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\begin{document}

\title{Bilateral Ovarian huge Benign Papillary Serous tumor in a teenage girl:
A Case Report}



\author[1]{Vishal Chavda}%
\author[2]{Anand Bhatt}%
\affil[1]{Nirma University}%
\affil[2]{Sardar Multispeciality Hospital, Ahmedabad, Gujarat, India}%


\vspace{-1em}



  
  \date{May 18, 2024}


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\selectlanguage{english}
\begin{abstract}
An 18-year-old female patient came with the complaint of abdominal pain
and diagnosed with some non-mobile mass above the umbilical level which
further ruled as big cysts like upon USG. Upon Surgical intervention, it
was turned out as a Benign Papillary Serous tumor which was confirmed
diagnosis upon histopathological examination.%
\end{abstract}%



\sloppy


\textbf{Bilateral Ovarian huge Benign Papillary Serous tumor in teenage
girl:}

\textbf{A case Report}

\textbf{Vishal\textsuperscript{1} Chavda* and Anand
Bhatt\textsuperscript{2}}

\textsuperscript{1}Department of Pharmacology, Pharmacology Research
lab, Nirma University, Ahmadabad, Gujarat, India-382481

\textsuperscript{2} Obstetrics and Gynaecology Department, Sardar
Multispecialty Hospital, Ahmadabad, Gujarat, India-382350

\textbf{Corresponding Author}

\textbf{*Vishal K Chavda, MS}

Department of Pharmacology, Nirma University, Ahmedabad, Gujarat, India

Department of Anaesthesia, Sardar Woemen's Hospital, Ahmedabad,

Gujarat, India-382481

Email: Chavdavishal2@gmail.com (M) +919723024857

\textbf{Anand Dineshkumar Bhatt}

MBBS, MS, FICS (USA), D.MAS (Germany, Kiel), PG Dip. IVF (UAE)

Consultant Obstetrician and Gynecologist,

Laparoscopic Surgeon and IVF Specialist,

Sardar Women's Hospital \& Dreamzz IVF Centre,

Nikol, Ahmadabad

Gujarat State, India-382350

E. Mail: dranandgyn@gmail.com

Tel: +91-9909953985

\textbf{Short Running Title:} Huge Benign Papillary Serous tumor

\textbf{Article Type: Case Report}

\textbf{Conflict of Interest:} Authors have no any conflict of interest
relevant to this article

\textbf{Funding Source:} Authors have no any funding support for this
research note or publication.

\textbf{Informed Consent:} The informed consent for publication of this
case report was taken in communicable and native understandable language
from the patient and her guardians.

\textbf{Abstract:}

\textbf{Objective:} Ovarian cysts are an extremely common gynaecological
problem in adolescent and at teenage. Majority of ovarian cysts are
benign with minority of cases turns into malignant. Ovarian serous
cystadenoma are rare in children and they further develop with
oncological changes as benign or malignant papillary serous tumor.

\textbf{Case report:} 18 year old female patient was brought to the
clinic with complain of heaviness in abdomen and abdominal pain. On per
abdominal examination some cystic non-mobile mass was palpable up to 6cm
above the umbilical level. On ultrasonographic examination cystic mass
of 17 x 10 x 8 com was found at the right ovary and was not seen
separately, another 7 x 6 cm cystic swelling was found arising from left
ovary. Serum CEA and CA 125 was done \& found to be 1.29 and 14.9
respectively for further onco analysis which was found to be within
normal limits. With skilful surgical technique the tube was gently
separated from the mass and the cystic mass from both the ovaries were
removed. The cystic masses were sent for further histopathological
examination which claimed Benign Papillary Serous tumor.

\textbf{Conclusion:} Benign Papillary Serous tumor in teenage girl is
mostly uncommon and hard findings. Cysts are common but papillary serous
tumor makes a different story. Careful USG and early diagnosis of such
cysts and skilful surgical removal of such can makes a difference in
quality of life in teenage.

\textbf{Keywords:} Benign Papillary Serous tumor, ovarian serous
cystadenoma, Ultrasonographic (USG) examination, Teenage girl, Ovarian
Cancer

\textbf{Background}

A serous tumor~comprises of the~surface epithelial-stromal tumor~group
of~ovarian neoplasms, which mainly derived from~epithelium of mullerin.
They are mostly common~neoplasms~with a strong tendency to bilateralism.
They account for half of all ovarian tumors. Mostly 60\% of them are
mostly~benign~(cystadenoma) in nature and, 10\% of them are borderline
and 30\% part of them is~malignant~(cystadenocarcinoma) in nature.
Cystic lesions of the ovary are most common during infancy and
adolescence, which are hormonally active periods of development {[}1{]}.
Cysts are mostly non-neoplastic in children and could be categorized as
follicular, simple, and corpus luteum cysts. Ovarian cysts rarely grow
immense. Ultrasonography scanning permits early detection and
appropriate treatment. Occasionally, ovarian cysts reach enormous
dimensions without raising any symptoms. A few cases of giant ovarian
cysts have been sporadically reported in the literature {[}1{]}. We
presented a case of a huge papillary serous benign ovarian cyst in an
18-year old girl, with characteristics of ovarian serous cystadenoma
both grossly and microscopically.

\textbf{Case Presentation}

An 18 year old female patient was brought to the clinic with complain of
heaviness in abdomen and abdominal pain. On per abdominal examination
some cystic nonmobile mass was palpable up to 6cm above the umbilical
level. Vital were in normal range. On ultrasonographic examination
cystic mass of 17 x 10 x 8 cm was found. Right ovary was not seen
separately. Another 7 x 6 cm cystic swelling was found arising from left
ovary. Serum CEA and CA 125 was done \& found to be 1.29 and 14.9
respectively, which is within normal limits. After preoperative fitness
patient was taken to the operation theatre. Pfannenstiel incision was
given considering patient's age and cosmetic factors. With good
anesthetic support and muscle relaxation exteriorization of cystic mass
was possible. Mass was arising from the right side ovarian tissue and
right fallopian tube was stretched out over the mass like a very thin
strip. With skillful surgical technique the tube was gently separated
from the mass and the cystic mass of about 19 x 15 x10 cm was taken
(Figure-1). Right side ovary and tubes were preserved. The right
fallopian tube was stretched to about 18-20 cm long. Serosa of tube was
sutured with vicryl 4-0 in such a way that the tubal opening was bear
right ovary and towards the ovary. Skillful and sterile salpingopexy to
the ovarian tissue was done. On left side 8 x 7 cm cystic mass was
separated and tube and ovary was preserved, closure done and post
operative period was uneventful. Both cystic masses were sent for
histopathological examination which turned out to be bilateral benign
papillary serous tumors. Postoperative follow up after 1 week was done
and stitches removed. Patient resumed the routine activity.

\textbf{Discussion:} The most common clinical presentations of ovarian
cysts are abdominal pain, nausea and vomiting, and a history of previous
episodes of similar pain and low grade fever {[}4, 5{]}. In pubertal
girls, the differential diagnosis with functional cysts can involve some
delay. A functional cyst is mainly a unilocular and anechoic cyst with
thin borders. Second differential diagnoses of ovarian cysts are omental
cysts. Omental cysts occur in all age groups, but most often they
present in children and young adults. Other diagnoses may be mesenteric
cysts, cysts arising from retroperitoneal structures like pancreatic
pseudo cysts, urinary retention, bladder diverticulum, hydronephrosis,
cystic lymphangiomas, choledochal cysts, splenic cysts, multicystic
dysplastic kidney, gastrointestinal duplication cysts and large uterine
tumors {[}7{]}. Malignant transformation is not well known but clonal
origin of benign CA, borderline tumors and low-grade epithelial
carcinomas is suspected as differential {[}3{]}. Management of ovarian
cysts depends on the patient's age, the size and structure of the cyst
and menopausal status. Surgical management of cysts is by laparotomic or
laparoscopic cyst excision or cystectomy with oophorectomy. In addition,
the contralateral ovary should be examined and where it looks
suspicious, a frozen section will assist in deciding whether to remove
it or not {[}2, 6{]}. Some authors have emphasized that intact cyst
removal, with gradual rolling of the mass off the inferior vena cava, is
the optimal technique. On the contrary, Hunter \emph{et al.} have
reported that gradual decompression prevents rupture of the cyst capsule
and greater dissemination {[}8{]}. The potential complication of
repeated paracentesis is the intraperitoneal spillage of cyst
components. This could result in tumor seeding of the peritoneal cavity
or paracentesis tract if the cyst is malignant. Other complications
associated with repeated paracentesis include infection, bleeding, and
an increase in the number and density of peritoneal adhesions, making
eventual cyst removal even more difficult {[}9{]}. In the cases of
emergency surgery that do not allow waiting for results of tumor
markers, decision of choice, laparoscopy versus laparotomy, can be based
on size and structure of the enlarged ovary {[}1,9{]}. Low malignant
recurrences have been reported more than ten years after initial surgery
in the adult patient population, so it may be safe to assume that those
diagnosed in adolescence should be observed into adulthood. Although
adherence to long-term follow-up can be difficult, as evidenced by
patient who was lost to follow-up since years, this should not alter the
decision to perform a conservative surgical procedure in an attempt to
preserve a patient's fertility {[}10{]}. A gynecologist should go for
Histopathological evaluation and blood biochemistry must be done in case
of family history of any ovarian cancer. Germ cell tumors are the most
important causes for giant ovarian masses in children, but epithelial
tumors must not be forgotten in the differential diagnosis.

\textbf{Key Clinical Message:}

Ultrasonography should be done with patience to diagnose such uterine
cysts which are many a time avoided as normal cysts in early age or
teenage patient. Skillful and sterile surgical techniques must be used
to avoid early infertility chances and post partum depression at late
stage of surgery in teenage patients.

\textbf{Acknowledgement: None}

\textbf{Disclosure for informed Consent:}

Proper informed and written consent in local understandable language was
taken from the patient regarding publication of the same case.

\textbf{Funding:} None to Declare

\textbf{Author Contribution: Vishal Chavda (VC)} Prepared Case report,
analysed case report, finalised manuscript draft, Assisted in
anaesthesia, \textbf{Anand Bhatt (AB)} analysed final report, Performed
Gynaecological surgery.

\textbf{References:}

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\end{enumerate}\selectlanguage{english}
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