Giant Seromucinous Adenofibroma Ovarian Cyst in Nulliparous Woman: A Rare Case Report of Clinical Dilemma and Surgical Challenges

Aim and background: An ovarian cyst is a fluid-filled structure over 3 cm in diameter, classified as simple or complex.Simple cysts can grow up to 10 cm and are usually benign, while complex cysts are more often linked to malignancy.Cysts larger than 10 cm are termed giant ovarian cysts (GOCs), but their nature is often difficult to determine due to their rarity.Case description: A 48-year-old nulliparous woman presented with a 10 years history of abdominal enlargement, with rapid progression over the past year.She arrived at the emergency department with anemia and urinary frequency following failed alternative treatments.Imaging showed a large hypoechoic abdominal mass with solid papillary components and bilateral hydronephrosis, requiring double J stent placement.She was stabilized with three units of packed red cells (PRCs), and cancer antigen-125 (CA-125) was 113.1 U/mL.Due to the patient's initial wish to preserve fertility, a unilateral salpingo-oophorectomy was performed.A GOC measuring 51 × 40 × 19 cm and weighing 38.46 kg was resected intact.Frozen section revealed a mucinous borderline tumor with microinvasion.Further exploration revealed uterine and mesorectal masses, prompting optimal debulking with assistance from a digestive surgeon.Conclusion: Giant ovarian cysts management depends on the patient's condition, but surgical plans may change intraoperatively.This case represents the largest reported ovarian cyst in Indonesia and one of the largest globally, with rare histopathology findings.Clinical significance: This case report demonstrates that GOCs are uncommon and often present challenges in management especially in a nulliparous woman.