case_images: PMC6883337_01
case_images: The CT scan that was made before the first operation: showing the huge extension of the cyst occupying all the abdomen, pushing other abdominal organs to the right.
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case_images: PMC6883337_01_gr1.jpg
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case_images: In addition, a left hydronephrosis was noticed due to compression of the left ureter (Fig. 1).
case_images: The microscopic appearance of the cyst's wall (A) showing the ciliated columnar epithelium (arrow), the fibrous stroma beneath it, and the intensive vascularity (*), (B) the single layer of the ciliated columnar epithelium without atypia. (C) showing the smooth muscle bundles within the cyst's wall (arrow heads).
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case_images: PMC6883337_01_gr2.jpg
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case_images: Microscopic examination revealed that the cyst was lined with a single layer of columnar epithelium with normal nuclei; no atypia was noticed, beneath the epithelium, a fibrous stroma, smooth muscle bundles, and extensive vasculature were found (Fig. 2).
case_images: The second CT scan that was made after 3 months of the first operation: showing the aggressive recurrence of the cyst to occupy the abdomen again.
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case_images: The cyst's recurrence was confirmed using the CT scan (Fig. 3), in addition to the elevated serum levels of cancer antigen 125 [41.2 IU/ml].
case_images: (A) The extremely distended abdomen of the patient before the second operation, (B) Intra-operative view of the cyst showing its huge size and some of its septa, (C) the dissection field after the surgical resection (D): Gross appearance of the mullerian cyst after the resection.
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case_images: The inferior vena cava, the abdominal aorta, the kidney and the ureter were heavily isolated and dissected from the cyst's septa (Fig. 4).
case_images: Three slices of the CT scan that was made 6 months after the second surgical resection showing the minimal recurrence of the cyst.
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case_images: PMC6883337_01_gr5.jpg
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case_images: After 6 months of follow up the patient was stable but a minimal cystic recurrence was detected by the CT scan (Fig. 5).