Massive ovarian edema (MOO) is a rare disease characterized by an enlarged edematous ovary, usually unilateral.
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Epidemiology
It characteristically presents during reproductive years including during pregnancy. The reported age range extends from 6 months to 60 years 6.
Associations
precocious puberty in infants 4
Clinical presentation
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.
Pathology
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).
Location
It is almost always unilateral and more common on the right.
Radiographic features
Ultrasound
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
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
Treatment and prognosis
Management options include wedge resection and oophoropexy for benign disease. Frozen section may be helpful to confirm benignity.
History and etymology
The term massive ovarian edema was first described by Kalstone in 1969.
Differential diagnosis
ovarian fibromatosis: from long-standing massive ovarian edema 4
ovarian torsion: twisted pedicle with whirlpool appearance is characteristic