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MOGS Chronicles | Volume 1 | Issue 1 | September 2024 3IntroductionOvarian cancer is the second most frequent gynaecological cancer complicating pregnancy.[1] With the use of routine ultrasound examination in every patient, the incidence of abdominal masses diagnosed during pregnancy has increased and is estimated to be 2%u201310% of all pregnancies.[2] Most common adnexal mass associated during pregnancy is a functional cyst. Majority of the benign masses are dermoid cyst, serous cystadenomas, rarely endometriomas, hydrosalpinx and leiomyomas.[3]Only 3%u20136% of all ovarian cysts associated with pregnancy are malignant.[4] Malignant germ cell tumours are the most common ovarian malignancies during pregnancy, while epithelial cancers are reported less frequently and are of low malignant potential.[5] Incidence of epithelial ovarian cancer (EOC) is 1:12,000 to 1:50,000 of all pregnancies.The rare occurrence and scant data prompted the reporting of the present case.Case ReportA 34-year-old primigravida with in vitro fertilization conception was referred to the Department of Obstetrics and Gynaecology of Bombay Hospital at 30 weeks of gestation with dull aching abdominal pain and inability to perceive foetal movements since few weeks. She also had loss of appetite and loss of weight during this pregnancy.On abdominal examination, there was an exaggerated fundal height and a huge abdominopelvic mass, round, non-ballotable, with ill-defined edges. Foetal poles were not felt separately. On pelvic ultrasound examination a large complex heterogenous mass of 20%u00d711%u00d711 cm with cystic component in the right pelvis with a single live intrauterine gestation ~26 weeks with AFI of 8 cm (mild oligohydramnios) with foetal growth restriction [Figure 1] was seen. Pelvic magnetic resonance imaging (MRI) showed a gravid uterus of 7 months with a large complex multiloculated cyst in right pelvis region 22%u00d711%u00d712 cm, mild to moderate ascites and few enlarged retroperitoneal lymph nodes, morphologically and structurally suspicious of malignancy [Figure 2]. Lab investigations showed CA125%u20135375 U/ML. LDH- 497 MU/ML.An ultrasound guided right ovarian mass biopsy was done which confirmed the diagnosis of adenocarcinoma of ovary [Figure 3]. A multidisciplinary team of oncologist and neonatologist were involved. 6 cycles of neoadjuvant chemotherapy were given to the mother with Carboplatin and Paclitaxel. Patient was weekly monitored for foetal well-being, which showed significant improvement in AFI and estimated foetal weight. A weekly blood test which included complete hemogram, liver function test and renal function test were also being done. Prophylactic antenatal corticosteroids cover was given to the mother at 30 weeks.An elective caesarean section with a Pfannenstiel incision was done at 36 weeks and a healthy female baby of 2.3 kg was delivered. Evidence of right ovarian fluid filled cyst of ~10%u00d78%u00d711 cm removed in toto [Figure 4]. Evidence of Successful Management of Ovarian Adenocarcinoma in an IVF Pregnancy - A Rare Case ReportViveka Jadkar, Shivani Agrawal, Nitin Pai DhungatDepartment of Obstetrics and Gynecology, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, IndiaAbstractThe occurrence of gynecologic cancer during pregnancy is extremely rare, affecting approximately 4%u20138 pregnancies per 100,000.The frequency of concomitant adnexal tumours in pregnancy is reported to be 0.150%u20135.7%, while ovarian cancer complicates 1 in 15000%u201332,000 pregnancies, being the second most common gynaecological cancer during pregnancy following cervical cancer%ufffd However, there is increasing incidence of ovarian cancer compared to cervical due to factors such as cervical cancer vaccination and increasing use of antiretroviral therapy and increasing maternal age%ufffd The diagnosis and management of ovarian cancer during pregnancy remain challenging due to its rarity and the limited data available%ufffd Here, we report a case involving a 34-year-old woman diagnosed with a large ovarian adenocarcinoma in the third trimester of pregnancy during routine antenatal scans%ufffd The patient was treated with neoadjuvant chemotherapy, followed by an elective cesarean section, cytoreductive surgery, and hyperthermic intraperitoneal chemotherapy%ufffdKeywords: Ovarian cancer, Adenocarcinoma, CA 125, Neoadjuvant chemotherapy, Cytoreductive surgery, HIPECAddress for correspondence: Viveka Jadkar, Department of Obstetrics and Gynecology, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India. E-mail: dr.vivekajadkar@gmail.comCase Report