Serous Cyst Adenocarcinoma in a Postmenopausal Woman: A Rare Case Report

Abstract

Background: Ovarian torsion is a gynecological emergency typically associated with benign adnexal pathology. Malignant ovarian tumors seldom present with torsion due to inflammatory adhesions or infiltrative growth patterns that fix the ovary within the pelvis. Low-Grade Serous Carcinoma (LGSC) is a rare subtype of epithelial ovarian cancer known for its indolent course and distinct molecular profile compared to high-grade serous carcinoma.

Objective: To describe the clinical presentation, intraoperative findings, diagnostic challenges, and surgical management of a rare case of Low-Grade Papillary Serous Cystadenocarcinoma presenting with triple ovarian torsion in a postmenopausal woman.

Case Presentation: We report the case of a 48-year-old postmenopausal female presenting with subacute lower abdominal pain and urinary frequency. Physical examination revealed a large, mobile, cystic mass corresponding to 20 weeks gravid uterus size. Preoperative imaging (USG and MRI) suggested a large neoplastic mass, but serum tumor markers were within normal range. The patient underwent a staging laparotomy. Intraoperatively, a 20cmxs18 cm cystic mass arising from the left ovary was found with triple torsion around its pedicle, alongwith a grossly dilated fallopian tube. Despite the benign macroscopic appearance and lack of adhesions, histopathology confirmed Low-Grade Papillary Serous Cystadenocarcinoma.

Conclusion: This case underscores the diagnostic complexity of LGSC, which  clinically and radiologically mimicked benign cyst. This case  highlights the critical importance of performing comprehensive surgical staging in postmenopausal women with adnexal masses, even when acute complications like torsion or normal tumor markers suggest a benign etiology.

Keywords: Low-Grade Serous Carcinoma, Ovarian Torsion, Postmenopausal Woman, Adnexal Mass, Surgical Staging.