Background: Ovarian giant masses remain today an uncommon clinical presentation thanks to their early incidental radiological discovery. Their symptomatic presentation is usually characterized by abdominopelvic pain and a feeling of heaviness. The most important management is the removal of the tumor in order to allow the anatomopathological study which is the only way to confirm or deny the malignancy. We hereby present an atypical case due to its occurrence in a young 48-year-old female patient, the considerable size of the tumor, its non-specific clinical and radiological presentation making the diagnosis difficult.

Case Presentation: This was the case of a 48-year-old woman with no particular antecedents, gravida 5 para 4 with four vaginal deliveries resulting in the birth of four healthy children and one miscarriage. She came to our department for management of a large abdominopelvic mass of more than 30 cm that was bulging out all abdominal organs. She had an MRI that strongly suspected ovarian origin and ROMA score that came back negative for malignancy. A left oophorectomy was followed by abdominal plasty. Anatomopathological study confirmed a serous cystadenoma with no sign of malignancy. The patient was discharged at D4 postoperatively. The follow-up was uneventful.

Conclusion: Giant ovarian masses, although uncommon, raise a double difficulty for the clinician. On the one hand, the diagnosis, although largely guided by MRI, can only be confirmed during surgery. On the other hand, it represents a surgical challenge whether by laparotomy or by laparoscopy. In addition, the ROMA score based on the dosage of tumor markers CA125 and HE4 allows malignant tumors to be screened, but confirmation is only provided by anatomopathological study, hence the importance of not rupturing the cyst during its extraction.