Abstract
Ovarian remnant syndrome (ORS) is a rare, but well-known gynecological complication, most often induced by difficult bilateral salpingo-oophorectomy (BSO) procedures that leave residual ovarian tissue on the pelvic wall. The most common preexisting conditions for this complication include endometriosis, pelvic inflammatory disease and prior abdominal surgery. The residual ovarian tissue may eventually cause malignant development. A total of 12 cases of malignant and benign tumors (clear cell adenocarcinoma in 1 case, mucinous-type tumors in 2, endometrioid-type tumors in 5, adenocarcinoma in 3 and border serous neoplasia in 1) and 21 benign cysts developing from an ovarian remnant have been described in the literature to date. Endometriosis, known to increase the risk of ovarian cancer, predisposes patients to ORS, with an incidence rate of 30 to 50% in ORS patients with ovarian carcinoma. Although the true incidence of ORS remains unknown, when endometriotic adhesions are diagnosed during BSO, the possibility of ORS and subsequent ovarian malignant transformation may mandate complete surgical resection.
Highlights
Ovarian remnant syndrome (ORS) is a rare, but well‐known gynecological complication, most often induced by difficult bilateral salpingo‐oophorectomy (BSO) procedures that leave residual ovarian tissue on the pelvic wall
The association was restricted to endometrioid [relative risk, 2.53; 95% confidence interval (CI), 1.19‐5.38] and clear cell malignancies, it was determined that females with endometriosis had a predisposition to developing ovarian cancer
In a study that interviewed 812 females diagnosed with ovarian cancer, Rossing et al [19] found that the risk of endometrioid/clear cell ovarian cancer for patients with endometriosis was three‐fold greater compared with population‐based controls
Summary
The incidence of adenocarcinoma and cystadenoma in ovarian remnants cannot be realistically calculated from the current small number of published series. Among the 186 patients included in the largest study by Magtibay et al [2], no cases of adenocarcinoma were encountered following excision of the ovarian remnants. The first case of ORS following laparoscopic salpingo‐oophorectomy was described by Nezhat et al [13], no adenocarcimona was observed during follow‐up. The incidence of ORS and the subsequent development of malignancies have increased. This may be due to the increasing numbers of laparoscopic oophorectomies that are being performed [8,9,11,12,13]
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