Presentation
Obese patient (BMI=39.69 kg/m2) with abdominal heaviness and fullness for 6 months and constipation for 3 months.
Patient Data
Well-defined right ovarian cystic lesion measuring 22 x 15 x 22 cm approximately. Multiple thin enhancing septations are seen within it. No enhancing solid component or internal calcifications are seen in it. A few small well-defined hypodensities, likely follicles, are seen in the left ovary. No CT evidence of peritoneal/omental dissemination is seen. No ascites, pneumoperitoneum or significant lymphadenopathy is seen. An IUCD is seen in place. No concerning abdominal visceral or osseous abnormality is seen. Multiple air densities are seen in the subcutaneous soft tissues of the anterior abdominal wall which are related to the history of recent laparoscopy.
Histopathology report confirming the benign nature of the right ovarian cystic mass lesion. Omental, peritoneal and lymph node biopsies were unremarkable.
Case Discussion
The patient was referred to our hospital for laparoscopic sleeve gastrectomy for her morbid obesity. At the time of surgery, a large right ovarian cystic mass lesion was discovered. The surgery was postponed after a diagnostic laparoscopy and the patient was referred to the gynecologist for further evaluation (tumor markers and abdominal CT scan).
CT scan showed a large benign looking multiseptated cystic right ovarian lesion, likely a mucinous cystadenoma.
Laboratory investigations: CA-125 = 21 U/ml (~35), CA 19.9 = <2 U/ml (~37), CEA = 4.5 ng/ml (~5).
Biopsies taken during the diagnostic laparoscopy were negative for any malignancy. After the complete work-up, the right ovarian lesion was excised and the histopathology revealed mucinous ovarian cystadenofibroma.
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