Ovarian Cysts No More
Both of these are unwanted guests in your abdominal cavity. Ovarian cysts are caused by growing cells in the uterus (see the discussion on endometriosis earlier in this chapter), which attach to and penetrate the tough covering of the ovary and begin to multiply. These cells form a cyst a closed pocket of tissue and can collect a large amount of blood, growing to the size of an egg or grapefruit. They are often called chocolate q sts because the blood darkens as it collects, giving it the appearance of a piece of chocolate attached to the ovary. Some women do not even know they have cysts, while others feel the characteristic lower abdominal achiness and discomfort. Sudden or sharp pain may point to a rupture of the cyst. Twisted ovarian q sts produce intermittent pain and are usually removed if pain becomes persistent.
As mentioned, the initial evaluation of an ovarian cyst includes a transvaginal ultrasound. Premenopausal women should have pregnancy testing, and postmenopausal women should have CA-125 testing. Simple cysts are more likely to be benign, whereas complex cysts (with thick walls, irregularity, papillations, septa, and echogenicity) have a higher risk of Dermoid cysts (teratomas) malignancy. Malignant neoplasms also display increased vascularity on Doppler ultrasound. Women with complex cysts, cysts larger than 10 cm in diameter, or elevated CA-125 levels should have a surgical referral (Modesitt et al., 2003). Although combination OCs can reduce the occurrence of functional ovarian cysts, OCs are not helpful for treatment (Grimes et al., 2007). Most simple ovarian cysts can be managed expectantly (Modesitt et al., 2003) (SOR B).
More recent studies have linked the occurrence of dysplastic gangliocytomas of the cerebellum to an autosomal dominant syndrome, Cowden's disease, leading to the development of multiple hamartomas and the predisposition for carcinomas of the breast.1,23,51,85,111,112,115 The autosomal-dominant Cowden's disease has been linked in some families to a germline mutation of PTEN86,100 and has the hallmark mucocutaneous manifestations of trichilemmomas, related follicular malformations, and a distinctive type of hyalinizing, mucinous fibroma,98 in addition to acral keratoses and oral papillomas.97 A significant number of patients also have thyroid adenoma or multinodular goiter, fibrocystic disease of the breast, gastrointestinal polyps (colon, gastric, and esophageal), and ovarian cysts or polyps.17,86,97 Approximately 40 of patients with Lhermitte-Duclos disease appear to have the clinical manifestations of Cowden's disease however, the actual percentage of cases is most likely much...
It is not uncommon for pregnant women to require surgery for non-obstetric reasons such as acute appendicitis, torsion of ovarian cysts and trauma. There are implications both for mother and fetus of which anaesthetists should be aware, but the questions in the viva will be predictable. For a mother whose pregnancy is well advanced the anaesthetic considerations are those which apply to Caesarean section under general anaesthesia. For a mother in the first trimester the main concerns relate to teratogenesis.
VHL disease is an autosomal dominant disorder with 90 penetrance attributable to loss of a tumor-suppressor gene on chromosome 3p25-26.15,30 Lesions associated with VHL disease include CNS hemangioblastoma, retinal angioma, renal cysts, renal cell carcinoma, pancreatic cysts, pheochromocytoma, and epididymal cystadenoma.21,49 vHL-disease families can be
Age has a strong association with the likely pathologic diagnosis. In the infant, teratomas and hamartomas are the most common lesions, followed by nasal gliomas and dermoid cysts and tract. Neurofibromas are occasionally seen in infants the most common sarcoma is rhabdomyosarcoma. The metastatic lesion that is most common is orbital neuroblastoma, which is often bilateral. The primary melanomas of the retina can metastasize to the skull base. Also, in the first year of life, Langerhans histiocytosis can affect the skull base, rather than the vault, and is usually misdiagnosed on imaging studies as rhabdomyosarcoma. The major differential of a mass at this age is encephalocele. In the toddler and young child, chordomas arise and can be seen through the rest of childhood. Sinus tumors such as the rare myxoma can occur at this age, as can neurofibromas. Metastatic tumors are most commonly Ewing's sarcoma or neuroblastoma. Some of the rare sarcomas begin to occur in the child older than...
Ovarian cysts, 179-181 acupuncture, 162-163 postpartum depression, 163-164 nutrition, 46 ovarian cysts, 179-181 physical exams, 15 abdomen, 17 checking channels, 15-16 plantar fasciitis, 89-91 PMS, 166-167 pregnancy, 158-159 Raynaud's Phenomenon, literature, 257-258 magnetics, 9, 40-41, 74 migraine headaches, 61 morning sickness, 158-159 moxibustion, 41-42 MS, 106-107 nausea, 149-152 neck pain, 64 needles, 38-41 new mothers, 162-163 Oriental Medicine, 94-96 ovarian cysts, 179-181 PMS, 166-167 back pain, 82 bursitis, 70-71 neck pain, 64 ovarian cysts, 179-180 sciatica, 86 tennis elbow, 71-72 uterine fibroids, 180
Epidermoid and dermoid cysts are the most common tumors, accounting for up to 60 of the calvarial masses in the pediatric population.52,72 The lesions result when cutaneous ecto-dermal rests are included in the developing cranium. They grow within the diploe and expand and erode the outer and inner tables of the skull. Both epidermoid and dermoid cysts are lined by stratified squamous epithelium and contain keratin from desquamation. Because a dermoid also has skin appendages, its cyst may contain hair and sebum as well. Because the primitive ectoderm has the capacity to form all the epidermal and dermal elements, these cysts embryologically can all be der-moids. Some reports, especially in the older literature, do not differentiate between epidermoid and dermoid cysts. Also, the tissue sent for histopathologic examination may not reflect the lesion in its entirety, or the dermal elements may have been destroyed by inflammation. FIGURE 102-1 Dermoid cyst. This 17-month-old girl...
Dermoid cysts typically develop along midline embryonic fusion planes and are composed of ectodermal and meso-dermal embryonic remnants. Their usual location in the neck is in the submental area. They are also found frequently along the dorsum of the nose. Dermoid cysts tend not to move with swallowing or elevate with tongue protrusion, unlike thyroglossal duct cysts. Treatment is surgical excision.
Epithelial neoplasms Benign salivary gland neoplasms Pleomorphic adenoma or mixed tumor Papillary cystadenoma lymphomatosum or Warthin's tumor Monomorphic adenomas Basal cell adenoma Canalicular adenoma Oncocytoma Sebaceous adenoma Sebaceous lymphadenoma Myoepithelioma Cystadenoma Ductal papillomas Sialoblastoma Malignant epithelial neoplasms Mucoepidermoid carcinoma Adenoid cystic carcinoma Adenocarcinomas Acinic cell carcinoma Polymorphous low-grade adenocarcinoma Adenocarcinoma, NOS Rare adenocarcinomas Basal cell adenocarcinoma Clear cell carcinoma Cystadenocarcinoma Sebaceous adenocarcinoma Sebaceous lymphadenocarcinoma Oncocytic carcinoma Salivary duct carcinoma Primary mucinous adenocarcinoma Malignant mixed tumors Carcinoma ex-pleomorphic adenoma Salivary carcinosarcoma Metastasizing mixed tumor Rare carcinomas Primary squamous cell carcinoma Epithelial-myoepithelial carcinoma Anaplastic small cell carcinoma Undifferentiated carcinomas Small cell undifferentiated carcinoma...
Of all salivary gland tumors, the vast majority (80 ) are found in the parotid gland. The submandibular gland contains approximately 10 , with the remainder in the sublingual and minor salivary glands. Of all parotid gland tumors, 80 are benign and 20 malignant. About 50 of submandibular gland tumors are benign and the vast majority of sublingual gland tumors are malignant. About 50 of minor salivary gland tumors are benign. The smaller the gland, the more likely that a mass within it is malignant. The pleomor-phic adenoma and papillary cystadenoma lympho-matosum (Warthin's) account for the vast majority of benign salivary tumors, with the former being the more common at about 80 of benign and the latter less common at about 15 of benign masses. Most of the malignant salivary gland tumors are represented by mucoepidermoid and adenoid cystic carcinomas. Papillary cystadenoma lymphomatosum, or War-thin's tumor, is the second most common benign lesion of the salivary glands. These tumors...
Dermoids and epidermoids (also referred to as dermoid and epi-dermoid cysts) make up a small subsection of pediatric spinal cord tumors. Constantini and Epstein report an incidence of a little more than 6 in an analysis of their own series and the current literature.7 DeSousa et al found that 8 of 81 (9.8 ) children with spinal cord tumors had either a dermoid or epider-moid.9 Predictably, as age demographics increase, the relative incidence of these two lesions decreases as the number of other intradural, extramedullary lesions seen in adulthood increases (e.g., meningioma and schwannoma).1 Microscopically, intraspinal dermoid cysts are lined by simple squamous epithelium and include dermis that may contain hair follicles, hair, sebaceous glands, oil, and other skin appendages indicative of dermal inclusion. Epidermoids are lined by compound squamous epithelium and grow via the accumulation of keratin.29
If ovarian cyst rupture occurs during laparoscopy, it is often helpful to place the patient in the reverse Trendelenburg position, to prevent the cyst contents from spreading throughout the pelvis. Using warm irrigation fluid, copiously irrigate the pelvic cavity to prevent the peritonitis that may result from the cyst contents.
The two most common management strategies of adnexal mass during pregnancy are operative extirpation of the mass or expectant management (72). Multiple authors recommend expectant management of adnexal masses 6 cm (125,126). Torsion usually occurs between the 6th and 14th weeks of gestation (129). Current conservative management of adnexal torsion involves unwinding the adnexa and assessing its viability. Only the gangrenous adnexa needs complete removal of the adnexa (130). When an ovarian cyst is present, a complete ovarian cystectomy should be performed for histologic diagnosis (131). If rupture and bleeding occur, laparoscopic cystectomy and coagulation of the base is appropriate in the
The historical diagnosis of dropsy - now obsolete - indicated an abnormal accumulation of fluid the word derives from the Greek hydrops ( water ). Alternative terms included hydrothorax (fluid in the chest cavity), ascites (excess fluid in the abdominal cavity), anasarca (generalized edema throughout the body), hydrocephalus (used until the nineteenth century to indicate excess fluid within the skull), and ovarian dropsy (large ovarian cysts filled with fluid). Edema was often a synonym for dropsy
Classification Systems for Salivary Gland Neoplasms The Cellular Classification of Salivary Gland Neoplasms Benign Salivary Gland Neoplasms Pleomorphic Adenoma Papillary Cystadenoma Lymphomatosum Monomorphic Adenomas Basal Cell Adenoma Canalicular Adenoma Oncocytoma Sebaceous Adenoma Sebaceous Lymphadenoma Myoepithelioma Cystadenoma Ductal Papillomas Sialoblastoma Malignant Epithelial Neoplasms Mucoepidermoid Carcinoma Adenoid Cystic Carcinoma Adenocarcinomas Acinic Cell Carcinoma Polymorphous Low-Grade Adenocarcinoma (PLGA)
Cystadenocarcinoma, also known as malignant papillary cystadenoma, mucus-producing adeno-papillary, or nonepidermoid, carcinoma, low-grade papillary adenocarcinoma of the palate, and papillary adenocarcinoma, is a rare, malignant epithelial tumor characterized histologically by prominent cystic and frequently papillary growth but lacking features that characterize cystic variants of several more common salivary gland neoplasms. Cystad-enocarcinoma is the malignant counterpart of cyst-adenoma (Ellis and Auclair 1996).
In children, dermoid cysts can present in the upper midline neck, and these developmental cysts may contain squamous debris, hair and even teeth A midline swelling in the region of the hyoid bone may represent a thyro-glossal cyst. This is a developmental abnormality with cystic thyroid tissue persisting along the thyroglossal duct. A thyroglossal cyst characteristically moves upwards on tongue protrusion due to a continuity of the cyst with the thyroglossal tract leading to the foramen caecum of the tongue. In the lower neck, midline swellings are most frequently related to the thyroid gland. Clinically, it is usually easy to distinguish between swelling of the thyroid gland and a swelling in the thyroid gland. Swellings of the thyroid gland may be due to simple goitre but thyroid cancer must be excluded. Diagnosis is made by fine-needle aspiration cytology and appropriate use of magnetic resonance imaging and radioisotope scanning. Occasionally, an early laryngeal cancer presents...
A common finding in both reproductive and nonreproductive age females is an adnexal cyst. These are sometimes found incidentally during urologic procedures. These may arise from the ovary, fallopian tube, or paratubal areas. In the reproductive age female, benign cysts usually include pelvic inflammatory disease, ectopic pregnancy, paratubal cysts, or Hydatid cysts of Morgagni. These cysts are remnants of the mesonephric or paramesonephric systems. They are usually less than 1cm and simple. Physiologic cysts include corpus luteal cysts, follicular cysts, or theca lutein cysts. The most common ovarian tumor in children and younger women is the mature cystic teratoma or dermoid cyst. These cysts contain the three embryologic germ cell layers endoderm, mesoderm, and ectoderm. Consequently, they often contain hair, teeth, and sebaceous fluid within the cyst cavity. These cysts are notorious for causing ovarian torsion in children or during pregnancy. Caution should be exercised if rupture...
The differential diagnosis of a parotid tumor includes lesions arising outside the parotid as well as intra-parotid masses. Skin lesions such as sebaceous or dermoid cysts are usually distinguished by their superficial origin in the overlying skin. Neoplasms of the masseter and masseteric hypertrophy will become fixed and more prominent on clenching the jaws. Condylar masses usually move with jaw opening and jaw lesions are usually bony hard to palpation. Intra-parotid masses that mimic parotid tumors include enlarged parotid nodes, and, as these may be metastatic, clinical examination of the parotid mass should always include the ear and the scalp for skin cancers. Parotid cysts may be difficult to distinguish from common parotid tumors such as PAs and low-grade muco-epidermoid carcinoma, which can present as fluctuant cysts. Tumors arising in the parotid tail may be mistaken for submandibular or neck masses (Figure 8.1), while those arising in the accessory gland may be thought to...
Among the cases seen in the 1920s by Sherwood Hall were the following gangrene, enlarged spleen due to chronic malaria, enlarged liver due to liver abscess, ascites, pleural effusion, edema, distomiasis due to lung flukes, and many forms of tuberculosis, often advanced cases. Hall thought that the use of unsterilized needles in acupuncture and moxa often led to infection and painful inflammation. Among women patients, Marian Hall encountered abdomens swollen from enlarged uterine fibroids, tumors, and ovarian cysts (Hall 1978).
There are potential side effects of IUD use. The most common adverse effects are cramping, abnormal uterine bleeding, and expulsion of the device. Other side effects seen are ectopic pregnancy, sepsis, PID, embedment of the device, uterine or cervical perforation, and ovarian cysts.41,42
The historical diagnosis of dropsy-which is now obsolete - indicated simply an abnormal accumulation of fluid the word derives from the Greek hydrops (water). Alternative or supplementary terms included hydrothorax (fluid in the chest cavity), ascites (which still indicates excess free fluid in the abdominal cavity), anasarca (still used to describe generalized edema throughout the body), hydrocephalus (used until the nineteenth century to indicate excess fluid within the skull), and ovarian dropsy (large ovarian cysts filled with fluid). Edema was often a synonym for dropsy, but it now has additional connotations, and pulmonary edema has been differentiated from hydrothorax. Since the mid-nineteenth century, dropsy has been recognized as a sign of underlying disease of the heart, liver, or kidneys, or of malnutrition. Untreated dropsy was, eventually, always fatal.
The location of the mass is also important. Midline masses tend to be benign or congenital lesions, such as thyroglossal cysts or dermoid cysts. Lateral masses are frequently neoplastic. Masses located in the lateral upper neck may be metastatic lesions from tumors of the head and neck, whereas masses in the lateral lower neck may be metastatic from tumors of the breast and stomach. One benign lateral neck mass is a branchial cleft cyst, which may manifest as a painless neck mass near the anterior upper third border of the sternocleidomastoid muscle.
You're riot wearing bandages, a plaster cast, or a sling, so you must not be hurt too bad. Without a reminder, your friends and family might forget you're dealing with a real health challenge. Sometimes other people don't understand that pain can be covered up as you try to live a normal life. Your pain doesn't always show. Most of the patients I've seen with the following conditions such as endometriosis, ovarian cysts, and chronic bladder infections have either a hard time finding the words for what is going on, or have given up reminding those around them. They often suffer in silence.
Endometriotic implants vary in size and appearance. They range from the classically described powder burn appearance to reddish-blue nodules and ovarian cysts. The repetitive process of hemolysis and encapsulation of debris causes extensive scarring of the affected surface. These surfaces usually include the ovary and posterior cul-de-sac with involvement of the distal uterosacral ligaments. Extensive involvement will include the rectum, tubes and ovaries, and the bladder. The overall positive predictive value for laparoscopic visualization of endometriosis is 43 to 45 (32,33). This is similar to appropriate history taking and physical exam. It is preferable to have a pathologic diagnosis if one suspects an implant may be endometriosis.
Rarely, men are diagnosed with masses of the seminal vesicle. Pain, obstruction of adjacent organs, dysuria, hematuria, or hematospermia can occur (24). Since the masses are often indistinguishable from adjacent organs, serum prostate-specific antigen and car-cinoembryonic antigen can be helpful in determining if there is a prostatic or colorectal origin (24). Alternatively, an elevated serum CA125 is strongly suggestive of a primary seminal vesicle carcinoma (25). Most masses of the seminal vesicle are benign, such as papillary adenomas, cystadenoma, fibromas, and leiomyomas. Seminal vesicle tumors with malignant potential are exceedingly rare. Primary malignancies of the seminal vesicle such as adenocarcinoma (24), sarcoma (26), schwannoma (27), and squamous cell carcinoma (28) can occur and are probably best managed by aggressive extirpative surgery via either radical prostatectomy or cystoprostatectomy. While surgical excision is the primary form of therapy, radiotherapy and...
Nevus sebaceous tumors are congenital hamar-tomas of the skin that probably arise from basal cells. These lesions typically involve the face and scalp regions of children, ranging in appearance from slightly raised flesh-colored plaques to verrucous nodular lesions. Although it is controversial, excision is usually recommended due to the risk of transformation to basal cell carcinoma. A study by Cribier and colleagues showed that of 596 excised cases of nevus sebaceous tumor, 0.8 percent contained coexistent basal cell carcinoma, while 13.6 percent of cases contained benign pathology, mainly syringo-cystadenoma papilliferum (37 ) and trichoblastoma (35 ).18 Similarly, a study by Chun and colleagues also observed low transformation rates, suggesting that excision of sebaceous nevi should be performed only in cases where transformation of benign to malignant pathology is suspected.19
Most salivary gland neoplasms arise in the parotid gland, and most are benign. Approximately 80 of parotid gland tumors are benign, with pleomorphic adenoma (mixed tumor) being the most common in adults. Hemangiomas are the most common benign tumor in children, but malignancy in children is more likely than in adults when a solid mass is found in the salivary gland. Other benign tumors include Warthin's tumors (papillary cystadenoma lymphomatosum) and oncocytomas. The most common malignancy in adults and children is mucoepidermoid carcinoma. Other malignancies include adenoid cystic carcinoma, malignant mixed tumor, and squamous cell carcinoma. Treatment of salivary gland neoplasms is surgical excision.
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