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LETTER TO EDITOR Table of Contents   
Year : 2010  |  Volume : 53  |  Issue : 1  |  Page : 180-181
Unilateral absence of uterine adnexa


1 Department of Pathology, Kasturba Medical College Mangalore, Karnataka, India
2 Department of Surgery, Kasturba Medical College Mangalore, Karnataka, India
3 Department of Obstetrics and Gynecology, Kasturba Medical College Mangalore, Karnataka, India

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Date of Web Publication19-Jan-2010
 

How to cite this article:
Pai RR, Augustine A, Nayak RS, Devadiga V. Unilateral absence of uterine adnexa. Indian J Pathol Microbiol 2010;53:180-1

How to cite this URL:
Pai RR, Augustine A, Nayak RS, Devadiga V. Unilateral absence of uterine adnexa. Indian J Pathol Microbiol [serial online] 2010 [cited 2019 Oct 23];53:180-1. Available from: http://www.ijpmonline.org/text.asp?2010/53/1/180/59227


Sir,

The unilateral absence of uterine adnexa is a rarely described entity. It may be due to developmental failure or auto amputation following adnexal torsion. [1] Such a condition may be discovered during investigation for infertility or primary amenorrhea in asymptomatic cases with or without past history of acute abdomen pain. It may be incidentally detected as a migratory abdominal calcification during radiologic investigation and also during postmortem examination. [2],[3],[4]

A 17-year-old girl presented with primary amenorrhea. There was past history of acute abdomen pain nine years ago, treated conservatively. She had no previous abdominal surgeries. On examination, her breast development appeared normal. Axillary and pubic hair was sparse. External genitalia were normal. All other systems were within normal limits. On laparoscopic examination, the ovary and distal portion of the  Fallopian tube More Details on the left side were absent. The round ligament, right adnexa were normal and uterus hypoplastic. There were two free loose bodies in the Douglas pouch [Figure 1]. In the appendix region there was evidence of dense fibrous adhesion suggesting a healed appendicitis. The urinary system was not specifically evaluated. The two loose bodies were sent for histopathological examination.

Grossly, the larger body was oval, measured 3x2x2 cms and had a smooth, white and shiny outer surface. Its cut surface was yellow with white specks of calcification. The smaller body was 0.5 cm in diameter with a gritty white cut surface. On microscopy, the larger body representing ovary showed a fibrous capsule enclosing a degenerating calcific carcinoid tumor with ghost outline of the tumor cells [Figure 2]. The amputated part of the fallopian tube appeared as a smaller calcific loose body.

A total absence of unilateral ovary, in the presence of a normal uterus, cervix and vagina, along with normal contra lateral adnexa is usually considered to be acquired because these two organs originate from two different embryonic elements. Ovarian torsion may present as an acute disease after birth or may be subclinical and detected incidentally. Sirisena [1] has opined that ovarian torsion is always associated with acute abdominal symptoms and the incidental finding of an absent adnexa is probably the result of torsion, infarction and auto amputation of normal or abnormal adnexa occurring during fetal life. However, it is possible that the severe pain would have been so transient that it was overlooked or was attributed to some other cause, as is sometimes the case with abdominal pain in infancy and childhood. [1] Absence of ovary may be associated with calcific peritoneal loose bodies representing the amputated ovary or attached to adjacent structures. [4]

In this case, the carcinoid tumor might have caused ovarian enlargement and predisposed to torsion. Most authors conclude that torsion and infarction of normal adnexae occur; however, except in a few cases, there is no evidence that the involved adnexae could be normal. It is difficult to ascertain whether past history of abdomen pain, in our case, was related to ovarian torsion or appendicitis. There are seven cases of ovarian torsion with associated appendicitis reported in literature. [5] Unlike in our case, in all the cases, both ovarian torsion and appendicitis were acute. Our patient also had a hypoplastic uterus and primary amenorrhea. This was probably related to hypothalamo-pituitary-ovarian axis or primary ovarian abnormality. The patient's parents refused further evaluation.

 
   References Top

1.Sirisena LA. Unexplained absence of an ovary and uterine tube. Postgrad Med J 1978;54:423-4.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]  
2.Nixon GW, Condon VR. Amputated Ovary: A Cause of Migratory Abdominal Calcification. Am J Roentgenol 1977;128:1053-5.  Back to cited text no. 2      
3.Ali V, Lynn S, Schmidt W. Unilateral absence of distal tube and ovary with migratory calcified intraperitoneal mass. Int J Gynecol Obstet 1980;17:328-31.  Back to cited text no. 3      
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; 2002. p. 675-727.  Back to cited text no. 4      
5. Hoey BA, Stawicki SP, Hoff WS, Veeramasuneni RK, Kovich H, Grossman MD. Ovarian torsion associated with appendicitis in a 5-year-old-girl: a case report and review of the literature. J Pediatr Surg 2005;40:E17-20.  Back to cited text no. 5      

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Correspondence Address:
Radha R Pai
Department of Pathology, P.O. Box 53, Mangalore - 575 001, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.59227

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