spread strongly support malignancy.We describe a case of bilateral large ovarian masses accompanied by peritoneal soft tissue implants. Imaging studies revealed predominantly cystic lesions in the ovaries with minimal solid components, lack of ascites and hypervascular enhancement of multiple small peritoneal masses. Given the prior history of splenectomy, suspicion for metastatic ovarian cancer was low, and the suggestion of peritoneal splenosis and bilateral benign ovarian cystic tumors was raised. Intraoperative findings supported this diagnosis and consequently a less radical surgery was performed. Case ReportA 58-year-old woman was referred to our institution for pelvic pain and abdominal distention. Past medical historyHer past medical history was remarkable for splenectomy performed following abdominal trauma in her youth, as well as an explorative laparotomy for chronic pelvic pain and infertility about 30-years-ago. Ovarian cyst aspiration performed at that time contained hemosiderin and erythrocytes but no tumor cells. Current medical historyShe was a smoker but otherwise healthy. The patient complained of worsening pelvic pain and abdominal distension. Laboratory results were normal apart of elevated CA-125 to a level of 331 U/ml. *Corresponding author: Alla Khashper, Medical Imaging Institute, Soroka Medical Center, Ben-Gurion University of the Negev, Beersheba, Israel, E-mail: khashper@yahoo.com AbstractA case of large bilateral cystic ovarian masses is reported. Initial imaging, including ultrasound (US) and computed tomography (CT), showed a large right ovarian cystic tumor, a smaller multicystic left ovarian tumor and multiple solid peritoneal implants suspicious for metastases. Due to a history of remote post-traumatic splenectomy, the presence of bilateral benign ovarian cystic tumors in combination with peritoneal splenosis was considered. Magnetic resonance imaging (MRI) followed by total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy were performed. The final histological diagnosis of the peritoneal implants was splenic tissue consistent with splenosis and the ovarian tumors were ovarian serous cystadenofibromas.