Unilateral Ovarian Hypoplasia with Ipsilateral Fallopian Tube Hypoplasia

Abstract

Herein, we present the case of a 36-year-old nulliparous woman with mild dysmenorrhea, diagnosed with a left endometrioma who underwent laparoscopic cystectomy. Laparoscopic findings confirmed an endometrioma with a normal fallopian tube in the left adnexa (Fig. 1a), and a hypoplastic ovary in the right adnexa (Fig. 1b). A balloon catheter was inserted into the uterus, and tube passage was verified using indigo carmine solution. The left fallopian tube was patent (Fig. 1c); however, the right fallopian tube was obstructed at the end of the fimbria (Fig. 1d). This was thus a rare case of unilateral ovarian hypoplasia with ipsilateral tubal hypoplasia, and we considered several theories to explain our findings. First, one theory to explain the etiology of congenital ovarian hypoplasia involves the loss of an ovary as a result of ischemia secondary to torsion of an ovarian pedicle with profound ovarian hypoxia, leading to cell death during fetal or early postnatal life [1, 2]; another theory is adnexal hypoplasia resulting from embryologic developmental agenesis or aplasia [3-5]. Second, embryologic theories of the etiology of unilateral adnexal agenesis and hypoplasia point to embryologic defects in the development of the genital ridge and the caudal end of the Müllerian (paramesonephric) duct [6, 7]. Failure of the Müllerian ducts to canalize is believed to result in failure of oviductal development, and Müllerian anomalies generally include combined ipsilateral uterine and renal-ureteric anomalies. The present case had only hypoplasia of the fallopian tubes, with the absence of other congenital anomalies of the reproductive organs or kidneys, making the hypothesis of an embryologic anomaly unlikely. Therefore, we postulated that the patient experienced torsion of the ovarian pedicle in the neonatal period or very early childhood.