A Synchronous Presentation of Two Different Ovarian Tumors: A Rare Occurrence
A 29-year-old lady P1L1 presented to the gynecology outpatient department with chief complaints of pain abdomen off and on since the last 1 year. The pain was predominantly in the right iliac fossa region. She kept taking medication for the pain until recently in January 2012, when she developed acute pain also on the left side of the abdomen for which she was admitted. She also complained of one episode of vomiting. Ectopic pregnancy was ruled out by urine pregnancy test. Abdominal examination did not reveal any mass and no abnormality was detected on per speculum examination. Bimanual examination revealed a normal-sized uterus and a cystic mass felt laterally near the posterior fornix that was approximately 4 cm in diameter. An ultrasound examination and CA-125 were requested. Ultrasonography revealed normal uterus with enlarged right ovary with a cyst measuring 46 mm × 36 mm × 55 mm showing internal echoes with volume of 50 cc, the left ovary was also enlarged with multiple well-defined cysts measuring 34 mm × 44 mm × 69 mm with volume of 55 cc and the largest cyst measured 37 mm []. The serum CA-125 level was 38 U/mL. Diagnostic laparoscopy followed by laparotomy with bilateral ovarian cystectomy was performed, followed by chromopertubation under general anesthesia. Intraoperative findings-adhesions present with omental and fat adhesions with the abdominal wall. The right cyst was approximately 5 cm in diameter with smooth surface and surface papillary excrecences and containing straw-colored fluid. The left ovarian cyst was approximately 5 cm × 4 cm, with a bosselated surface. Cut-surface revealed multiloculated cyst with thick walls. Omentum was healthy. On chromopertubation, bilateral tubes were patent. Bilateral ovarian cystectomy specimens were received in the Department of Pathology. On gross examination, the right ovary revealed an opened up cystic structure approximately 6 cm in diameter. The inner surface of the wall revealed multiple papillary excrescences. The left ovary was 7 cm in diameter, with the cut surface revealing multiloculations with solid and cystic areas. Microscopic examination of the right ovary revealed cyst wall lined by simple columnar lining with papillary proliferations at places, and the left cyst revealed a thick-walled cyst with endocervical like mucinous cell lining [Figure -]. Thus, a diagnosis of right ovarian serous cystadenoma with left ovarian mucinous cystadenoma was made.