Successful preoperative diagnosis of massive ovarian edema aided by comparative imaging study using magnetic resonance and ultrasound

doi:10.1016/S0301-2115(99)00185-2

European Journal of Obstetrics & Gynecology and Reproductive Biology

Volume 89, Issue 1, March 2000, Pages 97-99

https://doi.org/10.1016/S0301-2115(99)00185-2 Get rights and content

Abstract

Massive ovarian edema (MOE) is a rare disease. Therefore, preoperative diagnostic method of massive ovarian edema (MOE) has not been established. We have succeeded in making a preoperative diagnosis of MOE aided by ultrasonogram and magnetic resonance imaging (MRI) and the patient’s ovaries were preserved. Characteristics and proposed diagnostic imaging criteria for MOE are discussed.

Introduction

Massive ovarian edema (MOE) is a tumor-like enlargement of the ovary secondary to an accumulation of edema fluid within the ovarian stroma. To date, approximately 80 cases have been reported since the first report by Kalstone et al. [1] in 1969. Reported MOEs occurred during the ages of 6 to 33 years [2]. Because of their young ages, conservative therapy for presevation of ovarian function should be undertaken for MOE patients. However, it is considered to be very difficult to make a preoperative diagnosis of MOE precisely because diagnostic imaging criteria for MOE has not been established and because MOE is too rare to be diagnosed by most gynecologists and surgeons.

We have succeeded in making a preoperative diagnosis of MOE aided by ultrasonogram and magnetic resonance imaging (MRI). The diagnosis was confirmed by an exploratory biopsy, and the patient’s ovaries were preserved. Characteristics and proposed diagnostic imaging criteria for MOE are presented below.

Section snippets

Case report

In March, 1998, a 28-year-old nulligravidous woman visited the Gynecologic Outpatient Division of Osaka City University Hospital complaining of irregular menstruation and mild epigastric pain. Pelvic examination revealed a large pelvic non tender elastic-hard tumorous lesion, which we suspected to be a right adnexal tumor. Transvaginal ultrasonography demonstrated a 8.0×5.9 cm of right adnexal solid tumorous lesion and a thickened endometrial echo (16 mm thick). When she was examined previously

Discussion

The MOE is thought to be results of the partial or intermittent torsion of ovary, causing venous and lymphatic drainage [3]. In our case, torsion was not diagnosed before and at surgery. The etiology of MOE is still unclear.

MOE patients have often undergone oophorectomy without a previous precise preoperative histopathological diagnosis having made, because the ultrasonographic findings of MOE are very similar to those of solid ovarian tumors. Indeed, the ultrasonogram of our patient indicated

References (6)

C.U.E. Kalstone et al.
Massive edema of ovary stimulating fibroma
Obstet Gynecol
(1969)
A.F. Tiltman et al.
Massive edema of the ovary-case reports
S Afr Med J
(1984)
B. Slotky et al.
Massive edema of the ovary
Obstet Gynecol
(1982)

There are more references available in the full text version of this article.

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Massive ovarian edema: About seven case reports
2010, Imagerie de la Femme
L’œdème massif de l’ovaire (OMO) est une condition pseudotumorale bénigne et rare, survenant chez des femmes jeunes, pouvant mimer une tumeur ovarienne. Les auteurs rapportent sept cas d’OMO dans le but de rappeler les principales caractéristiques cliniques et anatomopathologiques de cette entité rare, souvent méconnue. L’âge des patientes allait de 17 à 50 ans, avec une moyenne de 25 ans. Les circonstances de découverte étaient dominées par des douleurs pelviennes. L’examen clinique trouvait une masse dans deux cas. À l’échographie, la tumeur était solido-kystique, dans trois cas, solide, dans trois cas, et kystique, dans un cas. Dans aucun cas, le diagnostic d’OMO n’a été évoqué en préopératoire. L’exploration chirurgicale trouvait une masse ovarienne droite, dans six cas, et gauche, dans un cas, une masse tordue, dans quatre cas, et associée à un kyste paratubaire homolatéral, dans un cas. Une ovariectomie était réalisée pour toutes ces patientes. La taille de l’ovaire variait de 4,5 à 15 cm, avec une moyenne de 8,35 cm. L’évolution était bonne sans récidive dans tous les cas, après un recul d’un à huit ans. La reconnaissance de l’OMO permet actuellement de privilégier le traitement conservateur chez ces patientes jeunes.
Massive ovarian oedema (MOO) is a benign and rare pseudotumoral condition occurring in young women, and can mimic ovarian tumour. The authors report seven cases of MOO with an aim of pointing out the principal clinical and anatomopathological characteristics of this rare entity, often ignored. The age of the patients varied from 17 to 50 years with an average of 25 years. The circumstances of discovery were dominated by pelvic pain. The clinical examination found a mass in two cases. At sonography, the tumour was solido-cystic in three cases, solid in three cases and cystic in a case. The diagnosis of MOO was not evoked preoperatively in any case. Surgical exploration found a right ovarian mass in six cases and left in one case; with torsion in four cases and homolateral cyst in a case. An ovariectomy was carried out for all patients. The size of the ovary varied from 4.5 to 15 cm with an average of 8.35 cm. The evolution was good in all cases after a follow-up varying from 1 to 8 years. The recognition of MOO allows a conservative treatment in these young patients.
Massive ovarian edema: A case report
2009, Journal de Gynecologie Obstetrique et Biologie de la Reproduction
L’œdème massif de l’ovaire (OMO) est une pseudotumeur rare. Une centaine de cas a été rapportée dans la littérature mondiale. Il est souvent confondu avec une tumeur maligne, conduisant à des ovariectomies chez des patientes jeunes, avec le risque de compromettre leur fertilité et leur fonction hormonale. Notre article, décrit un OMO découvert chez une patiente âgée de 29 ans, nulligeste qui se présente dans un tableau d’abdomen aigu évoquant une torsion d’annexe. L’échographie montre une hypertrophie de l’ovaire gauche mesurant 75 mm × 51 mm. Une résection partielle de l’ovaire a été réalisée par cœlioscopie et l’examen histologique a conclut à un OMO. L’annexe n’était pas tordue. Une jeune femme qui présente une hypertrophie ovarienne, avec des antécédents évocateurs, doit bénéficier d’une cœlioscopie, afin de réaliser des biopsies pour un examen extemporané et permettre une éventuelle détorsion et fixation de l’annexe. Seul l’examen histologique permet d’obtenir le diagnostic d’OMO et d’éviter ainsi une ovariectomie inutile.
Massive ovarian œdema (MOO) is a rare pseudotumour. It is often mistaken for a malignant tumour leading to radical treatment in young patients with the risk of compromising their fertility and hormonal function. Our article describes a case of MOO in a 29-year-old nulligravid patient, who presented with an acute abdomen evocative of an ovarian torsion. Ultrasonography revealed an enlargement of he left ovary measuring 75 mm × 51 mm; partial resection of the ovary was performed by laparoscopy and MOO was diagnosed on histological examination. Torsion of the pedicle was not observed. In the event of ovarian hypertrophy, in a young woman with a symptomatic previous history, an exploratory laparoscopy should be undertaken to obtain biopsies for extemporaneous examination and detorsion of the ovary with suspension. Histology is the only means of obtaining a definitive diagnosis, thus preventing unnecessary oophorectomy.
A Photo Album of Pediatric and Adolescent Gynecology
2009, Obstetrics and Gynecology Clinics of North America
Citation Excerpt :
The child was followed, and within 6 weeks an ultrasound revealed entirely normal ovaries bilaterally. A review the medical literature found several publications describing massive ovarian edema.36–44 Although some have postulated intermitted torsion with only lymphatic and venous (not arterial) obstruction, no definite cause or etiology is known.
Although dysmenorrhea, pelvic mass or pain, genital irritation, and amenorrhea are relatively common complaints, the astute clinician needs a broad differential diagnosis to avoid missing uncommon underlying etiologies such as Müllerian anomalies and cryptomenorrhea, ovarian teratomas and torsion, labial hypertrophy, vaginal foreign bodies, dermopathies, genital ulcers, imperforate hymen, and the absent vagina. This article discusses and illustrates uncommon pediatric and adolescent gynecologic conditions that present with these common complaints.
Hemorrhagic Corpus Luteum is Associated with Ovarian Edema
2006, Journal of Pediatric and Adolescent Gynecology
Citation Excerpt :
The ultrasound findings have been reported as a solid tumor-like mass or as a solid mass containing a cystic component. Recent reports using magnetic resonance imaging have demonstrated multiple ovarian follicles in the periphery of the ovary.2,5 Color Doppler may demonstrate either the presence or absence of blood flow; however, Doppler flow signals may persist when lymphatics and veins are obstructed but arterioles are still pumping blood into the ovary.
Most cases of ovarian edema are thought to result from intermittent ovarian/adnexal torsion. This study describes how, in some cases, this etiology was ruled out even though the edema was unexplained.
To evaluate the association between ovarian edema and hemorrhagic corpus luteum.
Department of gynecology in an urban medical center.
Five patients admitted to the department of gynecology with a sonographic diagnosis of ovarian edema of unexplained etiology.
Laparoscopy performed on three of five patients in whom a diagnosis of unexplained ovarian edema revealed hemorrhagic corpus luteum and ovarian edema. The remaining two patients displayed typical sonographic imaging of hemorrhagic corpus luteum and ovarian edema and they were managed expectantly. The affected ovaries were between 4.8 and 10 times larger than the unaffected ovaries. During follow-up, the affected ovaries returned to their normal size and appearance.
Hemorrhagic corpus luteum can cause ovarian edema without interrupting the blood flow supply. The outcome of expectant management without any surgical intervention is the gradual disappearance of the ovarian edema in these patients and the return of ovaries to a normal sonographic appearance.
Massive edema of the ovary: A case report and review of the pertinent literature
2005, Journal of Pediatric and Adolescent Gynecology
Citation Excerpt :
However, recently, there have been a few reports of specific sonographic findings associated with massive edema of the ovary including multiple ovarian follicles situated at the periphery of the enlarged ovary. Some have managed to successfully diagnose this entity preoperatively, using both ultrasound and MRI.5 The CT scan that was done in our case and in another one demonstrated a complex mass.4
Massive edema of the ovary is a rare entity affecting mainly young women. It is often misdiagnosed for a malignancy, posing the young patient at risk for over-treatment with resultant loss of hormonal function and fertility.
A 13-year-old premenarchal girl presented with a large solid pelvic mass after recurrent episodes of self-limited abdominal pain. With a working diagnosis of malignant ovarian tumor, an exploratory laparotomy was done in which a twisted ovarian mass was found and excised completely. Pathological examination of the mass revealed massive edema of the ovary with hemorrhagic necrosis.
After extensive review of the literature, it seems most cases were over-treated, as was ours. This entity should be suspected in women at the fertile age range with solid enlargement of the ovary and definite treatment should be undertaken only after confirmed pathological diagnosis. Conservative treatment is feasible and should be the rule in these cases, where fertility preservation is mandatory.
Massive ovarian edema revealing gastric carcinoma: A case report
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Tumor-like enlargement of the ovaries due to accumulation of edema fluid within the ovarian stroma is referred to as massive ovarian edema (MOE). The pathogenesis of MOE is thought to be intermittent torsion of the ovary on its pedicle, causing partial obstruction of venous and lymphatic drainage. The diagnosis of MOE is based on imaging techniques. The case described here due to ovarian lymphatic vessel obstruction by carcinoma cells shows that metastatic disease may be a cause of MOE.

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Case ReportSuccessful preoperative diagnosis of massive ovarian edema aided by comparative imaging study using magnetic resonance and ultrasound

Abstract

Introduction

Section snippets

Case report

Discussion

Massive edema of ovary stimulating fibroma

Obstet Gynecol

Massive edema of the ovary-case reports

S Afr Med J

Massive edema of the ovary

Obstet Gynecol

Case Report
Successful preoperative diagnosis of massive ovarian edema aided by comparative imaging study using magnetic resonance and ultrasound