Appendiceal tumour case study

INTERESTING CASE

Submitted by: R Caroco,  University College Hospital London

Patient presentation :

A 39 year old female patient was seen on the Gynae department for a transvaginal early pregnancy ultrasound following in-vitro fertilization (IVF).

A viable single intrauterine pregnancy was seen with appearances consistent with 7 weeks gestation.
The pelvic ultrasound also revealed the presence of a blind-ending unilocular cystic structure within the right iliac fossa, which had also been identified on her last scan 2 weeks ago. Doppler examination did not reveal increased blood flow to the mass and this was not tender during the examination. There was no change observed on this structure between the two scans. The patient did not complain of pain, fever or any appetite change and her bowels were opening normally.

For further characterization of the blind-ending structure, the patient was booked for an abdominal ultrasound scan.

Curiously, when looking at the patient’s past medical notes, there was previous history of right iliac fossa (RIF) pain and a laparoscopy done earlier on the same year, in the private sector, identified intra-abdominal jelly like fluid and pelvic adhesions which were treated with adhesiolysis. 

The images acquired during the abdominal ultrasound examination are shown below:

Ultrasound images of the right iliac fossa using B-mode and colour Doppler.

What is the most likely diagnosis and differential diagnosis?

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