Dear Editor,

I have read with interest the paper titled “Case report of ovarian torsion mimicking ovarian cancer as an uncommon late complication of laparoscopic supracervical hysterectomy” written by Ciebiera et al. and published in “Menopause Review” in 2016; 15: 223-226.
The authors described what they call an unusual presentation of an adnexal +10 cm large mass with adnexal torsion in a 46-year-old woman who previously had laparoscopic hysterectomy with unilateral adnexectomy due to fibroids, and a haemorrhagic cyst of her left ovary. The patient had preoperative tumour markers assessment, pelvic ultrasound, and pelvic computed tomography. The Authors claim that all these studies indicated an “elevated risk of malignancy”, and because of this, laparotomy with midline vertical incision was performed. During surgery they collected multiple cytological smears and “mid-surgical evaluation with the possibility of conversion to a full oncological profile (excision of the cervix, greater omentum, appendix, and lymphadenectomy)” was planned. To document their thesis, two preoperative sonographic images of the smooth-shaped solid-cystic mass are presented. Despite a detailed description of the preoperative diagnostic methods, there are a number of important issues around the design, analysis, and reporting of this case that I wish to raise.
First, ultrasound scans, contrary to the macroscopic picture of the removed tumour, are not presented in colour, so the vascularity of the mass is difficult/impossible to assess. Moreover, these “representative” scans were made in greyscale only, and because of this they do not contain a colour Doppler map on the right side of the images. Therefore, we have to believe the Author’s claim that the subjective assessment of the examiner suggested high vascular content, at least in some portions of this mass. Secondly, since preoperative levels of serum CA-125 antigen and HE-4 protein were 41.1 U/ml and 83.1 pmol/l, respectively, the Authors claim that the calculated Risk of Ovarian Malignancy Algorithm (ROMA) was 31.5%, which, according to their beliefs, “classified the patient in the ‘high risk for ovarian cancer’ group”. Unfortunately, this is not so easy. The patient, despite hysterectomy at the age of 46, was still premenopausal, because the menopause in women after uterus removal is stated as +50 years of age in most scientific papers. Premenopausal status makes a possibility of repeated haemorrhagic...


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