OVARIAN CYSTS IN POSTMENOPAUSAL WOMEN I

Size: px
Start display at page:

Download "OVARIAN CYSTS IN POSTMENOPAUSAL WOMEN I"

Transcription

1 OVARIAN CYSTS IN POSTMENOPAUSAL WOMEN I Is it raccomended that ovarian cysts in postmenopausal women should be assessed using CA 125 and transvaginal grey scale sonography. Serum CA 125 is raised in over 80% of ovarian cancer cases and, if a cut-off of 30 U/ml is used, the test has a sensivity of 81% and specificity of 75%. Ultrasound is also well established achieving a sensitivity of 89% and specificity of 73% when using a morphology index. There is no routine role yet for Doppler, MRI, CT or PET. (RCOG 2003)

2 OVARIAN CYSTS IN POSTMENOPAUSAL WOMEN II Ovarian cysts are common in postmenopausal women, although the prevalence is lower than in premenopausal women. Of healthy postmenopausal women screened, 21,2 % had abnormal ovarian morphology either simple or complex. The greater use of ultrasound means that an increasing proportion of these cysts will come to the attention of gynaecologists. (RCOG 2003)

3 OVARIAN CYSTS IN POSTMENOPAUSAL WOMEN III It is recommended that a risk of malignancy index should be used to select those women who require primary surgery in a cancer centre by a gynaecological oncologist. (RCOG 2003)

4 OVARIAN CYSTS IN POSTMENOPAUSAL WOMEN CONSERVATIVE MANAGEMENT Simple, unilateral, unilocular and echo-free with no solid parts or papillary formations, less than 5 cm in diameter, have a low risk of malignancy (less than 1%). It is recommended, in presence of a normal serum CA 125 levels, they to be managed conservatively, with a follow-up ultrasound scan, a reasonable interval being four months. (RCOG 2003)

5 OVARIAN CYSTS IN POSTMENOPAUSAL WOMEN SURGICAL MANAGEMENT ASPIRATION Cytological examination of ovarian cyst fluid is poor at distinguishing between benign and malignant tumours, with sensitivity of around 25%. In addition, there is a risk of cyst rupture: aspiration, therefore, has no role in the management of asymptomatic ovarian cysts in postmenopausal women. (RCOG 2003)

6 OVARIAN CYSTS IN POSTMENOPAUSAL WOMEN SURGICAL MANAGEMENT LAPAROSCOPY The laparoscopic approach should be reserved for those women who are not eligible for conservative management but still have a relatively low risk of malignancy. The appropriate laparoscopic treatment should involve oophorectomy (usually bilateral) rathen than cystectomy, with removal of the ovary intact in a bag without cyst rupture into the peritoneal cavity. (RCOG 2003)

7 OVARIAN CYSTS IN POSTMENOPAUSAL WOMEN SURGICAL MANAGEMENT LAPAROSCOPY Women at intermediate risk undergoing laparoscopic oophorectomy should be counselled preoperatively that a full staging laparotomy would be required if evidence of malignancy is revealed. If a malignancy is revealed during laparoscopy or subsequent histology, it is recommended that the woman is referred to a cancer centre as quickly as possible. (RCOG 2003)

8 OVARIAN CYSTS IN POSTMENOPAUSAL WOMEN SURGICAL MANAGEMENT LAPAROTOMY A high risk of malignancy index or clinical suspicion or findings at laparoscopy are likely to require a full laparotomy and staging procedure which should include: Citology : ascites or washing TAH, BSO and infracolic omentectomy Biopsies from adhesion and suspicious areas Appendicectomy Bilateral pelvic and paraortic lymphadenectomy (RCOG 2003)

9 ( RCOG 2003)

10 ( RCOG 2003)

11 (RCOG 2003)

12 Table1. Morphological score Value Wall Septa Vegetations Echogenicity 1 3 mm no septa no vegetations sonolucent* 2 > 3 mm 3 mm low echogenicity 3 > 3 mm 4 irregular, mostly solid 3 mm with echogenic area 5 irregular, non applicable > 3 mm with disomogeneous echogenic areas, solid *or with fine trabecular and jelly like hypoechoic content typical of endohaemorragic corpus luteum. Cut-off value for risk of malignancy 9 (Ferrazzi, 1997)

13 Cisti ovariche semplici in postmenopausa Prevalenza: 6.6% Conway et al % Wolf et al % Aubert et al % Levin et al Incidenza simile di anno in anno Castillo et al Prevalenza non è correlata all età della menopausa Castillo et al. 2003, Wolf et al Diametro medio circa 3 cm, +80% <5 cm Castillo et al. 2003, Wolf et al. 1991, Bailey et al. 1998, Valentin et al. 2002

14 Prevalenza delle cisti ovariche semplici in postmenopausa Prevalenza all esame autoptico del 19.7% 62.7% diametro medio <20 mm 29.4% diametro medio tra 20 e 50 mm 7.8% diametro medio >50 mm Prevalenza simile a quella riportata in molti studi in base all esame US Ecografia è procedura elettiva per identificare le cisti ovariche Dorum et al. 2004

15 Cisti ovariche semplici in postmenopausa 50% Risolve spontaneamente in 2 aa 50% Persiste 65-75% invariate 25-35%: 50% diminuisce di volume 50% aumenta di volume Nei follow-up nessuna paziente ha sviluppato Ca a mesi Castillo et al. 2006, Valentin et al. 2002, Modessit et al. 2003

16 Cisti ovariche semplici in postmenopausa Potenziale rischio di malignità < 1% Castillo et al., Gynecol Oncol 2003 Bailey et al. Gynecol Oncol 1998 Aubert et al. Maturitas 1998 Andolf et al. J Clin Ultrasound 1988 Conway et al. J Ultrasound Med 1998 Levine et al. Radiology 992 Padilla et al. Obstet Gynecol 2000 Bar-Haval et al. Acta Obstet Gynecol Scand 1997 Modesssit et al. Obstet Gynecol 2003 Kroon et al. Obstet Gynecol 1995 Auslender et al. J Clin Ultrasound 1996 Valentin et al. Ultrasound Obstet Gynecol 2002 La piu frequente istologia: cistoadenoma sieroso (>80%)

17

18 (Castilllo 2004)

19 (Castillo 2004)

20 Table 2. Histologic results from the 211 premenopausal patients treated by laparoscopy Number of cysts Percentage Serous cyst 72 (34.13%) Endometriotic cyst 68 (32.23%) Paraovarian cyst 7 (3.32%) Hemorrhagic cyst 11 (5.22%) Cystadenomas 9 (4.27%) Dermoid cyst 14 (6.64%) Hydrosalpinx 6 (2.90%) Primary tubal carcinoma 1 (0.48%) Follicular cyst 19 (9.10%) Lutein cyst 4 (1.90%) (Stamatellos, Gynecol Surg 2006)

21 BENIGN CYSTIC TERATOMA I The majority occurs during reproductive years. Malignancy complicates % of cases. The rate of bilateral mature cystic teratomas is >10%. Risk of torsion (3%), acute rupture (1-3%.) or chronic leakage (1%). (Commerci 1994) Granulomatous chemical peritonitis associated with the leakage of cystic teratomas is characterized by multiple small yellow-white implants and dense adhesions. (Stern 1981)

22 BENIGN CYSTIC TERATOMA II 178 cystic teratomas. Overall incidence of leakage at cystectomy was not statistically different between patients undergoing laparotomy (38.7%) and laparoscopy (42.2%). There was no difference between cysts that leaked and those that did not in location, mean diameter at preoperative ultrasound, diameter as estimated at surgery and presence of adhesions. Cystectomy by laparotomy is insensitive to surgeon experience as misured in years; however, laparoscopic experience (20 cases for year) is highly predictive of success at laparoscopic cystectomy. (Milad 1999)

23 Laparoscopic cystectomy is currently considered the first-line choice for the conservative treatment of benign ovarian cysts However the safety of this technique in term of ovarian damage to the operated gonad has recently been questioned

24 Nargund,Human Reprod.1996 In patients previously operated for endometriotic ovarian cysts, during IVF the number of both follicles and retrieved oocytes obtained in the operated gonad during ovarian hyperstimulation is markedly reduced when compared to the controlateral intact ovary

25 Potential deleterious mechanisms Amount of ovarian tissue removed during cystectomy Damage inflicted to ovarian stroma by electrosurgical coagulation during hemostasis Previous presence of the cyst

26 Somigliana, Fertil. Steril., patients 53 cycles of IVF control ovary operated ovary Basal volume 9.6 ± ± 5.5 cm3 p<0.007 N follicles 4.4 ± ± 1.4 p<0.001 Mean reduction in follicles retrieval 56% (95% C.I.) This reduction did not seems to be related to the dimension of the excise ovarian cyst

27 Canis, Human Reproduction, Pts : laparoscopic ovarian cystectomy for endometrioma > 3 cm 139 Pts : pelvic endometriosis without ovarian endometrioma 59 Pts: tubal infertility Ovarian stimulation with CC+Gn or GnRHa + Gn Number of oocytes and embryos obtained is not significantly decreased by laparoscopic cystectomy

28 Does laparoscopic removal of nonendometriotic benign ovarian cysts affect ovarian reserve? Seventeen IVF-cycles in women who previously underwent laparoscopic excision of a monolateral nonendometriotic benign ovarian cyst. Basal volumes of the intact and the operate gonads were 5.7 ± 3.3 and 3.4 ± 2.3 cm³ respectively (P=0.01), corresponding to a mean reduction of 39%. The numbers of dominant follicle were 4.6 ± 2.5 and in the control ovary and in the previous operated ovary, respectively (P=0.01), corresponding to a mean reduction of 42%. (Somigliana 2006)

29 Muzii L. et Al, Fertil.Steril.,77,609,2002 Laparoscopic excision of ovarian cyst using stripping technique 42 women Results Recognizable ovarian tissue adjacent to the cyst wall in 36% Significant difference between endometriotic and nonendometriotic cyst (54% vs 6%, p<0.005) No specimen showed the normal follicular pattern observed in healthy ovaries

30 Indicators of ovarian reserve Ovarian volume (Lass 1999) Antral follicle count (Bancsi 2002) Stromal blood flow (Tarlatzis 2003)

31 Exacoustos et al.,amj.obstet.gynecol,191,68,2004

32 Exacoustos et al.,amj.obstet.gynecol.,191,68,2004

33 Exacoustos et al.,am.j.obstet.gynecol.191,68,2004

34 Ovarian cortex surrounding benign neoplasms I Specimens obtained from the area of maximum distension of the ovarian cortex overlying benign cyst. Evaluation of the type and number of follicles and vascular network ( Maneschi,1993 )

35 Ovarian cortex surrounding benign neoplasms II Teratomas Cystoadenomas Endometriomas Normal morphologic 92% 77% 19% pattern Regular vascular 84% 78% 22% network P < 0.01 ( Maneschi, 1993)

36 Ovarian cortex surrounding benign neoplasms III Stretching and thinning the ovarian cortex are not associated with morphologic alterations Endometrioma is often associated with microscopic endometriosis in surrounding cortical tissue and with alterations of the follicular and vascular patterns ( toxic or inflammatory mechanism? ) ( Maneschi, 1993 )

37 Conclusions Laparoscopic excision of ovarian cyst is associated with a damage of ovarian reserve at least in a short term follow up Our results tend to rule out a role for an injury of ovarian vascularization The modality to achieve a good hemostasis may be important Is the reduction of ovarian reserve a consequence of surgery or,conversely,the damage is already present before surgery?

Ovarian cysts Diagnosis and Management

Ovarian cysts Diagnosis and Management Ovarian cysts Diagnosis and Management Mr P K Athanasias MRCOG Consultant Gynaecologist St Anthony s Hospital pathanasias@gmail.com Introduction ovary is an ovum-producing reproductive organ located in

More information

Management fertility sparing degli endometriomi Errico Zupi

Management fertility sparing degli endometriomi Errico Zupi Management fertility sparing degli endometriomi Errico Zupi Università Tor Vergata Roma Management of endometrioma Pain Infertility Surgical treatment Medical treatment Infertility clinic Both medical

More information

Benign Ovarian Masses

Benign Ovarian Masses Benign Ovarian Masses Anthony Hanbidge Learning Objectives Describe technique for assessment of ovarian masses Explain importance of transvaginal scan List the common benign masses Specify distinguishing

More information

POSTMENOPAUSAL ASSESS AND WHAT TO DO

POSTMENOPAUSAL ASSESS AND WHAT TO DO POSTMENOPAUSAL OVARIAN CYSTS:HOW TO ASSESS AND WHAT TO DO Steven R. Goldstein, MD Professor of Obstetrics and Gynecology Director of Gynecologic Ultrasound Co-Director, Bone Densitometry New York University

More information

Endometrioma : what is the best option? Claudia Tosti, Errico Zupi

Endometrioma : what is the best option? Claudia Tosti, Errico Zupi Endometrioma : what is the best option? Claudia Tosti, Errico Zupi Clinical symptoms Endometrioma Deep endometriosis Adenomyosis Ovarian reserve Bilateral endometrioma Previous surgery American Society

More information

OVARIAN CYSTS. Types of Ovarian Cysts There are many types of ovarian cysts and these can be categorized into functional and nonfunctional

OVARIAN CYSTS. Types of Ovarian Cysts There are many types of ovarian cysts and these can be categorized into functional and nonfunctional OVARIAN CYSTS Follicular Cyst Ovarian cysts are fluid-filled sacs that form within or on the ovary. The majority of these cysts are functional meaning they usually form during a normal menstrual cycle.

More information

Guideline on the management of ovarian masses. Gynaecologists, radiologists, sonographers, nurses. Ovarian masses, ovarian cysts, management

Guideline on the management of ovarian masses. Gynaecologists, radiologists, sonographers, nurses. Ovarian masses, ovarian cysts, management Guideline on the management of ovarian masses. A clinical guideline recommended for use In: By: For: Key words: Written by: Gynaecology Services Gynaecologists, radiologists, sonographers, nurses Management

More information

Endometriosis will not Lower IVF Success

Endometriosis will not Lower IVF Success Endometriosis will not Lower IVF Success Endometriosis will not Lower IVF Success Effects of endometriosis on fertility treatment success has always been a controversy. When a woman is diagnosed with endometriosis,

More information

The Adnexal Mass and Early Ovarian Cancer

The Adnexal Mass and Early Ovarian Cancer The Adnexal Mass and Early Ovarian Cancer Fred Ueland, MD University of Kentucky Gynecologic Oncology Never give in. Never give in. Never, never, never, never- in nothing great or small, large or petty-

More information

ProSono Copyright 2006. Ovarian Pathology

ProSono Copyright 2006. Ovarian Pathology Ovarian Pathology Physiologic cysts: Functional cysts Pathology: A simple cyst is a sac containing fluid or semi-solid material. Physiologic cysts are generic types of hormonally active cysts that result

More information

Gynecology Abnormal Physiology of the ovaries. Simple Cystic Masses

Gynecology Abnormal Physiology of the ovaries. Simple Cystic Masses Gynecology Abnormal Physiology of the ovaries (Effective February 2007) pediatric, reproductive, and perimenopausal/postmenopausal (24-28 %) Simple Cystic Masses ovary s function is to mature oocytes until

More information

Treatment of endometrioma

Treatment of endometrioma Treatment of endometrioma GKS Marjaleena Setälä Conflicts of interest Head of the Obstetrics and Gynecology department Päijät-Häme Central Hospiltal Laparoscopic surgery training collaboration with Olympus

More information

Sonographic Features of Ovarian Remnants

Sonographic Features of Ovarian Remnants Sonographic Features of Ovarian Remnants Arthur C. Fleischer, MD, David Tait, MD, Jack Mayo, MD, Lonnie Burnett, MD, Jean Simpson, MD Ovarian remnants occur after a portion of ovarian tissue is left behind

More information

Introduction Ovarian cysts are a very common female condition. An ovarian cyst is a fluid-filled sac on an ovary in the female reproductive system.

Introduction Ovarian cysts are a very common female condition. An ovarian cyst is a fluid-filled sac on an ovary in the female reproductive system. Ovarian Cysts Introduction Ovarian cysts are a very common female condition. An ovarian cyst is a fluid-filled sac on an ovary in the female reproductive system. Most women have ovarian cysts sometime

More information

Ovarian Cysts Made Simple Michael East. Oxford Clinic

Ovarian Cysts Made Simple Michael East. Oxford Clinic Ovarian Cysts Made Simple Michael East Oxford Clinic Objectives of this talk To understand risk of malignancy and thus not fear it Practical advice for follow up of asymptomatic cysts Practical advice

More information

Ovarian Cancer. Andreas Obermair. Gynaecological Oncologist

Ovarian Cancer. Andreas Obermair. Gynaecological Oncologist Ovarian Cancer Andreas Obermair Gynaecological Oncologist www.obermair.info Ovarian cancer in QLD Five patients with ovarian cancer per week in QLD. Two patients will be diagnosed in early stage (stage

More information

Ultrasound assessment of women with pelvic pain

Ultrasound assessment of women with pelvic pain Ultrasound assessment of women with pelvic pain Lil Valentin Department of Obstetrics and Gynecology Skåne University Hospital Malmö, Sweden How to make optimal use of ultrasound in women with pelvic pain

More information

Risk of Malignancy in Unilocular Ovarian Cystic Tumors Less Than 10 Centimeters in Diameter

Risk of Malignancy in Unilocular Ovarian Cystic Tumors Less Than 10 Centimeters in Diameter Risk of Malignancy in Unilocular Ovarian Cystic Tumors Less Than 10 Centimeters in Diameter Susan C. Modesitt, MD, Edward J. Pavlik, PhD, Frederick R. Ueland, MD, Paul D. DePriest, MD, R. J. Kryscio, PhD,

More information

Research Journal of Pharmaceutical, Biological and Chemical Sciences

Research Journal of Pharmaceutical, Biological and Chemical Sciences Research Journal of Pharmaceutical, Biological and Chemical Sciences Ovarian Cyst: A Review Article. Zeenath M*. SreeBalaji College of Nursing, Bharath University, Chennai, Tamil Nadu, India. ABSTRACT

More information

Saint Mary s Hospital. Ovarian Cysts. Information For Patients

Saint Mary s Hospital. Ovarian Cysts. Information For Patients Saint Mary s Hospital Ovarian Cysts Information For Patients 2 Contents Welcome 4 What are ovarian cysts? 4 How common are ovarian cysts? 6 Ovarian cysts and fertility 6 What are the symptoms of ovarian

More information

Simple ovarian cysts in pre and post menopausal women: what, where and when.

Simple ovarian cysts in pre and post menopausal women: what, where and when. Simple ovarian cysts in pre and post menopausal women: what, where and when. Award: Certificate of Merit Poster No.: C-1438 Congress: ECR 2012 Type: Educational Exhibit Authors: R. A. Gray, S. Higgins,

More information

良 性 附 屬 器 腫 瘤 簡 介. Benign adnexal mass

良 性 附 屬 器 腫 瘤 簡 介. Benign adnexal mass 良 性 附 屬 器 腫 瘤 簡 介 Benign adnexal mass Prepubertal Age Group Adolescent Age Group Reproductive Age Group Postmenopausal Age Group Prepubertal Age Group Differential Diagnosis Diagnosis and Management Prepubertal

More information

Ovarian endometrioma: guidelines for selection of cases for surgical treatment or expectant management

Ovarian endometrioma: guidelines for selection of cases for surgical treatment or expectant management Review Ovarian endometrioma: guidelines for selection of cases for surgical treatment or expectant management Expert Rev. Obstet. Gynecol. 8(1), 29 55 (2013) Molly Carnahan, Jennifer Fedor, Ashok Agarwal

More information

WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500. Ovarian Cysts

WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500. Ovarian Cysts Ovarian Cysts WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500 The ovaries are two small organs located on either side of a woman s uterus. An ovarian cyst is a sac or pouch filled with fluid

More information

ENDOMETRIOSIS & INFERTILITY. Professor T C Li Sheffield

ENDOMETRIOSIS & INFERTILITY. Professor T C Li Sheffield ENDOMETRIOSIS & INFERTILITY Professor T C Li Sheffield PRESENTATIONS Pain dysmenorrhoea dyspareunia chronic pain low back iliac fossa Infertility Ovarian cyst/mass PAIN PAIN IS THE PASSION OF THE SOUL

More information

What are the differences between fibroid and ovarian cyst?

What are the differences between fibroid and ovarian cyst? DR LEE KEEN WHYE MBBS (Singapore), FRCOG (U.K), FAMS (Singapore) Consultant Obstetrician & Gynaecologist Advisor, Endometriosis Association, Singapore KW Lee Clinic & Surgery For Women No. 6 Napier Road,

More information

Reproductive Health Group

Reproductive Health Group Gynaecology Services & Treatments 2015 Fee Schedule Consultations - Assessment Initial gynaecology consultation 200-250 Follow-up gynaecology consultation 150-175 Initial fertility consultation *Harley

More information

Mucinous Cystadenoma of the Ovary

Mucinous Cystadenoma of the Ovary Case Studies [1] September 24, 2012 By Harpreet Singh, MD [2] A 50-year-old female with a history of progressive abdominal distention and discomfort for six months. A 50-year-old female with a history

More information

Comparison of anti-mullerian hormone level in nonendometriotic benign ovarian cyst before and after laparoscopic cystectomy

Comparison of anti-mullerian hormone level in nonendometriotic benign ovarian cyst before and after laparoscopic cystectomy Iran J Reprod Med Vol. 13. No. 3. pp: 149-154, March 2015 Original article Comparison of anti-mullerian hormone level in nonendometriotic benign ovarian cyst before and after laparoscopic cystectomy Sedigheh

More information

Ovarian Cancer: A Case Report

Ovarian Cancer: A Case Report Ovarian Cancer: A Case Report Abstract Ovarian cancer is a very common cancer among women. It is an extremely diverse disease requiring several treatment options. Occasionally ovarian cancer is diagnosed

More information

OVARIAN CYSTS IN POSTMENOPAUSAL WOMEN

OVARIAN CYSTS IN POSTMENOPAUSAL WOMEN Guideline No. 34 October 2003 OVARIAN CYSTS IN POSTMENOPAUSAL WOMEN 1. Aim The aim of this guideline is to provide information, based on clinical evidence where available, on the investigation and management

More information

The Management of Ovarian Cysts in Postmenopausal Women

The Management of Ovarian Cysts in Postmenopausal Women The Management of Ovarian Cysts in ostmenopausal Women Green-top Guideline No. 34 July 2016 The Management of Ovarian Cysts in ostmenopausal Women This is the second edition of this guideline, which was

More information

Sonographic Spectrum of Hemorrhagic Ovarian Cysts

Sonographic Spectrum of Hemorrhagic Ovarian Cysts Image Presentation Sonographic Spectrum of Hemorrhagic Ovarian Cysts Kiran A. Jain, MD Objective. To present the spectrum of sonographic findings associated with hemorrhagic ovarian cysts. Methods. Experience

More information

Welcome to chapter 8. The following chapter is called "Monitoring IVF Cycle & Oocyte Retrieval". The author is Professor Jie Qiao.

Welcome to chapter 8. The following chapter is called Monitoring IVF Cycle & Oocyte Retrieval. The author is Professor Jie Qiao. Welcome to chapter 8. The following chapter is called "Monitoring IVF Cycle & Oocyte Retrieval". The author is Professor Jie Qiao. The learning objectives of this chapter are 2 fold. The first section

More information

Transvaginal Sonographic Guidance of Puncture Procedures: Minimally Invasive Surgery

Transvaginal Sonographic Guidance of Puncture Procedures: Minimally Invasive Surgery : Safety and Efficacy Frances R. Batzer, MD, MBE Clinical Professor, Obstetrics & Gynecology Thomas Jefferson University Hospital Philadelphia, PA Safety and Efficacy Learning Objectives Describe patient

More information

LAPAROSCOPIC OVARIAN CYSTECTOMY

LAPAROSCOPIC OVARIAN CYSTECTOMY LAPAROSCOPIC OVARIAN CYSTECTOMY Information Leaflet Your Health. Our Priority. Page 2 of 5 About this information This leaflet is for you if you have a cyst on one or both ovaries and are considering surgery.

More information

Ovarian Torsion: Sonographic Evaluation

Ovarian Torsion: Sonographic Evaluation J Clin Ultrasound 17:327-332, June 1989 Ovarian Torsion: Sonographic Evaluation Mark A. Helvie, MD,* and Terry M. Silver, MDI Abstract: The sonographic and clinical findings of 13 patients with surgically

More information

Ovarian Cystectomy / Oophorectomy

Ovarian Cystectomy / Oophorectomy Cystectomy and Ovarian Cysts Ovarian cysts are sacs filled with fluids or pockets located on or in an ovary. In some cases, these cysts need to be removed surgically. Types of Cysts Ovarian cysts are quite

More information

DISCLOSURE OBJECTIVES IN THE INEREST OF TIME LAPAROSCOPY AND AN APPROACH TO THE ADNEXAL MASS

DISCLOSURE OBJECTIVES IN THE INEREST OF TIME LAPAROSCOPY AND AN APPROACH TO THE ADNEXAL MASS LAPAROSCOPY AND AN APPROACH TO THE ADNEXAL MASS DISCLOSURE I do not have any financial relationship with commercial interests. Michael Traynor Michael Traynor MD MPH Northwest Permanente, PC KAISER PERMANENTE

More information

IOTA Terminology, Simple Descriptors and Simple Rules

IOTA Terminology, Simple Descriptors and Simple Rules IOTA Terminology, Simple Descriptors and Simple Rules Susanne Johnson Princess Anne Hospital Southampton UK susanne.johnson@uhs.nhs.uk Ovarian pathology ClassificaGon system for ovarian pathology StandardisaGon

More information

The high mortality rates of ovarian cancer are

The high mortality rates of ovarian cancer are Volumes of Normal Ovaries, Ovaries with Benign Lesions, and Ovaries with Cancer in Menopausal Women: Is There an Optimal Cut-off Value to Predict Malignancy? Rami Aviram, MD, 1,3 Gilad Gassner, MD, 2 Ofer

More information

K Raja/N Varol FPA 2013. FPA Sydney August 31 2013

K Raja/N Varol FPA 2013. FPA Sydney August 31 2013 FPA Sydney August 31 2013 Ms wilson 32 year old woman Presents with worsening, heavy menstrual and intermenstrual bleeding and pain for 6 months. Ms Wilson What is the differential diagnosis What are the

More information

PATHOLOGY OF THE OVARY AND CLINICAL CORRELATES

PATHOLOGY OF THE OVARY AND CLINICAL CORRELATES PATHOLOGY OF THE OVARY AND CLINICAL CORRELATES Teri A. Longacre, MD Dept. of Pathology Paula J Adams Hillard, MD Dept. of Obstetrics and Gynecology HHD Autumn 2015 At the conclusion of this session, students

More information

Pathology of Ovary and Fallopian Tube Thomas C. Wright, Jr.

Pathology of Ovary and Fallopian Tube Thomas C. Wright, Jr. Pelvic Inflammatory Disease Most common diseases: Inflammation - as part of pelvic inflammatory disease Ectopic pregnancy Endometriosis Primary tumors - quite rare Most common causes of PID Chlamydia trachomatis

More information

Kate O Hanlan, M. D. F. A. C. O. G., F. A. C. S.

Kate O Hanlan, M. D. F. A. C. O. G., F. A. C. S. Kate O Hanlan, M. D. F. A. C. O. G., F. A. C. S. Gynecologic Oncology, Surgery and Endoscopy 4370 Alpine Road Portola Valley, CA 94028-7523 Phone: (650)-851-6669 FAX: (650) 851-9747 Regarding Ovarian Cancer,

More information

Safe and Effective Surgery for Endometriosis Including Detection and Intervention for Ovarian Cancer

Safe and Effective Surgery for Endometriosis Including Detection and Intervention for Ovarian Cancer Safe and Effective Surgery for Endometriosis Including Detection and Intervention for Ovarian Cancer Camran Nezhat,, MD, FACOG, FACS Stanford University Medical Center Center for Special Minimally Invasive

More information

Surgical Staging of Endometrial Cancer

Surgical Staging of Endometrial Cancer Surgical Staging of Endometrial Cancer I. Endometrial Cancer Surgical Staging Overview Uterine cancer types: carcinomas type I and type II, sarcomas, carcinosarcomas Hysterectomy with BSO Surgical Staging

More information

Original Study. Hemorrhagic Corpus Luteum Cysts: An Unusual Problem for Pediatric Surgeons

Original Study. Hemorrhagic Corpus Luteum Cysts: An Unusual Problem for Pediatric Surgeons J Pediatr Adolesc Gynecol (2009) 22:163e167 Original Study Hemorrhagic Corpus Luteum Cysts: An Unusual Problem for Pediatric Surgeons C. Spinelli, MD 1, M. Di Giacomo, MD 1,N.Mucci,MD 1, and F. Massart,

More information

Laparoscopic management of endometriosis in infertile women and outcome

Laparoscopic management of endometriosis in infertile women and outcome International Journal of Reproduction, Contraception, Obstetrics and Gynecology Sahu L et al. Int J Reprod Contracept Obstet Gynecol. 2013 Jun;2(2):177-181 www.ijrcog.org pissn 2320-1770 eissn 2320-1789

More information

OVARIAN CYSTS, MASSES and other pains OBJECTIVES FETAL AND NEONATAL OVARIAN CYSTS 11/26/2012. Anne Marie Priebe, DO

OVARIAN CYSTS, MASSES and other pains OBJECTIVES FETAL AND NEONATAL OVARIAN CYSTS 11/26/2012. Anne Marie Priebe, DO OVARIAN CYSTS, MASSES and other pains Anne Marie Priebe, DO Fellow, Adolescent Gynecology Children s Mercy Hospital Kansas City, MO OBJECTIVES Describe the normal anatomical and physiologic development

More information

Variations in Appearance of Endometriomas

Variations in Appearance of Endometriomas CME rticle Variations in ppearance of Endometriomas Elizabeth sch,, Deborah Levine, MD Objective. ecause of the range of patient ages with endometriosis, the persistence of endometriomas, and the degradation

More information

Male factor 30% Combined 20% Unexplained 15% Consultant Philips Healthcare. Forti and Krausz. J Clin Endo Metab 1998; 83:

Male factor 30% Combined 20% Unexplained 15% Consultant Philips Healthcare. Forti and Krausz. J Clin Endo Metab 1998; 83: Conflict of Interest Disclosure Ultrasound and Infertility Consultant Philips Healthcare William W. Brown, III, MD Director, Ambulatory Ob/Gyn & Ultrasound Denver Health Medical Center Associate Professor,

More information

Try out the online ROMA calculator available on the Elecsys HE4 page at cobas.com

Try out the online ROMA calculator available on the Elecsys HE4 page at cobas.com Try out the online calculator available on the Elecsys HE4 page at cobas.com Download the Roche application for the iphone and the ipad from the App Store. Roche References 1 Huhtinen, K. et al. (29).

More information

Discuss the post-operative counselling and the implications for future fertility of a woman who had laparoscopic surgery for an ectopic pregnancy.

Discuss the post-operative counselling and the implications for future fertility of a woman who had laparoscopic surgery for an ectopic pregnancy. Discuss the post-operative counselling and the implications for future fertility of a woman who had laparoscopic surgery for an ectopic pregnancy. Emily Hutchinson 5 th Year Medical Student Imperial College

More information

3 Summary of clinical applications and limitations of measurements

3 Summary of clinical applications and limitations of measurements CA125 (serum) 1 Name and description of analyte 1.1 Name of analyte Cancer Antigen 125 (CA125) 1.2 Alternative names Mucin 16 1.3 NLMC code To follow 1.4 Description of analyte CA125 is an antigenic determinant

More information

Preoperative differentiation of malignant from benign ovarian tumors: the efficacy of morphology indexing and Doppler flow sonography

Preoperative differentiation of malignant from benign ovarian tumors: the efficacy of morphology indexing and Doppler flow sonography Available online at www.sciencedirect.com R Gynecologic Oncology 91 (2003) 46 50 www.elsevier.com/locate/ygyno Preoperative differentiation of malignant from benign ovarian tumors: the efficacy of morphology

More information

Percutaneous drainage as the treatment of choice for neonatal ovarian cysts

Percutaneous drainage as the treatment of choice for neonatal ovarian cysts Pediatr Radiol DOI 10.1007/s00247-006-0240-0 ORIGINAL ARTICLE Ada Kessler. Hagith Nagar. Moshe Graif. Liat Ben-Sira. Elka Miller. Drora Fisher. Irith Hadas-Halperin Percutaneous drainage as the treatment

More information

Fibroids - Management

Fibroids - Management Fibroids - Management Scenario: Diagnosis of fibroids How do I know my patient has fibroids? Fibroids are commonly asymptomatic and may be identified incidentally by examination or investigation for gynaecological

More information

Training in Reproductive Medicine LOG BOOK

Training in Reproductive Medicine LOG BOOK Training in Reproductive Medicine LOG BOOK Approved by The European Board and College of Obstetrics and Gynaecology (EBCOG) The European Society of Human Reproduction and Embryology (ESHRE) TO BE COMPLETED

More information

Influence of Gynaecologic Adnexal Surgeries on Subsequent Ovarian Function and In Vitro Fertilization Treatment Outcome

Influence of Gynaecologic Adnexal Surgeries on Subsequent Ovarian Function and In Vitro Fertilization Treatment Outcome Journal of Reproduction & Contraception doi: 10.7669/j.issn.1001-7844.2014.02.0072 2014 Jun.; 25(2):72-80 E-mail: randc_journal@163.com Influence of Gynaecologic Adnexal Surgeries on Subsequent Ovarian

More information

Endometriosis & Infertility& Treatments. A. Musa Zamah, MD, PhD

Endometriosis & Infertility& Treatments. A. Musa Zamah, MD, PhD Endometriosis & Infertility& Treatments A. Musa Zamah, MD, PhD Full Disclosure of Faculty Financial Interests or Relationships I agree to follow the UIC and ACCME policies and declare that I do not have

More information

Frequently Asked Questions About Ovarian Cancer

Frequently Asked Questions About Ovarian Cancer Media Contact: Gerri Gomez Howard Cell: 303-748-3933 gerri@gomezhowardgroup.com Frequently Asked Questions About Ovarian Cancer What is ovarian cancer? Ovarian cancer is a cancer that forms in tissues

More information

All you need to know about Endometriosis. Nordica Fertility Centre, Lagos, Asaba, Abuja

All you need to know about Endometriosis. Nordica Fertility Centre, Lagos, Asaba, Abuja All you need to know about Endometriosis October, 2015 About The Author Nordica Lagos Fertility Centre is one of Nigeria's leading centres for world class Assisted Reproductive Services, with comfort centres

More information

Ovarian Cancer. Stacey N. Akers, MD July 14, 2015

Ovarian Cancer. Stacey N. Akers, MD July 14, 2015 Ovarian Cancer Stacey N. Akers, MD July 14, 2015 Ovarian cancer Statistics Risk factors Inherited Syndromes Prevention Diagnosis Staging Treatment Overview Ovarian Cancer Epidemiology 9 th most common

More information

Ovarian Cyst. Homoeopathy Clinic. Introduction. Types of Ovarian Cysts. Contents. Case Reports. 21 August 2002

Ovarian Cyst. Homoeopathy Clinic. Introduction. Types of Ovarian Cysts. Contents. Case Reports. 21 August 2002 Case Reports 21 August 2002 Ovarian Cyst Homoeopathy Clinic Check Yourself If you have any of the following symptoms call your doctor. Sense of fullness or pressure or a dull ache in the abdomen Pain during

More information

Ovarian Imaging and Ovarian Cancer

Ovarian Imaging and Ovarian Cancer January Ovarian Imaging and Ovarian Cancer Patrick Yachimski Harvard Medical School, Year- III MD Objectives 1) Introduction to ovarian cancer 2) Indications for ovarian imaging 3) Basic ovarian ultrasonography

More information

Cystic Neoplasms of the Pancreas: A multidisciplinary approach to the prevention and early detection of invasive pancreatic cancer.

Cystic Neoplasms of the Pancreas: A multidisciplinary approach to the prevention and early detection of invasive pancreatic cancer. This lecture is drawn from the continuing medical education program Finding Hope: Prevention, Early Detection and Treatment of Pancreatic Cancer, Nov, 2011. Robert P. Jury, MD Cystic Neoplasms of the Pancreas:

More information

Unoperated ovarian endometriomas and responsiveness to hyperstimulation

Unoperated ovarian endometriomas and responsiveness to hyperstimulation Human Reproduction, Vol.26, No.6 pp. 1356 1361, 2011 Advanced Access publication on April 7, 2011 doi:10.1093/humrep/der097 ORIGINAL ARTICLE Gynaecology Unoperated ovarian endometriomas and responsiveness

More information

Role of surgery in the management of Ovarian cancer. Waseem Kamran Sub-speciality Fellow Surgical Gynaecological Oncology St James Hospital

Role of surgery in the management of Ovarian cancer. Waseem Kamran Sub-speciality Fellow Surgical Gynaecological Oncology St James Hospital Role of surgery in the management of Ovarian cancer Waseem Kamran Sub-speciality Fellow Surgical Gynaecological Oncology St James Hospital Role of surgery Prevention Diagnosis Staging Treatment Palliative

More information

Pediatric Gynecologic Ultrasound. Objectives

Pediatric Gynecologic Ultrasound. Objectives Pediatric Gynecologic Ultrasound Marilyn J. Siegel, M.D. Mallinckrodt Institute of Radiology Washington University School of Medicine St. Louis, MO Objectives Review normal anatomy Discuss causes of acute

More information

Assisted Reproductive Technologies at IGO

Assisted Reproductive Technologies at IGO 9339 Genesee Avenue, Suite 220 San Diego, CA 92121 858 455 7520 Assisted Reproductive Technologies at IGO Although IGO no longer operates an IVF laboratory or program as such, we work closely with area

More information

Ovarian cancer. A guide for journalists on ovarian cancer and its treatment

Ovarian cancer. A guide for journalists on ovarian cancer and its treatment Ovarian cancer A guide for journalists on ovarian cancer and its treatment Contents Contents 2 3 Section 1: Ovarian Cancer 4 i. Types of ovarian cancer 4 ii. Causes and risk factors 5 iii. Symptoms and

More information

Acute Gynaecology and Early Pregnancy

Acute Gynaecology and Early Pregnancy Acute Gynaecology and Early Pregnancy Learning Outcomes: To develop knowledge and skills, which should enable the candidate to take a leading role in the management of women with acute gynaecological and

More information

The Radiologic Evaluation of the Ovary

The Radiologic Evaluation of the Ovary September 2000 The Radiologic Evaluation of the Ovary Aradhana M. Venkatesan,, Harvard Medical School Year- IV MD 1 Menu of Tests Trans-abdominal pelvic ultrasound Trans-vaginal pelvic ultrasound Pelvic

More information

Costing statement: Ovarian cancer: the recognition and initial management of ovarian cancer

Costing statement: Ovarian cancer: the recognition and initial management of ovarian cancer Costing statement: Ovarian cancer: the recognition and initial management of ovarian cancer 1 Resource impact The guideline on ovarian cancer (NICE clinical guideline 122) is unlikely to have a significant

More information

Common Surgical Procedures Gyn/Oncology

Common Surgical Procedures Gyn/Oncology Malignancy Description Codes wrvu Comments Cervical Typical Open Cone biopsy 57520 4.11 Leep conization 57522 3.67 Colposcopy/Leep 57461 3.43 TAH +/- BSO 58150 17.31 Radical hysterectomy +/- BSO (Total,

More information

Pelvic Pain and In Vitro Fertilization

Pelvic Pain and In Vitro Fertilization September 2006 Pelvic Pain and In Vitro Fertilization Celeste Lopez, Harvard Medical School Year III September 18, 2006 Mrs. G 37yo with IVF oocyte retrieval the day before presentation to the ED Complains

More information

Management of endometrioma prior to IVF: compliance with ESHRE guidelines

Management of endometrioma prior to IVF: compliance with ESHRE guidelines Reproductive BioMedicine Online (2010) 21, 325 330 www.sciencedirect.com www.rbmonline.com ARTICLE Management of endometrioma prior to IVF: compliance with ESHRE guidelines Tarek A Gelbaya a, Stephan Gordts

More information

Fertility Treatment - Glossary

Fertility Treatment - Glossary {loadpositionaddthis} Fertility Treatment - Glossary Adoption: The legal process in which a couple adopt parents. a child and become its legal Annovulatory: Absence of ovulation. Antral Follicles: Smaller

More information

Guideline for the Imaging of Patients Presenting with Breast Symptoms incorporating the guideline for the use of MRI in breast cancer

Guideline for the Imaging of Patients Presenting with Breast Symptoms incorporating the guideline for the use of MRI in breast cancer Guideline for the Imaging of Patients Presenting with Breast Symptoms incorporating the guideline for the use of MRI in breast cancer Version History Version Date Summary of Change/Process 0.1 09.01.11

More information

In 1981, the antigen CA-125 was identified by Bast

In 1981, the antigen CA-125 was identified by Bast Case Report 695 Ovarian Endometrioma Associated with Very High Serum Levels Chii-Shinn Shiau, MD; Ming-Yang Chang, MD; Chi-Hsin Chiang, MD; Ching-Chang Hsieh, MD; T'sang-T'ang Hsieh, MD is a 220-kD cell

More information

Introduction to Gynecologic Oncology

Introduction to Gynecologic Oncology Introduction to Gynecologic Oncology Department of Obstetrics and Gynecology University of Western Ontario Objectives Endometrial Neoplasia Endometrial hyperplasia and cancer: Discuss the epidemiology

More information

The position of hysteroscopy in current fertility practice is under debate.

The position of hysteroscopy in current fertility practice is under debate. The position of hysteroscopy in current fertility practice is under debate. The procedure is well tolerated. No consensus on effectiveness of HSC in improving prognosis of subfertile women. systematic

More information

The following chapter is called The Role of Endoscopy, Laparoscopy, and Hysteroscopy in Infertility.

The following chapter is called The Role of Endoscopy, Laparoscopy, and Hysteroscopy in Infertility. Welcome to Chapter 14. The following chapter is called The Role of Endoscopy, Laparoscopy, and Hysteroscopy in Infertility. The authors are Dr. Jose Remohi and Dr. Jaime Ferro. 1 There are several tools

More information

Ovarian Cancer. Josie Rutovitz

Ovarian Cancer. Josie Rutovitz Ovarian Cancer Josie Rutovitz Extent of the Problem In 2006 = 9 th most common cancer in women (Aust Institute of Health and Welfare). 1226 new cases in 2006. 60% of cases are post menopausal. 47% increase

More information

Endometriosis, Fertility and Pregnancy

Endometriosis, Fertility and Pregnancy This leaflet covers endometriosis and fertility. It provides information for women who have been diagnosed with endometriosis who would like to know if and how this can affect their fertility, and for

More information

Fertility care for women diagnosed with cancer

Fertility care for women diagnosed with cancer Saint Mary s Hospital Department of Reproductive Medicine Fertility care for women diagnosed with cancer Information For Patients INF/DRM/NUR/16 V1/01/11/2013 1 2 Contents Page Overview 4 Our Service 4

More information

Role of Robotic Surgery in Obese Women with Endometrial Cancer

Role of Robotic Surgery in Obese Women with Endometrial Cancer Role of Robotic Surgery in Obese Women with Endometrial Cancer Anil Tailor Consultant Gynaecological Oncologist Royal Surrey County Hospital Guildford, Surrey, UK St Peters Hospital Chertsey, Surrey, UK

More information

Giant Cysts of Ovary, A Benign Neoplastic Disease Mimicking Ascites

Giant Cysts of Ovary, A Benign Neoplastic Disease Mimicking Ascites Article ID: WMC002405 ISSN 2046-1690 Giant Cysts of Ovary, A Benign Neoplastic Disease Mimicking Ascites Corresponding Author: Dr. Tanweer Karim, MS, Department of Surgery, MGM Medical College, Navimumbai,

More information

Management of ovarian cysts and cancer in pregnancy

Management of ovarian cysts and cancer in pregnancy Facts Views Vis Obgyn, 2015, 7 (1): 25-31 Review Management of ovarian cysts and cancer in pregnancy J. de Haan *, M. Verheecke *, F. Amant KU Leuven University of Leuven, Department of Oncology; University

More information

Diagnosis of Ovarian Torsion with Color Doppler Sonography: Depiction of Twisted Vascular Pedicle

Diagnosis of Ovarian Torsion with Color Doppler Sonography: Depiction of Twisted Vascular Pedicle Diagnosis of Ovarian Torsion with Color Doppler Sonography: Depiction of Twisted Vascular Pedicle Eun Ju Lee, MD, Hyuck Chan Kwon, MD, Hee Jae Joo, MD, Jung Ho Suh, MD, Arthur C. Fleischer, MD The purpose

More information

Harvard-MIT Division of Health Sciences and Technology HST.071: Human Reproductive Biology Course Director: Professor Henry Klapholz

Harvard-MIT Division of Health Sciences and Technology HST.071: Human Reproductive Biology Course Director: Professor Henry Klapholz Harvard-MIT Division of Health Sciences and Technology HST.071: Human Reproductive Biology Course Director: Professor Henry Klapholz IN SUMMARY HST 071 OVARIAN PATHOLOGY Types of Ovarian Tumors Epithelial

More information

Acute Pelvic Pain. Ultrasound First: Pelvic Pain. Chronic Pelvic Pain. Ultrasound First. Acute Appendicitis in Pelvis. Acute Pelvic Appendicitis

Acute Pelvic Pain. Ultrasound First: Pelvic Pain. Chronic Pelvic Pain. Ultrasound First. Acute Appendicitis in Pelvis. Acute Pelvic Appendicitis Acute Pelvic Pain Ultrasound First: Pelvic Pain OKSANA H. BALTAROWICH, M.D. Professor, Department of Radiology Thomas Jefferson University, Philadelphia PA RLQ pain: acute appendicitis Acute pelvic pain

More information

PROGNOSTIC FACTORS IN ADVANSED OVARIAN CANCER

PROGNOSTIC FACTORS IN ADVANSED OVARIAN CANCER PROGNOSTIC FACTORS IN ADVANSED OVARIAN CANCER Dr. Hisham Rahahle Gynecologist, MD, Ph.D Subspecialty in Gynecological Oncology E-mail: hisham_re@yahoo.com Abstract: This study includes (68) patient diagnosed

More information

GORDTS and CAMPO Coagulating Suction Tube GYN /2015-E

GORDTS and CAMPO Coagulating Suction Tube GYN /2015-E GORDTS and CAMPO Coagulating Suction Tube GYN 25 5.0 06/2015-E GORDTS and CAMPO Coagulating Suction Tube Introduction Although diagnosed in 25-30% of patients with infertility, the causal relation between

More information

Comparison of ovarian cyst formation in women using the

Comparison of ovarian cyst formation in women using the Ultrasound Obstet Gynecol 2002; 20: 381 385 Comparison of ovarian cyst formation in women using the Blackwell Science, Ltd levonorgestrel-releasing intrauterine system vs. hysterectomy P. INKI*, R. HURSKAINEN

More information

Ultrasound of Benign Pathology. Reni Butler, M.D. Department of Radiology and Biomedical Imaging Yale School of Medicine

Ultrasound of Benign Pathology. Reni Butler, M.D. Department of Radiology and Biomedical Imaging Yale School of Medicine Ultrasound of Benign Pathology Reni Butler, M.D. Department of Radiology and Biomedical Imaging Yale School of Medicine Ultrasound of Benign Pathology Cyst Intramammary Lymph Node Lipoma Fibroadenolipoma

More information

Women s Health Laparoscopy Information for patients

Women s Health Laparoscopy Information for patients Women s Health Laparoscopy Information for patients This leaflet is for women who have been advised to have a laparoscopy. It outlines the common reasons doctors recommend this operation, what will happen

More information

Screening Asymptomatic Women for Ovarian Cancer: American College of Preventive Medicine Practice Policy Statement

Screening Asymptomatic Women for Ovarian Cancer: American College of Preventive Medicine Practice Policy Statement ATTENTION This Policy was reaffirmed by the ACPM Board of Regents on 1/31/2005 and is effective through 1/31/2010. Screening Asymptomatic Women for Ovarian Cancer: American College of Preventive Medicine

More information