Indian Journal of Obstetrics and Gynecology Research

Print ISSN: 2394-2746

Online ISSN: 2394-2754

CODEN : IJOGCS

Indian Journal of Obstetrics and Gynecology Research (IJOGR) open access, peer-reviewed quarterly journal publishing since 2014 and is published under auspices of the Innovative Education and Scientific Research Foundation (IESRF), aim to uplift researchers, scholars, academicians, and professionals in all academic and scientific disciplines. IESRF is dedicated to the transfer of technology and research by publishing scientific more...


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Mandal, Dastidar, Chatterjee, and Das: An ovarian mucinous cystadenoma, presenting with umbilical herniation


Introduction

A 59-year old postmenopausal lady, presented to the gynecological OPD with an umbilical hernia and a hugely distended abdomen (Figure 1). She reported gradual painless distension of her abdomen for the preceding 10 months, unassociated with any gastrointestinal or genito-urinary symptoms; this was followed by gradual protrusion of her umbilicus over the preceding three months. On examination a massive, firm but elastic, pelvi-abdominal lump was palpable; the contents of the umbilical hernia had a consistency similar to the abdominal lump and were irreducible, though not strangulated. A CECT scan of the abdomen revealed a huge multiloculated mass, of ovarian origin, with protrusion of a portion through the umbilicus. (Figure 2). The levels of the tumour markers, CA-125-5, CA 19-9 and CEA, were unremarkable.

Case Report

The patient underwent a bilateral salpingo-oophorectomy and total hysterectomy with removal of the entire tumor mass. The umbilical defect was closed with polypropylene sutures. Histopathological examination established the diagnosis as a benign mucinous cystadenoma.

Figure 1

Showing hugely distended abdomen with the umbilical hernia

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Figure 2

CT scan image showing the tumor mass with a part of it protruding through the umbilicus

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/bb506f66-1dbd-4a05-b465-b1f643297e87image2.png

Mucinous cystadenoma of the ovary is a tumor of the epithelial cells of the ovary, with a 10-15% malignant potential.1 Around 10% of these are bilateral.2 These neoplasms more commonly occur in the third to sixth decade but may also occur in younger women.3 They usually present as large, multi-loculated, mucin-filled cysts, with an average diameter of around 18cm.4 Microscopically, these tumors consists of multiple cysts and glands lined by simple non-stratified mucinous epithelium. Sometimes neuroendocrine cells or Paneth cells may also be present. Usually no cytologic atypia and no mitotic figures are seen.5 Owing to the extremely large size of the tumor, it has the potential to fill up the entire pelvis and abdomen, causing complications. Some reports of this tumor presenting with a clinical picture of ascites, exist.6 A number of studies have also reported this tumor to have caused complications like abdominal compartment syndrome.7, 8 Reports of this tumor presenting with an umbilical hernia are very rare; these include presentation with hernial incarceration and with maceration of overlying skin.1, 9 The unique feature of this case was the presentation as an uncomplicated umbilical hernia and the absence of any overt symptoms, other than the massive distension of the abdomen. The fact that all these occurrences are associated with mucinous tumours lead us to believe that, may be, the consistency of the mucin-filled sacs, make it more prone to herniation through preexisting abdominal wall defects.

Source of Funding

None.

Conflict of Interest

None.

References

1 

Z Karabulut Ö Aydın E Onur NY Çelik G Moray Giant Ovarian Tumor Presenting as an Incarcerated Umbilical Hernia: A Case ReportJ Korean Med Sci200924353941

2 

AS Alobaid Mucinous cystadenoma of the ovary in a 12-year-old girlSaudi Med J20082911268

3 

S Mishra M Yadav SJ Walawakar Giant Ovarian Mucinous Cystadenoma Complicating Term PregnancyJNMA J Nepal Med Assoc20185621062932

4 

A Alobaid H Elamir M Abuzaid A Abu-Zaid An Extremely Giant Ovarian Mucinous CystadenomaGulf J Oncolog2019129836

5 

F Limaiem MR Lekkala M Mlika Ovarian CystadenomaTreasure IslandStatPearls Publishing2020http://www.ncbi.nlm.nih.gov/books/NBK536950/

6 

EV Yeika DT Efie PN Tolefac JN Fomengia Giant ovarian cyst masquerading as a massive ascites: a case reportBMC Res Notes201710174910.1186/s13104-017-3093-8

7 

A Chao A Chao YS Yen CH Huang Abdominal compartment syndrome secondary to ovarian mucinous cystadenomaObstet Gynecol2004104511802

8 

A Giuliani L Basso M Demoro ' M Scimo F Galati G Galati Bilateral ovarian mucinous cystadenoma in an adolescent presenting as abdominal compartment syndromeEur J Obstet Gynecol Reprod Biol200814022789

9 

VK Singh K Nishant BK Sharma R Lamichaney A weeping umbilical hernia: bilateral ovarian mucinous cystadenoma with disseminated peritoneal adenomucinosisBMJ Case Rep201410.1136/bcr-2014-204748



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© This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Article type

Case Report


Article page

411-412


Authors Details

Aparna Khan Mandal, Aheli Ghosh Dastidar*, Dibyendu Chatterjee, Subhabrata Das


Article History

Received : 02-10-2020

Accepted : 21-04-2021

Available online : 25-08-2021


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