The patient is a 25-year-old woman, gravida 0, who was referred to the gynecology oncology division at Chonnam National University Hospital with lower abdominal pain and abdominal mass. Her gynecologic history was unremarkable. Physical examination was notable for abdominal mass that was near at xiphoid process. Pelvic ultrasound revealed about more than 20 cm cystic mass. Magnetic resonance imaging of the pelvis revealed about 23×21×9 cm sized serous borderline cystic tumor in the right ovary and 2.2 cm corpus luteum of the left ovary. There was no remarkable findings in the uterus and no abnormal pelvic lymphadenopathy. The tumor marker profile was as follows: CA-125 38.2 U/mL (0-35). Another tumor markers and the result of hematological analyses were within their normal ranges.\nExploration of the abdominopelvic cavity revealed about 23 cm sized brownish fluid contained cyst located within the right fallopian tube. Its surface was clear and on cut section, it had multiple papillary growing in inner surface (). The left ovary had about 1 cm sized whitish nodule. A right salpingectomy, left ovary wedge biopsy, appendectomy and cytology were performed. A frozen section of the right fallopian tube revealed a serous borderline tumor. And a frozen section of the left ovary revealed a fibroma. Exploration of the right ovary and left tube was unremarkable, and, in view of patient's age and desire for future fertility, no further surgical procedure was undertaken. Histologically, right tubal mass was serous borderline tumor and appendix uninvolved by tumor cells and cytology of peritoneal washing fluid was negative for malignant cells. Tumor had cystic change and papillary nodules. On microscopic examination the papillae were covered by serous type of epithelium (), displaying stratification and budding with focal nuclear atypia (). There was no invasion of the supportive stroma of the papillae or into the fallopian tube wall. Micropapillary pattern of the tumor was absent and there was no papillary tubal hyperplasia in the fallopian tube. In general, the histology of the tumor was similar to that of an ovarian borderline serous tumor. Pathologic diagnosis was serous borderline tumor of the right fallopian tube. Close follow-up was recommended and currently, the patient's postoperative recovery was uneventful.
A 31-year-old woman presented with abdominal distention and discomfort worsening over the past 6 months. Concurrently, she had development overactive bladder symptoms, bloating, and dyspepsia. Her medical history was pertinent for epilepsy controlled with antiepileptic medications. Urine analysis was negative for any signs of infection, and her pregnancy test was negative. Abdominal examination was positive for a firm and distended abdomen, uniformly enlarged from the xiphoid bone to the pubic symphysis. No tenderness was reported on palpation; however, pressure was endorsed. A bedside abdominal ultrasound was performed that revealed an abdomen fully distended with fluid, initially suspected to be ascites. Computed tomography in 2.5 mm helical slices with both IV and oral contrast suggested the presence of an encapsulated cystic mass containing clear fluid (6 Hounsfield units). Dimensions reported were 36 cm in long axis, 28 cm in transverse diameter, and 15 cm in anteroposterior diameter, corresponding to 7 liters in volume, suggestive of a right ovarian cystadenoma (Figures and ). No capsular irregularities were seen or intracystic vegetations identified. Concurrently noted was right renal pelvicalyceal dilatation resulting from compression due to the proximity of the right ureter with the renal pelvis measuring 2 cm in anteroposterior diameter. No abdominal ascites or other abdominopelvic abnormalities noted. Tumor markers were in the normal ranges (CA125: 12.13 U/ml, CEA:1.51 ng/ml, and AFP: 1.46 IU/ml). While understanding her risks, the patient stressed the avoidance of excision of ovarian or fallopian tissue due to fertility concerns and preferred that the cyst be removed in a cosmetic manner including avoidance of larger laparotomy incisions.\nThe patient underwent resection of the mass. The procedure was begun by drainage of the cyst in order to identify the stalk and excise all cyst walls. A 3 cm supraumbilical incision was performed with careful dissection until reaching the peritoneal cavity. An Alexis O™ wound protector/retractor Applied Medical was introduced through the small incision permitting better visualization of the cyst (). Three hemostats were used to hold the cyst wall in place, followed by meticulous introduction of an 11 mm trocar into the cyst cavity under direct vision. This was followed by insertion of a 5 mm suction tube through the trocar to aspirate the fluid contents while avoiding spillage of fluid into the peritoneal cavity. Eight liters of serous fluid were aspirated. Following fluid evacuation, the cyst wall had collapsed. The trocar site in the cyst wall was sutured shut in a purse-string manner followed by a second closure layer. Then, the cyst was released off the hemostats, and the laparoscopic gel cap was fitted onto the Alexis retractor to convert the abdominal incision into a laparoscopic port site. This was used to insufflate the abdomen with CO2. Thereafter, 2 additional 5 mm trocars on each side of the midline were introduced.\nThe cyst borders were identified (). Using the bipolar forceps and scissors, it was completely dissected off the fallopian tube. Both the fallopian tube and ovarian tissues were noted to be intact. The cyst was removed through the supraumbilical incision and sent to pathology. The trocars were removed and all incisions approximated as per protocol. The patient was discharged soon thereafter from the observation unit.