Uterus-like mass of the broad ligament

Abstract

function and for preserving fertility. Imagingmayhelp to establish timely diagnosis. In most cases of concomitant bilateral adnexal torsion, cystic tumors in adnexa/ovaries were identified preoperatively by ultrasound or computed tomography [1–3]. However, diminished Doppler flows were noted only in 1 case [1]. In the past, removalwithout untwisting of ischemicor gangrenouslooking ovaries to prevent thromboembolism or housing of malignancies was advocated. Because the clinical significance of embolism is questionable and the risk of malignancy is low (b2%), conservation is the accepted management in pediatric ovarian torsion. Two months after detorsion, follicles can been found inmore than 90% of patients, indicating ovarian viability after temporary ischemia [4]. The patient in the reported case presented postoperatively with signs of precocious puberty. Bilaterally enlarged, cystic ovaries combined with premature breast enlargement without hormonal changes are indicative of an autonomous ovarian cyst rather than endocrine ovarian activity as seen in secreting ovarian tumors (typically unilateral) or central precocious puberty (maturation of the entire hypothalamic–pituitary–gonadal axis) with the full spectrum of physical and hormonal changes of puberty. Autonomous ovarian cysts are found in 5% of girls with ovarian cysts, causing isosexual precocious pseudopuberty in some cases. Patients present with signs of estrogenization (bilateral breast development, vaginal discharge/bleeding, swelling of the labia minora), with elevated estrogen levels and suppressed gonadotropin response to GnRH stimulation. Bone age is rarely advanced. As in the present case, these findings depend on the stage of the disease. Autonomous ovarian cysts develop and regress spontaneously after 2–3 months, while clinical signs of precocity may still be present after hormone levels have normalized and the cysts are no longer detectable. The entity is self-limiting and requires mostly no treatment. However, prolonged exposure to estrogen may lead tomaturation of the GnRHpulse generator, resulting in central precocious puberty (so-called combined precocious puberty), and may require GnRH therapy to prevent loss of height potential.