Collision tumors are rare neoplasms defined by the presence of two distant tumors in the same organ without any histological intermixing. Ovarian tumors are often asymptomatic during the early stages and become symptomatic when increased in size causing vague abdominal pain, abdominal distention, vomiting, and frequent urination. We report here a case of a 28-year-old female who presented with a history of worsening abdominal pain and distension. An abdominopelvic ultrasound scan showed a huge complex mass occupying the pelvic area with non-visualization of the left ovary suggesting an ovarian origin; further characterization by cross-sectional imaging by both CT and MRI were performed confirming a left ovarian complex mass containing multiseptated cystic and fat component at the same time along with massive ascites. After surgical resection of the mass, histopathology revealed mucinous cystadenoma coexisting with cystic teratoma.

The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) stratifies patients with thyroid nodules for further evaluation. We evaluated the accuracy of this risk stratification and compared it with that of fine-needle aspiration cytology (FNAC) and final pathology. The nodules (n = 381) of 329 patients (mean age, 45.5 y; 251 female) who underwent thyroid surgery from January 2021 to September 2023 were retrospectively analyzed for the ACR TI-RADS, FNAC, and final pathology results. The nodules were categorized according to risk of malignancy as 75.9% ACR TI-RADS 5, 72.6% ACR TI-RADS 4, 38.9% ACR TI-RADS 3, and 33.3% ACR TI-RADS 2. Considering ACR TI-RADS 5 and 4 as high-risk categories, the sensitivity, specificity, positive-predictive value, and negative-predictive value of the ACR TI-RADS categories were 77.9%, 57.3%, 73.8%, and 62.8%, respectively. With both ACR TI-RADS and FNAC high-risk categories combined, the sensitivity and specificity improved to 82.4% and 58.6%, respectively. The ACR TI-RADS score effectively predicts malignancy in higher-risk categories; however, some malignant cases were found within lower-risk categories, implying the need for careful utilization of this system. Combining high-risk ACR TI-RADS and FNAC results improves the diagnostic accuracy of thyroid nodules. Confirmation from further prospective studies is required.

Obturator hernia is a pelvic floor type of hernia in which abdominal or pelvic contents protrude through the obturator foramen. It is considered rare in patients with signs and symptoms of intestinal obstruction causing a diagnostic challenge for clinicians. This case reports a 91-year-old multiparous female who presented with vague lower abdominal pain associated with obstipation and vomiting. We present a successful laparoscopic repair of obturator hernia in an elderly female.