Dear Editor,
Sixty-two-year-old patient presented to our Department with moderate abdominal pain and a significantly enlarged abdominal circumference. An abdominal CT scan detected a giant polycyclic fluid space, with a solid area originating from the adnexa (Fig. 1A). Tumor markers showed CA 125 at 79.62 U/mL and HE4 at 123.9 pmol/l. Surgical treatment involved a median suprapubical incision extended beyond the umbilicus. The tumor originating from the left adnexa was excised (Fig. 1B). Both the uterus and the remaining adnexa were removed. No hemodynamic or cardiac complications were observed intraoperatively. The final histopathological examination revealed a tumor measuring 40 cm and weighing 14.46 kg. The tumor was diagnosed as a borderline malignant mucinous tumor of the ovary (Fig. 1C). Postoperative recovery was uneventful, and the patient was discharged on the fourth day after surgery.
Fig. 1.
A Abdominal CT scan detected a polycyclic fluid space 40 cm in length originating from the adnexa (arrows). B H&E (Hematoxylin and Eosin) stained specimens of mucinous borderline ovarian tumor, primary objective magnification 10x. C The tumor was removed without any spillage with intact outer wall
Discussion
The diagnosis of giant borderline ovarian tumor (gBOT) can be established through physical examination, USG, CT, or MRI [1]. Despite these diagnostic tools, the possibility of malignancy often remains uncertain until a final pathologic diagnosis is made. Treatment strategies are guided by the FIGO classification, age and the patient’s fertility wishes. For patients with a FIGO grade I tumor (confined to the ovary): If fertility preservation is not a concern, a hysterectomy with bilateral salpingo-oophorectomy may be performed. If the patient wishes to preserve fertility, a unilateral salpingo-oophorectomy can be applied [2]. A critical aspect of surgical treatment is ensuring complete removal of the lesion while avoiding rupture of the tumor capsule during surgery which can increase the risk of disease progression and recurrence [3]. The literature underscores the significant risk of intraoperative complications due to rapid changes in body circulation, which include pulmonary and cardiac failure or pulmonary embolism [4]. The complexity of treating gBOTs necessitates a multidisciplinary approach, which is crucial for providing optimal patient care.
Acknowledgements
Authors would like to thank: Pawel Grochowski MD, PhD for histopathological consultation of the case Mgr Andrzej Sołtek and Ms Agnieszka Nowicka for photographical documentation of the case. The anaesthesiology team of the Regional Polyclinical Hospital in Grudziadz for the perfect preparation and management of anesthesia, which enabled the safe performance of the surgery.
Author contributions
PS: conceived and designed the analysis, collected the data, and wrote the paper. KD: collected the data and wrote the paper. PD: collected the data and wrote the paper. MWS: contributed data and revise the final version of the manuscript.
Funding
The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.
Data availability
The data used to support the findings of this study are available from the corresponding author upon request.
Declarations
Conflict of interest
The authors declare that there is no conflict of interest regarding the publication of this article.
Ethical approval
This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee at the Kujawsko-Pomorskie Regional Chamber of Physicians in Torun, under authorization number 20/KB/2023.
Consent to participate
Written informed consent was obtained from the patient for the publication of this case report and accompanying images. Patient anonymity is preserved.
Consent for publication
The authors affirm that the participant provided informed consent to publish the images in Fig. 1.
Footnotes
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References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data used to support the findings of this study are available from the corresponding author upon request.