This salpingo-oophorectomy specimen is from an adult female who presented with severe abdominal pain. Ultrasound examination revealed multicystic ovarian lesion which was removed at laparotomy. The 10 x 8 x 6 cm ovarian mass was adherent to the fallopian tube, had a bosselated surface and was blackish-blue in color. It was composed of multiple cysts filled with altered blood and blood clots separated by fibrous septae. Microscopic examination showed ischemic necrosis in most places and features of serous cystadenoma in viable areas of the lesion. Ovarian torsion (adnexal torsion) refers to rotation of the ovary and a portion of the fallopian tube on its supplying vascular pedicle. It is a medical emergency requiring immediate surgical intervention to prevent ovarian necrosis. Obstruction to the arterial inflow, venous outflow, and lymphatic drainage can cause hemorrhagic necrosis within hours of onset. Ovarian torsion shows a bimodal age distribution affecting young women of reproductive age and post-menopausal women. The risk factors include: benign and malignant ovarian neoplasms, polycystic ovaries, corpus luteum cyst during early pregnancy, developmental anomalies, and pelvic inflammatory disease. Case courtesy of: Dr. Sanjay D. Deshmukh, Professor of Pathology, Dr. V. Vikhe Patil Medical College & Hospital, Ahmednagar, India.