Imaging description

Ovarian transposition (or oophoropexy) is the surgical relocation of one or both ovaries into a fixed anatomic position, and is usually performed to shield the ovaries from radiation therapy to the pelvis and hence preserve gonadal function in premenopausal women or to prevent recurrent ovarian torsion [1–3]. Typically the ovaries are sutured superolaterally in the paracolic gutters, up to the level of the lowest ribs [4]. At cross-sectional imaging, the displaced ovaries typically appear as mixed solid and cystic ovoid masses in the iliac fossae (Figure 76.1) and may be mistaken for primary or secondary tumors [4]. Specifically, the displaced ovaries may be misinterpreted as peritoneal implants in patients who have a history of pelvic radiation for malignancy [5]. The transposed ovaries are commonly marked with metallic surgical clips [2,6], which may facilitate correct identification. Other helpful signs are the presence of multiple small intralesional cysts (presumably follicles) and the identification of a vascular pedicle in continuity with the gonadal vessels [7]. The frequency of benign cysts and peritoneal inclusion cysts is increased in transposed ovaries (Figures 76.2 and 76.3) [4, 7].

Importance

Misdiagnosis of ovarian transposition as primary or secondary ovarian tumor may result in unnecessary surgery or treatment, particularly when recurrent malignancy is suggested in patients with a history of irradiated pelvic cancer.

Typical clinical scenario

Transposed ovaries are typically seen when surveillance imaging is performed in women of reproductive age with a history of radiation for pelvic malignancies such as cervical cancer, rectal cancer, or lymphoma.