An unusual presentation of huge paraovarian cyst as papillary serous cyst adenofibroma: a rare case report

Abstract

Paraovarian cysts constitute 10-20% of all adnexal masses and are usually less than two centimeter in diameter. Authors reported a 20-year-old unmarried female with vague abdominal discomfort since 1 year. On examination abdomen was uniformly distended with central position of umbilicus. Ultrasonography showed a large cystic mass extending from pelvis to pancreas likely of ovarian origin. Biochemical evaluation was not suggestive of malignant nature of this cystic mass. So, with due care of cosmesis, surgery was planned. After the midline vertical incision, peritoneal washings were collected for oicytological analysis to further exclude malignancy. Then 5mm cannula with trocar was inserted into the cyst to suck out the fluid then shrunken cystic wall was exteriorised. Right ovary was absolutely healthy. Enucleation of the cyst was done with preservation of ovary. Histopathology reported as a papillary serous cyst adenofibroma. Follow up period was uneventful.

Clinical, Imaging, Histological and Surgical Aspects Regarding Giant Paraovarian Cysts: A Systematic Review

“…All the cases were reported by physicians working in University Hospitals from many countries in the world: Turkey, 11 , 20 , 26 , 27 India, 2 , 10 , 12 , 15 , 28 Serbia, 29 Austria, 22 Spain, 30 Egypt, 31 Italy, 5 United States of America, 16 South Korea, 25 , 32 Japan, 23 Romania, 19 Lebanon, 13 Portugal, 33 Jordan, 14 Nepal, 34 Bosnia and Herzegovina, 24 , 35 Indonesia, 1 and Oman. 3 …”

“… 59 The anesthesiologists prefer the inhalational induction with sevoflurane, because of its rapid action, pleasant odor and absence of airways irritation, 60 but they should be aware of the intraoperative allergic reactions caused by the neuromuscular blocking agents. 61 The literature review showed that open surgery has been preferred by 57.1% (n = 16) of the authors, with 8 cases of midline incision, 1 , 10 , 11 , 20 , 29 , 32 , 33 , 35 2 of Pfannenstiel incision, 16 , 24 and 1 of paramedian incision. 15 In the last decade, there have been reported 22 giant POCs, but only 9 (40.9%) were treated laparoscopically, and in all these cases, an open-entry technique was used transumbilical, 5 , 25 in the left umbilical fold, 22 supraumbilical, 3 , 13 , 29 subumbilical, 14 or in Palmer’s point.…”

“… 25 , 32 Reviewing the literature we found the following histopathological types of giant POCs: 33.3% (n = 9) serous cystadenomas, 3 , 12 , 14 , 20 , 22 , 24 , 27 , 29 , 34 18.5% (n = 5) simple serous cysts, 1 , 15 , 19 , 31 , 35 22.2% (n = 6) paratubal/paraovarian cysts, 13 , 16 , 23 , 28 7.4% (n = 2) paramesonephric cyst, 2 , 5 and 25.9% (n = 7) borderline serous papillary cystadenomas (only one in a 17-year-old patient). 10 , 11 , 25 , 26 , 30 , 32 , 33 …”

“…Serum marker testing was indicated in 17 cases, but Ca 125 levels were elevated only in the case reported by Bayar et al 26 Of the 7 cases included in the present review, papillary projections inside the cyst were found on USG, 26 , 32 on CT, 11 , 25 or intraoperatively. 10 , 30 , 33 Some authors recommend supplementary intraoperative measures for cyst’s drainage in these situations, as well as the confirmation of cyst malignancy by frozen sections. 1 , 44 …”

“…The estimated mean size of POCs is 75.1 mm (10–80 mm), 10–12 and 95% of them have the diameter smaller than 20 mm. 9 There is not an explicit definition of giant POCs.…”