Clinical, Imaging, Histological and Surgical Aspects Regarding Giant Paraovarian Cysts: A Systematic Review

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Ioana Anca Stefanopol,1,2,* Liliana Baroiu,3,4 Anca-Iulia Neagu,1,5 Dumitru Marius Danila,2,6 Alexandru Nechifor,3,* Magdalena Miulescu,7,* Gabriela Balan,3,8,* Claudiu Ionut Vasile,3,9,* Elena Niculet,1,10 Alin Laurenţiu Tatu3,11– 13 1Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, Romania; 2Department of Pediatric Surgery and Orthopedics, “Sf Ioan” Clinical Emergency Hospital for Children, Galați, Romania; 3Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, Romania; 4Infectious Diseases Department, “Sf Cuv Parascheva” Clinical Hospital of Infectious Diseases, Galați, Romania; 5Department of Anatomopathology, “Sf Ioan” Clinical Emergency Hospital for Children, Galați, Romania; 6Clinical Surgical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, Romania; 7Research Center in the Functional Cardiorespiratory and Neuromotor Exploration, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, Romania; 8Department of Gastroenterology, “Sf Ap Andrei” Emergency County Clinical Hospital, Galați, Romania; 9“Elena Doamna” Clinical Hospital of Psychiatry, Galaţi, Romania; 10Department of Pathology, “Sf Ap Andrei” Emergency County Clinical Hospital, Galați, Romania; 11Research Center in the Field of Medical and Pharmaceutical Sciences, ReFORM-UDJ, Galați, Romania; 12Dermatology Department, “Sf Cuv Parascheva” Clinical Hospital of Infectious Diseases, Galați, Romania; 13Multidisciplinary Integrated Center of Dermatological Interface Research MIC DIR, Dunarea de Jos” University, Galati, Romania*These authors contributed equally to this workCorrespondence: Liliana Baroiu, Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos”University, 47 Domnească Street, Galați, 800010, Romania, Tel +40723201241, Email lilibaroiu@yahoo.com Anca-Iulia Neagu, Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, 47 Domnească Street, Galați, 800010, Romania, Tel +40754937354, Email ancazanoschi@gmail.comAbstract: Paraovarian cysts (POCs) develop within the broad ligament of the uterus. POCs are considered to be giant when the threshold of 150 mm is exceeded. Clinical signs and symptoms occur as a consequence of the pressure effect on adjacent organs or due to complications. Abdominal ultrasonography, computed tomography or magnetic resonance imaging are useful imaging tools, but most often the exact origin of such voluminous cysts is revealed only by surgical exploration. The review aims to appraise and update the diagnostic, the histological aspects and the treatment of the giant POCs in rare cases. We carried out a systematic search in Medline-PubMed, Google Scholar and ResearchGate electronic databases. Twenty-seven papers fulfilling the selection criteria were included in the review. The data extracted included information about first author, year of publication, country, patient age, size and side of the POCs, symptoms, tumoral markers, imaging methods, preoperative diagnosis, surgical management and histopathological findings. Although not very numerous, all the studies highlighted the low incidence of giant POCs, the impossibility of establishing the origin of the cystic mass by clinical and imaging methods even with advanced technical tools and the low risk of torsion (11.1%). Despite the recognized benign nature of POCs, we found an unexpected high percent (25.9%) of borderline giant POCs. Surgical excision is the only treatment option. Ovarian-sparing surgery was performed in 85.1% of the cases, and minimally invasive techniques were applied in only 42.9% of the patients, which demonstrates the need of a high-level laparoscopic expertise. Knowledge of this pathology, its recognition as a possible etiology of an abdominopelvic cyst, and a higher awareness of the possibility of a borderline histology in giant POCs are required for the proper management of these particular cases.Keywords: paraovarian cyst, paratubal cyst, giant, serous cystadenoma, torsion, management

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