Giant Cystadenofibroma in an Octogenarian: Diagnostic Challenges and Surgical Decision-Making in the Context of Multiple Comorbidities

Background: Giant ovarian cystadenofibromas are rare benign epithelial tumors, and their occurrence in very elderly women is exceptional. In postmenopausal patients, adnexal masses carry a higher risk of malignancy, and diagnostic uncertainty, combined with advanced age and comorbidities, markedly complicates clinical management. Case Presentation: We report the case of an 82-year-old woman presenting with a three-month history of progressive abdominal distension, discomfort, constipation, urinary difficulty, early satiety, and weight loss. Imaging revealed a giant multilobulated cystic ovarian mass, classified O-RADS 3. Tumor markers (CA-125, CEA, CA19-9) were normal. Her medical history included poorly controlled hypertension and extrapulmonary tuberculosis under treatment. On admission, physical examination showed a markedly distended abdomen with a large palpable mass. Following multidisciplinary assessment and optimization, an exploratory laparotomy was performed. Three large multilobulated right ovarian cysts, the largest measuring approximately 35 × 32 cm, were removed, along with a hysterectomy. Postoperative recovery was complicated by transient anemia requiring transfusion. Histopathology confirmed a benign serous cystadenofibroma. The patient was discharged on postoperative day 7 with favorable outcomes. Conclusion: This case illustrates the diagnostic and therapeutic challenges of giant ovarian masses in frail elderly patients. Despite their benign nature, giant cystadenofibromas may mimic malignancy and require surgical intervention. Multidisciplinary preoperative assessment is essential to balance surgical benefits with the increased anesthetic and medical risks inherent to advanced age and comorbidities.