Secondary appendiceal neoplasms are extremely rare conditions accounting for about 0.1% of total appendix malignancies (1). The clinical presentation is most prevalent as acute appendicitis and incidental finding can occur during other investigations (2). Ovarian cancer prognosis, especially dissemination form remains poor with a high mortality rate (3).
Synchronized evidence of bilateral ovarian masses with an asymptomatic incidental appendiceal solitary mass is an unusual event during operation.  The results of Babaier et al., and Kumar demonstrated, that the main differential diagnosis is metastatic mucinous adenocarcinoma of ovary to appendix versus metastatic mucinous neoplasm of appendix in both sides of ovaries (4,5). Yoon et al., study findings showed that metastasis of bilateral ovarian high grade serous carcinoma to the appendix is an extremely rare event (6).
A 43-year-old woman presented to our hospital with a several- month history of menstrual irregularity. She underwent physical, imaging, and laboratory evaluations. Finally surgical interventions were made. Imaging studies, including ultrasound and CT scan findings showed bilateral ovarian solid cystic masses and mild peritoneal effusion. CA 125 hadincreased mildly. (60 U/mL). During surgery, on palpation, an incidental small- sized appendiceal lesion was found. The patient underwent total abdominal hysterectomy, bilateral salpingo oophorectomy, omentectomy, pelvic lymph nodes dissection and appendectomy.
 Histomorphologic results of ovaries and appendix showed malignant   infiltrative   neoplasm   populated by pleomorphic tumoral cells in   solid   , cribriform, papillary pattern. The atypical mitosis   and necrosis   were seen. The psammoma bodies, were exclusively seen in appendiceal sections (Figures 1 and 2 A,B ).

Conflicts of Interest

Authors declared no conflict of interest.