Explanation imageIn October 2009, a 24-year-old woman was admitted to our emergency services for massive abdominal distension causing dyspnoea and inability to walk. She had noticed weight gain and progressive abdominal distension for 10 months. She delayed seeking medical advice because of social isolation resulting from family problems. The patient weighed 122 kg for a height of 165 cm and showed signs of hirsutism. Her medical history was unremarkable except for congenital bilateral clubfoot, and she was nulligravida. The CA-125 levels were increased (405.5 U/ ml n:0-35) A computerised tomography scan showed a large fluid density mass filling the entire abdominal cavity, with some papillary projections (Fig. 1).A peridural was performed, and a general anaesthesia was induced before the transfer to the surgical table. The patient was installed supine position, with the table slightly tilted to the left to avoid caval vein compression syndrome. A midline laparotomy was performed (Fig. 2). We found a large cystic mass arising from the right adnexa. The left adnexum was normal. A right salpingo-oophorectomy was performed, and a smooth-walled cystic mass measuring 50×40 cm was removed without disruption of the capsule.During the surgery after the mass had been removed, a decreased cardiac frequency and an increased ejection fraction were observed. Throughout surgery and postoperatively, respiratory and hemodynamic parameters remained stable, and the patient made an uneventful recovery. She is recovering well and is receiving psychological support. An abdominoplasty will probably be necessary in the future.Pathology diagnosed a giant mucosal-serosal cystadenoma weighing 59 kg with borderline potential in one of the papillary projections (Figs. 3 and 4). Void of its clear Fig. 1 Computed tomography scan showing a large fluid density mass with a papillary projection