Journal of Obstetrics and Gynaecology
ISSN: 0144-3615 (Print) 1364-6893 (Online) Journal homepage: http://www.tandfonline.com/loi/ijog20
Successful laparoscopic management of a giant ovarian cyst A. Macciò, C. Madeddu, P. Kotsonis, M. Pietrangeli & A. M. Paoletti To cite this article: A. Macciò, C. Madeddu, P. Kotsonis, M. Pietrangeli & A. M. Paoletti (2014) Successful laparoscopic management of a giant ovarian cyst, Journal of Obstetrics and Gynaecology, 34:7, 651-652 To link to this article: http://dx.doi.org/10.3109/01443615.2014.902432
Published online: 30 Apr 2014.
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Gynaecology Case Reports and non-ciliated epithelia, subsequently diagnosed as serous cystadenoma. In addition, atypical glandular structures were observed in the right ovary. The immunostaining was positive for TTF-1, napsin A, surfactant and cytokeratin-7. Their distinct histological features were consistent with metastatic adenocarcinoma from the lung (Figure 1d). Subsequently, she was transferred to a regional hospital for adjuvant chemotherapy and was lost to further follow-up.
A. Macciò1, C. Madeddu2, P. Kotsonis3, M. Pietrangeli1 & A. M. Paoletti4
Discussion
1Department of Gynaecologic Oncology, A. Businco Hospital,
Although renal cell carcinoma is by far the most common recipient among malignant tumours, ovarian tumours are also potential recipients of metastases. A previous study demonstrated similar general metastatic tendencies among all lung cancers in tumour-to-tumour metastasis, regardless of their histological subgroup. Metastatic lesions involving primary ovarian tumours have been reported infrequently. In a review of the English literature, six of these cases originated in the breast, four in the stomach and one in the uterine cervix. Eight of the 11 tumours were benign and included three dermoid cysts, two Brenner tumours, one combined cystadenoma/Brenner tumour, one fibroma and one thecoma. The remaining neoplasms were potentially malignant and included one pseudomucinous cystadenocarcinoma, one borderline cystadenoma and one cystic ovarium carcinoma. In our patient’s case, we observed the coexistence of two neoplasms within one site: a serous cystadenoma of local origin and a metastasis of lung adenocarcinoma. A similar case had not been reported previously. The mechanism of tumour-to-tumour metastasis results from a complex cascade of interactions between the tumour cells and their environment (Hart and Saini 1992). The process begins with shedding of cells from a primary tumour into the circulation, where they must survive until they can arrest in another organ, followed by extravasation into the surrounding tissue, growth, and vascularisation (Chambers et al. 2002). These complex interactions between the primary tumour and the organ-specific patterns of metastasis are consisted with the ‘seed and soil’ analogy, first proposed over a century ago by Paget (1989). It is not known why tumours so rarely become sites of metastasis of malignant neoplasms. Metastasis is a ‘hidden’ process that occurs inside the body and so is inherently difficult to observe (Chambers et al. 2002). Since the normal ovarian environment provides rich ‘soil’ for the growth of metastases, ovarian tumours could play host to metastases from specific organs. In each specific case, it is possible that molecular factors in the environment associated with a benign ovarian cyst influence the metastatic implantation of lung adenocarcinomas. However, the pre-existing tumour could even produce factors that inhibit colonisation by other neoplasms. In conclusion, we report for the first time, a case of tumour-totumour metastasis of lung adenocarcinoma into an ovarian serous cystadenoma. Although the incidence of tumour-to-tumour metastasis is very rare, raising awareness of this pathology is important to avoid unnecessary diagnostic procedures in the evaluation of mass lesions with dimorphic patterns. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
References Berent W. 1902. Seltene Metastasenbildung. Zentralblatt fur Allgemeine Pathologie und Pathologische Anatomie 13:406–410. Chambers AF, Groom AC, MacDonald IC. 2002. Dissemination and growth of cancer cells in metastatic sites. Nature Reviews. Cancer 2:563–572. Hart IR, Saini A. 1992. Biology of tumour metastasis. Lancet 339:1453–1457. Honma K, Hara K, Sawai T. 1989. Tumour-to-tumour metastasis. A report of two unusual autopsy cases. Virchows Archives A, Pathological Anatomy and Histopathology 416:153–157. Paget S. 1989. The distribution of secondary growths in cancer of the breast. 1889. Cancer and Metastasis Reviews 8:98–101. Ro JY, Sahin AA, Ayala AG et al. 1990. Lung carcinoma with metastasis to testicular seminoma. Cancer 66:347–353. Sella A, Ro JY. 1987. Renal cell cancer: best recipient of tumor-to-tumor metastasis. Urology 30:35–38.
651
Successful laparoscopic management of a giant ovarian cyst
Regional Referral Center for Cancer Disease, 2Department of Medical Science ‘Mario Aresu’, 4Department of Obstetrics and Gynaecology, University of Cagliari, Cagliari, and 3Department of Obstetrics and Gynaecology, Sirai Hospital, Carbonia, Italy DOI: 10.3109/01443615.2014.902432 Correspondence: A. Macciò, Department of Gynaecologic Oncology, Businco Hospital, Regional Referral Center for Cancer Disease, via Edward Jenner, 09121 Cagliari, Italy. E-mail: [email protected]
Introduction Laparoscopy is considered the treatment of choice for the management of benign ovarian cysts. Its benefits include reduced invasiveness, reduced postoperative analgesic requirement, shorter hospitalisation, quicker recovery and an earlier resumption of patients’ social and professional life. A major factor for surgeons when deciding whether to perform a laparoscopy or laparotomy is the size of the ovarian mass. We report the case of a very large ovarian cyst safely and successfully treated with laparoscopy.
Case report A 72-year-old woman was referred to our department with a giant abdominal mass, worsening dyspnoea and swallowing problems. The patient weighed 122 kg and was unable to walk due to the huge mass. She had a 6-month history of vague abdominal pain and abdominal swelling, which gradually increased over the previous 4 months. Her bowel and bladder habits were normal. The abdominal wall was maximally tense, with a tumour filling the whole abdominal cavity with engorged veins (Figure 1a). Abdominal ultrasound showed a cystic unilocular structure with increased echogenicity. She was anaemic (haemoglobin 8.5 g/dl) with normal liver and renal functions and the CA125 was 89.7 ng/ml. Given the patient’s clinical picture and symptoms, urgent surgery was required. We opted for a laparoscopic approach on the assumption that this would afford the patient the best and most effective overall management and care. Following a minilaparotomy of about 5 cm above the umbilicus, to achieve the cyst decompression and minimise spillage we used a specially designed double balloon catheter (SAND balloon catheter, Hakko Medical, Tokyo, Japan). The punctured cyst wall was sandwiched between the two inflated balloons. About 35 litres of apparently haematic fluid were collected. Patient respiratory function improved soon after. We then used an abdominal hand-assisted laparoscopic device (Endopath® Dextrus™ Ethicon) placed in the supraumbilical port. Laparotomic access: a successful pneumoperitoneum was obtained by insertion of the first 10 mm trocar and was maintained throughout the surgery. The intra-abdominal cavity was visualised using a 10 mm, 0 degree telescope (Karl Storz, Tuttlingen, Germany) and four ancillary trocars (5 mm) were positioned under laparoscopic visualisation: two in the bilateral lower quadrants, one between the umbilicus and the pubic symphysis and one in the left side above and parallel to the lower homolateral trocar site (Figure 1b). The liver, gallbladder, stomach and diaphragm appeared normal. We proceeded to carefully separate the mass from its adherences to the abdominal wall. We found the mass arising from the right adnexa. Following coagulation with BiClamp LAP forceps (ERBE GmbH, Tubingen, Germany) of the uteroovarian and infundibulopelvic ligaments and the tube, the annex with the giant ovarian cyst was dissected using monopolar forceps. The cyst was excised intact. Thereafter, total laparoscopic
652
Gynaecology Case Reports
Downloaded by [University of Nebraska, Lincoln] at 20:49 05 November 2015
Figure 1. Patient’s abdomen preoperatively (A). Patient on operating room table at the end of surgery (B): the position of the ancillary trocars is showed.
hysterectomy with salpingo-oophorectomy was performed using a typical technique (Reich 2007). We proceeded also with laparoscopic omentectomy. The cyst was carefully removed from the abdominal cavity with external morcellation through the ‘Endopath Dextrus’ avoiding tumour spillage. No blood loss or anaesthesia-related complications occurred. The operating time was approximately 150 min. The tumour, after fluid emptying, weighed 7 kg (total weight 42 kg) with a wall thickness of 0.2–0.5 cm. At histopathology, the cyst section was a serous tumour with nuclear atypia and increased mitotic activity suggestive of serous borderline cystadenoma. The sections from uterus, tubes and ovaries were normal. The postoperative period was uneventful. The patient had a quick recovery and was discharged on day 3, walking, and with no dyspnoea. The patient has remained healthy, with neither hernia, urinary or bowel problems, nor any other symptoms and has returned to her usual daily activities.
Discussion Giant ovarian cysts are very rare and require resection because of associated symptoms, complications due to mass effect, difficulties in establishing the origin of the mass and risk of malignancy (Westfall and Andrassy 1982; Dolan et al. 2006). Laparoscopic surgery is currently considered the gold standard treatment for small to moderate size ovarian cysts. However, when confronted with extremely large cysts, only a few surgeons favour laparoscopic management due to technical difficulties, such as space constraints and fear of cyst rupture and spillage of malignant cells (Alobaid et al. 2013; Teng et al. 1996). There is, however, increasing evidence that giant ovarian cysts can be managed by laparoscopy, regardless of their size (Dolan et al. 2006; Alobaid et al. 2013; Teng et al. 1996; Pelosi and Pelosi 1996). Pre-laparoscopic decompression is required for the management of these cysts. This technique allows room to work, facilitates handling of the cyst and ovary and prevents inadvertent perforation and spillage. Possible options include: (1) ultrasound-guided drainage; (2) decompression via minilaparotomy and (3) laparoscopic-guided aspiration (Dolan et al. 2006; Murawski et al. 2012; Ateş et al. 2006; Goh et al. 2007). There is still no consensus as to the size limit of ovarian cysts that can be safely managed by laparoscopy. However, in our opinion, with proper patient selection to minimize the risk of draining malignant masses, the development of complex surgical techniques, which enable avoidance of spillage, and the increasing availability of experienced surgeons, giant ovarian cysts can be managed laparoscopically, regardless of the size of the tumour. The case reported here suggests that laparoscopy is feasible, safe, minimally invasive and effective also in very large ovarian cysts. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
References Alobaid A, Memon A, Alobaid S et al. 2013. Laparoscopic management of huge ovarian cysts. Obstetrics and Gynecology International 2013:380854. Ateş O, Karakaya E, Hakgüder G et al. 2006. Laparoscopic excision of a giant ovarian cyst after ultrasound-guided drainage. Journal of Pediatric Surgery 41:E9–E11. Dolan MS, Boulanger SC, Salameh JR. 2006. Laparoscopic management of giant ovarian cyst. Journal of the Society of Laparoendoscopic Surgeons 10: 254–256. Goh SM, Yam J, Loh SF et al. 2007. Minimal access approach to the management of large ovarian cysts. Surgical Endoscopy 21: 80–83. Murawski M, Gołębiewski A, Sroka M, et al. 2012. Laparoscopic management of giant ovarian cysts in adolescents. Videosurgery and other Miniinvasive Techniques 7:111–113. Pelosi MA 2nd, Pelosi MA 3rd. 1996. Laparoscopic removal of a 103-pund ovarian tumor. Journal of the American Association of Gynecologic Laparoscopists 3:413–417. Reich H. 2007. Total laparoscopic hysterectomy: indications, techniques and outcomes. Current Opinion in Obstetrics and Gynecology 19:337–344. Teng FY, Muzsnai D, Perez R et al. 1996. A comparative study of laparoscopy and colpotomy for the removal of ovarian dermoid cysts. Obstetrics and Gynecology 87:1009–1013. Westfall CT, Andrassy RJ. 1982. Giant ovarian cyst: case report and review of differential diagnosis in adolescents. Clinical Pediatrics 21: 228–230.
Abnormal innervation of narrowed, uterine arterioles in cornual ectopic pregnancy X. Q. Wu1, H. Y. Chen1, L. Wan2 & M. Quinn1 Departments of 1Gynaecology and 2Histopathology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China DOI: 10.3109/01443615.2014.903911 Correspondence: M. Quinn, First Affiliated Hospital of Wenzhou Medical University, 1, Shangcaicun Road, Wenzhou, Zhejiang 325000, China. E-mail: [email protected]
Introduction Cornual ectopic pregnancy accounts for 2–4% of ectopic pregnancies and carries a higher risk of maternal death (2–3%), with four deaths reported in the 2000–02 Confidential Enquiry into Maternal Deaths (CEMACH 2004). Ultrasound criteria for its diagnosis include: (a) an empty uterus (and positive pregnancy test); (b) a gestational sac ⬍ 1 cm from the edge of the uterus; (c) a thin layer of myometrium around the gestational sac; (d) the ‘interstitial line’ sign, which
ISSN: 0144-3615 (Print) 1364-6893 (Online) Journal homepage: http://www.tandfonline.com/loi/ijog20
Successful laparoscopic management of a giant ovarian cyst A. Macciò, C. Madeddu, P. Kotsonis, M. Pietrangeli & A. M. Paoletti To cite this article: A. Macciò, C. Madeddu, P. Kotsonis, M. Pietrangeli & A. M. Paoletti (2014) Successful laparoscopic management of a giant ovarian cyst, Journal of Obstetrics and Gynaecology, 34:7, 651-652 To link to this article: http://dx.doi.org/10.3109/01443615.2014.902432
Published online: 30 Apr 2014.
Submit your article to this journal
Article views: 64
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ijog20 Download by: [University of Nebraska, Lincoln]
Date: 05 November 2015, At: 20:49
Downloaded by [University of Nebraska, Lincoln] at 20:49 05 November 2015
Gynaecology Case Reports and non-ciliated epithelia, subsequently diagnosed as serous cystadenoma. In addition, atypical glandular structures were observed in the right ovary. The immunostaining was positive for TTF-1, napsin A, surfactant and cytokeratin-7. Their distinct histological features were consistent with metastatic adenocarcinoma from the lung (Figure 1d). Subsequently, she was transferred to a regional hospital for adjuvant chemotherapy and was lost to further follow-up.
A. Macciò1, C. Madeddu2, P. Kotsonis3, M. Pietrangeli1 & A. M. Paoletti4
Discussion
1Department of Gynaecologic Oncology, A. Businco Hospital,
Although renal cell carcinoma is by far the most common recipient among malignant tumours, ovarian tumours are also potential recipients of metastases. A previous study demonstrated similar general metastatic tendencies among all lung cancers in tumour-to-tumour metastasis, regardless of their histological subgroup. Metastatic lesions involving primary ovarian tumours have been reported infrequently. In a review of the English literature, six of these cases originated in the breast, four in the stomach and one in the uterine cervix. Eight of the 11 tumours were benign and included three dermoid cysts, two Brenner tumours, one combined cystadenoma/Brenner tumour, one fibroma and one thecoma. The remaining neoplasms were potentially malignant and included one pseudomucinous cystadenocarcinoma, one borderline cystadenoma and one cystic ovarium carcinoma. In our patient’s case, we observed the coexistence of two neoplasms within one site: a serous cystadenoma of local origin and a metastasis of lung adenocarcinoma. A similar case had not been reported previously. The mechanism of tumour-to-tumour metastasis results from a complex cascade of interactions between the tumour cells and their environment (Hart and Saini 1992). The process begins with shedding of cells from a primary tumour into the circulation, where they must survive until they can arrest in another organ, followed by extravasation into the surrounding tissue, growth, and vascularisation (Chambers et al. 2002). These complex interactions between the primary tumour and the organ-specific patterns of metastasis are consisted with the ‘seed and soil’ analogy, first proposed over a century ago by Paget (1989). It is not known why tumours so rarely become sites of metastasis of malignant neoplasms. Metastasis is a ‘hidden’ process that occurs inside the body and so is inherently difficult to observe (Chambers et al. 2002). Since the normal ovarian environment provides rich ‘soil’ for the growth of metastases, ovarian tumours could play host to metastases from specific organs. In each specific case, it is possible that molecular factors in the environment associated with a benign ovarian cyst influence the metastatic implantation of lung adenocarcinomas. However, the pre-existing tumour could even produce factors that inhibit colonisation by other neoplasms. In conclusion, we report for the first time, a case of tumour-totumour metastasis of lung adenocarcinoma into an ovarian serous cystadenoma. Although the incidence of tumour-to-tumour metastasis is very rare, raising awareness of this pathology is important to avoid unnecessary diagnostic procedures in the evaluation of mass lesions with dimorphic patterns. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
References Berent W. 1902. Seltene Metastasenbildung. Zentralblatt fur Allgemeine Pathologie und Pathologische Anatomie 13:406–410. Chambers AF, Groom AC, MacDonald IC. 2002. Dissemination and growth of cancer cells in metastatic sites. Nature Reviews. Cancer 2:563–572. Hart IR, Saini A. 1992. Biology of tumour metastasis. Lancet 339:1453–1457. Honma K, Hara K, Sawai T. 1989. Tumour-to-tumour metastasis. A report of two unusual autopsy cases. Virchows Archives A, Pathological Anatomy and Histopathology 416:153–157. Paget S. 1989. The distribution of secondary growths in cancer of the breast. 1889. Cancer and Metastasis Reviews 8:98–101. Ro JY, Sahin AA, Ayala AG et al. 1990. Lung carcinoma with metastasis to testicular seminoma. Cancer 66:347–353. Sella A, Ro JY. 1987. Renal cell cancer: best recipient of tumor-to-tumor metastasis. Urology 30:35–38.
651
Successful laparoscopic management of a giant ovarian cyst
Regional Referral Center for Cancer Disease, 2Department of Medical Science ‘Mario Aresu’, 4Department of Obstetrics and Gynaecology, University of Cagliari, Cagliari, and 3Department of Obstetrics and Gynaecology, Sirai Hospital, Carbonia, Italy DOI: 10.3109/01443615.2014.902432 Correspondence: A. Macciò, Department of Gynaecologic Oncology, Businco Hospital, Regional Referral Center for Cancer Disease, via Edward Jenner, 09121 Cagliari, Italy. E-mail: [email protected]
Introduction Laparoscopy is considered the treatment of choice for the management of benign ovarian cysts. Its benefits include reduced invasiveness, reduced postoperative analgesic requirement, shorter hospitalisation, quicker recovery and an earlier resumption of patients’ social and professional life. A major factor for surgeons when deciding whether to perform a laparoscopy or laparotomy is the size of the ovarian mass. We report the case of a very large ovarian cyst safely and successfully treated with laparoscopy.
Case report A 72-year-old woman was referred to our department with a giant abdominal mass, worsening dyspnoea and swallowing problems. The patient weighed 122 kg and was unable to walk due to the huge mass. She had a 6-month history of vague abdominal pain and abdominal swelling, which gradually increased over the previous 4 months. Her bowel and bladder habits were normal. The abdominal wall was maximally tense, with a tumour filling the whole abdominal cavity with engorged veins (Figure 1a). Abdominal ultrasound showed a cystic unilocular structure with increased echogenicity. She was anaemic (haemoglobin 8.5 g/dl) with normal liver and renal functions and the CA125 was 89.7 ng/ml. Given the patient’s clinical picture and symptoms, urgent surgery was required. We opted for a laparoscopic approach on the assumption that this would afford the patient the best and most effective overall management and care. Following a minilaparotomy of about 5 cm above the umbilicus, to achieve the cyst decompression and minimise spillage we used a specially designed double balloon catheter (SAND balloon catheter, Hakko Medical, Tokyo, Japan). The punctured cyst wall was sandwiched between the two inflated balloons. About 35 litres of apparently haematic fluid were collected. Patient respiratory function improved soon after. We then used an abdominal hand-assisted laparoscopic device (Endopath® Dextrus™ Ethicon) placed in the supraumbilical port. Laparotomic access: a successful pneumoperitoneum was obtained by insertion of the first 10 mm trocar and was maintained throughout the surgery. The intra-abdominal cavity was visualised using a 10 mm, 0 degree telescope (Karl Storz, Tuttlingen, Germany) and four ancillary trocars (5 mm) were positioned under laparoscopic visualisation: two in the bilateral lower quadrants, one between the umbilicus and the pubic symphysis and one in the left side above and parallel to the lower homolateral trocar site (Figure 1b). The liver, gallbladder, stomach and diaphragm appeared normal. We proceeded to carefully separate the mass from its adherences to the abdominal wall. We found the mass arising from the right adnexa. Following coagulation with BiClamp LAP forceps (ERBE GmbH, Tubingen, Germany) of the uteroovarian and infundibulopelvic ligaments and the tube, the annex with the giant ovarian cyst was dissected using monopolar forceps. The cyst was excised intact. Thereafter, total laparoscopic
652
Gynaecology Case Reports
Downloaded by [University of Nebraska, Lincoln] at 20:49 05 November 2015
Figure 1. Patient’s abdomen preoperatively (A). Patient on operating room table at the end of surgery (B): the position of the ancillary trocars is showed.
hysterectomy with salpingo-oophorectomy was performed using a typical technique (Reich 2007). We proceeded also with laparoscopic omentectomy. The cyst was carefully removed from the abdominal cavity with external morcellation through the ‘Endopath Dextrus’ avoiding tumour spillage. No blood loss or anaesthesia-related complications occurred. The operating time was approximately 150 min. The tumour, after fluid emptying, weighed 7 kg (total weight 42 kg) with a wall thickness of 0.2–0.5 cm. At histopathology, the cyst section was a serous tumour with nuclear atypia and increased mitotic activity suggestive of serous borderline cystadenoma. The sections from uterus, tubes and ovaries were normal. The postoperative period was uneventful. The patient had a quick recovery and was discharged on day 3, walking, and with no dyspnoea. The patient has remained healthy, with neither hernia, urinary or bowel problems, nor any other symptoms and has returned to her usual daily activities.
Discussion Giant ovarian cysts are very rare and require resection because of associated symptoms, complications due to mass effect, difficulties in establishing the origin of the mass and risk of malignancy (Westfall and Andrassy 1982; Dolan et al. 2006). Laparoscopic surgery is currently considered the gold standard treatment for small to moderate size ovarian cysts. However, when confronted with extremely large cysts, only a few surgeons favour laparoscopic management due to technical difficulties, such as space constraints and fear of cyst rupture and spillage of malignant cells (Alobaid et al. 2013; Teng et al. 1996). There is, however, increasing evidence that giant ovarian cysts can be managed by laparoscopy, regardless of their size (Dolan et al. 2006; Alobaid et al. 2013; Teng et al. 1996; Pelosi and Pelosi 1996). Pre-laparoscopic decompression is required for the management of these cysts. This technique allows room to work, facilitates handling of the cyst and ovary and prevents inadvertent perforation and spillage. Possible options include: (1) ultrasound-guided drainage; (2) decompression via minilaparotomy and (3) laparoscopic-guided aspiration (Dolan et al. 2006; Murawski et al. 2012; Ateş et al. 2006; Goh et al. 2007). There is still no consensus as to the size limit of ovarian cysts that can be safely managed by laparoscopy. However, in our opinion, with proper patient selection to minimize the risk of draining malignant masses, the development of complex surgical techniques, which enable avoidance of spillage, and the increasing availability of experienced surgeons, giant ovarian cysts can be managed laparoscopically, regardless of the size of the tumour. The case reported here suggests that laparoscopy is feasible, safe, minimally invasive and effective also in very large ovarian cysts. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
References Alobaid A, Memon A, Alobaid S et al. 2013. Laparoscopic management of huge ovarian cysts. Obstetrics and Gynecology International 2013:380854. Ateş O, Karakaya E, Hakgüder G et al. 2006. Laparoscopic excision of a giant ovarian cyst after ultrasound-guided drainage. Journal of Pediatric Surgery 41:E9–E11. Dolan MS, Boulanger SC, Salameh JR. 2006. Laparoscopic management of giant ovarian cyst. Journal of the Society of Laparoendoscopic Surgeons 10: 254–256. Goh SM, Yam J, Loh SF et al. 2007. Minimal access approach to the management of large ovarian cysts. Surgical Endoscopy 21: 80–83. Murawski M, Gołębiewski A, Sroka M, et al. 2012. Laparoscopic management of giant ovarian cysts in adolescents. Videosurgery and other Miniinvasive Techniques 7:111–113. Pelosi MA 2nd, Pelosi MA 3rd. 1996. Laparoscopic removal of a 103-pund ovarian tumor. Journal of the American Association of Gynecologic Laparoscopists 3:413–417. Reich H. 2007. Total laparoscopic hysterectomy: indications, techniques and outcomes. Current Opinion in Obstetrics and Gynecology 19:337–344. Teng FY, Muzsnai D, Perez R et al. 1996. A comparative study of laparoscopy and colpotomy for the removal of ovarian dermoid cysts. Obstetrics and Gynecology 87:1009–1013. Westfall CT, Andrassy RJ. 1982. Giant ovarian cyst: case report and review of differential diagnosis in adolescents. Clinical Pediatrics 21: 228–230.
Abnormal innervation of narrowed, uterine arterioles in cornual ectopic pregnancy X. Q. Wu1, H. Y. Chen1, L. Wan2 & M. Quinn1 Departments of 1Gynaecology and 2Histopathology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China DOI: 10.3109/01443615.2014.903911 Correspondence: M. Quinn, First Affiliated Hospital of Wenzhou Medical University, 1, Shangcaicun Road, Wenzhou, Zhejiang 325000, China. E-mail: [email protected]
Introduction Cornual ectopic pregnancy accounts for 2–4% of ectopic pregnancies and carries a higher risk of maternal death (2–3%), with four deaths reported in the 2000–02 Confidential Enquiry into Maternal Deaths (CEMACH 2004). Ultrasound criteria for its diagnosis include: (a) an empty uterus (and positive pregnancy test); (b) a gestational sac ⬍ 1 cm from the edge of the uterus; (c) a thin layer of myometrium around the gestational sac; (d) the ‘interstitial line’ sign, which
