Matteo Giudice

Background: Fetal lymphangioma is a rare congenital malformation, generally isolated and clinically asymptomatic, except when it invades adjacent tissues, causing compression-related symptoms. Objectives: To present a rare case of a giant fetal abdominopelvic lymphangioma and to perform, to our knowledge, the first scoping review of the literature specifically addressing prenatal diagnosis, intrauterine monitoring and postnatal management of this condition. Methods: The PubMed, Scopus and Embase databases were searched up to September 2025. No limitations on the country were made. Results: We present the case of a 38-year-old primigravida with gestational diabetes, hypothyroidism and severe obesity referred to our institute for a second opinion after prenatal detection of a large multiloculated cystic abdominal mass in the fetus, extending to the pelvis, without vascularization. Follow-up imaging, including a fetal magnetic resonance imaging (MRI), confirmed the suspicion of a giant lymphatic malformation with progressive fetal ascites and associated symptomatic polyhydramnios requiring amnioreduction. A male infant was delivered via emergency cesarean section at 34 + 3 weeks and admitted to neonatal intensive care unit (NICU) with respiratory distress. Due to progressive clinical worsening and persistent fluid accumulation, an abdominal drain was placed, followed by debulking surgery at four months, which confirmed the diagnosis of lymphangioma. Gradual clinical improvement enabled the patient's transfer to the Nutritional Rehabilitation Unit and subsequent discharge. Regarding the scoping review, 20 case reports fulfilled the inclusion criteria. Patients were analyzed concerning the prenatal ultrasound diagnosis of a fetal abdominal lymphangioma, pregnancy outcomes, intrauterine and postnatal treatment of the mass. Conclusion: Clinical presentation and outcomes of fetal abdominal and abdominopelvic lymphangiomas are highly heterogeneous and strongly influenced by lesion extent and intra-abdominal involvement. Our case, characterized by diffuse intestinal and mesenteric disease, highlights the limitations of curative surgical strategies and underscores the need for early recognition of patients who may require prolonged supportive management rather than a complete excision. The scoping review suggests that while focal lesions are often amenable to surgery with favorable outcomes, diffuse forms often require a multidisciplinary, staged approach, with realistic prognostic counseling and long-term follow-up.

Objective: To systematically analyze and synthesize the evidence from the literature, we compared outcomes of the PPOS + LE protocol versus standard PPOS in patients undergoing IVF. Materials and Methods: We systematically searched the MEDLINE, Scopus, EMBASE, and Science Citation Index databases to identify relevant studies. The clinical questions were developed according to the PICO framework. Quality assessment of the included studies was performed using the Newcastle–Ottawa Scale. Primary outcomes were ovarian stimulation outcomes (oocyte retrieved and mature oocytes). Secondary outcomes were hormonal levels during COS and pregnancy outcome. Results: Five retrospective studies compared oocyte yields between the PPOS and PPOS + LE protocols across diverse populations. While some authors reported significantly higher numbers of retrieved and mature oocytes with letrozole co-administration in a normal infertile population and in POSEIDON group 4, others found no benefit in the PCOS or POSEIDON 3 groups, indicating variable efficacy depending on patient characteristics. Conclusions: Incorporating letrozole counteracts the intense pituitary suppression typically associated with standard PPOS, increasing LH levels and the number of retrieved and mature oocytes in normal and poor responders, but not in PCOS women. Retrospective data do not allow for definitive conclusions to be drawn. Further studies are needed to confirm these results.

Background and Objectives: Uterine sarcomas represents only 3% of all the female genital tract ones. The tumoral stage is the most significant prognostic factor. The role of the bilateral salpingo-oophorectomy (BSO) in the surgical management of FIGO stage IA and IB appears still controversial. This review aims to investigate the impact of bilateral adnexectomy in the treatment of uterine sarcoma. Methods: Following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we systematically searched the PubMed, Scopus, Cochrane, Medline, and Medscape databases in February 2022. We applied no language or geographical restrictions, but we considered only English studies. We included the studies containing data about Recurrence Rate (RR), Disease-free Survival (DFS), and Overall Survival (OS). We used comparative studies for meta-analysis. Results: Seventeen studies fulfilled the inclusion criteria; 2 retrospective observational studies, and 15 retrospective comparative studies, And 14 out of the 15 comparative studies were enrolled in meta-analysis. A total of 3743 patients were analyzed concerning the use of adnexectomy with hysterectomy in patients with uterine sarcoma and compared with those who did not. Meta-analysis highlighted a non-significant worsening of the OS in the BSO group compared to the OP group and showed that adnexectomy does not improve the DFS (BSO OR 1.23 (95% CI 0.81–1.85) p = 0.34; I² = 24% p = 0.22). Conclusions: Most studies selected for our review showed that adnexectomy does not significantly affect the RR, OS, and PFS in treating FIGO stage I uterine sarcomas. Therefore, even if there is a unanimous consensus about bilateral adnexectomy in menopausal patients, preservation of ovarian tissue may be considered in premenopausal women. Nonetheless, there are not enough cases in the literature to recommend this procedure.