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Background: Endometriosis is a relatively common gynaecological condition affecting premenopausal women often associated with pelvic pain and infertility. It is pathologicaly characterised as the presence of ectopic endometrial glands and stroma outside the uterus. Because its effects may be life impacting, radiologists should be familiar with the various imaging manifestations of the disease, especially those that are relatively specific for the disease. Aims and objectives : The aim of our study is to describe the various common patterns of MRI manifestations of pelvic endometriosis in premenopausal women from Kashmir. Methodology : The current study is a cross sectional observational study conducted by reviewing already existing MRI images in the radiology department of SMHS hospital Srinagar from September 2021 to December 2022 . All the pelvic MRI studies of premenopausal females who had MRI features of endometriosis where included in the study. The MRI studies of these patients where reevaluated and compiled by experienced radiologists with more than 8 years of experience in radiology. Exclusion criteria included a history of pelvic surgery for endometriosis or adnexal disease. Results : We gathered the imaging data from 47 patients. Out of these 27 patients had ovarian endometriosis with its varied manifestations, endometriosis associated adhesions were seen in 16 patients,14 patients had posterior cul de sac disease, anterior cul de sac involvement was seen in 7 patients. Round ligaments were involved in 7 patients, 9 patients had tubal disease. Deep pelvic endometriosis infiltrating the rectal wall was seen in 5 patients Conclusion : In our study we were able to depict the commonest MRI imaging patterns in pelvic endometriosis in Kashmiri women. Indeed MRI is able to preoperatively detect maximum endometriotic lesions thereby improving diagnostic imaging accuracy and patients' outcome, and to reduce postoperative complication rates. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine whether incorporating qualitative parameters of contrast-enhanced ultrasound (CEUS) can increase the accuracy of adnexal lesion assessments with Ovarian–Adnexal Reporting and Data System (O-RADS) ultrasound category 4 or 5. Retrospective analysis of patients with adnexal masses who underwent conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) examinations between January and August of 2020. The study investigators reviewed and analyzed the morphological features of each mass before categorizing the US images independently according to the O-RADS system published by the American College of Radiology. In the CEUS analysis, the initial time and intensity of enhancement involving the wall and/or septation of the mass were compared with the uterine myometrium. Internal components of each mass were observed for signs of enhancement. The sensitivity, specificity, and Youden's index were calculated as the contrast variables and O-RADS. Receiver operating characteristic curve analysis revealed that the best cutoff value was higher than O-RADS 4. When information on the extent of enhancement was applied to selectively upgrade O-RADS category 4 and selectively downgrade O-RADS category 5, the overall sensitivity increased to 90.2%, while the level of specificity (91.3%) remained the same. Incorporating additional information from CEUS with respect to the extent of enhancement helped to improve the sensitivity of O-RADS category 4 and 5 masses without loss of specificity. [ABSTRACT FROM AUTHOR]

Purpose: To assess the agreement between the diagnosis made by trained technicians at vision centers (VC) and oculoplasty specialists at the base hospital, in patients referred from VC to the orbit and oculoplasty clinic of a tertiary eye care hospital in south India. Methods: This was a retrospective study that compared the findings of VC technicians and the specialists of the orbit and oculoplasty services in a base hospital. A total of 384 patients referred from 17 VCs between May 2021 and May 2022 were included. The diseases were categorized according to the site of involvement as diseases of the eyelids (43%), diseases of the lacrimal system (37.3%), orbital diseases (15.6), and others (4.1%). The mean age of the patients was 35.9 years and 50.6% were females. Medical records of all referred patients who attended the orbit clinic were analyzed. Results: Of the 384 patients, 378 (98.67%) were confirmed to have orbital and adnexal diseases. There was an overall 80% agreement between the diagnosis made by trained VC technicians and oculoplasty specialists; the kappa coefficient was 0.78 (95% confidence interval [CI]: 0.76 to 0.80), with a P value < 0.001. The agreement was the highest for diseases of the lacrimal system (90.9%, kappa coefficient 0.87), followed by eyelid pathologies (80%, kappa coefficient: 0.77). Of these, 54.8% of patients were managed with surgical procedures. Conclusion: There is good agreement between the findings of VC technicians and oculoplasty specialists. Trained technicians can help in the early detection and referral to higher centers. They also help to make sure adherence to treatment and periodic evaluation, especially in resource-constraint settings. [ABSTRACT FROM AUTHOR]

Background: Several ultrasound (US) features help ultrasound experts in the classification of benign vs. malignant adnexal masses. US scores serve in this differentiation, but they all have misdiagnoses. The main objective of this study is to evaluate what ultrasound characteristics are associated with malignancy influencing ultrasound scores. Methods: This is a retrospective analysis of ultrasound features of adnexal lesions of women managed surgically. Ultrasound characteristics were analyzed, and masses were classified by subjective assessment of the ultrasonographer (SA) and other ultrasound scores (IOTA Simple Rules Risk Assessment SRRA, ADNEX model, and O-RADS). Results: Of a total of 187 adnexal masses studied, 134 were benign (71.7%) and 53 were malignant (28.3%). SA, IOTA SRRA, ADNEX model with or without CA125 and O-RADS had high levels of sensitivity (93.9%, 81.1%, 94.3%, 88.7%, 98.1%) but lower specificity (80.2%, 82.1%, 82.8%, 77.6%, 73.1%) with similar AUC (0.87, 0.87, 0.92, 0.90, 0.86). Ultrasound features significantly related with malignancy were the presence of irregular contour, absence of acoustic shadowing, vascularized solid areas, ≥1 papillae, vascularized septum, and moderate-severe ascites. Conclusion: IOTA SRRA, ADNEX model, and O-RADS can help in the classification of benign and malignant masses. Certain ultrasound characteristics studied in ultrasound scores are associated with malignancy. [ABSTRACT FROM AUTHOR]

Background: Adnexal masses are a frequent cause of patient complications that necessitate diagnostic imaging, surgical intervention, and postoperative pathology. No large-scale clinical investigation had previously explored the wide variation in GI-diagnostic RADS's performance among trials. Objective: The aim of the current study was to highlight the role of Gynecological Reporting Data System (GIRADS) and Ovarian Reporting Data System (ORADS) in differentiating ovarian lesions and determine which of them a higher accuracy has based on biopsy result and short interval follow up. Patients and methods: A cross-sectional study was conducted on 100 female patients with ovarian mass, attending at Radiodiagnosis Department of Zagazig University Hospitals from March 2020 to March 2021. Results: With an AUC of 0.983, 100% sensitivity, 96% specificity, 82% positive predictive value (PPV), 100% negative predictive value (NPV), and 97% accuracy, GIRAD can distinguish between benign and malignant lesions. ORAD has a high area under the curve (AUC) for distinguishing between benign and malignant lesions; its sensitivity is 92.9%, specificity is 91.9%, PPV is 65%, and NPV is 98.8%. Kappa (?) = 0.834 indicates moderate agreement between GIRAD and ORAD in determining whether lesions are benign or malignant. Conclusion: Clinical decision-making appears to be aided by the GI-RADS categorization of adnexal masses, in comparison to the GIRADS, the ORADS classification system for ovarian masses is a useful non-invasive diagnostic tool with excellent sensitivity in differentiating between benign and malignant neoplastic lesions. When compared to the ORADS simple rules, the GIRADS was more sensitive while maintaining equivalent specificity as well as reliability. [ABSTRACT FROM AUTHOR]

Background: Ultrasound (US) is the first radiological modality to examine females with higher suspicion of adnexal lesions owing to its widespread accessibility, affordable cost, and higher sensitivity in mass detection. Magnetic resonance imaging (MRI) offers essential data for the classification of a lot of ovarian masses as neoplastic or nonneoplastic, and benign or malignant. MRI can identify an adnexal mass and plays an essential role as regard to the differentiation between benign and malignant tumours. Objective: The current study aimed to compare the diagnostic accuracy of Doppler US and MRI in diagnosis of nature of ovarian mass in teenagers. Methods: This was a descriptive prospective study that included 32 patients with 20 years or less and with adnexal mass attending OB/GYN clinic, admitted and prepared for surgery at Mansoura University Hospitals. All patients were examined after explaining of the procedure of transabdominal US or transvaginal US (for married) according to scanning condition and 23 patients had MRI. Results: MRI had 100% sensitivity, 90% specificity, 92.8% accuracy and US achieved 87.5% sensitivity, 96.2% specificity and 91.2% accuracy. Conclusion: There were no significant differences in sensitivity, specificity, and accuracy of Doppler US and pelvic MRI in characterization of ovarian masses in teenagers. MRI should be used for cases when US results are indeterminate or equivocal, in particular when tumour markers are normal. [ABSTRACT FROM AUTHOR]

The eyelid tumours are uncommon in dogs. In the present study, out of 102 ocular and adnexal samples from the dogs examined for a period of 2.5 years, 11 cases (10.78 per cent) were neoplastic in nature. The major location of the neoplasms was eyelids (8/11). One case (0.98 per cent) was diagnosed as pigmented sebaceous gland epithelioma. The tumour mass was present in the palpebral conjunctiva of the lower eyelid near the medial canthus of the left eye in a five-yearold Labrador dog. Grossly, the tumour mass appeared to be a greyish-black, firm, cauliflower-like growth. The mass was resected and submitted for histopathology. Microscopic examination of the mass showed a preponderance of basaloid reserve cells in the tumour tissue. The proliferating reserve cells formed irregular islands or trabeculae separated by thin fibrous connective tissue. They showed minimal to no pleomorphism, scanty amphophilic cytoplasm and oval nuclei. Melanin-containing cells were frequent, while mature sebocytes were infrequent. Mitotic figures were occasional. Pigmented sebaceous gland epithelioma was diagnosed based on gross and histopathological features. Apart from this, neoplasms such as fibrosarcoma, meibomian gland adenocarcinoma, well differentiated squamous cell carcinoma, papilloma and non-pigmented sebaceous gland epithelioma involving eyelids, histiocytoma of third eyelid, periglobular lymphoma and leukemic infiltration of choroid were also recorded. The present research underlines the lower incidence of eyelid tumours in dogs. [ABSTRACT FROM AUTHOR]

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Hidradenomas are benign adnexal neoplasms, which were recently been subdivided into two groups: eccrine differentiation (poroid hidradenomas) or apocrine differentiation (clear cell hidradenomas) with the latter being rarer. These types of tumors have been associated with recurrence and malignant transformation; however, recurrence and malignancy are considered very rare. We present a case report of a 35-year-old male who presented with two lumps, clinically representing simple lipomas but one of them turned to be a hidradenoma. A 35-year-old gentleman not known to have any medical illnesses and surgically free, presented to our general surgery clinic complaining of two slow-growing (over 3 years) painless lumps, one in the right upper thigh and the other one in the left shoulder. The patient denied any previous history of trauma or infection nor any history of discharge or overlying skin changes, and there were no clinical features that might suggest the presence of malignancy. Upon examination, both lumps were firm, freely mobile, non-tender, intact overlying skin, with no skin changes, and no regional lymphadenopathy. Prior to excision, our preliminary impression was lipoma for both masses. Surgical excision was carried out with clear margins; each mass was labeled separately, and specimens were sent for histopathology. Histopathological diagnosis of the left shoulder mass was consistent with lipoma; however, the right upper thigh mass turned to be a hidradenoma. Hidradenomas are uncommon benign neoplasms with varied types. Recurrence and transformation into malignancy have been reported in some cases. Complete surgical excision with negative margins and further follow-up with the patient are crucial to prevent such consequences. Clinical diagnosis can be difficult; however, the management is the same with surgical removal as it will give us the definitive diagnosis with the pathology report. [ABSTRACT FROM AUTHOR]

Acquired elastotic hemangioma is a benign vascular lesion associated with sun exposure. It typically manifests as a flat or raised, erythematous plaque that slowly grows and is often solitary. The diagnosis relies on histopathological characteristics, such as a vascular proliferation in the superficial dermis with vessels arranged horizontally and parallel to the epidermis. Treatment usually involves surgical excision, but it does not alter the course of the disease. Early recognition of acquired elastotic hemangioma can prevent unnecessary investigation and treatment. [Extracted from the article]

This article discusses the rare condition known as proliferative trichilemmal cyst. It is a benign tumor that typically affects elderly females, with a preference for the scalp. While most cases have a benign evolution, there is a risk of malignant transformation. Diagnosis is based on clinical examination and confirmed through histological analysis. Treatment involves surgical removal with safety margins, and surveillance is necessary due to the high risk of recurrence. In rare cases, radiotherapy and chemotherapy may be employed. The article emphasizes the importance of early detection and diagnosis to improve prognosis and limit aggressiveness. [Extracted from the article]

We herein report a 76-year-old male who presented to the ophthalmology clinic after complaining from excessive lacrimation for ~6 months prior to presentation. He reports previously undergoing a nasolacrimal recanalization procedure in attempts to resolve his symptoms, but reported no improvement. On examination, a mass on the nasal conjunctiva around the medial canthus of the right eye was noted and subsequently excised. The findings support the diagnosis of low-grade follicular lymphoma. The patient was referred to radiation oncology for radiation therapy and received a total dose of 2400 cGy. Most ocular adnexal lymphomas are B-cell in origin, with follicular lymphomas being one of the rarest forms of such lymphomas. The most common translocation reported in over 85% of follicular lymphomas of the ocular adnexa is t(14; 18) (q32; q21). Traditional treatment options typically include a mix of chemical, surgical, and radio-oncological interventions. [ABSTRACT FROM AUTHOR]

The article focuses on the potential histologic pitfall when distinguishing between plaquelike syringoma and microcystic adnexal carcinoma (MAC). It mentions Plaquelike syringoma is a benign variant that can mimic MAC, leading to unnecessary treatment if not differentiated early, and this case report highlights the importance of careful recognition and collaboration with dermatopathologists to prevent unwarranted surgical morbidity.

Background: Laparoscopy for benign ovarian pathology is the appropriate surgical approach and it has many well-known advantages. Minimal invasive gynecological surgery increases the quality of life of the patient. The learning process of laparoscopy is difficult and requires many interventions to acquire manual skills. The objectives of the study were to assess the learning process of laparoscopy for adnexal pathology surgery performed by beginner laparoscopists. Materials and Methods: This study included three gynecological surgeons who were beginners in laparoscopy and who were named A, B, and C. We collected information about patients, diagnosis, surgical technique, and complications. Results: We have analyzed the data from 159 patients. The most frequent primary diagnosis was functional ovarian cyst, and the laparoscopic cystectomy was performed in 49.1% of interventions. The need to convert a laparoscopy into laparotomy was necessary in 1.3% of patients. There were no cases of reintervention, blood transfusion, or ureteral lesions. The duration of the surgical intervention varied statistically significantly according to patient's BMI and to the surgeon. After 20 laparoscopic interventions, a significant improvement was found in the time needed to perform ovarian cystectomy (operators A and B) and salpingectomy (operator C). Conclusions: The process of learning laparoscopy is laborious and difficult. We found a significant decrease in operating time after a twenty laparoscopic interventions. [ABSTRACT FROM AUTHOR]

To investigate the utility of preoperative neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) in the differential diagnosis of benign, borderline, and malignant ovarian tumors. This retrospective study was conducted on patients with adnexal masses who underwent surgical resection at Haseki Training and Research Hospital between September 2008 and September 2015. Sociodemographic characteristics, histopathological results and laboratory parameters were obtained from medical reports. Hematological parameters and calculated NLR and PLR were analyzed between tumor groups using IBM SPSS statistics version 22. 381 patients with a mean age of 40.81 (age range: 13-83 years) were included. Of those, 293 patients (76.91%) had benign ovarian tumors, 18 (4.72%) had borderline, and 70 (18.37%) had malignant ovarian tumors. The mean NLR was 2.318 ± 2.29 and the mean PLR was 134.35 ± 59 in benign ovarian tumors, the mean NLR was 4.27±5.23 and the mean PLR was 165.06±98.72 in borderline ovarian tumors, the mean NLR was 4.08±4.37 and the mean PLR was 194.72±114.85 in malign ovarian tumors. The NLR and PLR were significantly higher in malignant than benign or borderline ovarian tumors (all p= 0.0001). The diagnostic cut-off value of NLR for differentiating between benign or borderline and malignant tumors was 1.17, whereas that of PLR for distinguishing between benign/borderline and malignancy was 87.94. The present study indicated that NLR and PLR were significantly higher in ovarian cancers than in benign or borderline ovarian masses. Preoperative NLR and PLR values may help distinguish malignant from benign or borderline ovarian tumors. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to perform a review of facial and periorbital squamous cell carcinoma (SCC) cases to assess the relative incidence of eyelid margin involvement. Methods: This is a retrospective review of all patients with biopsy-proven SCC who were evaluated at a single oculoplastic surgery practice from 2007 to 2019. The charts were reviewed for the anatomical location of the malignancy, and those involving the eyelid were further divided into marginal and non-marginal lesions. Statistical analysis was performed using a one proportion z-test. Results: A total of 76 patients with a diagnosis of biopsy-proven periorbital and facial SCC were identified, 67 involved the ocular adnexa. Thirty-nine (58.2%) patients had lesions located on the eyelid. Of these, 33 (84.6% p < 0.0001, 95% CI 69.45-94.13) had lesions located at the margin, six of the 39 lesions were non-marginal. The remaining lesions were present within the brow (n = 10, 14.9%), medial canthus (n = 10, 14.9%), palpebral conjunctiva (n = 1, 1.5%), or orbit (n = 1, 1.5%). In six patients (8.9%) lesions involved multiple anatomic subunits. Conclusion: We present our investigation of the incidence of SCC of the marginal vs. non-marginal eyelid, revealing a statistically significant increased involvement of the eyelid margin. Future investigations are necessary to further elucidate the vulnerability of the eyelid margin to the development of SCC in particular in regards to the role of the unique genetic expression profile of eyelash follicular stem cells. [ABSTRACT FROM AUTHOR]

Intramuscular hemangioma (IMH) is rare in the ocular adnexa and is uncommonly found in infants. We describe a 1-month-old female infant with an unremarkable birth history presented with subacute onset of right upper eyelid swelling. Clinical examination revealed a purplish subcutaneous mass over the right upper eyelid causing mechanical ptosis. MRI revealed a well-defined subcutaneous mass, which was hyperintense on the T1 weighted images and showed intense enhancement after administration of intravenous gadolinium. Our working diagnosis was infantile capillary hemangioma, and the patient received two intralesional steroid injections without diminishing the lesion size. The lesion had become static in size and the subsequent MRI 14 years later revealed the same lesion had become hyperintense on the T1 weighted image. An excisional biopsy revealed mixed type IMH. IMH should be considered among young patients with upper eyelid swelling, particularly in those who show a poor response to steroid treatment. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Microcystic adnexal carcinoma (MAC) is a rare kind of cutaneous neoplasm with a very aggressive local infiltration that destructs the affected tissues. Its rate of recurrence is high and it mostly involves the face and scalp regions and most of the patients get affected in the fourth or fifth decades of their life. Here in, we report a 61‐year‐old woman with a right‐sided eyebrow MAC lesion with recurrency. Total excisional surgery was performed. A‐T Flap surgery was applied on the involved area, and after a 2‐year period of follow‐up, with no recurrency, hair transplantation with follicular unit transplantation method was successfully performed on the scarred area. Although microcystic adnexal carcinoma is an uncommon neoplasm; dermatologists and ophthalmologists should consider it as a differential diagnosis, due to its aggressive local infiltration. Complete surgical excision and long‐term follow‐up must be applied to manage the disease. Also, hair transplantation with follicular unit transplantation technique can be considered as a beneficial method for treating scars resulted from MAC excisional surgery. [ABSTRACT FROM AUTHOR]

Adnexal masses are identified in pregnant patients at a rate of 2 to 20 in 1000, approximately 2 to 20 times more frequently than in the age-matched general population. The most common types of adnexal masses in pregnancy requiring surgical management are dermoid cysts (32%), endometriomas (15%), functional cysts (12%), serous cystadenomas (11%), and mucinous cystadenomas (8%). Approximately 2% of adnexal masses in pregnancy are malignant. While most adnexal masses in pregnancy can be safely observed and around 70% spontaneously resolve, a minority warrant surgical intervention due to symptoms, risk of torsion, or suspicion for malignancy. Ultrasound is the mainstay of evaluation of adnexal masses in pregnancy due to accuracy, safety, and availability. Several ultrasound mass scoring systems, including the Sassone, Lerner, International Ovarian Tumor Analysis (IOTA) Simple Rules, and IOTA Assessment of Different NEoplasias in the adneXa (ADNEX) scoring systems have been validated specifically in pregnant populations. Decisions regarding expectant versus surgical management of adnexal masses in pregnancy must balance the risks of torsion or malignancy with the likelihood of spontaneous resolution and the risks of surgery. Laparoscopic surgery is preferred over open surgery when possible due to consistently demonstrated shorter hospital length of stay and less post-operative pain, as well as some data demonstrating shorter operative time, lower blood loss, and lower risks of fetal loss, pre-term birth, and low birth weight. Best practices for laparoscopic surgery during pregnancy include left lateral decubitus positioning after the first trimester, port placement with respect to uterine size and pathology location, insufflation pressure of less than 12-15 mm Hg, intraoperative maternal capnography, pre- and post-operative fetal heart rate and contraction monitoring, and appropriate mechanical and chemical thromboprophylaxis. While planning surgery for the second trimester generally affords time for mass resolution while optimizing visualization with regards to uterine size and pathology location, necessary surgery should not be delayed due to gestational age. When performed at a facility with appropriate obstetric, anesthetic, and neonatal support, adnexal surgery in pregnancy generally results in excellent outcomes for mother and fetus. [ABSTRACT FROM AUTHOR]

After the global COVID-19 pandemic, there has been an alarming concern with the monkeypox (mpox) outbreak, which has affected more than 110 countries worldwide. Monkeypox virus is a doublestranded DNA virus of the genus Orthopox of the Poxviridae family, which causes this zoonotic disease. Recently, the mpox outbreak was declared by the World Health Organization (WHO) as a public health emergency of international concern (PHEIC). Monkeypox patients can present with ophthalmic manifestation and ophthalmologists have a role to play in managing this rare entity. Apart from causing systemic involvement such as skin lesions, respiratory infection and involvement of body fluids, Monkeypox related ophthalmic disease (MPXROD) causes varied ocular manifestations such as lid and adnexal involvement, periorbital and lid lesion, periorbital rash, conjunctivitis, blepharocounctivitis and keratitis. A detailed literature review shows few reports on MPXROD infections with limited overview on management strategies. The current review article is aimed to provide the ophthalmologist with an overview of the disease with a spotlight on ophthalmic features. We briefly discuss the morphology of the MPX, various modes of transmission, an infectious pathway of the virus, and the host immune response. A brief overview of the systemic manifestations and complications has also been elucidated. We especially highlight the detailed ophthalmic manifestations of mpox, their management, and prevention of vision threatening sequelae. [ABSTRACT FROM AUTHOR]

Imaging plays an important role in characterizing and risk-stratifying commonly encountered adnexal lesions. Recently, the American College of Radiology (ACR) released the Ovarian-Adnexal Reporting and Data System (O-RADS) for ultrasound and subsequently for magnetic resonance imaging (MRI). The goal of the recently developed ACR O-RADS MRI risk stratification system is to improve the quality of imaging reports as well as the reproducibility of evaluating adnexal lesions on MRI. This review focuses on exploring this new system and its future refinements. [ABSTRACT FROM AUTHOR]

Adnexal masses during pregnancy are a relatively uncommon entity. Their clinical management is challenging given the overlapping features of certain entities on imaging and histopathology, which can mimic malignancy, and the potential side effects to the mother and fetus, whether expectant management versus surgery is pursued. Ultrasonography with Doppler evaluation is the modality of choice for evaluating adnexal masses during pregnancy. Magnetic resonance imaging is the second-line modality useful when US findings are inconclusive/indeterminate. Most adnexal masses in pregnant patients are benign in origin (e.g., functional cysts, mature cystic teratoma, decidualization of endometrioma), but a few are malignant in origin (e.g., dysgerminoma, granulosa cell tumor). Most cases of adnexal masses are asymptomatic, but complications such as ovarian torsion can occur. This review aims to familiarize the radiologist with the imaging of adnexal lesions during pregnancy so that the radiologist can identify ovarian cancer. Specifically, the review will detail the most common benign and malignant adnexal masses in pregnancy, mimickers, and their corresponding imaging findings on US and MRI. [ABSTRACT FROM AUTHOR]

Background: Ocular adnexal lymphoma (OAL) and idiopathic orbital inflammation (IOI) are malignant and benign lesions for which radiotherapy and corticosteroids are indicated, but similar clinical manifestations make their differentiation difficult. Purpose: To develop and validate an MRI‐based radiomics nomogram for individual diagnosis of OAL vs. IOI. Study Type: Retrospective. Population: A total of 103 patients (46.6% female) with mean age of 56.4 ± 16.3 years having OAL (n = 58) or IOI (n = 45) were divided into an independent training (n = 82) and a testing dataset (n = 21). Field Strength/Sequence: A 3‐T, precontrast T1‐weighted imaging (T1WI), T2‐weighted imaging (T2WI), and postcontrast T1WI (T1 + C). Assessment: Radiomics features were extracted and selected from segmented tumors and peritumoral regions in MRI before‐and‐after filtering. These features, alone or combined with clinical characteristics, were used to construct a radiomics or joint signature to differentiate OAL from IOI, respectively. A joint nomogram was built to show the impact of the radiomics signature and clinical characteristics on individual risk of developing OAL. Statistical Tests: Area under the curve (AUC) and accuracy (ACC) were used for performance evaluation. Mann–Whitney U and Chi‐square tests were used to analyze continuous and categorical variables. Decision curve analysis, kappa statistics, DeLong and Hosmer–Lemeshow tests were also conducted. P < 0.05 was considered statistically significant. Results: The joint signature achieved an AUC of 0.833 (95% confidence interval [CI]: 0.806–0.870), slightly better than the radiomics signature with an AUC of 0.806 (95% CI: 0.767–0.838) (P = 0.778). The joint and radiomics signatures were comparable to experienced radiologists referencing to clinical characteristics (ACC = 0.810 vs. 0.796–0.806, P > 0.05) or not (AUC = 0.806 vs. 0.753–0.791, P > 0.05), respectively. The joint nomogram gained more net benefits than the radiomics nomogram, despite both showing good calibration and discriminatory efficiency (P > 0.05). Data Conclusion: The developed radiomics‐based analysis might help to improve the diagnostic performance and reveal the association between radiomics features and individual risk of developing OAL. Evidence Level: 3 Technical Efficacy: 3 [ABSTRACT FROM AUTHOR]

Eccrine porocarcinoma (EPC) constitutes a rare malignant adnexal tumor, which accounts for about 0.005–0.01% of all cutaneous malignancies. It may develop de novo or arise from an eccrine poroma, after a latency period of years or even decades. Accumulating data suggest that specific oncogenic drivers and signaling pathways may be implicated in its tumorigenesis, while recent data have demonstrated a high overall mutation rate attributed to UV exposure. Diagnosis may be challenging and should rely on the combination of clinical, dermoscopical, histopathological and immunohistochemical findings. The literature is controversial regarding tumor behavior and prognosis and, therefore, there is no consensus on its surgical management, utility of lymph-node biopsy and further adjuvant or systemic treatment. However, recent advances in tumorigenesis of EPC may aid in the development of novel treatment strategies, which could improve survival of advanced or metastatic disease, such as immunotherapy. This review presents an update of the epidemiology, pathogenesis and clinical presentation of EPC and summarizes current data on diagnostic evaluation and management of this rare cutaneous malignancy. [ABSTRACT FROM AUTHOR]

Background: Ovarian torsion (adnexal torsion) is a rare event in pediatric patients which is primarily managed by pediatric general surgeons. Case presentation: This study presents a case of ovarian torsion in a 2-yr-old girl with a history of episodic lower abdominal pain, nausea, and vomiting for 2 days. Her physical examination was normal except for mild tenderness in the lower abdomen with no palpable mass. A color Doppler ultrasound was performed for further investigation, and an ovarian torsion was reported without sonographic signs of intussusception and acute appendicitis, so she underwent laparotomy. A relatively complete torsion was observed in the left ovarian pedicle. Initially, the left ovary and fallopian tube had a dark appearance, and 10-15% of the ovarian tissue was still normal. Detorsion of ovary was done and it was decided to preserve the ovary. After about 20 min, the color of ovary and fallopian tube returned to relatively normal, indicating normal blood flow. The patient was discharged 2 days later because a follow-up color Doppler ultrasound showed normal ovarian blood flow. Conclusion: The possibility of ovarian torsion must be considered in all female infants with suspicious abdominal pain. [ABSTRACT FROM AUTHOR]

Hepatoid carcinoma of the ovary (HCO) is a tumor that resembles, both histologically and cytologically, hepatocarcinoma (HCC) in a patient with a non-cirrhotic liver not involved by the disease. Hepatoid carcinoma is an extremely rare histologic subtype of ovarian cancer and should be distinguished from metastatic HCC. Here, we report the rare case of a 67-year-old woman with ovarian recurrence of HCC 12 years after first diagnosis. The patient was being followed by oncologists because she had been diagnosed with HCV-related HCC (Edmonson and Stainer grade 2, pT2 N0 M0, G2, V1) in 2009. She had undergone surgery for enlarged left hepatectomy to the 4th hepatic segment with cholecystectomy and subsequent placement of a Kehr drain. The preoperative alpha-fetoprotein (AFP) level was 8600 ng/mL, while the postoperative value was only 2.7 ng/mL. At the first diagnosis, no other localizations of the disease, including the genital tract, were found. At the time of recurrence, however, the patient was completely asymptomatic: her liver function was within normal limits with negative blood indices, except for an increased blood dosage of AFP (467 ng/mL), and CA125, which became borderline (37.4 IU/mL). The oncologist placed an indication for a thoracic abdominal CT scan, which showed that the residual liver was free of disease, and the presence of a formation with a solid–cystic appearance and some calcifications at the left adnexal site. The radiological findings were confirmed on level II gynecological ultrasound. The patient then underwent a radical surgery of hysterectomy, bilateral oophorectomy, pelvic peritonectomy, and omentectomy by a laparotomic approach, with the sending of intraoperative extemporaneous histological examination on the annexus site of the tumor mass, obtaining RT = 0. Currently, the patient continues her gyneco-oncology follow-up simultaneously clinically, in laboratory, and instrumentally every 4 months. Our study currently represents the longest elapsed time interval between first diagnosis and disease recurrence, as evidenced by current data in the literature. This was a rather unique and difficult clinical case because of the rarity of the disease, the lack of scientific evidence, and the difficulty in differentiating the primary hepatoid phenotype of the ovary from an ovarian metastasis of HCC. Several multidisciplinary meetings for proper interpretation of clinical and anamnestic data, with the aid of immunohistochemistry (IHC) on histological slides were essential for case management. [ABSTRACT FROM AUTHOR]

Simple Summary: Characterization of an adnexal mass may be challenging since there are several benign and malignant pelvic conditions with similar appearances on imaging. The aim of this study is to comprehensively review discriminative MRI features of common and uncommon adnexal masses in order to help radiologists more accurately diagnose ovarian cancer. Imaging findings of ovarian tumors in specific settings, including adolescence and pregnancy, are also discussed. Imaging plays a pivotal role in the diagnostic approach of women with suspected ovarian cancer. MRI is widely used for preoperative characterization and risk stratification of adnexal masses. While epithelial ovarian cancer (EOC) has typical findings on MRI; there are several benign and malignant pelvic conditions that may mimic its appearance on imaging. Knowledge of the origin and imaging characteristics of a pelvic mass will help radiologists diagnose ovarian cancer promptly and accurately. Finally, in special subgroups, including adolescents and gravid population, the prevalence of various ovarian tumors differs from that of the general population and there are conditions which uniquely manifest during these periods of life. [ABSTRACT FROM AUTHOR]

Introduction: A paraovarian cyst (POC) is a cyst in the broad ligament or mesosalpinx. Paraovarian cysts have an estimated prevalence of 5-20% amongst the adnexal masses. Despite the high prevalence and availability of advanced imaging modalities, an accurate pre-operative diagnosis of POC is still made in less than 50% of patients. Case reports: Two females with suspected ovarian torsion underwent laparotomy and had POCs. A 42-yearold hysterectomized female underwent surgery for a suspected POC which turned out to be a mesenteric cyst. Two females underwent laparotomy for suspected mesenteric cysts which turned out to be POCs. A nulliparous female with infertility conceived spontaneously after cystectomy of POC. Results: Optimal management of an adnexal mass depends on the knowledge of the origin and the exact nature of the mass. No clear-cut guidelines exist for the management of POCs despite their high prevalence. There is a need for further research on this topic to formulate clear-cut guidelines for their management. Conclusions: Radiologists and gynaecologists need to keep them in mind as differentials for patients with adnexal masses to ensure a correct pre-operative diagnosis in order to achieve an optimal outcome for these females. Gynaecologists need to be aware of the cases which can be managed conservatively and those that need surgery, along with the extent of the surgery required, taking care to protect the ovary at all costs, particularly in benign cases. [ABSTRACT FROM AUTHOR]

Adnexal lesions are a common finding in women and pose a clinical challenge since ovarian cancer is a highly lethal disease. However, most adnexal masses are benign, benefiting from a more conservative approach. In preoperative assessment, transvaginal ultrasound plays a key role in evaluating morphologic features that correlate with the risk of malignancy. The acoustic shadow is the loss of echo behind sound‐absorbing components, such as calcifications or fibrous tissues, which are predominantly found in benign lesions. However, recognizing the acoustic shadow is a difficult skill to master, and its usefulness may be underappreciated. [ABSTRACT FROM AUTHOR]

The coronavirus disease–19 (COVID-19) infection may remain asymptomatic or may have several different presentations. Although this disease primarily affects the respiratory system, systemic manifestations affecting the gastrointestinal, cardiovascular, neurological, otorhinolaryngologic, and ophthalmic systems have been reported. Ophthalmic signs may be the first and only sign of COVID-19 infection in children. In the current narrative review, we report the ophthalmic manifestations of COVID-19 in the pediatric age cohort. We performed a comprehensive literature search for the publications on ophthalmic manifestations of COVID-19 in children between 1 March 2020 and 1 January 2022 and compiled the ophthalmic manifestations of this entity among the pediatric population. Conjunctivitis is the most common ophthalmic manifestation in children and can develop at any stage of the disease. Ophthalmic manifestations are seen more commonly in children with severe systemic disease. Long-term and indirect consequence of the COVID-19 disease is the rise of myopia among children. Ophthalmic signs may be the first and only sign of COVID-19 infection in children. Pediatricians, as well as ophthalmologists, must keep observing all children with COVID-19 closely for ophthalmic signs. [ABSTRACT FROM AUTHOR]

Ovarian cancer management during pregnancy is a topic of limited research due to low occurrence rates of malignant adnexal tumors. To shed further light on this issue, we present a case series of 22 pregnant ovarian cancer patients referred to an academic hospital's gynecology oncology department over six years. Data on each patient's demographic and clinical background were collected using a registry software recording surgical tumor staging, disease-free survival (DFS), and overall survival (OS). According to the data analysis reports, subtype epithelial tumor and germ cell pathology were equally 45.4%. However, sex-cord tumors were observed in a smaller percentage of cases (9.1%). Serous adenocarcinoma was the most common subtype among those with epithelial tumors (60%). Meanwhile, 72.7% of these pregnant women had a palpable mass in physical examination. In addition, adnexal mass was detected in 95.4% of ultrasonography. Due to the young age of the patients, fertility-preserving surgery was performed on 63.6% of patients, and chemotherapy was prescripted on 59% of patients. Over a six-year follow-up period, there was a recurrence rate of 22.7%, while DFS and OS were reported as 56% and 82%, respectively. In conclusion, treatment of ovarian malignancies during pregnancy requires an experienced multidisciplinary approach. However, more extensive studies with larger samples are needed to gain more insight into the treatment of ovarian cancer during pregnancy. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the accuracy of IOTA Simple Rules (SR), IOTA ADNEX model, Risk of Malignancy Index (RMI), and subjective assessment (SA) which is used for adnexal mass assessment in our institution. Design: This is a prospective observational study. Participants/Materials, Setting, Methods: We included patients with at least one adnexal mass who needed elective surgical evaluation based on clinical and laboratory findings. Patients admitted to Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, were recruited for the study between January 2019 and June 2021. Level II ultrasonographers performed a gray scale and Doppler exam for each patient. Preoperative classification of adnexal masses (benign or malignant) was performed by SA, the International Ovarian Analysis Group (IOTA) SR, IOTA ADNEX model, and Risk of Malignancy Index (RMI). Postoperatively obtained histological findings were used as a reference. Results: During the study period, we enrolled 179 premenopausal and 217 postmenopausal patients, representing 396 patients in our sample. Prevalence of malignant disease in pre- and postmenopausal groups was 16.2% (29/179) and 41% (89/217), respectively. Malignant disease was diagnosed in 29.8% (118/396) of patients. SA achieved the highest discrimination accuracy between benign and malignant tumors (area under the curve [AUC] of 0.928, 95% CI [0.898–0.952]). For SA, the overall diagnostic accuracy, sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR−) were 91.4%, 88.1%, 92.8%, 12.25, and 0.13. The AUC for Simple Rules with subjective assessment in inconclusive cases (SR + SA) was 0.912 (95% CI [0.880–0.938]). Regarding SR + SA, diagnostic accuracy, sensitivity, specificity, LR+, and LR− were 92.4%, 88.1%, 94.2%, 15.31, and 0.13. The ADNEX model had the AUC of 0.914 (95% CI [0.882–0.940]). Binary classification using the ADNEX model at a cut-off value of 10% for malignancy had the sensitivity, specificity, LR+ and LR− of 92.4%, 73.0%, 3.42, and 0.10. This resulted in the lowest overall accuracy of 78.8%. The AUC for RMI was 0.854 (95% CI [0.815–0.887]), with overall accuracy, sensitivity, specificity, LR+ and LR− of 82.3%, 73.7%, 86.0%, 5.26, and 0.31. There was no difference in the AUCs of the SA and IOTA models for the whole group, premenopausal, and postmenopausal groups. RMI performed worse compared to SA and the IOTA models. The ADNEX model achieved the highest accuracy at the cut-off value of 35%. Limitations: The data generalizability is limited by a single institution-dependent sampling. Conclusions: The IOTA SR and ADNEX model were reliable and comparable with the SA and performed better than the RMI. The IOTA SR model offers the potential for immediate and reliable diagnosis, even in the hands of less experienced ultrasonographers. Both IOTA models studied can be a valuable adjunct to a clinician's decision-making process. [ABSTRACT FROM AUTHOR]

(1) Background: Spiradenocarcinoma is an extremely rare malignant adnexal tumor and there are only few studies on survival outcomes. Our aim was to perform an analysis of the demographic and pathological characteristics, treatment patterns, and survival outcomes of patients affected by spiradenocarcinoma. (2) Methods: The Surveillance, Epidemiology, and End Results program database of the National Cancer Institute was searched for all cases of spiradenocarcinoma diagnosed between 2000 and 2019. This database is considered representative of the US population. Demographic, pathological, and treatment variables were retrieved. Overall and disease-specific survival were computed according to the different variables. (3) Results: 90 cases of spiradenocarcinoma (47 females, 43 males) were identified. Mean age at diagnosis was 62.8 years. Regional and distant disease at diagnosis were rare, occurring in 2.2% and 3.3% of cases, respectively. Surgery alone was the most frequent treatment (87.8%), followed by a combination of surgery and radiotherapy (3.3%) and radiation therapy only (1.1%). Five-year overall survival was 76.2% and five-year disease-specific survival was 95.7%. (4) Conclusions: Spiradenocarcinoma equally affects males and females. Regional and distant invasion rates are low. Disease-specific mortality is low and is probably overestimated in the literature. Surgical excision remains the main form of treatment. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the risks of developing gestational diabetes (GDM) and pregnancy-induced hypertension (PIH) in women with polycystic ovary syndrome (PCOS) using data from Korea's National Health Insurance Service. Method: The PCOS group comprised women aged 20 to 49 years diagnosed with PCOS between 1 January 2012, and 31 December 2020. The control group comprised women aged 20 to 49 years who visited medical institutions for health checkups during the same period. Women with any cancer within 180 days of the inclusion day were excluded from both the PCOS and control groups, as were women without a delivery record within 180 days after the inclusion day, as well as women who visited a medical institution more than once before the inclusion day due to hypertension, diabetes mellitus (DM), hyperlipidemia, DM in pregnancy, or PIH. GDM and PIH were defined as cases with at least three visits to a medical institution with a GDM diagnostic code and a PIH diagnostic code, respectively. Results: Overall, 27,687 and 45,594 women with and without a history of PCOS experienced childbirth during the study period. GDM and PIH cases were significantly higher in the PCOS group than in the control group. When adjusted for age, SES, region, CCI, parity, multiple pregnancies, adnexal surgery, uterine leiomyoma, endometriosis, PIH, and GDM, an increased risk of GDM (OR = 1.719, 95% CI = 1.616–1.828) was observed among women with a history of PCOS. There was no increase in the risk of PIH among women with a history of PCOS (OR = 1.243, 95% CI = 0.940–1.644). Conclusion: A history of PCOS itself might increase the risk of GDM, but its relationship with PIH remains unclear. These findings would be helpful in the prenatal counseling and management of patients with PCOS-related pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Background: To describe the clinical characteristics and treatment outcomes of secondary ocular adnexal lymphoma (OAL), and emphasise the impact of timely biopsy and systemic evaluation on the diagnosis and treatment. Methods: The data of patients with secondary OAL in our hospital from January 2010 to June 2021 were retrospectively reviewed. Results: A total of 54 patients (30 men and 24 women) were included in the study. The mean age at presentation was 60 years (median 62 years; range 37–83 years). The main symptoms included ocular mass (74%), periorbital swelling (43%), and proptosis (39%). The main histopathological types were mucosa‐associated lymphoid tissue lymphoma (30%), diffuse large B‐cell lymphoma (28%), and natural killer/T‐cell lymphoma (18%). In particular, three patients exhibited different pathological types of ocular lymphoma compared to previously diagnosed systemic lymphoma. The most common site of ocular and systemic involvement was the orbit (85%) and lymph nodes (56%), respectively, and 25 (46%) patients had occult extraocular lesions. Additionally, the 5‐year overall survival rate of the entire cohort was 56%, and significant differences were observed between the three main pathological types and stages of the disease (all p < 0.001). Conclusions: Secondary OAL is a rare disease with a poor prognosis. That the disease is associated with a more aggressive pathological type is well established, indolent lymphoma is not uncommon. Furthermore, OAL and previously diagnosed systemic lymphoma may be pathologically distinct in some patients. Therefore, we recommend a prompt excision biopsy and a thorough systemic evaluation of patients with suspected OAL. [ABSTRACT FROM AUTHOR]

BACKGROUND: Borderline ovarian tumors (BOTs) and early clinical stage malignant adnexal masses can make sonographic diagnosis challenging, while the clinical utility of tumor markers, e.g., CA125 and HE4, or the ROMA algorithm, remains controversial in such cases. OBJECTIVE: To compare the IOTA group Simple Rules Risk (SRR), the ADNEX model and the subjective assessment (SA) with serum CA125, HE4 and the ROMA algorithm in the preoperative discrimination between benign tumors, BOTs and stage I malignant ovarian lesions (MOLs). METHODS: A multicenter retrospective study was conducted with lesions classified prospectively using subjective assessment and tumor markers with the ROMA. The SRR assessment and ADNEX risk estimation were applied retrospectively. The sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR−) were calculated for all tests. RESULTS: In total, 108 patients (the median age: 48 yrs, 44 postmenopausal) with 62 (79.6%) benign masses, 26 (24.1%) BOTs and 20 (18.5%) stage I MOLs were included. When comparing benign masses with combined BOTs and stage I MOLs, SA correctly identified 76% of benign masses, 69% of BOTs and 80% of stage I MOLs. Significant differences were found for the presence and size of the largest solid component (p = 0.0006), the number of papillary projections (p = 0.01), papillation contour (p = 0.008) and IOTA color score (p = 0.0009). The SRR and ADNEX models were characterized by the highest sensitivity (80% and 70%, respectively), whereas the highest specificity was found for SA (94%). The corresponding likelihood ratios were as follows: LR+ = 3.59 and LR− = 0.43 for the ADNEX; LR+ = 6.40 and LR− = 0.63 for SA and LR+ = 1.85 with LR− = 0.35 for the SRR. The sensitivity and specificity of the ROMA test were 50% and 85%, respectively, with LR+ = 3.44 and LR− = 0.58. Of all the tests, the ADNEX model had the highest diagnostic accuracy of 76%. CONCLUSIONS: This study demonstrates the limited value of diagnostics based on CA125 and HE4 serum tumor markers and the ROMA algorithm as independent modalities for the detection of BOTs and early stage adnexal malignant tumors in women. SA and IOTA methods based on ultrasound examination may present superior value over tumor marker assessment. [ABSTRACT FROM AUTHOR]

Introduction: Despite advancements in cross-sectional aging techniques, ultrasonography continues to remain the first-line imaging modality for the preoperative assessment of pelvic adnexal masses. Ultrasound strain elastography is a novel technique that can characterise adnexal lesions based on their tissue stiffness and when used in conjunction with conventional USG, it may increase the precision of diagnosis and can act as a cost-effective viable ancillary tool. Aim: To assess the role of strain sonoelastography in characterising the adnexal lesion as benign or malignant. Materials and Methods: This cross-sectional study was conducted in the Department of Radiodiagnosis, Teerthankar Mahaveer Medical College and Research Centre (TMMC&RC), Moradabad, Uttar Pradesh, India, for a period of 18 months (January 2020 to June 2021) and consisted of 110 patients with clinical suspicion of adnexal mass, who were evaluated on SIEMENS Acuson S 3000 scanner (from the total of 130 cases). Various morphological features of mass (size, laterality, consistency, echogenicity and internal contents) were assessed on Gray scale and vascularity was assessed on colour doppler Ultrasonography (USG). Subsequently, real time strain elastography (eSie touch) was performed to assess the tissue stiffness. Elasticity was indicated on a colour-coded elastogram map, with blue areas denoting hard tissue, green areas suggesting intermediate tissue, and red portions denoting soft tissues. The sonographic findings were compared with histopathological diagnosis. Sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were calculated for Gray scale sonography in combination with Doppler (conventional ultrasound techniques) and in conjunction with elastography. The Chi-square test was applied for comparing the frequency and p-value less than 0.05 was considered to be significant. Results: The mean age of study population was 36.35±14.82 years. On histopathology out of 110 patients, 95 (86.36%) had benign adnexal lesions and 15 (13.64%) had malignant adnexal lesions. The youngest patient was 16-year-old and eldest was 70 years and the mean age of the study population was 36.35 years. When conventional ultrasound technique was used alone for differentiating benign and malignant adnexal masses the sensitivity was 96.7%, specificity was 83%, PPV was 96.7% and NPV was 83% while on addition of sonoelastography the sensitivity increased to 98.9%, specificity increased to 93%, PPV increased to 98.9% and NPV increased to 93.7%. Conclusion: Conventional ultrasound techniques should be combined with sonoelastography in a diagnostic system to achieve better characterisation and differentiation of benign and malignant adnexal masses. [ABSTRACT FROM AUTHOR]

Malignant cutaneous adnexal tumors are rare dermatosis that can have extradermal twins. Diagnosis of adnexal skin tumors is sometimes difficult. Immunohistochemistry has limited value in the diagnosis. Most adnexal skin tumors are localized on the head and neck. Difficulties in their diagnosis associated with absence of strict clinical criteria. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the diagnostic accuracy of different ultrasound signs for diagnosing adnexal torsion, using surgery as the reference standard. Methods: This was a systematic review and meta‐analysis of studies published between January 1990 and November 2021 evaluating ovarian edema, adnexal mass, ovarian Doppler flow findings, the whirlpool sign and pelvic fluid as ultrasound signs (index tests) for detecting adnexal torsion, using surgical findings as the reference standard. The search for studies was performed in PubMed/MEDLINE, CINAHL, Scopus, The Cochrane Library, ClinicalTrials.gov and Web of Science databases. The Quality Assessment of Diagnostic Accuracy Studies‐2 (QUADAS‐2) tool was used to evaluate the quality of the studies. Pooled sensitivity, specificity, and positive and negative likelihood ratios were calculated separately, and the post‐test probability of adnexal torsion following a positive or negative test was also determined. Results: The search identified 1267 citations after excluding duplicates. Eighteen studies were ultimately included in the qualitative and quantitative syntheses. Eight studies (809 patients) analyzed the presence of ovarian edema, eight studies (1044 patients) analyzed the presence of an adnexal mass, 14 studies (1742 patients) analyzed ovarian Doppler flow, six studies (545 patients) analyzed the whirlpool sign and seven studies (981 patients) analyzed the presence of pelvic fluid as ultrasound signs of adnexal torsion. Overall, the quality of most studies was considered to be moderate or good. However, there was a high risk of bias in the patient‐selection and index‐text domains (with the exception of the whirlpool sign) in a significant proportion of studies. Pooled sensitivity, specificity, and positive and negative likelihood ratios of each ultrasound sign were 58%, 86%, 4.0 and 0.49 for ovarian edema, 69%, 46%, 1.3 and 0.67 for adnexal mass, 65%, 91%, 7.6 and 0.38 for the whirlpool sign, 53%, 95%, 11.0 and 0.49 for ovarian Doppler findings and 55%, 69%, 1.7 and 0.66 for pelvic fluid. Heterogeneity was high for all analyses. Conclusions: The presence of an adnexal mass or pelvic fluid have poor diagnostic accuracy as ultrasound signs of adnexal torsion, while the presence of ovarian edema, the whirlpool sign and decreased or absent ovarian Doppler flow have good specificity but moderate sensitivity for detecting adnexal torsion. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. A video abstract of this article is available online here. [ABSTRACT FROM AUTHOR]

This study aimed to investigate clinical presentations, surgical procedures and findings, complications, and predisposing factors of adnexal torsion in pregnant women. We searched PubMed/Medline, Embase, and Web of Science from January 2000 to March 2022. All case reports and case series with full-text English language reporting adnexal torsion in pregnant women were included. Medical history, clinical presentations, surgical procedures and findings, complications related to adnexal torsion, and predisposing factors were independently extracted by two investigators. A total of 182 articles reporting 662 pregnant women with adnexal torsion were included. Most of the adnexal torsions occurred during the first trimester (54.63%), while others occurred during the second (26.36%) and third (19.00%) trimesters. The most common symptom of adnexal torsion was sudden-onset pain (80.60%). Enlargement of the adnexa was the most prevalent ultrasound finding in a twisted adnexa (95.20%). Additionally, about half of the patients had decreased blood flow in Doppler ultrasound (53.80%). Laparoscopic surgery was the favorite option (56.88%), while cystectomy and detorsion were the most commonly performed procedure (29.06%). Expectant management was reported in only 2.99% of the patients. In addition, the most common complications were preterm labor (27.58%) and emergent cesarean sections (25.28%). Clinicians should think of adnexal torsion when pregnant women complain of sudden-onset pain. Then, using ultrasound, adnexal enlargement or masses should be explored seriously. They should take invasive and urgent therapy to preserve ovaries and prevent complications. [ABSTRACT FROM AUTHOR]

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Fifteen patients (83%) received combined modality therapy with R-CHOP followed by radiation therapy (RT); among these, 10 had short-course R-CHOP (three to four cycles) and five completed full course R-CHOP (six cycles). Long-term outcomes of patients with limited-stage ocular adnexal DLBCL treated with combined modality therapy in the rituximab era Keywords: diffuse large B cell lymphoma; ocular adnexa; orbit; outcomes; radiation; rituximab; treatment EN diffuse large B cell lymphoma ocular adnexa orbit outcomes radiation rituximab treatment 524 527 4 02/07/23 20230215 NES 230215 Primary diffuse large B-cell lymphoma involving the ocular adnexa (OA-DLBCL), including the orbit, eyelids or lacrimal glands, is a rare manifestation of DLBCL, and data to guide management are limited.[[1], [3]] Historically OA-DLBCL has been associated with poor prognosis, but reported cases were largely treated prior to the rituximab era, and many were managed with local therapy alone without systemic chemotherapy.[[2], [4], [6]] In the rituximab era, its prognosis remains unknown, particularly in individuals with limited-stage disease.[8] Published case series of patients with extranodal limited-stage DLBCL rarely included OA-DLBCL.[9] Thus, the optimal management and outcomes of patients with limited-stage OA-DLBCL treated with modern therapy remain poorly defined. [Extracted from the article]

Ovarian cancer is a common gynecological malignant tumor. Early diagnosis is important for the prognosis of patients with ovarian cancer. To evaluate the accuracy of the Copenhagen Index (CPH‐I) in detecting malignant adnexal tumors and to compare the diagnostic accuracy of CPH‐I and the Risk of Ovarian Malignancy Algorithm (ROMA). PubMed, Web of Science, and Cochrane Library databases were used to retrieve eligible studies. The overall sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the (summary receiver operating characteristic) curve (AUC) were 0.81, 0.88, 6.61, 0.22, 30.43, and 0.91, respectively, in diagnosing malignant adnexal tumors. In addition, using ROMA, the sensitivity, specificity, and AUC were 0.83, 0.85, and 0.90, respectively. CPH‐I showed high accuracy in diagnosing malignant adnexal tumors, which could be an alternative method with similar efficacy to ROMA. CPH‐I was more advantageous in diagnosing adnexal tumors in postmenopausal women. Synopsis: The Copenhagen Index (CPH‐I) is an accurate and simple method for diagnosing ovarian cancer. The diagnostic performance is similar to Risk of Ovarian Malignancy Algorithm (ROMA), and is more accurate in postmenopausal patients. [ABSTRACT FROM AUTHOR]

The American College of Radiology (ACR) Ovarian-Adnexal Reporting and Data System (O-RADS) lexicon and risk assessment tool for ultrasound (US) provides a framework for characterization of ovarian and adnexal pathology with the ultimate goal of harmonizing reporting and patient management strategies. Since the first O-RADS US publication in 2018, multiple validation studies have shown O-RADS US to have excellent diagnostic accuracy, with the majority of these studies using O-RADS 4 as the optimal cut-off for detecting ovarian cancer. Most of the existing validation studies include a dedicated training phase and confirm that ORADS US categories and lexicon descriptors are associated with high level inter-read agreement, regardless of radiologist training level or practice experience. O-RADS US has a similar inter-reader agreement when compared to Gynecologic Imaging Reporting and Data System (GIRADS), Assessment of Different Neoplasias in the adnexa (ADNEX), and International Tumor Analysis Group (IOTA) simple rules. System descriptors have been shown to correlate with expected malignancy rates and the O-RADS US risk stratification system has been shown to perform in the expected range of malignancy risk per category. Further directions will focus on clarifying governing concepts and lexicon terminology as well as further refining risk stratification categories based on data from published validation studies. [ABSTRACT FROM AUTHOR]

Background: Primary ocular adnexal mucosa‐associated lymphoid tissue (MALT) lymphoma (POAML) is the most common subtype of indolent ocular adnexal lymphomas. Although radiotherapy (RT) is the standard of care for localized POAML, it can occasionally lead to permanent side effects. Other treatment strategies, such as rituximab (R) monotherapy and immunochemotherapy, have been used for POAML treatment, but their long‐term benefits and relative merits remain unclear. While watchful waiting (WW) is a potential option for some indolent lymphomas, the benefits of WW for POAML patients are also unclear. Methods: We here retrospectively analyzed 75 patients who were diagnosed with POAML between 2008 and 2019 in the institutions of the Kyoto Clinical Hematology Study Group. Results: Commonly involved sites were conjunctiva (42.7%), orbit (36.0%), and lacrimal gland (12.0%), and most patients (92.0%) presented with Ann Arbor stage IE disease. The treatment strategy was selected at the physicians' discretion. More patients without subjective symptoms by tumor mass were subjected to WW (29 patients), while more patients with tumor‐derived subjective symptoms were treated by tumor‐directed therapy (24 received focal RT, and 19 received R monotherapy). Complete response rates were 79.2% and 42.1% in the RT and R groups, respectively. At 60 months of follow‐up, the estimated proportions of POAML patients not requiring new treatment were 69.4%, 85.2%, and 53.8% in the WW, RT, and R groups, respectively. There were no significant differences in the time to start a new treatment between WW and RT groups (median: both not reached [NR], p = 0.187) and between WW and R groups (median: NR vs. 69.0 months, p = 0.554). No specific predictive factor for the future need of treatment was identified in the WW group. Conclusion: Our results demonstrate WW may be an acceptable treatment option for POAML, especially for asymptomatic patients. [ABSTRACT FROM AUTHOR]

Background: Primary ocular adnexal extranodal marginal zone mucosa‐associated lymphoid tissue lymphoma (OAML) is a rare subtype of non‐Hodgkin's lymphoma, and no consensus has been defined concerning the optimal treatment strategies. This study aims to investigate the associations of disease characteristics and different treatments with long‐term outcomes of patients with localized OAML. Methods: A large retrospective cohort study was conducted in a single‐center of China, and 166 patients with newly diagnosed primary localized OAML were enrolled. Detailed data of disease characteristics at diagnosis and treatments were collected for all patients. We compared treatment response and progression‐free survival (PFS) among patients with different characteristics and treatments. Results: Of the 166 patients, 52 received complete resection of neoplasm, whereas 114 had residual lesion after surgery. Among the 114 patients, 61 underwent watchful waiting and 53 received further treatment including localized radiotherapy, chemotherapy, or combined radiotherapy and chemotherapy. Median follow‐up was 49 months. A total of 31 patients had disease progression or relapse, including four patients with such event more than five years after initial treatment. The 5‐year PFS was 73.9%, 70.6%, and 85.9%, whereas the 10‐year PFS was 69.3%, 59.2%, and 79.3%, among patients with complete resection of neoplasm, patients in the watchful waiting group and patients with further treatment, respectively. Patients with further treatment had longer PFS, compared with patients in the watchful waiting group (p = 0.011). Bilateral involvement at diagnosis was associated with significantly inferior PFS (p = 0.029), whereas age, IPI score, or TNM staging were not associated with PFS. No serious adverse reaction was reported among patients with further treatment. Conclusions: Bilateral involvement was associated with poor prognosis. Among patients with residual lesions after surgery, further treatment was associated with improved survival. Patients with OAML might experience disease progression or relapse more than five years after initial treatment. [ABSTRACT FROM AUTHOR]

Objective: Previous work has suggested that the ultrasound‐based benign simple descriptors (BDs) can reliably exclude malignancy in a large proportion of women presenting with an adnexal mass. This study aimed to validate a modified version of the BDs and to validate a two‐step strategy to estimate the risk of malignancy, in which the modified BDs are followed by the Assessment of Different NEoplasias in the adneXa (ADNEX) model if modified BDs do not apply. Methods: This was a retrospective analysis using data from the 2‐year interim analysis of the International Ovarian Tumor Analysis (IOTA) Phase‐5 study, in which consecutive patients with at least one adnexal mass were recruited irrespective of subsequent management (conservative or surgery). The main outcome was classification of tumors as benign or malignant, based on histology or on clinical and ultrasound information during 1 year of follow‐up. Multiple imputation was used when outcome based on follow‐up was uncertain according to predefined criteria. Results: A total of 8519 patients were recruited at 36 centers between 2012 and 2015. We excluded patients who were already in follow‐up at recruitment and all patients from 19 centers that did not fulfil our criteria for good‐quality surgical and follow‐up data, leaving 4905 patients across 17 centers for statistical analysis. Overall, 3441 (70%) tumors were benign, 978 (20%) malignant and 486 (10%) uncertain. The modified BDs were applicable in 1798/4905 (37%) tumors, of which 1786 (99.3%) were benign. The two‐step strategy based on ADNEX without CA125 had an area under the receiver‐operating‐characteristics curve (AUC) of 0.94 (95% CI, 0.92–0.96). The risk of malignancy was slightly underestimated, but calibration varied between centers. A sensitivity analysis in which we expanded the definition of uncertain outcome resulted in 1419 (29%) tumors with uncertain outcome and an AUC of the two‐step strategy without CA125 of 0.93 (95% CI, 0.91–0.95). Conclusion: A large proportion of adnexal masses can be classified as benign by the modified BDs. For the remaining masses, the ADNEX model can be used to estimate the risk of malignancy. This two‐step strategy is convenient for clinical use. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. Linked article: There is a comment on this article by Jurkovic. Click here to view the Editorial. [ABSTRACT FROM AUTHOR]