PMC9997864_01
(a) MRI pelvis coronal view illustrate right adnexal mass (M) and uterus (U). (b) MRI pelvis sagittal view demonstrating cystic adnexal mass (M) with papillary projecting solid mural nodule (N). (c) MRI pelvis axial view demonstrate relationship between adnexal cyst (M), uterus (U) and uterine leiomyoma (L). MRI: Magnetic resonance imaging
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F1
Other differential diagnosis could not be excluded radiologically such as para-ovarian cyst (mesonephric or para-mesonephric) and pelvic wall peritoneal cyst [Figure 1a-c].
(a) The cyst before removal (M). The right ovary (O) is seen on the left side of the cyst. The fallopian tube is shown (F). (b) The right ovary and fallopian tube after removal of the cyst (c) The cyst (left) alongside three uterine leiomyomas (d) The cyst wall showing endometrial glands and stroma (H and E, x200) (e) Higher magnification of the cyst wall showing endometrial glands and stroma (H and E, x400)
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F2
However, a mesosalpinx (para-ovarian) cyst overstretched the right fallopian tube that was otherwise normal with a free fimbrial end [Figure 2a]. It was excised with the preservation of the right ovary and right fallopian tube [Figure 2b]. Myomectomy was done [Figure 2c]. Microscopically, endometrial stroma and glands were seen in the cyst wall embedded in a dense fibrous stroma [Figure 2d and e].
(a) The tumor showed confluent growth of relatively well-defined glands in a hyalinized stromal background (H and E, x40) (b) Hyalinized stromal background (H and E, x200) (c) Squamous morules were evident (H and E, x200) (d) The glandular epithelium in the tumor expressed ER (ER IHC, x200) (e) The glandular epithelium in the tumor was positive for Vimentin (Vimentin IHC, x200)
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F3
The polypoid mass that was attached to the inner wall of the cyst showed predominantly back-to-back (confluent) growth of relatively well-defined glands, resembling proliferative-phase endometrium [Figure 3a and b]. Squamous morules were identified throughout the tumor (shown in Figure 3c). The glandular epithelium stained positive for estrogen receptor and vimentin [Figure 3d and e].