Fig. 26

Bilateral adnexal inflammatory pseudotumor. A 25-year-old female with progressively increasing dull pain in lower abdominal quadrants which started 4–6 weeks before her initial presentation. Physical examination revealed mild abdominal tenderness and suspicious palpable masses in the pelvis without fever. Serum CA-125 level was 250 U/mL (N: 0–35 U/mL), and an ovarian malignancy was suspected based on the clinical and laboratory findings. a Gray scale US showed bilateral adnexal complex cystic masses with thick irregular walls (arrowheads) and layering echogenic internal debris (asterisk). b Color Doppler US demonstrates internal vascularity within the irregularly thickened walls (arrows). Based on sonographic findings, malignancy could not be excluded, and MRI was performed for further characterization. c-d Axial plane T2-weighted and T1-weighted postcontrast MR images, respectively, better demonstrated the enhancing, irregularly thickened walls of the cystic lesions in both adnexa (arrows). Histopathological examination revealed chronic inflammatory changes secondary to plasma cell and macrophage infiltration, and found consistent with inflammatory pseudotumors. Cultures from the surgical specimen did not grow any microorganism