Ovarian remnant syndrome at the port site

Branch of Obstetrics and Gynecology, Dou-Liou Branch of National Cheng Kung University Hospital, Yunlin, Taiwan.
Journal of Minimally Invasive Gynecology (Impact Factor: 1.83). 07/2008; 15(4):505-7. DOI: 10.1016/j.jmig.2008.04.007
Source: PubMed


Ovarian remnant syndrome is a rare gynecologic complication, mostly induced by difficult salpingo-oophorectomy with the residual ovarian tissue on the pelvic side wall. This is a report of a rare case of ovarian remnant syndrome at a port site after laparoscopic oophorectomy and a review of the related literature. A 22-year-old virgin had a laparoscopic oophorectomy for an endometrioma 5 years earlier. Postoperatively, she visited gynecologic clinics for a frequent painful sensation at the left port site. After sonographic examination and under the impression of a recurrent endometrioma, laparotomy and cyst excision were performed. Surprisingly, ectopic ovary was diagnosed by the pathologist. Review of the literature revealed ovarian remnant implantation at a port site as a very rare type of ovarian remnant syndrome. During laparoscopic oophorectomy in a woman without sexual exposure who is not a good candidate for culdotomy, the removal of the excised ovary through the port site is sometimes difficult and residual ovarian tissue implantation may occur. There are many methods to reduce the risk of port-site seeding, which we must keep in mind and execute to prevent such a complication.

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    • "The incidence of ORS and the subsequent development of malignancies have increased. This may be due to the increasing numbers of laparoscopic oophorectomies that are being performed (8,9,11–13). "
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    ABSTRACT: Ovarian remnant syndrome (ORS) is a rare, but well-known gynecological complication, most often induced by difficult bilateral salpingo-oophorectomy (BSO) procedures that leave residual ovarian tissue on the pelvic wall. The most common preexisting conditions for this complication include endometriosis, pelvic inflammatory disease and prior abdominal surgery. The residual ovarian tissue may eventually cause malignant development. A total of 12 cases of malignant and benign tumors (clear cell adenocarcinoma in 1 case, mucinous-type tumors in 2, endometrioid-type tumors in 5, adenocarcinoma in 3 and border serous neoplasia in 1) and 21 benign cysts developing from an ovarian remnant have been described in the literature to date. Endometriosis, known to increase the risk of ovarian cancer, predisposes patients to ORS, with an incidence rate of 30 to 50% in ORS patients with ovarian carcinoma. Although the true incidence of ORS remains unknown, when endometriotic adhesions are diagnosed during BSO, the possibility of ORS and subsequent ovarian malignant transformation may mandate complete surgical resection.
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    ABSTRACT: Ovarian remnant syndrome (ORS), a rare condition in which remnant ovarian tissue presents as a pelvic mass and/or pain after previous oophorectomy, poses a diagnostic and treatment challenge. This study reviews the recent studies in the past 5 years on the subject. Incomplete removal of ovarian tissue at the time of initial oophorectomy from inability to obtain adequate surgical margins or inappropriate extraction from the pelvic cavity during laparoscopy can cause ORS. Excision of ovarian remnant tissue is increasingly approached minimally invasively. Cases of malignant involvement of the remnant ovary have been reported. Endometriosis, recently suggested to increase the risk for ovarian cancer, predisposes to ORS and is associated with 50% of patients with ovarian carcinoma in ORS patients. Surgical excision remains the treatment of choice in ORS as malignancy can be associated with the remnant tissue. In cases of endometriosis, complete excision of endometriosis and ovarian tissue at the time of initial surgery prevents recurrence of endometriosis, subsequent development of ORS and possible ovarian malignant transformation.
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