Case report An obese 14-year www.selleckchem.com/products/Gemcitabine-Hydrochloride(Gemzar).html old virgin girl presented at our Department with gradually increasing abdominal swelling first noticed 1 year before. Abdominal distension was accompanied with vague abdominal symptomatology from 3 months with localized pain in the right hypochondrium started one month earlier. There was no history of colic pain, vomiting or other gastrointestinal disturbances. Bowel and bladder functions were normal. There was no anorexia, weight loss or weakness. She had regular menstruations at intervals of 25�C28 days, lasted for 5�C6 days, associated with mild dysmenorrhea. At abdominal examination, a smooth tense cystic mass arising from the pelvis and extending to the mesogastric region could be palpated. The mass was neither mobile nor tender.

Rectal examination showed a large mass compressing bladder, uterus and rectum. At ultrasound scanning, uterus was normal in size and shape, right ovary was rounded by an 30 cm size homogeneous anechoic cyst. Left ovary was normal, with 1 cm anechoic structure. The huge cyst arising from the pelvis and occupying the whole abdomen, pressed both ureteres and caused bilateral hydronephrosis, more evident on the right renal pelvis. These foundings were confirmed by magnetic resonance imaging (Figure 1). Fig. 1 Magnetic resonance imaging showing a giant paratubal cyst. Preoperative investigations, including the renal function tests and the serologic oncological markers [beta-human chorionic gonadotrop (b-HCG), CA-125, CA 15-3, CA 19-9, carcinoembryonic antigen (CEA), and alfa-phetoprotein] were normal, reflecting the benign origin of the cyst (4).

Because of the mass effect with compression to the adjacent organs and the benign nature of the lesion, the patient was scheduled for laparoscopic surgery. A Hasson – trocar was introduced through a 1-cm umbilical incision, and other two 5-mm trocars were inserted in the lower abdominal quadrants. The leaves of broad ligament were separated and the limit of the giant cyst was identified. After its aspiration, the cyst was enucleated with preservation of residual ovarian parenchyma and tube. Exploration of the abdominal cavity, and particularly of the uterus, was normal. The other adnexa presented a little paraovarian cyst (1 cm), which was also removed. Both the cyst were pulled out through the umbilical incision, after insertion in an endobag and fluid aspiration from the larger cyst.

Preservation of both ovary and tube was accomplished. Intra- and post-operative course was uneventful, and the patient was discharged three days after surgery. After 1 week, hydronephrosis disappeared completely. Histological report confirmed the diagnosis of paramesonephric cysts. Discussion Small paratubal cysts are most commonly found in middle-aged women (30 to 40 Entinostat years of age), and are often indistinguishable from simple ovarian cysts.