Ovarian Pregnancy Presenting as Ovarian Tumour: Report of 2 Cases
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Annals of African Medicine
Vol. 6, No .1; 2007: 36 – 38
Ovarian Pregnancy Presenting as Ovarian Tumour: Report of 2 Cases
1
M. O. A. Samaila, 2A. G. Adesiyun and 3L. M. D. Yusufu
Departments of 1Pathology, 2Obstetrics and Gynaecology, and 3Surgery, Ahmadu Bello University Teaching
Hospital, Shika –Zaria, Nigeria
Reprint requests to: Dr M. O. A. Samaila, Department of Pathology, Ahmadu Bello University Teaching
Hospital, Shika-Zaria, Nigeria. E-mail: mamak97@yahoo.com
Abstract
We present 2 cases of ovarian masses diagnosed as tumours but turned out to be pregnancy. Ovarian
pregnancy, a form of ectopic gestation has a distinct pathology though it can be a source of diagnostic
difficulty clinically and intraoperatively. A total of 71 ectopic pregnancies were seen in the department
from January 2001 to December 2005, of these only two were ovarian ectopics. Both patients were
nulliparous and presented with lower abdominal pains, abdominal masses and menstrual irregularity.
They both had laparotomy and total right salpingo-oophorectomy. Grossly, the ovaries were enlarged,
grey tan and globular. Focal ruptures in the wall of the ovaries showed protruding fetal parts. Microscopy
showed chorionic villi within and in continuity with ovarian stroma and corpus luteum. They were both
diagnosed ovarian ectopics. A good knowledge and understanding of the gross pathology, combination
of imaging studies and high index of suspicion should help in making an intra-operative diagnosis.
Key word: Ovary, pregnancy, tumour
Résume
Nous présentons deux cas de masse ovariennes diagnostiques cliniquement comme des tumeurs mais
après histologiquement ce sont révèles être des grossesses ectopiques. Les grossesses ovariennes, une
forme de grossesse ectopique as une pathologie distincte est es difficilement diagnostiquée cliniquement.
Un total de 71 grossesses ectopiques a été vues au Département de Pathologie entre Janvier 2001 et
Décembre 2005. Deux grossesses étaient des grossesses ovariennes. Les deux patientes étaient
nullipares et ce sont présentées avec des douleurs au bas ventre, des tumeurs abdominales et des
menstruations irrégulières. Les deux ont eu une exploration abdominale suivie d’une salpingo-
ovarectomie. Anatomiquement, les ovaires étaient, gris, globulaire, et hypertrophier. Des ruptures de la
paroi ovaire montrait des protrusions d’éléments fœtal. Histologiquement les ovaires ont révélés les
villosités chorioniques dans et en continuité avec le stroma ovarien et le corpus luteum. Les deux ovaires
ont étaient diagnostiqués comme grossesse ovarienne. Une bonne connaissance et un bon entendement
de l’anatomie-pathologie, une combinaison de l’imagerie et un fort taux de suspicion aide a faire un
diagnostique clinique.
Mots clés : Grossesse, ovarienne, tumeur
Introduction ectopic pregnancies. This is a report of 2 ovarian
pregnancies, mistaken clinically for tumours.
Ovarian pregnancy, a form of ectopic gestation with a
distinct pathology, can be a source of diagnostic Case reports
difficulty clinically and intraoperatively.1 It shares Case 1: A 32year old nulliparous woman presented
similarity of presenting symptoms with other forms of with a 4months history of lower abdominal pains and
extrauterine or ectopic pregnancy and ovarian 6months history of irregular menstruation.
tumours.4, 5 Ultrasounography revealed right ovarian pregnancy
A total of 71 ectopic pregnancies and 173 cases of which was removed at laparotomy. She had a right
ovarian lesions were seen in the Department of salpingo-oophorectomy.
Pathology, Ahmadu Bello University Teaching Grossly, a globular mass measuring 12x9cm and
Hospital, Zaria, Nigeria, from January 2001 to weighing 190g was seen. Parts of a well formed foetal
December 2005. Of these only two were ovarian skull and upper limbs protruded through a rupture in
37 Ovarian pregnancy presenting as ovarian tumour. Samaila M. O. A. et al.
the mass. Part of tubal fimbria attached to the mass Figure 3: Ovarian mass with macerated fetus
was also seen. Cut sections of the mass showed areas consistent with 3.5 lunar months in case 2
of haemorrhage and cystic dilations. Histology
showed chorionic villi of varying sizes within ovarian
stroma, extensive haemorrhage and corpus luteum
(Figure 1).
Case 2: A 27year old nulliparous woman presented
with a six months history of right lower abdominal
pains and regular menstruation. Investigations
revealed a right ovarian mass which was considered a
teratoma. At laparotomy, the mass which was still
suspected to be a tumour was excised along with the
right fallopian tube.
Grossly, the ovary was enlarged and grey tan in
appearance. It measured 8.5x6.5cm and weighed
120g. A small cyst and part of the fallopian tube
fimbria was adherent to the ovarian wall. Cut sections
showed grey and dark areas and a well formed foetus
with macerated head and a crown rump length of
Discussion
70mm consistent with three and half lunar months
gestation (Figures 2 and 3). Histology showed
Ovarian pregnancy results from the fertilization of a
chorionic villi within and in continuity with ovarian
trapped ovum within the follicle or corpus luteum at
stroma, areas of haemorrhage and corpus luteum.
the time of rupture.4, 6 Implantation within the ovarian
stroma is aided by secretions of the corpus luteum.
The fertilized ovum undergoes development with
Figure 1: Histology in case 1 showing chorionic villi
formation of placental tissue, amniotic sac and fetus.6
(H & E x100)
However, normal implantation occurs within the
uterine cavity.
The incidence of ectopic gestation is 4.5/1000 -
16.8/1000 pregnancies.4,7 Tubal pregnancy with an
incidence rate of 1/200 - 1/300 pregnancies is the
commonest form. 4, 8 The incidence of ovarian
pregnancy ranges from 1/6000 - 1/40,000
pregnancies.9, 10 Ovarian pregnancy constitute 0.5%
to 6% of all ectopic pregnancy, 1: 3000 of live births
leading to a mean ovarian pregnancy per year of 1.6.9,
11-13
It comprised 1.2% of all ovarian lesions and 2.2%
of all ectopic pregnancy in the present report, which
compares favourably with other reports.9, 11-13
Ovarian pregnancy may present a clinical and
operative diagnostic difficulty. 1-3 There are no
specific clinical, laboratory or ultrasonographic signs
to differentiate it from a tubal pregnancy.9 However,
Figure 2: Ruptured ovarian mass with protruding fetal diagnosis should be based on a combination of rise in
parts in case 2 serum β-human chorionic gonadotrophin (hCG),
ultrasonography and laparoscopy.3,14
The macroscopic characteristics of ovarian
pregnancy should be helpful in making a laparoscopic
or intra-operative diagnosis. These features include an
intact fallopian tube and fimbria ovarica clearly
separated from the ovary, a gestational sac located
within the ovary and connected to the uterus by the
ovarian ligament as well as demonstrable ovarian
tissue in the sac.4 Histology remains the only means of
confirming diagnosis of ovarian pregnancy with the
presence of chorionic villi within and in continuity
with ovarian stroma or a corpus luteum.4, 9, 11
A good knowledge of the gross pathology, along
with imaging and high index of suspicion should help
in making an intra-operative diagnosis of ovarian
pregnancy.
Ovarian pregnancy presenting as ovarian tumour. Samaila M. O. A. et al. 38
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