Ms. VR, 19 year old girl came to us on 12/11/2005 with complaints of irregular periods since 3 years and chronic lower abdomen pain for the previous 3 weeks. She was a resident of Ludhiana (Punjab) and had an interesting medical history. She had approached a local gynecologist for the same complaints on 1/11/2005 for which an ultrasound abdomen at two different medical centres was sought. Two different reports suggesting an enlarged right ovary 85 mm X 80 mm X 65mm with an impression to rule out ovarian tumor at one centre and at the other, an opinion of a large midline pelvic mass with solid and cystic components, in favour of dysgerminoma or invasive mole, was given. Further investigations suggested were urine pregcolor, CA-125, and diagnostic laparoscopy. The gynecologist decided to do CA-125 and the level was 107.0 Uml (Ref.Range < 35 Uml.). An MRI was done on 2/11/2005 which suggested a large solid midline pelvic S.O.L measuring 9.5 x 6.4 cm with mass effect on the urinary bladder and uterus, requesting FNAC for further evaluation. Hence FNAC was proceeded with on 7/11/2005. Two attempts were made to obtain tissue giving a final cytology report of inflammation, and also suggesting that the tumor is non-yielding cytologically. By this time the young girl had to endure pain and emotional turbulence due to the fear of an ovarian tumor. In all this time she had been treated with antispasmodics and antibiotics.

At our centre on 12/11/2005 she was diagnosed as PCOS by history and on ultrasound, the left ovary was visualised with multiple small follicles and cysts while the right ovary was not imaged. Hence an opinion at a reputed centre (Mediscan) for sonology was advised in order to rule out ovarian torsion. We had suspected an ovarian torsion due to the fact that she was a case of PCOS where follicular cysts are common and the sudden pain could be due to torsion rather than an ovarian tumor, especially since her right ovary was not seen. The second opinion report suggested a normal left ovary with a 6.4 X 4.4 cms hypoechoic solid mass in the left adnexa just above the left ovary.The right ovary was not imaged in its normal position. Color doppler showed normal vascularity in the left ovary with absence of flow in the mass.