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Table of Contents
CASE REPORT
Year : 2014  |  Volume : 1  |  Issue : 1  |  Page : 43-44

A huge mucinous cystadenoma complicating third trimester of pregnancy with previous two caesarean sections


1 Assistant Professor, Department of Obs & Gynae, Government Medical College, Haldwani, Uttarakhand, India
2 PG. Student, Department of Obs & Gynae, Government Medical College, Haldwani, Uttarakhand, India
3 Professor, Department of Obs & Gynae, Government Medical College, Haldwani, Uttarakhand, India

Date of Web Publication3-Jul-2017

Correspondence Address:
Priyanka Chauhan
Department of Obs & Gynae, Government Medical College, Haldwani, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


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  Abstract 


The incidence of ovarian tumor complicating caesarean section was about 1 in 200 caesarean births while ovarian tumors complicated termination of pregnancy in 1 of 594 procedures. Any type of Ovarian mass can be encountered during pregnancy, but the most common are cystic. Because pregnant women are usually young, malignant tumors are relatively uncommon. A patient third gravida with previous 2 caesarean sections presented in an emergency with complaints of persistent pain in abdomen for last 7 days with gestational age of 35 weeks and 3 days. Emergency Caesarean section was done to deliver an alive male baby of 2.25 Kg with good Apgar score. Intraoperative finding was suggestive of a huge multiloculated left ovarian mass of approximately. 40×30×15 cm weighing 20 Kg with straw coloured mucinous fl uid. Up to 3 liters of fl uid aspirated before delivering the cyst out of the abdomen. Left salpingoopherectomy was done and specimen sent for histopathological examination that showed Mucinous cystadenoma of the ovary. Post operative period remain uneventful.

Keywords: Complicated caesarean section, Mucinous cystadenoma, Ovarian tumor, Pregnancy


How to cite this article:
Pangtey N, Chauhan P, Rawat U, Jain G. A huge mucinous cystadenoma complicating third trimester of pregnancy with previous two caesarean sections. Acta Med Int 2014;1:43-4

How to cite this URL:
Pangtey N, Chauhan P, Rawat U, Jain G. A huge mucinous cystadenoma complicating third trimester of pregnancy with previous two caesarean sections. Acta Med Int [serial online] 2014 [cited 2019 Jul 16];1:43-4. Available from: http://www.actamedicainternational.com/text.asp?2014/1/1/43/209397




  Aim Top


To report a benign case of mucinous cystadenoma of ovary with pregnancy.


  Method Top


The data were collected by history-taking, clinical examination, laboratory investigations, trans abdominal ultrasonographic examination, and by histopathological study of the excised surgical specimen.


  Case Presentation Top


Our case was a 25 years old woman, G3P2L2 with 35 weeks 3 days pregnancy with previous two LSCS with huge benign ovarian cyst. She presented to Dr. Sushila Tiwari Hospital, Haldwani with complaints of eight and half months amenorrhoea with excessive abdominal distension and difficulty in breathing. Patient had only one antenatal visit in the second trimester of pregnancy when her ultrasound revealed a huge left ovarian mass (16 × 18 × 16 cm) with 19 weeks of pregnancy. General examination revealed normal vital signs other than a slight tachypnoea (respiratory rate was 24/minute). Her abdominal circumference was 127 cm. On abdominal examination, fundal height extended up to xiphisternum. Presentation of fetus and lie could not be appreciated. The abdomen was cystic tense on palpation without tenderness or shifting dullness.

The patient underwent an emergency caesarean section in view of previous two LSCS with scar tenderness. An alive male baby of 2.25 kg weight was delivered as vertex. Intra-operative findings were extraordinary large multiloculated left ovarian cyst measuring 40×30×15 cm, weighing 20 Kg with straw coloured mucinous fluid in it [Figure 1] and [Figure 2]. Since the cyst was huge and could not be extracted intact, thus, about three litres of seromucinous fluid was aspirated before delivering the cyst out of the abdomen. Thus, left salpingoopherectomy was done along with right sided tubal ligation. Specimen sent for histopathological examination revealed it as mucinous cystadenoma of ovary lined by mixed endocervical and gastric foveolar type of mucinous epithelium. The postoperative course was unremarkable.
Figure 1: Huge mucinous cystadenoma

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Figure 2: Operating mucinous cystadenoma

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  Discussion Top


Most of the adnexal masses are discovered incidentally during pregnancy because of the routine use of ultrasound. Most masses in pregnancy are benign in character and malignancy rate is low.[1] The frequency of ovarian tumors is about 1 in 1000 pregnancies[2] and those which are malignant represent about 1 in 15000 to 32000 pregnancies.[3] Mucinous cystadenomas are benign epithelial ovarian tumours that are characterized by multilocularity, smooth outer and inner surface and tend to be large. Mucinous cystadenomas are one of the largest tumours known.[4] There are several case reports in literature showing huge mucinous cystadenomas complicating the pregnancy and need emergency surgical intervention as in this case.[5],[6],[7] Conservative surgery as ovarian cystectomy and salpingo-oophorectomy is adequate for benign lesions.[8] In our patient, left salpingo-oophorectomy was performed as there was no ovarian tissue left and the tube was unhealthy. After surgery, the patient should be followed-up carefully as some tumour reoccur.[9] It is concluded that ovarian cyst in pregnancy must be followed-up properly. Early diagnosis and appropriate intervention is associated with the best fetomaternal outcome.



 
  References Top

1.
Boulay R, Podczaski E. Ovarian cancer complicating pregnancy. Obstet Gynaecol Clin North Am 1998; 25:385-97.  Back to cited text no. 1
    
2.
Hermans RHM, Fischer DC, Van der Putten Hwhm, et al., adnexal masses in pregnancy, Onkologie 2003, 26:167-172.  Back to cited text no. 2
    
3.
Goffnet F; Ovarian cyst and pregnancy, J Gynecol Obstet Bio Reproduce 2001, 30:100-108.  Back to cited text no. 3
    
4.
Yenicesu GI, Cetin M, Arici S. A large ovarian mucinous cystadenoma complicating pregnancy: A case report. Cumhuriyet Med J 2009; 31:174-7.  Back to cited text no. 4
    
5.
Turgrul S, Pekin O, Ayvaci H Tarhan N, Uludogar M. Giant benign mucinous cystadenoma growing during pregnancy: A case report. Clin Exp Obstet Gynecol 2007; 34:126-7.  Back to cited text no. 5
    
6.
Balat O, Kutlar I, Erkilic S, Sirikci A, Aksoy F, Aydin A. Unthreatened late pregnancy with a huge mucinous cystadenoma of the left ovary: Report of an usual case. Eur J Gynaecol Oncol 2002; 23:84-5.  Back to cited text no. 6
    
7.
Kuczkowski KM, Wong D. Images (and challenges) in the delivery suite: Large mucinous cystadenoma coexisting with an intrauterine pregnancy in a healthy parturient. Arch Gynecol Obstet 2007; 275:413-4. Epub 2006 June 8.  Back to cited text no. 7
    
8.
Alobaid AS: Mucinous cystadenoma of the ovary in a 12-year-old girl. Saudi Med J 2008, 29(1):126-128.  Back to cited text no. 8
    
9.
Ozgun MT, Turkyilmaz C: A giant ovarian mucinous cystadenoma in an adolescent: A case report. Arch Med Sci 2009, 5(2):281-283.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2]



 

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