Fukuda Takeshi, Imai Kenji, Yamauchi Makoto, Kasai Mari, Ichimura Tomoyuki, Yasui Tomoyo, Sumi Toshiyuki
Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan.
Med Int (Lond). 2021 Oct 12;1(5):17. doi: 10.3892/mi.2021.17. eCollection 2021 Nov-Dec.
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.
巨大卵巢水肿是一种罕见的妇科疾病，由于卵巢间质内积聚水肿液，类似实性卵巢肿瘤。这种情况很容易被误诊为肿瘤，导致因切除整个患侧卵巢而过度治疗。本研究描述了一名28岁女性的病例，该患者患有巨大卵巢水肿伴卵巢旁囊肿扭转，接受了腹腔镜手术治疗。患者下腹部疼痛持续1周，前往当地诊所就诊。超声检查发现两个有分隔的卵巢肿块，随后患者被转诊至医院。经阴道超声检查显示左侧附件区有一个77.9mm的囊性病变和一个57.7mm的实性病变。磁共振成像检查显示左侧附件区有一个55mm的病变，周围有多个卵巢卵泡，在T1加权图像上呈等信号，在T2加权图像上呈高信号，还有一个75mm的囊性病变，无实性成分，在T1加权图像上呈低信号，在T2加权图像上呈高信号。右侧附件区和子宫未见异常。基于临床怀疑巨大卵巢水肿伴卵巢旁囊肿扭转，进行了腹腔镜手术。术中，在左侧附件区发现一个扭转360˚的卵巢旁囊肿。左侧附件扭转解除后，肿大的左侧卵巢大小恢复至几乎正常。最终诊断为巨大卵巢水肿，通过切除卵巢旁囊肿进行治疗，同时保留整个左侧卵巢。切除的卵巢旁囊肿病理检查显示为浆液性囊腺瘤。因此，本研究表明，当遇到具有多个周围卵巢卵泡的复杂实性卵巢肿块时，尤其是有反复腹痛病史的病例，应考虑巨大卵巢水肿的存在。
