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The Adnexal Mass
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Connie D. Cao, Norman G. Rosenblum
An adnexal mass is any mass in the ovary or tube or attached to them (adnexa). There is an increase in the detection of asymptomatic adnexal masses in pregnancy due to the increase in prenatal ultrasounds. The vast majority (>90%) of adnexal masses in pregnancy are ovarian. Most are benign simple cysts under 5 cm. The diagnosis is most accurately made by ultrasound, even if it is possible to diagnose an adnexal mass by bimanual physical exam. A persistent adnexal mass is one that does not resolve by the second trimester.
Testicular Cancer
Published in Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple, Basic Urological Sciences, 2021
Selma Masic, Abhishek Srivastava, Alexander Kutikov
Non-GCTs are rare:Sex cord-stromal tumours.Tumours of collecting duct and rete testis.Lymphoid and haematopoietic tumours.Adnexa and tumours metastatic to the testes.
Acute abdomen in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Nicole Fearing, William L. Holcomb
Surgery may be done laparoscopically and is recommended by SAGES guidelines for both diagnosis and treatment of the torsed ovary unless clinical severity warrants a laparotomy (13). The conventional surgical therapy of adnexal torsion is extirpation of the involved tissues, particularly if they appear ischemic or necrotic. If it is necessary to remove the corpus luteum prior to 10 weeks of gestation, there is justification for progesterone supplementation in an effort to maintain the pregnancy. If tissue distal to the site of torsion appears viable, unwinding of the adnexa is an alternative therapy. One group has advocated unwinding, regardless of the appearance of the adnexa, in cases of ovarian hyperstimulation syndrome (94). If the ovary is conserved, the surgeon must be assured that it does not contain a neoplasm. There is little information available to quantify the fetal risk following adnexal torsion. Generally, the pregnancy outcome is good (92).
Increase in serum creatinine levels after PARP inhibitor treatment
Published in Journal of Obstetrics and Gynaecology, 2023
Di You, Lan Zhong, Rutie Yin, Liang Song
The patient was a 53-year-old BRCA1-mutation positive female (height: 153 cm; weight: 57.5 kg) who was referred for surgical resection of a ‘right adnexal mass’ on October 15, 2020. Intra-operative frozen section confirmed a diagnosis of poorly differentiated carcinoma of the right adnexa. The patient then underwent a comprehensive staging operation, and complete resection (R0) of the cancer was performed. The post-operative paraffin-section was diagnosed as stage IIIB high-grade serous adenocarcinoma of the right fallopian tube. Six cycles of paclitaxel plus carboplatin chemotherapy were administered after the operation. After chemotherapy, the cancer antigen 125 level was 4.2 U/ml. Combined with the computed tomography result, the treatment efficacy was evaluated as a complete response.
Concurrent caecum perforation in second trimester pregnant woman complicated with SARS-CoV-2 infection: a case report
Published in Journal of Obstetrics and Gynaecology, 2022
Ümran Kılınçdemir Turgut, Ebru Erdemoğlu, Mihriban Kılçar, Mekin Sezik, İbrahim Barut
On the 17th day of SARS-CoV-2 infection, obstetric examination revealed a uterine cervical length of 16 mm, there were regular uterine contractions. Tocolytic therapy with indomethacin and betamethasone for lung maturation was administered. On the 19th day of the SARS-CoV-2 infection, due to the onset of labour and non-vertex presentation, a 1000 g male baby was delivered by caesarean section with a median incision below the umbilicus. On exploration, a mass surrounded by omentum and an abscess formation in the right lower quadrant, including the caecum, right adnexa and right colon was detected. The general surgery team got involved in the operation and the conglomerate was dissected out. The right adnexa was hyperaemic secondary to infection. The appendix was hyperaemic and there was no perforation area. Two perforation areas, one approximately 3 cm in diameter and the other 1–2 cm in diameter were detected in the caecum (Figure 1(d)). The surgical procedure was completed by performing appendectomy, right hemicolectomy, end-to-end anastomosis and right salpingo-oophorectomy.
Well-differentiated peritoneal papillary mesothelioma located in the uterus of a menopausal patient
Published in Journal of Obstetrics and Gynaecology, 2022
Andrea Caruso, Alba Rodríguez Pérez, Marta Romero Matas, Manuel Pantoja Garrido, Álvaro Gutiérrez Domingo
A multicystic image of 48×40mm, compatible with a complex adnexal formation, was found in the ultrasound. Tumour markers were requested, all of them negative. Since the ultrasound image had a low suspicion of malignancy, the patient was offered the possibility of a close monitoring, although after three months, the patient related abdominal pain and expressed her desire of a surgical intervention. An exploratory laparoscopy with an intraoperative biopsy (IOB) was performed. A tumour with a mucinous content, which originated in the left cornual uterine area was objectified. Both adnexa were macroscopically normal. The intraoperative study of the mass was inconclusive, and a deferred pathological study was referred. Due to these intraoperative results and patient’s wish, a bilateral adnexectomy with surgical excision of the cystic formation was performed with no complications. Final diagnosis showed a well differentiated papillary mesothelioma, with a positive immunohistochemical study for CK, calretinin, D2-40 and CK 5/6, with negative CD34 and EGR.