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Ovary - nontumor

Non-neoplastic cysts/other

Ovarian pregnancy


Reviewer: Shahid Islam, M.D., (see Reviewers page)
Revised: 5 June 2012, last major update June 2012
Copyright: (c) 2002-2012, PathologyOutlines.com, Inc.

General
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● 1-3% of ectopic pregnancies; often conceptus dies or involutes spontaneously
● Resembles tubal pregnancy due to similar symptoms (abdominal pain, amenorrhea, abnormal vaginal bleeding) and risk factors (pelvic inflammatory disease, prior pelvic surgery, IUD [Eur J Obstet Gynecol Reprod Biol 2004;114:92], use of progesterone only minipill)
● Due to retention of ovum in ovarian operculum and continued entrapment within ruptured ovarian follicle; sperm fertilizes entrapped ovum, and implantation occurs within ovary
● Difficult to diagnose clinically or even intraoperatively
● Patients have excellent prognosis for future fertility; recurrence is virtually nonexistent

Spiegelberg criteria:
1) intact ipsilateral tube, clearly separate from the ovary
2) gestational sac within or replacing the ovary
3) sac connected to the uterus by the ovarian ligament
4) histologically proven ovarian tissue located in the sac wall (Arch Gynaekol 1878;13:73)

Case reports
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● 23 year old woman (Indian J Pathol Microbiol 2008;51:37)
● 31 year old woman (Arch Pathol Lab Med 2003;127:1635)
● Patient with intact IUD (Arch Pathol Lab Med 1981;105:112)

Treatment
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● Methotrexate (ISRN Obstet Gynecol 2012:2012;637094)
● Wedge resection if unsuccessful (MedGenMed 2006;8:35)

Gross description
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● Enlarged gray-tan ovaries; may clinically resemble tumor (Ann Afr Med 2007;6:36)

Gross images
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Intraoperative


Hemorrhagic cavity


Ovary is replaced by a hemorrhagic mass containing a small, pale yellow fetus (AFIP)


Ovary containing gestational sac

Micro description
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● Evidence of pregnancy (chorionic villi, trophoblastic tissue), ovarian tissue in wall of gestational sac

Micro images
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Corpus luteum, chorionic villi and trophoblastic tissue


Chorionic villi surrounded by corpus luteum

End of Ovary - nontumor > Non-neoplastic cysts/other > Ovarian pregnancy


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