Intact Resection and Surgical Staging of a Giant Right Ovarian Mucinous Borderline Tumor in a Patient With a Complex Surgical History: A Case Report

Giant ovarian tumors present significant diagnostic and surgical challenges, particularly in patients with extensive prior abdominal and pelvic surgery.We report the surgical management of a giant right ovarian mucinous borderline tumor in a 44-year-old woman, gravida 3 para 3, who presented with a 2-year history of chronic pelvic pain that progressed to severe stabbing pain over 2 weeks.Her surgical history included three cesarean deliveries, open cholecystectomy, laparoscopically assisted vaginal hysterectomy with left ovarian cystectomy and bilateral salpingectomy with preservation of both ovaries, laparoscopic leiomyoma excision, and open abdominoplasty.Contrast-enhanced computed tomography demonstrated a 26 × 21 × 22 cm multiloculated right ovarian mass with cystic and solid components extending from the pelvis into the right upper quadrant.The available tumor markers, including CA-125, lactate dehydrogenase, inhibin A, and inhibin B, were within normal limits.Results for carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9) were not documented in the available records.The patient underwent exploratory laparotomy requiring extensive adhesiolysis lasting more than 60 minutes and bilateral ureterolysis.The mass was successfully excised intact without rupture or spillage, followed by surgical staging procedures involving omental and peritoneal biopsies, pelvic and para-aortic tissue sampling, and peritoneal washings.Intraoperative cystoscopy confirmed bilateral ureteral patency, and estimated blood loss was less than 50 mL.Gross pathological examination revealed a 4.96-kg ovarian mass measuring 28.5 × 21 × 18.5 cm, with final histopathology confirming a mucinous borderline tumor.Omental and peritoneal biopsies demonstrated no malignancy.The postoperative course was uneventful, and the patient was discharged home in stable condition on postoperative day two.This case highlights the importance of careful operative planning, meticulous adhesiolysis, ureteral identification and protection, and intact specimen extraction when managing giant ovarian tumors in patients with complex surgical histories.