Giant ovarian cystadenoma weighing 59 kg
© Springer-Verlag 2010
Received: 8 April 2010
Accepted: 11 May 2010
Published: 26 May 2010
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.
Ovarian cysts are common particularly in females of child-bearing age. They fall into two main categories: functional cysts that arise from follicular cells and the organic cysts that arise from epithelial cells, germ cells and sex cord-stromal cells. Cancer can arise from non-functional cysts . Among organic cysts, those derived from epithelial cells are by far the most common. Cystic teratomas and serous cystadenomas are the most common benign ovarian neoplasms .
These neoplasms are usually diagnosed earlier. A patient may complain of abdominal pain/mass or simply an increase in abdominal girth revealed by clothing too tight to be worn. Cysts are also detected incidentally on imaging studies or during routine gynaecological examination. The diagnosis can be overlooked because of pronounced obesity or negligence in patients who present at a late stage with giant ovarian cysts [1–4]. In 1922, Spohn reported successful treatment in a patient with a huge ovarian cyst weighing 148.6 kg . In 2007, Yanazume et al. reported a cyst estimated at 100 kg. Unfortunately, the patient died of massive abdominal bleeding caused by disseminated intravascular coagulation 10 h postoperatively. Generally speaking, the majority of giant ovarian tumours are benign, borderline or of low malignant potential because when invasive cancer is present, clinical symptoms occur before the mass reaches a significant volume .
These huge neglected cysts can mimic other medical conditions on physical examination, like pregnancy, massive ascites, colonic volvulus and idiopathic megacolon , and they can give rise to various clinical complications resulting from local compression such as abdominal pain, hydronephrosis and aortocaval compression. This last condition is a well-known complication of supine positioning in pregnant women beyond 16–20 weeks of gestation but is often underestimated in subjects with intra-abdominal pathology. It has to be considered because of its anaesthetic implications (essentially resulting in positioning the patient in a left lateral tilt position in order to avoid hypotension) .
The surgical resection of these masses can be delicate. The cyst capsule should be respected to avoid potential tumoural dissemination. Hemodynamic instability induced by fluid depletion and aortocaval decompression during removal of the cyst is also a concern. Some advocate progressive preoperative drainage to avoid the development of severe clinical hypotension [7, 9]. Five potential problems have been associated with the resection of massive ovarian tumours: respiratory failure, intraoperative fluids shifts, adequate exposure, orthostatic hypotension and adynamic intestine. The patient reported by Yanazome et al. indicates that there may be a risk of significant bleeding from redundant parietal peritoneum, and the authors recommend that sufficient amounts of blood be prepared should transfusion be necessary.
When indicated, abdominoplasty is performed at a later stage when the patient has fully recovered.
Conflicts of interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
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