OBJECTIVE: To show feasibility and techniques used to perform a total hysterectomy, bilateral salpingectomy, endometriosis resection, and ovarian reconstruction in a patient with a frozen pelvis secondary to a history of ruptured tubo-ovarian abscess.
METHODS: Narrated step-by-step video demonstration.
METHODS: Single academic institution.
METHODS: In patients with a history of multiple abdominal surgeries, abdominal mesh, or in the case of this patient, a history of a ruptured tubo-ovarian abscess, a vaginal approach may be safer. Immediate access to the uterine pedicles through the vagina bypasses the need for extensive enterolysis and adhesiolysis when compared to an abdominal approach. With the use of indocyanine green injected into bilateral ureters, we highlight the benefits of immediate identification of the ureters allowing for safer and more efficient dissection. We show rotational uterine maneuvers to aid in rectosigmoid-to- posterior-uterus dissection in a limited space due to dense pelvic adhesions. Lastly, we demonstrate ovarian reconstruction and oophoropexy for the purpose of easier ovarian identification in future surgeries to possibly reduce the risks of ovarian remnant syndrome.
CONCLUSIONS: This video highlights the feasibility and strategies used to perform robot-assisted vaginal natural orifice transluminal endoscopic surgery on a patient with a frozen pelvis.

Ovarian remnant syndrome (ORS) is a rare complication that occurs after oophorectomy, characterized by residual ovarian tissue causing pelvic pain, masses, and various symptoms. The clinical manifestations of ORS are nonspecific, and its diagnosis relies on histological examination. Since ORS typically represents a benign ovarian lesion, there have been few reported cases of malignant transformation. In this report, we presented a unique case of ovarian clear cell carcinoma (OCCC) arising from an ovarian remnant following salpingo-oophorectomy.
Our patient was a 47-year-old female initially diagnosed with uterine myoma. She had previously undergone cesarean section and unilateral salpingo-oophorectomy. Transvaginal ultrasound and computed tomography (CT) scans revealed a soft tissue mass adjacent to the right lateral wall of the myometrium. The patient opted for transabdominal hysterectomy, left adnexal resection, laparoscopic omentectomy, appendectomy, and pelvic and abdominal lymphadenectomy. The final pathology results confirmed the diagnosis of OCCC, consistent with ORS. The patient subsequently received six cycles of intravenous chemotherapy using the carboplatin/paclitaxel (TC) regimen (paclitaxel liposomes 175 mg/m², carboplatin AUC 5). After 3 years of follow-up, the patient\'s condition remained normal.
ORS can significantly impact patients\' quality of life and pose challenges for clinicians. Complete excision of ovarian tissue during the initial surgery is crucial in preventing ORS recurrence and potential malignant transformation of ovarian remnants.

暂无摘要。

The aim of this study was to reveal (1) the determination of the serum antimüllerian hormone concentrations in cats with ovarian remnant syndrome and ovarian cyst, (2) the effectiveness of the serum antimüllerian hormone concentrations in detecting gonadectomy status, and (3) ovarian expression of the antimüllerian hormone in the ovarian cysts and ovarian remnant tissue. For this purpose, a total of 31 domestic cats older than 1 year, including ORS (n = 9), OC (n = 3), spayed (n = 8), and intact (n = 11), were used in the study. Serum and intrafollicular AMH concentrations were determined by the electrochemiluminescence immunoassay, and expression of the AMH was determined by the immunohistochemical method. The serum AMH concentration in the ORS group was 1.49 ± 1.24 ng/ml (0.10-3.63 ng/ml) whereas it was 1.78 ± 0.92 ng/ml (0.8-2.63 ng/ml) in the OC group. AMH concentration in the intrafollicular fluid was determined as 0.023 ng/ml in a cat with an ovarian cyst. While the serum AMH concentration was below 0.01 ng/ml in spayed cats, it was 5.80 ± 3.30 ng/ml (1.88-11.86 ng/ml) in the intact cats. There was a significant difference between the spayed and intact groups in terms of serum AMH concentration (p < 0.05). Moreover, in cats with ovarian cyst and ovarian remnant syndrome, no difference was found between the groups in terms of serum AMH concentration (p > 0.05). No difference was found between the ovarian remnant syndrome and intact cats in terms of serum AMH concentration (p > 0.05). In immunohistochemical staining, ovarian cysts were found to be negative for AMH while a moderate (+2) AMH positivity was observed in other follicles. Furthermore, in cats with ovarian remnant syndrome, severe (+3) AMH positivity was observed. As a result, it was determined that gonadectomy status can be accurately diagnosed by the AMH measurement. Ovarian remnant syndrome cannot be diagnosed accurately by AMH measurement. In addition, it was found that AMH did not seem to play a role in the pathogenesis of ovarian cysts in cats.

A 9-year-old spayed female Terrier dog was evaluated for lethargy, anorexia, polyuria, polydipsia and dysuria. The dog had been diagnosed with diabetes mellitus about 6 months ago and received subcutaneous doses of insulin. The patient showed insulin resistance and severe persistent fasting hyperglycemia in the face of high-dose insulin treatment, hyper-cholesterolemia and urinary tract infection. After a complete evaluation, the dog was diagnosed with a polycystic ovary and a cystic uterine remnant during an exploratory celiotomy. The polycystic ovary and cystic uterine remnant were removed and submitted for histopathological evaluation. Two weeks after surgery the blood glucose level and one month later serum cholesterol level were controlled, using a low level of insulin therapy (0.25 IU kg-1 Neutral Protamine Hagedorn (NPH) insulin, every 12 hr). In the present study, the clinical and laboratory results showed that ovarian remnant syndrome as an infrequently encountered condition in dog was related to some metabolic disorders such as insulin resistance, uncontrolled hyperglycemia, dyslipidemia and also recurrence urinary tract infection. To the best of authors\' knowledge, no reports of hypercholesterolemia in dog have been made before as a complication of ovarian remnant syndrome.

Serous cystadenomas are benign epithelial neoplasms of the ovary, and they typically have an average size of around 10 cm. Our patient is a 68-year-old female who originally presented with abdominal page. Our patient\'s prior surgical history includes a bilateral salpingo-oophorectomy. Computed tomography scans showed five abdominal and pelvic masses of significant size. Our patient elected to undergo exploratory laparotomy and mass excision, and all five masses were able to be removed successfully. Final pathology confirmed the diagnosis of serous cystadenomas consistent with ovarian origin despite our patient undergoing a previous bilateral salpingo-oophorectomy. Our patient presented with a rare syndrome known as ovarian remnant syndrome that is thought to be caused by difficult hysterectomy procedures and prior abdominal surgeries that can unknowingly leave ovarian remnants. Second, the patient was found to have 5 abdominal and pelvic masses, and most of the masses were a very large size.

BACKGROUND: Clinical signs of heat in bitches that have been previously spayed are often associated with the presence of ovarian remnant syndrome. The inclusion of exogenous estrogens as a differential diagnosis in this regard is often ignored and may lead to misinterpretation of the case.
METHODS: Herein, we report a case of exogenous estrogen exposure over several months to a 6.5-year-old spayed crossbred bitch, weighing 8.4 kg. The bitch presented in the clinic because of suspected ovarian remnant syndrome. Castration was performed within the first 6 months after birth. Important endocrine parameters measured at the first appointment were Anti-Müllerian hormone (< 0.01 ng/mL), progesterone (0.36 ng/mL), estradiol-17ß (20.7 pg/mL), and luteinizing hormone (< 0.1 ng/mL). After an extensive conversation with the owner, it was revealed that she was using an estrogen spray because of severe menopausal symptoms. After the owner stopped using this spray, the symptoms of the bitch disappeared.
CONCLUSIONS: Therefore, the uptake of estrogens should be a differential diagnosis for symptoms of the ovarian remnant syndrome. A detailed anamnesis is crucial to identify the source of estrogen in the environment of the affected bitch.

Endometrial adenocarcinomas present rare neoplasia of bitches. This case report describes mucinous endometrial adenocarcinoma in a bitch with concurrent pyometra for the first time. A mass on the uterine stump was removed during surgery of a 13-year-old bitch with clinically suspected pyometra. Histopathology revealed mucinous endometrial adenocarcinoma. The tumor was classified according to human classification, responding to women\'s type I (endometrioid carcinoma). Immunohistochemistry showed a positive expression of estrogen receptor α, progesterone receptor, p53, and p16 gene, while vimentin was not expressed.

Ovarian remnant syndrome (ORS), in which a portion of the ovary is retained following bilateral salpingo-oophorectomy (BSO), is uncommon but can negatively impact patient management. Evaluation should be performed in a patient who has clinical signs or symptoms suggestive of ORS, especially in a premenopausal woman with breast cancer who is treated with an aromatase inhibitor following bilateral salpingo-oophorectomy (BSO), or a woman with a pathogenic variant in BRCA1 or BRCA2 who undergoes BSO for ovarian cancer risk reduction.

The aim of this study was to determine the serum concentrations, ovarian presence and expression of anti-Müllerian hormone (AMH) in pre-pubertal, bitches with signs of ovarian remnant syndrome (ORS) and intact bitches. In addition, we aimed to verify the suitability of serum AMH concentrations for diagnostic purposes in sterilized bitches and/or in suspected cases of ORS in the field of veterinary medicine. For this purpose, 36 healthy female dogs divided into six groups: proestrus, oestrus, dioestrus, anoestrus, pre-pubertal and ORS. Serum AMH concentrations were determined by electrochemiluminescence immunoassay, and ovarian presence and distribution of AMH was confirmed by immunohistochemical and qPCR techniques. According to the results of qPCR, while the expression values of AMH were at the highest concentrations in the proestrus and oestrus, there was a statistically significant decrease in these values at the later stages of the cycle (p < 0.05). According to hormone analysis, the serum AMH values of the ORS group had decreased significantly compared with the proestrus and oestrus (p < 0.05). Although serum AMH levels of ORS group were increased compared with anestrus and pre-pubertal groups, this increase was statistically non-significant (p > 0.05). Immunohistochemically, AMH expression was first observed in the granulosa cells of primordial follicles in folliculogenesis. Expression values were the highest in the proestrous and oestrus groups, but values from bitches in later stages of the cycle were statistically significant decrease in comparison with these groups (p < 0.05). As a result, AMH concentration and expression were found to be higher in proestrus and oestrus than in other periods (p < 0.05). In addition, the measurable level of AMH concentration in bitches with ORS is an indication that it can be used in the diagnosis of ORS.