MUCINOUS OVARIAN CYST

VERY LARGE OVARIAN CYST- FIFTYEIGHT LBS

BENIGN MUCINOUS CYSTADENOMA.

Deena a thirty two year old very emaciated women came to our medical college from another state about 400 hundred miles away by train and then the three wheeler from the station. She was unable to get any treatment in her state. I wonder how she travelled. She was told that this tumour had become too big, and if they did anything she would die. Her family had heard of this new medical school. Therefore   she was brought to our very new medical college. This was in 1962, the college was very new. There were two lecturers, myself, who had just done her master of surgery after three years of graduation, which we could do after 3years, in those days, and another lecturer who was two years senior to me.

Deena came on my outpatient’s day so I took charge of her. Deena was young, skin and bones except for this very large ovarian cyst. It had been growing for the last six years. First the family thought that she was pregnant. She had had a baby six years ago when no baby arrived they started to get concerned.  There was no one to take her to the hospital.  Her husband was in the army and could not get leave. Any way when she saw me, she begged me to save her life for her son.

She had this very large ovarian cyst, and her total weight was 86kg I believe the cyst was about 50kgms. Her breathing was very shallow. A chest x-ray showed small lung capacity but, they were clear. Her Haemoglobin was 8 which was not too bad and her urine was clear. Ultrasound was not known in those days. I decided to operate on her.  I had to take consent from her and her family that if she died during the operation I would not be held responsible. I spoke the same language as Deena so I was able to explain everything to her in detail and reassure her.  My anaesthetist refused to anesthetise her, but he promised to be in theatre with me. It was difficult to put her straight on the table . We kept her upper body slightly raised. I gave her a local anaesthesia along the length of the cyst about 6cm long and made a tiny cut. It was great to notice that the cyst was multi loculated. Extremely carefully I aspirated hundreds of cysts so that they did not leak .After I had removed about thirty pounds of fluid from her cyst my anaesthetist was happy to anaesthetise her and relax her. I was able to put my hand in and feel around the cyst .The cyst was arising from the left ovary and was mobile. The ovary was totally gone the left tube was also destroyed. I put a catheter in her urinary bladder to protect it, and  extended the incision from just above the umbilicus to the pubic bone,  sealed or closed all the punctures I had made, and then very carefully removed the tumour with the tube ,of course the ovary was all incorporated in it. The right ovary and tube was normal. I made sure there was no spill. The weight of the remaining cyst was 28 ILBS. So the total weight of this cyst was 58 LBS. This meant that Deena weight was only 26 LBS, as the total weight preoperatively 86 LBS. I was very happy that the operation went very well. But then I had a big problem, how to close the belly. I had such large amount of Skin freely floating after being stretched for so long. I double breasted the muscles and the sheaths, cut the superfluous skin and stitched it in two layers. The sutures were removed after ten days. I kept the patient in hospital for two weeks to nourish her. The biopsy on the cyst confirmed it to be gigantic cyst adenoma without any evidence of malignancy.  Deena came to see me at three and six months. She was very well happy and grateful.

I earned a big name in town .Our photos were in the local papers.

Benign mucinous cyst adenomas of the ovary are common. They make up for 20 -25 % of all benign ovarian tumours occurring in 30 - 50 year old age group and they can, often be cancerous. Mucin is a protein produced by the epithelial cells of the baby, other organs such as pancreas; appendix and fingers can have this type of cyst. If ovarian mucinous cyst rupture they can cause mucinous deposits which can become a major problem .I have removed 100’s of mucinous ovarian cysts but never as big as this one.I have also seen an ovarian tumour in 1961 when a mucinous ovarian cyst must have ruptured, her abdominal cavity was full of mucinous cysts. We could not do anything for her. I wondered if they were cancerous as well.  My professor closed her without doing anything; she passed away a few days later.