Massive ovarian edema

Last revised by Liz Silverstone on 17 Feb 2024

Massive ovarian edema (MOO) is a rare disease characterized by an enlarged edematous ovary, usually unilateral. 

It characteristically presents during reproductive years including during pregnancy. The reported age range extends from 6 months to 60 years 6.

Most patients present with intermittent pelvic pain of several months duration +/- a palpable adnexal mass. Abnormal uterine bleeding, virilization due to elevated androgens (21%) 6 or abdominal distension can occur.

The most probable cause is recurrent partial torsion of the mesovarium with obstruction to venous and lymphatic drainage. This causes ovarian stromal swelling and edema with peripheralisation of ovarian follicles. At surgery the ovaries are white and weep fluid when incised. Torsion is found in 43% 6. Focal stromal luteinisation and hyperthecosis may occur and the cortex demonstrates fibrosis.

Occasionally chronic ovarian edema is caused by malignant lymphatic invasion due to cervical cancer or Krukenberg tumors (2% of women with gastric cancer).

It is almost always unilateral and more common on the right.

The imaging features are similar to ovarian torsion with stromal swelling and peripheral follicles. In 15% of cases there may be an underlying cyst or mass, usually benign.

MRI may also demonstrate an enlarged edematous ovarian mass with peripheral follicles. Described signal characteristics include 4 :

  • T1: hypointense

  • T2: hyperintense

  • T1 C+ (Gd): may show enhancement 

Management options include wedge resection and oophoropexy for benign disease. Frozen section may be helpful to confirm benignity.

The term massive ovarian edema was first described by Kalstone in 1969.

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