2015 Volume 67 Issue 1 Pages 14-20
A-55-year-old nulliparous postmenopausal woman visited our clinic complaining of three weeks of continuous abdominal pain and mild fever. Her past medical history included type2 diabetes mellitus, hypertension and left sided paralysis due to an old brain infarction. She was remarkably obese, her BMI was 47 and she had gained 30 kg in the past year. Ultrasonography detected a right ovarian cyst with a diameter of 20 cm, with massive ascites. Serum CA19-9 was 496 U/ml and CA125 was 238 U/ml. No malignant cells were detected during repeated aspiration cytology of ascites. Enhanced MRI of the pelvis showed the same findings as with ultrasonography. Cyst wall and visceral peritoneum were partially thickened and enhanced ; thus, ovarian cancer with carcinomatous peritonitis was included in differential diagnosis. Considering her multiple complications, we performed laparoscopic right adnexectomy for an operative diagnosis. We removed 22400 ml of reddish ascites from the peritoneal cavity. The ovary weighed 1180g, after removing 4200 ml brownish fluid in the tumor. The post operative course was routine and she was discharged seven days after the surgery without additional treatment. Histological diagnosis was an suspected endometriotic cyst of the ovary. This is a case report of a large ovarian cyst after menopause with massive ascites, mimicking malignancy. We successfully treated the case with laparoscopy, in spite of her multiple complications, including prominent obesity. Although we could find some reports of endometriotic cysts with ascites, this is possibly the first case of such tumor after menopause. [Adv Obstet Gynecol, 67 (1) : 14-20, 2015 (H27.2)]
