Basic anatomical knowledge should be improved during residency period with clinical practice. Especially pelvic surgeons; obstetricians, gynecologists, gynecological oncologists, urologists and general surgeons must have an advanced level practise of retroperitoneal anatomy to gain surgical skills. Retroperitoneal topographic anatomy, retroperitoneal vasculature, ureteric dissection and pelvic avascular spaces are the precise points during pelvic surgery.

Aim: To evaluate the clinico-pathologic features, treatment options, prognostic factors, and survival outcomes of malignant struma ovarii based on a systematic literature review in association with our case study. Methods: A systematic review of the medical literature was performed to identify articles about malignant struma ovarii from January 1983 until July 2020. We evaluated 178 cases. Results: The 5-year progression-free survival (PFS) and overall survival (OS) of the entire cohort was 72.5% and 91%, respectively. In univariate analysis, younger age (<43 years), whole strumal cyst diameter >95 mm, presence of a histologic type other than papillary classic-type thyroid carcinoma within the tumor and lymphovascular space invasion were related to poor PFS. Patients who received radioactive iodine ablation (RIA) before the treatment failure had significantly higher PFS than those who did not receive RIA (94.9% vs. 64.8%, p = 0.041, respectively). In univariate analysis, PFS was significantly higher in patients who underwent gynecologic surgery followed by thyroidectomy and RIA compared with those who had surgical treatment only (94.5% vs. 64.3%, p = 0.05, respectively). However, this result could not be identified as an independent prognostic factor in multivariate analysis (p = 0.207). Younger age and absence of capsular involvement were related to significantly increased OS. Histologic type was the only independent prognostic factor for PFS (hazard ratio: 3.30, 95% confidence interval: 1.122-9.748; p = 0.030) Conclusion: The most common histologic subtype was the papillary classic type. The presence of a histologic type other than the classic papillary thyroid carcinoma within the tumor was an independent adverse prognostic factor.

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Mucinous cysts are benign, are cystic lesions that can be encountered in vulvar region and filled with mucin. The majority of these cysts are small and asymptomatic. However, occasionally they may reach unusually large sizes, and may become pedunculated. Here, we report a case of vulvar mucinous cyst which was unusually large and pedunculated treated via complete excision.