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 ().
A 34-year old multigravida was found to have right adnexal mass on her routine gynecologic examination. Her previous medical history was uneventfull and Pap smear was normal. Transvaginal ultrasonography identified a cystic mass adjacent to the right ovary. Serum CA 125 was 5.1 U/ml (reference range: < 35 U/ml). At laparoscopy a dilated fallopian tube with bluish discoloration was found. The contralateral fallopian tube, ovaries and uterus were unremarkable. Exploration of the abdomino-pelvic cavity revealed smooth and shiny peritoneal surphace. Obtained peritoneal and pelvic washing were negative. Fine needle aspiration of dilated part of the fallopian tube revealed a 4 ml of bloody content. Cytological findings were consistent with hematosalpinx. Right salpingectomy was performed without using endoscopic bag. The patient was followed up by means of ultrasonography and serum CA 125 for 4.6 years. During this period she had no evidence of the disease.\nGrossly, a 7.0 cm long fallopian tube was irregularly dilated up to 4.4 cm in diameter at the ampulary region. The fimbriae were intact. The serosal surphace was smooth. Sections of the dilated part of the fallopian tube revealed a cystic tumor with focally yellow to tan, soft papillary excrescences protruding into the lumen (Fig. ) and foci of intracystic hemorrhage. On microscopic examination the papillae were covered by serous type of epithelium, displaying stratification and budding with focal nuclear atypia (Fig. ). Three types of cells were recognised; ciliated cells, hob-nail cells and mesothelium-like cells. Small foci of tumor tissue necroses and hemorrhage were noted. There was no invasion of the supportive stroma of the papillae or into the fallopian tube wall. Focus of endosalpingiosis within the adjacent mesosalpinx was found. DNA analysis determined by flow cytometry paraffin technique revealed DNA diploid tumor with low S-phase fraction of 6.5 %.