Ovarian hyperstimulation,hyperprolactinaemia and LH gonadotroph adenoma

This report considers a highly exceptional case of ovarian hyperstimulation syndrome due to a gonadotroph adenoma secreting LH in a 31-year-old patient who presented with amenorrhoea and galactorrhoea syndrome and a complex bilateral ovarian mass. Magnetic resonance imaging revealed a pituitary adenoma, and laboratory tests corroborated the hyperprolactinaemia without other hormonal pituitary abnormalities. Ovarian hyperstimulation syndrome due to a gonadotroph adenoma with normal gonadotrophins is extremely rare. Most of the described cases are caused by FSH adenomas. Due to the originality of the case, it was considered useful for understanding the management of this entity, and it is proposed that LH adenomas should also be considered in the differential diagnosis of patients with spontaneous ovarian hyperstimulation syndrome.     

Exacerbation of ovarian hyperstimulation by leuprolide reveals a gonadotroph adenoma

OBJECTIVE: To report a case of a gonadotroph adenoma diagnosed after a dramatic increase in estradiol level and ovarian hyperstimulation in response to a gonadotropin-releasing hormone agonist. DESIGN: Case report. SETTING: Outpatient practice and university hospital. PATIENT(S): A 35-year-old woman who presented with infertility, amenorrhea, and an elevated basal estradiol concentration. INTERVENTION(S): Ultrasonography, laparoscopy, endocrinologic assays, magnetic resonance imaging, transsphenoidal surgery, and immunocytochemical staining. MAIN OUTCOME MEASURE(S): Ultrasonography and laparoscopy demonstrated bilaterally enlarged ovaries containing multiple preovulatory follicles, similar in appearance in those women undergoing controlled ovarian hyperstimulation with exogenous FSH. The serum estradiol level was moderately elevated, the FSH level was within the normal range, and LH was suppressed. Administration of leuprolide acetate resulted in very elevated estradiol concentrations and even larger ovarian cysts. Magnetic resonance imaging demonstrated a sellar mass. Examination of the tissue excised by transsphenoidal excision of the mass showed a pituitary adenoma that stained strongly for FSH. RESULT(S): Regular menses resumed soon after excision of the gonadotroph adenoma, followed by a spontaneous pregnancy. CONCLUSIONS: Gonadotroph adenoma should be suspected in a reproductive age woman with oligomenorrhea or amenorrhea, infertility, multiple preovulatory follicles, and a persistently elevated serum estradiol concentration. Exacerbation of the ovarian hyperstimulation in response to a gonadotropin-releasing hormone agonist in this setting also strongly suggests a gonadotroph adenoma but can be avoided by recognizing the presenting features of this condition.     

Ovarian remnant syndrome: a case report and review of the literature

The ovarian remnant syndrome in an unusual complication of bilateral oophorectomy, usually presenting with pelvic mass and pain. A case of the syndrome is described in a 35-year-old woman with a history of abdominal hysterectomy and bilateral oophorectomy. We suggest that ovarian remnant syndrome should be considered in the differential diagnosis of chronic pelvic pain after recorded oophorectomy.     

Ovarian and vesical actinomycosis: a case report and literature review

We present a patient with a tubo-ovarian abscess pathologically confirmed to be actinomycosis in a 44-year-old woman with an intrauterine device (IUD). An ultrasound showed that the IUD was imposed on an apparently degenerated myoma. A pelvic MRI was performed to differentiate the uterine findings from a sarcoma. The MRI showed a heterogeneous pelvic mass and a bladder mass suggesting chronic inflammation caused by an organism such as actinomycosis. An exploratory laparotomy was performed, which revealed a right tubo-ovarian mass with abscess formation as well as a bladder mass. A subtotal hysterectomy, right salpingoophorectomy, partial cystectomy, and appendectomy were performed in addition to drainage of the abscess. Histopathological examination revealed a tubo-ovarian abscess and a bladder mass with colonies of actinomycoses.     

Ovarian metastasis of a primary renal cell carcinoma: case report and review of literature

Ovarian metastases from renal cell carcinoma (RCC) are very rare, with only 23 cases reported in the literature. We report a case of 54-year-old women who developed bilateral ovarian metastasis 39 months after diagnosis of clear cell carcinoma. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was carried out. Subsequently she was treated with sunitinib and her disease stabilized. She is still alive four years after diagnosis of the renal primary, and disease has stabilized on sunitinib. We conclude that, although rare, the possibility of metastatic RCC should be considered in the differential diagnosis of clear cell tumors of the ovary. Due to therapeutic and prognostic implications, it is very important to differentiate if the tumor is a primary ovarian tumor or a metastasis from a renal cell carcinoma. Early diagnosis of this rare metastatic tumor results in prompt treatment and prolonged patient survival.     

Ovarian mixed germ cell tumor with predominance of polyembryoma: a case report with literature review.

An ovarian mixed germ cell tumor in a 34-year-old woman contained a predominant component of polyembryoma as well as foci of choriocarcinoma, yolk sac tumor, and immature teratoma. No previous cases of identical composition have been found in the literature.     

Ovarian hyperstimulation syndrome. A case history and review

For the past two decades, significant advances have been made in the treatment of anovulation. The use of therapeutic agents for induction of ovulation, however, has given rise to several adverse reactions, the most important and serious of such complications being the ovarian hyperstimulation syndrome (OHSS), which can be fatal. It is characterized by gross ovarian enlargement, ascites, pleural effusion, hemoconcentration and thromboembolic disorder, which are potentially lethal conditions. The main pathogenic mechanism is considered to be increased capillary permeability, especially of the ovarian vessels, causing acute body fluid shift from the intravascular compartment to the peritoneal and pleural cavities. An experimental model of OHSS suggests that prostaglandins mediate this increased capillary permeability and transudation. Management is based on the concept of the pathogenic mechanism and includes maintenance of intravascular volume by plasma volume expanders, reduction of capillary permeability and prevention of thromboembolic complications. Surgical intervention is indicated only in cases of ovarian torsion or rupture and should be as conservative as possible.     

Ovarian metastasis from primary renal cell carcinoma: report of a case and review of literature

BACKGROUND: Ovarian metastasis from renal cell adenocarcinoma is quite rare. They are often mistaken for primary clear cell tumours of the ovary because of histological similarity and propensity to appear years before or after the renal primary is detected. CASE: A case of ovarian metastasis from renal cell adenocarcinoma is reported. Patient developed bilateral ovarian metastasis 7 years after diagnosis of renal primary. She is alive 2 years after removal of ovarian tumours, with evidence of metastases to pelvic and paraaortic lymph nodes. Review of literature with analysis of 11 such reported cases in English literature is included. CONCLUSION: Although rare, possibility of metastasis from renal cell adenocarcinoma should be considered as a differential diagnosis in cases of clear cell ovarian tumours. Imaging studies are warranted in such cases to rule out renal tumour. It is important to differentiate between the two because of therapeutic and prognostic implications. Careful histological and histochemical analysis may help to differentiate between the two.     

Ovarian ectopic pregnancy after ICSI-ET: a case report and literature review

INTRODUCTION: Primary ovarian ectopic pregnancy (OEP) is one of the the rarest form of extratubal pregnancies and its pathophysciological mechanism is not fully understood. On the other hand, OEP after intra-cytoplasmic sperm injection with embryo transfer (ICSI-ET) is even more rare and just a few cases have been reported in literature. MATERIALS AND METHODS: A case with OEP after ICSI-ET presented and managed by conservative laparoscopic approach. Also, literature associated with OEP after ICSI-ET have been summarized. Pubmed search using "Ovarian ectopic pregnancy" and "ICSI-ET" keywords revealed four similar case in the literature. CONCLUSION: Underlying pathophysiological mechanism of OEP after ICSI-ET is unclear. Indeed, gynecologists should be aware about the development of the OEP after ICSI-ET. Early diagnosis will give the opportunity to use conservative managements for these infertile patients.     

Ovarian carcinoma metastatic to breast: a case report and review of the literature

Breast metastasis from ovarian carcinoma is a rare event, with only 26 cases being previously reported in the English literature. The twenty-seventh such case is presented herein, and the literature on this topic is reviewed. Metastases to the breast from the ovary signal widespread metastases and generally herald a rapid deterioration and death. Although rare, it is important that metastatic cancer to the breast be differentiated from primary breast carcinoma as both the treatment and prognosis differ significantly.     

Ovary hyperstimulation syndrome accompanying molar pregnancy: case report and review of the literature

Purpose

To describe a naturally conceived woman with ovary hyperstimulation syndrome (OHSS) accompanying molar pregnancy and review the literature on this condition.

Methods

We report a 31-year-old 2 parous naturally conceived woman with OHSS accompanying partial molar pregnancy. Dilatation and evacuation (D&E) were performed at 10 weeks of gestation. The signs and symptoms of OHSS were the severest on day 8 after D&E, when hCG had already decreased. This case is reported in detail. We also review the literature.

Results

A literature search yielded seven cases of this condition. Any type of molar pregnancy, i.e., complete, partial, or invasive, can accompany OHSS. The initial manifestation of OHSS occurred at a median of the 12th week of gestation (range 7–16), which may be later compared with OHSS caused by ovulation induction. In all cases, OHSS aggravated after D&E.

Conclusions

We must be aware that OHSS can occur during molar pregnancy, and can be exacerbated after D&E.     

Ovarian Sertoli-Leydig cell tumor with coexisting vaginal angiomyxoma: case report and review of the literature

An extremely rare case of a postmenopausal patient with an ovarian Sertoli-Leydig cell tumour and a coexistent vaginal angiomyxoma is reported. A 71-year-old patient was admitted complaining of abdominal distension. A thorough diagnostic evaluation revealed a large tumour of the right ovary, and an oval-shaped greyish-white polypoid vaginal lesion. Total hysterectomy with bilateral salpingooophorectomy and lymph node sampling was performed, followed by excision of the vaginal lesion. Histological examination showed a Sertoli-Leydig cell tumour of the right ovary, and a vaginal angiomyxoma. Twenty-six months after the operation the patient is well with no signs of recurrence. To the best of our knowledge, no case of coexistence of an ovarian Sertoli-Leydig cell tumour with a myxoma has been previously reported.     

Ovarian embedding of a transmigrated intrauterine device: a case report and literature review

Aim  To report an unusual location of a transmigrated IUD which become embedded in the right ovary causing chronic pelvic pain and dyspareunia. Case  A 22-year-old woman who had an IUD (Copper T), inserted 7 years ago presented with complaint of lower abdominal pain. Pelvic ultrasonographic examination revealed ovarian embedding of the IUD. Laparoscopic IUD removal was successfully performed. Discussion  De novo lower abdominal pain in a woman with an IUD in situ should alert the clinician to the possibility of total or partial transmigration of the device into the pelvis or abdomen. Ovarian penetration is very rare and this is the second case of IUD transmigration into the ovary reported in the medical literature.     

Ovarian carcinoma complicated by sigmoid colon fistula formation: a case report and review of the literature

Formation of a fistula to a digestive organ is an extremely rare phenomenon in cases of ovarian carcinoma. We report a case of ovarian clear-cell carcinoma complicated by formation of a sigmoid colon fistula, and review the related literature. A 61-year-old woman, who had undergone hysterectomy and right salpingo-oophorectomy due to myoma and an ovarian tumor, developed bloody bowel discharge and abdominal distention. Computed tomography revealed a huge pelvic tumor with a thickened wall and internal gas. As the patient also had severe anemia and peritonitis, emergency laparotomy was performed, and intraoperatively it was noted that the tumor was tightly attached to the sigmoid colon, and contained bloody pus. Left salpingo-oophorectomy was performed and pathological examination of the specimen revealed fistula formation between the ovarian tumor and the sigmoid colon. The tumor was diagnosed as left ovarian clear-cell carcinoma, but no diverticulum or direct tumor invasion was evident around the fistula. The patient was given chemotherapy with paclitaxel and carboplatin, and she is now doing well after 9 months with no evidence of tumor recurrence. Although fistulation to the digestive tract is very rare in cases of ovarian cancer, it must be diagnosed and treated promptly because severe inflammation can make it potentially life-threatening.     

Ovarian cancer associated with carcinomatous meningitis: a case report and review of the literature

We report the case of a 62-year-old patient who developed a carcinomatous meningitis while on second-line chemotherapy for ovarian cancer. Cytologic analyses confirmed that carcinomatous cells of ovarian origin were present in cerebrospinal fluid. Carcinomatous meningitis is a very rare event in the natural history of ovarian carcinoma. We discuss the specificity of our case in the light of the literature. In addition, we present some relevant radiologic and pathologic documents illustrating this rare entity.     

Ovarian ginandroblastoma as a transcesarean incidental finding. A case report and literature review

The gynandroblastoma is an extremely rare sexual cord stromal tumor, which contains both male and female elements, characterized by Sertoli or Leydig cells and granulose cells. We describe an ovarian gynandroblastoma in a 28 year-old female patient, found accidentally during a cesarean section operation. There is only one reported case in world literature occurring in a pregnant woman. The principal component we found was adult granulose cells, with a microfollicular pattern, and the presence of luteinized cells in some areas; besides we found the presence of well differentiated Sertoli cells elements, in addition to Leydig cells groups, in over 10% of the tumoral surface. Inmunohistochemical stainings were performed: citokeratin, which resulted positive in Sertoli cells and negative in granulose cells; and inhibin, which was positive in both components showing its mixed origin.     

Ovarian abscess following cesarean section. A case report and review of literature

Ovarian abscess is presented although such a finding is an unusual gynecologic complication. It is difficult to distinguish from a tubo-ovarian abscess. Its presence may be suspected in a patients after surgery, carrying IUD, having intraperitoneal infection and pregnancy. If an abscess is present, a tubo-ovarian abscess is much more common, except in pregnancy. For the last 110 years only 120 cases of ovarian abscesses have been reported in the Literature.