Presentation
Abdominal distension.
Patient Data
There is a very large mass which is largely fills the abdomen and pelvis. It is predominantly cystic with numerous septations. No discrete nodularity or solid enhancing soft tissue component is identified. There are slight prominence of the right adnexal veins which appear to lead into the posterior aspect of the mass, indicating that it comes from the right ovary. The left ovary can be seen separate from the mass, following the relatively diminutive left adnexal vein into the left lower quadrant. There is a small amount of free fluid within the pelvis.
PATHOLOGY REPORT:
Clinical History: Ovarian mass, postmenopausal bleeding, endometrial thickening.
Operation/Procedure: Removal of mass / Hysterectomy / Bilateral salpingo-oophorectomy / +/- More
Gross: Tissue "A" - Received fresh for frozen section is an 11.5 x 10 x 8.5 cm cyst mass containing thick, pasty, tan-red contents. The outer surface has a rubbery, white, thick, 5.5 cm in diameter lesion with laminated cut surfaces, in addition to a 2.5 cm disrupted, hemorrhagic cyst. The inner lining of the cyst is carpeted with 0.3-1.8 cm nodules and the entire inner lining is red-brown and hemorrhagic. Normal ovarian parenchyma is not identified. The mass is sampled on two blocks for frozen section.
Diagnoses:
Tissue "A" - Right ovary, oophorectomy - Serous cystadenoma with hemorrhage and infarct, 11.5 cm.
Tissue "B" - Right tube, salpingectomy - Ovarian tissue and a fallopian tube with extensive hemorrhagic change, no malignancy.
Case Discussion
This is an impressive presentation of a very large serous cystadenoma of the right ovary. These are slow growing neoplasms, and therefore can present late as the patient develops gradual symptoms distention. A serous cystadenoma is a benign epithelial neoplasm of the ovary, and therefore no further treatment was required following pathologic diagnosis.
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