Gynecology & Obstetrics
Open Access
ISSN: 2161-0932
ISSN: 2161-0932
Lovina S M Machado
Posters: Gynecol Obstet (Sunnyvale)
Objective: A rare case of a giant borderline mucinous cystadenoma presenting as acute abdomen on the 7th postpartum day following an uncomplicated pregnancy and normal vaginal delivery is presented. Introduction: The incidence of adnexal masses in pregnancy is 0.5-2 per 1000 pregnancies. More than 90% of these are benign. About 28% of adnexal masses diagnosed during pregnancy are serous or mucinous cystadenomas and torsion is the commonest complication followed by rupture of the cyst. Mucinous cystadenomas are benign epithelial ovarian tumors,tend to be unilateral and multilocular with a smooth surface and contain mucinous fluid & tend to occur in the third to fifth decades of life. 75% of all mucinous tumors are benign, 10% borderline and 15% invasive carcinomas. They may attain a large size during pregnancy and may also tend to be hormonally responsive with stromal luteinization, maternal virilisation and intrauterine growth restriction. It is presented a 26 year old Para 3,unbooked for antenatal care at our hospital, who presented to the emergency room 7 days following a spontaneous normal vaginal delivery with acute generalized abdominal pain. Examination revealed a huge soft, mass with a smooth surface arising from the pelvis extending to the xiphisternum. The uterus was not separately palpable. She had been following up at health centres during pregnancy, scans did not report any abnormality, pregnancy and delivery was uneventful. The neonate was healthy and of normal weight. Lab. Investigations: Normal CBC, electrolytes, LFT,RFT. CA-125-37, beta HCG 137 iu/l, other tumor markers were normal. At laparotomy, peritoneal fluid sent for cytology. A massive left sided ovarian tumor about 38x30 cms in diameter was found weighing 4ooo gms, mostly cystic, some areas hemorrhagic. Capsule was intact. Entire cyst removed intact. Left salpingoovariotomy performed rt. ovarian biopsy. Peritoneal and omental biopsy was taken. Other intra-abdominal organs were normal. Appendectomy done as frozen section was reported as left ovarian benign mucinous cystadenoma. Multiple saline washes given though no spillage occurred. Histopathology however revealed a left ovarian borderline mucinous cystadenoma with no evidence of microinvasion. Post-op recovery was uneventful. CA-125 and scans were normal on six month follow up. Discussion: Most adnexal masses are discovered incidentally during pregnancy on routine scans. The most common are cystic teratomas (36%) and cystadenomas (15%). Giant cysts of 20 cms or more are found in less than 1% of all ovarian cysts complicating pregnancy. Fortunately, most of these are benign. Giant mucinous cystadenomas complicating pregnancy are extremely rare. Histologically,they are lined by tall columnar non-ciliated epithelial cells with apical mucin& basal nuclei, goblet cells (intestinal type) as in our case. The other type is the mullerian, which is typically associated with endometriotic cysts. There are about 10 case reports in literature of mucinous cystadenomas complicating pregnancy that have been surgically removed during pregnancy or during cesarean sections, to our knowledge, this is the fifth reported case of a giant mucinous cystadenoma not interfering with pregnancy or vaginal delivery & presenting for the first time with acute abdominal pain on the 7th postpartum day and only the second reported case of a giant borderline mucinous cystadenoma in pregnancy.