A week after hoisting a 180-pound ovarian cyst from the abdomen of a West Virginia woman, doctors at Johns Hopkins Hospital said yesterday that she stands a good chance for recovery and hopes her story will prompt women to get routine gynecological care.
"She could still have complications which are serious, but overall we expect her to be fully functional and walk out of the hospital and go back to a normal life," said Dr. John L. Currie, the chief surgeon in a 9 1/2 -hour operation that involved 25 operating-room personnel.
He predicted the woman could leave the hospital in three weeks if she does not suffer serious complications.
Speaking at a news briefing, Dr. Currie said he didn't know much about the 40-year-old patient's history -- including why she waited so long to be treated -- because she had only just begun to speak following the operation. But given its size, he said, it was conceivable that the cyst had been growing inside her for five years.
"We're still piecing together the history that allowed it to grow that big," he said. But, he said, the cyst's dimensions suggest that the woman did not get routine gynecological examinations -- recommended for healthy women -- on an annual basis. "Certainly a routine exam should have have been able to detect that," he said, explaining that a pelvic examination would turn up a cyst an inch wide.
This cyst was 3 feet in diameter, occupied seven-eighths of her abdomen and pushed many of her internal organs aside as it grew to its immense proportions. Surgery reduced her weight from 708 pounds to 400 pounds. The lost weight represents the cyst and layers of stretched, dying and infected tissue, which surgeons removed from the abdominal wall. Early lab results suggest that the cyst was benign, although further analysis will determine if the growth was indeed free of cancer.
Despite this cyst's size, others have been larger. The largest ovarian cyst on record, removed by a Texas surgeon in 1905, weighed 328 pounds. Since 1947, there have been two others that weighed more than 180 pounds -- a 184-pound cyst in 1954 and a 198-pound cyst in 1963, according to a Johns Hopkins spokeswoman.
The patient, who is married, requested anonymity. To protect her privacy, Dr. Currie said he was reluctant to disclose many personal details, including where she lives. But he gave this account of the operation and the events leading up to it:
On May 1, she began having difficulty breathing. The cyst had been pressing against her lungs for some time, limiting their ability to expandormally. But that day, "the complications of a cold were just enough to put her over the edge," and she called an ambulance.
At a local hospital, a general surgeon recognized that she had an immense cyst but judged that the hospital lacked the resources to remove it. That night, paramedics transported her by helicopter to Hopkins.
By the time she arrived, she had turned blue -- a sign that her lungs were trapped under the weight of the cyst and couldn't deliver enough oxygen to her body. If medical care had been delayed much longer, she could have died from asphyxiation.
The next day, she was wheeled into an operating room, where she occupied two beds. She lay on her side on one bed; her swollen abdomen filled the other.
First, surgeons cut through several layers of tissue and severed the cyst from blood vessels that connected it to a few organs. Then, they hoisted the cyst from her abdomen on a sling that hung from a bed scale -- the type designed to lift and weigh incapacitated patients.
Besides compressing her lungs, the growing cyst forced her intestines into a new configuration farther up in her abdomen. "How it functioned at all is a miracle of nature," Dr. Currie said.
After the operation, the woman remained on a respirator for four days. Now, she breathes on her own but inhales hospital oxygen.
"All her vital organs are working fine," Dr. Currie said. "Her heart and kidneys are working perfectly. Her brain, she's very alert." Her intestines, however, are not yet functioning.
Dr. Currie said she faces several hurdles. Blood clots could form in the lungs, and the intestines could twist as they expand to fill her enlarged abdominal cavity -- a problem that could be corrected surgically.
He described his patient as an intelligent and articulate person who consented to the release of information so other women could understand the importance of getting pelvic examinations on a regular basis.
Dr. Currie said most gynecologists recommend that women get annual gynecologic exams to make sure that cysts, malignancies and other problems are detected early.
While only a small percentage of small cysts are malignant, he said, one-quarter of massive cysts are cancerous. Doctors ordinarily remove cysts that have grown to more than 4 inches in diameter, he said.