A case report and review of literature on torsion of the pedicle of ovarian cyst

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Abstract: in this paper, we report a case of misdiagnosis of ovarian cyst and discuss the histogenesis, diagnosis and treatment.Keyword: lit


Abstract: in this paper, we report a case of misdiagnosis of ovarian cyst and discuss the histogenesis, diagnosis and treatment.

Keyword: literature review of the crown cyst

One of the most common ovarian cyst crown female non genital cystic mass, it is easily confused with ovarian cyst itself, because it is cystic, slow growth and low tension, activity, generally no symptoms, often found in the gynecological examination, doctors consider ovarian neoplastic the preoperative cyst, often misdiagnosed [1]. The cyst is located between the ovary and the fallopian tube, with the pedicle cyst and the cyst of the broad ligament. In this paper, 1 cases of ovarian cyst were misdiagnosed, and the histogenesis, diagnosis and treatment were discussed.

Case introduction

Patient Tian Moumou, 38 years old, hospitalized number of 70111, the main cause of ovarian cysts found more than 2 years, sudden abdominal pain for up to 6 hours, an increase of 3 hours in the 2004-8-14 by the clinic to ovarian cyst pedicle twist?" Income home. 2 years ago were found to have ovarian cyst, without treatment, August 14th: pelvic ultrasound scan showed a 7.9cm * 8.1cm * 5.4cm echo free zone, reported as pelvic cyst. PV: right and accessories can be a 7cm size mass and tenderness. The admission showed acute tolerance, severe pain, lower abdomen, nausea and vomiting, vomit for stomach contents, with sweat, no vaginal bleeding. PE:BP:105/70mmHg, P:84 /min, muscle tension, tenderness and rebound tenderness (+) and (-) shifting dullness. Patients with previous menstrual regularity, LMP2004- 8-2, diagnosed as torsion of ovarian cyst pedicle? Based on actively improve the relevant laboratory examination on anesthesia laparotomy immediately under continuous epidural anesthesia, intraoperative see right fallopian tube and parovarian cyst torsion for 2 weeks, a dark purple, lost egg length of 14cm, ovarian cyst crown about 7cm * 6cm * 5cm size 3cm * 4cm * 3cm about ovarian size, surface scattered in purple blue spots. To bend with two pliers parovarian cyst after restoration of ligaments rotation to the normal anatomical structure observation, right ovary soon returned to normal ruddy color, good blood supply, no signs of necrosis, considering the age of the patients is light, so to retain ovarian resection of parovarian cyst excision, pathology. The operation was successful, and the patient returned to the hospital after the operation. Postoperative pathological return: (right) crown cyst.

Two, discussion

The source and 1 malignant ovarian cyst crown tissue: parovarian cyst is a benign non neoplastic tumor, endoscopic examination for mesothelial type, paramesonephric duct type and three type tubular [2]. Liu Guixin reported 117 cases of parovarian cyst with mullerian origin rare, from the mesonephric duct accounted for only 25 cases of [3]. Wang believes that the [4] female mesonephric about embryo sixth 8 weeks of degradation, only in the broad ligament, fallopian tube and ovary and uterus and vagina left lateral residual tissue remains, for the development of parovarian cyst. Mesonephric adenoid structure residual small diameter, epithelial secretion and peripheral muscle layer is solid, stationary state, which is less likely to develop ovarian cyst crown. However, [5] is not uncommon in the literature. Some scholars put forward the parovarian cyst from the fallopian tube or embryo remnants can be observed with oviductal epithelial like cilia and ciliated [6 from micro, light microscope and electron microscope in 7]; the coelomic epithelium and metaplasia of mesothelial cells in the formation of [8]. Some authors suggest that the clinical diagnosis of [5] is more reasonable.

Parovarian cyst is benign tumor, slow growth, a small part of papillary hyperplasia, cavity or canceration, but rare malignancy. Reported that [9] in some cases can have canceration, and even the formation of substantial tumor.

2 misdiagnosis rate of ovarian cyst and misdiagnosis reasons: preoperative diagnosis rate of ovarian cyst is low, it is easy to be misdiagnosed. Huang's [11] was used in 45 cases, the misdiagnosis rate was 80.9%. 45 cases of Lee [12] statistics, the misdiagnosis rate of 100%. And the statistics of [13] in 58 cases, the misdiagnosis rate was 81%.

The causes of misdiagnosis, is a lack of attention to the ovarian cyst crown: most physicians believe that ultrasound examination showed adnexal cysts or lumps, usually for benign lumps, easy to make a diagnosis of ovarian cyst; two parovarian cyst tubal, ovarian position and close, and similar redundant ovarian cyst, in gynecology when the check is not easy to identify is parovarian cyst, when the cyst is large, is not generally considered as parovarian cyst, especially in postmenopausal women or the occurrence of acute abdomen. The cases of parovarian cyst patients come for treatment because of gynecological acute abdomen, and B ultrasound and gynecological examination support, so the diagnosis of ovarian cyst, to be diagnosed only after laparotomy.

3 the diagnosis of ovarian cyst: ovarian cyst has the following characteristics: (1) the ovary is completely separate from the cyst. (2) the cystic wall was thin and translucent, vascular network and broad ligament cyst wall itself vascular network like cross overlap, depth of two small vascular network. (3) the top of the cyst is usually attached to a flat and elongated fallopian tube. Huang [11] proposed from the following aspects: to improve the diagnostic rate (L) of unilateral or bilateral cystic, smooth surface, spherical or oval lumps, larger, especially reach normal ovary, should be highly suspected of parovarian cyst; (2) the simple cystic mass, ultrasound check should be carefully checked the ipsilateral normal ovary echo; (3) ovarian cyst crown activity, tumor pedicle is large, prone to torsion.

Diagnosis of ovarian cyst crown except with doctor's clinical experience, ultrasound examination is simple economy, no pain, should carefully check the ipsilateral normal ovarian echo on simple cystic mass; laparoscopy can confirm the diagnosis, but also can do the treatment, diagnosis and treatment of this disease has broad application prospects.

Treatment of 4 ovarian cyst crown: the treatment of ovarian cyst crown are the following: (1) the expectant therapy: for some of the smaller cysts do not stay cyst treatment, surgical treatment was slightly larger, but should be charged with clinical follow-up, to prevent torsion; (2) abdominal surgery: according to the age of patients, fertility and complications of operation method, no complications in particular have fertility requirements, should be simple cystectomy, the elderly can remove the side attachment, but no necessary hysterectomy; (3) interventional therapy: through abdominal or vaginal B ultrasound guided puncture in extraction of cystic. In the liquid medicine injection, can achieve good results. In 12 patients with [14]250, the abdominal wall was punctured under the guidance of abdominal probe, and the puncture was performed successfully in all the cases, and the puncture was performed successfully in 38 cases. The cystic fluid pathology showed no abnormalities. (4) laparoscopic treatment: laparoscopy has been widely used in clinic because of its advantages of minimally invasive surgery and diagnosis and treatment.

5 the rate of torsion and prevention of the cyst of the ovary: the [11] torsion rate was 14.3%. And that [13] because of parovarian cyst activity, tumor pedicle is long, prone to torsion, torsion was 13.8%. Lee [14] collected 125 cases of clinical statistics torsion rate was 4.8%, the preoperative diagnosis of ovarian cyst pedicle torsion.

In order to reduce the incidence of pedicle torsion, we should improve the understanding of the cyst of the ovary and the operation of some patients who have the operation indication.

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