case_images: PMC11165209_01
case_images: Whole-abdomen enhanced computed tomography image. (A-C) Preoperative CT findings: Abdominal distension and a substantial cystic fluid lesion in the abdomen measuring approximately 40 cm x 30 cm x 34 cm. Contrast enhancement revealed mild strengthening of both septum and capsule wall, with no internal fluid density shadow enhancement at any stage. No distinct limited thickening of the septum was observed. Uterine compression and leftward displacement, along with compression of the abdominal aorta and adjacent intestinal lumen, were noted. Right renal corpuscle and calyces exhibited dilatation and hydronephrosis, as did the upper part of the right ureter. Provisional diagnosis: Massive cystic presence in the abdominopelvic cavity, suggestive of a cystic tumor likely of right adnexal origin, possibly a plasma cystadenoma. Right upper ureter compression was implicated in right lower ureter dilatation and hydronephrosis. (D) Postoperative CT findings: Changes in the right ovary, with a few striated shadows and effusion in the operative area. Discernible uterine morphology, and the left adnexa appeared replete.
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case_images: f1
case_images: Whole-abdomen computed tomography (CT) revealed abdominal distention, the presence of a large cystic fluid-filled mass in the abdomen, measuring about 40 x 30 x 34 cm, separated cystic cavity visible inside; slight enhancement of the division and cyst wall was observed, but no enhancement was observed in the internal fluid shadow at each stage, and no significant localized thickening was observed in the division ( Figure 1 ).
case_images: Abdominal color ultrasonography scans.
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case_images: The spleen was enlarged ( Figure 2 ).
case_images: (A) Approximately 14,000 mL of sac fluid was aspirated intraoperatively; (B) The cyst size measured about 40 x 35 x 15 cm after draining the fluid from the sac; (C) The internal structure of the cyst was examined on a section prepared postoperatively; (D) Internal solid area of cyst was 5 x 5 x 1.5 cm.
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case_images: f3
case_images: Left and right peritoneal tissues and lesion-like tissues of the omentum were retained for examination ( Figure 3 ).
case_images: (A, B) Preoperative and postoperative comparison (preoperative abdominal circumference, 125 cm; weight, 98 kg; postoperative abdominal circumference, 90 cm; weight 74 kg). (C-F) Postoperative pathological images of paraffin wax. Postoperative paraffin pathology revealed that the cyst wall exhibited a single layer of columnar epithelium, with intracellular mucus observed. In certain areas, sieve-like, labyrinthine, and papillary epithelial hyperplasia was evident, accompanied by increased cell layers, disorganized polarity, and noticeable anisotropy. Nuclear schizophrenic images were also observed. The pathological diagnosis based on the paraffin section report identified mucinous cystadenocarcinoma of the expansion infiltration type in the right ovary.
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case_images: f4
case_images: Histological examination of the mass specimen obtained during surgery showed that the capsule wall was lined with a single columnar epithelium and showed intracellular mucous with epithelial hyperplasia in some areas; cribriform, labyrinth like and papillary structures, were observed, with increased cell layers, disordered polarity, obvious atypia, and visible mitotic figures ( Figure 4 ).