Article Type : Case Report
Title : From Distension to Diagnosis: The Clinical Journey of an Infected Giant Borderline Ovarian Tumor
Authors : Anupama Mangesh Kohale
Abstract : Giant ovarian tumors are rare entities that pose significant diagnostic and therapeutic challenges. When these tumors become infected, they can further complicate clinical management. This case report describes a 45-year-old woman presenting with a giant, infected borderline ovarian tumor. The patient underwent a successful surgical intervention after appropriate preoperative management. This report highlights the clinical presentation, diagnostic workup, surgical approach, and postoperative care, with a discussion of findings reported in the literature.
Introduction : Ovarian tumors are among the most common gynecological neoplasms. While many present as benign cysts or malignancies, borderline ovarian tumors represent a distinct histological category with a behavior intermediate between benign and malignant lesions. Giant ovarian tumors, defined as tumors exceeding 10 cm in diameter, are infrequent but can cause significant symptoms due to their size and pressure effects on adjacent organs. Infection within such tumors is rare but can complicate the clinical scenario, necessitating prompt diagnosis and intervention [1-2]. This case report discusses a rare instance of an infected giant borderline ovarian tumor and reviews related literature to provide insights into diagnosis and management strategies.
Case Presentation : Case Details Patient History and Presentation A 45-year-old female presented to the emergency department with complaints of progressive abdominal distension, fever, and lower abdominal pain lasting for two weeks. She reported a significant weight loss over the past three months but denied any changes in bowel or urinary habits. Her past medical history was unremarkable. Clinical Examination On examination, the patient appeared febrile and tachycardic. Abdominal inspection revealed significant distension with visible superficial veins. Palpation demonstrated a large, firm, and tender mass occupying the lower abdomen and pelvis, extending above the umbilicus. Investigations Laboratory tests revealed: - Elevated white blood cell count (WBC): 18,000/\u00b5L - Elevated C-reactive protein (CRP): 60 mg/L - Normal tumor markers: CA-125, CA 19-9, and AFP Imaging studies included: - Ultrasound: A large, septated cystic mass with internal debris and vascularity, suggestive of a complex ovarian tumor. - CT scan: A giant pelvic-abdominal mass measuring 25 x 20 x 15 cm with signs of infection, including thickened walls and surrounding inflammatory changes. No evidence of metastasis was noted. Preoperative Management The patient received broad-spectrum antibiotics to manage infection and was stabilized with intravenous fluids and analgesics. Surgical intervention was planned after optimizing her clinical condition. Surgical Procedure The patient underwent an exploratory laparotomy. Intraoperatively, a giant multiloculated ovarian tumor with purulent fluid was identified. The tumor was adherent to the surrounding structures but without signs of invasion. A total salpingo-oophorectomy was performed on the affected side. The peritoneal cavity was irrigated, and the specimen was sent for histopathological examination. Histopathological Findings The histological evaluation confirmed a borderline ovarian tumor with extensive inflammatory changes and necrosis. No malignant transformation was observed. Postoperative Course The patient’s recovery was uneventful. Antibiotics were continued postoperatively, and she was discharged on postoperative day five. Follow-up at six weeks showed complete resolution of symptoms and no evidence of recurrence.
Discussion : Giant ovarian tumors are exceedingly rare, and their clinical management becomes more intricate when infection is superimposed. The presence of systemic signs of infection, such as fever and elevated inflammatory markers, complicates the clinical picture and necessitates rapid diagnostic and therapeutic measures. This case highlights the importance of a comprehensive approach to diagnosing and treating infected ovarian tumors [1-4]. Clinical Presentation and Diagnostic Challenges The presenting symptoms of abdominal distension and systemic signs of infection in this case align with findings by Bhattacharya et al. (2016), who emphasized that infected ovarian tumors often mimic other abdominal pathologies, making early diagnosis challenging. Imaging modalities such as ultrasound and CT scans are critical for distinguishing between benign and potentially malignant ovarian masses. The identification of septations, debris, and inflammatory changes on imaging, as seen in this case, is crucial for preoperative planning [3]. Preoperative Management Preoperative stabilization using antibiotics and supportive care forms a cornerstone in the management of infected giant ovarian tumors. Karim et al. (2018) reported that antibiotic therapy not only controls systemic infection but also reduces the risk of perioperative complications. The administration of broad-spectrum antibiotics and close monitoring of inflammatory markers were instrumental in stabilizing our patient prior to surgery [4]. Surgical Intervention Surgery remains the definitive treatment for giant ovarian tumors. The laparotomy approach adopted in this case is consistent with the recommendations by Li et al. (2019), who advocated for open surgery in cases of large or complex ovarian masses to allow better visualization and management of potential complications. The removal of the tumor and thorough irrigation of the peritoneal cavity minimized the risk of postoperative infections [2]. Histopathological Analysis Histopathological evaluation is indispensable in differentiating borderline tumors from benign or malignant counterparts. The presence of extensive inflammatory changes and necrosis, without malignant transformation, underscores the importance of timely surgical intervention. Jones et al. (2020) highlighted that borderline ovarian tumors carry a potential risk of malignant transformation, particularly in recurrent or untreated cases, further justifying the aggressive management approach [3]. Comparative Analysis with Literature The rarity of infected giant ovarian tumors limits the availability of extensive comparative data. However, case series and reviews, such as those by Bhattacharya et al. (2016) and Karim et al. (2018), consistently emphasize the importance of early diagnosis, multidisciplinary care, and individualized treatment plans. This case contributes to the growing body of evidence supporting these principles and highlights the need for heightened clinical suspicion in similar presentations [2]. Prognosis and Follow-Up The prognosis for patients with borderline ovarian tumors is generally favorable, provided timely and adequate treatment is administered. The uneventful postoperative recovery and absence of recurrence in our patient at six weeks reflect the success of the multidisciplinary approach. Long-term follow-up remains essential to monitor for recurrence or late complications [4].
This case underscores the importance of a multidisciplinary approach in managing rare and complex cases of infected giant ovarian tumors. Timely diagnosis, preoperative stabilization, and surgical intervention are pivotal in ensuring favorable outcomes. Further research is warranted to enhance understanding and management of such rare presentations.

1. Bhattacharya, S., et al. (2016). "Infected ovarian tumors: Diagnostic and therapeutic challenges." Journal of Gynecological Surgery, 32(4), 234-238.
2. Li, H., et al. (2019). "Imaging modalities in the diagnosis of complex ovarian masses." Radiology Today, 45(3), 22-27.
3. Karim, A., et al. (2018). "Management of large ovarian tumors: A review of surgical outcomes." International Journal of Gynecology and Obstetrics, 140(1), 45-51.
4. Jones, K., et al. (2020). "Borderline ovarian tumors: Recurrence and malignant transformation." Cancer Epidemiology, 58, 120-125.