Giant ovarian cysts: Is a pre- and intraoperative drainage an advisable procedure?

Einenkel, Jens; Alexander, H. Richard; Schotte, D.; Stumpp, Patrick; Lc, Horn

doi:10.1111/j.1525-1438.2006.00745.x

Cited by 34 publications

(48 citation statements)

References 9 publications

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“…3 The lack of quality data on the risk of peritoneal contamination has led some researchers to discourage preoperative drainage. 12 A low-grade mucinous cyst/adenocarcinoma with minimal ascites was noted in the current series. In this case (patient #2), there was no recurrence after 5½ years of follow-up.…”

Section: Discussionmentioning

confidence: 86%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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. Abdominal distension, shifting fluid dullness, and transabdominal fluid thrill were positive findings in all 5 of the current patients, suggesting significant ascites.…”

Section: Discussionmentioning

confidence: 99%

“…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. 3 The lack of quality data on the risk of peritoneal contamination has led some researchers to discourage preoperative drainage.…”

Section: Discussionmentioning

confidence: 99%

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

DiopBalla

Mansour²,

Abdoulaye

et al. 2016

Journal of Gynecologic Surgery

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Background: Articles on giant ovarian cysts have become less common in medical literature. These cysts mimic ascites, presenting with abdominal distension and shifting dullness. They are predominantly serous and mucinous cystadenomas. Rare cases of low-grade of malignant tumors and adenocarcinomatous ovarian cysts have been reported. Materials and Methods: This was a retrospective descriptive study of 5 cases recruited between 2009 and 2012. The selected patients had large ovarian cysts extending to the epigastric region. Solid, mixed, or predominantly solid ovarian cysts were excluded from the study. Results: The mean age of the patients was 28, with extremes of ages 22 and 39. Ascites was detected clinically with transabdominal fluid thrills in all cases. Cysts were unilocular in 4 cases and multilocular in 1 case. Oophorectomy and salpingectomy were performed without preoperative drainage. Histology testing showed serous cystadenoma in 4 cases and mucinous low-grade adenocarcinoma in 1 case. The average follow-up time was 54 months. No recurrences were observed. Conclusions: Imaging (ultrasound, computed tomography, and/or magnetic resonance imaging) is paramount for planning management of giant ovarian cysts as imaging facilitates the distinction between ascites and pseudoascites as well as the identification of any suspicious features of malignancy (multiple partitions, and endo-or exocystic vegetations). Complete excision without opening the cyst is the procedure of choice. ( J GYNECOL SURG 32:162)

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

DiopBalla

Mansour²,

Abdoulaye

et al. 2016

Journal of Gynecologic Surgery

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“…Although ovarian cysts over 10 kg are rare with the advent of modern health care imaging, the most common etiology of benign tumors -cystic and otherwise -includes mature teratomas, fibromas, serous cystadenomas, mucinous cystadenomas, and Brenner tumors [4,5]. Ovarian serous cystadenofibromas as described here are characterized by a prominent fibrous tissue component in addition to the epithelial elements [6].…”

Section: Case Report Discussionmentioning

confidence: 99%

Management of a Giant Cystic Mass in a Young Otherwise Healthy Woman

Gaffey¹,

Raper²

2018

ACRI

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A 22-year-old female student presented with pain, early satiety, a dragging sensation in the abdomen, and weight gain. She had been diagnosed with irritable bowel syndrome several years prior based on the symptoms. Over the preceding 6 months, she reported increasing frequency of progressive nausea primarily with meals, emesis nearly every day, and constipation. She noted early satiety but no evidence of dysphagia or odynophagia. Overall, she had a 20-pound weight gain within 4 months prior to diagnosis. The patient had no significant past medical or surgical history. Within her family history, there was no history of ovarian disease, gastrointestinal malignancies, or cystic disease. She reported regular menstrual cycle with an age of menarche of 12. A pregnancy test at admission was negative. Prior to diagnosis she had taken to wearing exclusively yoga pants because belts were uncomfortable.Physical examination was notable for diffuse abdominal distention and a fluid wave without peritonitis or evidence of a hernia. Percussion was dull throughout. A CT scan of the abdomen and pelvis noted a large cystic mass with internal attenuation, occupying the majority of the abdomen with mass effect resulting in superior displacement of the liver, spleen, stomach, as well as the majority of the small bowel located in the left side of the abdomen (Figure 1). Tumor marker studies, including beta-HCG, CA 19-9, carcinoembryonic antigen, and CA125 were negative.After discussion of options including a laparoscopic approach, and the small but real risk of a cancer diagnosis, an open approach was judged best to avoid rupture of the cyst. The patient was taken to the operating room for an exploratory laparotomy. A 40-cm cyst arising from the right ovary was noted (Figure 2) and on full inspection of the abdomen there was a normal appearing uterus, normal left ovary and fallopian tube, normal pelvis and paraaortic lymph nodes, normal peritoneum, and normal bowel. Gynecologists, having obtained prior consent, performed a right oophorectomy and salpingectomy in continuity with the mass. She recovered rapidly with normal dietary intake. The final pathology of the 10.4 kg cyst was serous cystadenofibroma and ovary with hemorrhagic corpus luteum. AbstractWe report a new perspective on the case of a 22-year-old female with no significant medical history who posed a diagnostic and therapeutic challenge; a giant cystic mass of the abdominal cavity. Work up was notable for no significant laboratory abnormalities but a large cystic lesion noted on imaging. The patient underwent open resection. A giant cystic abdominal tumor may present with the common and protean abdominal symptoms of bloating, pain, and early satiety from either mass effect or adhesions to surrounding structures. Caution is advised in attempting the laparoscopic resection of such tumors.

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