A Rare Torsion Case of Polycystic Ovarian Syndrome: A Natural Course with Laparoscopic, Cytological and Pathological Findings

Abstract

Polycystic ovary (PCO) syndrome cases with adnexal torsion in a natural cycle without ovarian induction are rare, and many torsion cases in PCOs involve pelvic masses, such as uterine fibroids. A 37-year-old woman, gravida two para two, came in an emergency because of lower abdominal pain for 2 or 3 days. PCO was followed in a previous hospital. At a visit in her Douglas pouch, a 7.3 x 4.5 cm mass that was consistent with the point of tenderness was detected by ultrasonography and magnetic resonance images. The patient underwent a semi-emergent laparoscopic surgery for a diagnosis of torsion of the left adnexa. At an abdominal exploration, the left ovary was swollen to approximate 7 cm in size and twisted 360°clockwise. The intraoperative imprint cytology showed the presence of fibrous cells alone, thus the malignancy denied. Histologically, fibrously thickened cortex and multiple follicular cysts due to atretic follicles were found, compatible with PCO. As the patient did not desire to have children and less likely to twist the right ovary, she wanted having low dose pills.