Ovarian mucinous cystadenoma associated with mural leiomyomatous nodule and massive ovarian edema

Mural nodules associated with mucinous and serous tumors of the ovary may represent a reactive process, a benign tumor, or a malignant neoplasm. Mural leiomyomatous nodule in mucinous cystadenoma is extremely rare. Two such cases had been described previously. In this case a 43-year-old white female presented with 24-h history of left quadrant pain and a left adenexal cystic mass on ultrasound examination. An exploratory laparotomy revealed a left ovarian mass with torsion on its pedicle. Frozen section of the cystic mass showed a mucinous cystadenoma with mural smooth muscle proliferation. A total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. Histologic examination of the mass revealed a mucinous cystadenoma with a mural leiomyomatous nodule and an enlarged ovary with massive stromal edema. This is the first case of a mural leiomyomatous nodule in association with a mucinous cystadenoma in an ovary with massive edema. This case broadens the histologic spectrum in which a mural leiomyomatous nodule may be encountered.