Extragonadal mature cystic teratoma at anterior uterine wall coexisting with a pararectal corpus luteum cyst and agenesis of left fallopian tube and left ovary

ObjectiveMature cystic teratomas are mostly confined to the ovaries, but several authors have reported findings of extragonadal occurrences along the migration pathway of primordial germ cells. Extragonadal mature cystic teratomas are extremely rare; their occurrences and pathogenesis are unknown.Case reportWe report the case of a 26-year-old woman who was admitted for scheduled laparoscopic right ovarian tumor excision. An anterior uterine wall mature cystic teratoma and a pararectal corpus luteum cyst were found intraoperatively with coexistence of left adnexal agenesis.ConclusionThe existence of an extragonadal mature cystic teratoma over the anterior uterine serosal layer may be caused by autoamputation and reimplantation as a result of ovarian torsion or displacement of primordial germ cells along their migration path. The existence of an ovarian mass over the sigmoid colon combined with left adnexal agenesis may be the result of ovarian torsion with remnant tissue attached to the sigmoid colon.     

A giant serous cystadenoma developing in an accessory ovary

BACKGROUND: Accessory ovaries are rare anomalies and cysts arising from accessory ovaries are extremely rare. Their reported incidence is 1/29,000-1/700,000. Establishing the diagnosis preoperatively is difficult. Radiologic methods are usually inadequate in recognizing the origin of these tumors. Thus, they are usually confused with other intraabdominal tumors. CASE: A 22-year-old nulliparous girl presented with abdominal pain and tumoral growth for 1.5 years. Abdominal ultrasound and computed tomography revealed a 33 x 26 x 15 cm cystic mass filling the abdominal cavity. The preoperative diagnosis was a mesenteric cyst. Diagnostic laparotomy revealed a giant cystic mass arising in an accessory ovary. The left tuba and fimbrias were adhered to the cyst. The tumor was totally removed and fimbrioplasty performed. CONCLUSION: In spite of being rare entities, paraovarian anomalies should be considered in the differential diagnosis of intraabdominal tumors, especially when the origin is not identified by radiologic means. CASE: A 22-year-old single, nulliparious female was admitted to our hospital with abdominal pain, nausea and a growing abdominal swelling since 1.5 years. A tumoral mass was palpated on physical examination. Abdominal ultrasound and computed tomography revealed a 33 x 26 x 15 cm cystic mass filling the abdominal cavity. The origin of the tumor could not be detected. Operation revealed a giant cystic mass arising from an accessory ovary. Histopathologic diagnosis was serous cystadenoma. CONCLUSION: Ovarian or accessory ovarian pathologies must be considered in the differential diagnosis of intraabdominal tumors, especially in young female population.     

Primary carcinoid tumor of the ovary: a case report

Primary ovarian carcinoid tumors are rare. A 47-year-old woman presented to our emergency room with lower abdominal pain. Physical examination, pelvic ultrasonographic evaluation and abdominal computed tomography revealed a 10-cm mass in the right ovary containing cystic and solid components, as well as calcifications typical of a dermoid cyst. At laparotomy, a smooth-surfaced, firm and mobile right adnexal mass with solid and cystic portions was detected. Initially, right salpingo-oophorectomy was performed. Frozen-section examination identified the mass as a sex cord stromal tumor containing a mature cystic teratoma. Based on this finding, total abdominal hysterectomy, left salpingo-oophorectomy, omentectomy, appendectomy were performed, and the pelvic-paraaortic lymph nodes were also removed. All histological findings in the right ovary were similar to the features of cystic teratoma and trabecular carcinoid tumor. Examination of the resected lymphatic, omental, and appendiceal tissue indicated no tumoral invasion. The diagnosis was ovarian carcinoid Stage IA. Serum testing post-surgery revealed that the levels of cancer antigen (CA) 19-9 and CA125 were 18.5 u/ml and 10.5 u/ml, respectively. The patient was discharged on postoperative day 5. The report describes the clinicopathologic and immunohistochemical features of a primary ovarian carcinoid that contained a mature cystic teratoma.     

An unusual case of trapped ovary in a peritoneal pouch causing extrinsic ureteric compression associated with endometriosis

A 35-year-old woman presented with long-standing right loin to groin pain and a right ovarian cyst. The ovarian cyst was considered physiological at the initial gynaecological evaluation. A subsequent transvaginal scan demonstrated a cystic immobile ovary adherent to the pelvic side wall. Laparoscopy revealed endometriosis and a peritoneal defect holding the cystic ovary against the ureter and causing compression with secondary loin pain. The trapped ovary was removed and the patient was cured of the long-standing ureteric colic. This is the first reported case of extrinsic ureteric compression caused by trapped ovary in a peritoneal pouch associated with endometriosis. The diagnosis was suspected preoperatively from the transvaginal scan findings demonstrating a cystic immobile ovary adherent to the pelvic side wall. This case demonstrates that in women with unresolved ureteric compression where adnexal cyst is found, the investigator should look for features that suggest entrapment to the pelvic side wall.     

Ruptured Hemorrhagic Corpus Luteum Cyst in an Undescended Ovary: A Rare Cause of Acute Abdomen

BackgroundUndescended ovaries are typically detected during infertility evaluations and are frequently associated with uterine malformations. Ruptured hemorrhagic corpus luteum cyst of an undescended ovary is an unusual cause of acute abdomen in an adolescent.CaseA 15-year-old girl presented with right lower quadrant pain, nausea, and vomiting, and transabdominal sonography and magnetic resonance imaging of the pelvis showed a 10 cm × 5 cm sized cystic mass at the level of the pelvic brim, anterior to the psoas muscle suggestive of a retroperitoneal hemorrhagic cyst. At surgery, the uterus and left adnexa appeared normal, but the right ovary was not visible within the pelvic cavity, and the right pelvic retroperitoneum was distended. After opening the retroperitoneum and aspirating blood clots, the undescended ovary with a ruptured cyst was visualized within the retroperitoneum. Right ovarian wedge resection was performed and the right ovary was repositioned in the pelvic cavity.Summary and ConclusionRupture of a corpus luteum cyst in an undescended ovary should be included in the differential diagnosis of acute abdomen in adolescents.     

IUD-associated ovarian actinomycosis causing bowel obstruction

This case report presents an unusual case of primary IUD-associated ovarian actinomycosis, which spread to the sigmoid causing intestinal obstruction. A 43-year-old gravida 3, para 2, had her 1st IUD from 1978-80 (Gyne-T) and her 2nd IUD from 1980 to October 1983 (Multiload). Right lower abdominal pain led to hospitalization in May 1983. A tender nodular mass was palpated in the left pelvic area. Laboratory results confirmed the presence of inflammation. Rapid improvement followed a course of laxatives and cephalosporin antibiotics, and the patient was discharged with the diagnosis of acute sigmoid diverticulitis. 2 months later, a double contrast examination of the large intestine was done and showed severe narrowing of the sigmoid colon over a distance of 12 cm and occasional sharp recesses. Colonoscopy showed a spastic stricture of the sigmoid with massive edema of the otherwise intact mucosa at 18 cm. Computer tomography of the abdomen showed a large, focally cystic infiltrative mass in the pelvis with congestion and displacement of both ureters as well as bilateral hydronephrosis, predominantly on the right side. The descending colon was congested. The patient was readmitted to hospital with the tentative diagnosis of ovarian cancer when her general condition deteriorated. She complained again of abdominal pain in the right lower quadrant and alternating diarrhea and constipation. Pyrexia and the hematological findings suggested sepsis. The pelvis contained a predominantly leftsided nodular mass and a brown fetid discharge was coming through the cervix. The IUD was removed and treatment with ampicillin and clindamycin was started with rapid improvement in the patient's condition. Obstruction with extreme distention of the colon required emergency laparotomy. An inflammatory mass was found in the pelvis consisting of a right-sided ovarian tumor, bilateral hydrosalpinges, and a tightly encased sigmoid colon. The dilated caecum had a large necrotic area in its wall which necessitated caecostomy and double-current sigmoidostomy after subtotal hysterectomy and bilateral salpingo-oophorectomy. The patient made a good recovery. As recently as the 1950s, primary pelvic actinomycosis was a rarity. In the last 4 years alone, 20% of all reported cases of actinomycosis involved the female genital tract. The percentage of cases found among IUD users has been continuously increasing and in the last 2 years all published cases were IUD users. The presence of actinomyces in vaginal smears always is indicative of the presence of a foreign body, most commonly and IUD.     

Ectopic ovary: a case of autoamputated ovary with mature cystic teratoma into the cul-de-sac

An ovary with a mature cystic teratoma which was autoamputated into the cul-de-sac and confirmed by laparoscopy is described. A 24-year-old woman with a history of chronic pelvic pain for 5 years presented with left abdominal pain. Magnetic resonance imaging revealed a left ovarian mass of 5 cm in diameter. The pain was relieved spontaneously after a few weeks. Laparoscopy was performed 5 months later. The mass was identified in the cul-de-sac partly enveloped in the omentum without any ligamentous or direct connection with the pelvic organs. There was no left ovary in its proper anatomical location. Histopathologic study revealed a mature cystic teratoma with viable ovarian tissue. These findings suggested autoamputation of the ovary either by inflammation or torsion, which is one of the mechanisms for the formation of an ectopic ovary.     

Acute urinary retention caused by a large peritoneal inclusion cyst: a case report

BACKGROUND: Pelvic masses have been known to cause bladder symptoms and compression. This is the first documented case of a large peritoneal inclusion cyst causing acute urinary retention from bladder outlet obstruction. CASE: A 36-year-old woman, gravida 2, para 2, presented to the gynecology clinic with an indwelling Foley catheter that was placed at an outside hospital secondary to acute urinary retention. Computed tomography, performed several days earlier for complaints of progressively worsening lower abdominal and pelvic pain, revealed a 10-cm, complex, cystic mass within the pelvis between the rectum and sigmoid colon, with anterior displacement of the bladder. The patient's past surgical history included a total abdominal hysterectomy as well as separate exploratory laparotomy for resection of a 20-cm peritoneal inclusion cyst and a prophylactic bilateral salpingo-oophorectomy. Due to the acute urinary retention and worsening pain, the decision was made to proceed with laparoscopic removal and drainage of the mass, which turned out to be consistent with a recurrent peritoneal inclusion cyst. Symptom relief was immediate. CONCLUSION: A large, recurrent, peritoneal inclusion cyst obstructed the bladder neck and presented as acute urinary retention. Laparoscopy relieved the symptoms.     

Benign ovarian dermoid cyst complicated with rectal fistula formation: an unusual case

Background  Fistulation in benign cystic teratomas has not been commonly reported in the literature. We present a case of a benign ovarian dermoid cyst complicated with a recto-ovarian fistula. Case report  A 30-year-old nonpregnant woman admitted to the gynecological outpatient clinic because of lower abdominal pain and purulent diarrhea. Gynecological examination and ultrasonography revealed a 10-cm heterogeneous cystic mass in the left ovary. Abdominopelvic CT scan revealed a left ovarian mass (10 × 9 cm) thought to be a dermoid cyst, which was seen to penetrate the proximal part of the rectum. Left adnexectomy and low anterior rectum resection were performed. The pathological evaluation suggested benign ovarian dermoid tumor penetrating the rectum wall. Conclusion  Fistula formation by a dermoid ovarian cyst is not always related to malignant transformation of the cyst. In addition to factors such as torsion, infection, trauma, and chronic pressure during labor, spontaneous rupture of the dermoid cyst resulting in leakage of fluid could be the cause of fistula formation.     

Isolated fallopian tube torsion: a rare diagnosis in a perimenopausal patient with adnexal mass and raised Ca 19-9

Isolated torsion of the fallopian tube in perimenopausal women is very rare. A patient who presented with an adnexal mass with possible ovarian torsion and with a raised Ca 19-9 titer is reported. A 48-year-old perimenopausal woman had acute lower right abdominal pain accompanied by nausea and vomiting. Ultrasonographic studies revealed a multiloculated cystic mass in the right adnexum, and Ca 19-9 was raised. The symptoms worsened, and emergency laparoscopy and salpingoophorectomy were performed. Histology revealed isolated fallopian tube torsion with a benign ovarian cyst. Torsion of the fallopian tube, although rare, should always be considered as part of the differential diagnosis of any symptomatic pelvic mass, even in a perimenopausal woman. Characteristic ultrasonographic and CT findings have been reported, an early diagnosis can be made, and an endoscopic, less radical procedure will be the treatment of choice resulting in shorter hospitalization, increased patient satisfaction, and more cost benefits.     

Rare case of an ovarian monodermal teratoma with functional stroma and extensive ovarian decidualization in a 74-year-old woman

We present the clinicopathological findings of a rare case of a monodermal teratoma of the right ovary with functional ovarian stroma and extensive decidualization in a 74-year-old woman. The patient presented with vaginal bleeding. Ultrasound scan revealed a pelvic mass measuring 9.5 cm in the lower right abdomen. A right oophorectomy was performed. The tumor was cystic and multilocular filled with colloid material. Histological examination revealed follicles of thyroid type, and stromal clusters of fusiform or polygonal cells were found in the stroma. An extensive decidual reaction was observed. Morphological and immunohistochemical examination of the tumor revealed cystic struma ovarii with functional ovarian stroma and ectopic decidua. Total abdominal hysterectomy with oophorectomy was performed. A benign endometrial polyp, proliferative endometrium, two fibroids, and an ovarian cyst were observed.     

Torsion of a functional ovarian cyst in a premenopausal patient receiving tamoxifen.

We report a case of torsion of an ovarian follicular cyst that developed during treatment with tamoxifen for breast cancer. A 40-year-old Japanese woman was admitted complaining of acute lower abdominal pain. Eight months earlier, she had undergone a partial mastectomy and local irradiation for ductal carcinoma of her left breast, estrogen receptor-positive stage I (T(1a) N(1b) M(0)). The administration of tamoxifen, 20 mg/day, and doxifluridine, 600 mg/day, were started immediately postoperatively. Pelvic examination after admission revealed the left ovarian cyst and enlarged uterus. Transvaginal ultrasonography and computed tomography revealed a multilocular cystic mass in the pelvic cavity. The pathological diagnosis of the tumor after total hysterectomy and bilateral salpingo-oophorectomy was a typical follicular cyst with torsion and uterine leiomyoma. This ovarian cyst was believed to have developed during tamoxifen administration.     

Eosinophilic perifolliculitis presenting as a painful cystic ovarian mass in a woman with fibromyalgia: a case report

BACKGROUND: Autoimmune oophoritis is characterized by an ovarian lymphocytic infiltrate and is a rare finding in women with premature ovarian failure. Eosinophilic perifolliculitis is a possible variant of autoimmune oophoritis, of which the pathogenesis and natural history are largely unknown. CASE: A 45-year-old woman, gravida 2, para 2, status post total abdominal hysterectomy, presented to her internist complaining of cyclic, throbbing, right lower quadrant pain. Her past medical history was significant forfibromyalgia. Pelvic ultrasound demonstrated a 2.3-cm, physiologic-appearing right ovarian cyst. Follow-up ultrasound showed a 2.2-cm, complex cyst on the right ovary that increased in size to 4.2 x 3.2 x 3.5 cm on repeat ultrasound 12 weeks later. Exploratory laparotomy and bilateral salpingo-oophorectomy were performed. Pathologic evaluation of the ovaries revealed a 3 x 2 cm regressing corpus luteal cyst with numerous eosinophils, lymphocytes, macrophages and plasma cells, infiltrating the cyst zoall. Serum antiovarian antibodies were positive. CONCLUSION: The patient's pathologic findings are consistent with the rare entity of eosinophilic perifolliculitis. The patient's history offibromyalgia is of particular interest given that both of these diseases may have an autoimmune etiology. Eosinophilic perifolliculitis should be considered in the differential diagnosis of premenopausal and perimenopausal women with pelvic pain and persistent cystic ovarian enlargement.     

Quiste ovárico fetal. Reporte de caso

Fetal ovarian cysts are the third cause of intra-abdominal cyst after renal and gastrointestinal cyst. The presence of these cysts can be suspected on ultrasound examination when a mass with a regular cystic structure is found in the inferior lateral region of the abdomen of a female fetus without urinary or intestinal tract anomalies. We report the case of an 18-year-old primigravida in whom ultrasound examination revealed an apparently soft tumor in the inferior, right region of the abdomen, corresponding to a fetal ovarian cyst clearly identified and separated from the bladder. A female newborn was delivered by cesarean section and was discharged on the third day of life without complications. At 3 months, spontaneous disappearance of the cyst was observed.     

Ovarian abscess caused by nontyphoidal Salmonella in a woman with systemic lupus erythematosus: a case report

BACKGROUND: Nontyphoidal Salmonella infection in a patient with systemic lupus erythematosus (SLE) is rare. CASE: A 24-year-old woman with a 9-year history of SLE, on corticosteroids, presented with severe abdominal pain, fever, vomiting and diarrhea for 1 day. Transabdominal sonography and abdominal computed tomography showed a right-sided well-defined pelvic mass. Laboratory study revealed leukocytosis. An emergency laparotomy revealed a right ovarian mass with purulent exudate. A right partial oophorectomy was performed. Pathologic examination revealed a hemorrhagic ovarian cyst with focal abscess. Culture of the ovarian mass grew Salmonella typhimurium. Postoperatively the patient did well and was discharged 5 days later. CONCLUSION: Patients with SLE are at risk of Salmonella infection. Gynecologists should be aware of the possibility of an ovarian abscess caused by Salmonella in such patients presenting with a pelvic mass and fever.     

Intra-retroperitoneal duplication cyst.

Duplication cyst occupying the retro- and intra-peritoneal space is a rare condition. We describe a case of duplication cyst in a 13-year-old girl who presented with abdominal pain, vomiting, and a lower abdominal mass. Plain abdominal X-ray films revealed local ileus over the lower abdomen. Ultrasonography revealed 2 double-layered cystic masses over the lower abdomen with a suspicious communicating tract. Mild hydropelvis of the right kidney was also noted. Abdominal computed tomography revealed 2 cystic lesions. One was located at the pelvic cavity just above the urinary bladder and the other was in the left retroperitoneal space. Laparotomy revealed a dumbbell-shaped intra-retroperitoneal duplication cyst with a small communicating tract. The cyst was excised without disturbing bowel continuity and the vascular supply. The patient was doing well at 1-year follow-up.     

Torsion of the fallopian tube in an adolescent female: a case report

BACKGROUND: Torsion of the fallopian tube is an infrequent but significant cause of acute lower abdominal pain in adolescent females that is difficult to recognize preoperatively, although prompt diagnosis and timely surgical treatment are vital to salvage the oviduct. CASE REPORT: A 17-yr-old virgin presented with sudden and severe right-sided lower abdominal pain with guarding and tenderness, fever, nausea, and vomiting at mid-cycle. Ultrasound scan showed a right ovarian cyst measuring 3 cm in diameter and a normal appendix. There was no leucocytosis. Presumptive diagnosis was a cystic ovarian follicle with ovulatory pain. Her condition improved but did not resolve with supportive treatment. At laparotomy, the right fallopian tube was twisted completely, distended with blood, and necrotic, with a small fimbrial cyst. The left tube, ovaries, appendix, and uterus were normal. Right salpingectomy was performed. Histologic examination revealed diffuse hemorrhagic infarction of the tube and a cyst of the hydatid of Morgagni. She remains well at follow-up. CONCLUSION: Unless a high index of suspicion is maintained for torsion of the fallopian tube in adolescent females, this disorder may not be detected until after tubal destruction.     

Benign mucinous cystadenoma with stromal luteinization during pregnancy: a hormonally responsive tumor and a rare cause of fetal intrauterine growth restriction

A 32-year-old woman, gravida 4, para 3, had a benign right ovarian mucinous cystadenoma. It was diagnosed 1 month before conception, measured 9 x 7cm, and reached 33 x 24 x 20cm at 38 weeks gestation. Cesarean delivery of a 2250 g normal female infant took place, and the removal of a 6300 g right ovarian cystic mass was also performed. Microscopic and immunohistochemical studies of the cyst wall revealed stromal luteinization and a strong reaction with antiserum to testosterone, estrogen and progesterone.     

Pelvic actinomycosis: a rare entity presenting as tubo-ovarian abscess

A 24-year-old woman having two children using an intrauterine contraceptive device was admitted with lower abdominal pain and fever. On clinical and radiographic examination revealed a 7 × 6 cm multi-loculated cystic mass in the lower abdomen. The differential diagnosis included twisted ovarian cyst, ectopic pregnancy, tubercular tubo-ovarian (TO) mass red degeneration fibroid, diverticular diseases, emphysematous cystitis, pelvic malignancy, and mesenteric cyst. On histologic examination, an actinomycotic TO abscess was found with sulfur granules.     

Neonatal ovarian lymphangioma

Ovarian cysts are primarily of follicular origin and ovarian lymphangioma is an extremely rare lesion. We report a case of prenatal diagnosis of unilateral ovarian cyst in which pathologic examination revealed an ovarian lymphangioma. Ovarian cystic lymphangioma should be included in the differential diagnosis of an ovarian cyst mass in neonate.