Large Serous Cystadenoma in a Postmenopausal Woman: A Case Report

INTRODUCTION

Serous cyst adenoma is a cystic ovarian tumor containing a serous fluid and a solid-tissue component. This tumor is a benign form, presenting as a cystic unilocular or a multilocular ovarian mass with a thin wall and minimal papillary projections.¹ Giant ovarian tumors have become rare because of the early detection of adnexal pathology with the advent of routine imaging modalities in the recent era of medical practice.^2,3 In previous studies, large or giant ovarian cysts were described as cysts measuring more than 10 cm in diameter in a radiological scan or those cysts reaching above the umbilicus.² Cystadenoma, adenofibroma, and surface papillomas are the benign serous tumors. These tumors occur in about 25% of all benign ovarian neoplasms and in 58% of all ovarian serous tumors.³ Serous tumors are commonly seen during the reproductive period and 50% of them occur before the age of 40 years. Most of these cysts are benign, with a chance of malignancy being only 7–13% in premenopausal and 8–45% in postmenopausal women.^4,5 Huge size ovarian serous cystadenomas are rare. In the literature, a few cases of giant ovarian cysts have been mentioned sporadically, primarily in elderly patients.

In this study, we report a case of 58-year-old woman who was diagnosed with a right ovarian benign serous cystadenoma measuring 30 × 26 × 24 cm in size with a weight of 5.5 kg.

CASE DESCRIPTION

A 58-year-old postmenopausal woman with previous 3 LSCS presented with a complaint of a gradual distension of the abdomen from the last 3 months. On general examination, the patient was vitally stable. A per abdominal examination revealed a large abdominal mass corresponding to a 34-weeks gestational-size uterus. The mass was firm in consistency with restricted mobility. A per speculum examination revealed a healthy cervix and vagina. On a per vaginal examination, a mass of 34-weeks gestational size was palpable which was firm to hard in consistency, uterus could not be felt separately, and right-side forniceal tenderness was present. An abdominal ultrasound examination showed a large cystic lesion (23 × 18 cm) arising from the pelvis and extending to the epigastric region with thick intenal septae. Contrast enhanced computer tomography of the abdomen and pelvis showed a large hypodense cystic density lesion of 25 × 23 × 21 cm, with multiple internal hyperdense septations, the evidence of a cyst adenoma of the ovary. Laboratory tests (including tumor marker CA125) were within normal limits.

The patient underwent an exploratory laparotomy with a right ovarian cystectomy, with total abdominal hysterectomy with left-sided salpingo-oopherectomy done. Intraoperative findings showed a large right ovarian cyst of 32 × 26 × 25 cm seen with a normal-sized uterus with the cystic mass adherent to the omentum; the mass was separated by blunt dissection and sent for frozen section, which was suggestive of a benign serous cystadenoma. A mass of 30 × 26 × 24 cm size with a weight 5.5 kg was successfully removed. Final impression was suggestive of a benign serous cystadenoma. The postoperative course of the patient was uneventful.

DISCUSSION

Large/giant ovarian cysts are benign in most of the cases, and histopathologically these cysts are either serous or mucinous.⁴ Serous tumors secrete serous fluids and are originated by an invagination of the surface epithelium of the ovary. Serous tumors are commonly benign (70%); 5–10% have borderline malignant potential, and 20–25% are malignant. Only 10% cases of all serous tumors are bilateral.³

Serous cystadenomas are multilocular. In some instances, they include papillary projections. Giant ovarian serous cyst adenoma is a rare finding. In the literature, a few cases of giant ovarian cysts have been mentioned sporadically and especially in elderly postmenopausal women (Figs. 1 and 2).^2,3

Sharatz et al. reported a case of a 11-year-old, morbidly obese female who presented with left flank pain, nausea, and irregular menses. Various diagnostic procedures suggested a large ovarian cyst, and a surgical resection was performed. They concluded that histologically, the resected mass was not of tubal origin as suspected, but a serous cystadenoma arising from the ovarian tissue. The patient’s two normal, eutopic ovaries were completely uninvolved and unaffected. A tumor arising from the ectopic ovarian tissue of embryological origin seems the most likely explanation.⁶ Mülayim et al. presented a case of 36-year-old virgin woman (nonmarried) presenting a giant ovarian serous cyst adenoma weighing 9.5 kg. When she was seen first at their outpatient clinic, she looked like a 9-month pregnant woman. Her medical history was normal. She had no serious illness or operation before. On abdominal ultrasound, a giant cyst was found, which encompassed the whole abdomen. At laparotomy, a giant, totally cystic, vascularized, and smooth mass attached to the right ovary was encountered, lying between the symphysis and the xiphoid. A ooferectomy was performed. On the postoperative second day, she was discharged without any problem. Her pathology report disclosed a 35 × 20 × 16 cm serous cyst adenoma weighing 9.5 kg.⁷ Şahin et al. reported a case of a 65-year-old patient with progressive pelvic pain and postmenopausal vaginal bleeding was evaluated by transvaginal ultrasound, which revealed bilateral adnexal masses measuring 5 cm in size and a normal uterus with an increased endometrial thickness of 7 mm. Initially the endometrial sampling result was reported as benign. The patient underwent abdominal hysterectomy and bilateral salpingo-oophorectomy and the pathological diagnosis was again benign, with a serous ovarian cystadenoma being found in both ovaries. The pathologist also reported an incidental ectopic adrenal tissue on the wall of the left ovarian cystadenoma.⁸

REFERENCES

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