Surgeon John L. Currie described it as "a water balloon so bi I couldn't get my arms around it. And I have a 35-inch sleeve."
"It" was a 180-pound ovarian cyst, cut and hoisted from a 40-year-old West Virginia woman last week in a 9 1/2 -hour operation at Johns Hopkins Hospital.
It is believed to be the fourth-largest ovarian cyst on record. The biggest was a 328-pounder removed from a woman in Texas in 1905.
In the first detailed description of the West Virginia woman's cyst, and the complicated, life-saving surgery to remove it, Currie yesterday described his patient as a "very intelligent and articulate woman" who saw the event as "a chance to change her life. I'd like to see her go into the medical profession; I think she could do it."
She agreed to let doctors discuss her case in public because she is "very interested in other women knowing about ovarian cysts," Currie said. But she asked that her name be withheld.
The woman is "recovery nicely" from the cystectomy and additional surgery to rearrange internal organs displaced by the growth, Currie said. She could be discharged from the hospital in as little as three weeks.
But there is much less of her now than when she was admitted May 1 weighing 708 pounds. After the removal of the fluid-filled cyst, and about 100 pounds of abdominal wall tissue, Currie said, the woman now weighs about 400 pounds, "as best we can tell."
Because she is still having difficulty breathing and talking, Currie said, doctors have learned few details of her life before the surgery. This much is known:
The woman lives in a rural section of West Virginia. She is married and has at least one daughter, 13.
Currie, a gynecologic oncologist specializing in cancers of the female organs, described his patient as "a large woman" but "well-proportioned." She apparently was "reasonably active" and able to work at home.
But if she suspected she had a cyst during the estimated five years it grew in her abdomen, she failed to seek medical help for it.
Then, last Wednesday, a cold she caught from her daughter "tipped her over the edge," Currie said.
The cyst, which measured 3 feet in diameter, had filled up seven-eighths of her abdominal cavity and distended its outer walls.
"Everything was squashed up in one part of her abdomen. How she functioned at all is a medical miracle," Currie said.
Her diaphragm -- the muscular tissue below the lungs that does most of the work of breathing -- had grown "useless," and the woman was able to breathe only by using muscles in her rib cage.
With the cold, the effort required to continue breathing became too great. She began having extreme respiratory distress and went to a local hospital for help.
By the time she arrived at Hopkins by helicopter from West Virginia, Currie said, "she was cyanotic, blue" and near death. Somehow, though, her heart continued to function well. "It was a champion throughout," he said.
On Thursday morning, doctors spent three hours preparing a special cardiac operating room. It required two operating tables -- one for the woman, one for the cyst -- and a complex array of anesthesia equipment.
Nearby they positioned a modified hospital bed scale, a kind of crane and sling normally used to weigh bedridden patients. It would be used this time as a hoist to remove the cyst after it was cut free.
Doctors began the operation with their patient lying on her left side. "If we turned her over [on her back] the cyst would press on her abdominal blood vessels and her blood pressure would virtually disappear," Currie said.
Currie was assisted in the surgery by Dr. Fouad Abbas, an instructor in gynecology and obstetrics. As many as 12 anesthesiologists helped stabilize her through massive changes in her body fluids, and 18 other operating room staff assisted.
Their first task was to cut the cyst loose from its only blood supply, near the uterus, and from attachments to other organs. Fortunately, Currie said, there were few.
Some ovarian cysts are cancerous. The surgeons took care not to rupture the cyst because there is evidence that fluid spilled from a cyst can spread cancer-causing cells to other locations in the body.
Carefully, they moved the freed cyst onto the makeshift sling, and wheeled it away. Preliminary tests indicate it was not cancerous.
The next job for the surgeons was to rebuild her badly distorted abdomen. They rearranged her organs and removed dead fat tissue destroyed when the cyst pinched off its blood supply. About 100 pounds of her distended front abdominal wall also were cut away.
Because she had lost the ability to breathe on her own, the womanspent her first few days after surgery in Hopkins' intensive care unit, receiving oxygen and mechanical help in breathing. Currie said she has now begun to breathe again on her own, but still requires oxygen.
The woman may require further reconstructive surgery as her organs readjust to the additional space. But, barring a medical crisis, she appears on her way to a full recovery.