Presentation
Severe left adnexal pain.
Patient Data
Unilocular solid mass in the left adnexa measuring 12.9 x 13.8 x 10.8 cm. There are numerous vascularized papillary projections along the periphery of the internal wall of the cyst.
Uterus was normal in size and position, measuring 6.4 x 6.3 x 6.4 cm. The myometrium had a uniform echotexture and the endometrium was smooth and thin. The right ovary was normal in size and position. It measured 2.7 x 2.5 x 3.2 cm, was perfused with 12 visualized follicles. Small amount of pelvic free fluid.
Case Discussion
Path proven ovarian serous borderline tumor. This case demonstrates the typical appearance of a unilocular lesion with papillary projections.
Based on IOTA simple rules, this is an indeterminate lesion, which contains both "B" features (B1 - unilocular) and "M" features (M3 - more than 3 papillary projections and M5 - strong color flow).
ADNEX model predicts a 73% chance of benign lesion.
O-RADS Category 5 - High risk of malignancy: Unilocular cyst, ≥ 4 papillary projections, any size, CS = any.
Note here discordance between the IOTA, ADNEX, and O-RADS.