April 2016 · Volume 5 · Issue 4 Page 1260 International Journal of Reproduction, Contraception, Obstetrics and Gynecology Singh A et al. Int J Reprod Contracept Obstet Gynecol. 2016 Apr;5(4):1260-1262 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 Case Report Müllerian duct cyst misdiagnosed as ovarian cyst: a rare case report Alpana Singh, Sneha Shree*, Vandana Mishra, Gita Radhakrishnan INTRODUCTION The Müllerian duct cyst is a remnant of the caudal ends of the fused embryologic paramesonephric ducts (or Müllerian ducts). 1 They are uncommon pelvic cystic lesions, with the peak clinical incidence between the third and fourth decades of life. 2 Usually they are small and asymptomatic, sometimes they are large, resulting in symptoms such as pelvic pain and pressure symptoms. They are thin walled and unilocular, hence it is difficult to differentiate them from a benign ovarian cyst on imaging. Treatment is indicated in symptomatic individuals only and is aimed at complete excision of the cyst. Both open and minimally invasive approaches have been described, but with pre-operative diagnosis, minimally invasive procedures may suffice in their management. METHODS A 32 year old multiparous female presented to our outpatient department with the complaint of a lump and dull aching pain in lower abdomen for three months. Her menstrual cycles were regular and she had five living issues. Her general physical examination was not remarkable. On abdominal examination, a mass arising from pelvis was palpated which corresponded to 16 weeks gravid uterus size and clinically measured 6X7 cm. It was cystic in consistency, with smooth surface and horizontal mobility. On bimanual pelvic examination, the Department of Obstetrics & Gynecology, Institute of University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India Received: 12 February 2016 Revised: 13 February 2016 Accepted: 08 March 2016 *Correspondence: Dr. Sneha Shree, E-mail: shreesnehapmc@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT The Müllerian duct cyst is a remnant of the caudal ends of the fused embryologic paramesonephric ducts (or Müllerian ducts). Preoperative distinction of ovarian cyst from a Müllerian duct cyst is important and is based on visualization of the ipsilateral ovary separate from the mass. Müllerian duct cysts may also be mistaken as paratubal, paraovarian or peritoneal inclusion cysts and hydrosalpinx. Thus, preoperative diagnosis of Müllerian cyst of the uterus can be very challenging. However, with increased awareness, preoperative diagnosis of this condition should be possible by sonography. Laparoscopy is useful as a minimally invasive treatment to diagnose as well as resect the cyst at the same time. We present a rare case of Müllerian duct cyst misdiagnosed as ovarian cyst pre-operatively and managed laparoscopically. A 32 year old multiparous female presented with the complaint of lump and dull aching pain in lower abdomen since three months. A cystic mobile mass measuring 6X7 cm with smooth surface which corresponded to 16 weeks gravid uterus size was palpated arising from pelvis. Her pelvic ultrasonography revealed a 7X7 cm unilocular thin walled simple cyst in right ovary suggestive of serous cystadenoma. Her CA-125 was 5.3 IU/ml. She was taken up for laparoscopic ovarian cystectomy. Intra-operatively, a 7X7 cm cyst was seen arising from right lateral wall of uterus. Histopathology showed the cyst wall features consistent with a Müllerian duct cyst. Keywords: Müllerian duct cyst, Ovarian cyst, Laparoscopy, Ultrasonography DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20160900