42-year-old female with history of immature teratoma with new ascites and pelvic cystic mass suspicious for inclusion cyst versus ovarian neoplasm. PELVIS:UTERUS, ADNEXA: Multiple uterine fibroids. Intermediate signal T2 lesion protruding into the left endometrial canal in the lower uterine segment (series 801/34) has signal characteristics that would be atypical for a fibroid, and as a result, endometrial polyp or neoplasm cannot be excluded.Small amount of endometrial fluid, most likely physiologic.The left ovary is not well-visualized, most likely due to surgical removal. In the expected location of the left ovary there is a tubular cystic structure similar in appearance and size to both prior CT exams, most compatible with residual hydrosalpinx.The right ovary is not well visualized. In the expected location of the right ovary, there is a multiloculated cystic lesion with thin wall without significant enhancement, mural nodularity, or solid components. The largest component posterior to the uterus measures up to 5.7 x 10.1 cm.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of pelvic ascites.
1. Large multiloculated cystic lesion without features suspicious for malignancy, which could be due to benign etiology such an inclusion cyst, as clinically questioned and particularly given that a normal right ovary was visualized on prior outside ultrasound. However, a normal right ovary is not visualized on the current MRI, and as a result, this examination alone cannot exclude ovarian neoplasm such as serous cystadenoma.2. Multiple uterine fibroids. A lesion protruding into the endometrial canal may be a subendometrial fibroid, but endometrial polyp or neoplasm cannot be excluded, as detailed above. Endometrial sampling and biopsy can be performed as clinically indicated.