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Special Feature
April 2008

Image of the Month—Quiz Case

Author Affiliations

Author Affiliations: Redcliffe Hospital, Redcliffe, Australia.


Copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2008

Arch Surg. 2008;143(4):421. doi:10.1001/archsurg.143.4.421

A 64-year-old woman presented with nonspecific lower abdominal pain and abdominal distention. She had previously undergone an extended right hemicolectomy for a moderated differentiated colonic adenocarcinoma with no lymph node involvement and clear margins.

Investigations noted mildly deranged transaminases, a raised carcinoembryonic antigen level (330 000 ng/mL [to convert to μg/L, multiply by 1.0]), and normal cancer antigen 19.9 and cancer antigen 125 levels. Colonoscopy results were normal. Computerized tomography demonstrated a multiloculated cystic mass rising from the central pelvis. This extended upwards into the lower abdomen. The mass showed multiple cysts of varying size seen as regions of low attenuation with the soft-tissue components (seen as irregular material of high attenuation between the cysts) (Figure 1).

Figure 1.
Image not available

Preoperative computed tomographic scan demonstrating a large cystic mass.

The patient underwent a laparotomy, and a 1765-g mass was found rising from the pelvis (Figure 2). Ascites was noted, but there was no evidence of peritoneal or hepatic deposits.

Figure 2.
Image not available

Operative specimen showing a large multiloculated cystic mass.

What Is the Diagnosis?

A. A primary ovarian neoplasm

B. A secondary ovarian neoplasm

C. Cystic sclerosing mesenteritis

D. Mesenteric cystic lymphangioma