Speakers - 2026

Title: Huge abdomino-pelvic mass in young girl : A diagnostic dilemma

Abstract

Introduction: Fallopian tube tumors are the rarest tumors of the female genital tract. Its incidence is 5-20% of all adnexal lesions and typically originate from the Mullerian duct. Giant cystadenomas of paraovarian origin are extremely uncommon during childhood and adolescence with as few as 30 cases reported in the literature.

Case Report: A 16-year-old postmenarchal female was admitted for evaluation of a 7-month history of gradual symmetric abdominal enlargement, mainly in the hypogastric region, followed by intermittent nonspecific abdominal pain. She had reported regular menstrual cycles. Her menarche was attained at the age 14. At admission, the patient was hemodynamically stable . On abdominal examination a smooth, cystic, mobile and non tender abdominal mass, extending from pubic symphysis to 2-3cm below the xiphisternum was felt.

• Abdomen ultrasound (US) and magnetic resonance imaging (MRI) revealed a huge abdominal-pelvic cystic lesion arising from the Right adnexa likely ovarian in origin. The cyst measured 30.5 × 20.4 cm on the cross-section and about 25 cm in length .It had a thin wall and contours without papillary proliferations, all of the features suggestive of its benign nature. The right ovary was not separately visualized while the left ovary was normal.

• Her tumor markers were CA 125: 5.2 U/mL, Lactate dehydrogenase (LDH): 180 U/L, Alpha-Fetoprotein (AFP): 1 ng/mL, Cancer antigen 90 and β-human chorionic gonadotropin (beta-hCG): 2.4 mlU/ml, all within normal limits.

• Her CECT whole abdomen was suggestive of Large mesenteric cyst extending from stomach superiorly, upto the level of urinary bladder inferiorly measuring approximately 30 x 23 x 12cm showing homogeneous density contents with thin imperceptible walls and no obvious internal enhancement or solid component. So provisional diagnosis of ?mesenteric cyst ? Ovarian cyst was made.
Patient was then taken up for Exploratory laparotomy with frozen section. Intraoperatively a huge cystic mass of around 36 x 24cm was seen covering the abdomen which was arising from the Right fallopian tube with non visualization of right fimbria. Right ovary seemed to be stretched. Uterus , left ovary , fallopian tube were normal. There were no palpable lymph nodes and no signs of metastasis were seen. Bowel and mesentry were also normal. Frozen section of the mass was suggestive of Serous Cystadenoma. Hence, Right paratubal cystectomy was done preserving the right fallopian tube and ovary. Ascitic fluid examination was also negative for malignant cells and was suggestive of Benign cystic lesion. Histopathology examination confirmed the diagnosis of Right Paratubal Serous cystadenoma.

Discussion: Only a few cases of giant paratubal SCAs have been reported so far and most of those cases are related to reproductive age group. Despite the advances in preoperative diagnostics, an accurate diagnosis of adnexal masses is still difficult and challenging. In addition, radiological approach to the adnexal masses, primarily paratubal cysts, is still not uniformly reported. However, the size, persistence, and separability from the adjacent ovaries are the most helpful clues for identification of non physiological paratubal cysts .There are no standard criteria for laparoscopy or laparotomy. The size of the cyst, patient’s preference, and cyst rupture concern were the reasons for deciding on a laparotomy in our case. Intraoperative management are varies between cystectomy, cystectomy plus salpingectomy, and adnexectomy

Conclusion: This case suggests that a paratubal cyst should be included in the differential diagnosis of pelvic masses, especially in the reproductive age. Giant paratubal SCAs in adolescent females are extremely rare, but have an excellent prognosis as confirmed in our case. A huge paratubal cyst may mimic a large ovarian cyst preoperatively and intraoperatively. Careful inspection during surgery is necessary to confirm a paratubal cyst. A fertility-sparing surgery should be a preferable treatment method and attempted whenever possible