EP23.71: That's huge! A case report of bilateral enlarged ovaries

Bilateral ovarian enlargement poses diagnostic challenges, spanning benign and malignant conditions. We present a case of a 35-year-old woman, with bilateral enlarged ovaries at one-month follow-up scan, after hysteroscopy for menorrhagia, which revealed atypical hyperplasia on histology. The patient had PCOS treated with Inositol, in addition to obesity. She had previously undergone two laparoscopic left ovarian cystectomies for mature cystic teratoma and papillary serous cystadenofibroma (2018) and serous cystadenoma (2021). Notwithstanding the surgeries performed, the patient had progressive ovarian enlargement attributed to her PCOS. At ultrasound scan, performed in our institution, the ovaries appeared enlarged, measuring 90x73x61mm on the right and 58x32x44mm on the left, with multiple(>20) cystic formations. The initial ultrasonographic suspicion was spontaneous Ovarian Hyperstimulation Syndrome(sOHSS), even though bilateral serous cystadenofibroma couldn't be excluded. Oncological markers resulted negative, hormonal profile tests were within range, and biochemical analysis revealed insulin resistance. The MRI scan described the presence of bilateral multilocular cystic formations, with no observed metastases in the pelvis. The patient underwent laparoscopic left monolateral salpingo-oophorectomy, right cystectomy, dilation and curettage, and intrauterine-device insertion. The histopathological examination confirmed the presence of serous cystadenofibromas in both ovaries. We describe the case of a young patient with bilateral ovarian cystadenofibroma misdiagnosed as PCOS. Due to the rarity of bilateral cystadenofibroma(~15%) this finding at ultrasound could be challenging. The main differential diagnosis can be PCOS or sOHSS necessitating meticulous evaluation and clinical supplemental examination. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.