Massive ovarian edema with paraovarian cyst torsion treated with laparoscopic surgery: A case report

Fukuda,Takeshi; Imai,Kenji; Yamauchi,Makoto; Kasai,Mari; Ichimura,Tomoyuki; Yasui,Tomoyo; Sumi,Toshiyuki

doi:10.3892/mi.2021.17

Massive ovarian edema with paraovarian cyst torsion treated with laparoscopic surgery: A case report

Authors:
- Takeshi Fukuda
- Kenji Imai
- Makoto Yamauchi
- Mari Kasai
- Tomoyuki Ichimura
- Tomoyo Yasui
- Toshiyuki Sumi
View Affiliations

Affiliations: Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545‑8585, Japan
Published online on: October 12, 2021 https://doi.org/10.3892/mi.2021.17
Article Number: 17
Copyright: © Fukuda et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Massive ovarian edema is a rare gynecological entity resembling a solid ovarian tumor due to the accumulation of edematous fluid within the ovarian stroma. This condition can be easily mistaken for a neoplasm, resulting in overtreatment by removal of the whole affected ovary. The present study describes the case of a 28‑year‑old woman who experienced massive ovarian edema with paraovarian cyst torsion treated with laparoscopic surgery. The patient experienced lower abdominal pain lasting for 1 week and visited a local clinic. The ultrasonographic examination revealed two loculated ovarian masses and the patient was then referred to the hospital. Transvaginal ultrasonographic examination revealed a 77.9‑mm cystic lesion and a 57.7‑mm solid lesion in the left adnexa. A magnetic resonance imaging examination revealed a 55‑mm lesion with multiple peripheral ovarian follicles, which was isointense on T1‑weighted images and hyperintense on T2‑weighted images, and a 75‑mm cystic lesion, without a solid component, which was hypointense on T1‑weighted images and hyperintense on T2‑weighted images in the left adnexa. There were no observed abnormalities of the right adnexa or uterus. Laparoscopic surgery was performed, based on a clinical suspicion of massive ovarian edema with paraovarian cyst torsion. Intraoperatively, a paraovarian cyst was identified in the left adnexa that was twisted 360˚. The size of the enlarged left ovary was reduced to almost normal following the detorsion of the left adnexa. The final diagnosis was that of a massive ovarian edema, which was treated by resecting the paraovarian cyst, while preserving the whole left ovary. The pathological examination of the resected paraovarian cyst revealed a serous cystadenoma. Therefore, the present study suggests that the presence of massive ovarian edema should be taken into consideration when encountering a complex solid ovarian mass with multiple peripheral ovarian follicles, particularly in cases with a history of recurrent abdominal pain.

View Figures

View References

1	Kalstone CE, Jaffe RB and Abell MR: Massive edema of the ovary simulating fibroma. Obstet Gynecol. 34:564–571. 1969.PubMed/NCBI
2	Heiss KF, Zwiren GT and Winn K: Massive ovarian edema in the pediatric patient: A rare solid tumor. J Pediatr Surg. 29:1392–1394. 1994.PubMed/NCBI View Article : Google Scholar
3	Shirk JO, Copas PR and Kattine AA: Massive ovarian edema in a menopausal woman. A case report. J Reprod Med. 41:359–362. 1996.PubMed/NCBI
4	Thomas RL, Carr BR, Ziadie MS and Wilson EE: Bilateral mucinous cystadenomas and massive edema of the ovaries in a virilized adolescent girl. Obstet Gynecol. 120:473–476. 2012.PubMed/NCBI View Article : Google Scholar
5	Peters FH, Brunell C and Benjamin E: Massive ovarian edema and contralateral mature cystic teratoma: Asymptomatic presentation in a premenarchal female. J Pediatr Adolesc Gynecol. 22:e118–e120. 2009.PubMed/NCBI View Article : Google Scholar
6	Khalbuss WE and Dipasquale B: Massive ovarian edema associated with ovarian serous cystadenoma: A case report and review of the literature. Int J Gynecol Cancer. 16 (Suppl 1):S326–S330. 2006.PubMed/NCBI View Article : Google Scholar
7	Harke AB, Sigamani K, Thukkaram C, Ramamurthy M and Sekar M: Massive ovarian oedema-a case report. J Clin Diagn Res. 10:Ed03–Ed04. 2016.
8	Alagoz T, Buller RE, Berman M, Anderson B, Manetta A and DiSaia P: What is a normal CA125 level? Gynecol Oncol. 53:93–97. 1994.PubMed/NCBI View Article : Google Scholar
9	Luo G, Jin K, Guo M, Cheng H, Liu Z, Xiao Z, Lu Y, Long J, Liu L, Xu J, et al: Patients with normal-range CA19-9 levels represent a distinct subgroup of pancreatic cancer patients. Oncol Lett. 13:881–886. 2017.PubMed/NCBI View Article : Google Scholar
10	Flamini E, Mercatali L, Nanni O, Calistri D, Nunziatini R, Zoli W, Rosetti P, Gardini N, Lattuneddu A, Verdecchia GM and Amadori D: Free DNA and carcinoembryonic antigen serum levels: An important combination for diagnosis of colorectal cancer. Clin Cancer Res. 12:6985–6988. 2006.PubMed/NCBI View Article : Google Scholar
11	Hashiguchi Y, Kasai M, Fukuda T, Ichimura T, Yasui T and Sumi T: Serum sialyl-Tn (STN) as a tumor marker in patients with endometrial cancer. Pathol Oncol Res. 22:501–504. 2016.PubMed/NCBI View Article : Google Scholar
12	Yagihashi Y, Kato K, Nagahama K, Yamamoto M and Kanamaru H: A case of laparoscopic excision of a huge retroperitoneal cystic lymphangioma. Case Rep Urol. 2011(712520)2011.PubMed/NCBI View Article : Google Scholar
13	Geist RR, Rabinowitz R, Zuckerman B, Shen O, Reinus C, Beller U and Lara-Torre E: Massive edema of the ovary: A case report and review of the pertinent literature. J Pediatr Adolesc Gynecol. 18:281–284. 2005.PubMed/NCBI View Article : Google Scholar
14	Natarajan A, Wales JK, Marven SS and Wright NP: Precocious puberty secondary to massive ovarian oedema in a 6-month-old girl. Eur J Endocrinol. 150:119–123. 2004.PubMed/NCBI View Article : Google Scholar
15	Nogales FF, Martin-Sances L, Mendoza-Garcia E, Salamanca A, González-Nuñez MA and Pardo Mindán FJ: Massive ovarian oedema. Histopathology. 28:229–234. 1996.PubMed/NCBI View Article : Google Scholar
16	Bychkov V and Kijek M: Massive ovarian edema. Four cases and some pathogenetic considerations. Acta Obstet Gynecol Scand. 66:397–399. 1987.PubMed/NCBI View Article : Google Scholar
17	Chervenak FA, Castadot MJ, Wiederman J and Sedlis A: Massive ovarian edema: Review of world literature and report of two cases. Obstet Gynecol Surv. 35:677–684. 1980.PubMed/NCBI View Article : Google Scholar
18	Eden JA: Massive ovarian oedema. Br J Obstet Gynaecol. 101:456–458. 1994.PubMed/NCBI View Article : Google Scholar
19	Gehrig PA, Fowler WC Jr and Lininger RA: Ovarian capillary hemangioma presenting as an adnexal mass with massive ascites and elevated CA-125. Gynecol Oncol. 76:130–132. 2000.PubMed/NCBI View Article : Google Scholar
20	Lakhey M, Upreti D, Kulshrestha R and Rani S: Massive ovarian edema with contralateral mature cystic teratoma-a case report of an uncommon combination. Indian J Pathol Microbiol. 46:219–221. 2003.PubMed/NCBI
21	Sakaki M, Hirokawa M, Horiguchi H, Wakatsuki S, Sano T and Izumi Y: Ovarian fibrothecoma with massive edema. J Med Invest. 47:148–151. 2000.PubMed/NCBI
22	Guvenal T, Cetin A and Tasyurt A: Unilateral massive ovarian edema in a woman with polycystic ovaries. Eur J Obstet Gynecol Reprod Biol. 99:129–130. 2001.PubMed/NCBI View Article : Google Scholar
23	Spurrell EL, Yeo YC, Rollason TP and Judson IR: A case of ovarian fibromatosis and massive ovarian oedema associated with intra-abdominal fibromatosis, sclerosing peritonitis and Meig's syndrome. Sarcoma. 8:113–121. 2004.PubMed/NCBI View Article : Google Scholar
24	Kawaguchi R, Ueda S, Tsuji Y, Haruta S, Kanayama S, Yamada Y, Ooi H and Kobayashi H: Massive ovarian edema in pregnancy after ovulation induction using clomiphene citrate. Arch Gynecol Obstet. 277:375–378. 2008.PubMed/NCBI View Article : Google Scholar
25	Krasević M, Haller H, Rupcić S and Behrem S: Massive edema of the ovary: A report of two cases due to lymphatic permeation by metastatic carcinoma from the uterine cervix. Gynecol Oncol. 93:564–567. 2004.PubMed/NCBI View Article : Google Scholar
26	Bazot M, Detchev R, Cortez A, Uzan S and Darai E: Massive ovarian edema revealing gastric carcinoma: A case report. Gynecol Oncol. 91:648–650. 2003.PubMed/NCBI View Article : Google Scholar
27	Wong SY: Bilateral massive ovarian oedema-report of a case due to lymphangiitis carcinomatosa. Virchows Arch A Pathol Anat Histopathol. 414:355–358. 1989.PubMed/NCBI View Article : Google Scholar
28	Umesaki N, Tanaka T, Miyama M and Kawamura N: Sonographic characteristics of massive ovarian edema. Ultrasound Obstet Gynecol. 16:479–481. 2000.PubMed/NCBI View Article : Google Scholar
29	Umesaki N, Tanaka T, Miyama M, Nishimura S, Kawamura N and Ogita S: Successful preoperative diagnosis of massive ovarian edema aided by comparative imaging study using magnetic resonance and ultrasound. Eur J Obstet Gynecol Reprod Biol. 89:97–99. 2000.PubMed/NCBI View Article : Google Scholar
30	Hall BP, Printz DA and Roth J: Massive ovarian edema: Ultrasound and MR characteristics. J Comput Assist Tomogr. 17:477–479. 1993.PubMed/NCBI View Article : Google Scholar
31	Young RH and Scully RE: Fibromatosis and massive edema of the ovary, possibly related entities: A report of 14 cases of fibromatosis and 11 cases of massive edema. Int J Gynecol Pathol. 3:153–178. 1984.PubMed/NCBI View Article : Google Scholar