Background Paraovarian/paratubal cysts constitute about 10% of adnexal masses and are usually small and asymptomatic. A huge paratubal cyst complicated by adnexal torsion is a rare cause of acute low abdominal pain. Case Report We report the case of an obese 31-year-old nulliparous woman who presented with a large pelvic cyst causing ovarian torsion. The size of the mass (~25 cm) caused pain, and obesity led to explorative laparotomy, which showed a huge central abdominal-pelvic cyst arising from the right adnexa. Cystectomy was technically impossible, so all the adnexa was removed. Pathologic diagnosis revealed a papillary serous cystadenoma with torsion of all structures. Conclusion A giant paratubal cystadenoma is a rare condition and management is challenging. If there are clinical and imaging signs of torsion, it should be approached like any other adnexal mass and surgery should be urgent in order to avoid irremediable compromise of ovarian function.
Although mature cystic teratoma (MCT) is benign, malignant transformation (MT) occurs in ∼ 1% to 2% of all cases, and usually consists of squamous cell carcinoma (SCC), which accounts for ∼ 80% of the cases. Spindle-cell (sarcomatoid) carcinoma (SCSC) is an uncommon type of SCC, comprising up to 3% of all cases. The lack of characteristic symptoms and specific imaging findings may lead to preoperative misdiagnosis. Moreover, the clinicopathologic characteristics, the treatment, the prognostic factors and the mechanism of MT have not yet been well understood due to the rarity of such tumors, especially in women of reproductive age. The authors present a case of a 34-year-old patient with 14 weeks of gestation who was diagnosed with an adnexal mass suggestive of ovarian teratoma. A laparoscopy salpingo-oophorectomy was performed after 6 months of delivery, and the histological exam revealed a sarcomatoid SCC in the MCT.
Objectives: To investigate whether structured intervention based on a Mediterranean diet (MedDiet) or mindfulness-based stress reduction (MBSR) in high-risk pregnancies for small-for-gestational-age (SGA) newborns, can reduce the incidence of pre-eclampsia. Methods: In a randomised clinical trial with parallel-group conducted at a University Hospital in Barcelona, Spain (2017-2020, 1221 pregnant women at high-risk for SGA newborns were randomly allocated at 19-23 weeks of gestation into three groups: a MedDiet intervention, a MBSR program or non-intervention. Participants in the MedDiet group (n = 407) received monthly individual and group educational sessions, and free provision of extra-virgin olive oil and walnuts. Women in the MBSR group (n = 407) underwent an 8-week MBSR program adapted for pregnancy. While the main outcome was the prevalence of SGA, early (delivery < 34 weeks) and late (delivery >= 34 weeks) pre-eclampsia were analysed as secondary outcomes. Results: Among 1182 participants included for the intentionto-treat-analysis (n = 392 MedDiet, n = 390 MBSR, n = 400 no intervention), pre-eclampsia occurred in 83 women (7%), and in the majority (n = 77, 6.5%) occurred late. Whereas the prevalence of early pre-eclampsia was similar among study groups (n = 2 MedDiet, n = 3 MBSR, n = 1 non-intervention), late pre-eclampsia was significantly reduced in the MedDiet group compared to non-intervention: n = 20 (5.1%) versus 36 (9%); OR 0.54, 95% CI 0.31-0.96; p = 0.035. Results persisted significantly after the exclusion of those cases of pre-eclampsia with also SGA: n = 13 (3.3%) versus 26 (6.5%); OR 0.49, 95% CI 0.25-0.98; p = 0.042. In MBSR group, there was a non-significant tendency of lower pre-eclampsia prevalence (n = 22 (5.5%), p = 0.054). Conclusions: A structured intervention during pregnancy based on Mediterranean diet reduced remarkably the prevalence of late pre-eclampsia. These results must be confirmed but open new research lines on preventive strategies for this unsolved condition.OC14.04 *Expectant observation as primary management for asymptomatic endometrial polyps: a prospective study
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