Autoamputation of pelvic adnexa: two case reports

Parasitic ovarian teratoma is a rare consequence of chronic torsion or auto-amputation of the adnexa. Delayed diagnosis may result in a free-floating pelvic mass without identifiable adnexal tissue.

Respectively, two young women (23 and 29 years) presented with ignored pelvic pain a few months ago. Both had previously self-medicated with oral analgesics without further treatment. The ultrasound revealed an isolated solid-cystic pelvic mass with absent colour Doppler signals. No normal ipsilateral ovarian or tubal tissue was visualised. Both patients had no positive findings on laboratory tests; their cancer antigen 125 (CA-125) levels were 7.81 and 11.7 IU/mL, respectively. Diagnosticlaparoscopy was performed. In both cases, the ipsilateral adnexa was completely absent; a pelvic mass was identified, extensively and densely adherent to the anterior abdominal wall and both pelvic sidewalls; after dissecting the adhesion, the mass was freed, with its surface smooth and pedicle-free. The diameters of the masses were 7cm and 8cm, respectively. Histology showed a cyst lined by mature squamous and ciliated columnar epithelium, containing hair shafts, cartilage, adipose tissue, and dilated lymphatics; no immature neural elements were seen, consistent with mature cystic teratoma. Post-operative recovery was uneventful; both patients were discharged on day 5. At the 3-month follow-up, the ultrasound showed normal contralateral adnexa and no recurrence.

Chronic adnexal torsion can lead to complete auto-amputation and an isolated pelvic mass. High index of suspicion and early diagnostic laparoscopy are essential in young women with acute or subacute abdominal pain.