Case history
A 34‐year‐old female that referred to a gynecologist in Mashhad, Iran in December 2022, with the chief complaint of hypogastric pain lasting more than 1 year which was firstly diagnosed as Pelvic inflammatory disease (PID). The initial trans-vaginal ultrasound revealed heterogeneous right adnexal mass with irregular margin measuring 3.1 × 6.3 cm in size and multi nodular small size mass on the right side of Culdesac. Abdominopelvic computed tomography (CT) scan in April 2023 illustrated solid masses in the pancreatic head (Figure 1A) and small intestine wall (Figure 1B) also solid cystic complex mass on the right side of pelvis, measuring 3 × 6 cm in size in the right parametrial space that extended and attached to right ovary (Figure 2A,B). Tumor marker CA125, CEA, CA19-9, βhCG and LDH were normal. Abdominopelvic sonography revealed normal abdominal viscera with a fluid-filled folded and tubular liquid right adnexal lesion measuring 2.9 × 6.7 cm suggesting long term lasting pyosalpinx. The abdominal pain had progressively worsened and she was referred for colonoscopy and endoscopy evaluation that revealed normal results. The patient was a candidate for diagnostic laparascopy in December 2023 since persistent abdominal pain, multiple smooth muscle-like nodules suggesting diffuse peritoneal lyomayomatosis was seen during operation, biopsies from omental lesions were obtained and referred to pathology, and the microscopic pathology findings confirmed myoma.