PMC8408003_01
Image finding at 1st ER visit and 2nd ER visit. (a, b) Image findings at 1st ER visit. (a) Small amount of ascites on the left side. (b) A left adnexa 3 cm in size, and a small cyst inside that was suspected to be a corpus luteum. (c-e) Image findings at 2nd ER visit. (c, d) There are two-follicular enlargement. (e) A band-like structure between the solid and cystic parts. Arrows are indicated.
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fig1
Small amount of ascites was also observed (Figures 1(a) and 1(b)). The mass had a complex solid cystic structure with a unilocular cyst much larger than solid component (Figure 1(c)). The mass, located on the ventral side of the uterus, showed a weak contrast effect and a separate cystic compartment connected to the solid area with a band-like structure (Figures 1(d) and 1(e)).
Intraoperative findings. (a) Adnexal torsion was observed. (b) Two-follicular enlargement was observed. (c) A band-like structure was observed. (d) Left salpingectomy was performed. Arrows are as indicated.
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On laparoscopic surgery, the whole left adnexa was found to be markedly swollen and twisted to at least 540 degrees (Figure 2(a)). On aspirating fluid from the cystic mass, fimbria-like structure was observed on the surface of cystic mass (Figure 2(b)) suggesting that the cystic mass was a hematosalpinx and the solid mass, an enlarged ovary. A band-like tissue was connected the solid ovary to the fimbria (Figure 2(c)). Considering the young age of the patient and the weak contrast effect seen in CT, the ovary was preserved (Figure 2(d)).
Image findings in postoperative period. (a, b) Ultrasonography findings. (a) An ultrasonography finding on 5th postoperative day. (b) An ultrasonography finding on 28th postoperative day. Arrows: left ovary. (c, d) Pathological findings. (c) Macroscopically, cyst was filled with blood. (d) Microscopically (40x), extensive necrosis and congestion of the cyst wall with some preserved fallopian tube epithelium were observed. Scale bar: 100 mum.
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On the fifth postoperative day, the left ovary measured 62 x 36 mm (Figure 3(a)), and the patient was discharged on the same day. On 28th postoperative day, physical examination was unremarkable, and the left ovary had shrunk to 35 x 29 mm in size (Figure 3(b)). Grossly, the cyst was unilocular, filled with blood, and had no obvious mass lesion (Figure 3(c)). Microscopically, extensive necrosis and congestion of the cyst wall with some preserved fallopian tube epithelium were observed (Figure 3d).