Hi everyone, my name is Dr. Sachin Sharma, JR3 and I'll be presenting a case series on benign ovarian cystic lesions. Introduction at nexal cystic masses can be broadly classified as ovarian and extra ovarian. The most commonly encountered extra ovarian masses are overwhelmingly benign including hydroselping, hematoselping, para ovarian, para tubul cis and peritoneal inclusions. Transvaginal ultrasonography remains the primary modality of choice for evaluating pelvic masses due to its easy availability, high sensitivity, cost effectiveness and lack of ionizing radiation. Transvaginal ultrasonography also remains helpful in differentiating various simple benign entities from intermediate or malignant lesions. Pellar Doppler has been proposed in differentiating benign from malignant neoplasms based on the fact that malignant neoplasms usually have a low resistive index. A resistive index of less than 0.4 and a pulsility index of less than 1.0 are considered suspicious of malignancy. However, due to overlap of these findings in benign and malignant neoplasms, the clinical utility of Doppler imaging is limited. Overall, ultrasound has variable sensitivity and specificity for identifying and characterizing borderline or malignant lesions which may partly be attributed to operator dependency and or patient's body habitus. Benign Cystic Adnexal Lesions Physiological These are functional or hemorrhagic cysts, PCOS slash MFOS, endometrioma, cystidinoma including cirrus or mucinus, ovarian cystidinofibroma, mature cystic teritoma. Case 1, a 52-year-old female came to the department of radio diagnosis with large lump in right elixosa since two months. She also had complaints of dull abdominal pain radiating to back. Her KFT and LFT were within normal limits. Imaging Findings Transabdominal and TBS Sonography Revealed a well-defined heterogeneously hyperechoic lesion in right adnexal region showing minimal vascularity and focus of calcification. Minimal paravirin free fluid was noted. Right ovary could not be delineated clearly and left ovary was normal. This is the hyperechoic lesion. CT Findings A well-defined non-enhancing cystic lesion with fat density seen in the right adnexal region with a calcific focus that is likely tooth. This is the lesion. Fairly well-defined heterogeneous but predominantly T2 hyperintense lesion is seen in the pelvis posterior superior to the uterus. It is predominantly T1 hyperintense with hypo intense areas within. On T2 fat saturated images the T1 and T2 hyperintense areas show complete signal drop as we can see here. So final diagnosis is mature ovarian teratoma. Ovarian dermoids are the most common ovarian neoplasm. They are mature teratomas arising from the germ cells and can therefore contain elements of all three germ layers such as epidermis, hair, calcified bone, teeth, fat and soft tissue. Often the tumor is asymptomatic and is detected incidentally or is associated with non-specific symptoms. Over lifetime malignant transformation occurs in about one to two percent of cases mostly towards squamous cell carcinoma. This can be prevented by ovarian cystectomy. Case 2 A 19-year-old female came to the department of radio diagnosis with irregular menses, menorrhagia and abdominal pain. Her CRP was also raised. Imaging findings TVS ultrasound shows a unilocular cystic lesion with pepillary projections but no other solid components. Arrow denotes the posterior shadowing. This CT findings. Contrast enhanced CT demonstrates a non-enhancing cystic lesion without internal septation arising from right ovary. Here. Patient underwent laparoscopic removal of the lesion and HPE confirmed the lesion as ovarian serous cystidinoma. Epithelial neoplasms of ovary accounts for 60% of all ovarian tumors and 40% of benign tumors. They classify as benign borderline or malignant tumors. Ovarian cystidinomas are common benign epithelial neoplasms which carry an excellent prognosis. The two most frequent types of cystidinomas are serous and musinous cystidinomas whereas endometroid and clear cell cystidinomas are rare. Despite advances in imaging studies, the establishment of a definitive diagnosis of cystidinomas is primarily by histopathological examination of the surgical specimen. Case 3 A 19-year-old female came to the department of radiodiagnosis with irregular menses, menorrhagia and abdominal pain. Her CRP was also raised. Imaging findings. There is a multi-septated cystic lesion seen in the right ovary. Here. The lesion does not show any vascularity on Doppler study. CT findings are there is a large non-enhancing multi-septated right ovarian lesion. Here. Fairly well-defined heterogeneous but predominantly T2 hyperintense lesion is seen in the pelvis, posterior superior to the uterus. Here. It is predominantly of T1 hyperintense with hyperintense areas within. These are the hyperintense areas. Patient underwent laparoscopic removal of the lesion and HPE confirmed the lesion as ovarian musinus cystidinoma. Benign musinus cystidinomas account for 80% of ovarian musinus tumors. Musinus cystidinomas of ovary occur mainly in during the third to sixth decades but they may also occur in younger. Case 4 A 33-year-old single nallipera with the three-year history of recurrent abdominal pain, abdominal swelling and difficulty in breathing. Symptoms initially began as a lower abdominal pain with associated dysmenorrhea and heavy menstrual bleeding. History of dysperiunia could not be ascertained because she was not sexually active. Imaging findings. There was a well-defined right ovarian lesion with fine ground glass debris and no vascularity on coladoplar study. This is a ground glass appearance. A large pelvic cystic lesion with thin wall and homogeneous T1 hyperintense signal and hypointense on T2 shading sign is seen here. The lesion is hyperintense on T1 and shows shading on T2. On the basis of imaging findings, the final diagnosis was ovarian endometrioma. The diagnosis was confirmed on histopathological correlation. Endometriosis including ovarian endometrioma is typically associated with chronic pelvic pain, dysmenorrhea, dysperiunia and infertility. TvS scan plays an important role in the initial evaluation of women with suspected ovarian endometriosis. They help in differentiation between ovarian endometrioma and other benign adnexal masses. B-mode ultrasound with the use of mean gray value has a sensitivity of 80% and specificity of 91% in differentiating endometriomas from other unilocular cysts. Ovarian endometriomas have a typical appearance of homogeneous low-level internal ecos and thick walls on ultrasound scans. CT scan is said to be a non-reliable imaging modality for the diagnosis of endometrioma and endometriosis. The features are non-specific and often mimic benign and malignant ovarian tumors. MRI is considered the best diagnostic imaging technique for ovarian endometriosis. The shading sign seen on T2 weighted images is pathognomic of ovarian endometrioma. As seen in our case, fluid fluid levels may also be noticed within the cyst. Therefore, on T2 weighted images, endometriomas show a gradual loss of signal within the lesion with low signal intensity till complete signal void in the declivious portion shading, whereas endometriotic cysts show high signal intensity on T1 weighted images. Discussion Ovarian masses present a special diagnostic challenge when imaging findings cannot be categorized into benign or malignant pathology. Ultrasound CT and MRI are currently used to evaluate ovarian tumors. Ultrasound is the first line of imaging investigation for suspected adenoxyl masses. Color Doppler ultrasound helps in diagnosis identifies vascularized components within the mass. CT is commonly performed in preoperative evaluation of suspected ovarian malignancy, but it exposes patient to radiation. When the USG findings are non-diagnostic or equivocal, MRI can be a valuable problem solving tool, also useful to give surgical planning information. Ultrasound is a primary imaging modality for identifying and characterizing ovarian masses. Ultrasound is a relatively simple and non-invasive diagnostic method and provides clinicians with useful information relevant for determining the optimal management strategy for a given patient. Lots of data have demonstrated that ultrasound can accurately characterize about 90 percent of adenoxyl masses. These are the references. Thank you.