Restoring Fertility: Excision of a Giant Ovarian Cyst in Women with Long-Standing Primary Infertility

Fitra Afdanil, Isny Novia Nurkharisma

Abstract


Background: Ovarian cysts are common in women of reproductive age and can vary from simple functional cysts to large benign or malignant neoplasms. Giant ovarian cysts are rare and may contribute to infertility due to mechanical and hormonal disruptions. Objective: To report the diagnosis and management of a giant ovarian cyst in a young woman with long-standing primary infertility, emphasising the importance of individualised surgical planning for fertility preservation. Case presentation: A 26-year-old nulligravida woman presented with progressive abdominal distension over three months. Imaging showed a 22 cm cystic adnexal mass with suspicious features and elevated CA-125 (84 U/mL). The patient underwent exploratory laparotomy and bilateral salpingo-oophorectomy. Histopathological examination confirmed a benign serous cystadenoma. The patient recovered well and was referred for fertility counselling. Conclusions: Early evaluation and careful management of large ovarian cysts are crucial in reproductive-age women with infertility. Although tumor markers and imaging guide diagnosis, histopathology is definitive. Surgical decisions must balance oncologic safety and fertility potential to optimise patient outcomes.


Keywords


CA-125, Fertility preservation, Giant ovarian cyst, Laparotomy, Primary infertility, Serous cystadenoma

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References


Albers, C. E., Ranjit, E., Sapra, A., Bhandari, P., & Wasey, W. (2020). Clinician Beware, Giant Ovarian Cysts are Elusive and Rare. In Cureus (Vol. 12, Issue 1, p. e6753). https://doi.org/10.7759/cureus.6753

Bašković, M., Habek, D., Zaninović, L., Milas, I., & Pogorelić, Z. (2025). The Evaluation, Diagnosis, and Management of Ovarian Cysts, Masses, and Their Complications in Fetuses, Infants, Children, and Adolescents. Healthcare (Switzerland), 13(7). https://doi.org/10.3390/healthcare13070775

Cheng, Y. (2021). Ovarian cysts. American Journal of Obstetrics and Gynecology, 225(5), B23–B25. https://doi.org/10.1016/j.ajog.2021.06.042

Corrias, F., Pederiva, F., Cozzi, G., Ammar, L., Cattaruzzi, E., Lembo, M. A., & Barbi, E. (2018). A Giant Ovarian Cyst in an Adolescent. Journal of Pediatrics, 199, 279. https://doi.org/10.1016/j.jpeds.2018.03.015

Farahani, L., Morgan, S., & Datta, S. (2017). Reprint of: Benign ovarian cysts. Obstetrics, Gynaecology and Reproductive Medicine, 27(7), 226–230. https://doi.org/10.1016/j.ogrm.2017.05.002

Hem avathy, V., Sathiyalathasarathi, & Gayathri, M. (2023). OVARIAN CYST : A LITERATURE REVIEW. Intermational Journal of Novel Research, 8(9), 663–666.

Huwidi, A., Abobrege, A., Assidi, M., Buhmeida, A., & Ermiah, E. (2022). Diagnostic value of risk of

malignancy index in the clinical evaluation of ovarian mass. Molecular and Clinical Oncology, 17(1), 118. https://doi.org/10.3892/mco.2022.2551

Kaur, N., & Ma, K. (2025). Benign ovarian cysts in premenopausal women. Obstetrics, Gynaecology & Reproductive Medicine, 35(1), 15–20.

https://doi.org/https://doi.org/10.1016/j.ogrm.2024.10.003

Khan, S. A., & Banoo, A. (2015). Role of colour doppler sonography in adnexal masses. International Journal of Medical Research & Health Sciences, 3(2), 233. https://doi.org/10.5958/j.2319-5886.3.2.051

Landolfo, C., Bourne, T., Froyman, W., Van Calster, B., Ceusters, J., Testa, A. C., Wynants, L., Sladkevicius, P., Van Holsbeke, C., Domali, E., Fruscio, R., Epstein, E., Franchi, D., Kudla, M. J., Chiappa, V., Alcazar, J. L., Leone, F. P. G., Buonomo, F., Coccia, M. E., … Valentin, L. (2023).

Benign descriptors and ADNEX in two-step strategy to estimate risk of malignancy in ovarian tumors: retrospective validation in IOTA5 multicenter cohort. Ultrasound in Obstetrics and Gynecology, 61(2), 231–242. https://doi.org/10.1002/uog.26080

Limaiem, F., & Mlika, M. (2023). Ovarian Cystadenoma. StatPearl Publishing. https://www.ncbi.nlm.nih.gov/books/NBK536950/

Liu, J. (2024). Ovarian Epithelial Carcinogenesis. In W. Zheng, O. Fadare, & C. M. Quick (Eds.), Gynecologic and Obstetric Pathology (pp. 1–29). Springer Nature Singapore. https://doi.org/10.1007/978-981-19-7696-4_4-1

Liu, S., Zeng, Q., Hu, L., Zeng, B., Wu, Y., Wang, C., Zhou, M., & Gan, X. (2025). Recurrent Giant Ovarian Cysts in Biological Sisters: 2 Case Reports and Literature Review—Giant Ovarian Cysts in 2 Sisters. Healthcare (Switzerland), 13(6), 1–11. https://doi.org/10.3390/healthcare13060656

Lotfy, A., Gonied, A., Mohamed, S., & Abd el monem, M. (2024). Effect of Ovarian Cysts on Women

Health Related Quality of Life. Zagazig Nursing Journal, 20(1), 81–93.

https://doi.org/10.21608/znj.2024.336837

Manodarshni, M., Pallavee, P., & Samal, R. (2023). Comparison of International Ovarian Tumor Analysis Simple Rules with Risk of Malignancy Index for Preoperative Differentiation of Benign and Malignant Adnexal Masses. Journal of South Asian Federation of Obstetrics and Gynaecology, 15(3), 321–325. https://doi.org/10.5005/jp-journals-10006-2258

Matalliotakis, M., Matalliotaki, C., Krithinakis, K., Laliotis, A., Kapetanios, G., Tsakiridis, I., & Kalogiannidis, I. (2023). Anatomic Distribution of Benign Ovarian Tumors in Perimenopausal and Postmenopausal Women. Cureus, 15(1), e34059. https://doi.org/10.7759/cureus.34059

Mobeen, S., & Apostol, R. (2022). Ovarian Cyst. In StatPearl Publishing.

Moss, E., Taylor, A., Andreou, A., Ang, C., Arora, R., Attygalle, A., Banerjee, S., Bowen, R., Buckley, L., Burbos, N., Coleridge, S., Edmondson, R., El-Bahrawy, M., Fotopoulou, C., Frost, J., Ganesan,

R., George, A., Hanna, L., Kaur, B., … Morrison, J. (2024). British Gynaecological Cancer Society (BGCS) ovarian, tubal and primary peritoneal cancer guidelines: Recommendations for

practice update 2024. European Journal of Obstetrics and Gynecology and Reproductive Biology, 300(June), 69–123. https://doi.org/10.1016/j.ejogrb.2024.06.025

Muhammad Yusuf, & Achmadi. (2022). Laporan Kasus: Kista Ovarium Permagna. Keluwih: Jurnal Kesehatan Dan Kedokteran, 4(1), 47–50. https://doi.org/10.24123/kesdok.v4i1.5301

Naz, R., Saeed, A., & Elcircevi, A. (2024). Case Study: Fetal Ovarian Cyst. Canadian Journal of Medical Sonography, 15(1), 17–21. https://doi.org/10.22374/cjms-2023-0055

Nur Syafiqa, A., Rosnani, Z., Noraini, M., Zainab, M. Y., & wan Aireene, W. A. (2023). A Huge Ovarian Cyst: Why was it Missed? IIUM Medical Journal Malaysia, 22(1), 99–102. https://doi.org/10.31436/imjm.v22i1.1901

Shih, I.-M., Wang, Y., & Wang, T.-L. (2021). The Origin of Ovarian Cancer Species and Precancerous Landscape. The American Journal of Pathology, 191(1), 26–39. https://doi.org/https://doi.org/10.1016/j.ajpath.2020.09.006

Smith, & Perry, R. (2024). Netter’s obstetrics & gynecology (4th editio). Elsevier Inc.

Solanki, K. G., Choudhary, N. V., & Gujrat, B. (2020). ROLE OF ULTRASONOGRAPHY & COLOUR DOPPLER IMAGING IN EVALUATION OF ADNEXAL MASSES Incharge HOD & Associate Professor , Department of Radiodiagnosis , Govt . Medical College and Sir T Hospital , 3 Year Resident , Department of Radiodiagnosis , Govt . Medica. International Journal of Medical and Biomedical Studies, 4(1), 187–191.

Timmerman, D., Planchamp, F., Bourne, T., Landolfo, C., du Bois, A., Chiva, L., Cibula, D., Concin, N., Fischerova, D., Froyman, W., Gallardo Madueño, G., Lemley, B., Loft, A., Mereu, L., Morice, P., Querleu, D., Testa, A. C., Vergote, I., Vandecaveye, V., … Fotopoulou, C. (2021). ESGO/ISUOG/IOTA/ESGE Consensus Statement on pre-operative diagnosis of ovarian tumors. International Journal of Gynecological Cancer, 31(7), 961–982. https://doi.org/https://doi.org/10.1136/ijgc-2021-002565

Zhang, S., Yu, S., Hou, W., Li, X., Ning, C., Wu, Y., Zhang, F., Jiao, Y. F., Lee, L. T. O., & Sun, L. (2019). Diagnostic extended usefulness of RMI: comparison of four risk of malignancy index in preoperative differentiation of borderline ovarian tumors and benign ovarian tumors. Journal of Ovarian Research, 12(1), 87. https://doi.org/10.1186/s13048-019-0568-3




DOI: http://dx.doi.org/10.30742/jikw.v14i2.4378

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