tumora giganta de ovar

1. C O O R D I N A T O R S : E . B R A T U C U * , S I N Z I A N A I O N E S C U * * ,
* P R O F . D R . E U G E N B R A T U C U , H E A D O F S U R G E R Y C L I N I C I A T T H E B U C H A R E S T O N C O L O G Y
I N S T I T U T E * * G E N E R A L S U R G E R Y R E S I D E N T A T T H E B U C H A R E S T O N C O L O G Y I N S T I T U T E
A U T H O R S : A N D R E E A T E O D O R A T O P O R , S T U D E N T
A L I N A E L E N A S T A N C A , S T U D E N T
C O - A U T H O R S : I R I N A S A N D R A , S T U D E N T
S O R E L A R A D O I , A N A E S T H E S I O L O G Y S P E C I A L I S T
A . T O M A , G E N E R A L S U R G E R Y R E S I D E N T
Complicated Giant Ovarian Cyst –
Clinical Case Presentation

2. INTRODUCTION
 Abdominal cysts = sacs or lumps surrounded by a thin
membrane consisting of fluid or semi fluid material.
 Giant ovarian cysts = cysts having more than 10 cm.
 Large cysts are more likely to be malignant than small
ones.
 Huge cysts - usually benign, or of low-grade malignancy.

3.  The indications for surgery are :
 Treatment or prevention of complications: torsion,
bleeding, or infection.
 Suspected malignancy.
 Discomfort due to size.

4. CLINICAL CASE PRESENTATION
 86 year old female
 History of progressive abdominal distension over the last years
 Recently aggravated pain in the left hypochondrium
 No history of digestive or urinary tract abnormalities, nor
breathlessness
 Abdominal discomfort due to size

5. PERSONAL PATHOLOGIC ANTECEDENTS
 Denies alcohol consumption and smoking
 Menopause at the age of 53, with regular previous
menses
 Gesta: 2, Para: 2

6. CLINICAL EXAM
 Abdomen diffusely distended
involving all quadrans
(circumference = 146,6 cm)
 Well defined giant pelvic and
abdominal mass, painful to
touch, dull to percussion
 No adjacent lymphadenopathy

7. Pulmonary exam: hydroaeric sounds in the left
basal pulmonary field
Cardiology exam:
 neglected arterial hypertension (210 mmHg
systolic)
 right bundle branch block
 chronic cardiac failure (NYHA III)

9. PARACLINIC INVESTIGATIONS
 standard pre-operatory battery tests - within normal
range.
 CA125 - 29.0 U/ml (normal).

10.  Abdominal and pelvic CT scan:
Left ovarian cyst: axial 29/15 cm, cranio-caudal
25 cm
Bochdaleck hernia

15.  chest X-ray -
hernia occupied
half of the right
pulmonary field

16. SURGICAL TREATMENT
 Minimal laparotomy
 Intermitent suction of the content of the cyst (5,5L of serous,
transparent liquid)
 Isolation and excision of the cyst’s wall with left adnexectomy.
 Unresolved Bochdaleck hernia
 No postoperative complications.
 Postoperative abdominal circumference – 96 cm (loss of 50,6
cm)

23. HISTOPATHOLOGICAL EXAM
Macroscopic aspect:
 polycystic tumor 20/25 cm diameter
 hematic deposits on the interior walls
 no vegetations
Microscopic aspect: mucinous cyst adenoma

24. DISCUSSION
The particularities of the case are:
 the dimensions of the cyst,
 the presence of an acquired Bochdaleck hernia ( in adults it
only appears secondary to massive abdominal processes
compressing the thorax),
 the multiple anaesthesiology risks due to the patient’s age
and condition
 the elected surgical technique (minimal laparatomy and
suction vs. large laparotomy and excision of the cyst).

25. THANK
YOU!