Case 1

Group 1A
CASE:
A 63 year old, menopause for 15 years, consulted because of abdominal
mass of 5 months duration. No history of postmenopausal bleeding.

● PE: movable non-tender cystic mass measuring 11.0 x 10.0cm, no

fluid wave.
● IE: cervix closed, corpus small, movable non-tender cystic mass on
the right measuring 11.0 x 10.0cm.
● TVS: normal uterus and left ovary, right ovary converted to a thin
wall unilocular anechoic cyst measuring 12.0 x 11.0 x 11.0 cm
 Questions:
What is the most probable diagnosis?
Right Ovarian Epithelial Cell Tumor (Ovarian Serous Cystadenoma)
2. What are the basis for the diagnosis?
● Gross Findings: usually composed of unilocular or at times multilocular cysts filled
with clear watery fluid.
● Size: 10 cm average in diameter but may be extremely large. Lining of the cyst is flat
but sometimes may have multiple papillary projections.
● Usually seen as a unilocular cystic/anechoic adnexal lesion as seen on the patient.
3. What is the appropriate management?
The management of ovarian cystadenomas depends on the following factors:

● Symptoms
● Size of the cyst
● Age of the patient
● Medical history
● Menopausal state of the patient
3. What is the appropriate management?
Diagnostic test:
Serum CA-125 assay:
Serum CA-125 assay is a useful tool that helps to distinguish between benign and malignant ovarian masses. The
combination of normal findings at serum CA-125 assay, imaging, and clinical findings exclude the possibility of
ovarian cancer.
Imaging studies:
Several imaging techniques are useful for the diagnosis of ovarian cystadenomas. They include:
● Pelvic ultrasonography (US)
● Computed tomography
● Magnetic resonance imaging
The features that are more suggestive of a benign cystic neoplasm include:
● Unilocularity of cysts
● Minimal septations
● Thin walls
● Absence of papillary projections
3. What is the appropriate management?

Treatment: Surgery
Unilateral Salphingo-Oophorectomy (USO) with biopsy - to check for a possible
malignancy

Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy (TAHBSO) - to

avoid recurrence
Clinical recurrence is uncommon and reflects either incomplete resection or a new
primary tumor.
3. What is the appropriate management?
Surgical removal

Indicated for:

● Post menopausal women with >10cm cysts or with abnormal CA125 )

● Persistent ovarian mass with pain (greater than 10 weeks)
● Complex cysts or persistent simple cysts larger than 10 cm
● If the cyst is suspicious of cancer