Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2020; 8(16): 3527-3533
Published online Aug 26, 2020. doi: 10.12998/wjcc.v8.i16.3527
Laparoscopic management of a giant mucinous benign ovarian mass weighing 10150 grams: A case report
Elisabetta Sanna, Clelia Madeddu, Luca Melis, Sonia Nemolato, Antonio Macciò
Elisabetta Sanna, Antonio Macciò, Department of Gynecologic Oncology, Azienda Ospedaliera Brotzu, Cagliari 09100, Italy
Clelia Madeddu, Department of Medical Sciences and Public Health, University of Cagliari, Monserrato 09042, Italy
Luca Melis, Department of Nuclear Medicine, Azienda Ospedaliera Brotzu, Cagiari 09100, Italy
Sonia Nemolato, Department of Pathology, Azienda Ospedaliera Brotzu, Cagliari 09100, Italy
Author contributions: Macciò A was responsible for the case management, the approach design, the manuscript writing and the revision of the manuscript for important intellectual content; Macciò A and Sanna E were the patient’s surgeons and were involved in the direct patient care; Macciò A, Sanna E, Madeddu C, Nemolato S and Melis L analyzed the clinical and pathological data, and interpreted the imaging findings; Maccio A, Sanna E and Madeddu C performed the data analysis, reviewed the literature and drafted and revised the manuscript; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for the surgical procedure, the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Antonio Macciò, MD, Chief Doctor, Department of Gynecologic Oncology, Azienda Ospedlaiera Brotzu, Via Jenner, Cagliari 09100, Italy. clelia.madeddu@tiscali.it
Received: May 5, 2020
Peer-review started: May 5, 2020
First decision: May 21, 2020
Revised: May 27, 2020
Accepted: July 30, 2020
Article in press: July 30, 2020
Published online: August 26, 2020
Processing time: 112 Days and 1 Hours
Abstract
BACKGROUND

Giant ovarian cysts (≥ 15 cm in diameter) are rare. The size limit of cysts and the methodology for a safe and successful minimally invasive surgery has not been established. Here we report a case of a large 10-kg multi-locular ovarian mass, which was successfully laparoscopically removed: Our aim was to innovate the surgical practice in this field by providing a safe, effective, and minimally invasive management method for such complex and rare cases.

CASE SUMMARY

A 49-year-old nulliparous woman presented with abdominal distension, lasting from six Mo prior to admission; she reported worsening abdominal pain, abdominal swelling, and mild dyspnea. Imaging showed a presumed benign multi-locular (> 10 locules) left ovarian cyst that measured about 30 cm in diameter. Based on the IOTA-ADNEX model the mass had a 27.5% risk of being a borderline or malignant tumor. The patient was successfully treated via a direct laparoscopic approach with salpingo-oophorectomy, followed by the external drainage of the cyst. Tumor spillage was successfully avoided during this procedure. The final volume of the drained mucinous content was 8950 L; the cyst wall, extracted through the minilaparotomy, weighed about 1200 g. The pathologic gross examination revealed a 24 cm × 15 cm × 10 cm mass; the histologic examination diagnosed a mucinous cystoadenoma. To our knowledge, this is the first case of a giant multi-locular ovarian cyst treated with a direct laparoscopy with salpingo-oophorectomy followed by external decompression.

CONCLUSION

Choosing the appropriate technique and surgeon skill are necessary for a safe and effective minimally-invasive approach of unique cases involving giant ovarian cysts.

Keywords: Giant ovarian cyst; Minimally-invasive surgery; Laparoscopy; Benign ovarian mass; Spillage; Case report

Core tip: To date, there are no standard guidelines regarding the maximum size of cysts that can be safely and effectively laparoscopically treated. To our knowledge, our case report is the first to describe a very large multi-locular ovarian cyst weighing 10150 g that was treated via a direct laparoscopic approach with salpingo-oophorectomy, followed by external decompression. Choosing the most appropriate technique is necessary for safely and effectively treating unique cases involving large cysts, and this choice is dependent on the experience and efficiency of the surgical team.