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Ovarian remnant syndrome (ORS) results from the presence of residual ovarian tissue after oophorectomy. The most common preexisting conditions include endometriosis, pelvic inflammatory disease and prior abdominal surgery as in these conditions the removal of ovarian tissue becomes difficult. It should be always considered as a differential diagnosis for chronic pelvic pain. A 50 year old postmenopausal multigravida female was diagnosed with hemoperitoneum. She had undergone hysterectomy with bilateral salpingoophorectomy for endometriosis 5 years ago. Laparotomy performed and a 10X16 cm hematoma along with ovarian tissue was evacuated and sent for histopathology which confirmed presence of ovarian cystadenoma tissue with hemorrhage that is consistent with the diagnosis of ORS.

Disorders of sexual differentiation (DSD) occur when an incongruity exists between a child's external genitalia, gonadal histology and chromosomal sex. Ovotesticular DSD (ODSD) represents 5% of DSD.1 In an ovotestis, the testis is always central and the ovary polar. There are three anatomic variants: • Bilateral: Testis and ovary bilaterally, either separate or united as an ovotestis (30%) • Unilateral: Testis or ovary on one side and a contralateral ovotestis (50%) • Lateral/Alternating: Testis and contralateral ovary (20%)1,2 We report a child with histologically documented Alternating ODSD who was later reclassified as having Unilateral ODSD after an ovarian remnant produced a corpus luteum cyst.

Case summary An 11-year-old female, reportedly spayed, domestic shorthair cat was examined for a 4-month history of weight loss, aggression, urine spraying, malodorous urine and estrus-like behavior. Physical examination revealed thickened skin, a mildly prominent vulva and confirmed malodorous urine. On abdominal ultrasonography, a 6 mm hypoechoic nodule was found in the left cranial abdomen. An adrenocorticotropic hormone (ACTH) stimulation test with adrenal panel revealed elevated serum concentrations of androstenedione and testosterone pre- and post-cosyntropin stimulation, mildly decreased cortisol pre- and post-cosyntropin stimulation, and decreased resting aldosterone. Exploratory laparotomy was performed and a cystic, nodular mass was found in the region of the left ovary. The mass was surgically removed and submitted for histopathology; results were conclusive for an ovarian remnant with an intact corpus luteum and non-neoplastic parovarian cysts. Previously observed clinical signs resolved within two weeks of ovariectomy. A follow-up ACTH stimulation test with adrenal panel 6 weeks postoperatively revealed normalization of serum androstenedione, testosterone and cortisol concentrations. Four years postoperatively, at the time of writing, the cat remains free of clinical signs. Relevance and novel information We are unaware of any previously reported cases of non-neoplastic ovarian remnants associated with clinically relevant hyperandrogenism. A non-neoplastic ovarian-dependent hyperandrogenism should be included as a differential diagnosis of spayed female cats showing aggression and urine spraying behavior.

Θηλυκός σκύλος, ηλικίας 3 ετών, προσκομίστηκε 1,5 χρόνο μετά από υποτιθέμενη στείρωση, διότι παρουσίαζε επί 2 μήνες αιμορραγικό έκκριμα από το αιδοίο. Στην κλινική εξέταση ψηλαφήθηκε ευμεγέθες, συμπαγές,ωοειδές μόρφωμα στην οπίσθια κοιλία, το οποίο στην απεικονιστική διερεύνηση προσδιορίστηκε ως διογκωμένο κολόβωμα μήτρας. Επιπλέον διαπιστώθηκε υψηλή συγκέντρωση προγεστερόνης στον ορό του αίματος, αποδεικτική παρουσίας λειτουργικού ωοθηκικού ιστού σε δίοιστρο. Με υποψία πυομήτρας του κολοβώματος της μήτρας καιλιγότερο άλλου είδους μορφώματος πραγματοποιήθηκε μέση λαπαροτομή. Βρέθηκε μόρφωμα – μάζα στο πρόσθιο άκρο του κολοβώματος το οποίο εξαιρέθηκε μαζί με το υπόλοιπο σώμα της μήτρας, καθώς και υπόλειμμα δεξιάς ωοθήκης. Το μόρφωμα προσδιορίστηκε ιστοπαθολογικά ως αδενοκαρκίνωμα και διαπιστώθηκε για πρώτη φορά σε κολόβωμα μήτρας σκύλας. Η αποτυχημένη, μερική ωοθηκυστερεκτομή μπορεί να επιτρέψει ακόμη και την εξαλλαγή των ιστών του κολοβώματος της μήτρας., A 3-year-old female spayed dog was presented with a history of sanguineous vaginal discharge of 2 month duration. The dog was spayed 1.5 years before presentation. Clinical examination revealed a large, solid, ovoid mass in the caudal abdomen, recognized by diagnostic imaging as an enlargement at the top of the uterine stump. Additionally, high serum progesterone concentration was measured, confirming the presence of functional ovarian tissue in dioestrus. With a suspicion for a related uterine stump pyometra or less likely, for other enlargements, a cοeliotomy was performed. A mass at the apex of the uterine body and a right side ovarian remnant were found. Both structures and the remaining uterine stump were excised. The uterine remnant mass was histologically diagnosed as uterine adenocarcinoma, herein detected for the first time at the uterine stump in the bitch. Unsuccessful, incomplete ovariohysterectomy may permit even neoplastic transformation of uterine stump tissues.

Video Objective This video describes a systematic stepwise approach for complete dissection of ovarian remnant in the setting of a previous ureteral re-implantation. Setting A 40 year old patient presenting with a history of ureteral injury during hysterectomy, followed by re-implantation. She had another ureteral injury during oophorectomy which required a secondary re-implantation. The patient then developed pelvic pain, and she was found to have a large pelvic mass. Hormonal assays confirmed premenopausal status consistent with ovarian remnant syndrome. The patient decided on medical management for several years, including progestational agents and GnRH agonists, but ultimately the pain became excessive, and she decided on surgery. Interventions Laparoscopic resection of ovarian remnant was performed in a systematic stepwise approach, with sealing and cutting of the ovarian vessels at the pelvic brim, and removing of the entire ovarian vessels pedicle together with the adherent pelvic side wall. Conclusion This stepwise approach for ovarian remnant resection provides a roadmap for the effective and safe excision of the ovarian remnant, while minimizing the risk of injury to the bladder, the ureters and the rectum.

ZusammenfassungBei einer 6-jährigen Pointer-Hündin mit periodisch auftretender Läufigkeitssymptomatik nach erfolgter Ovariohysterektomie wurde Ovarrest-Gewebe diagnostiziert. Die Diagnose basierte auf vaginoskopischer und vaginalzytologischer Befunderhebung, einer Serumprogesteronanalyse und einer magnetresonanztomographischen Untersuchung. Über eine Laparoskopie wurde das verbliebene Ovargewebe mithilfe eines Versiegelungsgeräts minimalinvasiv entfernt. Die Läufigkeitssymptomatik verschwand 14 Tage nach dem Eingriff.

A 3-year-old female spayed dog was presented with a history of sanguineous vaginal discharge of 2 month duration. The dog was spayed 1.5 years before presentation. Clinical examination revealed a large, solid, ovoid mass in the caudal abdomen, recognized by diagnostic imaging as an enlargement at the top of the uterine stump. Additionally, high serum progesterone concentration was measured, confirming the presence of functional ovarian tissue in dioestrus. With a suspicion for a related uterine stump pyometra or less likely, for other enlargements, a cοeliotomy was performed. A mass at the apex of the uterine body and a right side ovarian remnant were found. Both structures and the remaining uterine stump were excised. The uterine remnant mass was histologically diagnosed as uterine adenocarcinoma, herein detected for the first time at the uterine stump in the bitch. Unsuccessful, incomplete ovariohysterectomy may permit even neoplastic transformation of uterine stump tissues.

Four partially intact, female dogs with a median age of 6 · 5 years were presented to Angell Animal Medical Center for laparoscopic treatment of ovarian remnant syndrome. Dogs were positioned in dorsal recumbency and a three-port laparoscopic technique was used to identify and remove en bloc any abnormal tissue in the area of the ovarian pedicles. None of the dogs required conversion to open coeliotomy and there were no major complications. Abnormal tissue, including granulosa thecal cell tumour (n = 1), was identified bilaterally in three dogs and unilaterally in one dog. Clinical signs associated with ovarian remnant syndrome resolved in all dogs following surgery.

A 4-year-old, spayed female ferret ( Mustela putorius furo ) presented for alopecia, pruritus, and swollen vulva. The ferret was treated for a suspected ovarian remnant at 1.5 years of age. On presentation, the physical examination revealed a large, hard, nonpainful caudal intraabdominal mass. The results of diagnostic blood tests and radiographic images were nonspecific relative to determining a definitive diagnosis. An exploratory laparotomy was performed to remove the mass. Histopathology identified the mass as a thecoma. Although neoplasia is common in ferrets, reproductive system malignancies are underreported in this species because most are acquired as gonadectomized pets. The following article describes a case of a sex hormone–producing thecoma in a female ferret with alopecia and swollen vulva.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 35 - N° 8 - p. 829-833

Study Objective To evaluate the degree of pain relief provided by laparoscopic surgical treatment of ovarian remnant and ovarian retention syndromes. Design Retrospective analysis (Canadian Task Force classification II-2). Setting Academic hospital and affiliated outpatient offices. Patients A total of 54 patients from 2004 to 2008 who underwent surgical treatment for suspected ovarian remnant syndrome or ovarian retention syndrome. Interventions Oophorectomy. Measurements and Main Results Preoperative and postoperative pain scores were recorded from patients who underwent surgical treatment for either ovarian remnant or ovarian retention syndrome. Data regarding comorbid diagnoses that would contribute to chronic abdominopelvic pain, previous surgical history, surgical complications, and pathology to confirm the preoperative diagnosis were also collected. Pathology confirmed that ovarian tissue was removed in 52 of the 54 patients. Forty percent and 41% of patients with ovarian remnant and ovarian retention, respectively, achieved a 50% reduction of their average pain levels; 50% and 56%, respectively, achieved a 30% reduction in average pain levels. There was not a statistically significant difference in postoperative pain relief between the 2 groups. Cases with ovarian remnant syndrome had more prior surgical procedures (4.8 vs 3.6, p = .049) and were more likely to have a surgical complication (25% vs 3%, p = .03) than cases with ovarian retention syndrome. Patients with a 30% or greater decrease in their pain levels postoperatively were likely to have fewer other diagnoses associated with chronic pain (1.4 ± 1.1 vs 2.1 ± 0.9, p = .009). Conclusion Surgical treatment for ovarian remnant or ovarian retention syndrome is effective but is most effective in patients with no other pain-related diagnoses. Thus, it is important to thoroughly evaluate women with ovarian remnant or ovarian retention syndrome for other pelvic pain–related disorders. In almost all cases, surgery can be done laparoscopically in patients with these syndromes.

Congenital hernias arising in the subcostal region are rare. We describe a case of a former preterm infant, born with congenitally fused right 11th and 12th ribs and a protuberant mass in the right subcostal region. This mass was associated with a small fascial defect and herniation of abdominal contents. At operation, the mass was determined to be a hernia with an incarcerated ovarian remnant and fallopian tube.

Serous cystadenoma arising from ovarian remnant has not been reported in the literature. We report 3 cases with ovarian remnant syndrome that were treated with laparoscopic excision and were proven to be benign serous neoplasia with ovarian origin on final pathologic examination. We review the current evidence for malignant transformation potential of ovarian serous cystadenoma and discuss laparoscopic techniques for management of ovarian remnant syndrome.

OBJECTIVE: Ovarian remnant syndrome has become increasingly recognized as a cause of pelvic pain after extirpative surgery. The purpose of this review was to compare our patient population with those reported in the literature, as well as to address the usefulness of careful retroperitoneal discussion in the surgical management of these patients. STUDY DESIGN: This article discusses the presentation and surgical management of eight cases of ovarian remnant. RESULTS: Data were obtained through a retrospective chart review of pathologically confirmed cases of ovarian remnant. Discussion focuses on the surgical management of these cases. CONCLUSION: In summary, extensive and careful retroperitoneal dissection is typically required to facilitate identification and removal of the ovarian remnant tissue. (AM J OBSTET GYNECOL 1996;174:641-5.)

Ovarian remnant syndrome was diagnosed in a 3-yr-old, female Toy Poodle presented with signs of estrus. The diagnosis was based on the clinical and laboratory changes in response to injection with hCG. The remnant of ovarian tissue was removed surgically under general anesthesia and the animal recovered uneventfully.

Objective To determine the diagnostic effectiveness and treatment of women with chronic lower abdominal pain due to residual ovaries or ovarian remnants. Design A prospective observational study. Setting Tertiary referral pelvic pain clinic. Subjects Seventeen women complaining of chronic pelvic pain of up to 25 years’ duration, of whom seven had residual ovaries and 10 ovarian remnant(s). Main outcome measures Persistent lower abdominal pain, pelvic tenderness and quality of life one year post-operatively. Results Six of the seven women with residual ovaries, and nine of the 10 women with presumed ovarian remnants experienced relief of the original pain, loss of pelvic tenderness and an improved quality of life. Conclusions Residual ovaries after hysterectomy and ovarian remnants are established causes of chronic pelvic pain. Diagnosis and surgical removal is frequently difficult. Management strategies are proposed for both conditions.

Summary: Laparoscopic adnexectomy was performed successfully in 38 patients in whom the procedure was attempted. Failure may result from inexperience of the surgeon or when preliminary dissection near bowel suggests trauma is likely. The duration of the operation was between 15 and 105 minutes, blood loss was minimal and all but 2 patients were discharged within 24 hours of surgery. Pain was relieved in 33 of 35 patients in whom this was the dominant symptom. In 1 patient a small ovarian remnant implanted on the bladder was removed at subsequent laparoscopy. Preliminary experience of this procedure suggest it may be preferable to laparotomy because of the reduced risk of wound complications, pain, time in hospital and duration of convalescence.

The ovarian remnant syndrome is a complication of ovariohysterectomy resulting in the presence of functional ovarian tissue in the abdomen. The usual symptom is a return to estrus in a previously ovariohysterectomized bitch or queen. The available methods of diagnosis are vaginal cytologic evaluation during estrus, resting hormone assays, hormone challenge testing, and exploratory laparotomy. Surgical removal of the ovarian remnant is the preferred treatment.

A two-year-old domestic shorthair presented for estrous behavior four months after ovariohysterectomy. On exploratory laparotomy, ovarian remnant tissue and multiple intestinal diverticula were found. Histopathology identified the diverticula as pseudodiverticula.

The ovarian remnant syndrome represents the development of symptoms due to residual ovarian tissue after bilateral salpingo-oophorectomy. Treatment generally consists of surgical resection but recurrence after resection is common. A case is reported in which a postoperative recurrent ovarian remnant was successfully managed by using a luteinizing hormone-releasing hormone agonist. In addition, this report includes a survey of gynecologists to determine the frequency of this syndrome and of ureteral involvement.

Objective To report outcomes of laparoscopic management of patients with ovarian remnant (OR). Design Retrospective chart review. Setting Referral practice and tertiary medical center. Patient(s) Sixty-four patients with confirmed OR who underwent laparoscopic treatment between July 1989 and September 2003. Intervention(s) Laparoscopic excision of OR. Main outcome measure(s) Technical feasibility and recurrence. Result(s) Sixty-nine laparoscopies were performed to remove ovarian remnants, with five patients requiring two laparoscopies. Two cases were converted to laparotomy and one to mini-laparotomy for bowel resection. In 64% (41 out of 64), pelvic mass was diagnosed by imaging (35 by ultrasound, 5 by computerized tomography [CT], and 1 by both). The majority of ovarian remnants were found attached to one or more of the following: ureter, bowel, pelvic sidewall, bladder, rectum, and uterosacral ligament. Intraoperative complications occurred in four cases: three enterotomy and repair; one cystotomy and repair. Twelve minor postoperative complications occurred including urinary tract infection, hematuria, umbilical incision infection, and transient tachycardia. Three major postoperative complications occurred: one umbilical omental hernia, one wound abscess requiring operation, and one vesicovaginal fistula. Adhesions were present in all cases, endometriosis in 55% (35 out of 64), and fibrosis in 30% (19 out of 64). Conclusion(s) In experienced hands, laparoscopic treatment of OR results in acceptable outcomes with its associated advantages over laparotomy.

Ovarian remnant syndrome is a rare condition which develops when functional ovarian tissue which is left in situ after intended bilateral oophorectomy produces clinically significant symptoms, namely chronic pelvic pain and/or dyspareunia. Women with this syndrome may have a pelvic mass palpable on bimanual examination, or visible on transvaginal ultrasound. However, visualization of an ovarian remnant is sometimes difficult because it is small and multiple previous pelvic operations have usually produced dense adhesions and distorted pelvic anatomy. Identification of these remnants may be facilitated by ovarian stimulation. Surgical removal is the optimal treatment, but hormonal suppression of ovarian activity may provide temporary relief of pain.

A case is presented in which an ovarian remnant following total abdominal hysterectomy and bilateral salpingo-oophorectomy resulted in unilateral ureteral obstruction. The obstructing tissue was excised laparoscopically with simultaneous ureteroscopic monitoring.