Figure-28-10 A 6-cm parovarian cyst(C)is seenmedial to therightovary(calipers) Multiple lesions within the pelvis can masquerade as an ovarian cyst(Table 28-9 ).The etiology of extraova rian cysts is suggested by visualization of a separate ipsilateral ovary(g 28-10 )and in some cases by connection with the organ of origin, such as in the case of a bladder diverticulum(13)or a Tarlov cyst (14) Bowel loops frequently mimic ovarian cysts. Therefore, watch for peristalsis when a questiona ble lesion is visua lized Nonvisualization of a Palpable Pelvic Mass Dermoid cysts have a variety of appea rances because of their aomplex nature. Frequently, the dermoid cyst mimics bowel gas and is seen only as an echogenic area with shadowing In a patient with a pa lpa ble pelvic mass in whom no abnorma lity is visual ized, consideran echogenic dermoid( Fig. 28-11Aand Fig 28-11B) and carefully scan in the region of the palpa ble mass. 28-11a. Dermoid Transabdominal view of the uterus(UT) demonstrates a questionable right mass (RT) Figure -28-11b Endovag inal scan demonstrates extremely echogenic nature of this mass, which was not recognized ontwo pnor sonograms. Don't stop After One Lesion Is Found Many benign ovarian tumors ocaurbilaterally(demoids, serous cystade nomas, and metastases). In addition, women with one gyn ecologic mal ignancy are at ncreased risk for a second mal ignancy ( Fig. 28-12Aand Fig 28-12B) Some ovarian tumors, such as endometria id tumors and estrogen-producing thecoma and granulosa cell tumors, are associated with endometrial hyperplasia and endometrial cancer(Fig. 28-13Aand Fig 28-13B). There also are rare syndromesin which gynecologic ma lignandes are grouped such as the Lynd cancer family syndrome, in which there is an assodation between ovarian cancer, colon cancer, and endometrial cancers (15)Figure - 28-10. A 6-cm parovarian cyst (C) is seen medial to the right ovary (calipers). Multiple lesions within the pelvis can masquerade as an ovarian cyst (Table 28-9 ).The etiology of extraovarian cysts is suggested by visualization of a separate ipsilateral ovary (Fig. 28-10 ) and in some cases by connection with the organ of origin, such as in the case of a bladder diverticulum (13) or a Tarlov cyst. (14) Bowel loops frequently mimic ovarian cysts. Therefore, watch for peristalsis when a questionable lesion is visualized Nonvisualization of a Palpable Pelvic Mass Dermoid cysts have a variety of appearances because of their complex nature. Frequently, the dermoid cyst mimics bowel gas and is seen only as an echogenic area with shadowing. In a patient with a palpable pelvic mass in whom no abnormality is visualized, consider an echogenic dermoid (Fig. 28-11A and Fig. 28-11B ) and carefully scan in the region of the palpable mass. Figure - 28-11a. Dermoid. Transabdominal view of the uterus (UT) demonstrates a questionable right adnexal mass (RT). Figure - 28-11b. Endovaginal scan demonstrates extremely echogenic nature of this mass, which was not recognized on two prior sonograms. Don't Stop After One Lesion Is Found Many benign ovarian tumors occur bilaterally (dermoids, serous cystadenomas, and metastases). In addition, women with one gyn ecologic malignancy are at increased risk for a second malignancy (Fig. 28-12A and Fig. 28-12B ) . Some ovarian tumors, such as endometrioid tumors and estrogen-producing thecoma and granulosa cell tumors, are associated with endometrial hyperplasia and endometrial cancer (Fig. 28-13A and Fig. 28-13B ) . There also are rare syndromes in which gynecologic malignancies are grouped such as the Lynch cancer family syndrome, in which there is an association between ovarian cancer, colon cancer, and endometrial cancers. (15)