Late aortic lymphocele and residual ovary syndrome after gynecological surgery

Maria Pastore,Pierluigi Benedetti Panici,Claudia Marchetti,Francesca Esposito,Natalina Manci,Marialetizia Iuliano,Lucia Manganaro

doi:10.1186/1477-7819-5-146

Maria Pastore, Pierluigi Benedetti Panici + Show 5 more

Open Access

https://doi.org/10.1186/1477-7819-5-146

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Abstract

BackgroundGynecological surgery, as radical hysterectomy or pelvic and aortic lymphadenectomy, accounts for more than 50% of iatrogenic injuries. In premenopausal women, an hysterectomy with ovarian sparing and concomitant lateral ovarian transposition is frequently performed. However, the fate of the retained ovary is complicated by the residual ovarian syndrome (ROS) and one of the most common postoperative complications of the lymphadenectomy procedure is the lymphocele, with an average incidence of 22–48.5%. The differential diagnosis of a postoperative fluid collection includes, in addition to a lymphocele, urinoma, hematoma, seroma or abscess and the computed tomography (CT) findings alone is not enough.Case presentationWe describe a patient, affected by ROS concomitant with a asymptomatic lymphocele, initially confused with an aortic lymph nodes relapse, after abdominal radical hysterectomy. The patient was subjected to a surgical approach, included a diagnostic open laparoscopy and laparotomy with sovraombelico-pubic incision, wide opening of the pelvic peritoneum and retroperitoneum. Examination of the mass revealed, macroscopically, a ovary with multiloculated cystic masses filled with clear or yellow serous fluid and the layers were composed by flat or cuboidal mesothelial cells.ConclusionThe tribute of this case illustrates the atypical appearance with uncertain aetiology after complex imaging. Gynecologist and radiologist should acquaint with the appearance of fluid collection (urinoma, lymphocele, seroma, hematoma, abscess) in gynecologic oncology follow-up to properly differentiated from tumor recurrence.

Highlights

Gynecological surgery, as radical hysterectomy or pelvic and aortic lymphadenectomy, accounts for more than 50% of iatrogenic injuries
The preservation of one or both ovaries at the time of hysterectomy consents to preserve the important role in steroid metabolism even after the menopause, but the residual ovary syndrome (ROS) results in the 2–3% of women [6,7,8]
We describe a case of residual ovarian syndrome (ROS) concomitant with a pregress asymptomatic lymphocele, in a 37-year-old woman who developed an abdominopelvic mass, initially confused with a recurrence in the aortic lymph nodes, 12 years after abdominal radical hysterectomy for cervical cancer

Summary

Conclusion

This case emphasizes that the gynecologist and radiologist should acquaint with the appearance of transposed ovaries and their abnormalities, to properly differentiated from other possible entities, such as peritoneal metastases, urinomas, seroma, hematoma, abscess, cystic neoplasm; the report strongly supports the evidence that more close radiological examinations in this setting of patients are required in order to promptly exclude tumor recurrence. SFuigrguircael 2specimen of right ovary Surgical specimen of right ovary. Ovarian pedicle adherent to aortic lymphocele are both visible

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