Resection of a Giant Ovarian Mucinous Cystadenoma with Intraoperative Drainage

Abstract

Background: Giant ovarian tumors are now rarely encountered, because of the wide availability of medical care, and most cases are benign. Case: A rare case of a giant ovarian cystadenoma in a 41-year-old woman, with such severe abdominal distension that she could not walk, is reported. Her abdominal girth was 141 cm. The patient was 151 cm tall and weighed 92.6 kg. Computed tomography (CT) showed a large, multilocular, cystic tumor that occupied the whole abdomen. The preoperative diagnosis was malignant ovarian tumor or ovarian cystadenoma. Results: On laparotomy, gradual intraoperative drainage of the tumor was first performed over 2 hours, and then total hysterectomy with bilateral salpingo-oophorectomy was performed successfully. Pathologic findings confirmed that the tumor was a mucinous cystadenoma. Conclusions: There is a lack of evidence on how to manage such giant tumors in the perioperative period; however, in the present case, intraoperative drainage and tumor resection were safely performed without complications. ( J GYNECOL SURG 28:215)

Management of Giant Ovarian Cysts: A Review of 5 Case Reports

“…14 Since then, Abe et al identified 22 cases of ovarian tumors reported in the literature measuring between 47 kg and 134 kg. 11 The cysts were benign in 72.7% of cases and borderline or malignant in 27.2% of cases. 11,15 In a literature review, Einenkel et al found an overall malignancy rate of 37% in giant ovarian cysts.…”

“…11 The cysts were benign in 72.7% of cases and borderline or malignant in 27.2% of cases. 11,15 In a literature review, Einenkel et al found an overall malignancy rate of 37% in giant ovarian cysts. 12 The differential diagnosis can be difficult to establish in the presence of abundant ascites.…”

“…These giant ovarian cysts are associated with uncomfortable abdominal distension, heaviness, weight gain, difficulty with walking, discomfort when recumbent, dyspnea or orthopnea, and tachycardia. 11,12 Giant cysts, as reported in the literature, might compress the inferior vena cava causing lower-limb edema, compression of the diaphragm with risks of atelectasis, pulmonary edema, and more seriously, abdominal compartment syndrome. 1,11,13 In 1905 Spohn reported a 328 pound ovarian tumor.…”

“…11,12 Giant cysts, as reported in the literature, might compress the inferior vena cava causing lower-limb edema, compression of the diaphragm with risks of atelectasis, pulmonary edema, and more seriously, abdominal compartment syndrome. 1,11,13 In 1905 Spohn reported a 328 pound ovarian tumor. 14 Since then, Abe et al identified 22 cases of ovarian tumors reported in the literature measuring between 47 kg and 134 kg.…”

“…However, it must be performed gradually, with the aim of avoiding long drainage tubes that carry risks of infection, peritonitis, and sudden massive bleeding. 11 The major drawback of drainage however, is the potential dissemination into the peritoneal cavity of a peritoneal carcinoma or gelatinous disease of the peritoneum caused by rupture of a mucinous cyst. 12 Several studies have shown a 10%-26% rate of cyst rupture in cases of laparotomy and 22%-100% for a laparoscopic incision.…”