A case report on peritoneal inclusion cyst with entrapped ovary and an endometriotic cyst causing diagnostic dilemma

Luciana Stumpf, Shuchi Zinzuwadia, Brett Ploussard, Shweta Zinzuwadia, Elizabeth Bhrahmbhatt, Kailynn Adam, A. Jawahar
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2022 · vol. 11(4) , pp. 1289 · doi:10.18203/2320-1770.ijrcog20220921 · W4220792787
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⚙ AI-generated summary by claude@2026-06, 2026-06-11 ⓘ

This case report describes a benign peritoneal inclusion cyst with an entrapped ovary and endometriotic cyst that mimicked malignancy on imaging but was confirmed benign by pathology after surgical resection.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-11 · read from full text ⓘ

This case report describes a woman with prior surgical history who presented with suprapubic pain and was found on imaging to have a complex large cyst with diagnostic uncertainty, prompting gynecologic oncology consultation despite negative tumor markers. The paper emphasizes peritoneal inclusion cysts as benign lesions related to abdominal adhesions that entrap physiologic post-ovulatory fluid, and it presents pathologic correlation of the imaging findings, including an endometriotic cyst creating a diagnostic dilemma. A key limitation is that the evidence is limited to a single patient, with no broader comparative analysis of diagnostic strategies beyond this case narrative. Relevance to endometriosis: the report specifically frames the diagnostic dilemma as arising from an accompanying endometriotic cyst within the setting of a peritoneal inclusion cyst, even though the paper’s main focus is a detailed case-based description rather than endometriosis mechanisms.

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Abstract

Peritoneal inclusion cysts (PIC) occur most frequently when abdominal adhesions attach to an ovary. These adhesions are commonly seen in patients with a history of abdominal surgery. Physiologic fluid following ovulation that would normally be absorbed by the peritoneum gets entrapped within these adhesions. Women most frequently complain of back pain or pelvic pain when peritoneal inclusion cysts are present. We present a patient with prior surgical history who presented with suprapubic pain and was found to have a complex cyst on imaging. Gynecologic oncology was consulted due to its complex imaging appearance and large size and was ultimately resected despite negative tumor markers. We present our case with pathologic correlation of imaging findings to emphasize this benign entity with no malignant potential. A confident imaging diagnosis in correlation with laboratory markers can help prevent aggressive surgical management.
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A case report on peritoneal inclusion cyst with entrapped ovary and an endometriotic cyst causing diagnostic dilemma DOI: https://doi.org/10.18203/2320-1770.ijrcog20220921Keywords: Peritoneal inclusion cyst, Peritoneal pseudocyst, Peritoneal inflammatory cysts, Entrapped ovarian cystAbstract Peritoneal inclusion cysts (PIC) occur most frequently when abdominal adhesions attach to an ovary. These adhesions are commonly seen in patients with a history of abdominal surgery. Physiologic fluid following ovulation that would normally be absorbed by the peritoneum gets entrapped within these adhesions. Women most frequently complain of back pain or pelvic pain when peritoneal inclusion cysts are present. We present a patient with prior surgical history who presented with suprapubic pain and was found to have a complex cyst on imaging. Gynecologic oncology was consulted due to its complex imaging appearance and large size and was ultimately resected despite negative tumor markers. We present our case with pathologic correlation of imaging findings to emphasize this benign entity with no malignant potential. A confident imaging diagnosis in correlation with laboratory markers can help prevent aggressive surgical management. Metrics References Kim JS, Lee HJ, Woo SK, Lee TS. Peritoneal inclusion cysts and their relationship to the ovaries: evaluation with sonography. Radiology. 1997;204(2):481-4. Jones SA, Salicco JM, Byers MS. Pelvic pain and history of previous pelvic surgery. Proc (Bayl Univ Med Cent). 2003;16(1):121-2. Jain KA. Imaging of peritoneal inclusion cysts. AJR Am J Roentgenol. 2000;174(6):1559-63. Vallerie AM, Lerner JP, Wright JD, Baxi LV. Peritoneal inclusion cysts: a review. Obstet Gynecol Surv. 2009;64(5):321-34. Goldfisher R, Awal D, Amodio J. Peritoneal inclusion cysts in female children: pathogenesis, treatment, and multimodality imaging review. Case Rep Radiol. 2014;2014:427427. Amesse LS, Gibbs P, Hardy J, Jones KR, Pfaff-Amesse T. Peritoneal inclusion cysts in adolescent females: a clinicopathological characterization of four cases. J Pediatr Adolesc Gynecol. 2009;22(1):41-8. Kozasa K, Takemoto Y, Goto T, Kobayashi M, Sakaguchi H, Fujiwara S et al. Two cases of giant peritoneal inclusion cysts requiring treatment after total laparoscopic hysterectomy. J Surg Case Rep. 2020;2020(12):rjaa506. Moyle PL, Kataoka MY, Nakai A, Takahata A, Reinhold C, Sala E. Nonovarian cystic lesions of the pelvis. Radiographics. 2010;30(4):921-38. Chand MT, Edens J, Lin T, Anderson I, Berri R. Benign multicystic peritoneal mesothelioma: literature review and update. Autopsy Case Rep. 2020;10(3):e2020159. Patel MD, Ascher SM, Paspulati RM, Shanbhogue AK, Siegelman ES, Stein M et al. Managing incidental findings on abdominal and pelvic CT and MRI, part 1: white paper of the ACR Incidental Findings Committee II on adnexal findings. J Am Coll Radiol. 2013;10(9):675-81.

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