CASE REPORT:
An 80‐year‐old multiparous woman presented with complaints of lower abdominal pain and back pain for two weeks. There was no history of weight loss and loss of appetite. Bowel and bladder habits were normal. There was no other significant clinical or family history. On abdominal examination, she had mild tenderness at the left iliac region. Per vaginal examination showed mild cervical erosion and a hard palpable mass in s left adnexa and pouch of Douglas’. Abdominal ultrasound revealed a complex adnexal cyst measuring 5.3 X 5.0 X 9.7 cm adjacent to the fundus of the uterus, likely originating from the right adnexa. The cyst had thick walls with polypoid projections and mural nodules measuring up to 15mm in thickness. Serum CA 125 and CEA were 200 IU/mL and 63.62 IU/mL, respectively. A computerized tomography scan of the abdomen and pelvis revealed a 10 X 6 X 6 cm cystic lesion in the pelvis anterosuperior to the uterus. Multiple enlarged para-aortic lymph nodes measuring 20 X 14 mm, a few sub-centimeter-sized left external, and common iliac lymph nodes were noted. A suspicious enhancing nodule was also noted in the Pouch of Douglas. A presumptive diagnosis of advanced ovarian cancer was made. The patient underwent total abdominal hysterectomy with bilateral salpingo‐oophorectomy with bilateral pelvic lymph node dissection, para-aortic lymph node dissection, total omentectomy, appendectomy, bladder peritoneal deposit removal with left Double J stenting.