Paraovarian Cyst Mimicking as Malignant Adnexal Mass: A Rare Diagnosis

Aim and background: This report aims to raise awareness among the probability for occurrence of a paraovarian serous cystadenofibroma, mimicking as malignant tumor and giving rise to management dilemma.Case description: A nulligravida in her 20s presented with primary infertility with normal male factor.On transvaginal scan, adnexal cyst was detected with Ovarian-Adnexal Reporting and Data System (ORADS) ultrasound (US) score suggestive of intermediate risk of malignancy.Patient was taken up for operative hysterolaparoscopy with laparoscopic paraovarian cystectomy.Histopathology examination suggestive of serous cystadenofibroma.Follow-up period was normal.Conclusion: As this case illustrates that we have reported occurrence of serous cystadenofibroma as a paraovarian cyst should be taken into consideration, even though it is thought to be rare, specific features on ultrasound as described in this case report will aid in reaching the diagnosis.Clinical significance: Serous cystadenofibroma presenting as paraovarian cysts is rare, our case highlights the importance of meticulously performing ultrasound of paraovarian cyst, applying ORADS US score and also emphasizing the ultrasound features that are reported to help reach a diagnosis without the requirement of higher imaging modality.