PMC6883337_01
The CT scan that was made before the first operation: showing the huge extension of the cyst occupying all the abdomen, pushing other abdominal organs to the right.
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In addition, a left hydronephrosis was noticed due to compression of the left ureter (Fig. 1).
The microscopic appearance of the cyst's wall (A) showing the ciliated columnar epithelium (arrow), the fibrous stroma beneath it, and the intensive vascularity (*), (B) the single layer of the ciliated columnar epithelium without atypia. (C) showing the smooth muscle bundles within the cyst's wall (arrow heads).
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Microscopic examination revealed that the cyst was lined with a single layer of columnar epithelium with normal nuclei; no atypia was noticed, beneath the epithelium, a fibrous stroma, smooth muscle bundles, and extensive vasculature were found (Fig. 2).
The second CT scan that was made after 3 months of the first operation: showing the aggressive recurrence of the cyst to occupy the abdomen again.
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The cyst's recurrence was confirmed using the CT scan (Fig. 3), in addition to the elevated serum levels of cancer antigen 125 [41.2 IU/ml].
(A) The extremely distended abdomen of the patient before the second operation, (B) Intra-operative view of the cyst showing its huge size and some of its septa, (C) the dissection field after the surgical resection (D): Gross appearance of the mullerian cyst after the resection.
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The inferior vena cava, the abdominal aorta, the kidney and the ureter were heavily isolated and dissected from the cyst's septa (Fig. 4).
Three slices of the CT scan that was made 6 months after the second surgical resection showing the minimal recurrence of the cyst.
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After 6 months of follow up the patient was stable but a minimal cystic recurrence was detected by the CT scan (Fig. 5).