Presentation
Lower abdominal pain for the last two days.
Patient Data
There is free fluid in the hepato-renal, bilateral iliac fossa, and pelvic region. The left ovary shows a solid mass lesion (about 89 x 79 x 66 mm) with acoustic shadow. Few flow signals are present in the peripheral part of the lesion. The compressed ovarian parenchyma shows follicles with an echogenic rim with no/poor parenchymal flow signals.
The right ovary is normal. The uterus is anteverted and shows normal size without a myometrial lesion. The combined endometrial thickness is 4 mm.
There is no pelvic/ retroperitoneal lymphadenopathy.
1st photo shows an enlarged left ovary. 2nd photo shows a cut section of the ovarian tumor.
Case Discussion
A female presented with lower abdominal pain. Ultrasound revealed an ovarian solid mass lesion with mild ascites. The possibility of ovarian torsion was suspected due to the presence of peripherally oriented ovarian follicles with echogenic rim (follicular ring sign), poor/no ovarian parenchymal flow signals along with abdominal pain. The ultrasound evaluation of the lesion was inconclusive. One possibility was a malignant neoplasm due to the presence of ascites. The other was a fibrous ovarian tumor due to the presence of sound attenuation. The patient was pain-free after two days.
MRI (done 3 days after pain) suggested a benign ovarian lesion without signs of ovarian torsion (not uploaded, no copyright). Tumor markers for ovarian malignancy were negative.
Surgical exploration revealed a small amount of hemorrhagic ascites, enlarged left ovary due to solid lesion, left tube adherent to the left ovary without torsion of the pedicle.
Histopathology revealed the ovarian tumor being an ovarian leiomyoma. There were no malignant cells in the peritoneal fluid.
Primary leiomyoma of the ovary is one of the rarest solid ovarian tumors1. Most such lesions coexist with uterine leiomyoma, unlike this case1.
Photos and surgical details courtesy: operating surgeon Dr. Reena R. Patel.