Management of a Giant Ovarian Tumor More Than 30 kg: A Case Report and Review of the Literature

Background: Giant ovarian tumors (> 30 kg) are very rare. Resection of giant ovarian tumors is challenging. Many severe complications have been reported. Surgical techniques and care have improved; however, many problems persist regarding resection of giant tumors. Case: A 37-year-old para 0, gravida 0, female had a 57-kg ovarian tumor. A laparotomy was performed to excise the tumor. There was a high probability that it was a borderline ovarian tumor, according to intraoperative pathology results. Thus, omentectomy, appendectomy, and pelvic lymph node biopsy were also performed. Results: This patient developed slight atelectasis on postoperative day 3. The atelectasis resolved, and her postoperative course was uneventful. The final diagnosis, after pathology testing of the excised tumor, was a mucinous borderline tumor, of a mixed type, in the right ovary and a dermoid cyst in the left ovary. Conclusions: A MEDLINE® search was performed, and articles on giant ovarian tumors >30 kg were reviewed. The search was limited to publications from January 2007 to June 2017 to analyze recent management approaches. During this decade, there were 19 reports—including the current case—of giant ovarian tumors. Five main problems were analyzed: (1) aspiration of tumors; (2) bleeding complications; (3) postoperative complications; (4) anesthesia; and (5) cosmetic problems. Intraoperative aspiration, rather than preoperative aspiration, was performed in these cases. Massive bleeding from an adhesion between a tumor and the abdominal wall can occur postoperatively and be life-threatening. Careful preoperative evaluation and a rehearsal should be performed for the best anesthetic management. Abdominoplasty might be necessary to enable a patient to resume an ordinary life. A multidisciplinary approach is essential. Knowing the possibility of complications and choices for management can lead to better outcomes in such rare cases.