Pure Laparoscopic Treatment of a Rare Giant Post-Mesenteric Benign Ovarian Seromucinous Cystadenoma: A Case Report and Literature Review

Pure Laparoscopic Treatment of a Rare Giant Post-Mesenteric Benign Ovarian Seromucinous Cystadenoma: A Case Report and Literature Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Pure Laparoscopic Treatment of a Rare Giant Post-Mesenteric Benign Ovarian Seromucinous Cystadenoma: A Case Report and Literature Review Yifan Ye, He Liu, Rui Huang, NingBo Li, Yaling Tang, Hong Chen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5917786/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Ovarian seromucinous tumors, although relatively rare, represent a distinctive subset of ovarian neoplasms. These tumors are predominantly benign but carry a potential risk of malignant transformation over time. Early detection and management are crucial for improving outcomes. For large or complex masses, open surgery is preferred for better access and intraoperative histological assessment. However, with the advancement of laparoscopic techniques, minimally invasive surgery has emerged as a viable alternative for select patients, offering comparable efficacy, along with the advantages of reduced recovery times and minimal scarring. Case report: A 65-year-old female presented with a seven-month history of abdominal distension, a sensation of fullness beneath the xiphoid, left-sided discomfort, and intermittent morning cramping. Laboratory findings revealed a mild elevation in CA-125 to 46 U/mL, and CT imaging suggested a diagnosis of an ovarian cystadenoma or possibly a retroperitoneal mass. Preoperative assessment was complicated by the tumor's irregular shape, large size, and adhesions to nearby structures, making its origin unclear. A single-port laparoscopic approach was selected to minimize tissue damage, improve tumor handling, and reduce risks of fluid leakage or tumor spread. Postoperative pathology confirmed the lesion as a seromucinous ovarian cystadenoma. Conclusion This case emphasizes the need for a multidisciplinary approach in tumor diagnosis and treatment, highlighting the benefits of minimally invasive surgical techniques for better patient outcomes. Given the rarity of ovarian seromucinous tumors, continued research into their pathogenesis, classification, and treatment strategies is essential for advancing our understanding and optimizing management approaches for patients affected by these tumors. Laparoscopic Treatment Ovarian Seromucinous Cystadenoma Giant Cyst Post-Mesenteric Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Ovarian seromucinous tumors are a rare subtype of ovarian tumors( 1 ). The 2014 revision of the World Health Organization (WHO) Classification of Tumors of Female Reproductive Organs (4th edition) introduced notable updates to the classification of ovarian tumors, particularly within the category of epithelial tumors. This includes an update to the grading system for serous carcinoma and the introduction of a new morphological category, the seromucinous tumor( 2 ). In certain instances, these tumors are associated with the presence of endometriosis( 3 – 5 ). Like other ovarian epithelial tumors, ovarian seromucinous tumors can be categorized into three distinct types: benign, borderline, and invasive carcinoma( 2 , 6 ). This tumor was initially described in 2002 and is characterized by a unique histological composition, featuring both serous and mucinous (cervical-type) epithelial components. In some cases, the lesions may also display a variety of additional epithelial types, including transitional epithelium, squamous epithelium, clear cell epithelium, or endomerioid epithelium ( 7 ). The existing research on the biological characteristics, clinical progression, and standardized treatment strategies for this tumor remains limited, especially in the context of surgical management. Furthermore, literature regarding the application of laparoscopy in this field is also sparse. The patient was diagnosed with an ovarian seromucinous tumor, a diagnosis complicated by the tumor's irregular morphology, considerable dimensions, and extensive adhesions to adjacent structures. A single-port laparoscopic technique was selected to minimize tissue trauma and diminish the risk of tumor dissemination. Postoperative pathology confirmed the presence of a seromucinous ovarian cystadenoma, with no definitive indicators of malignancy. Nevertheless, vigilant monitoring and follow-up remain imperative due to potential associated risks. Case presentation A 65-year-old female patient presented with a gradual increase in abdominal circumference over the past seven months, along with progressively worsening sensations of fullness beneath the xiphoid process, left-sided abdominal discomfort, and intermittent morning cramping. The ultrasound examination identified a cystic mass located within the pelvic and abdominal regions, measuring approximately 32 cm × 33 cm. The mass was characterized by well-defined borders and displayed low echogenicity. Following the initial finding, the patient was referred to our institution for further evaluation. On physical examination, significant abdominal distention was noted, along with a markedly thin abdominal wall. Palpation revealed the upper edge of the mass located just below the xiphoid process. Notably, no shifting dullness was observed upon percussion. The tumor marker CA-125 is mildly elevated at 46.0 U/mL, while all other tumor markers remain within normal limits. Gastrointestinal endoscopy has excluded any digestive tract-related pathology. As shown in Fig. 1, further assessment with both plain and contrast-enhanced CT imaging revealed a large lesion in the pelvic cavity, measuring approximately 22.8 cm × 12.4 cm× 30 cm, with separation echo inside. On contrast-enhanced CT scans, the solid portions and septal regions showed enhancement, whereas the cystic areas appeared non-enhancing. The preoperative diagnosis was highly suggestive of either an ovarian cystadenoma or a retroperitoneal mass. After thoroughly discussing the condition with the patient and excluding any contraindications, a single-port laparoscopic exploration was performed. This approach was selected to minimize the likelihood of requiring conversion to an open abdominal incision should the surgery prove challenging. A 2 cm incision was made at the umbilicus, followed by careful, layer-by-layer dissection to access the abdominal cavity. A 60mm single-use incision fixation retractor was subsequently placed to ensure optimal visualization and access throughout the procedure. The laparoscopic examination revealed a large cystic mass exhibiting high tension, a smooth surface, and clear fluid content. Due to limited visibility of the pelvic and abdominal cavity, it was not possible to definitively ascertain whether the mass originated from the pelvic region or the retroperitoneum. To enhance the operative field and gain a clearer understanding of the mass's source, we cautiously elevated the mass through an umbilical incision. The cyst wall was subsequently sutured using a purse-string technique, effectively sealing the outlet to prevent fluid leakage and mitigate the risk of spillage during the procedure (Fig. 2). As shown in Fig. 3A, the negative pressure suction device was connected to the 5mm abdominal laparoscopic trocar's insufflation port. A puncture needle was carefully inserted to puncture the cyst wall, allowing for controlled aspiration while maintaining stable vital signs. This technique effectively minimized the risk of cyst fluid leakage and iatrogenic dissemination. Approximately 5000 mL of cystic fluid was aspirated in a slow and controlled manner. Upon complete aspiration, the puncture site was carefully sutured (Fig. 3B, C, D). Upon re-examination with the laparoscope, it was noted that the patient had a history of abdominal hysterectomy due to uterine fibroids. Dense adhesions involving the bowel and part of the omentum were observed, resulting in a closed pelvic and abdominal cavity. As a result, the large ovarian cyst had extended upward into the posterior mesentery and other expandable areas, presenting as a mass resembling a retroperitoneal tumor. Our surgical team meticulously separated the adhesions and proceeded with the excision of both adnexa for pathological evaluation. The intraoperative frozen section pathology confirmed the presence of a mucinous tumor of the ovary. Following informed consent from the family, the appendix was also removed for further examination. The postoperative pathology report confirmed the diagnosis of an ovarian seromucinous cystadenoma. As shown in Fig. 4A, immunohistochemical analysis revealed the following marker profile: CK7 (+), CK20 (partial +), PAX-8 (+), ER (-), CDX-2 (+), MUC5AC (+), HNF4a (+), and Ki67 (+) at 1%. Special staining techniques demonstrated mucin positivity, as evidenced by both Alcian Blue (AB) and Periodic Acid-Schiff (PAS) stains (Fig. 4B). The patient experienced an uneventful postoperative course, with a smooth recovery, and was discharged on the third day following surgery. Discussion The ovarian seromucinous tumors is a rare and distinct subtype of ovarian epithelial tumor, characterized by the coexistence of both serous and mucinous epithelial components. This tumor is notable for its unique histological features, which result from the fusion of two different types of epithelial tissue( 1 , 6 ). Ovarian seromucinous tumors, first described by Shappell HW et al. in 2002, present intricate diagnostic challenges. Their comprehensive study of 54 cases elucidated a range of histological features, including the presence of papillary structures and two distinct types of epithelial cells: the ciliated serous epithelium and the cervical mucinous epithelium. Accurate diagnosis hinges on the meticulous evaluation of the morphological characteristics of the tumor cells, particularly the differentiation of epithelial cell types and the organization of glandular structures(7). In 2014, the World Health Organization (WHO) implemented an important revision to the classification of ovarian tumors, reclassifying them under the category of seromucinous tumors ( 2 ). This revision highlighted the unique histological features and clinical manifestations of these tumors, fostering a more refined and comprehensive understanding that enhances the approach to the diagnosis. Robert J. Kurman and Ie-Ming Shih have contended that while the WHO's revised classification of seromucinous tumors has contributed to a broader understanding of this tumor category, it nonetheless presents several limitations. In their view, it does not entirely capture the distinctive pathological features that define this particular tumor type. These tumors encompass a variety of epithelial types, including serous epithelium, endometrioid glandular mucinous epithelium, cervical-type mucinous epithelium, endometrial-type epithelium, undifferentiated epithelium, and squamous epithelium. These tumors frequently demonstrate positive expression of estrogen receptor (ER) and progesterone receptor (PR). However, their expression of WT1 is generally weak, and they are negative for CK20 and CDX2. This immunophenotypic profile is distinctly characteristic of the Müllerian tube immunophenotype. Further observations have indicated that ovarian seromucinous tumors often coexist with endometriosis, a factor that significantly influences their clinical manifestation. This association leads to a clinical presentation that bears a closer resemblance to that of endometrioid tumors, including both endometrioid and clear cell variants. This contrasts with the clinical characteristics typically associated with traditional serous or intestinal-type mucinous tumors. It is important to emphasize that a significant proportion of ovarian seromucinous tumors demonstrate a loss of ARID1A gene expression( 8 ). This mutation is predominantly observed in approximately 50% of endometrioid and clear cell tumors, while remaining relatively rare in serous or intestinal-type mucinous tumors. Owing to their distinct clinical, pathological, and molecular characteristics, researchers have advocated for the reclassification of these lesions as mixed Müllerian tumors. Within this proposed classification, potential subtypes such as mixed Müllerian cystadenoma, mixed Müllerian atypical hyperplasia (borderline), and mixed Müllerian carcinoma are suggested, aiming to more accurately reflect their unique attributes and divergent biological behaviors( 9 – 11 ). In the 2020 edition of the WHO Classification of Tumors of the Female Reproductive Organs , ovarian seromucinous tumor is no longer regarded as a distinct pathological entity. It has instead been reclassified as a subtype of endometrioid carcinoma( 2 ). In a 2018 study involving 340 patients with endometrial cancer, a comprehensive analysis of the pathological features of tumors was performed. The findings indicated that 31 patients (9.1% of the total cohort) presented with tumors containing a serous-mucinous component in conjunction with endometrial cancer. Further investigation revealed that patients with the serous-mucinous component exhibited significantly improved progression-free survival (PFS) compared to those without this component( 12 ). These results provide important insights into the clinical characteristics and prognostic factors associated with such tumors. The ovarian seromucinous tumors are considered to be quite rare, and as a result, epidemiological data regarding the incidence remains limited. However, existing studies indicate that these tumors predominantly occur in adults, with a higher prevalence observed in women, particularly those of reproductive age or older( 2 , 13 ). Our case report pertained to a 65-year-old postmenopausal female patient. The clinical manifestations and signs of this patient have nonspecific characteristics, primarily including lower abdominal pain and abdominal distension. Similar nonspecific symptoms have been reported in related literature( 2 , 9 ). The patient presented with symptoms including abdominal bloating, left-sided discomfort, and intermittent morning abdominal pain. Although these symptoms were relatively nonspecific, they warranted further investigation, as they could indicate the presence of an ovarian mass. Imaging scans revealed a large cystic mass with well-defined borders in the abdomen, with the solid component showing enhancement on contrast-enhanced CT scans. The initial preoperative diagnosis considered differential possibilities, including an ovarian cystadenoma or a retroperitoneal mass. However, this case has underscored the diagnostic challenges associated with ovarian seromucinous tumor, particularly when the mass is irregularly shaped or located in the pelvic region, complicating precise localization. Moreover, due to the tumor's adhesions to surrounding tissues and its large size, the mass displayed characteristics resembling a retroperitoneal tumor, further complicating the preoperative diagnosis and clinical decision-making process. In this case we reported, the tumor measured 22.8 cm × 12.4 cm × 30 cm, indicating a relatively large tumor volume. Retrospective analyses of multiple ovarian seromucinous tumors have demonstrated considerable variation in tumor size, with the smallest tumors measuring 1.8 cm and the largest reaching up to 18 cm. Research data indicates that the average size of ovarian seromucinous tumors varies across different studies, with reported averages ranging from 9.3 cm to 10.5 cm and 12 cm( 4 , 14 , 15 ). These findings not only highlight the variability in tumor size among patients but also serve as important considerations for clinicians when evaluating the benign or malignant nature of ovarian tumors and determining appropriate treatment strategies. Larger tumors are frequently associated with symptoms such as abdominal distension, pain, or compression, and may, in some cases, lead to complications such as bowel obstruction or urinary symptoms. Early detection and precise assessment of tumor size enable clinicians to more effectively evaluate the feasibility of surgical resection and its associated risks, facilitating more personalized treatment decisions. In a series of reports, cases initially diagnosed with seromucinous tumors of the ovaries often exhibited papillomatous protrusions on the inner surface of the cyst( 2 , 6 ). To further investigate the clinical significance of this feature, a retrospective study was conducted, analyzing the imaging findings of 10 patients. The results indicated that while 9 tumors presented smooth exteriors and relatively regular cystic structures, 6 cases exhibited prominent papillomatous protrusions on the inner surface. This distinctive feature, the presence of papillomatous protrusions, may serve as an indicator of potential malignant transformation. These findings suggest that the biological behavior of the tumor could be more complex than previously assumed, potentially linked to factors such as tumor cell differentiation, proliferation rate, and metastatic potential. Consequently, the identification of papillomatous protrusions could provide valuable clinical insights for both the diagnosis and prognostic evaluation of seromucinous tumors of the ovaries. Ovarian seromucinous tumors are relatively uncommon ovarian neoplasms, generally presenting as benign, though they carry a certain risk of malignant transformation( 4 , 6 , 11 ). Early detection and appropriate management are essential to optimize patient outcomes. Currently, no standardized surgical treatment protocol exists; management is tailored to the individual patient's condition, considering factors such as tumor size, location, and its impact on surrounding structures(6). For larger or more complex ovarian masses, surgical intervention typically involves open surgery. This approach provides greater access to the tumor, facilitating thorough removal and enabling intraoperative assessment of the tumor’s characteristics( 16 ). However, with advancements in medical technology, particularly in laparoscopic techniques, minimally invasive surgery has become increasingly favored for a growing number of patients. Laparoscopic surgery offers several benefits, including smaller incisions, reduced intraoperative trauma, and enhanced precision in tumor excision, aided by high-definition endoscopic visualization. Compared to conventional open surgery, laparoscopic techniques provide notable advantages, such as shorter recovery times, reduced postoperative pain, and a shorter hospital stay, all of which contribute to improved patient outcomes and quality of life( 17 – 21 ). During the laparoscopic procedure, we encountered a tense cyst containing clear fluid. To effectively seal the cyst wall and mitigate the risk of fluid leakage and potential dissemination of malignant cells, we employed the suture ring technique. In an effort to minimize surgical risks, we meticulously aspirated the fluid utilizing controlled suction. This method proves especially advantageous in the management of large ovarian cysts, as it not only reduces the risk of abdominal contamination but also aids in preventing intraoperative complications. Abdominal adhesions from the patient's prior hysterectomy complicated surgical management, making tumor origin identification challenging. Meticulous dissection was required to separate the adhesions. The tumor and both adnexa were successfully excised and sent for pathology, with an appendectomy performed during the procedure. The patient had a smooth postoperative recovery, but long-term follow-up is essential for serous mucinous ovarian tumors due to recurrence risks. The role of laparoscopy in managing these tumors is evolving, necessitating further research to establish standardized treatment protocols for complex cases. Conclusions Ovarian seromucinous tumors are rare and complex entities, often presenting as large masses that pose significant diagnostic challenges. The application of minimally invasive surgical techniques, such as single-port laparoscopic surgery, can reduce tissue damage, expedite postoperative recovery, and minimize complication risks. However, achieving successful treatment outcomes requires precise preoperative evaluation, meticulous surgical technique, and comprehensive pathological assessment. Continuous postoperative surveillance is crucial for early detection of recurrence or malignant transformation due to limited clinical data. Declarations Acknowledgements None. Authors' contributions Yifan Ye, He Liu, Rui Huang, NingBo Li acquired the medical report and data from the patient. Yaling Tang and Hong Chen revised the final manuscript. All authors read and approved the final paper. Funding This work supported by the Natural Science Foundation of Fujian Province, China (Grant No. 2022J05310). Ethics approval and consent to participate The article has been submitted with the patient's consent and conducted in accordance with the Declaration of Helsinki for research purposes. Consent for publication Written informed consent was obtained from the patient about publication of this case report. Competing interests The authors declare that they have no competing interests. References Taylor J, McCluggage WG (2015) Ovarian seromucinous carcinoma: report of a series of a newly categorized and uncommon neoplasm. Am J Surg Pathol 39(7):983–992. 10.1097/PAS.0000000000000405 Idrees R, Din NU, Siddique S, Fatima S, Abdul-Ghafar J, Ahmad Z (2021) Ovarian seromucinous tumors: clinicopathological features of 10 cases with a detailed review of the literature. 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Diagnostics (Basel) 10(2). 10.3390/diagnostics10020077 Shappell HW, Riopel MA, Smith Sehdev AE, Ronnett BM, Kurman RJ (2002) Diagnostic criteria and behavior of ovarian seromucinous (endocervical-type mucinous and mixed cell-type) tumors: atypical proliferative (borderline) tumors, intraepithelial, microinvasive, and invasive carcinomas. Am J Surg Pathol 26(12):1529–1541. 10.1097/00000478-200212000-00001 Ok Atilgan A, Ozen O, Haberal Reyhan AN, Ayhan A (2023) Clinicopathologic Features and the Loss of ARID1A Expression in Ovarian Seromucinous Borderline Tumors and Seromucinous Carcinomas. Int J Surg Pathol 31(4):398–408. 10.1177/10668969221134695 Kurman RJ, Shih Ie M (2016) Seromucinous Tumors of the Ovary. What's in a Name? Int J Gynecol Pathol 35(1):78–81. 10.1097/PGP.0000000000000266 Nagayoshi Y, Yamada K, Kiyokawa T, Fukasawa N, Kuroda T, Noguchi D et al (2023) Clinical Features of Borderline Ovarian Seromucinous Tumor. 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Cureus 15(1):e33901. 10.7759/cureus.33901 Jiang L, Zhao X, Han Y, Liu K, Meng X (2021) Giant Ovarian Cysts Treated by Single-Port Laparoscopic Surgery: A Case Series. Front Oncol 11:796330. 10.3389/fonc.2021.796330 Droste A, Anic K, Hasenburg A (2022) Laparoscopic Surgery for Ovarian Neoplasms - What is Possible, What is Useful? Geburtshilfe Frauenheilkd 82(12):1368–1377. 10.1055/a-1787-9144 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5917786","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":408212354,"identity":"ca5d8824-1522-43b8-988d-dd8f19f3aa20","order_by":0,"name":"Yifan Ye","email":"","orcid":"","institution":"Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yifan","middleName":"","lastName":"Ye","suffix":""},{"id":408212355,"identity":"e49e5b2e-1928-49a6-982d-37f20f4e32da","order_by":1,"name":"He Liu","email":"","orcid":"","institution":"The First Affiliated Hospital of Chongqing Medical University","correspondingAuthor":false,"prefix":"","firstName":"He","middleName":"","lastName":"Liu","suffix":""},{"id":408212356,"identity":"d70f2cf6-9a99-422e-b950-bcc50d57e563","order_by":2,"name":"Rui Huang","email":"","orcid":"","institution":"The First Affiliated Hospital of Xiamen University","correspondingAuthor":false,"prefix":"","firstName":"Rui","middleName":"","lastName":"Huang","suffix":""},{"id":408212357,"identity":"bb2c3ee6-86c2-4355-859c-24957161ebf8","order_by":3,"name":"NingBo Li","email":"","orcid":"","institution":"The First Affiliated Hospital of Xiamen University","correspondingAuthor":false,"prefix":"","firstName":"NingBo","middleName":"","lastName":"Li","suffix":""},{"id":408212358,"identity":"9fec75b7-9685-4a68-8423-591903a40ff3","order_by":4,"name":"Yaling Tang","email":"","orcid":"","institution":"The First Affiliated Hospital of Xiamen University","correspondingAuthor":false,"prefix":"","firstName":"Yaling","middleName":"","lastName":"Tang","suffix":""},{"id":408212359,"identity":"1d02d9ac-b180-4943-926c-d9eeb42f014e","order_by":5,"name":"Hong Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA30lEQVRIiWNgGAWjYBACxmYYi5n54IOEihpStLC3JRs8OHOMFPt4zphJPmxhJqyQuZ352cOvbXZ58hE5ZhWJDWwM/O3dCQQcxmZuLNuWXGx4I63sRuIOGQaJM2c3ENDCYCYt2cacuHFG8rYbiWfYGAwkcglpYf8G1FIP1JJgVpDYxkyMFh4zyY9thxPn8xwxYyBWS5k0w7njiRuAgSyRcOYYD0G/GPYf3yb5o6w6cX4z88GPPypq5PjbewloaQAGNA+QYXAAIsCDVzkIyIMc9wPEaCCodhSMglEwCkYqAAB8Q0ofRb+mtwAAAABJRU5ErkJggg==","orcid":"","institution":"The First Affiliated Hospital of Xiamen University","correspondingAuthor":true,"prefix":"","firstName":"Hong","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2025-01-28 10:08:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5917786/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5917786/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":75188219,"identity":"7bd1f8da-899f-49cd-b0fd-4890f9d29432","added_by":"auto","created_at":"2025-01-31 18:00:41","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":5238632,"visible":true,"origin":"","legend":"\u003cp\u003eCT imaging demonstrated a substantial lesion within the pelvic cavity, measuring approximately 22.8 cm × 12.4 cm × 30 cm, suggesting a complex internal structure.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5917786/v1/7cb1f838fbbcf2fee70c6dc2.jpg"},{"id":75188215,"identity":"a9f68381-87e6-4433-b786-291f55e691ef","added_by":"auto","created_at":"2025-01-31 18:00:40","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":2055650,"visible":true,"origin":"","legend":"\u003cp\u003eSuturing of the cyst wall using a purse-string technique. A. The cyst wall was meticulously sutured utilizing a purse-string technique, ensuring the outlet was securely sealed. This approach effectively prevented fluid leakage and minimized the risk of spillage throughout the procedure. B. The diagram demonstrates the suturing of the cyst wall.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5917786/v1/dc51a0400517e47cf7a54b77.jpg"},{"id":75188220,"identity":"adb67902-0d6c-4674-b9dd-dfbedf1906b3","added_by":"auto","created_at":"2025-01-31 18:00:41","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":10359521,"visible":true,"origin":"","legend":"\u003cp\u003eIllustration of the connection between the negative pressure suction device and the 5mm abdominal laparoscopic trocar's insufflation port. A\u003cstrong\u003e:\u003c/strong\u003e The controlled aspiration of cystic fluid was achieved through the precise insertion of a puncture needle, effectively minimizing the risk of fluid leakage and iatrogenic dissemination. Approximately 5000 mL of cystic fluid was aspirated in a slow, methodical manner to ensure safety and efficacy. B-D\u003cstrong\u003e: \u003c/strong\u003eDepiction of the final puncture site closure, with suturing performed after the complete aspiration of the cystic fluid.\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5917786/v1/95ba67e6bac96794e6ab87d6.jpg"},{"id":75188221,"identity":"da697506-1695-4064-8956-eb28d95e617b","added_by":"auto","created_at":"2025-01-31 18:00:41","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":29924859,"visible":true,"origin":"","legend":"\u003cp\u003eImmunohistochemical and Special Staining Analysis. A. The\u003cem\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/em\u003e\u003cem\u003ehe\u003c/em\u003ematoxylin-eosin staining andimmunohistochemical marker profile reveals positive expression of CK7, partial positivity for CK20, and strong expression of PAX-8, CDX-2, MUC5AC, and HNF4a. Additionally, ER is negative, and Ki67 demonstrates a proliferation index of 1%. B\u003cstrong\u003e.\u003c/strong\u003e Special staining techniques, including Alcian Blue (AB) and Periodic Acid-Schiff (PAS) stains, confirm the presence of mucin positivity.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-5917786/v1/05bbb16e8b5f3dd6cbec83b3.png"},{"id":75564517,"identity":"21bdb055-b191-4a33-9bd0-432d7029cc5c","added_by":"auto","created_at":"2025-02-06 01:31:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":76430487,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5917786/v1/226615af-d7b2-4ce2-bfc3-2136f0665972.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Pure Laparoscopic Treatment of a Rare Giant Post-Mesenteric Benign Ovarian Seromucinous Cystadenoma: A Case Report and Literature Review","fulltext":[{"header":"Background","content":"\u003cp\u003eOvarian seromucinous tumors are a rare subtype of ovarian tumors(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The 2014 revision of the \u003cem\u003eWorld Health Organization (WHO) Classification of Tumors of Female Reproductive Organs\u003c/em\u003e (4th edition) introduced notable updates to the classification of ovarian tumors, particularly within the category of epithelial tumors. This includes an update to the grading system for serous carcinoma and the introduction of a new morphological category, the seromucinous tumor(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In certain instances, these tumors are associated with the presence of endometriosis(\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Like other ovarian epithelial tumors, ovarian seromucinous tumors can be categorized into three distinct types: benign, borderline, and invasive carcinoma(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). This tumor was initially described in 2002 and is characterized by a unique histological composition, featuring both serous and mucinous (cervical-type) epithelial components. In some cases, the lesions may also display a variety of additional epithelial types, including transitional epithelium, squamous epithelium, clear cell epithelium, or endomerioid epithelium (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The existing research on the biological characteristics, clinical progression, and standardized treatment strategies for this tumor remains limited, especially in the context of surgical management. Furthermore, literature regarding the application of laparoscopy in this field is also sparse.\u003c/p\u003e \u003cp\u003eThe patient was diagnosed with an ovarian seromucinous tumor, a diagnosis complicated by the tumor's irregular morphology, considerable dimensions, and extensive adhesions to adjacent structures. A single-port laparoscopic technique was selected to minimize tissue trauma and diminish the risk of tumor dissemination. Postoperative pathology confirmed the presence of a seromucinous ovarian cystadenoma, with no definitive indicators of malignancy. Nevertheless, vigilant monitoring and follow-up remain imperative due to potential associated risks.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 65-year-old female patient presented with a gradual increase in abdominal circumference over the past seven months, along with progressively worsening sensations of fullness beneath the xiphoid process, left-sided abdominal discomfort, and intermittent morning cramping. The ultrasound examination identified a cystic mass located within the pelvic and abdominal regions, measuring approximately 32 cm \u0026times; 33 cm. The mass was characterized by well-defined borders and displayed low echogenicity. Following the initial finding, the patient was referred to our institution for further evaluation. On physical examination, significant abdominal distention was noted, along with a markedly thin abdominal wall. Palpation revealed the upper edge of the mass located just below the xiphoid process. Notably, no shifting dullness was observed upon percussion. The tumor marker CA-125 is mildly elevated at 46.0 U/mL, while all other tumor markers remain within normal limits. Gastrointestinal endoscopy has excluded any digestive tract-related pathology. As shown in Fig.\u0026nbsp;1, further assessment with both plain and contrast-enhanced CT imaging revealed a large lesion in the pelvic cavity, measuring approximately 22.8 cm \u0026times; 12.4 cm\u0026times; 30 cm, with separation echo inside. On contrast-enhanced CT scans, the solid portions and septal regions showed enhancement, whereas the cystic areas appeared non-enhancing.\u003c/p\u003e \u003cp\u003eThe preoperative diagnosis was highly suggestive of either an ovarian cystadenoma or a retroperitoneal mass. After thoroughly discussing the condition with the patient and excluding any contraindications, a single-port laparoscopic exploration was performed. This approach was selected to minimize the likelihood of requiring conversion to an open abdominal incision should the surgery prove challenging. A 2 cm incision was made at the umbilicus, followed by careful, layer-by-layer dissection to access the abdominal cavity. A 60mm single-use incision fixation retractor was subsequently placed to ensure optimal visualization and access throughout the procedure.\u003c/p\u003e \u003cp\u003eThe laparoscopic examination revealed a large cystic mass exhibiting high tension, a smooth surface, and clear fluid content. Due to limited visibility of the pelvic and abdominal cavity, it was not possible to definitively ascertain whether the mass originated from the pelvic region or the retroperitoneum. To enhance the operative field and gain a clearer understanding of the mass's source, we cautiously elevated the mass through an umbilical incision. The cyst wall was subsequently sutured using a purse-string technique, effectively sealing the outlet to prevent fluid leakage and mitigate the risk of spillage during the procedure (Fig.\u0026nbsp;2). As shown in Fig.\u0026nbsp;3A, the negative pressure suction device was connected to the 5mm abdominal laparoscopic trocar's insufflation port. A puncture needle was carefully inserted to puncture the cyst wall, allowing for controlled aspiration while maintaining stable vital signs. This technique effectively minimized the risk of cyst fluid leakage and iatrogenic dissemination. Approximately 5000 mL of cystic fluid was aspirated in a slow and controlled manner. Upon complete aspiration, the puncture site was carefully sutured (Fig.\u0026nbsp;3B, C, D). Upon re-examination with the laparoscope, it was noted that the patient had a history of abdominal hysterectomy due to uterine fibroids. Dense adhesions involving the bowel and part of the omentum were observed, resulting in a closed pelvic and abdominal cavity. As a result, the large ovarian cyst had extended upward into the posterior mesentery and other expandable areas, presenting as a mass resembling a retroperitoneal tumor. Our surgical team meticulously separated the adhesions and proceeded with the excision of both adnexa for pathological evaluation. The intraoperative frozen section pathology confirmed the presence of a mucinous tumor of the ovary. Following informed consent from the family, the appendix was also removed for further examination. The postoperative pathology report confirmed the diagnosis of an ovarian seromucinous cystadenoma. As shown in Fig.\u0026nbsp;4A, immunohistochemical analysis revealed the following marker profile: CK7 (+), CK20 (partial +), PAX-8 (+), ER (-), CDX-2 (+), MUC5AC (+), HNF4a (+), and Ki67 (+) at 1%. Special staining techniques demonstrated mucin positivity, as evidenced by both Alcian Blue (AB) and Periodic Acid-Schiff (PAS) stains (Fig.\u0026nbsp;4B). The patient experienced an uneventful postoperative course, with a smooth recovery, and was discharged on the third day following surgery.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe ovarian seromucinous tumors is a rare and distinct subtype of ovarian epithelial tumor, characterized by the coexistence of both serous and mucinous epithelial components. This tumor is notable for its unique histological features, which result from the fusion of two different types of epithelial tissue(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Ovarian seromucinous tumors, first described by Shappell HW et al. in 2002, present intricate diagnostic challenges. Their comprehensive study of 54 cases elucidated a range of histological features, including the presence of papillary structures and two distinct types of epithelial cells: the ciliated serous epithelium and the cervical mucinous epithelium. Accurate diagnosis hinges on the meticulous evaluation of the morphological characteristics of the tumor cells, particularly the differentiation of epithelial cell types and the organization of glandular structures(7). In 2014, the \u003cem\u003eWorld Health Organization (WHO)\u003c/em\u003e implemented an important revision to the classification of ovarian tumors, reclassifying them under the category of seromucinous tumors (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). This revision highlighted the unique histological features and clinical manifestations of these tumors, fostering a more refined and comprehensive understanding that enhances the approach to the diagnosis. Robert J. Kurman and Ie-Ming Shih have contended that while the WHO's revised classification of seromucinous tumors has contributed to a broader understanding of this tumor category, it nonetheless presents several limitations. In their view, it does not entirely capture the distinctive pathological features that define this particular tumor type. These tumors encompass a variety of epithelial types, including serous epithelium, endometrioid glandular mucinous epithelium, cervical-type mucinous epithelium, endometrial-type epithelium, undifferentiated epithelium, and squamous epithelium. These tumors frequently demonstrate positive expression of estrogen receptor (ER) and progesterone receptor (PR). However, their expression of WT1 is generally weak, and they are negative for CK20 and CDX2. This immunophenotypic profile is distinctly characteristic of the M\u0026uuml;llerian tube immunophenotype. Further observations have indicated that ovarian seromucinous tumors often coexist with endometriosis, a factor that significantly influences their clinical manifestation. This association leads to a clinical presentation that bears a closer resemblance to that of endometrioid tumors, including both endometrioid and clear cell variants. This contrasts with the clinical characteristics typically associated with traditional serous or intestinal-type mucinous tumors. It is important to emphasize that a significant proportion of ovarian seromucinous tumors demonstrate a loss of ARID1A gene expression(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). This mutation is predominantly observed in approximately 50% of endometrioid and clear cell tumors, while remaining relatively rare in serous or intestinal-type mucinous tumors. Owing to their distinct clinical, pathological, and molecular characteristics, researchers have advocated for the reclassification of these lesions as mixed M\u0026uuml;llerian tumors. Within this proposed classification, potential subtypes such as mixed M\u0026uuml;llerian cystadenoma, mixed M\u0026uuml;llerian atypical hyperplasia (borderline), and mixed M\u0026uuml;llerian carcinoma are suggested, aiming to more accurately reflect their unique attributes and divergent biological behaviors(\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). In the 2020 edition of the \u003cem\u003eWHO Classification of Tumors of the Female Reproductive Organs\u003c/em\u003e, ovarian seromucinous tumor is no longer regarded as a distinct pathological entity. It has instead been reclassified as a subtype of endometrioid carcinoma(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In a 2018 study involving 340 patients with endometrial cancer, a comprehensive analysis of the pathological features of tumors was performed. The findings indicated that 31 patients (9.1% of the total cohort) presented with tumors containing a serous-mucinous component in conjunction with endometrial cancer. Further investigation revealed that patients with the serous-mucinous component exhibited significantly improved progression-free survival (PFS) compared to those without this component(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). These results provide important insights into the clinical characteristics and prognostic factors associated with such tumors.\u003c/p\u003e \u003cp\u003eThe ovarian seromucinous tumors are considered to be quite rare, and as a result, epidemiological data regarding the incidence remains limited. However, existing studies indicate that these tumors predominantly occur in adults, with a higher prevalence observed in women, particularly those of reproductive age or older(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Our case report pertained to a 65-year-old postmenopausal female patient. The clinical manifestations and signs of this patient have nonspecific characteristics, primarily including lower abdominal pain and abdominal distension. Similar nonspecific symptoms have been reported in related literature(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The patient presented with symptoms including abdominal bloating, left-sided discomfort, and intermittent morning abdominal pain. Although these symptoms were relatively nonspecific, they warranted further investigation, as they could indicate the presence of an ovarian mass. Imaging scans revealed a large cystic mass with well-defined borders in the abdomen, with the solid component showing enhancement on contrast-enhanced CT scans. The initial preoperative diagnosis considered differential possibilities, including an ovarian cystadenoma or a retroperitoneal mass. However, this case has underscored the diagnostic challenges associated with ovarian seromucinous tumor, particularly when the mass is irregularly shaped or located in the pelvic region, complicating precise localization. Moreover, due to the tumor's adhesions to surrounding tissues and its large size, the mass displayed characteristics resembling a retroperitoneal tumor, further complicating the preoperative diagnosis and clinical decision-making process. In this case we reported, the tumor measured 22.8 cm \u0026times; 12.4 cm \u0026times; 30 cm, indicating a relatively large tumor volume. Retrospective analyses of multiple ovarian seromucinous tumors have demonstrated considerable variation in tumor size, with the smallest tumors measuring 1.8 cm and the largest reaching up to 18 cm. Research data indicates that the average size of ovarian seromucinous tumors varies across different studies, with reported averages ranging from 9.3 cm to 10.5 cm and 12 cm(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). These findings not only highlight the variability in tumor size among patients but also serve as important considerations for clinicians when evaluating the benign or malignant nature of ovarian tumors and determining appropriate treatment strategies. Larger tumors are frequently associated with symptoms such as abdominal distension, pain, or compression, and may, in some cases, lead to complications such as bowel obstruction or urinary symptoms. Early detection and precise assessment of tumor size enable clinicians to more effectively evaluate the feasibility of surgical resection and its associated risks, facilitating more personalized treatment decisions.\u003c/p\u003e \u003cp\u003eIn a series of reports, cases initially diagnosed with seromucinous tumors of the ovaries often exhibited papillomatous protrusions on the inner surface of the cyst(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). To further investigate the clinical significance of this feature, a retrospective study was conducted, analyzing the imaging findings of 10 patients. The results indicated that while 9 tumors presented smooth exteriors and relatively regular cystic structures, 6 cases exhibited prominent papillomatous protrusions on the inner surface. This distinctive feature, the presence of papillomatous protrusions, may serve as an indicator of potential malignant transformation. These findings suggest that the biological behavior of the tumor could be more complex than previously assumed, potentially linked to factors such as tumor cell differentiation, proliferation rate, and metastatic potential. Consequently, the identification of papillomatous protrusions could provide valuable clinical insights for both the diagnosis and prognostic evaluation of seromucinous tumors of the ovaries.\u003c/p\u003e \u003cp\u003eOvarian seromucinous tumors are relatively uncommon ovarian neoplasms, generally presenting as benign, though they carry a certain risk of malignant transformation(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Early detection and appropriate management are essential to optimize patient outcomes. Currently, no standardized surgical treatment protocol exists; management is tailored to the individual patient's condition, considering factors such as tumor size, location, and its impact on surrounding structures(6). For larger or more complex ovarian masses, surgical intervention typically involves open surgery. This approach provides greater access to the tumor, facilitating thorough removal and enabling intraoperative assessment of the tumor\u0026rsquo;s characteristics(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). However, with advancements in medical technology, particularly in laparoscopic techniques, minimally invasive surgery has become increasingly favored for a growing number of patients. Laparoscopic surgery offers several benefits, including smaller incisions, reduced intraoperative trauma, and enhanced precision in tumor excision, aided by high-definition endoscopic visualization. Compared to conventional open surgery, laparoscopic techniques provide notable advantages, such as shorter recovery times, reduced postoperative pain, and a shorter hospital stay, all of which contribute to improved patient outcomes and quality of life(\u003cspan additionalcitationids=\"CR18 CR19 CR20\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDuring the laparoscopic procedure, we encountered a tense cyst containing clear fluid. To effectively seal the cyst wall and mitigate the risk of fluid leakage and potential dissemination of malignant cells, we employed the suture ring technique. In an effort to minimize surgical risks, we meticulously aspirated the fluid utilizing controlled suction. This method proves especially advantageous in the management of large ovarian cysts, as it not only reduces the risk of abdominal contamination but also aids in preventing intraoperative complications.\u003c/p\u003e \u003cp\u003eAbdominal adhesions from the patient's prior hysterectomy complicated surgical management, making tumor origin identification challenging. Meticulous dissection was required to separate the adhesions. The tumor and both adnexa were successfully excised and sent for pathology, with an appendectomy performed during the procedure. The patient had a smooth postoperative recovery, but long-term follow-up is essential for serous mucinous ovarian tumors due to recurrence risks. The role of laparoscopy in managing these tumors is evolving, necessitating further research to establish standardized treatment protocols for complex cases.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOvarian seromucinous tumors are rare and complex entities, often presenting as large masses that pose significant diagnostic challenges. The application of minimally invasive surgical techniques, such as single-port laparoscopic surgery, can reduce tissue damage, expedite postoperative recovery, and minimize complication risks. However, achieving successful treatment outcomes requires precise preoperative evaluation, meticulous surgical technique, and comprehensive pathological assessment. Continuous postoperative surveillance is crucial for early detection of recurrence or malignant transformation due to limited clinical data.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYifan Ye, He Liu, Rui Huang, NingBo Li acquired the medical report and data from the patient. Yaling Tang and Hong Chen revised the final manuscript. All authors read and approved the final paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work supported by the Natural Science Foundation of Fujian Province, China\u003c/p\u003e\n\u003cp\u003e(Grant No. 2022J05310).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe article has been submitted with the patient\u0026apos;s consent and conducted in accordance with the Declaration of Helsinki for research purposes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient about publication of this case report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTaylor J, McCluggage WG (2015) Ovarian seromucinous carcinoma: report of a series of a newly categorized and uncommon neoplasm. Am J Surg Pathol 39(7):983\u0026ndash;992. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/PAS.0000000000000405\u003c/span\u003e\u003cspan address=\"10.1097/PAS.0000000000000405\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIdrees R, Din NU, Siddique S, Fatima S, Abdul-Ghafar J, Ahmad Z (2021) Ovarian seromucinous tumors: clinicopathological features of 10 cases with a detailed review of the literature. J Ovarian Res 14(1):47. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13048-021-00796-y\u003c/span\u003e\u003cspan address=\"10.1186/s13048-021-00796-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKurman RJ, Shih Ie M (2016) The Dualistic Model of Ovarian Carcinogenesis: Revisited, Revised, and Expanded. 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Geburtshilfe Frauenheilkd 82(12):1368\u0026ndash;1377. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1055/a-1787-9144\u003c/span\u003e\u003cspan address=\"10.1055/a-1787-9144\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Laparoscopic Treatment, Ovarian Seromucinous Cystadenoma, Giant Cyst, Post-Mesenteric","lastPublishedDoi":"10.21203/rs.3.rs-5917786/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5917786/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eOvarian seromucinous tumors, although relatively rare, represent a distinctive subset of ovarian neoplasms. These tumors are predominantly benign but carry a potential risk of malignant transformation over time. Early detection and management are crucial for improving outcomes. For large or complex masses, open surgery is preferred for better access and intraoperative histological assessment. However, with the advancement of laparoscopic techniques, minimally invasive surgery has emerged as a viable alternative for select patients, offering comparable efficacy, along with the advantages of reduced recovery times and minimal scarring.\u003c/p\u003e\u003ch2\u003eCase report:\u003c/h2\u003e \u003cp\u003eA 65-year-old female presented with a seven-month history of abdominal distension, a sensation of fullness beneath the xiphoid, left-sided discomfort, and intermittent morning cramping. Laboratory findings revealed a mild elevation in CA-125 to 46 U/mL, and CT imaging suggested a diagnosis of an ovarian cystadenoma or possibly a retroperitoneal mass. Preoperative assessment was complicated by the tumor's irregular shape, large size, and adhesions to nearby structures, making its origin unclear. A single-port laparoscopic approach was selected to minimize tissue damage, improve tumor handling, and reduce risks of fluid leakage or tumor spread. Postoperative pathology confirmed the lesion as a seromucinous ovarian cystadenoma.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis case emphasizes the need for a multidisciplinary approach in tumor diagnosis and treatment, highlighting the benefits of minimally invasive surgical techniques for better patient outcomes. Given the rarity of ovarian seromucinous tumors, continued research into their pathogenesis, classification, and treatment strategies is essential for advancing our understanding and optimizing management approaches for patients affected by these tumors.\u003c/p\u003e","manuscriptTitle":"Pure Laparoscopic Treatment of a Rare Giant Post-Mesenteric Benign Ovarian Seromucinous Cystadenoma: A Case Report and Literature Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-31 18:00:36","doi":"10.21203/rs.3.rs-5917786/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4dbe7274-65d8-4656-9601-427f3e626874","owner":[],"postedDate":"January 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-06T01:23:18+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-31 18:00:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5917786","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5917786","identity":"rs-5917786","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}