Clinical, Imaging, Histological and Surgical Aspects Regarding Giant Paraovarian Cysts: A Systematic Review

Ștefanopol, Ioana Anca; Baroiu, Liliana; Neagu, Anca-Iulia; Danila, Dumitru Marius; Nechifor, Alexandru; Miulescu, Magdalena; Bălan, Gabriela; Vasile, Claudiu Ionuț; Niculeț, Elena; Tatu, Alin Laurențiu

doi:10.2147/tcrm.s361476

Cited by 15 publications

(7 citation statements)

References 52 publications

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“…If the tumor reaches a large size, signs of neighboring organ compression may occur, as well, such as: dysuria, polyuria or hydronephrosis, constipation, etc. [21]. Abdominal enlargement is commonly determined by a palpable pelvic or abdominopelvic mass, as was the case in our patient, but in one-third of cases, it may be due to the associated ascites.…”

Section: Discussionsupporting

confidence: 59%

Giant Benign Struma Ovarii with High-Grade Fever, Elevated CA 125, and Hormonal Function in an Adolescent Patient

Stefanopol,

Petecariu,

Baroiu

et al. 2023

Children

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Struma ovarii (SO) is a monodermal teratoma containing at least 50% thyroid tissue. Classically, SO is a hormonally inactive benign neoplasm that occurs in premenopausal women, and has unspecific clinical and imaging features. Its treatment is surgical and its diagnosis is established histopathologically. We report the case of a euthyroid 16-year-old girl presenting with abdominal girth increase. An abdomino-pelvic ultrasound showed a giant multicystic mass with transonic content and multiple septa, and magnetic resonance imaging suggested the diagnosis of right ovarian mucinous cystadenoma. Blood tests showed inflammatory syndrome, iron deficiency anemia, mild hepatocytolysis, and elevated serum CA 125 levels. High-grade fever occurred on the third day of hospitalization, but none of the preoperative tests could identify its origin. Cystectomy was performed, and the histopathological examination revealed benign SO with a few small cysts with purulent content. The patient developed hypothyroidism postoperatively. In conclusion, this case report reunites most of the uncommon features of SO and confirms the superiorityof histopathology in its definitive diagnosis, as well as the suitability of ovarian sparing techniques, as the best treatment option for cystic ovarian pathology in pediatric patients, even in cases of large tumoral size and elevated serum CA 125 levels.

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Section: Discussionsupporting

confidence: 59%

Giant Benign Struma Ovarii with High-Grade Fever, Elevated CA 125, and Hormonal Function in an Adolescent Patient

Stefanopol,

Petecariu,

Baroiu

et al. 2023

Children

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“…There are no studies which report quality of life associated with BLT. Additionally, the treatment impact, its recurrences, or morbidity are not reported in existing surveys [ 28 , 29 ]. It is considered that this disease, because of its morbidity and the signs and symptoms associated with surgical management, the need for chemotherapy or radiotherapy, and the high rate of recurrence, has a negative influence on patients’ quality of life [ 30 ].…”

Section: Resultsmentioning

confidence: 99%

Surgical Management of Perianal Giant Condyloma Acuminatum of Buschke and Löwenstein: Case Presentation

Mihailov,

Tatu,

Niculet

et al. 2023

Life

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Introduction: The Buschke–Löwenstein tumor (BLT) is an uncommon sexually transmitted ailment attributed to the human papillomavirus (HPV)—usually the 6 or 11 type (90%)—with male predominance and an overall infection rate of 0.1%. BLT or giant condyloma acuminatum is recognized as a tumor with localized aggressiveness, displaying distinctive features: the potential for destructive growth, benign histology, a rate of 56% malignant transformation, and a high rate of recurrence after surgical excision. There are several treatment choices which have been tried, including laser, cryotherapy, radiotherapy, electrocoagulation, immunotherapy, imiquimode, sincatechins, intralesional injection of 5-fluoruracil (5-FU), isolated perfusion, and local or systemic chemotherapy. In the case of an extensive tumor, preoperative chemotherapy or radiotherapy is used for tumor shrinkage, making the debulking procedure safer. HPV vaccines significantly decrease the incidence of genital warts, also decreasing the risk of BLT; HPV-6 and HPV-11 are included in these vaccines. Materials and methods: We present a 53-year-old heterosexual man, hospitalized in our department in June 2021 with a typical cauliflower-like tumor mass involving the perianal region, which progressively increased in size for almost 7 years. The perianal mass was completely removed, ensuring negative surgical margins. The large perianal skin defect which occurred was reconstructed with fascio-cutaneous V-Y advancement flap. There was no need for protective stoma. The literature review extended from January 1980 and December 2022, utilizing Pubmed and Google Scholar as search platforms. Results: Due to the disease’s proximity to the anal verge and the limited number of reported cases, arriving at a definitive and satisfactory treatment strategy becomes challenging. The optimal approach entails thorough surgical removal of the lesion, ensuring well-defined surgical margins and performing a wide excision to minimize the likelihood of recurrence. In order to repair the large wound defects, various rotation or advancement flaps can be used, resulting in reduced recovery time and a diminished likelihood of anal stricture or other complications. Our objective is to emphasize the significance of surgical excision in addressing BLT through the presentation of a case involving a substantial perianal condyloma acuminatum, managed successfully with complete surgical removal and the utilization of a V-Y advancement flap technique. In the present case, after 5 months post operation, the patient came back with a buttock abscess, which was incised and drained. After another 5 months, the patient returned for difficult defecation, with an anal stenosis being diagnosed. An anal dilatation and sphincterotomy were carried out, with good postoperative results. Conclusions: The surgical management of Buschke–Löwenstein tumors needs a multidisciplinary team with specialized expertise. The reconstruction techniques involved can be challenging and may introduce additional complications. We consider aggressive surgery, which incorporates reconstructive procedures, as the standard treatment for Buschke–Löwenstein tumors. This approach aims to achieve optimal surgical outcomes and prevent any recurrence.

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“…Benign cases should be treated by cystectomy by enucleating the cyst from the surrounding mesosalpinx [ 6 ]. An effort should be made to conserve the ovary and fallopian tube of these females at all costs, though at times excision of large POCs may necessitate removal of the tube or even the ovary [ 2 ]. There is no consensus on the management of borderline or malignant POCs [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…A paraovarian cyst (POC) is defined as a cystic mass located in the broad ligament or the mesosalpinx [ 1 , 2 ]. They are labelled as paraovarian or paratubal depending on the proximity to the respective structure, though the two terms are generally interchangeable [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

a case series and review of the literature

Singh¹,

Agarwal²,

Begum³

et al. 2023

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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-year-old 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.

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Clinical, Imaging, Histological and Surgical Aspects Regarding Giant Paraovarian Cysts: A Systematic Review

Cited by 15 publications

References 52 publications

Giant Benign Struma Ovarii with High-Grade Fever, Elevated CA 125, and Hormonal Function in an Adolescent Patient

Giant Benign Struma Ovarii with High-Grade Fever, Elevated CA 125, and Hormonal Function in an Adolescent Patient

Surgical Management of Perianal Giant Condyloma Acuminatum of Buschke and Löwenstein: Case Presentation

a case series and review of the literature

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