A Surprise Guest in the Paratubal Region – The Deep Bond Depicting Embryology and its Roots – A Case Report and Review of Literature

Abstract Choristoma is an ectopic rest of normal tissue. The presence of adrenal tissue outside its normal anatomical location is referred to as ectopic adrenal rests. Ectopic adrenal rests can be identified in the genitourinary system, pelvis, etc., and is an incidental finding on histopathological examination. We report a rare case of ectopic adrenal surprise guest in the paratubal region – of a 49-year-old female patient who presented with menorrhagia. Laparoscopic-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy was performed. Gross and microscopic examination revealed an intramural fibroid. An interesting and an incidental finding was noted in the paratubal region, which showed a circumscribed nodule composed of closely packed nests of clear cells separated by delicate fibrovascular septae. Immunohistochemistry showed diffuse strong positivity for inhibin. This case is presented due to its extreme rarity which can cause diagnostic dilemmas and to provide insight into rare entities and its prognostic significance.