Incidentally Discovered Giant Benign Ovarian Serous Cystadenoma in Elective Bariatric Surgery

TL;DR

A large benign ovarian tumor was discovered unexpectedly during bariatric surgery in an asymptomatic patient with obesity.

Contribution

Highlights the importance of thorough evaluation in obese patients to avoid misdiagnosis due to provider bias.

Findings

A giant ovarian serous cystadenoma was found incidentally during elective bariatric surgery in an asymptomatic patient.

Postoperative pathology confirmed the tumor was benign, emphasizing the need for comprehensive exams in obese individuals.

The case underscores how obesity-related biases may lead to overlooked diagnoses in healthcare.

Abstract

Ovarian cystadenomas are benign epithelial neoplasms, many of which are of the serous subtype. Most patients present with symptoms such as abdominal pain, bloating, and bladder issues. This patient, who had a BMI of 45, presented with a giant ovarian serous cystadenoma identified during an elective bariatric surgery; interestingly, she was completely asymptomatic at the time of discovery. A large, predominantly cystic pelvic mass with internal septations and soft tissue components, suspicious for ovarian neoplasm, was discovered on a CT abdomen and pelvis with IV contrast. She underwent an exploratory laparotomy with complete resection, right oophorectomy, and ovarian cystectomy. Her postoperative pathology report revealed the mass to be a benign serous cystadenoma. This case serves as an example of how a massive tumor can potentially get overlooked for many years, only to be detected unintentionally in an asymptomatic patient. Healthcare quality is often negatively impacted by the inherent prejudice that many healthcare providers have toward their obese patients. Providers may mistakenly over-attribute a patient’s symptoms to their obesity, failing to effectively evaluate the patient’s concerns, which could lead to overlooking potentially harmful diagnoses. A comprehensive history and physical exam in all patients, especially those who are obese, is vital in ensuring timely diagnosis and management to improve patient outcomes.

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