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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
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LETTERS TO THE EDITOR
Year : 2020  |  Volume : 25  |  Issue : 4  |  Page : 256-257
 

Massive ovarian edema: An extremely rare cause of ovarian mass in a 7-year-old girl


1 Department of Pathology, Chacha Nehru Bal Chikitsalaya, Delhi, India
2 Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, Delhi, India
3 Department of Radiology, Chacha Nehru Bal Chikitsalaya, Delhi, India

Date of Submission28-Jun-2019
Date of Decision07-Nov-2019
Date of Acceptance01-Feb-2020
Date of Web Publication24-Jun-2020

Correspondence Address:
Arti Khatri
Department of Pathology, Chacha Nehru Bal Chikitsalaya, Delhi - 110 031
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaps.JIAPS_111_19

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How to cite this article:
Mahajan N, Khatri A, Khan NA, Gupta N. Massive ovarian edema: An extremely rare cause of ovarian mass in a 7-year-old girl. J Indian Assoc Pediatr Surg 2020;25:256-7

How to cite this URL:
Mahajan N, Khatri A, Khan NA, Gupta N. Massive ovarian edema: An extremely rare cause of ovarian mass in a 7-year-old girl. J Indian Assoc Pediatr Surg [serial online] 2020 [cited 2020 Jul 11];25:256-7. Available from: http://www.jiaps.com/text.asp?2020/25/4/256/287644




Sir,

Massive ovarian edema is a very rare, benign entity. There are <200 cases which have been reported in the literature after its first report by Kalstone et al. in 1969.[1],[2]

A 7-year-old girl presented to the pediatric surgery outpatient department with complaints of intermittent, nonradiating pain in the right lower abdomen for 20 days, associated with vomiting. The patient was tanner Stage 1 clinically. Per abdomen, a mass was felt in the right iliac fossa. The hematological, biochemical investigations and tumor markers (CA-125, alpha-fetoprotein, and human chorionic gonadotropin) were within the normal limits. Ultrasound examination suggested a right ovarian mass measuring 4.5 cm diameter with no torsion or evidence of ascites. Contrast-enhanced computed tomography (CECT) showed bilateral enlarged ovaries with the presence of solid component in the right ovary, suggestive of a neoplasm [Figure 1]a. In view of the radiological findings and an increased ovarian size, right salpingo-oophorectomy with left ovarian biopsy was planned. Intraoperatively, the diagnosis was ovarian mass likely malignant in view of variegated consistency. Grossly, the ovary was enlarged with a preserved capsule [Figure 1]b. Cut section was glistening, solid with the presence of few tiny cysts in the cortex [Inset, [Figure 1]b. No papillae or necrosis was identified. Microscopic sections revealed marked edema of the ovarian stroma with foci of hyalinization [Figure 1]c and preserved primordial follicle and luteinized cells in the cortex [Figure 1]d. The left ovary showed normal histology. CECT was reviewed and showed the presence of follicles in the ovarian cortex.
Figure 1: (a) Contrast-enhanced computed tomography shows a right-sided hypoechoic well-defined mass (possibly ovarian origin [long arrow]) with few enhancing areas and with peripheral follicles. Enlarged left ovary (short arrow). The uterus is prepubertal. (b) Right ovarian mass with preserved capsule. Inset: Cut surface of the ovary is solid, glistening with variable-sized follicles in the cortex. (c) Microscopy shows marked stromal edema with few dispersed congested vessels (H and E, ×10). (d) High-power view shows the presence of mainly primordial follicles within dispersed edematous stroma (H and E, ×40)

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Massive ovarian edema is most commonly seen in the second and third decades of life.[3] The edema can be seen in one or both the ovaries. The etiopathogenesis of this rare condition is not clearly defined. However, the intermittent or partial torsion of the ovarian pedicle that interferes in the venous and lymphatic drainage of the ovary is the proposed etiology. The partial torsion explains the fact that massive enlargement of the ovary can occur due to the accumulation of the fluid within the stroma without any underlying neoplastic process or ovarian cell necrosis.[4] Depending on the progression of torsion, the clinical manifestation of this condition varies from acute abdominal pain to menstrual irregularities, precocious puberty, solid adnexal mass, and even Meigs syndrome.[3],[4] The majority of the cases of ovarian edema which have been reported in the literature have undergone salpingo-oophorectomy as there is always a presumptive diagnosis of ovarian neoplasm both pre- and intraoperatively.[1] Majority of the radiologists and pediatric surgeons are unfamiliar with the characteristics of this rare and underreported entity. Hence, this case highlights the importance of recognizing massive ovarian edema which can be confused with ovarian neoplasm. It is also advisable that a frozen section or biopsy of the mass be taken before one proceeds for a salpingo-oophorectomy while dealing with ovarian masses in pediatric age females bearing normal tumor markers to preserve the hormonal function and fertility.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Dahmoush H, Anupindi SA, Pawel BR, Chauvin NA. Multimodality imaging findings of massive ovarian edema in children. Pediatr Radiol 2017;47:576-83.   Back to cited text no. 1
    
2.
Kalstone CE, Jaffe RB, Abell MR. Massive edema of the ovary simulating fibroma. Obstet Gynecol 1969;34:564-71.  Back to cited text no. 2
    
3.
Machairiotis N, Stylianaki A, Kouroutou P, Sarli P, Alexiou NK, Efthymiou E, et al. Massive ovarian oedema: A misleading clinical entity. Diagn Pathol 2016;11:18.   Back to cited text no. 3
    
4.
Varma A, Chakrabarti PR, Gupta G, Kiyawat P. Massive ovarian edema: A case report presenting as a diagnostic dilemma. J Family Med Prim Care 2016;5:172-4  Back to cited text no. 4
    


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