PMC9790169_01
Ultrasonography revealed a solid mass (7.0 cm x 4.0 cm) containing cystic portion (A) without blood flow (B).
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The mass considered as an enlarged right ovary was characterized by central edema and peripherally displaced follicles (Figure 1A). There was no blood flow in the mass (Figure 1B) and tenderness appeared on the transducer pressure.
On pelvic magnetic resonance imaging (MRI), the patient had an intrauterine pregnancy (red asterisk) and a normal looking 5cm sized left ovary on T2-weighted image without (A) and with (B) fat saturation (white eclipse). Instead of a normal right ovary, a 7cm sized edematous mass (yellow eclipse) with low signal intensity on T2-weighted image without (C) and with (D) fat saturation was seen on the right side of the uterus, which was suspected to be right ovarian torsion.
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Pelvic magnetic resonance imaging (MRI) revealed an intrauterine pregnancy and 5 cm sized normal-looking left ovary (Figure 2A and B). Instead of the normal right ovary, a 7 cm edematous mass with low signal intensity was observed on the right lateral side of the uterus on T2-weighted imaging, suggesting right ovarian torsion (Figure 2C and D).
Initial laboratory studies (Day 1 of admission) revealed elevated levels of white blood cell counts (WBCs) (13,200/microL), segmented neutrophile percent (81.6%), neutrophile-to-lymphocyte ratio (NLR) (6.6), but C-reactive protein (CRP) (0.28 mg/dL) was within normal range. On day 2 of admission, the patient's symptoms worsened with acute elevation in CRP (4.55 mg/dL) and NLR (10.1), and uterine contractions (A) were not controlled. After operation, blood test results improved, and uterine contractions disappeared (B).
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One day after admission (Day 2 of admission), the patient's symptoms worsened with acute elevation in CRP (4.55 mg/dL) and NLR (10.1) (Figure 3), despite the use of analgesics, antibiotics and tocolytics, and uterine contractions were not controlled (Figure 3A). After laparoscopic myomectomy, her laboratory results were improved, and her abdominal pain and uterine contraction disappeared (Figure 3B).
During laparoscopy, a subserosal pedunculated myoma (yellow asterisk) was found in a state of torsion, with complete necrosis at its pedicle (red asterisk) on the right side of the uterus (A). Hematoxylin and eosin stain of specimen showed well demarcated spindle cell (arrowhead) tumor with infarction (black arrow) and hemorrhage (white arrow) (B).
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Contrary to expectations, during laparoscopy, a pedunculated subserosal myoma was revealed in the torsion state with complete necrosis on the right side of the uterus (Figure 4A). Hematoxylin and eosin stain of specimen showed well demarcated spindle cell tumor with infarction and hemorrhage (Figure 4B).