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Query: UMLS:C0030794 (pelvic pain)
 4,056 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Well-differentiated papillary mesothelioma (WDPM) is an uncommon mesothelial tumor that occurs in the peritoneum of women over a wide age range. Although considered a tumor of uncertain malignant potential, information about its biological behavior is still limited. In this study, we present the clinicopathologic features of 26 cases of WDPM of the female peritoneum seen in our institution over a 20-year period (1990 to 2010). Clinical information and pathology material were reviewed in all cases. Patients ranged in age from 23 to 75 years (median, 47 y; mean, 48.6 y). There was no history of asbestos exposure in any of our cases. Ten patients had undergone surgery previously, and 6 had a history of endometriosis. In 24 patients, the WDPM was an incidental finding during surgery for a benign or malignant lesion. Only 2 patients presented with symptoms: 1 with an acute abdomen and the other with chronic pelvic pain. The former had developed a small hemoperitoneum because of bleeding of 1 of the lesions of WDPM, whereas the latter had a 2-cm WDPM involving the distal fallopian tube. The lesions were single or multiple (13 cases each) and ranged in size from 0.1 cm to 2 cm. The following sites were involved: abdominal or pelvic peritoneum not otherwise specified (10 cases), omentum (7 cases), cul-de-sac (6 cases), colonic serosa (4 cases), small bowel mesentery (2 cases), uterine serosa (2 cases), stomach serosa (1 case), large bowel mesentery (1 case), fallopian tube (1 case), ovary (1 case), and inguinal hernia (1 case). In all cases the lesions were excised. Microscopically, all of our cases had the typical features described for WDPM (ie, a papillary architecture that may be accompanied by glandular/tubular patterns, nests of cells and individual cells, bland mesothelial cells, absent or rare mitotic figures). The initial diagnosis in our cases was variable, including WDPM, mesothelial hyperplasia, malignant mesothelioma, serous tumor of low malignant potential of the peritoneum, papillary endosalpingiosis, and chronic xanthogranulomatous salpingiosis. Follow-up was obtained for 25 patients, and it ranged from 4 to 192 months (mean, 47.5 mo; median, 32 mo); 22 patients are alive with no evidence of WDPM after a follow-up that ranged from 5 to 144 months. One of these patients experienced recurrence of WDPM 46.5 months after initial diagnosis. In this patient, WDPM was an incidental finding during a total abdominal hysterectomy and bilateral salpingo-oophorectomy for serous cystadenofibroma. The recurrence was also an incidental finding during a colectomy for colonic adenocarcinoma. This patient is alive with no other recurrences 73 months after initial diagnosis and 36 months after diagnosis of the recurrence. Three patients died of other causes: pancreatic cancer at 4 months and 12 months and leukemia at 192 months. Recognition of the histologic features of WDPM and proper clinical correlation allow for the correct diagnosis of this entity. If necessary, immunohistochemical studies such as calretinin and keratin 5/6 facilitate the recognition of the mesothelial nature of this neoplasm. Although no patient died of disease in this series, follow-up of patients with this diagnosis is warranted on the basis of possible recurrences or misdiagnosis of an undersampled malignant mesothelioma.
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PMID:Well-differentiated papillary mesothelioma of the female peritoneum: a clinicopathologic study of 26 cases. 2202 62

Isolated torsion of the fallopian tube occurring in pregnancy is very rare. This entity should be considered in the differential diagnosis of acute pelvic pain with cystic adnexal mass associated with a normal ipsilateral ovary. This is a case report of a primi gravida at 29 weeks of pregnancy who was presented with isolated fallopian tube torsion.
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PMID:Isolated fallopian tube torsion with pregnancy- a case report. 2233 57

We report a rare case of adenomyoma localized only in the left fallopian tube mimicking tubal malignant tumor. A 45-year-old woman presented with mild pelvic pain, dysmenorrhea and left adnexal mass. Magnetic resonance imaging showed a solid tumor, suspected primary cancer of the fallopian tube, and serum carbohydrate antigen 125 was elevated to 72 U/mL (normal; 0-35). At surgery, the tumor was revealed as a left fallopian tube tumor without torsion. Postoperative histopathology showed that the tumor included bundle-like growing non-atypical leiomyoma cells and ectopic normal endometrium accompanied with endometrial stroma and we diagnosed primary adenomyoma of the left fallopian tube. Adenomyoma localized only in the fallopian tube is a rare entity and it can occur only in the fallopian tube.
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PMID:Primary adenomyoma of the fallopian tube mimicking tubal malignant tumor. 2238 May 32

Pelvic inflammatory disease (PID) refers to a group of inflammatory disorders of the female upper genital tract caused by the spread from the lower genital tract of Chlamydia trachomatis and other organisms. PID can cause chronic pelvic pain, fallopian tube damage, infertility and ectopic pregnancy. Between January 2002 and December 2011, 16,817 female service members met the surveillance case definition for acute PID. Incidence rates were stable at approximately 8 per 1,000 person-years overall and 11 per 1,000 person-years among known high-risk sub-populations (i.e., women 17-24 years old, in the Army, and of black, non-Hispanic race/ethnicity). Twenty-six women were diagnosed with PID within 10 days after medical evacuation from Iraq/Afghanistan. The proportion of servicewomen diagnosed with infertility subsequent to an incident diagnosis of acute PID increased during the period. Rates of PID are higher in the Army than the other Services. This may reflect differences in Service policies for chlamydia screening of new accessions.
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PMID:Acute pelvic inflammatory disease, active component, U.S. Armed Forces, 2002-2011. 2287 1

Endometriosis, which is defined as the presence of ectopic endometrial glands and stroma outside the uterus, is a common cause of pelvic pain and infertility, affecting as many as 10% of premenopausal women. Because its effects may be devastating, radiologists should be familiar with the various imaging manifestations of the disease, especially those that allow its differentiation from other pelvic lesions. The "pearls" offered here are observations culled from the authors' experience with the use of magnetic resonance (MR) imaging for the detection and characterization of pelvic endometriosis. First, the inclusion of T1-weighted fat-suppressed sequences is recommended for all MR examinations of the female pelvis because such sequences facilitate the detection of small endometriomas and aid in their differentiation from mature cystic teratomas. Second, it must be remembered that benign endometriomas, like many pelvic malignancies, may exhibit restricted diffusion. Although women with endometriosis are at risk for developing clear cell and endometrioid epithelial ovarian cancers (ie, endometriosis-associated ovarian cancers), imaging findings such as enhancing mural nodules should be confirmed before a diagnosis of ovarian malignancy is offered. The presence of a dilated fallopian tube, especially one containing hemorrhagic content, is often associated with pelvic endometriosis. Deep (solid infiltrating) endometriosis can involve the pelvic ligaments, anterior rectosigmoid colon, bladder, uterus, and cul-de-sac, as well as surgical scars; the lesions often have poorly defined margins and T2 signal hypointensity as a result of fibrosis. The presence of subcentimeter foci with T2 hyperintensity representing ectopic endometrial glands within these infiltrating fibrotic masses may help establish the diagnosis.
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PMID:MR imaging of endometriosis: ten imaging pearls. 2306 64

Accurate diagnosis of adnexal torsion is often challenging, as clinical presentation is nonspecific and the differential for pelvic pain is broad. However, prompt diagnosis and treatment is critical to good clinical outcomes and preservation of the ovary and/or fallopian tube. Ultrasound (US) imaging is most frequently used to assess torsion. However, as computed tomography (CT) utilization in the emergency setting has increased, there are times when CT is the initial imaging test. Additionally, the nonspecific clinical presentation may initially be interpreted as gastrointestinal in etiology, where CT is the preferred exam. For these reasons, it is imperative to know the findings of adnexal torsion on CT as well as US. Magnetic resonance imaging (MRI) is helpful in cases where the diagnosis remains unclear and is particularly helpful in the young or pregnant patient with equivocal sonographic findings, as it provides excellent soft tissue contrast without ionizing radiation. This article will illustrate the findings of surgically confirmed ovarian and fallopian tube torsion on US, CT, and MRI, including those in the pregnant patient. Ovarian enlargement, adnexal mass, twisting of the vascular pedicle, edematous and heterogeneous appearance of the ovary, peripheral ovarian follicles, free fluid, uterine deviation towards the side of torsion, adnexal fat stranding, tubal dilatation, and decreased adnexal enhancement will be reviewed. Familiarity with the range of imaging findings across multiple modalities is key to improving the likelihood of timely diagnosis and therefore improved clinical outcomes.
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PMID:Ovarian and tubal torsion: imaging findings on US, CT, and MRI. 2407 82

Background. Fallopian tube torsion is a rare cause of acute abdomen, occurring commonly in females of reproductive age. It lacks pathognomonic symptoms, signs, or imaging features, thus causing delay in surgical intervention. Case. We report two cases of isolated fallopian tube torsion in adolescent girls. In the first case a 19-year-old patient presented with acute pain in the left iliac region associated with episodes of vomiting for one day and mild tenderness on examination. Laparoscopy revealed left sided twisted fallopian tube associated with hemorrhagic cyst of ovary. The tube was untwisted and salvaged. In another case an 18-year-old virgin girl presented with similar complaints since one week, associated with mild tenderness in the lower abdomen and tender cystic mass on per rectal examination. On laparoscopy right twisted fallopian tube associated with a paratubal cyst was found. Salpingectomy was done as the tube was gangrenous. Conclusion. Fallopian tube torsion, though rare, should be considered in women of reproductive age with unilateral pelvic pain. Early diagnostic laparoscopy is important for an accurate diagnosis and could salvage the tube.
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PMID:Isolated fallopian tube torsion in adolescents. 2425 Oct 52

We report MR imaging findings of a rare case of endocervical mucinous borderline tumor (MBT) involving the cul-de-sac and left fallopian tube arising from extensive pelvic endometriosis with pathologic correlation in a 35-year-old woman presented with vague pelvic pain. Endocervical MBT is a type of endometriosis-associated carcinoma. Imaging findings of endocervical MBT are unilocular or oligolocular cystic lesions with enhancing mural nodules, which are different from those of the more common intestinal type MBT.
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PMID:MR imaging findings of extraovarian endocervical mucinous borderline tumors arising from pelvic endometriosis. 2426 67

Many women experience pain during hysterosalpingogram (HSG). This prospective, randomized, double-blinded, placebo-controlled study assessed whether the use of benzocaine spray during HSG is associated with reduced pain as compared with placebo. Thirty women presenting for HSG were enrolled and randomized to either benzocaine or saline spray. Treatment groups were similar in age, race, parity, pre-procedure oral analgesic use and history of dysmenorrhoea and/or chronic pelvic pain. Median change in pain score from baseline to procedure was 50.6mm (-7.4 to 98.8mm) in the benzocaine group and 70.4mm (19.8 to 100mm) in the placebo group. There was no difference between groups after adjusting for history of dysmenorrhoea. There was no difference in resolution of pain in benzocaine versus placebo groups at 5 min post procedure--median pain score difference -11.1 (-90.1 to 18.5) versus -37.0 (-100 to 1.2)--or at 30 min post procedure. Satisfaction scores did not differ by treatment and did not correlate with pain score during the procedure (rho=0.005). The use of benzocaine spray does not significantly improve pain relief during HSG nor does it hasten resolution of pain post HSG. Of interest, patient satisfaction was not correlated with pain. Many women experience pain during hysterosalpingogram (HSG), which is a test used to evaluate the uterine cavity and fallopian tube. We conducted a prospective, randomized, double-blinded, placebo-controlled study to assess whether the use of benzocaine spray during HSG is associated with reduced pain as compared with placebo. Thirty women presenting for HSG were enrolled and randomized to either benzocaine or saline spray. Treatment groups were similar in age, race, previous pregnancies, pre-procedure oral analgesic use and history of dysmenorrhoea (painful periods) and/or chronic pelvic pain. There was no difference in pain scores or resolution of pain between the two groups. Satisfaction scores did not differ by treatment group and did not correlate with the pain score during the procedure. We conclude that the use of benzocaine spray does not significantly improve pain relief during HSG nor does it hasten resolution of pain post HSG. Of interest, patient satisfaction was not correlated with pain.
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PMID:Randomized controlled trial of benzocaine versus placebo spray for pain relief at hysterosalpingogram. 2474 39

Ovarian pregnancy is very rare and to our knowledge, no case has been reported in Cameroon. We herein report a case at the Yaounde Central Hospital. It is the case of a 29 years old woman who consulted in emergency for left pelvic pain at 9 weeks of pregnancy. The level of beta human chorionic gonadotropin was 96702 milli-international Units/ milliliter and ultrasound revealed an intra-ovarian gestational sac, an empty uterus and no peritoneal effusion. In the absence of facilities for laparoscopy, an emergency laparotomy was done. We found the non ruptured mass inside the left ovary. The left fallopian tube, the uterus and the right adnexae were normal. We did a successful ovarian dissection and resection of gestational sac. Trophoblastic tissue was found at pathology. Similar symptoms should draw attention of practitioners on the plausibility of ovarian pregnancy.
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PMID:Ovarian pregnancy: a case report in a resource-poor setting. 2487 2


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