Huge cystic ovarian lesions

Case contributed by Dr Yair Glick

Presentation

Right flank pain, constipation. Huge abdominal mass palpated.

Patient Data

Age: 17 years
Gender: Female
CT

CT abdomen performed using the split bolus technique.

Two huge cystic multilocular lesions appear to arise from each of the ovaries. No obvious soft tissue or hyperenhancing component. Several tiny peripheral calcific specks. The right lesion measures 19 x 17 x 24.8 cm and the left one - 17.3 x 12.9 x 25.2 cm. Massively dilated renal collecting systems, with significantly dilated ureters due to mass effect on the distal ureters and substantially delayed renal excretion of contrast material (20 ml of IV contrast bolus given 20 minutes before the scan for the split bolus). The lesions displace all of the small bowel loops superiorly; the ileocecal valve is located at the level of the right renal midzone. The left lesion displaces the uterus to the right and presses down on the urinary bladder. The greater omentum shows fat stranding.

Case Discussion

Bilateral double-J stents were inserted and she went on to have bilateral ovarian cystectomy.

Pathology:

1. Lesion from left ovary surface:

2. Cysts from right ovary:

  • multilocular serous cystadenoma/cystadenofibroma
  • few small follicular cysts
  • extensive tissue sampling performed

3. Cysts from left ovary:

4. Omentum:

  • adipose tissue shows acute inflammation

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