A 27-year-old, nulliparous (0-0-0-0), married woman was referred to our institution with a huge pelvic mass and left flank pain. She had no history of surgical or medical disease. Transvaginal ultrasonography revealed a 16 cm right adnexal cyst with intramural nodules and thickened cyst wall (). Abdomino-pelvic computed tomography (CT) scan showed a 16 cm cystic mass with enhancing solid intramural nodules in the pelvic cavity (). The CT scan showed no evidence of ascites, peritoneal seeding, omental cake, or pelvic or para-aortic lymph node involvement. It looked like an epithelial ovarian cancer because the CT scan showed delayed enhancement. Her serum cancer antigen 125 (CA-125) concentration was 19.3 U/mL (reference value, <35 U/mL), and the results of other preoperative work-up tests were unremarkable.\nWe performed an exploratory laparotomy through a low midline abdominal incision, which revealed a 16 cm right paratubal cyst completely differentiated from the right ovary and fallopian tube. Paratubal cystectomy was performed without rupture of the cyst. Frozen section analysis of the specimen showed that it was a paratubal serous borderline tumor. Exploration of the entire peritoneal cavity showed no evidence of intraperitoneal tumor spread. Her fallopian tubes, ovaries and uterus were not involved. Washing cytology and multiple peritoneal biopsies were taken. Because the patient and her husband had a strong desire to preserve fertility, her uterus and both adnexae were preserved.\nGrossly, the tumor had a homogeneous, purplish white inner surface and multiple papillary projections up to 2.1 cm in greatest dimension (). The external surface of the tumor was homogeneously purplish white and smooth, with multifocal hemorrhage. However, there was no evidence of surface involvement. The final pathology results were identical to the frozen biopsy results indicating that the mass was a paratubal serous borderline tumor (). The results of the peritoneal washing cytology and multiple biopsies were negative.\nHer postoperative course was uneventful and she was discharged 5 days after surgery. Regular check-ups at the outpatient clinic include serum CA-125 measurements, transvaginal ultrasonography, and/or abdomino-pelvic CT. She delivered a healthy baby at term 13 months after surgery. Twenty months after surgery, she is doing well, without evidence of disease.
A 30-year-old woman visited the outpatient clinic seeking treatment for abdominal\ndistention present since the last 4 months. She had no history of surgery. Bowel and\nbladder functions were normal. Menstruation was regular and without any pain. The\npatient was nulliparous. Computed tomography (CT) scan with contrast showed a thin\nwalled unilocular cyst arising from the left adnexa with dimensions of\n22.3 cm × 18.4 cm × 6.8 cm; no papillary projections or nodules were observed (). The Ca 125 level\nwas 13.64 U/mL.\nBecause of the large size of the cyst and the patient’s preference, a laparotomy was\nperformed. We performed a midline incision above the umbilicus, trying to\nexteriorize the cyst without any rupture. Intraoperative exploration showed a large,\nthin-walled, unilocular cyst arising from the left para-tubal tissue without any\nadhesions; the left tube and left ovary were normal (). The para tubal cyst was dissected\nto separate it from the normal ovary and tube (). The para tubal cyst was removed\nand sent for histopathological examination (). The left tube and left ovary were\npreserved (). The\nuterus and right adnexa were normal. Frozen section examination confirmed by final\nhistopathological examination revealed a benign serous cyst of size\n22 cm × 17 cm × 6 cm.\nWritten, informed consent was obtained from the patient for the publication of this\nreport and its accompanying images ().