Coexistence of Giant Serous Cystadenoma and Hemorrhagic Corpus Luteal Cyst in a 12- Year-Old: Diagnostic and Fertility-Sparing Surgical Approach

Coexistence of Giant Serous Cystadenoma and Hemorrhagic Corpus Luteal Cyst in a 12- Year-Old: Diagnostic and Fertility-Sparing Surgical Approach | 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 Coexistence of Giant Serous Cystadenoma and Hemorrhagic Corpus Luteal Cyst in a 12- Year-Old: Diagnostic and Fertility-Sparing Surgical Approach Aseel Faroun, Batoul Abu Gharbieh, Ahmad Sarahna This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6546632/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 Jul, 2025 Read the published version in BMC Pediatrics → Version 1 posted 13 You are reading this latest preprint version Abstract Background: Ovarian cysts are typically slow-growing neoplasms, but giant ovarian tumors with dual histological types are rare, particularly in pediatric populations. They pose significant diagnostic and therapeutic challenges due to the potential for rapid enlargement and surgical complexity. Case Presentation: A 12-year-old female presented with progressive abdominal pain, early satiety, and a two-month history of abdominal distension. Imaging revealed a 30 × 22 × 12 cm intraperitoneal cystic mass with negative tumor markers. She underwent mini-laparotomy and cystectomy, during which 4400 cc of serous fluid was aspirated. Histopathology revealed a serous cystadenoma alongside a hemorrhagic corpus luteal cyst. Fertility was successfully preserved. Discussion: Despite their rarity, large benign ovarian cysts with differing histology should be considered in young patients presenting with abdominal symptoms suggestive of malignancy. Early imaging, tumor marker evaluation, and fertility-preserving surgical strategies are crucial for optimal outcomes. Conclusion: Benign giant ovarian cysts with concurrent histological types may mimic malignancy. Thorough preoperative evaluation and conservative surgical management are essential to balance oncological safety with fertility preservation in pediatric patients. Giant ovarian cyst serous cystadenoma hemorrhagic corpus luteal cyst pediatric gynecology fertility preservation mini-laparotomy diagnostic challenge Figures Figure 1 Figure 2 Introduction Ovarian cysts are generally slow-growing, with average dimensions of 6.4 to 7.0 cm and an annual growth rate of approximately 1.8 mm. Rapid growth, particularly in patients under 15 years old, is rare and raises concerns about malignancy ( 1 – 4 ). In this age group, ovarian cysts can arise from paramesonephric (Müllerian) duct remnants and are benign in the majority of cases ( 1 , 5 ). About 25% of ovarian cysts in adolescents are epithelial tumors, including serous and mucinous cystadenomas ( 1 , 4 ). These tumors are typically asymptomatic but may cause discomfort or compressive symptoms when large ( 6 – 8 ). Rarely, giant ovarian tumors containing multiple histological types present diagnostic and therapeutic challenges due to potential misdiagnosis and the need for individualized surgical planning ( 7 , 9 – 10 ). This case report presents a 12-year-old female with concurrent giant serous cystadenoma and hemorrhagic corpus luteal cyst, highlighting the clinical presentation, imaging findings, surgical management, and successful fertility preservation. Case Presentation A 12-year-old Middle Eastern female presented to the emergency department with two months of progressive abdominal distension, dull left lower quadrant pain, early satiety, and prolonged menstrual bleeding lasting two weeks. She also had iron deficiency anemia but no significant medical or family history of ovarian or gastrointestinal malignancies. On examination, she appeared pale, with a markedly distended abdomen (abdominal circumference: 75 cm), dullness to percussion, positive shifting dullness, and a smooth, non-tender liver edge. Vital signs were stable. She demonstrated Tanner stage IV pubertal development. Initial transabdominal ultrasound revealed a large, septate, cystic mass originating from the left ovary, extending superiorly over the uterus, with mixed hypoechoic and anechoic regions. No free fluid was seen in the pouch of Douglas. The complex appearance raised concern for a neoplastic process. Further laboratory tests showed hemoglobin 9.6 g/dL and ferritin 5.1 ng/mL, consistent with iron deficiency anemia. Tumor markers including CA-125 (24 U/mL), CA 19 − 9 (2 U/mL), β-HCG, inhibin, estradiol (239 ng/mL), and α-fetoprotein were all within normal ranges or negative (Table 1). An abdominal X-ray demonstrated a massive cystic shadow occupying the entire abdomen. Subsequent contrast-enhanced CT confirmed a 30 × 22 × 12 cm left ovarian cystic mass, displacing intra-abdominal organs and causing mild bilateral hydroureteronephrosis (Figs. 1 and 2). The patient underwent mini-Pfannenstiel laparotomy and cystectomy under general anesthesia. After aspirating 4400 cc of clear serous fluid from the main cyst, the cyst wall was exteriorized and excised. A smaller hemorrhagic cyst (~ 4 cm) was identified and resected simultaneously. Ovarian parenchyma was preserved. Histopathological examination confirmed a benign serous cystadenoma (26 × 10 × 1 cm) and a hemorrhagic corpus luteal cyst (4.5 × 4 × 2.7 cm). Postoperatively, the patient received two units of packed red blood cells. She had an uneventful recovery, was discharged after two days, and resumed normal activities within one week. Follow-up showed no evidence of recurrence. Results and Discussion Ovarian cysts in pediatric populations are uncommon but usually benign ( 11 ). The concurrence of two distinct cystic pathologies—serous cystadenoma and hemorrhagic corpus luteal cyst—mimicking malignant disease in a 12-year-old female is exceptionally rare ( 12 – 14 ). The patient’s symptoms of abdominal distension, early satiety, and iron-deficiency anemia, combined with imaging findings of a complex cyst, initially raised concern for malignancy. However, normal tumor markers and histopathological confirmation indicated a benign process. Functional ovarian cysts, such as corpus luteal cysts, can contribute to hormonal fluctuations, including prolonged menstrual bleeding and anemia ( 7 – 9 ). Serous cystadenomas, although typically asymptomatic, may cause compressive symptoms if they reach massive sizes ( 8 , 9 ). Successful management of such cases depends on careful preoperative assessment, appropriate imaging, tumor marker analysis, and fertility-preserving surgery ( 11 , 15 ). In this case, mini-laparotomy and complete cystectomy allowed resolution of symptoms while preserving the ovarian tissue, reflecting an optimal surgical outcome. This case underscores the importance of including benign etiologies in the differential diagnosis of large ovarian masses in young patients and highlights the necessity for histological confirmation before aggressive management. Conclusion Benign giant ovarian cysts of dual histological origin are rare but important differential diagnoses in pediatric patients presenting with compressive abdominal symptoms. Early imaging, tumor marker evaluation, and fertility-preserving surgical strategies are critical for successful outcomes. Histopathological confirmation remains the gold standard for definitive diagnosis and appropriate management. Declarations Availability of Data and Materials Data related to this case report are available from the corresponding author upon reasonable request. Acknowledgments The authors thank all participants involved in this case report. Authors’ Contributions AF contributed to the study design, data collection, interpretation, and drafting of the manuscript. BA contributed to study design and manuscript drafting. AS supervised the clinical management and manuscript preparation. All authors read and approved the final manuscript and take responsibility for its content. Funding This case report received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Ethics Approval and Consent to Participate This article does not report any research involving human participants or animals conducted by the authors. Clinical Trial Number: Not Applicable Consent for Publication Written informed consent was obtained from the patient’s guardian for publication of this case report and accompanying images. A copy of the consent form is available for review by the editor. Competing Interests The authors declare no competing interests. References Caspi B, Appelman Z, Rabinerson D, Zalel Y, Tulandi T, Shoham Z. The growth pattern of ovarian dermoid cysts: A prospective study in premenopausal and postmenopausal women. Fertil Steril. 1997;68(3):501–5. https://doi.org/10.1016/s0015-0282(97)00228-8 . Zvizdic Z, Bukvic M, Murtezic S, Skenderi F, Vranic S. Giant paratubal serous cystadenoma in an adolescent female: Case report and literature review. J Pediatr Adolesc Gynecol. 2020;33(4):438–40. https://doi.org/10.1016/j.jpag.2020.03.010 . Jermy K, Luise C, Bourne T. The characterization of common ovarian cysts in premenopausal women. Ultrasound Obstet Gynecol. 2001;17(2):140–4. https://doi.org/10.1046/j.1469-0705.2001.00330.x . Suh-Burgmann E, Nakhaei M, Gupta S, Brook A, Hecht J, Hung YY, Levine D. Ovarian cystadenomas: Growth rate and reliability of imaging measurements. J Ultrasound Med. 2022;41(9):2157–67. https://doi.org/10.1002/jum.15895 . Cobb LP, Gaillard S, Wang Y, Shih IM, Secord AA. Adenocarcinoma of Mullerian origin: Review of pathogenesis, molecular biology, and emerging treatment paradigms. Gynecologic Oncol Res Pract. 2015;2:1. https://doi.org/10.1186/s40661-015-0008-z . Biçer S, Erkul Z, Demiryilmaz I, Peker N. A 9-kg ovarian mucinous cystadenoma in a 14-year-old premenarchal girl. Am J Case Rep. 2014;15:326–9. https://doi.org/10.12659/AJCR.890862 . Sasidharan JK, Patra MK, Singh LK, Saxena AC, De UK, Singh V, Mathesh K, Kumar H, Krishnaswamy N. Ovarian cysts in the bitch: An update. Top Companion Anim Med. 2021;43:100511. https://doi.org/10.1016/j.tcam.2021.100511 . Ross EK, Kebria M. Incidental ovarian cysts: When to reassure, when to reassess, when to refer. Cleve Clin J Med. 2013;80(8):503–14. https://doi.org/10.3949/ccjm.80a.12155 . Birbas E, Kanavos T, Gkrozou F, Skentou C, Daniilidis A, Vatopoulou A. Ovarian masses in children and adolescents: A review of the literature with emphasis on the diagnostic approach. Child (Basel). 2023;10(7):1114. https://doi.org/10.3390/children10071114 . Marchand GJ, Sainz K, Ruther S, Azadi A, Ware K, Brazil G, King A, Vallejo J, Cieminski K, Galitsky A, Ulibarri H, Calteux N, Osipov R. Two-port laparoscopic removal of large ovarian cystadenoma. J Obstet Gynecol Can. 2022;44(8):924–e9251. https://doi.org/10.1016/j.jogc.2021.01.020 . Grapsa D, Kairi-Vassilatou E, Kleanthis C, Dastamani C, Fillipidou A, Kondi-Pafiti A. Epithelial ovarian tumors in adolescents: A retrospective pathologic study and a critical review of the literature. J Pediatr Adolesc Gynecol. 2011;24(6):386–8. https://doi.org/10.1016/j.jpag.2011.07.011 . Morowitz M, Huff D, von Allmen D. Epithelial ovarian tumors in children: A retrospective analysis. J Pediatr Surg. 2003;38(3):331–5. https://doi.org/10.1053/jpsu.2003.50103 . Shrestha Prajapati S, Shrestha A, Bade Shrestha U. Rare presentation of giant ovarian cyst. J Nepal Health Res Counc. 2022;19(4):849–51. https://doi.org/10.33314/jnhrc.v19i04.3851 . Mehboob M, Naz S, Zubair M, Kasi MA. Giant ovarian cyst—An unusual finding. J Ayub Med Coll Abbottabad. 2014;26(2):244–5. Jiang L, Zhao X, Han Y, Liu K, Meng X. Giant ovarian cysts treated by single-port laparoscopic surgery: A case series. Front Oncol. 2021;11:796330. https://doi.org/10.3389/fonc.2021.796330 . Table Table (1): Laboratory Results Test Name Result Normal Value WBC 5.85 4.60-10.2 K/mL RBC 4.51 4.00-5.20 M/ul HGB 9.62 12.0-16.0 g/dl HCT 33.1 33-51 % MCV 73.4 80-97 fL MCH 21.3 27-31.2 pg MCHC 29.0 31.8-35.4 g/dl RDW 16.1 11.6-14.8 % PLT 314 142-424 K/mL MPV 6.44 5-15 fL Blood Group AB+ - Coombs Indirect Positive - LDH 177.0 135-225 U/L Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 19 Jul, 2025 Read the published version in BMC Pediatrics → Version 1 posted Editorial decision: Revision requested 10 Jun, 2025 Reviews received at journal 07 Jun, 2025 Reviewers agreed at journal 07 Jun, 2025 Reviews received at journal 01 Jun, 2025 Reviewers agreed at journal 01 Jun, 2025 Reviewers agreed at journal 01 Jun, 2025 Reviews received at journal 11 May, 2025 Reviewers agreed at journal 11 May, 2025 Reviewers invited by journal 09 May, 2025 Editor invited by journal 08 May, 2025 Editor assigned by journal 07 May, 2025 Submission checks completed at journal 07 May, 2025 First submitted to journal 28 Apr, 2025 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. 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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-6546632","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":454955992,"identity":"e4a74962-8940-4eb8-9072-6c690d9cb2d0","order_by":0,"name":"Aseel Faroun","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+UlEQVRIiWNgGAWjYLCCBzZgivHBhwogxczcQFhLQhqYYjaccQZEMRKvhU2asw1sG34t/P2HDz5ISLDL55fIPSDNOK82mr8dqOVHxTacWiRupCUbJCQkW86ckZdgXLjteO6Mw4wNjD1nbuO25gaPmUTiD2YDgxs5Bskztx3LbQBqYWZsw61F/vz57z8SEurBWg7zzjmWO5+QFoMDOWwMCQmHQVoMm3kbanI3ENJieCPNWCIh4biBZM8bY8YZxw7kbgRqOYjPL3LnDz/88CGh2oCfPcf8x4eautx554Fh+KMCj/fRwGEweYBo9UBQR4riUTAKRsEoGCEAAEF0XqZWBX9jAAAAAElFTkSuQmCC","orcid":"","institution":"Al-Quds University","correspondingAuthor":true,"prefix":"","firstName":"Aseel","middleName":"","lastName":"Faroun","suffix":""},{"id":454955993,"identity":"2a2ff049-6ed7-4ce3-84f3-e9d9ab980544","order_by":1,"name":"Batoul Abu Gharbieh","email":"","orcid":"","institution":"Al-Quds University","correspondingAuthor":false,"prefix":"","firstName":"Batoul","middleName":"Abu","lastName":"Gharbieh","suffix":""},{"id":454955994,"identity":"3f8be7e3-1cdd-449e-bb0f-ec02574cb76b","order_by":2,"name":"Ahmad Sarahna","email":"","orcid":"","institution":"Al-Quds University","correspondingAuthor":false,"prefix":"","firstName":"Ahmad","middleName":"","lastName":"Sarahna","suffix":""}],"badges":[],"createdAt":"2025-04-28 10:08:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6546632/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6546632/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12887-025-05932-x","type":"published","date":"2025-07-19T16:04:56+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82717317,"identity":"7f9edf8d-8a9d-4dee-abd7-ecb35fd983dd","added_by":"auto","created_at":"2025-05-14 12:23:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":129528,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eshows sagittal and axial abdominal X-ray\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6546632/v1/ffa9ed809c594074d472f89a.png"},{"id":82717293,"identity":"21dcb5a3-23dd-42ee-8708-f449b56f4f7b","added_by":"auto","created_at":"2025-05-14 12:23:43","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":113061,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eshows abdominal CT Scan\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6546632/v1/2cb466c22b8d954a21bb45db.png"},{"id":88506115,"identity":"e5754f6f-5844-4cb6-9cba-2fb0bdeaaa7e","added_by":"auto","created_at":"2025-08-07 07:31:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":772590,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6546632/v1/f3aa8c0b-ae0e-47ef-ad3c-56a32ae1ddb7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Coexistence of Giant Serous Cystadenoma and Hemorrhagic Corpus Luteal Cyst in a 12- Year-Old: Diagnostic and Fertility-Sparing Surgical Approach","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOvarian cysts are generally slow-growing, with average dimensions of 6.4 to 7.0 cm and an annual growth rate of approximately 1.8 mm. Rapid growth, particularly in patients under 15 years old, is rare and raises concerns about malignancy (\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In this age group, ovarian cysts can arise from paramesonephric (M\u0026uuml;llerian) duct remnants and are benign in the majority of cases (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAbout 25% of ovarian cysts in adolescents are epithelial tumors, including serous and mucinous cystadenomas (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). These tumors are typically asymptomatic but may cause discomfort or compressive symptoms when large (\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Rarely, giant ovarian tumors containing multiple histological types present diagnostic and therapeutic challenges due to potential misdiagnosis and the need for individualized surgical planning (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis case report presents a 12-year-old female with concurrent giant serous cystadenoma and hemorrhagic corpus luteal cyst, highlighting the clinical presentation, imaging findings, surgical management, and successful fertility preservation.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 12-year-old Middle Eastern female presented to the emergency department with two months of progressive abdominal distension, dull left lower quadrant pain, early satiety, and prolonged menstrual bleeding lasting two weeks. She also had iron deficiency anemia but no significant medical or family history of ovarian or gastrointestinal malignancies.\u003c/p\u003e \u003cp\u003eOn examination, she appeared pale, with a markedly distended abdomen (abdominal circumference: 75 cm), dullness to percussion, positive shifting dullness, and a smooth, non-tender liver edge. Vital signs were stable. She demonstrated Tanner stage IV pubertal development.\u003c/p\u003e \u003cp\u003eInitial transabdominal ultrasound revealed a large, septate, cystic mass originating from the left ovary, extending superiorly over the uterus, with mixed hypoechoic and anechoic regions. No free fluid was seen in the pouch of Douglas. The complex appearance raised concern for a neoplastic process.\u003c/p\u003e \u003cp\u003eFurther laboratory tests showed hemoglobin 9.6 g/dL and ferritin 5.1 ng/mL, consistent with iron deficiency anemia. Tumor markers including CA-125 (24 U/mL), CA 19\u0026thinsp;\u0026minus;\u0026thinsp;9 (2 U/mL), β-HCG, inhibin, estradiol (239 ng/mL), and α-fetoprotein were all within normal ranges or negative (Table\u0026nbsp;1). An abdominal X-ray demonstrated a massive cystic shadow occupying the entire abdomen. Subsequent contrast-enhanced CT confirmed a 30 \u0026times; 22 \u0026times; 12 cm left ovarian cystic mass, displacing intra-abdominal organs and causing mild bilateral hydroureteronephrosis (Figs.\u0026nbsp;1 and 2).\u003c/p\u003e \u003cp\u003eThe patient underwent mini-Pfannenstiel laparotomy and cystectomy under general anesthesia. After aspirating 4400 cc of clear serous fluid from the main cyst, the cyst wall was exteriorized and excised. A smaller hemorrhagic cyst (~\u0026thinsp;4 cm) was identified and resected simultaneously. Ovarian parenchyma was preserved. Histopathological examination confirmed a benign serous cystadenoma (26 \u0026times; 10 \u0026times; 1 cm) and a hemorrhagic corpus luteal cyst (4.5 \u0026times; 4 \u0026times; 2.7 cm).\u003c/p\u003e \u003cp\u003ePostoperatively, the patient received two units of packed red blood cells. She had an uneventful recovery, was discharged after two days, and resumed normal activities within one week. Follow-up showed no evidence of recurrence.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Results and Discussion","content":"\u003cp\u003eOvarian cysts in pediatric populations are uncommon but usually benign (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The concurrence of two distinct cystic pathologies\u0026mdash;serous cystadenoma and hemorrhagic corpus luteal cyst\u0026mdash;mimicking malignant disease in a 12-year-old female is exceptionally rare (\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The patient\u0026rsquo;s symptoms of abdominal distension, early satiety, and iron-deficiency anemia, combined with imaging findings of a complex cyst, initially raised concern for malignancy. However, normal tumor markers and histopathological confirmation indicated a benign process.\u003c/p\u003e \u003cp\u003eFunctional ovarian cysts, such as corpus luteal cysts, can contribute to hormonal fluctuations, including prolonged menstrual bleeding and anemia (\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Serous cystadenomas, although typically asymptomatic, may cause compressive symptoms if they reach massive sizes (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Successful management of such cases depends on careful preoperative assessment, appropriate imaging, tumor marker analysis, and fertility-preserving surgery (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In this case, mini-laparotomy and complete cystectomy allowed resolution of symptoms while preserving the ovarian tissue, reflecting an optimal surgical outcome.\u003c/p\u003e \u003cp\u003eThis case underscores the importance of including benign etiologies in the differential diagnosis of large ovarian masses in young patients and highlights the necessity for histological confirmation before aggressive management.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBenign giant ovarian cysts of dual histological origin are rare but important differential diagnoses in pediatric patients presenting with compressive abdominal symptoms. Early imaging, tumor marker evaluation, and fertility-preserving surgical strategies are critical for successful outcomes. Histopathological confirmation remains the gold standard for definitive diagnosis and appropriate management.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData related to this case report are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank all participants involved in this case report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAF contributed to the study design, data collection, interpretation, and drafting of the manuscript. BA contributed to study design and manuscript drafting. AS supervised the clinical management and manuscript preparation. All authors read and approved the final manuscript and take responsibility for its content.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis case report received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis article does not report any research involving human participants or animals conducted by the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number:\u003c/strong\u003e Not Applicable\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’s guardian for publication of this case report and accompanying images. A copy of the consent form is available for review by the editor.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCaspi B, Appelman Z, Rabinerson D, Zalel Y, Tulandi T, Shoham Z. The growth pattern of ovarian dermoid cysts: A prospective study in premenopausal and postmenopausal women. Fertil Steril. 1997;68(3):501\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/s0015-0282(97)00228-8\u003c/span\u003e\u003cspan address=\"10.1016/s0015-0282(97)00228-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZvizdic Z, Bukvic M, Murtezic S, Skenderi F, Vranic S. 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Epithelial ovarian tumors in children: A retrospective analysis. J Pediatr Surg. 2003;38(3):331\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1053/jpsu.2003.50103\u003c/span\u003e\u003cspan address=\"10.1053/jpsu.2003.50103\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShrestha Prajapati S, Shrestha A, Bade Shrestha U. Rare presentation of giant ovarian cyst. J Nepal Health Res Counc. 2022;19(4):849\u0026ndash;51. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.33314/jnhrc.v19i04.3851\u003c/span\u003e\u003cspan address=\"10.33314/jnhrc.v19i04.3851\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMehboob M, Naz S, Zubair M, Kasi MA. Giant ovarian cyst\u0026mdash;An unusual finding. J Ayub Med Coll Abbottabad. 2014;26(2):244\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang L, Zhao X, Han Y, Liu K, Meng X. Giant ovarian cysts treated by single-port laparoscopic surgery: A case series. Front Oncol. 2021;11:796330. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fonc.2021.796330\u003c/span\u003e\u003cspan address=\"10.3389/fonc.2021.796330\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003e\u003cstrong\u003eTable (1): Laboratory Results\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTest Name\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eResult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNormal Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWBC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.60-10.2 K/mL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRBC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.00-5.20 M/ul\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHGB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e9.62\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e12.0-16.0 g/dl\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHCT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e33.1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e33-51 %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMCV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e73.4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e80-97 fL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMCH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e21.3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e27-31.2 pg\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMCHC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e29.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e31.8-35.4 g/dl\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRDW\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e16.1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e11.6-14.8 %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePLT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e314\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e142-424 K/mL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMPV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5-15 fL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBlood Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAB+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCoombs Indirect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePositive\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLDH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e177.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e135-225 U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Giant ovarian cyst, serous cystadenoma, hemorrhagic corpus luteal cyst, pediatric gynecology, fertility preservation, mini-laparotomy, diagnostic challenge","lastPublishedDoi":"10.21203/rs.3.rs-6546632/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6546632/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003cbr\u003e\nOvarian cysts are typically slow-growing neoplasms, but giant ovarian tumors with dual histological types are rare, particularly in pediatric populations. They pose significant diagnostic and therapeutic challenges due to the potential for rapid enlargement and surgical complexity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Presentation:\u003c/strong\u003e\u003cbr\u003e\nA 12-year-old female presented with progressive abdominal pain, early satiety, and a two-month history of abdominal distension. Imaging revealed a 30 × 22 × 12 cm intraperitoneal cystic mass with negative tumor markers. She underwent mini-laparotomy and cystectomy, during which 4400 cc of serous fluid was aspirated. Histopathology revealed a serous cystadenoma alongside a hemorrhagic corpus luteal cyst. Fertility was successfully preserved.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion:\u003c/strong\u003e\u003cbr\u003e\nDespite their rarity, large benign ovarian cysts with differing histology should be considered in young patients presenting with abdominal symptoms suggestive of malignancy. Early imaging, tumor marker evaluation, and fertility-preserving surgical strategies are crucial for optimal outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003cbr\u003e\nBenign giant ovarian cysts with concurrent histological types may mimic malignancy. Thorough preoperative evaluation and conservative surgical management are essential to balance oncological safety with fertility preservation in pediatric patients.\u003c/p\u003e","manuscriptTitle":"Coexistence of Giant Serous Cystadenoma and Hemorrhagic Corpus Luteal Cyst in a 12- Year-Old: Diagnostic and Fertility-Sparing Surgical Approach","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-14 12:07:38","doi":"10.21203/rs.3.rs-6546632/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-10T07:04:12+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-07T13:45:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"34227042956918907855667512093257518470","date":"2025-06-07T13:32:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-01T14:53:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"334220102227475758232752594775406376982","date":"2025-06-01T14:35:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"166591041581075246962037118554085190216","date":"2025-06-01T10:58:07+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-11T19:16:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"251769441594477231641165180500741162910","date":"2025-05-11T12:24:30+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-09T07:11:55+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-08T06:17:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-07T07:26:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-07T07:22:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2025-04-28T10:00:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"39825b3f-6797-4e2b-98bb-757a6fc02737","owner":[],"postedDate":"May 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-07T07:13:30+00:00","versionOfRecord":{"articleIdentity":"rs-6546632","link":"https://doi.org/10.1186/s12887-025-05932-x","journal":{"identity":"bmc-pediatrics","isVorOnly":false,"title":"BMC Pediatrics"},"publishedOn":"2025-07-19 16:04:56","publishedOnDateReadable":"July 19th, 2025"},"versionCreatedAt":"2025-05-14 12:07:38","video":"","vorDoi":"10.1186/s12887-025-05932-x","vorDoiUrl":"https://doi.org/10.1186/s12887-025-05932-x","workflowStages":[]},"version":"v1","identity":"rs-6546632","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6546632","identity":"rs-6546632","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}