful pregnancy rate in Romania so far. [ABSTRACT FROM AUTHOR]

Background: Infertility is a common health problem requiring imaging to delineate the anatomical causes in women. Three dimensional multi-detector computed tomography hysterosalpingography (3D-MDCT-HSG) offers an easy workup for uterine, tubal and peritoneal factors. Methods: To present the spectrum of uterine, tubal and peritoneal factors on 3DMDCTHSG and determine its diagnostic accuracy for female factor infertility, a prospective study was conducted on 25 infertile women with non-diagnostic HSG from November 2012 to March 2014. Sixty four slice MDCT acquired the scan during pre-ovulatory phase by contrast instillation into uterine cavity. A blinded reviewer interpreted the 3D-MDCT-HSG and results were compared with final diagnosis made on hystero-laproscopy in 22 patients. Diagnostic accuracy of 3D-MDCT-HSG for various factors was expressed as sensitivity, specificity, positive and negative predictive value. Results: MDCT-HSG demonstrated definite findings in 96% of patients having nondiagnostic HSG. In this study, tubal, uterine and peritoneal abnormalities were present in 68.75%, 56% and 32% of cases, respectively. 48 tubes in 25 patients were evaluated of which 22 tubes were blocked constituting the commonest finding present in 15 (60%) patients. The sensitivity, specificity, positive predictive value and negative predictive value for uterine factors was 83.33% ,100%, 100% and 96.84%, respectively, for tubal factors 93.55%, 94.68%, 85.29% and 96.83%, respectively and for peritoneal factors 62.5%, 92%, 71.43% and 88.46%, respectively. Mean effective radiation dose was 1.76±0.18 mSv in MDCT-HSG. Conclusion: 3D-MDCT-HSG can detect various factors responsible for female infertility especially tubal and uterine; in cases where HSG fails to clearly delineate the pathology. [ABSTRACT FROM AUTHOR]

A key feature of high-grade serous ovarian carcinoma (HGSOC) is frequent amplification of the 3q26 locus harboring PRKC-ι (PRKCI). Here, we show that PRKCI is also expressed in early fallopian tube lesions, called serous tubal intraepithelial carcinoma. Transgenic mouse studies establish PRKCI as an ovarian cancer-specific oncogene. Mechanistically, we show that the oncogenic activity of PRKCI relates in part to the up-regulation of TNFα to promote an immune-suppressive tumor microenvironment characterized by an abundance of myeloid-derived suppressor cells and inhibition of cytotoxic T-cell infiltration. Furthermore, system-level and functional analyses identify YAP1 as a downstream effector in tumor progression. In human ovarian cancers, high PRKCI expression also correlates with high expression of TNFα and YAP1 and low infiltration of cytotoxic T cells. The PRKCI-YAP1 regulation of the tumor immunity provides a therapeutic strategy for highly lethal ovarian cancer. [ABSTRACT FROM AUTHOR]

The aim of the study was to analyze the application value of three-dimensional hysterosalpingo-contrast sonography (3D-HyCoSy) in the diagnosis of oviduct obstruction. Fifty-two patients with infertility and oviduct obstruction were continuously selected and treated with 3D-HyCoSy and CLP (CLP). It was found that according to CLP diagnosis, 40 oviducts were obstructed, 30 were partially obstructed, 12 were tortuous and 22 were completely obstructed. The 40 cases were unilaterally pathological, 24 were bilaterally pathological, 10 were diagnosed as congenital dysplasia, 35 were diagnosed as inflammation and 19 were diagnosed as tumor and cyst. Based on the diagnostic criteria of CLP, the diagnostic sensitivity, specificity, positive predictive values and negative predictive values of 3D-HyCoSy was 82.4, 88.3, 77.9 and 90.2%, respectively. The contrast agent flow time of oviduct obstruction (tortuosity and complete obstruction) as diagnosed by 3D-HyCoSy was significantly prolonged when compared with that of partial oviduct obstruction (P<0.05), and flow time of inflammation as diagnosed thereby was longer than that of congenital dysplasia, tumor and cyst. Following the diagnosis of inflammation, the shape of the contrast agent was tenuous, swollen, angled, rigid and distorted and the occurrence rate of inflammation was significantly higher (P<0.05). In conclusion, the diagnostic effect of 3D-HyCoSy on oviduct obstruction was more accurate and can show different features when diagnosing different types of inflammation, thus having a certain value for identifying the inflammation. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to document ovarian cyst frequency and characteristics as well as distribution of these parameters with respect to age in children and adolescents. Methods: We retrospectively analyzed the medical records of 1009 girls between the ages of 5-18 years who presented to our pediatric emergency department (PED) with pelvic pain and therefore underwent pelvic ultrasound examination between June 2011 and May 2014. Results: In total, 132 of 1009 girls (13.1%) were identified as having ovarian cysts ≥1 cm in diameter. The frequency of ovarian cysts was found to be 1.8% (6/337) in children aged 5-9 years and 18.8% (126/672) in those aged 10-18 years. All the cysts detected in children aged 5-9 years were small (<3 cm) and simple with age-specific frequencies ranging between 1.5-2.7%. With the onset of adolescence, ovarian cyst frequency started to increase with age and ranged between 3.8-31.3% throughout adolescence. Age of peak ovarian cyst frequency was 15 years with a rate of 31.3%. Large ovarian cysts (>5 cm) were identified in 19 adolescents (15.1%) with most occurring during middle adolescence. Of the 19 adolescents, five were found to have cyst-related significant ovarian pathologies including cystadenoma (n=3) and ovarian torsion (n=2). Conclusion: In children aged 5-9 years, ovarian cysts were infrequent and small (<3 cm). Peak ovarian cyst frequency was detected at the age of 15 years. All patients diagnosed with cyst-related significant ovarian pathologies were adolescents having a cyst >5 cm in diameter with a complex appearance in most. [ABSTRACT FROM AUTHOR]

In this study, we examined whether the proportion of tubal factor infertility (TFI) that is attributable to Chlamydia trachomatis, the population excess fraction (PEF), can be estimated from serological data using finite mixture modeling. Whole-cell inclusion immunofluorescence serum antibody titers were recorded among infertile women seen at St. Michael's Hospital in Bristol, United Kingdom, during the period 1985-1995. Women were classified as TFI cases or controls based on laparoscopic examination. Finite mixture models were used to identify the number of component titer distributions and the proportion of serum samples in each, from which estimates of PEF were derived. Four titer distributions were identified. The component at the highest titer was found only in samples from women with TFI, but there was also an excess of the second-highest titer component in TFI cases. Minimum and maximum estimates of the PEF were 28.0% (95% credible interval: 6.9, 50.0) and 46.8% (95% credible interval: 23.2, 64.1). Equivalent estimates based on the standard PEF formula from case-control studies were 0% and over 65%. Finite mixture modeling can be applied to serological data to obtain estimates of the proportion of reproductive damage attributable to C. trachomatis. Further studies using modern assays in contemporary, representative populations should be undertaken. [ABSTRACT FROM AUTHOR]

Objectives: Essure® has been tested as an alternative treatment for hydrosalpinx before embryo transfer (ET) in women undergoing assisted reproduction techniques. However, the persistence of a foreign body inside the uterine cavity might have a negative impact on the outcome of pregnancy. The present systematic review aimed at identifying, appraising and summarizing the available evidence regarding the effectiveness and safety of using Essure prior to ET for women with hydrosalpinx.Methods: We searched for studies in PubMed, Scopus, CENTRAL, Web of Science and ClinicalTrials.gov and the reference lists of eligible studies. All studies including at least 10 women with hydrosalpinx who received Essure, any other intervention or no treatment prior to ET were considered eligible. Study selection, data extraction and evaluation of the risk of bias were performed independently by two authors. Study outcomes were miscarriage per clinical pregnancy, singleton preterm birth per singleton live birth and live birth/ongoing pregnancy and clinical pregnancy per ET. The pooled results for each outcome and intervention were summarized as proportions with their respective 95% CIs, using a random-effects model.Results: Our electronic search of databases was performed on 7 November 2015, and 26 studies with 43 study arms were considered eligible: eight study arms evaluating Essure; seven assessing tubal aspiration; seven appraising effects of no treatment; 12 evaluating salpingectomy; two assessing tubal division; and seven evaluating tubal occlusion. When compared with women who had no intervention, women with Essure had a higher clinical pregnancy rate per ET (36% (95% CI, 0-43%) vs 13% (95% CI, 9-17%)). When compared with women who had other interventions, women with Essure had a higher miscarriage rate per clinical pregnancy (38% (95% CI, 27-49%) vs 15% (95% CI, 10-19%)).Conclusions: The available evidence suggests that, although Essure prior to ET in women with hydrosalpinx improves the chance of achieving a clinical pregnancy compared with no intervention, it is associated with a higher rate of miscarriage when compared with the other interventions. Although this evidence is based on observational studies, we believe that salpingectomy should be the first option for women who are eligible for videolaparoscopy. However, it is still premature to make recommendations for women who are not eligible for surgery, and randomized controlled trials are needed to clarify which is the best treatment alternative in such a scenario. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Background: To investigate the role of CD138 immunohistochemistry in the diagnosis of chronic endometritis (CE) and the risk factors for assisted conception patients having CE complications.Methods: Ninety-three patients, with normal uterine shape confirmed by examination and who were planning to undergo assisted conception treatments, were selected as research subjects. Endometrial tissue was isolated for routine hematoxylin and eosin (HE) and CD138 immunohistochemical staining. Additionally, the disease histories of patients were collected, and the reproductive prognosis was followed up.Results: ① CE detection rate: The rate of CD138 immunohistochemical staining was greater than that of HE staining (27.96 % vs. 26.89 %, P <0.05); ② Pregnancy rate: the pregnancy rate of CD138-positive patients (7.7 %) was lower than the pregnancy rate of CD138-negative patients (31.3 %) (p = 0.017 < 0.05); ③ The results from univariate analysis showed that a previous history of prolonged menstrual bleeding episodes, an abortion history, and complications of fallopian tube obstruction were associated with CE (P <0.05). The results of logistic regression analysis confirmed that prolonged menstrual bleeding episodes (P = 0.014, OR = 5.394, 95 % CI 1.405-20.699), a previous abortion history (P = 0.029, OR = 3.194, 95 % CI 1.125-9.073), and fallopian tube obstruction (P = 0.028, OR = 3.274, 95 % CI 1.139-9.415) were independent risk factors for positive CD138 results.Conclusions: CD138 immunohistochemistry can improve the CE diagnosis rate. A previous history of prolonged menstrual bleeding episodes, an abortion history, and a history of fallopian tube obstruction are risk factors for chronic endometritis, and a CD138 immunohistochemical examination should be advised among them. [ABSTRACT FROM AUTHOR]

Cystic endosalpingiosis refers to the existence of heterotopic cystic müllerian tissue resembling structures of the fallopian tubes. We report a case of florid cystic endosalpingiosis discovered in a pregnant woman during a scheduled cesarean section and review the current knowledge of this disease. A 30-year-old woman with a twin pregnancy attended the hospital day unit at term. The first twin was in a breech presentation and a cesarean section was scheduled. During the procedure the uterine fundus and part of the body were seen completely seeded with multitude of cyst-like structures resembling hydatids of Morgagni. The immunohistochemistry analysis showed a positive expression for PAX8 (Box-8), CK7, and estrogen and progesterone receptors. The lesions did not disappear after pregnancy. Cystic endosalpingiosis should be always borne in mind, even in pregnancy, when it comes to making the differential diagnosis of a pelvic or systemic multicystic mass. [ABSTRACT FROM AUTHOR]

Background: Fallopian tube involvement by cervical carcinoma has rarely been documented, with literature reports focusing primarily on squamous cell carcinoma. Case presentation: In this report, we present the case of a 50 year old woman who presented with an abnormal Pap test with atypical squamous and glandular cells. A loop electrosurgical excision procedure (LEEP) was performed and led to the diagnosis of stage IB1 endocervical adenocarcinoma. Subsequent radical hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic lymph node dissection showed a well-differentiated endocervical adenocarcinoma of usual type with superficial spread to the endometrium and right fallopian tube. The patient received no adjuvant therapy and has remained without evidence of disease. Conclusions: While the advent of more extensive fallopian tube sampling has led to increased discovery and discussion of fallopian tube involvement by metastatic carcinoma, its impact on treatment and prognosis remains to be seen. [ABSTRACT FROM AUTHOR]

Opportunities for patients undergoing hemodialysis to receive chemotherapy are increasing. A combination of paclitaxel and carboplatin (TC) is first-line chemotherapy in patients with Müllerian cancer. However, the optimal dose and time interval between the end of carboplatin administration and initiation of hemodialysis remains to be elucidated. TC was administered to a patient with fallopian tube cancer undergoing hemodialysis. The paclitaxel regimen was determined to be 135 mg/m² (total of 210 mg) over 3 h. After paclitaxel administration, 125 mg of carboplatin was administered over 1 h to achieve a target area under the concentration-time curve (AUC) of 5.0 mg•min/ml using the Calvert formula. The time interval between the end of carboplatin administration and hemodialysis initiation was 1 h at the first cycle, 16 h at the second cycle and 20 h at the third cycle, and the AUC obtained was 2.86, 4.16 and 6.0 mg•min/ml, respectively. The desired AUC of free platinum was demonstrated and only mild side effects were observed at the third cycle. Therefore, hemodialysis was initiated 20 h after completion of carboplatin infusion at cycles 4-6. The total chemotherapy planned was completed without severe adverse events. Measurement of the concentration of free platinum subsequent to administration is useful for determination of the optimal dose of carboplatin and time interval following administration to obtain an adequate AUC. The present study suggests that carboplatin can be administered to a patient undergoing hemodialysis, and that an adequate interval between the end of carboplatin administration and hemodialysis initiation may be ~20 h. [ABSTRACT FROM AUTHOR]

Primary carcinoma of the fallopian tube represents <1% of all gynecological tumors, and benign tumors of the fallopian tube are encountered even less frequently. Mature teratomas of the fallopian tube and ovary are extremely rare, and to date, only a few cases have been reported. A 31-year-old woman presented with a left adnexal mass that was identified by pelvic ultrasonography during a regular checkup. The patient underwent laparoscopic left salpingectomy and left ovarian cystectomy. Histopathological examination of the removed tissue revealed features compatible with mature cystic teratomas of both the left fallopian tube and ovary. At 26 months post-surgery, the patient underwent a cesarean section at 39+2 weeks of gestation. A right ovarian cystic mass was incidentally identified during the procedure. Right ovarian cystectomy was performed, and histopathological analysis revealed the mass to be a teratoma. The patient continued to receive annual follow-up after surgical intervention and demonstrated no evidence of disease at a routine 2-year follow-up examination. The discussion of the present case is followed by a brief review of the literature. [ABSTRACT FROM AUTHOR]

Hemangioma of the female genital tract is very uncommon. Histologically, these are predominantly cavernous type, with few capillary and mixed type reported in the literature. Hence, we report a case of concurrent occurrence of capillary hemangioma of the ovary and fallopian tube, an incidental finding. [ABSTRACT FROM AUTHOR]

Pelvic inflammatory disease (PID) is an acute and sometimes subclinical infection of the upper genital tract in women, involving any of the uterus, fallopian tubes and ovaries. The condition commonly can involve also the other pelvic organs mainly the peritoneum. It results in oophoritis, salpingitis, tubo-ovarian abscess, peritonitis or perihepatitis. A 26-year-old woman was admitted in our clinic for lower abdominal pain, fever and vaginal discharge. The ultrasound aspect was suggestive for PID with tubal involvement (salpingitis). The lab finding proved an important inflammatory syndrome (high C protein level, elevated white blood cells count). We decided to perform exploratory laparoscopy for PID. Intraoperative findings consisted of: both fallopian tubes were enlarged, with congestive vascularization and adhesion process to the surrounding tissue resulting in bilateral tubo-ovarian abscess. Due to further patient wish to conceive we decided to perform conservative treatment: lavage and drainage of the abscess. The patient outcome was favorable with the discharge in the 3rd postoperative day. The patient returns in our unit after 6 months following the operation for similar symptomatology. The clinical and ultrasound examination established the diagnosis of recurrent PID bilateral sactosalpinx. We decided to perform laparoscopic surgery, with bilateral salpingectomy. The patient had no gynecological complain one year later. The histopathological examination depicted an unusual degeneration of the fallopian tube of mucocystic aspect. We presented a case with clinical and imaging scan that imposed the diagnosis of Pelvic Inflammatory Disease. The particularity of this case is the pathological exam that proved the mucocystic degeneration of the fallopian tube. It represents an extremely rare condition. [ABSTRACT FROM AUTHOR]