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WeBSurg, the e-surgical reference of Laparoscopic surgery

Clinical Case

VOLUMINOUS OVARIAN TUMOR


M Vix, MD, Hôpitaux Universitaires de Strasbourg, Strasbourg, France

1. Summary


Giant ovarian cysts are rare. Diagnosis should be considered in patients presenting with rapidly increasing obesity or an abdomen out of proportion to their morphology. The treatment is surgical resection, and this may be done after emptying the cyst.

2. Keywords


Morbid obesity, ovary, cyst

3. Patient


Woman, 45-year-old

4. Past history


Childhood appendectomy

5. Present history


The patient was admitted for a preoperative workup for morbid obesity and for possible surgical management.
An operation was not undertaken as the BMI of the patient was less than 40. The patient was placed on a monitored weight-loss program.
Height: 175 cm, weight: 110 kg, BMI: 33
Screening laboratory values were normal before the start of the program. Though the patient lost 12 kg during the program she complained that her abdominal girth had not changed.
An abdominal ultrasound was performed, which revealed a large multicystic septated mass in the pelvis measuring 40 cm at its greatest diameter.

6. CT scan


A CT scan confirmed the presence of a large abdominal mass, and its ovarian origin was suspected.

7. Treatment


The preoperative aspect confirmed the “out of proportion” volume
of the abdomen as compared to the patient’s morphology, signaling the presence of an intra-abdominal tumor (Figure 7.a). A transversal laparotomy with an abdominoplasty (Figure 7.b) was performed. The removal of the tumor was simple (Figure 7.c), no abdominal adhesions being present. The postoperative course was uneventful.

8. Pathologic examination


A pathologic examination revealed a right ovarian cystic mass weighing 19 kg: serous cystadenoma of the ovary.

9. Discussion


Giant ovarian cysts are now rarely seen because of the development in health care systems and education. Many symptoms can reveal the presence of such tumors, such as a distended abdomen, tachypnea and dyspnea, pitting edema of both legs and difficulty in walking. Based on an ultrasonographic examination, the rapid accumulation of fluid may be confused with ascites. Processes such as bladder distension or diverticulum, hydronephrosis, pancreatic pseudocysts, and large uterine or ovarian tumors can also mimic ascites. The cause, however, is ultimately determined by a CT scan. Clinicians must therefore consider processes other than ascites in the differential diagnosis of large abdominal fluid accumulation. Abdominal ultrasounds and CT scans for the diagnosis of giant cysts should be kept in mind in cases of severe obesity, particularly if this is disproportionate. Suitable treatments include intact removal and preoperative/intraoperative drainage of such tumors. Thus, it is necessary to consider each case individually.

10. References


  1. Menahem S, Shvartzman P. Giant ovarian cyst mimicking ascites. J Fam Pract 1994;39:479-81.
  2. Nishiyama T, Hanaoka K. Same day drainage and removal of a giant ovarian cyst. Can J Anaesth 1997;44:1087-90.
  3. Ottesen M, Rose M. Giant ovarian tumor masked by obesity. Acta Obstet Gynecol Scand 1994;73:349-51.
  4. Zamora-Garza M, Rizo J, Dominguez A. Giant ovarian cyst: case report. Am J Obstet Gynecol 1992;166:1247-8.