Laparoscopic resection of a giant post-mesenteric ovarian seromucinous cystadenoma: a case report and review

Abstract

Background: Ovarian seromucinous tumors represent a rare subclass of ovarian neoplasms. While the majority of these tumors are benign, the potential for malignant transformation persists and should be considered. To enhance patient outcome and mitigate the risk, early detection and timely intervention are paramount. In cases involving large or complex ovarian masses, open surgery is often the preferred approach, as it provides superior access for comprehensive tumor resection and enables immediate histopathological evaluation. Nevertheless, with advancements in laparoscopic techniques, single-port laparoscopic surgery has emerged as a viable alternative for patients. This approach not only demonstrates comparable effectiveness but also offers the benefits of expedited recovery and reduced scarring.

Case report: A 65-year-old female presented with a seven-month history of abdominal distension, a sensation of fullness beneath the xiphoid, left-sided discomfort, and intermittent morning cramping. Laboratory findings revealed a mild elevation in CA-125 to 46 U/mL, and CT imaging suggested a diagnosis of an ovarian cystadenoma or possibly a retroperitoneal mass. Preoperative assessment was challenging due to the tumor's irregular morphology, substantial size, and its adhesions to surrounding pelvic and abdominal structures, making it difficult to precisely determine its origin. In light of these complexities, a single-port laparoscopic approach was chosen to minimize trauma, allow for more precise handling of the tumor, and reduce the risk of cystic fluid leakage or inadvertent dissemination of the tumor. Postoperative pathological examination confirmed the lesion to be a seromucinous ovarian cystadenoma.

Conclusion: This case exemplifies the imperative for a multidisciplinary approach in the diagnosis and treatment of ovarian seromucinous tumors, emphasizing the advantages of minimally invasive surgical techniques. Given the rarity of such tumors, it is essential that ongoing research into the pathogenesis, classification, and treatment strategies be prioritized to enhance patient outcomes.

Keywords: giant cyst; laparoscopic treatment; ovarian seromucinous cystadenoma; post-mesenteric; single-port laparoscopic surgery.

Figure 1

Preoperative imaging examination and intraoperative findings. (A, B) CT imaging demonstrated a substantial lesion within the pelvic cavity, measuring approximately 22.8 cm × 12.4 cm × 30 cm, suggesting a complex internal structure. (C, D) Laparoscopic examination revealed a large cystic mass with high tension, smooth surface, and clear fluid.

Figure 2

Suturing of the cyst wall using a purse-string technique. (A) The cyst wall was meticulously sutured utilizing a purse-string technique, ensuring the outlet was securely sealed. This approach effectively prevented fluid leakage and minimized the risk of spillage throughout the procedure. (B) The diagram demonstrates the suturing of the cyst wall.

Figure 3

Illustration of the connection between the negative pressure suction device and the 5mm abdominal laparoscopic trocar’s insufflation port. (A) The controlled aspiration of cystic fluid was achieved through the precise insertion of a puncture needle, effectively minimizing the risk of fluid leakage and iatrogenic dissemination. Approximately 5000 mL of cystic fluid was aspirated in a slow, methodical manner to ensure safety and efficacy. (B-D) Depiction of the final puncture site closure, with suturing performed after the complete aspiration of the cystic fluid.

Figure 4

Immunohistochemical and special staining analysis. (A) The hematoxylin-eosin staining and immunohistochemical marker profile reveals positive expression of CK7, partial positivity for CK20, and strong expression of PAX-8, CDX-2, MUC5AC, and HNF4a. Additionally, ER is negative, and Ki67 demonstrates a proliferation index of 1%. (B) Special staining techniques, including Alcian Blue (AB) and Periodic Acid-Schiff (PAS) stains, confirm the presence of mucin positivity.