Tien Chin-Tzu, Cheng Chiu-Hsuan, Hong Mun-Kun
Department of Obstetrics and Gynecology, Minimally Invasive Gynecology Surgery Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
Department of Anatomical Pathology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
Medicine (Baltimore). 2025 Jan 24;104(4):e41282. doi: 10.1097/MD.0000000000041282.
Ovarian tumor torsion is a critical gynecological emergency, predominantly affecting women of reproductive age, with benign teratomas being the most common culprits. In contrast, malignant ovarian tumors, such as mucinous cystadenocarcinoma, infrequently present with torsion due to their invasive and angiogenic characteristics. The occurrence of torsion in malignant tumors complicates diagnosis and management, particularly when associated with complications like congestion, infarction, and internal bleeding. This report details a rare case of primary ovarian mucinous cystadenocarcinoma presenting with acute torsion and significant internal bleeding. Our study highlights the diagnostic challenges and the urgent need for clear treatment guidelines, addressing an important gap in the existing literature regarding the management of torsion malignant ovarian tumors. By documenting this case, we aim to contribute to the understanding of this rare condition and provide insights that may help clinicians in similar scenarios.
A 51-year-old postmenopausal woman presented with acute abnormal pain. Transvaginal ultrasound examination showed an 8-cm heterogeneous right ovary mass without ovarian blood flow on color Doppler.
Laparoscopy revealed torsion and rupture of the right ovarian tumor with 900 mL hemoperitoneum. The patient underwent right salpingo-oophorectomy complicated by continuous oozing and hematoma formation in the infundibular ligament. Unexpectedly, histopathology revealed a mucinous cystadenocarcinoma of the right ovary, pT1c2.
The patient underwent staging surgery and prophylactic hyperthermic intraperitoneal chemotherapy.
After 4 years of follow-up, no tumor recurrence or metastasis was found.
Currently, there are no effective preoperative diagnostic and treatment guidelines for ruptured malignant ovarian tumors with torsion. The possibility of malignancy should be considered, and frozen section biopsy should be considered during surgery. Full detorsion before tumor resection to avoid incomplete pedicle coagulation and bleeding. Specimen removal by in-bag morcellation in minimally invasive surgery to prevent complications related to residual fragments of the specimen or dissemination of an occult malignancy.
卵巢肿瘤扭转是一种严重的妇科急症，主要影响育龄女性，其中良性畸胎瘤是最常见的病因。相比之下，恶性卵巢肿瘤，如黏液性囊腺癌，由于其侵袭性和血管生成特性，很少出现扭转。恶性肿瘤发生扭转会使诊断和治疗复杂化，尤其是当伴有充血、梗死和内出血等并发症时。本报告详细介绍了一例罕见的原发性卵巢黏液性囊腺癌伴急性扭转和大量内出血的病例。我们的研究突出了诊断挑战以及对明确治疗指南的迫切需求，填补了现有文献中关于恶性卵巢肿瘤扭转管理的重要空白。通过记录该病例，我们旨在增进对这种罕见病症的理解，并提供有助于临床医生处理类似情况的见解。
一名51岁绝经后女性出现急性异常疼痛。经阴道超声检查显示右侧卵巢有一个8厘米的异质性肿块，彩色多普勒显示卵巢无血流信号。
腹腔镜检查发现右侧卵巢肿瘤扭转并破裂，腹腔积血900毫升。患者接受了右侧输卵管卵巢切除术，术中漏斗韧带持续渗血并形成血肿。出乎意料的是，组织病理学检查显示右侧卵巢黏液性囊腺癌，pT1c2。
患者接受了分期手术和预防性热灌注腹腔化疗。
经过4年随访，未发现肿瘤复发或转移。
目前，对于破裂的伴有扭转的恶性卵巢肿瘤，尚无有效的术前诊断和治疗指南。应考虑恶性的可能性，手术中应考虑进行冰冻切片活检。在肿瘤切除前完全扭转，以避免蒂部凝血不完全和出血。在微创手术中采用袋内粉碎术取出标本，以防止与标本残留碎片或隐匿性恶性肿瘤播散相关的并发症。
