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Simultaneous serous cyst adenoma and ovarian pregnancy in an infertile woman.

Ebrahimi M, Akbari Asbagh F - Int J Fertil Steril (2014)

Bottom Line: She had a concurrent benign serous cyst adenoma in the same ovary.The ovary was preserved.Removal of gestational tissue and preservation of the involved ovary are the best options for management of ovarian pregnancy in young patient.

View Article: PubMed Central - PubMed

ABSTRACT
Ovarian pregnancy is a rare form of extra uterine pregnancy. Serous cyst adenoma is a benign variant of epithelial cell tumors of ovary. The coexistence of a cyst adenoma with an ovarian pregnancy in the same ovary is extremely rare. Some studies suggested that infertility or ovulation-inducing drugs can be involved in increased risk of ovarian tumors and ovarian pregnancies. A 28-year-old infertile woman presented with a ruptured ovarian pregnancy following ovulation induction with metformin. She had a concurrent benign serous cyst adenoma in the same ovary. Resection of both ovarian pregnancy and tumoral mass were performed. The ovary was preserved. Removal of gestational tissue and preservation of the involved ovary are the best options for management of ovarian pregnancy in young patient. Although there is an association between infertility/ovulation inducting medications and ovarian gestation, their connections with serous cyst adenoma are undetermined.

No MeSH data available.


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Photomicrograph identified serous cyst adenoma(H&E); ×400.
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Figure 3: Photomicrograph identified serous cyst adenoma(H&E); ×400.

Mentions: In January 2013, a 28-year-old primigravidawoman with sever lower abdominal pain presented to the emergency room of our hospital (Tehran Women General Hospital, Tehran,Iran). She suffered from vaginal spotting and lower abdominal pain for 5-6 consecutive days.She revealed a history of primary infertilitywith 3 years duration. Because of clinical andparaclinical manifestations of polycystic ovarian syndrome, metformin (1500 mg/day) hasbeen prescribed for induction of ovulation since8 months ago. After starting this medication,she developed regular menstruation pattern.Her last menstrual period was 25 days prior toadmission date. She had no previous history ofpelvic inflammatory disease, abdominal surgery, abortion, or use of any intrauterine contraceptive device (IUCD). Her hysterosalpingography (HSG) demonstrated an otherwisenormal image without uteroovarian fistula. Ongeneral examination, she was pale. Abdominalexamination showed abdominal distention andguarding. On vaginal examination, the uteruswas normal in size and the cervix was tenderin motion. There was a tenderous mass in deeppalpation of right fornix. Clinical investigationshowed hematocrit level of 25.2%, and betahuman chorionic gonadotropin (β-hCG) titer of3569 m IU/mL. Vaginal ultrasonography demonstrated empty uterus with 6 mm endometrialthickness, free fluid in the peritoneal cavity,and a right sided heterogeneous adnexal mass(52×61 mm) beside the uterus. These findingswere suggestive of ruptured ectopic gestation.Based on the above findings, the patient underwent emergency laparotomy in which demonstrated an enlarged and bluish right ovary witha 4 cm hemorrhagic and ruptured ovarian massand a leaking hematoma on its surface. A 3×3cm multicystic structure was identified in theother side of right ovary and was presumed tobe a tumorous lesion. The uterus, both tubesand the left ovary appeared to be normal in appearance. The right tube had normal fimbriatedend without dilation. There was no obviousevidence of endometriosis, metastatic lesions,pelvic inflammation, or adhesion. We found1500 mL bloody fluid in abdominal cavity.The diagnosis of ovarian pregnancy was made.Therefore, surgical resection of hemorrhagicmass with conservation of the right ovary wasdone carefully. Because of bad looking appearance of the concurrent cyst in the right ovary,ovarian cystectomy and endometrial curettingwere performed, respectively. The final pathologic analysis revealed vascularized chorionicvilli and trophoblastic cells within ovarian paranchymal tissue (Figes1, 2). Histopathologicalstudy demonstrated that the excised cyst wasa benign serous cyst adenoma (Fig 3). The endometrial sample showed decidual change, butno gestational tissue. The post-operative coursewas uneventful. On monitoring of β-hCG lev-els, they were undetectable (<5 m IU/ mL) onthe 21stpostoperative day. The patient menstru-ated 37 days after the surgical operation.


Simultaneous serous cyst adenoma and ovarian pregnancy in an infertile woman.

Ebrahimi M, Akbari Asbagh F - Int J Fertil Steril (2014)

Photomicrograph identified serous cyst adenoma(H&E); ×400.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3973168&req=5

Figure 3: Photomicrograph identified serous cyst adenoma(H&E); ×400.
Mentions: In January 2013, a 28-year-old primigravidawoman with sever lower abdominal pain presented to the emergency room of our hospital (Tehran Women General Hospital, Tehran,Iran). She suffered from vaginal spotting and lower abdominal pain for 5-6 consecutive days.She revealed a history of primary infertilitywith 3 years duration. Because of clinical andparaclinical manifestations of polycystic ovarian syndrome, metformin (1500 mg/day) hasbeen prescribed for induction of ovulation since8 months ago. After starting this medication,she developed regular menstruation pattern.Her last menstrual period was 25 days prior toadmission date. She had no previous history ofpelvic inflammatory disease, abdominal surgery, abortion, or use of any intrauterine contraceptive device (IUCD). Her hysterosalpingography (HSG) demonstrated an otherwisenormal image without uteroovarian fistula. Ongeneral examination, she was pale. Abdominalexamination showed abdominal distention andguarding. On vaginal examination, the uteruswas normal in size and the cervix was tenderin motion. There was a tenderous mass in deeppalpation of right fornix. Clinical investigationshowed hematocrit level of 25.2%, and betahuman chorionic gonadotropin (β-hCG) titer of3569 m IU/mL. Vaginal ultrasonography demonstrated empty uterus with 6 mm endometrialthickness, free fluid in the peritoneal cavity,and a right sided heterogeneous adnexal mass(52×61 mm) beside the uterus. These findingswere suggestive of ruptured ectopic gestation.Based on the above findings, the patient underwent emergency laparotomy in which demonstrated an enlarged and bluish right ovary witha 4 cm hemorrhagic and ruptured ovarian massand a leaking hematoma on its surface. A 3×3cm multicystic structure was identified in theother side of right ovary and was presumed tobe a tumorous lesion. The uterus, both tubesand the left ovary appeared to be normal in appearance. The right tube had normal fimbriatedend without dilation. There was no obviousevidence of endometriosis, metastatic lesions,pelvic inflammation, or adhesion. We found1500 mL bloody fluid in abdominal cavity.The diagnosis of ovarian pregnancy was made.Therefore, surgical resection of hemorrhagicmass with conservation of the right ovary wasdone carefully. Because of bad looking appearance of the concurrent cyst in the right ovary,ovarian cystectomy and endometrial curettingwere performed, respectively. The final pathologic analysis revealed vascularized chorionicvilli and trophoblastic cells within ovarian paranchymal tissue (Figes1, 2). Histopathologicalstudy demonstrated that the excised cyst wasa benign serous cyst adenoma (Fig 3). The endometrial sample showed decidual change, butno gestational tissue. The post-operative coursewas uneventful. On monitoring of β-hCG lev-els, they were undetectable (<5 m IU/ mL) onthe 21stpostoperative day. The patient menstru-ated 37 days after the surgical operation.

Bottom Line: She had a concurrent benign serous cyst adenoma in the same ovary.The ovary was preserved.Removal of gestational tissue and preservation of the involved ovary are the best options for management of ovarian pregnancy in young patient.

View Article: PubMed Central - PubMed

ABSTRACT
Ovarian pregnancy is a rare form of extra uterine pregnancy. Serous cyst adenoma is a benign variant of epithelial cell tumors of ovary. The coexistence of a cyst adenoma with an ovarian pregnancy in the same ovary is extremely rare. Some studies suggested that infertility or ovulation-inducing drugs can be involved in increased risk of ovarian tumors and ovarian pregnancies. A 28-year-old infertile woman presented with a ruptured ovarian pregnancy following ovulation induction with metformin. She had a concurrent benign serous cyst adenoma in the same ovary. Resection of both ovarian pregnancy and tumoral mass were performed. The ovary was preserved. Removal of gestational tissue and preservation of the involved ovary are the best options for management of ovarian pregnancy in young patient. Although there is an association between infertility/ovulation inducting medications and ovarian gestation, their connections with serous cyst adenoma are undetermined.

No MeSH data available.


Related in: MedlinePlus