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Background: Management of ovarian torsion has evolved toward ovarian preservation regardless of ovarian appearance during surgery. However, patients with torsion and an ovarian neoplasm undergo a disproportionately high rate of oophorectomy. Our objectives were to identify factors associated with ovarian torsion among females with an ovarian mass and to determine if torsion is associated with malignancy., Methods: A retrospective review of females aged 2-21 y who underwent an operation for an ovarian cyst or neoplasm between 2010 and 2016 at 10 children's hospitals was performed. Multivariate logistic regression was used to assess factors associated with torsion. Imaging data were assessed for sensitivity, specificity, and predictive value in identifying ovarian torsion., Results: Of 814 girls with an ovarian neoplasm, 180 (22%) had torsion. In risk-adjusted analyses, patients with a younger age, mass size >5 cm, abdominal pain, and vomiting had an increased likelihood of torsion (P < 0.01 for all). Patients with a mass >5 cm had two times the odds of torsion (odds ratio: 2.1; confidence interval: 1.2, 3.6). Imaging was not reliable at identifying torsion (sensitivity 34%, positive predictive value 49%) or excluding torsion (specificity 72%, negative predictive value 87%). The rates of malignancy were lower in those with an ovarian mass and torsion than those without torsion (10% versus 17%, P = 0.01). Among the 180 girls with torsion and a mass, 48% underwent oophorectomy of which 14% (n = 12) had a malignancy., Conclusions: In females with an ovarian neoplasm, torsion is not associated with an increased risk of malignancy and ovarian preservation should be considered., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Introduction: Parotid masses causing facial palsy are highly indicative of malignancy. A significant number of cases describing benign parotid disease causing facial palsy have been reported., Materials and Methods: We performed a systematic review of the literature to establish the aetiology, clinical features, investigations and management undertaken during these presentations to assess how these factors differed from malignant presentations and to establish an evidence-based algorithm for their management., Results: A total of 85 cases were identified from 78 articles. Cystadenolymphomas were the most common histopathological type ( p = 0.034). Mean facial palsy recovery duration in neoplastic aetiology was longer than for infective aetiology ( p = 0.033). A significant association existed between uncommon infective organisms and development of facial palsy ( p = <0.0001)., Conclusion: Uncommon benign aetiologies are associated with facial palsy. Investigations and management should be guided by patients' clinical presentations, avoiding excessive treatment. Complete facial palsy recovery rates are high, although not immediate.

Background: Juvenile cystic adenomyoma is a rare condition that is often misdiagnosed as a noncommunicating uterine horn or adnexal mass during adolescence., Cases: We describe two patients who presented with dysmenorrhea unresponsive to standard management with oral contraceptives. Both patients were initially misdiagnosed as having endometriotic cysts. Juvenile cystic adenomyoma was suspected on standard pelvic ultrasound scan and subsequent high-resolution three-dimensional ultrasonography. The diagnosis was subsequently confirmed and the lesions successfully treated laparoscopically., Conclusion: Gynecologists should be aware of the possibility of juvenile cystic adenomyoma in adolescents with dysmenorrhea refractory to medical management. Three-dimensional ultrasonography may provide the resolution necessary to distinguish this rare condition.

Rationale: Appendiceal mucocele is a rare entity of mucinous cystic dilatation of the appendix. It has no typical clinical presentation and is considered a potentially premalignant condition., Patient Concerns: We present a case of accidental intraoperative finding of an appendiceal mucocele in a 54-year old woman that clinically presented with an exacerbated chronic tubo-ovarian abscess., Diagnoses: Trans-vaginal ultrasonography showed an encapsulated, oval, unilocular mass above the uterus with a heteroechogenic structure, homogeneous fluid content, and smooth regular walls without inner proliferation. The histopathologic diagnosis was consistent with an appendiceal cystadenoma., Interventions: The patient underwent a simple appendectomy., Outcomes: There were no clinical, biochemical or imaging signs of the disease recurrence at 6 months follow up., Lessons: To our knowledge, this is the only well-documented case of appendiceal mucocele mimicking exacerbated chronic tubo-ovarian abscess reported in the literature. Awareness of a rare entity such as an appendiceal mucocele, which is frequently misdiagnosed as a potential cause of acute abdomen, is necessary for the appropriate management strategy in order to prevent complications.

Background: Adnexal paraovarian cysts are not frequently seen during teen development, their incidence is around 10% and usually benign., Clinical Case: Adolescent female 15 years old with no pathological family and personal history relevant to her current condition. Chief complaint: Six months ago she complained with abdominal pain in meso, hypogastrium and right iliac fossa. Later, she observed an increased volume on her lower quadrant of the abdomen, mostly on her right side. During physical examination an abdominal tumor was palpated. By an abdominal-rectal manouvre, the presence of tumor was confirmed and located in front of the rectum and no implants. Imaging studies confirmed a paraovarian cyst. She underwent on surgical laparatomy and a paraovarian cyst was found. The histological diagnosis was a cystadenoma. The postoperative course was satisfactory., Discussion: Epidemiological data and ultrasonographic findings are examined to confirm the diagnosis of paraovarian cyst. The laparoscopic treatment for adnexal problems is described., (Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.)

Appendiceal diverticulosis is a rare condition with a frequency of 0.004% to 2.1%, and is sometimes an occasional finding during anatomopathologic study of the surgical specimen. It may be presented acutely as a right lower quadrant pain, similar to acute appendicitis for which differential diagnosis must be carried out, and it is associated with appendicular tumors. We report a case of diverticulitis of the appendix as debut of appendicular cystadenoma and carcinoid tumor with representative iconography, being unusual the association of both diseases and even more its preoperative diagnosis.

Background/purpose: Ovarian preservation is desirable in children with ovarian tumors. However, the diagnostic and treatment strategies are heterogeneous. The aim of this study was to investigate the management and preservation of ovarian tissue in order to identify the factors associated with ovarian preservation., Methods: Thirty-seven patients (41 ovaries) were surgically treated for ovarian tumors. Four cases were bilateral. The data on the patient symptoms at presentation, imaging, treatment, outcome, pathology, and status of ovarian preservation were retrospectively analyzed for each patient., Results: Histological examinations revealed 25 mature teratomas, 5 immature teratomas, 5 cystadenomas, 2 dysgerminomas, and other tumors. Ovarian torsion occurred in 16 ovaries (39%). Ovary-sparing surgery was performed in 22 ovaries (53.7%). Successful ovarian preservation was significantly associated with a smaller tumor size, benign pathology, and a lower degree of torsion (P<0.01)., Conclusions: Because the prognosis was favorable in most cases, the preservation of fertility and gonadal function should be a goal in the surgical treatment of ovarian tumors. We recommend ovary-sparing surgery as the first-line treatment for all pediatric ovarian tumors other than those that are preoperatively diagnosed as being malignant and those in which emergent surgical intervention is indicated owing to the suspicion of ovarian torsion., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: Serous tumors can occur on the surface of the ovaries and-rarely-as primary tumors on the peritoneal surface. However, the origin of extraovarian serous tumors is unknown. An unusual case of a serous tumor is presented here., Case Report: A 34-year-old nulligravid woman presented for evaluation of her primary infertility, with acute abdominal pain. At laparoscopy, a paratubal cyst, independent of the ovaries, was found to be associated with bilateral hydrosalpinges. The final pathology diagnosis was of a benign paratubal serous cystadenoma., Conclusion: We present an unusual case of a paratubal serous cystadenoma with bilateral hydrosalpinges in an infertile woman, which was resected laparoscopically.., (Copyright © 2014. Published by Elsevier B.V.)

Biliary cystadenoma (BCA) is a rare hepatic neoplasm. Although considered a benign cystic tumor of the liver, BCA has a high risk of recurrence with incomplete excision and a potential risk for malignant degeneration. Correct diagnosis and complete tumor excision with negative margins are the mainstay of treatment. Unfortunately, due to the lack of presenting symptoms, and normal laboratory results in most patients, BCA is hard to distinguish from other cystic lesions of the liver such as biliary cystadenocarcinoma, hepatic cyst, hydatid cyst, Caroli disease, undifferentiated sarcoma, intraductal papillary mucinous tumor, and hepatocellular carcinoma. Ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) may be necessary. They demonstrate intrahepatic cystic lesions with features such as mural nodules, varying wall thickness, papillary projections, and internal septations. Nevertheless, surgery is still the only means of accurate diagnosis. Definitive diagnosis requires histological examination following formal resection. We describe a 57-year-old woman initially diagnosed with polycystic liver who was subsequently diagnosed with giant intrahepatic BCA in the left hepatic lobe. This indicates that both US physicians and hepatobiliary specialists should attach importance to hepatic cysts, and CT or MRI should be performed for further examination when a diagnosis of BCA is suspected.

We report a case of sex cord tumor with annular tubules featuring a giant multilocular cyst, grossly similar to cystadenoma, in the ovary of an 8.5 year old girl. Estrogen-related symptoms, including precocious puberty and irregular uterine bleeding, immediately improved after tumor resection., (Copyright © 2012 Mosby, Inc. All rights reserved.)

Background: Hepatobiliary cystadenomas and cystadenocarcinomas are rare and often misdiagnosed., Aims: We report our experience with 33 cases over 20 years to discuss an algorithm for these diseases., Methods: Patients presenting with a diagnosis of hepatobiliary cystadenomas and cystadenocarcinomas were retrospectively reviewed from January 1991 to October 2010. Clinical data were collected by examining hospital records and by follow-up questionnaire interviews., Results: Thirty-three patients had pathologically diagnosed hepatobiliary cystadenomas (19/33, 17 females and two males) or cystadenocarcinomas (14/33, five females and nine males). Symptoms of cystadenomas at hospitalization were abdominal bloating or pain (9/19). Nine patients had an elevated level of carbohydrate antigen (CA) 19-9. The surgical procedures, i.e. cyst enucleation, segmentectomy, sectionectomy and hemihepatectomy, were performed with satisfactory outcomes. Symptoms of cystadenocarcinomas included abdominal bloating or pain (8/14) and fever (3/14). Seven patients had elevated CA19-9. The imaging characteristics of cystadenocarcinomas were similar to those of cystadenomas. The clinical outcomes for cystadenocarcinomas were mostly poor after either surgical or conservative treatment., Conclusions: Clinical symptoms are unreliable for these diagnoses and their differential diagnosis. Imaging evaluations and CA19-9 are of value for the recognition of cystadenoma and cystadenocarcinoma, but not for their differential diagnosis. Any recurrence of liver cyst after surgery or other treatments should lead one to suspect one of these diseases. Invasive examination and percutaneous fine-needle aspiration cytology are not recommended. Complete excision or careful enucleation should be the first treatment choice for a better prognosis., (© 2011 John Wiley & Sons A/S.)

A 52-yr-old man presented with severe obstructive urinary symptoms. Ten years earlier, a digital rectal examination disclosed a small mass above the prostate, and a computed tomography (CT) scan showed a 3.5-cm cystic tumor of the right seminal vesicle. He had been followed conservatively elsewhere. Reevaluation of the mass with a CT scan and magnetic resonance imaging showed that the mass had grown to a maximal diameter of 14 cm. A transabdominal needle biopsy revealed benign fibromuscular tissue. The tumor was then resected by an open transvesical approach. Pathology was consistent with a benign seminal vesicle cystadenoma. The natural history, pathology, and surgical approach are described., (Copyright © 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Unlabelled: Biliary cystadenomas are benign but potentially malignant cystic neoplasms, which classically contain mesenchymal stroma similar to ovarian tissue. We report a case of an extra-hepatic biliary cystadenoma with mesenchymal stroma along with a discussion of current pathological opinion., Case Presentation: A 54-year-old female presented with abdominal pain, abnormal liver function tests and a mass on ultrasound. Computerized Tomography identified a complex multi-locular cyst in the common hepatic duct. Radical excision of the lesion and a Roux-en-Y loop bilio-enteric anastomosis was performed. Histology confirmed the presence of a benign biliary cystadenoma with ovarian type stroma., Conclusion: Biliary cystadenomas classically contain mesenchymal stroma similar to ovarian tissue. It now appears that cystadenomas without mesenchymal stroma appear to be more akin to similar cystic lesions of the pancreas, and may represent a dissimilar neoplasm. Therefore, malignant transformation can occur, so complete excision is recommended.

We conducted this retrospective study to evaluate the outcomes, indications and post-operative findings of adnexal torsion cases and compared the features of benign cystic teratoma with the other cases. We analyzed a series of 143 cases of adnexal torsion from 2000 to 2009 at current clinic, retrospectively. The data were collected from the patient's specific files and hospital records descriptively. The demographic characteristics, sonographic findings and post-operative invention were evaluated. Statistical analyses were carried out by using the statistical packages for SPSS 15.0 for Windows (SPSS Inc., Chicago, IL, USA). A total of 143 cases were operated for adnexal torsion during the study period at our clinic. The clinical and demographic characteristics of the cases are shown in table 1. Of all patients, forty of them were diagnosed as benign cystic teratoma and this group of the adnexal torsion cases had statistically different gravidy, mass size and torsion number from the non-benign cystic teratoma group. Age was not a statistically different between two groups. According to this study, benign cystic teratoma increases risk of adnexal torsion. When detecting benign cystic teratoma the patients should be informed about the risk of torsion and explained the signs of this situation. The early diagnosis and appropriate surgical management of adnexal torsion is the only way to prevent complications and to preserve future fertility. Being aware of the different sonographic findings of torsionated adnexa may assist in the correct diagnosis of these patients.

Spontaneous mediastinal hematoma as initial presentation of cystic adenoma of ectopic parathyroid Atraumatic spontaneous mediastinal hematomas are uncommon. They are secondary to trauma, rupture of great vessels or heart and associated to iatrogenic events. We report a case of a 61 year-old woman who consults for mediastinal hematoma without previous trauma. Imaging studies ruled out cardiac or vascular lesions. At exploratory thoracotomy, a large mediastinal hematoma was evidenced without obvious mass or bleeding vessel. The material sent to the Pathology service was diagnosed as cystic adenoma of ectopic parathyroid gland. Mediastinal hematomas are related to traumatic causes, cardiac or great vessels rupture or iatrogenic proceedings. Once these causes are ruled out, an injury of ectopic parathyroid tissue must be considered in the differential diagnosis because mediastinum is the most frequent ectopic location. Histopathological and immunohistochemical studies are useful in determining the cause-related hematoma, as in this case determined the parathyroid origin of the lesion, and to rule out involvement by other tumors.

We present a case of a biliary cystadenoma, a rare benign cystic tumor arising in most cases of the intrahepatic bile ducts. A 30-year old woman presented with abdominal pain in the right upper quadrant for about 10 days with increasing severity. Radiological evaluation by means of abdominal ultrasound and CT-scan revealed a multilocular cystic lesion in the right liver lobe, not present on abdominal ultrasound performed 10 years before. The diagnosis of a biliary cystadenoma was proposed and complete surgical resection of the mass was performed.

Background: Patients with ulcerative colitis (UC) or Crohn's disease (CD) have an increased risk for the development of colorectal dysplasia and carcinoma. Although appendiceal inflammation occurs histologically in 40-86% of colectomy specimens from patients with inflammatory bowel disease (IBD), appendiceal neoplasms have been reported only infrequently, and the notion of a direct association between IBD and appendiceal neoplasia is speculative., Clinical Case: A 54-year-old male patient developed abdominal pain and bloody diarrhea 3 years prior. Colonoscopy and biopsy established the diagnosis of UC (proctosigmoiditis). Disease activity was moderate at the beginning and the patient initially received medical treatment with mesalazine and prednisone. He was admitted to our clinic for right lower abdominal pain. Physical examination revealed tenderness on palpation at this site. Laboratory tests were normal (including serum carcinoembryonic antigen and CA 19-9). Colonoscopy showed intrinsic compression of the cecum. The patient underwent partial cecum resection and extirpation of the mucocele. He presented postsurgical ileus resolved with medical treatment. Final histological report revealed cystadenoma of the appendix. At the 20-month follow-up, the patient was in satisfactory condition., Conclusions: We present the eighth patient, to our knowledge, with a primary cystadenoma of the appendix and UC. Special attention should be paid to patients with extraordinary symptoms during follow-up, even in UC patients.

This report describes a rare benign cystic lesion of the pancreas known as acinar cell cystadenoma. There are 12 previously reported cases, the youngest patient from which was age 16. We report the youngest case to date, occurring in a 9-year-old boy. The pancreatic lesion was found incidentally and confirmed by laparoscopic biopsy. A pseudocyst formed, which was drained endoscopically. Given that the lesion was benign and the patient was asymptomatic, no further intervention was recommended. Complete resection would require a total pancreatectomy, with attendant morbidity, and review of the literature suggests a benign course. In asymptomatic cases, we recommend biopsy for histologic diagnosis, with close follow-up and without further surgical intervention., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)

Context: Solid pseudopapillary tumor of the pancreas is a rare neoplasm which affects young women. On the other hand, pancreas divisum is an anomaly which develops at 7 weeks of gestation. Here, we report a case of a solid pseudopapillary tumor of the pancreas with concomitant pancreas divisum., Case Report: A 26-year-old woman was diagnosed as having a pancreatic tumor with solid and cystic components in the pancreatic head. Pancreatograms obtained by ERCP and MRCP showed no communication between the ventral and dorsal pancreatic ducts, indicating that pancreas divisum was present. Microscopically, the resected tumor had solid and cystic components. Immunohistochemical study demonstrated that the tumor cells were positive for alpha-1-antitrypsine, vimentin and progesterone receptors but negative for estrogen receptors, NSE, insulin or glucagon. The tumor was diagnosed as a solid pseudopapillary tumor of the pancreas. Although more than 700 cases of solid pseudopapillary tumors of the pancreas have been reported in the English literature, a search of PubMed turned up no reports of concomitant solid pseudopapillary tumor and pancreas divisum., Conclusion: Solid pseudopapillary tumors of the pancreas with concomitant pancreas divisum are extremely rare.

Extrahepatic biliary cystadenoma is a rare benign lesion with malignant potential. Fewer than 100 cases have been reported in the literature. The most common clinical presentation is obstructive jaundice. Frank cholangitis is extremely rare. The authors report a case of extrahepatic biliary cystadenoma in a 55-year-old woman who presented with recurrent episodes of cholangitis.

We report a case of a 56-year-old woman with intrahepatic biliary cystadenoma (IBC) accompanying a tumor embolus in the extrahepatic bile duct, who was admitted to our department on October 13, 2008. Imaging showed an asymmetry dilation of the biliary tree, different bile signals in the biliary tree, a multiloculated lesion and an extrahepatic bile duct lesion with internal septation. A regular left hemihepatectomy en bloc was performed with resection of the entire tumor, during which a tumor embolus protruding into the extrahepatic bile duct and originating from biliary duct of segment 4 was revealed. Microscopically, the multiloculated tumor was confirmed to be a biliary cystadenoma with an epithelial lining composed of biliary-type cuboidal cells and surrounded by an ovarian-like stroma. An aggressive en bloc resection was recommended for the multiloculated lesion. Imaging workup, clinicians and surgeons need to be aware of this different presentation.

Syringocystoadenoma papilliferum is a benign adnexal tumor usually located in head and neck that occurs during childhood or adolescence. A case of a syringocystoadema papilliferum associated with apocrine hydrocystoma and verruca is presented. It is unusual to see the occurrence of three histopathologic types of tumors coexisting in one cutaneous lesion.

This report describes a solitary syringocystadenoma papilliferum, a rare skin tumor, in a 9-year-old boy who was known to have Niemann-Pick disease. To our knowledge, this association has not been described in the medical literature and this is the first report describing such association.

A 40-year-old woman without symptoms, with a three-week amenorrhea, and with no previous pregnancy history. Three months before she followed treatment with clomifeno and no other risk factors. A measure of beta fraction is performed, finding a probable pregnancy of 3-4 weeks. A new measure of beta fraction is made three weeks later with an ultrasound, finding an important increment in measure, but without evidence of intrauterine pregnancy in the ultrasound. A new ultrasound is made seven weeks after her last period, finding a mass in the left ovary, but without increment in beta fraction. At week ten, she presents an uterine bleeding during a trip, which is diagnosed as a probable mole without any further medical treatment and from the 12th week, there is a considerable decrement in the beta fraction measure, without any other symptom, but the persistent adnexal mass at the left ovary, with irregular septum images at ultrasound. A laparotomy is performed finding an ectopic pregnancy surrounded by a serum cystadenoma.

The aim of this study was to evaluate the pathological features and pregnancy outcomes of pregnancy-associated adnexal masses, between 2001 and 2007. During this period, 0.3% of deliveries (35) were associated with adnexal masses. Torsion or rupture of the adnexal mass complicated pregnancy in 17.1% (6/35) of the cases. The most common histopathological diagnosis was dermoid cyst in 40% of cases (14/35), and 8.5% of cases (3/35) were malignant, including borderline ovarian lesion. None of the patients had an adverse pregnancy outcome due to emergency laparotomy. Pregnancy-associated persistent adnexal masses with large size, complex or solid appearance and bilateral location can be managed surgically, which can decrease the risk of complications, such as torsion or rupture and which can diagnose malignancies early.

Introduction: Mucocele is a rare pathology of the appendix characterized by expansion of the lumen for a slow storage of mucous. Represents the 0.2-0.3% of all the appendectomies. Clinical signs and the symptoms are similar to those of the acute appendicitis, while the disease is occasionally recorded and the diagnosis is essentially histological., Aim of Study: To recall the clinical and anatomopathological features of mucocele evaluating the possible evolutions of this rare appendicular pathology according to the updating reports of the literature., Materials and Methods: Study of a clinical case., Discussion: In this study diagnostic chriteria and prognostic factors are revised. Authors evaluate anatomopathological classification, possibility of evolution in a preneoplastic and neoplastic lesion and association with other colon cancers. The surgical treatment is evaluated too., Conclusions: A correct preoperative mucocele diagnosis is emphasized as indispensable in the choice of the proper surgical treatment since a good prognosis is consequent to a radical treatment.

This case represents the first laparoscopic removal of a gallbladder containing a polypoid cystadenoma, which had prolapsed into the common bile duct. During the operation it was necessary to reduce the prolapsed polyp out of the cystic duct back into the gallbladder. The gallbladder was removed and the specimen was identified as cystadenoma on pathologic review. Only 7 gallbladder cystadenomas have been previously reported in literature. Although this is the second reported gallbladder cystadenoma to cause intrinsic obstruction of the common bile duct, it is the first to be treated with a minimally invasive laparoscopic cholecystectomy.