Diagnostic challenge posed by an intriguing case of simultaneous bilateral ovarian torsion and synchronous endometrial adenocarcinoma

Objective

We present an intriguing case of simultaneous, bilateral, complete ovarian torsion with synchronous endometrial adenocarcinoma in a previously healthy patient with a reported history of unilateral oophorectomy. This unique case demonstrates the limitations of pelvic imaging and patient history.

Case report

A 32-year-old woman with a history of unilateral oophorectomy, presented to the emergency department with worsening left lower abdominal pain concerning for ovarian torsion. A pelvic ultrasound showed an 8-cm heterogeneous right ovarian cyst with preserved arterial flow. The left ovary appeared absent. The endometrium appeared irregular with scant anechoic intracavitary fluid. She underwent a diagnostic laparoscopy, revealing large bilateral ovarian masses, each with torsion along its infundibulopelvic ligament. Concurrent hysteroscopic sampling demonstrated endometrial adenocarcinoma.

Conclusion

This unique case of simultaneous bilateral ovarian torsion with synchronous endometrial adenocarcinoma emphasizes the vigilance required to pursue a diagnosis when a clinical presentation conflicts with reported patient history and imaging findings.