Coexistence of giant serous cystadenoma and hemorrhagic corpus luteal cyst in a 12-year-old: diagnostic and fertility-sparing surgical approach

Abstract

Background: Ovarian cystic lesions 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 tumor enucleation, 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.