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Congenital absence of an ovary in a Nigerian woman
Int. J. Gynecol. Obstet., 1989; 29: 311-318 International Federation of Gynecology and Obstetrics
Congenital
absence of an ovary in a Nigerian woman
F.O. Dare, 0.0.
Makinde,
O.N. Makinde
and R. Odutayo
Lkpartment of Obstetrics and Gynecology, Obqfemi A wolowo University Teaching Hospital, lie-lfe (Nigeria} (Received August 1st. 1988) (Accepted September 13th, 1988)
Abstract A case of unilateral absence of the left ovary in a 45year-old grand multiparous Nigerian woman is reported. Congenital absence of a gonad is extremely rare and it indicates a genetic or chromosomal error in the formation of the urogenital ridge. Keywords: Ovary; Absence; Congenital Introduction Rudimentary ovaries which are functionless or cease to function at early age have been described in the past. These now come under the headings of streak gonads and gonadal dysgenesis and are usually associated with errors in the sex chromosome pattern [ 1,2]. Also an ovary is occasionally parasitic to the omentum or other intra-abdominal structures and is completely separate from its normal attachment. The condition is caused by torsion of ovarian pedicle [3,4]. However, unilateral absence of the ovary as found in this woman is extremely rare [ 1,4]. Case report
Mrs. 0.1. was 45 years old, para 8 + 1 (7 0020-7292/89/$03
SO
0 1989 International Federation of Gynecology and Obstetrics Published and Printed in Ireland
alive), her last menstrual period was on July 31st, 1987. She was referred from the State Health Centre, Sabo, Ile-Ife on February 22nd, 1988 with a history of irregular vaginal bleeding with clots since July 31st, 1987. Prior to her presentation, she had had a dilatation and curettage performed by the referring doctor for the above complaints with no improvement. Clinically, she was pale, afebrile and not jaundiced. The pulse was 82/min and the blood pressure was 130/80 mmHg. The chest was clinically clear and the abdomen normal. The vaginal walls were normal. The cervical OS was healthy and closed with slight blood coming from the OS. The uterus was consistent with 10 weeks size gestation irregular, firm and anteverted. Both adnexae were normal. A provisional diagnosis of uterine fibroid was made, possibly complicated by endometrial carcinoma. The packed cell volume was 24%. Serum electrolytes and urea were normal. Blood group was 0 positive and the chest X-ray was normal. She was transfused with two units of whole blood. Fractional dilatation and curettage of the uterus was done on February 24th, 1988 and histological examination showed a normal cervical epithelium and a proliferative endometrium. She subsequently had a total abdominal hysterectomy and right Case Report
378
Lkve et al.
salpingo-oophorectomy done on March 9th, 1988. The operative findings were as follows: bulky uterus with multiple fibroids; right ovarian cyst measuring 3 x 4 cm; normal fallopian tubes and absence of the left ovary. There was no ectopic gonad in the pelvis or abdominal cavity. Histology report confirmed intramural fibroids, normal fallopian tubes and degenerating right corpus albican cyst. Discussion A case of unilateral absence of the left ovary in a grand-multiparous patient is reported. This is an extremely rare condition ~41. According to Gilman [5], the gonad is embryologically of triplet origin from celomic epithelium of the genital ridge, the underlying mesoderm and the primitive germ cells which arise from the endoderm of the yolk sac [6,7]. Abnormalities of the ovary could arise from imperfect development of the primitive gonad due to failure of migration of germ cells into it and probably on genetic features as well 111. It was quite interesting to note that the fer-
Znt J Gynecol Obstet 29
tility in this woman was not impaired despite the presence of only one ovary. References Jeffcoate N: Absence or underdevelopment of the ovary. In Principles of Gynaecology, 4th edn, pp 145-146. Butterworth, UK, 1975. Daw E: Absence of an ovary and uterine tube - further evidence for the torsion theory. J Obstet Gynaecol 7: 70, 1986. Novak ER, Geogeanna SJ, Howard J: Development of the ovary. In Novak’s Textbook of Gynaecology, 9th edn, pp 126-132. Williams& Wilkins. Baltimore, MD, 1975. Sirigena LAW: Unexplained absence of an ovary and uterine tube. Postgrad Med J 54: 423,1978. Gilman J: Development of the gonads in man, with consideration of the role of fetal endocrines and the histogenesis of ovarian tumour. Contrib Embryo1 32: 81,1948. Wischi E: Migration of the germ cells of human embryos from yolk sac to the primitive gonadal folds. Contrib Embryo1 32: 67.1948. Pinkerton JHM, Hickay DG, Adams EL and Henry AH: Gynaecol NY 18: 152, l%l. Address for reprints: F.O. Dare Department of Obstetrics and Gynecology Obnfemi Awolowo University Teaching Hospitals Complex P.M.B. 5538 Ile-lfe, Oyo State Nigeria
Congenital
absence of an ovary in a Nigerian woman
F.O. Dare, 0.0.
Makinde,
O.N. Makinde
and R. Odutayo
Lkpartment of Obstetrics and Gynecology, Obqfemi A wolowo University Teaching Hospital, lie-lfe (Nigeria} (Received August 1st. 1988) (Accepted September 13th, 1988)
Abstract A case of unilateral absence of the left ovary in a 45year-old grand multiparous Nigerian woman is reported. Congenital absence of a gonad is extremely rare and it indicates a genetic or chromosomal error in the formation of the urogenital ridge. Keywords: Ovary; Absence; Congenital Introduction Rudimentary ovaries which are functionless or cease to function at early age have been described in the past. These now come under the headings of streak gonads and gonadal dysgenesis and are usually associated with errors in the sex chromosome pattern [ 1,2]. Also an ovary is occasionally parasitic to the omentum or other intra-abdominal structures and is completely separate from its normal attachment. The condition is caused by torsion of ovarian pedicle [3,4]. However, unilateral absence of the ovary as found in this woman is extremely rare [ 1,4]. Case report
Mrs. 0.1. was 45 years old, para 8 + 1 (7 0020-7292/89/$03
SO
0 1989 International Federation of Gynecology and Obstetrics Published and Printed in Ireland
alive), her last menstrual period was on July 31st, 1987. She was referred from the State Health Centre, Sabo, Ile-Ife on February 22nd, 1988 with a history of irregular vaginal bleeding with clots since July 31st, 1987. Prior to her presentation, she had had a dilatation and curettage performed by the referring doctor for the above complaints with no improvement. Clinically, she was pale, afebrile and not jaundiced. The pulse was 82/min and the blood pressure was 130/80 mmHg. The chest was clinically clear and the abdomen normal. The vaginal walls were normal. The cervical OS was healthy and closed with slight blood coming from the OS. The uterus was consistent with 10 weeks size gestation irregular, firm and anteverted. Both adnexae were normal. A provisional diagnosis of uterine fibroid was made, possibly complicated by endometrial carcinoma. The packed cell volume was 24%. Serum electrolytes and urea were normal. Blood group was 0 positive and the chest X-ray was normal. She was transfused with two units of whole blood. Fractional dilatation and curettage of the uterus was done on February 24th, 1988 and histological examination showed a normal cervical epithelium and a proliferative endometrium. She subsequently had a total abdominal hysterectomy and right Case Report
378
Lkve et al.
salpingo-oophorectomy done on March 9th, 1988. The operative findings were as follows: bulky uterus with multiple fibroids; right ovarian cyst measuring 3 x 4 cm; normal fallopian tubes and absence of the left ovary. There was no ectopic gonad in the pelvis or abdominal cavity. Histology report confirmed intramural fibroids, normal fallopian tubes and degenerating right corpus albican cyst. Discussion A case of unilateral absence of the left ovary in a grand-multiparous patient is reported. This is an extremely rare condition ~41. According to Gilman [5], the gonad is embryologically of triplet origin from celomic epithelium of the genital ridge, the underlying mesoderm and the primitive germ cells which arise from the endoderm of the yolk sac [6,7]. Abnormalities of the ovary could arise from imperfect development of the primitive gonad due to failure of migration of germ cells into it and probably on genetic features as well 111. It was quite interesting to note that the fer-
Znt J Gynecol Obstet 29
tility in this woman was not impaired despite the presence of only one ovary. References Jeffcoate N: Absence or underdevelopment of the ovary. In Principles of Gynaecology, 4th edn, pp 145-146. Butterworth, UK, 1975. Daw E: Absence of an ovary and uterine tube - further evidence for the torsion theory. J Obstet Gynaecol 7: 70, 1986. Novak ER, Geogeanna SJ, Howard J: Development of the ovary. In Novak’s Textbook of Gynaecology, 9th edn, pp 126-132. Williams& Wilkins. Baltimore, MD, 1975. Sirigena LAW: Unexplained absence of an ovary and uterine tube. Postgrad Med J 54: 423,1978. Gilman J: Development of the gonads in man, with consideration of the role of fetal endocrines and the histogenesis of ovarian tumour. Contrib Embryo1 32: 81,1948. Wischi E: Migration of the germ cells of human embryos from yolk sac to the primitive gonadal folds. Contrib Embryo1 32: 67.1948. Pinkerton JHM, Hickay DG, Adams EL and Henry AH: Gynaecol NY 18: 152, l%l. Address for reprints: F.O. Dare Department of Obstetrics and Gynecology Obnfemi Awolowo University Teaching Hospitals Complex P.M.B. 5538 Ile-lfe, Oyo State Nigeria