case_images: PMC11100640_01
case_images: (a and b) Well-defined cystic lesion showing thick internal septation. The inner wall is irregular. (c and d) Eccentric solid component is seen. No vascularity perceivable in the solid component
case_images: JMH-15-43-g001.jpg
case_images: PMC11100640_01_JMH-15-43-g001.jpg
case_images: jmh_5_24-f001
case_images: All these features favored a lesion of intermediate risk (Ovarian-Adnexal Reporting Data System USG Score of 4) suggestive of ORADS-4 [Figure 1].
case_images: Noncontrast axial (a) and coronal (b) images reveal a thin-walled well-defined cystic lesion (long arrows) arising from the right adnexa extending into the right iliac fossa. Thick internal septations (short arrows) and a smooth eccentric solid component (black arrow) are noted. Axial postintravenous contrast (c and d). The septations (short arrow) and solid components (black arrow) reveal homogenous enhancement. Urinary bladder (*)
case_images: JMH-15-43-g002.jpg
case_images: PMC11100640_01_JMH-15-43-g002.jpg
case_images: jmh_5_24-f002
case_images: The findings were suggestive of a right ovarian complex cyst, likely neoplastic [Figure 2].
case_images: Postoperative computed tomography of abdomen and pelvis. (a and b) Axial images reveal collapsed distal ileal loops (long arrows) adherent to a contained abscess with adjacent inflammation (*) just deep to the surgical scar. The zone of transition in the distal ileal loop is seen in b (arrow). (c) Dilated ileal loops in close approximation to the anterior abdominal wall (arrowheads). Dilated small bowel loops (*). (d) Coronal image shows free air (short arrow), intraperitoneal contained inflammation (*) with adherent bowel loops (long arrow)
case_images: JMH-15-43-g003.jpg
case_images: PMC11100640_01_JMH-15-43-g003.jpg
case_images: jmh_5_24-f003
case_images: The abdominal CT scans revealed dilated bowel loops, mesenteric thickening, inter-bowel loop adhesions, and free gas under the diaphragm, with around 6 cm x 4 cm x 3 cm of pelvic fossa fluid collection [Figure 3].
case_images: Intraoperative image during re-exploration, showing dense inter-bowel loop adhesions, gangrenous segment of small bowel, and site of perforation
case_images: JMH-15-43-g004.jpg
case_images: PMC11100640_01_JMH-15-43-g004.jpg
case_images: jmh_5_24-f004
case_images: One 6-8 cm length of the mid-ileal segment is presented as a closed loop [Figure 4].
case_images: (a) Cut surface of the ovarian mass displaying multiloculated cyst with varying wall thickness and papillary excrescences (circled) at places, (b and c) Cyst wall with polypoidal projections lined by a single layer of flattened to columnar cells and showing prominent fibroblastic stromal component with varying degrees of cellularity (x10, hematoxylin and eosin), (d) Higher magnification showing single layer of tall, columnar, ciliated cells (arrow) resembling normal tubal epithelium with underlying stroma containing bland spindled fibroblasts in a collagenized background (x40, hematoxylin and eosin)
case_images: JMH-15-43-g005.jpg
case_images: PMC11100640_01_JMH-15-43-g005.jpg
case_images: jmh_5_24-f005
case_images: The diagnosis was confirmed as serous CAF of the right ovary [Figure 5].