Old Abdominal Pregnancy Presenting as an Ovarian Neoplasm

Abstract

INTRODUCTIONThe incidence of abdominal pregnancy varies from one in 372 to one in 9,714 live births; and the abdominal pregnancy is associated with high morbidity and mortality (1). The lithopedion formation, a dead fetus undergoing intra-abdominal calcification instead of spontaneous resorption, is an unusual complication. There has been only a single report on presentation of lithopedion as an ovarian neoplasm in the literature (2). We herein report the second such case. CASE REPORTA 63-yr-old, gravida 2, para 1, woman was referred to our hospital for a palpable abdominal mass with a 40-yr history. The patient had recently suffered from urinary frequency and lower abdominal discomfort and was recommended for further evaluation of the mass at a local clinic. Pelvic examination revealed a normal postmenopausal uterus and a fetal head-sized movable hard mass in the lower abdomen. We supposed the mass to be a calcified myoma or a solid adnexal tumor. The sonographic findings revealed a huge densely calcified mass suggesting an ovarian tumor. The abdominopelvic computed tomographic scan revealed a highly calcified mass in the midline of the lower abdomen, which appeared to be a solid ovarian tumor such as teratoma. The tumor markers were within normal limits. The size, the consistency of the mass, and the old age of the patient lead us to conclude that the mass would be a low-grade malignant ovarian tumor and that explolaparotomy was needed. During laparotomy, a well-demarcated stony hard and 11×11×8 cm-sized mass was found embedded within the omentum, and was resected from the omental bed. The right adnexa were atrophied but the tubal isthmic portion was calcified, and therefore the right salpingo-oophorectomy was performed. The atrophied and small genital tract as usual as in the most postmenopaused women made us abandon the consideration of the possibility of low-grade malignant ovarian tumor, so we did not do any further procedures. We supposed that it would be a calcified omental or mesenteric tumor rather than an ovarian tumor.Until this point, we had never suspected that the mass could be a lithopedion. On further questioning, the patient reported that she had become pregnant 40 yr before and that the pregnancy had continued for about 9-10 months with fetal movement and abdominal distension, until she experienced a vaginal bleeding without any signs of labor. Because of poor accessibility to doctors and hospitals, she stayed at home and sought the alternative medicine such as herb medication. After some time, the fetal movement and the abdominal distension disappeared and the palpable mass developed. Two years later, she became pregnant again and successfully delivered a daughter, who was 38 yr old at the time the patient was admitted to our hospital. From history taking, we suspected the possibility of old advanced abdominal pregnancy.On gross pathologic examination, the mass showed a glistening, stony hard calcified external surface. After decalcifica- Old Abdominal Pregnancy Presenting as an Ovarian Neop...

Embarazo abdominal calcificado con 44 años de evolución

“…Algunos autores consideran que la intervención por intermedio de cirugía en esos casos es necesaria, pero otros no observaron efectos indeseables en pacientes que no se sometieron a ese procedimiento (15). La morbilidad aumenta cuando se realiza la operación en una paciente anciana (16). De acuerdo a esas informaciones, los médicos concordaron que la cirugía no era necesaria, una vez que se trataba de una paciente anciana y sin complicaciones, a pesar de los episodios recurrentes de dolor abdominal durante años.…”

Laparoscopic Removal of Lithopaedion

“…Differential diagnosis includes ovarian tumours [6], myomas, teratoma, inflammatory masses and urinary tract or bladder tumours [3]. Surgical removal is the treatment of choice.…”

Developmental and Clinical Overview of Lithopaidion

“…In 2000, Passini et al [20] found fewer than 300 reported cases in 400 years of world medical literature; however, from 1968 to 1999 at least 47 new cases of lithopaidion were published. Moreover, it has been confirmed that in the last 10 years, as prenatal care and surveillance have increased, the presentation of lithopaidions is rare [28], even though at least 17 cases of lithopaidions were demonstrated in the last century [1,20,23,25,28,29,30,31,32,33,34,35,36,37,38,39,64]; only in this case, we have not considered the 4 cases of lithopaidions reported by Sunday-Adeoye et al [40] because it was not possible to determine the exact century of their occurrence. However, a complete analysis of the English literature has revealed more than 330 case of lithopaidion so far.…”

“…Frequent symptoms are abdominal/pelvic pain (even if its character is variable), abdominal/pelvic heaviness (that is not specific) and compression syndromes particularly affecting the urinary tract and bowel (table 5). The differential diagnosis on the presentation of lithopaidion may include ovarian neoplasm [32], myomas, inflammatory masses, epiploon calcifications, and urinary tract or bladder tumors [45]. …”

“…Overall, 21 articles were cited twice, 1 article was cited 3 times, and 86 papers were excluded because the abstract was not available (n = 40), the study was not published in English (n = 30) or the subject was not related to the topic of our review (n = 17). Thus, 52 references were selected [1,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53]. The full paper was available for 30 articles, and 22 abstracts provided sufficient information.…”