Reversible decreased ovarian reserve after conservative ovarian surgery for benign lesion other than endometrioma – case report

Abstract

A 36-year-old woman presented with abdominal pain and diagnosed provisionally as complicated ovarian cyst. The trans-vaginal ultrasound (TVS) done for the studied woman showed, well-defined solid mass, measuring 10 × 8 cm related to the anterior uterine wall most probably subserous uterine leiomyoma or ovarian fibroma. The TVS finding of left solid mass was confirmed by the magnetic resonance imaging (MRI). At laparotomy, the solid mass was originating from the left ovary and the right ovary and uterus were completely normal. The left ovarian mass excised (confirmed as ovarian fibroma by histological examination), and more than half of the left ovary was preserved during surgery. The pre-operative ovarian reserve hormones, anti-Müllerian hormone (AMH), follicle stimulating hormone (FSH), and luteinizing hormone (LH) were completely normal. Post-operative follow-up of the studied woman showed regular menstrual rhythm and duration, elevated FSH and LH for one year after surgery and both the FSH and LH returned to normal levels at the end of the first post-operative year. This report represents the finding of reversible decrease ovarian reserve (RDOR) after conservative ovarian surgery for benign lesion other than endometrioma to minimise normal ovarian tissue damage during surgery as much as possible and to counsel women at risk of DOR that any ovarian surgery may be associated with further decrease in the ovarian reserve and reproductive ability.

Morphological parameters of ovarian masses and accuracy of the risk of malignancy index in diagnosing ovarian malignancy

“…High CA125 is frequently associated with epithelial ovarian tumours [10]. Cancer antigen125 is also elevated in other malignancies (breast, lung, GIT, pancreatic, en dometrial, and fallopian tube cancers) and benign con ditions (endometriosis, adenomyosis [12][13][14][15], fibroid uterus, PID, normal, and ectopic pregnancies, peritoni tis, diverticulitis, inflammatory bowel disease, tubercu losis, and liver diseases) [14,15].…”

Accuracy of the risk of malignancy index-I in diagnosing ovarian malignancy in menopausal women

“…CA-125 is normally secreted from the ovarian epithelial and peritoneal lining cells, and cells of the gastrointestinal tract (GIT), pancreas, and lungs [11]. CA-125 is commonly elevated in epithelial ovarian tumours, breast, lung, pancreatic, and endometrial cancers, pelvic inflammatory disease (PID), endometriosis, adenomyosis, inflammatory bowel, and liver diseases [12][13][14].…”