Department of Obstetrics & Gynaecology, MAMC SEROUS CYSTADENOFIBROMA : MASQUERADER OF MALIGNANCY Dr Vaishali Paliwal, Dr Latika Sahu, Dr Ashmita M Rathore, Dr Chandan Dubey Department of Obstetrics & Gynaecology, MAMC INTRODUCTION DISCUSSION Rare. comprises 1.7% of all benign ovarian tumours Age group: 15-65yrs Bilateral : 15% cases Classified into serous, mucinous , endometroid, clear cell Little known about malignant potential Even on gross examination at the time of surgery, a cystadenofibroma may resemble a malignant tumor. The routine imaging features of this tumor may mimic a malignant neoplasm, but the presence of the fibrous component often gives a specific/characteristic MRI appearance of very low T2 signal intensity, that may help differentiate it from malignant ovarian tumors. Malignant ovarian tumors with a fibrous component and low-T2-signal intensity are likely to be metastases from the gastrointestinal tract. Metastases demonstrate a relatively low-T2 intensity of the fibrous component (although not as low as in a cystadenofibroma) and also show postgadolinium enhancement. CASE REPORT 71yr old female presented to opd with C/o pain abdomen and bloating sensation for the past 3 months. Past history: Operated for pancreatic cancer 2 years back. Whipples pancreaticoduodenectomy. CA 125 was normal. Ultrasound: There was cystic mass with septations , low level echoes & solid components in the right adnexa. Left adnexa also had a cystic mass. Uterus also had an intramural fibroid. Per op: 7x7x6 cm solid cystic mass in left adnexa and 4x4cm paraovarian cyst in right adnexa , 7x7 cm intramural fibroid . No evidence of metastasis. CONCLUSION Benign tumour & frozen establishes diagnosis. MRI the modality of choice for complex cystic masses. REFERENCES GROSS: Solid cystic mass with blackish appereance. 1.:Czernobilsky B, Borenstein R, Lancet M. Cystadenofibroma of the ovary. A clinicopathologic study of 34 cases and comparison with serous cystadenoma. Cancer. 1974;34:1971–1981. [PubMed] 2. Cho SM, Byun JY, Rha SE, Jung SE, Park GS, Kim BK, et al. CT and MRI findings of cystadenofibromas of the ovary. Eur Radiol. 2004;14:798–804. [PubMed] 3. Jung DC, Kim SH, Kim SH. MR imaging findings of ovarian cystadenofibroma and cystadenocarcinofibroma: clues for differential diagnosis. Korean J Radiol. 2006;7:199–204. HISTOLOGY: Mixture of epithelial & fibrous components. Glands and cysts are scattered in a fibrous stroma. FROZEN : Multiloculated cystic ovarian stroma & hemosiderin laden macrophages TREATMENT: TAH with B/L salpingoophorectomy FINAL HPE: Serous cystadenofibroma