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Sciatic schwannomas (SSs) are extremely rare, and most are benign. Herein, we report a case of giant SSs in a woman who presented with abdominal pain. Because of the pain pattern and auxiliary examination findings, the patient was initially diagnosed with an ovarian cystadenoma. Magnetic resonance imaging (MRI) revealed an intrapelvic tumor. Histopathological examination confirmed that the mass was a benign intrapelvic schwannoma. Two days after complete tumor resection, the patients experience impaired mobility of the right lower limb. The tumor was 7 × 5.5 × 5 cm3 in size and in contact with the sacrum. The patient was followed up for up to 2 years. No evidence of recurrence was observed in the MRI scan. Severe damages to the sciatic nerve during surgery resulted in permanent neurological deficits. Hence, we also discuss the diagnostic tools and treatments for intrapelvic SSs, as well as the importance of careful radiological examination and multidisciplinary collaboration.

Autoamputation of the ovary is a rare occurrence of uncertain aetiology with only a few cases reported in literature. It usually develops following ovarian torsion or torsion of a dermoid cyst with subsequent necrosis of the pedicle and autoamputation. We present the case of a 42 year-old woman was admitted for a laparoscopic removal of a right ovarian cyst. The ultrasound showed a right ovarian cystic mass suggestive of a cystadenoma, and another heterogeneous small echogenic cyst of the left ovary. During laparoscopy, excessive bleeding from the ovarian cortex complicated the cyst stripping and, considering the age of the patient and the emerging technical difficulty of the procedure, a total adnexectomy for the right ovary was performed. While exploring the small cyst on the left ovary, a dermoid cyst was found in the Douglas pouch. This finding could be interpreted as an autoamputation of the adnexa due to an asymptomatic torsion of a previous ovarian cyst arising from the left ovary. Medical errors could occur due to lack of knowledge, expertise, as well as lack of training and surgical skills, but also due to an unfortunate association of very rare confounding factors. Even in the hands of experts, following the basic rules of surgery remains a milestone in teaching and preventing surgical complications.

The article describes a clinical case of drug resistant miliary tuberculosis in an immunocompetent woman with a multifetal pregnancy after in vitro fertilization (IVF). Difficulties in diagnosing miliary tuberculosis were due to the late detection of the initial focus of infection, that was endometrial tuberculosis, which generalized after IVF. The rare association of isthmic nodose salpingitis and a borderline ovarian tumor (serous ovarian cystadenoma) was a factor complicating the detection of tuberculosis.Conclusion: In an IVF program with bilateral fallopian tube occlusion, tuberculosis should be considered as a possible cause of this pathology. Endometrial tuberculosis is associated with a risk of repeated implantation failure and generalization of the disease.

BACKGROUND Pelvic washing specimens are relatively common and are submitted for patients undergoing gynecologic surgery to evaluate them for metastatic or occult disease. Psammoma bodies are a relatively uncommon finding in these specimens. To date, large-scale studies of their cytologic-histologic correlates and thus clinical significance have been limited. METHODS A 10-year retrospective search for all pelvic washing specimens was performed, and all cases were reviewed for the presence of psammoma bodies. The findings for the corresponding surgical pathology specimens were then catalogued. RESULTS Psammoma bodies were present in 138 cases (3.6% of 3840 total pelvic washings). More than half of the cases (n = 73 [53%]) were associated with benign processes, including mesothelial hyperplasia (n = 44), endosalpingiosis (n = 11), endometriosis (n = 11), and ovarian cystadenoma/cystadenofibroma (n = 7). Nineteen cases (14%) were associated with serous borderline tumors. Malignancies were noted in a third of the cases (n = 46 [33%]) and were most frequently low-grade serous adenocarcinomas (n = 15), high-grade serous adenocarcinomas (n = 11), or endometrioid endometrial carcinomas (n = 8). Patients found to have benign processes (median age, 50 years) or borderline disease (median age, 56 years) were significantly younger than patients with malignancies (median age, 65 years; P

El cistoadenoma seroso de ovario es un tipo de tumor derivado del epitelio celómico superficial. Se denominan quistes ováricos gigantes aquellas que miden más de 10 cm de diámetro o que se extienden por encima del ombligo. En la literatura, algunos casos de quistes ováricos gigantes se han mencionado esporádicamente, especialmente en pacientes posmenopáusicas. Los tumores serosos son comúnmente benignos en 70-80%, 5–10% tiene límite potencial maligno, y 20-25% son malignos. Solo el 10-20% de los casos son bilaterales. Ocurren en adultas de todas las edades, con edades medias reportadas de 40 a 60 años. Se reporta el caso de una mujer posmenopáusica de 79 años con un quiste ovárico izquierdo gigante que mide 14x11x7.5 cm y 794 g de peso conteniendo líquido seroso. Acude a consulta por presentar dolor pélvico tipo cólico irradiada a región lumbar desde hace 4 meses, con antecedente de hipertensión arterial crónica. Teniendo en cuenta la edad y el estado de la menopausia, se le realiza laparotomía para quistectomía izquierda sin ninguna complicación significativa. En el examen histopatológico, el quiste se confirmó como cistoadenoma seroso benigno del ovario. Tuvo evolución posoperatoria favorable.

Ovarian cystadenomas may present in a functional manner. Biochemical workup of seemingly benign ovarian lesions should be considered in the appropriate clinical context.

Mixed epithelial and stromal tumor (MEST) of the kidney is a rare tumor composed of epithelial and stromal cells. Steroid hormones seem to have a role in genesis and evolution of MESTs family, considering the marked female predominance, common history of long-term estrogen replacement, the frequent expression of estrogen (ER) and progesterone (PR) receptors in tumor mesenchymal component. We report the case of a 37-year-old woman admitted to the Department of Surgery because of abdominal pain. She had taken oral estrogen-progestin therapy for 4 years until the age of 35 for dysmenorrhea. During an abdominal ultrasound (US) was identified a left ovarian cyst, 60 mm x 20 mm, suggestive of simple cyst. Then a US repeated after 12 months showed the enlargement of the ovarian cyst (76 mm × 53 mm x 78 mm) and the appearance of a new exophytic cystic-solid mass of 120 mm in the lower pole of the left kidney. The patient underwent laparoscopic left partial nephrectomy and left ovariectomy. Histopathological examination and immunohistochemical analysis was consistent with a MEST of the kidney and a primary serous cystadenoma of the ovary. We report the second case in the literature of a MEST of the kidney along with a primary serous ovarian cystadenoma. We emphasize the hypothesis of the correlation between MESTs and hormonal milieu and the importance of clinical evaluation prior to the administration of any hormone therapy.

Yingying Sun,1,* Xuan Wang,1,* Hexin Wen,2 Bo Zhu,1,3 Lan Yu1,3 1Department of Pathology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, People’s Republic of China; 2Department of Gastrointestinal Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, People’s Republic of China; 3Bengbu Medical College, Anhui Key Laboratory of Infection and Immunology, Bengbu, People’s Republic of China*These authors contributed equally to this workCorrespondence: Lan YuDepartment of Pathology, The First Affiliated Hospital of Bengbu Medical University, 287, Changhuai Road, Bengbu, Anhui Province, People’s Republic of ChinaTel +86-18555520163Email yulan790210@163.comPurpose: Recurrence and metastasis are the most common causes of high mortality rates in patients with serous ovarian cancer (SOC). Non-structural maintenance of chromosomes (non-SMC) condensin I complex subunit H (NCAPH) is a newly identified essential oncoprotein whose function in SOC pathogenesis has not been reported yet. Angiogenic factor with G patch and FHA domains 1 (AGGF1) is an effective promoter of angiogenesis in humans, leading to cancer cell infiltration and progression. Forkhead box C2 (FOXC2) plays a pivotal role in epithelial-to-mesenchymal transition (EMT). The present study analyzed the correlations among the expressions of these three proteins and their relationships with the clinicopathological characteristics and survival of patients with SOC.Patients and Methods: The expressions of NCAPH, AGGF1, and FOXC2 were detected by the immunohistochemical examination of 153 SOC tissue samples and 30 serous ovarian cystadenoma tissue samples. Clinicopathologic and follow-up data of the patients were collected.Results: The expressions of NCAPH, AGGF1, and FOXC2 were remarkably higher in the SOC tissue samples than in the serous ovarian cystadenoma tissue samples. The protein expressions were positively correlated with the histological tumor grade, the International Federation of Gynecology and Obstetrics (FIGO) stage, lymph node metastasis, and intraperitoneal implantation, but were negatively correlated with the overall survival (OS). Moreover, multivariate analysis showed that the NCAPH, AGGF1, and FOXC2 expressions, FIGO stage, and histological tumor grade were independent adverse prognostic factors for OS in patients with SOC.Conclusion: The results of this study show that the expressions of NCAPH, AGGF1, and FOXC2 are promising biomarkers and possible therapeutic targets in patients with SOC.Keywords: serous ovarian cancer, NCAPH, AGGF1, FOXC2, cancer prognosis

Patient: Female, 72 Final Diagnosis: Benign ovarian mucinous cystadenoma Symptoms: Difficulty breathing and ambulation • heartburn • reflux • early satiety • nausea Medication: — Clinical Procedure: Total abdominal hysterectomy along with bilateral salpingo-oophorectomy Specialty: Obstetrics and Gynecology Objective: Rare disease Background: Mucinous cystadenoma is a benign cystic ovarian tumor arising from the surface epithelium of the ovary; it usually presents with vague, unspecific abdominal symptoms. If not detected early, they have the potential to grow to a substantial size and can present with huge abdominal distention leading to various compression symptoms. Mucinous cystadenomas most commonly occur in the third to sixth decades of life, and rarely occur in extremes of age. The reported incidence of giant ovarian cystadenoma in postmenopausal women is low or relatively unknown due to widespread use of ultrasound and other radiological imaging modalities these days. Here, we report a case of giant mucinous cystadenoma in a 72-year-old postmenopausal woman with multiple comorbidities. Case Report: We present the case of a 72-year-old postmenopausal high-risk patient who presented with a huge abdominal distention which started gradually 1 year before. Abdominopelvic ultrasound showed a left giant multiloculated abdominal cyst. An intact 27-kg ovarian cyst was removed, and a total abdominal hysterectomy (TAH) along with bilateral salpingo-oophorectomy (BSO) was performed. The final histopathological report showed a benign ovarian mucinous cystadenoma. Conclusions: Mucinous cystadenoma is a benign neoplastic disease that can reach a massive size. They are rare in the post-menopausal age group, but when they do occur, they pose a diagnostic and therapeutic challenge. This case report highlights the importance of early detection and management of adnexal masses in postmenopausal high-risk patients to decrease preoperative and postoperative complications and improve quality of life.

An ovarian mucinous cystadenoma is a common benign tumour of the ovary that tends to reach very large sizes. Although traditional morcellation in the abdominal cavity is largely avoided in gynaecologic surgery, several authors have proposed other systems and techniques for the removal of large masses without resorting to laparotomy. We proposed an extremely minimally invasive technique to remove a large mass with a very low suspicion of malignancy, and created a video demonstration of the procedure. In this short film we illustrate our novel technique using only 2 laparoscopic ports, which maximizes both cosmesis and speed of recovery. The technique is not a completely closed system, therefore the potential for spreading an undiagnosed malignancy still exists. Accordingly, the authors do not suggest this technique for masses with a high potential for malignancy. However, in properly consented patients where there is very little suspicion for malignancy, our technique may be a reasonable option to promote fast recovery and provide excellent cosmesis.

Endometrial adenocarcinomas arising in a complete septate uterus with cervical and vaginal duplication are rare. Here, we report a case of stage III endometrioid endometrial adenocarcinoma arising in a complete septate uterus with a double cervix and vagina coupled with a left serous ovarian cystadenoma in a 35-year-old-female patient. The patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy and was addressed to the oncologist for adjuvant radio-chemotherapy. We highlight the symptoms, diagnosis, and therapeutic management, and compare them to the recent literature.

Objective: To construct and validate a combined Nomogram model based on radiomic and semantic features to preoperatively classify serous and mucinous pathological types in patients with ovarian cystadenoma. Methods: A total of 103 patients with pathology-confirmed ovarian cystadenoma who underwent CT examination were collected from two institutions. All cases divided into training cohort (N = 73) and external validation cohort (N = 30). The CT semantic features were identified by two abdominal radiologists. The preprocessed initial CT images were used for CT radiomic features extraction. The LASSO regression were applied to identify optimal radiomic features and construct the Radscore. A Nomogram model was constructed combining the Radscore and the optimal semantic feature. The model performance was evaluated by ROC analysis, calibration curve and decision curve analysis (DCA). Result: Five optimal features were ultimately selected and contributed to the Radscore construction. Unilocular/multilocular identification was significant difference from semantic features. The Nomogram model showed a better performance in both training cohort (AUC = 0.94, 95%CI 0.86-0.98) and external validation cohort (AUC = 0.92, 95%CI 0.76-0.98). The calibration curve and DCA analysis indicated a better accuracy of the Nomogram model for classification than either Radscore or the loculus alone. Conclusion: The Nomogram model combined radiomic and semantic features could be used as imaging biomarker for classification of serous and mucinous types of ovarian cystadenomas.

Specific microRNAs (miRNAs) are packaged in exosomes that regulate processes in tumor development and progression. The current study focuses on the influence of exosomal miRNAs in the pathogenesis of epithelial ovarian cancer (EOC). MiRNA profiles were determined in exosomes from plasma of 106 EOC patients, eight ovarian cystadenoma patients, and 29 healthy women by TaqMan real-time PCR-based miRNA array cards containing 48 different miRNAs. In cell culture experiments, the impact of miR-200b and miR-320 was determined on proliferation and apoptosis of ovarian cancer cell lines. We report that miR-21 (P = 0.0001), miR-100 (P = 0.034), miR-200b (P = 0.008), and miR-320 (P = 0.034) are significantly enriched, whereas miR-16 (P = 0.009), miR-93 (P = 0.014), miR-126 (P = 0.012), and miR-223 (P = 0.029) are underrepresented in exosomes from plasma of EOC patients as compared to those of healthy women. The levels of exosomal miR-23a (P = 0.009, 0.008) and miR-92a (P = 009, 0.034) were lower in ovarian cystadenoma patients than in EOC patients and healthy women, respectively. The exosomal levels of miR-200b correlated with the tumor marker CA125 (P = 0.002) and patient overall survival (P = 0.019). MiR-200b influenced cell proliferation (P = 0.0001) and apoptosis (P < 0.008). Our findings reveal specific exosomal miRNA patterns in EOC and ovarian cystadenoma patients, which are indicative of a role of these miRNAs in the pathogenesis of EOC.

A 61-year-old Caucasian female presented for surgical resection of a 80-kg ovarian cystadenoma. Symptoms included bilateral pedal oedema, a grossly distended abdomen with abdominal venous collaterals secondary to inferior vena cava compression, and intermittent syncope secondary to compression of

We are conducting a prospective study trying to determine, in both sexes, the frequency of appearance of ectopic Leydig cells, their preferred location, their relationship with nerve structures and the possible causes of their appearance. We have studied 86 cases that were removed according to different clinical indications for pathological study: uterine leyomiomas (n = 12), ovarian cystadenoma (n = 4), endometrial hyperplasia (n = 8), endometrial carcinoma (n = 12), cervical carcinoma (n = 4), seminoma (n = 4), fallopian tube ligatures (n = 24), vasectomies (n = 8), nonspecific orchiepididymitis (n = 2), and unknown (n = 8). We have observed ectopic Leydig cells in 13/86 cases (15.11%), 9/72 in the female samples (12.50%) and 4/14 in male samples (28.57%). The most frequent location was the mesosalpinx (4 of 13: 30.76%). These high figures lead us to believe that the ectopia of Leydig cells is not really a pathologic entity, but a finding related to specific functions yet to be determined.

A case of large benign serous cystadenoma in 68 year post hysterectomy woman presented with distension and pain in abdomen. Ultrasonography was suggestive of large multinucleated multiseptic cystic lesion extending from right adnexa up to right hypochondriac and epigastric region measuring 28 cm ×20 cm may be a complex ovarian cyst. Computed tomography (CT) showed 25.9 cm×15cm×23cm multiloculated cyst with multiple internal septations suggestive of ovarian neoplasm such as serious cystadenoma. Exploratory laparotomy with right ovarian cystectomy was done. Mass of 32 cm×25cm×15 cm size of weight 6.2kg was removed and send for frozen section which suggestive of benign serous cystadenoma.

Collision tumors represent a coexistence of two adjacent but histologically distinct tumors without histologic admixture in an organ. Ovarian fibroma is the most common benign stromal tumor. Serous tumors of the ovary are the most common of epithelial tumors. However, a collision between them is a rare pathology mimicking a malignant tumor. We report a 63-year-old woman with sparse postmenopausal bleeding. Ultrasound examination of organs in a small pelvis rounded right ovary formation with hypo and hyperdense sections. Paraclinical: CA125 slightly increased. Histological: collision between two benign ovarian tumors imitating carcinoma.

Mucinous ovarian cystadenoma is a benign tumor, which accounts for 15% of all ovarian tumors and when diagnosed, 80% are benign, 10% limitrophe, and 10% malignant. It is a cyst that arises from the ovary surface epithelium, presenting multilocular features with a plain surface. It is more common between 30- and 50-years old persons and clinical signs differ from other ovarian pathologies because they present rapid growth, reach large dimensions, and evolve with peritoneal pseudomyxoma, causing a significant increase in abdominal volume. Imaging methods such as ultrasonography and computed tomography, as well as the tumor markers CA-125 and CEA, are fundamental for its elucidation and therapeutic planning. We report a case of giant mucinous cystadenoma of the left ovary in a 61-year-old patient admitted to the emergency room.

Giant ovarian cystadenoma is a rare and often late presentation. The mass effect of such tumors can lead to profound respiratory and cardiovascular compromise, predominately through inferior vena cava compression, but also restriction of normal lung function through transdiaphragmatic mass effect and, as is seen in this case, cardiac tamponade. In this article, the authors outline an expedited program of preoperative optimization and a choreographed physiological assessment strategy to functionally assess the hemodynamic consequences of a giant ovarian mucinous neoplasm, thereby informing the safe conduct of anesthesia and surgery.

A female in her thirties fell face down in her room. She was motionless when her sister found her. She was transported to the hospital by ambulance and was in a state of cardiopulmonary arrest on admission. She did not respond to resuscitation. Her abdomen had started to swell 3years before her death. An autopsy was performed to clarify the decedent's cause of death. She was 172cm tall and weighed 146kg. Her maximum abdominal girth was 172.1cm. A subcutaneous hemorrhage measuring 4.5cm in diameter was observed in the epigastric region. The abdominal cavity contained brownish ascites (54.1L). The left ovary was markedly swollen, and the combined weight of the uterus and right ovary was more than 13.0kg. A left ovarian tumor consisting of serous and mucinous cysts was detected. There were no metastatic lesions in the peritoneum or other organs. She might have suffered circulatory disturbance caused by the ascites and ovarian tumor. Moreover, being in a prone position would have resulted in an increase in intra-abdominal pressure, further exacerbating her circulatory problems. Therefore, her cause of death was considered to be circulatory failure caused by significant ascites and a large ovarian tumor.

WOS: 000402089000024, PubMed ID: 28285211, INTRODUCTION: Ectopic adrenal tissue is a very rare entity in adult females, especially in the ovary, and is generally diagnosed incidentally during surgery. Although it can present at various sites during childhood, it becomes atrophic by adulthood due to normally functioning adrenal glands. Patients are predominantly asymptomatic; however, in some cases endocrine symptoms such as hypertension and fasciotruncal obesity due to hormonal activity can be seen or neoplastic transformation can appear. PRESENTATION OF CASE: A 65-year-old patient with progressive pelvic pain and postmenopausal vaginal bleeding was evaluated by transvaginal ultrasound, which revealed bilateral adnexal masses measuring 5 cm in size and a normal uterus with an increased endometrial thickness of 7 mm. Initially the endometrial sampling result was reported as benign. The patient underwent abdominal hysterectomy and bilateral salpingo-oophorectomy and the pathological diagnosis was again benign, with serous ovarian cystadenoma being found in both ovaries. The pathologist also reported incidental ectopic adrenal tissue on the wall of the left ovarian cystadenoma. DISCUSSION: Ectopic adrenal tissue is infrequent in female genital organs especially at older ages. Only a few cases of ovarian ectopic adrenal tissue have been reported. To the best of our knowledge the present case is the fourth report in the English literature, and is of additional importance given the patient's age. CONCLUSION: Ectopic adrenal tissues are generally asymptomatic and revealed incidentally during surgery; however some cases have demonstrated the risk of neoplastic transformation. Therefore, surgeons must be aware of this rare entity that bears the risk of malignancy, and should surgically remove all suspicious lesions. (C) 2017 The Author(s). Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.

Adenomatoid tumor of the ovary is rare, and so are collision tumors in this location. The most common histological combination of ovarian collision tumors is the coexistence of mature cystic teratoma with ovarian cystadenoma or cystadenocarcinoma. Presented herein is a rare case of ovarian adenomatoid tumor found incidentally and coexisting with mature cystic teratoma. A 44-year-old woman presented with a one-year history of intermittent right-sided pelvic pain. Ultrasound evaluation revealed a heterogeneous cystic mass in the right ovary, and a clinical diagnosis of teratoma was made. The patient subsequently underwent a right salpingo-oophorectomy. Pathological examination revealed a mature cystic teratoma and coexistent adenomatoid tumor. The two tumors were separate and no transitional features were recognized histologically. To our knowledge, no previous report of coexistence of these two tumors has been reported. Both tumors are benign and completely excised; therefore no adverse consequences are expected.

The purpose of the present study was to assess the association of regulatory T cells (Tregs; CD4+ FOXP3+) and helper T lymphocytes (Th17) releasing interleukin (IL)-21 and IL-22, with the Risk of Ovarian Malignancy Algorithm (ROMA). Similar association was made with two additional tumour markers, human epididymis protein 4 (HE4) and carbohydrate antigen 125 (CA125) from patients serum. The presence of Tregs and Th17 was determined both in the peripheral blood and in the tissue of epithelial ovarian tumors. Mononuclear cells obtained from patient's peripheral blood (PBMCs) and from ovarian tissue were isolated by density gradient centrifugation. As a control group patients who had undergone surgery for infertility without ovarian pathology were selected. The percentage of Tregs and Th17 releasing IL-21 or IL-22 cells from both peripheral blood and tumor tissue was measured by flow cytometry. No differences in demographic parameters like body mass index, age, or gravidity were observed among the studied groups. However, an increased concentration of marker HE4 and value of ROMA was identified in individuals with ovarian cancer when compared with women with cystadenomas. Furthermore, a negative correlation between the ROMA value in the serum and Tregs from the peripheral blood of patients with cystadenoma ovarian tumors was detected. The presented work documents, for the first time, the negative association between peripheral blood Tregs and ROMA evaluation based on the tumour markers present in the serum of women with ovarian cystadenoma. Such an effect might result from the negative impact of Tregs on the inflammation process and on tumorigenesis caused by the persistent inflammation.

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