Giant cystadenoma of twisted ovarian in a pregnant woman: a case report

Abstract

Ovarian cystadenomas originate from the coelomic epithelium on the surface of the ovary and the embryological remnants of Muller's ducts. They are seen predominantly in adult women in the reproductive range, with a lower occurrence in adolescents. Ovarian torsion is a serious complication, occurring when the ovary and/or fallopian tube twist around their own vascular axis, leading to blood obstruction to the organ. It can be triggered by the increase in size and weight of the tumor. The evolution of the mass accompanied by an exponential increase in volume changes the patient's course and prognosis. As there is no established clinical protocol, management must take into account the condition of each patient. The aim of this study is to report the case of a 17-year-old primigravida, in her second trimester of pregnancy, who reported intense and sudden pain in the right inguinal region with dorsal irradiation. Obstetric and transvaginal ultrasound evaluation revealed the presence of a voluminous cystic image measuring around 271 x 115 mm and the absence of parenchymal vascularization in the right ovary. A month earlier, it had measured 195 x 122 mm. The patient underwent exploratory laparotomy and the presence of the cystic image with hemorrhagic foci, containing three twists, was visualized. Histologically, the examination revealed that it was a serous cystadenoma. The patient evolved satisfactorily, continuing with the pregnancy without any morphological alterations to the fetus.