Clinicopathologic Review of Uterine Adnexal Tumor Torsion

Ha, Jun Young; Yang, Hoe Saeng

Abstract

OBJECTIVE
We analyzed the frequency, clinical symptom, physical exam, site and the degree of torsion, ultrasound findings, histological aspects and the relationship between the pregnancy of ovarian torsion in order to help the early detection of the disease and conservation of the ovary.
METHODS
Out of 510 operative cases of adnexal mass patients in Dongguk university hospital from March 1993 to March 2003, 50 histologically confirmed cases of ovarian torsion were selected and retrospectively analyzed.
RESULTS
Operative cases of adnexal mass were 510 including the 42 complicated by pregnancy and out of these, torsion occurred in 50 cases (10%) with 16 pregnancy complication. Clinical features of 50 torsion cases are as follows. The frequencies of uterine adnexal tumor torsion were reported by age, 36 cases (72%) in their twenties and thirties, with 21 (42%) nulliparous women at the highest. 42 (84%) had no previous operative history. On the clinical features and physical exam, in the order of frequency, 48 cases (96%) of lower abdominal pain were the highest, and 42 (84%) of GI symptoms, 11 (22%) of urogenital symptoms, and 4 cases (8%) of vaginal bleeding was noted. Under CBC study, 28 (56%) leukocytosis were reported. And on the ultrasound findings, 46 cases (90%) of tumor with hypertrophic wall were noted, septum existed in 12 cases (24%), and 40 (78%) represented internal shadow of the solid portion. The tumor size between 5 to 9 centimeters were the most with 30 cases (58%), and the sum of torsions with 360 and 720 degrees consisted of 40 (78%), occupying for the most of the cases. 27 (55%) of right side existed compared to the 22 (45%) of left. 42 had no previous transabdominal surgery. In the method of operation, 41 (82%) explorative surgeries and 9 cases (18%) of laparoscopic surgery was done, and 5 of these were conservative (12%). The necrosis was noted in 44 cases, and internal bleeding was present in 39 cases. Histologically, functional cyst consisted highest in numbers with 25 (49%), where benign neoplasm with 22, and one malignant neoplasm. About relationship with pregnancy, 9 cases (56%) of corpus luteal cyst were the most. Outcome of the pregnancy was 9 (56%) full term deliveries, 2 abortions (12%), and 1 (6%) preterm delivery.
CONCLUSION
Ovarian torsion should be considered when women in between their twenties and thirties with abrupt onset of lower abdominal pain along with nausea and vomiting, leukocytosis, and 5 to 9 cm sized cystic mass with the wall hypertrophy present in ultrasound. Immediate and accurate diagnosis and treatment should follow.