CASE REPORT: We present the case of a 72-year-old postmenopausal high-risk patient who presented with a huge abdominal distention which started gradually 1 year before. Abdominopelvic ultrasound showed a left giant multiloculated abdominal cyst. [amjcaserep.com]

Pallor was present; she was normotensive and had bilateral pitting pedal odema. On abdominal examination, abdomen was grossly distended, engorged veins present, Fluid thrill was present. Abdominal girth at the level of the umbilicus was 42 inches. [casesjournal.biomedcentral.com]

Presentation A young woman presents with dull, chronic pain in the lower abdomen. An ultrasound was performed. Caption: Sagittal view of right adnexa Description: A large complex cystic mass is seen in the right adnexa. [sonoworld.com]

While the most common presentation is pelvic discomfort, we report the case of a 14-year-old female presenting with menorrhagia which is an unusual initial complaint for a large pelvic tumor. [journals.sagepub.com]

They are usually asymptomatic and the patient presents with abdominal swelling because of its size. [medcraveonline.com]

• Soft Tissue Mass

  A CT scan (Fig. 1A and B) demonstrated a large 38 32 23 cm cystic collection occupying most of the abdominal and pelvic cavity with multiple thin septations but no discrete soft tissue mass or mural nodules. [academic.oup.com]

• Euthyroid

  Patient was euthyroid and was not on any medications. On General examination her vitals were stable. Systemic examination showed no abnormality in respiratory and cardiovascular system. [medcraveonline.com]

• Tachypnea

  Upward displacement of the diaphragm affecting air entry into the lower lobes of lungs (explains patient's tachypnea). [ncbi.nlm.nih.gov]

• Respiratory Distress

  A giant ovarian cyst (8 kg, 40 cm) removed from the patient Gradually, mild respiratory distress occurred and given the exacerbated abdominal pain, the patient was referred to a gynecology clinic. [jmrh.mums.ac.ir]

• Yawning

  Leibson CL, Good AE, Hass SL, Ransom J, Yawn BP, O'Fallon WM, Melton LJ. Incidence and characterization of diagnosed endometriosis in a geographically defined population. Fertil Steril. 2004;82:314-321. [PubMed] [DOI] 2. [wjgnet.com]

• Orthopnea

  GOMCs may have several clinical manifestations including orthopnea/dyspnea, difficulty ambulating, tachycardia, abdominal compartment syndrome [6], inferior vena cava compression and subsequent lower extremity edema, and respiratory manifestations such [academic.oup.com]

• Epigastric Tenderness

  In physical examination, there were no positive findings, except epigastric pain with diffuse abdominal distension and moderate epigastric tenderness without guarding. No well-defined mass was detected on palpation. [jmrh.mums.ac.ir]

• Periumbilical Pain

  CASE REPORT A 26-year old female with a 4-year history of progressive abdominal swelling with no other past medical or surgical history presented to the emergency room complaining of increasing periumbilical pain for 2 days. [academic.oup.com]

• Adnexal Mass

  Adnexal masses are usually asymptomatic and incidentally detected. Before extensive use of ultrasound, they are usually discovered during C-section or when they become symptomatic(3). The majority of adnexal masses originate from the ovaries. [jmrh.mums.ac.ir]

  Case report First Online: 05 March 2016 Abstract Introduction Adnexal masses in pregnancy occur in 0.5–2/1000 pregnancies. (1) More than 90 % of cysts are benign. [link.springer.com]

  CASE SUMMARY In this article we present an uncommon association of three distinct ovarian pathologies in a same woman presenting with adnexal mass. A 31-year-old nulliparous woman with a large persistent adnexal mass underwent laparoscopic surgery. [wjgnet.com]

  Ultrasound typically large cystic adnexal mass multilocular with numerous thin septations loculations may contain low-level internal echogenicity due to increased mucin content different locules may contain various degrees of echogenicity MRI Mucinous [radiopaedia.org]

  This case report highlights the importance of early detection and management of adnexal masses in postmenopausal high-risk patients to decrease preoperative and postoperative complications and improve quality of life. [amjcaserep.com]

(See Presentation, DDx, and Workup.) [emedicine.medscape.com]

Ultrasound workup of ovarian masses Benign Malignant Internal structure Uniform, thin walls Irregularly thickened septa Margins Smooth Indistinct borders; papillary projections Echogenicity Anechoic Hypoechoic, anechoic, and hyperechoic components Content [amboss.com]

If on the unenhanced-CT the density is equal to or below 10 HU the lesion is considered to be an adenoma and no further workup is neccessary If the density is more than 10 HU the wash out should be calculated. [radiologyassistant.nl]

• Atelectasis

  […] may have several clinical manifestations including orthopnea/dyspnea, difficulty ambulating, tachycardia, abdominal compartment syndrome [6], inferior vena cava compression and subsequent lower extremity edema, and respiratory manifestations such as atelectasis [academic.oup.com]

• Ovarian Mass

  The case was managed by abdominal hysterectomy and bilateral salphingectomy of the hematosalphinx, which had formed a tubo-ovarian mass. One ovary was preserved. [ncbi.nlm.nih.gov]

  Ovarian mass was explored out, pedicles traced and dissection of ureter done, pedicles clamped and ovarian mass was excised and sent for frozen section which reported as mucinous cystadenoma of ovary. [medcraveonline.com]

  The majority of ovarian masses are cystic, and many of them are functional which may spontaneously resolve (2). [jmrh.mums.ac.ir]

• Multilocular Cyst

  cysts containing fluid of various viscosity. [radiopaedia.org]

  It is a multilocular cyst with smooth outer and inner surfaces. It tends to be huge in size. Of all ovarian tumours, mucinous tumours comprise 15% [1,2]. About 80% of mucinous tumours are benign, 10% are border-line and 10% are malignant. [ncbi.nlm.nih.gov]

The advances made in the treatment of gynecologic malignancies are due, in part, to the clinical studies performed by many of the contributors to this volume. [books.google.com]

Treatment The three basic treatment methods for ovarian cancer, including endometroid adenoma, are local surgical resection of the cancerous cells, intraperitoneal chemotherapy, (drugs are delivered directly to the affected area) and systemic chemotherapy [knowcancer.com]

In fact, earlier diagnosis is associated with less invasive treatment approaches and prevention of tissue destruction. [jmrh.mums.ac.ir]

After 4 weeks of treatment with the two drugs, her estradiol levels were undetectable, the ovarian volume had decreased, and the patient was asymptomatic, showing the initial efficacy of this treatment. [fertstert.org]

[…] differentiating malignant from benign masses Malignancies are rich in neovascularization and therefore have lower resistive and pulsatile indices Gray-scale ultrasound for diagnosis of ovarian malignancy is 62 – 100% sensitive and 77 – 95% specific Treatment [learningradiology.com]

Treatment and prognosis A mucinous cystadenoma is benign with excellent prognosis (c.f. borderline mucinous tumors of the ovary or mucinous cystadenocarcinoma of the ovary). [radiopaedia.org]

Clear cell cystadenoma: Clear cell cystadenoma is a benign cyst with an excellent prognosis. Complications Cystadenomas of the ovary are benign lesions that rarely recur after incomplete resection. [ncbi.nlm.nih.gov]

Etiology Thought to largely derive from ovarian epithelial inclusions, which itself is derived from fallopian tube epithelium. Location They can be bilateral in 15% of cases. [radiopaedia.org]

Use of transvaginal ultrasound in diagnosing the etiology of menometrorrhagia. J Reprod Med 1994; 39(5): 362–372. Google Scholar Medline ISI [journals.sagepub.com]

Diagnostic laparoscopy can be used in masses of uncertain etiology, as well. Surgery is the treatment of choice for serous cystadenomas. Unilateral salpingo-oophorectomy is commonly considered in huge tumors (7). [jmrh.mums.ac.ir]

[…] the cyst lining consists of a simple epithelium, whose cells may be either:[3] be columnar and tall and contain cilia, resembling normal tubal epithelium be cuboidal and have no cilia, resembling ovarian surface epithelium Microscopical images[edit] Epidemiology [en.wikipedia.org]

References:[1][2][3] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

Seromucinous cystadenoma: According to some authors, seromucinous cystadenomas likely derive from endometriosis.[5] Epidemiology Serous cystadenoma: Benign serous tumors of the ovary represent 16% of all ovarian epithelial neoplasms and account for two-thirds [ncbi.nlm.nih.gov]

A definitive pathophysiology remains uncertain, although several postulations were proposed. A 23-year-old nulliparous woman presented with transient bloating of her abdomen associated with menstruation for the last four cycles. [tandfonline.com]

Forensic Medicine (260) Internal Medicine (229) Oncology, Radiation Therapy (166) Surgery, Traumatology and Orthopaedics (163) Gastroenterology and Hepatology (149) Paediatrics, Neonatology (133) Medical Chemistry and Biochemistry (126) Physiology and Pathophysiology [portal.mefanet.cz]

The absence of suppression may constitute the pathophysiology of these tumors (15x15Shimon, I., Rubinek, T., Bar-Hava, I., Nass, D., Hadani, M., Amsterdam, A. et al. [fertstert.org]

Sleisenger & Fordtran's gastrointestinal and liver disease: pathophysiology, diagnosis, management. 7th ed. Philadelphia: Saunders, 2002: 2175-214. 22. Atkin WS, Morson BC, Cuzick J. [nejm.org]

Pathophysiology Functional cysts The median menstrual cycle lasts 28 days, beginning with the first day of menstrual bleeding and ending just before the subsequent menstrual period. [emedicine.medscape.com]

Conclusion: Proper diagnosis of masses during pregnancy can save maternal and fetal health through preventing adverse outcomes, such as abortion or preterm labor. [jmrh.mums.ac.ir]

Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths.N Engl J Med. 2012; 366: 687-696 5. Winawer SJ Zauber AG Ho MN et al. Prevention of colorectal cancer by colonoscopic polypectomy.N Engl J Med. 1993; 329: 1977-1981 6. [thelancet.com]

[…] of surgical complications, because we use disposable and qualitative tools Good tolerance to surgery because we practice only the noninvasive techniques Excellent cosmetic effect, because we impose intradermal sutures that don’t even need to remove Prevention [allcysts.com]