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Giant Mucinous Cystadenoma in Adolescent – A Rare Case Report

Authors:
Sant Prakash Kataria at Pt. BD Sharma Post Graduate Institute of Medical Sciences, Rohtak
Sant Prakash Kataria
  • Pt. BD Sharma Post Graduate Institute of Medical Sciences, Rohtak
Rattan KN
Rattan KN
Rattan KN
  • This person is not on ResearchGate, or hasn't claimed this research yet.
S. Lal at ESI PGIMSR Basaidarapur Nwe Delhi
S. Lal
  • ESI PGIMSR Basaidarapur Nwe Delhi
Sanjay Kumar at Post Graduate Institute of Medical Sciences, Rohtak
Sanjay Kumar
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Annex Publishers | www.annexpublishers.com
Volume 4 | Issue 1
Giant Mucinous Cystadenoma in Adolescent – A Rare Case Report
Kataria SP1, Rattan KN2, Lal S*1, Kumar S1, Singh G1 and Rattan A2
1Department of Pathology, PGIMS, Rohtak, Haryana, India
2Department of Paediatric Surgery, PGIMS, Rohtak, Haryana, India
*Corresponding author: Lal S, Resident, Department of Pathology, PGIMS, Rohtak, Haryana A-19,
Aakash Ganga Apartments, Plot No. 17, Sector 6, Dwarka, Delhi, India 110075, Tel: 96710909783, E-Mail:
shubha1504@gmail.com
Case Report Open Access
Citation: Kataria SP, Rattan KN, Lal S, Kumar S, Singh G, et al. (2016) Giant Mucinous Cystadenoma in
Adolescent – A Rare Case Report. J Case Rep Stud 4(1): 101. doi: 10.15744/2348-9820.4.101
Volume 4 | Issue 1
Journal of Case Reports and Studies
ISSN: 2348-9820
Introduction
Abstract
Mucinous cystadenomas account for approximately 10-20% of all epithelial ovarian tumours. About 75-80% of these tumours are
benign [1]. ey are usually seen between the third and h decades and 5-10% of them are bilateral. ese benign tumours are
rare entity in adolescents. e majority of ovarian masses in adolescent patients are non-epithelial in origin, with a predominance
of germ cell tumours, while epithelial neoplasms make up a small proportion of ovarian masses in this age group [2,3]. Here
we report a giant ovarian mucinous cystadenoma in an adolescent, the seventh largest mucinous cystadenomas reported in the
literature.
A 13 year old, premenarchal, previously healthy girl presented to the emergency department of our hospital with complaints of vomiting,
constipation and abdominal pain for past one day. e patient also complained of slowly increasing abdominal distension and mild
abdominal discomfort since past four months. Patient was taken up for laparotomy. A cystic solid pelvic mass was present originating
from right ovary. Unilateral salpingoophorectomy with tumor removal was performed. e tumor measured 25x20x15 cm and weighed
3.5 kilograms. Specimen was sent for histopathological examination and diagnosis of mucinous cystadenoma was made.
Keywords: Giant mucinous cystadenoma adolescent
Case Presentation
Abbreviations: CM: Centimeter
A 13 year old, premenarchal, previously healthy girl presented to the emergency department of our hospital with complaints
of vomiting, constipation and abdominal pain for past one day. e patient also complained of slowly increasing abdominal
distension and mild abdominal discomfort since past four months. On physical examination, a huge, well dened, immobile pelvic
mass was palpable which lled the whole pelvis and abdomen and extended upto xiphoid process. e sonographic appearance
of the tumor was predominantly multicystic with some solid regions at the margin. ere was minimal intra-abdominal uid
located around the tumor. Uterus was depressed and displaced by the tumor. Le ovary appeared normal. Routine hematological
and biochemistry tests were within normal limits. Patient was taken up for laparotomy. A cystic solid pelvic mass was present
originating from right ovary. Examination of the pelvis, abdominal walls, diaphragmatic surface and peritoneum did not show
presence of implants and metastasis. Unilateral salpingoophorectomy with tumor removal was performed. e tumor measured
25x20x15 cm and weighed 3.5 kilograms (Figure 1). Specimen was sent for histopathological examination; where cyst wall revealed
the presence of columnar epithelium overlying ovarian stroma. e epithelium was tall columnar, with basal nuclei and abundant
intracellular basophilic mucin. A nal diagnosis of mucinous cystadenoma was made. Postoperative recovery was uneventful and
the patient was discharged on the sixth postoperative day. Menarche occurred six months later. e patient is being followed up
regularly and there has been no evidence of recurrence aer 36 months of surgery.
Discussion
Ovarian neoplasms may be divided according to original cell types into three main groups: epithelial, sex cord stromal cell,
and germ cell. Taken as a group, the epithelial tumors are by far the most common type. e most common types of epithelial
neoplasms are benign cystadenoma of which 75% are serous cystadenomas and 25% are mucinous cystadenomas. Serous or
mucinous cystadenomas of the ovary, benign or malignant, are rare in children. ey arise from mullerian germinal epithelium.
Patients are usually post-pubertal [1,4].
Received Date: March 06, 2015 Accepted Date: February 11, 2016 Published Date: February 15, 2016
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Volume 4 | Issue 1
Journal of Case Reports and Studies
2
Figure 1: Giant Mucinous Cystadenoma Weighing 3.5 Kilograms
Figure 2: Mucinous Cystadenoma Ovary (H&E, 100x)
Mucinous cystadenoma of the ovary; a benign neoplasm accounts for 15% of all ovarian neoplasms. Being most prevalent in third
to h decade, its incidence in adolescents is a rarity. ese neoplasms vary in size from few centimeters to several centimeters
and can weigh as heavy as a few kilograms. Grossly, mucinous neoplasms are characterised by cysts of variable sizes without
surface invasion. Histologically, mucinous cystadenoma is lined by tall columnar non-ciliated epithelial cells with apical mucin
and basal nuclei. ey are classied according to the mucin-producing epithelial cells into three types. Mucinous neoplasms
are classied into three types according to mucin producing epithelial cells namely endocervical, intestinal and mullerian [5].
Mucinous tumours are usually cystic, with 76% being multilocular and 24% unilocular. Only approximately 10% of mucinous
tumours are bilateral, excluding metastatic spread to the contralateral ovary [5,6].
Dierential diagnosis of ovarian masses in adolescence includes cyst formation, ovarian torsion, benign or malignant ovarian
neoplasm and involvement of the ovary in lymphoma, leukaemia or metastatic disease [2] (Figure 2). Malignant transformation of
these tumors is a rare event and has been reported in 5-10% of cases. Because of this potential, these tumours must be histologically
classied and appropriately treated [1,3].
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Volume 4 | Issue 1
3 Journal of Case Reports and Studies
In our patient, the mass was enormous in size and there was no normal ovarian tissue grossly. erefore, right salpingo-
-oophorectomy was performed. e patient is being followed up regularly and there has been no evidence of recurrence aer 36
months of surgery.
References
1. Brown MF, Hebra A, McGeehin K, Ross AJ (1993) Ovarian masses in children: A review of 91 cases of malignant and benign masses. J Pediatr Surg 28: 930-3.
2. Quint EH, Smith YR (1999) Ovarian surgery in pre-menarchal girls. J Pediatr Adolesc Gynecol 12: 27-9.
3. Grapsa D, Kairi-Vassilatou E, Hasiakos D, Kondi-Pati A (2006) Ovarian mucinous cystadenoma with extended calcication in an 11-year-old girl: case report
and review of the literature. Clin Exp Obstet Gynecol 33: 181-2.
4. Cici I, Sekmenli T, Ugras S (2013) Ovarian huge serous cystadenoma in adolescent girl: a case report. Nat J Med Res 3: 187-9.
5. Kamel RM (2010) A massive ovarian mucinous cystadenoma: a case report. Reprod Biol Endocrinol 8: 24.
6. Sri Paran T, Mortell A, Devaney D, Pinter A, Puri P (2006) Mucinous cystadenoma of the ovary in peri- menarchal girls. Pediatr Surg Int 22: 224-7.
7. Stankovic Z, Djuricic S, Djukic M, Jovanovic D, Vasiljevic M (2006) Epithelial ovarian tumors and CA125 in premenarchal girls. Eur J Gynaecol Oncol 27: 597-9.
8. Park JY, Kim DY, Kim JH, Kim YM, Kim YT (2009) Surgical management of borderline ovarian tumors: e role of fertility-sparing surgery. GynecolOncol
113: 75-82.
Management of ovarian cysts depends on the patient’s age, the size and structure of the cyst and menopausal status. Conservative
surgery is the treatment of choice in younger patients due to the low rate of malignant transformation. ough cystectomy
has a greater chance of preserving fertility, is associated with higher recurrence rate. Salpingo-oopho- rectomy has thus been
recommended as fertility-sparing surgery. Patient should be followed up carefully for recurrence, especially if tumor was not
completely removed by surgery. Prognosis though excellent for these tumors, careful follow up is mandatory due to risk of
recurrence [7,8].
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... Common between 3 rd and 5 th decade. They may reach enormous size filling the entire abdominal cavity [3,4]. Sometimes they may get complicate by torsion, haemorrhage, rupture etc. hence early diagnosis and prompt treatment is key for successful management [5]. ...
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