Large ovarian cystadenoma masked by obesity in a patient with graves' hyperthyroidism

Abstract

Ovarian tumors are a common entity in clinical practice. Tumors with an ovarian mass diameter exceeding 20 cm are termed giant ovarian tumors. Their prevalence is low, as most cases are diagnosed early during routine gynecological examinations or are incidental findings. A 34-year-old patient was admitted to the Clinic for Endocrinology for the initiation of a weight loss regimen and reevaluation of hyperthyroidism. She reported gaining about 70 kg since 2019, during which she was also diagnosed with hyperthyroidism. In September 2022 she underwent thyroid surgery (right lobe and isthmus removed); histopathology result: colloid cystic goiter, partly hyperplastic thyroid gland. Upon admission, her main complaints were abdominal pressure and shortness of breath. On examination, the patient was morbidly obese (BMI 62 kg/m²). Initial and repeated abdominal ultrasound showed a well-defined subcutaneous fluid collection measuring about 240 mm, creating cellulitis in the anterior abdominal wall. A gynecological examination revealed an anechoic formation measuring 110x80 mm behind and above the uterus. A CT scan of the abdomen without IV contrast showed a large cystic expansive tumor change in the right adnexa measuring 318x380x242mm with sharp contours, filled with serous fluid, and surrounded by a capsule, differential diagnosis: cystadenoma of the right ovary. The patient was presented to the Oncology and Radiology Institute of Serbia (IORS) for a multidisciplinary consultation, where it was decided to remove the tumor of the right ovary and the remaining left lobe of the thyroid gland in one operation. On September 21, 2023, the patient was operated at IORS, where the tumor weighing about 30 kg was removed. Histopathology results: 1. mucinous cystadenoma of the ovary; 2. colloid goiter micro and macrofollicular thyroid gland. Follow-up in January 2024 showed the patient without previously mentioned symptoms of dyspnea and abdominal pressure, with TSH 7.21, fT4 16.4 on a dose of 175mcg levothyroxine. The patient continued with a reduction diet at home.

Keywords

• hyperthyroidism
• obesity
• ovarian tumor