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Abstract
Introduction/Background Adnexal masses are encountered in 2.4–5.8% of all pregnancies.In 0.2–3.8 per 100000 pregnancies, ovarian cancer is diagnosed. Low-grade serous ovarian cancer is rare,as it accounts for 2% of all epithelial ovarian cancers.
Results A 26-year-old primigravida was referred to our gynecological oncology unit for evaluation and management of a adnexal mass during pregnancy. At a gestational age of 12 weeks, sonography revealed a heterogeneous image in the left ovary of 122x104x90mm with vascularized inner wall. Pelvic MRI revealed a large right adnexal cystic mass of 104x118x116mm, multiloculated with papillary projections. Blood serum demonstrated cancer antigen (CA) 125 levels of 60U/mL, carcinoembryonic antigen (CEA) and CA 19.9 were within normal limits. The patient underwent exploratory laparotomy at 27 weeks of gestation, a right adnexal tumor of approximately 8cm was attached to the right posterolateral wall of the uterus and to posterior cul-de-sac. Left adnexa without macroscopic changes and absence of peritoneal carcinomatosis.
Right salpingooophorectomy was performed, with intraoperative capsule rupture,and inconclusive frozen secction. Final histopathology revealed a low grade serous cystadenocarcinoma, absence of linfovascular infiltration, ovarian surface was not compromised, right uterine tube not compromised, and peritoneal fluid cytology negative for malignancy.
Following discussion in the multidisciplinary tumor board, it was decided to perform videolaparoscopy for reestaging at a second time after delivery. Patient underwent cesarean delivery at 36 weeks of gestation due to labor and anomalous fetal presentation. Videolaparoscopy was performed 46 days after the delivery, peritoneal washings were collected and multiple peritoneal biopsies were performed, intraoperative frozen secction and the final histopathology revealed absence of malignancy. The patient had a well recovery, in clinical follow-up, with no evidence of the disease so far.
Pelvic MRI
Conclusion Since there is limited information regarding the optimal therapeutic approach to epithelial ovarian cancer during pregnancy, each case needs to be addressed individually.
Disclosures Gestational age at diagnosis, the initial surgical procedure, disease stage and patient’s preferences are the key factors to establish the best treatment strategy.