PMC5405651_01
(a) Transabdominal US image showing a solid near-homogenous isoechoic mass. (b, c) Axial T1W and T2W MRI showing a large isointense-to-hypointense mass (white asterisk) in the right lower abdomen and the adnexal region compressing the urinary bladder (black asterisk). (d) Sagittal T2W MRI showing a small hypoplastic uterine tissue/Mullerian remnant (black arrow) behind the urinary bladder (black asterisk)
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F1
Pelvic ultrasound (US) was performed, wherein a solid mass was seen in the right adnexa [Figure 1] with the nonvisualized uterus and the ovaries. The patient was convinced for pelvic magnetic resonance imaging (MRI), which revealed a hypoplastic uterus with a solid right adnexal mass [Figure 1].
Karyotyping of the patient shows normal male genotype (46XY)
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F2
Further evaluation was performed with karyotyping and serum testosterone levels, which revealed 46XY pattern genotype [Figure 2] and low serum testosterone levels (0.45 ng/dl).
Histopathological analysis of the mass (a) on H&E staining. Complex neoplasm composed of a mixture of large primordial germ cells, immature sertoli cells, and gonadal stroma (black arrow). (b) The streak gonad showing the loss of gonadal stroma (black arrow) with paucity of the germ cells
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F3
Histopathological analysis showed the right-sided gonadoblastoma and the left-sided streak gonad of ovarian origin [Figure 3].