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A 25-year-old woman presented with backache of 2 weeks duration and had 45-60 days menstrual cycle. On transvaginal sonography (TVS), her left adnexa showed a heterogenous solid mass of 5.3×4.2 cm and moderate vascularity on color doppler. Serum inhibin B was raised to 2249 pg/ml. MRI showed 5.5× 4.5 cm solid mass in the left ovary with lobulated margins suggestive of sex cord-stromal/ germ cell tumor. Laparoscopy showed an enlarged left ovary with intact surface. Left adnexectomy with staging biopsies and infracolic omentectomy was performed. Histopathology showed adult granulosa cell tumor with intact ovarian capsule. One-month post-surgery, inhibin B level was 44 pg/ml. She wishes to conceive after six months follow-up.

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Aim: To present a rare case of cauliflower-like pelvic tumor in a 29-year-old lady with an intraoperative diagnostic dilemma. Background: Ovarian adenofibromas are rare benign neoplasms accounting for 1.7% of all benign ovarian tumors. A cauliflower-like growth is usually suggestive of malignancy; however, benign tumors like leiomyoma, granulomas, and polypoidal endometriosis can have similar morphology, especially in young women. Case description: A 29-year-old nulligravida with abnormal uterine bleeding and abdominal pain for 2 months presented to our outpatient department. Ultrasonography demonstrated a well-defined left adnexal solid cystic lesion with the minimal color flow. Laparoscopy was done and intraoperatively there was solid, cauliflower-like growth of 3 cm in the pouch of Douglas (POD) between the left ovary and posterior uterine surface that mimicked a malignancy. The left ovary had a simple cyst of 4 cm. Complete excision of the cauliflower-like pelvic mass, left ovarian cystectomy and staging peritoneal biopsies were done. On histopathology, the cauliflower lesion was diagnosed as ovarian serous adenofibroma. Conclusion: Ovarian serous adenofibromas are benign lesions that look deceptively malignant but have a good prognosis. Intraoperative frozen section is ideal for the appropriate management in such situations of clinical dilemma. If a frozen section facility is unavailable, performing an excision biopsy to confirm or refute a malignancy before proceeding with radical surgery, particularly in young women, is advised. Clinical significance: Ovarian serous adenofibromas are uncommon benign neoplasms that morphologically mimic malignancy and can cause a diagnostic dilemma but have a good prognosis after excision.

Struma ovarii is a rare ovarian tumor and a monodermal variant of dermoid tumors of the ovary in which thyroid tissue components constitute more than 50% of the mass. Struma ovarii accounts for 0.5–1.0% of all ovarian tumors and 2-5% of ovarian teratomas. Most cases are benign, but malignant transformation is found in a small percentage. It usually presents as a unilateral adnexal mass at fifth and sixth decades of life, with symptoms like other ovarian tumors. The definitive diagnosis is made by histological examination. Adnexectomy remains the standard line of treatment for benign disease. A 41-year-old lady presented with pain in abdomen for 3 months. On ultrasonography and MRI, a multiloculated solid cystic lesion of 7×6 cm with internal echoes was found in the right adnexa. Laparoscopic right adnexectomy was performed. Histopathology was consistent with struma ovarii. Due to its vague clinical manifestations and diverse imaging characteristics, pre-operative diagnosis is challenging.