Management of a huge ovarian cyst in a first trimester pregnant woman: A case report

Massively huge ovarian cysts during pregnancy are relatively uncommon, and the occurrence of a large ovarian cyst in the first trimester presents diagnostic and therapeutic challenges. Herein, we report a rare case of a huge ovarian cyst identified during the first trimester of pregnancy in a 26-year-old primigravida at 13 weeks of gestation who presented to the antenatal clinic with complaints of abdominal bloating and intermittent lower abdominal pain. Obstetric history was unremarkable. On examination, abdominal distension was noted. A transabdominal ultrasound revealed a large unilocular cystic mass measuring approximately 27 cm × 14 cm, separate from the gestational sac, suggestive of an ovarian origin. The fetus appeared viable with appropriate growth for gestational age. An MRI confirmed a large right ovarian cyst with no solid components or papillary projections, consistent with a benign etiology. Due to increasing abdominal discomfort and risk of torsion, the patient was planned for surgical management. Laparotomy was performed at 13 weeks gestation under general anesthesia. The huge right ovarian cyst was excised. The contralateral ovary was preserved. Histopathological examination confirmed a diagnosis of benign follicular cyst. Postoperative recovery was uneventful. The pregnancy progressed normally. This case highlights the importance of early detection, careful monitoring, and individualized management of large adnexal masses during pregnancy.