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Ovary-nontumor

Infectious disorders

Abscess


Reviewer: Mohiedean Ghofrani, M.D. (see Reviewers page)
Revised: 14 April 2012, last major update August 2011
Copyright: (c) 2002-2012, PathologyOutlines.com, Inc.

Definition
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● Non-specific abscess localized to the ovary
● Primary ovarian abscess is defined as inflammation arising in the ovarian tissue
● Secondary ovarian abscess originates in extraovarian sites

Laboratory
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● Most common infectious organisms are Streptococcus type B; other bacteria

Epidemiology
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● Primary ovarian abscesses are quite rare; most cases of ovarian abscess are secondary

Etiology
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● Primary abscesses may arise due to disruption of ovarian capsule, as in ovulation or surgical intervention (vaginal hysterectomy, ovarian cystectomy, caesarean section, pregnancy, use of intrauterine device, transvaginal or percutaneous needle aspiration of endometrioma, or follicle aspiration as part of in vitro fertilization, Tunis Med 2010;88:285), which gives bacteria access to the ovarian stroma
● Also occurs due to hematogenous and lymphatic spread
● Secondary ovarian abscess may be associated with tuboovarian abscess, salpingitis, ascending infection of lower genital tract (pelvic inflammatory disease) or complication of GI infections (diverticulitis, appendicitis)

Clinical features
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● Non-specific symptoms, making diagnosis difficult
● Time between capsule disruption and clinical presentation depends on bacterial inoculum dose, type and virulence, and if infection occurred secondary to direct contamination at surgery or via devitalized tissue

Case reports
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● Two cases of Brucella ovarian abscess (J Clin Ultrasound 2007;35:395)
Enterobius vermicularis infection with tuboovarian abscess and peritonitis occurring during pregnancy (Surg Infect (Larchmt) 2009;10:545)
● Tubo-ovarian abscess with Morganella morganii bacteremia (J Microbiol Immunol Infect 2009;42:357)
● Abdominal abscesses with Streptococcus milleri group after laparoscopic chromopertubation (Acta Obstet Gynecol Scand 2010;89:982)

Treatment
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● Initial treatment is intravenous antibiotics
● If no response within 72 hours, if abscess ruptures, or if surrounding organs are affected, immediate laparoscopy or laparotomy with removal of the ovary is the main treatment

Gross description
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● Large, loculated cyst with pus or secretion

Gross images
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Tubo-ovarian abscess complicating colonic diverticulitis-the left ovary and tube have been transformed into a multicystic mass with a yellow lining (AFIP)


Ovarian abscess associated with Crohn’s disease shows replacement of the ovarian tissue by yellow, soft tissue (AFIP)

Micro description
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● Cyst wall often contains ovarian stroma

Micro images
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Ovarian stroma is replaced by collagenous tissue containing numerous chronic inflammatory cells / xanthogranuloma (AFIP)

   
Tubo-ovarian actinomycosis

End of Ovary-nontumor > Infectious disorders > Abscess


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