Introduction
Mucinous cystadenoma is a rare benign tumor affecting glandular tissues such as the ovary or pancreas. Characterized by mucus-filled cysts, it may be asymptomatic or present with symptoms such as abdominal pain or distension. Due to its similarity to malignant tumors, precise diagnosis and prompt management are of paramount importance. This report highlights a unique case of ovarian mucinous cystadenoma in a young patient following a cesarean delivery.
Case Presentation
Patient Information
• Age: 15 years
• Reproductive Status: G1P1A0
• Initial Symptoms: Severe abdominal pain, shortness of breath, abdominal enlargement, urinary difficulty, with a history of cesarean delivery 50 days earlier, at another hospital, where the associated cyst was not removed.
Clinical Examination
• Consciousness: The patient was alert and responsive.
• Vital Signs: Blood pressure 90/40 mmHg, heart rate 110 beats/min.
• Abdominal Examination: The abdomen was distended to the size of a 37-week pregnancy (reaching the xiphoid process) with abdominal tenderness.
Radiological Imaging
• Ultrasound: Revealed a multilocular cyst occupying the abdominal cavity.
• Computed Tomography (CT): Showed a 28 × 20 × 4 cm ovarian cyst without adhesions to surrounding organs; the rest of the abdominal organs appeared normal.
Surgical Management
An emergency laparotomy was performed with the following steps:
• Under general anesthesia, a midline Pfannenstiel incision was made to access the abdominal cavity.
• A bluish ovarian mass from the left adnexa was found, occupying the entire abdominal cavity up to the epigastric region.
• Aspiration of 6.5 liters of blood-tinged mucinous fluid was carried out.
• Two twists of left adnexal torsion were identified, prompting a decision to perform left adnexectomy.
• Samples of tissue and fluid were sent for histopathological examination.
• The abdominal cavity was thoroughly irrigated to ensure cleanliness..
Post-operative Course
The patient was discharged the following day in good general condition.
Pathological Findings
The pathology report confirmed the diagnosis: Twisted Hemorrhagic Mucinous Cystadenoma
Discussion
Ovarian tumors during pregnancy are rare occurrences, with an incidence rate of 1-2%.(1,2) Mucinous cystadenomas are predominantly benign tumors characterized by multiloculated structures, smooth surfaces, and considerable dimensions reaching 20-30 cm. These neoplasms constitute 12-15% of all ovarian tumors, with 75% being benign, while 10% are borderline and 15% are malignant.(3)
Ovarian tumors may occasionally be complicated by torsion, occurring in approximately 5% of cases, which significantly increases the clinical severity. The differential diagnosis of these tumors necessitates precise imaging studies, including ultrasonography and CT scanning, alongside histological examination for diagnostic confirmation.
Surgical intervention represents the optimal therapeutic approach for these cases in the absence of malignancy indicators, as demonstrated in our patient’s case. Successful surgical intervention is reflected in the complete excision of the tumor without complications.
Conclusion
This report highlights the significance of early diagnosis and prompt surgical management in cases of ovarian mucinous cystadenomas, particularly when complicated by torsion. Despite the rarity of these tumors, they should be included in the differential diagnostic considerations when evaluating ovarian masses in women of reproductive age.
Surgery remains the treatment of choice, and careful follow-up ensures the prevention of subsequent complications. Clinicians are advised to maintain vigilance regarding these rare cases to provide optimal patient care.
Disclaimer
This case was managed in Al Nour hospital, and the surgery was performed by resident doctor Aziza Misto, under the supervision of a specialized doctor Fetnet Tahan, team. This report is published with the consent of the patient and her family for educational purposes.
References
Brown J, Frumovitz M. Mucinous tumors of the ovary: Current thoughts on diagnosis and management. Curr Oncol Rep. 2014;16(6). - Ozcan A, Balikoglu M, Alkan KO, Gulseren V. Investigation of the predictive factors of recurrent ovarian mucinous cystadenoma. Gynecology Obstetrics & Reproductive Medicine. 2024 Aug 9;1–6.
- Bell DA, Scully RE. Atypical and borderline endometrioid adenofibromas of the ovary. A report of 27 cases. American Journal of Surgical Pathology. 1985;9(3).