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. 2025 Jun 27;17(2):170-179.
doi: 10.52054/FVVO.2025.49. Epub 2025 Jun 10.

Ovarian remnant syndrome: an unsuspected diagnosis

Irene Colombi  1 , Gabriele Centini  1 , Francesco Giuseppe Martire  1 , Alessandro Ginetti  1 , Alberto Cannoni  1 , Lucia Lazzeri  1 , Filiberto Maria Severi  1 , Errico Zupi  1
Affiliations

Ovarian remnant syndrome: an unsuspected diagnosis

Irene Colombi et al. Facts Views Vis Obgyn. .

Abstract

Background: Ovarian remnant syndrome (ORS) is a rare condition defined by the presence of residual tissue of ovarian origin, histologically confirmed in a woman with a previous salpingo-oophorectomy, usually as a result of difficult surgery in the presence of adhesions.

Objectives: To evaluate the existing literature on ORS.

Methods: A narrative review was performed. A search for relevant articles was carried out in PubMed for the period from January 2014 to July 2024. Three original cases of ORS are also reported.

Main outcome measures: All available literature on the subject was analysed and articles relevant to the topic of the review were included. Additional articles were reviewed to provide an overview of the issue.

Results: A total of 10 different cases of ORS found in the literature were analysed, together with 3 original cases.

Conclusions: The presence of distorted anatomy and extensive adhesions may lead to an increased risk of residual ovarian tissue. Residual ovarian tissue may sometimes evolve into a malignant lesion. When difficult oophorectomy is suspected, the surgeon must proceed with caution to complete oophorectomy. Strict follow-up is essential to detect ORS.

What is new?: This is the first narrative review including cases described in the literature and three new original cases. Our work provides a comprehensive and global view of this condition and may help in clinical practice to reduce the risk of ORS through appropriate surgical planning and possibly early diagnosis of the syndrome.

Keywords: Ovarian remnant syndrome; endometrioid ovarian carcinoma; ultrasound.

PubMed Disclaimer

Conflict of interest statement

Data sharing: The data supporting the results of the article are stored in an archive. The authors are available to share the data upon request.

Figures

Figure 1
Figure 1
PRISMA 2020 flow diagram which includes searches of PubMed. Literature search diagram. A total of 55 papers filled the search string. Of these, 1 article was excluded because the full text was not available. In addition, 23 were excluded because they were out of topic and 21 were excluded because they were studies on animals. A total of 10 papers were eligible for review. PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2
A-E) Ultrasonographic pelvic assessment during follow-up (case 1).
Figure 3
Figure 3
Ultrasonographic pelvic assessment (case 2). A solid multilocular cyst with a vascularized central solid part is observed on power Doppler (A). 3D appearance of the mass (B). The cyst was located posterior to the uterine body and cervix as clearly visible in the longitudinal scan of the uterus (C). The Pouch of Douglas was obliterated. Picture D shows the ultrasound appearance of the mass in May 2024, with the cyst no longer visible, appearing as ovarian parenchyma.
Figure 4
Figure 4
Ultrasound scan at 6 months (case 3). Residual ovarian tissue with follicular activity is observed (A-C). A nodule of deep endometriosis infiltrating the anterior wall of the rectum is visible in the posterior compartment (D).
Figure 5
Figure 5
Ultrasonographic aspect of the endometrioid ovarian cancer in the context of ORS. It appears as a large, unilateral, multilocular-solid tumour, with anechoic cystic fluid. A large central solid component located within locules can be observed corresponding to a cockade-like sign. ORS: Ovarian remnant syndrome
See this image and copyright information in PMC

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