Surgical transposition of the ovary: radiologic appearance.

Abstract

Therapeutic irradiation of the pelvis of a young female patient will result in loss of ovarian function. In a surgical technique termed ovarian transposition, the ovary is repositioned to the iliac fossa or paracolic gutter outside the radiation field. The computed tomographic (CT) scans and sonograms of five patients with cervical carcinoma who underwent this procedure were reviewed. The normal transposed ovary was of soft-tissue attenuation, often with one or more small cysts. Large cysts developed in the ovaries of three patients. One cyst was functional, another was due to a mesothelial inclusion cyst, and the third was most probably related to the transposition itself. Since the transposed ovary is difficult to palpate, CT or sonography can be used to demonstrate and follow up a cystic mass. Recognition of the appearance and location of the transposed ovary is important to avoid misinterpretation of a solid or cystic mass in patients who are at risk for tumor recurrence.

Characterization of surgically transposed ovaries in integrated PET/CT scan in patients with cervical cancer

“…The normal transposed ovary may appear on abdominal CT as a soft‐tissue mass, sometimes with small cysts, or as a predominant cystic lesion, mimicking a peritoneal or retroperitoneal tumor implant. The location of the transposed ovary on CT is generally either adjacent to the ascending or descending colon, or in the upper pelvis lateral to or anterolateral to the psoas muscle (2–5). In one of our cases, the transposed ovary was in an atypical location mimicking a peritoneal metastatic lesion, which was documented in the operation record, and located in the anterior abdominal cavity between the abdominal wall musculature and the small bowel loops.…”

“…The purpose of this procedure is to place the ovaries outside the radiation field to preserve normal ovarian function (1). Surgical clips are usually placed to permit identification of the transposed ovary (2–5). Most often, ovarian transposition for cervical cancer has been performed at radical hysterectomy.…”

Added Value of Multiplanar Reformation in the Multidetector CT Evaluation of the Female Pelvis: A Pictorial Review

“…intraperitoneal space in the upper pelvis in proximity to the psoas muscle (52). Aids in accurately characterizing surgically transposed ovaries include tracking the ovarian vessels to the transposition site and the presence of metallic surgical clips and physiologic cysts (Fig 17).…”

“…Correct identification is crucial, since there have been reports of surgically transposed ovaries being mistaken for colonic, ovarian, or peritoneal masses (15,52,53). The most common locations for transposition are the lower paracolic gutters and the posterior …”

Avoidance of female genital tract complications in relation to pelvic surgery for cancer

“…This situation poses challenging differential diagnoses: recurrent cancer, primary or metastatic ovarian cancer, lymphocele, urinoma, peritoneal inclusion cysts and functional cysts in ovaries that are entrapped by adhesions. Although oophoropexy has been suggested as a preventive measure, such manipulation with lateral ovarian transposition during radical hysterectomy has only resulted in an increase in these painful, cystic masses, probably due to disturbance of the ovarian blood supply, local adhesions or ovarian entrapment [31]. Subsequent oophorectomy has been necessary in 18% to 24% of patients with transposed ovaries and an additional 14% have required medical management with oral contraceptives or gonadotrophin (GnRh) analogs.…”