Open Journal of Obstetrics and Gynecology, 2012, 2, 220-222 OJOG Published Online September 2012 (
Giant benign mucinous cystadenoma: A case report
Ajit Sebastian, Anitha Thomas*, Annie Regi
Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
Email: *
Received 13 February 2012; revised 20 March 2012; accepted 3 April 2012
Giant benign tumours of the ovary are rare in the
modern world due to the improved technologies and
general awareness. They are known to cause pressure
sy mpto ms to the surrounding structures. Though they
appear frighteningly large, they are amenable to sur-
gical debulking with good results in survival and post
operative recovery. Here we would like to present a
case where the patient could not access medical care,
which led to the presentation of a very large muci-
nous cystadenoma which responded remarkably to
surgical excision. The patient could go back to her
normal life following the procedure. Conclusions
Giant benign mucinous tumours are a rarely seen in
the modern world. They have excellent surgical re-
sults and survival rates.
Keywords: Giant; Benign; Mucinous; Cystadenomas
Mucinous cystadenomas make up 15% - 20% of all ova-
rian tumors. They often become very large and can ex-
tend up into the abdomen [1,2]. About 80% of mucinous
tumors are benign, 10% are border-line and 10% are ma-
lignant. Although benign ovarian mucinous tumors are
rare at the extremities of age, before puberty and after
menopause [3], they are common between the third and
the fifth decades [4]. The most frequent complications of
benign ovarian cysts, in general, are torsion, hemorrhage
and rupture. Pseudomyxoma peritonei can result if the
tumor ruptures and spills its contents into the abdomen.
This report presents a case of a giant ovarian mucinous
cystadenoma in an Indian woman, one of the biggest re-
ported ovarian tumors in the medical literature.
A 44 yr old P3L3 lady, presented to emergency depart-
ment with history of progressive distension of abdomen
over 2 years. She was seen in the outpatient department
of the hospital 2 yrs back with similar complaints and
was advised on surgical intervention but as patient did
not understand the intensity of the problem she returned
back to her home. She is a resident of a tribal settlement
in a hilly region which is a very remote area far from the
hospital with very minimal transport facilities. The peo-
ple in that area live on food available from the surround-
ing forest. She finally decided to come to the hospital
with the help of a social worker, when the distension was
unimaginably large and difficult to manage.
On clinical examinatio n the lad y was found to be ema-
ciated, in distress with gross abdominal distention (Fig-
ure 1). An ultrasound done revealed a huge ovarian cyst,
side of origin not known with moderate ascitis. A thera-
peutic tap was planned to relieve her of her symptoms.
Approximately 2 liters of brownish mucinous material
was aspirate and sent for cancer cytology.
She weighed 68 kilograms preoperatively. A Compute-
rized Tomography imaging done after admission showed
a large ovarian tumor with multiple locules and no as-
cites, bilateral hydroureteronephrosis. She was planned
for laparotomy proceed, abdominal hysterectomy with
bilateral salpingo oophorectomy and ureteric stenting .
Intra operatively approximately 35 liters’ of fluid was
aspirated from the mucinous cyst which was arising from
the right ovary. It was multiloculated and was seen
Figure 1. Over distended abdomen.
*Corresponding a uthor.
A. Sebastian et al. / Open Journal of Obstetrics and Gynecology 2 (2012) 220-222 221
pushing the liver, bowel and spleen upwards (Figure 2).
The specimen after decompression weighed 5 kg with
multiple solid and cystic areas. The uterus and other
ovary were normal. Bilateral ureteric stenting was also
Post operatively patient was managed in intensive care
unit for a day and transfused one unit of blood. She
weighed 38 kg post operatively and had a uneventful
post operative period. She was discharged on the 6th post
operative day. Patient was advised to follow up after 6
weeks for ureteric stent removal. The biopsy was re-
ported as benign mucinous cystadenoma .She recovered
completely from her surgery and has gone back to her
normal daily activity as a daily wages worker.
There are four major categories of ovarian tumors:
1) Epithelial tumors (65% - 75%)—serous or muci-
nous cystadenoma/carcinoma, clear cell carcinoma, Br en-
ner tumor;
2) Germ cell tumors (15%)—dysgerminoma, embryo-
nal cell cancer, choriocarcinoma, teratoma;
3) Sex-chord-stromal tumors (5% - 10%)—granulosa
cell tumor, thecoma, fibroma;
4) Metastatic tumors (10%)—uterine, stomach, colon,
breast, lymphoma [5].
These tumors are usually evaluated using ultrasound,
CT scan, or MRI. Findings on imaging studies are non-
specific. These ovarian tumors may be multi-septated,
cystic masses with thin walls. They may contain varying
amounts of solid tissue which consists of proliferating
stromal tissue, papillae, or malignant tumor cells. Tu-
mour markers may also aid us in telling us the origin of
the tumour.
Mucinous cystadenomas are divided into three catego-
ries: benign, borderline, and malignant. Survival is
largely dependent on the histology of the tumor, with a
Figure 2. Cut section of the large ovarian tumour.
10 year survival rate of 100% for benign tumors, 60% for
borderline tumors, and only 34% for the malignant sub-
type. Benign mucinous tumors tend to present earlier,
while malignant tumors are often seen later in life.
Benign mucinous cystadenomas comprise 80% of
mucinous ovarian tumors and 20% - 25% of benign
ovarian tumors overall. The peak incidence occurs be-
tween 30 - 50 years of age. Benign tumors are bilateral in
5% - 10% of cases.
Borderline mucinous cystadenomas make up about
10% of mucinous ovarian neoplasm’s and are bilateral in
10% of cases.
Malignant mucinous cystadenoms are rare, and en-
compass 10% of mucinous ovarian tumors and 5% - 10%
of primary malignant ovarian neoplasms overall. They
are bilateral in 15% - 30% of cases and have a peak in-
cidence between 40 - 70 years of age.
Giant ovarian tumours have become rare in current
medical practice, as most cases are discovered early dur-
ing routine check-ups. Detection of ovarian cysts causes
considerable worry for women because of fear of malig-
nancy, but fortunately the majority of ovarian cysts are
benign. These giant tumours may be associated with
pressure symptoms, urinary tract changes, respiratory
embarrassment and debilitation. While operating on su ch
tumours care has to be taken to manage these complica-
tions as well as the problems associated with sudden de-
compensation of such large tumours.
Histologically, mucinous cystadenoma is lined by tall
columnar non-ciliated epithelial cells with apical mucin
and basal nuclei. 80% tumours are cystadenomas while
the remaining 20% is of the borderline variety, noninva-
sive (intraglandular; intraepithelial) carcinomas, or inva-
sive carcinomas. The borderline tumors may be of intes-
tinal type or mullerian (endocervical-like) type. The in-
testinal-type tumors are by far the most common [6].
Mucinous cystadenoma is a benign ovarian tumor. It is
reported to occur in middle-aged women. It is rare
among adolescents [7] or in association with pregnancy
[8]. On gross appearance, mucinous tumors are charac-
terised by cysts of variable sizes without surface invasion.
Only 10% of primary mucinous cystadenoma is bilateral
[7]. In our case, the tumor was unilateral, affecting the
left ovary. The cyst was filled with sticky gelatinous fluid
rich in glycoprotein.
Management of ovarian cysts depends on the patient’s
age, the size of the cyst and its histo-pathological nature.
Conservative surgery as ovarian cystectomy and salpingo-
oophorectomy is adequate for benign lesions [7].
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