Giant ovarian cyst masquerading as a massive ascites: a case report

A giant 25 litre volume ovarian cystic mucinous borderline ovarian tumour with intraepithelial carcinoma in a 24-year-old nulliparous woman: Case report

INTRODUCTION AND IMPORTANCE

Giant ovarian cysts are rare and usually pose significant diagnostic challenges especially in adolescents and young adults. There is limited report of such cases reported in existing literature with hardly any cases published from the Sub-Sharan African region.

CASE PRESENTATION

We present the case of a 24-year-old young woman who reported to our gynaecology clinic on the 23rd of January 2023 with a year's history of a progressively increasing abdominopelvic mass. She was successfully managed surgically and made smooth recovery.

CLINICAL DISCUSSION

Based on the history and examination findings, confirmed the diagnosis clinically with abdomino-pelvic ultrasound scan, removed the tumour surgically and undertook histopathological studies to confirm a benign disease. To the best of our knowledge, our successful management of this patient is the first case of such a huge borderline ovarian tumour reported in Ghana and the Sub-Saharan African region to inform clinicians on safe surgical management in our context.

CONCLUSION

Our successful management of this giant mucinous BOT reiterates the fact that in the absence of precise prognostic marker of malignancy, clinicians should always balance the oncologic safety of the patient against less radical treatment modality.

Infected, giant borderline ovarian tumor: A case report

INTRODUCTION AND IMPORTANCE

Gigantic borderline ovarian cancer, also known as giant borderline ovarian tumor, is a rare subtype of borderline ovarian cancer. This type of ovarian cyst can be associated to various complication, including superinfection.

CASE PRESENTATION

We present the case of a 30-year-old woman who sought medical attention due to chronic abdominal pain and a rapid increase in abdominal girth over the past four months. Pelvic ultrasound and pelvic magnetic resonance imaging (MRI) revealed an abdominal-pelvic mass of 27 ∗ 12 cm. The tumoral markers were elevated. During her hospitalization, she developed a fever along with abdominal pain and biological inflammatory syndrome. Surgical intervention a 30-cm-long solid cystic mass located on the right ovary, accompanied by moderate ascites. The surgical procedure included a right adnexectomy, omentectomy, and appendicectomy, with cytology performed. Postoperative antibiotics were administered, and the patient showed favorable clinical and biological progress. The anatomopathological examination confirmed a 35-cm borderline mucinous tumor with signs of infection.

CLINICAL DISCUSSION

Giant borderline ovarian tumor is characterized by the presence of an ovarian mass measuring at least 10 cm in diameter. Infectious complications are rare, and their clinical features usually mimic those of a peritonitis. Treatment is based on antibiotics and chirurgical removal of the tumor based on the FIGO classification along with peritoneal biopsies and cytology.

CONCLUSION

This study explores the diagnosis, treatment, and prognosis of infected giant borderline ovarian tumors.

Bilateral Ovarian Torsion Due to a Giant Mucinous Cystadenoma, Contralateral Mature Teratoma, and Paratubal Cyst in a Young Adult

Giant ovarian cysts (>10 cm) are rare due to the widespread use of routine imaging. However, in the absence of compressive symptoms, giant cysts remain a diagnostic challenge, especially in patients with larger body habitus. Complications of benign ovarian cysts are infrequent but can include torsion of the adnexa. Bilateral torsion is a rare emergency that can threaten a patient's future fertility. In this case, we report on a 24-year-old female with bilateral torsion due to a triad of adnexal masses including a 30 cm mucinous cystadenoma, a 10 cm mature teratoma, and an 8 cm paratubal cyst. Controlled fluid aspiration was performed prior to en bloc resection of the cystadenoma due to the emergent nature of the case and lack of malignant features.

Giant Ovarian Cyst in a Term Pregnancy Simulating a Massive Ascites: A Case Report

The diagnosis of ovarian mass during pregnancy may be missed if early ultrasonographic assessments of pregnancy are not done, resulting in late detection and management. Hence, this case report is aimed at underscoring the possibility of misdiagnosis of a giant ovarian mass for massive ascites in pregnancy. We present the case of a 35-year-old unbooked multigravida woman who was referred to our centre on account of polyhydramnios in labour, misdiagnosed as a massive ascites on admission. The incidental intraoperative diagnosis of a right giant ovarian cyst resulted in the right salpingo-oophorectomy of a huge cyst with the histological diagnosis of a benign ovarian serous cystadenoma. Huge cystic ovarian tumours coexisting with a normal pregnancy may simulate massive ascites resulting in a misleading diagnosis as reported in this case study. We report this case to awaken the suspicion index of a giant ovarian cyst in any patient presenting with massive ascites in pregnancy.

MRI Appearance of a Giant Ovarian Sero-mucinous Cystadenofibroma Mimicking Ascites. A Case Report and Brief Literature Review

Introduction: Giant ovarian cystadenofibromas are rare, mostly benign tumors. In the early stages, they are asymptomatic; however, as they grow in size, they begin to produce symptoms, most often due to the compressive effects they exert on surrounding structures. In the early stages, they are frequently diagnosed by ultrasonography, but complicated cases or cystadenofibromas that reach giant dimensions are ideally evaluated by magnetic resonance imaging (MRI) to establish a therapeutic surgical decision that is as safe as possible for the patient.

Case report: We present the case of a 49-year-old perimenopausal patient without vaginal bleeding or other gynecological symptoms who presented to the hospital with abdominal pain and abdominal distension with increasing intensity. Ultrasound examination revealed the presence of a high volume of fluid in the abdomen, and MRI and histopathological examination confirmed the diagnosis of a giant left ovarian type III seromucinous cystadenofibroma. The patient was treated surgically, with favorable postoperative evolution.

Conclusion: Giant cystadenofibromas are rare clinical entities that must always be considered in the differential diagnosis of an abdominopelvic pathology in middle-aged female patients and should ideally be investigated by MRI to accurately define their origin, characteristics, and local invasion.

Delayed presentation of a huge abdominopelvic mass during the COVID-19 pandemic

Background

Giant ovarian cysts are rare in developed countries due to advanced achievements in medical diagnostics. However, in the midst of the coronavirus disease 2019 (COVID-19) pandemic, patients with non-COVID-19-related illnesses tend to delay their health-seeking attention; thus, they had presented late.

Case presentation

A 25-year-old single lady complained of a 3-month worsening abdominal pain and distention. She was initially well but neglected the symptoms due to the COVID-19 situation, yet came to our attention after she developed obstructive symptoms. A computed tomography (CT) scan of the abdomen revealed a huge cystic lesion from the pelvic area, which later was found to be from the right ovary upon urgent laparotomy exploration. The histopathological examination was consistent with mucinous cystadenoma of the ovary.

Discussion

Acute non-COVID-19-related emergencies have decreased, as evidenced by reduced visits to the Emergency Department, and the number of abdominal CT scans. An emergency case like a huge abdominopelvic mass deserves an extensive radiologic examination as clinical assessment alone may not be adequate. Preoperative CT is superior to ultrasonography in getting the extent of the lesion, local infiltration, staging purpose, and surgical intervention. Pathology with a variety of spectrums such as mucinous neoplasm deserves to be investigated, evaluated, and resected even during the COVID-19 pandemic.

Conclusion

A giant abdominopelvic cystic mass can present emergency havoc during the COVID-19 pandemic. Urgent surgical intervention is mandatory by using full protection and exercising extreme precaution, regardless of the preoperative screening to avoid unnecessary viral transmissions.

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Acute abdomen cases have reduced in numbers during COVID-19 pandemic which can cause delay in diagnosis and management.

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Preoperative CT scan can determine the extent of the lesion, local infiltration, staging, and surgical intervention.

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During pandemic, urgent surgical intervention is mandatory by using full protection regardless of the preoperative screening to avoid unnecessary viral transmissions.

Postmenopausal giant ovarian tumor: a rare case report and literature review

OBJECTIVE

A giant ovarian tumor weighing 62 kg and containing 51 L cyst fluid is rare among postmenopausal women, and an early diagnosis contributes to a good prognosis.

METHODS

We report a case of a 62-kg giant ovarian tumor, the largest ovarian tumor ever reported in China. A 64-year-old woman with a giant pelvic abdominal mass underwent surgery. Because of the occurrence of serious perioperative and postoperative complications, we then conducted a literature review to investigate possible risk factors for severe complications.

RESULTS

During the operation, 51 L of intratumoral fluid was drained, and a giant ovarian tumor of approximately 62 kg was removed. The pathological examination showed that the tumor was a mucinous borderline one. The patient had perioperative hypotension and postoperative respiratory failure. After a comprehensive literature review, we found that the occurrence of serious complications may not be related to tumor volume and weight but age and the amount of fluid in the tumor.

CONCLUSIONS

The high incidence of severe complications should be carefully considered when huge ovarian tumors or tumors containing a large amount of tumor fluid in postmenopausal women are removed.

Giant ovarian mucinous cystadenocarcinoma: A case report

Giant ovarian tumors are rare in the present day due to the early diagnosis and treatment. However, owing to the large size, it can often compress the inferior vena cava and sudden decompression of it during the removal can lead to hemodynamic instability with disastrous outcomes.

A case report of partial bowel obstruction as the first symptom of a sizeable adnexal mucinous cystadenoma

Objectives

Mucinous cystadenomas are among the most common benign adnexal masses. The peak incidence of mucinous cystadenoma appears between the third and fifth decades of life, but rare cases in younger and older women have also been reported. Ovarian cystic formations are usually asymptomatic at early stages, until they grow in size and various compression symptoms appear, such as abdominal discomfort, distention, nausea, vomiting, and increased urination.

Case presentation

This is a case of an 86-year-old woman with partial bowel obstruction due to a sizeable adnexal mass. The patient was submitted to exploratory laparotomy due to intestinal obstruction symptoms, the mass was removed and the final histopathological report indicated a benign mucinous cystadenoma (maximum diameter 25 cm). Physical examination was remarkable due to the large size of the mass. Computed tomography revealed the sizeable abdominal mass in contact with the uterus and the ovaries resulting in bowel compression. Exploratory laparotomy due to bowel obstruction symptoms confirmed the imaging results. The abdominal mass was removed without being ruptured, and total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy were done.

Conclusions

Our case report highlights the clinical suspicion that is required for the diagnosis and appropriate treatment of this clinical entity. These tumors are uncommon in postmenopausal women, and when they do appear, they can be difficult to differentiate from cancer.

A Giant Ovarian Cystadenoma in A 20-Year-Old Nulliparous Woman: A Case Report

Giant ovarian cyst itself is defined as a cyst >10 cm in diameter from radiological- examination or the size of the cyst exceeds the umbilicus. Extra-large benign and malignant cysts of the ovary are uncommon and involve diagnostic and management challenges. We present the case of a 20-year-old nulliparous woman who was referred to our center with complaints of abdominal pain and heavy breathing. She benefited from a salphingo-oophorectomy laparotomy procedure. Benign and malignant gynecologic and non-gynecologic etiologies are included in the differential diagnosis of an abdominal mass. Because of the infrequent occurrence or absence of distinctive clinical presentation of the giant ovarian cyst, accurate preoperative diagnosis is challenging.

Giant Ovarian Cysts Treated by Single-Port Laparoscopic Surgery: A Case Series

Background

Ovarian cysts are very common diseases of the female reproductive system. Giant ovarian cysts refer to the tumors with diameters greater than 10 cm. In recent years, due to the development of clinical diagnosis, imaging modalities, and the improvement of patients’ cognition of the diseases, the occurrence of giant ovarian cysts has become rare. The purpose of this study was to show a new operation method of single-port laparoscopy to treat giant ovarian cysts.

Methods

We report a case series of five patients with giant ovarian cysts who underwent single-port laparoscopic surgery in the gynecology department of the Shengjing Hospital of China Medical University between June 2020 and March 2021. The inclusion criteria were ovarian cysts at least 20 cm in diameter, and cases when the tumor might be malignant were excluded.

Results

The patients’ mean age was 26.2years. The most common clinical presentation was progressive abdominal distension. Median size of the cysts at imaging was 39.2 cm (range 21–63 cm). All patients underwent single-port laparoscopic surgery, and none of them converted to laparotomy. On final pathological reports, two cysts were serous cystadenomas, and three were mucinous cystadenomas. All patients recovered well and were discharged on time.

Conclusion

Giant ovarian cysts can be treated by single-port laparoscopic surgery. In addition to the well-known advantages of laparoscopic surgery (e.g., small pelvic interference, fast postoperative recovery), it can also play the role of perfect cosmetic results, which has more advantages for young women.

Severe abdominal distention due to ovarian cysts in a parrot fish (Paraneetroplus synspilus)

In autumn of 2019 a three years old female parrot fish was referred to the veterinary hospital for diagnosis and treatment. The prominent symptom was inappetence and a large mass or unilateral distention in the abdominal cavity. Ultrasonography and radiology imaging with contrast media were done to evaluate the abdominal cavity. According to presumptive diagnosis by imaging, the fluid-filled mass was aspirated by a sterile syringe. No bacteria or other microorganisms were seen in the fluid using microscopy and culturing of the fluid on trypticase soy agar. The parrot fish died after three days because of imbalance and inappetence. Two fluid-filled masses were seen in necropsy. The ovarian structure of the cyst was proved based on the anatomical position, histopathology, ultrasonography and radiology of the cyst tissue. It could be concluded that prompt diagnosis and therapy of ovarian cyst may be necessary for saving the life of the fish.

Giant Ovarian Mucinous Borderline Tumors. A Report of Two Cases and Literature Review

Introduction: Adnexal masses are a common finding in gynecological sonographic examinations. Usually, these tumors are detected in early stages while they are asymptomatic. However, in some cases ovarian masses remain undetected and grow to giant size. The majority of these giant tumors are benign. Here we report two cases of giant ovarian mucinous tumors with areas of borderline malignancy. Case description:We present the cases of two women, aged 45 and 54 years, with abdominal masses causing vague symptoms. Abdominal imaging revealed giant cystic masses arising from the pelvis. Both women treated surgically. The first woman underwent right adnexectomy and the second one a total hysterectomy with bilateral adnexectomy and omentectomy. In both cases, the histopathological diagnosis was giant ovarian mucinous borderline cystadenoma. On the 12-month follow up they do not report any discomfort. Discussion and conclusion:Giant ovarian mucinous borderline tumors are uncommon and need surgical resection to eliminate the compressive symptoms that they usually cause. A giant abdominal mass must be always suspected in women with vague compressive symptoms.

A case report for a diagnostic dilemma of a giant intra-abdominal cyst with an uncertain origin

INTRODUCTION

Giant intra-abdominal cystic lesions are seldom encountered and can post a diagnostic challenge pre-operatively. These often present as increasing abdominal size and from its mass effect.

PRESENTATION OF CASE

Here, we present a case of a 58 year-old gentleman with worsening bloating and abdominal distension. A contrasted CT scan of the abdomen revealed a giant intra-abdominal cyst with no definite organ of origin. He underwent a laparotomy and excision of the giant cyst which was not found to be attached to any organ or mesentery. This resulted in resolution of his symptoms and a drastic improvement in his appetite.

DISCUSSION

It is often difficult to identify the origin of giant intra-abdominal cysts as pre-operative imaging may show it abutting multiple organs due to its size. Common intra-abdominal cysts include mesenteric, ovarian or peritoneal cysts. A precipitating history such as pancreatitis or surgical implants can suggest pseudocysts. Surgical excision alone is curative but can be difficult due to the size. Controlled intra-operative aspiration can aid in visualization and dissection.

CONCLUSION

Giant intra-abdominal cystic lesions cause significant discomfort due to its mass effect. Pre-operative investigations may not identify its cause. Surgical excision is recommended to diagnostic and therapeutic purposes.

Clinician Beware, Giant Ovarian Cysts are Elusive and Rare

Giant ovarian cysts, which are described in the literature as measuring more than 10 cms in size in their largest diameter, are rare in occurrence. With the availability of multiple imaging modalities and routine physical examinations, it has become even rarer to find such cases. Ovarian serous cystadenomas, which are benign tumors arising from the ovarian epithelium, represent the most common type.

We present a case of a 58-year-old female who came to establish primary care in our clinic. She reported ongoing symptoms of constipation, abdominal discomfort, bloating, as well as intermittent postmenopausal bleeding for the past few months. The patient reported taking over-the-counter medications for her predominant gastrointestinal symptoms with no improvement at all.

Transvaginal ultrasonography (TVUS) and magnetic resonance imaging (MRI) of the pelvis revealed the presence of giant bilateral ovarian masses measuring more than 17 X 10cms each. Further testing revealed highly elevated levels of tumor markers cancer antigen 125 (CA-125) and human epididymis protein 4 (HE-4). The patient subsequently underwent total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO). Her histopathology report revealed the presence of bilateral benign cystadenomas.

From a primary care physician's perspective, this case highlights the importance of possible rare pathologies that can present with symptoms of a completely unrelated organ system. Even with the rarity of these cases, a clinician may encounter such a case in their everyday practice. Patients can endorse a plethora of vague complaints, often masquerading other entities seen commonly in the clinic.

Diagnosis and management of a giant ovarian cyst in the gravid-puerperium period: a case report

BACKGROUND

Giant ovarian cyst is very rare in gravid-puerperium period. It is a cause of a maternal-fetal morbidity. We report a case of a giant benign ovarian cyst in gravid-puerperium period which was diagnosed and managed in a hospital of a low-resource country.

CASE PRESENTATION

Data were collected by historical review, clinical examination, laboratory investigations, imaging examination, and by histopathological study of the excised surgical specimen. It is the case of a 25-year-old woman who was third gravida and third para with unknown pathological history. After she had given birth through vagina, a giant ovarian cyst, unknown during pregnancy, was diagnosed. A left oophorectomy carrying the cyst was performed after laparotomy in Yalgado Ouedraogo University Hospital Center of Ouagadougou (Burkina Faso). The cyst was 42 cm long and weighed 19.7 kg. The histology of the operative specimen revealed serous cystadenoma of the ovary. The postoperative course was uneventful.

CONCLUSION

This case reports that vaginal delivery is possible with a giant ovarian cyst associated with pregnancy. Surgical management of the cyst can be performed in the postpartum with satisfaction.

Giant ovarian mucinous cystadenoma, a challenging situation in resource-limited countries

Mucinous cystadenomas are a common benign neoplasm of the ovaries that can grow much larger than other adnexal masses; they are recognized as precursors of ovarian cancer and may slowly transform to borderline tumors and invasive ovarian cancer. Prompt and accurate treatment is essential as these tumors can grow to massive sizes and be potentially lethal if left untreated. Health care providers must understand the patient, their expectations and their problems; without proper communication and follow-up, any treatment is destined to disappoint. We present a case of a 76-year-old female with limited access to health care. She presented with a giant cystadenoma that grew over 1 year. Complete resection was decided and the patient underwent complete recovery. On follow-up control patient is doing well.

A 27-kg Giant Ovarian Mucinous Cystadenoma in a 72-Year-Old Postmenopausal Patient: A Case Report

BACKGROUND Mucinous cystadenoma is a benign cystic ovarian tumor arising from the surface epithelium of the ovary; it usually presents with vague, unspecific abdominal symptoms. If not detected early, they have the potential to grow to a substantial size and can present with huge abdominal distention leading to various compression symptoms. Mucinous cystadenomas most commonly occur in the third to sixth decades of life, and rarely occur in extremes of age. The reported incidence of giant ovarian cystadenoma in postmenopausal women is low or relatively unknown due to widespread use of ultrasound and other radiological imaging modalities these days. Here, we report a case of giant mucinous cystadenoma in a 72-year-old postmenopausal woman with multiple comorbidities. CASE REPORT We present the case of a 72-year-old postmenopausal high-risk patient who presented with a huge abdominal distention which started gradually 1 year before. Abdominopelvic ultrasound showed a left giant multiloculated abdominal cyst. An intact 27-kg ovarian cyst was removed, and a total abdominal hysterectomy (TAH) along with bilateral salpingo-oophorectomy (BSO) was performed. The final histopathological report showed a benign ovarian mucinous cystadenoma. CONCLUSIONS Mucinous cystadenoma is a benign neoplastic disease that can reach a massive size. They are rare in the postmenopausal age group, but when they do occur, they pose a diagnostic and therapeutic challenge. This case report highlights the importance of early detection and management of adnexal masses in postmenopausal high-risk patients to decrease preoperative and postoperative complications and improve quality of life.

Giant mucinous cystadenoma: a case report

INTRODUCTION

Giant ovarian cysts are rarely described in the literature, owing to the availability of advanced imaging technologies in developed countries leading to early treatment. In resource-limited settings, various factors lead to late presentation.

CASE PRESENTATION

We present a case of a 48-year-old black African woman with a giant mucinous cystadenoma who presented to a tertiary hospital with massive abdominal distention 5 years after being referred from a district hospital for the same problem. Surgical management resulted in fatal complications.

CONCLUSIONS

The surgical management of these huge tumors is associated with many life-threatening complications. Transvaginal ultrasound should be used in resource-limited settings to delineate ovarian masses. Community health workers must be involved in scouting and follow up of community members with unusual abdominal swellings in developing countries to avoid delays in care.

Dilemma of the giant abdominal cyst

Giant abdominal cyst can lead to various non-specific symptoms such as abdominal bloating, nausea/vomiting, constipation due to its mass effect. In rarer circumstances, it can lead to bowel obstruction, hydronephrosis and even abdominal compartment syndrome. Hereby, we present a case of giant abdominal cyst in a young woman where its origin was a diagnostic dilemma despite exhausting all imaging techniques. A laparotomy was performed and the giant cyst was found to be originating from the left ovary. The final histopathology confirmed it as an ovarian benign serous cystadenoma. The patient made a fully recovery without any complications.