Bilateral Ovarian Masses Research Articles

Ovarian preservation in a young patient with Gorlin syndrome and multiple bilateral ovarian masses

To report a case of bilateral ovarian fibromas and ovarian leiomyomas in a young patient with Gorlin syndrome and to highlight issues of fertility preservation, ovarian conservation, and preimplantation genetic diagnosis in this population. Case report. University hospital. A 15-year-old female patient with Gorlin syndrome and bilateral ovarian masses. Ultrasound, magnetic resonance imaging, hormone analysis, and laparotomy with resection of ovarian fibromas. Preservation of ovarian function, pathologic diagnosis. Our patient represented an adolescent case of bilateral ovarian fibromas and leiomyomas in Gorlin syndrome presenting with menstrual irregularities. She was managed surgically with resection of the lesions and conservation of normal ovarian tissue. In Gorlin syndrome, ovarian fibromas are a common clinical manifestation. Patients with ovarian involvement may present with complex gynecologic needs and may have decreased fertility potential. Careful surgical management, follow-up, and counseling on options for future fertility should be offered to all patients.

A Huge Ovarian Cyst in a Hysterectomized Bitch

A 11-year-old, spayed, female mixed breed-dog was presented with an abdominal mass that was detected 1 month ago. Upon abdominal palpation a large, firm, oval shaped, movable mass was found in the mid-abdominal region. Survey radiograph of the abdomen demonstrated an oval soft tissue dense mass located on the right side of the abdominal cavity. A large, heteregenous and cystic mass with solid components occupying the majority of the abdomen and a small, cystic mass with solid components caudal to the left kidney were identified by transabdominal ultrasonography. Computed tomography scans revealed bilateral ovarian masses, and a small volume of retroperitoneal fluid on the right side. A cystic, but otherwise solid mass located in the right ovary and small retained left ovary encapsulated in the ovarian bursa were excised surgically by midline laparotomy. Histopathological examination of the excised mass from the right side revealed a large cystic structure consistent with an ovarian cyst and multiple corpora lutea and follicles at different maturational stages were detected in the left ovary. The precise origin of the ovarian cyst could not be determined by morphological appearance. Immunohistochemical staining suggested a cyst of surface epithelial origin. At re-examination 6 months after the surgery, the bitch appeared healthy and the clinical findings were all normal. To our knowledge, the cyst described here is the largest reported in an incompletely ovariohysterectomized bitch.

Erythroblastic sarcoma presenting as bilateral ovarian masses in an infant with pure erythroid leukemia

Pure erythroid leukemia is a rare subtype of acute erythroid leukemia that is characterized by a predominant erythroid population, and erythroblastic sarcoma has not yet been described in the English literature. Here, we report a first case of erythroblastic sarcoma that presented as bilateral ovarian masses in a 3 ½-month-old infant girl with pure erythroid leukemia. Bone marrow aspirate and biopsy showed that the marrow was completely replaced by large-sized blasts consistent with erythroblasts. Immunophenotypically, both the tumor cells from the ovarian mass and bone marrow blasts were positive for CD117, glycophorin A, and hemoglobin A, demonstrating erythroid differentiation. Reverse transcriptase polymerase chain reaction showed that the tumor cells from ovarian mass expressed hemoglobin F and α1 spectrin, confirming their erythroid lineage. Conventional karyotype of the bone marrow aspirates revealed del(6)(q23q25) and trisomy 7 in all 21 cells examined. Fluorescence in situ hybridization of the ovarian mass demonstrated loss of c-myeloblastosis viral oncogene (C-MYB) at 6q23 locus in 41% of the cells, and deletion of chromosome 7 and 7q in 37% and 66% of cells, respectively. Taken together, we showed, for the first time, that pure erythroid leukemia presented as a myeloid sarcoma in the form of ovarian masses.

Bilateral Burkitt Lymphoma of the Ovaries: A Report of a Case in a Child with Williams Syndrome

A 10-year-old female with Williams Syndrome (WS) presented with a two-month history of fatigue, weight loss, and bilateral ovarian masses. Histologic, immunophenotypic, and cytogenetic studies confirmed the diagnosis of Burkitt lymphoma (BL). While there is no established association between the two disorders, this is the third case in the literature of Burkitt lymphoma in a patient with Williams Syndrome.

Highly Metastatic Ovarian Yolk Sac Carcinoma in a Rat

We investigated a highly metastatic ovarian yolk sac carcinoma in a 52-week-old female Crl:CD(SD) rat. Macroscopically, the present case had severe ascites, bilateral ovarian masses and numerous nodules in the abdominal and thoracic cavities. Histopathologically, these masses and nodules were generally composed of two types of cells mimicking a parietal and visceral yolk sac. The parietal cells were round to polygonal, contained eosinophilic droplets and were arranged in nests and cords in the eosinophilic matrix. Both the intracytoplasmic droplets and the matrix were stained positively with PAS. The visceral cells were cylindriform, and proliferated in papillary and tubular patterns and occasionally formed Shiller-Duval body-like structures. In the dissemination sites, the neoplastic cells proliferated on the surface of the various tissues and often infiltrated into deeper parts of the tissues. Immunohistochemically, both neoplastic cells were positive for α-fetoprotein and keratin, and the eosinophilic matrix was positive for laminin. Ultrastructurally, the parietal cells had dilated rough endoplasmic reticulums, which were filled with electron-lucent laminated structures. The visceral cells had poorly to moderately developed intracytoplasmic organelles and were interconnected with desmosomes. Taken together, the present tumor was diagnosed as yolk sac carcinoma arising from the ovary and was characterized by not only high metastasis but also invasive infiltration with biphasic proliferation of the parietal and visceral cells.

Anti-Yo positive dorsal root ganglionopathy

A 62 year old Romanian lady presented with a 1 year history of pain in her hands and feet which radiated up her arms and legs. It progressed over the year to severe, sharp pain involving all four limbs, associated with a tingling sensation and numbness. Two months after onset of symptoms she required assistance to mobilise. On presentation she required bilateral assistance and used a wheelchair outside of her home. There was no sphincter disturbance. Past medical history included chronic hepatitis C infection (genotype 1b), ischaemic heart disease and hypertension. She was an ex-smoker. On examination, the gait was ataxic and she required the assistance of two people. She had a sensory ataxia which increased with her eyes closed. There was decreased soft touch and pinprick sensation to the elbows and knees bilaterally. Proprioception was decreased to the ankles. Vibration sensation was decreased to the elbows and knees. She was areflexic throughout. Plantars were downgoing bilaterally. Vitamin B12 and folate levels were normal. Serum electrophoresis was normal. Serum cryoglobulins were normal. HIV serology and syphilis serology were negative. ANA was positive at 1:80 with a nucleolar pattern. Cerebrospinal fluid examination was normal and oligoclonal bands were negative. On nerve conduction testing, the motor study was well preserved with uniformly absent sensory nerve action potentials consistent with a dorsal root ganglionopathy. CT thorax, abdomen and pelvis showed cirrhosis of the liver with splenomegaly but no evidence of any malignancy. She was treated with intravenous immunoglobulin therapy and started on pregabalin. There was minimal improvement in her condition. Western blot assay was negative for anti-HU, RI, MA1, MA2, anti-CV2/CRMP5 and anti-amphiphysin paraneoplastic antibody markers but positive for anti-Yo. GAD and MAG antibodies were also negative. This prompted a further search for a malignancy. Bilateral mammography was normal. PET scan showed intense uptake in bilateral ovarian masses and no other areas of abnormal uptake. Bilateral salpingo-oophorectomy was carried out and the histology showed stage III papillary serous carcinoma with omental metastases. She was commenced on carboplatin chemotherapy but only tolerated one cycle due to neutropenia, lymphopenia and thrombocytopenia. She had two further cycles of intravenous immunoglobulin therapy for worsening symptoms but with little improvement. We present this case as we believe it to be unusual that a paraneoplastic dorsal root ganglionopathy is associated with anti-Yo antibodies. Anti-Yo antibodies were first reported in 1983 by Greenlee et al. [1] when they reported antibodies to Purkinje cells in two patients with ovarian cancer and paraneoplastic cerebellar degeneration. Anti-Yo antibodies are usually associated with ovarian or breast cancer and typically present with a cerebellar syndrome [2]. Anti-Hu antibodies and CV2 antibodies are most commonly associated with dorsal root ganglionopathy or sensory neuronopathy as a paraneoplastic phenomenon [3]. Peripheral nerve manifestations associated with seropositivity for anti-Yo antibodies have been described previously by Tracy et al. They described six patients with peripheral neuropathies and positive anti-Yo antibodies from a cohort of 76 anti-Yo seropositive women who were P. McNamara (&) L. Costelloe J. Redmond Department of Neurology, St James’s Hospital, Dublin, Ireland e-mail: pmcnamara2004@hotmail.com

Hashimoto Thyroiditis as a Manifestation of Struma Ovarii

Abstract: We describe clinicopathologic features, laboratory data, and imaging and therapeutic management of a rare case of Hashimoto thyroiditis arising in struma ovarii. The patient was a 38-year-old woman with clinical symptoms of hyperthyroidism. Laboratory data showed elevated levels of total and free thyroxine, low thyrotropin level, and positive specific antithyroid antibodies without ultrasound evidence of morphologic abnormalities of the thyroid gland. Pelvic ultrasonography and magnetic resonance imaging of the abdomen showed bilateral solid ovarian masses containing cystic and fat areas diagnostic of teratoma. The performance of a 131I whole-body scan demonstrated a focus of intense uptake in the pelvis with minimal residual thyroid gland. The patient had a bilateral oophorectomy, and histologic examination revealed thyroid tissue in both masses with all the features of Hashimoto thyroiditis in the right ovary. Symptoms of hyperthyroidism diminished after the surgery, and the thyroid hormone levels and antithyroid antibodies were in the normal range in 1 month. The present case further confirms the rare occurrence of Hashimoto thyroiditis in struma ovarii. This diagnosis should be suggested in the differential diagnosis of patients with symptoms of thyroid disease and a normal thyroid gland.

Endometriomas in adolescents

To report a rare presentation of bilateral endometriomas in an adolescent and describe characteristics of endometriomas. Case report. Major academic medical center. An 18-year-old G0 presented with an incidentally found 35-cm pelvic mass that was found to be bilateral endometriomas. Exploratory laparotomy with resection of endometrioma cyst walls and lysis of adhesions. The incidence, pathogenesis, fertility implications, and treatment options for endometriomas in adolescents. Endometriomas are rare in adolescents. There are no case reports in the literature to date. Endometriosis should be considered in adolescents presenting with bilateral complex ovarian masses regardless of their size.

Theca lutein cyst rupture - an unusual cause of acute abdomen : a case report

A 20 year old illiterate woman who had a spontaneous first trimester abortion followed by instrumental evacuation, presented 4 days later with sudden onset of pain and distension of abdomen along with difficulty in breathing. On examination, she was tachypnoeic, icteric with tachycardia. Abdominal examination revealed guarding and rigidity along with free fluid and vague mass in lower abdomen. Gynaecological examination showed purulent discharge through os with bogginess in all fornices. USG revealed echogenic fluid with bilateral large ovarian masses containing multiple small cysts. Laparotomy was performed with a provisional diagnosis of ruptured theca leutein cysts after 24 hrs of administration of broad spectrum antibiotics. There were bilateral theca leutein cysts of more than 10X15 cm, the left of which has ruptured and the right on the verge of rupture. Bilateral partial cystectomy was performed and histopathological examination confirmed theca lutein cysts with inflammatory infiltrate.

Non‐Hodgkin lymphoma presenting as an ovarian tumor

Sir, We came across a case where the initial manifestation of non-Hodgkins lymphoma was in the form of ovarian involvement. Involvement of the ovary by malignant lymphoma is well known as a late manifestation of disseminated nodal disease, but secondary ovarian involvement as initial manifestation of lymphoma is unusual (1). A 24-year-old woman, with one living child delivered six months previously, presented in emergency with the complaint of progressive abdominal distension for two weeks and pain for three days. A tender cystic mass with restricted mobility was felt in the lower abdomen. On vaginal examination the uterus was not felt separate from the mass. Ultrasonography showed ascites and a left adnexal mass, 18 × 20 cm in diameter, with variable echogenecity. CA-125 levels were 118.7 IU/ml. With the possibility of ovarian tumor torsion, exploratory laparotomy was done. There was ascites with bilateral solid ovarian masses each measuring 20 × 15 cm and multiple malignant deposits over the uterovesical peritoneum, uterosacral ligaments, left broad ligament, and omentum. Malignant deposits were also seen over the ileum, the largest 6 × 5 cm. Mesenteric lymph nodes were enlarged. The spleen, liver, diaphragm, and kidneys were normal. Total abdominal hysterectomy with bilateral salpingo-oophorectomy, omentectomy, lymph node sampling, and ileal resection with end-to-end anastomosis was performed. Postoperative recovery was uneventful. Histopathology revealed undifferentiated high grade non-Hodgkins lymphoma (Figure 1) involving both ovaries, a segment of small intestine, and the mesenteric lymph nodes. Post-operatively chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisolone was planned. The patient was given two courses, which she tolerated well and did not come for follow-up after that. High-power view of the ovary showing monomorphic population of immature lymphoid cells with conspicuous nuclei. (H&E 400x) Malignant lymphomas frequently involve the ovaries at autopsy with a frequency of 7–26% (2). Less than 1% of patients with malignant lymphoma initially present with ovarian enlargement (3). The occurrence of lymphomas primarily in the ovaries is debatable. Fox et al. have proposed certain criteria for the diagnosis of primary ovarian lymphoma (4), such as confinement to the ovary and no abnormal cells in the peripheral blood and bone marrow. Ovarian lymphoma, whether a secondary manifestation of disseminated disease or truly primary in the ovary, is difficult to ascertain. Bilateral ovarian involvement, peritoneal implants, omental involvement, and metastasis in the intestine may be used as an argument against primary ovarian lymphoma in this patient. The prognosis depends on the clinical stage, modality of onset, histological type, and phenotype, with B-cell tumors having a better prognosis than T-cell/natural killer cell lymphomas (5). Debulking at the time of surgery followed by chemotherapy carries a good prognosis. Hence, we report this case to emphasize the presence of this entity.

Bilateral Ovarian Serous Borderline Tumor with a Giant Non-invasive Peritoneal Implant in a Four-Year-Old Girl

Epithelial ovarian tumors are uncommon before 20 years of age and rarely occur before puberty. The vast majority of these tumors are benign, and few cases of malignant and borderline tumors are described. We report a case of a 4-year-old premenarchal girl, previously healthy, who presented with two abdominal masses. Laboratory analysis of blood showed elevation of the serum level of the CA-125. Ultrasonographic examination disclosed bilateral cystic ovarian masses. Laparoscopic exploration revealed bilateral ovarian multicystic masses with retro-uterine peritoneal implant. Bilateral salpingo-oophorectomy with implant resection was performed. Histologic findings were consistent with a serous borderline tumors of both ovaries and the peritoneal implant was of the non-invasive type. There is no evidence of recurrence at 3-year follow-up. To our knowledge, there are only four cases of ovarian borderline tumors in premenarchal girls reported in the English literature: three of the mucinous type and only one of the serous type.

Magnetic resonance imaging findings of ovarian stromal hyperthecosis

Ovarian stromal hyperthecosis is characterized by diffuse distribution of luteinized stromal cells accompanied by varying degrees of stromal hyperplasia. We report a case of ovarian stromal hyperthecosis with particular regard to magnetic resonance (MR)-pathologic correlation. At initial MR imaging, the central areas of the bilateral ovarian masses showed hypointensity on T1-weighted images and hyperintensity on T2-weighted images, while the peripheries of the bilateral masses showed isointensity to myometrium on T1-weighted images and heterogeneous signal intensities on T2-weighted images. At 15 days after the initial MR imaging examination, a second MR imaging demonstrated shrinkage of the bilateral ovarian masses. Change in the peripheries to predominantly isointensity to myometrium on the T2-weighted images was also observed. The patient underwent bilateral oophorectomy. Microscopic examination revealed scattered nests of lutein cells on a background of densely proliferated ovarian stroma with minimal collagen production in both ovaries. Edema was occasionally seen in the outer portion but was marked in the central zone of the ovaries, particularly on the left. The final pathologic diagnosis was stromal hyperthecosis. With regard to MR-pathologic correlation, the MR findings in the peripheries of the bilateral masses (isointensity relative to myometrium on both T1- and T2-weighted imaging) showed the characteristics of stromal hyperthecosis.

Recurrent Bilateral Serous Cystadenomas in a Premenarchal Girl: A Case Report and Literature Review

Background Ovarian serous cystadenomas are rare in children. No case of recurrence after surgical resection in a premenarchal girl has been published. Case An 8-year-old presented with abdominal pain and ultrasound showed bilateral ovarian cystic masses with normal clinical and laboratory exam. Cystectomies were performed revealing serous cystadenomas. Ten months later, her pain returned and ultrasound showed new cysts. Persistence of cysts and symptoms required repeat surgery with the same pathology. Summary and conclusion Premenarchal girls with ovarian cystic masses require surgical intervention in cases of persistent symptoms, uncertain diagnosis, or concern for ovarian torsion. With reassuring imaging and tumor markers, conservation of the ovary can be achieved with cystectomy alone. Ultrasound follow-up is recommended after surgical resection until bimanual exam can be performed.

Bilateral metachronous ovarian metastases from clear cell renal carcinoma: a case report

IntroductionBilateral ovarian metastases from a clear cell renal carcinoma are uncommon findings and need to be differentiated from primary cancers. Diagnostic imaging and histopathological features are often inconclusive, unless they are combined.Case presentationA 56-year-old woman with a history of right radical nephrectomy for a renal clear cell carcinoma diagnosed 10 years earlier was referred for abdominal distension and pelvic pain. Color-Doppler US and Computer Tomography scan revealed the presence of bilateral ovarian masses with regular margins, a low resistance index and poor contrast enhancement. Immunohistochemistry showed positive epithelial membrane antigen, cytokeratin, vimentin and CD10, suggesting clear cells from the previously diagnosed kidney cancer.ConclusionAlthough bilateral metachronous ovarian metastases from clear cell renal carcinoma are a very uncommon finding, they can be considered in the differential diagnosis and investigated with imaging and immunohistochemistry. The 6 cases reported in the literature indicate a good prognosis for this condition.

Impact of laparoscopic cystectomy on ovarian reserve: serial changes of serum anti-Müllerian hormone levels

To evaluate the ovarian reserve changes after laparoscopic cystectomy, we prospectively evaluated pre- and postoperative serum anti-Müllerian hormone (AMH) level, and ovarian volumes. Prospective longitudinal study. University Hospital. Twenty women with benign ovarian masses participated; endometrioma [13], mature teratoma [6], and mucinous cystadenoma [1]. Seven patients had bilateral ovarian masses. All patients had undergone laparoscopic ovarian cystectomy. Serum AMH levels were serially measured: preoperative, 1 week, 1 month, and 3 months after operation. Volumes of total ovary and ovarian mass were measured by 3D ultrasonography before operation. Postoperative serum AMH level and ovarian volume. Median AMH level was 2.23 ng/mL (95% confidence interval [CI] 1.35-3.41 ng/mL) before operation, but reduced to 0.67 ng/mL (95% CI 0.44-1.70 ng/mL) at the first week postoperatively and then increased to 1.14 ng/mL (95% CI 0.79-2.36 ng/mL) in the first month and 1.50 ng/mL (95% CI 0.58-3.26 ng/mL) in the third month. The serum AMH level after 3 months postoperatively was recovered to about 65% of the preoperative level. The serum AMH level at postoperative 1 week was more decreased in endometrioma compared with nonendometrioma (33.9% vs. 69.2% of preoperative level), and in bilateral group compared with unilateral group (16.9% vs. 62.9%). This study suggests that ovarian reserve could be reduced after laparoscopic cystectomy; however, it could be restored thereafter up to 3 months postoperative in reproductive women.

Endometriomas in Adolescents

Objective To report a rare presentation of bilateral endometriomas in an adolescent and describe characteristics of endometriomas. Design Case report. Setting Major academic medical center. Patient(s) An 18-year-old G0 presented with an incidentally found 35-cm pelvic mass that was found to be bilateral endometriomas. Intervention(s) Exploratory laparotomy with resection of endometrioma cyst walls and lysis of adhesions. Main Outcome Measure(s) The incidence, pathogenesis, fertility implications, and treatment options for endometriomas in adolescents. Result(s) Endometriomas are rare in adolescents. There are no case reports in the literature to date. Conclusion(s) Endometriosis should be considered in adolescents presenting with bilateral complex ovarian masses regardless of their size.

Ovarian hyperstimulation, hyperprolactinaemia and LH gonadotroph adenoma

This report considers a highly exceptional case of ovarian hyperstimulation syndrome due to a gonadotroph adenoma secreting LH in a 31-year-old patient who presented with amenorrhoea and galactorrhoea syndrome and a complex bilateral ovarian mass. Magnetic resonance imaging revealed a pituitary adenoma, and laboratory tests corroborated the hyperprolactinaemia without other hormonal pituitary abnormalities. Ovarian hyperstimulation syndrome due to a gonadotroph adenoma with normal gonadotrophins is extremely rare. Most of the described cases are caused by FSH adenomas. Due to the originality of the case, it was considered useful for understanding the management of this entity, and it is proposed that LH adenomas should also be considered in the differential diagnosis of patients with spontaneous ovarian hyperstimulation syndrome.

Fine needle aspiration diagnosis of bilateral dysgerminoma with syncytiotrophoblastic giant cells

Dysgerminoma accounts for only 1–3% of ovarian cancers and about 30–40% of all ovarian germ cell malignant tumors. Literature states that about 2% of nonpregnant patients with dysgerminomas present with elevated serum or urine levels of human chorionic gonadotropin (hCG). Here, we report a 34 year-old multiparous woman presenting with an abdominal lump, ascites, and abdominal pain with elevated urinary and serum hCG levels. An abdominal ultrasound showed bilateral ovarian mass. An ultrasound-guided, transabdominal fine needle aspiration revealed dysgerminoma with syncytiotrophoblastic giant cells. Bilateral oophorectomy was done and the diagnosis was confirmed on histopathology.

Metastatic signet ring cell adenocarcinoma of bone marrow with bilateral ovarian masses: a case report

We present a case of metastatic signet ring cell adenocarcinoma of bone marrow with radiologically proven bilateral ovarian masses in a 50 year old Asian Indian female. Even after thorough search no extraovarian primary site could be found. Based on overall clinicopathologic correlation, a diagnosis of metastatic signet ring cell adenocarcinoma of bone marrow with uncertain primary was established.

Abdominal Carcinomatosis Attributed to Metastatic Breast Carcinoma

A 41-year-old female suffered from epigastralgia and intermittent constipation for 10 months, and abdominal fullness and intermittent pain for 6 months, before seeking help. Double contrast barium study of the colon showed multiple indentations on the sigmoid, ascending, and proximal transverse portions with tethered adjacent mucosal outline as well as the presence of ascites compatible with peritoneal carcinomatosis. Mediolateral oblique mammogram showed a speculated mass with some intratumoral microcalcifications in the upper retroareolar portion of the right breast. Due to the persistent abdominal complaints, laparotomy was done. Breast lump biopsy was done simultaneously. On opening abdominal cavity, massive yellowish ascites was noted. Diffuse small nodules over omentum and mesentery retraction were found. Bilateral ovarian masses were also noted. Right oophorectomy and omentectomy were performed. Histologic findings and results of immunohistochemical stains were consistent with diagnosis of primary breast cancer with metastasis to ovary and omentum.