Giant Ovarian Serous Cystadenofibroma Mimicking Bilateral Ovarian Tumour in a 75-Year-Old Woman: A Case Report
This case report describes a 75-year-old woman in whom a giant benign ovarian serous cystadenofibroma mimicked bilateral ovarian malignancy on imaging and showed mild CA-125 elevation, underscoring the necessity of histopathological confirmation to avoid unnecessary radical surgery despite suspicious preoperative findings.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In the human body, the ovaries are small, almond-shaped organs that sit on either side of the uterus. Occasionally, these organs develop growths called cysts, which are fluid-filled sacs. While many cysts are harmless and disappear on their own, some grow very large and complex, developing thick walls and multiple internal compartments. When doctors see these large, messy-looking masses on scans, they often worry they might be cancer. This fear is heightened when a blood test shows a slight rise in a protein called CA-125, a marker often associated with ovarian cancer. However, not every large mass is dangerous, and not every elevated marker means cancer is present. Distinguishing between a benign, non-cancerous growth and a malignant one is one of the most critical challenges in gynecology, because the treatment for cancer involves removing the uterus and both ovaries, a major surgery that carries significant risks and life-altering consequences. Getting the diagnosis right before the knife cuts is essential to avoid unnecessary trauma for the patient.
This story begins with a seventy-five-year-old woman living in Sudan who arrived at a hospital complaining of pain in her right side and lower abdomen, symptoms that initially pointed toward a urinary tract infection. During a routine physical exam, a doctor noticed something unexpected: a large, painless swelling on the left side of her abdomen. The woman had not felt this lump and was unaware it was there. Further investigation revealed a massive cystic mass, a fluid-filled sac, that was so large it stretched from her pelvis up into her abdomen. An ultrasound showed this mass was divided into sections by thick and thin walls, and a follow-up CT scan confirmed its enormous size and complex structure. The radiologist, looking at the images, suspected that the growth might be affecting both ovaries, a sign that often points toward a more serious condition. A blood test added to the concern, showing a CA-125 level of 39.5 units per milliliter, which was just slightly above the normal limit of 36.
Faced with a huge, complex mass that looked suspicious on scans and had a slightly elevated cancer marker, the medical team decided surgery was necessary. The goal was to remove the growth and examine it closely to determine if it was cancer. The patient underwent a total abdominal hysterectomy, which involves removing the uterus, cervix, and both ovaries and fallopian tubes. When the surgeons opened the abdomen, they found a single, gigantic cyst attached to the left ovary. It measured 20.8 by 16.3 by 8.7 centimeters, roughly the size of a large cantaloupe, and was filled with deep yellowish fluid. In stark contrast to the preoperative suspicion that both ovaries were involved, the right ovary appeared completely normal in size and texture, showing no signs of the disease.
The true nature of the mass was revealed only after the tissue was examined under a microscope by a pathologist. The analysis confirmed that the giant growth was a serous cystadenofibroma, a rare but benign tumor made of glandular tissue and dense fibrous material. It was confined entirely to the left ovary. The right ovary, which the scans had suggested might be part of the problem, showed only minor inflammation and no cancer cells. The slight elevation in the blood marker was a non-specific reaction to the large mass stretching the body's tissues, not a sign of malignancy. The patient recovered from the surgery, though she experienced a temporary drop in potassium levels and a very high platelet count, both of which are known reactions to major surgery and resolved with supportive care. She was discharged in stable condition, free of symptoms.
This case serves as a powerful reminder that appearances can be deceiving in medicine. Even in an elderly woman, a massive, multi-chambered cyst that looks like cancer on a scan and has a slightly high cancer marker can turn out to be a harmless, albeit giant, benign tumor. The imaging suggested the disease was on both sides, but the final diagnosis showed it was only on one. The story underscores that while scans and blood tests are vital tools, they cannot always provide the final answer. Only a complete surgical removal followed by a detailed microscopic examination can definitively confirm whether a growth is benign or malignant, ensuring that patients receive the precise care they need without undergoing unnecessarily radical procedures.
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