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a. CT picture of Uterus surrounded with multiple cysts b. MRI T 2 sequences showing multiple cysts around the uterus, c. MRI coronal section showing uterus surrounded by cysts.
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Imaging (MRI) of pelvis revealed fibroma of the uterus. In addition, MRI showed multiple cystic areas in the pelvis and right iliac fossa (Fig. 1).
Intra-operative picture showing omental cystic lesion. Uterus enlarged due to fibroma and Arrow marking the liver for identification.
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Similar cystic lesion was found in pouch of douglas adjacent to the uterus (Fig. 2).
Microscopic Picture a. 4x- Cysts lined by cuboidal mesothelial cells, b. Cuboidal mesothelial cells in 10X view, c. IHC depicting mesothelin positivity in cystic space lining, d. Ki-67 positive in few cells.
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Pathological examination showed multiple cysts lined with a layer of cuboidal mesothelial cells with no atypia (Fig. 3). Immunohistochemically the cells were positive for mesothelin, calretinin and negative CEA, CD-31, p 53 and D-2 40 (Fig. 3c-d).
a. Focal proliferation of mesothelial cells, b. corresponding IHC positivity of mesothelin in these cells, c. Ki-67 -3 % in this focal cluster.
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There are focal areas of proliferation of mesothelial cells in the omentum (Fig. 5).