A 52-year-old woman with a known history of uterine fibroids visited her gynecologist with dysfunctional uterine bleeding. She denied having abdominal pain, nausea, vomiting, diarrhea, melena, or change in her weight. Her father had a history of colon cancer, but the remainder of her history was otherwise noncontributory. On examination, the patient was well nourished. Her abdomen was soft and nontender with no palpable mass.
For further evaluation of her bleeding, she underwent pelvic ultrasonography, which was notable for a fibroid uterus and a right lower quadrant cystic mass that appeared to be associated with the appendix. A computed tomographic scan of the abdomen and pelvis was obtained (Figure 1).
Computed tomographic scan revealing a cystic mass in the right lower quadrant.
The patient was explored laparoscopically. We encountered a cystic lesion that was localized to the right lower quadrant. The mass was excised laparoscopically and sent for gross (Figure 2A) and microscopic (Figure 2B) examination.
Gross and microscopic images of the retroperitoneal cystic mass. A, Gross pathologic specimen. B, Ciliated columnar epithelium lining the cyst; arrows indicate ciliated cells (hematoxylin-eosin, original magnification ×60).
A. Appendiceal mucinous cystadenocarcinoma
B. Mucocele of the appendix
C. Cystic teratoma
D. Benign retroperitoneal cyst
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