Accessory Ovary: A rare case
Report
DR.SUJON MAHMUD
MEDICAL OFFICER
INSTITUTE OF NUCLEAR MEDICINE & ALLIED
SCIENCES ,RAJSHAHI
Abstract
• Accessory ovary is a rare gynecologic condition, and tumors arising in
accessory ovaries are extremely rare. Accessory ovary may result from
separation of migrating ovaries during embryogenesis and injuries such as
inflammation and operation on normal ovary. It has various clinical
implications. Removal of this additional ovary tends to stay in dilemma,
because its follicles can be used in the treatment of infertility and it has
malignant potential. Hence, correct diagnosis and prompt decision making
is necessary based on the patient age and parity. We report a case of
incidental finding of an Accessory Ovary in a nulliparous female trying to
conceive with ovulation induction drug.
. Keywords: Accessory ovary, asymptomatic torsion, ectopic ovary, fetal
functional ovarian cyst, laparoscopic surgery
Introduction
Ectopic ovary, either accessory or supernumerary, is
among the rarest gynecologic abnormalities.[1] The
incidence for these abnormalities is estimated to
occur in 1 in 29,000 to 1 in 70,000 gynecologic
admissions.[2] In addition, when limited to infertile
women, incidences for accessory and supernumerary
ovaries are 2 in 3811, respectively.[3]
An accessory ovarian tissue has the
functional and pathological abilities
of normal ovary.[4] We report a case
of an accessory ovary incidentally
discovered during Transvaginal
ultrasound of pelvic organs.
Case report
The case was a, a 25 years old woman, who
came to our center for transvaginal
sonographic examination of her pelvic organs
with history of repeated abortions. She was
married for 6.5 years, nulliparous, regularly
menstruating came to us for TVS to exclude
polycystic ovary due to previous bilateral
prominet and hypoechoic ovaries.
• The patient had history of irregular
menstruation,not conceiving after marriage ,
having total four(4) abortions with gestational
age approximately within 4-6months, of which
one was TWIN and aborted at 20th weeks. She
was in a regular follow up with an infertility
specialist. Her biochemical findings were:
Discussion
• Ectopic ovaries including accessory ovaries and
supernumerary ovaries are very rare gynecological
conditions.[1] The distinction between accessory
ovaries and supernumerary ovaries was defined for
the first time by Wharton.[1] Wharton's criteria for
supernumerary ovary are; the third ovary must
contain ovarian follicle tissue, it must be entirely
separated from normally located ovary, and it must
arise from a separate primordium.[1]
Accessory ovary can be distinguished from
supernumerary ovary by its relationship with
normal ovary,[1] as it is situated near or
connected to normal ovary. It can also be found
attached to the fallopian tube or one of the
various ligamentous structures of the uteroovarian complex.[2]
• The present case can be categorized as
accessory ovary according to Wharton's
criteria.Since there was no history of previous
pelvic disease or surgery, we believe this case
to be a true embryologically ectopic ovary.
Accessory ovary is defined as a third ovary which
has close proximity and some form of association
with eutopic ovary and its blood supply.[2]
The accessory ovaries have both the functional
and pathological potentials of normal
ovaries.[3] There are reports of tumors such as
mature cystic teratoma, serous cystadenoma,
mucinous cystadenoma, Brenner tumor, steroid
cell tumor, sclerosing stromal tumor, and
fibroma arising from accessory ovaries.[3] Thus,
any tumor arising in the normal ovarian tissue
can develop in accessory ovary, although they
are extremely rare in accessory ovary.[3
Suspecting an additional ovarian tissue also plays a
decisive role in the management of certain conditions
where the removal of all of the ovarian tissue is crucial,
such as hormone-dependent neoplasia, preventive
oophorectomy in high-risk women, and radical
treatment of endometriosis. Thus, they should be taken
into consideration in cases where a pelvic mass
presents with normal eutopic ovaries and also vigilantly
looked for in cases of laparotomies.
REFERENCES
1. Wharton LR. Two cases of supernumerary
ovary and one of accessory ovary, with an
analysis of previously reported cases. Am J
Obstet Gynecol. 1959;78:1101–
19. [PubMed] [Google Scholar]
2. Vendeland LL, Shehadeh L. Incidental finding
of an accessory ovary in a 16-year-old at
laparoscopy. A case report. J Reprod
Med. 2000;45:435–8. [PubMed] [Google
Scholar]
3. Chen T, Li J, Yang X, Huang H, Cai S.
Ultrasound manifestations of lobulated
ovaries: Case report. Medicine
(Baltimore) 2018;97:e0550. [PMC free
article] [PubMed] [Google Scholar]
4. Clement PB. Nonneoplastic lesions of the
ovary. In: Kurman RJ, editor. Blaustein's
Pathology of the Female Genital Tract. 5th ed.
New York: Springer Press; 2002. pp. 675–
728. [Google Scholar]