{'fraction_non_alphanumeric': 0.021103896103896104, 'fraction_numerical': 0.0183982683982684, 'mean_word_length': 4.888535031847134, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
An atypical hydrosalpinx: a differential diagnosis of an ovarian cyst

Case report A 37-year-old woman was referred to clinic with a 5-year history of primary infertility. She had no relevant medical or social history. Her menstrual cycles were regular and day 21 progesterone measurements confirmed ovulation. Trial sperm washings on her partner’s semen revealed a moderate degree of oligospermia. The couple were informed and counselled with regard to the finding and therapeutic options available. The couple wished to pursue in-vitro fertilisation, therefore formal tubal assessment was not performed. Super-ovulation was carried out until satisfactory ovulation induction was achieved. At the time of follicle tracking a 56 6-cm encapsulated ovarian or para-ovarian cyst was noted. As this cyst did not have any solid elements or any area of vascularity demonstrated with aid of power Doppler, treatment was continued and a cyst aspiration was performed at the time of transvaginal oocyte retrieval. The cyst was first aspirated through a transvaginal needle draining 600 ml of clear acellular fluid. Oocyte retrieval of 14 follicles generated 11 oocytes. Two oocytes were fertilised successfully but failed to implant. Four months after IVF a repeat transvaginal ultrasound scan revealed the recurrence of the cyst with increased dimensions of 120 mm by 49 mm (Figure 1). Tumour markers CA125, CA199, HCG and AFP were all normal but CEA was elevated at 15 mg/ litre. In view of the elevated CEA measurement and increased cyst dimensions it was decided to perform a laparotomy. At operation a 76 10-cm left-sided hydrosalpinx filling the pelvis and lower abdomen with multiple adhesions was noted (Figure 2). There was a minimal right sided hydrosalpinx present. Both ovaries and abdominal organs were normal. Left salpingectomy was performed.