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Paper 3
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
The appearances are consistent with a corpus luteum cyst, they occur in premenopausal women following the release of an ovum and usually involute and resolve if fertilisation does not occur. There are described as thick walled with intense peripheral ‘ring of fire’ vascularity. Sometimes this vascularity can be described in association with ectopic pregnancies; however, these are usually extra-adnexal and not within the ovary. The anechoic, avascular lesions on the contralateral ovary likely represent follicles and are physiological.
Ovarian Ectopic Pregnancy
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Common presenting symptoms of ovarian pregnancy are similar to the classic ectopic pregnancy triad of amenorrhea, irregular bleeding, and abdominal pain [1]. Usual pregnancy symptoms, such as breast tenderness, nausea, and urinary frequency, are commonly present [9]. Less commonly, it presents with dizziness, syncope, hypovolemic shock due to acute intra-abdominal bleeding, or shoulder pain worsened by inspiration, usually caused by phrenic nerve irritation from subdiaphragmatic blood. Some women, however, can be totally asymptomatic [16]. These symptoms can present in early pregnancy conditions such as threatened or missed abortion or hemorrhagic corpus luteum cyst. Moreover, approximately 20% of women with normal pregnancies have early bleeding and/or mild abdominal pain. Of note, pregnancy-unrelated disorders may present with symptoms that mimic ectopic pregnancy, and many of these conditions may coexist concurrently with pregnancy [17, 18].
Ectopic Pregnancy and Pregnancy of Unknown Location
Published in Arianna D'Angelo, Nazar N. Amso, Ultrasound in Assisted Reproduction and Early Pregnancy, 2020
The first case of ovarian pregnancy was reported in 1876 [175]. Women with ovarian pregnancy most commonly present with pelvic pain with or without vaginal bleeding early in gestation due to ovarian tissue invasion by the trophoblastic tissue, while a ruptured ovarian pregnancy can present with severe lower abdominal pain and signs of acute abdomen. These signs and symptoms are similar to tubal ectopic gestation or ruptured hemorrhagic corpus luteum cyst. In one study, two-thirds of ovarian ectopics were diagnosed clinically as hemorrhagic corpus luteum [178–181]. Sonographic features are shown in Box 17.8 [65,139,182–185] (Figures 17. 24–17.26).
Evolution of a corpus luteum cyst: how to avoid a pitfall due to its varying appearance
Published in Journal of Obstetrics and Gynaecology, 2020
Ioannis Tsakiridis, Themistoklis Dagklis
A 26-year-old nulliparous woman attended the emergency gynaecological department complaining of abdominal pain. She reported of an acute pain in the lower abdomen, mostly to the left. The last menstrual period was 14 days before and the woman reported regular cycles of 28–29 days. The pregnancy test taken was negative. The clinical examination showed a mild abdominal tenderness and a possible mass at the left adnexa. The pelvic ultrasound showed there was a cystic structure at the left adnexa, with a maximum diameter of 57 mm, likely corresponding to a corpus luteum cyst containing a blood clot (Figure 1(A)). No blood flow was noted inside the clot using the Doppler and the clot was mobile following slight sudden pressure on the cyst. The woman was reassured and dismissed; however, she returned two days later complaining of a continuing pain. A follow-up scan showed persistence of the cyst which reached a diameter of 61 mm, whereas the clot appeared less prominent (Figure 1(B)). There was no evidence of ovarian torsion and the woman was again dismissed. Five days later, the woman attended again with the same symptoms and the new scan showed persistence of the cyst which reached a diameter of 63 mm, whereas the clot appeared almost solid and much less prominent (Figure 1(C)). Seven days later, the cyst appeared to be slightly smaller (a maximum diameter of 55 mm) and the clot had disappeared (Figure 1(D)). The woman had her next menstrual period the day after. A week later, the cyst measured less than 30 mm with collapsed walls (Figure 1(E)). This sequential scanning revealed the continuous change in appearance of a corpus luteum cyst.
A case of excision of ovarian torsion necrosis due to luteoma in a female who conceived a twin pregnancy through in vitro fertilization misdiagnosed with acute appendicitis
Published in Gynecological Endocrinology, 2022
Lihua Zhu, Dachuan Zhang, Yanjun Yang
The pathological results showed a hemorrhagic corpus luteum cyst with severe interstitial edema of organization and chronic inflammation of the fallopian tube in the right ovary, and the fallopian tube was removed. The luteoma of pregnancy had typical microscopic characteristics, including spare lipid, acidophilic granular cytoplasm, and an unique pattern of reticulum fibers (Figure 2(C)–(E)). The patient, whose abdominal pain was relieved, underwent physical examination on the first day after laparotomy, and there was no obvious uterine contraction. She was treated with anti-inflammatory agents, fluid replacement and fetal protection after surgery.