Clinical:
- A 61 years old lady
- Post menopausal
- Complaints of abdominal distension
- Gradually increase in size
- Presented with recent onset of abdominal discomfort
- No obstructive symptom
CT scan findings:
- There is a big mass in the abdominopelvic region measuring about 13x14x6 cm
- The lesions show well defined margin and thin wall
- The upper part of the lesion is cystic and lower part of lesion shows higher density which may represent solid component
- The solid region shows minimal enhancement post contrast. The cystic part shows no enhancement.
- No calcification or fat component within the lesion.
- No septa, no local infiltration and no ascites.
Intra-operative findings:
- TAHBSO, omentectomy and pelvic nodes dissection done
- A right ovarian tumour 20×30 cm, gangrenous looking, twisted 1 ½ times, capsule intact, no obvious tumour deposits
- Removed intact in total
- Right fallopian tube with suspicious tumor deposit
- Left ovary atrophic, left fallopian tube normal
- Uterus atrophic with small fibroid
HPE findings:
- Macroscopy: The right ovarian mass measuring 240mm x 140 mm x110 mm. A whitish rounded mass measuring 20x30x35 mm in the uterine wall. Cut section of right ovary shows multilocular cysts measuring 20 mm to 120 mm in diameter filled with greenish and chocholate jelly-like material. Hemorrhagic areas are seen.
- Microscopy: sections show the right ovarina cyst wall is lined by single layer mucin producing secreting epithelium with no nuclear atypia or stromal invasion.
- Diagnosis: Right ovary: mucinous cystadenoma
Diagnosis: Twisted hemorrhagic right ovarian mucinous cystadenoma
Discussion:
- Mucinous cystadenomas make up 15-20% of all epithelial tumors.
- It is common in middle-aged women. It is rare among adolescents/teenager.
- They could reach large size before being discovered but this does not necessarily indicate malignancy. On average, the mucinous tumors measure 15 to 30 cm in diameter.
- The most frequent complications of benign ovarian cysts are torsion, hemorrhage and rupture.
- Pseudomyxoma peritonei can result if the tumor ruptures and spills its mucinous deposits on the peritoneum.
