Diagnostic challenge posed by an intriguing case of simultaneous bilateral ovarian torsion and synchronous endometrial adenocarcinoma

Objective: We present an intriguing case of simultaneous, bilateral, complete ovarian torsion with synchronous endometrial adenocarcinoma in a previously healthy patient with a reported history of unilateral oophorectomy. This unique case demonstrates the limitations of pelvic imaging and patient history. Case report: A 32-year-old woman with a history of unilateral oophorectomy, presented to the emergency department with worsening left lower abdominal pain concerning for ovarian torsion. A pelvic ultrasound showed an 8-cm heterogeneous right ovarian cyst with preserved arterial flow. The left ovary appeared absent. The endometrium appeared irregular with scant anechoic intracavitary fluid. She underwent a diagnostic laparoscopy, revealing large bilateral ovarian masses, each with torsion along its infundibulopelvic ligament. Concurrent hysteroscopic sampling demonstrated endometrial adenocarcinoma. Conclusion: This unique case of simultaneous bilateral ovarian torsion with synchronous endometrial adenocarcinoma emphasizes the vigilance required to pursue a diagnosis when a clinical presentation conflicts with reported patient history and imaging findings.