Cystic Ovarian Mass Research Articles

Ovarian Cystic Lymphangioma: A Rare Case Report with Review of Literature

Lymphangiomas of the ovary are unusual benign tumours characterised by proliferation of lymphatic channels, composed of cystic spaces lined by a single layer of endothelial cells. We present a case of 61-year-old woman who presented with complaints of pain abdomen. Investigations revealed a large left ovarian multiseptate multiloculated cystic mass extending to pelvis, abdominal cavity and infraumbilical region likely neoplastic. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed suspecting malignancy. Histopathological examination revealed an ovarian lymphangioma.

English

English

Management of Large Pediatric and Adolescent Ovarian Neoplasms with a Leak-Proof Extracorporeal Drainage Technique: Our Experience Using a Hybrid Minimally Invasive Approach.

In a pediatric setting, laparoscopic management of large cystic ovarian neoplasms with low malignancy probability is not suitable, because of the mass size; nevertheless, an effort should be made to be as minimally invasive as possible, without violating the principles of oncologic surgery. We describe our experience in managing these neoplasms with leak-proof extracorporeal drainage through mini laparotomy, followed by cyst excision or oophorectomy. Case series study, describing interventions and outcomes. Department of pediatric surgery in a tertiary pediatric and adult university hospital. Pediatric patients affected by large cystic ovarian mass. Hybrid minimally invasive approach using leak-proof extracorporeal drainage. Data on demographic characteristics, tumor marker values, and imaging findings were collected and analyzed. Outcome of surgical technique was evaluated and reported. Between 2011 and 2018, 17 patients (mean age, 10.2years; range, 2-14years) affected by large cystic ovarian mass, were eligible for this technique. All patients had negative preoperative tumor markers. Of the seventeen subjects, 13/17 girls (76%) underwent pelvic magnetic resonance imaging. No sign of lymphadenopathy or metastasis was found. Surgery was successful in all patients, with ovarian preservation in 5/17 cases (29.4%). Mean surgical time was 98minutes; no intra-abdominal leakage of neoplasm content or postoperative complications occurred. Mature cystic teratoma was the most frequent histopathological diagnosis (71%). After a thorough patient selection, the management of large cystic ovarian neoplasms with leak-proof extracorporeal drainage performed through a mini laparotomy is a feasible and safe approach, with excellent cosmetic results. When achievable, ovarian-sparing surgery has to be considered.

Guideline No. 404: Initial Investigation and Management of Benign Ovarian Masses.

To provide recommendations for a systematic approach to the initial investigation and management of a benign ovarian mass and facilitate patient referral to a gynaecologic oncologist for management. Obstetricians, gynaecologists, family physicians, internists, nurse practitioners, radiologists, general surgeons, medical students, medical residents, fellows, and other health care providers. Women ≥18 years of age presenting for evaluation of an ovarian mass (including simple and unilocular cystic masses, endometriomas, dermoids, fibromas, and hemorrhagic cysts) who are not acutely symptomatic and without known genetic predisposition to ovarian cancer. This guideline aims to encourage conservative management and help reduce unnecessary surgery and long-term health complications, maintain fertility, and decrease operative costs and improve overall patient care and outcomes by providing criteria for referral of patients with ultrasound imaging findings suggestive of a malignant mass to a gynaecologic oncologist. Databases searched: Medline, Cochrane, and PubMed. Medical terms used: benign asymptomatic and symptomatic ovarian cysts, adnexal masses, oophorectomy, ultrasound diagnosis of cysts, simple ultrasound rules, surgical and medical therapies for cysts, screening for ovarian cancer, ovarian torsion, and menopause. Initial search was completed by 2017 and updated in 2018. Exclusion criteria were malignant ovarian cystic masses, endometriosis therapies, and other adnexal pathologies unrelated to the ovary. The content and recommendations were drafted and agreed upon by the authors. The Society of Obstetricians and Gynaecologists of Canada's Board of Directors approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development and Evaluation methodology framework. Implementation of the recommendations could reduce costs due to unnecessary surgeries and hospitalizations and reduce lost work days and the risk of loss of fertility, early menopause, and surgical complications. RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).

Benefits, Drawbacks and Precautions of Performing Laparoscopy and Laparotomy in Management of Benign Adnexal Masses in Pregnant Women; A Comparative Study

Surgical management strategies of benign ovarian cysts diagnosed during pregnancy include cyst resection, ovarian excision, or salpingo-oophrectomy but the best surgical procedure is still controversial. Using laparoscopic assisted methods has been extensively used in management of many gynecologic related diseases in non-pregnant women. Previously, performing laparoscopic surgeries for management of benign ovarian cysts during pregnancy was limited to only case reports, case series and retrospective studies. Aim of the study was to compare between laparoscopic and conventional open surgery for management of benign adnexal cysts in pregnant women, regarding; pregnancy outcome, benefits and drawbacks on mother and fetus, operative and perioperative details. Patients and methods We included 80 pregnant females with benign ovarian cysts who were eligible for the study, splitting them in to 2 cohorts each group contain 40 patients the first cohort underwent laparoscopic excision of the ovarian cyst and the second cohort underwent conventional laparotomy for management of the ovarian cysts. Results We found statistically significant differences between both studied groups regarding the overall costs of the operation as; anesthesia, surgery, and materials costs and in comparison with laparotomy, the laparoscopy related costs associated were higher (p < 0.001). We found that duration of post-operative hospital staying was shorter in laparoscopy group than laparotomy group (p < 0.001). The rate and duration of antibiotic prophylaxis was lower in laparoscopy group than laparotomy group (p < 0.001). The rate of wound healing was higher in the laparoscopy group. The postoperative fever rate and degree of maximum temperature was less in laparoscopy group than laparotomy group (p = 0.005). Conclusion We concluded that performing laparoscopic assisted surgical procedure for excision of benign ovarian cystic masses in pregnant women lead to less blood loss, shorter hospitalization better wound healing with no increased risks of fetal or maternal complications than laparotomy. Although laparoscopy has higher costs but it was more accepted by the patients as it is minimally invasive.

Benefits, Drawbacks and Precautions of Performing Laparoscopy and Laparotomy in Management of Benign Adnexal Masses in Pregnant Women; A Comparative Study

Surgical management strategies of benign ovarian cysts diagnosed during pregnancy include cyst resection, ovarian excision, or salpingo-oophrectomy but the best surgical procedure is still controversial. Using laparoscopic assisted methods has been extensively used in management of many gynecologic related diseases in non-pregnant women. Previously, performing laparoscopic surgeries for management of benign ovarian cysts during pregnancy was limited to only case reports, case series and retrospective studies. Aim of the study was to compare between laparoscopic and conventional open surgery for management of benign adnexal cysts in pregnant women, regarding; pregnancy outcome, benefits and drawbacks on mother and fetus, operative and perioperative details. Patients and methods We included 80 pregnant females with benign ovarian cysts who were eligible for the study, splitting them in to 2 cohorts each group contain 40 patients the first cohort underwent laparoscopic excision of the ovarian cyst and the second cohort underwent conventional laparotomy for management of the ovarian cysts. Results We found statistically significant differences between both studied groups regarding the overall costs of the operation as; anesthesia, surgery, and materials costs and in comparison with laparotomy, the laparoscopy related costs associated were higher (p < 0.001). We found that duration of post-operative hospital staying was shorter in laparoscopy group than laparotomy group (p < 0.001). The rate and duration of antibiotic prophylaxis was lower in laparoscopy group than laparotomy group (p < 0.001). The rate of wound healing was higher in the laparoscopy group. The postoperative fever rate and degree of maximum temperature was less in laparoscopy group than laparotomy group (p = 0.005). Conclusion We concluded that performing laparoscopic assisted surgical procedure for excision of benign ovarian cystic masses in pregnant women lead to less blood loss, shorter hospitalization better wound healing with no increased risks of fetal or maternal complications than laparotomy. Although laparoscopy has higher costs but it was more accepted by the patients as it is minimally invasive.

A giant ovarian follicular cyst - a rare case report

Background: Benign cystic ovarian mass is a very common incidentally detected mass lesion in the reproductive age group female. A giant ovarian follicular cyst is a very rare entity described in the literature. Imaging modalities including ultrasonography (USG) and magnetic resonance imaging (MRI) play a pivotal role in the differential diagnosis of cystic ovarian mass lesions. Case Presentation: A young adult female presented to surgery outpatient department with the complaints of abdominal pain with normal vital parameters. Subsequent USG and MRI study showed a large abdominopelvic cystic mass lesion with right mild hydroureteronephrosis. Furthermore, the histopathological investigation confirms the diagnosis of a simple follicular cyst. Conclusion: Imaging modality collaboration with the histopathological findings may lead to accurate diagnosis of cystic ovarian mass. USG and MRI play a vital role in narrow down the differential diagnosis, which can be further confirmed on histopathological investigations.

The Usefulness of Diffusion Weighted and Contrast Enhanced Magnetic Resonance Imaging in Characterization of Inconclusive Ovarian Mass

Introduction: Ovarian cancer is the commonest reason for death in females due to gynecologic malignancy around the world. In contrast to other gynecologic tumours, the definitive diagnosis is accomplished days after of the index surgery by the histopathology. Preoperative assessment based on conventional MRI is not accurate. Information is expanding increasing about the ability of new MRI modalities to assess ovarian mass. Aim of the study: To assess the ability of dynamic contrast-enhanced MRI (DCE–MRI), and Diffusion-weighted image (DWI) to describe uncertain ovarian masses. Patients and Methods: This is a retrospective study. Patients were referred from radio-diagnosis department and gynecology department of Qena faculty of medicine hospitals, South Valley University. Patients had uncertain adnexal masses at ultrasound. Magnetic resonance examination was doneutilizing 1.5 Tesla machine. The protocol included T1WI, T2WI, T1WI following contrast, and DWI. Results: We included 44 patients with different forms of complex cystic and solid ovarian masses. The final pathology of the ovarian masses was 18 benign, 4 borderline, and 22 malignant. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for DWI were 100%, 94.4%, 96.3%, 100%, and 97.7% respectively. The performance of DWI was higher than the conventional MRI and DCE-MRI. Conclusion: DCE-MRI and DWI have accepted ability to recognize malignant ovarian mass.

2679 Management of a Large Uterus and its Complications to a Successful Laparoscopic Surgery

Video Objective Present and demonstrate a pre operative and surgical management of large uterus and its complications. Setting A 37-years-old, G2P2, who complained of progressive dysmenorrhea, genital pelvic and low-back pain without improvement with hormonal treatment. Complementary exams showed deep endometriosis on the posterior compartment, myomatosis uterus with 848cc of volume and an 139cc cystic right ovarian mass, which generated an extrinsically compression on the right ureter and ureterohydronephrosis. Interventions Pre operative management consisted in double J catheter in the right ureter and uterine artery embolization with prophylactic antibiotic 3 months before the surgery. Final complementary exams showed an uterine volume reduction to 313cc. Laparoscopic treatment consisted of inspecting pelvic and abdominal cavities. Right ovarian mass was adhered to the posterior compartment including ovarian fossa, rectovaginal septum and right uterossacral ligament. Strategy consisted of right ovariectomy, Latsko and Okabayashi space dissection to identify bilateral hypogastric nerves and ureters. After identifying anatomy landmarks, endometriotic lesions were removed from uterossacral ligament and ureter. Rectovaginal septum was dissecated and bowel superficial lesion identified. Hysterectomy and bilateral salpingectomy were performed as treatment. Linear stapler was used to remove bowel endometriotic lesion. Ureterohydronephrosis became absent and controlled and Double J catheter was removed right after the surgery. Double J catheter right after surgery. Conclusion Pre operative strategies are very important to a successful surgery. Double J catheter is a temporary intervention to prevent ureteres complications. Uterine artery embolization reduced more than 50% of the uterine volume. These strategies facilitated the access to the pelvis and promoted excellent laparoscopic view to completely treat myomatosis and deep endometriosis.

Abdominal Mass in the Puerperium: Challenges in Diagnosis

Ovarian cancer is the fourth most common cancer among women in Peninsular Malaysia. Epithelial ovarian cancer accounts for 90% of all ovarian tumours. Herein, we present a rapidly growing ovarian tumour in a young female patient, following an uneventful vaginal delivery at home. We discuss on the challenges of making said diagnosis in a post-partum patient who presented with abdomen distension. A 19-yearold lady presented to the Emergency Department three days after spontaneous vaginal delivery at home. Her chief complaint was that of a rapidly progressive abdominal distension. Diagnostic and therapeutic emergency laparotomy were done, revealing a huge cystic ovarian mass. Histopathology reported a high grade, serous ovarian carcinoma. There are multiple causes for abdominal distension in post-partum women, however priority should be given into looking for gynaecological origin, given the changes in hormone. Sudden abdominal distension during post-partum period is rare and a systemic approach in its management is vital. There is, inarguably, a role of diagnostic and therapeutic laparotomy in this.

Ovarian Endometrioid Borderline Tumor With Massive Squamous Differentiation: A Case Report

Abstract Introduction Ovarian endometrioid borderline tumor is uncommon and constitutes only 0.2% of all epithelial ovarian tumors. Many patients have associated endometriosis, and coexisting endometrial hyperplasia and/or carcinoma is commonly present. Methods Here we report an ovarian endometrioid borderline tumor with massive squamous differentiation. The peculiar histologic features made the diagnosis of this uncommon entity even more challenging. The patient was a 43-year-old female with a history of chronic pelvic pain. A pelvic ultrasound showed a 7.9-cm complex solid and cystic right ovarian mass and a hypoechoic left ovarian mass. Patient underwent a hysterectomy with bilateral salpingo-oophorectomy. Grossly, the right ovary showed a 2.5-cm solid and cystic lesion with focal papillary inner surface. Microscopic examination showed uterine adenomyosis with serosal endometriosis. The left ovary showed endometriosis with atypical hyperplasia. Initial representative sections from the right ovary demonstrated extensive squamous cell proliferation with papillary architecture. The squamous cells had pink or clear cytoplasm, intracellular bridging, irregular nuclei, and prominent nucleoli. Immunostains confirmed the squamous differentiation. Based on the histologic features and immunophenotype, a well-differentiated squamous cell carcinoma was considered one of the differential diagnoses. However, further examination of additional sections from entirely submitted lesion showed some areas with classic morphologic features of endometriosis with atypical hyperplasia. With the consideration of clinical-pathological correlations, a diagnosis of endometrioid papillary cystic borderline tumor with massive squamous differentiation was rendered and close follow-up was recommended. The patient was doing well at 4-month postoperative follow-up. Conclusion We present this case to emphasize (1) extensive squamous metaplasia arising in endometriosis can make the rendering of a definitive diagnosis challenging. (2) Primary squamous cell carcinoma of ovary is very rare. (3) Careful sampling is very important for achieving a precise pathologic diagnosis.

A rare case of ovarian lymphangioma with elevated CA-125 causing pseudo-Meigs’ syndrome

Lymphangiomas are benign congenital malformations of the lymphatic system, thought to occur as a result of obstruction of the local lymph flow system. They can occur anywhere in the skin and mucous membranes. The most common sites are the head and neck, but sometimes they are found in the intestines, pancreas and mesentery. Lymphangioma of the ovary is an extremely rare lesion. It was first described in 1908. Clinical manifestations can vary, from an asymptomatic ovarian mass to an acute abdomen. These may be confused with malignant ovarian masses, resulting in extensive surgery. A 34-year-old woman presented with dull aching pain localised to the lower abdomen, present for the previous 6 months. Ultrasound and a contrast-enhanced computed tomography scan of the abdomen were suggestive of an enlarged right ovary with massive ascites. The cancer antigen 125 (CA-125) level was 685 units/mL. Diagnostic laparoscopy revealed chylous ascites, and further, a frozen section revealed a few atypical cells, additionally strengthening the diagnosis of a malignant tumour. Staging laparotomy with total abdominal hysterectomy and salpingo-oophorectomy was finally performed. Histopathology revealed lymphangioma, with no evidence of malignancy. CA-125 also showed a rapid decline following surgery. Lymphangiomas should be included in the differential diagnosis of ovarian cystic masses, especially in patients with chylous ascites. It is very important to discriminate such cases from other malignant tumours in order to avoid overtreatment. However, a careful follow-up for at least 2 years is needed for patients with lymphangioma of the ovary, to exclude recurrence.

Splenosis Mimicking Peritoneal Implants in a Female with Ovarian Cystic Masses: A Case Report

Splenosis Mimicking Peritoneal Implants in a Female with Ovarian Cystic Masses: A Case Report

Rapidly growing juvenile granulosa cell tumor of the ovary arising in adult: a case report and review of the literature

BackgroundOvarian granulosa cell tumors (GCTs) are divided into adult GCT (AGCT) and juvenile GCT (JGCT). The AGCT is more common type, conversely, less than 5% of tumors are the JGCT and occur in mainly premenarchal girls and in women younger than 30 years. Although JGCT have different histologic features compared to AGCT, the two types have similar imaging features because they have similar gross appearance. Therefore, it is difficult to distinguish two types by radiologic findings. In addition, it has not been described about the growth rate of JGCTs in past literatures. The aims of this report were to describe a case of rapidly growing JGCT arising in adult with difficulty in diagnosing and to review the literatures.Case presentationA 38-year-old woman, presented with abdominal distension and frequent urination, was found to have a pelvic mass measuring approximately 12 cm on ultrasonography. On magnetic resonance imaging (MRI), right ovarian multiloculated cystic mass accompanied with hemorrhagic foci was demonstrated. Although the presumptive diagnosis of GCT was made based on MR findings, the intraoperative differential diagnoses included GCT, yolk sac tumor or malignant mucinous tumor due to cytologic atypia and lack of the typical findings for AGCT such as nuclear grooves and Call-Exner bodies. As a result, abdominal simple total hysterectomy, bilateral oophoro-salpingectomy, partial omentectomy and appendectomy were performed. Moreover, she had a history of laparoscopic uterine myomectomy about one year before, and during that surgery bilateral ovaries were found to be macrospically normal. Therefore, it was suspected the tumor became enlarged within the short period of time.ConclusionsEven though it is difficult to distinguish two types of GCT by imaging findings, in some cases without typical findings for AGCT pathologically, MRI could provide useful information in accurately diagnosing JGCT. Moreover, in this case, the tumor growth rate seemed to be rapid regardless of its borderline malignant potential. It may be related with nuclear atypia and high mitotic rate of the tumor.

Acquired resistance to immunotherapy in MMR-D pancreatic cancer

BackgroundMMR-D pancreatic cancer have been reported to respond to checkpoint inhibitor therapy. Here, we report the first case of acquired resistance to immunotherapy in MMR-D pancreatic cancer.Case presentationA 45-year-old woman with unresectable MMR-D pancreatic cancer was initially treated with FOLFIRINOX, FOLFIRI, and stereotactic body radiation with stable disease burden. After 3 months, imaging showed progression of disease with an increase in CA19-9. She was subsequently enrolled in a clinical trial of an anti-PD-L1 antibody in combination with an IDO1 inhibitor. She demonstrated a partial response to therapy by RECIST 1.1 criteria with declining tumor markers. Twenty-two months after beginning immunotherapy, imaging revealed an increasing left ovarian cystic mass. There were no other sites of progressive disease. The patient underwent a total hysterectomy and bilateral salpingo-oophorectomy, appendectomy, omentectomy and pelvic lymphadenopathy. Pathology was consistent with a metastasis from the pancreas involving the endometrium and left ovary. Thereafter, the patient continued with PD-1 blockade therapy off protocol with no further progressive disease. Immune profiling showed high levels of CD8+ T cells and PD-1 positive immune cells infiltrating the tumor, with a moderate level of PD-L1 expression in both the immune cells and the tumor cells. Next generation sequencing found only the KRAS G12D and RNF43 G659Vfs*41 mutations were retained from the pre-treatment tumor in the treatment-resistant tumor.ConclusionsThis is the first report describing acquired resistance to immunotherapy in MMR-D pancreatic cancer with accompanying genomic and immune profiling. This case of oligoprogression in the setting of immunotherapy demonstrates the feasibility of localized treatment followed by continuation of immunotherapy to sustain ongoing response.

DWI in characterization of complex ovarian masses, would it help?

ObjectiveTo define the role ofdiffusion-weightedimaging& apparent diffusion coefficient (ADC) in characterizingcomplexovarian masses, with particular concern to differentiating benign versus malignant masses. Materials and methodsWe enrolled in this prospective study 30 patients with complex cystic ovarian masses between June 2014 and July 2015. Pelvic MRI and diffusion weighted images at b value of 0, 500, 1000 and 1500 s/mm2 at 1.5 T unit were performed for all patient. The mean ADC values were calculated for both solid & cystic component of the masses. The final diagnoses were confirmed by either pathological examination or culture of aspiration material. ResultsIncluded masses proved benign in 17 (56%) and malignant in 13 (44%). ADC of solid component of malignant showing no statistically significant difference from that of the benign lesions, while ADC values of cystic component in malignant masses were significantly higher than those in benign masses (p < 0.05). The Receiver operator characteristic (ROC) analysis indicated that a cutoff ADC value of 1.97 × 10−3 mm2/s may be the optimal one for differentiating between benign and malignant masses. ConclusionThe combination of DWI with ADC value measurement and conventional MRI is useful for differentiating benign and malignant ovarian masses.

A Giant Ovarian Cyst in an Iranian Older Woman: A Case Report and Literature Review

A 70-year-old woman without any history of illness was admitted to Imam Reza Hospital (Amol, Iran) with abdominal mass. In her last visit about 3 months ago, transvaginal ultrasound showed an ovarian cystic mass without solid components, with septations and widespread adhesions to the abdominal wall, bowel and bladder. Patient was brought to the operating room for a laparotomy. A giant ovarian cyst (about 10 kg) with regular wall was resected. In the second follow-up visit, the patient and her family did not mention any complaints. Regarding the importance of assessment and determination of the main factors of these rare cases, the necessity of comprehensive studies in this field was seen.

Laparoscopic ovarian cystecomy for a huge ovarian cystic mass : A case report and review of literature

Introduction: Huge ovarian cystic lesions are rarely encountered in modern practice due to the marked development in health care services and technology on both the diagnostic and therapeutic levels, in addition to the continuous rise of awareness of women's health issues. Laparoscopic management seems to be the ideal line of intervention.Case Report: An 18-year-old, virgin female, was presented with abdominal distension. Physical examination and ultrasonography revealed a huge pelvi-abdominal cystic mass. A laparoscopic ovarian cystectomy was performed. A follow up for 12 months and was unremarkable. The technique of the operation as well as tips in such a heroic surgery were described.Conclusion: Huge ovarian cysts might be successfully and safely treated by laparoscopic excision. There seem to be no size-related limits for laparoscopic intervention for ovarian cysts; however, experience is a crucial factor.

Laparoscopic Management of Giant Ovarian Cysts at the Gynecology and Obstetrics Department of Ouakam Military Hospital (Senegal)

Objectives: To remind the epidemiology, the diagnosis and the surgical aspects of laparoscopic management of giant ovarian cysts at the Gynecology and Obstetrics Department of Ouakam Military Hospital.Materials and methods: This is a prospective and descriptive study carried out during 2 years, from February 1st 2015 to January 31st 2017 at the Gynecology and Obstetrics Department of Ouakam Military Hospital. It involved all patients who had undergone laparoscopic surgery for an ovarian cyst which measures 15 cm or more. The parameters studied were the patient's socio-demographic characteristics, the clinical symptomatology, ultrasound and/or CT scan results, surgical data, the histological nature of the cyst and the length of hospital stay. Data was captured and analyzed by Excel.Results: Patients' age ranged from 13 to 41 years with an average of 27.1 years. Physical examination had shown an abdominal mass in all patients. Imaging examinations (ultrasound and/or CT scan) found an ovarian cystic mass that varied in size from 15 to 27 cm with an average of 20 cm. Only one patient (9.1%) had a rate of CA 125 above the threshold. Laparoscopy confirmed the diagnosis of all patients. We performed 9 cystectomies (81.8%) and 2 adnexectomies (18.2%). The procedure lasted in average 72 min with extremes of 50 and 90 min. The surgical follow-up was simple and the discharge was authorized 3 days after surgery. The histological examination of the surgical specimens performed in all patients revealed 3 serous cystadenomas (27.3%), 3 dermoid cysts (27.3%), 3 endometriomas (27.3%) and 2 mucinous cystadenomas (18.2%).Conclusion: Laparoscopy should be indicated to treat giant ovarian cysts. Ultrasound and CT scan allow making good selection of cases for this approach.

A case of pseudomyxoma peritonei originating from an appendiceal mucinous tumor that was incidentally diagnosed during laparoscopic surgery for an ovarian cystic mass

A case of pseudomyxoma peritonei originating from an appendiceal mucinous tumor that was incidentally diagnosed during laparoscopic surgery for an ovarian cystic mass