Laparoscopic Management of a 20 cm Ovarian Serous Cystadenoma at 20 Weeks of Pregnancy: A Case Report.

Despite adnexal masses being common in the first trimester of pregnancy, large cystic tumours are rare. The management of pregnancy with an ovarian mass is challenging due to the limited data available on the size at which surgery is required. To the best of our knowledge, we did not find any case in the literature of a pregnancy with a 20 cm cyst in the second trimester managed by laparoscopy. Therefore, we present a case of a 20 cm ovarian cyst at 20 weeks of pregnancy. Our case describes an incidentally diagnosed benign ovarian cyst at 20 weeks of pregnancy in a 24-year-old patient who had previously delivered vaginally. Magnetic resonance imaging (MRI) revealed a cystic lesion measuring 19.8 x 14.8 x 10.6 cm in the left lumbar region, extending into the left iliac fossa, with the left ovary not separately visualized. After a thorough workup, the patient was managed laparoscopically. The patient tolerated the procedure well. Even in cases of large benign cysts greater than 10 cm, laparoscopy can be safely performed during pregnancy when done by experienced hands with adequate anesthetic facilities, without adverse effects on the fetus. However, proper case selection is mandatory, and further studies are needed before it can be recommended as routine practice.