V A Postma1, J A Wegdam, I M C Janssen. 1. Department of Surgery, Rijnstate Hospital, Postbus 9555, 6800 TA Arnhem, The Netherlands. v.postma@student.kun.nl
Abstract
BACKGROUND: The differential diagnosis of unilocular intraabdominal cysts includes ovarian, gastrointestinal, urological, and lymphatic processes. They occur at all ages and can be benign or malignant. METHODS: We present a case of a 17-year-old female with asymptomatic abdominal distension. Ultrasonography (US) revealed a 20 x 21-cm unilocular cystic mass with smooth surface lining. Paracentesis was performed during diagnostic laparoscopy, recovering more than 7 L of clear fluid. The cyst and left adnex were completely removed laparoscopically and diagnosis of ovarian cystadenoma was made. The patient made a quick and uneventful recovery. CONCLUSIONS: In all cases of abdominal distension, US must be performed and a tumor marker profile consisting of AFP, LDH, testosterone, estradiol, and CA-125 must be established in order to differentiate between benign and malignant processes. When the latter is suspected, additional computerized tomographic scanning must be performed. In this case, a normal tumor marker profile and benign ultrasonographic appearance excluded the possibility of malignancy. Conventional treatment in these large cysts is laparotomy. We propose that complete laparoscopic drainage and extirpation should be the treatment of choice, regardless of cystic size.
BACKGROUND: The differential diagnosis of unilocular intraabdominal cysts includes ovarian, gastrointestinal, urological, and lymphatic processes. They occur at all ages and can be benign or malignant. METHODS: We present a case of a 17-year-old female with asymptomatic abdominal distension. Ultrasonography (US) revealed a 20 x 21-cm unilocular cystic mass with smooth surface lining. Paracentesis was performed during diagnostic laparoscopy, recovering more than 7 L of clear fluid. The cyst and left adnex were completely removed laparoscopically and diagnosis of ovarian cystadenoma was made. The patient made a quick and uneventful recovery. CONCLUSIONS: In all cases of abdominal distension, US must be performed and a tumor marker profile consisting of AFP, LDH, testosterone, estradiol, and CA-125 must be established in order to differentiate between benign and malignant processes. When the latter is suspected, additional computerized tomographic scanning must be performed. In this case, a normal tumor marker profile and benign ultrasonographic appearance excluded the possibility of malignancy. Conventional treatment in these large cysts is laparotomy. We propose that complete laparoscopic drainage and extirpation should be the treatment of choice, regardless of cystic size.