Ovarian pregnancy is a rare type of extrauterine pregnancy accounting for 1 to 3% of all extrauterine pregnancies. We report a rare case of a ruptured ovarian pregnancy. A 22 year old, gravida 2 para 1 living 1 was admitted with amenorrhea of 4 weeks and 6 days with chief complaints of severe acute lower abdomen pain. Urine beta hCG pregnancy test was positive. Ultrasonogram of pelvis revealed left sided ruptured adnexal mass with moderated hemoperitoneum. Laparotomy was performed and a diagnosis of ruptured ovarian pregnancy was made. The mass was excised and sent for histopathological examination which confirmed the diagnosis. Although ovarian pregnancy is rare, in any case of a ruptured ectopic pregnancy where the tubes are found to be normal on laparotomy, an ovarian pregnancy must be ruled out. Early detection and prompt diagnosis can preserve the future fertility of the woman.

Abstract

A 21 year old female presented with amenorrhea, hirsutism and change in voice along with an elevated serum β-HCG (human chorionic gonadotrophin) level and normal CA-125 level. Laparotomy revealed an enlarged right ovary measuring 6×5×1 cms with presence of an ovarian hemangioma along with stromal luteinization and HCG producing mononucleate as well as multinucleate cells of uncertain histogenesis on histopathological examination. Immunohistochemistry for inhibin and calretinin were positive in the luteinized component whereas β-HCG and Ki-67 were positive in the multinucleate cell component. The diagnostic rarity and therapeutic dilemma of such a rare mixed tumor within a single ovary has proven to be an exceptional case and an excellent investigative opportunity.