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.
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.