Chistadenom mucinos ovarian gigantic la o pacientă tânără: implicații clinice și terapeutice

Introduction

Ovarian mucinous cystadenoma is a benign tumor originating from the ovarian surface epithelium. Characterized by a multilocular cyst with smooth inner and outer surfaces, these tumors can often grow to significant sizes. Mucinous tumors account for approximately 15% of all ovarian tumors, of which about 80% are benign, 10% are borderline, and 10% are malignant⁽¹⁾. Although benign mucinous ovarian tumors are rare at age extremes (before puberty and after menopause), they are commonly observed between the third and fifth decades of life⁽²⁾. The most frequent complications of benign ovarian cysts include torsion, hemorrhage and rupture. Rupture of mucinous tumors, in particular, can lead to the dissemination of mucinous fluid within the peritoneum, potentially causing pseudomyxoma peritonei⁽³⁾.

The association of mucinous cystadenomas with dermoid cysts suggests a germ cell origin for some, while their co-occurrence with Brenner tumors indicates a surface epithelial origin for another subset. KRAS mutations are identified in up to 58% of cases⁽⁴⁾. Generally, primary ovarian mucinous tumors are unilateral and average about 10 cm in size, though some may exceed 30 cm. Their surfaces typically remain smooth, even in malignant cases⁽⁵⁾. Imaging typically reveals these tumors as predominantly cystic and multilocular, containing liquid components. However, some benign tumors may appear as simple unilocular cysts. Unlike borderline serous tumors, borderline mucinous tumors lack velvety papillary projections visible macroscopically⁽⁶⁾.

The benignity criteria for mucinous cystadenomas include thin walls lined by a single layer of mucinous columnar cells with basal nuclei. Stromal components, if present, exhibit a fibrous appearance, and tumors with predominant stromal structure are classified as mucinous cystadenofibromas. Occasionally, small papillary formations, seen as stromal projections, may be noted⁽⁷⁾. Borderline mucinous tumors, also known as low malignant potential mucinous tumors or atypical proliferative mucinous tumors, consist of cysts of varying sizes. At least 10% of the tumor’s total area displays epithelial stratification and small excrescences⁽⁸⁾. These tumors are often heterogeneous, combining areas with simple cystadenoma-like architecture and regions with classic borderline features⁽⁹⁾.

The management of ovarian cystadenomas is influenced by multiple factors, including clinical symptoms, cyst size, patients’ age, medical history, and menopausal status⁽¹⁰⁾. The standard treatment typically involves unilateral salpingo-oophorectomy or ovarian cystectomy. Recurrences are rare and usually indicate either incomplete resection or the development of a new primary tumor⁽¹¹⁾.

Case presentation

A 20-year-old female with no significant personal medical history presented with pelvic-abdominal pain, abdominal distension due to a large tumor, dyspnea, and urinary incontinence. The MRI revealed a giant ovarian tumor measuring 25 cm, originating from the left ovary. ROMA score, complete blood count, coagulation profile, liver markers, and urine culture were all within normal limits. Despite being technically simpler due to the tumor’s size and the increased risk of bleeding from the extensive ovarian bed, oophorectomy was avoided, and ovarian cystectomy was chosen to preserve fertility.

The surgical intervention prioritized the avoidance of ovarian content spillage into the pelvis. Through a minimal Pfannenstiel incision, the ovarian mass, which extended beyond the visible margins, was accessed. Continuous aspiration of cystic content was performed by one operator while maintaining field isolation. Complete excision of the cystic membrane followed, ensuring hemostasis with electrocautery and gel foam placement. Excessive electrocautery was avoided in order to preserve the ovarian tissue. The remaining ovarian tissue was sutured with effective hemostasis. Intraoperative histopathological examination confirmed the diagnosis of ovarian mucinous cystadenoma.

Autor corespondent: Cristiana-Elena Durdu E-mail: cristianadurdu@gmail.com

CONFLICT OF INTEREST: none declared.

FINANCIAL SUPPORT: none declared.

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