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REPORT
Year : 2007  |  Volume : 6  |  Issue : 1  |  Page : 36-38 Table of Contents     

Ovarian pregnancy presenting as ovarian tumour: Report of 2 cases


1 Department of Pathology, Ahmadu Bello University Teaching Hospital, Shika -Zaria, Nigeria
2 Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital, Shika -Zaria, Nigeria
3 Department of Surgery, Ahmadu Bello University Teaching Hospital, Shika -Zaria, Nigeria

Date of Web Publication10-Oct-2009

Correspondence Address:
MOA Samaila
Department of Pathology, Ahmadu Bello University Teaching Hospital, Shika-Zaria
Nigeria
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PMID: 18240491

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   Abstract 

We present 2 cases of ovarian masses diagnosed as tumours but turned out to be pregnancy. Ovarian pregnancy, a form of ectopic gestation has a distinct pathology though it can be a source of diagnostic difficulty clinically and intraoperatively. A total of 71 ectopic pregnancies were seen in the department from January 2001 to December 2005, of these only two were ovarian ectopics. Both patients were nulliparous and presented with lower abdominal pains, abdominal masses and menstrual irregularity. They both had laparotomy and total right salpingo-oophorectomy. Grossly, the ovaries were enlarged, grey tan and globular. Focal ruptures in the wall of the ovaries showed protruding fetal parts. Microscopy showed chorionic villi within and in continuity with ovarian stroma and corpus luteum. They were both diagnosed ovarian ectopics. A good knowledge and understanding of the gross pathology, combination of imaging studies and high index of suspicion should help in making an intra-operative diagnosis.

   Abstract in French 

Nous présentons deux cas de masse ovariennes diagnostiques cliniquement comme des tumeurs mais après histologiquement ce sont révèles être des grossesses ectopiques. Les grossesses ovariennes, une forme de grossesse ectopique as une pathologie distincte est es difficilement diagnostiquée cliniquement. Un total de 71 grossesses ectopiques a été vues au Département de Pathologie entre Janvier 2001 et Décembre 2005. Deux grossesses étaient des grossesses ovariennes. Les deux patientes étaient nullipares et ce sont présentées avec des douleurs au bas ventre, des tumeurs abdominales et des menstruations irrégulières. Les deux ont eu une exploration abdominale suivie d'une salpingo-ovarectomie. Anatomiquement, les ovaires étaient, gris, globulaire, et hypertrophier. Des ruptures de la paroi ovaire montrait des protrusions d'éléments fútal. Histologiquement les ovaires ont révélés les villosités chorioniques dans et en continuité avec le stroma ovarien et le corpus luteum. Les deux ovaires ont étaient diagnostiqués comme grossesse ovarienne. Une bonne connaissance et un bon entendement de l'anatomie-pathologie, une combinaison de l'imagerie et un fort taux de suspicion aide a faire un diagnostique clinique.

Keywords: Ovary, pregnancy, tumour


How to cite this article:
Samaila M, Adesiyun A G, Yusufu L. Ovarian pregnancy presenting as ovarian tumour: Report of 2 cases. Ann Afr Med 2007;6:36-8

How to cite this URL:
Samaila M, Adesiyun A G, Yusufu L. Ovarian pregnancy presenting as ovarian tumour: Report of 2 cases. Ann Afr Med [serial online] 2007 [cited 2014 Oct 31];6:36-8. Available from: http://www.annalsafrmed.org/text.asp?2007/6/1/36/55731


   Introduction Top


Ovarian pregnancy, a form of ectopic gestation with a distinct pathology, can be a source of diagnostic difficulty clinically and intraoperatively.[1] It shares similarity of presenting symptoms with other forms of extrauterine or ectopic pregnancy and ovarian tumours.[4],[5]

A total of 71 ectopic pregnancies and 173 cases of ovarian lesions were seen in the Department of Pathology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, from January 2001 to December 2005. Of these only two were ovarian ectopic pregnancies. This is a report of 2 ovarian pregnancies, mistaken clinically for tumours.

Case reports

Case 1: A 32year old nulliparous woman presented with a 4months history of lower abdominal pains and 6months history of irregular menstruation. Ultrasounography revealed right ovarian pregnancy which was removed at laparotomy. She had a right salpingo-oophorectomy.

Grossly, a globular mass measuring 12x9cm and weighing 190g was seen. Parts of a well formed foetal skull and upper limbs protruded through a rupture in the mass. Part of tubal fimbria attached to the mass was also seen. Cut sections of the mass showed areas of haemorrhage and cystic dilations. Histology showed chorionic villi of varying sizes within ovarian stroma, extensive haemorrhage and corpus luteum [Figure 1].

Case 2: A 27year old nulliparous woman presented with a six months history of right lower abdominal pains and regular menstruation. Investigations revealed a right ovarian mass which was considered a teratoma. At laparotomy, the mass which was still suspected to be a tumour was excised along with the right  Fallopian tube More Details.

Grossly, the ovary was enlarged and grey tan in appearance. It measured 8.5x6.5cm and weighed 120g. A small cyst and part of the fallopian tube fimbria was adherent to the ovarian wall. Cut sections showed grey and dark areas and a well formed foetus with macerated head and a crown rump length of 70mm consistent with three and half lunar months gestation[Figure 2] and [Figure 3]. Histology showed chorionic villi within and in continuity with ovarian stroma, areas of haemorrhage and corpus luteum.


   Discussion Top


Ovarian pregnancy results from the fertilization of a trapped ovum within the follicle or corpus luteum at the time of rupture.[4],[6] Implantation within the ovarian stroma is aided by secretions of the corpus luteum. The fertilized ovum undergoes development with formation of placental tissue, amniotic sac and fetus.[6] However, normal implantation occurs within the uterine cavity.

The incidence of ectopic gestation is 4.5/1000 - 16.8/1000 pregnancies.[4],[7] Tubal pregnancy with an incidence rate of 1/200 - 1/300 pregnancies is the commonest form. [4],[8] The incidence of ovarian pregnancy ranges from 1/6000 - 1/40,000 pregnancies.[9],[10] Ovarian pregnancy constitute 0.5% to 6% of all ectopic pregnancy, 1: 3000 of live births leading to a mean ovarian pregnancy per year of 1.6.[9],[11],[12],[13] It comprised 1.2% of all ovarian lesions and 2.2% of all ectopic pregnancy in the present report, which compares favourably with other reports.[9],[11],[12],[13]

Ovarian pregnancy may present a clinical and operative diagnostic difficulty. [1],[2],[3] There are no specific clinical, laboratory or ultrasonographic signs to differentiate it from a tubal pregnancy.[9] However, diagnosis should be based on a combination of rise in serum β-human chorionic gonadotrophin (hCG), ultrasonography and laparoscopy.[3],[14]

The macroscopic characteristics of ovarian pregnancy should be helpful in making a laparoscopic or intra-operative diagnosis. These features include an intact fallopian tube and fimbria ovarica clearly separated from the ovary, a gestational sac located within the ovary and connected to the uterus by the ovarian ligament as well as demonstrable ovarian tissue in the sac.[4] Histology remains the only means of confirming diagnosis of ovarian pregnancy with the presence of chorionic villi within and in continuity with ovarian stroma or a corpus luteum.[4],[9],[11]

A good knowledge of the gross pathology, along with imaging and high index of suspicion should help in making an intra-operative diagnosis of ovarian pregnancy.



 
   References Top

1.Schwartz LB, Carcangiu ML, DeCherney AH. Primary ovarian pregnancy. A case report. J Reprod Med 1993;38 :155-158  Back to cited text no. 1      
2.Mathew M, Al-Hinai M. Primary ovarian pregnancy. Saudi Med J 2002; 23:93-95   Back to cited text no. 2      
3.Phupong V, Ultchaswadi P. Primary ovarian pregnancy. J Med Assoc Thai 2005; 88:527-529  Back to cited text no. 3  [PUBMED]    
4.Novak ER, Woodruff JD. Ovarian pregnancy. In: Novak's gynaecology and obstetric pathology with clinical and endocrine relations. Saunders, Philadelphia, 1967; 432-450   Back to cited text no. 4      
5.Stanley JR, Harris AA, Gilbert CF, Dellinger EH. Magnetic resonance imaging in evaluation of a second trimester ovarian twin pregnancy. Obstet Gynecol 1994; 84: 648-652   Back to cited text no. 5  [PUBMED]    
6.Crum CP. The female genital tract. In: Cotran RS, Kumar V, Collins T (eds). Robbin's pathologic basis of disease. Saunders, Philadelphia, 1999;1079-1080  Back to cited text no. 6      
7.Bustos-Lopez HH, Rojas-Poceros G, Barron-Vallajo J, Cintora-Zamadio J, Kably-Ambe A, Valle RF. Conservative laparoscopic treatment of bilateral ectopic pregnancy: 2 case reports and review of the literature. Ginecol Obstet Mex 1998;66:13-17  Back to cited text no. 7      
8.Razcel A, Schachter M, Mordechai E, Friedler J, Panski M, Ron-El R. Ovarian pregnancy-a 12year experience of 19 cases in one institution. Eur J Obstet Gynecol Reprod Biol 2004;114:92-96   Back to cited text no. 8      
9.Kraiem J, Bouden S, Ounaissa F, Falfoul A. Ovarian pregnancy: the situation in 2003. A report of four cases and literature review. Tunis Med 2004;82: 858-866  Back to cited text no. 9      
10.The management of tubal pregnancy. Royal College of Obstetrician and Gynaecologists. RCOG Guideline No 21. RCOG Press, London, 2004  Back to cited text no. 10      
11.Itoh H, Ishihara A, Koita H, et al. Ovarian pregnancy: report of four cases and review of the literature. Pathol Int 2003;53:806-809   Back to cited text no. 11  [PUBMED]  [FULLTEXT]  
12.Ercal T, Cinar O, Mumcu A, Lacin S, Ozer E. Ovarian pregnancy: relationship to an intrauterine device. Aust NZ J Obstet Gynaecol 1997;37: 362-364  Back to cited text no. 12      
13.Razcel A, Mordechai E, Schachter M, Friedler J, Pansky M, Ron-El R. A comparison of the incidence, presentation and management of ovarian pregnancies between two periods of time. J Am Assoc Gynecol Laparosc 2004;11: 191-194  Back to cited text no. 13      
14.Terzi M, Stimec B, Marici S. Laparoscopic management of consecutive ovarian pregnancy in a patient with infertility. Zentralbl Gynakol 2001; 123: 162-164  Back to cited text no. 14      


    Figures

  [Figure 1], [Figure 2], [Figure 3]


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