A rare cause of acute abdomen in postmenopausal women: borderline mucinous ovarian tumor with torsion

Tanya Singhal; Satyabhama Marandi; Sugatha Sahu; Keshari Rajmohan Pattayat

doi:10.18203/2320-1770.ijrcog20260212

Authors

Tanya Singhal Department of Obstetrics and Gynecology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Orissa, India
Satyabhama Marandi Department of Obstetrics and Gynecology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Orissa, India
Sugatha Sahu Department of Pathology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Orissa, India
Keshari Rajmohan Pattayat Department of Pathology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Orissa, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20260212

Keywords:

Postmenopausal adnexal mass, Ovarian torsion, Borderline ovarian tumor, Brenner tumor, Staging laparotomy

Abstract

Ovarian torsion accounts for 2–3% of gynecological emergencies and is typically associated with benign, mobile ovarian cysts in reproductive-age women. Torsion involving malignant or borderline ovarian tumors is rare, particularly in postmenopausal women, and may obscure timely diagnosis and management. We report a rare case of a 45-year-old postmenopausal woman presenting with acute abdominal pain, nausea, and vomiting. Clinical examination revealed a large, firm abdominopelvic mass with restricted mobility. Ultrasound and contrast-enhanced CT demonstrated a 20 cm multiloculated right ovarian mass with solid components and >270° vascular pedicle torsion, raising suspicion for malignancy. Tumor markers showed normal CA-125 and CEA but elevated CA-19.9. The patient underwent staging laparotomy with total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. Intraoperatively, a 20 cm twisted ovarian mass with areas of hemorrhage and necrosis was identified. Histopathology confirmed a mucinous borderline ovarian tumor with microinvasion, confined to the right ovary (FIGO stage pT1a). The contralateral ovary unexpectedly showed a benign Brenner tumor. Omentum and peritoneal cytology showed no malignant involvement. This case underscores that adnexal torsion in postmenopausal women warrants a high index of suspicion for malignancy. Mucinous tumours may present with normal CA-125 but elevated CA-19.9, particularly in the setting of torsion. Early imaging, comprehensive evaluation, and prompt surgical staging are crucial to prevent complications such as capsular rupture and peritoneal dissemination. Timely management in this case enabled complete oncologic surgery and a favorable postoperative outcome.

Metrics

Metrics Loading ...

References

Hibbard LT. Adnexal torsion. Am J Obstet Gynecol 1985;152(4):456–61 DOI: https://doi.org/10.1016/S0002-9378(85)80157-5

Templeman C, Fallat ME, Blinchevsky A, Hertweck SP. Noninﬂammatory ovarian masses in girls and young women. Obstet Gynecol 2000;96(2):229–33. DOI: https://doi.org/10.1097/00006250-200008000-00014

Moro F, Bolomini G, Sibal M, et al. Imaging in gynecological disease (20): clinical and ultrasound characteristics of adnexal torsion. Ultrasound Obstet Gynecol. 2020;56:934–43 DOI: https://doi.org/10.1002/uog.21981

Bridwell RE, Koyfman A, Long B. High risk and low prevalence diseases:ovarian torsion. Am J Emerg Med 2022;56:145–50 DOI: https://doi.org/10.1016/j.ajem.2022.03.046

Abes M, Sarihan H. Oophoropexy in children with ovarian torsion. Eur JPediatr Surg 2004;14(3):168–71. DOI: https://doi.org/10.1055/s-2004-817887

Oophoropexy: The Hotdog in a Bun Technique. J. D. Kondrup. J. Measick OB/GYN. Lourdes Hospital, Binghamton, New York. Journal of Minimally Invasive Gynecology. 2012; 19:S151-S178. DOI: https://doi.org/10.1016/j.jmig.2012.08.507

Novoa M, Friedman J, Mayrink M. Ovarian torsion: can we save the ovary?Arch Gynecol Obstet 2021;304(1):191–5. DOI: https://doi.org/10.1007/s00404-021-06008-8

Eitan R, Galoyan N, Zuckerman B, Shaya M, Shen O, Beller U. The risk of malignancy in post- menopausal women presenting with adnexal torsion. Gynecol Oncol 2007;106(1):211–4. DOI: https://doi.org/10.1016/j.ygyno.2007.03.023

Cohen A, Solomon N, Almog B, Cohen Y, Tsafrir Z, Rimon E, et al. Adnexal torsion in postmenopausal women: clinical presentation and risk of ovarian malignancy. J Minim Invasive Gynecol 2017;24(1):94–7. DOI: https://doi.org/10.1016/j.jmig.2016.09.019

Tien C-T, Cheng C-H, Hong M-K. Torsion and ruptured ovarian cystadenocarcinoma with internal bleeding complicated with retroperitoneal hematoma after tumor transection: A case report. Medicine 2025;104:4 DOI: https://doi.org/10.1097/MD.0000000000041282

Emin U, Tayfun G, Cantekin I, Ozlem UB, Umit B, Leyla M. Tumor markers in mature cystic teratomas of the ovary. Archives of Gynecology and Obstetrics. 2009;279(2):145–47. DOI: https://doi.org/10.1007/s00404-008-0688-2

Kelly PJ, Archbold P, Price JH, Cardwell C, McCluggage WG. Serum CA19-9 levels are commonly elevated in primary ovarian mucinous tumours but cannot be used to predict the histological subtype. J Clin Pathol 2010; 63: 169–73 DOI: https://doi.org/10.1136/jcp.2009.072355