Recently, a "special" patient, Ms. RU, was presented at the clinic of the Interim Chair of SAHZU Gynecology Dr. ZHOU Jianwei.

 When Ms. RU walking into his clinic, as experienced as Dr. ZHOU, he was still stunned by the scene. Because Ms. RU had a rather big belly bulge as if she was about to labor. She told Dr. ZHOU that she was not pregnant at all but had something growing inside her.

The tumor even exceeds the CT scan range

Abnormal Belly Bulge

Two years ago, 33-year-old Ms. RU started to notice increased menstrual fluid volume and stomach size. She thought that she just ate too much and believed that bed rest could improve her condition.

However, her stomach continued to grow bigger, and she could even feel something hard to touch was inside. At this point, Ms. RU still decided to try her luck and didn't take it seriously, thinking she might be just overweight.

Six months ago, Ms. RU began to experience shortness of breath, chest tightness, double lower limbs edema and other symptoms. But again, she chose to put up with all her conditions until she finally couldn’t take it anymore this month.

She went for a physical examination in a local hospital where she found out she was not overweight at all, but having a huge mass inside her abdomen.

No one expected for this result.

Ms. RU was also diagnosed with other conditions, such as severe anemia and hypoproteinemia, due to the huge size of the abdominal mass.

Her condition is so complicated that if the slightest process went wrong during the mass removal surgery, cardiac arrest and even patient death may occur. Ms. RU was then referred to Dr. ZHOU and his team for advanced surgical treatment.

67.5kg Tumor

After thorough examinations at SAHZU, the tumor was considered to be mucinous cystadenoma arising from the left ovary.

The tumor caused multiple damages to Ms. RU’s health. Because of the lack of timely treatment, the hemorrhagic tumor induced severe anemia in her; Tumor depletion caused her malnutrition; The huge tumor size pushed the other internal organs out of place, elevated her diaphragm, and affected her cardiopulmonary function; Her constant bed rest resulted from her decreased ability to walk led to increased risks of complications such as blood clots.

The Gynecology Department therefore organized a preoperative multidisciplinary discussion with Anesthesiology, Intensive Care Unit, and Gastrointestinal Surgery. All departments schemed a best surgery plan to together guard her life and health.

During the surgery, it could be seen that the huge tumor has extensive adhesion with the greater omentum, retroperitoneum, and rectum-Sigmoid colon region. The abdominal vein was severely compressed too.

In order to prevent the risk of cardiac arrest caused by the sudden decrease of cardiac blood volume, the fluid in the tumor must be slowly released first, and then the adhesion between the tumor and surrounding tissues and organs must be carefully separated.

The surgeon would have to be extremely careful to identify the displaced organs due to the tumor, in order to prevent damages to the intestines, bladder, ureter, and blood vessels.

Four senior anesthesiologists were there in the operation room throughout the surgery, closely watching for possible risks such as low blood pressure, insufficient blood volume, or sudden cardiac arrest.

The tumor was completely removed in about 4 hours. Pathological examination proved that it was focal borderline mucinous cystadenoma with low-grade malignancy. The postoperative tumor weighs 67.5kg (about 150 pounds), being the largest and heaviest reported by Chinese surgeons to date.

Ms. RU had a well-managed recovery under the SAHZU nursing team and was discharged quickly. But she still has the hernia caused by the tumor and needs regular follow-ups to decide whether a repair surgery is necessary.

About Ovary Tumor

What is ovarian mucinous cystadenoma?

Ovarian mucinous cystadenoma usually is benign, accounting for 20-25% of all benign tumors of the ovary, mostly seen in women aged 30-50. Mucinous cystadenoma can grow very large, and if not treated in time, may turn malignant. “But such a huge tumor seen in this patient is a result of delayed treatment." Dr. ZHOU said.

What are the symptoms and signs of ovarian tumors?

(1) Discomfort in abdomen and bloating;

(2) Abdominal mass;

(3) Abdominal pain, low back pain, or lower limb pain due to compressed nerves;

(4) Compression symptoms, such as frequent urination, dysuria, constipation, shortness of breath, palpitations, due to the occupation of the pelvic cavity by the large tumor size;

(5) Menstrual disorders or abnormal uterine bleeding, or postmenopausal uterine bleeding;

(6) Symptoms of metastatic lesions, such as coughing up blood or breathing difficulties caused by lung metastasis, or stool change, bloody stool and bowel obstruction caused by intestinal metastasis, etc.

What tests can detect ovarian tumors?

(1) Ultrasound;

(2) Laboratory test: complete blood count and tumor marker tests;

(3) MRI or CT

Treatment Tips

Minimally invasive laparoscopic procedure can be performed to remove small ovarian tumors; If the ovarian tumor is larger than 10 centimeters, or if it is suspected of malignancy or has rich blood flow, it can only be removed through open surgery.

So according to gynecologists, every female should have regular physical examinations and go see a doctor in time if feeling unwell. It is suggested that gynecological ultrasound should be done every six months.