2,281 posters, 63 videos, 56 audios, 43 topics, 18 sessions, 6,174 authors, 2,323 institutions

RCOG World Congress 2025

June 23 - 25, 2025 | ExCeL London, UK

EP.0838

Giant Rapidly Expanding Ovarian Mass in a Multimorbid Patient: A Case Report

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Poster Presenter

Amy Newnham

Authors

Sujaree Kuenghakit, Amy Newnham, Satyam Kumar

Affiliations

Warwick Medical School, Division of Biomedical Sciences, Clinical Sciences Research Laboratories, Warwick Medical School, University of Warwick, Coventry CV2 2DX, United Kingdom University Hospitals Coventry & Warwickshire, Coventry CV2 2DX, United Kingdom, University Hospitals Coventry & Warwickshire, Coventry CV2 2DX, United Kingdom Pan-Birmingham Gynaecological Cancer Centre, Sandwell and West Birmingham NHS Trust

Part of Topic

Gynaecological oncology

Massive Serous Cystadenofibroma with Umbilical Endometriosis in a Morbidly Obese Patient Presenting as Acute Respiratory Compromise

S Kuenghakit1, A Newnham2,3, S Kumar3

¹Warwick Medical School, University of Warwick
²Division of Biomedical Sciences, Warwick Medical School
³University Hospitals Coventry & Warwickshire

Introduction

Giant ovarian cysts (>10 cm) are rare in high-income countries (1). Serous cystadenofibromas are uncommon benign tumours, often radiologically indistinct from malignancy (2). Morbid obesity compounds diagnostic, surgical, and anaesthetic risks (3).

Case Summary
A woman in her 50s (BMI 62.7) presented with a 2-month history of abdominal distension, pelvic pain, and worsening orthopnoea. CT revealed a 40×31×31 cm complex ovarian mass with elevated CA-125 (425 U/mL), raising malignancy concerns. Comorbidities included hypertension, hypothyroidism, PCOS, fibromyalgia, and chronic ulcers. Respiratory compromise necessitated urgent surgery.

Management
After MDT planning and optimisation, she underwent laparotomy with:

•Controlled cyst drainage (approx. 36L endometriotic fluid)

•Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy

•Infracolic omental biopsy

•Umbilical hernia repair

Despite intraoperative anaesthetic challenges, surgery was uneventful. Blood loss approx. 1L

Outcome
Postoperative recovery in HDU was uncomplicated. Histology confirmed benign serous cystadenofibroma with umbilical endometriosis. CA-125 elevation was attributed to endometriosis. She was discharged from gynae-oncology care.

Discussion

• Cystadenofibromas can mimic malignancy on imaging.

• CA-125 lacks specificity in endometriosis.

• Obesity heightens perioperative risks, including poor ventilation, infection, and thromboembolism.

• Large cysts exacerbate respiratory compromise via diaphragmatic splinting.

• Open surgery remains preferred for giant masses to prevent rupture and ensure staging.

Learning Points

• Giant ovarian masses may present with acute respiratory symptoms, particularly in obese patients.

• CA-125 should be interpreted cautiously, especially with endometriosis.

• Multidisciplinary perioperative planning is essential in multimorbid cases.

• Controlled cyst decompression aids access and reduces incision size.

• Laparotomy is the safest approach for staging and mass removal in such complex presentations.

Figure 1 post-drainage appearance of the cyst

Figure 2 Approx. 36 litres of fluid drained from the cyst

References:

1.Fatema N, Mubarak Al Badi M. A Postmenopausal Woman with Giant Ovarian Serous Cyst Adenoma: A Case Report with Brief Literature Review. Case Rep Obstet Gynecol. 2018;2018:5478328.

2.Wasnik A, Elsayes K. Ovarian cystadenofibroma: A masquerader of malignancy. Indian J Radiol Imaging. 2010;20(4):297-9.

3.Cai B, Li K, Li G. Impact of Obesity on Major Surgical Outcomes in Ovarian Cancer: A Meta-Analysis. Front Oncol. 2022;12:841306.