582
Brief reports
Histoputhology 1992, 21, 582-583
B R I E F REPORT
Supernumerary or ectopic ovary: a case report J . B.McCULLOUGH, A.T.I!VANS & M.P.HOLLEY Departmcnt of Histopathology, Ninewells Hospital and Medical School, Dundee, Scotland. U K Date of submission 2 lune 1992 Accepted for publication 6 Iuly 1992
Keywords: ovary, supernumerary, ectopic
Introduction Supernumerary ovary is an uncommon condition, and it has been suggested that a proportion of cases are related to pelvic inflammation or surgery. We describe a case of supernumerary ovary arising in a woman with a long history of gynaecological problems. During this time she underwent a number of surgical procedures, and the presence of normal pelvic viscera had previously been noted.
Case report The patient, now 27 years old, first presented in 1980 at the age of 1 5 years with irregular periods and intermittent abdominal pain. Her first pregnancy was terminated in 1981 but over subsequent years she underwent investigation for secondary infertility. In 1 9 8 3 she had an appendicectomy having again presented with abdominal pain. The appendix was histologically normal. During this operation mild inflammation involving both Fallopian tubes-was noted but no other abnormality was identified. At a laparoscopy 2 years later, pelvic viscera were considered to be within normal limits. In 1987 she had a further episode of abdominal pain of 5 days duration and at ltaparotomy a ruptured haemorrhagic cyst of the right ovary measuring 6-8 cm diameter was found and removed. Histological examination showed this to be a ruptured corpus luteum cyst. She continued to receive treatment for secondary infertility and subsequently pregnancy was achieved by gamete intra fallopian transfer (GIFT). Her episodes of intermittent abdominal pain appeared to settle following this pregnancy. Address for correspondence: Dr J.B.McCullough,Department of Histopathology, Ninewells Hospital and Medical School, Dundee DD1 9SY. Scotland, UK.
A second termination of pregnancy was performed in 1990, 10 years after her initial presentation. Following this she complained of bleeding per vaginam and deep dyspareunia. A laparotomy with division of adhesions produced little improvement and a total hysterectomy with left salpingo-oophorectomy was carried out. PATHOLOGICAL FINDINGS
The uterus and cervix together measured 8 5 x 5 0 x 3 5 mm and the attached left ovary and Fallopian tube appeared unremarkable. An oval piece of tissue 18 x 8 x 5 mm was identied on the external surface at the junction of uterus and cervix. On histological examination this nodule was found to be a normal ovary which contained primordial follicles and corpora albicantes, consistent with a supernumerary ovary (Figures 1 & 2).
Discussion Supernumerary ovary is a n extremely rare condition and we have found fewer than 2 5 cases reported in the literature. The subject was reviewed by Wharton’, in 1959, who defined it as a third ovary, entirely separate from the normally placed ovaries and apparently arising separately. He regarded this as distinct from accessory ovary which is situated near a normally placed ovary, which may be connected with it and seems to have developed from it. Proposed mechanisms of origin include migratory arrest of germ cells and germinal ridge transplant, i.e. detachment of the cranial part of the germinal ridge following incorporation of gonocytes2. An increased incidence of genitourinary tract abnormalities has been noted in association with supernumerary and accessory ovary3. In a recent review it was noted that almost 50% of cases of supernumerary or accessory ovary have a history of previous pelvic surgery or inflammatory
Brief reports
583
Figure I . Cut surface of tissue found between uterus and cervix showing several cysts.
Figure 2. Full mount H & E section showing ovarian type stroma, follicular cysts and corpora albicantes.
disease, suggesting that some of these cases may be secondary to implantation of ovarian tissue4. It has therefore been suggested that the terms accessory and supernumerary ovary be replaced by ‘ectopic ovary’ followed by some indication as to its origin, for example, embryologic,post-inflammatory or post-surgical. In the case reported here there was a long history of gynaecological problems and several instances of abdominal surgery suggesting origin as implanted ovarian tissue. Indeed, the tissue was not noted at previous laparoscopy or laparotomy and, in particular, the history of a ruptured ovarian cyst may be of significance here. Supernumerary or ectopic ovaries are usually asymptomatic. Whatever their origin they are of interest because they may have the functional capability of a
normal ovary and it should be borne in mind that they may also develop the same range of pathological conditions such as endometriosis and tumours.
References Wharton LR. Two cases of supernumerary ovary and one of accessory ovary, with an analysis of previously reported cases. Am. J. Obstet. Gynaecol. 1959: 78; 1101-1119. Cruikshank S. Supernumerary ovary: embryology. Int. 1. Gynecol. Obstet. 1990: 34; 175-178. Cruikshank S. Van Due DM. Supernumerary ovaries: update and review. Obstet. Gynecol. 1982: 6 0 126-129. Lachman MF. Berman MM. The ectopic ovary. Arch. Pathol. Lab. Med. 1991: 115; 233-235.
Brief reports
Histoputhology 1992, 21, 582-583
B R I E F REPORT
Supernumerary or ectopic ovary: a case report J . B.McCULLOUGH, A.T.I!VANS & M.P.HOLLEY Departmcnt of Histopathology, Ninewells Hospital and Medical School, Dundee, Scotland. U K Date of submission 2 lune 1992 Accepted for publication 6 Iuly 1992
Keywords: ovary, supernumerary, ectopic
Introduction Supernumerary ovary is an uncommon condition, and it has been suggested that a proportion of cases are related to pelvic inflammation or surgery. We describe a case of supernumerary ovary arising in a woman with a long history of gynaecological problems. During this time she underwent a number of surgical procedures, and the presence of normal pelvic viscera had previously been noted.
Case report The patient, now 27 years old, first presented in 1980 at the age of 1 5 years with irregular periods and intermittent abdominal pain. Her first pregnancy was terminated in 1981 but over subsequent years she underwent investigation for secondary infertility. In 1 9 8 3 she had an appendicectomy having again presented with abdominal pain. The appendix was histologically normal. During this operation mild inflammation involving both Fallopian tubes-was noted but no other abnormality was identified. At a laparoscopy 2 years later, pelvic viscera were considered to be within normal limits. In 1987 she had a further episode of abdominal pain of 5 days duration and at ltaparotomy a ruptured haemorrhagic cyst of the right ovary measuring 6-8 cm diameter was found and removed. Histological examination showed this to be a ruptured corpus luteum cyst. She continued to receive treatment for secondary infertility and subsequently pregnancy was achieved by gamete intra fallopian transfer (GIFT). Her episodes of intermittent abdominal pain appeared to settle following this pregnancy. Address for correspondence: Dr J.B.McCullough,Department of Histopathology, Ninewells Hospital and Medical School, Dundee DD1 9SY. Scotland, UK.
A second termination of pregnancy was performed in 1990, 10 years after her initial presentation. Following this she complained of bleeding per vaginam and deep dyspareunia. A laparotomy with division of adhesions produced little improvement and a total hysterectomy with left salpingo-oophorectomy was carried out. PATHOLOGICAL FINDINGS
The uterus and cervix together measured 8 5 x 5 0 x 3 5 mm and the attached left ovary and Fallopian tube appeared unremarkable. An oval piece of tissue 18 x 8 x 5 mm was identied on the external surface at the junction of uterus and cervix. On histological examination this nodule was found to be a normal ovary which contained primordial follicles and corpora albicantes, consistent with a supernumerary ovary (Figures 1 & 2).
Discussion Supernumerary ovary is a n extremely rare condition and we have found fewer than 2 5 cases reported in the literature. The subject was reviewed by Wharton’, in 1959, who defined it as a third ovary, entirely separate from the normally placed ovaries and apparently arising separately. He regarded this as distinct from accessory ovary which is situated near a normally placed ovary, which may be connected with it and seems to have developed from it. Proposed mechanisms of origin include migratory arrest of germ cells and germinal ridge transplant, i.e. detachment of the cranial part of the germinal ridge following incorporation of gonocytes2. An increased incidence of genitourinary tract abnormalities has been noted in association with supernumerary and accessory ovary3. In a recent review it was noted that almost 50% of cases of supernumerary or accessory ovary have a history of previous pelvic surgery or inflammatory
Brief reports
583
Figure I . Cut surface of tissue found between uterus and cervix showing several cysts.
Figure 2. Full mount H & E section showing ovarian type stroma, follicular cysts and corpora albicantes.
disease, suggesting that some of these cases may be secondary to implantation of ovarian tissue4. It has therefore been suggested that the terms accessory and supernumerary ovary be replaced by ‘ectopic ovary’ followed by some indication as to its origin, for example, embryologic,post-inflammatory or post-surgical. In the case reported here there was a long history of gynaecological problems and several instances of abdominal surgery suggesting origin as implanted ovarian tissue. Indeed, the tissue was not noted at previous laparoscopy or laparotomy and, in particular, the history of a ruptured ovarian cyst may be of significance here. Supernumerary or ectopic ovaries are usually asymptomatic. Whatever their origin they are of interest because they may have the functional capability of a
normal ovary and it should be borne in mind that they may also develop the same range of pathological conditions such as endometriosis and tumours.
References Wharton LR. Two cases of supernumerary ovary and one of accessory ovary, with an analysis of previously reported cases. Am. J. Obstet. Gynaecol. 1959: 78; 1101-1119. Cruikshank S. Supernumerary ovary: embryology. Int. 1. Gynecol. Obstet. 1990: 34; 175-178. Cruikshank S. Van Due DM. Supernumerary ovaries: update and review. Obstet. Gynecol. 1982: 6 0 126-129. Lachman MF. Berman MM. The ectopic ovary. Arch. Pathol. Lab. Med. 1991: 115; 233-235.
