Intraoperative Evaluation of a Serous Cystadenofibroma of the Fallopian Tube in a 13-Year-Old Female

Background: Cystadenofibromas (CAFs) are defined as benign mixed mullerian tumors. They are diagnosed mainly in the ovary. Nonetheless, extraovarian locations, such as endometrium, uterine cervix, fallopian tube, and parasalpinx, were reported. Clinical course is commonly asymptomatic, and tumors are often diagnosed on histology after adnexal cyst surgery for benign indications. Case: A 13-year-old female was admitted into our emergency room with acute lower right abdominal pain as her main complaint. Abdominopelvic ultrasonography showed a right adnexal unilocular cyst with small papillary projections on the inner wall of the cyst, with no apparent solid component. Result: During laparoscopy, two cystic masses dependent on the distal region of the right fallopian tube were seen. After fluid aspiration of the first cyst, capsule was opened to see the nodular formations (papillary projections) previously described by ultrasonography. Right salpingectomy was performed due to high suspicion of a borderline tumor. Histopathologic diagnosis was compatible with a serous CAF. Conclusion: In our case we tried an intraoperative evaluation of the inner surface of the cyst, observing papillary projections that were regular and well adhered to their wall. However, microscopic pathology assessment of the tumor is mandatory to have definitive diagnosis. Surgical treatment, especially in child and youth population, should be conservative and adnexectomy should be avoided. Laparoscopic approach is often successful and can be considered in these cases. Although previous published cases were diagnosed in an incidental manner, our case highlights the importance of a thorough intraoperative assessment of adnexal tumors in child and adolescent patients.