PMC10359676_01
PMC10359676_02
a Midline pelvic cystic lesion superior to the bladder on pelvic ultrasound. b Cyst noted to be separate from left ovary on pelvic ultrasound (right ovary not pictured). c Cyst identified in the retroperitoneum and identified as separate from both ovaries and the bladder on T2-weighted MRI. d Multicystic lesion in left adnexa on pelvic ultrasound.
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F1
A dedicated pelvic ultrasound re-demonstrated this pelvic cystic lesion crossing midline (shown in Fig. 1a). This repeat ultrasound was able to identify both ovaries, and the mass was felt to be non-ovarian (shown in Fig. 1b). Although this imaging was not consistent with ovarian pathology, it did expand the differential diagnosis to include paraovarian/paratubal lesion or neurenteric cyst (shown in Fig. 1c). These now identified a second multicystic structure in the left adnexa measuring 1.5 x 0.8 x 1.3 cm, concerning for a potential MCDK versus obstructed Mullerian structure (shown in Fig. 1d).
PMC10359676_03
PMC10359676_04
a Intraoperative view of cyst identified in the retroperitoneum, posterior to small bowel mesentery. b Gross appearance of excised cyst. c Primitive glomeruli and renal tubules identified on pathology (hematoxylin and eosin stain).
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F2
The cystic structure was identified in the retroperitoneum via a transmesenteric approach (shown in Fig. 2a). Grossly, it appeared thin walled without solid components (shown in Fig. 2b). Surgical pathology returned as benign cystic tissue containing abortive glomeruli and renal tubules and mesenchyme-like tissue (shown in Fig. 2c).
PMC10359676_05