Presentation
A female patient presented with complaints of two episodes of post-menopausal bleeding during the last six weeks. She had menopause for the last 13 years. There is a past history of two LSCS and a tubal ligation surgery.
Patient Data
There is a large lesion in the lower abdomen and pelvis. It is a multilocular cystic lesion with low-level internal content. There is no solid nodule/ papillary structures/ wall irregularity/ wall vascularity. There is a presence of a few tiny calcification foci. The cyst size is 225 x 200 x 105 mm. The left ovary is not separately seen.
The right ovary is atrophic without any lesion.
The uterus is anteverted with a normal postmenopausal appearance. The uterine cervix is normal. The endometrial thickness is 3 mm. There is no endometrial collection.
The urinary bladder is empty and compressed by the lesion.
There is no ascites.
Case Discussion
The case shows a 23cm left ovarian multilocular cystic lesion with a few calcification foci in a postmenopausal female.
According to IOTA simple rules, this is an indeterminate lesion (No B or M features).
ADNEX score: 84% chance benign
According to the O-RADS risk stratification, this is an O-RADS 4 lesion (intermediate risk, 10-50% risk of malignancy)
Surgical excision was done and the histopathology proved the lesion being an ovarian mucinous cystadenoma.
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