PMC9286997_01
MRI of the pelvis. (a) (11) Axial T2-weighted image demonstrating the large complex cystic mass (C) located at the right hemipelvis. The lesion is multiloculated with internal haemorrhage seen as fluid-fluid levels and T2 shading (darker cyst content). (b) Coronal T2-weighted image with the normal right ovary (RO) is demonstrated lateral to the complex cystic mass (C). Large irregular low T2 signal intensity regions within the cystic lesion relate to blood products. Ut: uterus.
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She underwent a pelvic MRI which showed an indeterminate large right adnexal lesion with large areas of low T1/T2 signal intensity, multiple small cysts, and no enhancement (Figure 1).
Intraoperative images obtained during laparoscopic cystectomy. (a) Cyst wall (C) firmly adherent to terminal ileum (I). (b) Normal uterus (Ut) and left and right ovaries (LO, RO) demonstrated postcystectomy.
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Operative findings revealed a large cyst that was separate from the normal-looking right ovary and was firmly adherent to the pouch of Douglas, right pelvic sidewall, terminal ileum, and sigmoid colon (Figure 2).
Histopathology. (a) Endometrioid epithelium showing reactive-type changes. (b) Estrogen receptor immunohistochemistry positivity in the endometrioid epithelium. (c) Stromal component showing fibrosis.
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Histopathology confirmed that the lesion was a fibrotic endometrial cyst with mesothelial hyperplasia, without evidence of malignancy (Figure 3).