Three deaths, one diagnosis: Forensic perspectives on giant ovarian tumors

When ovarian tumors (OTs) reach a size of more than 10 cm in diameter, they are classified as a giant ovarian tumor (GOTs). Thanks to modern diagnostics and treatment, GOTs have become rare autopsy findings and are typically associated with cases of severe neglect. Here, we present a series of three autopsy cases involving GOTs. The first case involved a 59-year-old woman with a cystic GOT containing 48 L of fluid. The second case was a 67-year-old woman with multiple cystic and solid GOTs. The third case concerned a 57-year-old woman with a giant, primarily solid OT, accompanied by bilateral pleural effusion, suggestive of Meigs syndrome. All three women were found in a state of advanced putrefaction, which limited the ability to determine the exact cause of death. Although GOTs are rarely fatal, they can lead to death through various complex pathophysiological mechanisms. These include spontaneous haemorrhage, torsion, infection, and tumor rupture resulting in acute peritonitis - conditions that represent surgical emergencies. Additionally, increased intra-abdominal pressure can elevate the diaphragm, impairing the function of the respiratory, cardiovascular, digestive, and urinary systems. Despite the limitations posed by postmortem decomposition, this case series provides an opportunity to summarize and discuss potential mechanisms of death associated with large intra-abdominal masses such as GOTs.