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Infertility, bilateral multicystic serous cystadenoma and pregnancy
RBMOnline - Vol 17. No 2. 2008 268-269 Reproductive BioMedicine Online; www.rbmonline.com/Article/3486 on web 25 June 2008
Images Article Infertility, bilateral multicystic serous cystadenoma and pregnancy Yariv Gidoni, Togas Tulandi1 Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada 1 Correspondence: [email protected]
Abstract This article presents a case of bilateral and multicystic serous cystadenoma that appears to return immediately after complete excision of the cysts. Its presence did not impair ovarian response to FSH stimulation, or the occurrence of pregnancy and delivery. Keywords: cystadenoma, images, ovarian cysts
Description Transvaginal sonography (TVS) carried out on a 30-year-old woman with 1 year of primary infertility revealed bilateral multiloculated ovarian cysts measuring 6 × 6 × 6 cm3 on the right side and 6 × 8 × 5 cm3 on the left (Figure 1). On laparoscopy, both ovaries were multicystic and mobile, with a smooth surface. The Fallopian tubes were normal and patent, and the remaining abdominal organs including the liver and diaphragm were within normal limits. The cysts were enucleated intact from both ovaries, and placed in an endoscopic pouch prior to removal from the abdominal cavity. There was no spillage of the cyst contents. The ovaries at the completion of the procedure were normal-looking and devoid of any cysts. Peritoneal cytology was negative, and histopathological examination of both ovarian cysts revealed
268
Figure 1. Transvaginal sonography carried out on a 30-yearold woman with 1 year of primary infertility revealed bilateral multiloculated ovarian cysts.
serous cystadenoma. About 4 weeks after the surgery, another TVS was performed prior to treatment of her infertility, on day 3 of the first menstrual cycle. To our surprise, bilateral multiloculated ovarian cysts were seen again; the right ovary measured 4.5 × 2.6 × 3.3 cm3, and the left 4.5 × 3.1 × 3.6 cm3 (Figure 2). Doppler study was negative. A gynaecological oncologist was consulted, who recommended close follow-up and an attempt to conceive. The patient underwent ovulation induction with follicle stimulating hormone (FSH) and was treated with intrauterine insemination. She conceived in the first cycle, and subsequently delivered a healthy boy at term. TVS examination 8 weeks after the delivery revealed the same bilateral multiloculated ovarian cysts.
Figure 2. Transvaginal sonography carried out on the same patient 4 weeks after surgery to remove the cysts. Cysts had reappeared but were smaller than before.
© 2008 Published by Reproductive Healthcare Ltd, Duck End Farm, Dry Drayton, Cambridge CB3 8DB, UK
Images article - Infertility, bilateral multicystic serous cystadenoma and pregnancy - Y Gidoni & T Tulandi
Comments Benign serous cystadenomata are common, accounting for 25% of all benign ovarian neoplasms. They usually appear as a unilocular, thin-walled cyst filled with fluid. In 90% of cases, the cyst is found unilaterally (Adams, 2007). In contrast, our patient presented with bilateral and multicystic serous cystadenoma. In addition, it appears that it returned immediately after complete excision of the cysts. Serous cystadenomata have potential for malignant transformation. However, most patients with low malignant potential have the same survival rate as the age-matched controls (Trimble and Trimble, 1994). The presence of serous
cystadenoma in our patient did not impair ovarian response to FSH stimulation, or the occurrence of pregnancy and delivery. In any event, the presence of a persistent ovarian cyst should be investigated, and its nature should be confirmed by histopathological examination.
References Adams PJH 2007 Benign diseases of the female reproductive tract. In: Berek JS (ed.) Berek and Novak’s Gynecology, 14th edn. Lippincott Williams and Wilkins, Philadelphia, pp. 432–497. Trimble CL, Trimble EL 1994 Management of epithelial ovarian tumours of low malignant potential. Gynecologic Oncology 55, S52–S61.
269 RBMOnline®
Images Article Infertility, bilateral multicystic serous cystadenoma and pregnancy Yariv Gidoni, Togas Tulandi1 Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada 1 Correspondence: [email protected]
Abstract This article presents a case of bilateral and multicystic serous cystadenoma that appears to return immediately after complete excision of the cysts. Its presence did not impair ovarian response to FSH stimulation, or the occurrence of pregnancy and delivery. Keywords: cystadenoma, images, ovarian cysts
Description Transvaginal sonography (TVS) carried out on a 30-year-old woman with 1 year of primary infertility revealed bilateral multiloculated ovarian cysts measuring 6 × 6 × 6 cm3 on the right side and 6 × 8 × 5 cm3 on the left (Figure 1). On laparoscopy, both ovaries were multicystic and mobile, with a smooth surface. The Fallopian tubes were normal and patent, and the remaining abdominal organs including the liver and diaphragm were within normal limits. The cysts were enucleated intact from both ovaries, and placed in an endoscopic pouch prior to removal from the abdominal cavity. There was no spillage of the cyst contents. The ovaries at the completion of the procedure were normal-looking and devoid of any cysts. Peritoneal cytology was negative, and histopathological examination of both ovarian cysts revealed
268
Figure 1. Transvaginal sonography carried out on a 30-yearold woman with 1 year of primary infertility revealed bilateral multiloculated ovarian cysts.
serous cystadenoma. About 4 weeks after the surgery, another TVS was performed prior to treatment of her infertility, on day 3 of the first menstrual cycle. To our surprise, bilateral multiloculated ovarian cysts were seen again; the right ovary measured 4.5 × 2.6 × 3.3 cm3, and the left 4.5 × 3.1 × 3.6 cm3 (Figure 2). Doppler study was negative. A gynaecological oncologist was consulted, who recommended close follow-up and an attempt to conceive. The patient underwent ovulation induction with follicle stimulating hormone (FSH) and was treated with intrauterine insemination. She conceived in the first cycle, and subsequently delivered a healthy boy at term. TVS examination 8 weeks after the delivery revealed the same bilateral multiloculated ovarian cysts.
Figure 2. Transvaginal sonography carried out on the same patient 4 weeks after surgery to remove the cysts. Cysts had reappeared but were smaller than before.
© 2008 Published by Reproductive Healthcare Ltd, Duck End Farm, Dry Drayton, Cambridge CB3 8DB, UK
Images article - Infertility, bilateral multicystic serous cystadenoma and pregnancy - Y Gidoni & T Tulandi
Comments Benign serous cystadenomata are common, accounting for 25% of all benign ovarian neoplasms. They usually appear as a unilocular, thin-walled cyst filled with fluid. In 90% of cases, the cyst is found unilaterally (Adams, 2007). In contrast, our patient presented with bilateral and multicystic serous cystadenoma. In addition, it appears that it returned immediately after complete excision of the cysts. Serous cystadenomata have potential for malignant transformation. However, most patients with low malignant potential have the same survival rate as the age-matched controls (Trimble and Trimble, 1994). The presence of serous
cystadenoma in our patient did not impair ovarian response to FSH stimulation, or the occurrence of pregnancy and delivery. In any event, the presence of a persistent ovarian cyst should be investigated, and its nature should be confirmed by histopathological examination.
References Adams PJH 2007 Benign diseases of the female reproductive tract. In: Berek JS (ed.) Berek and Novak’s Gynecology, 14th edn. Lippincott Williams and Wilkins, Philadelphia, pp. 432–497. Trimble CL, Trimble EL 1994 Management of epithelial ovarian tumours of low malignant potential. Gynecologic Oncology 55, S52–S61.
269 RBMOnline®