Huge fimbrial cyst causing bilateral hydroureteronephrosis
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Small fimbrial cysts are most commonly seen, sometimes become larger and presents with symptoms. Published in the The New Indian Journal of OBGYN, the authors present a case of huge fimbrial cyst detected incidentally in a 20-year nulligravida who reported with abdominal distention.

A 20 years old girl married, nulligravida came with complains of distention of abdomen since 3months. Otherwise patient was comfortable. She had history of 3 months of amenorrhea followed by menses. On abdominal examination cystic tense mass up to 34 weeks size felt. On vaginal examination uterus was difficult to palpate. On ultrasound large cystic lesion in abdomen and pelvis was seen. Right ovary was not visualized separately. Left adnexa was normal.

In CT abdomen and pelvis a large 12x 20x 21 (APXMLXSI) cm sized, well defined thin walled cystic lesion showing mild heterogenous enhancement of wall arising from right adnexa and its extension to abdomen. Mass effect was seen on the urinary bladder, adjacent bowel loops, spleen, pancreas and kidney. Mass effect was seen on bilateral ureter at the level of illial vessel crossing with bilateral mild proximal hydronephrosis and hydroureter. The level of CA-125 and LDH (Lactate Dehydrogenase) was 32.6U/ml and 642 U/L respectively.

Minilaparotomy was done with 3cm infraumbilical midline vertical incision. An aproximately 2.5 liter of clear fluid was aspirated from cyst. Cyst found to be arising from terminal portion of right fallopian tube and fimbria. Right ovary was normal. Cystectomy was done. Postoperatively patient recovered well. Histopathology report was consistent with fimbrial cyst.

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