A case of massive ovarian edema: Ovarian wedge resection by laparoendoscopic single-site surgery (LESS) resulted in complete remission of hyperandrogenic symptoms

Abstract

Massive ovarian edema is a rare entity and easily mistaken as a malignant neoplasm of ovary. This pseudo-tumor occurs predominantly in young women and its presentation varies from being asymptomatic and to being a cause of acute abdomen, such as ovarian torsion. Polycystic ovary syndrome (PCOS) is characterized by elevated androgen and its pathogenesis is associated with endocrine dysfunction. Here the authors present a young woman who showed typical symptoms and signs of PCOS that was finally diagnosed to have massive ovarian edema by laparoendoscopic single-site surgery (LESS) and disappearance of the symptoms of PCOS after resection of edematous pseudo-tumor. This correlation is thought to be the removal of ovarian edema including large proportion of theca tissue which is responsible for overproduction of androgen in ovarian follicles.A 23-year-old woman, a registered nurse at this facility, visited the gynecologic department complaining of six-month amenorrhea and male pattern pubic hair growth. Initial transvaginal ultrasonography showed polycystic morphology in the left ovary and a large right adnexal solid mass with positive Doppler flows. Magnetic resonance imaging was performed and it revealed enlargement of right ovary measuring 9.3 centimeters in largest diameter, with peripheral displacement of follicles and massive ovarian edema was assumed to be a diagnosis. Operation for confirming diagnosis was decided after discussion with patient, as she was anxious for the uncertainty of the nature of the mass. Frozen section pathology report of right ovarian biopsy suggested cystic follicles with edematous stroma. Operation was ended after resection of the two-thirds of the right ovary that showed marked edematous change, while preserving one-third for future fertility. Final pathology confirmed the frozen biopsy. Her symptoms of PCOS that included irregular menstruation and male pattern pubic hair growth were completely improved after the surgery at six-month follow-up.