Ovarian remnant syndrome

What causes ovarian remnant syndrome?

The risk of ovarian remnant syndrome (ORS) is increased by incomplete removal of the ovarian tissue at the time of oophorectomy. Surgical factors that contribute to incomplete removal include those that limit surgical exposure of the ovary, or compromise surgical technique. Factors may include:

  • Pelvic adhesions – these can limit visualization of the ovary and may also cause it to adhere to surrounding tissues. Adhesions are often present due to preexisting conditions and/or prior surgeries. In the majority of cases reported since 2007, endometriosis was the most common indication for the initial oophorectomy in patients who subsequently had ORS. Endometriosis increases the risk for functional ovarian tissue being embedded into adjacent structures, making complete excision of tissue challenging.
  • Anatomic variations - unusual location of ovarian tissue, for example
  • Intraoperative bleeding
  • Poor surgical technique – this may include failure to obtain adequate exposure or restore adequate anatomy, or imprecise choice of incision site

Last updated on 05-01-20

How is ovarian remnant syndrome diagnosed?

Ovarian remnant syndrome (ORS) may first be considered in women who have undergone oophorectomy and have suggestive symptoms, the presence of a pelvic mass, or evidence of persistent ovarian function (by symptoms or laboratory testing). A history of oophorectomy is required, by definition, to make the diagnosis. Notes regarding the indication for the procedure and the procedure itself should be reviewed and may include prior abdominal or pelvic surgery, endometriosis, and/or poor surgical visualization. If ORS is possible, pelvic ultrasound should be performed to evaluate for a pelvic mass.

Surgical exploration and biopsy of possible ovarian tissue is required for the definitive diagnosis of ORS, and treatment by excision of the remnant ovarian tissue may be performed during the same procedure. For women who are not candidates for surgery, a clinical diagnosis can be made based on the symptoms and hormone levels (follicle-stimulating hormone and estradiol, after bilateral oophorectomy) and/or imaging findings consistent with the presence of residual ovarian tissue.

Last updated on 05-01-20

Can a pelvic mass associated with ovarian remnant syndrome rupture?

We are not aware of reports in the medical literature regarding the rupture of pelvic masses associated with ovarian remnant syndrome (ORS). Therefore, we are unable to comment on whether there is a risk of rupturing. Both malignant and benign tumors, and cysts, have developed from ovarian remnants. Whether there is a risk of rupturing (and what the risk is) may depend upon the nature of the mass (i.e tumor or cyst); the location of the mass; and the size of the mass. We strongly recommend that women with ORS who have questions and concerns regarding their signs and symptoms discuss these with their doctor.

Last updated on 05-01-20

How can I find help treating my ovarian remnant syndrome?

Ovarian remnant syndrome occurs when ovarian tissue is left behind following surgery to remove both ovaries (bilateral oophorectomy). Common signs and symptoms include a mass and regular pelvic pain. Ovarian remnant syndrome can cause blockages of the urinary tract (ureteral obstruction). Ureteral obstruction may cause serious, even life-threatening symptoms. You can familiarize yourself with the signs and symptoms of urinary tract blockage by visiting the MayoClinic.com Web site at the following link:
http://www.mayoclinic.org/ureteral-obstruction

Treatment of ovarian remnant syndrome may involve surgery to remove the remnant ovarian tissue. Because the ovarian remnant can be very difficult to distinguish from surrounding tissues, surgery should be performed by highly experienced surgeons. When surgery is not an option, treatment may be aimed at preventing blockages of the urinary tract. There have been individual case reports describing the use of leuprolide acetate therapy for treatment of ovarian remnant syndrome. Ovarian remnant syndrome may recur following treatment.

It can be difficult to find healthcare professionals who are experienced in treating an uncommon condition like ovarian remnant syndrome. If you have not already done so, we suggest beginning by talking with your healthcare provider regarding an appropriate referral. For additional tips, we invite you to visit the following link on Finding An Expert.
http://rarediseases.info.nih.gov/GARD/FindAnExpert.aspx

In addition, professional societies like the following provide physician finder tools which may be helpful in locating local specialists.

The American Congress of Obstetricians and Gynecologist
Find an OBGYN: http://www.acog.org/About_ACOG/Find_an_Ob-Gyn

The Society of Gynecologic surgeons
Find an SGS Physician: http://www.sgsonline.org/findsgsphys.php

Last updated on 05-01-20

How rare is ovarian remnant syndrome?

The incidence of ovarian remnant syndrome is difficult to determine. The available data are limited to case reports or to retrospective case series. The best available data are from a study describing the frequency and outcome of laparoscopy in women with chronic pelvic pain and/or a pelvic mass who were found to have ovarian remnants. In 119 women who underwent hysterectomy and oophorectomy by laparoscopy, ovarian remnants were known in 5 and were found during surgery in 21 patients (18%). However, this was a small study and the participants were only symptomatic women. Therefore, it is not known whether the data can be extrapolated to include all women who have undergone oophorectomy.

Last updated on 05-01-20

How might ovarian remnant syndrome be treated?

Treatment for ovarian remnant syndrome (ORS) is generally indicated for women with suspected ORS who have symptoms (such as pelvic pain); have a pelvic mass; or need or desire complete removal of tissue to decrease the risk of ovarian cancer (for example, BRCA mutation carriers). The mainstay of treatment is surgery to remove the residual ovarian tissue. Women with ORS with a pelvic mass should have appropriate evaluation for malignancy (cancer). Hormonal therapy to suppress ovarian function is an alternative treatment for those who refuse surgery, or those who are not candidates for surgery.

Last updated on 05-01-20


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