Giant ovarian tumors: diagnosis, management and treatment

Large size of some tumors has been described with fascination, over time. These include gynecological ones, of which cases of enormous growth are described, especially before the advent of ultrasound. Terminology of these large tumors contains very varied and confusing qualifiers, including ”immense”, ”extensive”, ”voluminous”, ”massive”, ”large”, ”very large”, ”giant”, ” gigantic”, etc. Term ”giant” is frequently used to refer to these large gynecologic tumors. Likewise, their measurements are usually used, to refer to them as ”giants”, but the limits for their definition are not mentioned. Usually, are termed “giant” if they are >10 cm for ones and for others, if they are >20 cm, while are referred to as” large” those >5 cm, those measuring between 10 and 20 cm or those reaching above the umbilicus. In the english literature, there has been agreement during 54 years on defining uterine or ovarian tumors weighing more than 25 lb. as ”giants”, because, in 1971, were reviewed the uterine or ovarian tumors, between 1946-1970, weighing 25 lb. or more. The most common clinical signs are rapidly expanding abdominal distension and a palpable mass. The main imaging modality is ultrasound, which allows accurate identification in approximately 90% of cases. The management approach is determined on the tumor size, the equipment available and the surgeon’s level of skill; and must be discussed with the gynecology team. Treatment of choice is surgery and must be carried out by a gynecologist with the appropriate surgical skills to reduce the need for an unnecessary laparotomy, removal of healthy ovarian tissue or oophorectomy. This article is intended to provide updated information on the diagnosis, management and therapy of giant ovarian tumors and to serve as a guide.