Ovarian tumor cases that were preoperatively diagnosed as benign but postoperatively confirmed as borderline or malignant after laparoscopic surgery

AbstractObjectiveLaparoscopic surgery is the gold standard for benign ovarian tumors because of its overall improved quality of life (QOL). However, some tumors diagnosed preoperatively as benign may be proven to be malignant by postoperative studies. The standard approach for the removal of a malignant ovarian tumor in our hospital is via laparotomy; however, there is no referential prognostic data on malignancies that are excised laparoscopically. To evaluate clinical and histological factors and prognosis, this study retrospectively reviewed patients who underwent surgery in our hospital, based on a preoperative diagnosis of benignancy, but later postoperative testing proved their tumors to be borderline or malignant.Participants and methodsThe study group comprised 1322 women who underwent a laparoscopic procedure in our hospital on the basis of a preoperative diagnosis of a benign ovarian tumor. The procedures were performed between 1995 and 2011. The rate of borderline and malignant cases, histology, and postoperative treatment were investigated.ResultsOf the 1322 patients, 15 (1.1%) patients were postoperatively diagnosed as having a borderline malignancy with various histological types and all of these patients had a good prognosis; four (0.3%) patients were postoperatively diagnosed as having a malignant tumor with various histological types; of these patients, two patients required emergency surgery. All four patients underwent additional surgery and chemotherapy with no recurrence to date.ConclusionSome tumors diagnosed preoperatively as benign proved postoperatively to be malignant. Appropriate postoperative treatment effectively improved the prognosis. Particular attention should be paid to a possible occult malignancy that may manifest postoperatively, especially in patients who underwent emergency surgery. We recommend preoperative magnetic resonance imaging, even for emergency cases, to improve preoperative diagnosis

Indication for Laparoscopically Assisted Vaginal Hysterectomy

When uterine weight is greater than 800 grams, total abdominal hysterectomy is more appropriate than laparoscopic-assisted vaginal hysterectomy

WITHDRAWN: Ovarian tumor cases preoperatively diagnosed as benign but postoperatively confirmed as borderline or malignant after laparoscopic surgery

The Publisher regrets that this article is an accidental duplication of an article that has already been published http://dx.doi.org/10.1016/j.gmit.2013.07.002. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy

Recurrence of uterine myoma after laparoscopic myomectomy: What are the risk factors?

Objective: Uterine myoma is a common gynecologic disease. Myomectomy is selected to preserve the uterus, and with recent advances in laparoscopic technology, laparoscopic myomectomy (LM) has become a common treatment. However, myoma can recur after LM, and to date, reports on post-LM recurrence rates and risk factors have been inconsistent. This retrospective study examines post-LM recurrence rates and the possible risk factors for recurrence. Materials and Methods: Between 1995 and 2010, 250 patients who underwent LM at a single institution were followed from the postoperative sixth month to the fifth year semiannually for recurrence by ultrasound/magnetic resonance imaging (MRI). Mean age, body mass index (BMI), preoperative gonadotropin-releasing hormone agonist (GnRHa) therapy, surgical time, blood loss, number of removed myomas, and largest myoma diameter were compared between patients with recurrence and those without. Recurrence rates were also investigated by individual risk factors, including patient age, GnRHa therapy, number of removed myomas, and largest tumor diameter. Results: Cumulative post-LM recurrence rates were 15.3%, 43.8%, and 62.1% at postoperative years 1, 3, and 5, respectively. There were significant differences in surgical time, blood loss, and number of removed myomas between patients with recurrence and those without. Analysis of risk factors revealed significant correlation between recurrence rates and patient age, number of myomas, and myoma size. Conclusion: Risk of post-LM recurrence increases over time. Risk factors are age, myoma size, and number of tumors. Particular attention to recurrence is required for patients with uterine myomas of ≥10 cm diameter, with numerous myomas, and those age 35 years or older

〈Cases Reports〉 Severe endometriosis treated with long-term GnRHa : case report

[Abstract] Gonadotrophin-releasing hormone agonist (GnRHa) therapy for endometriosis is rarely used for long periods of time because it leads to decreased bone density and menopausal syndrome. Here, we describe a patient with severe endometriosis who underwent a colostomy and hysterectomy at a young age and has been on GnRHa therapy for 13 years since the surgery. The patient is a 37-year-old G0P0 woman who underwent a colostomy for ileus of the sigmoid colon and rectal endometriosis at the age of 21 years. At the age of 22 years, she underwent total abdominal hysterectomy, chocolate cystectomy, and partial rectectomy. After the surgery, her ovarian endometrioma recurred and ureteral endometriosis developed. She was then started on GnRHa therapy and has been on continuous therapy for 13 years up to the present. Side effects as such as decreased bone mineral density and menopausal syndrome have not been observed. Although GnRHa therapy is generally not used chronically because of its side effects, it has been possible to use it in this patient over a long period of time by ongoing monitoring for the development of deleterious side effects and adjusting the dose as needed

A long-term follow-up case of intravenous leiomyomatosis treated with anticoagulant therapy following conservative surgery

An intravenous leiomyomatosis is a benign smooth muscle tumor that develops in a vein. Approximately 200 cases have been reported in the literature thus far ; however, no case has been reported to date of an intravenous leiomyomatosis treated conservatively with anticoagulant therapy that has received longterm follow-up. We here present a case report of patient a 44-year-old G2P2. Hysterectomy and adnexectomy were performed and the uterine vein and internal iliac vein were removed, but the superior-located masses were conserved. Currently, in the 6^<th> post-operative year, no changes have been detected in the location, size, and property of the remaining masses. In addition, thromboses in the deep vein and along the inferior vena cava were confirmed pre-operatively and anticoagulant therapy has been administered continuously post-operatively. Thus, a thorough pre-operative search for thrombi is required in patients with intravenous leiomyomatosis. Anticoagulant therapy may be necessary for patients with tumor conserved in the IVC following conservative surgery