CONDITIONS SIMULATING OVARIAN NEOPLASMS I
Low-lying distended cecum. Normally,
the cecum lies in the right iliac fossa upon the iliopsoas muscle, with its
apex or lowest point a little to the mesial side of the middle of the inguinal
ligament. In some cases, however, the cecum hangs over the pelvic brim or is
lodged entirely within the pelvic cavity. It may be mistaken for an ovarian
cyst.
Redundant sigmoid colon. The sigmoid lies in close relationship to the uterine fundus within the true pelvis. When the redundant loop is filled with fecal material or gas, it may suggest the possibility of ovarian neoplasm.
Appendiceal
abscess. When the cecum is low or the appendix is long,
the latter may lie within the right pelvis. Should an acute appendix rupture,
the resultant localized abscess may be situated in the region of the right
adnexa. The pelvic findings may suggest the possibility of a hemorrhage,
rupture, or torsion of an ovarian neoplasm. A low-lying, acutely inflamed appendix with adherent omentum may also simulate an accident involving an ovarian
neoplasm.
Paraovarian
cysts, derived from the vestigial remnants of the
wolffian body within the broad ligament, are intraligamentous. They may be
small, incidental findings at operation or may grow to a large size. A
paraovarian cyst should be kept in mind if a unilateral, ovoid, fixed,
thin-walled cyst is palpated.
Ruptured
ectopic pregnancy with hematocele may, at times,
be confused with an acute accident in an ovarian tumor, an enlarged cystic
corpus luteum with incomplete abortion, a rupture of a graafian follicle or
hemorrhagic corpus luteum, an acute appendicitis with adherent omentum, or an
exacerbation of a predominantly unilateral chronic adnexitis.
Distended
urinary bladder. A partially filled bladder may simulate a soft,
thin-walled, anteriorly located neoplasm. If tensely distended, it may suggest
a large cyst or uterine pregnancy. A catheter or bedside ultrasonography will
resolve the question.
Intrauterine
pregnancy. The corpus of a gravid uterus is oval, smooth,
soft, cystic, and movable from side to side. When the isthmic portion of the
uterus is particularly soft (Hegar sign), it is easily compressed between the
examining fingers in the vagina and on the abdomen, suggesting the possibility
of a cystic mass separate from the cervix. The body of a pregnant uterus in
marked retroversion and retroflexion may similarly be mistaken for a cyst in the
posterior culdesac.
Pregnancy
in one horn of a bicornuate uterus is associated with
slight hypertrophy of the other horn. Pelvic examination during the first half
of pregnancy may suggest the presence of a cystic mass contiguous to a slightly
enlarged uterus. If a double vagina or a double cervix is found, a uterus
bicornis or didelphys may be suspected.
Desmoid
tumor. Situated in the hypogastric portion of the
anterior abdominal wall, this tumor may, on examination, suggest a possible
origin in the pelvis. Desmoids are solid, fibrous, benign tumors, oval in shape,
and sometimes quite large. Sarcomatous changes may occur.
Urachal
cyst. As a result of the incomplete obliteration of
the urachus at birth, a cystic dilation may, at times, be found in the
hypogastrium. Its location in the midline between the parietal peritoneum and
the anterior abdominal wall aids in the diagnosis.
Uterine fibromyomas. The presence of other multiple fibromyomas is helpful but not conclusive proof of origin. A pedunculated fibroid is freely movable, as are most ovarian neoplasms. Its broad attachment, however, may be traced to a portion of the uterus other than the ovarian ligament. A pedunculated fibroid may undergo torsion of its pedicle with infarction and peritoneal irritation, similar to twisted ovarian cysts. Ultrasonography, computed tomography, or magnetic resonance imaging may be helpful but may not always provide an unambiguous diagnosis.
