Ovarian mucinous cystadenoma

Case contributed by Dr Yair Glick

Presentation

Left lower quadrant pain.

Patient Data

Age: 50 years
Gender: Female

Multiseptated ovoid cystic mass measuring 21.1 x 15.3 x 12.3 cm in the abdominal cavity, containing denser areas (approx. 30 HU) and blood vessels, arising from the right ovary. The non-cystic areas could represent solid components or hemorrhage. Omental fat stranding anterior to the mass, suspicious metastatic spread to the omentum.
The uterine cavity contains a hypodense ovoid structure measuring 5.4 x 5.7 x 4.8 cm with an enhancing peripheral nodule - most probably a leiomyoma.

Case Discussion

The large cystic ovarian mass was suspicious for mucinous cystadenocarcinoma, given the non-cystic areas, the internal vasculature and the omental fat stranding. A bilateral salpingo-oophorectomy was performed and fortunately, pathology proved otherwise:

Macroscopic description:
Cystic mass weighing 3 Kg, measuring 24 x 18 x 12 cm. The mass contains turbid fluid, mucinotic, and consists of secondary cysts. Adjacent to the cyst there is a fallopian tube stump 2.5 cm long, with a 5-cm diameter.
Microscopic description:
Rt ovarian cystectomy:
Multilocular mucinous cystadenoma with foci showing borderline features.
Extensive necrosis and fresh hemorrhages are present.
The fallopian tube (rt part) shows no significant pathological changes.

Both fallopian tubes and the left ovary were without significant pathological changes.

The omentum showed areas of fresh hemorrhage, with no evidence of malignancy.

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