A Pelvic Cauliflower-like Growth: A Misleading Diagnosis

Abstract

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.