{"paper_id":"626d770b-c06e-42c8-a0db-f5e15f0daea9","body_text":"Defined as an ectopic ovarian tissue without any \nconnection with the utero-ovarian ligament, broad \nligament, or infundibulopelvic ligament, a supernu-\nmerary ovary is an extremely rare gynecological \nanomaly. It was first described by Winckel in 1890. \nThe supernumerary ovary is unrelated to normal \novaries but has a normal ovarian function, although \nthey may also sometimes be non-functional.\n1-3 In this \npaper, we report the clinical, radiological, and \nhistopathological features of a supernumerary ovary \nin the right abdominal region that was excised la-\nparoscopically, and diagnosed histopathologically. \n CASE REPORT \nA female infant born at 39 th gestational week had \nbeen found to have an abdominal cystic mass by pre-\nnatal ultrasonography (US) at 28th week of gestation. \nUS was performed right after birth (Figure 1A), and \na magnetic resonance imaging (MRI) examination \nhad revealed that the abdominal cystic mass con-\ntained patchy semisolid components within a hemor-\nrhagic or mucinous fluid (\nFigure 1B, Figure 1C).  \nSurgery had been recommended for the lesion, \nbut the patient’s parents had refused it. The patient \nwas referred to our hospital for jaundice 3 months \nlater. In laboratory studies, she had a hemoglobin \nlevel of 7.7 g/L, a thrombocyte count of 17,000/mm\n3, \nand an indirect bilirubin level of 4.6 mg/dL. On ex-\namination, there was a mass with a size of approxi-\nmately 5 cm on the right side of the abdomen. US \nexamination showed no significant morphological \nchange but a modest increase in size compared to the \nTurkiye Klinikleri J Case Rep. 2022;30(2):149-52\n149\nSupernumerary Ovary Characterized by  \nCystic Changes in the Omentum: A Rare Pathology \n    Levent CANKORKMAZa,     Mehmet Haydar ATALARb,     Hatice ÖZERc,     Gökhan KÖYLÜOĞLUd, \n    Nisa BAŞPINARb \naDepartment of Pediatric Surgery, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Türkiye \nbDepartment of Radiology, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Türkiye \ncDepartment of Pathology, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Türkiye \ndDepartment of Pediatric Surgery, İzmir Kâtip Çelebi University Faculty of Medicine, İzmir, Türkiye \n \nThis study was presented as a poster in “55. Türkiye Milli Pediatri Kongresi”, October 12-16, 2011, Antalya, Türkiye. \nABS TRACT Supernumerary ovary is a rarest gynecologic condition in children. The presence of cystic changes within the supernumerary ovary \nis extremely rare. We report a case of neonate with supernumerary ovary. The patient was 3-month-old girl with a right-side cys t diagnosed by \na prenatal ultrasonographic evaluation. Ultrasonography performed right after birth, and a magnetic resonance imaging examination had revealed \nthat the abdominal cystic mass contained patchy semisolid components within a hemorrhagic or mucinous fluid. Laparotomy reveale d a cystic \nmass which has no connection with the normal reproductive organs. Two normal ovaries were identified in the abdominal cavity. After excision, \nhistopathologic study revealed that cystic mass was supernumerary ovary on the omentum. The baby had no postoperative complicat ions. Pre-\nnatal differential diagnosis of abdominal cystic masses in infants with supernumerary ovary will be useful to keep in mind. \n \nKeywords: Supernumerary ovary; neonatal ovarian\nDOI: 10.5336/caserep.2021-87516\nCASE REPORT\nCorrespondence: Levent CANKORKMAZ \nDepartment of Pediatric Surgery, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Türkiye \nE-mail: lcankorkmaz@gmail.com  \nPeer review under responsibility of Turkiye Klinikleri Journal of Case Reports.  \nRe ce i ved: 14 Dec 2021          Received in revised form: 16 Feb 2022         Ac cep ted: 17 Feb 2022          Available online: 25 Feb 2022  \n2147-9291 / Copyright © 2022 by Türkiye Klinikleri. This is an open \naccess article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).\nTurkiye Klinikleri Journal of Internal Medicine \nTürkiye Klinikleri Journal of Case Reports\n\n\nprevious US examination. This time, the patient’s \nfamily gave consent for surgery. In laparotomy, a \nbrown-colored cystic mass connected to omentum \nwas excised, which had a size of 7x5x3 cm and a \nweight of 80 grams (\nFigure 2A). The cystic mass did \nnot have any connection with normal reproductive or-\ngans. It was, however, connected to the greater omen-\ntum and twisted around a pedicle. It had a thin and \nsmooth wall. Cyst fluid had a hemorrhagic character. \nThere were 2 normal ovaries and a normal uterus in \nthe pelvic cavity. Histologically, a normal ovarian \nstroma with scattered primordial follicles was seen \n(\nFigure 2B-D). The histopathological diagnosis of a \nsupernumerary ovary with signs of torsion and cystic \nchanges was made. The patient had no postoperative \ncomplications and was discharged on the 4\nth postop-\nerative day. Her follow-up was also non-problematic. \nInformed consent was obtained from the parents of \nthe patient for this study. \n DISCUSSION \nThe supernumerary ovary is a rare congenital, \nanatomic, and genital condition. Lachman and \nBerman classified its etiology as being postoperative, \npost-inflammatory, or true embryological.\n2 Primor-\ndial germ cells found on the cyst’s wall confirm that \nthe omental cystic lesion of our patient originated \nfrom the ovarian tissue. These findings, taken to-\ngether with those of previous reports, made us hy-\npothesize that the ectopic ovarian tissue transformed \ninto an omental cyst after abnormal embryological \nmigration. We may suggest that supernumerary \novaries possibly have an embryological origin as per \nLachman’s classification.\n2-4 \nAccording to Wharton criteria, the supernumer-\nary ovary has 3 major characteristics.5 \n1. It must contain ovarian follicular tissue \n2. It must be completely separate from the nor-\nmal ovarian tissue \n3. It must originate from a separate primordium.  \nAccessory ovary, a condition most commonly \nconfused with the supernumerary ovary, is either lo-\ncated in the vicinity of or in relation to a normal \novary. It may also be connected to accessory ovaries, \nfallopian tubes, or various ligamentous structures of \nthe utero-ovarian complex.\n6 \nSupernumerary ovaries may be located in the \npelvis, retroperitoneum, para-aortic region, inguinal \narea, or colon mesentery. Omental location, however, \nis less common. Omental supernumerary ovary with \ncystic changes is particularly rarer.\n7 Our literature \nsearch identified only eight cases with omental su-\npernumerary ovary.\n7,8 It has been reported that 23-\n36% of supernumerary ovary cases are associated \nwith other congenital malformations of the geni-\ntourinary system such as kidney and ureter agenesis, \nbladder diverticula, ureteral duplication, and bicor-\nnuate/unicornuate uterus.\n2,6,9 No associated malfor-\nmation was detected in our patient. Furthermore, \nendometriosis at various locations of the pelvic cav-\nity may also be associated with supernumerary ovary \nin about 20% of adult patients.\n6 \nThe majority of cases with supernumerary ovary \nare asymptomatic and diagnosed incidentally at sur-\ngery performed for other indications, or at autopsy. \nThe supernumerary ovary may become clinically \nLevent CANKORKMAZ et al. Turkiye Klinikleri J Case Rep. 2022;30(2):149-52\n150\nFIGURE 1: A) An ultrasonographic image shows a large, complex mass with a mixed echo pattern; B) T1-weighted and C) T2-weighted coronal magnetic resonance ima-\nges show a hyperintense expansile cystic mass lesion at the right lower quadrant. Hyperintensity in the T1-weighted magnetic re sonance image is based on the hemorr-\nhagic nature of the lesion.\n\nsymptomatic when it gets enlarged or twisted around \na pedicle, as in our case. They may rarely show the \ncystic or neoplastic transformation. US, computed to-\nmography, and MRI may aid in the diagnosis of the \nsupernumerary ovary.\n6,7 Unfortunately, no specific \nimaging finding has been reported for supernumer-\nary ovary in the literature. However, supernumerary \novary should be suspected in cases having bilaterally \nnormal ovaries and a thick-walled, complex cystic le-\nsion, especially in the pelvic region. \nThe differential diagnosis of supernumerary \novary should include hydrosalpinx, ectopic preg-\nnancy, para-ovarian cyst, pedunculated myoma uteri, \nparasitic tumors of internal genital organs, cysts of \nmesenteric and omental origin, and lymphangioma. \nDefining supernumerary ovary may be important for \nthe differential diagnosis of neonatal ovarian cysts. \nSupernumerary ovary should be remembered in the \nprenatal differential diagnosis of ovarian cystic mass \nlesions.\n3,5,6,8,10,11 \nOwing to the risk of malignant transformation, \nsupernumerary ovary should be treated by surgical \nexcision.\n11 \nIn conclusion, the supernumerary ovary is an ex-\ntremely rare gynecological condition. It should be re-\nmembered in the differential diagnosis of \nintraabdominal cystic mass lesions in the prenatal pe-\nriod, as was the case in our patient. \nSource of Finance \nDuring this study, no financial or spiritual support was received \nneither from any pharmaceutical company that has a direct \n connection with the research subject, nor from a company \n that provides or produces medical instruments and materials \nwhich may negatively affect the evaluation process of this \n study. \nConflict of Interest \nNo conflicts of interest between the authors and / or family mem-\nbers of the scientific and medical committee members or members \nof the potential conflicts of interest, counseling, expertise, working \nconditions, share holding and similar situations in any firm. \nAuthorship Contributions \nIdea/Concept: Levent Cankorkmaz, Mehmet Haydar  \nAtalar, Hatice Özer, Gökhan Köylüo ğlu, Nisa Ba şpınar;  \nDesign: Levent Cankorkmaz, Mehmet Haydar Atalar,  \nHatice Özer, Gökhan Köylüo ğlu, Nisa Ba şpınar; Control/ \nLevent CANKORKMAZ et al. Turkiye Klinikleri J Case Rep. 2022;30(2):149-52\n151\nFIGURE 2: A) Postoperative gross specimen shows a thin-walled cyst containing intraluminal hemorrhage; B) Hemorrhage, necrosis and microc alcified body are seen in \novarian stromal-like connective tissue (H&E, original magnification x40); C) Primordial germ cell (marked with an arrow) (H&E, original magnification x200), and D) Tuba \nuterina (H&E, original magnification x40).\n\nSupervision: Levent Cankorkmaz, Mehmet Haydar Atalar, Hatice \nÖzer, Gökhan Köylüoğlu, Nisa Başpınar; Data Collection and/or \nProcessing: Levent Cankorkmaz, Hatice Özer, Gökhan \nKöylüoğlu; Analysis and/or Interpretation: Levent Cankorkmaz, \nMehmet Haydar Atalar, Nisa Ba şpınar; Literature Review: \n Levent Cankorkmaz, Mehmet Haydar Atalar; Writing the Article: \nLevent Cankorkmaz, Mehmet Haydar Atalar, Hatice Özer, Gökhan \nKöylüoğlu, Nisa Başpınar; Critical Review: Levent Cankorkmaz; \nReferences and Fundings: Levent Cankorkmaz; Materials:  \nLevent Cankorkmaz, Hatice Özer.\nLevent CANKORKMAZ et al. Turkiye Klinikleri J Case Rep. 2022;30(2):149-52\n152\n1. Irving JA, Clement PB. Nonneoplastic lesions of the ovary. In: Kurman \nRJ, Ellenson LH, Ronnett BM, eds. Blaustein's Pathology of the Female \nGenital Tract. 6th ed. Boston (MA): Springer; 2011. p.579-624. \n[Cross-\nref]  \n2. Lachman MF, Berman MM. The ectopic ovary. A case report and  \nreview of the literature. Arch Pathol Lab Med. 1991;115(3):233-5. \n[PubMed]  \n3. Matsubara Y, Fujioka T, Ikeda T, Kusanagi Y, Matsubara K, Ito M. Peri-\nodic size changes in a supernumerary ovary with associated corpus \nluteal cyst. J Obstet Gynaecol Res. 2009;35(1):180-2. \n[Crossref]  \n[PubMed]  \n4. Alpern HD. Supernumerary ovary. A case report. J Reprod Med. \n1990;35(3):283-5. [PubMed]  \n5. Lim MC, Park SJ, Kim SW, Lee BY, Lim JW, Lee JH, et al. Two dermoid \ncysts developing in an accessory ovary and an eutopic ovary. J Korean \nMed Sci. 2004;19(3):474-6. \n[Crossref]  [PubMed]  [PMC]  \n6. 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