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We describe the perioperative management of a patient requiring removal of a 56.7-kg ovarian cystadenoma, highlighting our techniques in managing the changes in the patient's respiratory, vascular, renal, and gastrointestinal systems due to the large mass. An appreciation of the unique physiologic and anatomical changes in patients with large abdominal masses allows for appropriate precautions in the perioperative period.

This study was conducted to determine the efficacy of ultrasound in first-level screening for ovarian cancer. In the 5 years from 1996 to 2001, 4350 women, average age 49 years, were screened for the presence of ovarian cancer using transabdominal and transvaginal probes. There were 176 (4%) positive ultrasound results, which included 29 findings suspicious for malignancy and 147 indicative of benign conditions. Forty-five of these patients were treated surgically, 40 were treated medically, and 91 were not treated. Of the 45 patients who underwent surgery, 35 women were diagnosed with cystic lesions, including 3 functional, 11 simple, 17 endometriotic, 3 dermoid, and 1 multilocular ovarian cyst. Five patients were found to have an ovarian cystadenoma, two had cystoadenofibromas, and one each had an ovarian fibroma and borderline mucinous tumor. The one frankly malignant diagnosis was a Krukenberg tumor metastatic to the ovary from the intestinal tract. Follow-up has been by clinical visit or telephone call. There are no reports of ovarian cancers among the screened women who were followed without surgery. Twenty-four of the 40 patients treated medically have not returned after their treatment. They were contacted by phone and indicated no symptoms. Sixteen patients have been followed with regular clinical examination. The adnexal mass resolved in 11 patients, but 5 women have had a persistent abnormality. Surgical treatment has been scheduled for these five. Twenty-six of the 91 patients who had no treatment have been rescreened with ultrasound. The results were negative in 13 and positive in 13. The women with positive findings are scheduled to undergo treatment. Follow-up interviews were made for 42 of the remaining patients. They all report no symptoms. The other 23 are considered lost to follow-up.

Seventeen renal transplant patients with pelvic lymphatic fluid collections were treated with percutaneous drainage. Eleven of 16 patients with lymphoceles (69%) were successfully managed without surgery, although seven of these patients required repeat catheter insertions, and three patients developed local infections. The patient with an ovarian cystadenoma was treated with surgery. The mean duration of catheter insertion was ten days for initial drainage and 16 days for repeat drainage. Elevated serum creatinines decreased in 14 of the patients with lymphoceles (88%), including all five patients without pelvocaliectasis, but never returned to baseline in six instances. This observation may reflect the inadequate therapy of frequently encountered concurrent renal parenchymal abnormalities (rejection, cyclosporine toxicity, acute tubular necrosis). While percutaneous management of lymphoceles is technically easy and usually ultimately effective, the interventional radiologist should be prepared for long duration of catheter insertions, repeat interventions, and variable clinical courses. Differentiation of lymphoceles from other fluid collections, such as cystic ovarian neoplasms, may be difficult.

In a group of 59 patients over the age of 55 years with ovarian serous and mucinous cystadenomas, a total of 29 (49%) showed moderate or strong oestrogenic activity as determined by maturation index in vaginal cytologic smears, in contrast to nine (13%) of 70 control patients with other gynecological disorders than ovarian tumours. The bacterial flora was dominated by Doderlein type bacilli in 24 of the 27 test patients with an elevated maturation index, also reflecting the abnormal oestogenic activity in these patients. When the serous and mucinous cystadenoma groups were compared, a striking difference was found: of the 30 patients with mucinous cystadenomas, 23 (77%) displayed moderate of strong oestrogenic activity, while this was the case with only six (21%) of the 29 patients with serous cystadenomas. These findings stress the importance of an abnormal oestrogenic activity, revealed by an elevated cytologic maturation index, as memento for the possibility of post-menopausal ovarian cystadenoma.