Jeon Hyeji, Ryu Aeli, Seo Hui-Gyeong, Jang Si-Hyong
Department of Obstetrics and Gynecology, Department of Pathology, Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
Medicine (Baltimore). 2017 Oct;96(40):e8207. doi: 10.1097/MD.0000000000008207.
Adnexal torsion is 1 of the most common emergency gynecological disease. It is more often diagnosed in reproductive age, but rarely in postmenopausal women. The clinical symptoms of adnexal torsion are nonspecific in postmenopausal women. Epithelial ovarian tumors are common in adults, and the risk of malignancy increases with age, especially after menopause. So, it is difficult to diagnose adnexal torsion precisely compared with reproductive women, and most cases of adnexal torsion with postmenopausal women are diagnosed as a malignancy preoperatively. We report a case of ovarian torsion with mixed epithelial tumor misdiagnosed as a malignancy in postmenopausal woman.
A 65-year-old woman presented lower left abdominal pain, and there was slight abdominal distension, but no tenderness or rebound tenderness on abdominal palpation.
Radiologic assessments showed a huge multiseptated cystic mass with solid portion in the left ovary, and malignancy was suspected. The test for serum tumor markers revealed normal levels of cancer antigen 125 (CA-125).
The patient underwent a laparotomy and there was torsion of the left ovary. We conducted frozen biopsy of left ovary for confirming malignancy before performing staging surgery.
The result of a frozen section biopsy confirmed a borderline Brenner tumor associated with a benign mucinous tumor. Subsequently, total hysterectomy and right salpingo-oophorectomy were performed. The operation was completed without addition procedures LESSONS:: Ovarian torsion is benign in most cases and malignancy is rare. Although very rare, ovarian torsion can occur in postmenopausal women, and it should be taken into consideration that the possibility of malignancy is low in postmenopausal women with normal CA-125 levels. Instead of performing staging surgery, it appears to be appropriate to carry out surgery based on the result of intraoperative frozen section biopsy so that we were able to avoid unnecessary surgical procedures.
附件扭转是最常见的妇科急症之一。其在育龄期女性中更常被诊断出来，而在绝经后女性中则较为罕见。绝经后女性附件扭转的临床症状不具有特异性。上皮性卵巢肿瘤在成年人中较为常见，且恶性风险随年龄增长而增加，尤其是在绝经后。因此，与育龄期女性相比，绝经后女性的附件扭转更难准确诊断，且大多数绝经后女性附件扭转病例在术前被诊断为恶性肿瘤。我们报告一例绝经后女性卵巢扭转合并混合性上皮肿瘤被误诊为恶性肿瘤的病例。
一名65岁女性出现左下腹痛，腹部有轻微腹胀，但腹部触诊无压痛或反跳痛。
影像学评估显示左卵巢有一个巨大的多房囊性肿块且伴有实性部分，怀疑为恶性肿瘤。血清肿瘤标志物检测显示癌抗原125（CA - 125）水平正常。
患者接受了剖腹手术，发现左卵巢扭转。在进行分期手术前，我们对左卵巢进行了冰冻活检以确认是否为恶性肿瘤。
冰冻切片活检结果证实为交界性布伦纳瘤合并良性黏液性肿瘤。随后进行了全子宫切除术和右侧输卵管卵巢切除术。手术顺利完成且未进行额外操作
大多数情况下卵巢扭转是良性的，恶性情况罕见。虽然绝经后女性发生卵巢扭转非常罕见，但对于CA - 125水平正常的绝经后女性，应考虑恶性可能性较低。基于术中冰冻切片活检结果进行手术似乎更为合适，这样我们能够避免不必要的手术操作。
